oral hygiene instructions Flashcards
_______ patient first, then sit ______ and give them a hand _______.
Show them areas of _____- correlate these to areas of _______.
2 tone disclosing solution:
Red/pink=____ plaque
Blue= ____ plaque
DISCLOSE patient first, then sit UPRIGHT and give them a hand MIRROR.
Show them areas of BIOFILM- correlate these to areas of DISEASE.
2 tone disclosing solution:
Red/pink= NEW plaque
Blue= OLD plaque
Evaluate and compare the __________ and the _______ of the patient at _____ appointment
review current and previous _____
evaluate whether there is ______, if not, review again or ________
Evaluate and compare the ORAL HEALTH STATUS and the HOME CARE ROUTINE of the patient at EVERY appointment
review current and previous TECHNIQUES
evaluate whether there is IMPROVEMENT, if not, review again or CHANGE PLAN
seat patient _______
(how they do it at home)
UP RIGHT
identify the reason for poor oral health status: (4)
every patients needs AND OHI are _______
lack of knowledge, ineffective technique, lack of motivation, or physical disability
DIFFERENT
Provide ______ information according to the patient’s needs and goals in ________ terms. Present relevant and sufficient ____________.
OHI should be related to _______ goals
review _________ with the patient during OHI and they relate to the patient’s goal(s).
Understandable terms- do not use dental jargon such as p_____, a_____, b____, L_____. Instead, use terms such as “_____ teeth”, “____ teeth”
______ can be incorporated into OHI
Provide FACTUAL information according to the patient’s needs and goals in UNDERSTANDABLE terms. Present relevant and sufficient SCIENTIFIC THEORY.
OHI should be related to PATIENT CENTERED goals
review ORAL HYGIENE AIDS with the patient during OHI and relate to the patient’s goal(s).
Understandable terms- do not use dental jargon such as POSTERIOR, ANTERIOR, BUCCAL, LINGUAL. Instead, use terms such as “front teeth”, “back teeth”
EBDM can be incorporated into OHI
examples of oral hygiene aids (6)
*retrieve from clinic assistant
Floss holder
Floss threader
Proxabrush
Rubber tip stimulator
End tuft brush
Denture brush
Utilize _________ charting and _______ points to emphasize that
bleeding is an indicator of active ______.
Drag perio chart to other _______ so the patient can see.
Explain _______ and bleeding.
_____ to these areas in the patient’s
mouth
Utilize PERIODONTAL charting and BLEEDING points to emphasize that
bleeding is an indicator of active DISEASE.
Drag perio chart to other MONITOR so the patient can see.
Explain PROBE DEPTHS and bleeding.
POINT to these areas in the patient’s mouth
utilize ________ deficits and goals for _________
use ______ questions and ______ counseling techniques
use _____ more than ______ and ________ more than _______
OHI is a _____ not telling someone what to do
utilize HUMAN NEEDS deficits and goals for PATIENT EDUCATION
use OPEN ENDED questions and NONDIRECTIVE counseling techniques
use LISTENING more than TALKING and PROBLEM SOLVING more than INSTRUCTING
OHI is a DISCUSSION not telling what to do
utilize the patients ______ to demonstrate effects of the _____
process and effective home care techniques on oral ______.
OHI ALWAYS has a _______ component in patient’s mouth
utilize the patients MOUTH to demonstrate the effects of the DISEASE process and effective home care techniques on oral STRUCTURE.
OHI ALWAYS has a HANDS-ON component in patient’s mouth; failure of hands on activity needs improvement in OHI
WHY HANDS ON
Disruption and removal of ______ must be a _____ activity
Biofilm forms ____ and becomes _______ the longer present
*telling is not active learning
*seeing the patient remove the biofilm makes you confident they can remove it at home
*BONUS: If the patient removes the biofilm during OHI, you don’t have to!
Disruption and removal of BIOFILM must be a DAILY activity
Biofilm forms QUICK and becomes PATHOGENIC the longer present
DO
- _______ the patient
- have patient ______ technique
TELL
- explain ___ and _____ to patient
SHOW
- show the ____ in the patients ___
- hand them the ____ to watch
DO
- have patient ______ it back
- provide ________ feedback/tips
DO
- disclose the patient
- have patient demonstrate their technique
TELL
- explain the technique and rationale to your patient
SHOW
- show the technique in the patients mouth
- hand them the mirror to watch
DO
- have patient demonstrate it back
- provide immediate feedback/tips
incorporate supplementary media to emphasize concepts
show them:
videos, pictures, or handouts
Demonstrate the use of appropriate oral ___________ aid to meet the needs of the patient.
Could be an aid we _______, one that will be covered in OHI aid presentations, or even adapting
something the patient is already using
Demonstrate the use of appropriate oral PHYSIOTHERAPEUTIC aid to meet the needs of the patient.
Could be an aid we DISCUSSED, one that will be covered in OHI aid presentations, or even adapting
something the patient is already using
what are the characteristics of good instructions (5)
- present in small increments
- patient actively participates
- self paced by the patient
- immediate feedback
- positive reinforcement provided
DOCUMENTATION IN SERVICES RENDERED
Services rendered: HH, AB rinse, EOE/IOE, Dental charting, Perio assmt, 4 HBW, OHI (c-shape flossing, caries process, importance of fluoride)
Services rendered: HH, AB rinse, RA, OHI (Stillman’s brushing, interproximal brush), Hand scale UR.
OHI GRADING
DNTH 306 Error margin= __
allowable errors
Critical errors: (3)
Grade for OHI given at ____
appointment that OHI
given/reviewed (except ________)
DNTH 306 Error margin= 2
allowable errors
Critical errors: not disclosing, not using a hands-on intraoral activity, not documenting OHI given and patients compliance with previous OHI
Grade for OHI given at EVERY
appointment that OHI
given/reviewed (except evaluation of DH treatment)
what are the parts of a manual toothbrush (6)
- handle
- shank
- head
- heel
- toe
- brushing plane
HANDLE AND SHANK PREFERRED CHARACTERISTICS
- ___ to grasp
- does not ____ or _____ during use
- no _____ corners
- ________
- variations:
*______, _____, ______, or _____ in the shank with or without a thumb rest can help with adaptation.
*______ diameter for patients with limited _________
- EASY to grasp
- does not SLIP or ROTATE during use
- no SHARP corners
- LIGHTWEIGHT
- variations:
*A TWIST, CURVE, OFFSET, or ANGLE in the shank with or without a thumb rest can help with adaptation.
*A LARGER diameter for patients with limited DEXTERITY
BRUSH HEAD
size
- select based on _____ not ____
- _____ enough to reach all areas
- _____ enough to remove ________
ADA recommends ____ toothbrush
SIZE
- select based on SIZE OF THE MOUTH NOT AGE
- SMALL enough to reach all areas
- LARGE enough to remove plaque efficiently
ADA recommends SOFT
types of brush heads (6)
- flat
- rippled
- tapered filament
- multilevel
- angled
- Bilevel-orthodontic
BRUSH HEAD FILAMENTS
- typically ____
- which brushing planes are more effective at removing plaque
- the end of bristles should be _____
- typically NYLON
- ANGLED AND MULTILEVEL
- the end of bristles should be ROUNDED
what factors influence toothbrush selection (8)
- ability to use the TB to remove biofilm and not damage tissues
- manual dexterity of the pt
- age
- status of gingival/periodontal health
- anatomic configurations of the gingiva
- position of the teeth
- patient preference
- ADA seal of acceptance
what factors influence TB efficacy (5)
- duration
- frequency
- pressure
- systematic approach
- method
DURATION AND FREQUENCY
- what is the recommended minimum to brush a day
- how many minutes is recommended vs what most do
- brushing twice a day has been shown to reduce ________ and _______
- failure to disturb ___ allows for continued ______ and pathogenic potential of the biofilm
two times a day
2 min recommended; most brush less than 1 min
brushing twice a day has been shown to reduce CARIES and SEVERITY OF PERIODONTAL DISEASE
Failure to disturb BIOFILM allows for continued MATURATION and pathogenic potential of the biofilm
Brushing must cover ___ tooth surfaces to be effective
Encourage the patient to establish a _______ and follow it each time (by quadrants/arch)
Starting in most ______ area may help
Brushing must cover ALL tooth surfaces to be effective
Encourage the patient to establish a SEQUENCE and follow it each time (by quadrants/arch)
Starting in most DIFFICULT area may help
PRESSURE
Excessive pressure may increase
likelihood of dental/gingival ____ and ______
_______ brushing should be avoided
Many power toothbrushes have an alert if the user is using _____ force
Excessive pressure may increase
likelihood of dental/gingival ABRASION and RECESSION
AGRESSIVE brushing should be avoided
Many power toothbrushes have an alert if the user is using EXCESSIVE force
BASS METHOD/ SULCULAR BRUSHING
INDICATIONS:
- for all patients: ____, _____ , and ______ patients
- removes dental biofilm adjacent to and beneath the _____, ______ area beneath the contour of enamel, and exposed ____ surfaces
PROCEDURE:
- Filament tips are directed into the gingival _____ at approximately __° to the long axis of the tooth.
- Vibrate the brush back and forth with _____ strokes
- Brush in ________ position for lingual surfaces of mandibular posterior teeth
- _____ position for lingual surfaces of _____ teeth
INDICATIONS:
- for all patients: HEALTHY, DISEASED (gingivitis and periodontitis) , and PERIODONTAL MAINTENCE patients
- removes dental biofilm adjacent to and beneath the GINGIVAL MARGIN, CERVICAL area beneath the contour of enamel, and exposed ROOT surfaces
PROCEDURE:
- Filament tips are directed into the gingival SULCUS at approximately 45° to the long axis of the tooth.
- Vibrate the brush back and forth with SHORT strokes
- Brush in HORIZONTAL position for lingual surfaces of mandibular posterior teeth
- VERTICAL position for lingual surfaces of ANTERIOR teeth
LIMITATIONS FOR BASS/SULCULAR BRUSHING
Bristles extend only __mm below the gingival margin so plaque removal in the sulcus is limited
An overeager brusher may convert the previously mentioned “very short strokes” into a ____ scrub
that can cause _____ to the gingival margin
_____ requirements may be difficult for certain patients
Because a __° angle can be difficult to visualize, emphasis is on placing the tips of the filaments into the
_____
Bristles extend only 0.9MM below the gingival margin so plaque removal in the sulcus is limited
An overeager brusher may convert the previously mentioned “very short strokes” into a VIGOROUS scrub that can cause INJURY to the gingival margin
DEXTERITY requirements may be difficult for certain patients
Because a 45° angle can be difficult to visualize, emphasis is on placing the tips of the filaments into the
SULCUS
STILLMAN METHOD
INDICATIONS
- progressive ___________
- ______ stimulation
PROCEDURE
- filaments tips are directed _______ at approximately __° to the long axis of the tooth
- filaments are placed partly on the ______ portion of teeth and partly on the ______
- short back and forth _______ strokes while counting to __
INDICATIONS
- progressive GINGIVAL RECESSION
- GINGIVAL stimulation
PROCEDURE
- filaments tips are directed APICALLY at approximately 45° to the long axis of the tooth
- filaments are placed partly on the CERVICAL portion of teeth and partly on the GINGIVA
- short back and forth VIBRATORY strokes while counting to 10
CHARTERS METHOD
INDICATIONS:
- ______ orthodontics
- cleaning _______ sites
- fixed ______
PROCEDURE
- __ degrees toward the _____
- short _______ strokes
INDICATIONS:
- FIXED orthodontics
- cleaning SURGICAL sites
- fixed PROTHESES
PROCEDURE
- 45 degrees toward the CROWN
- short VIBRATORY strokes
what makes a method “modified”
what methods can be modified (3)
- adding a “roll stroke” 5 times for each tooth/group of teeth
- modified bass, modified Stillman, modified charters
MODIFIED STILLMAN BRUSHING
A: Initial brush placement with sides of bristles or filaments against the
__________
B: The brush is _______ and ______,
then ______.
C: Vibrating is continued as the brush is _____ slowly over the _____.
D: Maxillary anterior lingual placement with the brush applied __________
E: Vibrating continues as the brush is rolled over the _______ and ________ areas. Placement is similar for the lingual surfaces of the mandibular anterior teeth. The _____ stroke brushing method has the same brush positions
A: Initial brush placement with sides of bristles or filaments against the
ATTACHED GINGIVA
B: The brush is PRESSED and ANGLED, then ROLLED.
C: Vibrating is continued as the brush is ROLLED slowly over the CROWN.
D: Maxillary anterior lingual placement with the brush applied VERTICALLY
E: Vibrating continues as the brush is rolled over the CROWN and INTERDENTAL areas. Placement is similar for the lingual surfaces of the mandibular anterior teeth. The ROLLING stroke brushing method has the same brush positions
FONES BRUSHING
INDICATION
- _______, _____ teeth only
TECHNIQUE
- ______, ______ motions
INDICATION
- YOUNG CHILDREN, PRIMARY teeth only
TECHNIQUE
- LARGER CIRCULAR motions
all techniques must be followed by _______ brushing
_______ or ________ technique on ______ in all 4 quadrants
all techniques must be followed by OCCLUSAL brushing
CIRCULAR or VIBRATORY technique on OCCLUSALS in all 4 quadrants
INDICATIONS FOR AN ELECTRIC TOOTHBRUSH (anyone, but particularly 8)
- history of failed attempts at more traditional biofilm removal
- Moderate-heavy biofilm
- Uncontrolled periodontal diseases
- Patients with a disability or limited dexterity
- Extensive prosthodontics
- Fixed Ortho
- Recession, toothbrush abrasion, abfraction
- Caregivers
why is an electric toothbrush beneficial compared to a manual (2)
- more effective in reducing plaque and gingivitis
- less gingival damage
OSCILLATING-ROTATING electric TB
examples (4)
how does it rotate
which brand has the ADA seal
works on how many teeth at once
Oral B Genius, Pro, Vitality, and Conair Opticlean
one direction then the other, some pulsate in and out
Oral B has the ADA seal
one tooth at a time
CIRCULAR electric toothbrush
example (1)
how does it rotate
how many teeth does it work on
example: rotadent
entire brush rotates in one direction
one tooth at a time and multiple heads
SONIC electric toothbrush
Examples: (3)
how do bristles move
Sonicare, Quip, and Burst
bristles vibrate side to side or up and down
ULTRASONIC electric toothbrush
examples: (2)
how do bristles move
emmi-dent and smileX
bristles vibrate at ultrasonic frequencies (faster than 20kHz)
TONGUE CLEANSING
Tongue harbors _____ that can translocate to _____ and cause _______
Can use a ______ or _______ to remove bacteria and produce an overall clean feeling
Process:
- _____ tongue
- Place brush/scraper on ______
- Draw forward with _____ pressure
- ______ until clean
Tongue harbors BACTERIA that can translocate to TEETH and cause MALODOR
Can use a TONGUE SCRAPER or TOOTHBRUSH to remove bacteria and produce an overall clean feeling
Process:
- EXTEND tongue
- Place brush/scraper on POSTERIOR
- Draw forward with LIGHT pressure
- REPEAT until clean
soft tissue lesions:
hard tissue lesions:
causes: (6)
what toothbrush is recommended and why
soft tissue lesions: recession and gingival abrasion
hard tissue lesions: dental abrasion
causes: multi-factorial, scrub brushing (facial surfaces, canines, and premolars are most commonly affected), bristles are not round-ended, mechanical abrasion, abrasive dentifrice, bristle stiffness
what toothbrush is recommended and why: soft TB with end-rounded bristles, less abrasive toothpastes, and modify brushing technique if needed
CARE OF TOOTHBRUSHES
Replace toothbrush every __ months or sooner if it becomes _____
Rinse toothbrush thoroughly after ___ use and allow to ____
Store in the _____ with head in an _____ position apart from contact with other brushes
Replace toothbrush every 3 months or sooner if it becomes FRAYED
Rinse toothbrush thoroughly after EACH use and allow to DRY
Store in the OPEN AIR with head in an UPRIGHT position apart from contact with other brushes
DH PROCESS OF CARE AND OHI
ASSESS
- current ______ habits
- during ______
- hard and soft _____
DIAGNOSE AND PLAN
- link _____ to other assessment findings
- determine _______
- work ____ the patient to create self-care plan goals
IMPLEMENT
- during OHI, patient should be asked to _________
EVALUATE
- _________ and at each subsequent appointment
DOCUMENT
- _______ given
- ________
- oral hygiene _______
ASSESS
- current SELF CARE habits
- during DENTAL HISTORY
- hard and soft LESIONS
DIAGNOSE AND PLAN
- link SELF CARE to other assessment findings
- determine UNMET HUMAN NEEDS
- work WITH the patient to create self-care plan goals
IMPLEMENT
- during OHI, patient should be asked to DEMONSTRATE TOOTHBRUSHING METHODS IN THEIR MOUTH
EVALUATE
- IMMEDIATELY and at each subsequent appointment
DOCUMENT
- INSTRUCTIONS given
- COMPLIANCE
- oral hygiene INDICES
IMPORTANCE OF INTERDENTAL CARE
can toothbrushing alone remove biofilm in the interdental area?
Removal of interdental biofilm is important to:
Prevent ________
Gingivitis commonly begins in the _______ area
NO brushing alone is not sufficient
Removal of interdental biofilm is important to:
Prevent PERIODONTAL DISEASE
Gingivitis commonly begins in the INTERDENTAL area
DENTAL FLOSS
- research has shown ______ in the effectiveness of waxed or unwaxed floss
- selection is based on ______ and ______
DENTAL TAPE
- _____ and ______ than floss; ribbon-like
TUFTED FLOSS
- __ segments
-EX: ________
DENTAL FLOSS
- research has shown NO DIFFERENCE in the effectiveness of waxed or unwaxed floss
- the selection is based on PATIENT PREFERENCE and EASE OF USE
DENTAL TAPE
- WIDER and FLATTER than floss; ribbon-like
TUFTED FLOSS
- 3 segments (stiffened end for insertion, thick, unwaxed dental floss)
-EX: superfloss
what are the flossing techniques
- spool
- loop/circle of floss (used for children or decreased dexterity)
both (moving along to clean the piece in each contact, maintain a C shape)
why isn’t floss for everyone?
everyone’s embrasures are different sizes, if an embrasure is too large floss would remove all the biofilm
periodontal patients need an aid that goes subgingival
describe embrasure type 1 (3)
- interdental papilla completely fills the interproximal
- floss indicated
- need to supplemental interproximal aid based on pt preference
describe embrasure type 2 (3)
- interdental papilla partially fills
interproximal area - Papillary recession present
- Supplemental IP aid needed
describe embrasure type 3 (4)
- Interdental papilla does not fill the interproximal area
- Complete papillary loss
- Extensive recession
- Supplemental IP aid needed
GAUZE STRIP
INDICATION:
TECHNIQUE:
indication: cleaning proximal surfaces when the adjacent tooth is missing
technique: wrap in a C-shape and use vertical motions to remove biofilm
FLOSS HOLDING DEVICES
INDICATIONS:
TECHNQIUE:
INDICATION: patient preference and/or decreased dexterity
TECHNIQUE: C-shaped
FLOSS THREADERS
INDICATIONS: (4)
technique: (3)
indications: bridges, fused crowns, orthodontics, bonded retainer
technique: thread floss through loop, pull floss threader under the fixed appliance, maintain C shape floss
ORAL IRRIGATORS
produce ____ stream of fluid
indications: (6)
produce PULSATING stream of fluid
- patient preference
- Orthodontics
- Implants
- Prosthodontics
- Decreased dexterity
- Periodontitis
ORAL IRRIGATORS
technique (3)
tips (2)
TECHNIQUE:
- 80-90 degree angle
- few seconds on each tooth (B&L)
- lean over sink with open mouth or close lips and spit every few teeth
TIPS
- let patient know this will be messy until technique improves
- steep learning curve
SUBGINGIVAL ORAL IRRIGATION
Specially designed tip to place into
______ - CAN NOT use this technique
without _________
Indication:
- _________
Technique:
- Insert tip pointed _______ slightly into the ______
Specially designed tip to place into
SULCUS - CAN NOT use this technique without SPECIAL TIP
Indication:
- PERIODONTAL POCKETS
Technique:
- Insert tip pointed APICALLY slightly into the SULCUS
are dental water jets able to replace an oral irrigator? why or why not
NO, dental water jets that hook into the shower/facet lack pulsating motions and supporting research
INTERPROXIMAL BRUSHES
indications: (4)
technique:
indications:
- type 2 and 3 embrasures
- fixed prosthodontics
- fixed orthodontics
- patient preference
technique
- in and out motion
GUM BRAND GO-BETWEENS
- we have these in the clinic available in different _____
SIZING:
- Bristles need to be slightly ______
than _________ space
- Should not need to be _____ and
wires should not be _______
- Patient may need _____ sizes
- Need to ______ patient about
sizing
- we have these in the clinic available in different SIZES
SIZING:
- Bristles need to be slightly LARGER
than EMBRASURE space
- Should not need to be FORCED and wires should not be RUBBING
- Patient may need MULTIPLE sizes
- Need to EDUCATE patient about sizing
TePe interdental brushes
- smaller than the gum brushes > no handle
- more difficult to use
GUM BRAND SOFT PICKS
- we have in clinic
- comes in wide and standard
- same indications and technique for IP brushes
RUBBER TIP STIMULATOR
- Clinical benefits _______
- Improves ______
- Increases ______ and epithelial ____
- Might remove SOME ______
Technique:
- __ degrees
- Rubbed along the ________
- Clinical benefits QUESTIONABLE
- Improves CIRCULATION
- Increases KERATINATION and epithelial THICKNESS
- Might remove SOME BIOFILM
Technique:
- 45 degrees
- Rubbed along the GINGIVAL MARGIN
END TUFT OR SULCUS BRUSH
indications (3)
tehcnique
indication:
- type 2 and 3 embrasures (large)
- furcations
- hard-to-reach areas such as crowding, distal of the molars, and mandibular anterior linguals
technique
- vibratory stroke (bass brushing)
toothpick in holder
indications (2)
technique (3)
indications:
- EXPOSED furcations
- removal of impacted food
technqiue
- 45 degree angle
- trace the gingival margin
- in and out of exposed furcations
WOODEN WEDGE
- indication
- technique (4)
indication: type 2 and 3 embrasures
technique:
- only use from the facial
- point tip occlusally or incisally at the IP spaces at a 45 degree angle
- in and out motion
- trace the GM
ORAL HYGIENE INDICES
- measure the client’s level of _______ to accomplish the following:
- Establish a ______ for an individual
- _____ the oral hygiene status within a ________
- Establish a _______ for a ________
population - Evaluate an ______, _____, or ______
- measure the client’s level of ORAL HYGIENE to accomplish the following:
- Establish a BASELINE for an individual
- SURVEY the oral hygiene status within a POPULATION
- Establish a BASELINE for a TARGET
population - Evaluate an INTERVENTION, DRUG, or DEVICE
PHP (PATIENT HYGIENE PERFORMANCE)
- used in clinic to _________
- can be done on ____ patient
- OHI must be done at ____ appointments to compare ___ and ____
- easy and quick ______ tool
- how many sets of OHI do we need in clinic
- used in clinic to ASSESS BIOFILM
- can be done on ANY patient
- OHI must be done at 2 appointments to compare PRE and POST
- easy and quick DOCUMENTATION tool
- WE NEED 1 SET OF OHI
PHP STEPS (5)
- disclose
- divide the teeth into 5 sections (3B, 14B, 8F, 19L, 30L, 24F) use adjacent tooth if one is missing
- count surface with biofilm present
- add the total number of surfaces
- divide by 6
