RATIONALE OF MECHANICAL PLAQUE CONTROL

Patients who have received extensive periodontal treatment also demons trate a high susceptibility to periodontal disease. Maintenance of per iodontal health following therapy includes a lifelong supportive care consisting of daily removal of the microbial plaque by the patient, su pplemented by professional care in an individually designed programme. Mechanical supragingival plaque control by self care is of utmost imp ortance. The goal is to create a positive attitude by information and motivation to give the patient knowledge and confidence. The patient s hould be advised to use appropriate aids and technique. A soft brush, an interspace brush, interdental tooth brushes or tooth picks are reco mmended in periodontal patients. Professional tooth cleaning involves removal of supragingival plaque from all tooth surfaces using mechanic ally driven instruments and fluoride prophy paste and, when indicated, removal of calculus and subgingival plaque. Disclosing solution is us ed to visualize the plaque to the patient and to the clinician in orde r to reinforce instruction in oral hygiene. Oral hygiene measures alon e seem to have limited effect on the subgingival microflora in cases o f severe disease. In shallow and moderately deep pockets a good plaque control can change the subgingival flora towards a more ''healthy'' c omposition. Subgingival plaque removal is performed with hand- and/or ultrasonic instruments. Cracks within the cementum, grooves, fissures, resorption lacunae, furcations may create difficulties in cleaning th e root surface. Ultrasonic instrumentation has a beneficial effect in creating a smooth surface without extensive removal of cementum. Besid es, the cavitational activity contributes to plaque removal which make s the instrument further suitable during maintenance therapy. The resu lt of the debridement is assessed on the healing response in the tissu es. The frequency of maintenance visits must be given on an individual basis according to the needs of every special patient. The visit incl udes plaque evaluation (disclosion), oral hygiene instruction, probing depth measurements, registration of bleeding on probing, scaling (pla que removal) if indicated, tooth polishing, fluoride application and r adiographs if indicated. The goal is to identify and treat signs of re currence of periodontal disease in order to prevent further loss of at tachment.