Plaque accumulation on the 7s

Heavier plaque accumulation is often noted on the 7s. In class 1 and class 3 occlusions, the distal half of the upper 7s are not in occlusion and in class 2 occlusions, the lower 7s are untouched. This removes the cleansing action of mastication and the fissures are often packed with organic debris as a result. It is prudent to instruct the patient to take their toothbrush further back to the distal surface of the second premolars to clean this area. You can consider Air abrasion or pumice to clear the fissures and placing of a GIC or resin fissure sealant to hinder plaque accumulation.

It is also difficult to clean on the buccal surfaces of the molars due to the proximity of the coronoid process. This is why patients often present with large buccal carious lesions on the buccal of the upper 7s and 8s. It may be a sign of salivary dysfunction as the upper molars are adjacent to the parotid salivary duct. Instruct the patient to close their teeth together and brush close mouthed. This moves the coronoid process posteriorly to allow the toothbrush to fit further back.