2 - nonsurgical at home mechanical and chemical Flashcards
plaque biofilm cannot be completely eliminated
plaque biofilm can be managed thru effective oral hygiene measures like
proper diet`- watch carbs/sugar frequency
toothbrushing 2X with ADA Fl toothpaste - 3x recommended
interdental cleaning
use of ada-accepted antimicrobial mouthrinse 2X
role of personal oral hygiene
~on the quantity and composition of _
~on longterm outcomes of _ tx
~on the quantity and composition of subgingival plaque
~on longterm outcomes of periodontal and surgical tx
ideal tooth brush features
handle size head size use of _ filaments use of soft bristle configurations bristle patterns which enhance interdental plaque removal
small size handle and head to reach posterior areas
use of end-rounded nylon or polyester filaments
we want soft brushes because somestimes too aggressive on the gingiva
6 brushing methods
stillmann's method roll and sweep method (modified stillmann's method) Bass Method Rotational Scrub Charters Method Horizontal Scrub
_ tooth brushing method
30 degree angle with bristles pointing toward the gingiva
movement in coronal direction with a vibrating and rolling stroke
half on gums half on tooth
Stillmann’s Method
_ brushing method
30 degree angle with bristles pointing toward the gingiva
movement in coronal direction with a rolling stroke
Roll or Sweet Method
Modified Stillman -
more coronal surface same angle to stillmans method
angle because trying to get bristles in sockets
_ brushing method
45 degree angle with the bristles pointing toward the gingiva
movement with a vibratory, circular motion
Bass Method
we have prob heard of this method
Modified Bass method
-additional sweeping motion following vibratory, circular motion - only one we can recommend
_ brushing Method
brush is positioned on the tooth surface
bristles are perpendicular to tooth and gingival surfaces
movement is in small circulatory motions
rotational scrub
no angle - perpendicular
_ brushing method
45 degree angle with bristles pointing toward the occlusal surface
movement back and forth in a circular motion
best method for patients with open interpoximal spaces
most difficult method to do correctly
Charters Method
angle is totally opposite of Bass
_ brushing Method
90 degree angle between brush and teeth
movement in horizontal motion
this method should be used occlusal surfaces
can cause both soft and hard tissue damage at cerical area
horizontal scrub
only good for occlusal surfaces
really no difference in tooth brushing methods as long as the patients are brushing
_ plaque removal with a toothbrush is ineffective
interproximal plaque
difference between waxed and unwaxed floss?
no difference
might use waxed in really tight contacts
when do we recommend using proxybrushes
where there are large interproximal spaces to clean
change every 2 weeks
explain in general toothbrushing frequency and duration study
for 6 weeks following a patient
12-48 hours of not brushing for 2 minutes didn’t really make a difference
we still recommend 3x a day because patients don’t brush for the full 2 minutes
2 minutes accepted to get big reduction in plqaue but after 2 minutes it slows
_ brush for distal of posterior molar - ortho brackets
end tufted brush
2 rows of bristles for gum line
sulcus brush
we use tongue brushers/scrapers especially for _
halitosis
bacteria on the tongue big cause of bad breath
3 things associated with trauma from brushing
gingival erosion
cervical abrasion
gingival recession
rounded or cut ended filaments for brush
rounded ends produce less trauma to gingival tissues
toothbrushes can effectively remove plaque for at least _ months and that after _ weeks one should consider replacement
2 months
9 weeks
2 weeks for interproximal brushes
big picture about powered toothbrushes
powered brushes with a rotation oscillation action provice slightly better plaque removal and may provide better protection against gingival inflammation than manual
Rotation and oscillation action are better
Not recommended for every patient because costly - we give to patients that have manual brushing problems - also for too aggressive brushing
Dentifrice(toothpaste) effects on periodontal health
Supragingival plaque control is necessary to reduce _
gingival inflammation
appropriate brushing and flossing can reduce supragingival plaque
toothpaste ingredients
for plaque and stain removal - can cause root sensitivity
make up 10-50%
abrasives ~Ca-phosphates ~Ca-pyrophosphates ~Hydrated Silica ~Alumina ~Ca-Carbonate ~Na-Bicarbonate
abrasion depends on particle hardness, size, and shape
toothpaste ingredients
therapeutic 0.2-1.5%
replace Ca in hydroxyappatite
fluorides
sodium fluoride
monofluoro-phosphate MFP
stabilized stannous fluoride
toothpaste ingredients
therapeutic 0.2-1.5%
_ only thing in toothpaste to help control inflammation or bleeding
Triclosan
Triclosan - only thing in toothpaste to help control inflammation
Patient has bleeding gums - we might want to give them a toothpaste with Triclosan
toothpaste ingredients
40-70%, act to retain moisture and prevent the toothpaste from hardening on exposure to air. Glycerol, sorbitol, Xylitol and propylene glycol are commonly used.
also sweeten the toothpaste, though this is not their main function.
humectants
toothpaste ingredients
foaming agents
thickening agents 0-12%
flavoring agents 0.8-1.5%
_0.5-2% mainly a foaming agent, which enables uniform distribution of toothpaste, improving its cleansing power.
surfactants
Na-lauryl-sulfate - Irium - SLS
Na-N-lauroyl sarcosinate 0 - Gardol
which is more statistically and clinically effective in reducing plaque
triclosan/copolymer dentifrice or fluoride dentifrice
- flouride better - tricolsan for bledding gumms
more effective at reducing gingival inflammation too
compare stannous fluoride to triclosan
stannous fluoride has anti-inflammatory effects but it causes staining
triclosan does not cause staining, only thing to activly reduce bleeding,
why use mouth rinse?
teeth only make up 25% of the oral cavity
biofilms cover the entire mouth, not just teeth
liquid carries actives to all areas of the mouth
plaque biofilm cannot be managed by tooth brushing and flossing alone
Phenols, quaternary ammonium compounds, bisbiguanides, herbal extracts are examples of _
supragingical anti plaque and gingivitis agents
Mouth Rinses
EO - Essestial Oils
fixed combo of
- Eucalyptol 0.092%
- Menthol 0.042%
- Methyl salicylate 0.060%
- Thymol 0.064%
LESTERINE
need alcohol as solution
mouth rinses
CPC cetylpridinium chloride - active ingredient
quaternanry ammonium compound
crest prohealth
mouth rinses
0.12% CHX
chlorhexidine
a _
Peridex and PerioGard
it is a bisbiguanide antiseptic
only one that needs a prescription
EO - Essential Oils - Listerine
26.9% alcohol
_compound
has ADA seal of acceptance for plaque and gingivitis
1st OTC mouthwash in 1914
phenolic compound
~might want to watch for history of alcoholism
EO - Essential oils exhibits broad spectrum of activity against gram positive or negative bacteria?
how?
both gram positive nand negative bacteria
EO non-selectively and rapidly disrupts bacteria cell wall
reduces plaque endotoxin levels and pathogencity for gingivitis
plaque reductions of up 56.3% and gingivitis reductions of up to 35.9% when used as directed
CPC - Cepacol
14% alcohol
_compound
has ADA seal
quaternary ammonium compound
plaque - 15-25%
gingivitis - 20%
ruptures bacteria cell membrane, leading to rapid leakage of cell contents and cell death
may alter bacterial metabolism inhibitiing cell growth
what kind of mouthwash?
ruptures bacteria cell membrane, leading to rapid leakage of cell contents and cell death
may alter bacterial metabolism inhibitiing cell growth
cpc cepacol
what kind of mouthwash?
non-selectively and rapidly disrupts bacteria cell wall
reduces plaque endotoxin levels and pathogencity for gingivitis
EO essential oils - listerine
what kind of mouthwash?
kills bacteria by altering the permeability of the cell membrane of the bacteria. this alteration causes the bacteria cell to leak. which eventually kills the bacteria
used to treat gingivitis and bleeding gums
peridex - chlorhexidine
0.12% chlorhexidine gluconate
Used to treated gingivitis and bleeding gums
Can’t brush teeth very well so always give CHX after surgery for post-op care
which mouthwash may cause tooth discoloration or increase in calculus formation?
peridex - CHX
which mouthwash may cause local hypersensitivity and sometimes generalized allergic reactions have also been reported
bitter taste and can cause taste interference
peridex - CHX
which mouthwash?
binds salivary mucins, reducing pellicle formation which in turn inhibits plaque bacteria colonization
plaque reduction up to 60.9% and gingivitis reduction up to 42.5% when used as directed
CHX
ruptures bacteria cell wall membrane leading to rapid leakage of cell contents and cell death
binds bacteria. inhibiting absorption onto the teeth
bacteria and bacterial by products like H2S CH3SH CH3SCH3 short chain fatty acids polyamines (cadeverin. putrecine) Nitrogen byproducts (urea) Keton byproducts Alkalines Phenyl byproducts
halitosis
malodor - bad breath
we need to eliminate etiological factors
review oral hygiene habits
recommend dietary changes
only herbal extract we use - may work. coat the sutures
may have antimicrobial properties
Chitosan
derived from Chitin
how can products get the ADA seal of acceptance
across two 6 month studies an average minimum of 20% gingivitis reduction is demonstrated in order to award the seal
