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A String around Your Finger: Do We Really Need to Floss?

Course Number: 550

Standards of Care for Oral Hygiene and Oral Hygiene Instruction

Current Oral Hygiene Recommendations

Dental healthcare professionals, including many dental professional and advocacy groups, have long advocated for an emphasis on the effective delivery of oral home care and the role of the patient as a co-practitioner in the prevention and treatment of dental diseases, including caries and periodontal diseases. The importance of patient-delivered oral hygiene, including effective interdental cleaning, in the control of both dental caries and periodontal disease has been reiterated by the ADA,15 the World Dental Federation,106 the EFP,57 and the European Organisation for Caries Research (ORCA).57 To achieve optimal oral hygiene and impact the health of both individual patients and the public overall, current home care habits are required and population and individual-based interventions must be employed and reinforced.

Patient-centered Behavior Management

Manual toothbrushing alone is inadequate in the treatment of gingivitis. However, even in the presence of gingival inflammation, toothbrushing coupled with interdental biofilm removal has been shown to reduce rates of interdental caries and signs of gingival inflammation.56,87 Despite the established importance of interdental cleaning for oral health, most patients are not following recommendations for ideal cleaning protocols. It is then imperative upon members of the dental healthcare team to instruct patients on the importance of such interdental cleaning and the best strategies for its implementation in based upon their clinical presentation. Optimal effectiveness of oral hygiene measures requires multiple rounds of oral hygiene instruction and reinforcement over time.106 Given patients’ low reporting of daily flossing and other forms of interdental tooth cleaning and the suboptimal performance oral hygiene measures overall,17,94,95 effective communication and targeting of patients to improve oral hygiene is of critical importance for all dental healthcare professionals.107 Psychological interventions, such as social cognition models, cognitive behavioral therapy, and motivational interviewing, have been shown to have an improved effect on patient performance of oral hygiene measures.107

Individualized, person-centered care, including encouraging goal-setting and accountability, has been shown to increase the longevity of effectiveness of oral hygiene instructions and to demonstrate clinically superior outcomes.107-109 An individualized approach may increase appointment time, but could also result in ultimate cost savings if improved patient-delivered oral home care results in a decreased incidence of oral diseases and their sequelae.