A key determinant of success for any aesthetic restoration is the patient’s level of dental IQ and day-to-day oral hygiene, says Dr David Winkler, president-elect of the International Federation of Esthetic Dentistry.
In Ireland recently to address delegates at the Irish Dental Association’s (IDA) annual conference, he states that patients have to become equal partners in their restorative dental treatments if lasting results are to be achieved that meet their expectations.
‘With good dental care, aesthetic restorations should last for decades, if not a lifetime. However, to get the best results and ensure restorations are successful in the long-term, it’s vital that we educate our patients about their oral health and ensure they are properly equipped to maintain good oral hygiene post-treatment. This is particularly important during the initial consultation phase, which provides a perfect opportunity to assess the patient’s level of dental IQ and establish their oral hygiene regime before treatment and therapy commence,’ says Dr Winkler.
He went on to say: ‘Given the average person only brushes their teeth for 47 seconds, there is clearly a lot more work to be done to address this issue and ensure patients are cleaning their teeth effectively so as to achieve a good long-term outcome. Equally, by ensuring patients have a reasonable expectation of what can be achieved, we can be better placed to put together treatment plans based on the available resources so as to meet the patient’s objective needs and their expectations – which can be very subjective in nature.’
Dr Winkler states that a change in mindset by the patient is sometimes required: ‘This is often the greatest challenge faced by aesthetic dentistry. There is no point looking for a quick fix that doesn’t provide the patient with the optimum restorative benefits long-term. Patients need to be made aware of the consequences of whichever treatment they receive in terms of longevity, costs and potential biological damage to their existing teeth. Key to this is getting the patient’s dental IQ up to a level where they understand the implications of whatever decision they make.’
Once an optimum treatment plan has been put together in consultation with the patient, it is vital that the patient continues to adhere to a thorough oral care regime.
Dr Winkler notes that significant barriers exist around educating, training and motivating patients to reduce plaque by brushing and flossing alone.
He says: ‘While brushing and flossing are the standard routine for cleaning, plaque is often left behind on teeth due to a combination of factors such as the inaccessibility of hard-to-reach areas, inadequate technique, loss of patient motivation over time and loss of patient compliance over time.
‘We know that patients are not flossing regularly and can quickly lose motivation with time. That’s where antiseptic mouthwashes come into play as an important adjunctive procedure to add to the traditional oral hygiene protocol, helping to reduce plaque build-up and gingivitis.
‘The two commonly used types of mouthwashes are those containing essential oils and those containing chlorhexidine. Both types act to disrupt the viability of bacteria by penetrating the plaque biofilm, breaking down the cell wall and disrupting cell adherence to the tooth structure. The advantage of essential oil mouthwashes is that they are suitable for continual, long-term use whereas chlorhexidine is only suited to short-term use as it cannot be used immediately after brushing and causes staining of the teeth and changes in taste perception.’
According to Dr Winkler, teeth account for only 25% of the mouth’s surface area. He states that, despite best efforts at brushing and flossing, bacteria are constantly multiplying across all surfaces.
He says: ‘That’s why it’s important to encourage patients to rinse with an antiseptic mouthwash containing essential oils in order to treat the entire mouth, including inaccessible areas. The benefits are clearly borne out by studies which show that flossing and rinsing with a mouthwash, in addition to brushing, can provide a significant improvement to a person’s overall oral health.’
A leading authority on aesthetic dentistry, Dr David Winkler was in Ireland recently as a guest of Listerine Total Care to speak at the IDA conference where he outlined recent advances in restorative dental treatments and new developments in oral hygiene. Dr Winkler is president-elect of the International Federation of Esthetic Dentistry, founding president of the Scandinavian Academy of Esthetic Dentistry, past-president of the European Academy of Esthetic Dentistry, and a founding member of the British Academy of Aesthetic Dentistry.