oral hygiene instructions

CONTENTS• INTRODUCTION

• STEPS IN A PREVENTIVE PROGRAM

• PATIENT COUNSELLING

• PATIENT COMPLIANCE

• MOTIVATIONAL INTERVIEWING

• LEARNING PROCESS

• PATIENT PLANNING

• BASIC STEPS FOR MAINTAINING ORAL HYGIENE

• TOOTH BRUSHES

• DENTIFRICES

• ORAL IRRIGATION DEVICES

• FLOSS

• INTERDENTAL CLEANING

• RINSING

• REGULAR DENTAL CHECKUPS

• PROPER DIET

• CONCLUSION

• REFERENCES

INTRODUCTION

• Oral hygiene includes all the processes for keeping mouth clean and healthy. Good oral hygiene

is necessary for prevention of dental caries, periodontal diseases, bad breath and other dental

problems.

• Oral health: oral health is defined as the retention throughout life of a functional, aesthetic &

natural dentition of not less than 20 teeth & not requiring prosthesis

WHO – 1982Oral hygiene

Importance

prevention

GOALSEliminate sources of infection

Stabilize and preserve oral tissues

Restore oral function

Educate patient regarding maintenance

Facilitate maintenance of adequate nutrition

Contribute to self-esteem and quality of life

ITI basic oral hygiene instruction manual

STEPS IN A PREVENTIVE PROGRAM

ASSESS THE PATIENT’S NEED

PLAN FOR INTERVENTION

IMPLEMENTATION CLINICAL

PREVENTIVE SERVICES

EVALUATE PROGRESSIVE

CHANGES

PLAN SHORT-AND LONG-TERM

MAINTENANCE

ITI basic oral hygiene instruction manual

PATIENT COUNSELING

• KNOWLEDGE

• ATTITUDES

• PRACTICES

Psychological interventions to improve adherence to oral hygiene instructions in adults

with periodontal diseases Renz a et al cochrane library 2007

PATIENT COMPLIANCE

• Successful long term periodontal therapy requires exceptional patient compliance to a

periodontal maintenance program

• 100% patient compliance has been reported to be as low as 16%, with nearly 34% of

patients failing to return for maintenance after completion of active therapy

Self perception of generalized aggressive periodontitis and its influence on the compliance

with the oral hygiene instructions renato correa et al braj j oral sci 2010

patient compliance contd…

Factors affecting patient compliance

time constraints

prolonged treatment plans

perceived unimportance of periodontal maintenance therapy

MODELS

• The health belief model

• Theory of planned behavior

• Leventhal’s model

• Trans theoretical model

Psychological interventions to improve adherence to oral hygiene instructions in adults

with periodontal diseases renz a et al cochrane library 2007


HEALTH BELIEF MODEL


THEORY OF PLANNED BEHAVIOUR


PATIENTS NON COMPLIANCE

• Current health beliefs

• EI (emotional intelligence)

• Psychosocial stressors

• Personality traits

MOTIVATION INTERVIEWING

• MI has been defined as a client centered, directive method for enhancing intrinsic

motivation to change by exploring and resolving ambivalenc, miller and rollnick 2002

Lindhe.Clinical-periodontology-implant-dentistry-2-volumes-5th-edition

• Jane stenman 2012 A single freestanding MI session as a prelude to conventional

periodontal treatment had no significant effect on the individuals' standard of self-

performed periodontal infection control in a short-term perspective.

DEVELOPMENT

• Motivation is elicited from within the patient rather than externally imposed upon the

patient by a practitioner.


Motivational interviewing contd…

IMPLEMENTATION

• Key principles of motivational interviewing

1. Express empathy

2. Develop discrepancy

3. Roll with resistance

4. Support self-efficacy



BASIC COMMUNICATION SKILLSOpen

ended questions

Affirm the patient

Reflect

Summarize.


GIVING ADVICE

elicit the patient’s readiness and interest in hearing the information.

provide the information in as neutral a fashion as possible.

elicit the patient’s reaction to the information presented.


LEARNING PROCESS• Principles of learning

• Learning is more effective when an individual is physiologically and psychologically

ready to learn.

• Individual differences must be considered if effective learning is to take place.

• Motivation is essential for learning.

• Evaluation of the results of instruction is essential to determine whether learning is taking

place.

Oral hygiene measures and promotion: review and considerations, Audrey choo et al

australian dental journal 2001

LEARNING LADDER

un

aw

are

ness

Aw

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ss

Self

in

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Invo

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nt

Acti

onHab

it

Oral hygiene measures and promotion: review and

considerations, Audrey choo et al australian dental journal

2001

INDIVIDUAL PATIENT PLANNING

• When to teach

• Initial instruction is best given first, before any clinical treatment

• The setting

• Teaching facility

Objective

Description

Evaluate with the Patient

Demonstration

Application of a Disclosing

Agent

Instruction

Summary of Lesson I

End of Appointment

PRESENTANTION, DEMONSTRATION, PRACTICE

FIRST LESSON

SECOND LESSON

• successObjectives

• Examine the Gingival Tissue

• Apply the disclosing agentEvaluation

• Questions???

• compliment Review and Extension

of Knowledge

CONTINUOUS INSTRUCTION

Number of Lessons

Relationship Gingival Health

Maintenance

Psychological interventions to improve adherence to oral hygiene instructions

in adults with periodontal diseases renz a et al cochrane library 2007

INSTRUCTION ADAPTABILITY

• The methods for presentation, demonstration, practice, and evaluation can be adapted

readily to various age levels.

• Awareness of the changing motivation and interests of the young to the elderly, and

adaptations of terminology with respect for the patient's level of understanding, ease the

transition from patient to patient.Psychological interventions to improve adherence to oral

hygiene instructions in adults with periodontal diseases

renz a et al cochrane library 2007

THE TEACHING SYSTEM

• Reevaluation

• Outcomes

EVALUATION OF TEACHING AIDS

General characteristics

• Simplicity

• Content

• Cultural and linguistic appropriateness

• Level of orientation

• Durability

• Cost

• Objectives

Visual Aids

Written Promotion

Audiovisual Aids

Interactive Formats

Table Dental Clinic

Main Educational Aids for the Dental Health Education

Cleeren G in 2014 stated that 3D animations are more effective than real time

drawings for periodontal patient education in terms of knowledge recall.

Yiran peng 2014 stated that The use of images showing the severe consequences of biofilm

accumulation enhanced the oral hygiene of patients treated with fixed appliances.

READING MATERIAL FOR THE PATIENT

• SELECTION

• THE TEACHER: THE DENTAL HYGIENIST

• Dental hygienists should pay more attention to instruction and education

regarding oral hygiene preventive measures Malka askhanazi 2014

• Elizabeth AH wilson 2012 Multimedia, health materials appears to be a promising

medium for patient education; however, the majority of studies found that print and

multimedia performed equally well in practice. Few studies involved patients in material

development, and less than half assessed the readability of materials.

Comparative analysis of print and multimedia health materials: A review of the

literature,

USE OF MODELS.

• Patient’s study cast

• Commercially available models.

USE OF DISCLOSING AGENTS• Purpose

• Methods for application

• Solution for direct application (painting)

• Rinsing

• Tablet or wafer

• Interpretation of findings

• Patient INSTRUCTION

• Explain dental biofilm

• Show location and distribution of biofilm

• Demonstrate methods for daily biofilm removal

• Iodine preparations

• Mercurochrome preparations

• Bismark brown

• Merbromin

• Erythrosin

• Fast green

• Fluorescin

• Two tone

• Tri plaque

TECHNICAL HINTS FOR DISCLOSING AGENTS

• Avoid using disclosing or antiseptic solutions on teeth that have tooth-color restorations

because these materials may be stained by coloring agents.

• Do not apply a disclosing agent before a sealant is to be placed.

• Purchase solutions in small quantities do not keep solutions containing alcohol longer than 2

or 3 months because the alcohol will evaporate and render the solution too highly

concentrated.

• Use small bottles with dropper caps for solutions. Transfer solution to a dappen dish for use.

Do not contaminate the solution by dipping cotton pliers with pellet directly into the container

bottle.

• Request local druggist to stock disclosing tablets for patients to purchase. Advise patients of

the stores where the agents may be purchased.

BASIC STEPS FOR MAINTAINING ORAL HYGIENE

• Brushing your teeth (at least twice a day or after every meal)

• Floss your teeth regularly

• Proper diet

• Other interdental cleaning

• Rinsing

• Regular dental checkups

TOOTH BRUSHES

• Uses

• Biofilm removal

• Application of treatment or preventive agents

• Halitosis control

• Sanitation of oral cavity

Tooth brush a key to mechanical plaque control by Deepak grover Indian journal of oral science

2012, vol3

• ADA specifications

• Brushing surface 1 to 1.25 inches in length

• 5/16 to 3/8 inches in width

• 2-4 rows of bristles

• 5-12 tufts per row

• 80-120 bristles per tuft

• Types of tooth brushes

• Manual

• Powered

• Sonic and ultra sonic

• Ionic

Evolution of tooth brush Dr M Praksh, IDA times, Mumbai, June 2008.

Parts of a toothbrush

• Handle: the part of the brush grasped in the hand during toothbrushing

• Head: the working end of the toothbrush that holds the bristles or the filaments.

• Tufts: clusters of bristles or filaments that are secured into the head.

• Brushing plane: the surface formed by the free ends of the bristles or the filaments.

• Shank: the section that connects head and handle.

• Manual brush trim profiles: a variety of filament profiles are available.

• The subject group using the powered toothbrush

demonstrated clinical and statistical improvement in

overall plaque scores. Powered toothbrushes offer an

individual the ability to brush the teeth in a way that is

optimal in terms of removing plaque and improving

gingival health, conferring good brushing technique on

all who use them, irrespective of manual dexterity or

training

A comparison of the efficacy of powered and manual

toothbrushes in controlling plaque and gingivitis: a clinical

study, Yashika jain, 2013.

•

ADAPTATION OF TOOTH BRUSH

POWER BRUSH TRIM PROFILES

Short-term changes in select clinical parameters and subclinical salivary biomarkers may be useful

in assessing efficacy of power brushing interventions in a spectrum of periodontal disease states

Clinical and subclinical effects of power brushing following experimental induction of biofilm

overgrowth in subjects representing a spectrum of periodontal disease, Marcelo B. Aspiras, JCP 2013

SONIC TOOTH BRUSHES

• Operates at 31 000 brush

strokes per minute (260

hz)

• High-speed scrubbing

strokes

• Cavitational effect, fluid

streaming, and acoustic

vibrations

Evolution of tooth brush Dr M Praksh, IDA times, Mumbai, June 2008

IONIC TOOTH BRUSHES• Works on the principle of changing

surface charge of tooth to repel plaque

even from inaccessible areas of teeth

• Ionic exchange, along with the normal

mechanical action of the bristles on the

tooth surface, enhances plaque

removal.

• Zimmer S, evaluated the efficacy of the

ultra sonex ultima in comparison with a

conventional manual toothbrush in 64

healthy volunteers. Ultra sonex is more

efficacious than manual toothbrushes

in removing plaque.Evolution of tooth brush Dr M Praksh, IDA times, Mumbai, June 2008

BRUSHING

• Always use a soft bristled toothbrush

• 2. Use anti-cavity fluoride toothpaste

• 3. Hold toothbrush at a 45-degree angle at the gum line, brushing in a circular motion.

This sweeps plaque out of the gingival pocket

• 4. Brush teeth for a minimum of two minutes at least twice a day.

• 5. Brush gums and tongue along with your teeth.

• 6. Don’t brush too hard because this can cause gingival (gum) recession.

BRUSHING METHOD

BASS METHOD

CHARTERS

STILLMANS

CARE OF TOOTH BRUSHES

• Supply of brushes

• Brush replacement

• Cleaning of tooth brushes

• Storage of brush

INTERDENTAL CLEANING DEVICES

• They are available as,

• Dental floss

• Interdental cleaners such as wooden (or) plastic tips

• Interdental brushes

DENTAL FLOSS

• Available as,

• Multifilament nylon that is either

• Twisted (or) non-twisted

• Bonded (or) non- bonded

• Waxed (or) unwaxed

• Thick (or) thin

PROCEDURE

• 12-18 inches of length are usually sufficient. Stretch the floss tightly between the thumb

and fore finger (or) between both forefingers and pass it gently through each contact

area with a firm back and forth motion.

TUFTED DENTAL FLOSS

• Also called as floss or yarn combination.

• Two commercially available variations

• Super floss

• Nufloss

• Clinical trial comparing the efficacy and safety of quik floss to conventional finger flossing

indicates quik floss to be a safe and effective alternative plaque removal aid.

Knitting yarn

• Yarn is looped through dental floss and floss is drawn through the contact area in the

usual manner.

Gauze strip

• 6 or 8 inch length of 1 inch bandage is folded in thirds and placed around a tooth

adjacent an edentulous area, a tooth with inter dental spacing or the distal surface of the

most posterior tooth.

• A shoe shine stroke is used to clean the dental bio-film from the surface

• Wooden tips

• Tooth pick in holder

• Wooden inter dental cleaner

Inter dental brushes

• Used in type II gingival embrasure.

• Their design is similar to that of bottle brush

Powered inter dental brushes

Uni tufted or single tufted brushes

DENTIFRICES • Dentifrices are aids for cleaning and polishing tooth surfaces.

Composition

• Abrasives

• Silicon oxide

• Aluminum oxide

• Surfactant agents

• Flavoring: pepperment oil

• Humectants: glycerin & sorbital

• Binders: sodium magnesium silicate , colloidal silica, magnesium aluminium silicate

ORAL IRRIGATION DEVICES

• Irrigation is targeted application of pulsated stream of water or other irrigants for

therapeutic purpose.

• Rationale for supragingival and sub gingival irrigation is to nonspecifically reduce the

microbial deposits that induce periodontal diseases.

• Primary objective of supragingival irrigation is to flush away the bacteria coronal to the

gingival margin thereby diminishing the potential of developing gingivitis.

• Sub gingival irrigation is to reduce the pocket micro-flora in an effort to prevent initiation

& progression of periodontitis.

• Classification of oral irrigation

• Supra-gingival irrigation

• Sub-gingival irrigation

• Sub gingival irrigation was introduced by newman et al 1982 as an adjunct to oral

hygiene procedure

AGENTS USED FOR IRRIGATION

• Chlorhexidine

• Hydrogen peroxide

• Water

• Saline

• Sanguinarine

• Stannous fluoride

• Povidone-iodine

• Tetrapotassium peroxydiphosphate

DIET

• Tongue cleaner

• Proper diet

Carbonated drinks, junk

foods, fruit juices

Protien rich, high fiber content

RINSING

• Regular rinses with a good mouthwash helps to keep your mouth clean, fresh and germ

free.

• Daily rinses must be alcohol free (they cause dryness of oral mucosa)

• Fluoride rinses helps to boost the strength of newly erupted teeth.

• It is important to follow manufacturer’s instructions.

• Do not rinse the mouth with water after using mouth wash

EXPANDED AND FUTURE USE OF MOUTH RINSES

• Prophylaxis for bacterial endocarditis

• Aerosol production

• Oral candidiasis

• Oral mucositis

• After periodontal surgery

• Regular dental checkups

SIGNS OF GOOD ORAL HYGIENE

• Good oral hygiene results in a mouth that looks and smells healthy.

• Teeth are clean and free of debris.

• Gums are pink and do not hurt or bleed when you brush or floss.

• Bad breath is not a constant problem.

ORAL HYGIENE INSTRUCTIONSSCALING AND ROOT PLANNING

• Refrain from eating for at least 2 hours or until the anesthesia wear off

• Medications: post treatment discomfort is normal. Discomfort should subside within a few

hours to a few days.

• Tooth sensitivity

• Eating

• Bleeding

• Appearance

• Oral hygiene

AFTER PERIODONTAL SURGERY

• Periodontal dressing

• Do not brush over the pack

• If given a prescription for chlorhexidine (peridex), bathe the area of surgery without

rinsing for 2 minutes after breakfast and before bedtime using a ½ of a capful of peridex.

ADDITIONAL INSTRUCTIONS FOR DENTAL IMPLANT SURGERY

• Do not rinse your mouth vigorously during the first 24 hours after surgery.

• If given a prescription for chlorhexidine (peridex), bathe the area of surgery without rinsing for

2 minutes after breakfast and before bedtime with ½ of a capful of peridex. Continue its use

until dentist tells you to stop.

• If nose bleeding occurs, do not blow your nose vigorously.

• Maintain a soft diet for the first 5 days after the operation and if possible, eat on the side of

your mouth that did not have surgery.

• Use an elevated headrest or an extra pillow for the first 2 nights after the operation.

• Do not use your prosthesis until it has been relined

RESPIRATORY DISORDER

• Patient should be encouraged to floss regularly and brush twice daily with a dentifrice

that offers antibacterial protection and anti-inflammatory benefits.

Chest. 2004 nov; 126(5):1575-82

INSTRUCTIONS DURING PREGNANCY

• Brush teeth with fluoridated toothpaste twice a day, and floss once a day.

• Limit foods containing sugar to mealtimes only.

• Drink water or low-fat milk. Avoid carbonated beverages (pop or soda).

• Choose fruit rather than fruit juice to meet the recommended daily intake

of fruit.

• Obtain necessary oral treatment before delivery.

• Diagnosis (including necessary dental x-rays) and necessary treatment can

be provided throughout pregnancy; however, the period between the 14th

and the 20th week of pregnancy is the best time to receive treatment.

• Treatment for conditions requiring immediate attention are safe during the

first trimester of pregnancy. Delaying necessary treatment could result in

significant risk to you, and indirectly to your baby.

ORAL HEALTH PROGRAM FOR CVS PATIENTS

• Frequent dental prophylaxis (every 3 months to 6 months)

• Twice daily brushing with fluoride toothpaste

• Avoid rinsing after brushing to maximize fluoride effect

• Use toothpaste containing 1,450 ppm fluoride or prescription toothpaste containing 2,500 ppm to 5,000

ppm fluoride

• Fluoride varnish application

• Frequent sips of water and rinsing with water after

• Meals and food supplements • saliva substitutes

• Using a straw with food supplements to minimize contact with teeth

• Power toothbrush

• Alcohol-free mouthrinse

• Floss

CONCLUSION

• To promote healthy periodontal and dental tissues, current mechanical and

chemotherapeutic approaches to oral hygiene aim to modify the oral micro flora.

• The challenge for oral hygiene promotion is effective delivery of these measures

combined with effectual motivation of individuals and communities to aspire to oral

health.

REFERENCES

• Soben peter. Essentials of preventive and community dentistry. Second edition.

• Park .Social and preventive medicine.18th edition.

• Wilkins. The clinical practice of the dental hygienist.10th edition.

• Carranza's clinical periodontology.10th edition

• Lindhe.Clinical-periodontology-implant-dentistry-2-volumes-5th-edition.

• Guljot singh, d. S. Mehta, shruti chopra, and manish khatri. Comparison of sonic and ionic toothbrush in

reduction in plaque and gingivitis. J indian soc periodontol. 2011 jul-sep; 15(3): 210–214.

• Audrey choo,* david m delac,* louise brearley messer*.Oral hygiene measures and promotion: review

and considerations. Australian dental journal 2001;46:(3):166-173

• Bakdash B. Current patterns of oral hygiene product use and practices. Periodontol 2000

1995;8:11-14.

• Carter-hanson c, gadbury-amycot c, killoy w. Comparison of the plaque removal efficacy

of a new flossing aid (quik floss) to finger flossing. J clin periodontol 1996;23:873-878.

• Kiger rd, nylund k, feller rp. A comparison of proximal plaque removal using floss and

interdental brushes. J clin periodontol 1991;18:681-684.

• Jenkins s, addy m, newcombe r. Evaluation of a mouthrinse containing chlorhexidine and

fluoride as an adjunct to oral hygiene. J clin periodontol 1993;20:20-25.

• Moran jm. Chemical plaque control – prevention for the masses. Periodontol 2000

1997;15:109-117.

• Smith aj, moran j, dangler lv, et al. The efficacy of an antigingivitis chewing gum. J clin

periodontol 1996;23:19-23.

• Claydon n, hunter l, moran j, et al. A 6-month home usage trial of 0.1% and 0.2%

delmopinol mouthwashes (I). Effect onplaque, gingivitis, supragingival calculus and tooth

staining. J clin periodontol 1996;23:220-228.

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