plaque control and oral hygiene aids Flashcards
plaque control =
disease control
plaque - primary agent in development of:
dental caries and periodontal disease
plaque control leads to
- resolution of gingival inflammation in the early stages
- reduction of calc formation
oral health can neither be attained or preserved without
plaque control
home care instructions
- need to be effective/personalized
- be none-traumatic when cleaning the teeth
plaque control depends on YOU:
- 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
consider the following 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
toothbrushes most important features
- able to reach all areas to be cleaned
- size of head is appropriate for patient
- no tissue trauma
(bristles softer is better)
toothbrush replacement
average life 3 months
-signs of bristles splaying
-consider replacing after illness
patient’s over or under estimate the time they brush
over-estimate
toothbrushing techniques
- bass (modified)
-rolling
-stillman
-charters - fones (circular)
-leonard
-horizontal
-smith-modified
-Angle bristles toward gingival
margin (approximately 45o angle) (angle towards gingival)
bass (modified)
bass modified steps
- gently press bristles to enter sulcus and or embrasures
-subgingival cleansing, gingival stimulation - vibrates brush (or use small strokes) without disengaging bristles
- roll the instrument toward the incisal/occlual
- 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
- 90 Degrees to tooth
- Larger circles over teeth and gingiva
- Easy for children to pick up
- Option for those with limited dexterity
fone’s circular
improper toothbrushing
- Hard toothbrush
- Horizontal scrubbing
- Excessive pressure
- Toothpaste too abrasive
- Gingival recession
- Cervical abrasion
- 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
ada guidelines for acceptance of powered toothbrushes
mechanical action of brush
- Uses the motion of the bristles to
remove plaque and debris - Rotation oscillation
emits soundwaves in addition to the movement of the brush filaments
sonic action of toothbrush
The evidence produced shows benefits in using a powered toothbrush when
compared with a manual toothbrush
- 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(s)
- Ortho or fixed appliance
- Tooth alignment
The purpose of flossing is to
remove interproximal plaque, not to dislodge food wedged between the teeth
Embrasure: II and III
Fixed bridge
Ortho appliances
Implant prosthesis
super floss
covers more surface area
stiff end
easier to insert
super floss
embrasure I
easy to insert into embrasure
unwaxed round floss
embrasure I around rough tooth surfaces and restorations
waxed dental floss
Embrasure: II and III
Loose contact
Large surface area
waxed dental tape
The ‘spool’ method may be
easier for someone
with less dexterity
how to floss
- Tear off an adequate amount of dental floss
- Wrap floss around middle fingers
- Floss is maneuvered between thumb and index finger
The floss is moved back and forth until
it is through/broken the contact
(See-saw motion)
(do/don’t) pop the floss
DONT
adapt floss 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
- Physical disabilities
- Poor manual dexterity
- Limited mouth opening
- Large hands
- Sensitive gag reflex
- Difficulty with manual flossing
- Plastic toothpick on one end, floss on
the other - Disadvantage: floss cannot be
changed as it gets used
floss swords/daily flossers
- 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
floss threaders
Ideal for plaque removal under
pontics and ortho appliances
super floss
Used for:
* large embrasures
* teeth with concavities
* around fixed appliances
* ortho appliances
* Furcations ( Class III, IV)
interdental brushes (proxybrush)
- Soft, flexible bristles
- Tapered to work around appliances
- Easy to use for patients who find flossing cumbersome
- Latex free
soft picks
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)
end-tuft toothbrush
- Primary use is for gingival massage
- Limited use for removing plaque from:
- exposed furcation(s)
- along gingival margins
- open embrasures
rubber-tipped stimulator
- Trace along gingival margins to remove plaque in sulcus/pockets
- May be used along:
- crown margins
- accessible furcations
- concave proximal surfaces
- orthodontic appliances
toothpick holders
(perio-aid; D-plak-R)
- Can 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 ineffective in reducing
inflammation - Best benefit is seen when irrigation is
combined with toothbrushing - Pts with ortho appliances, bridges, or
implants
oral irrigators
AAP confirms supragingival irrigation with _____:
chlorhexidine CHZ vs water
-slight clinical and microbial improvements noted in gingivitis patients only
use device syringe to distribute CHX
preventive philosophy
- 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
