Plaque Control and Patient Advice Flashcards
which type of toothbrush ahas the most effective inter-proximal efficacy
one with multilevel profiles
NB. an oscillating powered toothbrush is the only type to outperform a manual tooth brush
will give toothbrushing instruction after using plaque disclosing tablet. what should the PFS be
> 70%
OR 80% if perio sugery
what should you consider when giving patient OH advice
- patient tailored
- never expect them to change more than 1 thing during a single session
- evaluate patient progress from session to session
key features of the modified bass technique
bristles need to get a few mm inside the sulcus
locate brush 45 degrees on margin
back and forth OR circular motions
key toothpaste ingredients
20-40% abrasives 20-40% h20 20-40% humectants 1-2% foaming agent 2% binding agent 2% flavouring agent 2% sweetening agent 5% therapeutic agent (fluoride/ de-sensitising) less than 1% colouring/ preservative
what does ‘pharmacological plaque control’ mean and give examples
it means that chemical compounds are prescribed to supplement the usual brushing/ flossing
e. g. colgate total (tricoslan)
e. g. crest pro health (stannous salts like stannous fluoride are key against caries, plaque and gingivitis)
e. g. oral b expert (sodium hexmetaphosphate)
which pharmacological plaque controls have ADAs seal of acceptance for many toothpaste categories
crest pro health
colgate total
both have ADAs acceptance as ANTI CARIES products with 0.243% NaFl
features of tricoslan (found in colgate total)
- anti septic
- broad spectrum anti-bacterial agent
- used widely as an OTC product
- safe to use in dentrifies
- has no/ little substantivity
triclosan oral retention is improved by a copolymer called
gantrex (made of methoxy-ethylene and maleic acid)
definition of ‘anti-calculus agent’
designed to interrupt the process of mineralisation of plaque to calculus due to the super saturation of saliva with calcium and phosphate ions
example of an anti calculus agent
pyrophosphates
examples of anti-hyper sensitivity products and what they contain
- rembrandt sensitive = sodium citrate
- sensodyne total care F= potassium nitrate. also HAS NaF, and takes 2-4 weeks for relief
- sensodyne original = strontium chloride. NO NaF
- sensodyne rapid relief= strontium acetate. HAS NaF. NO novamin (sodium lauryl sulphate). 60 second relief!
- sensodyne repair and protect= calcium- sodium phosphosillicate.
For patients with exposed dentine. builds up a reparative layer. HAS sodium mono- fluoro- phosphate (NA MFP), novamin - colgate sensitive= potassium citrate. HAS NA MFP, novamin
- colgate pro relief= arginine. HAS NA MFP, novamin
- colgate gel kam sensitive= 0.4% stannuous fluoride.
this is a low abrasive gel for caries prevention.
interdental brush is more superior to floss thus we use this except for when…
there is TIGHT inter-proximal contact
there are 4 types of interdental papillae.
type 1 interdental papillae features
INTACT interdental papillae
NARROW interdental space
type 2 inter-dental papillae features
MODERATE papillary recession
slightly open interdental space
type 3 interdental papillae features
complete loss of papillae
open interdental space
type 4 interdental papillae features
wide embrasure space
diastema
furcation
posterior surface of most distal molar
for each type of inter-dental papillae, which type of interdental cleaning method would you recommend
type 1= dental floss
type 2= dental floss/ small ID brush
type 3= TePes/ ID brushes
type 4= single tufted/ end tufted brush OR graze strip
where is bacteria on tongue and why would you recommend tongue cleaning
posterior/ dorsum of tongue has a lot of bacteria= halitosis
tongue cleaning= reduces halitosis and tongue coating
oral irrigators are effective against …but not___
gingivitis but not plaque accumulation
anti-mircobials can be local or systemic. what is the difference between what they are effective against
local anti- microbials= directed against SUPRA gingival plaque (mouthrinses, enzymes, phenolic antiseptics, metal ions, natural products)
systemic anti-microbials= directed against SUB gingival plaque
define substantivity
the ability of a drug to absorb / and bind to hard soft tissues. this depends on the concentration of drugs, pH, T, and length of time of contact of solution
define plaque inhibitory
will inhibit plaque formation but not to a level we want it to
define anti-plaque
prevents plaque formation and prevents gingivitis
e.g. chlorohexidine
define anti- gingivitis
prevents inflammation, by reducing inflammation it prevents gingivitis
key features of chlorohexidine (corsodyl)
- most effective anti plaque agent
- slowly released, inactive form, over 12-24 hrs therefore…
- high substantivity
- corsodyl= contains 0.2% w/v chloroheixidine di gluconate
- corsodyl daily= 0.06% chlorohexidine, 250 ppmFl, and 7% alcohol
- can be prescribed
- can cause staining, altered taste sensation. evidence of increase supra-gingival calculus, mucosal erosion, parotid swelling, anaphylaxis
when would you prescribe chlorohexidine
if patient had perio treatment and cannot brush for 2-3 days
trauma
acute oral infection
when prescribing chlorohexidine, what amount are you recommending/ advice would you give
0.2%, 10 ml volume per rinse = 20 mg of chlorohexidine
would advice its use for SHORT periods of time- up to 2 weeks after perio surgery, acute oral infection, trauma
—-> would NOT recommend for long periods of time
active ingredients in essential oils such as listerine
- 21.7% alcohol (high percentage masks the odour)
- thymol
- menthol
- eucalyptol
- methyl salicylate
active ingredient in colgate plax (mouthwash)
cetyl pyridinium chloride, CPC (0.05%)
fluoride
alcohol/ no alcohol versions are available
e- cigarets are used to help quit because they are perceived to be less risky but…
- more harmful
- increases the risk of periodontitis and involved in the aetiology of NUG
- causes pocketing in anterior segments of teeth
smoking cessations aids which are NOT pharmacological include…
will power advice/counselling hypnosis acupuncture behavioural therapy
smoking cessation aids which ARE pharmacological include…
nicotine gum/patches lozenges inhalators nicotine nasal spray zyban/ champix tablets (prescription only) e- cigarettes
