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
Toothbrushing for Acute Oral Inflammatory or Traumatic Lesions
Brush all areas of the mouth not affected and if tolerable clean the affected area with an extrasoft toothbrush. Reducing the bacterial load is essential to aid in healing.
Rinse with a warm saline solution to encourage healing and debris removal.
Consider prescribing an antimicrobial rinse like chlorhexidine to aid in the reduction of
bacterial load until normal oral self-care can
resume.
Resume regular biofilm control measures on the affected area as soon as possible.
Toothbrushing following periodontal surgery
Perform oral self-care in the areas not involved in the surgery as usual.
Follow directions provided by the
periodontal office for care of the surgical area.
Rinsing and brushing the surgical area may not be recommended until at least 24 hours after surgery care should be taken to avoid the gingival areas when brushing. If gingival grafting was done, no brushing may be
allowed until the postoperative follow-up appointment.
Toothbrushing following dental extraction
Clean the teeth adjacent to the extraction site the day following surgery.
Brush areas not involved in the surgery, as usual, to reduce biofilm and promote healing.
Beginning 24 hours after surgery, rinse the mouth with a warm, mild saline solution after each meal or snack to help remove
food debris from the extraction site.
Oral Self-Care for the Neutropenic
Patient Neutropenia or a low white blood cell count (<500 absolute neutrophil count)
occurs during treatment such as
chemotherapy, radiotherapy, and bone marrow transplant associated with many
cancers. Neutropenia puts the patient at increased risk for life-threatening infection.
Tongue Cleaning/Brushing
- Doral surface of tongue hosts an abundance of organisms
- Halitosis (bad breath): common
patient complaint - Tongue cleaners, or scrapers, are designed and intended for
removal of debris and bacteria
from tongue’s dorsal surface - Brushing tongue with toothbrush also can remove bacteria and debris
How do the public and dental professionals make informed choices about oral healthcare products?
The ADA and CDA work to evaluate and interpret information regarding:
- Safety and efficacy
- Promotional claims
- Proper use of dental products
- Both for public and professional use
The CDA reviews manufacturer submissions to verify the research methodology and evidence that the manufacturer’s statement of claim can be scientifically supported.
These reviews will evaluate the data from all clinical and laboratory tests mentioned in the submission. The CDA may also require additional data to be gathered for
further testing.
Removal of plaque biofilm from spaces where toothbrushing does not reach is important for following reasons:
To prevent periodontal disease
◦ To prevent halitosis
Interdental Aids - know the types
Special devices are recommended as aids for cleaning between teeth wit large or open interdental spaces and under fixed bridges. These are aids to flossing but do not replace it in all areas of the oral cavity
Interproximal Cleaning Devices
included wooden tips
Interproximal Brushes
Rubber tipped Stimulators
Dental Floss Considerations for Use
- Tightness of Contact Area: Floss must fit comfortably between teeth; tighter spaces may require waxed or thinner floss.
- Contour of Gingival Tissue: The shape and health of the gums can affect the ease
of flossing; certain types may be better for sensitive or irregular gum contours. - Roughness of Interproximal Surface: Rough surfaces may require more durable
floss to withstand abrasion and effectively remove plaque. - User’s Manual Dexterity and Preference: Individual comfort and skill level in handling floss can influence the choice, with some preferring traditional floss and others opting for floss picks or other alternatives.
Waxed vs. unwaxed dental floss
Research has shown no difference in the effectiveness of waxed or unwaxed floss for biofilm removal however, the effectiveness of flossing for biofilm removal is not supported by evidence
Silk Floss
Silk - Historically, floss was made of silk fibers loosely twisted together to form a strand and waxed for proximal surface cleaning
Nylon Floss
Nylon multifilaments, waxed or unwaxed, have been widely used in circular (floss) or flat (tape)
form for biofilm removal from proximal tooth surfaces.
Polytetrafluoroethylene
(PTFE) Floss
Monofilament PTFE is used for biofilm removal from proximal tooth surfaces.
Flossing Steps
- Hold a 12- to 15-inch length of floss with the thumb and index finger of each hand; grasp firmly with only 1/2-inch of floss
between the fingertips. - The ends of the floss may be tucked into the palm and held by the ring and little finger, or the floss may be wrapped around
the middle fingers
Flossing “Loop Method”
A circle of floss or “floss loop” may be made by tying the ends together; the circle may be rotated as the floss is used
Circle of Floss. The ends of the
floss can be tied together for
convenient holding.
A child may be able to manage
floss better with this technique.
Prevention of Flossing Injuries
Location:
Floss cuts or clefts occur primarily on facial and lingual or palatal surfaces directly beside or in the middle of an interdental papilla. They appear as straight-line cuts beginning at the gingival margin and may result in a floss cleft if the tissue is repeatedly injured.
Causes
* Using a piece of floss that is too long between the fingers when held for insertion.
* Snapping the floss forcefully through the contact area.
* Not curving the floss about the tooth adequately and cutting into the gingival margin.
Flossing for Children
- Importance: Flossing helps remove plaque and food particles between teeth where brushes can’t reach, reducing
the risk of cavities and gum disease. - Age Recommendations: Children should start flossing as soon as they have two teeth that touch. This typically occurs around age 2-3.
- Parental Guidance: Young children need help with flossing until they can handle it on their own, usually around age 8-10. Parents should assist and supervise.
- Techniques: Use a gentle sawing motion to slide the floss between teeth, and curve it around each tooth to clean below the gumline.
- Floss Picks: Consider using floss picks or devices designed for kids to make the process easier and more engaging.
- Education: Teach children the importance of flossing through fun activities or by setting a good example with their
own dental care routine. - Regularity: Encourage daily flossing, ideally before bedtime, to instill good habits early on.
- Dental Visits: Regular check-ups with a dentist can reinforce the importance of flossing and provide personalized
guidance
Dental Flossing Limitations
- Technique Sensitivity: Proper technique is crucial; incorrect use can lead to gum injury or ineffective cleaning.
- Access Issues: Some individuals may have difficulty accessing certain areas of their mouth, making flossing challenging.
- Time-Consuming: Flossing can be seen as time-consuming, leading some people to skip it.
- Discomfort: Some may experience discomfort or bleeding when starting to floss, which can discourage consistent use.
- Not Always Effective: Flossing may not adequately clean areas with tight contacts or gaps that are too wide.
- Children’s Compliance: Younger children may resist flossing or not do it correctly without parental supervision.
- Cost of Alternatives: Some may find alternatives, like water flossers, more expensive and not as accessible.
- Misunderstandings: Many people might not understand the importance of flossing, leading to inconsistent habits.
- Limited Impact on Certain Conditions: Flossing alone may not significantly reduce issues like periodontal disease if other factors (e.g., genetics, overall dental hygiene) are at play
Floss Threaders
Can either consist of a stiff end of floss that can be threaded or a separate device to use similar to a sewing needle and thread
Floss Holder
Plastic handles that aid in holding floss strand
Studies have shown that use of floss with proper use of a floss holder reduced gingivitis as effectively as use of string floss
Floss Pick
Helpful for people with limited dexterity (Children)
Dental Water Flosser
- Mechanism of action
-Produces pulsating stream of fluid
-Works by impacting gingival margin with pulsed
irrigant and subsequent flushing of gingival crevice or
pocket - Depth of delivery of a solution
-Has ability to reach deeper into periodontal pocket
than a toothbrush, interdental aid, or rinsing
-Standard jet tip has been shown to reach 71% in sulcus depths of 0 to 3 mm
End-tuft brushes
Small, tufted brushes designed to clean hard-to-reach areas, like behind back teeth and around dental work. They effectively remove plaque and debris in tight spaces.
Interdental/Proxa Brush
Tapered brushes that fit between teeth, ideal for cleaning interdental spaces. They come in various sizes and are especially useful for those with braces or larger gaps.
Stimudent
A small wooden or plastic stick used to clean between teeth
and massage gums. It helps maintain gum health by removing debris and stimulating blood flow.
Rubber Tip Stimulator
A tool with a rubber-tipped end for gently massaging gums and removing plaque. It’s beneficial for promoting gum health and preventing gum disease
Mouth Rinses Importance
- Plaque Control: They help reduce plaque buildup and prevent tooth decay.
- Cavity Prevention: Fluoride rinses strengthen enamel, making teeth more
resistant to cavities. - Fresh Breath: Mouth rinses eliminate bacteria that cause bad breath.
- Gum Health: Antimicrobial rinses can help reduce the risk of gum disease.
- Enhanced Cleaning: They reach areas that brushing and flossing may miss,
providing an extra layer of oral hygiene. - Incorporating mouth rinses into your oral care routine can significantly contribute to overall dental health.
Benefits of Pre-Procedural Rinse
- Reduces Oral Bacteria: Pre-procedural rinses help decrease the microbial load in the mouth, lowering the risk of infections during dental procedures.
- Minimizes Contamination: Helps protect both the patient and the dental
team by reducing the spread of bacteria. - Improves Treatment Outcomes: A cleaner oral environment can enhance
the effectiveness of dental treatments. - Promotes Patient Comfort: Can provide a sense of cleanliness and comfort
before procedures. - Reduces Inflammation: Some rinses can help reduce gum inflammation and
improve overall gum health prior to treatment.
Fluoride Mouth Rinse
Benefits:
Cavity Prevention - helps demineralize enamel
Strengthens Enamel - repair early stages of enamel
Reduces Sensitivity - by reinforcing enamel
Easy to Use - simple to incorporate into routine
Recommended Usage:
Frequency - daily use
Age considerations - over 6 y.o.
Timing - after brushing flossing for max benefit
Considerations:
Swallowing Caution - excessive fluoride can lead to fluorosis, children should be supervised
Not a substitute - compliment not replace brushing and flossing
Consultation - consult with dentist for personalized use
Chlorhexidine Mouth Rinse
Benefits
Reduces Plaque
Prevents Gum Disease
Post-Surgical Care - promote healing/reduce infection
Long-Lasting Effect - residual effect
Recommended Use
Prescribed Use - typically prescribed for gum disease or after procedures
Frequency - usually 2x daily
Duration - usually short duration - 2 weeks
Considerations
Taste and staining - bitter taste, can lead to staining of teeth & tongue
Mucosal irritation - irritation or dryness of the mouth
Not for everyone - if allergic or under certain age
Triclosan
Benefits:
Antibacterial Properties - reduces growth of bacteria, prevent plaque buildup and gum disease
Oral Health - in tooth paste & mouth rinses reduces gingivitis & caries
Wide Usage - Found in various products
Recommended Usage:
Age considerations - not recommended for young children
Potential Risks - Concerns about hormonal effects and resistance
Alternatives - fluoride based products for kids
Considerations:
Regulatory Scrutiny - safety of it has been debated, hormonal effects/environmental concerns
Resistance - overuse may contribute to antibiotic resistance
Alternatives - many products now use alternative antibacterial agents
Biotin Mouth Rinse
Benefits
Moisturizes Oral Cavity - Helps alleviate dryness in mouth
Maintains oral health - promotes saliva production/neutralizing acids
Soothes irritation - relief from dry mouth which can lead to sore throats
Safe for Daily Use - can be used multiple times throughout the day
Recommended Usage:
Frequency - can be used as needed - particularly after meals/before bed time
Application - gels, sprays, mouthwashes
Considerations:
Consultations - consult with professional if dry mouth persists.. could be due to underlying health issue
Not a Substitute for Saliva - helps manage symptoms, but doesn’t replace natural saliva
Contraindications of Mouth Rinses
- Allergies: Individuals with known allergies to ingredients in the mouth rinse (e.g., chlorhexidine, alcohol, flavorings) should avoid those products.
- Children Under Age: Some mouth rinses are not recommended for young children due to the risk of swallowing or irritation.
- Dry Mouth: Certain alcohol-based mouth rinses may worsen dry mouth symptoms and should be avoided by individuals with xerostomia.
- Oral Irritation: Those with oral sores, ulcers, or sensitive mucosa may experience increased irritation from certain rinses.
- History of Oral Reactions: Individuals with a history of adverse reactions to specific mouth rinses should consult a healthcare provider before use.
- Pregnancy and Nursing: Some ingredients in mouth rinses may not be recommended during pregnancy or breastfeeding. Consult a healthcare provider for safe options.
- Certain Medical Conditions: Conditions like mucositis or other oral health issues may require caution or alternative treatments.
