Chapter 26 Oral Infection Control: Toothbrushes and Toothbrushing PDF

Chapter 26 Oral Infection Control: Toothbrushes and Toothbrushing Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Learning Objectives  Identify the characteristics of effective manual and power toothbrushes...

Chapter 26 Oral Infection Control: Toothbrushes and Toothbrushing Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Learning Objectives  Identify the characteristics of effective manual and power toothbrushes Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Differentiate between manual toothbrushing methods, including limitations and benefits of each  Describe the different modes of action of power toothbrushes  Identify the basis for power toothbrush selection  Describe tongue cleaning and its effect on reducing dental biofilm  Identify adverse effects of improper toothbrushing on hard and soft tissues Development of Toothbrushes  Origins of the toothbrush  Babylonia chew sticks in early 3500 BC Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  “Chew stick” appears in Chinese literature around 1600 BC  Early toothbrushes  Chinese literature mentions horsehair bristles being used around 1000 AD  1728: Pierre Fauchard recommends sponges instead of soft horse hair Development of Toothbrushes  Early toothbrushes (cont.):  1780: William Addis produces toothbrush in England Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Throughout early 19th century, handles made out various materials with replaceable heads  First toothbrush patent in United States issues in 1860  1938: introduction of nylon bristles  1960: first power brush appears in American markets Characteristics of an Effective Toothbrush  Conforms to patient requirement Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Size, Shape & Texture  Easily & efficiently manipulated  Readily cleaned  Durable and inexpensive  Functional Properties: flexible, soft, strength, light handle  End rounded filaments 11/24/2024 Parts of a Toothbrush  Handle, Shank & Working End Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Brush Head: Variation in Tufts & Rows of bristles  Brushing Plane: Flat, Rippled, Dome, Multilevel, Angled, Bilevel orthodontic 11/24/2024  Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Parts of a Toothbrush  Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Manual Brush Trim Profiles  Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Comparison Natural and Synthetic Bristles Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com 11/24/2024 Toothbrush Selection  Patient’s Ability: Age, dexterity Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Gingiva: Health/Disease  Position of Teeth: Malocclusion  Compliance: Personal Preference  Bristles: hard, medium, soft, extra soft  ADA recommends a soft  Type: Manual vs Power  Affordability 11/24/2024 Guidelines for Toothbrushing Instructions  Toothbrush grasp Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Brushing sequence  Frequency brushing: minimum 2 x a day  Emphasis on compete plaque removal rather than number of times brushing.  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 are beneficial  Disclosing solution and observe patient’s technique Methods for Manual Toothbrushing Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com The Bass and Modified Bass Methods Purposes and indications Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Recommended for all Patients  Removes biofilm from adjacent to and directly beneath the gingival margin  Cervical/proximal areas, open embrasures  Exposed root surfaces  Abutment teeth of fixed partial denture & orthodontic appliances The Bass and Modified Bass Methods  Procedure  Position brush: Direct bristles apically Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Strokes: press with light pressure, move brush back and forth to the count of 10  Reposition brush: Move up to the next 2-3 teeth  Repeat strokes  Position brush for lingual and palatal anterior surfaces  Limitations  Dexterity requirements high  Injury to the gingival margin  Plaque removal in the sulcus is limited to 0.9mm  Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Bass/Modified Bass and Brushing Position The Stillman and Modified Stillman Methods  Purposes and indications Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Designed for cleaning the sulcus, cervical areas and massaging the gingiva. Procedure Place side of brush on attached gingiva Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Plastic part of brush head is level with occlusal plane Press to flex and angle filaments at a 45 degree angle to the long axis of the tooth. Rotary Motion to the count of 10 Roll brush over tooth 11/24/2024  Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Modified Stillman Method of Brushing Limitations Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Tissue laceration due to incorrect placement Dexterity requirements May roll over the teeth too quickly eliminating the biofilm removal at gingival margin 11/24/2024 Rolling Stroke Method Removes biofilm etc. from teeth without Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com emphasis on the gingival margin. Recommended for children 11/24/2024 Procedure Direct filaments apically Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Place side of the brush on attached gingiva. Press to flex filaments Roll the brush slowly over the teeth Repeat 5 times for each group of teeth 11/24/2024 Limitations Laceration to the alveolar mucosa Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com when brush placed too high Quick sweeping strokes miss the cervical third 11/24/2024 Charter Method Removes biofilm from proximal surfaces Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Massage marginal & interdental gingiva Adapts to cervical areas below the height of contour To clean under the margins of a fixed partial denture (BRIDGE) Orthodontic Appliances. 11/24/2024 Procedure Apply rolling stroke for general cleaning Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Direct filaments at a 45-degree angle toward the occlusal/ incisal plane Press filaments between the teeth Move the bush in a rotary motion to The count of 10 11/24/2024 Limitations Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Difficult on lingual surfaces Brush may not engage sulcus High dexterity requirements 11/24/2024  Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com 11/24/2024 Modified Stillman VS Charter Fones Method/Circular Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Alfred Fones: Father of Dental Hygiene /Chapter 1 Toothbrush placed at a 90 -degree angle to the long axis of the teeth. Circular motion in each area 11/24/2024  Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Fones Method of Brushing The Horizontal (or Scrub) Method  Horizontal scrubbing motion with bristles at a 90- degree angle to the teeth Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Considered detrimental  May produce toothbrush abrasion Leonard’s (or Vertical) Method  Purposes and indications  May work well for small children Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Procedure  Place toothbrush at 90° to the long axis of the teeth, buccal and lingual, and press bristles gently against the teeth  The teeth are edge to edge  Stroke  Limitations: minimal plaque removed from the sulcus and proximally Power Toothbrush Could you imagine using a typewriter today? Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Why do we still use manual toothbrushes?? 11/24/2024 Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com 11/24/2024 Power Toothbrushes  Facilitate mechanical removal of biofilm Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Found to be more effective than manual brushes  Research proves a reduction in calculus & removes more stain 11/24/2024  Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Power Toothbrush Motions Recommendations  Any patient may benefit Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Orthodontics  Dental Implant patients  Aggressive brushers  Patients with disabilities or limited dexterity  For use by caregivers 11/24/2024  Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Power Brush and Child Power Brush Profiles Procedure  Use small amounts of dentifrice Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Place brush in mouth before turning on power  Utilize a sequence  Let the brush do the work  Angle the bristles toward the sulcus  Use light steady pressure 11/24/2024  Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Occlusal Brushing  Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Brushing Problems and Vertical Brush Position Supplemental Brushing Methods  Tongue cleaning Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Anatomic features of the tongue conducive to debris retention  Microorganisms of the tongue  Purposes and indications  Reduces bacteria, halitosis, coating and stain from smoking & coffee  Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Tongue Cleaners and Scrapers Toothbrushing for Special Conditions  Acute oral inflammatory or traumatic lesions  Clean areas unaffected and use saline solution and or chlorhexidine Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Following periodontal surgery  Oral care in areas not involved in the surgery  Rinsing or brushing of the surgical after 24 hours  If a gingival graft was done, no brushing until recommended  Chlorhexidine  Following dental extraction  Brush areas not affected by the extraction  24 hours after rinse with saline solution  Oral self-care for the neutropenic patient: Physician will give instructions for when oral care can be resumed. Adverse Effects of Toothbrushing  Soft-tissue lesions  Gingival abrasion Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Hard-tissue lesions  Dental abrasion  Bacteremia  No clear association of transient bacteremia and infective endocarditis  Oral hygiene is especially important for patients who are medically compromised Care of Toothbrushes  Supply of brushes  How many of you have more than 1 toothbrush? Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Brush replacement every 2-3 months, after illness and at first sign of wear  Cleaning toothbrushes  Disinfection: soaking in hydrogen peroxide or Listerine reduces bacterial load  Brush storage: place in an area where the brush can dry 46 Documentation  Documentation for initial toothbrush instruction will include the following:  Type of toothbrush patient has used to date: manual versus power Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Recommended changes in type of brush or method of use  Description of soft-tissue health and/or plaque score with goal(s) for improvement  Description of toothbrush education and areas patient has difficulty reaching  Tongue cleaning method education provided  See Box 26-2 for sample documentation for toothbrush selection and toothbrushing method Factors to Teach the Patient  The effect dental biofilm has on the teeth and gingiva Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Rational for thorough daily removal of dental biofilm  The type of brush ideal for the patient  Individualized, hands-on instruction on the appropriate method for manual or power brushing  Proper care and maintenance of manual versus power brushes  Indications for and use of tongue cleaner