Pearls of Wisdom 5

Why does periodontal disease start interproximally? If you watch patients using manual toothbrushes then the most common method of brushing is backwards and forwards, a method that will always leave plaque in these sites. Over time the body’s hypersensitivity reaction will cause inflammation and gradual bone loss in less susceptible patients, or more rapid bone loss in the more susceptible.

Why do some areas of the mouth exhibit more periodontal disease than others? For a right handed patient you will find that maxillary left molars are cleaned less well than right molars, that maxillary right lateral incisors have more bone less than left ones, and that mandibular right lingual surfaces are often less well cleaned than the left. The reverse is true for left handed patients. Surprisingly, the answer lies in the limitations allowed by the anatomy of the wrist in the angle that the brush is held in relation to a parasagittal plane in the case of maxillary molars and the inability to carry out rotational movements for the other two sites. The answer, teach your patients to use the opposite hand.

Better still, changing to electric brushes may eliminate some of the above, but do check.