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Five best practices for the dental hygienist maintaining implant patients

The role of the dental hygienist is critical in implant maintenance, and in our office, we’ve created a hygienist protocol around five best practices.
  1. The patient interview.  The dental hygienist always begins the exam by asking the patient several questions:  “How does the implant feel?  Do you notice any bleeding or pus when you brush your teeth?  Do you have any bad taste around the implant?  Do you have any pain?”.  We ask open-ended questions about pain or mobility to get as specific a description as possible from the patient.  This helps later during the doctor’s exam.
  2. Tissue evaluation.  The hygienist evaluates the tissue surrounding the implant for color, tone, texture, inflammation, redness, bleeding, mobility and exudate (pus).  We evaluate any exudate through palpation (massaging the tissue gently).  The peri-implant pocket depth is assessed by gentle probing; the probing must be done with a light hand.
  3. Scaling. Implants surrounded by healthy tissue don’t require scaling, but a light polish using a fine polishing paste and rubber cup is appropriate.  We avoid medium and coarse grades of paste.  Where the tissue is unhealthy (deep pocket depth with bleeding or exudate), we use a cavitron tip, especially designed for implant maintenance, on low power.  It has a soft-tip plastic sleeve that will not scratch the surface of the implant.  After the polish, we use an irrigating syringe with chlorhexidine gluconate (Peridex) or Super Floss soaked in chlorhexidine around the implant.  Betadyne can also be used as an irrigant in patients who are not allergic to iodine.
  4. Home care instructions.  Our hygienists always review the steps of implant care with the patient.  Our view is that implants need to be maintained aggressively, and we remind patients at every visit.  Daily flossing is essential along with twice daily brushing.  At The Practice SF, we recommend waxed or Glide Floss, Soft Picks, Sulcabrush, End Tuft Brush, Go-Betweens, Super Floss and soft-bristled toothbrushes.  (Electric or sonic toothbrushes are OK only a week or two after the implant is restored.)
  5. Documentation.  We believe that detailed notes are as important as detailed questions and examination technique — not just for the current appointment but so that our periodontal team has a baseline of conditions and symptoms to measure in subsequent appointments.  Also, taking the time to address even the slightest symptoms with the patient during the appointment can minimize potential future problems.  Finally, patients know when you’re paying attention, and they appreciate it.  This is important to the referring dentist as well.

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Dr. Gregory Conte, DMD, MS, is a periodontist and partner in The Practice SF. He received his dental degree from the University of Pittsburgh School of Dental Medicine and completed his Certificate in Periodontics and Masters Degree in Oral Biology from the University of California at San Francisco. Dr. Conte is a member of The American Dental Association, The American Academy of Periodontics, The Academy of Osseointegration and the California Society of Periodontists, where he served on the Board of Directors. He is a Fellow of the International Team for Oral Implantology.

One Response to “Five best practices for the dental hygienist maintaining implant patients”

  1. milpitas dentist January 12, 2011 at 5:49 PM #

    Good day Doc, i just want to congratulate you with this excellent post..it will help many people who will going to read this especially implant patients..you’re such a great person..cheers!

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