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Root fractures and its management



Brushing techniques

It is a detailed description of the various brushing techniques practiced. It is a presentable seminar which is easy to understand. It helped me a lot to learn the technique in detail.
I would like to thank everyone associated with me and this presentation.

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Brushing techniques

  2. 2. INTRODUCTION • Brushing our teeth is an important part of our dental care routine. • For a healthy mouth and smile the ADA recommends- • Brush your teeth twice a day with a soft-bristled brush. The size and shape of your brush should fit your mouth allowing you to reach all areas easily. • Replace your toothbrush every three or four months, or sooner if the bristles are frayed. A worn toothbrush won’t do a good job of cleaning your teeth. • Make sure to use an ADA specified fluoride toothpaste.
  4. 4. THE BASS METHOD OR SULCUS CLEANING METHOD It is the most accepted and effective method for the removal of dental plaque present adjacent to and underneath the gingival margin. INDICATIONS:  It is most adaptable for : • Open interproximal areas. • Cervical areas beneath the height of contour of enamel. • Exposed root surfaces.  It is recommended for patients with or without periodontal involvement.
  5. 5. The bristles are placed at a 45º angle to the gingiva and moved in small circular motions. Strokes are repeated around 20 times,3 teeth at a time. On the lingual aspect of the anterior teeth, the brush is inserted vertically and the heel of the brush is pressed into the gingival sulci and proximal surfaces at a 45º angle. The bristles are then activated. Occlusal surfaces are cleaned by pressing the bristles firmly against pit and fissures and then activating the bristles. TECHNIQUE
  6. 6. ADVANTAGES: o Effective method for removing plaque. o Provides good gingival stimulation. o Easy to learn. DISADVANTAGES: o Overzealous brushing may convert very short strokes into scrub technique of brushing and cause injury to the gingival margin. o Time consuming. o In certain patients dexterity requirement is too high.
  7. 7. MODIFIED BASS TECHNIQUE This method differs from bass technique in that it has sweeping motion from cervical to incisal or occlusal surface. INDICATION:  As a routine oral hygiene measure.  Intrasulcular cleansing. ADAVANTAGE:  Excellent sulcus cleaning.  Good inter proximal and Gingival cleaning.  Good gingival stimulation. DISADVANTAGE:  Dexterity of wrist is required. Toothbrush positioned on facial and maxilloproximal surfaces of maxillary molars. Palatal position on molars and pre molars.
  8. 8. • This technique combines the vibratory & circular movements of the Bass technique with the sweeping motion of the Roll technique. The toothbrush is held in such a way that the bristles are at 45° to the gingiva. • Bristles are gently vibrated by moving the brush handle in a back & forth motion. • The bristles are then swept over the sides of the teeth towards their occlusal surfaces in a single motion. Brush position on the occlusal surface used with Bass, Stillman, Charter's method. Palatal position on incisors. Intrasulcular position of the brush at 45º angle to the long axis of the tooth.
  9. 9. MODIFIED STILLMAN’S TECHNIQUE INDICATION: • Dental plaque removal from the cervical areas below the height of contour of enamel and from exposed proximal surface. • Cleaning tooth surfaces and gingival massage. • It is recommended for cleaning in areas with progressing gingival recession and root exposure to prevent abrasive tissue destruction. • A soft toothbrush is indicated for this technique. DISADVANTAGE: • Time consuming. • Improper brushing can damage the epithelial attachment.
  10. 10. The sides of the bristles are pressed against the teeth and gingiva, while moving the brush with short ‘back and forth’ strokes in a coronal direction. Modified Stillman’s Technique
  11. 11. TECHNIQUE The bristles are pointed apically with an oblique angle to the long axis of the tooth. The bristles are positioned partly on the cervical aspect of tooth and partly on the adjacent gingiva. The bristles are activated with short back and forth motion and simultaneously in coronal direction. 20 strokes are applied and procedure is repeated systematically on adjacent teeth.
  12. 12. FONES METHOD OR CIRCULAR/SCRUB METHOD INDICATION:  Young children.  Physically or emotionally handicapped individuals.  Patients who lack dexterity.
  13. 13. TECHNIQUE The child is asked to stretch his/her are such that they are parallel to the floor. The child is asked to draw big circles using whole arm in the air. The diameter of circles is reduced untill small circles are not formed in front of the mouth. The child is now ready to make circles on the teeth with the toothbrush, making sure that all teeth and gums are covered.
  14. 14. ADVANTAGE:  It is easy to learn.  Shorter time is required. DISADVANTAGE:  Possible trauma to gingiva.  Interdental areas not properly cleaned.  Detrimental for the adults especially who use the brush vigorously.
  15. 15. VERTICAL METHOD-LEONARD’S METHOD Vertical stroke is used. Maxillary and mandibular teeth are brushed separately. ADVANTAGE: • It is the most convenient and effective for small children with deciduous teeth. DISADVANTAGE: • Interdental space of the permanent teeth of adult are not properly cleaned.
  16. 16. TECHNIQUE The bristles of the toothbrush are placed at 90° angle to the facial surface of teeth. With the teeth edge to edge, place the brush with filaments against the teeth at right angle to the long axis of teeth. Brush vigorously without great pressure with a stroke which is mostly up and down the tooth surfaces with a slight rotation or circular movements after striking the gingival margin with force. It is not intended that the upper and lower teeth shall be brushed in the same series of strokes. The teeth are placed edge to edge to keep the brush slipping over the occlusal or incisal surface.
  17. 17. CHARTER’S METHOD INDICATIONS: • Individuals having open inter dental spaces with missing papilla and exposed root surfaces. • Those wearing fixed partial dentures or orthodontic appliances. • For patients who have had periodontal surgery. • Patients with moderate interproximal gingival recession.
  18. 18. TECHNIQUE A soft/medium multi-tufted toothbrush is indicated for this technique. Bristles are placed at an angle of 45° to the gingiva with the bristles directed coronally. The bristles are activated by mild vibratory strokes with the bristle ends lying interproximally.
  19. 19. ADVANTAGE: • Massage and stimulation of marginal and interdental gingiva. DISADVANTAGES: • Brush ends do not engage in the gingival sulcus to remove sub gingival bacterial accumulations. • The correct brush placement is limited or impossible, therefore modifications become necessary which add to the complexity of the procedure. • Requirements in digital dexterity are high.
  20. 20. SCRUB BRUSH METHOD This method of brushing requires vigorous horizontal, vertical and circular motions. It is the virtual free style of the brushing scene. DISADVANTAGE: • Not very effective at plaque removal. • Tooth abrasion and gingival recession.
  21. 21. THE ROLL TECHNIQUE • This method of brushing is also known as the Rolling Stroke method or ADA method or the Sweep method. It works fairly well for patients with anatomically normal gingival tissues. INDICATIONS: • Children. • Adult patient with limited dexterity. • Useful for preparatory lesson for modified Stillman’s technique since the initial brush placement is the same.
  22. 22. TECHNIQUE The bristles are placed at a 45° angle. Toothbrush is rolled across the tooth surface towards the occlusal surface. This technique requires some flexibility around the wrist.
  23. 23. ADVANTAGE: • Provide gingival massage and stimulation. DISADVANTAGE: • Brushing too high during initial placement can lacerate the alveolar mucosa. • Tendency to use quick, sweeping strokes resulting in no brushing for cervical third of the tooth, since the brush tips pass over rather than into the area and likewise for the interproximal area. • Replacing the brush with filament tips directed into the gingiva may produce punctuate lesions.
  24. 24. PHYISIOLOGIC METHOD- SMITH METHOD The physiologic method was described by Smith and advocated later by Bell. It was based on the principle that toothbrush should follow the physiologic pathway that is followed by food when it transverses over the tissues during mastication.
  25. 25. TECHNIQUE Bristles are pointed incisally or occlusally and then moved along and over the tooth surfaces and gingiva. The motion is gentle sweeping from incisal or occlusal surface over to facial surface and progressing towards and over the gingiva. It is almost an attempt to duplicate nature’s self cleansing and gingival stimulation mechanism during mastication of food.
  26. 26. ADVANTAGE: • Natural self cleansing mechanism. • Supragingival cleaning is good. DISADVANTAGE: • Interdental spaces and sulcular areas of teeth are not properly cleaned.
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It is a detailed description of the various brushing techniques practiced. It is a presentable seminar which is easy to understand. It helped me a lot to learn the technique in detail. I would like to thank everyone associated with me and this presentation.


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