Ch. 26 Oral Infection Control: Toothbrushes and Toothbrushing Flashcards
Tooth brush originated as
Babylonian chew stick 3500 BC
1st was made of horse hair
First US patent
1860 to HN wadsworth
Nylon bristles introduced in
Why
1938
WWII prevented export of bristles so synthetic materials were substituted
Now exclusively made of synthetic
First power toothbrush in US
Broxodent in 1960
Characteristics of Effective Manual Toothbrush (9)
- Conforms to individual pt
- Easily and efficiently manipulated
- Readily cleaned
- Durable and inexpensive
- Soft bristles
- Multilevel or angled bristles
- End rounded filaments
- Utility efficiency cleanliness
- ADA seal of acceptance
Handle shape should be
Easy to grasp
Lightweight
Most current toothbrushes have _____ filaments (bristles)
Nylon
Power toothbrushes have what percentage of reduction in plaque
Gingivitis reduction
10-20%
10%
Indications for use of power toothbrush ppl with
Ortho
Aggressive brushing
Disabilities/dexterity
Caregivers
Pt may resist change
Methods for manual tooth brushing
Sulcular (modified bass) (modified stillman)
Roll (rolling strokes, modified stillman)
Vibratory (charters and bass)
Horizontal (scrub)
Circular (Fones)
Vertical (Leonard)
Bass and modified bass method
Widely accepted as most effective
for removal beneath gingival margin
45* (long axis of tooth) up into gums
Short strokes back and forth, sulcular
Limitations of bass method
Roll method used as well for crowns
Aggressive brushes bc angling into gums can cause damage
Bristles only reach 0.9 mm beneath GM
Stillman and modified stillman methods
Massage and stimulation for clean of cervical areas
Adds rolling method and vibratory method to clean crown of tooth
Place side of tooth brush on attached gingiva (partly on gingiva and partly on crown)
45* angle (not into gums)
Roll/rolling stroke method
What it Removes
How brush is positioned
Limitation
Used in conjunction with other methods to clean crowns
Removes biofilm and materia alba without emphasis on gingiva sulcus
Brush parallel to and against attached gingiva. Plastic portion of head level with occlusal plane
Limitation:
Minimal plaque removal inter-proximally or in sulcular areas
(Hard to reach areas)
Charters method
Geared toward children
Purpose: loosen debris and biofilm
Stimulate marginal and interdental gingiva
Direct bristles at 90* to teeth and 45* to occlusal plane
-tips toward Incisal/occlusal edge
Limitation- does not engage gingival sulcus to disturb Subgingival bacteria
Horizontal (scrub) method
Children younger than 6
Should be combined with outer methods
Posterior: Head at 90*
Anterior: parallel to long axis
Posterior: Back and forth motion
Anterior: Up and down
Limitations:
Doesn’t reach interproximal
Cervical abrasion if excessive pressure
Fones (circular) method
Easy for children
90* to long axis of tooth
Bristles moved in circular motion
Limitation: lowest efficiency in plaque removal
Leonard’s (vertical) method
Works well for small children
90* to long axis of tooth
Move up and down with light pressure, moving systematically
Limitation: minimal plaque removal inter-proximally
Power tooth brushing
Bristles at 45-90*
Built in 2 minute timer
Limitations: cost and vibrations/sound
Supplemental brushing method
Occlusal brushing
-pits and fissures
Brushing difficult to reach areas
-distal surface of most posterior molars
-facially displaced tooth (canines and premolars) where attached gingiva and Buccal alveolar bone is minimal (recession)
Tongue cleaning
Microorganisms in saliva are same as found on tongue
-high bacterial load
-anatomic features of tongue conducive to debris retention
Procedure:
Place toward most posterior area of dorsal surface
Light but firm stroke and pull forward
Repeat several times, on entire surface
Wash under running water
Brushing sequence
No 1 recommended sequence, systemic way
but pt should have a system to make sure all areas are clean
Demonstration has largest effect on pt outcome
Neutropenia
Low white blood cell count from chemo, radiation and bone marrow transplant
At risk for oral complications
Mucositis-inflammation of mucous
Important for them to brush softly through pain
-non alcohol mouth wash (not chlorhexidine)
-fluoride
Common areas for recession/abrasion with aggressive brushes
Canines and premolars, midfacial aspect
Bacteremia
Daily oral activities (chewing brushing flossing) can reduce
Medically compromised need to maintain biofilm removal every day to minimize the magnitude
Tooth brush care
Replace 2-3 months
Rinse with tap water until completely clean within the filaments after each use
Stored in open air with head in upright position
-No closed containers and away from others brushes
