DH102 Clinic II OHI & Products Lisa Mayo, RDH, BSDH Concorde Career College
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Lisa Mayo, RDH, BSDH Concorde Career College. 1.Discuss dentifrice 2.Discuss toothrbushing and technique 3.Discuss interdental care 4.Present advantages.
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Slide 1
Lisa Mayo, RDH, BSDH Concorde Career College
Slide 2
Slide 3
1.Discuss dentifrice 2.Discuss toothrbushing and technique
3.Discuss interdental care 4.Present advantages to tongue cleaning
5.Discuss oral irrigators 6.Present mouthrinse options 7.Discuss
fluoride Goals for Today
Slide 4
Slide 5
#1: Dentifrice
Slide 6
Prevention of dental caries: Remineralization Reduction of
biofilm 1.Triclosan: reduces gingival inflammation Colgate has the
patent on triclosan substantivity of fluoride 2.Zinc citrate
3.Stannous fluoride Dentifrices
Slide 7
Slide 8
Which of the following is the primary agent that has shown
efficacy in reducing gingival inflammation? A) Xylitol B) Triclosan
C) Zinc citrate D) Stannous fluoride Review
Slide 9
B) Triclosan is the correct answer. Triclosan is the primary
agent for reducing gingival inflammation. Xylitol is a flavoring
agent in some dentifrices that has been shown to provide anticaries
benefits. Zinc citrate and stannous fluoride are agents used to
reduce biofilm formation. Answer
Which of the following ingredient in a dentifrice would a
dental hygienist recommend to a client struggling to minimize
supragingival calculus formation? a.Potassium nitrate
b.Pyrophosphate c.Hydrogen peroxide d.Triclosan NBQ
Slide 15
Which of the following ingredient in a dentifrice would a
dental hygienist recommend to a client struggling to minimize
supragingival calculus formation? a.Potassium nitrate dentinal
hypersensitivity b.Pyrophosphate calcium phosphate bond in calculus
matrix a.Hydrogen peroxide staining b.Triclosan antigingivitis
NBQ
Slide 16
#2: Toothbrushing
Slide 17
Bristles and Filaments Most tb today are Nylon Natural
bristles: unsanitary Factors influencing stiffness Depends on
diameter and length of the filament Diameter: thinner = softer and
more resilient Length: shorter are stiffer and less flexible Angle
of filaments: more angled = more flexible and less stiff
End-rounding : each nylon filament is sealed and rounded by heat
treatment
Slide 18
Power Toothbrushes: Description Motion Entire brush head moves
as a unit in one type of motion Groups of tufts on the same brush
head may move differently Entire brush head moves as a unit, but in
different, yet simultaneous motions Different-shaped brush heads
move separately, and in different, yet simultaneous motions Speeds:
low to high Battery: slower Rechargeable: 3,800-40,000 movements
per min
Slide 19
Power Toothbrushes: Description Brush head design Adult : Small
and round, conical, or like traditional manual heads Child:
Designed for smaller mouth, slower movement Interdental: D esigned
to fit a standard power brush handle and are similar in shape to
manual interdental brushes Filaments: soft, end-rounded nylon
Diameter 0.075-0.15nm Either flat, bi-level or multi-level
trims
Slide 20
Slide 21
Slide 22
Power Toothbrushes: Description Handles larger than manual
Several have ADA seal of approval for reduction biofilm and
gingivitis Motion of brush varies High frequency pulsating combo
with oscillating or rotating movement Sonic vibratory from
low-frequency acoustic energy
Slide 23
Slide 24
Which toothbrushing method should be recommended for a client
with plaque biofilm control problems around the cervical areas of
the teeth? a.Stillmans method b.Charter method c.Bass method
d.Leonard method NBQ
Slide 25
Which toothbrushing method should be recommended for a client
with plaque biofilm control problems around the cervical areas of
the teeth? a.Stillmans method gingival stimulation b.Charter method
c.Bass method sulcular d.Leonard method NBQ
Slide 26
Power toothbrushing should be recommended to clients with all
of the following EXCEPT one. Which one is the EXCEPTION?
a.Meticulous oral hygiene b.Gingivitis c.Orthodontic appliances
d.Abrasion NBQ
Slide 27
Power toothbrushing should be recommended to clients with all
of the following EXCEPT one. Which one is the EXCEPTION?
a.Meticulous oral hygiene b.Gingivitis c.Orthodontic appliances
d.Abrasion NBQ
Slide 28
Dental Abrasion Definition: abrasion is the wearing away of
tooth structure that results from a repetitive mechanical habit
Incorrect toothbrushing, especially with an abrasive dentifrice, is
the most common cause Appearance: wedge-shaped indentations with
smooth, shiny surfaces
Slide 29
Dental Abrasion Location Facial surfaces Canines Premolars
Sometimes first molars Cervical areas
Slide 30
Dental Abrasion Contributing factors Brushing with abrasive
agent in the dentifrice Horizontal brushing with excessive pressure
Prominence of the tooth surface labially or buccally
Slide 31
Dental Abrasion Corrective measures Explain the problem to the
patient Use end-rounded filaments Change toothbrushing method
Recommend less abrasive dentifrice Use a smaller amount of
dentifrice
Slide 32
Bacteremia Toothbrushing and scaling actions can produce
Magnitude higher in patients with periodontitis & gingivitis No
evidence on the risks of using manual or electric tb in pts
predisposed to infective endocarditis Imperative to maintain oral
health
Slide 33
#3: Interdental Care
Slide 34
Disclosing agents Floss and tape Floss threader Tufted floss,
yarn, gauze: embrasures, pontics, ortho, implants End Tuft
Interproximal: embrasures, pontics, FPD, ortho, perio splints,
proximal cavities, class V furcations, delivering chemotherapeutics
Wooden/plastic/triangular wedges/sticks: embrasures Toothpicks,
perio aid, rubber tip: embrasures, concavities, furcation's, ortho,
apply chemotherapeutics, biofilm removal at/below gum line Tongue
cleaners Power brush Oral Irrigation Supplemental Aids
Slide 35
The Interdental Area Anatomy of Posterior teeth Between
adjacent posterior teeth are two papillae, one facial and one
lingual/palatal Papillae are connected by a col, a depressed
concave area that follows the shape of the apical border of the
contact area
Slide 36
The Interdental Area Anatomy of Anterior teeth Between anterior
teeth in contact is a single papilla with a pyramidal shape Tip of
the papilla may form a small col under the contact area
Slide 37
The Interdental Area Proximal tooth surfaces Interdental
papillae are reduced in height Bacterial infection Loss of
attachment Dental biofilm can accumulate Easy access for removal of
bacterial deposits by the individual is prevented Root surface
morphology: concavities, depressions, grooves are predisposed to
bacterial accumulations
Slide 38
People who are physically / dexterity challenged to use dental
floss with fingers Those with large hands Gag reflex Floss Holder
Indications
Slide 39
Floss holder/pickers
Slide 40
Floss holders should be recommended for clients with which one
of the following? a.Manual dexterity problems b.Excellent home oral
care c.Dentinal hypersensitivity d.Inadequate exposure to fluoride
NBQ
Slide 41
Floss holders should be recommended for clients with which one
of the following? a.Manual dexterity problems b.Excellent home oral
care c.Dentinal hypersensitivity d.Inadequate exposure to fluoride
NBQ
Slide 42
Fixed bridges Ortho Use in conjunction w/dental floss Floss
Threader Indications
Slide 43
Floss Threader
Slide 44
Slide 45
Also called a floss/yarn combination Regular dental floss is
alternated with a thickened tufted portion Indications for use Wide
embrasures where interdental papillae have been lost Flossing
abutments and under pontic of a bridge Implant posts Two products
available commercially: 1.Single, precut lengths: Super Floss (2ft
length) 2.Roll: NUfloss is available in a roll that is similar to
that of regular floss and has a cutting device to allow selection
of a preferred length Tufted Floss Indications
Slide 46
Super Floss
Slide 47
Slide 48
Slide 49
Knitting Yarn Indications for use Wide proximal spaces Areas
where regular floss too narrow to remove biofilm efficiently
Abutments and under pontics Diastema Distal surfaces of most
posterior teeth
Slide 50
Interdental Brushes Brush with plastic handle Soft nylon
filaments are twisted into a fine stainless steel wire Tapered or
cylindrical brush heads Very short, soft filaments form a narrow
brush
Slide 51
Interdental Brushes Indications for use Sufficient space
available for the insertion of an interdental brush without excess
force Removal of dental biofilm and debris Embrasures Orthodontic
appliances Fixed prostheses Dental implants Periodontal splints
Space maintainers Concave proximal surfaces where dental floss and
other interdental aids cannot reach
Slide 52
Interdental Brushes Procedure Select brush of appropriate
diameter Moisten the brush and insert at an angle in keeping with
gingival form Brush in and out
Slide 53
An interdental brush can be used to effectively remove plaque
biofilm in all of the following situations EXCEPT one. Which one is
the EXCEPTION? a.Teeth with large diastemas b.Teeth with enamel
erosion c.Type II embrasure space d.Fixed orthodontic appliances
NBQ
Slide 54
An interdental brush can be used to effectively remove plaque
biofilm in all of the following situations EXCEPT one. Which one is
the EXCEPTION? a.Teeth with large diastemas b.Teeth with enamel
erosion c.Type II embrasure space d.Fixed orthodontic appliances
NBQ
Slide 55
Design: flat or tapered Uses Remove plaque and biofilm from
surface not accessible with larger brushes Crowding Furcations
Embrasures Distal to last molar Dental prosthesis End Tuft or
Single-Tufted
Slide 56
Flexible rubber tip attached to the end of the handle Adapted
into interdental area & below the gingival margin without
causing damage to the epithelial lining Indications Cleaning debris
from the interdental area Removal of biofilm by rubbing the exposed
tooth surfaces Biofilm removal at & just below gingival margin
Rubber Tip Stimulators
Slide 57
Procedure Trace along the gingival margin with the tip
positioned just beneath the margin Rub the tip against the teeth as
it is moved in & out of an embrasure and under a contact area
Do not flatten the interdental tissue Rinse the tip as indicated
during use to remove debris, and wash thoroughly at the finish
Rubber Tip Stimulators
Slide 58
Rubber tip Stimulators
Slide 59
Stim-U-Dents Accessible furcation areas Shallow pockets Normal
sulcus depths Patient who already uses toothpicks Ortho Perio:
proximal concavities Gum stimulation Toothpick Indications
Slide 60
#4: Tongue Cleaning
Slide 61
Tongue Cleaning Microorganisms of the tongue constantly
changing Effects of cleaning the tongue Reduce # microorg. Reduce
halitosis Anatomic features of tongue are conductive to debris
retention Surface papillae Fissures
Slide 62
Tongue Cleaning Brushing procedure Hold the brush handle at a
right angle to the midline of the tongue With the tongue extruded,
the sides of the filaments are placed on the posterior part of the
tongue With light pressure, draw the brush forward and over the tip
of the tongue Do not scrub the papillae Do not use electric tb when
it is on
Slide 63
Slide 64
Tongue Cleaning Tongue cleaner may be made of plastic, rubber,
stainless steel Single or double handle Procedure Place the cleaner
toward the most posterior area of the dorsal surface Press with a
light but firm stroke, and pull forward Repeat several times,
covering the entire surface of the tongue Wash the tongue cleaner
under running water
Slide 65
Slide 66
Tongue cleaners
Slide 67
#5: Oral Irrigators
Slide 68
Effective method of delivery for chemotherapeutic agents
Disrupts loosely adherent microbial colonization Point tip
perpendicular to long axis of tooth: 90 degree angle to long axis
of the tooth Oral Irrigation
Slide 69
Slide 70
Delivery of liquid antimicrobial agent Presence of gingival
inflammation & bleeding Disruption of loosely adherent plaque
Ortho Least effective method of removing plaque when compared to
other oral physiotherapy aids Oral Irrigator Indications
Slide 71
Subgingival access Standard jet tip placed supragingivally can
penetrate below the gingival margin 44% to 71% of the pocket depth
Specialized tips used for marginal or subgingival delivery have
shown penetration between 41% and 90% Oral Irrigator Benefits
Slide 72
Slide 73
Slide 74
All of the following are true regarding the use of the oral
irrigator EXCEPT one. Which one is the EXCEPTION? a.Used with
cannula to irrigate to the base of the pocket b.Can be used as an
adjunct to mechanical root debridement c.Delivers the antimicrobial
mouthrinse subgingivally d.Eliminates the need for controlled
release drug therapy NBQ
Slide 75
All of the following are true regarding the use of the oral
irrigator EXCEPT one. Which one is the EXCEPTION? a.Used with
cannula to irrigate to the base of the pocket b.Can be used as an
adjunct to mechanical root debridement c.Delivers the antimicrobial
mouthrinse subgingivally d.Eliminates the need for controlled
release drug therapy NBQ
Slide 76
All of the following are true regarding oral irrigation devices
EXCEPT one. Which one is this EXCEPTION? a.Recommended for clients
with fixed prosthetics b.Can be effectively used to treat
periodontitis c.Helps reduce gingivitis d.Used for the delivery of
antimicrobial agents subgingivally NBQ
Slide 77
All of the following are true regarding oral irrigation devices
EXCEPT one. Which one is this EXCEPTION? a.Recommended for clients
with fixed prosthetics b.Can be effectively used to treat
periodontitis c.Helps reduce gingivitis d.Used for the delivery of
antimicrobial agents subgingivally NBQ
Slide 78
What is the MOST commonly used product to control plaque
biofilm? a.Antimicrobial mouthrinses b.Dental floss c.Power
toothbrush d.Toothbrush NBQ
Slide 79
What is the MOST commonly used product to control plaque
biofilm? a.Antimicrobial mouthrinses b.Dental floss c.Power
toothbrush d.Toothbrush NBQ
Slide 80
Disclose Show pt in mirror Review how to remove areas that
stained: TB, floss, interdental aids, etc. OHI Basics
Slide 81
Clinical Assessment of Oral Biofilm Disclosing agents are used
to make oral biofilm clinically visible 1.FLUORESCEIN DYE (FD&C
Yellow No.8) Visible under UV light More expensive but will leave
no visible stain behind 2.Two-tone dyes (FD&C Red No.3 &
Green No.3) Combo solution Can differentiate old from new biofilm
Discloses plaque but not gingival tissues
Slide 82
Disclosing Solution Will stain decalcified and pitted tooth
surfaces Use Vaseline on lips and restorations Avoid using prior to
sealant application
Slide 83
Slide 84
Slide 85
#6: Mouthrinse
Slide 86
Mouthrinses Treatment of disease by means of chemical
substances or pharmaceutical agents Purposes In-Office 1. Pretx
rinse to reduce org. 2. Pretx rinse to reduce aerosol contamination
3. Facilitate impressions 4. Rinse and fresh breathe 5. Fluoride
rinse as part of caries prevention pgrm
Slide 87
Mouthrinses Purposes At Home 1.Vigorous rinsing to aid in oral
cleansing 2.Saline rinse after nonsurgical perio therapy 3.Caries
prevention
Slide 88
Mouthrinses Ingredients (combo of any of the following):
1.Water: largest amt of volume 2.Alcohol: stability essential oils,
surface tension 3.Flavoring agents: essential oils, eucalyptus oil,
oil of wintergreen 4.Aromatic waters: peppermint, spearmint,
wintergreen 5.Sweetening agents 6.Astringents: zinc chloride,
citric acid 7.Anodynes (pain relief) 8.Buffering agents
9.Oxygenating agents: H 2 O 2 10.Fluoride: decrease caries
11.Deodorizing: sodium bicarbonate, chlorine dioxide. Neutralize
odors and volatile sulfur compounds 12.Whitening: H 2 O 2
Chemotherapeutics Antimicrobial Agents Reduce oral microbial
count Inhibit bacterial activity Agents contain any of the
following: Chlorahexidine Phenolic compounds Cetylpyridinum
chloride Sanguinarine Triclosan
Slide 91
Antimicrobial CHX RX: Peridex, PerioGard, ProDentx, PerioRx
Effective plaque & gingivitis reducer Broad spectrum
bacterio-static/cidal Kills gram (+)/(-) microbes US: only 0.12%
Mode of action: binds to hydroxyapatite and glycoPRO thus pellicle
formation Absorbs into bacterial cell surface & interferes with
cell attachment Inactivated by SLS detergents 8-12 active hours
Alcohol or alcohol-free Recommended for short-term use
Slide 92
Antimicrobial CHX Side Effects Temp loss of taste Bitter or
metallic taste Burning sensation of mucosa Dryness Epithelia
desquamation Discoloration of teeth, tongue, restorations Slight
increase supragingival calculus formation (related to dead bacteria
that remin. as a result of bactericidal action)
Slide 93
Antimicrobial Uses Tobacco User Advise to use non-alcohol
Alcohol + tobacco = synergistic effect, increase risk of cancer
Cancer Pt Rinse baking soda/saline followed by H 2 O/CHX, avoid
alcohol mouthrinses Acute Perio Disease Warm water or weak saline
solution, CHX Alcohol Condition Avoid alcohol rinses, if being
treated with DISULFIRAM can have medical emergency
Mechanism of action Cationic agents that bind to oral tissues
Rupture the cell wall and alter the cytoplasm Low substantively
Most commonly used agent is cetylpyridinium chloride (CPC)
Quaternary Ammonium Compounds
Slide 96
Reduce biofilm accumulation Reduction in gingivitis has not
been demonstrated in studies like antimicrobials Considerations:
Staining of teeth Increased supragingival calculus formation A
burning sensation and occasional desquamation Quaternary Ammonium
Compounds
Listerine Non-RX Mechanism of action Phenolics disrupt cell
walls Low substantively Composition Combination of thymol,
eucalyptol, menthol, methylsalicylate in a hydroalcohol solution pH
= 5.0 Phenolic-Related Essential Oils
Slide 99
Recommended uses Gingivitis, hyperplasia Ortho Pre-procedural
rinse Immunosuppression Efficacy Significant reduction in the
levels of biofilm and gingivitis (ADA seal of approval) Reduce
S.mutans Inhibits calculus formation (contains zinc chloride)(ADA
seal of approval) Phenolic-Related Essential Oils
All of the following may contribute to oral malodor EXCEPT one.
Which one is the EXCEPTION? a.Active periodontal disease b.Aphthous
ulcer c.Use of tobacco products d.Lack of tongue brushing NBQ
Slide 102
All of the following may contribute to oral malodor EXCEPT one.
Which one is the EXCEPTION? a.Active periodontal disease b.Aphthous
ulcer c.Use of tobacco products d.Lack of tongue brushing NBQ
Slide 103
Which one of the following antimicrobial mouthrinses is
available only as a prescription in the United States? a.0.12%
chlorhexidine gluconate mouthrinse b.0.0 5% sodium fluoride
mouthrinse c.Essential oils mouthrinse d.Cetylpyridinium chloride
mouthrinse NBQ
Slide 104
Which one of the following antimicrobial mouthrinses is
available only as a prescription in the United States? a.0.12%
chlorhexidine gluconate mouthrinse b.0.0 5% sodium fluoride
mouthrinse c.Essential oils mouthrinse d.Cetylpyridinium chloride
mouthrinse NBQ
Slide 105
#7: Fluoride
Slide 106
Fluoride Strong affinity for calcified tissues 99% located in
mineralized tissues Stored in crystal lattice of teeth and bones
Highest level is on the tooth surface Pre-Eruptive Stage Deposited
during formation of enamel starting at DEJ Incorporated in crystals
during mineralization New crystals = fluoroapatite = less soluble
then hydroxyapatite Results = shallower grooves, less fissures
Slide 107
Fluoride Post-Eruptive Stage F benefits from topical
application only Uptake most rapid on enamel surface during 1 st
2yrs after eruption Topical = fluorhydroxyapatite (Free F ion moves
into crystal & forms) Mature enamel reacts with fluoride to
primarily form CaF Demin: Calcium Fluoride dissolves 1 st, then
hydroxyapatite, then fluorhydroxyapatite (NEED TO KNOW THIS
ORDER!)
Slide 108
Fluoride: Role in Caries Process Reacts with hydroxyapatite to
form FLUORAPATITE Interferes with bacterial metabolism High
concentrations: bactericidal Low concentrations: bacteriostatic Has
substantivity: ability to be bound to pellicle and tooth surface
and be released over a period of time with retention of
potency
Slide 109
Fluoride Therapy Methods 1.Systemic: water, supplements, food
Most efficient from 6mo-14yrs 2.Topical: toothpaste, rinse,
in-office
Slide 110
Fluoride Therapy Professional Application 1.APF: Acidulated
Phosphate Fluoride 1.23% foam, gel, thixotropic gels 4min
application Low pH = 3.5 Not for tooth colored restorations: acid
will etch glass components - pits and roughens material 2.NaF:
Neutral Sodium Fluoride 2% foam or gel with 4min application 5%
varnish 3.SnF: Stannous Fluoride (8%) Unpleasant taste, Stains
teeth, Gingival sloughing, discolors restorations Typically not
used for caries alone, antigingivits/antisensitivity 4.MFP:
monofluorophosphate
Slide 111
Fluoride Therapy: Topical Varnish Procedure 1.Dry teeth Gauze
for areas of recession or sensitivity A/W syringe Rsrch shows some
saliva contamination does NOT affect effectiveness of varnish
2.Apply varnish to teeth with applicator Use small amounts do not
glop on teeth to the point where you can see excess amt of varnish
Need just enough the coat the teeth A little goes a long way 3.Use
saliva ejector to suction patient as you apply
Fluoride Therapy Indications for topical fluoride in DH Care
Plan (Mosbys/ADA) 1.Children/adults with high to mod risk for
caries (CAMBRA) Fl varnish or gel at RC appts 2.No community water
fluoridation 3.Fair or poor OH 4.Decalcification, demin, active
caries 5.Dentinal exposure 6.Irregular RC appts 7.Xerosotmia
8.Ortho or Pros appliances
Slide 116
At-Home Fluoride Mosbys Application: tray, rinse, toothbrush
Promote remin (bacteriostatic effect) RINSES Daily use of
self-applied fluorides: low potency, high frequency 1.0.044% APF
rinse 2.0.05% NaF 3.0.1% SnF 2 rinse Weekly use of self applied
fluorides: high potency, low frequency 1.0.2% NaF
Slide 117
At-Home Fluoride Mosbys GELS OTC & Rx 1.1% NaF (brush on,
tray or paste) 0.05% APF (tray) 0.4% SnF 2 (brush on or tray) Some
studies show antiplaque, antihypersensitivity, anticaries
effects
Slide 118
Dietary Fluoride Supplements Recommended for kids who live in
areas with inadequate water fluoridation Fluoride in foods:
tea/fish contain large amounts Includes tablets, lozenges, drops,
liquids Tablets intended to be chewed, swished and swallowed Drops
are used on infants NOT recommended for pregnant women Not
recommended on infants who are breastfed (breast milk contains
0.0004ppm) School-based fluoride supplement programs yield 30%
caries
Slide 119
All of the following are true statements about 5% fluoride
varnish EXCEPT one. Which one is the EXCEPTION? a.Approved for
caries control b.Can be applied to both children and adults teeth
c.Recommended for clients with high caries risk d.Available over
the counter for caries prevention NBQ
Slide 120
All of the following are true statements about 5% fluoride
varnish EXCEPT one. Which one is the EXCEPTION? a.Approved for
caries control b.Can be applied to both children and adults teeth
c.Recommended for clients with high caries risk d.Available over
the counter for caries prevention NBQ
Slide 121
Which of the following professional fluoride agents is known
for both its efficacy in caries prevention and control of dentinal
hypersensitivity because of its high concentration of fluoride?
a.Acidulated phosphate fluoride gel b.Stannous fluoride c.Sodium
fluoride varnish d.Neutral sodium fluoride foam NBQ
Slide 122
Which of the following professional fluoride agents is known
for both its efficacy in caries prevention and control of dentinal
hypersensitivity because of its high concentration of fluoride?
a.Acidulated phosphate fluoride gel b.Stannous fluoride c.Sodium
fluoride varnish d.Neutral sodium fluoride foam NBQ