Interdental care Flashcards
(39 cards)
1
Q
purpose of interdental care:
A
- remove plaque and debris from sulcus and interproximal areas
- polishes tooth and massages papilla
- identify calculus/overhangs
- prevents 2 major oral diseases
- deliver chemotherapeutic agents
- contributes to general oral health and decreases halitosis
2
Q
interdental area types
A
- type 1: normal papilla fills space
- type 2: slight to moderate recession of papilla
- type 3: extensive recession or complete loss of interdental papilla
3
Q
anatomy of the interdental area
A
- posterior teeth
- anterior teeth
- epithelium
4
Q
posterior and anterior papilla
A
- two interdental papilla: one facial and one lingual
- they are connected by a col, a concave area that follows the shape of the contact area
- on anterior teeth, there is a single papilla with a pyramid shape
5
Q
epithelium
A
- the epithelium covering a col is thin non-keratinized
- col is less resistant to infection
- as inflammation increases, the col gets deeper
- most gingival diseases begin in the col area
- incidence of gingivitis is greatest in the interdental tissues
6
Q
interdental proximal tooth surfaces
A
- with bacterial infection and loss of gingival attachment, the interdental papillae are reduced in height
- proximal tooth surfaces become exposed
- dental biofilm can accumulate
- irregularities of tooth position, such as rotation or overlapping, and deviations related to malocclusion or tooth loss may be present
- easy access for removal of bacterial deposits by the individual is prevented
- root surface morphology of the proximal surfaces is typical for each tooth type
- concavities and grooves are predisposed to bacterial accumulations
- with advanced periodontitis, furcation areas of maxillary first premolars and molars open onto the proximal surfaces
7
Q
patient assessments:
A
- history of personal oral care: types of brush and floss used, frequency and time of use, patient priorities (subjective)
- dental and gingival anatomy (position of teeth, shapes of embrasures, probing depths, prostheses, areas where tooth brush can’t reach
- extent and location of dental biofilm: plaque score
- personal factors: motivation and ability
8
Q
hygiene care:
A
- select appropriate aids for each patient’s needs
- teach the correct system
- motivate patient to accept responsibility
9
Q
initial care plan for patients:
A
- keep is simple silly (KISS)
- minimal frequency ie once per day
- keep oral regime at a realistic level
- as the patient’s priorities change a more refined program can be introduced
- avoid the dental aid BOUQUET
10
Q
selective interdental biofilm removal: relation to toothbrushing
A
- vibratory and sulcular toothbrushing, such as that performed with the charters, sillman and bass methods, can be successful to some degree in removing dental biofilm near the line angles of the facial and lingual or palatal embrasures
- brush in vertical position is effective for additional access around the line angles onto the proximal surfaces
11
Q
selection of interdental aids
A
- dependent on oral helth, disease status and the risk for future recurrence
- a patient working to control or arrect disease may need more frequent self-care than the patient who is practicing prevention
- more than the toothbrush is needed for complete biofilm removal from exposed proximal tooth surfaces
- dental floss, interdental brushes, and other aids are described in this chapter
12
Q
floss
A
- no difference between waxed or unwaxed research proven. it is technique and patient preference that contributes to compliance and effectiveness
- floss is round dental tape is flat
- floss vs tape
13
Q
types of floss:
A
- materials: silk, nylon and expandable. features of waxed or expanded PTFE
- features of unwaxed
- enhancements: colour and flavour (fluoride and whitening agents also but limited research as to effectiveness)
14
Q
unwaxed floss
A
- thinnest
- filaments spread, increase removal
- shreads easily
- will not leave wax behind (fluoride uptake)
15
Q
waxed and polyfluroethylene
A
- slide in tight contacts
- good if overhangs or sensitive tissue
- good for rubber dam placement
- dental tape - good for large embrasures or spacing
- glide: shred proof
- satin floss
16
Q
tufted dental floss
A
description
- single, precut lengths super floss
- roll
indications for use
- biofilm removal from tooth surfaces adjacent to wide embrasures where interdental papillae have been lost
- biofilm removal from mesial and distal abutments and under pontic of a fixed partial denture or orthodontic appliance
- variable diameter/tufted: very effective (superfloss), 3 segments all attached, 1/3 waxed, 1/3 nylon meshwork/braided (spongy), 1/3 nylon ‘needle’, - for fixed prosth and ortho
17
Q
procedure for flossing
A
- when to floss
- floss preparation
- application
- insertion
- cleaning stroke
- additional suggestions
18
Q
precautions for flossing
A
- pressure in col area
- prevention of floss cuts and floss clefts
- aid for flossing (floss holder or floss picks can help)
19
Q
methods for flossing
A
- most difficult daily activity
- requires coordination, manipulation of floss in a very small space
- two main types: spool and loop
20
Q
spool flossing
A
suited for teenagers and adults
- 18 inches of floss
- most floss around middle and/or ring finger
- no floss wrapped on index finger
- 1 inch of floss between hands
- for max anterior teeth floss guided mainly with thumb and finger
- mand anterior teeth index fingers guide
- posterior teeth floss guided mainly with 2 index fingers
21
Q
loop flossing
A
- 18 inches long floss
- tie into a circle
- all fingers loop except thumb
- guided same as spool: anterior guided with thumbs sometimes index finger also, posterior with index fingers
22
Q
how to floss
A
- anterior: one hand behind the other
- posterior: hands beside each other
- ‘see saw’ through the contact - watch not to snap the floss
- wrap around tooth in a C shape, keep floss on tooth at all times
- move floss apically into sulcus
- until you reach resistance
- then up and down for 5-6 times
- repeat procedure on each side of the contact area - mesial/distal
- change 1 ince of floss when soiled
- helps if sequence is developed
- do posterior first
23
Q
floss aids:
A
- usually Y-shaped devices
- same method
0 more difficult to get subgingivally and adapt C shape
recommended for: - lack of dexterity
- large hands/small jaw or TMJ disorders
- gag, low motivation
- hand fetish
24
Q
how can we assess to determine if a patient is flossing correctly:
A
- effectiveness: extent to which plaque is removed
- safety: damage to oral tissues
25
common errors in flossing:
- no c shape around tooth - floss not tight
- back and forth motion
- wrapped around index fingers and/or thumbs
- too long a piece between hands
26
gingival signs of incorrect flossing
- cuts on the gingiva
- clefts in the gingiva - see flossing scars
- patient complains of pain during flossing
27
bleeding during flossing
- most bleeding is caused by disease - not damage!!!
- without flossing infection will occur in IP areas. because of infection bleeding will be caused when cleaned by floss
- very important concept to understand
- in general, bleeding = disease
28
what is bacteremia?
- bacteria in the blood stream
- may happen with infrequent flossing and poor oral hygiene
- concern for medically compromised patients, ie. heart disease, valve replacement, rheumatic fever, joint replacements, etc...
29
floss and children
- good habits start early
- parents responsible before 8 years of age
- primary teeth that have a lot of spacing limit the need for daily flossing
30
flossing methods for children
- start with the loop method due to lack of dexterity
| - floss pics work well, to begin the habit of flossing... parents will need to monitor and help
31
gauze strips
indications for use
- for proximal surfaces of widely spaced teeth. gauze is too thick to pass through tight contact areas
- for surfaces of teeth next to edentulous areas
- for distal and mesial surfaces of abutment teeth
- for areas under posterior cantilevered section of a fixed appliance, such as the distal portion of a denture supported by implants
32
sulcus brush
- two rows of bristles
- aim is for gingival access
- for perio patients
33
types of interdental brushes used for...
- for removal of dental biofilm and debris
| - for application of chemotherapeutic agents
34
indications for use of interdental brushes
- select brush of appropriate diameter
| - moisten the brush and insert at an angle in keeping with gingival form; brush in and out
35
procedure for use of interdental brushes
- select a brush head (shape) for appropriate embrasure space
- moisten brush head and insert moving in and out, keep moving gingival contour
36
why should we clean our brushes? how can we do this? when should we discard our toothbrushes?
- to remove debris and biofilm
- hold under actively running water
- clean thoroughly after use and dry in open air
- discard when filaments become loose or deformed
37
single tuft toothbrushes
```
indications for use
- for open interproximal areas
- for fixed dental prostheses
- for difficult-to-reach areas
procedure
- direct the end of the tuft into the interproximal area and along the gingival margin
- combine a rotating motion with intermittent pressure
- use a sulcular brushing stroke
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38
interdental tip
composition and design:
- flexible rubber tip adaptable to interdental area
indications for use:
- for cleaning debris from the interdental area and for removal of biofilm by rubbing the exposed tooth surfaces
- for biofilm removal at and just below the gingival margin
procedure:
- trace along the gingival margin with the tip positioned just beneath the margin
- for additional cleaning of the proximal surfaces of the teeth. rub the tip against the teeth as it is moved in and out of an embrasure and under a contact area
- rinse the tip as indicated during use to remove debris, and wash thoroughly at the finish
39
wooden interdental cleaner
description:
- wood bass wood or birch wood, 2 inches long tirangular in cross section
indications for use:
- application: for die hard toothpick users with open large embrasure spaces
- limitation. only those that can do it well, and change stimudent for each arch or quad as wood may splay
procedure:
- fulcrum
- preparation
- directions
