Personal Plaque Control Aides

Leila H. Liberman, RDH, MDE November 2014 Assignments Reading: Chapter 44,Clinical ,11th Edition Newman, Takei, Klokkevold, Carranza Thread Conversation: You will be assigned to one of the 13 thread topics. You must contribute to the thread within one week of this lecture to receive credit. The session will be locked out on 29 November 2014. I will be present in the threads and comment. Please build the conversation from each other.

Dental Plaque

White, grayish or yellow & globular appearance Typically observed on gingival third of tooth Location & rate of formation vary depending on oral hygiene, diet, and salivary composition & flow rate. Detect with explorer, probe, and/or disclosing solution Gross Plaque • Primary etiologic factor in dental caries, gingivitis, and periodontitis • Host-associated biofilm • Composed of more than 600 types of microorganisms appearing as soft deposits that form the biofilm • Adhering to the tooth surface or other hard surfaces in the oral cavity, including removable and fixed restorations • Organized intercellular matrix Calculus (a.k.a.-Tartar)

• Hard deposit that forms by mineralization of dental plaque • Generally covered by soft layer of un-mineralized plaque • Functions to retain plaque and keep plaque closer to gingival epithelium • Increases rate of plaque accumulation Calculus Formation

 Mineralization of dental plaque  Can begin as early as 4 hours after plaque formation  Can begin as late at 14 days after plaque formation  Clinical significance—retains plaque close to the gingival tissues

Note: Some plaque never mineralizes

Mineralized Plaque: (calculus or tartar) Covered by a soft layer of bacterial plaque

C D

Caries (C) and Demineralization (D) caused by supra-gingival plaque Therapeutic Goals of Plaque Control • Minimize inflammation

• Prevent recurrence or progression of periodontal disease and caries Disclosing Tablets

Disclosing a patient

• Available as tablets . Move the patient chair to upright position, • Temporary “stain” show patient disclosed plaque (using a hand • Will not penetrate mirror) surfaces of crowns or

composite restorations . Relate the disclosed • May be temporarily plaque with disease retained in defective process previously tooth surfaces or noted, comparing margins of restorations patient’s plaque free score to goal of (80%)

Disclosing the Patient Manual Toothbrushes Toothbrushes

• Should be soft nylon brush with rounded bristles • Used with light to moderate pressure against tooth surfaces • Size of brush should be small enough to access all areas of patient’s mouth • Should be replaced about every 3 months 1890 21st century

Bass Sulcular Brushing Technique • Place the brush so that the bristles will enter the sulcus at approximately a 45° angle (we tell patients to angle toward the gum line) • Gently vibrate the bristles in short circular strokes with enough pressure to blanch gingiva slightly. • Repeat motion several times at each site (3 teeth) and continue until all teeth have been brushed. •Recommend that the patient sets a pattern as to not miss any areas in the mouth Have a pattern set. Always start in the same area in the mouth in order not to miss any surface. End tuft brush—for hard to reach spots

-Pointed or Flat Ended -, -bridges (under pontics), -edentulous areas -furcation - root concavities-distal of last molars in a quadrant. End Tuft

Use the endtuft around teeth that the partial sits up against or the terminal tooth in an arch Electric Tooth Brushes/Power Brushes Oral B Sonicare by Philips Short Tip

between the teeth, sweeping under the gums, and under braces

Hollow Tip clean and polish the large surfaces of the teeth as well as sweep under the gums Long Tip

large spaces occur between teeth, when roots are exposed, under fixed bridges, in certain Average cost $125.00 areas where braces are being worn, or where additional periodontal conditions exist FLOSS Floss • Thickness- regular/fine/tape • Waxed/un-waxed • w/fluoride • Expanding • Monofilament •Teflon coated Personal preference-depending on needs of patient: tight contacts, rough interproximal restorations, open contacts,etc. Flossing technique -12”- 18” floss -wrap around middle fingers and use index finger and thumb -guide floss gently through contact area into sulcus -Adapt the floss to the tooth surface with a “C-wrap” -scrape the floss in a coronal direction against the tooth several times to disrupt plaque -when in between 2 teeth-2 surfaces to floss Note that the floss is wrapped around a finger NOT working to adapt the floss to the sides of the teeth. Note that the “working area” of floss is approximately half an inch. Demo: -Floss is gently through the contact into the sulcus -Moved in a coronal direction -Scraping the proximal surface of each tooth, under the papilla Different types of floss aides/floss holders

Floss Holders

-good for patients who cannot maneuver floss

-same technique-stroking the proximal surface

-use one hand

-good for less motivated patients

-good for patients that may have a disability leaving them with dexterity issues Floss fingers are available in the clinic

Floss Threader Monofilament loop which can be inserted between abutment tooth and pontic at the gingival margin . Floss is then carried through as the open loop passes through the embrasure.

Note: Pontic is the term for the artificial tooth (P) that is

connected on both P a sides to “abutment a teeth” (a) in a fixed partial denture, aka “bridge”. Floss Flossthreaders

abutment abutment pontic threader

Superfloss Thick, fuzzy section to use under pontic or between splinted teeth

Regular floss

Stiff area similar to floss threaders Gum EasyThread Floss

Floss Limitations Floss may not remove plaque from concavities on proximal surfaces. These areas may need to be accessed with other specific aids such as inter-proximal brushes or an end tuft brush. Interdental Brush- Proxabrush Interdental brushes are effective aids for plaque removal in wide proximal areas, especially when concavities are present. Snap On Heads Snap On System Hinged Head Soft-picks- Sunstar Butler

Travel size proxabrushes The proxabrush is slightly angled away from the gingival margin. This way we do not injure the gum line/avelor bone.

The proxabrush is cleaning the interproximal surface around the implant. Note the wire is blue. The blue means the wire is coved in nylon and is safe to use adjacent an implant. Proxa Brush with Braces

Proxabrush cleaning Proxabrush cleaning the Mesial of the the Distal of the bracket on #22 bracket on #23 Go Betweens-Butler Sunstar Den Tek

Wooden Interproximal Cleaners

Stimudents and Perio Aid Perio-aid 800-359-3206 Stimudents Oral Irrigators -Oral irrigators can be helpful as an adjunct to bushing and flossing -Recent supragingival plaque (non-adherent) and food debris can be removed by the pressurized stream of water -Attachments are available for sub-gingival irrigation -Effective when used with anti-microbial agents -Recommended for patients with orthodontics, bridges & implants Water Pik Water Pik Sonicare-AirFloss Other aids A variety of other “creative” aids may be used to achieve plaque control in problem sites. Gauze can be refolded and used like floss to clean proximal surfaces of teeth adjacent to edentulous areas.

Interdental Stimulators

Interdental stimulators are often available on tooth brush handles or as individual aids. They are designed to stimulate the gingiva to achieve improved tissue tone. Can remove food debris, materia alba and substantial plaque, but NOT effective for complete plaque removal. They are usually made out of rubber. They work great on tissues that are hyperplastic. Rubbertip Stimulator Patient Demo

Dentifrices  Have emulsifiers (sodium laurel sulfate) to aid in plaque removal. Some patients are allergic to SLS.

 Fluoride - proven caries prevention by re- mineralization of the tooth surface

 Tartar control – pyrophosphate helps to delay calcification of plaque

 ACP (amorphous calcium phosphate) - new advancement in caries control. Can be paired with CCP (casein phosphopeptide).

Dry brushing is actually more effective at plaque removal. Crest Products

Active Ingredients:

• Majority products-Sodium Fluoride

• ProHealth Products-Stannous Fluoride

• Crest Sensitivity-Potassium Nitrate and Sodium Fluoride Newest Crest is Pro Health Clinical Gum Protection • Sensitivity • Antibacterial • Stannous Fluoride .454% Colgate Products: 4 different active ingredients Sodium Fluoride .24% with .16% fluoride ion • Tartar protection whitening • Triple Action • Sparkling White with CinnaMint Gel • MaxClean Smart Foam w/whitening • Max White w/mini bright strips • Max fresh w/mouthwash beads

Colgate Total

• Colgate Total contains the anti-microbial ingredient triclosan

Sodium Monoflurophosphate

• Sparkling white-bakingsoda and peroxide • Bakingsoda and Perodixde whitening Mint gel • Colgate cavity protection

Potassium Nitrate and Sodium Fluoride

• Sensitive Mulitprotection

• Sensitive Whitening

• (all the sensitivity products by Colgate)

Potassium Nitrate Home Fluorides: for patients with moderate to high caries risk

• Gel-Kam – stannous fluoride gel; available from pharmacist without prescription

• Prevident 5000 – 1.1 % sodium fluoride dentifrice, available by prescription or at our school store on the ground floor.

• Listerine, ACT or Fluoriguard - Sodium Fluoride mouth rinse, available without prescription www.gcamerica.com

water-based, sugar-free crème

sensitivity

RECALDENT™ CPP-ACP is milk derived with lactose

Relieving dry mouth

Calcium, Phosphate and Fluoride

3 minutes

Tray use as well Use MI Paste

• • Pregnant women • For children six years and under • During and/or after orthodontics • Desensitizing • To provide extra protection for teeth

Use MI Paste Plus

• Desensitizing • During and/or after orthodontics • White spot lesions • Medically compromised patients • For salivary deficiency/dry mouth • For patients with acidic oral environments • For erosion and gastric reflux

Mouthwash

•ADA approved products to follow: -fluoride -sodium phosphate -1 time a day -30 mins no rinse -ADA seal -OTC Crest Pro-Health For Me Anticavity Fluoride Rinse

Alcohol-free

Mint, Berry Bubblegum

ADA seal Help prevent cavities in children over six as their teeth are developing

Strengthen tooth enamel

Prevent white spot lesions in teens with braces

Help protect the roots of adult teeth as their gums begin to recede

ADA seal LISTERINE® SMART RINSE

• cetylpyridinium chloride • ages 6 and older • 1 minute in the morning and the evening • alcohol-free product • Not approved for fluoride • ADA seal Listerine

• ONLY 4 Products approved for lowering bacteria • Cool Mint, Fresh Burst, Soft Mint and original Alcohol Free Mouthwash With and without alcohol

BreathRx contains ZYTEXTM #1 - ZYTEX reduces the foul smelling volatile sulfur compounds which provide the "odor" of bad breath #2 - ZYTEX kills the gram negative organisms

Zinc chloride-mouthwash

Alcohol free Xerostomia: Dry Mouth Products

Causes: Conditions:

Medication Use Oral Dryness and Discomfort Auto-immune Diseases Dental Caries Head and Neck Radiation Oral Irritation Increased Levels of Plaque Bad Breath Difficulty Eating or Speaking NaF-sensitivity and dry mouth OraMoist www.oramoist.com

Natural product

Adheres to inner cheek or roof of mouth

2-4 hours

Orazyme

Natural product 2-3 times a day 30 seconds Biotene www.biotene.com

Xylitol

Trauma caused by poor technique or excessive pressure • Gingival recession

• Gingival clefting- forceful flossing

• Bacteremia

• Wedge-shaped defects in cervical area of root surfaces- tooth brush abrasion

• Painful ulceration of gingiva Toothbrush Abraison Gingival Recession •May occur naturally •May be exacerbated by using excessive pressure on tooth brush and/or poor technique Toothbrush Abrasion

Use of excess force and long scrubbing strokes with a tooth brush can result in : • Gingival recession • Wedge-shaped defects in cervical area of root surfaces requiring restorations. Soft Tissue Trauma

Ulcerations due to: • hard bristle brush • excessive pressure • incorrect angulation during brushing Tongue Scrapers

Types of Tongue Scrapers Dentek

Denture Care Tissue inflation from not removing the denture on a regular basis to allow the tissues to breathe. Summary The purpose of personal plaque control is to ensure that each patient understands the disease process taking place in his/her own mouth and has the ability to use the plaque control devices necessary to stop and/or prevent that disease. Long term success requires constant evaluation, review and feedback to the patient. This is the most valuable service a patient can receive. Patients will ask you about all types of products and you must keep up with the latest and greatest! •Be sure to watch the videos!!!