Abrasion of teeth involves an abnormal mechanical process that results in enamel, dentin and cementum being worn away over time. Susceptibility to abrasion is increased in the presence of erosion of the surface of the tooth, which results in softening of the tooth structure. Professional dental care is aimed at preventing disease and restoring oral health for patients with oral disease. The appropriate use of professional and home use oral care products is required to achieve these objectives. Careful selection of polishing techniques is required by the dental clinician to ensure optimized stain removal, polishing and preservation of surface integrity, and the oral care regimen recommended to patients for home care must also consider the risk of abrasion.

Despite revolutionary advances in all fields of dentistry, a critical factor in the success of any treatment program is patient compliance. A number of factors are involved in encouraging and ensuring cooperative patients, including a thorough assessment of a patient’s medical, dental, and social history and any related fears or phobias. In addition, effective communication is vital in motivating and educating patients about their dental needs. This course examines the roles all of these play in ensuring patient compliance, reviews the literature regarding oral hygiene programs, and addresses the particular compliance issues involved in specialty fields, such as orthodontics and esthetic dentistry.

Dental implants are a well-accepted treatment for the replacement of missing teeth. An estimated two million implants are placed annually, and it can be anticipated that an increasing number of implants will be placed and need to be maintained in the coming years. The intraoral environment and overall health of an individual patient influence patient selection/implant candidacy and the outcome of implant therapy. Factors affecting the intraoral environment include the patient’s heath status, medication use, level of oral hygiene, and habits such as smoking and drinking. Oral hygiene is an important determinant of implant success, as it is with the health of the natural dentition. Brushing and flossing are also critical success factors, requiring considerable patient education and motivation, and adjunctive therapy may be considered. With careful patient selection and patient commitment to oral hygiene measures, the potential for long-term success and implant health is excellent.

Gains in oral health have been considerable in the last 50 years. However, by adolescence 68% of people have tooth decay and gingivitis is also prevalent, with 50% of US adults experiencing this around a minimum of three to four teeth. Brushing and flossing are typically considered to be the basic procedures required for good oral hygiene; yet oral hygiene is generally inadequately performed. Patient compliance issues related to brushing and flossing are well documented and well recognized. Rinsing offers an opportunity to reduce plaque and gingivitis, incremental to the reductions obtained by brushing and flossing alone. Use of a chemotherapeutic mouth rinse together with brushing and flossing as a three-step program may help to reduce plaque accumulation and prevent the formation of mature plaque and the onset of disease.

Upon completion of this course, the clinician will be able to do the following: Discuss the factors involved in patient noncompliance. List the methods that can be used to help compliance. Describe the techniques and aids that can be used to assist with patient home care compliance. Understand the factors and techniques that can help improve patient compliance with treatment.

Upon completion of this course, the clinician will be able to do the following: Discuss the current status of caries, gingivitis, and periodontal disease in the United States, list the dental implications associated with inadequate/ineffective interdental plaque control, recognize the clinical signs of infrequent interdental plaque control and identify patients who are at a high risk for periodontal diseases, and recommend appropriate interdental cleaning methods and devices for specific patient needs, and explain the necessity of interdental plaque control as part of the patient’s complete self-care program.

Overall goal: The purpose of this article is to provide dental professionals with information on risk assessment, preventive and treatment options that will further the practice of a medical model and minimal intervention dentistry.

The first major active ingredient introduced into modernday, over-the-counter dentifrices was fluoride. Since then, dentifrices have been developed with ingredients offering anti-plaque/anti-gingivitis, anti-halitosis, whitening or desensitizing benefits, or a multiplicity of benefits. Given the range of dentifrices currently available, and their differences, a recommendation is important; this should be based on the individual patient’s specific needs and desires and the scientific support for a dentifrice.

Dental offices’ clinical objectives are to provide patients with the best possible treatment that is effective and safe, and to deliver this in a patient-friendly manner. Business objectives are to maintain and increase production and productivity and to limit expenses, thereby ensuring the financial health of the office and increasing profitability. Technologies such as locally-applied noninjectable anesthetic gel and endodontic rotary nickel titanium (NiTi) files increase productivity. Both reduce chairside time and the potential number of visits, while the locally-applied noninjectable anesthetic gel also offers the opportunity to completely delegate a procedure. Technology plays a key role in the modern dental office in improving the standard of care and practice-building, improving convenience and flexibility for clinicians and patients alike.

Orthodontic treatment is widely recognized for its results. By accepting orthodontic treatment, patients usually commit to two to three years of active therapy. Increases in plaque retention in orthodontic patients lead to an increased incidence of decalcifications. Almost all fixed applicance orthodontic patients experience moderate gingivitis and, to varying degrees, oral irritations. Even with attention to oral hygiene procedures, patients are at risk. Consideration of the use of antibacterial mouthrinses may be warranted for these patients. Oral irritations cause pain and impede oral hygiene—medications in the form of pastes, gels, liquids, and rinses can help relieve pain and, depending upon the medication used, may also promote healing. Patient selection, education, and adherence to oral hygiene measures, together with adjunctive preventive, palliative, and curative care, will not only help patients have a more comfortable experience, but will also increase the likelihood of both functional and aesthetical success.

Caries remains an endemic problem worldwide. A number of primary and contributory factors determine whether or not caries develops as well as a patient’s risk, while risk modifiers mitigate caries risk. Fluoride has played a central role for several decades in caries prevention, with in-office and home-care options available. Performing an individual risk assessment enables the dental professional to determine the level and type of preventive care appropriate for a particular patient.

Twenty-six million people in the United States are living with chronic kidney disease (CKD). As the baby boomer generation continues to mature, medical procedures extending life improve,and with pharmacology advances, this number will increase. With an increased number of patients living with CKD seeking dental treatment, will the dental healthcare provider be prepared to provide treatment to patients living with renal disease-induced anemia, and with secondary hyperparathyroidism and its effects on bone metabolism and the cardiovascular system? Many providers are familiar with providing palliative treatment for xerostomia, but how do you recommend palliative treatment for someone who is on strict fluid and dietary restrictions, such as patients living with end stage renal disease? Diabetes and hypertension are the two greatest causes of kidney disease. Dental providers should be knowledgeable about the different stages of renal disease and different treatments associated with this condition, and be prepared to address oral complications of renal disease. The dental healthcare provider must become more familiar with the impact of periodontal disease on renal disease, specific medical challenges and become proficient in collaborating with medical healthcare providers to provide dental treatment to these patients.

Following the discovery that fluoride plays a role in the prevention of dental caries, professional topical fluorides were developed. Traditionally, fluoride gels and, later, fluoride foams were used in the US and Canada. More recently, fluoride varnishes were introduced first in Canada. More recently, fluoride varnishes were introduced first in Canada, and then in the US where they are cleared for use as desensitizing agents. The use of fluoride varnishes for caries prevention is 'off-label' in the US. A recent publication by the ADA Council on Scientific Affairs recommends the use of fluoride varnish or fluoride gel for professional topical fluoride treatments, with the choice depending on patient age and risk category. Due to insufficient evidence, foams are not recommended for professional topical fluoride treatment and there is no evidence to support rinses. Fluoride gel and varnish have both proven to be effective, with only varnish recommended in the under-6 age group. Evidence-based treatment requires that the clinician assess a patient's risk level prior to treatment, which can be done with formal risk level prior to treatment, which can be done with formal risk assessment tools such as CAries Management by Risk Assessment (CAMBRA) and the Caries Assessment Tool (CAT).

The prevention of periodontal disease is a key factor in oral health. It has also become evident that periodontal health is associated with systemic health. Nonsurgical scaling and root planing is the standard of care for periodontitis. Supragingival plaque removal influences the bacterial environment in pockets up to 3 mm in depth, while subgingival scaling and root planing is essential in pockets 4 mm or more with attachment loss to remove and reduce the levels of periodontal bacteria. The thorough removal of both supragingival and subgingival deposits is important to remove niches for microbes, prevent inflammation, and prevent future growth of a mature subgingival biofilm. Ultrasonic scaling offers practical and practicebuilding advantages over manual scaling. Consideration of the advantages, safety and technique-sensitivity of method of scaling is required in selecting one. Given the oral-systemic link, periodontal treatment is important to help systemic health and the patient’s quality of life.