For DH Theory IV, students paired up to present over topics they still wanted to review before taking their boards exam. My partner and I discussed toothbrushing methods, instruments, fluoride doses, and the lymphatic system.

1. Kalvin & Megan’s
Boards Review
SFCC
DH Theory IV

2. Toothbrushing Methods

3. Toothbrushing Methods
Toothbrushing methods can be classified based on the position and motion of
the brush. Some of these methods include:
● Sulcular: Bass
● Roll: Modified Stillman
● Vibratory: Charters
● Circular: Fones

4. Bass Method
● Angle bristles 45° toward the apex at gingival ⅓, placing the bristles into the
sulcus
● Recommended method for perio patients
● Also good for open embrasures, cervical areas beneath the height of contour
of the enamel, and exposed root surfaces

5. Modified Stillman Method
● Angle bristles 45° toward the apex with ½ of bristles placed on the tooth, the
other half on the gingiva. Differs from Stillman method by incorporating a
rolling stroke after the vibratory phase.
● Used for the general cleaning of tooth surfaces and massage of the gingiva

6. Charters Method
● Place bristles 45° towards occlusal/incisal plane; move bristles in several
small rotary motions keeping in contact with gingival margin
● Recommended method for ortho patients
● Also good for abutment teeth and under the gingival border of a fixed partial

7. Fones Method
● Position bristles perpendicular to crown of the teeth; brush in circular
motion
● Recommended for pedo patients
● Can be detrimental for adults who brush too vigorously

8. Instruments

9. Scalers
● 2 cutting edges
● Removal of supragingival calculus
● Pointed toe
● Internal angles of 70-80°
Montana Jack
McCalls 13/14
204S
Nebraska

10. Universal Curets
● 2 cutting edges
● Removal of supragingival and subgingival calculus
● Rounded toe
● Face of instrument is perpendicular (90°) to the lower shank
● Internal angles of 70-80°
Columbia 4R/4L

11. Area-Specific Curets (Gracey’s)
● 1 cutting edge
● Removal of subgingival calculus
at the base of deep pockets
● Rounded toe
● Face is “offset” (70°) in relation
to the lower shank
Gracey 1/2
Gracey 11/12
Gracey 13/14

12. Fluoride Doses

13. Fluoride Doses
Age Concentration of Fluoride Ion in Drinking Water
<0.3 PPM 0.3 – 0.6 PPM >0.6 PPM
Birth – 6 months NONE NONE NONE
6 months – 3 years 0.25 mg/day NONE NONE
3-6 years 0.50 mg/day 0.25 mg/day NONE
6 -16 years 1.00 mg/day 0.50 mg/day NONE

14. The Lymphatic System

15. Lymphatic System
❏ Network of tiny channels and nodes
❏ Helps venous circulation return interstitial fluid to the bloodstream
from the tissues of the body, and plays a key role in our immune system
❏ Lymphocytes, derived from stem cells in the bone marrow
❏ Present in lymph nodes (T cells mature in the Thymus)
❏ Respond to foreign antigens in the tissue fluids
❏ Tender and/or enlarged lymph nodes can indicated infection or
malignancy
❏ Detected by palpation: border of the mandible, sternocleidomastoid,
cervical triangle

16. Lymph Nodes to Remember (pg 108)
1) Submental
a) Drain fluid from the mandibular incisors, tip of the tongue, midline of the lip, chin, and floor
of the mouth
2) Submandibular
a) Drains the Submental nodes and remaining teeth
b) May or may not include 3rd molars due to anatomical variation
3) Superior and Inferior Deep Cervical Nodes
a) Drains the Submandibular nodes, 3rd molars, and the wall of the throat (includes the
retropharyngeal nodes)
b) Structures of the oropharynx, drained by superior deep cervical nodes
c) Superior deep cervical drained y inferior deep cervical

17. Infection Impact upon nodal sequence
1) Primary node
a) First node affected by a disease process
2) Secondary Node
a) The next set of nodes affected by a disease or process
3) Tertiary Node
a) He third nodal set affected by a disease process