Oral Infection Control: Toothbrushes
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Questions and Answers

What is the average recommended duration for brushing teeth?

  • 120 – 150 seconds
  • 60 – 80 seconds (correct)
  • 90 – 120 seconds
  • 30 – 50 seconds

    • Which of the following statements accurately describes the Bass method of tooth brushing?

  • The method is primarily for cleaning the occlusal surfaces.
  • It involves positioning the brush with bristles directed apically. (correct)
  • Biofilm removal is limited to 1.5mm in the sulcus.
  • It is recommended for patients with low dexterity.

    • What is a limitation of the Bass and Modified Bass methods?

  • They can be harmful to tooth enamel.
  • They provide significant plaque removal in the sulcus.
  • They are suitable for all patients.
  • They require high dexterity. (correct)

    • What is the primary purpose of the Stillman method of tooth brushing?

    <p>To clean the sulcus and massage the gingiva.</p> Signup and view all the answers

    Which brushing technique is suited for abutment teeth of fixed partial dentures?

    <p>Bass method</p> Signup and view all the answers

    What is a primary limitation of the Modified Stillman Method of brushing?

    <p>It may cause tissue laceration due to incorrect placement.</p> Signup and view all the answers

    Which of the following is a potential adverse effect of improper toothbrush use?

    <p>Injury to the gingival margin</p> Signup and view all the answers

    Which brushing technique is most suitable for children based on the information provided?

    <p>Rolling Stroke Method</p> Signup and view all the answers

    What is the recommended angle for directing filaments in the Charter Method?

    <p>45 degrees toward the occlusal/incisal plane</p> Signup and view all the answers

    What angle should be used when positioning the brush in the Stillman method?

    <p>45 degrees</p> Signup and view all the answers

    Which of the following does the Rolling Stroke Method not effectively address?

    <p>Emphasizing gingival margin cleaning</p> Signup and view all the answers

    What is the consensus on tooth brushing duration beyond two minutes?

    <p>It is not recommended.</p> Signup and view all the answers

    What adverse effect can occur with improper use of the Rolling Stroke Method?

    <p>Lacerations to the alveolar mucosa</p> Signup and view all the answers

    Which technique is designed specifically to clean under dental appliances like bridges?

    <p>Charter Method</p> Signup and view all the answers

    What is a common misconception regarding the effectiveness of quick sweeping strokes?

    <p>They can miss the cervical third of teeth.</p> Signup and view all the answers

    What action should be performed while using the Charter Method?

    <p>Press filaments between the teeth using a rotary motion.</p> Signup and view all the answers

    What is a primary benefit of using power toothbrushes over manual brushes?

    <p>They have a greater effectiveness in reducing calculus and removing stains.</p> Signup and view all the answers

    Who might benefit from using a power toothbrush?

    <p>Patients with limited dexterity and dental implant patients.</p> Signup and view all the answers

    Which technique is recommended for using a power toothbrush effectively?

    <p>Position the bristles towards the sulcus.</p> Signup and view all the answers

    What is one purpose of tongue cleaning?

    <p>To reduce bacteria and associated halitosis.</p> Signup and view all the answers

    What should be used to clean areas with acute oral inflammatory lesions?

    <p>Saline solution or chlorhexidine.</p> Signup and view all the answers

    Which of the following statements about the use of power toothbrushes is incorrect?

    <p>They are not suitable for aggressive brushers.</p> Signup and view all the answers

    Which statement regarding supplemental brushing methods is true?

    <p>Clean tongue can reduce damage from oral debris.</p> Signup and view all the answers

    What is a recommended practice when using a power toothbrush?

    <p>Use light and steady pressure.</p> Signup and view all the answers

    Which of the following was a significant development in toothbrush history that occurred in 1938?

    <p>Introduction of nylon bristles</p> Signup and view all the answers

    The earliest known toothbrushes consisted of horsehair bristles.

    <p>True</p> Signup and view all the answers

    What is the primary modality of action associated with power toothbrushes?

    <p>Mechanical agitation or vibration</p> Signup and view all the answers

    The __________ is considered beneficial for reducing dental biofilm and improving oral hygiene.

    <p>tongue cleaning</p> Signup and view all the answers

    Which of the following is NOT a functional property of brushes mentioned?

    <p>Heavy</p> Signup and view all the answers

    Match the toothbrush type with its characteristic:

    <p>Manual Toothbrush = Requires user technique to be effective Power Toothbrush = Provides mechanical action for cleaning Chew Stick = Earliest form of toothbrush Nylon Bristles = Introduced in 1938 and widely used today</p> Signup and view all the answers

    The ADA recommends using hard bristles for effective brushing.

    <p>False</p> Signup and view all the answers

    Which option is a limitation of manual toothbrushing methods?

    <p>Incapable of reaching tight spaces</p> Signup and view all the answers

    What are the three main parts of a toothbrush?

    <p>Handle, Shank, Working End</p> Signup and view all the answers

    Selecting a power toothbrush is solely based on the cost of the device.

    <p>False</p> Signup and view all the answers

    Patients are recommended to brush a minimum of _____ times a day.

    <p>2</p> Signup and view all the answers

    Name one adverse effect that can occur from improper toothbrushing.

    <p>Gum recession or erosion of enamel</p> Signup and view all the answers

    Match the following toothbrush bristle types with their recommended usage:

    <p>Hard = Not recommended by the ADA Medium = Can be used for adults with healthy gums Soft = Recommended for most people Extra Soft = Ideal for sensitive gums</p> Signup and view all the answers

    What is an important factor to consider when selecting a toothbrush?

    <p>Patient's ability and age</p> Signup and view all the answers

    Brushing sequence does not affect the effectiveness of plaque removal.

    <p>False</p> Signup and view all the answers

    The recommended brushing plane options include flat, rippled, _____.

    <p>dome</p> Signup and view all the answers

    What is the recommended average duration for brushing teeth?

    <p>60 – 80 seconds</p> Signup and view all the answers

    The Bass method is only recommended for patients with advanced gum disease.

    <p>False</p> Signup and view all the answers

    What is one of the primary purposes of the Stillman method of brushing?

    <p>To clean the sulcus and massage the gingiva.</p> Signup and view all the answers

    The Bass and Modified Bass methods remove biofilm from adjacent to and directly beneath the _______.

    <p>gingival margin</p> Signup and view all the answers

    Match the following brushing methods with their primary purpose.

    <p>Bass Method = Removes biofilm beneath gingival margin Stillman Method = Cleans sulcus and massages gingiva Modified Bass Method = Similar to Bass but with an added technique Rolling Stroke Method = General cleaning of tooth surfaces</p> Signup and view all the answers

    What is a limitation of the Bass method of tooth brushing?

    <p>Injury to the gingival margin</p> Signup and view all the answers

    Using a timer during tooth brushing can help ensure that the average duration is met.

    <p>True</p> Signup and view all the answers

    What kind of instruction aids are beneficial for teaching tooth brushing techniques?

    <p>Typodont and disclosing solutions.</p> Signup and view all the answers

    Which of the following statements is true about the Rolling Stroke Method?

    <p>It is primarily used for children.</p> Signup and view all the answers

    The Charter Method is designed to specifically address cleaning under orthodontic appliances.

    <p>True</p> Signup and view all the answers

    What is one limitation of the Modified Stillman Method of brushing?

    <p>Tissue laceration due to incorrect placement.</p> Signup and view all the answers

    The brush should be directed at a _____ degree angle in the Charter Method.

    <p>45</p> Signup and view all the answers

    Match the following brushing techniques with their main purpose:

    <p>Modified Stillman Method = Prevents laceration to alveolar due to incorrect placement Rolling Stroke Method = Recommended for children Charter Method = Effective for proximal surfaces and orthodontic appliances Bass Method = Cleans along the gingival margin</p> Signup and view all the answers

    What is a recommended action when employing the Charter Method?

    <p>Press filaments between the teeth.</p> Signup and view all the answers

    Quick sweeping strokes of the toothbrush are effective at removing biofilm from the cervical third of the teeth.

    <p>False</p> Signup and view all the answers

    What is a potential risk associated with placing the brush too high while using the Rolling Stroke Method?

    <p>Laceration to the alveolar mucosa.</p> Signup and view all the answers

    What angle should a toothbrush be placed at when using the Fones Method?

    <p>90 degrees</p> Signup and view all the answers

    The Horizontal (or Scrub) Method is recommended for effective plaque removal.

    <p>False</p> Signup and view all the answers

    Which brushing method may work well for small children?

    <p>Leonard’s Method</p> Signup and view all the answers

    The ________ toothbrush facilitates mechanical removal of biofilm.

    <p>power</p> Signup and view all the answers

    Match the following brushing methods with their characteristics:

    <p>Fones Method = Circular motion with toothbrush at 90 degrees Horizontal Method = Scrubbing motion at 90 degrees Leonard's Method = Vertical stroke for small children Power Toothbrush = Mechanical removal of biofilm</p> Signup and view all the answers

    Which method is often considered detrimental due to possible toothbrush abrasion?

    <p>The Horizontal Method</p> Signup and view all the answers

    Power toothbrushes are not recommended due to their high dexterity requirements.

    <p>False</p> Signup and view all the answers

    What is a limitation of the Leonard's Method in terms of plaque removal?

    <p>Minimal plaque is removed from the sulcus and proximally.</p> Signup and view all the answers

    What is recommended for oral care after periodontal surgery?

    <p>Do not brush the surgical area until 24 hours have passed.</p> Signup and view all the answers

    It is safe to brush a gingival graft area immediately after the procedure.

    <p>False</p> Signup and view all the answers

    What solution should be used for rinsing the mouth 24 hours after a dental extraction?

    <p>saline solution</p> Signup and view all the answers

    Patients who are medically compromised should emphasize _____ hygiene.

    <p>oral</p> Signup and view all the answers

    Match the type of lesion to its description:

    <p>Soft-tissue lesions = Gingival abrasion Hard-tissue lesions = Dental abrasion Bacteremia = Transient bacteria in the bloodstream</p> Signup and view all the answers

    How often should toothbrushes be replaced?

    <p>Every 2-3 months or after illness</p> Signup and view all the answers

    Disinfecting toothbrushes by soaking them in hydrogen peroxide can reduce bacterial load.

    <p>True</p> Signup and view all the answers

    What should be documented regarding the type of toothbrush a patient is using?

    <p>manual or power</p> Signup and view all the answers

    Study Notes

    Oral Infection Control: Toothbrushes and Toothbrushing

    • Learning Objectives:
      • Identify characteristics of effective manual and power toothbrushes
      • Differentiate between manual toothbrushing methods (limitations & benefits)
      • Describe power toothbrush modes of action
      • Identify the basis for power toothbrush selection
      • Describe tongue cleaning and its effect on reducing dental biofilm
      • Identify adverse effects of improper toothbrushing

    Development of Toothbrushes

    • Origins of toothbrush: Babylonia chew sticks (early 3500 BC)
    • Chew sticks appeared in Chinese literature around 1600 BC
    • Early toothbrushes: Chinese literature mentions horsehair bristles (around 1000 AD)
    • 1728: Pierre Fauchard recommended sponges instead of horsehair
    • 1780: William Addis produces toothbrush in England
    • Throughout the early 19th century: toothbrushes with replaceable heads
    • 1860: First toothbrush patent in the US
    • 1938: Introduction of nylon bristles
    • 1960: First power brush in American markets

    Characteristics of an Effective Toothbrush

    • Conforms to patient requirements (size, shape, texture)
    • Easily & efficiently manipulated
    • Readily cleaned
    • Durable and inexpensive
    • Functional properties: flexible, soft, strength, light handle
    • End-rounded filaments

    Parts of a Toothbrush

    • Handle, shank & working end
    • Brush head: variations in tufts and rows of bristles
    • Brushing plane: flat, rippled, dome, multilevel, angled, bilevel, orthodontic

    Comparison of Natural and Synthetic Bristles

    • Natural Bristles: Historically made from hog/wild boar hair. No uniformity in texture; properties vary by animal, location, and season. Diameter varies by bristle portion, age and life of the animal. Often irregular, frequently open ended. Cannot be standardized. Wear rapidly and irregularly. Hollow ends allow microorganisms and debris to collect.
    • Synthetic Bristles/Filaments: Synthetic, plastic materials (primarily nylon). Uniformity controlled during manufacturing. Diameter ranges from extra-soft (0.075 mm) to hard (0.3 mm). End rounded; Rinse clean, dry rapidly; Durable and maintained longer; end-rounded and closed, repel debris and water. More resistant to accumulation of microorganisms.

    Toothbrush Selection

    • Patient's ability: age, dexterity, gingival health, position of teeth (malocclusion)
    • Compliance: Personal preference
    • Bristles: hard, medium, soft, extra soft (ADA recommends soft)
    • Type: Manual vs. Power
    • Affordability

    Guidelines for Toothbrushing Instructions

    • Toothbrush grasp
    • Brushing sequence
    • Frequency brushing: minimum 2 x a day, emphasis on complete plaque removal
    • Duration of brushing: average 60-80 seconds (no evidence of benefit beyond 2 minutes)
    • Timers
    • Toothbrushing force
    • General toothbrush instruction
    • Typodont and other education aids beneficial
    • Disclosing solution, observe patient technique

    Methods for Manual Toothbrushing

    • Bass and Modified Bass Methods: Recommended for all patients, biofilm removal from adjacent to and directly beneath the gingival margin, cervical/proximal areas, open embrasures, exposed root surfaces, abutment teeth.
    • Procedure: Position brush, light pressure strokes, reposition brush, repeat. Limitations include dexterity requirements, injury to gingival margin, and limited sulcus plaque removal (up to 0.9 mm).
    • Stillman and Modified Stillman Methods: Designed for cleaning the sulcus, cervical areas, and massaging the gingiva.
      • Procedure: Place brush side on attached gingiva; plastic part of brush head level with occlusal plane; press to flex and angle filaments at a 45° angle to the long axis of the tooth; rotary motion to the count of 10; roll brush over tooth.
      • Limitations: Tissue laceration, dexterity requirements, potential for teeth being rolled over too quickly.
    • Rolling Stroke Method: Removes biofilm from teeth, with no emphasis on gingival margin; recommended for children.
      • Procedure: Direct filaments apically; place brush side on attached gingiva; press to flex filaments; roll brush over the teeth; repeat 5 times for each group of teeth.
      • Limitations: Laceration of alveolar mucosa if brush positioned too high, quick sweeping strokes may miss the cervical third.
    • Charter Method: Removes biofilm from proximal surfaces, massages marginal and interdental gingiva; adapts to cervical areas; used to clean under margins of fixed partial dentures or orthodontic appliances.
      • Procedure: Apply rolling stroke for general cleaning, direct filaments at 45° angle toward occlusal/incisal plane, press filaments between teeth, move brush in rotary motion to count of 10.
      • Limitations: Difficult on lingual surfaces, brush may not engage sulcus, high dexterity requirements.
    • Fones Method/Circular: Alfred Fones developed this method; involves placing brush at a 90° angle to teeth and performing circular motions.
    • Horizontal (or Scrub) Method: Horizontal motion with bristles at 90°; considered detrimental and may cause toothbrush abrasion.
    • Leonard's (or Vertical) Method: May work for small children; involves placing brush at a 90° angle to the teeth; tooth edges are pressed gently with bristles. Minimal plaque removal of sulcus and proximally.

    Power Toothbrushes

    • Facilitate mechanical biofilm removal

    • Found to be more effective than manual brushes

    • Research proves a reduction in calculus and stain removal

    • Power Toothbrush Motions: Rotational, counterrotational, oscillating, pulsating, cradle/twist, side-to-side, translating, combination, ultrasonic.

    Recommendations

    • Any patient may benefit (orthodontics, dental implant patients, aggressive brushers, patients with disabilities)
    • For use by caregivers

    Care of Toothbrushes

    • Supply of brushes and frequency of replacement
    • Cleaning toothbrushes (disinfection with hydrogen peroxide or Listerine)
    • Brush storage

    Documentation

    • Documentation for initial toothbrush instruction includes: type of brush (manual/power), description of soft tissue health/plaque score/goals for improvements, description of toothbrushes and areas with patient difficulty, and tongue cleaning methods.

    Factors to Teach the Patient

    • Effect of dental biofilm on teeth and gingiva
    • Daily removal of dental biofilm
    • Type of brush ideal for the patient
    • Individualized, hands-on instruction (manual/power brushing)
    • Proper care and maintenance of manual/power brushes
    • Indications for/use of tongue cleaner

    Adverse Effects of Toothbrushing

    • Soft tissue lesions (gingival abrasion)
    • Hard tissue lesions (dental abrasion)
    • Bacteremia (no clear association with infective endocarditis)

    Supplemental Brushing Methods

    • Tongue cleaning methods
    • Removing debris & microorganisms associated with the tongue
    • Reducing bacteria, halitosis and coating and stain from smoking/coffee.
    • Using tongue cleaners and scrapers

    Toothbrushing for Special Conditions

    • Acute oral inflammatory/traumatic lesions: Clean unaffected areas using saline solution and/or chlorhexidine.
    • Following periodontal surgery: Oral care in unaffected areas, rinsing/brushing of surgical site (24-hours), then complete oral care when recommended.
    • Following dental extraction: Brush unaffected areas, saline rinse (24-hours).
    • Oral self-care of neutropenic patients: Instructions from physician; resuming oral care when recommended.

    Occlusal brushing

    • Method of brushing

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    Chapter 26 Oral Infection Control: Toothbrushes and Toothbrushing PDF

    Description

    Explore the essential characteristics and methods of effective toothbrushes, both manual and power. This quiz will guide you through the history of toothbrushes, their modes of action, and best practices for maintaining oral hygiene. Learn to identify adverse effects of improper brushing techniques and the importance of tongue cleaning.

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