Test 2 Flashcards
Principle instrument in general use for removal of dental biofilm
tooth brush
Removal of biofilm and debris on/in proximal surfaces
dental floss
Final step in oral cleanliness and health is to..
clean the tongue
Uses of the toothbrush are:
Biofilm removal
Application of treatment or prevenetive agents
Contribute to halitosis control
Sanitation of oral cavity
Ideal outcome for hygiene is
tooth remineralization
Characteristics of an effective tooth brush
Proper size, shape and texture Easily and efficiently manipulated Easy to clean Durable and inexpensive Good functional properties End-rounded filaments Properly designed for utility, efficiency and cleanliness
Parts of toothbrush
Handle, Head, Shank
The Bass Method: Sulcular Brushing
What it does:
Effectively removes biofilm above and below gingival margin.
The Bass Method: Sulcular Brushing
Purposes and indications:
For all patients.
For open embrasures, cervical areas beneath the height of contour of enamel, and exposed root surfaces.
For patients who had periodontal surgery.
For adaptions to abutment teeth, under the gingival border of a fixed partial denture, and orthodontic appliances.
The Bass Method: Sulcular Brushing
Procedure
Direct filaments apically (Up for max, down for mand.)
Positions the sides of the filaments parallel with long axis of tooth.
From there, turn brush head toward the gingival margin to make 45 degree angle to long axis of tooth.
Direct filament tips into the gingival sulcus.
(Hold brush long narrow way for anteriors)
The Bass Method: Sulcular Brushing
Stroke:
Press lightly so filament tips enter gingival sulci and embrasures and cover the gingival margin.
Vibrate the brush back and forth with very short strokes,
Count 10 vibrations.
The Rolling Stroke Method
Purposes and indications:
Cleaning gingiva and removing biofilm, materia alba and food debris without emphasis on gingival sulcus.
Meant for children with healthy gingiva and normal tissue contour.
Meant for general cleaning, to be combined with another method.
The Rolling Stroke Method
Procedure:
Direct filaments apically (up for max, down for mand.)
Place side of brush on attached gingiva.
(Hold brush long narrow way for anteriors)
The Rolling Stroke Method
Stroke:
Press lightly to flex filaments against gingiva.
Roll brush slowly over the teeth.
Repeat at least 5 times
The Stillman Method
Purpose:
Procedure:
Stroke:
Designed to massage and stimulate.
Half on ginival, half on tooth. Directed slightly apically.
Press lightly, handle is slightly rotated.
The Modified Stillman Method
Purpose and indications:
Dental biofilm removal from cervical areas below height of contour of the crown and from exposed proximal surfaces.
General application for cleaning tooth surfaces and massage gingiva.
The Modified Stillman Method
Procedure:
Direct filaments apically (up for max, down for mand).
Place side of brush on attached gingiva. (Plastic portion of tooth brush is level with occlusal or incisal plane)
The Modified Stillman Method
Stroke:
Press to flex filaments.
Angle filaments 45 degrees with long axis of tooth.
Activate brush using a slight rotary motion. Count to 10 slowly.
Roll and vibrate the brush.
Repeat five or more times.
(Hold long and narrow way for anteriors)
The Charters Methods
Purposes and indications:
Loosen debris and dental biofilm.
Massage and stimulate marginal and interdental gingiva.
Remove biofilm from abutment teeth and under gingival border of fixed partial denture (bridge).
Cleansing orthodonic appliances.
Adapt to cervical areas below height of contour of the crown and to exposed root surfaces.
The Charters Methods
Procedure:
First instruct The Rolling Stroke Method.
Down for max, up for mand.
Place sides of filaments against enamel.
Angle filaments 45 degrees to occlusal or incisal plane.
Slide brush to a position at the junction of the free ginival margin and tooth surface.
The Charters Methods
Stroke:
Press lightly to flex filaments and force tips between teeth.
Press sides of filaments against the gingival margin.
Vibrate brush.
Count to 10 slowly as brush is vibrated with a rotary motion of handle.
Fone’s (circular) Brushing Technique
The simplest of all methods, simply move brush in circular motion around a set of teeth.
Easy for children to learn .
Is the least effective method.
What is caluculus made from
oral biofilm that has been mineralized by calcium and phosphate salts from saliva.
Another name for calculus
tartar
Does calculus cause periodontal infection
Not directly, but it allows attachment and retention of plaque biofilm.
Why do DH’s remove calculus
So that the tooth surface is smooth, less likely for biofilm to attach and form.
How is calculus classified?
Either supra, or subgingivally
Degree (slight, moderate, heavy)
Extent (localized or generalized)
Where is supragingival calculus usually located?
Sublingual (under tongue) and adjacent to parotid salivary gland ducts.
Resulting in calculus on mand anterior lingual surfaces and max posterior facial surfaces.
Other factors that influence calculus
Kidney dialysis, use of .12 chlorhexidine mouth wash, or genetic predisposition (increase in likelihood of getting something)
How is supragingival calculus detected
direct vision and compressed air.
Look of supragingival calculus
Yellowish- white but may take on stains and appear dark yellow/light brown.
Use of compressed air does what to the look of supragingival calculus
Make it appear to be chalky white.
Subgingival calculus is located..?
Below free gingival margin, often on root surface.
Subgingival calculus color
Dark green-brown-black color due to absorption of blood pigments.
How to detect subgingival calculus
Can be viewed by the use of compressed air deflecting gingival margin.
Use of periodontal explorer. (sometimes by probing), feels like a ledge or ring around tooth.
With trans-illumination calculus can be observed as dark.
Sometimes visible on radiographs.
Calculus formation
It’s formation follows the stages of biofilm formation.
Calculus grows by the apposition of new layers of biofilm.
Mineral source from saliva.
About 10 (rapid calculus formers) to 20 days (slow calculus formers) are required for undisrupted oral biofilm to change to mineralized calculus.
Calculus composition
Inorganic 75-85%
Organic 15-25%
Materia alba
what is it?
loosely attached collection of oral debris.
Materia alba
what does it look like?
whitish to yellowish to greyish mass on teeth or overlying oral biofilm.
Food debris
composed of remnants of food.
How is materia alba and food debris removed?
Rinsing, use of an oral irrigator and self cleansing action of tongue and saliva.
A discoloured accretion or area on a tooth
Tooth stain
Stains that incorporate within the tooth structure
Intrinsic stains, cannot be removed via cleaning
Stains that occur on the outer surface of tooth
Extrinsic stains, removable by scalling, polishing, toothbrushing
3 general ways discolourations of teeth and restorations occur
- Stain adheres directly to tooth surface.
- Stain within calculus and/or soft deposits
- Stain within tooth structure.
Significance of tooth stains
- Appearance
- Irritate gingival tissue, rougher surface for plaque and calculus adhesion.
- Motivation to improve client’s oral hygiene.
Exogenous (tooth stains)
Originate from sources outside, extrinsic (remains on tooth surface) - removable but may become intrinsic.
Endogenous (tooth stains)
Originate within, always intrinsic.
Common types of extrinsic stain:
Yellow
Green
Blackline
Tobacco
Yellow extrinsic stain;
what is it, and occurrence
dull yellowish plaque; associated with poor oral hygiene. Origin - food pigment.
Green extrinsic stain
what is it
Light or yellowish to dark green, appears in plaque.
Green extrinsic stain
what shape is it
- curved line along facial, gingival crest.
- smeared irregularly on a smooth surface of tooth.
- following developmental grooves on buccal of tooth.
Green extrinsic stain
significance
Enamel under stain is often decalcified***
Green extrinsic stain
location
labial, facial (may extend proximal.
usually labial cervical third of max anteriors.
Green extrinsic stain
composition
Chromogenic bacteria and fungi.
Decomposition of hemoglobin.
Inorganic elements.
Green extrinsic stain
occurrence
All ages, a sign of poor oral hygiene.
Usually children with enamel irregularities.
Black line stain
appearance
Continuous fine black/brown line.
1mm wide.
Black line stain
location
Follows curves of gingival crest, 1mm away from edge.
In pits and fissures
Not usually on labial of max molars.
Black line stain
composition
Similar to plaque, difficult to remove with polishing, must be scaled off.
Black line stain
occurence
More common in children.
Females
In clean mouths, no plaque
Natural tendency for some people to form it.
Tobacco stain
appearance
light brown - dark brown - black
leathery looking
Tobacco stain
occurance
cervical third on lingual surfaces, any surface; pits and fissures.
Tobacco stain
composition
tar from smoke; chewing tobacco, often accompanied by poor oral hygiene.
All extrinsic stain is exogenous or endogenous?
exogenous
Endogenous intrinsic stains.
Pulpless Teeth:
Appearance
Yellow-brown, grey, reddish brown bluish black.
Endogenous intrinsic stains.
Pulpless Teeth:
Cause
Caused by breakdown of the pulp or due to endodontic treatment.
Endogenous intrinsic stains.
Medications
Tetracycline -
antibiotics absorbed by bones and teeth.
Causes yellow to brown endogenous pigmentation of teeth.
Can be passed on to fetus.
Colour depends on type of tetracycline, dosage, duration.
Generalized (specific teeth)
Intrinsic
In the tooth structure.
Can occur during develipment of tooth.
Can take place after eruption.
Not sign of tooth weakness.
“hypo”
insufficient/lacking
Enamel hypoplasia
defect occurs as a result of a disturbance in formation of organic enamel matrix.
Local or single tooth may exhibit the condition; due to trauma.
Hypomineralization
Insufficient mineralization during tooth formation.
White spots on enamel
Due to high fever at the time of development.
Pink tooth of Mummery
is a tooth exhibiting a pinkish hue as a result of hematologic staining of the dentin.
Endogenous intrinsic stain.
Exogenous intrinsic stain
Restorative materials:
Amalgams - dental silcer amalgam - migration of metallic ions into tooth structure.
Exogenous intrinsic stain
Endodontics:
Mainly from older methods.
Exogenous intrinsic stain
Demineralization:
White to brown enamel.
Acid erosion by plaque
Minerals removed from enamel after tooth has erupted.
Exogenous intrinsic stain
Arrested caries:
Remineralized tooth structure following caries.
Stain entered into the ‘porous’ demineralized area - then remineralized.
Dark brown to black.
On crowns, root surfaces.
Enamel fluorisis
Colour
Enamel fluorisis can be seen either mostly brown (A) or mostly white (B) discolorations.
Type I Embrasure
Papillae fills interproximal
Type II Embrasure
Slight to moderate recession (blunted papillae)
Types III Embrasure
Excessive or complete loss.
Indications for Bass/Sulcular technique
For open proximal areas (embrasures), beneath height of contour of enamel, exposed root surfaces.
Indications for Stillman’s brushing technique
Gingival recession, for gingival stimulation, to clean from large embrasures, remove plaque and biofilm from cervical region.
Indications for Charter’s brushing technique
Orthodontic and fixed prosthetic appliances, temporary cleaning of surgical site. Cleans interproximal areas.
Modified /bass, modified stillman’s, and modified charter’s
Adding a rolling stroke to all methods.
Modified /bass, modified stillman’s, and modified charter’s
Indications
Clean entire facial/buccal surfaces, avoids damage to bass of gingival sulcus.
Indication for Fones (circular) brushing technique
Indicated for children, sometimes for adults.
Simplest technique, but less effective.
Rolling stroke brushing technique indications
Used mostly in addition to bass, stillmanes and charters, we use this at the end of each technique.
