16. The individual methods of periodontal diseases prevention. The role of hygiene to equipment in periodontal diseases prevention. The periodontal office (branch), its equipment and necessary medicines.
Periodontal Diseases and Their Prevention
Periodontal diseases are infections of the gums, which gradually destroy the support of your natural teeth. There are numerous disease entities requiring different treatment approaches. Dental plaque (bacteria and their byproducts/toxins) is the primary cause of gum disease in genetically susceptible individuals. Daily brushing and flossing will prevent most periodontal conditions.
Why is oral hygiene so important? Adults past the age of 35 lose more teeth due to gum diseases, (Periodontal Disease) than from cavities. Three out of four adults are affected at some time in their life. The best way to prevent cavities and Periodontal Diseases is when good tooth brushing and flossing techniques are performed daily.
Periodontal Disease and Decay are both caused by Bacterial Plaque. Plaque is a colorless film, which sticks to your teeth at the gumline. Plaque consists of germs on your teeth. By thorough daily brushing and flossing you can remove these germs and help prevent Periodontal Disease.
Periodontal disease can be prevented with:
• Daily meticulous removal of plaque by toothbrushing
• Regular visits to the dentist/hygienist (once a year)
Avoidance of behavioural and environmental risk factors(e.g., smoking, stress, poor diet).
Aids to Plaque Removal
Plaque removal can be aided with the use of:
Plaque disclosing agents
Dental floss and other interdental cleaning aids
Mouthrinses.
Plaque disclosing agents colour plaque to make it easily visible and are a useful aid for improving plaque control. Plaque disclosing agents should be used after brushing the teeth, to reveal areas where plaque still remains. Plaque disclosing agents will not in themselves remove plaque, but simply direct users to areas that they have missed with their toothbrush. Dental floss and other interdental cleaning aids are of value if used correctly, which usually requires professional advice and instruction. An additional method of plaque control is the use of antiseptics, of which chlorhexidine is the most effective. Although chlorhexidine is available over the counter in Ireland in the form of mouthrinses and gels, its tendency to stain teeth and impair taste makes its long-term use generally unacceptable. Toothpastes and mouthrinses containing other antiseptic agents, while less effective than chlorhexidine, do not have these side effects and are of some value to gingival health.
Recommended Toothbrushing Technique
While brushing the outside surfaces of your teeth, position the brush at a 45-degree angle where your gums and teeth meet. Gently move the brush in a circular motion several times using small, gentle strokes. Use light pressure while putting the bristles between the teeth, but not so much pressure that you feel any discomfort.
When you are done cleaning the outside surfaces of all your teeth, follow the same directions while cleaning the inside of the back teeth.
To clean the inside surfaces of the upper and lower front teeth, hold the brush vertically. Make several gentle back-and-forth strokes over each tooth. Don’t forget to gently brush the surrounding gum tissue.
Next you will clean the biting surfaces of your teeth. To do this use short, gentle strokes. Change the position of the brush as often as necessary to reach and clean all surfaces. Try to watch yourself in the mirror to make sure you clean each surface. After you are done, rinse vigorously to remove any plaque you might have loosened while brushing A gentle scrub technique with very short horizontal movements to dislodge plaque at the gum margins is effective for most people and is easy to teach and readily accepted. Thus, careful use of a gentle scrub method using a toothbrush with densely packed, round-ended synthetic filaments of soft to medium texture should be encouraged for effective plaque removal. A toothbrush with a small brush head may also be recommended, as a small brush head enables better access to the back of the mouth and to tooth surfaces than a large brush head. While a variety of powered toothbrushes have become increasingly available, only powered toothbrushes with a rotation oscillation action (i.e., brush head moves in one direction and then the other) have been found to be better than manual toothbrushes at removing plaque and reducing gum inflammation, and are no more likely to cause injuries to gums.
Faulty toothbrushing techniques involving excessive pressure may considerably increase gingival recession (i.e., the gum line recedes leading to exposure of the roots of the teeth), and loss of tooth substance by mechanical abrasion, and must therefore be corrected. Holding the toothbrush in a pen grip using just the thumb and forefinger, as opposed to resting the toothbrush in the palm of the hand and gripping with four fingers, results in less pressure being applied when toothbrushing and is recommended.
Many different types of toothbrushing methods are developed.The best methods are effective in removing plaque biofilm and debris, stimulate gingiva, and are able to deliver fluoridated dentrifice to the tooth surface . For adequacy in cleaning, 10 strokes are adviced for each area.
There are 6 tooth brushing methods :
(1) BASS METHOD
Importance
1) Most effective in cleaning cervical 1/3 & beneath gingival margins
2) Suitable for everyone – Periodontally healthy & periodontally disease
3) Periodontal maintenance
4) Cleanses sulcus (space between tooth and gums)
Direct bristles apically to sulcus at 45° to the long axis of the tooth. Use gentle force to insert bristles into sulcus.
Apply firm but gentle 10 back-and-forth strokes of vibratory motion without removing bristle ends from sulcus. Move brush head to the next group of teeth by overlapping with the completed area.
On the lingual surfaces of front teeth, brush is placed vertically and apply gentle vibratory motion of up-and-down strokes.
On the chewing surface apply a motion of back-and-forth brushing strokes.
(2) STILLMAN’S METHOD
Importance
1) Provides gingival stimulation (vibratory motion)
2) Suitable for gingival recession (Toothbrush bristle ends not directed into sulcus)
3) Less traumatic to the gingiva
4) Who should use this?
People with continuous gingival recession
Direct bristles apically to sulcus at 45° to the long axis of the tooth . Place bristles partly on the cervical part and on the gingiva. Apply vibratory motion with slight pressure to stimulate gingiva.
Repeat for the lingual surface of the tooth
Use short back-and-forth strokes on the occlusal surfaces gently. Place toothbrush perpendicular to the tooth surface.
(3) CHARTER’S METHOD
Importance
1) Efficiently cleans interproximal areas
2) Able to clean areas between fixed appliances (prosthetic and orthodontic) and gingival margins
3) Who should use this? People with orthodontic and fixed prosthetic appliances People who have just undergone periodontal surgery (temporary cleaning of surgical wounds)
Place bristles horizontally and parallel to the arch at 45°at the gingival margin. Direct bristles toward the crown of the tooth rather than the root.
Bristles are directed occlusally and vibrate into the interdental spaces. Use short back-and-forth strokes for activation. Repeat for other parts of the mouth until all areas are cleaned.
(4) MODIFIED BASS, CHARTER’S AND STILLMAN’S METHOD
Importance 1) Clean entire facial/buccal and lingual surfaces
A Bass or Stillman’s or Charter’s–Complete the original stroke to clean the cervical one-third
Roll toothbrush bristles to clean entire facial and lingual surfaces
(5) HORIZONTAL SCRUB
Importance
1) Most common method but has no benefits because it causes gingival recession
Move bristles horizontally using gentle scrubbing motions
(6) FONES’ (CIRCULAR)
Importance
1) An easy-to-learn first technique for young children
Teeth are held in occlusion.
Bristles are activated in a circular motion.
Recommended Flossing Technique
Starting with clean hands, break off about 45 cm (18 inches) of dental floss from its dispenser. Wind one end of the floss around a middle finger of one hand. Wrap the other end and most of the floss on the same finger of the other hand, leaving a small length (7 to 10 cm / 3 to 4 inches) stretching between the hands. With the floss held tightly between thumb and forefinger or using your interdental flosser, use a gentle sawing motion to guide the floss between adjacent teeth. Take care not to snap the floss against the gums when doing this to avoid injury.
When the floss reaches the gum line, curve it into a C shape against one tooth and gently slide it into the space between the gum and the tooth. With the floss kept tight against the side of the tooth, gently move the floss away from the gum with up and down motions. Repeat this scrubbing action to clean plaque off the adjacent tooth. If preferred, interdental flossers such as shown in the image may also be used. Move the floss back out from between the flossed teeth and repeat this procedure till all teeth have been cleaned. As the floss gets frayed or dirty, unwind unused floss from one hand and take up the used slack on the other hand. Wash hands again after flossing.
Choosing Oral Hygiene Products
There are so many products on the market it can become confusing and choosing between all the products can be difficult. Here are some suggestions for choosing dental care products that will work for most patients.
Automatic and “high-tech” electronic toothbrushes are safe and effective for the majority of the patients. Oral irrigators (water spraying devices) will rinse your mouth thoroughly, but will not remove plaque. You need to brush and floss in conjunction with the irrigator. We see excellent results with electric toothbrushes. Some toothbrushes have a rubber tip on the handle; this is used to massage the gums after brushing. There are also tiny brushes (interproximal toothbrushes) that clean between your teeth. If these are used improperly you could injure the gums, so discuss proper use with your doctor.
If used in conjunction with brushing and flossing, fluoride toothpastes and mouth rinses can reduce tooth decay as much as 40 percent. Remember, these rinses are not recommended for children under six years of age. Tartar control toothpastes will reduce tartar above the gum line, but gum disease starts below the gum line so these products have not been proven to reduce the early stage of gum disease. Anti-plaque rinses, approved by the American Dental Association, contain agents that may help bring early gum disease under control. Use these in conjunction with brushing and flossing.
