Patient Education

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Educating dental patients on the importance of healthy teeth.

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Help Patients to Understand the Importance of Teeth :

Power point presentation by Nicole Costello Help Patients to Understand the Importance of Teeth

DENTAL BIOFILM :

DENTAL BIOFILM Commonly referred to as dental plaque that consist of microorganisms and bacterial substances found on teeth . Present by dentalcare.com (Wilkins, 2009, p. 68)

CALCULUS:

CALCULUS Also known as tartar which is a harden biofilm like that attaches to the tooth surface. Can not be remove with a toothbrush. Present by dental.com Bird & Robinson, 2009

Caries are cavities or decayed teeth:

Development of Dental Caries start with cariogenic foods. Cariogenic means producing or promoting tooth decay. Caries are cavities or decayed teeth

Teeth with caries:

Teeth with caries Present by dentalcare.com

The path that leads to dental caries :

Cariogenic Food chemical reaction takes place with the biofilm. Dental Biofilm Rapid action pH of biofilm drops. Acid Formation Acid is sitting on the tooth surface Demineralization Tooth starts to break down and tooth will form white spots. Dental Caries The path that leads to dental caries (Wilkins, 2009 )

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Acid formation begins immediately when cariogenic substance is taken into the biofilm. For the next 20 minutes the teeth will have acid attack and the pH in saliva will be lower. (Wilkins, 2009)

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Acid left undisturbed will be cleared from mouth from 40 minutes to up to 2 hours, depending primarily on salivary flow. Frequency intake of snack or drink cariogenic substance the acid will continue to form on the teeth. (Wilkins, 2009)

Critical pH of Biofilm Before Eating:

Critical pH of Biofilm Before Eating A normal pH level in a healthy mouth before eating ranges from 6.2 to 7.0 A abnormal pH level to a person who is susceptible to caries will have a lower pH (Wilkins, 2009)

Critical pH of Biofilm after Eating:

Critical pH of Biofilm after Eating Average critical pH for enamel 4.5 to 5.5 On root surface critical pH is 6.0 to 6.7 Demineralization will start when pH level is below normal. (Wilkins, 2009)

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The more carbohydrates eaten the more regular acid attack will occur on the teeth surfaces. This will occur every time there is a carbohydrate intake.

Gingivitis is inflammation found only in the gums and it is easy to treat!:

Gingivitis is inflammation found only in the gums and it is easy to treat! Red and inflamed gingiva Bleeds easily P ainless Gingivitis will turn into periodontitis if the brushing method and flossing technique are not changed. Present by dentalcare.com (Bird & Robinson, 2009 )

PERIODONTITIS:

Is inflammation of the bone of the teeth. This disease is difficult to control and to correct damage done will need a surgical intervention. A person can stop/slow the progression of the disease. PERIODONTITIS (Bird & Robinson, 2009)

Dental biofilm is the primary cause in the development of gingivitis and periodontitis.:

Dental biofilm is the primary cause in the development of gingivitis and periodontitis. Present by dentalcare.com (Wilkins, 2009)

Others contributing :

Others contributing Dental Factors Gingivia Factors Tooth surface irregularities Tooth contour Tooth position Dental appliances Deviations from normal gingiva Different size and contour Effect of mouth breathing (Wilkins, 2009)

RISKS FACTORS FOR PERIODONTAL DISEASE:

RISKS FACTORS FOR PERIODONTAL DISEASE Medications: can lead to enlarge gingiva and xerostomia (dry mouth). Tobacco: gingival recession, higher risk with oral cancer, lesions and bone loss. Diabetes: increased susceptibility to infections. Osteoporosis: bones become very porous, break easily, and heal slowly. Psychosocial: stress and high levels of social strain. (Wilkins, 2009)

Manual TOOTHBRUSHES:

Manual TOOTHBRUSHES Conforms to individual person needs in size, shape and texture. Easily and efficiently manipulated. Readily cleaned and expose to air; resistant to moisture. Durable and inexpensive. Prime functional properties of flexibility softness and diameter of bristles or filaments and of strength, rigidity and lightness of the handle End-round bristles Designed for utility, efficiency and cleanliness (Wilkins, 2009)

Guidelines for manual tooth brushing:

Guidelines for manual tooth brushing Use light, comfortable grasp and effective position each stroke and follow through to complete stroke. Sequence to ensure complete coverage for each tooth surface Amount of brushing is to remove the dental biofilm from all the surfaces Two brushings is the minimum for each day (Wilkins, 2009)

The Bass Method:

The Bass Method Starting with the back teeth, place the toothbrush on the tooth surface and then direct the bristles at 45-degree to the long axis of the teeth and the bristles tip should contact the gingival margin. (Wilkins, 2009)

Continue on The Bass Method:

Continue on The Bass Method Press the bristles lightly without bending them, so that they reach the gingival sulcus underneath the gingival margin, and even cover a part of gingiva near the margin. Now vibrate the toothbrush with short back and forth motions, keeping in mind that the bristles should not be dislodged and count to ten while in motion. Now repeat the same process for the other teeth. (Wilkins, 2009)

General Purposes of the Powered Toothbrush:

General Purposes of the Powered Toothbrush Reduce calculus and stain To help removal of biofilm and food debris Recommended for physically able with ineffective manual techniques Power brushes move in speeds and motions that cannot be duplicated by manual brushes (Wilkins, 2009)

Indications Who May Need a Powered Toothbrush:

Indications Who May Need a Powered Toothbrush Those with failed traditional methods Orthodontic patients Restorative and prosthodontic treatment Dental implants Aggressive brushers Patients with disabilities/limited dexterity Patients unable to brush (Wilkins, 2009)

Description of Powered Toothbrushes:

Description of Powered Toothbrushes Motion Speeds Rotational Counter-rotational Oscillating Pulsating Cradle or Twist Side-to-Side Translating Combination Vary low to high Replaceable battery slower than rechargeable power brushes Movement varies from 3,800 to 40,00 movements per minute (Wilkins,2009)

Description continued:

Description continued Brush head design Filaments or Bristles Adult Child Interdental Soft end-rounded nylon Diameters extra-soft to soft Some children’s power brush heads have extra softness (Wilkins,2009)

Power source:

Power source Cord directed to outlet Replaceable batteries Rechargeable Disposable (Wilkins, 2009)

Procedure:

Procedure Select brush with soft end-rounded bristles Use toothpaste with minimum abrasives Place small amount of toothpaste on brush and spread over teeth Turn on brush in mouth to prevent splashing Vary the brush position for each tooth surface Angulated for access to surfaces of rotated, crowd, displaced teeth Use light steady pressure Floss (Wilkins, 2009 )

Supplemental Brushing:

Supplemental Brushing Problem Areas Occlusal Brushing Adaptations Each tooth is brushed Areas for special attention Abrasion on canines and premolars Expose roots Brush vertical overlap teeth Back teeth Loosen and remove biofilm Place brush on occlusal surfaces of molar teeth Use short overlapping vibrating strokes in a slight circular movement or force the bristles against the occlusal surface with sharp, quick strokes Clean pits and fissures for sealants (Wilkins, 2009)

Continue Supplemental Brushing:

Continue Supplemental Brushing Tongue Cleaning Alternative Biofilm Removal Reduces the number of microorganisms Reduces potential for bad breath Contributes to overall cleanliness Use with the toothbrush or a tongue scraper Tooth wipes (Wilkins,2009)

Caring for Toothbrushes:

Caring for Toothbrushes Two toothbrushes at home and one for traveling Replace every 2-3 months Avoid contamination Rinse and tap out excess water after each use Storage head upright in open air (Wilkins 2009)

TOOTHPASTES (dentifrices):

TOOTHPASTES (dentifrices) Forming agents Cleans and Polish Thickeners/stabilize formation Humectants/ retain moisture Purpose to prevent bacterial growth Pleasant flavor (Wilkins, 2009)

Therapeutic Benefits:

Therapeutic Benefits Reduction of : Biofilm Formation Gingivitis Sensitivity Calculus Prevention of : Dental Caries Fluoride: Remineralization Cosmetic: Removes stain Present by Stock Photos (Wilkins, 2009)

FLOSS:

FLOSS (Wilkins, 2009)

Features of Unwaxed Floss:

Features of Unwaxed Floss (Wilkins, 2009 )

Floss comes in::

Floss comes in : Different colors Variety of flavors Therapeutic agents Fluoride Whitening agents (Wilkins, 2009)

FLOSSING TECHNIQUE:

FLOSSING TECHNIQUE Floss once a day & before brushing teeth Middle finger wrap floss Hold with thumb and index finger Insert in diagonal position and seesawing motion Curve the floss around the tooth in a C shape Press the floss firmly against the tooth to remove biofilm; old biofilm may need more strokes Do not snap Use clean floss portion (Wilkins, 2009)

The COL is a depression in the gingival tissue where two teeth have contact:

The COL is a depression in the gingival tissue where two teeth have contact (Wilkins, 2009)

Precautions with Flossing:

Precautions with Flossing (Wilkins, 2009)

Tufted Dental Floss:

Tufted Dental Floss Floss/yarn combination Regular dental floss with alternated thickened tufted Use to remove biofilm from tooth surfaces adjacent to a wide embrasure Can be used under fixed partial denture, implants, orthodontic appliance Curve floss around the tooth or implant in a C to remove dental biofilm and move floss vertically and horizontally Thread floss over pontic and apply to back and front of abutment (Wilkins, 2009)

Interdental Tip:

Interdental Tip Pyramidal flexible rubber or plastic tip, on the end of a toothbrush handle Cleans debris from in between teeth Removes biofilm at and below the gingival margin Use by tracing along the gingival margin with the tip Rub tip against teeth Rinse the tip during use and wash at the end of the procedure (Wilkins, 2009 )

Gauze Strip:

Gauze Strip (Wilkins, 2009)

Wooden Interdental Cleaner Stim-U-Dent:

Wooden Interdental Cleaner Stim-U-Dent Two inches long, made of basswood or birch wood in a triangular in cross-section Used for: cleaning in between the surfaces of exposed teeth and where gingiva missing New one for each mouth quadrant Applying: use finger rest, soften wood with saliva Base of triangle toward the gingiva, move wedge in and out with 4 strokes Do Not use in tight spaces (Wilkins, 2009 )

MOUTHRINSES :

MOUTHRINSES Ingredients Therapeutic Agents Active ingredients Water Alcohol Flavoring Fluoride Chlorhexidine Triclosan Phenolic-related essential oils Quaternary ammonium compounds Oxygenating agents (Wilkins, 2009)

How to Rinse with Mouth Rinse:

How to Rinse with Mouth Rinse Take small amount of mouth rinse in mouth Close lips and hold teeth slightly apart Force mouth rinse by using pressure through interdental areas. Use lips, cheeks, and tongue action to force fluid back and forth between teeth Balloon the cheeks, then suck them in several times Divide mouth into 3 parts: front, right, and left Concentrate rinsing on front, then right, then left Expectorate Follow directions on the length and frequency (Wilkins, 2009)

Purpose and Uses of Mouth Rinse:

Purpose and Uses of Mouth Rinse Reduce: intraoral microorganisms & aerosol contamination Biofilm Control Prevention of Gingivitis Dental Caries Prevention Remineralization Part of Malodor Control Post Treatment Therapy (Wilkins, 2009)

FLUORIDES:

Nutrient essential to the formation of sound teeth and bones FLUORIDES (Wilkins, 2009)

Fluoride in Food :

Fluoride in Food Foods: Meat Eggs Vegetables Cereals Fruits Tea Fish Salt: Fluoridated Halo/Diffusion effect Foods and beverages commercially processed in fluoridated cities and distributed to nonfluoridated communities Bottle Water: check label (Wilkins, 2009)

Dietary Fluoride Supplements :

Dietary Fluoride Supplements Administration: Prescription Determine the need with patients history, fluoridated community and water analysis Available form: Tablets Lozenges Swish/ rinse Drop (Wilkins, 2009)

Profession Topical Fluoride:

Profession Topical Fluoride Compounds Techniques 2% sodium fluoride gel or foam 1.23% APT gel or foam 5% neutral sodium fluoride as a varnish Tray technique: gel or foam Paint-on technique: Varnish (Wilkins, 2009)

Tray Technique :

Tray Technique Indications Rampant caries Xerostomia Radiation therapy Root hypersensitivity Concentration Gel NaF 1.1% APF 1.1% Precautions Avoid large quantities Use neutral sodium on porcelain, composites, titanium & sealants avoid APT Patient instructions Use gel tray 1x/day before bed Give copy of instructions (Wilkins, 2009)

Fluoride Mouthrinse:

Fluoride Mouthrinse Indications General prevention Moderate to rampant caries risk Biofilm retentive appliances Xerostomia Hypersensitivity of exposed root surfaces Limitations Age/Inability to rinse Alcohol content Compliance Preparations Low-potency/High Frequency High-Potency/ Low Frequency ( Prescription) Benefits 26-29% average reduction (Wilkins, 2009)

Brush-on Gel:

Brush-on Gel Preparations 1.1% Sodium Fluoride or 1.1% Acidulated Sodium Fluoride Stannous Fluoride Procedure Brush/floss Use 1x/day at night Place 2mg of gel over brush head and spread over teeth Brush 1 minute then swish Do not rinse (Wilkins, 2009)

Fluoride Dentifrices:

Fluoride Dentifrices Development 1 st fluoride dentifrice to gain ADA, Council on Dental Therapeutics 0.4% stannous fluoride Indications Dental caries prevention All patients Preparations Current constituents Sodium fluoride Sodium monfluorophosphate Stannous fluoride Patient Instruction: Recommended Procedures Toddler1/2 of small pea size Older child: small pea size Adults: ½ inch or less Benefits 20-30% reduction when NaF or Na2PO3F (Wilkins, 2009)

Emergency Treatment:

Emergency Treatment Induce vomiting Second person: call 911 Administer fluoride binding liquid when not vomiting Milk Milk of magnesium Lime water Support respiration and circulation Additional therapy at emergency room (Wilkins, 2009)

Chronic toxicity:

Chronic toxicity Skeletal fluorosis – isolated instances of osteosclerosis from long term (20 or more years) use of water with high count of fluoride in water Dental fluorosis – naturally occurring excess fluoride in the drinking water during tooth development Mild fluorosis – mild form of dental fluorosis, teeth have white spots and the surface is dried Present by dentalcare.com (Wilkins, 2009)

References :

References   Beautiful Woman Smiles And Teeth. Over White Background Royalty Free Stock Photo, Pictures, Images And Stock Photography. Image 5813204. . (n.d.). Stock Photos and Royalty Free Image Subscription from 123RF Stock Photography . Retrieved April 6, 2012, from http://123rf.com/photo_5813204_beautiful-woman-smiles-and-teeth-over-white- background.html   Bird, D., Robinson, D., & Torres, H. O. (2009). Torres and Ehrlich Modern Dental Assisting (9th ed.). St. Louis, Mo. : Saunders Elsevier.   Dental Care Resources from Crest and Oral-B Professional | DentalCare.com. (n.d.). Dental Care Resources from Crest and Oral-B Professional | DentalCare.com . Retrieved March 27, 2012, from http://www.dentalcare.com   Pictures & Images: Picture of Dental Floss & Flossing Methods. (n.d.). Pictures & Images . Retrieved April 6, 2012, from http://xyzabc888.blogspot.com/2010/03/picture-of-dental-floss- flossing.html  Wilkins, E. M. (2009). Clinical practice of the dental hygienist (10th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.