oral hygiene instructions

2. CONTENTS
• INTRODUCTION
• STEPS IN A PREVENTIVE PROGRAM
• PATIENT COUNSELLING
• PATIENT COMPLIANCE
• MOTIVATIONAL INTERVIEWING
• LEARNING PROCESS
• PATIENT PLANNING
• BASIC STEPS FOR MAINTAINING ORAL HYGIENE
• TOOTH BRUSHES
• DENTIFRICES
• ORAL IRRIGATION DEVICES
• FLOSS
• INTERDENTAL CLEANING
• RINSING
• REGULAR DENTAL CHECKUPS
• PROPER DIET
• CONCLUSION
• REFERENCES

3. INTRODUCTION
• Oral hygiene includes all the processes for keeping mouth clean and healthy. Good oral hygiene
is necessary for prevention of dental caries, periodontal diseases, bad breath and other dental
problems.
• Oral health: oral health is defined as the retention throughout life of a functional, aesthetic &
natural dentition of not less than 20 teeth & not requiring prosthesis
WHO – 1982
Oral
hygiene
Importance
prevention

4. GOALS
Eliminate sources of infection
Stabilize and preserve oral tissues
Restore oral function
Educate patient regarding maintenance
Facilitate maintenance of adequate nutrition
Contribute to self-esteem and quality of life
ITI basic oral hygiene instruction manual

5. STEPS IN A PREVENTIVE PROGRAM
ASSESS THE
PATIENT’S NEED
PLAN FOR
INTERVENTION
IMPLEMENTATION
CLINICAL
PREVENTIVE
SERVICES
EVALUATE
PROGRESSIVE
CHANGES
PLAN SHORT-AND
LONG-TERM
MAINTENANCE
ITI basic oral hygiene instruction manual

6. PATIENT COUNSELING
• KNOWLEDGE
• ATTITUDES
• PRACTICES
Psychological interventions to improve adherence to oral hygiene instructions in adults
with periodontal diseases Renz a et al cochrane library 2007

7. PATIENT COMPLIANCE
• Successful long term periodontal therapy requires exceptional patient compliance to a
periodontal maintenance program
• 100% patient compliance has been reported to be as low as 16%, with nearly 34% of
patients failing to return for maintenance after completion of active therapy
Self perception of generalized aggressive periodontitis and its influence on the compliance
with the oral hygiene instructions renato correa et al braj j oral sci 2010

8. patient compliance contd…
Factors affecting patient compliance
time constraints
prolonged treatment plans
perceived unimportance of periodontal maintenance therapy

9. MODELS
• The health belief model
• Theory of planned behavior
• Leventhal’s model
• Trans theoretical model
patient compliance contd…
Psychological interventions to improve adherence to oral hygiene instructions in adults
with periodontal diseases renz a et al cochrane library 2007

10. HEALTH BELIEF MODEL
patient compliance contd…

11. patient compliance contd…
THEORY OF PLANNED BEHAVIOUR

12. PATIENTS NON COMPLIANCE
• Current health beliefs
• EI (emotional intelligence)
• Psychosocial stressors
• Personality traits

13. MOTIVATION INTERVIEWING
• MI has been defined as a client centered, directive method for enhancing intrinsic
motivation to change by exploring and resolving ambivalenc, miller and rollnick 2002
Lindhe.Clinical-periodontology-implant-dentistry-2-volumes-5th-edition
• Jane stenman 2012 A single freestanding MI session as a prelude to conventional
periodontal treatment had no significant effect on the individuals' standard of self-performed
periodontal infection control in a short-term perspective.

14. DEVELOPMENT
Motivational interviewing contd…
• Motivation is elicited from within the patient rather than externally imposed upon the
patient by a practitioner.
Lindhe.Clinical-periodontology-implant-dentistry-2-volumes-5th-edition

15. IMPLEMENTATION
• Key principles of motivational interviewing
1. Express empathy
2. Develop discrepancy
3. Roll with resistance
4. Support self-efficacy
Motivational interviewing contd…
Lindhe.Clinical-periodontology-implant-dentistry-2-volumes-5th-edition

16. BASIC COMMUNICATION SKILLS
Open
ended
questions
Affirm the
patient
Reflect
Summari
ze.
Motivational interviewing contd…

17. GIVING ADVICE
Motivational interviewing contd…
elicit the patient’s readiness and interest in hearing
the information.
provide the information in as neutral a fashion as
possible.
elicit the patient’s reaction to the information presented.

18. LEARNING PROCESS
• Principles of learning
• Learning is more effective when an individual is physiologically and psychologically
ready to learn.
• Individual differences must be considered if effective learning is to take place.
• Motivation is essential for learning.
• Evaluation of the results of instruction is essential to determine whether learning is taking
place.
Oral hygiene measures and promotion: review and considerations, Audrey choo et al
australian dental journal 2001

19. LEARNING LADDER
unawareness
Awareness
Self interest
Involvement
Action
Habit
Oral hygiene measures and promotion: review and
considerations, Audrey choo et al australian dental journal
2001

20. INDIVIDUAL PATIENT PLANNING
• When to teach
• Initial instruction is best given first, before any clinical treatment
• The setting
• Teaching facility

21. Objective
Description
Evaluate with
the Patient
Demonstration
Application of a
Disclosing
Agent
Instruction
Summary of
Lesson I
End of
Appointment
PRESENTANTION, DEMONSTRATION, PRACTICE
FIRST LESSON

22. SECOND LESSON
• success
Objectives
• Examine the Gingival Tissue
• Apply the disclosing agent
Evaluation
• Questions???
• compliment
Review and Extension
of Knowledge

23. CONTINUOUS INSTRUCTION
Number of Lessons
Relationship Gingival Health
Maintenance
Psychological interventions to improve adherence to oral hygiene instructions
in adults with periodontal diseases renz a et al cochrane library 2007

24. INSTRUCTION ADAPTABILITY
• The methods for presentation, demonstration, practice, and evaluation can be adapted
readily to various age levels.
• Awareness of the changing motivation and interests of the young to the elderly, and
adaptations of terminology with respect for the patient's level of understanding, ease the
transition from patient to patient.
Psychological interventions to improve adherence to oral
hygiene instructions in adults with periodontal diseases
renz a et al cochrane library 2007

25. THE TEACHING SYSTEM
• Reevaluation
• Outcomes

26. EVALUATION OF TEACHING AIDS
General characteristics
• Simplicity
• Content
• Cultural and linguistic appropriateness
• Level of orientation
• Durability
• Cost
• Objectives

27. Main Educational Aids for the Dental Health Education
Visual Aids
Written Promotion
Audiovisual Aids
Interactive Formats
Table Dental Clinic
Yiran peng 2014 stated that The use of images showing the severe consequences of biofilm
accumulation enhanced the oral hygiene of patients treated with fixed appliances.
Cleeren G in 2014 stated that 3D animations are more effective than real time
drawings for periodontal patient education in terms of knowledge recall.

28. READING MATERIAL FOR THE PATIENT
• SELECTION
• THE TEACHER: THE DENTAL HYGIENIST
• Dental hygienists should pay more attention to instruction and education
regarding oral hygiene preventive measures Malka askhanazi 2014
• Elizabeth AH wilson 2012 Multimedia, health materials appears to be a promising
medium for patient education; however, the majority of studies found that print and
multimedia performed equally well in practice. Few studies involved patients in material
development, and less than half assessed the readability of materials.
Comparative analysis of print and multimedia health materials: A review of the
literature,

29. USE OF MODELS.
• Patient’s study cast
• Commercially available models.

30. USE OF DISCLOSING AGENTS
• Purpose
• Methods for application
• Solution for direct application (painting)
• Rinsing
• Tablet or wafer
• Interpretation of findings
• Patient INSTRUCTION
• Explain dental biofilm
• Show location and distribution of biofilm
• Demonstrate methods for daily biofilm removal

32. • Iodine preparations
• Mercurochrome preparations
• Bismark brown
• Merbromin
• Erythrosin
• Fast green
• Fluorescin
• Two tone
• Tri plaque

33. TECHNICAL HINTS FOR DISCLOSING AGENTS
• Avoid using disclosing or antiseptic solutions on teeth that have tooth-color restorations
because these materials may be stained by coloring agents.
• Do not apply a disclosing agent before a sealant is to be placed.
• Purchase solutions in small quantities do not keep solutions containing alcohol longer than 2
or 3 months because the alcohol will evaporate and render the solution too highly
concentrated.
• Use small bottles with dropper caps for solutions. Transfer solution to a dappen dish for use.
Do not contaminate the solution by dipping cotton pliers with pellet directly into the container
bottle.
• Request local druggist to stock disclosing tablets for patients to purchase. Advise patients of
the stores where the agents may be purchased.

34. BASIC STEPS FOR MAINTAINING ORAL
HYGIENE
• Brushing your teeth (at least twice a day or after every meal)
• Floss your teeth regularly
• Proper diet
• Other interdental cleaning
• Rinsing
• Regular dental checkups

35. TOOTH BRUSHES
• Uses
• Biofilm removal
• Application of treatment or preventive agents
• Halitosis control
• Sanitation of oral cavity
Tooth brush a key to mechanical plaque control by Deepak grover Indian journal of oral science
2012, vol3

36. • ADA specifications
• Brushing surface 1 to 1.25 inches in length
• 5/16 to 3/8 inches in width
• 2-4 rows of bristles
• 5-12 tufts per row
• 80-120 bristles per tuft
• Types of tooth brushes
• Manual
• Powered
• Sonic and ultra sonic
• Ionic
Evolution of tooth brush Dr M Praksh, IDA times, Mumbai, June 2008.

37. Parts of a toothbrush
• Handle: the part of the brush grasped in the hand during toothbrushing
• Head: the working end of the toothbrush that holds the bristles or the filaments.
• Tufts: clusters of bristles or filaments that are secured into the head.
• Brushing plane: the surface formed by the free ends of the bristles or the filaments.
• Shank: the section that connects head and handle.
• Manual brush trim profiles: a variety of filament profiles are available.

38. • The subject group using the powered toothbrush
demonstrated clinical and statistical improvement in
overall plaque scores. Powered toothbrushes offer an
individual the ability to brush the teeth in a way that is
optimal in terms of removing plaque and improving
gingival health, conferring good brushing technique on
all who use them, irrespective of manual dexterity or
training
A comparison of the efficacy of powered and manual
toothbrushes in controlling plaque and gingivitis: a clinical
study, Yashika jain, 2013.

39. •
ADAPTATION OF
TOOTH BRUSH

41. POWER BRUSH TRIM PROFILES
Short-term changes in select clinical parameters and subclinical salivary biomarkers may be useful
in assessing efficacy of power brushing interventions in a spectrum of periodontal disease states
Clinical and subclinical effects of power brushing following experimental induction of biofilm
overgrowth in subjects representing a spectrum of periodontal disease, Marcelo B. Aspiras, JCP 2013

43. SONIC TOOTH BRUSHES
• Operates at 31 000 brush
strokes per minute (260
hz)
• High-speed scrubbing
strokes
• Cavitational effect, fluid
streaming, and acoustic
vibrations
Evolution of tooth brush Dr M Praksh, IDA times, Mumbai, June 2008

44. IONIC TOOTH BRUSHES
• Works on the principle of changing
surface charge of tooth to repel plaque
even from inaccessible areas of teeth
• Ionic exchange, along with the normal
mechanical action of the bristles on the
tooth surface, enhances plaque
removal.
• Zimmer S, evaluated the efficacy of the
ultra sonex ultima in comparison with a
conventional manual toothbrush in 64
healthy volunteers. Ultra sonex is more
efficacious than manual toothbrushes
in removing plaque.
Evolution of tooth brush Dr M Praksh, IDA times, Mumbai, June 2008

45. BRUSHING
• Always use a soft bristled toothbrush
• 2. Use anti-cavity fluoride toothpaste
• 3. Hold toothbrush at a 45-degree angle at the gum line, brushing in a circular motion.
This sweeps plaque out of the gingival pocket
• 4. Brush teeth for a minimum of two minutes at least twice a day.
• 5. Brush gums and tongue along with your teeth.
• 6. Don’t brush too hard because this can cause gingival (gum) recession.

46. BRUSHING METHOD

47. BASS METHOD

49. CHARTERS

51. FONES

52. ROLL

53. STILLMANS

55. CARE OF TOOTH BRUSHES
• Supply of brushes
• Brush replacement
• Cleaning of tooth brushes
• Storage of brush

56. INTERDENTAL CLEANING DEVICES
• They are available as,
• Dental floss
• Interdental cleaners such as wooden (or) plastic tips
• Interdental brushes

57. DENTAL FLOSS
• Available as,
• Multifilament nylon that is either
• Twisted (or) non-twisted
• Bonded (or) non- bonded
• Waxed (or) unwaxed
• Thick (or) thin

58. PROCEDURE
• 12-18 inches of length are usually sufficient. Stretch the floss tightly between the thumb
and fore finger (or) between both forefingers and pass it gently through each contact
area with a firm back and forth motion.

59. TUFTED DENTAL FLOSS
• Also called as floss or yarn combination.
• Two commercially available variations
• Super floss
• Nufloss
• Clinical trial comparing the efficacy and safety of quik floss to conventional finger flossing
indicates quik floss to be a safe and effective alternative plaque removal aid.

60. Knitting yarn
• Yarn is looped through dental floss and floss is drawn through the contact area in the
usual manner.
Gauze strip
• 6 or 8 inch length of 1 inch bandage is folded in thirds and placed around a tooth
adjacent an edentulous area, a tooth with inter dental spacing or the distal surface of the
most posterior tooth.
• A shoe shine stroke is used to clean the dental bio-film from the surface

61. • Wooden tips
• Tooth pick in holder
• Wooden inter dental cleaner

62. Inter dental brushes
• Used in type II gingival embrasure.
• Their design is similar to that of bottle brush
Powered inter dental brushes
Uni tufted or single tufted brushes

63. DENTIFRICES
• Dentifrices are aids for cleaning and polishing tooth surfaces.
Composition
• Abrasives
• Silicon oxide
• Aluminum oxide
• Surfactant agents
• Flavoring: pepperment oil
• Humectants: glycerin & sorbital
• Binders: sodium magnesium silicate , colloidal silica, magnesium aluminium silicate

64. ORAL IRRIGATION DEVICES
• Irrigation is targeted application of pulsated stream of water or other irrigants for
therapeutic purpose.
• Rationale for supragingival and sub gingival irrigation is to nonspecifically reduce the
microbial deposits that induce periodontal diseases.
• Primary objective of supragingival irrigation is to flush away the bacteria coronal to the
gingival margin thereby diminishing the potential of developing gingivitis.
• Sub gingival irrigation is to reduce the pocket micro-flora in an effort to prevent initiation
& progression of periodontitis.

65. • Classification of oral irrigation
• Supra-gingival irrigation
• Sub-gingival irrigation
• Sub gingival irrigation was introduced by newman et al 1982 as an adjunct to oral
hygiene procedure

66. AGENTS USED FOR IRRIGATION
• Chlorhexidine
• Hydrogen peroxide
• Water
• Saline
• Sanguinarine
• Stannous fluoride
• Povidone-iodine
• Tetrapotassium peroxydiphosphate

67. DIET
• Tongue cleaner
• Proper diet
Carbonated
drinks, junk
foods, fruit juices
Protien rich, high
fiber content

68. RINSING
• Regular rinses with a good mouthwash helps to keep your mouth clean, fresh and germ
free.
• Daily rinses must be alcohol free (they cause dryness of oral mucosa)
• Fluoride rinses helps to boost the strength of newly erupted teeth.
• It is important to follow manufacturer’s instructions.
• Do not rinse the mouth with water after using mouth wash

69. EXPANDED AND FUTURE USE OF MOUTH
RINSES
• Prophylaxis for bacterial endocarditis
• Aerosol production
• Oral candidiasis
• Oral mucositis
• After periodontal surgery
• Regular dental checkups

70. SIGNS OF GOOD ORAL HYGIENE
• Good oral hygiene results in a mouth that looks and smells healthy.
• Teeth are clean and free of debris.
• Gums are pink and do not hurt or bleed when you brush or floss.
• Bad breath is not a constant problem.

71. ORAL HYGIENE INSTRUCTIONS
SCALING AND ROOT PLANNING
• Refrain from eating for at least 2 hours or until the anesthesia wear off
• Medications: post treatment discomfort is normal. Discomfort should subside within a few
hours to a few days.
• Tooth sensitivity
• Eating
• Bleeding
• Appearance
• Oral hygiene

72. AFTER PERIODONTAL SURGERY
• Periodontal dressing
• Do not brush over the pack
• If given a prescription for chlorhexidine (peridex), bathe the area of surgery without
rinsing for 2 minutes after breakfast and before bedtime using a ½ of a capful of peridex.

73. ADDITIONAL INSTRUCTIONS FOR DENTAL IMPLANT SURGERY
• Do not rinse your mouth vigorously during the first 24 hours after surgery.
• If given a prescription for chlorhexidine (peridex), bathe the area of surgery without rinsing for
2 minutes after breakfast and before bedtime with ½ of a capful of peridex. Continue its use
until dentist tells you to stop.
• If nose bleeding occurs, do not blow your nose vigorously.
• Maintain a soft diet for the first 5 days after the operation and if possible, eat on the side of
your mouth that did not have surgery.
• Use an elevated headrest or an extra pillow for the first 2 nights after the operation.
• Do not use your prosthesis until it has been relined

74. RESPIRATORY DISORDER
• Patient should be encouraged to floss regularly and brush twice daily with a dentifrice
that offers antibacterial protection and anti-inflammatory benefits.
Chest. 2004 nov; 126(5):1575-82

75. INSTRUCTIONS DURING PREGNANCY
• Brush teeth with fluoridated toothpaste twice a day, and floss once a day.
• Limit foods containing sugar to mealtimes only.
• Drink water or low-fat milk. Avoid carbonated beverages (pop or soda).
• Choose fruit rather than fruit juice to meet the recommended daily intake
of fruit.
• Obtain necessary oral treatment before delivery.
• Diagnosis (including necessary dental x-rays) and necessary treatment can
be provided throughout pregnancy; however, the period between the 14th
and the 20th week of pregnancy is the best time to receive treatment.
• Treatment for conditions requiring immediate attention are safe during the
first trimester of pregnancy. Delaying necessary treatment could result in
significant risk to you, and indirectly to your baby.

76. ORAL HEALTH PROGRAM FOR CVS PATIENTS
• Frequent dental prophylaxis (every 3 months to 6 months)
• Twice daily brushing with fluoride toothpaste
• Avoid rinsing after brushing to maximize fluoride effect
• Use toothpaste containing 1,450 ppm fluoride or prescription toothpaste containing 2,500 ppm to 5,000
ppm fluoride
• Fluoride varnish application
• Frequent sips of water and rinsing with water after
• Meals and food supplements • saliva substitutes
• Using a straw with food supplements to minimize contact with teeth
• Power toothbrush
• Alcohol-free mouthrinse
• Floss

77. CONCLUSION
• To promote healthy periodontal and dental tissues, current mechanical and
chemotherapeutic approaches to oral hygiene aim to modify the oral micro flora.
• The challenge for oral hygiene promotion is effective delivery of these measures
combined with effectual motivation of individuals and communities to aspire to oral
health.

78. REFERENCES
• Soben peter. Essentials of preventive and community dentistry. Second edition.
• Park .Social and preventive medicine.18th edition.
• Wilkins. The clinical practice of the dental hygienist.10th edition.
• Carranza's clinical periodontology.10th edition
• Lindhe.Clinical-periodontology-implant-dentistry-2-volumes-5th-edition.
• Guljot singh, d. S. Mehta, shruti chopra, and manish khatri. Comparison of sonic and ionic toothbrush in
reduction in plaque and gingivitis. J indian soc periodontol. 2011 jul-sep; 15(3): 210–214.
• Audrey choo,* david m delac,* louise brearley messer*.Oral hygiene measures and promotion: review
and considerations. Australian dental journal 2001;46:(3):166-173

79. • Bakdash B. Current patterns of oral hygiene product use and practices. Periodontol 2000
1995;8:11-14.
• Carter-hanson c, gadbury-amycot c, killoy w. Comparison of the plaque removal efficacy
of a new flossing aid (quik floss) to finger flossing. J clin periodontol 1996;23:873-878.
• Kiger rd, nylund k, feller rp. A comparison of proximal plaque removal using floss and
interdental brushes. J clin periodontol 1991;18:681-684.
• Jenkins s, addy m, newcombe r. Evaluation of a mouthrinse containing chlorhexidine and
fluoride as an adjunct to oral hygiene. J clin periodontol 1993;20:20-25.
• Moran jm. Chemical plaque control – prevention for the masses. Periodontol 2000
1997;15:109-117.
• Smith aj, moran j, dangler lv, et al. The efficacy of an antigingivitis chewing gum. J clin
periodontol 1996;23:19-23.
• Claydon n, hunter l, moran j, et al. A 6-month home usage trial of 0.1% and 0.2%
delmopinol mouthwashes (I). Effect onplaque, gingivitis, supragingival calculus and tooth
staining. J clin periodontol 1996;23:220-228.