Mechanical and Chemotherapeutic Home Oral Hygiene

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

The most accepted techniques for plaque removal These include:

Tooth brushing Flossing Disclosing agents Oral irrigators Tongue scrapers

Mechanical Methods of Plaque Control

 Manual toothbrush -Most common method for removing plaque -Variable

Bristle material Length Diameter Number of fibers Length of brush head Number and arrangement of bristle tufts Angulation of brush head to handle Handle design

How to brush your teeth

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

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

 Step 4 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.

REMINDERS
thorough brushing is a very important step in preventing tooth decay and gum disease thorough brushing is a very important step in preventing tooth decay and gum disease

Floss

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.. Types of floss Flavoured and unflavored Waxed and unwaxed Thin, tape and meshwork

How to floss
Step 1 Take a length of floss equal to the distance from your hand to your shoulder

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

How to floss
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.

Step 3 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.

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.

Dentrifices
Plaque and stain removing agents through the use of abrasives and surfactants Composition

 Disclosing Agents Allow visualization of plaque Compostion

Iodine Gentian violet 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)

Techniques roll method Charters method Horizontal scrubbing method Modified stillman method

Chemotherapeutic Plaque Control

characteristics of an ideal Chemotherapeutic plaque control agent
specificity only for the pathogenic bacteria substantivity, the ability to attach to and be retained by oral surfaces and then be released over time without loss of potency chemical stability during storage absence of adverse reactions, such as staining or mucosal interactions toxicology safety ecologic safety so as not to adversely alter the microbiotic flora ease of use

Different ways to administer antiplaque agents

Mouthwashes Dentrifices Gels Irrigators (provide supragingival and subgingival delivery) Floss Chewing gum Lozenges Capsules (systemic distribution) All of these are for local, supragingival administration except capsules and irrigators

Antiseptic Agents
Chlorhexidine
Positively Charged Organic antiseptic agent Reduces plaque, gingivitis, mucositis Binds with anionic glycoproteins and phosphoproteins on the buccal, palatal and labial mucosa and tooth-borne pellicle Can be of great use in immunocompromised patients esp. mental retardation and patients undergoing bone marrow transplantation

Chlorhexidine
Antibacterial effects:
Binding well to bacterial cell membrane Increasing their permeability Initiating leakage Precipitating intracellular components Decrease levels of streptococcus mutans

Antiseptic Agents
Listerine Noncharged phenolic antiseptic agent Burning sensation Bitter taste Highest alcohol contents (25 %)

Enzymes, Plaque- Modifying Agents and Plaque Attachment Interference Agents

Enzyme System
Alter plaque architecture

Urea Peroxide
Plaque modifying agent Increased stability over hydrogen peroxide Protein denaturation effect of urea

Delmopinol
Binds to salivary protein and alters cohesiveness and adhesiveness properties of films formed

Sugar Substitutes
Incorporated in chewing gums to:
Decrease plaque accumulation and pH Lower incidence of caries

Examples of Sugar Substitutes

Xylitol Mannitol Sucralose Aspartame

 Prenatal Counseling
Before birth of child Discuss Pregnancy gingivitis

Infants (0 1 year old)

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

 Toddlers (1 to 3 years old)

Toothbrush must be introduced Parent remains primary caregiver of hygienic procedures Flossing, if interproximal contacts are closed

Preschoolers (3 to 6 years)
Fluoride dentrifice can be introduced at 3 years Pea - sized amount of tooth paste Daily flossing

 School-Aged Children (6-12 years)

Parents may find they only need to brush or floss their childs teeth in difficult to reach areas of mouth Use of disclosing agent for parents inspection Ingestion is the primary concern Fluoridated dentrifices is necessary Use of chemotherapeutic agents is recommended

Adolescents (12 19 years)

Motivation Poor dietary habits and pubertal hormonal changes increase the risk for caries and gingivitis

In- office Oral Hygiene Programs

Dental education of parent and child describing exactly the importance of oral hygiene Delivered in simple terms with enthusiasm and conviction Conveyed in a childs age-appropriate language Positive reassurance, not critical let me show you how to improve rather than saying youre doing it all wrong Recare intervals should be personalized with patients needs

The end
Agbayani. Cassieopea Dimatulac, Kevin Tesoro, Joseph Paulo D.