Preventive Procedures - Outcome 4 Flashcards
What are disclosing agents?
Disclosing agents are solutions or tablets that stain deposits on teeth to make them visible, helping patients see areas needing better oral care.
Bacterial plaque is generally colourless but can be stained by foods, drinks, or tobacco. When a disclosing agent is applied, it colours these deposits, making them easier for patients to see. This visual aid helps patients identify plaque and focus on areas that require extra cleaning during their oral care routine
Disclosing Agent: Erythrosin Dye
The most widely used disclosing agent, erythrosin stains plaque red and the acquired pellicle pink. It is found in products like F.D. and C. No. 28 and F.D. and C. No. 3, which is ADA-approved.
Disclosing Agent: Fluorescein
This ADA-approved dye is applied without visible staining. It becomes visible under ultraviolet light, aiding both the patient and dental professional in seeing the stained areas.
Disclosing Agent: Two-Tone Agents
These agents use different colours to differentiate between older, thicker plaque (blue) and newer, thinner plaque (red), providing a clearer view of plaque distribution.
Characteristics of Effective Disclosing Agents:
Clear Staining: This should provide a distinct colouring of deposits that does not easily rub off.
Pleasant Taste: Must be acceptable to patients to encourage use.
Non-Irritating: Should not cause discomfort to oral tissues.
Uses of Disclosing Agents
Education: Helps in teaching patients where plaque accumulates and the best removal methods.
Evaluation: Assists in assessing the effectiveness of plaque removal techniques.
Monitoring: Used periodically to track progress, adjust plaque control strategies, and maintain plaque control records.
Research: Aids in studying plaque formation and incidence for further insights
Contraindications for Disclosing Agents
Assessment Impact: Before applying a disclosing agent, conduct a full assessment of oral mucosa and gingival tissue to avoid masking signs of disease.
Patient Education: Explain how plaque contributes to gum disease and tailor explanations to the patient’s specific oral health needs.
Application Techniques for Disclosing Agents
Protective Barriers: Apply barriers to protect lips and light-coloured restorations from staining.
Application Methods: Solutions can be applied with a cotton-tipped applicator or used as an oral rinse. Tablets are chewed and swished around the mouth. The excess agent is removed by suction or expectoration.
Patient Instructions: Provide a mirror for patients to see stained areas and guide them in improving brushing techniques. Each area of concern should be practiced to ensure effective plaque removal.
Considerations and Precautions for Disclosing Agents
Allergic Reactions: Review patient history for possible allergic reactions to disclosing agents. Keep alternative agents available if needed.
Staining Risks: Be cautious of staining on restorations, clothing, and materials. Use protective barriers and be prepared with stain removal products like Eradosol.
Solution Management: Store disclosing solutions in small quantities and avoid keeping alcohol-containing solutions for more than 2-3 months to prevent concentration issues.
Avoid Cross-Contamination: Pre-dispense solutions to maintain hygiene and prevent contamination.
What are Plaque Indices?
Plaque indices help measure and track the amount of bacterial plaque on teeth, which is linked to gum disease and tooth decay. These indices provide a way to see how much plaque is present, where it’s located, and its thickness. They are useful in both clinical practice and research.
Types of Plaque Indices:
- Plaque Index
- O’Leary’s Plaque Index (Plaque Control Record)
- Simplified Oral Hygiene Index (OHI-S)
Describe Plaque Index
What It Is: A numerical value representing the amount of plaque on teeth.
How It Works: Count the number of tooth surfaces with plaque, then divide by the total number of surfaces and multiply by 100 to get a percentage. This percentage helps track plaque levels over time.
Example: If 20 out of 80 surfaces have plaque, the index is 25%. This helps monitor progress during follow-up visits.
Describe O’Leary’s Plaque Index (Plaque Control Record)
What It Is: A tool for tracking where plaque is on teeth and how well the patient is cleaning.
How It Works: Teeth are stained with a special solution, then each surface is checked for plaque. Mark the presence of plaque on a record sheet and calculate a score. This score helps identify problem areas and track improvement over time.
Describe Oral Hygiene Index (OHI-S)
What It Is: Measures how clean the teeth are by looking at plaque and calculus (hardened plaque).
How It Works: Each of the four surfaces of a tooth (front, back, sides) is scored from 0 to 3 based on the amount of debris. Average the scores to get the plaque index for each tooth.
Example: If a tooth has scores of 2, 1, 1, and 2 on its surfaces, the average score is 1.5, indicating moderate plaque.
Why use Plaque Indices?
Assess Oral Hygiene: They show how well a person is brushing and flossing.
Plan Treatment: Helps create tailored care plans.
Track Progress: Compare scores over time to see if cleaning habits are improving.
Research: Study how plaque builds up and how to prevent dental issues.
How to Use Plaque Index
Stain the Teeth: Apply a disclosing solution to make plaque visible.
Examine and Record: Check each tooth surface for plaque and mark it on a record sheet.
Calculate the Index: Use the number of plaque-covered surfaces to determine the percentage or score.
Monitor and Adjust: Compare scores over time to see if cleaning habits are improving and make changes as needed.
Key Features of a good toothbrush
Soft Bristles: To reduce gum damage and wear on enamel.
Nylon Bristles: Preferred for their durability and effectiveness.
Multi-Tufted: More bristles cover a larger area for better cleaning.
Rounded Bristles: To prevent irritation and enhance comfort.
Benefits of a good toothbrush
Easier Adaptation: Soft, rounded bristles are gentle on gums and easier for patients to adjust to.
Less Abrasion: Soft bristles reduce the risk of enamel and gum damage.
Increased Flexibility: Multi-tufted brushes offer better coverage and flexibility in reaching different areas of the mouth.
Toothbrush replacement
Typical Lifespan: Replace manual toothbrushes every 3-4 months.
Signs of Wear: Replace if bristles are splayed, bent, or broken.
Frequent Replacement: If a toothbrush wears out faster than 3 months, it may indicate a problem with brushing technique.
Power Toothbrushes Effectiveness & Advantages
Effectiveness: Both manual and power toothbrushes can clean teeth effectively. Power brushes are not known to cause more harm to gums than manual ones.
Advantages for Certain Patients: Children might enjoy using them, and individuals with specific needs (e.g., orthodontic patients, those with disabilities) may find them easier or more comfortable.
Overall, while most patients can maintain good oral health with a standard toothbrush and proper technique, power toothbrushes offer additional benefits for those with special needs or preferences.
General Toothbrushing instructions
Hold the Toothbrush: Grip the handle with your fingers curved around it and your thumb against the brush.
Brushing Surfaces: Use the bristle tips on the chewing surfaces to clean pits and grooves.
Use the sides of the bristles on other tooth surfaces to avoid injuring the gums.
Brushing Technique:
Start with the chewing surfaces, brushing in a vibrating motion.
Begin in the upper left, brushing the outer surfaces, and move around to the upper right, covering two to three teeth at a time.
Continue with the inner surfaces of the upper teeth, then move to the lower teeth.
For the inner surfaces of the front teeth, hold the brush lengthwise.
Overlap each brushing area for complete coverage.
End by brushing your tongue and cheeks, then rinse to remove debris.
Special Attention Areas:
Last molars’ outer surfaces.
Areas without teeth (edentulous areas).
Exposed surfaces of crooked teeth.
Cervical areas of teeth with receding gums.
Fones (Circular) Method:
Who Should Use It: Young children or those with limited coordination.
Technique: Brush with circular motions, covering all surfaces with light pressure. Use quick, wide circles and bring teeth into contact for complete coverage.
Disadvantages: May harm gums or not clean between teeth well.
Rolling Stroke Method
Who Should Use It: General cleaning, especially for children with healthy gums.
Technique: Apply the brush bristles facing up or down, gently roll the brush over teeth, and overlap strokes.
Advantages: Simple and effective for cleaning the teeth and gumline.
Disadvantages: Improper technique may cause gum damage or miss parts of the teeth.
Modified Stillman Method
Who Should Use It: For thorough cleaning and gum stimulation.
Technique: Place bristles against the gums and tooth, press gently, then vibrate and roll the brush to cover all areas.
Advantages: Stimulates gums and cleans interproximal spaces effectively.
Disadvantages: Requires careful technique to avoid damaging tissues.
Bass (Sulcular) Method
Who Should Use It: Effective for cleaning along the gumline and in between teeth.
Technique: Hold the brush at a 45-degree angle, brush gently into the gumline, and use short strokes. Optionally, roll the brush down the teeth.
Advantages: Excellent for cleaning the gumline and exposed root surfaces.
Disadvantages: Overzealous brushing can damage the gums. Requires good dexterity.
ADA Seal of Acceptance
The American Dental Association (ADA) has a Seal of Acceptance program managed by its Council on Scientific Affairs. This council reviews and evaluates dental products based on scientific data to ensure their safety and efficacy. The Seal is granted to products that meet these standards, but not all products qualify.
CDA Seal of Recognition Program
The Canadian Dental Association (CDA) offers a Seal of Recognition for products that benefit oral health. This program helps both consumers and dental professionals make informed choices by reviewing and approving products based on their effectiveness and research.
The CDA’s Professional Products Recognition Program identifies products for use in dental practices, such as:
Surgical gloves
Full-spectrum lighting
Chlorhexidine rinses
Evaluation Process of CDA Seal Recognition Program
The CDA reviews manufacturers’ submissions to ensure research methodology and claims are valid.
Only products with supported claims and appropriate scientific evidence receive the Seal of Recognition.
Where does periodontal disease often start?
Periodontal diseases often start in the col area, the depression between the facial and lingual aspects of the interdental gingiva. To prevent and control these diseases, it’s crucial to remove dental plaque from the interproximal surfaces of the teeth.
Purposes of Dental Floss
Removes Plaque and Debris: Cleans teeth, restorations, orthodontic appliances, fixed prostheses, pontics, and around implants, as well as the gingiva in the interproximal area and sulcus.
Identifies Issues: Helps detect subgingival calculus deposits, overhanging restorations, or interproximal decay.
Reduces Gingival Bleeding: Aids in preventing periodontal disease.
Applies Agents: This can be used to apply polishing or chemotherapeutic agents to interproximal and subgingival areas.
Prevents Caries: Helps prevent interproximal caries lesions.
Flossing is most effective when…
Flossing is most effective when the interdental papilla fills the space between teeth. If gingival recession causes the papilla to recede, flossing can still be used, but other interdental devices may be more effective or used alongside floss.
Types of Dental Floss/Tape
Dental floss and tape come in various types to suit different interproximal spaces and patient preferences. Most floss products are made of nylon and may be flavoured or fluoride-impregnated.
Types Available:
Unwaxed
Waxed
Polytetrafluoroethylene (PTFE)
Tufted
Braided
