WHY DO WE GIVE ORAL HEALTH ADVICE

¢ Prevent Periodontal Disease

¢ Plays a part in preventing Dental Caries

¢ Reduce Halitosis

INTRODUCTION TO ORAL HYGIENE ¢ Improve aesthetics

METHODS & AIDS
Year 1 Dental Science

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DENTAL PLAQUE
¢ Microbial biofilm it is a soft, non calcified layer of bacteria ¢ Normal Plaque (Young)
which accumulates on and adheres to teeth and other solid — Cocci, rods, epithelial cell
structures.
— Little motility
¢ It cannot be removed by simple mouth rinsing alone.

¢ The ability to adhere to surfaces is a general property of

almost all bacteria.
¢ Plaque from gingivitis
(Mature)
¢ It may be supra or sub gingival.
QU — Spirochetes

A
— Great motility

PL
E
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 PLAQUE FORMATION
¢ Plaque forms rapidly after cleaning and has relatively little
influence by dietary factors, although sucrose may speed up its
formation.

¢ Formation occurs most rapidly in the cervical area adjacent to the

gingival crevice and in other sheltered sites such as occlusal
fissures and pits.

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PLAQUE PERIODONTITIS

¢ Primary aetiological factor of:

— Gingivitis and Periodontitis
— Denture Stomatitis
— Dental Caries
— Peri-implantitis

Good plaque control might solve most problems.

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FIXED PROSTHODONTICS
¢ Treatment of fixed restorations without regard for gingival
tissue health will typically lead to a less than ideal
prosthesis, risking in biological and aesthetic failure.
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WHY?
FIXED PROSTHODONTICS
¢ Appreciation of the anatomy of periodontal issues is
paramount. The health should be carefully assessed before
tooth preparation.
¢ Important for patients to realise the impact of good OH
both for overall health of the periodontium but specifically
for a tooth treatment planned for fixed restoration.
¢ It is equally necessary to remove pre-existing supra and
sub gingival calculus before preparation.
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 FIXED PROSTHODONTICS
¢ Provisional restorations should not interfere with routine
oral hygiene procedures and allow full plaque removal.
This is largely dependant on the contour and surface finish
of the restoration
¢ Existing poor periodontal health or poorly fitting existing
restorations/crown can lead further periodontal
intervention before definitive tooth preparation
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DESIGN
¢ For any restoration it should facilitate oral hygiene
procedures. Particularly important where complex designs,
pontics or connectors exist. Sufficient space should exist for
the use of oral hygiene aids – floss interdental brushes
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IMPRESSIONS
¢ It is paramount when impression taking that the gingival tissue
is in optimal health for preparations for the impression so that
marginal accuracy is achieved
¢ When completing fixed restorations it is important that the finish
line is placed at or above the gingival margin p18 figure
¢ Soft tissue management is important for optimal impression
taking
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PLACEMENT OF RESTORATION MATERIALS
¢ Defective contact and contour of a restoration = overhangs
which greatly hinder good oral hygiene procedures
¢ Placement and use of matrix bands/wedges
¢ Materials – moisture sensitive
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 PERI-IMPLANTITIS IMPLANT AND IMPLANT RETAINED DENTURES

Titanium Instruments
Plastic Probes
Covers for ultrasonic tips

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HOW DO WE ASSESS PATIENTS PLAQUE

ORTHODONTIC APPLIANCES CONTROL?

¢ Removable appliance therapy

¢ Fixed appliance therapy
¢ Retainers
¢ OH Hygiene considerations
— Gingival inflammation
— Gingival hyperplasia
— Denture stomatitis
— Calculus build up around appliances
— Decalcification and caries

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 PLAQUE MEASURING INDICES WHAT TO ADVISE
¢ O Leary (1972) ¢ The choice……..
— Presence or absence of Q1 Q2
plaque.

— The tooth is divided into 6

surfaces.

— The total number of

surfaces with plaque
present is then divided by
the total number of
surfaces present in order
to calculate a plaque score
Q3
¢ Plaque control devices should be tailored to
%. Q4
the individual needs

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WHAT TO CONSIDER: IMPLEMENTS USED

¢ Site- morphology/upper 3rd molars
¢ Access – Ortho appliances
¢ Dexterity – we have high level of dexterity but no everyone
does
¢ Availability – professionally supplied only/ mail
order/online
¢ Cost

¢ Tailored oral hygiene starts with disclosure of a problem

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 TOOTHBRUSHING TECHNIQUE

¢ There are many methods accepted ¢ Placement of the toothbrush

— Modified Bass – angles/technique
— Modified Stillman
— Charters ¢ Brushing outer, inner and
biting surfaces
¢ However, no one method is superior

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MODIFIED BASS MODIFIED BASS

¢ https://www.youtube.com/watch?v=4iIGhqi57es

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 TYPE OF TOOTHBRUSH ELECTRIC VERSE’S MANUAL TOOTHBRUSH
¢ Soft/medium tuft manual toothbrush Electric Manual

¢ Hard toothbrushes combined with vigorous

horizontal brushing may lead to cervical
abrasion of the teeth and recession of the
gingiva

¢ Brushes need to be replaced every 3months

http://onlinelibrary.wiley.com/doi/10.1002
/14651858.CD002281.pub3/pdf

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POOR MANUAL DEXTERITY

¢Disclosing Exercise!

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 POWERED TOOTHBRUSH INTERDENTAL CLEANING AIDS
¢ Toothbrush alone will not completely remove interdental
plaque
¢ Used to remove plaque not just food wedged between teeth
¢ Disease often leaves open spaces between teeth and exposed
roots with concavities and furcation's which are difficult to
access with the toothbrush

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DENTAL FLOSS FLOSS/FLOSSETTS/SUPERFLOSS

¢ Dental floss is a bundle of thin

filaments made with either nylon or
silk

¢ Most widely used interdental aid

¢ Available unwaxed, waxed, tape and

super floss

¢ Coated with fluoride

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 INTERDENTAL BRUSHES
¢ Suitable for cleaning large, irregular or concave tooth
surface
¢ Inserted interproximally and are activated with short back
and forth strokes in between the teeth

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SINGLE – TUFTED BRUSHES OTHER AIDS

¢ Suitable for cleaning large, irregular or concave tooth
spaces

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 DENTIFRICES

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REFERENCES
¢ Foundations of Periodontics for the Dental Hygienist.(2011) 3 rd
Ed. Jill S Neild-Gehrig and Donald E Willmann.

¢ Clinical Periodontology and Implant Dentistry. (2008) 5th Ed. J.

Lindhe, Niklaus P Lang, Thorkild Karring.

¢ Michael O'Sullivan (2005). Fixed Prosthodontics in Dental

Practice. London: Quitessentials.

¢ Periodontics. (2010) 6th Ed. B.M Eley, M Soory, J.D Manson.

¢ http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD002
281.pub3/pdf

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