20 year old Middle Eastern male was present for an initial exam. His chief complaint was: “I want a dental exam and cleaning.” He has been undergoing orthodontic therapy for over one year: it started in March 2018 and a panoramic radiograph was exposed showing #17 and #32 partial erupted at that time. This is his first orthodontic treatment. His last cleaning took place approximately one year ago.

  • Pre-Scaling
  • Post-Scaling

Medical History:
BP 127/89 P 62. Patient reported no known allergies and currently does not take any medications – ASA I.

Reported Self-Care:
Patient uses a medium-bristled manual toothbrush twice a day with Colgate regular toothpaste once a day and flosses with floss picks once a day. His orthodontist did not recommended any interdental aids specialized for braces.

Intraoral/Dental Conditions:
Patient presented with bilateral, slightly enlarged tonsils. Tonsilloliths were present on the right tonsil. Patient had 20% overbite, 3mm overjet, and bilateral Class I occlusion. Moderate attrition were identified on #23 – #26.

Gingival and Deposit Statement:
Tissue was generalized dark pink with slightly overgrown, puffy with rounded margins. Interdental space was bulbous. As for deposits, there were localized supragingival and subgingival calculus on the linguals of #20 – #26 and subgingival calculus on the mesials of the premolars.

Periodontal/Dental Charting:
Patient was classified as a medium case and perio type I – gingivitis. Since patient had wired braces, only the lingual aspects were probed. Probing depth readings were generalized 3 – 4mm with no gingival recession. Patient also had partially erupted #17 and #32 – an adult referral was written for evaluation.

Treatment Care Plan:
Patient was completed in one visit. After completing all assessments, the plan was to perform OHI, conduct patient education, debride full mouth with ultrasonic and hand instruments, introduce electronic toothbrush and Superfloss as interdental aids, and supragingival air polishing with glycine powder. The post-op instructions were to not consume anything that can potentially stain the cleaned teeth. Next recare visit is in Sept 2019 (6 MRC).

Oral Self Care Recommendations – Summary:
Since patient is currently undergoing orthodontic therapy, an electronic toothbrush and Superfloss were recommended. Superfloss has a rigid end which makes it easier for patient to weave under the braces wires to floss. Other interdental suggestions include floss with floss threader and an interdental brush. Additionally, an electronic toothbrush was suggested for optimal plaque removal – however, using a manual soft-bristled tooth brush and Charter’s method was also recommended in the case patient does not choose to purchase an electronic toothbrush. Lastly, since having braces automatically places patient with moderate risk for caries, fluoride mouth rinse was also recommended.