plaque control: toothbrushing and interdental cleaners Flashcards

Question

what are the contraindications for toothbrushes?

Answer 1

The use of a hard bristled toothbrush , vigorous horizontal brushing and the use of a very abrasive dentifrice, may lead to cervical abrasion of teeth and recession of gingiva.

Answer 2

``` Purpose: Reduces number of microorganisms Slows biofilm formation Reduces potential for halitosis Contributes to total mouth cleanliness ```

Answer 3

Extrude the tongue Place head of toothbrush on the midline of the tongue The sides of the filaments are placed on the posterior of the tongue The filament tips are directed toward the throat Use light pressure and draw the brush forward toward the tip of the tongue Repeat 3-4 X Do NOT scrub the papillae **NOTE: Gagging can be a problem

Answer 4

Made of plastic, rubber, stainless steel or other flexible metals May be curved, raised, textured Position the cleaner toward the most posterior area of the tongue surface Pull forward, using a light but firm stroke Cover the entire surface of the tongue Repeat several times Rinse tongue cleaner under running water

Answer 5

Tooth brushing does not remove biofilm on proximal surfaces Interdental cleaning is essential for a patient’s self care program Things to consider: History of patient’s oral care-what are they currently using for self care Position of the teeth Shape of embrasures Probing depths Fixed or removable prostheses Personal factors e.g. disability/handicap that limit ability to perform self care

Answer 6

Types of Floss: Waxed -slides easily through contact points, less shredding Unwaxed –thinner-better for tight contact points, tends to shred Tape-wider ribbon, easier to grasp Tufted floss e.g. super floss or NUFloss-for wide embrasures, abutment teeth, under pontics of a fixed bridge, ortho appliances

Answer 7

Best results are obtained before brushing When flossing is accomplished first, biofilm is removed Fluoride from a dentifrice used while brushing reaches the proximal surfaces=dental caries prevention If brushing occurs before flossing, patient may not have time to floss or may feel mouth is clean and that flossing is not necessary

Answer 8

Use approx. 18” of floss Wrap loosely around middle finger Firmly grasp ½” of floss between the fingertips Tuck excess floss in the palm of the hand For maxillary teeth: hold floss between thumb + index finger For mandibular teeth: direct floss down by holding the index fingers on top of the floss Guide the floss between the contact points using a controlled, short sawing motion- do NOT snap the floss between the contact points onto the gingiva Curve the floss around the tooth in a “C” shape Press the floss firmly against the tooth Slide the floss up and down the side of 1 tooth, moving gently beneath the gingiva Move the floss to the top of the papilla and reposition the floss on the next tooth Remove the floss by using the same controlled, short sawing motion or unwrap the floss from the fingers and pull through the teeth Slide to a new, unused portion of floss for succeeding proximal surfaces

Answer 9

Occur on facial/lingual surfaces Appear as straight-line cuts from the gingival margin ``` Caused by: Using a piece of floss that is too long Snapping the floss through the contact Not curving the floss around the teeth Holding the floss straight Using undue pressure ```

Answer 10

Floss Threader-threads floss under ortho appliances, fixed bridges Floss Holder/Floss Wand/Floss Picks-patient with disability Knitting Yarn-distals of posterior teeth, isolated teeth, diastemas, abutments/pontics of fixed bridges Gauze Strip-proximal surfaces of widely spaced teeth, teeth next to edentulous areas, abutments of fixed bridges, under a cantilevered bridge

Answer 11

``` Under bridges (abutments) small diastemas orthodontic flossing furcation Type III (through and through) Dental implants ```

Answer 12

A uni-tuft , firm bristled brush angled for “outside” (buccal) and “inside” (lingual) Tips are replaceable Used for cleaning the gingival margin and sulcus Ideal for ortho appliances, crowns, bridges, dental implants Travel size available Place the angled tuft on the distal surface of the last tooth The tip should be 1-2 mm beneath gingival margin Follow the outline of the gingival margin Add a circular motion in-between the teeth Use the end labeled “outside” for all buccal surfaces and for lingual posterior Use the end labeled “inside” for maxillary and mandibular anterior lingual

Answer 13

Flexible rubber tip attached to a handle or to the end of a toothbrush handle Removes biofilm at and below gingival margin Trace the tip along the gingival margin Tip should be positioned 1-2 mm beneath the margin For proximal surfaces-rub the tip against the teeth, moving it in & out of the embrasure and under the contact point

Answer 14

Known as a Perio-Aid Round toothpick is inserted into a plastic handle with contra-angled ends Used for patients with periodontitis-removes biofilm at & under gingival margin, interdental cleaning, concave proximal surfaces, exposed furcations Insert round, tapered toothpick into end of holder Break off the long end of the toothpick cleanly so that there are no sharp edges Apply toothpick slightly under the gingival margin at a slant Using moderate pressure, outline the gingival margin around each tooth

Answer 15

For cleaning proximal surfaces where tooth surfaces are exposed & interdental gingiva are missing Made of basswood or birch wood Triangular cross-section Instruct patient to use a fulcrum on cheek/chin Soften pointed end by placing in mouth & moisten with saliva Insert the flat base of the triangle on the gingival side Clean the tooth surface by moving the wedge in & out Apply moderate pressure

Answer 16

76 soft rubber bristles in a wire-free, tapered design Safe for crowns, bridges, dental implants, orthodontic appliances Difficult to access lingual surfaces Used like a toothpick

Answer 17

A home care device that delivers a pulsating or steady stream of water/therapeutic agent Used to remove loosely attached supragingival and subgingival biofilm Reduces gingivitis and bleeding Provides subgingival delivery of antimicrobial agents Variety of tips available-monojet, soft rubber tip, cannula

Answer 18

Fill reservoir with lukewarm water Insert tip-tapered plastic tip is designed to be placed at the gingival margin Adjust pressure to lowest setting for first time use Lean over sink and place tip in mouth, directing the tip at the teeth turn it on Direct tip at 90 degree < to gum line Slightly close lips to avoid splashing, but still allow water to flow from mouth into sink Start in molar region working to the front teeth Glide tip along gum line, pausing between teeth Gradually increase the pressure over a period of time-i.e. 1 notch every 2 weeks

Answer 19

Soft rubber tip is designed to be placed 2 mm below gingival margin

Answer 20

Substance applied with a toothbrush for the removal of food debris, biofilm, stain from the gingiva and tooth surfaces Variety of active ingredients to help prevent caries, sensitivity, biofilm, gingivitis, calculus formation and halitosis

Answer 21

anti-biogilm/anti-gingivits - triclosan, zinc citrate, stannous fluoride anti-calculus - Pyrophosphate salts, zinc chloride, zinc citrate, Triclosan, Sodium Hexametaphosphate de-sensitizer - Potassium Nitrate, Strontium Chloride, Stannous Fluoride malodour - Chlorine Dioxide, Essential Oils, Zinc Chloride, Triclosan

Answer 22

Anti-biofilm/Anti-gingivitis (Triclosan) E.g. Colgate Total Anti-calculus (Disodium Pyrophosphate) E.g. Crest Tartar Control Desensitizer (Potassium Nitrate) E.g. Sensodyne Malodour (Chlorine Dioxide) E.g. CloSYS Xerostomia (Enzymes/Fluoride) E.g. Biotene

Answer 23

``` Formulated for a variety of oral benefits: Mouth freshening Caries prevention Control biofilm Contol oral malodour ``` Classified as: preventive, cosmetic, therapeutic

Answer 24

FLUORIDE-stannous or sodium fluoride e.g. Crest Pro-Health Complete dental caries prevention reduce hypersensitivity reduce gingivitis Disadvantage: stannous fluoride may stain teeth CHLORHEXIDINE (CHX) e.g. Peridex Pre-procedural rinse to reduce bacterial aerosols Before, during & after perio debridement Post-surgery wound healing CHLORHEXIDINE (CHX) Disadvantages: staining of teeth, pits & fissures may cause an increase in supragingival calculus altered taste perception interacts with & is inactivated by the toothpaste ingredient sodium lauryl sulfate when occurs immediately after brushing **must wait 30 min after brushing before rinsing with CHX TRICLOSAN e.g. Colgate Total Reduces biofilm and biofilm accumulation Reduces gingivitis Reduces supragingival calculus formation PHENOL-RELATED ESSENTIAL OILS e.g. Listerine Reduces biofilm Reduces gingivitis ``` PHENOLIC-RELATED ESSENTIAL OILS Disadvantages: Burning sensation Bitter taste Contraindicated for current/recovering alcoholics due to alcohol content ``` ``` QUATERNARY AMMONIUM COMPOUNDS e.g. Cepacol, Scope Disadvantages: Staining of teeth Increased supragingival calculus Burning sensation/desquamation ``` OXYGENATING AGENTS- 1.5% hydrogen peroxide or 10% carbamide peroxide Debriding agent Recommended for short-term use to reduce symptoms of ANUG & pericoronitis e.g. amosan, Colgate Peroxyl OXIDIZING AGENTS-chlorine dioxide e.g. Crest 3D White Short-term use to control oral malodour-cosmetic

Answer 25

BIRTH -1ST TOOTH ERUPTION -parents should clean child’s gums with a soft cloth + H2O or finger brush ERUPTION OF 1ST TOOTH -start brushing 2X/day with a soft, infant toothbrush and a non-fluoridated child toothpaste 2-5 YEAR OLDS -parents should dispense a “pea-sized” amount of a fluoridated toothpaste and perform/assist the child with brushing

Answer 26

Plaque forms on natural teeth and partial denture surfaces Partial dentures need to be brushed/cleaned as well Toothbrushing and interdental cleaning must be emphasized around abutment teeth

Answer 27

Tissue under denture must be cared for: Remove denture daily Stimulate tissue with soft toothbrush or a facecloth Any deposit that can form on natural teeth can also form on denture surfaces. Immersion will not remove plaque, still requires mechanical friction

Answer 28

Use caution not to scratch titanium on implant. No sulcus but plaque and calculus can form. WHAT YOU CAN RECOMMEND TO YOUR IMPLANT PATIENTS FOR HOME CARE: Dental tape or tufted floss e.g. Superfloss Nylon coated interdental brushes (no metal wire) e.g. Proxabrush Sulcabrush Rubber tip stimulator Perio-aid Soft picks Water irrigator e.g. waterpik

Answer 29

FLOSSING TECHNIQUE FOR AN IMPLANT: Insert dental tape or Superfloss on both sides (mesial/distal) of the implant. Wrap the floss around the implant and crisscross in front. Move floss in a sawing or shoe-shine motion.

Answer 30

``` Complicating factors: Age Hormonal imbalances Exaggerated gingival response to local irritants Gingival enlargement Position of the teeth Problems with the appliances Self-care is difficult and tedious ```

Answer 31

Power brushes a very effective Select a brush with bi-level filaments i.e. middle row is shorter so that it can be applied directly over the brackets ``` Insert brush above, over, and below brackets Additional recommendations: floss threader, interdental brushes, sulcabrush, rubber tip, oral irrigation ```

Answer 32

XERSTOMIA: -dryness of the mouth caused by a lack of normal secretions ``` CAUSES: Pharmacologically induced-side effect Sjogren’s syndrome Surgical removal of salivary glands Radiation treatment to head/neck ``` USE OF A SALIVA SUBSTITUTE -preparation with chemical/physical properties similar to saliva -contains CMC-carboxymethycellulose and the minerals calcium, phosphorous & fluoride Instruct patient to place a small amount in their mouth Distribute the solution over all surfaces with the tongue Use as needed for comfort

Answer 33

Dietary survey may be needed Explain the relationship between plaque, sucrose and dental caries Fluoride in toothpastes, rinses, professional applications important e.g. PreviDent toothpaste

Answer 34

Is a liquid/tablet preparation containing dye | Used to identify biofilm deposits for evaluation/instruction

Answer 35

SOLUTION: Gingival tissue examination must be completed before disclosing agent is applied because disclosing agents mask tissue colours Apply lubricant to lips to prevent staining Retract the lips/cheek/tongue, and dry teeth with compressed air Use a cotton tip applicator & generously paint the crowns of the teeth with the solution Rinse mouth with 3-way syringe/suction RINSE: Place a few drops of concentrated disclosing agent in a paper cup and dilute with water Instruct the patient to rinse/swish the solution over the teeth TABLET: Instruct patient to chew ½-1 tablet and swish the dissolved solution for 30-60 seconds, covering the teeth Rinse with water