simple description about inter dental cleaning aids and caries prevention

2.  People have used various compounds
(eg.pumice,oyster shells, and chalk) to clean
their teeth since around 5000BC.
 Dentrifice ingredients help to reduce caries,
plaque, gingivitis, calculus, stain, halitosis,
and hypersensitivity.

3.  Caries is simply the result of
demineralisation/remineralisation cycles where,
over time, demineralisation conditions prevail.
 Fluoride can be delivered in several different
chemical forms:
 Stannous fluoride(SnF2)
 Sodium fluoride(NaF)
 Sodium monofluorophosphate
 Amine fluoride
 Aluminium fluoride(AlF3)

4.  The chemical agents used for calculus control in dentrifice are
 Pyrophosphate: It occurs naturally in saliva and plays a role in
inhibiting calculus formation. These molecules chelate calcium,
slowing the rate of nucleation (crystal formation) and
calcification of plaque.
 Sodium hexametaphosphate (HMP): sodium HMP is a large
polyphosphate molecule and has multiple calcium binding sites in
one molecule. Sodium HMP is too large of a molecule to enter
into tooth enamel, so there is no danger of it entering between
enamel rods and sequestering calcium from sound enamel. It is
sometimes called a calcium surface – active builder.
 Zinc: positively charged zinc ion (Zn2+) inhibits crystal growth by
substituting for calcium in the crystal lattice of calcium
phosphate.
 Gantrez: gantrez is a copolymer of methylvinyl ether(PVM) and
maleic acid (MA) and acts as a chelating agent.

5. • Bleaching products that contain hydrogen peroxide or
carbamide peroxide(ie, dental office bleaching trays)
address intrinsic stains as well as extrinsic stains.
Extrinsic stain: Extrinsic (surface) stains can be relatively
easily removed on a daily basis by proper tooth brushing
with a dentrifrice. The abrasivity of dentrifrice is
measured in terms of Relative dentin abrasivity, or RDA.
The lower the RDA, the less abrasive the dentrifrice. The
international standards organisation (ISO) states that a
dentrifrice should not exceed an RDA of 250, which is
considered safe for hard tissue.
Intrinsic stain: intrinsic stains are stains and
discolourations that are located below the enamel
surface. Bleaching is usually used to remove or minimize
intrinsic discolourations.

6.  Stannous: Stannous fluoride by being bactericidal and non specific
interaction with the bacterial membrane causes membrane
disruption. Stannous ion’s inhibition of metabolic enzymes, which
further lead to reduction of bacterial growth, prevention of bacterial
adhesion to oral surfaces(eg.enamel) and reduction in bacterial
hypoproducts.
 Triclosan: triclosan is a broad spectrum antibacterial agent that
inserts into and distrupts the bacterial membrane. Being a nonpolar
molecule, it has an affinity for the hydrophobic environment of lipid
bilayer.
 Zinc: it has mild antibacterial properties inhibiting cell division and
slowing the growth cycle. When it is added with dentrifrice
formulation it present some challenges such as poor bioavailability
and an unpleasant taste.
 Chlorhexidine: chlorhexidine disrupts bacterial membranes,
resulting in bacterial death. It is used as an ingredient in mouth wash
and dentrifrice. it has some side effects such as poor taste and
staining.

7.  It is generally treated in one of the two ways.
 Chemical desensitization of the tooth nerve endings
 Tubule occluding agents or barriers to reduce dentin permeability
 Calcium carbonate creates a basic environment. Calcium
phosphate salts are less soluble at higher PH(more basic),
therefore the combination of high local calcium
concentration at the dentin tubule at basic PH promotes
rapid precipitation of calcium phosphate salts.
 Strontium(Sr2+) is a metal ion, and in the oral cavity it can
form insoluble metal salts that can plug dentin tubules.
 Stannous ion is also a tubule occluding agent that treats
dentin hypersensitivity through hydrolysis and oxidation
reactions.

8.  Humactants – glycerin and sorbitol
 Binders – referred as thickeners.
o They provide texture and determine how “thick” or “runny” the
dentrifrice is.
o Xanthun gum, carboxymethyl cellulose(CMC) carbomers, carrageenan,
and synthetic cellulose are commonly used.
 Buffers:: they help to maintain PH constant.
Eg:Trisodium phosphates, and sodium citrate.
 Flavours and sweeteners: to improve dentrifrice taste. Eg:peppermint,
saccharin, and xylitol.
 Surfactants: they create foaming and aid in the cleaning process by
helping to loosen plaque and debris. Eg: sodium lauryl sulfate(SLS).
 Colours/visuals: the colouring agents are added to provide dentrifrice with
pleasing colours.
o Opacity of a paste dentrifrice - titanium dioxide
o Mica - sparky appearance

9.  Any tooth brush, regardless of the brushing method used, does not
completely remove interdental plaque biofilms.
 Dental floss: floss is made from nylon filaments or plastic mono filaments
and comes in waxed, unwaxed, thick, thin, and flavoured varieties.
 Waxed dental floss was thought to leave a waxy film on proximal surfaces,
thus contributing to biofilm accumulation and gingivitis.
 Disposable single use floss holders with prethreaded floss are also
available.
 Powered flossing devices are also available. The devices have shown to be
safe and effective, but no better at plaque biofilm removal than holding the
floss in the fingers.
 Uses:
o Removal of adherent plaque and food debris from the
interproximal embrassure
o Polishing of tooth
o Stimulating and massaging the inter dental pappilae

10. oHelping in locating the following
Subgingival calculus deposits
Overhanging margins of the restorations
Proximal carious lesions
oVehicle for application of polishing or theraupeutic
agents to interproximal and subgingival areas.
Disadvantages:
oIt is time consuming
oRequires skill
oCarries the risk of tissue damage if not used properly

11. Spool method:

12. Circle or loop method:
 In this method, a loop or circle of the floss is
made from about 12-18 inches long piece and
both ends are tied securely with the three
knots. All the fingers except the thumbs of
both the hands are placed within the loop and
the floss is held tightly by both the hands
having about 1-2 inches of floss between
fingers of both the hands.
 Floss holders may also be used for holding the
floss, especially in patients lacking manual
dexterity. Powered flossing devices are also
available which moves the pestrung floss in
short motions.

13.  The floss is then passed gently through each
contact area with a firm back and forth motion.
 Once the floss is apical to the contact area, it is
wrapped around the proximal surface of one
tooth and slipped gently under the marginal
gingiva.
 The floss is then moved firmly along the tooth up
to the contact area and gently down into the
sulcus again, repeating this stroke for 2-3 times.
 Then move the floss across the interdental
gingiva and repeat the procedure on the
adjacent tooth until the whole dentition is
covered.

14. Interdental cleaning devices: concave root
surfaces such as the mesial aspect of the
maxillary first bicuspid and furcations are often
present in periodontal patients who have
experienced significant attachment loss and
recession, they are not cleaned well with dental
floss

15.  Interdental brushes: a wide variety of interdental cleaning devices are
available for removing microbial plaque biofilm from between the teeth.
The most common types are conical or cylindrical brushes, tapered
wooden tooth picks that are round or triangular in cross section, and
single-tufted brushes.
o interdental brushes of any style are inserted through the
interproximal spaces and moved back and forth between the teeth
with short strokes.
o single tufted brushes provide access to furcation areas, or isolated
areas of deep recession and work well on the lingual surfaces of
mandibular molars and premolars, these areas are often missed when
using a tooth brush and floss.
 Wooden or rubber tips: they are used either with or without a handle.
 triangular wooden tips are also available; this design is most useful in
the anterior areas when used from buccal surfaces of the teeth.
 rubber tips are conical and mounted on handles or the ends of the
tooth brushes; they are reusable and can be easily adapted to all
proximal surfaces in the mouth.
 plastic tips that resemble wooden or rubber tips are also available and
are used in the same way.

16.  They are 5 or 6mm long
 Soft, triangular wooden or plastic picks are placed in the
interdental space with the base of the triangle resting on
the gingiva and the sides in contact with the proximal
surfaces of the tooth.the pick Is then repeatedly moved in
and out of the embrassure several times to remove the
biofilm. The disadvantage of this is they do not reach well
in to the posterior areas or lingual surfaces.
 Rubber tips should be placed into the embrassure space
resting on the gingiva, and used in a circular motion.

17. Home/self - applied irrigation:
The body of evidence on the oral
irrigators(also called water flosser and dental
water jet) consistently has been shown to
significantly reduce gingivitis, bleeding on
probing, and periodontal pathogens.

18.  The mechanism of action of irrigation occurs through the direct
application of pulse stream of water or other solution.
 Pulsating devices have been shown to be 3 times as effective as
continuous - stream irrigating syringe.
 clinical efficacy have been done using water flosser with 1200-1400
pulsations per minute set on a medium to a high pressure setting (50-90
psi)
 Oral irrigators with varying pulsation and pressure are available, but like
other self-care products, research from one product brand should not be
extrapolated to other brands since they may have used a different
pressure setting and pulsation rate.
 Two zones of hydrokinetic activity: the impact zone in which the solution
reaches into the subgingival sulcus.
 Home irrigation has been demonstrated to penetrate subgingivally with
both a jet tip and soft, site-specific, subgingival tip.

19.  Supragingival irrigation is irrigation with a jet tip
placed above the gingival margin resulting in
penetrtion of a solution into the subgingival
sulcus to approximately 50%
 The jet tip is generally used for full - mouth
irrigation.
 Supragingival tips enhanced with soft, tapered
bristles.
 Irrigation with soft, site - specific tip is called
subgingival irrigation.
 The subgingival tip is used for the localised
irrigation of a specific site such as deep pocket,
furcation, implant, or crown and bridge.

20.  Removal of plaque biofilm and reductions in
calculus, gingivitis, bleeding on probing,
probing depth, periodontal pathogens, and
inflammatory mediators.
 Home irrigation has been studied and found
safe and effective for those with gingivitis,
implants, crown and bridge, orthodontics,
intermaxillary fixation, and diabetes; patients
who are non complaint with dental floss; and
in periodontal maintanance.