Ch. 26 Oral Infection Control: Toothbrushes and Toothbrushing

Question 1

Tooth brush originated as

Answer 1

Babylonian chew stick 3500 BC

1st was made of horse hair

Question 2

First US patent

Answer 2

1860 to HN wadsworth

Question 3

Nylon bristles introduced in

Why

Answer 3

1938

WWII prevented export of bristles so synthetic materials were substituted

Now exclusively made of synthetic

Question 4

First power toothbrush in US

Answer 4

Broxodent in 1960

Question 5

Characteristics of Effective Manual Toothbrush (9)

Answer 5

1. Conforms to individual pt
2. Easily and efficiently manipulated
3. Readily cleaned
4. Durable and inexpensive
5. Soft bristles
6. Multilevel or angled bristles
7. End rounded filaments
8. Utility efficiency cleanliness
9. ADA seal of acceptance

Question 6

Handle shape should be

Answer 6

Easy to grasp
Lightweight

Question 7

Most current toothbrushes have _____ filaments (bristles)

Answer 7

Nylon

Question 8

Power toothbrushes have what percentage of reduction in plaque
Gingivitis reduction

Answer 8

10-20%

10%

Question 9

Indications for use of power toothbrush ppl with

Answer 9

Ortho
Aggressive brushing
Disabilities/dexterity
Caregivers

Pt may resist change

Question 10

Methods for manual tooth brushing

Answer 10

Sulcular (modified bass) (modified stillman)

Roll (rolling strokes, modified stillman)

Vibratory (charters and bass)

Horizontal (scrub)

Circular (Fones)

Vertical (Leonard)

Question 11

Bass and modified bass method

Answer 11

Widely accepted as most effective

for removal beneath gingival margin

45* (long axis of tooth) up into gums

Short strokes back and forth, sulcular

Question 12

Limitations of bass method

Answer 12

Roll method used as well for crowns

Aggressive brushes bc angling into gums can cause damage

Bristles only reach 0.9 mm beneath GM

Question 13

Stillman and modified stillman methods

Answer 13

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)

Question 14

Roll/rolling stroke method

What it Removes
How brush is positioned
Limitation

Answer 14

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)

Question 15

Charters method

Answer 15

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

Question 16

Horizontal (scrub) method

Answer 16

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

Question 17

Fones (circular) method

Answer 17

Easy for children

90* to long axis of tooth

Bristles moved in circular motion

Limitation: lowest efficiency in plaque removal

Question 18

Leonard’s (vertical) method

Answer 18

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

Question 19

Power tooth brushing

Answer 19

Bristles at 45-90*

Built in 2 minute timer

Limitations: cost and vibrations/sound

Question 20

Supplemental brushing method

Answer 20

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)

Question 21

Tongue cleaning

Answer 21

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

Question 22

Brushing sequence

Answer 22

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

Question 23

Neutropenia

Answer 23

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

Question 24

Common areas for recession/abrasion with aggressive brushes

Answer 24

Canines and premolars, midfacial aspect

Question 25

Bacteremia

Answer 25

Daily oral activities (chewing brushing flossing) can reduce

Medically compromised need to maintain biofilm removal every day to minimize the magnitude

Question 26

Tooth brush care

Answer 26

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