Chapter 27 Oral Infection Control: Interdental Care PDF

Chapter 27 Oral Infection Control: Interdental Care Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Learning Objectives (1 of 2)  Review anatomy of the interdental area; explain why toothbrushing alone cannot remove biofilm adequately for prevention of peri...

Chapter 27 Oral Infection Control: Interdental Care Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Learning Objectives (1 of 2)  Review anatomy of the interdental area; explain why toothbrushing alone cannot remove biofilm adequately for prevention of periodontal infection Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Describe embrasure size and patient status of health or disease as factors for evidence-based clinical decision making for which interdental device to recommend.  Describe the types of interdental brushes and why they can be better for some patients Learning Objectives (2 of 2)  Describe dental floss types; outline steps for use of floss on proximal surfaces Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Develop a list of the types/purposes of various floss aids; provide a rationale for the choice of the best ones to meet a specific patient’s needs  Demonstrate and recommend other devices for biofilm removal including interdental rubber tip, toothpick in holder, wooden interdental cleaner, and oral irrigation  Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  The removal of biofilm from the proximal surfaces. Interdental Care Patient Assessment & Planning Interdental Care Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  History of Personal Oral Care  Dental and Gingival Anatomy  Embrasure spaces  CAL: Perio condition  Prostheses  Extent and Location of Biofilm  Biofilm score: Plaque record  Personal Factors: Dexterity, health literature (Dental IQ) Embrasure Types Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Type I: No gingival Recession  Dental floss  Type II: Moderate papillary recession  Interdental brush  Type III: Complete loss of Papillae or extensive recession  Unitufted Brush Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Class II Gingival Embrasure Selective Interdental Biofilm Removal  Relation to toothbrushing  Various toothbrushing methods can successfully remove most dental biofilm near Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com the line angles  Brushing vertically is also effective for additional access  Selection of interdental aids  Floss: Healthy sulcus, good dexterity, and the ability to slide through contacts  Floss Holder: Healthy sulcus, dexterity problems, ability to slide through contacts  Water flosser/irrigation: Gingivitis, implants, orthodontics deeper pockets  Interdental brushes: Embrasure spaces II & III, Perio patients , exposed root surfaces  Wood Sticks: Embrasure spaces II & III, Perio patients, exposed root surfaces Interdental Brushes  Types  Small insert brushes with reusable handle Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Travel interdental brush  Rubber interdental cleaners  Procedure: gently move brush into embrasure space with emphasis on proximal surfaces  Care of brush: Rinse and store, or disposable Indications for Use Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Proximal surfaces adjacent to open embrasures  Orthodontic appliances  Fixed prosthesis  Implants  Exposed furcations  Application of chemotherapeutic agents  Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Interdental Brushes/Cleaners and Interdental Care Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Dental Floss and Tape Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Most frequently recommended for interdental cleaning of Type I embrasures  Unwaxed & Waxed  Flossing Tape  Silk, Nylon, and Polytetrafluoroethylene (PTFE)  Variable Diameter: Tufted Dental Floss  Enhancements: color, flavor, therapeutics Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Use of Dental Floss Tufted Dental Floss Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Single precut or in a Roll: “Super Floss”  Removal of biofilm from teeth adjacent to wide embrasures –loss of papilla  Abutment teeth and under a pontic of a fixed bridge or orthodontic appliance  Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Tufted Dental Floss Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Gauze Strips Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Proximal surfaces of widely spaced teeth  Tooth surfaces next to an edentulous area  Abutment teeth: Distal portion of a denture supported by implants Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Flossing Injury Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Cuts & Clefts directly beside or in the middle of the interdental papilla.  Too long of a piece of floss  Snapping the floss through the contact  Not curving the floss in a C-shape  Not using a rest to prevent excess pressure Flossing Aids Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Power flossing instruments  Floss Holders  Floss Threaders  Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Use of a Floss Holder  Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Use of Floss Threader  Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Disposable Single-Use and Two-Handle Floss Aid  Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Air Flosser using bursts of air and water  Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Power Dental Flossing Devices Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Platypus Single Tuft Brush (End-Tuft) Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Single tuft or group of small tufts  Open interproximal areas  Fixed prostheses, orthodontics, implant abutments  Difficult to reach areas Interdental Tip  Conical flexible rubber of plastic tip Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Cleans interdental area at and just below the gingival margin  Furcations  Recontour or shape the papilla after perio surgery  Massages the gingiva to improve blood flow (unsupported by research) Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Wooden Interdental Cleaner Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Bass or birch wood stick  Triangular in cross section  Proximal surfaces where interdental papilla are missing Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Wooden Interdental Cleaner  Trace along gingival margin with trip positioned just beneath the margin by 1–2 mm  Similar to toothpick holder Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Tooth Pick Holder Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Perio- Aid: round toothpicks  Patients with periodontitis  Orthodontic patient Oral Irrigation/ Water Flosser  Targeted application of a pulsated or steady stream of water or other agent for preventive or therapeutic purposes. Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  The purpose of irrigation is to reduce the biofilm bacteria.  Effective alternative to floss  Can deliver solution to 50% of the pocket depth. Oral Irrigation  Benefits Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Reduction of gingivitis and bleeding  Reduction/alteration of biofilm  Subgingival access to pathogenic microorganisms  Subgingival delivery of antimicrobial agents or just water  Some research supports the claims listed above; however, most funding is from a single manufacturer. (Bias) Oral Irrigation  Other Indications:  Orthodontics Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Crowns and bridges  Removes food debris  Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com © ai_stock/Shutterstock Water and Air Flossers © olegganko/Shutterstock  Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Tips for Water Irrigator © aon168/Shutterstock Tip is placed interproximal for 3 seconds then sweep across gingival margin to next tooth. Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com (Source: Adapted with permission from Carranza FA. Clinical periodontology. 8th ed. Philadelphia: Saunders; 1996. 89 p.) Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Documentation  Documentation for a patient interdental care progress should include:  All interdental aid recommendations and demonstrations with the patient Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Factors to Teach the Patient (1 of 2)  Using disclosing solution will help with visual understanding of limitations of toothbrush in accessing and cleaning the interdental area Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Discuss biofilm and how it collects on the proximal tooth surfaces when left undisturbed  Educate the patient on why the interdental area is more vulnerable to infection Factors to Teach the Patient (2 of 2)  Use hands-on demonstrations to show how interdental aids are used to clean the proximal tooth surfaces Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Have the patient demonstrate the use of recommended aid  Ensure patient understands the need to ask the dental professional about new products and whether the product meets their individual need