Mr. L, a 40-year-old physical therapist, presented to the practice for a six-month continuing care appointment. Although caries-free, he routinely had clinical evidence of generalized moderate proximal gingival inflammation with bleeding upon probing. His home care regimen consisted of manual tooth brushing twice daily and intermittent flossing. The patient reported that he brushed throughout the day and used mouthwash in between working on his own patients. However, he reported difficulty flossing due to tight contacts and frustration with floss breaking. He noted that the other dental hygienist in the practice advised him that he must perform interdental cleaning, but he was particularly frustrated that he had been unsuccessful with flossing and was unwilling to continue using string floss.
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Further examination revealed that the patient was in general good health. Vital signs were within normal limits with blood pressure at 110/68 mm Hg right arm, pulse at 62 right arm, respiration at 16, height at 5’10”, weight at 165 lbs, and temperature at 97°F. The comprehensive oral examination revealed no abnormalities. The patient presented with minimal plaque, having recently brushed; however, tight contacts were evident, making it clear that the usage of string floss would be difficult. Mild generalized gingivitis was noted with probe depths ranging from 2–3 mm throughout and localized areas of proximal bleeding.
Upon completion of the prophylaxis, the patient was offered the option of using a different device for interdental biofilm removal—the Philips Sonicare AirFloss Pro. He was advised that this interproximal cleaning device uses microdroplets of water with pressurized air to clean between teeth. Rather than using string floss, we discussed using the AirFloss Pro for a period of three weeks to see if his gingivitis would improve.
Mr. L was told that there would be a learning curve, as with any new device, and that he had to be willing to use the device once daily in addition to his brushing regimen. He was interested in trying something different, so we stood at the sink and tested the AirFloss Pro so he could see firsthand how it felt in his hand and in his mouth and learn to use the flossing device properly. Mr. L agreed to use the AirFloss Pro daily and return in three weeks for an exam to determine whether it made a difference in his gingival condition.
Mr. L returned to the practice three and a half weeks after his dental hygiene appointment for a follow-up examination. He reported that it did take him several days to adapt to using the AirFloss Pro, but once he felt comfortable using the device, he felt that this was much easier to use than string floss. Clinical examination revealed healthy gingival tissue and no bleeding upon probing—a significant improvement from the prior exam. The patient had no areas of abrasion or other safety concerns. He was very pleased with the improvement in his oral health and was delighted to have found an alternative to battling string floss through tight contacts.
The important consideration from this case is that there are alternatives to string floss that can be offered. The Philips Sonicare AirFloss Pro provided this patient the chance to take control of his oral health, rather than feel helpless and ineffective. And that is exactly what we want for our patients!
JoAnn R. Gurenlian, RDH, PhD, MS, is president of Gurenlian & Associates and provides consulting services and continuing education programs to health-care providers. She is a professor and dental hygiene graduate program director at Idaho State University, and she is the president of the International Federation of Dental Hygienists.