Oral Prophylaxis

and
instrumentation
 Prophylaxis-Prophylaxis (Greek- to guard or prevent
beforehand) is any medical or public health procedure
whose purpose is to prevent, rather than treat or cure,
a disease or other medical issue.
 Prophylactic measures are divided
between primary prophylaxis (to prevent the
development of a disease) and secondary prophylaxis
(whereby the disease has already developed and the
patient is protected against worsening of this process)
Oral prophylaxis

 Oral prophylaxis is the science of

practice of preventing the onset of
diseases of the teeth and adjoining
oral tissues.
 It involves the thorough scaling and
polishing of your teeth surfaces above,
between and under the gums.
 Scaling removes the hard tartar which
forms on your teeth like scale inside a
kettle. You can’t remove it just by brushing
your teeth. Scaling also removes trapped
food and plaque containing millions of germs
which can cause tooth decay and gum
disease. Stains from coffee, tea, cigarettes
or red wine are also cleaned away when your
dentist polishes your teeth
 The polishing process smoothens the teeth
to remove rough spots which might
otherwise attract bacteria. Dentists also
offer tooth sealant services, which are
designed to prevent decay of the teeth.
 On the whole, oral prophylaxis involves but
not limited to – Daily oral hygiene habits like
brushing, flossing and using mouthwash.
Professional dental care such as scaling
polishing and preventive procedures.
Scaling

 It is the process of removing or

eliminating the etiologic agents –
dental plaque, its products,
and calculus, both supra and sub
gingival– which cause
inflammation, thus helping to establish
a periodontium that is free of disease.
 Dental plaque is a bio film, usually a
pale yellow, that develops naturally on
the teeth. Like any bio film, dental
plaque is formed by
colonizing bacteria trying to attach
themselves to the tooth's smooth
surface
 The mechanisms of plaque formation include:
 Adsorption of proteins and bacteria to form a film on
the tooth surface.
 The effect of van der Waals and electrostatic forces
between microbial surfaces and the film to create
reversible adhesion to the teeth.
 Irreversible adhesion due to intermolecular
interactions between cell surfaces and the pellicle.
 Secondary colonizers attach to primary colonizers by
intermolecular interaction.
 The cells divide and generate a bio film.
 calculus or tartar is a form of
hardened dental plaque. It is caused by
the continual accumulation of minerals
from saliva on plaque on the teeth. Its
rough surface provides an ideal medium
for further plaque formation, threatening
the health of the gingiva.
 Calculus can form both along the gumline,
where it is referred to as supragingival ("above
the gum"), and within the narrow sulcus that
exists between the teeth and the gingiva,
where it is referred to as sub gingival ("below
the gum"). Calculus formation can result in a
number of clinical manifestations,
including bad breath, receding
gums and chronically inflamed gingiva.
 There are two ways to scale teeth.
 Hand scalers – these come in different
sizes and shapes, to reach different
parts of your teeth.
 Ultrasonic scalers – these use very fast
vibration with water. The water is sucked
out of the mouth. A hand scaler is used
to check whether the teeth are
completely clean.
Indications of scaling

 To remove plaque,calcuus and other

calcified deposits from the crown and
root surface of the tooth
 To remove altered cementum from the
subgingival root surface – root planing.
To debride the soft tissues lining the
pocket.
Instruments used for scaling:

 Periodontal probes:
used to locate, measure and mark
pockets ,as well as determine their
course on individual tooth surfaces.
Periodontal Probes
 Explorers:
used to locate calculus deposition and
caries.
 Scaling, root planing and curettage
instruments:
Used for removal of plaque and calcified
deposits from the crown and root of a
tooth, removal of altered cementum from
sub gingival root surface and
debridement of soft tissue lining the
pockets
 Scaling and curettage instruments are
classified as follows:
 Sickle scalers: are heavy instruments
used for removal of supragingival
calculus.
 Curettes are fine instruments used for
sub gingival scaling,root planing and and
debridment of soft tissue linging the
pockets.
 Hoe, chisel and fine scalers are used to
remove tenacious sub gingival calculus
and altered cementum.
 Ultrasonic and sonic instruments:
Used for scaling and cleansing tooth
surfaces and curetting the soft tissue
wall of the periodontal pocket.
 Periodontal endoscope:
Used for sub gingival visualization in
pockets and the detection of deposits.
 Cleansing and polishing instruments:
Rubber cups, brushes and dental tape
are used to clean and polish tooth
surfaces. Also available are air powder
abrasive systems for tooth polishing.
UNIVERSAL SCALER

 It is a large supra gingival scaler. As the

name suggests it can be used to work on
all the areas of the mouth. It has 2
working ends.
 One end is sickle shaped and the other
is contra angled to reach the posterior
segment. Mere ends have a flat surface
and a cutting edge. May have sharp
pointed tip.
Grasps:

 Pen grasp:
Index finger and the thumb used to grasp
instrument while the middle finger rests
below it.
 Less tactile sensitivity and flexibility of
movement.
 Modified pen grasp:
Index finger thumb and the middle finger
are used to hold the instrument.
 Palm and thumb grasp:
 The instrument is held in the palm of the
hand with the fingers coiled around it and
the thumb stabilizing it by pessing
against it.
Rests:

 The finger rests help to stabilize the

hand and are the instruments by
providing a firm fulcrum as movement
are made to activate the instruments.
 Conventional :
Conventional finger rest is established
on the tooth surface immediately
adjacent to the working area.
Seating positions

 Right front position (7 o clock):

 For examination on
 Mandibular anterior teeth
 Mandibular right posterior teeth
 Maxillary anterior teeth
 Right position (9 o clock) :
 Dentist sits on the right of the patient
while working on the facial surfaces of
maxillary and mandibular right posterior
teeth and the occlusal surfaces of the
mandibular right posterior teeth.
 Right rear postion (11 o clock):
 Preferred position for most proceddures.
 The dentist sits on the right and slightly
behind the patient and the left arm is
positioned around the patient’s head. In
this position working on the lingual
surface of maxillary anterior teeth is most
convenient.
 Direct rear position ( 12 o clock)
Dentist sits directly behind the patient
and looks down over the patient’s head.
The position is mainly used when
working on the lingual surfaces of
mandibular anterior teeth.
 It can also be used on the lingual
surfaces of maxillary anterior teeth.