Toothbrushing Methods

Question 1

oral hygiene prevention of

Answer 1

caries
perio
halitosis
staining

Question 2

toothbrush design options

Answer 2

size (L, M, S)
hardness - hard, medium, soft, extra soft
bristle length
**figure slide 5

Question 2

toothbrush profiles

Answer 2

concave
convex
multilevel
flat

Question 3

thinner bristles allows for…

Answer 3

more resiliency and softness

Question 4

shorter filament ->

Answer 4

stiffer bristle

Question 5

what things influence bristle texture?

Answer 5

temp, uptake of water, fx of use

Question 6

what shape of bristle is recommended

Answer 6

end rounding

Question 7

what is better for bristles, nylon or natural?

Answer 7

nylon - more flexible, do not split/abrade

Question 8

purpose of toothbrushing

Answer 8

remove plaque, food, debris, stain
stimulate gingival tissue
application of dentine containing ingredients for caries, perio, sensitivity

Question 9

handle designs

Answer 9

may have curves/twists to allow for hard to reach areas
plastic handle is best

Question 10

disclosing tablets use

Answer 10

identify plaque and problems

Question 11

toothbrushing methods

Answer 11

bass*****
rolling
stillman
charters
fones
leonard
horizontal
smith
scrub

Question 12

bass method

Answer 12

acceptable for all patients
bristles angled apically at 45* to long axis of tooth
filaments subgingival
short horizontal strokes
2-3 teeth at a time

Question 13

powered toothbrushes

Answer 13

mechanical, sonic, ionic
main patterns of movement: oscillation, reciprocation, rotational
direct source/cord or battery
brush movements range from 3800-7600 per minute
ex: crest spin brush, oral B sonic complete, sonicare elite

Question 14

benefits of powered toothbrushes

Answer 14

parents who brush children’s teeth
physically handicapped, dev disabled, elderly, dexterity issues

Question 15

why are powered toothbrushes considered more effective?

Answer 15

remove up to 70% plaque
3 month review - plaque reduced up to 21%, gingivitis 11%

Question 16

toothbrushing time and frequency

Answer 16

different amount of time/individual depending on need
rule of 2 (2 mins, 2xday, dentist 2xyear)

Question 17

flossing/IP care

Answer 17

toothbrush can’t remove interproximally
should be done every 24 hours
reduces calc formation, gingival bleeding/inflammation
can be used as a vehicle for chemo agents to interprox and sub gingival areas

Question 18

flossing techniques (string floss)

Answer 18

spool method (wrap around fingers)
loop method (tie floss in large loop)
should adapt to tooth surface in a C shape without cutting gingiva

Question 19

oral care plans should be _________ to the patient

Answer 19

personalized

Question 20

adjunctive aids (examples)

Answer 20

floss
floss holder/threader
power floss
super floss
interproximal brush
uni-tuft/end-tuft brush
toothpick
wooden/plastic triangular stick
rubber tip
gauze strip
oral irrigator
water pik
tongue scraper

Question 21

adjunctive aids purposes

Answer 21

proximal surfaces/hard to reach areas
rotated/malaigned teeth
partially erupted teeth
irregular tooth morph
furcations
embrasure spaces
ortho
implants
fixed prosthetic

Question 22

should I demonstrate how to use an adjunct to a patient?

Answer 22

absolutely

Question 23

interproximal aids should be used with caution, why?

Answer 23

can cause severe abraision and damage to hard and soft tissue

Question 24

halitosis

Answer 24

bad breath could be from oral cavity, but is likely from something else (nasal, tonsil, respiratory, systemic disease, GI, foods) perio xerostomia (reduced saliva) tongue scraping could help

Question 25

ADA seal of acceptance indicates a product is...

Answer 25

safe and good to use/recommend to patients use caution with recommending things not approved by ADA or FDA

Question 26

dentrifices

Answer 26

substances used to clean teeth aka toothpaste therapeutic = reduce caries, gingivitis, plaque, sensitivity cosmetic = removing stain beware of deceptive marketing (lots of claims made)

Question 27

chewing gums

Answer 27

newer category of products with cosmetic claims and ability to deliver therapeutic compounds

Question 28

dentrifices abrasives

Answer 28

common types are carbonates, phosphates, and silicas humectants - maintain moisture preservatives - prevents most, may cause sensitivity

Question 29

what relative dentin abrasion (RDA) is considered safe for long-term?

Answer 29

under 70, 250 is upper limit anything above 70 should be monitored by a dentist

Question 30

charcoal toothpaste's

Answer 30

insufficient research abrasive not ADA approved

Question 31

sodium lauryl sulfate (SLS)

Answer 31

detergent stable some antibacterial properties can cause allergies (tissue sloughing) many brands don't have this

Question 32

fluoride

Answer 32

most commonly used therapeutic agent OTC: 1000 ppm FL, 120mg FL prescription: 5000 ppm, 260mg FL

Question 33

triclosan

Answer 33

**NO LONG FDA APPROVED antibacterial agent previously used to prevent gingivitis and reduce plaque promotes bacterial resistance - problematic disrupts thyroid hormones IBS changes in microbiome

Question 34

potassium nitrate

Answer 34

FDA approved OTC desensitization agent reduces reaction of nerves in teeth to stimuli such as heat and cold desensitize nerve by penetrating through length of dentinal tubules and ro depolarize sensory nerve endings at dentin pulpal interface many sensitivity brands use this **good to use with SRP

Question 35

whitening agents

Answer 35

carbamide peroxide - breaks down to form urea and hydrogen peroxide, in toothpaste (but not in contact with tooth long enough to have good effect), whitening usually from abrasives and stain removal hydrogen peroxide - free radical -> contains oxygen -> bleaching

Question 36

nano-hydroxyapatite (n-HA)

Answer 36

nano materials: materials with 1+ external dimensions with a size of 1-100nm, widely used in resins/bonding/bioceramics/sealers/toothpastes/cosmetics n-HA: synthetic Ca phosphate compound, biologically similar to hydroxyapatite claim: tooth remineralization, FL alt **differences in particle shape between HAP and nano-HA (needle is not good - banned by EU) **major safety concerns - not FDA approved (potential systemic absorption, Ca level concerns, crossing blood brain barrier concerns)

Question 37

ADA position on nHA?

Answer 37

no formal position/seal of approval for nHA best recommendation is FL

Question 38

mouth rinses

Answer 38

traditional method for stabilizing/delivering pharmaceutical active agents primarily cosmetic benefits (pleasant taste/sensation) therapeutic benefits (reduce plaque, gingivitis, caries) OTC and prescription

Question 39

zinc chloride

Answer 39

found in some mouth rinses effective in neutralizing VSC and killing G- bacteria responsible for VSC formation greater than 3 hours

Question 40

xerostomia

Answer 40

artificial salivas, mouthwashes, sprays increased caries risk - added FL dif claims help provide moisture and relief for dry and irritated oral tissue - oasis mouthwash (sensodyne), biotene mouthwash

Question 41

chlorhexidine gluconate

Answer 41

peridex (for perio issues, remember this) FDA approved prescription plaque control rinse one of the most effective anti-plaque agents could cause some staining and altered taste sensation/irritation of oral mucosa - not for longterm usage

Question 42

essential oil mouth rinses

Answer 42

listerine effective in controlling plaque and gingivitis with alcohol is best - vehicle for EO

Question 43

cetylpyridinium chloride

Answer 43

most common quaternary ammonium compound used in mouth rinses clinically studied bactericidal agent - disrupts membrane to kill bacteria reduced plaque and gingivitis reduced plaque biofilm by 14-24% extrinsic staining** no alcohol

Question 44

FL mouth rinses are effective in reduction of?

Answer 44

caries intended for daily/weekly use varying concentrations of FL

Question 45

chewing gum

Answer 45

potential to delivery cosmetic/therapeutic agents for a longer time than with denitrifies or mouthiness **stimulate salivary flow - mechanical removal of plaque/debris helps reach hard to brush areas

Question 46

"sugar free" products

Answer 46

xylitol - non acidogenic/fermentable by bacteria, deadly to pets sorbitol - not as effective as xylitol, low carcinogenicity when chewed no more than 3 times per day