Non-surgical Therapy - Mechanical Home Care

Question 1

T/F - It is possible to completely eliminate plaque biofilm

Answer 1

False

Question 2

What are ways to manage plaque biofilm?

Answer 2

Proper diet
Tooth-brushing 2x a day with ADA-accepted fluoride toothpaste
Interdental cleaning (for people missing teeth)
Use of ADA-accepted antimicrobial mouth rinse 2x a day

Question 3

What are reasons mechanical plaque control can be difficult to achieve?

Answer 3

Improper brushing and flossing technique
Insufficient time
Implants, crowns, braces, etc
Post surgical gingival sensitivity
Limited dexterity
Higher risk of developing gingivitis

Question 4

Why is a patient higher risk of furthering gingivitis when they have gingivitis

Answer 4

Because the area will hurt and they will avoid brushing and flossing that area

Question 5

What are the major forms of self-performed plaque control?

Answer 5

Toothbrush + toothpaste
Mouthiness
Interdental cleaning devices (not just floss)

Question 6

What is the ideal handle size of a toothbrush?

Answer 6

Whatever’s comfortable

Question 7

What is the ideal head size of a toothbrush?

Answer 7

Smaller heads are usually better - they can reach the gingival line and harder to reach areas

Question 8

What is the ideal bristle material for a toothbrush?

Answer 8

End-rounded nylon OR Polyester filaments

Question 9

What is the ideal bristle type for a toothbrush?

Answer 9

Soft, because harder bristles can lead to recession

Question 10

What is the ideal bristle pattern for a toothbrush?

Answer 10

Patterns that enhance interdental plaque removal

Question 11

What are the different types of Brushing Methods?

Answer 11

Stillmann's method
Roll and sweep method (Modified Stillmann's)
Bass method
Rotational Scrub
Charters method
Horizontal Scrub

Question 12

Stillmann’s Method

Answer 12

30’ angle with bristles pointing towards the gingiva

Movement in a coronal direction with a vibrating and rolling stroke

Question 13

Roll and Sweep Method (modified stillmann’s)

Answer 13

30’ angle with bristles pointing towards the gingiva

Movement in a coronal direction with a rolling stroke

Question 14

Bass Method

Answer 14

45’ angle with bristles pointing towards the gingiva (helps bristles get into sulci)
Movement with a vibratory and circular motion around the tooth
Modified: additional sweeping motion following vibratory, circular motion (if pt has never seen a toothbrush, tell them to use this method)

Question 15

Rotational Scrub Method

Answer 15

Brush is positioned on the tooth surface - bristles are perpendicular to tooth and gingival surfaces
Movement in small circulatory motions

Question 16

Charter’s Method

Answer 16

45’ angle with bristles pointing toward occlusal surfaces
Movement back and fourth (in and out) in a circular motion
Best method for patients with open inter proximal spaces and need to clean interdentally
Most difficult to do correctly

Question 17

Horizontal Scrub Method

Answer 17

90’ angle between brush and teeth
Movement in horizontal motion
This method should be used only for occlusal surfaces
Can cause both soft and hard tissue damage at cervical areas

Question 18

Which method of toothbrushing should be recommended?

Answer 18

There’s no difference in toothbrushing methods

Spend time to improve patient care where needed

Question 19

T/F - Interproximal plaque removal with a toothbrush is sufficient

Answer 19

False - it’s ineffective

Question 20

What area do plaque deposit appear earlier and most prevalent?

Answer 20

Interproximal/interdental areas (Col)

Toothbrushing alone cannot effectively control interdental plaque

Question 21

T/F - Interdental cleaning is regularly practiced

Answer 21

False

Question 22

Which patients are more prone to clean interdentally?

Answer 22

Patients treated for periodontitis

Question 23

What are different interdental cleaning tools?

Answer 23

Dental floss
Dental tape
Inter proximal brushes
Toothpicks
Electrically powered cleaning aids

Question 24

What is the proper way to floss?

Answer 24

Go down to the gingival margin

Pull the floss to make sure it contours to the surface of the tooth

Question 25

Proxybrush

Answer 25

Brush to clean large inter proximal spaces Some patients will try and substitute floss for this, but make sure they only use it if they have a large gap (can damage surfaces)

Question 26

T/F - Frequency matters when brushing

Answer 26

True - Mostly the more often the better, but there is little difference between brushing every 12 hours and every 48 hours?

Question 27

If there is little difference between brushing every 12 hours and every 48 hours, why do we tell patients to brush 2x a day?

Answer 27

Because they will always do it less often than we tell them | Plus, it's rarely being done properly and the study that tells us this assumes proper brushing technique

Question 28

Sulcus brush

Answer 28

Specifically designed to clean sulcus | Can also be used for oath patients to get between brackets

Question 29

Tongue brushers or scrapers

Answer 29

For people with bad breath | Should brush tongue because we can get biofilm in soft tissues as well

Question 30

What are types of trauma that can occur from toothbrushing

Answer 30

Gingival erosion Cervical abrasion Gingival recession

Question 31

What should we recommend a patient do when using a new toothbrush?

Answer 31

Make sure the bristles are wet - this will reduce the likelihood of abrasion and other trauma

Question 32

Why do we want patients to use Rounded-end bristles?

Answer 32

Because they are shown to produce less trauma on gingival tissues than cut-end bristles

Question 33

How long should a tooth-brush be used? How long are they effective at plaque removal?

Answer 33

They're effective at removing plaque for 2 months | Patients should consider replacing their toothbrush after 9 weeks of use

Question 34

Interplak (Connair)

Answer 34

Electric toothbrush with counter-rotating bristle action Head of the brush has both long and short-tapered bristles Promoted for cleaning around braces dental work Cannot use regular toothpaste with it - has a special agent to use with it (that sucks)

Question 35

Oral-B Braun

Answer 35

``` Electric toothbrush Head moves in and out at ~40,000x/min Head moves side to side at ~7,600x/min Brush is color coded to remind of replacement Has a 2min timer ```

Question 36

Sonicate Elite

Answer 36

Electric toothbrush No rotating parts, but the head produces 31,000 strokes/min and sonic waves to remove plaque on teeth Has 2 min timer Shown to have a 72% plaque reduction in 12 weeks

Question 37

What conclusions can we draw in the argument of electric toothbrushes v manual toothbrushes?

Answer 37

Powered toothbrushes with a rotation oscillation action provide a slightly better plaque removal and may provide bettie protection against gingival inflammation - if patient is using proper brushing technique with a manual, they will survive - if patient just can't stop inflammation, you should probably recommend an electric toothbrush