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Oral Hygiene

Microbial plaque biofilm

 Microbial plaque biofilm control is an effective

way of treating and preventing gingivitis and is
an essential part of all procedures involved in
the treatment and prevention of periodontal
 Microbial biofilm growth occurs within hours
and it must be completely removed at least
once every 48 hrs to prevent microorganisms
accumulation and reduces calculus formation,
however it prevents inflammation.
 Plaque is the primary agent in the development of
caries, periodontal disease and calculus

 If plaque, particularly at interproximal and gingival

areas, is completely removed with home-care
procedures, these dental-disease conditions can be
 Regularly and
completely removing
the biofilm prevents or
arrests caries
 Plaque deposits can be
removed either
mechanically or
Correlation between Oral
Hygiene and Caries

 Dental plaque is a complex oral biofilm.

 Bacteria associated in biofilms are highly resistant to
antimicrobial substances, which limits the efficacy of
chemotherapeutic approaches to control dental plaque.
Correlation between Oral
Hygiene and Caries

 Even if good oral hygiene is performed, the oral cavity is

never free from microbial deposits and hence in many
patients factors other than oral hygiene may play a
dominant role, especially in tooth sites that are hard to
clean, even by highly motivated individuals.
 This is important to consider, as oral hygiene education
should be a major, but not the only, focus of caries
 In general, mechanical plaque control can be performed by the
patient (self-applied) and by dental personnel (professional tooth
 Tooth brushing with either manual or powered toothbrushes is the
most common oral hygiene method in most countries.
 It is mostly performed using either manual or powered plastic
brushes and in combination with a toothpaste.
Manual toothbrush

 Ancient people chewed

twigs from plants with
high aromatic properties
 The Arabs used a piece of
the root of the arak tree
 Aromatic wood
 Physical clean and
antibacterial oils and
The Chinese invented the tooth brush the
handle with bristles
The first modern toothbrush appeared in
1780 by Addis Williams
 1890. Celluloid replaced bone handle

 During the World War II nylon bristles were used

 Nylon filaments can be prepared in various

diameters and shapes, can be end-rounded and be
more gentle on gingival tissues
Manual toothbrushes

 Various in size, shape, texture

and design

 Large, medium and small

 Different in hardness- hard,

medium and soft
 Handle: it is grasped in hand
during brushing.

 Head: working end that holds

bristles or filaments.

 Tufts: clusters of bristles secured

into head.

 Brushing plane: the surface formed

by free ends of the bristles.

 Shank: section that connects head

and handle.
Design of toothbrush

 Brushing surface = Diameter of commonly used

25.4- 35.8 mm bristles are:

 wide (7.9-9.5mm)
• Soft = 0.007 inch (0.2mm)
 2 - 4 rows of bristles • Medium = 0.012 inch (0.3mm)
 5 -12 tufts per row • Hard = 0.014 inch (0.4mm)

 80-86 bristles per tuft

Nylon Bristles

 Uniform diameter

 Predictable textures – firmness and hardness

 Flexibility

 Hygiene

 Uptake of water
Handle Design

 Flat, concave, multilevel profiles

 Handle design and length may

provide comfort and compliance
during toothbrush use
Toothbrushes for children
Powered toothbrushes

 Electrically powered
toothbrushes designed to mimic
back-and-forth brushing
techniques were invented in

 Battery powered with advantage

of being portable and available at
lower cost

 With rotating head and sonic-


 Plaque removal appears more

effective than manual
Powered toothbrushes

 Motivation to improve oral hygiene appears to be a

key factor for patients to purchase powered
 When the consumer buys more, he increases the
frequency of brushing
Powered toothbrushes

 In most developed countries, the number of

powered toothbrush products sold increased in
recent years ( in Switzerland from 10% to 30%)
 But in that populations increased gingival abrasion
and recession.
Tooth brushing methods

The objectives of toothbrushing are:

 To remove the plaque
 To clean teeth of food, debris and stain
 To stimulate the gingival tissues
 To apply dentifrice with specific ingredients for caries, periodontal
disease or sensitivity
Toothbrushing methods

 Many toothbrushing methods have been introduced,

and most are identified by name such as Bass,
 Or by a term indicating a primary action such as
roll or scrub
Toothbrushing methods

 The plain bristle field of most manual brushes makes it

difficult to reach the proximal areas.
 Therefore, most brushing techniques suggest holding the
brush at about a 45 degree angle to better penetrate proximal
Horizontal scrub technique

 Easiest technique

 Allowed for children

 Occlusal surfaces of the teeth

 Erosions

 Inadequate for cleaning of inter-

proximal areas
Rotary technique

Rotary technique Up-down motion

Stillman’s method

 Was developed to provide

gingival stimulation

 Bristles inclined 45⁰ to the apex

with part of brush resting on

 Vibratory motions with a slight

Bass technique

 Focus is on removal of dental

plaque from gingival sulcus

 Use of soft and ultra soft brush

 Bristles IN sulcus

 Vibratory movements
Bass technique

 The filaments point

toward roots of teeth at
45° angle
 Short vibratory or circular
movement while brushing
forward and backward
Modified toothbrushes

 The term dentifrices is derived from dens

(tooth) and frices-friction (to rub)

 Definition of a dentifrice is a mixture used on

the tooth in conjunction with a toothbrush
Dentifrices -toothpaste

 Pastes, gels, stripes..

 Conventional tubes, stand-up tubes, pumps

 They prevent calculus and caries,

 Whiten teeth

 Eliminate hypersensitivity

 Reduce plaque and gingivitis


 Marked as toothpowders, toothpastes gels

 Sold as cosmetic and therapeutic products

 Cosmetic effect- pleasant taste

Composition of dentifrices

Most dentifrices are produced in paste form and have similar basic formulation:

 Cleaning and polishing agents (Silica, Calcium carbonate)

 Detergents (Sodium lauril sulphate-SLS)

 Binding agents

 Humectants(Glycerol, sorbitol).

 Flavoring and sweetening agents(Aromatic oils , menthol).

 Preservatives

 Therapeutic agents (fluorides, desensitizing agents..)

 Bicarbonates

 Xylitol
Interdental cleaning

 Aproximal surfaces cannot be reached with an ordinary

toothbrush even for periodontal patients with wide open
 Additional aids are dental floss or tape, woodsticks, single-
tufted brushes and interdental brushes.
 Choice depend on the shape of interdental area and
dexterity of individual.
Interdental cleaning
Dental Floss

 Most widely recommended tool

for removing biofilm from
proximal tooth surfaces.
 It’s composed of nylon fillaments
and it comes in waxed, unwaxed,
thick, thin and flavor varieties.
 Can be used with a floss holder,
however it’s been shown that
flossing tools work as well as
using fingers.
 Flossing habit, though, is difficult
to establish and requires positive
reinforcement during dental
Dental floss

 When there is recession of the

inter-dental papillae, woodsticks
are indicated for inter-dental

 Made of soft wood and triangular

in shape so they fit the inter-
dental space.
Interdental brushes

 Probably the most effective plaque

biofilm removal method for interdental

 A comparison between dental floss in

moderate to severe interdental patients
indicated that the interdental brushes
removed greater amount of plaque

 They vary greatly in size and shape.

 General rule -> the larger the space, the

larger the instrument needed to clean it
Single tufted brushes

 For distal surfaces of posterior


 Or lingual surfaces of molars

especially for pregnant women

 Or orthodontic patients
Water pick, water jet
Toothbrushing time and

 For many years dentists advised patient to brush their teeth

after every meal.
 ADA statement – patient should brush regularly
 Research has indicated that if plaque is completely removed
every other day- no pathological effects in oral cavity
 Brushing twice daily develop less caries compared with
brushing just once daily
Toothbrushing time and
On the other hand ..
 Only few individuals completely remove plaque
 Daily brushing is important for periodontal disease control measure
 If periodontal pockets exist even more frequent oral hygiene is
Toothbrushing time and

 In the last two decades, the average brushing time have

increased from 20 to 60 and 80 seconds.
 In all of these studies individuals claimed that they usually
brushed for 2 or 3 minutes.

 People telling their professionals what would like to hear


 It is often recommended to brush the

teeth directly after meals and
especially before going to bed
 brushing after meals might help to
clear carbohydrates from the oral
 Brushing directly after acidic meals
can trigger erosion, as the softened
enamel is easily brushed away and has
no time to remineralize.
 a safety period of more than one hour
seems to be necessary before brushing
after erosive meals
Toothbrush replacement

 The average life of

toothbrush is approximately
3 months.

 It depends of brushing
When to start with oral

 It is recommended to inform the

parents about oral hygiene as early
as the first tooth eruption, and to
make sure they possess the
knowledge needed to take care of
their baby’s teeth.
Gingival Massaging

 Massaging the gingiva with toothbrush or an

interdental cleaning devices produces epithelial
thickening, increased keratinization, and increased
mitotic activity in epithelium and connective tissue.
 Chemical antimicrobial agents such as Chlorhexidine
used to control infection(2x daily, 30 seconds), side
effects: staining and taste alteration.
 Routine visits to dental office is also essential to
successful microbial plaque control and long-term
therapy success.
In conclusion

 After thorough patient education, the hygiene technique should be

demonstrated in the patient’s own mouth.
 All patients require a use of a toothbrush, at least once per day.
 Emphasize the importance of targeted hygiene extending onto the
proximal surfaces.
 Dental floss should be used in all interdental spaces filled with
 Interdental aids should be used for adequate removal of plaque
biofilm especially in the periodontal patient.
 Caries control requires daily use of a dentifrice with low-
concentration of fluoride. Oral rinses with higher concentrations
of fluoride should be used for patients with a high risk of caries
 Reinforcement of these practices and routine visits to the dental
office for maintenance care are essential for the long-term success
of therapy.