Ch 16 Oral Health Promotion, Prevention, Control-WW.pptx

CH 16 ORAL HEALTH PROMOTION, PREVENTION, AND CONTROL Copyright © 2010 by Saunders, an imprint of Elsevier Inc. 1 Fluoride  Fluoride Metabolism Food & Liquids Fluoride Denti...

CH 16 ORAL HEALTH PROMOTION, PREVENTION, AND CONTROL Copyright © 2010 by Saunders, an imprint of Elsevier Inc. 1 Fluoride  Fluoride Metabolism Food & Liquids Fluoride Dentifrices, Mouthrinses & supplements Intake Passive diffusion from stomach as HF Absorption- Within 60 mins Gastrointestinal Excess Small intestine Tract Plasma carries for distribution & elimination Absorption- Within 30 mins Bloodstream Cont…… fluoride metabolism Plasma to all tissues & organs 99% mineralized Distribution tissue and Storage is an integral part of the crystal lattice retention of teeth & bones Highest level is on the tooth surface Kidneys Sweat glands Excretio Feces n Some to breast milk Tooth Surface Fluoride  Fluoride in enamel Uptake Fluoride in enamel surface  Fluoride in dentin  Fluoride in cementum  Demineralization Remineralization (inhibits) (enhances)  Fluoride in biofilm and saliva  Summary of fluoride action High concentrations can inhibit bacterial activity Water Supply Adjustment  Fluoride level .7 to 1.2 ppm  Chemicals used Sources ○ Naturally occurring- fluorspar, cryolite, apatite Criteria for acceptable compounds ○ Solubility and inexpensive Compounds used ○ Sodium fluoride ○ Sodium silicofluoride ○ Hydrofluorosilicic acid Effects and Benefits of Fluoridation  Dental caries: primary teeth  Tooth loss  Adults  Periodontal diseases Fluoride in Foods  Foods  Salt  Halo/diffusion effect  Bottled water Dietary Supplements  General facts – check the water supply  Determine the need  Available forms Tablets, lozenges Swish and swallow rinses Drops  How much for this house? Prescription Na F mg  Guidelines 26 mg Fl 2) 4 (120  Storage.25 mg Review What is the maximum amount of NaF that can be dispensed per household at one time? A) There is no limit to the amount dispensed per household B) No more than 132 mg NaF (60 mg of fluoride) C) No more than 264 mg NaF (120 mg of fluoride) D) No more than 396 mg NaF (180 mg of fluoride) Topical Compounds  2.0% sodium fluoride (NaF) Gel or foam  1.23% acidulated phosphate fluoride (APF) Gel or foam  5% neutral sodium (NaF) varnish Clinical Procedures: Professional Topical Fluoride  Objectives Prevention of caries Remineralization of demineralized areas Desensitization Remineralization Caries Sensitivity During the appointment  Removal of plaque biofilm and calculus  What if it is a separate appointment?  Patient and/or parent counseling  What are the caries risks?  Post-op instructions  When can they eat or drink? Educate, Educate, Educate! Technique  Tray: gel or foam  Paint-on technique: varnish  After application WHICH IS CORRECT? No more than 2 mL of gel should be placed in each tray for small children, and no more than 2.5 mL for patients with permanent teeth Self-Applied Fluorides  Indications  Methods Tray Rinsing Toothbrushing  Tray Technique: Home Application  Indications for use  Gels used Concentrations Precautions Patient instructions Fluoride Mouthrinses  Indications  Limitations Fluoride Mouthrinses  Preparations Low potency/high frequency High potency/low frequency  Benefits  Brush-On Gels  Preparation of fluoride 1.1% NaF (neutral pH) 1.1% acidulated NaF (3.5 pH) 0.4% stannous fluoride in glycerin base (1,000 ppm)  Procedures Fluoride Dentifrices ?  Development  Indications Dental caries protection All patients regardless of caries risk  Preparations Patient Instructions: Recommended Procedures  Select fluoride-containing dentifrice Toddler (age 2 years) Child (3 to 5 years) Adult  Benefits Patient Instructions: Recommended Procedures  Combined fluoride program  Fluoride safety Toxicity  Acute  Chronic  Accidental ingestion Lethal Fluoride Dose  Certain lethal dose (CLD) Child 0.5 to 1.0 g NaF Adult 5 to 10 g NaF (32 to 64 mg Fl2) (mg F/kg).  Safely tolerated dose (STD) Child.5 exceeds for all ages ○ **Under the age of 6,.5 g would be lethal Adult 1.25 to 2.5 g (8 to 16 mg F/kg) Signs and Symptoms of Acute Toxic Dose  Gastrointestinal tract  Systemic involvements  Emergency treatment Induce vomiting Second person Administer binding liquid Additional therapy indicated at ER Chronic Toxicity  Skeletal fluorosis  Dental fluorosis  Mild fluorosis Clinical evaluation Relation to fluoride sources Factors to Teach the Patient  Personal use of fluorides  Need for parental supervision  Determining need for supplements  Fluorides part of preventive program  Fluoridation  Bottled drinking water FLUOROSIS CLASSIFICATION OF CARIES & RESTORATIONS G.V.BLACK’S CLASS I CLASS II CLASS III CLASS IV CLASS V CLASS VI Toothbrushing CHAPTER 21 Copyright © 2010 by Saunders, an imprint of Elsevier Inc. Halitosis….  Breathe Copyright © 2010 by Saunders, an imprint of Elsevier Inc. 42 Manual Toothbrushes  The most commonly used device for removing oral biofilm  Well designed to remove oral biofilm from the facial, lingual, and occlusal tooth surfaces  Clients need toothbrushing instructions m a de s t h br ushe a l too r igi n t he o t w ere Wha ? u t o f o 43  Early toothbrushes  Hog bristles  Herb roots or sponges  Precious element handles with replaceable brush heads  AAP specifications (1919)  Nylon bristles (1938)  Power brushes (1960s) 44 Copyright © 2010 by Saunders, an imprint of Elsevier Inc. 45 Copyright © 2010 by Saunders, an imprint of Elsevier Inc. 46 Manual Toothbrushes Toothbrush Filament Design  Number and length of filaments in a tuft, number of tufts, and arrangements of tufts vary with toothbrush designs  Filament design is assumed to affect toothbrushing efficacy  Most filaments are 10 to 12 mm long Copyright © 2010 by Saunders, an imprint of Elsevier Inc. 47 Copyright © 2010 by Saunders, an imprint of Elsevier Inc. 48 Power Toothbrushes  Typically activated by electricity or battery  Suitable for almost any client  Effective in controlling stain  Clients need power toothbrushing instructions Copyright © 2010 by Saunders, an imprint of Elsevier Inc. 49 Copyright © 2010 by Saunders, an imprint of Elsevier Inc. 50 Toothbrushing Instruction  2 minutes is often the recommended amount of time  Average brushing time is less than or equal to 1 minute!  Clients usually think their brushing time is more than double the actual time Copyright © 2010 by Saunders, an imprint of Elsevier Inc. 51 Copyright © 2010 by Saunders, an imprint of Elsevier Inc. 52 Toothbrushing Techniques Copyright © 2010 by Saunders, an imprint of Elsevier Inc. 53 Bass (sulcular) Filaments directed apically at 45° angle to the long axis of the tooth; gentle force is applied to insert bristles into the sulcus Gentle but firm vibratory (back and forth) strokes without removing filament ends from sulcus Copyright © 2010 by Saunders, an imprint of Elsevier Inc. 54 Stillman  Filaments are directed apically and angled similar to Bass method; filaments are placed partly on cervical portion of teeth and partly on adjacent gingiva  Rotary motion is used Copyright © 2010 by Saunders, an imprint of Elsevier Inc. 55 Charter  Filaments are directed toward the crown of the tooth, placed at the gingival margin and angled 45 ° to the long axis of the tooth  Short back-and-forth vibratory strokes are employed  **Bristles are directed away from the gingiva and pointed towards the occlusal/incisal edge Copyright © 2010 by Saunders, an imprint of Elsevier Inc. 56 Roll Stroke  Filaments are directed apically and rolled occlusally in a vertical motion  Used in conjunction with Bass, Stillman, and Charter methods Copyright © 2010 by Saunders, an imprint of Elsevier Inc. 57 Fones  Filaments are activated in a circular motion  Young children only, otherwise not recommended Copyright © 2010 by Saunders, an imprint of Elsevier Inc. 58 Modified Bass/Stillman  Means to add a rolling stroke afterwards Copyright © 2010 by Saunders, an imprint of Elsevier Inc. 59 Soft- and Hard-Tissue Lesions Soft-Tissue Lesions  Gingival recession affects 80% to 100% of middle-aged Americans to some degree Increased risk of dentinal hypersensitivity, loss of tooth support, root caries, aesthetic dissatisfaction  Toothbrush trauma can appear in the form of gingival abrasions Redness, scuffing, or punctate lesions Copyright © 2010 by Saunders, an imprint of Elsevier Inc. 60 Soft- and Hard-Tissue Lesions (cont’d) Hard-Tissue Lesions  Tooth abrasion Typically located around the cementoenamel junction (CEJ)  Dental abfractions Caused by excessive occlusal loading resulting in tooth flexure and subsequent loss of hard tooth structure at the CEJ Copyright © 2010 by Saunders, an imprint of Elsevier Inc. 61 Copyright © 2010 by Saunders, an imprint of Elsevier Inc. 62 Tongue Cleansing 63 Dental Hygiene Process of Care and Toothbrushing  Instruction, practice, and reinforcement are indicated at all appointments subsequent to the planning phase, regardless of the client’s situation  Hygienists must be aware of their personal biases and be accepting of all clients’ personal abilities and values2 Copyright © 2010 by Saunders, an imprint of Elsevier Inc. 64 Legal, Ethical, and Safety Issues  Dental hygienist’s ethical responsibility to use the highest level of professional knowledge, judgment, and ability to increase public awareness and understanding of high-quality oral health practices Copyright © 2010 by Saunders, an imprint of Elsevier Inc. 65 Legal, Ethical, and Safety Issues  Dental hygiene care requires allocation of time for instruction, repetition, reinforcement, and continual assessment of each client’s oral health practices Copyright © 2010 by Saunders, an imprint of Elsevier Inc. 66 Legal, Ethical, and Safety Issues  The dental hygienist has an ethical obligation to review scientific literature related to preventive interventions and to apply the knowledge to client care Copyright © 2010 by Saunders, an imprint of Elsevier Inc. 67 Legal, Ethical, and Safety Issues  The legal standard of care requires that dental hygienists educate clients about oral self-care considering the client’s age, language, culture, and learning style Copyright © 2010 by Saunders, an imprint of Elsevier Inc. 68 Best Practices for Teaching OHI 69  WEEK 9 CHAPTER 14 SICKLE SCALERS Sickle Scaler  A periodontal instrument used to remove calculus deposits from the crowns of the teeth  Should NOT be used on root surfaces d oes actly re ex e Wh ean? h is m t Unique Design Characteristics  Pointed tip and back  Triangular in cross section  Two cutting edges per working-end Unique Design Characteristics (cont.)  The face of a sickle scaler is perpendicular to the lower shank. Anterior and Posterior Designs  Anterior sickles —often single-ended; may have two different sickles on a double-ended instrument  Posterior sickles —usually two sickles paired on a double- ended instrument; working ends are mirror images Uses  Removal of medium- to large-sized supragingival calculus deposits  Not recommended for use on root surfaces Correct Angulation  Correct angulation is achieved by tilting the lower shank toward the tooth surface.  This creates a face-to-tooth surface angulation of 70 to 80 degrees. Incorrect vs. Correct Always One Step at a Time  Remember: “Me, My patient, My light, My mirror, My grasp, My finger rest, My adaptation” is! !! h th atc W Adaptation Adjacent to Papillary Gingiva Papillary Gingiva  Instrumentation of proximal surfaces adjacent to papillary gingiva can be challenging  New clinicians may “trace the pointed contours of the papilla” with the working-end— Incorrect  Instead position cutting edge against proximal tooth surface— Correct Incorrect Correct Incorrect Correct Working-End Application (cont.) How cutting edges are applied to mandibular molar and mandibular right posterior sextant: Always One Step at a Time  Remember: “Me, My patient, My light, My mirror, My grasp, My finger rest, My adaptation” is! !! h th atc W Sequence for Sextant Correct or Incorrect? Correct or Incorrect? Correct or Incorrect? Correct or Incorrect?