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PD Ch7Prevention of biofilm accumulation:Mechanical approaches…
PD Ch7Prevention of biofilm accumulation:Mechanical approaches
Background
is the removal of microbial plaque and the prevention of accumulation on the teeth and adjacent gingival surface by the use of toothbrush and other mechanical hygiene aids
very critical in every phase of therapy that plaque control must be maintained
Is the most important predictive factor in determining the overall prognosis of the therapy
effective way of treating and preventing
gingivitis
caries
periodontitis
Introduction
When plaque control was initiated, the gingivitis was reversed (by means of efficient plaque control, i.e., brushing and flossing) to clinical gingival health
Removal of microbial plaque leads to
cessation of gingival inflammation
cessation of plaque control measure leads to recurrence of inflammation
plaque was allowed to accumulate, gingivitis developed within 21 days
removal of plaque also decreased the rate of formation of calculus. (Sanders , 1962)
cause and effect relationship between supra-gingival plaque and gingivitis was demonstrated by Loe and colleagues in 1965.
liminating the plaque is the key to prevent the
occurrence of periodontal disease and caries
halting the progression of the disease.
Plaque formation
first develops in molars, premolar areas
Second followed by proximal surfaces of the anterior teeth, and the buccal surfaces of molars and premolars
Objective of mechanical plaque control
Removal of dental plaque with a minimum of effort, time, and devices, using the simplest methods possible
According to American Dental Association Council on Dental Therapeutics ‘The toothbrush is designed primarily to promote cleanliness of teeth & oral cavity
Objective
To clean teeth and interproximal spaces of food, debris & stains
To prevent plaque formation.
To disturb and remove plaque.
To stimulate and massage gingival tissues.
To clean the tongue.
Halitosis control
Sanitation of oral cavity
Types of mechanical plaque control
Dentifrice潔牙劑
Interdental cleaning aids
toothpick
inter proximal brush(proxy-brush)
Interdental brushes are conical圓錐形 shape brushes made of bristles mounted on a handle, single tufted brushes, or small conical brushes.
They are suitable for cleaning large, irregular, or concave tooth surfaces adjacent to wide interdental spaces.
They are inserted interproximally and are activated with short back and forward strokes in between the teeth.
dental floss
most widely recommend
floss is wrapped around each proximal surface and is activated with repeated up and down stroke.
should pass gently through the contact area. Do not snap the floss pass the contact area as it may injure the papilla.
Types of floss
Unwaxed
Waxed
contained wax to facilitate passing the floss the floss through the contact and alleviate fraying減輕磨損
Taped floss
contain cris-scross fibers and eliminate wearing.縱橫交錯的纖維,消除磨損
PTFE floss(Glide floss)
teflon鐵氟龍 floss which allow passing through very tight contact easily without fraying.
Superfloss
web-like material which improved proximal cleaning efficiency.
Wong and Wade in 1985 compared the effectiveness of super floss and waxed dental floss as proximal surface cleansing agent in 34 subject.
Super floss was found to be superior (50%) to waxed dental floss (45%) in removing proximal plaque but neither was 100% effective.發現在去除近端牙菌斑方面，超級牙線優於蠟狀牙線（45％），但都不是100％有效。
Background
Any toothbrush, regardless of the brushing method, does not completely remove interdental plaque. Even for patients with wide-open dental embrasures. (Gjermo 1970, Schmid 1976).
The majority of dental and periodontal diseases originate in interproximal area; interdental plaque removal is necessary
Tissue destruction associated with periodontal disease often leaves large, open spaces, between teeth and exposed roots with anatomic concavities and furcation which are difficult to clean and access with the toothbrush.
The purpose of interdental cleaning aids is to remove plaque, not to dislodge food wedged between teeth.
Toothbrush
Sonica toothbrush
aids in stain removal as well as disruption of the bacterial cell wall (bactericidal).
produce high frequency vibrations (1.6MHz) which leads to the phenomenon of cavitation渦凹 and acoustic microstreaming.微流
Ionic toothbrush
It change the surface charge of a tooth by an influx of positively charged ions
The plaque with a similar charge is thus repelled排斥 from the tooth surface & is attracted by the negatively charged brush.帶有類似電荷的牙菌斑因此從牙齒表面被排斥，並被牙齒表面吸引。
帶負電的刷子
Oral irrigation
Oral irrigation devices include the use of water picks.
The high pressure, pulsating stream of water through a nozzle is directed to the tooth surface and subgingival, washing away debris and plaque containing bacteria.
They are helpful surrounding orthodontic appliance, and when used as an adjunctive treatment in shallow pocket depth.
Patients require antibiotic pre- medication should not use oral irrigation.
removing food only, not the plaque
When used as adjuncts to toothbrushing , irrigation devises, can have a beneficial effect on periodontal health by reducing the accumulation of plaque and calculus and decreasing inflammation and pocket depth.( Robinson and Hoover, 1971)
Toothbrush
Charateristic
Conforms to individual patient requirements in size, shape & texture.
Easily & efficiently manipulated.
Impervious to moisture防潮 ; readily cleaned & aerated.
Durable耐用 & Inexpensive.
Has prime functional properties of flexibility, softness, & of strength, rigidity & lightness of the handle.
Is designed for utility, efficiency & cleanliness.
Parts
Handle
The part grasped in the hand during tooth brushing.
Head
The working end of a tooth brush that holds the bristle or filaments.
Tufts
Clusters of bristles or filaments secured into the head.
Brushing plane
The surface formed by the free ends of the
bristles or filaments.
Shank
The section that connects head and handle.
The toothbrush
Background
Soft, nylon bristle toothbrush clean effectively
Soft bristle are more flexible, clean beneath the gingival margin, and reach farther into the proximal tooth surfaces.
Soft toothbrush is atraumatic
eliminates the risk for gingival recession, tooth surface abrasion (classical wedge shape defect in the cervical area of root
eliminate trauma to soft tissue
history of the toothbrush
William Addis – The Inventor (1780)
H. N. Wadsworth - 1857 – First person to patent專利 the toothbrush
DuPont de Nemours-24 FEB, 1938 – First nylon bristle toothbrush.
The first electric toothbrush, the Broxodent, was invented in Switzerland in 1954
Selection
• Ability of the patient
• Manual dexterity of the patient
• Age of the patient
• Size & Shape
brush soft
head small
• Professional personnel
• Clinicalsituation/disease
Negative toothbrush
Toothbrushes need to be replaced every 3-6 months
Trauma
The use of hard toothbrush , vigorous horizontal brushing, the use of extremely abrasive dentifrices may lead to cervical abrasion of teeth and recession of the gingiva (Jepson ,1998).
Changes in the Gingival Contour
Gingival Recession
How to brush
Method
Patient instructed to stroke each area ten time and spend 10 seconds per area then move on to next area.
Time : 2 minutes ( 30 sec per quadrant )
BUCCAL--> LINGUAL --> OCCLUSAL (last surface to brush)
start with molar region
look at the ppt page22
Different tecnique
the Bass method, (Bass 1931)
method often recommended is the Bass technique because it emphasise sulcular placement of the bristles.
method
Bristle placement
Apical towards gingival into sulcus at 450 to tooth surface
Motion
Rotation or back-forward vibratory motion while bristles remain in sulcus
Advantage/disadvantage
Cervical plaque removal
Easily learned
Good gingival stimulation
cleaning cervical, treat gingivitis
Stillman
method
Bristle placement
On buccal and lingual, apically at an oblique angle to long axis of tooth.
Ends rest on gingiva and cervical part.
Motion
On buccal and lingual slight rotary motions with bristle ends stationary
Advantage/disadvantage
Excellent gingival stimulation
Moderate dexterity required
Moderate cleaning of interproximal area
the Charters method (Carter’s 1948)
use in
Crown
Bridge
Orthodontics
Method
Bristle placement
Coronally 45o, sides of bristles half on teeth and half of gingiva
Motion
Small circular motions with apical movements towards gingival margin
Advantage/disadvantage
Hard to learn Clean interproximal
Gingival stimulation
Fones
For children of patient doesn’t follow other method
Method
Bristle placement
Perpendicular to the tooth
Motion
With teeth in occlusions, move brush in rotary motion over both arches and gingival margin
Advantage/disadvantage
Easy to learn
Interproximal not cleaned
May cause trauma
Rolling
Easy
Can use with Fones
Methods
Motion
On buccal and lingual inward pressure, then rolling of head to sweep bristle over gingiva & tooth
Advantage/disadvantage
Doesn't clean sulcus area
good gingival stimulation
Easy to learn
Bristle placement
Apically, parallel to tooth and then over tooth surface
Scrub
Method
Bristle placement
Horizontal on gingival margin
Motion
Scrub in anterior position direction keeping brush horizontal
Advantage/disadvantage
Easy to learn & best suited fro children
the modified Stillman method (Stillman 1932)
Method
Bristle placement
Pointing apically at and angle of 45o to tooth surface
Motion
Apply pressure as in Stillmans's method but vibrate brush and also move occlusally
Advantage/disadvantage
Easy to master Gingival stimulation
stimulating brushing technique
for gingival recession(stimulate the gingival tissue)
brush almost to the vestibular--> roll
Clinical controlled studied evaluating the most common brushing technique have shown that all methods perform the same.
Dentists must be aware that a plaque control devices should be tailored to the individual, similarly to his or her plaque control program.
Power -assisted or electric toothbrush
Indication
Ineffective manual biofilm removal techniques
Reduce calculus & stain build-up
Undergoing orthodontic treatment
Aggressive brushers
Patients with disabilities or limited dexterity靈巧
Patients unable to brush
Advantage
It increases patient motivation resulting in better patient compliance.
Increased accessibility in interproximal and lingual tooth surface
No specific brushing technique required
Uses less brushing force than manual toothbrushes
Brushing timer is incorporated in some brushes to help the patient in brushing for the required duration.
The heads of these toothbrushes oscillate in a side to side motion or in rotary motion. The frequency of the oscillations is around 40Hz in an ordinary powered toothbrush
How to clean toothbrush
Clean thoroughly after each use.
Hold brush under strong stream of warm water to remove particles of dentifrice and bacteria from between the filaments.
Tap the handle on the edge of sink.
Use one toothbrush to clean another brush.
Rinse completely & tap out excess water or disinfectant.
Toothbrush storage
Open air – upright position, apart from contact with other brushes.
Portable brush containers – with sufficient holes.
At least 6 feet away from the toilet.