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118 terms

toothbrushing

STUDY
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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