What treatment is recommended for an adolescent with localized bleeding of the gums and presence of plaque and calculus on non-loose teeth?

Professional Dental Cleaning and Improved Oral Hygiene Practices for Adolescent with Gingivitis

The nurse practitioner should recommend professional dental cleaning (scaling) to remove plaque and calculus, along with proper oral hygiene instruction including brushing technique and daily flossing. 1

Assessment and Diagnosis

The adolescent's clinical presentation indicates gingivitis:

• Localized bleeding of the gums when brushing 1
• Presence of plaque and calculus on the teeth 1
• Teeth are not loose, indicating the condition has not progressed to periodontitis 1

Treatment Recommendations

Immediate Professional Care

• Professional dental cleaning (scaling and root planing with polishing) to remove plaque and calculus deposits 1
• This should be performed by a dental professional as calculus cannot be removed by regular brushing 1

Daily Oral Hygiene Instructions

1. Proper Brushing Technique:

   • Use a small, soft-bristled toothbrush 1
   • Brush at least twice daily, ensuring the gingival portion of the tooth and periodontal sulcus are included 1
   • Brush for at least 2 minutes each time 2
   • Consider using plaque-disclosing agents to improve visualization of plaque for better removal 2

2. Interdental Cleaning:

   • Daily flossing is essential for removing plaque between teeth 1
   • Floss before brushing for more effective plaque removal 3
   • For patients with larger interdental spaces, interdental brushes may be more effective than floss 4, 5

3. Mouthwash Options:

   • Consider recommending an antimicrobial mouthwash as an adjunct to mechanical cleaning 1
   • Options include:
     • Chlorhexidine-based mouthwash (most effective but has side effects like staining) 1
     • Natural alternatives like green tea catechin mouthwash may be effective with fewer side effects 1

Follow-up and Monitoring

• Schedule a follow-up dental appointment in 2-4 weeks to assess improvement 2
• Regular dental check-ups every 6 months to monitor oral health 1
• Monitor for signs of improvement:
  • Reduction in gingival bleeding 1
  • Reduction in plaque accumulation 1
  • Healthier gingival appearance 2

Common Pitfalls and Considerations

• Inadequate interdental cleaning: Many patients focus only on brushing but neglect interdental spaces where plaque accumulates most readily 4, 5
• Improper brushing technique: Adolescents often brush too quickly or miss important areas like the gingival margin 2
• Non-compliance with daily oral hygiene: Emphasize the importance of consistency in oral hygiene practices 6
• Ignoring bleeding gums: Educate that bleeding is a sign of inflammation, not a reason to avoid brushing or flossing 1
• Relying solely on mouthwash: Stress that mechanical plaque removal (brushing and flossing) is primary, with mouthwash as a supplement 1

By implementing these recommendations, the adolescent should experience significant improvement in gingival health and reduction in plaque and calculus formation, preventing progression to more serious periodontal disease 1.