plaque control: toothbrushing and interdental cleaners Flashcards
What’s the most important part of any dental appointment?
Prevention is the most important part of any dental appointment!
why is plaque control importnat?
an effective way of treating and preventing gingivitis
critical part of all the procedures involved in the treatment & prevention of periodontal disease.
key element of the practice of dentistry.
permits each patient to assume responsibility for his or her own oral health on a a daily basis. Without it, optimal oral health cannot be attained.
every patient in every dental practice should be educated about plaque control and be encouraged to perform a personalized program on a daily basis.
Should we use natural bristle toothbrushes?
Should be avoided:
More porous
Collect moisture,
odours & bacteria.
What type of toothrbush should we use?
Soft, nylon bristle toothbrushes clean effectively(when used properly), remain effective for a reasonable time, and tend not to traumatize the gingiva or root surfaces
what are the parts of a toothbrush?
Handle - plastic, straight variations ,thickened -sometimes helpful to those who have arthritis or other disabilities.
Head - working end holds bristles (straight & even) bristles are in tufts
Shank - connects head to handle
What’s the correct manual toothrbush size?
The length of the brush head should fit the length of the 4 mandibular incisors on the lingual surface
What brushing sequence should you use?
Begin brushing from the buccal molar region of 1 arch and work to the opposite side
Continue back around on the lingual
Repeat in the opposing arch
Each brush placement should overlap the previous one
Brush the occlusal/incisal surfaces
What frequency of brushing should be use?
A minimum of 2 brushings, accompanied by interdental cleaning per day
Brushing before bed is strongly recommended
Children-after meals
3 minutes is recommended
What are the 7 manual toothrbushing methods?
Bass Modified Bass Rolling Stroke Modified Stillman Charters Fones Scrub
What is the bass method? When is it recommended?
Recommended for patients with: Biofilm adjacent to & directly beneath gingival margin Open embrasures, exposed root surfaces Orthodontic appliances Crowns/bridges Perio surgery
Hold the toothbrush using a palm grasp
Position the toothbrush filaments:
Apically
Parallel to long axis of tooth
Turn brush toward gingival margin to make a 45 degree > to long axis of tooth
Direct filament tips into gingival sulcus
Lightly press filament tips to enter gingival sulci, embrasures and cover gingival margins
Do NOT use excess pressure
Vibrate toothbrush bristles back/forth without moving the filaments from the sulci
Be careful the vibration does NOT turn into a scrub method
results in DAMAGE
Count 10 vibrations minimum
Reposition brush to the next 2-3 teeth-overlapping placement
Repeat at each position around Max/Mand arches on facials/lingual
What is the bass method for anterior teeth lingual/palatal?
Utilize heel of the brush head
Direct filament tips into sulci
what’s the modified bass method/
Identical to the Bass method
The modification incorporates a rolling stroke after the vibratory phase at the gingival sulcus
what’s the rolling stroke method?
Recommended for :
Removal of biofilm, material alba & food debris
Cleaning gingiva without emphasis on gingival sulcus
Meant for children with healthy
gingiva/normal tissue contour
Useful to prepare for Modified
Stillman instruction
Hold the toothbrush using a palm grasp Position the toothbrush filaments: Apically Place side of brush on attached gingiva Plastic portion of brush head level with occlusal/incisal plane of teeth
Flex side of filaments lightly against the gingiva
Gingiva will blanch
Slowly roll the brush over the teeth, rotating the wrist
Filaments remain flexed and follow the contour of the teeth
Repeat stroke 5 times minimum for each group of teeth
Reposition brush to the next 2-3 teeth, overlapping placement
for the lingual and palatal of anterior teeth
Use the heel of the brush head
Place filaments against teeth and gingiva
Press filaments and roll the brush-up for mand/down for max
Repeat 5X for each brush width
what’s the modified stillman method?
Recommended for:
Removal of biofilm on tooth surfaces and massaging of the gingiva
Hold toothbrush using a palm grasp Position the toothbrush filaments: Apically Place side of brush on attached gingiva Plastic portion of brush head level with occlusal/incisal plane of teeth
Flex side of filaments against the gingiva
Gingiva will blanch
Angle the filaments by rotating the wrist
Filaments should be directed at a 45 degree < with long axis of tooth
Activate brush - using a slight rotary motion
- keep filament tips in constant contact
- use light pressure on filaments
Roll and vibrate brush-turn wrist, working the vibrating brush over gingiva and teeth
Be careful the vibration does NOT turn into a scrub method results in DAMAGE
Repeat stroke 5X minimum for each group of teeth
Reposition brush to the next 2-3 teeth, overlapping placement
for anterior teeth lingual/palatal
Use the heel of the brush head
Place filaments against teeth and gingiva
Press filaments, vibrate and roll the brush-up for mand
-down for max
Repeat 5X for each brush width
What ais the charters method?
Recommended for: Loosening debris and biofilm Massage/stimulation of gingiva Removal of biofilm on proximal surfaces, when interproximal tissue is missing following perio surgery Crowns/bridges Orthodontic appliances
Patient to use a basic rolling stroke first, for general cleaning
Grasp toothbrush with a palm grasp
Direct filaments toward the occlusal/incisal plane of teeth to be brushed-i.e. down for max & up for mand
Insert brush inside mouth
Place sides of filaments against tooth with brush tips toward occlusal/incisal plane
Angle filaments at 45 degree < to occlusal/incisal plane
Using light pressure:
Flex the filaments
Force filament tips between the teeth
Press sides of filaments against gingiva
Vibrate brush gently, keeping filament tips in contact with tooth surface
Count to 10 slowly as the brush is vibrated
Reposition brush to the next 2-3 teeth, overlapping placement
The Charters method of toothbrushing is very difficult to position on lingual surfaces
Recommend a Modified Stillman technique
What’s the fones method?
Recommendation:
An easy-to-learn 1st technique for young children
Considered detrimental for adults-especially by a vigorous brusher
Select a soft toothbrush
Keep teeth closed
Place brush inside cheek, with filament tips contacting gingiva over last max. molar
Use light pressure
Use a fast, wide, circular motion, sweeping from maxillary gingiva to mandibular gingiva
Use light pressure
Use a fast, wide, circular motion, sweeping from maxillary gingiva to mandibular gingiva
Bring anterior teeth in end-to-end contact-continue with circular strokes
With jaws apart-use smaller circular sweeping motion to clean on the lingual surfaces of maxilla and mandible
Occlusal surfaces are brushed in an anteroposterior direction
what’s the scrub-brush method?
Recommendations:
Acceptable method initially for very young children
Generally not recommended-encourages gingival recession, tooth abrasion
Does not clean gingival margins/sulci or interproximal surfaces well
critical areas are missed
Select a soft toothbrush
Hold toothbrush using a palm grasp
Place filament tips perpendicular to long axis of teeth
Use a combination of vertical, horizontal and circular strokes
what are power toothbrushes?
Also known as power-assisted, automatic, mechanical or electric
Move in various speeds + motions not duplicated by manual toothbrushing
Research indicates power brushes to be more effective than manual toothbrushes
what should you consider for power toothbrushes?
Design-size + shape
Brushing method
Cost
when are power toothbrushes recmmmended?
Recommended for:
The removal of dental biofilm and food debris
The reduction of calculus and stain
When to recommend a Power Toothbrush:
Patients who have difficulty removing biofilm
Aggressive toothbrushers
Orthodontic patients
Dental implants
Major restorative/prosthodontic treatment
Patients with limited dexterity
Patients with disabilities
Patients who are unable to brush e.g. a parent or caregiver
What are the power sources for the power toothbrushes?
Power sources can be: Direct-connects to electrical outlet Replaceable batteries Rechargeable batteries Disposable-batteries are not replaceable or rechargeable
**NOTE: power brushes with replaceable batteries move slower than
those with rechargeable batteries
what’s the power brush procedure?
Provide patient with video instructions or demonstration model of the brush
Instruct patient to floss 1st
Use a dentifrice with minimum abrasivity -apply a small amount on the brush
Place brush inside mouth before turning on power prevents splashing
Move brush from most posterior teeth toward the anterior, quadrant by quadrant
Use light pressure
How should you care for toothbrushes?
Replace toothbrushes every 2-3 months before filaments become splayed
Clean thoroughly after each use by holding the brush head under a strong stream of warm water to remove debris, toothpaste and bacteria from between the filaments
Store brush in open air, toothbrush head in an upright position and not in contact with other brushes
