Plaque Control and Oral Hygiene Aids Flashcards
Plaque – primary agent in development of:
(2)
Dental Caries
Periodontal Disease
Plaque Control leads to:
(2)
Resolution of gingival inflammation in the early stages
Reduction of calculus formation
Oral health can neither be attained or preserved without
plaque control
To have effective plaque control,
have to
get your patients attention
Plaque Control Depends
on
YOU
Plaque Control Depends
on YOU
(3)
Educate the patient
Show patient disease in his/her
own mouth
Utilize disclosing agent
Show patient disease in his/her
own mouth
(3)
Bleeding points
Periodontal probing
Red, bleeding gums
Utilize disclosing agent
(2)
Educational tool
Motivational tool
Home care instructions
(2)
Need to be effective/personalized
Be non-traumatic when cleaning the teeth
Home care instructions
Consider the following:
(5)
Areas of plaque accumulation
Restorative dentistry
Anatomical features
Patient’s dexterity
Patient’s motivation
Areas of plaque accumulation
Interproximal, buccal, lingual, occlusal
Restorative dentistry
Crowns, bridges, overhangs, etc.
Anatomical features
Embrasure spaces, furcation involvement, etc.
Toothbrushes
Most important features:
(3)
Able to reach all areas to be cleaned
Size of head is appropriate for patient
No tissue trauma
Toothbrush Bristles
Natural
(4)
Made of wild boar or hog hair
Bristles vary greatly in each
filament
Absorbs water, bristles soften
Hollow bristles
Bristles vary greatly in each
filament
Varies texture, size, flexibility
Hollow bristles
May harbor bacteria
Toothbrush Bristles
Nylon
(4)
Flex 10x’s more before breaking
Do not split or abrade
Easier to clean and dry more
rapidly
Shape, stiffness of bristles more
standardized
Shape, stiffness of bristles more
standardized
Manufactured according to federal
specifications
Bristle Shape
End rounded vs. blunt cut
(3)
Researched determined:
Rounded, tapered, or smooth bristles
were less abrasive
Rounded bristle tips are recommended
Bristle Texture
(3)
Bristle resistance to pressure
Firmness, stiffness, hardness
Thinner filaments = softer,
more resilient
Thinner filaments = softer,
more resilient
Soft:
Medium:
Hard:
.007-.009 inches
.010-.012 inches
.013-.015 inches
Toothbrush Replacement
(3)
Average life of toothbrush – 3 months
Signs of bristles splaying
Consider replacing after illness
ADA’s position –
“brush regularly”
Patients rarely completely remove
plaque
Patients over-estimate time they brush
Spend most of time on the facial surfaces
Importance of:
(3)
Daily fluoride use
Routine brushing pattern
Emphasis on all areas
Toothbrushing Techniques
Bass (modified)*
Rolling
Stillman
Charters
Fones (circular)*
Leonard
Horizontal
Smith-Modified
IMPORTANT
Bass (modified)*
Fones (circular)*
skipped - kind of
Bass (modified)
(10)
Angle bristles toward gingival
margin (approximately 45o
angle)
Gently press bristles to enter
sulcus and/or embrasures
Subgingival cleansing, gingival
stimulation
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
Turn brush lengthwise
Place ‘heel’ of brush
along gingival margin
Vibrate to dislodge
plaque
‘Roll’ the toothbrush to
cleanse the lingual
surface
Fone’s (circular)
(4)
90 Degrees to tooth
Larger circles over teeth and gingiva
Easy for children to pick up
Option for those with limited
dexterity
Improper Toothbrushing
(4)
Hard toothbrush
Horizontal scrubbing
Excessive pressure
Toothpaste too abrasive
Toothpaste too abrasive
(2)
Gingival recession
Cervical abrasion
skipped
ADA guidelines for acceptance
of powered toothbrushes
(4)
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 action of brush
(2)
Uses the motion of the bristles to
remove plaque and debris
Rotation oscillation
Sonic action of toothbrush
Emits soundwaves in addition to
the movement of the brush
filaments
Ionic action of toothbrush
(3)
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
Plain language summary:
The evidence produced shows benefits in using a powered
toothbrush when compared with a manual toothbrush
(4)
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 Interproximal Aid based on:
(4)
Size of interdental spaces
Presence of furcation(s)
Ortho or fixed appliance
Tooth alignment
Flossing
The purpose of flossing is to
remove interproximal plaque….not to
dislodge food wedged between the teeth.
skipped
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.**
The floss is moved back and
forth until it is through the
contact- See-saw motion
Do NOT ‘pop’ the floss
Adapt to each interproximal surface by making C-shape.
Floss should be placed into sulcus area
Once the floss is below the contact
area and wrapped around the tooth,
it should be moved “up and down”
against the tooth
Floss Holders
Recommended for patient’s with:
(6)
Physical disabilities
Poor manual dexterity
Limited mouth opening
Large hands
Sensitive gag reflex
Difficulty with manual flossing
Floss Swords/Daily Flossers
(2)
Plastic toothpick on one end, floss
on the other
Disadvantage: floss cannot be
changed as it gets used
Automated Flossers
(2)
May help with patient motivation
Helpful for patients who need handle with
larger diameter
Floss Threaders
(2)
Floss is threaded through loop
Used to carry floss interproximally
Floss Threaders
Ideal for:
(5)
abutment teeth
beneath pontics
ortho appliances
teeth that are splinted together
tight contact
Super Floss
Ideal for plaque removal under
pontics and ortho appliances
Platypus Ortho Flosser
(3)
Created to floss around orthodontic brackets
- Floss spread between two “spatula” ends
- Bracket brush on the opposite end
Interdental Brushes
(Proxybrush)
Used for:
(5)
large embrasures
teeth with concavities
around fixed appliances
ortho appliances
Furcations ( Class III, IV)
Soft Picks
(4)
Soft, flexible bristles
Tapered to work around appliances
Easy to use for patients who find flossing cumbersome
Latex free
Rubber-tipped stimulator
(2)
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 difficult to reach places:
(6)
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
(3)
More narrowed brush head
Fits along the gumline
Softer bristles for inflamed gums
Toothpick Holders
(Perio-aid; D-PLAK-R)
Trace along gingival margins to remove
plaque in sulcus/pockets
Toothpick Holders
(Perio-aid; D-PLAK-R)
May be used along:
(4)
crown margins
accessible furcations
concave proximal surfaces
orthodontic appliances
Wooden or Plastic Triangular Sticks
(Stim-U-Dent)
(4)
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
(3)
Pipe cleaners
Yarn
Gauze
Oral Irrigators
Can result in disruption of
Irrigation not indicated for pts who have
Irrigation alone is
Best benefit is seen when irrigation is
combined with
Pts with
loosely attached
or unattached supra/subgingival plaque
effective OH or no inflammation
ineffective in reducing
inflammation
toothbrushing
ortho appliances, bridges, or
implants
Irrigation with antimicrobials
(2)
Some clinical and microbial improvements noted in gingivitis patients
Irrigation with chlorhexidine vs irrigation with water
Preventive Philosophy
(4)
Must be promoted by all staff members, but your role is most significant
Treat your patients as individuals
Provide accurate information
Reinforce; don’t assume your patient understood everything
