Preventative Dentistry

1. *

2. *
*A number of oral hygiene aids are on the market today for
patient use
*It is important to keep in mind that the simpler the task, the
greater the chance of getting it accomplished
*Adding too many steps will make it more difficult to
accomplish the task daily
*Suggestions for the proper aid and its correct usage will
come from the dental team members
*DA’s should stay up to date with the aids on the market and
know how they can help specific patients

3. *
*Disclosing Solution
*Dentifrice (toothpaste)
*Mouth rinses
*Chewing gum
*Interdental aids
*Toothbrushes
*Floss

4. *
*Substances used to clean the teeth, commonly
referred to as toothpastes
*Numerous claims are made for dentifrices
including the prevention or reduction of
calculus formation, dental caries, plaque,
gingivitis, hypersensitivity, and the ability to
whiten teeth
*Because the public routinely uses dentifrices
one to three times per day, they may be the
most beneficial dental products.

5. *
*Use only those that have been reviewed and accepted by the ADA
*American Dental Association
*ADA seal of acceptance
*Products are first subject to a rigorous scientific review by the ADA
Counsel on Scientific Affairs (CSA) to determine if they meet ADA
criteria for safety and effectiveness
*Products that meet these criteria are awarded the ADA seal
*Appears on the product packaging and labeling
*Seal is awarded for a period of 5 years; after that, products are
resubmitted

6. *
*Toothpaste is used by most individuals for dental care
*Many types are available, with numerous different flavors
and consistencies
*Pastes, gels, stripes
*Conventional tubes, stand-up tubes, pumps
*Should be chosen carefully based on the abrasives as well
as carries control
*The dentifrice most often recommended is one that
contains fluoride
*Especially for children and adults who are prone to
caries

7. *
*The degree of dentifrice abrasiveness depends on the
inherent hardness of the abrasive, the size of the abrasive
particle, and the shape of the particle.
*Humectants were added to maintain the moisture and
prevent hardening.
*Humectants can cause mold growth, and thus,
preservatives such as sodium benzoate are added to
prevent their growth
*Sodium lauryl sulfate (SLS) is the most widely used
detergent

8. *
*Stannous fluoride, specifically the stannous ion, has
reported activity against caries, plaque, and gingivitis.
*Potassium nitrate is a commonly used, FDA-approved OTC
desensitization agent, that is, it reduces the reaction of
nerves in the teeth to stimuli such as heat and cold
*Whitening toothpastes generally use either
*Carbamide peroxide, which breaks down to form urea and
hydrogen peroxide
*Hydrogen peroxide, which forms a free radical that
contains oxygen, which is the active bleaching molecule

9. *
*A small, pea-sized amount should be expelled onto
the toothbrush for use
*Toothpaste should not be ingested
*Because of the possibility of excessive intake of
fluoride
* A toothpaste with low abrasives is also
recommended because extremely high abrasives
can permanently damage the patient’s teeth with
repeated use
*Actually abrade the tooth surface

10. *
*Available in liquid form, the traditional method
for stabilizing and delivering many
pharmaceutically active agents
*Used for cosmetic or therapeutic reasons
*Advertisements may lead patients to believe that
mouthwashes do more than possible
*Vigorous rinsing with mouthwashes may loosen
debris and give the patient a pleasant taste and
feel
*They should not be used to replace brushing and
flossing

11. *
*Cosmetic benefits include
*Pleasant taste and sensation
*A decrease in microorganisms
*Halitosis control
*Therapeutic benefits include
*Reduction in bacterial plaque
*Reduction in gingivitis
*Reduction in dental caries

12. *
*Should not be used to replace brushing and
flossing
*ADA has approved oral rinses that contain fluoride
*Helps reduce dental decay and supragingival
plaque

13. *
*Rinses with fluoride are often prescribed for
patients who have high incidence of decay
*OTC fluoride rinses generally contain 0.05 percent
sodium fluoride and are for daily use
*Prescribed fluoride generally contains 0.2 percent
sodium fluoride or 0.63 percent stannous fluoride
*Stannous fluoride can also be used for decreasing
the sensitivity of the tooth to hot and/or cold
(dental hypersensitivity)

15. *
*Best to brush and floss thoroughly and THEN
dispense about 10mL of solution and swish in the
mouth for 1 minute then spit it out
*Do not swallow; children should be monitored
while using
*After rinsing with the solution, the patient should
not eat or drink for 30 minutes
*Allows the rinse time to be effective

16. *
*Chewing gum designed specifically for oral
hygiene purposes is a fairly new aid on the market
*Recommended for use after the intake of
carbohydrates
*Stimulates saliva that buffers the plaque acid
*Chewing action also helps dislodge particles for
the teeth
*Chewing gum is even more effective at
preventing cavities if it contains a sugar
replacement called Xylitol

17. *
*Used to aid in cleaning the area between the teeth and to
stimulate the gingival tissue in that area
*The interproximal brush is a small hand-held brush with
soft nylon bristles twisted in wire and adapted into a handle
*Placed in the interproximal area and rooted back and
forth using light pressure
*Patients who benefit from the interproximal brush
*Open contact areas
*Substantial amount of bone loss due to periodontal disease
*Ortho patients

18. *

19. *
*Rubber and wooden dental stimulators are placed in the
interproximal area, angling them toward the occlusal surface and
rotating them in a circular pattern
*This action stimulates the soft tissues
*Removes plaque in these areas
*Some toothbrushes have a rubber stimulator at one end
*Wooden stimulators often come in a pack; much like a book of
matches
*These elongated, soft-wood wedges are first moistened before use
*Normally made of balsam wood
*Wood has a little give as it stimulates the tissue
*Another type has a plastic handle device that holds a moistened
toothpick tip to be used in the same manner as the rubber and
wooden stimulators

20. *

21. *
*A floss holder is a Y-shaped device with a handle used by
some individuals to hold the floss tightly as it is placed in
the interproximal area of the teeth
*Makes flossing easier for individuals
*Arthritis
*Poor manual dexterity
*Hands that seem too large to allow access to posterior
teeth
*Moved up and down on the sides of the tooth and into the
sulcus area to remove plaque and clean the area

22. *

23. *
*The floss threader is used to removed plaque
and debris form under fixed bridges, orthodontic
wires, and retainers
*Comes in a variety of shapes
*Made form stiff plastic
*Designed like a needle with a large eye
*Floss is threaded through the eye of the
threader and the needle (stiff end) portion is
then threaded through the intended area by the
patient

24. *
**Super floss

25. *
*A water irrigation device is used to flush away debris from
orthodontic brackets and other prosthetic devices
*Does not remove plaque and should NOT replace brushing and
flossing
*Pulsating water flow allows food debris to be removed easily
*Some patients place mouthwash in the fluid-holding
container to gain fresh breath in the process
*Use device carefully, because it can cause tissue damage
when turned on high and directed toward the gingival sulcus
*It could force debris into the tissue and damage the
periodontium
*It should be used at low speed and in a direction that forces
debris to be pushed away from the gingival area

26. *

27. *
*Most patients use toothbrushes, but many have never been
shown the proper techniques and methods
*Patients should be shown that the toothbrush only cleans 3
of the 5 surfaces
*60% = toothbrush
*40% = floss
*Proximal tooth surfaces normally are not accessible with a
toothbrush
*Variety of toothbrushes to select from
*Various styles and designs

28. *
*Manual toothbrushes are powered by the human
band
*Mechanical toothbrushes are powered by
electricity or batteries
*The toothbrush moves while merely being held
by the individual
*Automatic toothbrushes normally come with
recharging units

29. *
*Correctly designed toothbrushes are sized and
shaped to allow for efficient cleaning and easy
management
*Should be durable and inexpensive and have bristles
that are flexible and soft, allowing for repeated use
*Handle must be firm and strong as well as
lightweight
*Choice of toothbrush should reflect the individual
needs of the patient
*Some adults use a children's toothbrush to gain
access to the teeth in the most posterior areas of
their mouth

30. *
*Parts of the manual toothbrush
* Head
* Shank
* Handle
*Bristles are placed on the head of the brush and can be multi-tufted or
spaces and in a number of patterns
*Nylon bristles are recommended
* They maintain their shape longer that natural bristles and they dry quickly
*Ends of the nylon bristles are often run over a flame to cause rounded ends
that will not abrade the tooth
*Soft bristles are recommended over medium and hard because they do not
abrade the tooth or the gingival surface

31. *
*Multi-tufted
*Spaced bristles

32. *
*Many patients like mechanical toothbrushes
*There are many models on the market today
*They have larger handles and charges
*Handles have to be larger to hold the rechargeable battery and circuit board
*Heads can move in several different directions
*Reciprocating
*Orbital
*Vibratory
*Arches
*Elliptical
*Combination of two or more of these motions
*Newer models also incorporate sonic action
*Particularly effective in removing plaque and extrinsic stains
*Some have built-in timing devices that allow 30 seconds for each quadrant
and stop when 2 minutes have elapsed
*Care should be taken to apply light pressure and to let the action of the
bristles clean the teeth and gums

34. *

35. *
*Several tooth brushing techniques can be used to
obtain proper oral hygiene
*Any technique should allow for all the surfaces of
tall the teeth to be cleaned
*Brushing will NOT clean interproximal areas
*Some patients will benefit from a timer
*2-3 minutes is recommended to clean all the
surfaces
*Facial, lingual, occlusal, and incisal

36. *
*A pattern should be developed by the patient to ensure that
no area is missed
*Starting at the same point each time when brushing is a good
idea
*Does not matter what pattern; it only matters that no teeth
are left uncleaned

37. *
*There are 6 commonly used brushing techniques
1. Bass or modified bass
2. Charters
3. Modified Stillman
4. Rolling Stroke
5. Fones
6. Modified scrub

38. *
*Most popular in the dental community
*Name for Dr. C. Bass
*A dentist who was an early advocate of
preventative dentistry
*Used to removed plaque next to and directly
beneath the gingival margin

39. *Bass
* Place brush so that the bristles are a 45-degree angle,
with the tips of the bristles directed straight into the
gingival sulcus
* Using the tips of the bristles, vibrate back and forth
with short, light strokes for a count of 10, allowing
the tips of the bristle to enter the sulcus and cover
the gingival margin
* Lift the brush and continue into the nest area or
group of teeth until all areas have been cleaned
* The toe bristles of the brush can be used to clean the
lingual anterior area in the arch
*Modified Bass
* Follow all the steps of the Bass
technique
* After the vibratory motion has
been completed in each area,
sweep the bristles over the
crown of the tooth, toward the
biting surface of the tooth
https://youtu.be/LqCpZm6s_dE
*initial position of the toothbrush when using the Bass technique

40. *
*Used to loosen plaque and debris
*Stimulate both marginal and interdental
gingiva
*Primary difference from the Bass
technique is the angel of the tooth brush
placement

41. *
*Place the toothbrush so that the
back of the head is directed
apically, with the bristles placed
downward on the maxillary and
upward on the mandibular
*The bristles should be placed over
the tissue, where the tooth and
gingiva meet
*Press the bristles into the space
between the teeth
*Vibrate gently back and forth while
maintaining position. Count to 10
*Reposition and repeat the technique
for each subsequent area
*For anterior areas, hold the brush
parallel to the teeth and use the
sides of the toe bristles to clean the
area. Count to 10
*https://www.youtube.com/watch?v
=6fj-IXzzH1o

42. *Designed to do a good overall cleaning
*Remove plaque
*Stimulate and massage the gingiva
*Bristle placement distinguishes this technique
from the Bass and Charters
*Positioned to that the bristles point apically
with the tooth brush handle level with the
biting surface of the tooth
*

43. *Place the toothbrush so that the
bristles are pointing apically and
the handle of the brush is level
with the biting surface of the
tooth
*Rotate the bristles downward and
vibrate back and forth until the
brush has rotated over the entire
surface of the tooth. Do this
motion slowly and count to 10
*Repeat this motion over the same
area at least five times
*Continue until each area and every
tooth have been cleaned in this
manner
*https://www.youtube.com/watch?
v=5zEDhurn7zY
*

44. *
*Method used to remove food debris
and plaque from teeth and to
stimulate the gingival tissue
*The brush is placed parallel to the
tooth with the bristles pointed
apically

45. *Place the brush parallel to the
tooth so that the bristles are
pointing apically, as in the
modified Stillman method
*Firmly but gently press the
bristles against the gingiva and
roll them slowly over the tissue
and the teeth, toward the biting
surface
*Repeat this rolling stroke over the
same surface a total of 5 rolling
strokes
*Use the heel or the toe of the
toothbrush to clean the lingual
surfaces of the anterior teeth.
The bristles will still need to be
pressed gently into the area and
rolled toward the biting surface
*

46. *
*Used as an initial brushing method to
achieve a good overall cleaning
*Most individuals can easily learn to make
the small circles over the teeth as they are
in the closed position
*It is very easy to do on the outside surface
of the teeth

47. *
*Close the jaws and place the brush
against the cheek. Starting with
the posterior teeth, the brush is
placed overt he maxillary and
mandibular teeth
*The brush proceeds over the teeth
in a circular motion as it progresses
toward the anterior in a sweeping
motion
*The anterior teeth are placed in the
biting position and the brush is used
in a circular motion sweeping from
right to left
*https://www.youtube.com/watch?v
=BB6CeOYzGKc

48. *
*Uses a scrubbing motion to remove
plaque and to stimulate the gingival
tissue

49. *
*Grasp the brush and place
the bristles at a right angle
to the tooth surface
*Use gentle but firm
pressure and place the
bristles over the area where
the tooth and gingiva come
together
*Activate the brush with
back-and-forth scrubbing
strokes

50. *
*Bacteria can collect in the irregular dorsal (top) surface of the
tongue
*The daily ritual of oral hygiene historically included scraping of
the tongue with a tongue scraper
*Several difference tongue cleaners are on the market today
*A conventional toothbrush is most often used to ensure cleaning of
the tongue surface
*Size of the toothbrush head may limit access to the posterior area
of the tongue because it may initiate gagging
*To clean the tongue, the toothbrush should be placed as far back
as is comfortable and then be drawn forward to the tip, allowing
the bristles to clean the debris that has accumulated
*Repeat this process until the entire tongue has been cleaned

51. Automatic
tongue
scraper
Tongue scraper on backside of the head

52. *
*The second essential element of a good oral
hygiene program
*Should be done daily
*Dental floss had been shown to be the most
effective way to remove bacterial plaque and other
debris from otherwise inaccessible areas
*Interproximal surfaces of the teeth

53. *
*Available in several forms
*Should be chosen according to the patients’ manual skills, dental
restorations, and preferences
*The DA can make suggestions to the patent that will meet the
patients dental needs
*Historically, patients have been advised to use unwaxed dental
floss with small, individual filaments that aid in plaque removal as
the floss is moved over the surface of each tooth
*However, some patients become frustrated while using unwaxed
floss because it is thinner and more likely to shred or to catch on
old dental restorations, make it difficult to remove from the
interproximal areas
*These patients should be encouraged to you waxed, lightly waxed,
or nonshredding dental floss
*Waxed floss will slide over the surface with greater ease for
patients who have tight contacts and roughened surfaces

54. *
*Dental floss can also be purchased as
*Extra fine
*Larger flat tape
*Tufted texture
*When tightened changes sizes
*Different colors
*Different flavors
*Flossing daily is more important that the type of floss that is
used

56. *
*Obtain the appropriate dental floss and dispense 18 inches
of it
*Wrap the ends of the floss around the middle or ring
finger as anchors

57. *Grasp the floss between the thumb and index finger of
each hand, allowing ½ to 1 inch to remain between
the two hands

58. *For the maxillary teeth, pass the floss over the
two thumbs or a thumb and finger, and direct
the floss upward
*For the mandibular teeth, pass the floss over
the two index fingers and guide it downward

59. *Direct the floss to pass gently between the teeth, using
a sawing motion. Try to avoid snapping the floss
through the contacts because it may damage the
interdental papilla
*Curve the floss in a C-shape to wrap it around the tooth
and allow access to the sulcus area. Resistance
indicates that the bottom of the gingival sulcus has been
reached

60. *Move the floss gently up and down the surface of the
tooth to remove the plaque
*Slightly lift the floss over the interdental papilla to the
adjacent tooth
*Lift slightly and wrap the floss in the opposite direction in
a C-shape over the adjacent tooth
*Move the floss gently up and down the surface of this
tooth before removing it from the area
*Rotate the floss on the fingers to allow for a fresh section
to be used each time. Doesn’t matter where a patient
begins, but it is best to do systematically so no area is
missed

61. *Use the dental floss around the distal surface of the
most posterior tooth by wrapping it into a tight C-
shape and moving it gently up and down with a firm
pressure

62. *
*An individual may have prosthetic devices that require
special oral hygiene care to obtain the desired plaque-
free result each day
*DA knowledge will aid patients in the care of their
prosthetic devices
*Fixed bridges
*Implants
*Orthodontic brackets
*Full and partial dentures

63. *
*A fixed bridge (permanent) that is anchored on
both sides with a pontic in the middle will not
allow normal flossing
*Patient will need special instructions on how to
use a floss threader to remove plaque and
debris from under the bridge
*Patient may also need special brushing
instructions to clean the gingival area more
carefully

64. *
*Implants replace missing teeth
*Long-term success is determined partially by
the patients and how well they maintain the
areas
*Patients can use yarn in place of floss and
Interproximal brushes to clean around implants
*A plastic scaler is used in the dental office to
thoroughly clean the implants and remove any
calculus
*Implants are made of titanium, and can be
scratched by metal instruments

65. *
*All removable dentures and appliances should be
carefully cleaned daily and rinsed following a meal
or as needed
*A denture brush is used to brush the appliance
*It is a large brush that can be used with
toothpaste or a mild soap
*A soft brush should be used on the tissue under the
appliance to clean and to stimulate circulation to
that area

66. *
*Commercial cleaning agents can be used daily on a denture
*Remove stains and help freshen breath
*Dentures are normally immersed in solutions according to
the manufacturer’s direction and rinsed after the specified
time has elapsed
*Soaking solution can be made at home
*1 cup warm water
*1 tsp bleach (not used with a partial denture as it may
corrode the metal)
*2 tsp anticorrosive agent
*Home solutions should be used only once a week

67. *

68. *
*Special oral hygiene techniques must be practiced to
maintain orthodontic appliances
*Must be kept plaque free
*When care is improper, the tooth structure around the
brackets may decay and the gingival tissue will become
irritated and virtually grow over the appliances
*Special orthodontic toothbrushes and aids can be used
*The bristles of the bush are designed to allow contact with
the surface of the tooth
*An interproximal brush can be used to gain access to difficult
areas
*Water irrigation device can be used for overall cleaning