Plaque Control and Oral Hygiene Aids Flashcards
plaque control =
disease control
plaque is the primary agent in development of:
- dental caries
- periodontal disease
plaque control leads to:
- resolution of gingival inflammation in early stages
- reduction of calculus formation
how do you educate the patient
- show patient disease in his/her own mouth
- utilize disclosing agent
how do you show patients disease in their mouth
- bleeding points
- periodontal probing
- red, bleeding gums
what is disclosing agent used for
- educational tool
- motivational tool
how should home care instructions be given
- need to be effective/personalized
- be non traumatic when cleaning the teeth
what should you consider when giving home care instructions
- areas of plaque accumulation
- restorative dentistry
- anatomical features
- patients dexterity
- patients motivation
what are the areas of plaque accumulation
interproximal, buccal, lingual, occlusal
what anatomical features should be considered
embrasure spaces
- furcation involvement
what are the most important features of toothbrushes
- able to reach all areas to be cleaned
- size of head is appropriate for patient
- no tissue trauma
what are the types of toothbrush bristles
- natural
- nylon
describe natural toothbrush bristles
- made of wild boar or hog hair
- bristles vary greatly in each filament
- various texture, size and flexibility
- absorbs water, bristles soften
- hollow bristles - may harbor bacteria
describe nylon toothrbush bristles
- flex 10 x’s more before breaking
- do not split or abrade
- easier to clean and dry more rapidly
- shape, stiffness of bristles more standardized
what are the types of bristle shape and what is better
- end rounded vs blunt cut
- rounded, tapered or smooth bristles are less abrasive
- rounded bristle tips are recommended
what are the bristle textures
- soft: 0.007-0.009 inches
- medium 0.01-0.02 inches
- hard: 0.13- 0.15 inches
thinner filaments of bristles are:
softer and more resilient
what is the average life of a toothbrush
3 months
when should you replace a toothbrush
- signs of bristles splaying
- consider replacing after illness
pateints ______remove plaque
rarely completely
ADA’s position on brushing:
regularly
patients _____ time they brush
over estimate
where do patients spend most time brushing
facial surfaces
what is the importance in brushing
- daily fluoride use
- routine brushing pattern
- emphasis on all areas
what are the toothbrushing techniques
- Brass ( modified)
- rolling
- stillman
- charters
- Fones (circular)
- leonard
- horizontal
- smith- modified
describe the brass (modified) technique
- angle bristles toward gingival margin (approximately 45 degrees angle)
- gently press bristles to enter sulcus and/or embrasures
- subgingival cleansing, gingival stimulation
- vibrate brush 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 on gingival margin
- vibrate to dislodge plaque
- roll the toothbrush to cleanse the lingual surface
describe Fone’s (circular)
- 90 degrees to tooth
- larger circles over teeth and gingiva
- easy for children to pick up
- option for those with limited dexterity
describe improper toothbrushing
- hard toothbrush
- horizontal scrubbing
- excessive pressure
- toothpaste too abrasive: gingival recession and cervical abrasion
what are the ADA guidelines for acceptance of powered toothbrushes
- 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
describe the mechanical action of brush
- uses the motion of the bristles to remove plaque and debris
- rotation oscillation
describe the sonic action of toothbrush
emits soundwaves in addition to the movement of the brush filaments
describe the ionic action of toothbrush
- temporarily reverses the negative ionic charge of a tooth to positive
- portion of tootbrush that is also positively charge “attracts” the plaque and food particles away from the tooth
- allows bristles the brush the loosened particles away
what are the benefits of using a powered toothbrush when compared to manual
- 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:
- size of interdental spaces
- presence of furcation
- ortho or fixed appliance
- tooth alignment
what is the purpose of flossing
to remove interproximal plaque
what are the types of floss
- waxed
- unwaxed
- tape
- colored
- flavored
how should you floss
- tear off an adequate amount of dental floss
- wrap floss around middle fingers
- floss is maneuvered between thumb and index finger
- adapt to each interproximal surface by making C shape
- floss should be placed into sulcus area
- do not pop the floss
- see- saw motion
what flossing method is better for someone with less dexterity
the spool method
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 are recommended for patients with
- physical disabilities
- poor manual dexterity
- large hands
- sensitive gag reflex
- difficulty with manual flossing
what are floss swords/daily flossers
plastic toothpick on one end, floss on the other
what is the disadvantage of floss words/ daily flossers
floss cannot be changed as it gets used
what are automated flossers useful for
- patient motivation
- patient who need handle with large diameter
what are floss threaders ideal for
- abutment teeth
- beneath pontics
- ortho appliances
- teeth that are splinted together
- tight contact
what is superfloss ideal for
plaque removal under pontics and ortho appliances
what is the platypus ortho flosser and what is it used for
- created to floss around ortho brackets
- floss spread between two spatula ends
- bracket brush on the opposite end
what are interdental brushes/proxybrush used for
- large embrasures
- teeth with concavities
- around fixed appliances
- ortho appliances
- furcations - class III, IV
describe soft picks and what they are used for
- soft, flexible bristles
- latex free
- tapered to work around appliances
- easy to use for patients who find flossing cumbersome
what are rubber tipped stimulators used for
for gingival massage
rubber tipped stimulator has limited use for removing plaque from:
- exposed furcations
- along gingival margins
- open embrasures
what is the end-tuft toothbrush used for
- difficult to reach places such as:
- around ortho appliances
- around pontics
- lingual or crowded lower anterior teeth
- distal of most posterior teeth
- wide embrasure spaces
- exposed furcations
describe the sulcus brush
- more narrowed brush head
- fits along the gumline
- softer bristles for inflamed gums
where are toothpick holders used
- along gingival margins to remove plaque in sulus/pockets
- crown margins
- accessible furcations
- concave proximal surfaces
- orthodontic appliances
describe wooden or plastic triangular sticks (Stim- U- Dent) and how is it used
- balsa or birchwood most common
- triangular in cross section
- stick is inserted from the facial with flat surface resting on gingiva
- move from buccal to lingual
what are other aids
- pipe cleaners
- yarn
- gauze
what can oral irrigators result in
disruption of loosely attached or unattached supra/subgingival plaque
irrigation not indicated for pts who have:
effective HC or no inflammation
irrigation alone is ________ in reducing inflammation
ineffective
best benefit of irrigation is seen when:
combined with toothbrushing
what patients really benefit from water picks
those with ortho appliances, bridges or implants
what agent is used as irrigation with antimicrobials
chlorhexidine
how is irrigation with antimicrobials done
must use device to distribute CHX
- no rinsing/swishing
what is the preventative philosophy
- must be promoted by all staff members but your role is most significant
- treat your patients as individuals
- provide accurate information
- reinforce: dont assume your patient understood everything
what are the indications, advantages, disadvantages of waxed dental tape
- indications: embrasure: II and III, loos contact, large surface area
- advantages: tear resistant
- disadvantages: difficult for tight contacts
what are the indications, advantages, disadvantages of waxed dental floss
- indications: embrasure: I, around rough tooth surfaces and restorations
- advantages: strength/durable, shred resistant, prevents tissue trauma
- disadvantages: patient comfort
what are the indications, advantages, disadvantages of unwaxed round floss
- indications: embrasure: I
- advantages: easy to insert into embrasure space
- disadvantages: tears easily on contact with calculus and defective restorations
what are the indications, advantages, disadvantages of super floss
- indications: embrasure II and III, fixed bridge, ortho appliances, implant prosthesis
- advantages: covers more surface area, stiff end, easier to insert
- disadvantages: requires coordination and can get caught on rough surfaces
what are the indications, advantages, disadvantages of colored floss
- indications: visual cue for plaque/debris, beginners or individuals with weak eyesight
- advantages: motivational and educational, increases compliance
- disadvantages: none indicated
what are the indications, advantages, disadvantages of flavored floss
- indications: appealing, patients lacking motivation
- advantages: motivational
- disadvantages: none indicated
