Ch 20 Flashcards
(40 cards)
1
Q
what is the goal of oral hygiene
A
- to keep biofilms below threshold levels for periodontal disease through
- home care procedures
- mechanical debridement
- supragingival plaque control contributes to preventing or moderating subgingival microbial recolonization
2
Q
what is oral hygiene self-care
A
- physical therapy for the mouth or oral cavity
- suppression of harmful microorganisms
- supragingival biofilms
- plaque (biofilm) control prevents potential detrimental effects of pathogens on the periodontium
3
Q
what are preventive measures
A
- primary goal of prevention is to achieve the lowest plaque (biofilm) level as possible
- total elimination of oral bacteria is not possible nor desirable
- oral cavity is not sterile
- beneficial (good) bacteria
4
Q
what is primary prevention
A
- preventive measures taken to prevent disease from occuring
5
Q
what is secondary prevention
A
- preventive measure taken to prevent the disease from progressing further
- or prevent the recurrence of the disease after treatment
6
Q
what is tertiary prevention/treatment
A
- restorative (surgery)
7
Q
what is halitosis and what causes
A
- common complaint among patients: high percent of population, some over 50%
- etiology: poor oral hygiene, local factors, systemic factors
- majority of cases oral malodor originates from oral cavity: gram-negative, anaerobic bacteria
8
Q
what are the compounds producing malodor in halitosis
A
volatile sulfur compounds (VSC) – (hydrogen sulfide, methylmercaptan, dimethyl sulfide)
- arise from bacterial metabolism (degrades) of sulfur containing amino acids
- intensity of malodor is associated with amount of VSC
- as is dorsum of tongue
- VSC also accelerate periodontal tissue destruction
- GI conditions: possible cause, more rare
- sinue/ENT: possible, require referral
9
Q
oral conditions that may cause bad breath
A
- periodontal pockets
- xerostomia (dryness of mouth)
- carious lesions
- bacterial biofilms
- interdental areas debris
- spaces between papillae of the tongue
- poor restorations
- calculus
- erupting wisdom teeth (pericoronitis)
- remaining roots
- gangrenous pulps (necrosed pulp tissue)
- NUG
10
Q
what are the 3 categories of halitosis
A
- genuine halitosis: physiological halitosis (tongue main origin), pathologic halitosis (subclassified as oral path and extraoral pathologic halitosis)
- pseudo-halitosis: pte thinks they have bad breath. psychosomatic condition
- halitophobia: psychosomatic condition
11
Q
how can we diagnose and assess oral malodor
A
- self-assessment: unable to smell ones own malodor
- gas chromatography: specific sulfur detector, gold standard for oral malodor measurement
- halimeter: significantly influenced by other oral gases such as chewing gum, smoking, etc
- simple determination of oral malodor: spoon test
- psychological assessment: halitophobia, psychosomatic condition, questionnaires
- tongue sulfide probe: sulfide level on the dorsum of the tongue, probe applied to different parts of the tongue, voltage proportional to concentration of sulfide ions present
- organoleptic measurement: natural smelling, good for dental practitioners
12
Q
what are the scores on the organoleptic scoring scale
A
0: absence of odor: detectable odor is completely absent
1: questionable: odor is detectable, although a judge could not recognize it as malodor. this is defined as the detection threshold
2: slight malodor: odor is deemed to exceed the threshold of malodor recognition. this is defined as the recognition threshold
3: moderate malodor: malodor is definitely detected
4: strong malodor: strong malodor, but examiner can tolerate
5: severe malodor: overwhelming malodor. examiner cannot tolerate malodor at this level (the examiner instinctively averts the nose)
13
Q
what is a diamond probe
A
- sensors are integrated into the periodontal probe
- probe is placed into the periodontal pocket or tongue
- electrical control unit and disposable sensor tip that combines a standard michigan 0 styled dental probe with a sulphide sensor which responds to the sulfides present in the periodontal pocket
14
Q
what are the treatment needs (tn) for breath odor
A
- tn-1: explanation of halitosis and instruction for oral hygiene. support and reinforcement of the patient’s self-care for further improvement of his or her oral hygiene
- tn-2: oral prophylaxis, professional cleaning, and treatment for oral diseases, especially periodontal disease
- tn-3: referral to a physician or medical specialist
- tn-4: explanation of examination data further professional instruction, education and reassurance for improvement
- tn-5: referral to a clinical psychologist, psychiatrist, or other psychological specialist
- tn-1 is applicable to all ases requiring tn-2 - tn-5
15
Q
treatment of oral malodor: physiological halitosis
A
- based on treatment needs (TN):
- tongue cleaning: physiologic halitosis (tn-1), reduces VSCs, brushing preferred over scraping?
- oral hygiene and mouth rinses: mechanical reduction of bacteria, included in tn-1, different options (zinc – breath prescription)
- toothpastes/rinses: triclosan containing pastes (colgate total, arm&hammer), may reduce certain amounts of VSCs
- chewing gum: 70% patients with halitosis use gum (sugar may reduce VSCs), sugarless gum masks halitosis
- periodontal and restorative treatment: periodontal treatment required as tn-2, treat xerostomia, caries may cause malodor
16
Q
treatment of oral malodor: pseudo-halitosis
A
- requires tn-3, tn-4 and/or tn-5
- referral to physician
- a treated patient may not believe their halitosis was treated and thinks it still exists
17
Q
what can we use for evaluation of mechanical plaque control
A
- disclosing solution/tablets
- good for patient education
18
Q
what are the factors contributing to the effectiveness of toothbrushes
A
- design
- side effects
- effectiveness
- alternatives to conventional manual brushes (disposable polyester foam sponge)
- care of toothbrushes
19
Q
what are the 4 toothbrushing methods
A
- horizontal – scrub
- circular – fones
- rolling stroke
- vibratory – bass, stillman, charters
20
Q
what are the mechanisms of action for powered toothbrushes
A
- reciprocating
- rotational
- counterrotational
- oscillating
- sonic
21
Q
what are the considerations regarding interdental care
A
- type of embrasures
- position of teeth
- interdental papillae
- tightness of tooth contact
- restorative/prosthetics
22
Q
what are the 3 types of gingival embrasures
A
- type I: completely filled with interdental gingiva
- type II: embrasure has partial loss of interdental gingiva
- type III: embrasure has complete loss of interdental gingiva
23
Q
what are dentifrices
A
- paste, powder, gel
- use in conjunction with toothbrush
- cosmetic or therapeutic
- ADA seal of approval
- use for the reduction of plaque (biofilm) dental hypersensitivity
24
Q
what are the components of dentifrices
A
- active ingredient
- water
- abrasive
- humectants: prevent hardening of dentifrice when exposed to air (ex. glycerin, sorbitol, mannitol)
- surfactants: foaming action, lowering surface tension and loosening deposits (sodium lauryl sulfate)
- binders: prevent separation of solids and liquids in dentifrice (cellulose, gums, alginates)
25
what are fluoride dentifrices
- 1950s stannous fluoride
- currently, sodium fluoride or sodium monofluorophosphate and some stannous fluoride
- anticaries effect
- fluoride safety of minor concern
- monitor children for enamel fluorosis
- sodium fluoride gels: root surface caries, 1.1% sodium fluoride (neutracare) prevident 5000
26
what is stannous fluoride
- substantive up to 5 hours: binds to tissues and slowly releases
- tin ion causes staining of teeth (negative effect)
- gel, mouth rinse
27
what are triclosan-containing dentifrices
- triclosan is a phenolic compound
- may reduce certain amounts of VSCs
- antiplaque/antigingivitis properties
- no adverse effects reported
- found in colgate total
- health canada says that triclosan is not a health risk at current levels of exposure and does not cause antimicrobial resistance but may pose a risk to the environment
28
what are maximum amounts of triclosan in mouthwashes? non-prescription drugs? cosmetics?
- mouthwashes: 0.03%
- non-prescription drugs: 1.0%
- 0.3% in cosmetics
29
what are sodium bicarbonate dentifrices
- plaque, gingivitis and stains
- baking soda disintegrates quickly during brushing; abrasive action is not sustained must be careful though
- usually combined with hydrogen peroxide 3%; may irritate gingival tissues
- limited benefits
30
what are tartar control dentifrices
- soluble pyrophosphates
- reduction in supragingival calculus formation (delay mineralization/crystal growth of plaque)
- effectiveness is limited to new supragingival calculus
- effective
31
what are zinc citrate-containing dentifrices
- viadent advanced care
- active ingredient is zinc citrate trihydrate
- antibacterial agent
32
what are herbal dentifrices
- alternative dentifrices
- efficacy remains questionable
- typically no fluoride
33
what is home care for the periodontal patient
- control plaque growth and recolonization after periodontal surgery (chx recommended)
- healing response
- use soft or ultrasoft toothburhs
- don't floss immediately after surgery
- don't brush if a periodontal dressing was placed
- after healing, open interdental spaces require use of interdental brushes and single-tuft brushes
- root hypersensitivity: stannous fluoride, prevident 5000
34
what is implant home care like
- plaque control procedure start immediately after uncovering the implants
- titanium abutment exposed above the soft tissues and small portion just below the gingiva
- prosthetic component (cast framework and tooth replacement materials)
- different home care devices
- manual and powered toothbrushes: soft/ultrasoft tb, different brush head size, soft nylon brush (single-tufted brush)
- interdental devices: interdental brushes, rubber-tip stimulators, floss. use plastic coated brushes
35
what is orthodontic home care like
- specific manual brushes available with the centre tufts removed for easy placement against braces
- floss threader or super floss
- floss fish
- stress importance of home care
- periodontal maintenance schedule
36
adjunctive aids for implant home care
- antimicrobial mouth rinse (chx)
- rinse or apply topically with brush, floss or cotton tipped applicator
- oral irrigation with chx or water: caution patient, don't damage perimucosal seal
- set up maintenance visit schedule
37
what are the effects of improperly using a toothbrush and interdental aids
- hardness of bristles
- angulation of placement
- heavy or ling brushing strokes
- gingival lesions (gingival recession)
- interdental: do not force the device into embrasure
38
how do we treat dentinal hypersensitivity
- treatment included as part of oral home care
- maintaining plaque control is important in reducing sensitivity of exposed root surfaces
- pain and discomfort
39
how do we desensitize
- use air syringe to assess which tooth (root surface) is sensitive
- first recommend use of a desensitizing dentifrice (potassium nitrate)
- correct brushing technique, if needed
- diet control
- if the potassium nitrate is not effective, try stannous fluoride 0.4% gel or rinse (gel-kam), available over the counter without a prescription, or prevident 5000 (1.1% sodium fluoride)
40
what are in office desensitizing treatments
- if patient-applied dentifrices and gels are ineffective, do in-office therapy
- fluoride
- use of bonding agents, varnishes and glass ionomers
