Mechanical and Chemotherapeutic Home Oral Hygiene-1

7/29/2019 Mechanical and Chemotherapeutic Home Oral Hygiene-1

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Mechanical and Chemotherapeutic Home Oral

Hygiene

Mechanical Methods of Plaque Control

- The most accepted techniques for plaque

removal

- These include:

o Tooth brushing

o Flossing

o Disclosing agents

o Oral irrigators

o Tongue scrapers

Manual toothbrush

- Most common method for removing plaque

- Variable

o Bristle materialo Length

o Diameter

o Number of fibers

o Length of brush head

o Number and arrangement of bristle

tufts

o Angulation of brush head to handle

o Handle design

Nowadays, brushes are made of synthetic (nylon)

bristles

Classification of brushes based on diameter of bristles

- Soft (0.16 0.22mm)

- Medium (0.23 0.29mm)

- Hard (0.30 mm and higher)

Types of Bristle Ends

- Coarse cut

- Enlarged bulbous

- Round (bristle type of choice. Why? Because its

associated with a lower incidence of gingival

tissue irritation)

What do you think is the most preferred brush to

be used in pediatric dentistry?

Answer: the soft brush with smaller head and thicker

handle.

o Decreased gingival tissue trauma.

o Increased interproximal cleaning

ability

o Aid in access to oral cavity

o Facilitates childs grip of hadle

When is the best time to replace your toothbrush?

Answer: when it appears well worn. Some children

chew their brushes.

Floss

Tooth brushing alone cannot remove plaque from all

tooth surfaces, especially the interproximal plaque.

Types of floss

- Flavoured and unflavored

- Waxed and unwaxed


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- Thin, tape and meshwork

Flosses can be made of:

- Nylon (floss of choice because of ease of

passing the floss in between teeth, lack of wax

residue, squeaking sound effect, fiber spread

increases the surface contact)

- Teflon

Powered Mechanical Plaque Removal

- Significantly proven more effective and

beneficial in reducing plaque index, gingival

index, percentage of sites that bled on probing,

pocket depth, total gram negative bacteria in

subgingval plaque than the manual tooth

brushes.

- It was designed because some people lackmanual dexterity in manipulation of brushes

- Uses acoustic energy

- Has an electromagnetic device that drives

bristles motion at 260 Hz or 31,320 brush

strokes per minute.

- Brushes with rotation-oscillation action removes

more plaque and reduces gingivitis

- Requires single handed usage

- Filament rotates to undergo an elliptical

movement, removes plaque attached to adjacent

Dentrifices

- Plaque and stain removing agents through the

use of abrasives and surfactants

- Composition

o Incorporated with pleasant flavors

and colors

o tartar control properties such as

pyrophosphate

o fluoride - anticaries and

desensitiation properties

- amount of dentrifices given to child patients

should be taken in consideration.

- Parents should be advised to delay the use of

fluoride dentrifice until the child is older than 36months and to use small pea-sized amount of

toothpaste

Disclosing Agents

- Allow visualization of plaque

- Compostion

o Iodine

o Gentian violet

o Erythrosine

o Basic fuchsin

o Fast green

o Food agents with antimicrobial

activity

Adjuncts for Plaque Control

- oral irrigators (uses pulsed water or

chemotherapeutic agents to dislodge plaque)

- tongue scrapers (flat, flexible plastic sticks that

are used to remove bacterial and food deposits

that accumulate within the rough dorsal surface

of the tongue. )

- gauze or special dental wash cloths (used in

infants to massage the gums and remove the

plaque in newly erupted teeth)

Techniques

- roll method- Charters method

- Horizontal scrubbing method

- Modified stillman method

- Roll method

o Brush is placed in vestibule

o Bristles ends directly apically

o Sides of bristles touching gingival

tissue

o Patient exerts lateral pressure with

the sides of the bristles and brush is

moved occlusally

o Brush is placed again in high

vestibule while rolling motion is

repeated

o Lingual surfaces are brush in the

same manner, with 2 teeth brushed

simultaneously

o Seldom used

- Charters Method

o Ends of the bristles are placed in

contact with the enamel and gingiva

o Bristles are pointed 45 degree

angle toward the plane of occlusion

o Lateral and downward pressure is

then placed on brush

o Brush is vibrated gently back and

forth a millimetre or so.

- Horizontal Scrubbing Method

o Brush is placed horizontally on

buccal and lingual surfaces and

moved back and forth with a

scrubbing motion.


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o Exhibited a more significant plaque

removing effect that the other

methods.

o Recommended for bushing

childrens teeth.

- Modified Stillman Method

o

Combines a vibratory action of thebristles with a stroke movement of

the brush in the long axis of the

teeth.

o Brush is placed at the mucogingival

line, with the bristles pointed away

from the crown, and moved with a

stroking motion along the gingival

and the tooth surface.

o The handle is rotated toward the

crown and vibrated as the brush is

moved.

Techniques in Flossing

o 46 to 61 cm is obtained and the

ends are wrapped in the middle

finger. Floss should be long enough

to allow the thumbs to touch each

other when the hands are laid flat.

o Thumbs and index fingers are used

to guide the floss as it gently sawed

between the two teeth to be

cleaned. Gingival trauma may occur

if the floss snaps down through the

interproximal area.

o

Floss is manipulated into C shapearound tooth individually and

moved in a cervical- occlusal

reciprocating motion until the

plaque is removed. In between

cleaning each pair of teeth the floss

is repositioned on the fingers so

that fresh, unsoiled floss is used at

each new location.

Time Consideration

How often should we brush and floss our teeth and for

how long?

Answer: 1 minute brushing period provides the

greatest plaque removal.

In Children, oral hygiene procedures must be done

once or twice daily with parental supervision.

Chemotherapeutic Plaque Control

- characteristics of an ideal Chemotherapeutic

plaque control agent

o specificity only for the pathogenic

bacteria

o substantivity, the ability to attach to

and be retained by oral surfaces

and then be released over time

without loss of potency

o chemical stability during storage

o absence of adverse reactions, such

as staining or mucosal interactions

o toxicology safety

o ecologic safety so as not to

adversely alter the microbiotic flora

o ease of use

- Different ways to administer antiplaque agents

o Mouthwashes

o

Dentrificeso Gels

o Irrigators (provide supragingival and

subgingival delivery)

o Floss

o Chewing gum

o Lozenges

o Capsules (systemic distribution)

o All of these are for local,

supragingival administration except

capsules and irrigators

Antiseptic Agents

- Chlorhexidine

o Positively Charged Organic

antiseptic agent

o Reduces plaque, gingivitis,

mucositis

o Binds with anionic glycoproteins

and phosphoproteins on the buccal,

palatal and labial mucosa and

tooth-borne pellicle

o Can be of great use in

immunocompromised patients esp.

mental retardation and patients

undergoing bone marrowtransplantation

o Antibacterial effects:

Binding well to bacterial

cell membrane

Increasing their

permeability

Initiating leakage

Precipitating intracellular

components


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Decrease levels of

streptococcus mutans

o Form

Rinse, spray, varnish, gel

in flossing

o Adverse reactions of positively

charged antiplaque agents Staining of teeth

Impaired taste sensation

Increased supragingival

calculus formation

Listerine

- Noncharged phenolic antiseptic agent

- Burning sensation

- Bitter taste

- Highest alcohol contents (25 %)

Enzymes, Plaque- Modifying Agents and Plaque

Attachment Interference Agents

- Enzyme System

o Alter plaque architecture

- Urea Peroxide

o Plaque modifying agent

o Increased stability over hydrogen

peroxide

o Protein denaturation effect of urea

- Delmopinol

o Binds to salivary protein and alters

cohesiveness and adhesiveness

properties of films formed

Sugar Substitutes

- Incorporated in chewing gums to:

o Decrease plaque accumulation and

pH

o Lower incidence of caries

- Examples of Sugar Substitutes

o Xylitol

o Mannitol

o Sucralose

o Aspartame

Age Specific Home Oral Hygiene Instructions

- Prenatal Counseling

o Before birth of child

o Discuss Pregnancy gingivitis

- Infants (0 1 year old)

o Plaque removal activity should

begin on eruption of primary teeth

o Cleaning and massaging of gums

using moistened gauze or

washcloth, soft bristled infant sized

toothbrush may be introduced

o Performed once daily

o Childs first visit to the dentist

approximately when the tootherupts or by the age of 12 months

- Toddlers (1 to 3 years old)

o Toothbrush must be introduced

o Parent remains primary caregiver of

hygienic procedures

o Flossing, if interproximal contacts

are closed

- Preschoolers (3 to 6 years)

o Fluoride dentrifice can be

introduced at 3 years

o Pea - sized amount of tooth paste

o Daily flossing

- School-Aged Children (6-12 years)o Parents may find they only need to

brush or floss their childs teeth in

difficult to reach areas of mouth

o Use of disclosing agent for parents

inspection

o Ingestion is the primary concern

o Fluoridated dentrifices is necessary

o Use of chemotherapeutic agents is

recommended

- Adolescents (12 19 years)

o Motivation

o Poor dietary habits and pubertal

hormonal changes increase the riskfor caries and gingivitis

- In- office Oral Hygiene Programs

o Dental education of parent and

child describing exactly the

importance of oral hygiene

o Delivered in simple terms with

enthusiasm and conviction

o Conveyed in a childs age-

appropriate language

o Positive reassurance, not critical

o let me show you how to improve

rather than saying youre doing it

all wrongo Recare intervals should be

personalized with patients needs


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Flossing

Flossing removes plaque and bacteria that you

cannot reach with your toothbrush. If you don't floss,

you are missing more than one-third of your tooth

surface. Plaque is the main cause of gum disease. It

is an invisible bacterial film that develops on your

teeth every day.

Within 24 to 36 hours, plaque hardens into tartar (also

called calculus), which can only be removed by

professional cleaning. Floss at least once a day, and

plaque never gets the chance to harden into tartar.

Getting into the habit of daily flossing is easier when

you floss while doing something else like watching TV

or listening to music, for example.

How to floss your teeth

Step 1

Take a length of floss equal to the distance from your

hand to your shoulder.

Wrap it around your index and middle fingers, leaving

about two inches between your hands.

Step 2

Slide the floss between your teeth and wrap it into a

"C" shape around the base of the tooth and gently

under the gumline. Wipe the tooth from base to tip

two or three times.

Step 3

Be sure to floss both sides of every tooth. Don't forget

the backs of your last molars. Go to a new section of

the floss as it wears and picks up particles.

Step 4

Brush your teeth after you floss - it is a more effective

method of preventing tooth decay and gum disease.

Flossing Problems and Solutions

Gums sometimes bleed when you first begin to floss.

Bleeding usually stops after a few days. If bleeding

does not stop, see your dentist. Floss can shred if you

snag it on an old filling or on the ragged edge of a

tooth.


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Try another type of floss or dental tape. Ask your

dentist or dental hygienist for advice. If your floss still

shreds, see your dentist.

Brushing

Regular, thorough brushing is a very important step in

preventing tooth decay and gum disease. Brushing

removes the bacteria that promote tooth decay and

the plaque that can cause gum disease.

Ideally, you should brush after every meal, because

the bacterial attack on teeth begins minutes after

eating. At the very least, brush once a day and always

before you go to bed. Brushing your teeth isn't

complicated, but there is a right and a wrong way.

How to brush your teeth

Step 1

Brush at a 45 degree angle to your teeth. Direct the

bristles to where your gums and teeth meet. Use agentle, circular, massaging motion, up and down.

Don't scrub. Gums that recede visibly are often a

result of years of brushing too hard.

Step 2

Clean every surface of every tooth. The chewing

surface, the cheek side, and the tongue side.

Step 3

Don't rush your brush. A thorough brushing should

take at least two to three minutes. Try timing yourself.

Step 4

Change your usual brushing pattern. Most people

brush their teeth the same way all the time. Thatmeans they miss the same spots all the time. Try

reversing your usual pattern.

Step 5

Use a soft brush with rounded bristles. The right

toothbrush cleans better. Choose a size and shape

that allow you to reach all the way to your back teeth.

There are many different types of brushes, so ask

your dentist to suggest the best one for you. CDA

recommends you replace your toothbrush every three

months.

Mechanical and Chemotherapeutic Home Oral Hygiene-1

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