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TOOTHBRUSH

A principal instrument in general use for removal of dental biofilm & a neccssary part of oral disease control.

What are the uses of the tooth brush?

Biofilm removal, Application of treatment or preventive agents,Halitosis control,Sanitation of oral cavity

If most pts. who haven't recieved professional advice for the best brush use brushs selected on the basis of what?

cost, availability,advertising claims,family tradition or habit

TOOTHPICKS

Earliest implement devised for the dental care

Who was Pierre Fauchard?

He condemned the toothbrush made of horse's hair because -it was rough & destructive to the teeth, so he advisd the use of sponges or roots

When did Nylon come into Toothbrush construction?

1938

Nylon

Most Toothbrushes are made exclusively of?

Early Brushing Methods:
The purpose of brushing was to provide massage to increase the resistance of the gingival tissue
So if you are increasing keratinization, what does this result to?

The resistance to bacterial invasion

What are the Chracteristic's of an effective toothbrush?

A. Conforms to indiv. pt. size, shape, & texture
B. Easily & efficiently manipulated
C. Is readily cleaned & aerated; impervious to
moisture
D. Is durable & inexpensive
E. Functional properties of flexibility, softness, & diameter of the bristles/filaments , strength, rigidity, and lightness of the handle
F.End-rounded filaments
G.Is designed for utility,efficiency, & cleanliness

Desription of TB: Handle

The pt. grasped in the hand

Head

The working end

Desription of TB: Shank

The sec.that connects the head & the handle

purpose for The Bass Method (sulcular)

most widely used; For all pt.s for dental biofilm removal adjacent to & directly beneath the gingival margin; for open embrasures, cervical areas beneath the height of contour of the enamel & exposed root surfaces; periodontal surgery;
adaptable to abutment teeth, under gingival border of F.P.D & orthodontic appliances

brush position forThe Rolling Stroke Method: (nonsulcular)

direct brush tips apically:max up & man down; place side of brush against attached gingiva; no 45 degree angle;

purpose for The Stillman Method (sulcular)

Designed by Stillman for massage and stimulation and cleaning of cervical area's

Circular: The Fones Method

The teeth are together when brushed, best for children

purpose for The Modified Stillman Method: (sulcular)

remove biofilm from cervical areas below height of contour & from exposed proximal surfaces; cleaning tooth surfaces & massage of the gingiva

purpose for The Charter's Method(nonsulcular)

the interproximal toothbrushing, used to stimulate marginal and interdental gingiva; to loosen debris and dental biofilm; following periodontal surgery; easily adapt to cervical areas below the height of contour of the crown and exposed root surfaces, for biofilm removal of abutment teeth and under the gingival border of a FPD and orthodontic appliances

early toothbrushes made of

boars head hairs

damage done, abrasion

more ___________________ with manuel toothbrush due to pressure, causing ___________

maintain a high level of knowledge

dental professional need to ______ _ ______ ______ __ _________ on toothbrushes/dental products to advise pts appropriately

better for use

nylon filaments are _________________

softer/more resilient

thinner filaments are ____________________

shorter filaments

__________________ are stiffer and have less flexibility

number of filaments

________________ determines tuft stregnth

more flexible and less stiff

angle of filaments may be _____________________

rounded by heat treatment

nylon filaments are sealed and _________________

direct relation, gingival damage, rounding

______ _______ exists between _______ ______ and the absence of end- ________

describe the stroke for Bass Method of brushing

Press brush filaments lightly into gingival sulculs and embrasures covering the gingival margin; vibrate back and forth with very short strokes without disengaging the brush; count at least 10 vibrations; reposition for the next group; repeat

Purpose for Rolling Stroke (nonsulcular)

Cleaning gingiva & removing biofilm/materia alba/ food debris

describe the stroke for the Rolling Stroke method

press lightly to flex filaments; when sides of filaments are pressed lightly against gingiva, gingiva will blanch; roll the brush slowly over the teeth; as the brush is rolled wrist is turned slightly; replace and repeat five times for each group of teeth

limitations for Bass Method

overeager brushers may brush too vigorously causing damage to the gingival margin; 45 degree angle requirement may be difficult for some pts.; pts may tend to seperate methods, performing rolling stroke first, instead of combining the two for complete sulcular brushing;

disadvantages of Modified Bass Method

brush not positioned into sulcus properly, or too much time spent trying to place brush tips into sulcus properly; injury to gingival margin from constant repositioning; premature sulcular brushing due to premature rolling stroke

brush position for Bass Method

Direct the filaments apically, Max up & Man down; position the sides of the filaments parallel with the long axis of the tooth; turn the brush head toward gingival margin at a 45 degree angle; directing brush tips into the sulcus

brush postition for the Stillman Method

place filaments partialy on gingiva & partialy on cervical areas; slightly directed apically; 45 degree angle; tissue blanching occurs with slight pressure on the gingival margin

describe the stroke for the Stillman Method

rotate the handle slightly causing the brush to go in a circular motion; brush ends maintaining position on the tooth surface; repeat several times for each group of teeth

position of brush for Modified Stillman Method

direct filaments apically, max. up and man. down; place side of brush on the attached gingiva; plastic portion of brush head should be level with occ/inc plane

strokes for Modified Stillman Method

same as stilman w/ rolling stroke included

limitations for Stillman Method

improper placement of bristles may cause tissue laceration; may ineffectively remove biofilm at the gingival margin cause by doing the rolling stroke too soon during brushing

brush position for Charters Method

direct filaments at a 45 degree angle; point toward incisal edge or occlusal; max. down; man. up; forcing tips into the interproximal area causing sides of bristles to come in contact with the gum margin for an ideal massage

limitations for Charters Method

brush ends do not engage the gingival sulcus to remove subgingival bacterial accumulations; brush placement limited in some areas, requires high digital dexterity

strokes for Charters Method

press lightly to flex filaments, forcing tips between the teeth; press sides of filaments against the gingival margin; vibrate brush gently but firmly, maintaining contact with tooth surface; count to 10 as you vibrate with a rotary motion; repostion the brush and repeat

methods considered detrimental

horizontal, scrub brush,

horizontal scrubbing motion, facially inclined

an unlimited sweep with a _______ _______ __________ bears pressure on the teeth that are most ________ ________ or prominent

abrasive dentifrice

with the use of an_______________________, horizontal brushing may produce tooth abrasion

dental biofilm

interdental areas are not touched by horizontal brushing, causing _______________________ to remain undisturbed on proximal surfaces

vigorously combined horizontal, vertical, circular strokes

a scrub brush procedure consists of ______ _______ _______ ______ and ______ ______ with some vibratory motions for certain areas

scrubbing, gingival recession, abrasiveness, tooth abrasion

without caution, vigorous _______________ can encourage ________ _________ and with a dentifrice of sufficient ___________, can create areas of ______ _________

occlusal surfaces

scrub brush procedure indicated for _________________ only

purposes for power toothbrushes

for physically able pts. with ineffective manual biofilm removal techniques; mechanical removal of dental biofilm and food debris from teeth and gingiva; reduce calculus build-up

power toothbrushes best used for

pts. with history of failed attempts at more traditional methods of biofilm removal; pts undergoing ortho treatment; pts undergoing complex restorative and prosthodontic treatment; pts with dental implants; aggresive brushers, pts with disabilities or limited dexterity, pts unable to brush; used by parents and caregivers

entire brush head

in some power toothbrushes the ____________________ moves as a unit

groups of tufts

______ __ ______ on the same brush head may move differently

simultaneous motions

the entire brush head moves as a unit, but in different yet __________ _______

seperately, simultaneous

different shaped brush heads move ________, and in different, yet _________ motions

motions of the power toothbrush

rotational/counter rotational; oscillating, pulsating, cradle or twist; side to side; translating; combination

rotational

moves in 360 degree circular motion

counter rotational

each tuft of filaments moves in a rotational motion, each tuft moves counter rotational to the adjacent tuft

oscillating

rotates from center tothe left, then to the right; degree of rotation varies from 25-55 degrees

pulsating

when brush head is on the tooth, pulsations toward the interproximal

cradle or twist

side to side with an arc

translating

up and down parallel to the long axis of the brush handle

combination

combination of simultaneous yet different type of movement

low to high

speeds vary from

brush head design for power toothbrushes

adult, child, interdental

soft, end-rounded

power toothbrush filaments are made of _________________ bristles

basis for brush selection

quality of clinical research that supports the efficacy and safety of the brush; dental professionals experience with the product; pt circumstances and preferences; dexterity of the pt., timer and pressure sensor

in preparation for instructing pt

review manufactures instructions; if possible use the product before teaching the patient

hands on instructions include

teach pts that power brushes require practice, provide demonstration on dental form, show and tell pt how to reach all areas of the mouth

procedure for use of power toothbrush

select brush with soft end-rounded filaments; select dentifrice with minimum abrasivity; place a small amount of dentifrice on the brush and spread over teeth; place brush in mouth before turning it on; vary brush position for each tooth surface; brush teeth and gingiva seperately; use light steady pressure

areas of special attention

facially displaced teeth, inclined teeth, exposed root, cemental and dentinal surfaces, overlapped teeth, wide embrassures, teeth next to edentulous areas, exposed furcation areas, right canine and lateral incisors, distal surfaces of most posterior teeth

dental floss, textured dental floss

supplementation with ____________ or _________________ is needed for distal surfaces

purpose for occlusal brushing

loosen biofilm microorganisms packe in pits and fissures; remove biofilm deposits from occlusal surfaces of teeth out of occlusion, remove biofilm from the margins of restorations; clean pits and fissure to prepare for sealants

brush position for occlusal brushing

place brush on occlusal surfaces of molar teeth with filament tips pointed into the occlusal pits at a right angle; position the handle parallel with the occlusal surface; extend toe of the brush to cover distal grooves of most posterior tooth

strokes for occlusal brushing

two acceptable strokes are suggested; vibrate brush in a slight circular movement while maintaining the filament tips on the occlusal surface; force filaments against occlusal surface with sharp, quick strokes; lift brush to dislodge debris, repeat about 10 times, moving from molar to premolar area, overlapping previous bush position

precaution for occlusal brushing

long scrubbing strokes from anterior to posterior on an occlusal surface may contact only the prominent parts of the cusps

tongue care

total mouth cleanliness includes _________________

main foci for oral microorganisms are

dorsum of the tongue; gingival sulci and pockets, dental biofilm on all teeth

tongue

microorganism in saliva are principally from the ____________

microflora, frequently

the _____________ of the tongue is not constant, and changes _______________

retards dental biofilm

tongue cleaning ______ ______ ______ and total biofilm accumulation

microorganisms

tongue cleaning reduces the number of __________________

halitosis

tongue cleaning reduces the potential for ________

tongue cleaning

___________________ contributes to overal oral cleanliness

filiform papillae, fungiform papillae, elevations, depressions, microorganisms

numerous _________ __________ extend as minute projections, whereas ________ ___________ are not as high and create ___________ and ____________ that entrap debris and ___________________

fissured tongue

fissures may be several millimeters deep and retain debris

tongue brushing instructions

hold brush handle at right angle to the midline of the tongue, directing brush tips toward the throat; with tongue extruded sides of filaments placed on posterior part of tongue; with light pressure, draw the brush forward and over the tip of the tongue; repeat three or four times

plastic, stainless steel

tongue cleaners may be made of ___________________ or other flexible metal

by removing debris and microorganisms pts can expect tongue cleaning to contribute to

overall mouth cleanliness; reduction in the number of bacteria abalable for biofilm formation, fewer mouth odors, improvements for pts with xerostomia, coated tongue and smokers

use of tongue cleaner

place the cleaner toward the most posterior area of the dorsal surface; press with a light but firm stroke, and pull forward; repeat several times, covering the entire tongue; wash tongue cleaner under running water

when acute oral condition precludes normal brushing instruct pt to

brush all areas of the mouth that are not affected; rinse with a warm, mild saline solution to encourage healing and debris removal; resume regular biofilm control measures on the afftected area as soon as possible

specific instructions following periodontal surgery

brush the occlusal surfaces of the teeth, using light strokes over the dressing; avoid direct vigorous brushing to prevent displacement of dressing; brush other teeth and gingiva not involved in the surgery;

lack of oral cleanliness

a major contributing factor in the development of NUG is a __________________________

acute stage, sensitive, neglected

during the _________________, oral tissues are ___________ to any touch, and toothbrushing therefore is ______________

following tooth extraction

teeth adjacent to the extraction site need cleaning as soon as possible to reduce biofilm collections and to promote healing

following dental restorations

pts tend to avoid brushing a newly placed FPD or other prosthesis, specific instructions are given at the time of insertion

gingiva, facial surfaces, prominent

trauma to the__________ occurs most frequently on the _______________ over teeth _____________ in the dental arch

lacerations or ulcerations

acute lesions are usually _____________________________

appearance of acute alterations

scuffed epithelial surface with denuded underlying connective tissue; punctate lesions that appear as red pinpoint areas; diffuse redness and denuded attached gingiva

precipitating factors for acute alterations

horizontal or veritical scrub brushing, excessive pressure applied using firm palm grasp of handle; use of abrasive dentifrice; overvigorous placement and application of toothbrush; penetration of gingiva by filament ends; use of a toothbrush with frayed/broken bristles; application of filaments beyond attached gingiva

changes is gingival contour, gingival recession

chronic alterations causes _________________________ and _________________________

appearance of gingival contour changes

rolled, bulbous, hard, firm marginal gingiva, gingival cleft

location of chronic alterations

usually appear only on the facial gingiva, frequently inversely related to the right or left handedness of the pt.; areas most often involved are around canines or teeth in labioversion or buccoversion

appearance of gingival recession

margin has moved apicallyand root surface is exposed

predisposing factors of gingival recession

anatomic: narrow band of attached gingiva and thin facial bone over teeth malposed in labioversion; toothbrushing habits; vigorous pressure brushing with abrasive dentifrice

suggested corrective measures for chronic alterations

recommended use of a soft toothbrush with end-rounded filaments; correct the pts toothbrushing method, demonstrating a toothbrushing method better suited for the oral condition

appearance of dental abrasion

wedge-shaped indentations with smooth shiny surface

abrasion

the wearing away of tooth structure that results from a repetitive mechanical habit

incorrect toothbrushing, abrasive

______________________ with an _____________ dentifrice is the most common cause

location of tooth abrasion

primarily on the facial surfaces of canines, premolars, and sometimes first molars; any tooth in bucco/labioversion

prominence on the curvature

the canines are susceptible because of their ____________________of the dental arches

abraded, cervical areas, root, enamel

most __________ areas are on the ________________ of exposed ________ surfaces, but occasionally they may occur on the __________________

in line with each other

when adjacent teeth are involved, the lesions appear _______________________

two, portable container

advise at least _____ brushes for home use and a third in a ______________ for use at work, school, or travel

2 to 3

frequent replacement recommended at least every _______ months

splayed or frayed

brushes need to be replaced before filaments become ________________ or lose resilience

cleaning toothbrushes

clean thoroughly after each use; hold brush head under strong streaming water to dislodge particles, dentifrice and bacteria, tap the handle on the edge of sink to remove remaining particles, use one toothbrush to clean another brush, rinse completely and tap out excess water

brush storage

brushes need to be kept in open air with head in upright position, apart from contact with other brushes; portable brrush container needs specific holes to give air temporarily until the brush is completely dry

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