Please enable JavaScript.
Coggle requires JavaScript to display documents.
Ch. 20 Oral Hygiene for the Periodontal Patient :Beyond the Basics. By:…
Ch. 20 Oral Hygiene for the Periodontal Patient :Beyond the Basics.
By: Sandy Rosales Diaz
Ms. McHuen
DHG 220
Definitions of Oral Hygiene Self-Care
AkA oral home care defined by physical therapy for the oral cavity.
Plaque control prevents the potential effects of pathogenic microorganisms on the teeth and periodontium.
Not all bacteria in biofilms are pathogenic. Therefore the purpose of treatment is not to eliminate all bacterial but to control it.
A pt's motivation and behavior is important in the overall treatment plan.
Before coming to the school I thought we had to eliminate all bacteria in the mouth. :star:
Periodontal Disease Control
Subgingival bacteria is derived from supragingival dental plaque.
Subgingival bacteria plays an important role in the progression of periodontal disease.
Patient Education
is one of the most important things a dental Hygienist does.
patient education provides the patient with the necessary skills for the prevention of dental caries and periodontal disease.
A disclosing solution helps show the presence of Supragingival dental plaque.
:star: I had my teeth disclosed here at the school and boy was it a wake up call.
Most common used disclosing agent is Erythrosin. Erythrosin stains newly formed dental plaque.
oral hygiene instructions can be given in person, self-instruction manual, pamphlet, or videotape.
Preventative Measures
Primary goal of prevention is to achieve the lowest plaque level possible. Total elimination is not recommended.
Primary Prevention:
measures that are taken to prevent a disease from occurring in everyone regardless of their susceptibility.
Secondary Prevention:
if patient already has a disease, this prevention stops the disease from progressing.
Mechanical Plaque Control
Regular removal of Dental Biofilm to prevent accumulation.
Disclosing solution can be used by the patient during daily oral care.
Exposing the plaque with tablets or liquid is the first step in evaluation of Biofilm.
Disclosing solution does not show the difference between food and plaque
The red solution does not contain FD&C red #3 or saccharin
Disclosing may not be enough to motivate the patient to clean their teeth, additional visual feedback like photographs may play an important part in health education. ( before and after pics)
:star:I use disclosing tablets for myself and my kids. They like brushing the pink away.
Interdental Care
Gingival embrasures:
Type 1: embrasure completely filled with gingiva, Type 2: slight to moderate recession of interdental papillae, Type 3: complete loss of interdental papillae
Floss and dental tape
Types of floss: waxed, unwaxed, flat, round, color, flavor, shred resistant, and impregnated with fluoride, baking soda and tetrasoium pyrophosphate.
Floss is used for Type 1 embrasures and implants. 80% effective
waxed floss is resistant to tearing but too bulky for tight contacts.
Teflon-coated floss is made of polytetrafluoroethylene. For difficult to reach areas.
Dental TApe is broad and flat and used in open interdental spaces.
Color floss provides the pt's ability to see what is removed by floss.
Tufted dental floss:
stiff straight end, unwaxed section, area of thicker nylon mesh work. Slides under bridges, around abutments, exposed furcation, and in between ortho appliance.
Floss Holder:
for those with limited dexterity.
Floss threaders:
needle like device floss use under pontics and splinted crowns. 12 inches of floss is used
Higher floss frequency among middle aged patients and women.
40% of ppl that report flossing are not doing it correctly.
:star: I have opened contacts in some areas and interdental brushes have changed my life
Oral Hygiene Self-Care Methods
Improve:
plaque control, improves appearance, refreshes breath, and provides a sense of oral cleanliness.
Toothbrushes
Toothbrushes should be recommended on:
tooth brushing methods RX, intraoral characteristics, pt's motivation, manual dexterity, and product cost .
Standard manual brush:
consists of a handle and a head with bristles and/ or filaments.
Handle
may be straight or angled, with or without thumb rest, and/ or have a wave like contour.
Shank:
maybe straight, offset, twisted, or curved.
Head:
diamond Shape, square, round, or different sizes for infants and children.
Bristles:
made from individual filaments and made from
nylon
nylon brushes:
durable, clean, and resist accumulation of bacteria and fungi.
Bristle stiffness:
soft, medium, hard. Soft bristle are recommended. Hard bristles cause gingival recession.
Bristle Planes:
flat, dome, bilevel, rippled, tuft
Brushing with a flat bristle brush removes only 50% of plaque.
end rounded bristles cause less damage to gingival tissue.
Sponge like brush:
disposable polyester, non foaming. Use in nursing homes and for after periodontal surgery.
:star:I used to buy toothbrushes based on how they looked.
Frequency of toothbrushing:
should be done regularly and should be tailored to pt needs.
low risk pt. should brush at least 2xdAY
Average time spent on brushing is 24- 60 seconds. 3 min is recommended
Power Brushes:
sonic and ultrasonic. Effectiveness depends on how it is used. Initially for pt. lacking fine motor skills. Everyone can use them .
Mechanism of action for power brushes:
rapid short strokes in the following directions:reciprocating ( in,out,up , down), rotational, counterroational, oscillaitng ( vibration)
Effectiveness of power brushes :
sonic brushes are better in resolving inflammation and reducing pockets in pt with moderate periodontal disease and removing stains.
Recommending a power brush:
give proper instructions, think bout the cost, require less pressure than manual brushes. It is safe for titanium dental implants.
Tongue cleaning
start in the most posterior part and roll to the tip of the tongue.
:star: Funny to think I just scraped my tongue the wrong way to clean it .
Dentrifrices
Selection is based on cosmetic qualities. They should be effective , stable, and nontoxic.
cosmetic of therapeutic
toothpowder, toothpaste, gel used with a toothbrush
Fluoride, stannous Fluoride, Triclosan containing, sodium bicarbonate, hydrogen peroxide, tartar control, zinc citrate- containing
:star: with such a wide selection of toothpaste I doubt people buy based of the ingredient
Implant homecare:
area specific soft nylon brush for use with individual implants. Antimicrobials help inhibit plaque and gingivitis around implants. Pt should not irrigate at home.
ortho home care:
soft bristle brush, oral rinse, charters method for brushing, use floss threaders.
improper toothbrushing:
leads to acute soft tissue lesions, chronic long standing recession, gingival recession, gingival abrasion.
improper use of interdental devices:
gingival ulcers, cuts and clefts
Dentinal Hypersensitivity:
recommend to use desensitizing agents to assist during cleanings.
Halitosis:
3 categories: genuine, pseudo, halitophobia
:star:I was not aware a phobia existed
volatile sulfur compounds
treatment:
tongue cleaning, oral hygiene and mouth rinse, sodium bicarbonate, triclosan, copolymer, chewing gums
may be caused by xerostomia
pt with halitophobia may need to referred for psychiatric care.