- BY TANMAY RAUT IV BDS ROLL NO.

57

 Home care- Oral hygiene maintenance practiced at home. Oral hygiene- It is the practice which enables to keep the oral cavity clean in order to prevent the onset and progression of common problems like dental caries, gingivitis, periodontitis, halitosis and other dental disorders.

Oral hygiene- 1)professional care 2)personal care

 As a part of personal care plaque control needs to be emphasized because dental plaque has been found to be the culprit for causation of various dental diseases. Dental plaque- It is a general term for the diverse microbial community(predominantly bacteria) found on the tooth surface,embedded in a matrix of polymers of bacteria and salivary origin.

 Dental plaque- sticky - soft - colourless film of bacteria - constantly builds on the surfaces of teeth and gums. - starts forming immediately after a tooth is clean.

Goals of plaque control

1) Use of mechanical and chemical agent on a personal day-to-day basis to eliminate supragingival plaque alongwith dietary control to prevent the onset of dental caries. 2) Mechanical removal of subgingival plaque through professional means periodically so as to maintain predominantly gram positive flora associated with gingival health.

Common oral hygiene aids

Mechanical aids
1) Gauge piece for infants 2) Manual toothbrush and dentifrices 3) Electronic/powered toothbrush 4) Dental floss 5) Disclosing agents 6) Tongue scrapers 7) Oral irrigators

Chemotherapeutic aids
1) Antiseptic mouthwash 2) Antibiotics 3) Enzymes 4) Plaque modifying agents 5) Sugar substitutes 6) Plaque attachment interfering agents.

Mechanical aids
1) Gauge piece in infants- A moist gauge piece wrapped around the finger is ideal for cleaning gumpads in infants. Cleaning and massaging of the gums helps in establishing a healthy oral flora and aids in teething.

 Cradling the child with one arm while massaging the teeth with the hand of the other may be the simplest and provides the infant with a strong sense of security.

2) Manual toothbrush and dentifrices- The toothbrush design is based on following variables:
Diameter of fibers- soft(0.16-0.22 mm) - medium(0.23-0.29 mm) - hard(>0.30 mm) Length of the bristles(mostly 11mm) No. of bristles No. and arrangement of bristles as tufts Length of the toothbrush head Length of the toothbrush Angulation of head Shape of the bristle head Design of the handle

Brushing techniques
Fones technique Horizontal scrub technique Bass technique Roll technique Charters method Modified stillman method

Fones technique- The child is asked to stretch out his arms so that they are parallel to the floor. Then using whole arm draw big circles in air. Then smaller circles and finally, very small circles in front of the mouth are made. Now the child is ready to make circles on the teeth with the toothbrush being sure the teeth and gums are covered in circular motion.

FONES TECHNIQUE

 Horizontal scrubbing method- The brush is placed horizontally on buccal and lingual surfaces and moved back and forth with a scrubbing motion.

Brushing at different ages

Infants(0-1 yr)- cleaning of gumpads using wrapped,moistened gauze piece by parents. Toddlers(1-3 yrs)-brushing by nonfluoridated toothpaste by parents using lap to lap positioning of the child. Preschoolers(3-6 yrs)-brushing with/without fluoridated pea size toothpaste. parents should stand behind the child & assist in brushing. School going children(6-12 yrs)-parents need to only actively supervise brushing for this age group as manual dexterity & expectoration is now learned by the child. Adolescents(12-18 yrs)-patient compliance is the most important area of concern in this age group.

Lap to lap position (toddlers)

Assisting from behind (preschoolers)

Dentrifices
Dentifrices- A dentifrice is a substance used with a toothbrush for the purpose of cleaning the accessible surfaces of the teeth.

composition
AGENTS 1) Polishing/ Abrasive Agents 2) Detergents/ surfactants 3) Binding/ Thickening Agents MATERIAL USED Calcium carbonate Alumina silicas Sodium lauryl sulfate FUNTIONS These agents have a mild abrasive action which aids in eliminating plaque and removing stains from the tooth surface. Produces the foam which aids in removal of food debris & also dispersion of the product within the mouth. They control stability and consistency of a toothpaste.

Water soluble agents: Alginates Cellulose Water insoluble: Colloidal silica Sorbitol Glycerin Peppermint oil Spearmint oil Oil of wintergreen

4) Humectants

Aids in reducing the loss of moisture from the toothpaste. They render the product pleasant to use and leaves a fresh taste in the mouth after use.

5) Flavoring Agent

Contd..
AGENTS MATERIAL USED FUNTIONS

6) Sweeteners and Coloring agents 7) Antibacterial Agents

Saccharin

Sweetener

Triclosan,Delmopinol,Metallic ions, Zinc citrate trihydrate.

8) Anticaries Agents

Sodium monofluoro phosphate Sodium fluoride Stannous fluoride

Pyrophosphates Zinc citrate Zinc chloride Sodium fluoride Potassium nitrate Strontium nitrate Inhibit the mineralization of the plaque. Crystal growth inhibitors.

9) Anticalculus Agents

10) Desensitizing Agents

Recommendations for use of fluoridated dentifrices in childrens

AGE 6 mon 3 yrs 3 -7 yrs TYPE OF DENTIFRICES Non fluoridated Non fluoridated Fluoridated FREQUENCY OF BRUSHING Twice daily in the morning or at night Once daily in morning Once daily at night

> 7 yrs

Fluoridated

Twice daily

Children tend to use larger amounts of dentifrice Brush for longer time Rinse and expectorate less

Increase in systemic fluoride concentration

Increase in risk of dental fluorosis

3) Electronic/Powered toothbrush
Indications Patients who lack the manual dexterity or have any disability that limits their ability to brush. Orthodontic patient or those with implants as these toothbrushes may reach crevices which cant be otherwise clean. According to Ho and Niederman, sonicare brushes are more effective in reducing the plaque index,gingival index,percentage of sites that bleed on probing,pocket depth & total gram negative bacteria in subgingival plaque sample.
According to ADA under unsupervised conditions an average layperson shows 15% more reduction in gingivitis and plaque over manual toothbrushes.

ELECTRIC TOOTHBRUSH

SONICARE TOOTHBRUSH

4) Dental floss
It is either a bundle of thin nylon filaments or a plastic(teflon or polyethylene) ribbon used to remove food and dental plaque from interproximal areas of the teeth. Types- Twisted or nontwisted Bonded or nonbonded Waxed or unwaxed Thick or thin

Functions of dental floss

1) Removal of adherent plaque & food debris from the interproximal embrassure & under the pontics of FPD. 2) Polishing of tooth surface during removal of the plaque & debris. 3) Stimulating & massaging the interdental papillae. 4) Helps in locating: (a) subgingival calculus deposits (b) overhanging margins of restorations (c) proximal carious lesions 5) Vehicle for application of polishing or therapeutic agents to interproximal & subgingival areas.

Tehniques of using dental floss

1) Spool method 2) Circle or loop method

Spool method
About 12-18 inches long floss is taken and from is end it is wound around the middle finger of each hand. In both the hands the last three fingers are folded & closed & both the hands are moved apart. In this way about 1-2 inches of floss is held tightly between the tips of thumbs of both the hands.

Circle/loop method
A loop or circle of floss is made from 12-18 inches long piece & both the ends are tied securely with the three knots. All fingers except the thumbs of both the hands are within the loop & floss is held tightly by both the hands having about 1-2 inches of floss between tip of thumbs of both the hands.

FLOSSING TECHNIQUE

FLOSS HOLDERS

5) Disclosing agents
Plaque disclosing agents are dye based products which increases the visualization of plaque by patients and thereby acts as educational and motivational tool to improve the efficiency of plaque control procedures. Most commonly used iodine erythrosine gentian violet basic fuschin fast green fluorescien two tone dye

Disclosing agents are available as:

1) Concentrated solutions which is applied on teeth by cotton swabs. 2) Diluted solutions used as rinses. 3) As wafers which can be crushed between teeth and swished in the oral cavity for a few seconds and then spitted out.

6)Tongue scrapers
Tongue scrapers are available as flat,flexible plastic or metal sticks which helps in cleaning the dorsal surface of the tongue . Additional gauge piece can be used as tongue scrapers. Tongue cleaning is routinely recommended for all the patient.

TONGUE SCRAPERS

7) Oral irrigators
These are devices which use pulses of water or chemotherapeutic agents used to dislodge plaque particularly from interdental areas.

Chemotherapeutic aids
1) Antiseptic mouthwashes

A) positively charge organic molecules:

a) quaternary ammonium compounds-cetylpyridinium chloride b) pyprimidines- hexidine c) Bis-biguanides- chlorhexidine, alexidine

B) noncharged phenolic agents:

listerine,triclosan,phenol and thymol

C) oxgenating agents: peroxides and perborate D) bispyridines: octenidine

E) halogens: iodine, iodophors and fluorides F) heavy metal salts: silver,mercury,zinc,copper & tin.

 Chlorhexidine-positively charged organic antiseptic. -reduces plaque and gingivitis -strong substantivity -binds well to many sites in oral cavity &
maintains ongoing antibacterial action.

-binds with anionic glycoproteins and

phosphoproteins on buccal,palatal & labial mucosa & tooth-borne pellicle.

-its antibacterial action is because of:

a) binds well to bacterial cell membranes b) increases their permeability c) initiates leakage d) precipitates intracellular components

-given in concentration of 0.12% or o.2%

Listerine-noncharged phenolic agent -reduces plaque and gingivitis -gives burning sensation -has bitter taste -has highest alcohol contents of all
mouthwash,approximately 25% -alcohol intoxication is more relevant to pediatric dentistry -alcohol containing mouthwashes causes oral carcinomas

2) antibiotics
Penicillin G administered parentally or orally are currently the antibiotic of choice for treatment of dental infections of usual etiology. Erythromycin is second-choice bacteriostatic antibiotic for patients allergic to penicillin. Cephalosporins- similar in action to penicillin & is used in patients with delayed-type allergic reactions to penicillin & when erythromycin connot be given.

Enzymes,plaque-modifying and plaque attachment interference agents.

The use of urea peroxide as a plaque-modifying agent is because of its increased stability over hydrogen peroxide and protein denaturation effect of urea. Delmopinol derived from orpholinoethanol exerts its affects by binding to salivary proteins and altering the cohesiveness and adhesiveness properties of the film formed.

Sugar substitutes
Sugar subtitutes used are xylitol,mannitol,sucralose and aspartame. They reduces the plaque PH. There intrinsic antiplaque activity is much lower than that of other plaque control agents. These agents have been sugested for use in chewing gum to decrease plaque accumulation and PH.

DIET COUNSELLING
Diet counseling =professional advice concerning the food
that you eat and drink daily.

Cariogenecity of diet
1. Nature of diet 2. Retention and oral clearance time of dietary components 3. Intake frequency 4. Chemical composition 5. Protective components in the diet

1.Nature of diet

Physical nature of food

Refined

Unrefined

2.Retention and oral clearance time

Sugars stick to the surface of teeth.

Food rapid clearance e.g juices, cold drinks slow clearance e.g chocolate

3.frequent snacking
Increases duration of time for which plaque pH remains below 5.2 5.5

4.Chemical composition
Carbohydrates

Monosaccharide

Disaccharides

polysaccharide

sucrose (easily fermentable)

increased destruction of tooth

5.Protective food components

1. Reducing the rate of dissolution of hydroxyapatite 2. Reducing the fall in plaque pH by buffering acids produced by fermentation 3. Enhancing remineralization 4. Modifying formation and composition of pellicle and plaque

Protective foods
Foods that require vigorous chewing such as raw fruit and vegetables, stimulate the flow of saliva and reduce the risk of dental disease. Saliva dilutes the acids formed by the interaction of bacteria and sugar. These acids cause tooth decay, so diluting them helps to prevent decay. Sugarless chewing gum stimulates saliva flow, and also helps to remove plaque by its physical contact with the tooth surface. Chewing gum containing sugar is no help at all, but simply adds to the problem of excessive sugar in the diet. Eating cheese after a meal can reduce the effect of the acid in the mouth.

Protective foods act by

1.Replacement of carbohydrates. 2.Formation of a protective barrier on enamel. 3.Certain fatty acids have an antimicrobial effect and thus they inhibit glycolysis in human dental plaque.

REFERENCES
TEXTBOOK OF PEDODONTICS-McDONALD TEXTBOOK OF PEDODONTICS-SHOBA TANDON TEXTBOOK OF PEDIATRIC DENTISTRY-S.G.DAMLE TEXTBOOK OF COMMUNITY DENTISTRY-SOBEN PETER GOOGLE SEARCH