Oral Prophylaxis Midterm Study Guide PDF

SCALING ORAL PROPHYLAXIS Presence of deposits in the mouth as a result of is a dental procedure that removes tartar and plaque uncleanliness and infection. build-up from the teeth through polishing and scaling. In this Process by which...

SCALING ORAL PROPHYLAXIS Presence of deposits in the mouth as a result of is a dental procedure that removes tartar and plaque uncleanliness and infection. build-up from the teeth through polishing and scaling. In this Process by which calculus is removed from the tooth surface process, the dental hygienist normally cleans under the from coronal to junctional epithelium. gums and the surface of the teeth. It is not considered to be an aesthetic procedure, and it is generally performed by an METHODS IN THE REMOVAL OF DEPOSITS experienced dental hygienist or dentist. 1.Rinse or spray the mouth with an antiseptic solution at the beginning and at intervals throughout the operation. 2.Remove the gross deposits with large scalers. Avoid injuring the enamel. 3. With small scalers of suitable shape , remove the small deposits in the crown and at the neck of all the teeth. Pass the Jacquet scalers between the cementum and the free margin and it must reach below the calculus to detach the deposit from the root surface. This procedure must be done without tearing and wounding the soft tissue attachment of the tooth. 4. Carry the small delicate scalers to the bottom of any pocket ORAL SEPSIS present. Avoid scraping the cementum of the affected tooth. Presence of deposits in the mouth as a result of 5. With the use of dixon’s brush go over the surfaces of the uncleanliness and infection. crowns and exposed roots and thoroughly smoothen and polish them with a pumice mixed with water. Always begin and end on ORAL HYGIENE the same side. Branch of sanitary science which treats the health of the Painting the teeth with a disclosing solution (dilute mouth. The practice of keeping one's oral cavity clean and tincture of iodine) will exhibit the bacteria plate present. free of disease and other problems by regular brushing of Hydrogen peroxide bleaches and greatly assists in the the teeth and adopting good hygiene habits. It is important removal of the stains. that oral hygiene be carried out on a regular basis to enable prevention of dental disease and bad breath. 6. Polish the proximal surfaces with dental floss carrying the ➔ it may include other prophylactic (preventative) pumice mixture. procedures such as an exam or checkup. It refers to dental care to protect your teeth and prevent 7. Scaling removes calcular deposits and food debris that serve as gum disease. irritants to the periodontium. The time interval of the procedure ➔ It includes a full examination of your mouth and is determined by the rate of the calculus formation. Most patients teeth and a thorough cleaning using an ultrasonic are given appointments on a 6 – month basis. However, some scaler, pick, or other tools to remove tartar, plaque, patients form deposits sooner and should be treated more and calcifications. The teeth are then polished, and frequently. a fluoride treatment or dental sealant is applied. ➔ In addition to the above, X-rays may be taken if a cavity is suspected or it has been a while since you FINGER REST is very important when scaling. had images taken. ORAL PROPHYLAXIS PROCEDURE 1. Let the patient rinse his mouth. 2. Dry the surfaces of the teeth. 3. Run the explorer. Use a disclosing solution then isolate. 4. Removal of deposits by scaling. 5. Smoothening of all the surfaces by polishing with prophylactic brush. a. Pumice and water b. Brush and rubber cup c. Proximal surface with dental floss d. Apply antiseptic  DENTAL DEPOSITS SOFT OR NON CALCIFIED HARD OR CALCIFIED DENTAL PLAQUE (BIOFILM) 1. Tenaciously adherent gelatinous mass comprised predominantly of bacterial colony (70%) with the remainder consisting of water, food residues, desquamated epithelial cells and white blood cells 2. Resistant to oral fluids and difficult to remove and found ROOT PLANING on hard to reach areas. Process by which residual calculus or portion of the cementum or dentin is removed to produce a smooth, 3. Act as semi – permeable membrane on tooth and hard, clean surface. identified as medium responsible for initiation of dental caries. Strokes ( push and pull ) MUCINOUS PLAQUE Film from saliva composed of mucin and saliva. It is not visible unless a disclosing solution is used. BACTERIAL PLAQUE Accumulation of mass of bacteria with mucilaginous film seen particularly on the cervical portion and on areas not subjected to friction or mastication. GOALS OF PLAQUE CONTROL Prevent dental caries Prevent gingivitis Prevent significant pathologic effect MECHANICAL MEANS OF PLAQUE CONTROL 1. Toothbrushing Most commonly used mechanical tool in the removal of dental plaque Recommended toothbrushes are with soft bristles with a bristle diameter of about.007 -.008 inch and with well – finished tips of bristles. 2. Use of dental floss ACTIVATING STROKES OF A SCALER EXPLORATION SCALING ROOT PLANING INSTRUCTION FOR PATIENTS Proper toothbrushing mouthrinsing use of dental floss twice a year visit to the dentist (( every 6 months ) teeth to be restored ( filling ) orrestoration of missing tooth/ teeth. Use of gum stimulator Restoration of contact points and contour of teeth. Change of faulty restorations. Smoothening and polishing of tooth surfaces. Removal and correction of all prosthetic appliances Elimination of harmful oral habits Role of dietary factor in dental caries  Dr. Bass proposed placing your toothbrush partly on the tooth and partly on the gum with the toothbrush bristles angled toward the gums. As you vibrated the toothbrush back and forth, the tips of the bristles slid below the gums to clean off plaque bacteria or germs below the gum or gingival margin. ❖ To perform the toothbrushing With this technique, a normal toothbrush can be used, but if it's available, you can use ADA approved HydraBrush to clean the teeth. The 3 major surfaces that are cleaned by this method and failed to do so by other methods are: 1. Gingival surface adjacent to the tooth 2. Cervical 3rd of the tooth, including proximal surfaces 3. Interdental gingiva between the teeth The Bass Method: Position the Toothbrush Toothbrush Direct the nylon filaments apically (up for maxillary, down for mandibular teeth) at a 45-degree angle. It is usually easier and safer if you first place the brush parallel with the long axis of the tooth. From that position the brush can be turned slightly and brought down to the gingival margin to the 45-degree angle. The Bass Method: Strokes ➔ Press lightly without flexing and bending the filaments. 3. Use of dentifrices and mouthwashes ➔ Nylon filament tips will enter the gingival sulci at gum- tooth border and cover the gum margin. TECHNIQUES OF TOOTHBRUSHING ➔ Vibrate the toothbrush back and forth with very short strokes without disengaging the nylon tips of BASS TECHNIQUE the filaments from the gum margin. Count at least Bass technique is an ADA approved technique where the 10 vibrations. stress is put on all the areas including the gingiva(gums) and ➔ Reposition the toothbrush and apply the brush to the tooth area adjacent to it. And so, the food debris, plaque the next group of two or three teeth. Take care to that gets accumulated in that region can be cleaned well. overlap placement. This technique is popularly mentioned when patients ask for ➔ Repeat the entire stroke at each position around sulcular cleaning techniques. the maxillary (upper jaw) and mandibular (lower jaw) arches, both for facial and lingual surfaces. HISTORY During the Second World War, Dr. Charles C Bass EXTRA TIPS AND PRECAUTIONS (1875-1975), a medical doctor, developed nylon Don’t use high pressure to vibrate the gingival area, dental floss as a replacement for silk floss for as it can damage the gingival area, and bleeding dental or teeth flossing. can occur. Use a soft bristle toothbrush rather than a hard one, Dr. Bass also designed the "Right Kind" as the softer one can go well deep into the multi-tufted toothbrush with tufts are spaced interproximal areas. closely to provide a smooth, narrow, compact and If you have a pretty large toothbrush, and trying to flat brushing plane. Similar toothbrush is still offered use it flat on the lingual sides of anterior teeth, its today. better to use it vertically than horizontally to access these areas. Around this time, a Mississippi physician named Have patience, as this method is a bit time taking, Charles Cassidy Bass began to suggest that but is beneficial. people did not just lose their teeth because they For a few days initially, the gingiva would give were getting old. He pointed out that if one worked burning sensation when you are using this hard to keep the area of the tooth at and below the technique, but that would gradually decrease when gum clean and free of germs or bacteria, even the you develop a habit of this method of elderly could keep their teeth. toothbrushing.  application and relatively safe. CIRCULAR SCRUB TECHNIQUE - 22,600 ppm fluoride Bristles are directed perpendicular to the buccal or lingual surfaces of the teeth and extended 2-3mm. beyond the free 4. PITS AND FISSURE SEALANTS gingival margin. Light pressure is applied to the brush and Applications the entire brush is moved in small (2-4 diameter ) circular includes: movements. 5 -8 circular movements can be made for each ➔ Cleaning of brush position. the pits and fissures as ADVANTAGES thoroughly as 1. It is more effective in plaque removal. possible through 2. More effective in removing plaque near the interproximal Prophylaxis. areas. ➔ Etching of 3. Easier to learn and requires shorter time. the enamel with a phosphoric STILLMAN’S METHOD acid to promote bonding. almost similar to the Bass method of brushing. But there is ➔ Placement of the resin. one significant difference, the bristles are not angulated into the gingival sulcus like the Bass method. Therefore it is very CHARACTERISTICS OF DENTAL PLAQUE appropriate for patients with gum recessions. Adheres firmly on tooth surface and can be removed only through mechanical cleaning. HORIZONTAL SCRUB Not visible unless disclosed by pigment from the the most commonly used method by most untrained oral cavity or disclosing solution. patients. It is considered a bad method because the Color may vary from gray to yellow. horizontal scrubbing method causes trauma to the gums and Occurs supragingivally or subgingivally. abrasion or wearing off of tooth surfaces. Forms more on the posterior and proximal surfaces and less on facial and lingual. CHEMICAL MEANS OF CHEMICAL PLAQUE DENTAL STAINS 1. CHLORHEXIDINE GLUCONATE Pigmented deposits on tooth surfaces Irritate the gums Prevents and eliminates causing gingivitis and results to esthetic problems. supragingival dental plaque Prevents the development of gingivitis with the use of.2% solution 2. COMMUNITY WATER FLUORIDATION Controlled adjustment of fluoride content of the public water supply to an optimal concentration governed by the geographic location and climatic conditions for that community Studies show that ingestion of optimally fluoridated TYPES OF STAINS water throughout the period of 1. Brown pre-eruptive tooth formation and 2. Metallic post- eruptive enamel maturation reduces the prevalence of 3. Tobacco dental caries by 55 – 60 % Imparted to both primary and 4. Green permanent dentition. 5. Black 6. Orange 3. TOPICAL FLUORIDE APPLICATION STAINS ARE procedure of applying DIVIDED INTO : concentrated 1. Extrinsic – from outer solutions of fluoride to environment erupted dentition in eg. Metallic (silver nitrate) the dental office Non – metallic ( cigar ) a. 2% sodium fluoride solution 2. Intrinsic - within the tooth tissues b. 8 % stannous eg. Tetracycline stain fluoride solution c. Acidulated Phosphate Fluoride ( APF ) solutions or gels having a fluoride concentration of 1.23% with a pH of about 3.5 d. Flouride Varnish – more effective, easier DENTAL CALCULUS Starts from dental plaque An adherent calcifying mass forming on surfaces of natural teeth and prosthesis. Calcular deposits, tartar 2 TYPES OF CALCULUS 1. SALIVARY OR SUPRAGINGIVAL Found largely on crowns of teeth opposite the ducts of the salivary glands ei., on the lingual surface of the lower incisors and buccal surfaces of the upper molars. CHARACTERISTICS OF SUPRAGINGIVAL CALCULUS Ranges from color white to yellow. Hard gray line easily detached from the tooth surface with a scaler. Color is affected by tobacco and brown pigment. Occurs in single tooth or group of teeth or maybe generalized in the mouth. Found opposite the salivary ducts - buccal surfaces in maxillary molars and lingual surfaces of mandibular molars and lower incisors. 2. SURUMAL OR SUBGINGIVAL Found under the free margin of the gingiva and the most harmful kind of calculus. CHARACTERISTICS OF SUBGINGIVAL CALCULUS Dark in color ranges from dark brown to green black Difficult to remove Dense and hard CALCULUS GRADING SCALE 0 No calculus 1 TRACE Trace levels of colculus at gingwal margin or between 2 SLIGHT Calculus deposits 1 mm or less 3 MODERATE Calculus deposits 1 to 2 mm, but covering less than one third of the tooth surface 4 HEAVY Calculus deposits greater thon 2 mm, may extend over soft tissues, or may bridge teeth  OCCLUSOLINGUAL cavity preparation and restoration CLASS I AND CLASS II When distal oblique and distal fissures are connected PREPARATIONS’ and carious or at caries risk and must give special importance to the following: 1. Cavity preparation must be no wider than necessary ( ideally the mesiodistal width should not exceed 1 mm, except for extension necessary to remove carious or CLINICAL FEATURES undermined enamel or to include unusual fissuring) 1. Conservative cavity preparation is recommended to protect the pulp. 2. deal outline include all pits and fissures. 3. No. 245 bur (pear - shaped) oriented parallel to the long axis of 2. Cavity preparation should be cut more at the expense of the tooth crown the oblique ridge rather than centering over the fissure. 4. Punch cut is made at the pit 3. On smaller teeth, the occlusal portion may have a slight to a depth of 1.5 - 2 mm or one - distal tilt. half to two - thirds the head of the bur. ( 1.5 mm depth is measured at the central fissure; the measurement of same 4. Margin should extend as little as possible onto the oblique entry cut but of prepared external wall is up to 2.0 mm. ridge, distolingual cusp and distal marginal ridge. desired pulpal depth is 0.1 - 0.2 mm into dentin. 5..Bur is inclined distally ( not more than 10 degrees)to establish proper occlusal divergence to distal wall to prevent removal of dentin supporting marginal ridge enamel when pulpal floor is in dentin and distal extension is necessary to include a fissure or caries. 6. Distance from margin to 4. Axial wall of lingual portion must be at a uniform depth of proximal surface must not be 1.5mm axial wall must follow the contour of the lingual less than 1.6 mm for surface of the tooth. premolars and for molars must not be less than 2 mm. 5. With rounded axiopulpal line angle, for secondary retention,lock and cove may be made. 7. A strong ideal enamel margin should remain: one that is made up of full length enamel rods resting on sound dentin, supported on the cavity side by shorter rods also resting on sound dentin, supported on the cavity sides by shorter rods also resting on sound dentin. REVIEW THE PRINCIPLES OF CAVITY PREPARATION 8. The conservative class I should have an outline form with gently flowing curves and distinct cavosurface margins.A CLASS 2 faciolingual width of no more than 1 to 1.5 mm and a depth FEATURES OF MODERN CLASS 2 TOOTH of 1.5 to 2 mm are considered PREPARATION ideal 1. Isthmus width of ¼ intercuspal distance 2. Dovetails are 1/3 intercuspal distance 9. Retention form is provided by 3. Pulpal floor depth of 1.5 - 2.0 mm from the cavosurface parallelism or slight occlusal margin convergence of two or more 4. Slightly converging B and L walls opposing external walls. 5. Intact proximal wall is 1.6 - 2.0 mm from the external tooth #245 BUR OR PEAR SHAPE BUR surface 6. S-curve or reverse curve at the buccoproximal area 7. Walls of proximal box are 0.5 mm out of contact 8. Axial wall is parallel to external tooth surface 9. Cervical floor is 1.0 mm wide mesio-distally for premolars and 1.5 mm wide for molars 10. Beveled axiopulpal line angle 11. Rounded internal line and point angles 12. Butt-joint or 90-degree cavosurface margin Isthmus width of ¼ intercuspal The external walls should be protected. distance and Dovetails are 1/3 intercuspal distance S-curve or reverse curve at the buccoproximal area "S** curve Reverse curve in case of wide proximal contact area will provide maximum conservation of the sound tooth structure during freeing of the contact, removal of all undermined enamel and correct cavo- surface configuration of 90° Less display of restorative material ( enhance esthetics) Walls of proximal box are 0.5mm out of contact PULPAL FLOOR DEPTH OF 1.5 - 2.0mm from the cavosurface margin Axial wall is parallel to external tooth surface Cervical floor is 1.0 mm wide mesio-distally for premolars and 1.5mm wide for molars 1mm or 0.5mm into dentin (range of.75 to 1.5mm) Intact proximal wall is 1.6 - 2.0mm from the external tooth surface