POLISHING, FLOSS,
FLUORIDE, INSTRUMENT
SHARPENING
Lisa Mayo,
RDH, BSDH
Staci Janous,
RDH, BS
DH101: PRECLINICAL SCIENCES
CONCORDE CAREER COLLEGE
REFERENCES





Wilkins
Wilkins
Wilkins
Wilkins
Wilkins
CH
CH
CH
CH
CH
27:
28:
29:
35:
38:
Toothbrushing
Interdental Care and Irrigation
Dentifrice & mouthrinses
Fluorides
Instruments and principles for instrumentation
 Nield CH 22: Concepts for instrument sharpening
 Nield CH 23: Instrument sharpening techniques
 Nield CH 28: Cosmetic polishing procedures
OUTLINE
1.
2.
3.
4.
5.
6.
7.
Polishing
Floss
Toothbrushing
Toothpaste
Fluoride
Adjunct Aids
Oral Hygiene Instruction
OBJECTIVE #1: POLISHING
NIELD CH28
POLISHING
 Cosmetic procedure to help remove extrinsic stains from teeth
 Thorough brushing/flossing can produce the same ef fects as
polishing
 Can scratch tooth surfaces: esp cementum/dentin
 Does NOT improve the uptake of fluoride
 Some patients like and others do not
POLISHING
ADVERSE EFFECTS
 Aerosol production and splatter
 Do not use on patients with known communicable conditions
(TB)
 Do not use on patients with respiratory conditions or
immunocompromised
 Creation of bacteremia (bacteria in the bloodstream)
 Need to make sure premed was taken prior to polishing
 Iatrogenic damage to tooth surface
 CEJ is thin and can be abraded by polishing agents
 Polishing creates heat is not done properly (primary teeth
w/large pulp chamber)
 Could injure gingiva
POLISHING
CONTRAINDICATIONS
1.
2.
3.
4.
5.
6.
7.
8.
Lack of stain
Sensitive teeth (can use sensitive polish paste)
Do not polish exposed cementum or dentin (recession)
Restored tooth surfaces (scratching, eroding, pitting can
occur)
Newly erupted teeth (mineralization is occurring)
Implant abutments
Areas of demineralization (soft tooth structure)
Gingiva
POLISHING
 Selective polishing: polishing only those areas with an
objectionable appearance
 Current theories: remove as much stain as possible with hand
or power driven devises first before polishing
 The most common technique for stain removal is with RUBBER
CUP POLISHING/POWER DRIVEN POLISHING
POLISHING
 Components
1. Handpiece (handle)
 Slow speed handpiece
 Attaches to dental unit
2. Prophy angles (shank)
 Can be right-angled (straight shank) or contra-angled (bent
shank)
 Many companies manufacture
 Can be reusable or disposable (our clinic uses, most
common)
3. Prophy cup attachments (more on another slide)
POLISHING
POLISHING
CORDS AND HANDPIECE
Poor Ergonomics
POLISHING
POLISHING
Latch Design
Threaded Head
Button-Ended Head
POLISHING
3. Prophy Cup Attachments
 Natural or synthetic rubbers: non-latex which are very
soft and flexible
 Internal cup design: wide range, effect cleaning
ability and amt prophy paste delivered to the tooth
 Length and diameter: vary (short or standard)
 Flexibility: soft and firm
 Bristle brush attachments
 Ortho appliances
 Pits and grooves of teeth
 Careful not to injure gingiva
POLISHING
POLISHING
MINIMIZING TOOTH LOSS
 Abrasive Agent
 Substances that remove extrinsic stains by
scratching and abrading the tooth surface
 Differing particle sizes/grit: larger the size = deeper
scratches
 Manufacturers label as extra fine, fine, medium,
coarse, extra coarse
 Use the smallest grit particle size to achieve your
goals
POLISHING
MINIMIZING TOOTH LOSS
 Rubber Cup Adaptation
 Parallel to tooth surface being polished
 When angle = ↑ scratching
 Pressure: use just enough pressure to make the cup
flare slightly
 Speed of Application: SLOWEST speed as possible so
as NOT to overheat tooth
 Application Time: 1-2sec per tooth
POLISHING
POLISHING
POLISHING
TOO
MUCH
PX
PASTE!!
POLISHING PROCEDURE
1. Before Polishing
 Discuss importance daily plaque control/removal
 Remove as much stain as possible with instruments
2. Patient Preparation
 Review patient medical history for contraindications
 Explain the rationale for selective polishing
 Obtain informed consent
 Make sure eyewear is in place
3. Clinician Preparation
 PPE
 Low or High Speed Suction
POLISHING PROCEDURES
4.
5.
6.
7.
Supine patient position
Latex-free cup with correct grit paste
Establish correct fulcrum
Rest handpiece in V -Shape area of your hand between index
finger and thumb
8. Hold cord between 4 th & 5 th finger
9. Hold cup away from tooth & activate foot pedal so speed is
slow and steady
10. Start UR Facial most posterior tooth and polish each tooth
until end at the UL Facial most posterior tooth
11. Apply just enough pressure to make rim of cup flare slightly
12. Use a wiping-motion on the crowns of the teeth covering the
entire facial surface and flaring the cup into the
interproximal
POLISHING PROCEDURE
13. Refill prophy cup with paste every 3 -4 teeth. An empty cup
will not polish the teeth and only create excessive heat. Be
sure to remove saliva from the cup on a dry gauze before
placing cup back into the mouth.
14. Once upper facials are completed, the clinician will polish
upper linguals #16-1
15. Rinse the upper arch thoroughly
16. Drop down to mandibular arch and polish in the same
sequence (#32-17F then #17-32L)
17. Rinse after mandibular arch completed
POLISHING
KEY POINTS
 Hard for patient if you do NOT rinse until completed both
arches of polishing (a lot of prophy paste in their mouths they
may swallow)
 Many prophy pastes DO contain fluoride (read labels carefully)
 Many ingredients in prophy paste: some patients may have
allergies to them (ex: Yellow dye #5)
 Some patient do NOT like px paste: of fer alternatives (no
polishing, let them brush their own teeth, air polishing)
 Use any sequence you like as long as it is the same for every
patient so you do NOT miss areas (for now while you are
learning, use the sequence presented today)
POLISHING COMPETENCY
Point Value:
1. Uses sufficient paste
2. Applies paste to 2 - 3 teeth at a time
3. Uses a secure fulcrum and fulcrum finger as pivot
4. Uses the proper speed (as slow as possible)
5. Uses the proper grasp on the handpiece
6. Cover all surfaces
7. Rinses or suctions paste as needed by patient
8. Operator position is correct
9. Adjusts light as necessary
10. Operator uses mirror correctly
*11. Utilizes proper infection control protocol
TOTAL POINTS:
1
0
OBJECTIVE #2: FLOSS
FLOSS
WILKINS P.412
 Recommended prior to brushing: fluoride from toothpaste can
reach interproximally
 12-15in length of floss
 Wrap floss around middle finger
 Use thumb and index finger of each hand for guiding
 Grasp firmly with only ½in of loss between fingertips
FLOSS
WILKINS P.412-413
 Rotate floss to use a new section often
 Use a GENTLE, slow, sawing motion to guide floss past
each contact area
 Control floss to avoid floss-cuts in gingival tissues
 Curve the floss around each tooth and slide up -and-down
with firm pressure making a “C-shape” with the floss
 Floss should be inserted under the gingival tissues until
reaching a “stopping point” (about 1-2mm deep)
30
Copyright © 2010 by Saunders, an imprint of
Elsevier Inc.
DENTAL FLOSS
WILKINS P.411
 Indicated for use proximal surfaces
 Aids in minimizing decay interproximally
 Materials
1. Silk: Not used anymore, 1 st developed
2. Nylon. Nylon multifilaments
 Waxed or Unwaxed
 Circular (floss) or flat (tape)
3. Expanded PFTE: Plastic monofilament
polytetrafluoroethylene with wax
 Types of floss
 Research has shown no difference in the effectiveness of
waxed or unwaxed floss for biofilm removal
 Biofilm removal depends on how floss is applied
DENTAL FLOSS
WILKINS P.411
 Waxed / PFTE
 Helps prevent trauma to tissues
 Slides through contact area with ease
 Resists breakage or shredding when passed over irregular
tooth or root surface (overhang fillings, calculus, etc…)
 Unwaxed
 Thinner
 Pressure against a tooth surface spreads the nylon fibers
and gives a wider surface for biofilm removal
 Be careful not to floss cut oneself!!
 Can fray when rubbed over an irregular tooth/root
surface
DENTAL FLOSS
 Enhancements
1. Color
2. Flavors (mint, cinnamon most common)
3. Therapeutic agents: fluoride, whitening
 Limited research as to their effectiveness
REVIEW
Floss is made of the following materials except:
A) silk
B) waxed nylon
C) unwaxed nylon
D) expanded PTFE
E) wood filaments
ANSWER
E) Wood filaments is the correct answer.
Floss is made from silk, waxed and unwaxed
nylon, and expanded PTFE.
FLOSSING COMPETENCY
Point Value:
1. Uses approximately 12 - 15 inches of floss
2. Wraps floss around middle fingers
3. Establishes and maintains a fulcrum (one in the anterior,
two in the posterior)
4. Uses index finger as a guide
5. Inserts floss at an angle to the tooth
6. Passes floss through the contact area with “see-saw”
motion
7. Controls floss to prevent “snapping”
8. Maintains short length ¾ “ to 1” between index fingers
9. Presses floss against teeth
10. Creates and maintains a “C” formation
11. Slides under the gums with an “up-and-down” motion
12. Avoids injury to the interdental papillae
13. Continually wraps / unwraps to use the clean portion of
the floss
14. Utilizes correct dental lighting positioning
*15. Utilizes proper infection control protocol
Total Points:
1
0
OBJECTIVE #3: TOOTHBRUSHING
WILKINS CH27
TOOTHBRUSHING
 The most commonly used device for removing oral
biofilm
 Well designed to remove oral biofilm from the facial,
lingual, and occlusal tooth surfaces
 Patients NEED toothbrushing instructions
 Toothbrush Filament Design
 Filaments: # & arrangement vary
 Most filaments are 10 -12 mm long
CHARACTERISTICS OF AN
EFFECTIVE MANUAL BRUSH
Conforms to patient requirements
Easily manipulated
Readily cleaned
End-rounded filaments
Properties
Flexibility, softness, strength, lightness of
handle
REVIEW
Which one of the following characteristics would
be least desirable in a toothbrush?
a. Conforms to individual patient in size, shape,
and texture
b. Readily cleaned and aerated, impervious to
moisture
c. Bristle or filament height 21 mm
d. End-rounded filaments
e. Durable and inexpensive
ANSWER
C) Bristle or filament height 21 mm is the
correct answer.
The filament height is usually 11 mm, not 21
mm. Filament height is not one of the
characteristics of an effective toothbrush,
either.
42
Copyright © 2010 by Saunders, an imprint of
Elsevier Inc.
43
Copyright © 2010 by Saunders, an imprint of
Elsevier Inc.
POWER TOOTHBRUSH
 Typically activated by electricity or battery
 Suitable for almost any client
 Effective in controlling stain
 Patients need power toothbrushing instructions
TOOTHBRUSH POINTS
 2 minutes is often the
recommended amount of time
 Average brushing time is
<30seconds
 Patients usually think their
brushing time is more than double
the actual time
 Recession & Abfraction
 Abrasive / Too Hard Brushing
 Incorrect technique (scrubbing
back-and-forth)
46
Copyright © 2010 by Saunders, an imprint of
Elsevier Inc.
TOOTHBRUSH TECHNIQUE
SEE HANDOUT FOR DIFFERENT METHODS & WILKINS P.393
Roll
Bass Sulcular
Modified Bass
Stillman
Modified Stillman
Fones(circular)
Horizontal (scrub)
Leonard (Vertical)
Occlusal
BASS
OR
STILLMAN
48
Copyright © 2010 by Saunders, an imprint of
Elsevier Inc.
CHARTERS
49
Copyright © 2010 by Saunders, an imprint of
Elsevier Inc.
ROLL
50
FONES
51
Copyright © 2010 by Saunders, an imprint of
Elsevier Inc.
HORIZONTAL/SCRUB
OCCLUSAL BRUSHING
QUESTION
If your patient was a child with limited
dexterity what method of brushing would you
recommend?
ANSWER
Roll or Fones
Fones 1 st technique for kids prior to dexterity
development
Roll: good as a technique prior to being able to
use sulcular
QUESTION
What method of brushing is recommended for
a 12 year old patient in full orthodontics?
ANSWER
Charters
Filaments 45 degree angle toward occlusal
Enough pressure to force filaments between
teeth
Vibrate back and for 10sec 2-3x/teeth
Heel/toe for anterior lingual’s
BRUSHING TECHNIQUE
 Light, comfortable grasp
 Control brush at all times
 Grasp handle in the palm of the hand with thumb against
the shank, near the head of the brush so that it can be
controlled effectively
 Position filaments in the proper direction for placement
on the teeth (depends on the brushing method using)
 Apply appropriate pressure: Too much pressure bends the
filaments and curves them away from the area where
brushing is needed
WHICH ONE DOES YOUR TOOTHBRUSH
LOOK LIKE?
CARE OF TOOTHBRUSHES
 Brush replacement: 2-3 months
 More often for immunosuppressed persons
 Dispose anytime after an illness or infection or
surgery
 Rinse thoroughly after each use
 Brush storage
 Open air with head in upright position
 Close container encourage bacterial growth
OBJECTIVE #4: TOOTHPASTE
WILKINS CH29
DENTIFRICES
 ↓ Caries
 ↓ Biofilm formation
 ↓ Gingivitis
 ↓ Supragingivial calculus
 ↓ Tooth sensitivity
 Remove stains
TOOTHPASTE COMPONENTS
WILKINS P.425
1.
2.
3.
4.
5.
6.
7.
8.
9.
Abrasives
Humectants
Water
Detergents
Binders
Sweeteners
Coloring Agents
Flavoring
Preservatives
20-40%
20-40%
20-40%
1-2%
1-2%
1-2%
as needed
as needed
2-3%
TOOTHPASTE COMPONENTS
 Abrasives (20-40%)
 Clean and polish
 Physically remove biofilm and stain
 Calcium carbonate, phosphate salts, hydrated
aluminum oxide, silica’s
TOOTHPASTE COMPONENTS
 Humectants (20-40%)
 Retain moisture
 Prevent hardening when exposed to air
 Stabilize preparation
 Xylitol, glycerol, sorbitol
 Detergents (1-2%)
 Loosen debris
 Surfactant (↓ surface tension)
 Foaming and emulsify debris
 Sodium lauryl sulfate
TOOTHPASTE COMPONENTS
 Binders (1-2%)
 Stabilize
 Mineral colloids, natural gums, seaweed, cellulose
 Coloring agents
 Attractiveness but may cause mucosal rxns
 Vegetable dyes, tartrazine
TOOTHPASTE COMPONENTS
 Sweeteners/Flavoring Agents
 Create a favorable taste
 Xylitol, glycerine, manitol, sorbitol, saccharine, essential
oils
 Preservatives (2-3%)
 Prevent bacteria growth
 Prolong shelf lifeAlcohol, benzoates, phenols
SPECIALT Y TOOTHPASTE
 Whitening
 Hydrogen peroxide
 Carbamide peroxide
 Tooth sensitivity: occlude dentinal tubules
 Potassium nitrate/citrate/chloride
 Gingivitis reduction
 Stannous Fluoride
 Triclosan
 Zinc citrate
 Sodium Monofluorophosphate
SPECIALT Y TOOTHPASTE
 Calculus reduction
 Tetrapotassium pyrophosphate
 Tetrasodium hexametaphosphate (ex: Crest Pro
Health)
 Zinc chloride
 Zinc citrate
 Triclosan (ex: Colgate)
REVIEW
In a dentifrice, what is the function of the
humectant?
A) Prevents separation of ingredients
B) Prolongs a product’s shelf life
C) Maintains the consistency of the product
D) Retains moisture
ANSWER
D) Retains moisture is the correct answer.
The purpose of the humectant is to retain
moisture. The binder prevents separation and
maintains consistency and the preservative
prolongs shelf life.
OBJECTIVE #5
Fluoride
FLUORIDE OUTLINE
Fluoride & Tooth Development
Fluoride & The Body
Fluoride Toxicity & Lethal Doses
Fluoride Delivery
1. Community Water
2. In-Office
3. At-Home OTC and Rx
FLUORIDE & TOOTH
DEVELOPMENT
WILKINS P.428 & CH35
MOSBY’S DENTAL HYGIENE BOARD REVIEW
FLUORIDE & TOOTH DEVELOPMENT
 Fluoride is a nutrient essential to the formation of
sound teeth and bones
 Pre-Eruptive: Mineralization stage
 Fluoride is deposited during the formation of the
enamel
 Fluoride is incorporated directly into the structure
during mineralization
 Results in the development of shallower occlusal
grooves and fissures
FLUORIDE & TOOTH DEVELOPMENT
WILKINS P.518-520
 Post-Eruptive
 Uptake is most rapid on the enamel surface during the
first years after tooth eruption
 Continuing intake of drinking water with fluoride
provides a topical source as it washes over the teeth
 Fluoride in enamel
 Uptake: depends on amt fluoride in oral environment
and length of time of exposure to fluoride
 Natural constituent of enamel
 Outer surface has highest concentrations
FLUORIDE ABSORPTION IN BODY
WILKINS P.518
 Begins in stomach as hydrogen
fluoride (HF)
 Rate depends on solubility of F
compound & gastric activity
 ↓ when taken with milk/food
 Whatever not absorbed by stomach
goes to small intestine
 Max blood levels reached in 30min
after intake
FLUORIDE DISTRIBUTION IN BODY
WILKINS P.518
 Strong affinity for calcified tissues – 99% located in
mineralized tissues
 Highest concentration in surfaces closest to the
source supplying F (ie: tooth surface)
 Stored in crystal lattice of teeth and bones
 Amount stored varies w/intake amt, exposure time,
age/stage of development
 Dentin fluoride concentrations < enamel
FLUORIDE EXCRETION IN BODY
WILKINS P.518
Kidneys by urine
Small amts in sweat and feces
Limited transfer via breast milk
FLUORIDE TOXICIT Y & LETHAL DOSE
WILKINS P.536
 Toxic Dose
 Induce emesis
 F ion will bind to MILK or LIME JUICE
 Call 911
 Safe Dose
 Adult: 1.25-2.5G
 Child: 0.5G
 Lethal Dose F
 32-64mg of PURE fluoride per Kg body weight
 Adult: 5-10G
 Child: 0.5-1.0G
Amt F Ingested
Emergency Tx
≤5mg/kg
1. Admin fluoride-binding agent
≥5mg/kg
1. Induce vomiting (emesis)
2. Admin fluoride-binding agent
3. Seek medical tx
≥15mg/kg
1. Seek medical tx
2. Induce vomiting
3. Cardiac monitoring
FLUORIDE: TOXICIT Y
WILKINS P.536
 Symptoms being within 30min – 24hrs
 GI: hydrochloric acid acts on F ion to form hydrofluoric
acid – irritates stomach lining
 Nausea, vomit, diarrhea, abdominal pain, increase
salivation, thirst
 Systemic Involvement
 Symptoms of hypocalcaemia (low calcium levels in
blood)
 Convulsions, paresthesia
 Cardiac failure, respiratory paralysis, death
 Treatment
 Induce vomiting (emesis)
 Administer F-binding agents
FLUORIDE: TOXICIT Y
WILKINS P.536
 Skeletal fluorosis
 Results after long-term use of water with 10-25ppm
for industrial exposure
 Dental fluorosis
 When excess F is in drinking water during the years
of tooth development
 Birth until 12-16yrs
FLUORIDE THERAPY
COMMUNIT Y WATER
WILKINS P.522-523
 Systemic
 Fluoridation: adjustment of F ion content in water
supply to the optimum physiologic concentration that
will provide:
 1965: 1 st communities fluoridated
 Avg cost: $0.13 - $5.48 per person/year
 Most cost effective way to bring F to a community!!
FLUORIDE THERAPY
COMMUNIT Y WATER
WILKINS P.522-523
 Community Fluoridation
 Levels range 0.7-1.2ppm mg/L
 EPA monitors
 Compounds used:
1. Sodium fluoride
2. Sodium silicofluoride
3. Hydrofluosilic acid
FLUORIDE THERAPY
COMMUNIT Y WATER
WILKINS P.522-523
 Community Fluoridation
 Most effective in reducing caries smooth surface
 Least effective in reducing caries pit and fissures
 Anterior teeth have better protection then posterior due to
above reason
FLUORIDE THERAPY
COMMUNIT Y WATER
WILKINS P.522-523
 Community Fluoridation
 Disadv.
1. Have to drink community water
 Reasons why not universal
1. Controversial effects of systemic F
2. Public not informed of benefits of F
3. Powerful Lobbyist's
FLUORIDE DELIVERY
IN-OFFICE
WILKINS P.527
 Prevention of dental caries
 Id special problems: areas adjacent to restorations,
orthodontic appliances, xerostomia
 Desensitization of recession
 Fluoride aids in blocking dentinal tubules
 Patient and/or parent education
 Help patients understand the benefits & limitations of
topical fluoride
IN-OFFICE FLUORIDE
WILKINS P.528
Fluoride
Percent
Notations
NaF (neutral sodium fluoride)
2%
Gel or foam
NaF (neutral sodium fluoride)
5%
Varnish
APF (acidulated phosphate fluoride) 1.23%
Gel or foam
Not for colored restorations
SnF (Stannous fluoride)
Unpleasant taste
Stains teeth
Gingival sloughing
Discolor restorations
0.8%
IN-OFFICE FLUORIDE
TECHNIQUE
WILKINS P.529-530
 Tray technique: Gel or foam
 Covers all exposed root surfaces
 Follow manufacturer recommendations for length of
time (ADA ONLY supports 4min)
 Post-Op: No rinse, eat, drink, brush, or floss 30 min
after tray
 Varnish technique (5% NaF)
 Premeasured wells w/ applicator brush
 Post-Op
 Avoid hot drinks, alcoholic beverages
 No brushing or flossing teeth 4 -6 hours
FLUORIDE COMPETENCY
TRAY ONLY, NOT VARNISH THIS TERM
Point Value:
1.
2.
3.
4.
5.
6.
Selects proper tray size
Use proper amount of fluoride foam
Patient in upright position
Dries teeth
Inserts trays properly
Inserts saliva ejector in between trays and positions for
patient comfort. Has patient hold suction.
7. Instructs patient to tilt head forward slightly
8. Stays with patient throughout procedure
9. Times procedure for 1min
10. Removes trays and saliva ejector correctly
11. Has patient inset saliva ejector for final suction
12. Gives proper post-op instructions
*13. Utilizes proper infection control protocol
TOTAL POINTS:
1
0
FLUORIDE FOR HOME USE
WILKINS P.523
At-Home Rx Fl in Trays
1.1%NaF (5,000ppm)
Safe for restorations
1.1%APF (5,000ppm)
Not safe for restorations
0.4%SnF (1,000ppm)
Can stain teeth
 Who? Xerostomia, Root surface hypersensitivity,
Rampant caries
 Dentifrices that are brushed on 2-3x/day OTC or Rx
 Stannous fluoride
 Neutral Sodium
 Sodium Monofluorophosphate
FLUORIDE MOUTHRINSE
WILKINS P.533
 Low potency/high frequency (OTC)
 High potency/low frequency (Rx)
 Not for use <6yrs
Mouthrinse Rx
Frequency
Rx or OTC
0.2% NaF (905ppm)
1x/week
Rx
0.044% NaF/APF (200ppm)
1x/day
OTC
0.05% NaF (230ppm)
1x/day
OTC
0.0221%NaF (100ppm)
2x/day
OTC
REVIEW
Which of the following systemic fluoride delivery
methods would be considered most economical?
A) Dietary fluoride supplements
B) Naturally occurring in foods
C) Community water fluoridation
D) Professional fluoride treatment
ANSWER
C) Community water fluoridation is the correct
answer.
Community fluoridation is the most economical
systemic method for caries prevention
available. Dietary supplements and foods that
contain fluoride are sources of systemic
fluoride, but are not as economical.
Professional applications are not considered
systemic.
OBJECTIVE #6: ADJUNCT AIDS
WILKINS CH28
WILL COVER IN MORE DEPTH IN CLINIC II
ADJUNCT AIDS
 Toothbrushing does not reach the interproximal surfaces
 Who may need:
1. Increased risk for or who have periodontal disease
2. Orthodontics
3. Large embrasure spaces
4. Arthritis (inability to floss correctly)
ADJUNCT AIDS













Disclosing agents
Floss (braided, unbraided, waxed, unwaxed, or tape)
Floss holder
Floss threader
Tufted floss, yarn, gauze
End Tuft
Interdental proxy brush/aids
Wooden/plastic/triangular wedges/sticks
Toothpicks, perio aid, rubber tip
Tongue cleaners
Power brush
Oral Irrigation/Water Jet
Denture brush
ADJUNCT AIDS
COMPETENCY
Point Value:
1. Disclosing agent
2. Fones method of brushing
3. Leonard method of brushing
4. Stillman method of brushing
5. Modified Stillman method of brushing
6. Charters method of brushing
7. Bass method of brushing
8. Modified Bass method of brushing
9. Roll method of brushing
10. Interdental brush
11. End tuft brush
12. Toothpick holder
13. Wedge stimulators
14. Rubber tip stimulator
15. Floss holder
16. Floss threader
17. Tongue cleaners
TOTAL POINTS:
1
0
ORAL IRRIGATION
Effective method of delivery for
Chemotherapeutic agents
Disrupts loosely adherent microbial
colonization
Point tip perpendicular to long
axis of tooth
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Copyright © 2010 by Saunders, an imprint of
Elsevier Inc.
DENTURE BRUSH
END-TUFT BRUSH
INTERDENTAL/PROXY BRUSH
WOODEN/PLASTIC PICKS
FLOSS HOLDER/PICKERS
RUBBER TIP STIMULATORS
TONGUE CLEANERS
POWER BRUSH
OBJECTIVE #7: OHI
WILL COVER IN MORE DEPTH CLINIC II
ORAL HYGIENE INSTRUCTIONS
 Explain what you will be discussing with patient
 Have patient demonstrate how they brush/floss first
 Make suggestions and teach correct way to
brush/floss
 Then you demonstrate how to brush/floss correctly
 Allow patient time to practice and demo
 Suggest adjunctive aids as indicated
 Encouraging and motivational
 Speaks at patient’s level
 Gives instructions written down if needed
OHI
 Disclosing solution to help identify areas of plaque & calculus
supragingivally!
 Good to do prior to OHI
 We use in clinic and record on Plaque -Index O’Leary’s Form
 Selective dye in solution that stains materia alba, plaque, soft
debris, pellicle (will learn next week)
OHI: PLAQUE INDEX
CLINICAL ASSESSMENT OF ORAL
BIOFILM
 The presence of oral biofilm is most commonly assessed
by passing a dental explorer over the tooth surface
 Disclosing agents are used to make oral biofilm clinically
visible
1. FLUORESCEIN DYE (FD&C Yellow No.8)
 Visible under UV light
 More expensive but will leave no visible stain behind
2. Two-tone dyes (FD&C Red No.3 & Green No.3)
 Combo solution
 Can differentiate old rom new biofilm
 Discloses plaque but not gingival tissues
DISCLOSING SOLUTION
Will stain decalcified and pitted tooth
surfaces
Use Vaseline on lips and restorations
Avoid using prior to sealant application
THE END