Tooth brushing 101: Oral Infection Control

Transcription

1 Tooth brushing 101: Oral Infection Control Toothbrush History Earliest chewed twigs or sticks 3500 BC Tombs Egyptians found with toothsticks China- bone handle & hog bristles England st modern 1900 s Celluloid handles replaced bone handles U.S. Nylon bristles replaced natural hog bristles around WW I 1916 Fones began teaching specific methods st power tb developed- available US 60 s 1 2 Manual Tooth brushing Purpose? Removal of plaque biofilm and disturbance of its re-formation Removal of food, debris, and stain from the oral cavity Stimulation of the gingival tissues Application of a dentifrice containing specific ingredients to address caries, periodontal disease, or sensitivity Natural bristles Hog bristle, hollow Wear rapidly and irregularly Bristle diameters vary greatly to 0.02 inches Cannot be standardized Extremely flexible wet Natural vs. Nylon bristles Nylon Flexes more often Uniformity controlled End rounded Resistant to bacteria Easier to clean and dry Economical Maintain form and durability 4 Toothbrush Profiles TB Design & Sizes (small or compact, medium or large)- know parts including tufts & filaments Four basic profiles Concave: Short bristles in the middle (lingual) Convex: Long bristles in the middle (facial) Multilevel: Multi lengths = **improved cleaning- especially interproximal Flat: Same length 5 1

2 Bristle Shape and Texture Bristle Shape: no standard criteria Firmness (texture or stiffness)- hard, medium, **soft, **extra soft Thinner diameter allows more resiliency and softness Usual range:.007 to.015 inches The shorter the filament, the stiffer it is- Harder NOT better! Temperature, uptake of water, and frequency of use also influence the bristle texture End rounding bristles recommended 7 Handle Designs Plastic handle Water resistant Inexpensive Easy to hold Dexterity Children/elderly Curves and twist allow for hard to reach areas Nothing lasts forever 10 Toothbrush Care Replace every 2 3 mo. Rotate so dry Replace after illness Color indicators Portable not kept in close container Separate Disinfect regularly Newer = BETTER What is wrong with this picture?

3 What about this picture? RDH recommendations Be familiar with different brands through use- what did you find? Keep examples of worn toothbrushes Demonstrate and give patients a brush or written recommendation with biofilm education Show IN PATIENT S mouth! Factors in TB Selection Hard & Soft Tissue Damage- Damage? What do we need to consider? Patient OH- Dexterity, age, ability Hard & soft tissues- gingival architecture/anatomical considerations, status of periodontal health, & position of teeth Position of teeth Preference & compliance/motivation Special needs- ortho/prostho? Other considerations- such as past damage/incorrect instruction or no instruction? Hard & Soft Tissue Damage- Damage? 18 3

4 *Most Common- Bass Method Tooth brushing Methods: Chart Acceptable for ALL patients but especially PERIO Requires moderate dexterity The toothbrush bristles are angled apically at a 45-degree angle to the long axis of the tooth Filaments subgingival (into sulcus) Jiggle/ vibrate /pulse 2-3 teeth at a time 19 *Most Common- Rolling Method Most appropriate for children (general cleaning) The bristles are positioned apically along the long axis of the tooth on attached gingiva & tb head even with occlusal plane Press bristles & blanche gingiva (roll & sweep slowly over gingiva/tooth towards occlusal) On lingual- use long ways- press & roll Repeat several times Can incorporate with Bass (MB) Useful to teach rolling then later add Stillman s (MS) *Most Common- Modified Stillman s Method Combination of Stillman s 1 st then Rolling each area Bristles are positioned partly on attached gingiva & partly on cervical part of tooth (slightly apical); head of tb level with occlusal plane Use firm but gentle vibration/pulsing with bristles stationary blanching tissue & flexing bristles then rotate & roll; count to 10 Position long-ways on lingual (same motion) with toe of brush- press, vibrate, roll Good gingival stimulation & massage; requires dexterity ORTHO- Charters Method Children- Fones Method Used to clean around appliances Bristles are placed at a 45-degree angle toward the occlusal or incisal surface of the tooth A circular -vibratory motion is then activated Must still recommend another method to clean cervical area esp Have specialized ortho toothbrushes too Used mainly by very young children The teeth are clenched- edge to edge, and the brush is placed inside the cheeks 90-degrees Brush is moved in large circular motion over both max/mand teeth & tissue Can be damaging if done too vigorously Should be taught different method when have the dexterity 4

5 Other Methods Horizontal * damaging Scrub brush technique combo *damaging Leonard (vertical) Circles one arch at a time Smith Change... If doing ok, do not insist on change- introduce ONLY if change will improve oral health and the method currently using is detrimental LET ME SAY AGAIN.. When no traumatic problems or disease is observed, the patient should NOT be taught a different brushing method! (how many tooth brushing methods have they already been taught??) COLLIS & HYDRABRUSH Collis s brush design allows for brushing three surfaces of the tooth simultaneously. A 45-degree angle is used when brushing in and around the gum line. Favored by special needs patients, as well as parents and caretakers who perform the task of brushing for others If it ain t broke, don t fix it Toothbrushing Time, Frequency & Sequence Skill Level After every meal? thorough Compromise by suggesting 5 10 strokes per area or counting 2 minutes use timer or song? Can begin in area of greatest need Some suggest routine/sequence others suggest varying** Not one set rule for everyone How evaluated?

6 Supplemental Brushing: Problem Areas Look at the Tongue! Our clinic Procedure Another Consideration... Powered Toothbrushes When used properly, consistently superior to manual toothbrushes in plaque removal and gingivitis efficacy. 34 Powered Toothbrushes Powered Toothbrushes Recommendations Parents brushing children s teeth

7 Physically handicapped, mentally challenged, aged, arthritic, poor dexterity, poorly motivated Patients who require a larger handle for grasp Motivational Interviewing Why won t our patients follow our advice? patient centered collaboration attempts to diminish expert role Establish Patient autonomy (they re responsible for themselves) Display empathy Roll with resistance! Avoid confrontation Use open ended questions Reflective listening (paraphrasing)