Preventive Procedures - Week 5 PP Flashcards
Plaque Control Program
- Plaque can be kept under control with the use of brushing, flossing, interdental cleaning aids, and antimicrobial solutions
- A goal of the program is to remove plaque at least once daily
- The techniques that are selected must be based on the needs and abilities of the individual patient
Disclosing Agents
Because plaque is not visible on most teeth, a disclosing agent can be used.
This is an effective aid that allows a patient to actually see plaque on their teeth. Disclosing agents are available in tablet or liquid form.
Oral Hygiene Indices
An index is a way to measure a clinical condition/observation in numerical values.
An oral hygiene index is a record of the presence of plaque on the surfaces of the patient’s teeth.
- Plaque Biofilm Control Record (PCR) or Biofilm Control Record (BCR)
- Simplified Oral Hygiene Index (OHI-S)
Oral Hygiene Indices and Biofilm Control Record
- Review Medical History - ensure no contraindictions are present (allergies to flavors of dyes)
- Dry Teeth with Gauze or A/W Syringe
- Place Vaseline on lips, labial mucosa and white or porcelain restorations
- For liquid: paint teeth with cotton tip applicator
For tablets (teeth not dried before): Have patient chew a tablet, swish and spit - rinse - Record findings on patients PCR and Calculate Plaque Score
Plaque Control Record - Calculation
- Count total number of plaque containing surfaces
- Count total number of available surfaces (4 per tooth – do not include occlusal)
- Multiply by 100 to get plaque score percentage
Total number tooth parts with biofilm divided by (4 x number of teeth present) or # of total surfaces x 100 = % Score
Simplified Oral Hygiene Index (OHI-S)
6 teeth are scored (one per sextant)
Scoring is from 0-3 based on tooth surfaces covered by debris.
Documentation
- All observations and treatment completed is documented in the patient’s chart ( it is considered an assessment - assessing patient on how much plaque is in mouth)
- We will learn more about documentation in upcoming weeks
- Suggestion: have a small calculator that you can bring to patient preventative clinic to calculate the PCR
The two basic types of toothbrushes are:
◦ Manual
◦ Automatic
* Used properly, both types are effective in the removal of dental
plaque - research is divided on which is “better”. More about the user not about the type of brush
Infant Toothbrushes
- Very small and soft; should be used as soon as the baby’s first tooth appears in the mouth
- Finger brush can also be used
Parts of the manual toothbrush
Handle - part grasped in the hand. Durable, impervious to moisture, low cost, easy to grasp, variety of sizes
Shank - the section that connects to the handle and head. A twist, curve, or offset angle may help with adaptation
Head - Working end; consists of tufts of bristles or filaments, rounded ends. Adjusted to the size of the patient’s mouth
Manual tooth brushes
- Come in many styles of head size, tuft shape, and angle and shape of handle
- In general, dental professionals recommend soft-bristled brushes (always!!!) because these bristles are gentler to the soft tissues and to any exposed cementum and dentin
- Nylon bristles are preferred
- Toothbrushes should be replaced every 8-12 weeks or as soon as the bristles show signs of
wear or begin to splay outward
Characteristics of an Effective Manual Toothbrush:
- Size, shape, weight, and texture meet individual user’s needs
- Easily held, used, and disinfected
- Inexpensive and durable
- Functional (flexible, comfortable, effective)
- Appropriate strength, rigidity, and weight.
Nylon or Natural Bristles?
The bristles may be nylon or natural.
Nylon is preferred because the ends are rounded and polished, which makes the toothbrush safer. The most important factor that should be ensured is that the toothbrush readily removes plaque without causing tissue damage.
End-Rounded Nylon Bristles
Most current toothbrushes have nylon filaments. Some evidence suggests that end-rounded bristles are less abrasive to gingival damage than bristles that are non-end rounded. However current research is inconclusive.
The physical properties of natural bristles cannot be
standardized. Natural bristles cannot be end-rounded.
Soft Nylon Brush
- More effective in cleaning cervical areas
- Less traumatic to tissue
- Can be directed into the sulcus
- Toothbrush abrasion and/or recession prevented or lessened
- More effective for sensitive gingiva A variety of filament designs are available and may include, but are not limited to, end-rounded, feathered, microfine, and conical shaped.
- Another factor to keep in mind is that the quality of end-rounding varies in both adult and children’s toothbrushes depending on the manufacturer.
Power Toothbrushes
- Have larger handles that contain a rechargeable battery
- The larger handle also makes them useful for patients with physical disabilities
- Automatic toothbrushes use one of several motions, including back and forth, up and down, or circular
- Some models feature pulsating and ultrasonic action
-Moderate evidence indicates power toothbrushes reduce plaque by 10-20%
and gingivitis by about 10% compared to manual toothbrushes. - Rotating oscillating power toothbrushes are more effective than side-to-side
brushes for reducing plaque and gingivitis. - Sonic power toothbrushes are not shown to be more effective than other power toothbrush types.
- Power toothbrushes generally cause less damage to gingival tissues than manual brushes, as they often include alerts for excessive pressure.
- Improper use of power toothbrushes can lead to increased abrasiveness.
- Recommendations for toothbrushes should be based on individual patient needs and preferences.
Indications for Use of Power Toothbrush
- Fixed orthodontic appliances
- Decalcification
- Uncontrolled oral biofilm and periodontal diseases
- Extensive prosthodontics or dental implants
- Dexterity and motivational challenges
- Gingival recession or noncarious cervical hard-tissue lesions
- Caregiver responsibilities
Factors influencing the selection of a proper manual or power toothbrush
Patient - ability of the patient to use the brush and remove dental biofilm from the tooth surfaces without damage to the soft tissue or tooth structure, manual dexterity of the patient, age of the patient
Gingiva - status of gingival and periodontal health, anatomic configurations of the gingiva
Position of the teeth - crowded teeth, open contacts
Compliance - patient preference may dictate which brush is recommended, patients may have preference and may resist change, patients may lack motivation, ability of willingness to follow the prescribed procedure
Power toothbrush - replaceable brush head, features that include a timer and pressure sensor, patient affordability
Fones (Tooth Brushing Method)
-Circular method/motion
-usually for young children, toddlers, and patients with decreased dexterity
-bring anterior teeth end-to-end emphasizing getting all teeth
-for lingual surfaces we do an in-and-out stroke
Rolling (Tooth Brushing Methods)
Cleaning gingiva, removal of
dental plaque, materia alba and
food debris from the teeth without focusing on the sulcus
Place brush apically close to
attached gingiva and apply slight
pressure and roll down or up
Usually used in combination with another technique
Modified Bass (Toothbrushing method)
The most widely accepted method for plaque removal adjacent and
directly below the gingival margin
Removal of dental plaque at the
cervical third
The brush is placed at 45 degrees
apically with 1-2 bristle rows
directed into the sulcus very gently
Vibrate the brush back-and-forth
for 5-10 strokes without removing the brush tips from the sulcus
Roll down or up after vibration
Modified Stillman (Tooth Brushing Method)
Ideal for individuals that have
recession
Removes plaque and massages
gingiva
Bristles help at 45 degrees apically and partly on the attached gingiva
Flex bristles so tissues blanch slightly
Vibrate gently, keeping the tips of
bristles in position
Roll down or up after vibration
Charters (Tooth Brushing Method)
Patients receiving orthodontic treatment
Patients with prosthetic appliances
Individuals with severe loss of
interdental papillae height