Prof. d-r R.Kabaktchieva -2014

1. Prof. d-r R.Kabaktchieva -2014 Oral hygiene – aim and theoretical base. Methods and instruments for assessment – oral –hygiene indeces. Individual and professional oral hygiene – methods and devices. Motivation programmes

2. Soft, microbialdentalplaquecontinuallyformsonthetoothsurfaces, istheprimaryagentinthedevelopmentofdentalcariesandperiodontaldiseases. Ifplaquebiofilmiscompletelyremovedwithself-careprocedures, dentalcariesandperiodontaldiseasescanbeprevented.

3. Plaquedepositscanberemovedeithermechanicallyorchemically. Thefocusofthislecturisthemechanicalremovalofplaque, usingtoothbrushesandtoothbrushingtechniques.

4. TheHistoryoftheToothbrush • Sinceancienttimes, individualshavechewedtwigsfromplantswithhigharomaticproperties. • InArabiccountriesindividualsused a pieceoftherootofthearaktree - therootfibersstoodoutlikebristles; thefiberscontainedantibacterialoilsandtannins. • (618-907 A.D.) theChineseinvented a toothbrushwith a handleandbristles. Theyusedhogbristles • In 1780 inEngland, WilliamAddismanufactured "thefirstmoderntoothbrush.“Thisbrushhad a bonehandleandholesforplacementofnaturalhogbristles.

5. Intheearly 1900s, celluloidbeganreplacingthebonehandle. • Nylonbristleswereintroduced; • Nylonbristlesdidnothavethehollowstemofnaturalbristles; therefore, theydidnotallowwaterabsorption. • Otheradvantagesofnylonbristles, weretheabilitytoformthebristlesinvariousdiametersandshapes, andtoroundthebristleendstobegentlerongingivaltissues.

6. In 1916, Dr. Alfred C. Fones, founderofdentalhygiene, wrote a textbook, MouthHygiene,whichspecificallydirecteddentalhygieniststoteachspecifictoothbrushingmethodstoschoolchildren. • In 1919, theAmericanAcademyofPeriodontologydevelopedguidelinesforbothtoothbrushdesignandbrushingtechniques.

7. FonesSchoolofDentalHygiene - instructorsandstudentsduring a toothbrushdrill, circaearly1900.

8. In 1939, thefirstpowertoothbrushwasdevelopedinSwitzerlandandwasintroducedintheUnitedStatesinthe 1960. • Inthe 1980s, poweredtoothbrusheswererevitalizedwiththeintroductionoftheInterPlak. • Comparedwithmanualtoothbrushes, poweredtoothbrusheshaveshownanincreasedefficacy (abilitytoproduce a desiredeffect);

9. Sonic-poweredtoothbrusheshavebeendeveloped; • Theyremovemoreplaquecomparedwithmanualtoothbrushes. • Mostrecently, battery-powered, disposabletoothbrusheshavebeenintroduced.

10. A toothbrushistheprimaryinstrumentusedfororalhygienecare. • Therearemanydifferenttypesoftoothbrushes. • Therearemanualandpowertoothbrushes, witheachhavingvariousdesignsofthehandle, head, andbristles. • Thesevariationsallhaveuniquebenefits.

11. ManualToothbrushDesigns • Manualtoothbrushesvaryinsize, shape, texture, anddesign Fig. Lateralprofilesofselectedtoothbrushes

12. A manualtoothbrushconsistsof a headwithbristlesanda handle. • Тhebristlesarebunchedtogether, and formtufts. • Theheadisdividedintothetoe, and theheel. Fig. Partsof a toothbrush.

13. Theshankoccursbetweenthehandleandthehead. • Toothbrushesaremanufacturedindifferentsizes: large, medium, andsmall

14. Toothbrushes are differintheirhardnessortexturebeingclassifiedas: hard, medium, soft, orextrasoft. • Extrasoftandsofttoothbrushbristles arepreferred, becausehardbristlesdamageteethbycausingabrasionofthetoothsurface.

15. Figure.Cross-sectionalprofileof toothbrushes: Figure.Overheadappearanceoftoothbrushes,  

16. ToothbrushProfiles • Viewedfromtheside, toothbrusheshavefourbasiclateralprofiles: concave, convex, flat, multileveledrippledorscalloped.

17. Theconcaveshape, withshorterbristlesinthemiddleofthehead, maybemostusefulforincreasedcleaningoffacialtoothsurfaces. • Convexshapes, withlongerbristlesinthemiddleofthehead, appearmoreusefulforimprovedcleaningoflingualsurfaces. • Toothbrusheswithmultilevelprofileswereconsistentlymoreeffective,especiallywheninterproximalefficacywasevaluated.

18. NylonVersusNaturalBristles • Thenylonbristleissuperiortothenaturalhogbristle: • Nylonbristlesflexmorethannaturalbristlesbeforebreaking; • Nylonbristlesdonotsplitorabradeandareeasiertoclean. • Theshapeandstiffnessofnylonbristlescanbestandardized.

19. BristleShape • Nylonbristlescanbemanufacturedinvariousdimensions. • A thinnerdiameterfilamentallowsthebristletobesofterandmoreresilient. • Angledfilamentsremovedirectpressurefromthetoothandgingiva, andthereforeappeartobemoreflexible. • Еnd-roundedtipsarerecommendedforthesafetyofhardandsoftoraltissues.

20. Fig.Endroundingoftoothbrushbristle.

21. ManualToothbrushingMethods Thepurposesoftoothbrushinginclude: • (1) removalofplaquebiofilmanddisturbanceofits re-formation; • (2) removaloffood, debris, andstainfromtheoral cavity; • (3) stimulationofthegingivaltissues; • (4) applicationof a dentifricecontainingspecific ingredientstoaddresscaries, periodontaldisease, orsensitivity.

22. Theseveraldifferenttoothbrushingmethodsremoveplaquemostefficiently,Theseveraldifferenttoothbrushingmethodsremoveplaquemostefficiently, • Anymethodthatistaughtshouldnotdamagehardorsofttissues, orcauseexcessivetoothwear.

23. Themostnaturalbrushingmethods: • horizontalscrubtechnique; • rotarymotionsuchastheFonestechnique; • simpleup-and-downmotionoverthemaxillaryandmandibularteeth, ( theLeonardtechnique.)

24. Тhesetechniquescan clean: • thefacial, • the lingual, • theocclusalsurfacesoftheteeth; • allareineffectiveincleaninginterproximalareas. • theBasstechniqueiseffectiveincleaningthesulcus.

25. BassMethod • TheBassmethodisacceptableforallpatients. • Thismethodiseffectiveatremovingplaqueatthegingivalmarginanddirectlybelowit.

26. Fig.Basstechnique. Thetoothbrushbristlesareangledapicallyat a 45-degreeangletothelongaxisofthetooth. Thefilamentsarethengentlyplacedsubgingivallyintothesulcus. Withverylightpressure, thebrushismoved withveryshorthorizontalstrokes, whilekeepingthebristlesinthesulcus. Afterseveralvibrations, thebristlesareremovedfromthesulcus, andthebrushisrepositionedonthenext 2 or 3 teeth.

28. RollingMethod • Therollingtechniqueismostappropriateforchildren. • Thebristlesarepositionedapicallyalongthelongaxisofthetooth. • Theedgeofthebrushheadshouldbetouchingthefacialorlingualaspectofthetooth. • Thenwithlightpressurethebristlesarerolledagainstthetoothfromtheapicalpositiontowardtheocclusalplane. • Thismotionisrepeatedseveraltimes; thenthebrushisrepositionedonthenextteeth, withbristlesoverlaping a portionoftheteethpreviouslycleaned. • Theheelortoeofthebrushisusedonthelingualaspectoftheanteriorteeth

29. Fig.Rollingstroketoothbrushingtechnique

30. StillmanMethod • TheStillmanmethodwasoriginatedtomassageandstimulatethegingivawhilecleansingthecervicalareas. • Thebristlesarepositionedapicallyalongthelongaxisofthetooth. • Theedgeofthebrushheadshouldbetouchingthefacialorlingualaspectofthetooth. • Thenthebrushisslightlyrotatedat a 45-degreeangleandvibratedoverthecrown .

31. Fig.Stillmantoothbrushingtechnique seen diagrammatically .

32. ChartersMethod • TheCharterstechniqueiseffectiveforcleaningarounddevicesusedtocorrectimpropercontactofopposingteeth (orthodonticappliances), andplaqueunderabutmentteethof a fixedbridge. • Thebristlesareplacedat a 45-degreeangletowardtheocclusalorincisalsurfaceofthetooth. • Thebristlesshouldtouchatthejunctionofthefreegingivalmarginandtooth. • A circularvibratorymotionisthenactivated.

33. Fig.Charters toothbrushingtechnique.

34. FonesMethod • TheFonesmethodis a easytechniqueforyoungchildrentolearn. • Theteethareclenched, andthebrushisplacedinsidethecheeks. • Thebrushismovedin a circularmotionoverbothmaxillaryandmanibularteeth. • Intheanteriorregion, theteethareplacedinanedge-to-edgepositionandthecircularmotioniscontinued. • Onthelingualaspect, anin-and-outstrokeisusedagainstallsurfaces. • Thistechniquecanbedamagingifdonetoovigorously

35. Fig.Fonestoothbrushingtechnique: Circulatorymotionextendingfrom maxillarytomandibularteeth.

36. LeonardMethod • Тhetoothbrushisplacedat a 90-degreeangletothelongaxisofthetooth. • Theteethareheldinanedge-to-edgeposition. • Next, thetoothbrushismovedin a vertical, vigorousmotionupanddowntheteeth. • Themaxillaryandmandibularteetharebrushedseparately .

37. Fig.Leonardtoothbrushing technique

38. HorizontalMethod • Inthehorizontaltechnique, theteethareplacededgetoedge, whilethebrushmaintains a 90-degreeangletothelongaxisofthetooth. • Thebrushisthenmovedin a horizontalstroke. • Thistechniqueisknowntocauseexcessivetoothbrushabrasion

39. Fig. Horizontaltoothbrushingtechnique.

40. SmithMethod • TheSmithmethodis a physiologictechnique, whichfollowsthepatternthatfoodfollowswhenitisinthemouthduringmastication. • Thebristlesarepositioneddirectlyontotheocclusalsurface. • Thebrushisthenmovedbackandforthwiththebristlesreachingfromtheocclusalsurfacetothegingiva. • Smithalsorecommends a fewgentlehorizontalstrokestocleanthesulcusareasnearfurcations .

41. Fig.Smithtoothbrushingtechnique.

42. ScrubToothbrushingMethod • Thescrubtoothbrushingtechniqueis a combinationofhorizontal, vertical, andcircularstrokes. • Italsoincorporatesvibrationmovementsincertainareas.

43. Fig. Scrubtoothbrushingtechnique.

44. ModifiedBrushingMethods • Inattemptstoenhancebrushingoftheentirefacialandlingualtoothsurfaces, theoriginaltechniqueshavebeenmodified. • Themodifiedbrushingtechniqueintegratesa rollingstrokeafteruseofthevibratorymotion. • Thepositionofthebrushismaintainedafterthecompletionoftheoriginalmethod'sstroke. • Thebristlesarethenrolledcoronallyoverthegingivaandteeth. • Duringthisrollingmotion, careshouldbetakenthatsomeofthefilamentsreachtheinterdentalareas.

46. PoweredToothbrushes • Poweredtoothbrusheswerefirstadvertisedin 1886. • Broxadentwasintroducedinthe 1960.

47. designofthepowertoothbrush Fig.Selectedpowertoothbrushes, fromlefttoright: CrestSpinBrush; Oral-B SonicComplete; SonicareElite.]

48. Thepowertoothbrushescanbecategorizedas: • mechanical, • sonic, • ionic.

49. A mechanicalbrushusesthemotionofthebristlestoremovetheplaqueanddebris. • Thesonictoothbrushemitssoundwavesinadditiontothemovementofthefilaments. • Theionictoothbrushestemporarilyreversethenegativeionicchargeof a toothto a positivecharge. A portionofthetoothbrush, thatispositivelycharged, attractstheplaqueandfoodparticlesawayfromthetooth.

50. Themainmovementsinthepowertoothbrushesareoscillation, reciprocation, androtational. • Theoscillationmovementtakesthebristlesin a consistentback-and-forthmovement. • The reciprocationmovesthebristlesupanddownorbackandforth. • The rotationalmovementsarecircular.