DHY Lecture Week 10 Ch 25 & 26 Darby PDF

DHY Lecture Week 10 Darby Mechanical Oral Biofilm Control & Dentifrices Chapters 25 & 26 Learning Objectives: 1. Discuss the appropriate use and indications for self-care devices designed to remove or reduce interdental and subgingival plaque biofilm. 2. Recommend the appropriate device...

DHY Lecture Week 10 Darby Mechanical Oral Biofilm Control & Dentifrices Chapters 25 & 26 Learning Objectives: 1. Discuss the appropriate use and indications for self-care devices designed to remove or reduce interdental and subgingival plaque biofilm. 2. Recommend the appropriate device for clients based on efficacy, client needs, and preferences. 3. Explain the role of dentifrices in the demineralization and remineralization process. 4. Describe the role of therapeutic and nontherapeutic ingredients in dentrifrices. 5. Recommend dentifrices appropriate for unique client needs and risk factors. 6. Establish the legal and ethical responsibilities of the dental hygienist with regard to dentifrices. **The importance of this information cannot be minimized. Malpractice cases against practicing RDH's include failure to recognize and treat periodontal disease that can be related to failure to teach adequate plaque biofilm and techniques to patients.** - **You must record patient's progress and compliance with recommendations with alternative methods recommended and demonstrated** **Darby Chapter 25 Interdental and Supplemental Oral Self-Care Devices** The procedure sheets 25-1, through 24-10 are very informative and will help you to understand technique, **study these procedures.** **Oral Piercings** Risks of oral piercings are due to lack of training of piercing professionals and lack of enforcement of sterilization procedures. Long-term tongue piercings lead to tooth fractures. A common risk to those with tongue or lip piercings is gingival recession, especially the mandibular anterior area, with associated bone loss. Complications of oral piercings can occur immediately following the procedure. Shor-term risk may include infection, swelling, and bleeding. Post-piercing instructions include use of non-alcohol based antimicrobial rinse 4-5 times a day. Cool liquids or ice can help with swelling. NSAIDS for pain and swelling can be recommended. Patient's should be instructed to gently brush their piercings daily as soon as they feel comfortable. Instruct patient to avoid clicking jewelry against teeth and avoid chewing gum or other objects (fingernails, pens). Darby Chapter 26 Dentifrices Tables 26-1A and 26-1B, 26.2, 26.3, & 26.4 will be used in class, this is very important material. Darby has more material on Therapeutic Agents so we will be using Darby for this material. There have been questions on the board regarding Mohs mineral hardness scale. (Fig. 26.5) Therapeutic Agents and Active Ingredients Fluoride and Nonfluoride Anticaries Components (will discuss in detail later) Xylitol - Sugar alcohol and sugar substitute extracted mainly from birch bark, corn cobs, and cane pulp has anti-caries and anti-plaque properties - Strep-mutans cannot metabolize xylitol therefore its acids cannot demineralize tooth structure - As a therapeutic dose, 1.55g can be used daily in the oral cavity to decrease S. mutans Triclosan - Is a **bisphenol and a broad spectrum antimicrobial agent** with **antiplaque and antigingivitis properties** (Colgate Total) has the ADA seal of acceptance for its safety and efficacy in reducing caries, plaque, calculus, and gingivitis. - Scientific evidence has shown that triclosan slows down the progression of periodontal disease. - Some countries, including Canada have restricted use of triclosan as an active ingredient, because of detection of trace amounts in water systems that may jeopardize the aquatic ecosystem. Short-term studies found that animals exposed to high doses of triclosan had decreased levels of thyroid hormones. At this time, neither these hormonal effects nor the development of antibiotic resistance have been demonstrated in humans. Anticalculus Agents (anti-tartar toothpastes) - Pyrophosphates: Inhibit mineralization of biofilm - Zinc chloride, and zinc citrate: prevent or break down calculus formation Hydrogen Peroxide - Also known as carbamide peroxide can remove stains, chemically whiten teeth and assist in mouth odor. Any daily whitening dentrifice should have a neutral pH, because acidic dentrifices can damage the teeth and dental restorations when used daily. Sodium Bicarbonate (Baking soda) - A mild abrasive has been shown to neutralize acids produced by cariogenic bacteria - Combined with hydrogen peroxide for tooth whitening and fluoride for anti-cavity effect Charcoal dentrifices - No scientific evidence currently supports any claims of whitening properties for dentrifices with charcoal. **Terms:** Bioavailability = occurs when therapeutic agent is stable during storage and biologically active when used in the mouth to achieve therapeutic results. Dentifrice: Preventive Measure or Risk Factor? - Can affect individuals with allergies or intolerances (i.e. dyes, natural flavors such as strawberries or cinnamon, milk derivatives, eggs - Risk of fluorosis if children ingest while teeth are still developing - Soft tissue reactions - Tartar control pyrophosphate, herbal, essential oils, antimicrobial agents can cause irritation, erythema, or allergic reactions - Sodium lauryl sulfates (SLS) can cause desquamation or ulceration of tissues Insoluble ingredients (cannot dissolve in water) such as abrasives with silica remain intact in water therefore increase a dentifrice's abrasiveness. Why would we recommend high abrasives??? (Advantage) For a patient without root exposure but with high amounts of oral biofilm the more abrasive paste will remove the biofilm and acquired pellicle faster than less abrasive. Refer to Tables 26-5, 26-6, 26.7 Become familiar with the abrasiveness scale and potential for loss of dental structures. Look at the products and get to know their abrasiveness and pH so you will make educated choices for products to your patients. **NOTE: Researchers have many scales to determine relative dentin abrasivity (MOhs, the Relative Dentin Abrasivity Scale (RDA).** The problem is that there is no link among the scales because research methodologies differ, it makes it hard to compare research findings because of this inconsistency. Dentifrice pH -- The pH of a dentifrice can be beneficial or detrimental to dental structures while interfering in the demineralization/remineralization process. Level 1 = very acidic 7 = neutral 14 = basic (alkaline) We have learned that in the presence of acids and from the fermentation of sugars by S. mutans decay occurs at a pH of 6.5 on cementum and dentin and at pH 5.5 on enamel. The majority of dentifrices have a neutral pH **Low or Acidic pH in dentifrice** Advantages: - Acidity of a dentifrice promotes the formation of fluorapatite by incorporating fluoride ions into the enamel crystals. As a result these fluorapatite crystals are larger, more stable and less acid soluble Disadvantages (root exposure and titanium implants) - Low pH contributes to erosion of tooth structure - Pay attention to the patient with root exposures to avoid recommending due to tooth mineral loss - A low pH can tarnish titanium implants **Neutral and Basic pH** Advantages: - Because a neutral pH is similar to healthy saliva it is less irritating for soft tissues and will not demineralize the teeth Disadvantages: - Basic pH levels promote the mineralization of biofilm to calculus which in turn creates a nidus for retention of more biofilm and extrinsic stains - A dentifrice with a pH under 6.5 (acid) demineralizes and weakens exposed root surfaces, then combine that with an abrasiveness and this further increases the loss of dental substance. **NOTE: the ADA has put its seal of acceptance to many dentifrices stating that they contain a safe level of abrasives, HOWEVER the companies do not mention the pH levels, the book notes that Crest Pro Health which has the ADA seal of acceptance has a pH of 5.5 and it is believed that this pH might risk root surface demineralization in persons with gingival recession. More research is needed.** **Note:** Persons with gastroesphageal reflux should wait 30-60 minutes before brushing to minimize loss of tooth structure, if they can't wait instruct them to rinse with water, a fluoride containing mouthrinse, water with baking soda or milk before toothbrushing. The same is true for the following patients: any patient that has a condition or takes medication that causes chronic xerostomia.