plaque control and hygiene aids- boles Flashcards
Plaque – primary agent in development of:
Dental Caries
Periodontal Disease
Plaque Control leads to:
Resolution of gingival inflammation in the early stages
Reduction of calculus formation
Oral health can neither be attained or preserved without:
Oral health can neither be attained or preserved without
plaque control
must get what for effective plaque control?
pt attention
how we can get pt attention for plaque control?
Educate the patient
Show patient disease in his/her
own mouth
Bleeding points
Periodontal probing
Red, bleeding gums
Utilize disclosing agent
Educational tool
Motivational tool
home care instructions should be?
Need to be effective/personalized
Be non-traumatic when cleaning the teeth
what to consider with home care instructions
Areas of plaque accumulation: Interproximal, buccal, lingual, occlusal
Restorative dentistry: Crowns, bridges, overhangs, etc.
Anatomical features: Embrasure spaces, furcation involvement, etc.
Patient’s dexterity
Patient’s motivation
most important features of toothbrushes
Able to reach all areas to be cleaned
Size of head is appropriate for patient
No tissue trauma
possible bristle materials
natural and nylon
natural bristles
Made of wild boar or hog hair
Bristles vary greatly in each
filament
Varies texture, size, flexibility
Absorbs water, bristles soften
Hollow bristles
May harbor bacteria
nylon bristles
Flex 10x’s more before breaking
Do not split or abrade
Easier to clean and dry more
rapidly
Shape, stiffness of bristles more
standardized: Manufactured according to federal specifications
bristle shape round vs blunt
End rounded vs. blunt cut
Researched determined:
Rounded, tapered, or smooth bristles
were less abrasive
Rounded bristle tips are recommended
bristle texture
Bristle resistance to pressure
Firmness, stiffness, hardness
Thinner filaments = softer, more resilient
Soft: .007-.009 inches
Medium: .010-.012 inches
Hard: .013-.015 inches
recomend softer, less abrasive
toothbrush replacement
Average life of toothbrush – 3 months
Signs of bristles splaying
Consider replacing after illness
ADA positions on brushing freq/ our recomendation
ADA: brush regularly
us: 2x for 2 min
can pt completely remove plaque
rarely completely remove plaque
can pt estimate time they brush? spend most time where?
Patients over-estimate time they brush
Spend most of time on the facial surfaces
toothbrushing techniques
bass and fones
bass technique for sulcus
Angle bristles toward gingival
margin (approximately 45o angle)
Gently press bristles to enter sulcus and/or embrasures= Subgingival cleansing, gingival stimulation
bass technique for facial
Vibrate brush (or use small strokes) without disengaging bristles
‘Roll’ the instrument toward the incisal/occlusal
Replace and repeat on next 2 or 3 teeth
bass technique for lingual
Turn brush lengthwise
Place ‘heel’ of brush along gingival margin
Vibrate to dislodge plaque
‘Roll’ the toothbrush to cleanse the lingual surface
fones technique
90 Degrees to tooth
Larger circles over teeth and gingiva
Easy for children to pick up
Option for those with limited dexterity
common forms of improper brushing
Hard toothbrush
Horizontal scrubbing
Excessive pressure
Toothpaste too abrasive= Gingival recession and Cervical abrasion
ADA guidelines for acceptance of powered toothbrushes
safety?
efficacy of?
labeling?
Laboratory evidence of electrical
safety
Clinical evidence of hard/soft tissue
safety under unsupervised conditions
Clinical evidence of plaque and
gingivitis efficacy when compared to
other ADA accepted toothbrush
Evidence of proper labeling and
advertising claims
mechanical actions of powered brushes
Uses the motion of the bristles to
remove plaque and debris via Rotation oscillation
sonic actions of powered brush
Emits soundwaves in addition to the movement of the brush filaments
ionic brushes
Temporarily reverses the negative ionic charge of a tooth to positive
Portion of toothbrush that is also positively charge “attracts” the plaque and food particles away from the tooth
Allows bristles the brush the loosened
particles away
mechanical vs manual brush reductions in plaque and gingivitis
benefits for mechanical
11% reduction in plaque at 1-3 months
21% reduction in plaque after 3 months
6% reduction in gingivitis at 1-3 months
11% reduction in gingivitis after 3 months
choose interprox aid based on:
Size of interdental spaces
Presence of furcation(s)
Ortho or fixed appliance
Tooth alignment
purpose of flossing
The purpose of flossing is to remove interproximal plaque….not to
dislodge food wedged between the teeth.
waxed tape indications
embrasure II and III
loose contact
large SA
wax tape pros
tear resistant
wax tape cons
no good for tight contacts
wax dental floss indications
embrasure I
tight contacts with rough surfaces
waxed floss pros
strong
shred resistant
no tissue trauma
waxed floss cons
pt comfort
unwaxed round floss infications
embrasure I
unwaxed round floss pros
easy insertion
unwaxed round floss cons
easy tears with calculus/defective restorations
super floss indications
embrasure I and II
fixed bridges
ortho
implant prothesis
super floss pros
cover more SA
easy to insert
super floss cons
req coordination
caught on rough surfaces
colored floss indication
beginners/weak eye sight
colors floss pros
motivation/education
increased compliance
colored floss cons
none
flavored floss indications
pts without motivation
flavored floss pros
motivational
flavored floss cons
none
what if limited dexterity?
prepparing floss for flossing
Tear off an adequate amount of
dental floss
Wrap floss around middle fingers
Floss is maneuvered between
thumb and index finger
The ‘spool’ method may be
easier for someone with less
dexterity.**
insertion of floss into contact
The floss is moved back and
forth until it is through the
contact
See-saw motion
Do NOT ‘pop’ the floss
adapting floss to tooth surface
Adapt to each interproximal surface by making C-shape.
Floss should be placed into sulcus area
flossing motion
Once the floss is below the contact
area and wrapped around the tooth,
it should be moved “up and down”
against the tooth
floss cuts
can occur if going too fast or hard
floss holders recommended for:
Physical?
Poor what?
Limited?
Large?
Sensitive?
difficulty with?
Physical disabilities
Poor manual dexterity
Limited mouth opening
Large hands
Sensitive gag reflex
Difficulty with manual flossing
Floss Swords/Daily Flossers
Disadvantage?
Plastic toothpick on one end, floss
on the other
Disadvantage: floss cannot be
changed as it gets used
helpful for?
automated flossers
May help with patient motivation
Helpful for patients who need handle with larger diameter
Floss Threaders
Used to?
Ideal for:
Floss is threaded through loop
Used to carry floss interproximally
Ideal for:
abutment teeth
beneath pontics
ortho appliances
teeth that are splinted together
tight contact
Super Floss
Ideal for:
Ideal for plaque removal under pontics and ortho appliances
Platypus Ortho Flosser
Created to floss around orthodontic brackets
- Floss spread between two “spatula” ends
- Bracket brush on the opposite end
Interdental Brushes(Proxybrush)
Used for:
large embrasures
teeth with concavities
around fixed appliances
ortho appliances
Furcations ( Class III, IV)
Soft Picks
work around appliances?
Easy to use for what patients?
Latex?
Soft, flexible bristles
Tapered to work around appliances
Easy to use for patients who find flossing cumbersome
Latex free
Rubber-tipped stimulator
Primary use?
Limited use for?
Primary use is for gingival massage
Limited use for removing plaque from exposed furcation(s), along gingival margins, and open embrasures
End-tuft toothbrush
Useful for?
around what appliances?
lingual of?
distal of most?
embrasure spaces?
exposed ?
Useful for difficult to reach places:
around ortho appliances
around pontic(s)
lingual of crowded lower anterior teeth
distal of most posterior teeth
wide embrasure spaces
exposed furcation(s)
Sulcus Brush
More narrowed brush head
Fits along the gumline
Softer bristles for inflamed gums
Toothpick Holders(Perio-aid; D-PLAK-R)
Trace along?
May be used along?
Trace along gingival margins to remove plaque in sulcus/pockets
May be used along:
crown margins
accessible furcations
concave proximal surfaces
orthodontic appliances
Wooden or Plastic Triangular Sticks
(Stim-U-Dent)
most common material?
cross-section shape?
Stick is inserted from?
Moved from?
Balsa or birchwood most common
Triangular in cross-section
Stick is inserted from the facial, with
flat surface resting on gingiva
Moved from buccal to lingual
Other aids
Pipe cleaners
Yarn
Gauze
Oral Irrigators
Can result in?
Irrigation not indicated for pts who?
Irrigation alone is ineffective in?
Can result in disruption of loosely attached or unattachedc supra/subgingival plaque
Irrigation not indicated for pts who have effective OH or no inflammation
Irrigation alone is ineffective in reducing inflammation
best benefots of irrigation seen in?
Best benefit is seen when irrigation is
combined with toothbrushing
Pts with ortho appliances, bridges, or
implants
Irrigation with antimicrobials
Some clinical and microbial improvements noted in gingivitis patients with Irrigation with chlorhexidine vs irrigation with water
