Mechanical and Chemotherapeutic Home Oral Hygiene

o o

Aid in access to oral cavity Facilitates childs grip of hadle

When is the best time to replace your toothbrush? 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 Answer: when it appears well worn. Some children chew their brushes.

Manual toothbrush Most common method for removing plaque Variable o Bristle material o 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) Floss Tooth brushing alone cannot remove plaque from all tooth surfaces, especially the interproximal plaque. Types of floss Flavoured and unflavored Waxed and unwaxed

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 o Decreased gingival tissue trauma. Increased interproximal cleaning ability

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

o o o o

Erythrosine Basic fuchsin Fast green 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)

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 lack manual 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 -

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.

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 36 months and to use small pea-sized amount of toothpaste

Disclosing Agents Allow visualization of plaque Compostion o Iodine o Gentian violet

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 the bristles 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.

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 Dentrifices o 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

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. 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. Floss is manipulated into C shape around 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.

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 marrow transplantation o Antibacterial effects: Binding well to bacterial cell membrane Increasing their permeability Initiating leakage Precipitating intracellular components

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.

 o Form

Decrease levels of streptococcus mutans

Rinse, spray, varnish, gel in flossing 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

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 tooth erupts 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 risk for 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 ageappropriate language o Positive reassurance, not critical o let me show you how to improve rather than saying youre doing it all wrong o Recare intervals should be personalized with patients needs

Flossing

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.

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.

Step 3 How to floss your teeth 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 1 Take a length of floss equal to the distance from your hand to your shoulder. Step 4 Brush your teeth after you floss - it is a more effective method of preventing tooth decay and gum disease.

Wrap it around your index and middle fingers, leaving about two inches between your hands. 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.

Try another type of floss or dental tape. Ask your dentist or dental hygienist for advice. If your floss still shreds, see your dentist.

Step 3 Don't rush your brush. A thorough brushing should take at least two to three minutes. Try timing yourself.

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. Step 4 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. Change your usual brushing pattern. Most people brush their teeth the same way all the time. That means they miss the same spots all the time. Try reversing your usual pattern.

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 a gentle, circular, massaging motion, up and down. Don't scrub. Gums that recede visibly are often a result of years of brushing too hard. 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.

Step 2 Clean every surface of every tooth. The chewing surface, the cheek side, and the tongue side.