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BY: AYUSHI AGRAWAL III rd yr BDS , INDIA
ØToothbrushes are most widely used oral hygiene aids for plaque control ØAcc. to ADA council “ The toothbrush is designed primarily to promote cleanliness of teeth & oral cavity” ØAdult Toothbrush length: 15 to 19 cm ( 6 to 7.5 inch) ØLength of brushing plane: 25.4 to 31.8 mm ØWidth of brushing plane: 7.9 to 9.5 mm ØBristle & filament height: 11mm
6. 4. HANDLE HEAD TUFTS BRUSHING PLANE SHANK . 5.ØParts of Toothbrush 2. 3.
• A handle of larger diameter may be useful for the patient with limited dexterity such as children. Handles with contra-angle provide better sense of touch . • Composition is single type of plastic or a combination of polymers. • Straight handles are more common. aging patient & those of any age with disability.I. HANDLE : • That part which is grasped in hand during tooth brushing.
Length of brush head: 5-12 tufts Width of brush head: 3-4 rows . It should be small enough for max.II. maneuverability in oral cavity. HEAD • • • • The working end of the toothbrush that holds the bristles or filaments.
III. TUFTS • • Cluster of bristles or filaments secured in head Toothbrush BRISTLES Multitufted & space tufted Natural & synthetic Hard . soft Medium .
Comparison of Natural & Synthetic bristles .
BRUSHING PLANE • • • • • The surface formed by the free ends of the bristles or filaments Length: Range from filaments of equal length (flat plane) to those variable length. ADA specification of toothbrush brushing surface:. Brushing plane is commonly soft and rounded for safety to oral soft tissues & tooth structure. multilevel.2 inch. dome. rippled. There are variously shaped filament profile like flat.5 . angled etc.IV.length: 1-1.9-9. width: 7.
V. .SHANK The section that connects head and handle.
ØTypes of Toothbrushes MANUAL POWERED SONIC & ULTRASONIC IONIC .
Designed for utility efficiency & cleanliness. h. Be easily& effectively manipulated Be readily cleaned & aerated. shape & texture. d.I. MANUAL TOOTHBRUSH The ideal characteristics for a manual toothbrush can be listed as follows: Should confirm individual patient requirement in size. c. Be impervious to moisture. e. . g. f. Durable& inexpensive.
PRINCIPLE: The head of toothbrush oscillate in a side to side motion or in rotary motion. The frequency of oscillation is around 40 Hz. The powered toothbrush was first designed in 1885 by Fredrick Tonberg & first made in 1939. Mechanical or Electric toothbrush.II. POWERED TOOTHBRUSH • • • Also known as Automatic. .
. 4.• INDICATIONS FOR POWERED TOOTHBRUSH:2. Institutionalized patient including the elderly who are dependent on care providers. Young children Handicapped patient Individuals lacking manual dexterity Patient with prosthodontic or endosseus implants. 8. 3. 7. 6. Orthodontic patient. 5. Patient on supportive periodontal therapy.
It increases patient motivation resulting in better patient compliance. Brushing timer is incorporated in some brushes to help the patient in brushing for required duration. Uses less brushing force than manual toothbrush. 5. Increased accessibility in the interproximal & lingual tooth surface. 3.•ADVANTAGES OF POWERED TOOTHBRUSH:2. . 4. No specific brushing technique required. 6.
ADVANTAGE: This phenomenon aids in stain removal as well as disruption of bacteria cell wall.6MHz) .III. SONIC AND ULTRASONIC TOOTHBRUSH • PRINCIPLE: These types of toothbrushes produce high frequency vibration(1. DISADVANTAGE: It leads to cavitation & acoustic • • .
. The plaque with similar charge is thus repelled from the tooth surface & is attracted by negatively charged bristles have to be carried out to prove the efficacy of these type of toothbrushes.IV. IONIC TOOTHBRUSH • • They change the charge of a tooth by an influx of positively charged ions.
TOOTH BRUSHING .
3) To disturb & remove plaque. .OBJECTIVES OF TOOTHBRUSHING 1) To clean teeth & interdental spaces of food remnant debris & stain. 5) To clean tongue. 2) To prevent plaque formation. 4) To stimulate & massage gingival tissue.
TOOTH BRUSHING IN CHILD & ADOLESCENT (0 to19 yrs) above) IN ADULT (19 yrs & .
Tooth brushing in Child & Adolescent Various methods of removal of plaque in child & adolescent are :- 4) TOOTHBRUSH • • Synthetic(nylon) manual toothbrush is the most commonly used. . Soft brushes are most preferred in pedodontics due to decreased chances of gingival tissue trauma & increased interproximal cleaning ability.
floss holders & floss & end tuft brushes.•Round type of bristles is of choice because it is associated with lower incidence of gingival tissue irritation. •Toothbrush shd also have smaller head & thicker handle to aid access to oral cavity & facilitate better child grip. . 4) FLOSS • Interproximal removal of plaque beyond tooth brushing is necessary which is done by interdental brushes.
•In pedodontics. Floss-holder . •Unwaxed nylon filament floss has generally been considered as floss of choice as it has an ease of passing b/w the tight junctions . flavored wax floss may be most effective.•Nylon & Teflon floss are available. this floss also does not shred & slides easily between tight contacts. increased surface contact & greater plaque removal. Teflon has advantage that it has lower coefficient of friction than nylon.lack of wax residue.
7) DENTRIFRICES • g) h) i) j) k) Dentifrices are used as:Plaque removing agents abrasives and Stain removing agents surfactants Tartar control properties pyrophosphates Anticaries property Desensitizing property fluoride .•For orthodontic patient super floss or floss threader is helpful.
• The use of much of toothpaste may lead to ingestion of fluoride which is a substantial source of systemic fluoride for children at risk of dental fluorosis.•The child dentifrices should contain fluoride. •The caries preventive efficacy of fluoride toothpastes in children has been good but these fluoride toothpaste has an adverse effect on the child by increasing the total fluoride intake. . rank low in abrasives & carry ADA seal of acceptance.
non foaming. It contain mild . d) To use small. without fluoride.•To reduce chance of dental fluorosis children: b) Manufacturers shd market low fluoride toothpaste for infants or reduce diameter of tube orifice.safe for infants & ideal for babies 4mth -3yr. pea sized quantity toothpaste. c) Shd advice to use a fluoride dentifrice in a child older 36months. • The manufacture shd state that it shd be non abrasive.
. tablet or lozenges form that contains dye or other coloring agent. • Use: e) Personalized patient instruction in location of soft deposits and techniques for removal.4) DISCLOSING AGENT • • A disclosing agent is a preparation in liquid. The bacterial plaque is usually colorless & after the use of disclosing agents it picks up color of the agent where as dye is rinsed off easily from plaque free areas. f) Self evaluation of patient on daily basis.
. e) To gain new information about the incidence & formation of deposits on the teeth. • Method of application: The patient chews the tablet moves it around for 30-60 seconds rinse it completely.c) Continuing evaluation of the effectiveness of the instructions for the patient to determine need for revisions of plaque control procedures. d) Preparation of plaque index.
Pathogenicity of plaque may be reduced by interference with metabolisation of plaque bacteria. . The formation of bacterial & salivary products which constitute the intermicrobial substance in plaque is inhibited. Established plaques may be dissolved.5) CHEMOTHERAPEUTIC PLAQUE CONTROL • c) d) e) f) g) h) Chemicals interfere at various stages of development of plaque:Micro. Calcification of plaque may be counteracted. for plaque formation may be reduced or eliminated in number.org. Colonization of bacteria on the tooth surface may be inhibited.
lingual surface same manner with 2 teeth c) ROLL METHOD • • • • . the bristle ends directed apically with the sides of bristles touching the gingival tissue. The brush is placed again high in the vestibule & the rolling motion is repeated. for children of 11 to 14 yrs old: The brush is placed in vestibule. The patient exerts lateral pressure with sides of bristles & brush is moved occlusally.6) TOOTH BRUSHING TECHNIQUE • There are predominantly 4 main tooth brushing technique that is described by Anaise.
. The bristles are placed at 45degree angle towards plane of occlusion. A lateral downward pressure is then placed on the brush & the brush is then vibrated gently back and forth a mm or so.b) CHARTERS METHOD • • • The bristles are placed in contact with enamel of teeth & gingiva.
• .c) MODIFIED STILLMAN METHOD • • This method combines a vibratory action of bristles with stroke movement of brush in long axis of teeth The brush is placed at mucogingival line. & moved with stroking motion along the gingiva & tooth surface. The handle is rotated toward the crown & vibrated as brush is moved. with bristles pointed away from the crown.
d) HORIZONTAL SCRUBBING METHOD • • • The brush is placed horizontally on buccal & lingual surfaces Then brush is moved back & forth with a scrubbing motion. charters & modified stillmans. Anaise concluded that horizontal scrubbing method exhibited a more significant plaque removing effect than the roll. • . As this method removes more of plaque as compared to other techniques and it is most naturally adopted by children so the HORIZONTAL SCRUBBING TECHNIQUE is the MOST RECOMMENDED brushing technique for CHILDREN.
7) FLOSSING TECHNIQUE 1. Floss is then manipulated into “c”.shape around each teeth individually & moved cervical-occlusal reciprocating motion until the plaque is removed. 4. Care shd be taken not to snap the floss down thru the interproximal contacts to avoid gingival trauma. 3. A 18-24 inch length of floss is obtained & ends are wrapped around the fingers. 2. . Thumb & index fingers are used to guide the floss b/w the 2 teeth to be cleaned.
AGE – SPECIFIC INSTRUCTIONS
II. INFANTS (0 TO 1 yr)
The plaque removal activities should begin on eruption of the first primary tooth. There shd be cleaning & massaging of gums before eruption of teeth to help establishing a healthy oral flora & to aid teething. This shd be done totally by the parent. Tooth brush can also be used if parent feel comfortable. This cleaning and massaging of gums can be done by wrapping a moistened gauze
•While massaging the child can be placed in numerous ways, but ARM- CRADLING POSITION is the simplest & provides the infant more security. In this the child is cradled with one arm while massaging is done with the other. This procedure shd be practiced once daily. •Nonflouridated tooth & gum cleanser may be used. •The child's first visit to dentist shd be during this period. •Dentifrice is not advised to be used becoz the foaming action of the paste is objectionable.
II. TODDLERS(1 TO 3 yr old)
• • • Introduction of moistened, soft–bristled, child or infant sized TOOTH BRUSH into plaque removing procedure. Only a non-fluoridated dentifrice shd be used. Positioning of child and parent is again important in this case. several positions can be used by the parent but LAP TO LAP POSITION is most common & allows one adult to control child's movements while the other adult
The child rests his or her head back in parents non. With the hand of this arm the cheeks can be retracted& the other hand is used for brushing . Only pea sized amount of toothpaste shd be used.III. A fluoride dentifrice can be introduced at 3 yrs of age.dominant arm. In the primary dentition . This position is also appropriate . PRESCHOOLERS (3 TO 6 yrs old) • • • • The parents shd continue to brush the teeth for the child. In this age the position can be such that the parent stands behind the child and both face the same direction. posterior contacts are the only areas where flossing is needed. Flossing is also started in this age.
e. This age is at high risk of caries & periodontal • • • . Early T/t of malocclusion in this age group. flossed & used disclosing agent. SCHOOL-AGED CHILDREN(612yr) • • Most of children can provide their basic oral hygiene i. the parent can easily visualize the remaining plaque & assist the child to remove it. after the child has brushed.IV. brushing & flossing under active supervision by parents. Use of fluoridated dentifrices is essential & fluoridated gels & rinses used in children at risk for caries. Parents can check the cleanliness of child’s teeth by use of disclosing agent.
ADOLESCENT(12-19yr old) • • • At this age the patient has developed adequate skills for oral hygiene procedures but compliance is major problem at this age. Increasing adolescents knowledge regarding plaque control & oral diseases.V. • . may also help in motivating these patients. These patients are at a risk for caries & gingival inflammation bcoz of poor dietary habits. Motivating an adolescent to assume responsibility for personal oral hygiene may lead to rebellious rxns. pubertal hormonal changes & poor plaque control habits due to increase in self-esteem. as well as appealing to their appearance.
Tooth Brushing In Adults .
8.I. 5. 6. 7. TOOTHBRUSHES B. TOOTH BRUSHING TECHNIQUES 3. The Bass method or Sulcus cleaning method Modified bass method Modified Stillman’s method Charter’s method Scrub brush method The Roll technique Fones method or Circular scrub method . 9. 4.
INDICATIONS: d. f. For all patients for dental plaque removal adjacent to & directly beneath gingival margin. cervical areas beneath the height of contour of enamel& exposed surfaces For routine patients with or without . adjacent & directly beneath the gingival margin.I. BASS/SULCUS CLEANING METHOD Most widely accepted & most effective method for dental plaque removal. Particularly adaptable for open interproximal areas. e.
3. making certain that the bristles are at gingival margin. upper & lower . gentle vibratory back & forth motion. Repeat the same method on the inner surface of the teeth as well. . Brush the outer surfaces of each tooth. tilt the brush vertically & make several gentle up and down strokes using the front half of brush. To clean the inside surfaces of the front teeth . 2. keeping the bristles against the gingival margin . Gently brush the surface of each tooth using a short. Scrub the chewing surfaces of the teeth using a short back & forth movement. Place the brush at a 45 angle against the tooth.1. Brushing the tongue will remove bacteria & freshen your breath. 4.
ADVANTAGES: b. . c. DISADVANTAGE: h. Recommended for routine patients with or without periodontal involvement. Time consuming i. Provides good gingival stimulation. d. e. Easy to learn. Dexterity requirement is too high in some patients. Effective method for subgingival cleansing.
MODIFIED BASS TECHNIQUE INDICATIONS: c. As a routine oral hygiene measure. In a single motion. .e. the bristles are then swept vertically over the sides of teeth towards their occlusal surfaces. TECHNIQUE: g. vibratory horizontal motion.II.degree angle at gingiva. The toothbrush is held such that the bristles are at a 45. Bristles are gently vibrated back & forth motion i. d. h. Intrasulcular cleaning. i.
ADVANTAGES: c. d. Excellent sulcus cleaning. Moderate dexterity of wrist is required. e. . DISADVANTAGES: h. Good gingival stimulation. Good interproximal & supragingival cleaning.
MODIFIED STILLMANS TECHNIQUE c. d.III. e. General application for cleaning tooth surfaces and massage of the gingiva. Recommended for cleaning in areas with progressing gingival recession & root exposure to prevent abrasive tissue destruction. INDICATIONS: Dental plaque removal from cervical areas below the height of contour of enamel & from exposed proximal surfaces. .
TECHNIQUE: b. Helps in supragingival cleaning. ADVANTAGE: e. . Place the toothbrush at 45 degree angle partly on gingiva & partly on cervix of teeth. Time consuming. DISADVANTAGE: g. The bristles are gently moved with a vibratory pulsating motion& gently swept occlusally over sides of teeth. h. c. Improper brushing can damage the epithelial attachment.
CHARTERS METHOD INDICATIONS: d. . Patients with moderate gingival recession particularly interproximally.IV. For patients who have had periodontal surgery. i. h. j. Massage & stimulation for marginal & interdental gingiva. Those wearing FPD or orthodontic appliances. Indications having open inter dental spaces with missing papilla & exposed root surfaces. g.
c. DISADVANTAGE: Brushing ends do not engage the gingival sulcus to remove subgingival bacterial accumulation. TECHNIQUE: b. The bristles are then moved in a circular vibratory motion. In some areas the correct brush placement is limited or impossible. Interproximal cleansing. j.IV. therefore modifications become necessary which add to the complexity of the procedure. h. Gingival stimulation. ADVANTAGE: e. i. The bristles are placed at a 90 degree angle to the tooth. . Requirements in digital dexterity are high. f.
f. i. h. j. SCRUB BRUSH METHOD c. . TECHNIQUE: The brush is kept in 90 degree angle to the tooth. The bristles are moved in horizontal strokes. ADVANTAGE: Supragingival cleansing. Tooth abrasion & gingival recession. DISADVANTAGE : Ineffective at plaque removal. Detrimental to general oral health. d.V.
THE ROLL TECHNIQUE Ø d. e.VI. material alba & food debris from the teeth without emphasis on gingival sulcus. For general cleaning in conjunction with the use of vibratory technique. f. h. Cleaning gingiva & removal of plaque. g. . In patients with anatomically normal gingiva Indications: Children & adult patients with limited dexterity. Patients required gingival massage & stimulation. Used as a preparatory instruction for modified stillmans technique.
TECHNIQUE: b. Replacing the brush with filament tips directed into the gingiva may produce punctuate lesions. c. Bristles are placed at a 45 degree angle to tooth surface. . DISADVANTAGE: Brushing too high during initial placement can lacerate the alveolar mucosa. Tendency to use quick. Bristles are lightly rolled across the tooth surface towards the occlusal surfaces. g. e. f. sweeping strokes resulting in no brushing for the cervical third of tooth & the interproximal area.
Ø e.VII. but do not have the muscle development for techniques which requires more co-ordinations. FONES METHOD INDICATION: Indicated for young patients who want to do brushing. . TECHNIQUE: The child is used to make big circles in air which are then reduced in diameter very small circles are made in front of mouth The brush is placed in 90 degree angle to the tooth & then bristles are moved in horizontal direction. f.
d. Possible trauma to gingiva. f. It is easy to learn. This technique has equal or better potential than bass technique for plaque removal & prevention of gingivitis. Gingiva is provided with good stimulation. g. Patients who lack dexterity for a more technical brushing method. handicapped individuals. k.ADVANTAGES: b. This technique may cause harm to adults especially who use the brush vigorously. e. Shorter time Physically or emotionally. DISADVANTAGE: j. l. c. Interdental areas are not properly cleaned. .
TOOTH BRUSHING METHODS CONTINUED……. .
. 8. Toothbrush trauma: gingival alterations Acute alteration Chronic alteration f. ACUTE ALTERATION(LACERATIONS) Scuffled epithelial border with denuded underlying connective tissue. Horizontal or vertical scrubbing tooth brushing method with pressure (either manual or powered) PRECIPITATING FACTORS: 11. 7. Diffuse redness && denuded attached gingiva.B. 9. EFFECTS OF IMPROPER TOOTH BRUSHING II. Punctate lesions that occur as red pinpoint spot.
Areas most commonly involved are around canines or teeth in labio.version. 12. CHRONIC ULCERATIONS 7. Malposition of teeth. Over vigorous placement & application of toothbrush. 8. Narrow band of attached gingiva cannot withstand pressures of brushing . Penetration of gingiva by filament ends. Predisposing anatomic factors xiii. g. Application of filaments beyond attached gingiva. xiv. Usually appear on the facial gingiva becoz of the vigor with which toothbrush is used. • RECESSION 11. 3. 4. 5.2. broken bristles or filaments. Appearance: margin of the gingiva has receded towards the apex & cementum is exposed. Use of toothbrush with frayed .or bucco.
Rolled. hard firm marginal gingiva in ‘piled up’ or festoon shape. PRECIPITATING FACTORS 5. . Use of long.• CHANGES IN GINGIVAL CONTOUR 2. brisk strokes with excessive pressure over a long period of time. Habitual prolonged brushing in one area. 3. vertical or horizontal tooth brushing techniques over a long period of time. bulbous. 7. Excessive pressure applied with worn out non-resilient brush. Gingival cleft. Repeated use of vigorous rotary. 6. 8. Suggested corrective measures • Use of softer toothbrush. • Demonstration of proper brushing technique.
vi. xii. Horizontal brushing Excessive pressure during brushing. v. Abrasion of teeth DEF: Abrasion is loss of tooth substance produced by mechanical wear other than by mastication.or labio version.II. Prominence of tooth surface labially or bucally. Most abraded area cervical areas of exposed root surface. vii. . viii. LOCATION OF ABRADED AREAS Facial surfaces of canine. xiii. Abrasive agent in the dentifrice. premolars & first molars or any tooth in bucco. CONTRIBUTING FACTORS Hard toothbrush. ix. or it may be defined as pathologic wearing away of tooth substance through some abnormal mechanical process.
Toothbrush has an avg. Change the tooth brushing technique. Toothbrush shd be kept in open air with head in upright position with no contact with other brushes. Use a smaller amount of dentifrice. vi. Advise a specific brush with soft textured bristles or filaments. . Store in dry areas as wet areas may allow bacterial proliferation. L. vii. lifespan of 3 to 6 months. viii. Recommend a less abrasive dentifrice. MAINTAINENCE OF TOOTHBRUSH • • • • As toothbrushes are vehicle in breeding & transmitting various organisms so advised cleaning with antiseptic mouthwash.APPEARANCE Saucer shaped or wedge shaped indentations with smooth shiny surfaces CORRECTIVE MEASURES v.
Under tension it flattens on tooth surface. xi. Dental floss is available in forms: Multifilament – twisted / non twisted Bonded / non bonded Thick / thin Waxed / non waxed Unwaxed dental floss is better than waxed bcoz: Small diameter & pass easily thru tight interproximal contact. xii. INTERDENTAL CLEANING AIDS • The toothbrush is not adequate for interproximal cleaning. DENTAL FLOSS • • • • x. . C. Unwaxed floss makes a squeaking noise & this can be used to monitor performance.II.
•Interproximal / Interdental brushes •Powered interdental brushes .
CLASSIFICATION OF FLOSS ON BASIS OF GINGIVAL EMBRASURES .
TECHNIQUES: BRUSHING Place sides of the brush on the dorsum of the tongue with the tip directed towards the throat. TONGUE SCRAPING • • 5. The process of removing debris from surface of tongue with some form of scraper designed for this purpose. g. i. . Most tongue scrapers are made of soft flexible plastic. f. 9. repeat to cover the entire surface. TONGUE CLEANING DEVICES Device is placed towards the back of tongue on the dorsal surface. the pulled forward with light pressure. Apply light pressure & move the brush forward & out.III.
Mainly composed of a pump & a reservoir These devices are used to deliver antimicrobial agents eg:chlorhexidine. IRRIGATION DEVICES • • • Valuable in removing the unattached plaque & debris.IV. X. . CHEMICAL PLAQUE CONTROL • Ideal adjunct to mechanical plaque control specially in individuals with a defective host defence mechanism. mentally or physically handicapped & in patients who have undergone surgical procedures postoperatively.
SOBEN PETER JOSEPH JOHN CARRENZA Textbook of periodontology. 4. .REFRENCES:2. 6. 3.WILKINS Textbook of child & adolescentMCDONALD. 5.
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