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Chapter 20: Oral Hygiene Self-Care Methods (Introduction: prevention…

- - - - types of gingival embrasure: 1. completely filled with gingiva, 2. slight/moderate recession, 3. extensive/complete loss
      - Dental floss and Tape: waxed, unwaxed, flat, round, colored, flavored, shred resistant, impregnated with FL, baking soda, & tetrasodium
      - Interdental and Sigle-Tuft brushes: exposed furcations, root concavities, type II/III embrasures, distal surface of molars, around pontics, maligned teeth, ortho.
        
        Do not force
      - rubber tip stimulator: Type II/III, remove plaque gingival margin, exposed furcation, concave surfaces, open interdental areas
      - Wooden toothpick: Type II & III embrasures. Used to engage, debride, and dislodge adherent plaque. Not as effective as floss
      - Electric interdental cleaning device: reduce plaque, gingivitis, and bleeding = > floss
    - - Dentifrice tube contamination from shared toothpaste
      - Components
        
        Stannous Fluoride: plaque and gingivitis
        
        Triclosan-containing: phenolic compound antiplaque/antigingivitis
        
        Sodium bicarbonate/hydrogen peroxide: reduction of plaque and gingivitis and stain removal
        
        Fluoride: anticaries
        
        tartar-control: soluble pyrophosphates
        
        zinc citrate: 2% zinc citrate and 0.8% sodium monofluoriophosphate antibacterialand anticaries
        
        others: herbal, natural, xerostomia (lactoperoxidase)
    - - Frequency of toothbrushing: rate of dental plaque, plaque visibility, state and susceptibility of oral disease, diet, and presence of contributory factors. At least 2xday for 2 minutes
      - Powered Toothbrush: sonic & ultrasonic. Effectiveness requires proper brush and bristles placement
        
        Mechanism of Action for Power toothbrushes: Rapid short strokes in combination with different directions such as; reciprocating (in and out, up and down), rotational, counterrotational, or oscillating(vibrational)
        
        Effectiveness: not superior to manual to removing plaque, but it is for stain and calculus
        
        Recommending: Perio patients, limited manual dexterity, ortho pts, and children
      - Manuel Toothbrush: recommendations based on method prescribed, pt's intraoral characteristics, pt motivation, pt's manual dexterity, and cost.
        
        Design
        
        Shank: straight, offset, twisted, curved
        
        Head: diamond shaped, squared, rounded, variable sizes for infants, children, young adults, adults
        
        Handle: straight/angled, double angulation, with/out thumb rest, wavelike contour
        
        Bristles/filaments: nylon, natural, stiffness (soft, medium, hard), planes(flat, dome, bilevel, rippled, and tuft) end-rounded
  - - - Evaluation: Photos for before and after. Showing where plaque accumulates.
  - - - Lesions, gingival recession, hard tissue lesions, cervical abrasions
    - - gingival ulcers, cuts, and clefts
  - - - Patients attitude and commitment to oral hygiene practices
  - - - Dentifrices: can take several weeks to work. needs to sit on teeth for 30 minutes
      - fluorides: stannous fluoride is a topical application as antibacterial and desensitizing agent. Can sting gums and cause staining
    - - Fluorides: Stannous Fl and Sodium Fl,
      - Restorative Materials/Restorations: Methacrylate resins, seal and protect. 6 months relief. Glass ionomer or restoration.
      - Oxalate Salts: Ferric oxalate & Potassium Oxalate are acidic solutions. Block dentin tubules when placed on exposed dentin. Can be brushed off, pt needs to be advised on brushing techniques
    - - Classification of Patient's with halitosis
        
        Treatment
        
        Oral Hygiene and Mouth Rinses
        
        Toothpastes
        
        Tongue Cleaning
        
        Chewing gums
        
        Periodontal/restorative dental tx and xerostomia
        
        Management pseudo-halitosis: psychological specialist
        
        Diagnosis and assessment of oral malodor
        
        Gas Chromatography: a flame photometric detector for diagnosing halitosis
        
        Halimeter: uses an electrochemical gas sensor cell
        
        Self-Assessment: patients incapable of scoring their own odor
        
        Organoleptic Measurement: smelling the patient's breath and assigning a score of oral malodor
        
        Simple Determination of Oral Malodor: scraping tongue with plastic spoon and smelling it later
        
        Psychological Assessment: established questionaire
        
        Tongue Sulfide Probe: a probe applied to the tongue and it senses sulfide
        
        OTC: tongue scrapers, mouth fresheners, oral sprays, and gels
        
        Genuine halitosis
        
        pathologic halitosis
        
        oral halitosis
        
        extraoral halitosis
        
        Physiologic halitosis
        
        Psychosomatic conditions: patients complain of bad breath but others don't smell it. Need therapy
        
        pseudo-halitosis
        
        Halitophobia