BACKGROUND & OBJECTIVES

Background

Oral hygiene therapy (OHT) may be one of the most challenging treatments because patient education is critical to encourage life-long changes in patients’ oral care habits. We believe that customizing OHT has great potential to improve patient outcomes. This case submission competition will encourage students to creatively engage in COHT with their patients, and share their results with faculty.

Objectives

  • To improve patient learning and engagement with customized oral hygiene instructions and videos
  • To enhance patient treatment outcomes through individualized interactions
  • To improve student clinician-patient interactions and communication
  • Share student-developed best practices for COHT (Phase 2)

CASE REPORT & VIDEO COMPETITION

Description and purpose

Students will engage their patients in customized oral health therapy (COHT) to address specific hot spots (worse plaque control areas) or improve overall oral hygiene. This report will include text, sequential individualized plaque control heat map, photos, and videos of the patient interaction or demonstrations of OHT techniques for the hot spots as well as a patient feedback from survey and/or video of patient’s testimony!

Basic requirements of the case report

  1. Written case report.
  2. Completed plaque control heat map
    (Two visits with at least one week in between)
  3. Video recording of the student provider teaching the patient how effectively use the adjunctive aids in the mouth specifically to clean the hot spot areas. Patient needs to have access to the video at home. (Use patient’s cellphone to record or send the video to the patient.)
  4. Student and patient surveys.

*Optional: Intraoral photos, a written report of other local plaque retentive factors and systematic aggravating factors that increase the patients risk for periodontal disease, and recorded testimonials from patients.

How to gather data - COHT sequence

Forms and Templates

Judging Criteria

The following rubric will be used to judge each case submission.

Customized Oral Hygiene Therapy Grading Rubric

Criteria Well Done Almost There Needs Improvement Total Points
Innovation 20-15 14-10 9-0  
Effectiveness 25-15 14-10 9-0  
Documentation 30-20 19-10 9-0  
Overall Report 25-15 14-10 9-0  
Comments ____/100

Submission Link

Submit your report

Detailed Requirements for Submissions

All submissions must have background, heat maps, teaching recordings or materials, and surveys. Optionally, you can add teaching media and data from a 3rd or 4th recall appointment.

View the rubric to see all the possible criteria. Remember - the KEY to successful periodontal therapy is efficient home care by a motivated individual!

  1. Background paragraph
    1. Description of baseline condition
    2. A description of systemic and local factors affecting the patient's oral health. DO NOT use any identifying patient information.
    3. A statement regarding the expected outcomes from the INITIAL COHT
  2. Heat Map - Initial/Recall
    1. Initial/baseline HEAT MAPs attached (scan or photo - no PHI) with a description of the findings in the report
    2. Description and location of "hot spots"
    3. Recall HEAT MAPs attached (scan or photo - no PHI) with a description of the findings in the report
  3. Introduction of Oral Hygiene Aids
    1. What specific oral aids selected for the patent and justification as to why those aids were INITIALLY chosen
    2. A description of how you taught the patient how to use the oral aids
    3. A brief description of how the patient responded to your initial instructions
  4. Media used to document the initial interaction (video or photographs- Optional) Include file names in the written report (should be same as case report). [Camera from dispensing and contact us for iPad]
    1. Intraoral photographs captured for initial presentation or areas of concern for targeted approach
    2. Initial instructional Video sent to patient for at home use.
    3. Media used to document the recall interaction
    4. Patient's testimony regarding the Customized Oral Hygiene Therapy
  5. Follow up appointment [Optional]
    1. A description of the status of the periodontium at the recall appointment
    2. A statement concerning the initial expected outcomes describing if they were met or not and why.
    3. Changes you are making to your instructions based off of the recall assessments and HEAT map
  6. Surveys [Please also summarize the positive findings in the case report]
    1. Complete student survey
    2. Complete Initial patient survey

DEMO CASE REPORT

Background and clinical examination

A 55-Year-old Male reported to the VIC clinic with the chief complaint of Malodor. Comprehensive oral examination and complete periodontal chart was performed. Localized moderate chronic periodontitis is diagnosed and initial comprehensive periodontal therapy is proposed to the patient, including mini-quadrants of scaling and root planning, controlling systemic & local factors, and oral hygiene therapy. The gingiva showed localized erythema, blunted papilla, and rolled margins. The Plaque remnants were visualized with disclosing agent such as Bismarck brown (Fig.1A). Patient received oral hygiene therapy over several visits during the initial periodontal therapy (Hygienic phase); local factors associated with the hot spots were also identified, including caries on #10 (D) and overhanged composite restorations were seen on #11(D) (Fig 1C). See patient demo video that easy flosser get stuck and broken off due to the cavity margin on tooth #10 (D) (Video 2).


Figure 1A: Poor oral hygiene revealed with disclosing agent. Generalized plaque accumulation, especially interproximal and embrasure surfaces. Most of the facial cervical deposit is associated with gingival recession and minor abrasion.

Figure 1B: One of the “hot spots” in this patient. Significant plaque accumulation associated with local factors (See Figure 1C).

Figure 1C: Local factors present: #10 (D) caries & #11 (D) over-contoured restoration. Both not only trap more plaque but also hinder patient’s home care. (Lingual view)

Treatment progress note

Consultation visit (Date: Oct 30th, 2015):

We explained to the patient that malodor is multifactorial and there are different contributing sources, including periodontal disease, oral hygiene, respiratory and digestive tract. Suggest the patient to drink green tea and also proceed with periodontal disease treatment.

Etiology of the periodontal disease was explained to the patient for motivation and oral care behavioral change. Utilization of visual aid in the consultation visit for patient education and this will help patients understand what’s happening and why targeting gum line. The patients will also appreciate why periodontal charting (probing) needs to be done.


Figure 1 Visual aids for initial consultation visit for motivational interviewing - Source

Significant generalized plaque accumulation, but due to the time constraint, verbal oral hygiene instructions were given.

“You need to brush two times a day and floss”
“You need to angle your brush toward the gum”

First visit for L’t Sc/Rp (Nov 10th, 2015):

During the periodontal record presentation, systemic factors (immune system, smoking, DM, nutrition) as well as local factors (caries and defective restoration, see the following progress) were also discussed with the patient (Could be done during the initial visit). Patient was disclosed and plaque control heat map was recorded before the scaling and root planning.

Conversion of analog heat map to gray scale:

Generalized plaque accumulation, especially interproximally over anterior maxilla
Very minimal improvement from the verbal instruction since last visit

Customized Oral Hygiene Therapy
A combined Bass and Fone’s technique was demonstrated to the patient. It is interesting to see that each technique has its specific efficiency over certain surface and plaque accumulation pattern. It seems that Bass method is more efficient on midbuccal cervical areas and Fone’s technique (vertical circular) can get into the embrasure area more effectively. Therefore we combined both techniques and instructed the patient to brush 3 secs for each methods for the a total of 6 secs per area.

Since the patient never floss, we started instructing easy-flosser (Fig 2) to begin and focusing over #10 & #11 area. Please see Video 1 & 2 regarding the demonstration and patient’s repeat exercise. The video was sent to the patient for at-home review.

During the initial periodontal therapy, as part of the comprehensive treatment, local factors were also removed. Composite restoration of #10(D) caries was done and adjustment of overhang at the distal-lingual line angle of tooth #11 with the polishing strip. After controlling the local factors, the patient was able to use flosser more easily and the area is better maintainable without these plaque retentive factors (Fig 3).


Figure 2: Easy Flosser for the anterior interproximal areas

Figure 3: Before and after addressing the local factors at the lingual side of the hot spot

Second visit for R’t Sc/Rp (Dec 1st, 2015):

Generalized improvement in terms of plaque index on most of the surfaces. Although there is not a specific improvement “pattern”, more targeted approach can still be implemented. End-tufted brush for distal of the premolars and isolated molar was demonstrated (Video 3 & 4). Given that most surfaces with plaque index of 2 were still mostly interproxinally, we reinforce the easy-flosser. We also asked the patient to brush well before coming in next visit.

Re-eval visit (Feb 23rd, 2016):

Significantly improved was noted after plaque control heat map was recorded. There is no plaque index of 2 areas. Very minimal and thin plaque at the interproximal or embrasure area. Localized periodontal pockets reduced from 6 to 4 mm with no bleed upon probing. Patient also self-reported that the malodor improved significantly resolved.

  Plaque Score 3 Plaque Score 2 Plaque Score 1 Plaque Score 0
First visit 37 68 40 5
Final visit 0 0 42 108

In addition, other oral hygiene devices such as tongue scrapper for cleaning the tongue was also introduced to the patient (Fig 4) at the initial visit.


Figure 4: Tongue scraper for tongue hygiene

Discussion

One of the challenges is that the video may be too big to send it through email. But after some minor editing with iMovie, using different format can reduce the file size a lot.


Summary of the survey

Patient thought that his oral hygiene is ok and brushes once a day. He received the videos through cellphone and watched the video once and found it helpful. After COHT, he brushed twice a day with the easy flosser – in an effective way! He feels his oral hygiene is good and feels more energetic afterwards. He strongly recommends this therapy to other patients.


Video 1

Provider demo for easy-flosser

Video 2

Patient repeat exercise (easy-flosser)

Video 3

Provider demo for end-tufted brush

Video 4

Patient repeat exercise (end-tufted brush)

VIDEOS

Easy Flosser

Is it really easy?
What is the problem in this video demonstration?

Interdental Brush

Do you know how the interdental brush sometimes needs to go from the lingual side?

SUBMISSIONS

This is the place to to submit your Customized Oral Hygiene Therapy intervention success stories. All submissions due by Midnight Nov 11, 2017. You may submit more than one case.

  1. Review the instructions and judging criteria
  2. Save your case report (with the scan or picture of the heat map embedded) as a PDF.
  3. Name your case report Clinic_lastname_XXXX (where XXXX is the last 4 digits of the patient’s record number)
  4. Name additional media Clinic_lastname_XXXX_video, Clinic_lastname_XXXX_pic1, etc.
  5. No identifiable patient information should be on any of the submissions only include that last 4 digits of the patient's ID number on the manuscript.
  6. Fill out the following form:

AWARDS

2016 AWARD CEREMONY

COHT Award Ceremony group photo

COHT Victors receiving their certificates

(Left to right) Dr. Jeff Wang, Barjinder Takra, Vaishnavi Bhaskar, Panchali Patel, Kanchi Shah, John Zona, Peter Liang, Sydney Sherman (in spirit)

2016 Outstanding Victor for Oral Health Education

Recipient: Vaishnavi Bhaskar

CONTACT

Jeff CW. Wang, DDS, DMSc

Clinical Assistant Professor
jeffwa@umich.edu

Martha McComas, RDH, MS

Clinical Assistant Professor
mccomas@umich.edu

Address

Department of Periodontics and Oral Medicine
School of Dentistry
University of Michigan Ann Arbor
1011 N University Ave
Ann Arbor,MI 48109