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Tooth Brush

Uses of tooth brush1. Remove & disrupt plaque formation.2. Clean food debris & stains.3. Stimulate gingival tissues.4. Apply fluoridated toothpaste.

Types of tooth brushes:-1. According to size: large, medium, small.2. According to hardness: hard, medium, soft.1. Special types of tooth brushes: a. Orthodontic toothbrush.b. denture brush: hard for denture & soft for oral tissues.c. Toothbrush for handicapped patient.2. Powered tooth brush (Electric toothbrush):3- Natural tooth brush ( Miswak)

Denture brush

Hard for denture & soft for oral tissues.

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Oral IrrigatorUsed to remove food debris & plaque from food bifurcation area & bridge.

Chemical antiseptic.Antiplaque.Help fluoride application.

Wedge stimulator: (tooth pick)1. Remove plaque from gingival margins & pockets.

2. Clean accessible furcation areas.3. Clean open proximal areas.4. Vehicle for chemotherapeutic agents (fluoride).

Contraindicated when interdental papilla widely fills embrasure (healthy gingva).

Dental floss Best supplemental aid, especially in tight contact cases.

Objectives:a. Remove plaque & debris.b. Massage for gingiva in interdental spaces.c. Vehicle for chemotherapeutic agents.

Types of dental floss:-b. Waxeda. Unwaxed c. Banded unwaxed floss.d. Flavored floss.e. Medicated floss.

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Interdental brush Single tuft brush.Uses:-

1. Clean intrproximal spaces between teeth.

2. Clean furcations.3. Clean orthodontic bands & brackets.4. Gingival stimulation.

Rubber tip Interdental tip stimulator.Uses:-

1. Remove supragingival deposists.2. Massage interdental tissues.3. Clean inaccessible area.Contraindicated when interdental papilla widely fills embrasure (healthy gingva).

Fissure sealantRequirement of fissure sealant materials:

1. Reduced water sorption & solubility.

2. Increased hardness & abrasion resistance

3. Adequate manipulation & good flow.

4. Good bond strength with enamel.

Uses:-1. Sealing deep pits, fissure & grooves in newly erupted teeth to be non-retentive.2. High caries susceptibility patient

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3. High risk patient (as medically compromised patient).4. Change fissure from retentive to non-retentive fissure.

Types:1. Chemically cured sealant (self-curing). 2. Light-activated sealant (Ultra violet cured, visible light cured).

Oral Hygiene measures

Disclosing tablets Dental plaque stained with

disclosing agent

Definition:-They are chemical agents that stain residual deposits selectively (plaque) so can be visible for patient).

Uses:-1. Allow spotting area of plaque.2. Help in patient motivation, education, demonstration & assessment.3. Used to evaluate the thoroughness of cleaning of the teeth.

Types:-1. Erythrocin .2. Fluorescin.3. Bismark brown.

Ideal requirement:-1. Non toxic& non irritant.2. Colorant.3. Good taste.

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4. Easily rinsed after use.May be in the form of liquid or chewable tablets.

Topical fluoridesFluoride foam (self application)

Fluoride concentration 1.23%

Advantage:-1. Very lighter than conventional fluoride gel so

minimal amount of fluoride used.2. Decrease risk of fluoride overdose.3. Contain surfactant which clean tooth surface &

facilitate fluoride penetration interproximal.

Fluoride Gel (self application)Fluoride concentration o.5 %

Advantage:-1. Has lower fluoride concentration so minimize systemic ingestion & reduce toxicity if swallowed. 2. Indicated only on cooperative patients.

Fluoride Varnish (professionally applied fluoride)

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Contain: - sodium fluoride & organic fluoride.Applied by paint-on technique using brush.Applied at interval 3-6 months especially in patient with high risk of dental caries.Advantage:-Overcome the problem of absorbed fluoride as fluoride varnish adheres to tooth surface for long time & release fluoride to tooth slowly.

1. Divergent roots of primary to accommodate bud of permanent successors.

So we should care during extraction.2. High mesial pulp hornSo we should care during cavity preparation to avoid pulp exposure.

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Large prominent buccal ridge So during restoration use T band to produce well contoured restoration due to prominent ridge and marked constriction of the crown.

T-band MatrixUsed to restore normal contact areas of primary teeth & prevent extension of excess amalgam during condensation in class II cavity design.

Stainless Steel CrownIndication:-1. Primary or permanent teeth with extensive caries.2. Following Pulpotomy or pulpectomy, as tooth becomes brittle.3. Teeth with developmental problems (enamel hypoplasia, Amelogenesis, Dentinogensis imperfecta)4. As abutment for certain for space maintainers.5. Patient with high caries susceptibility.

6. Oral hygiene measures can't be done (handicapped patient).

Early Childhood Caries

Initial stage Damaged stage

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Deep lesion stage Traumatic stage 1. Cessation of habit and feeding recommendation to mother.2. Sealing all caries-free pits & fissures with fissure sealant.3. Fluoride application.4. Excavation of caries, then filling with ZO/E (IRM) or G.I.(prevent progression)5. Pulp therapy (pulpotomy –pulpectomy) & build up of restoration compo mere. St.st. crowns.

6. General anaesthesia is required for small children with extensive caries.

Ellis Class IFracture of permanent tooth enamel only or with little amount of dentine.Treatment:-Enamel only: - no treatment need follow up with x-Ray.Enamel with small dentine:-leave it or just smoothening of sharp edges to avoid injury to tongue or lip.

follow up with x-Ray at 2 weeks & 4 weeks.

Ellis Class IIFracture of enamel & dentine without pulp exposure.Treatment:-Emergency treatment:-Cover exposed dentine by hard setting layer Ca (OH)2 dressing to :-1. Stimulate reparative dentine formation.2. Reduce further trauma to pulp.Ca(OH)2 dressing protected with:-Fragment reattachment(ideal)or Acid etch composite.Or st.st crown or orthodontic band.

Ellis Class IIIFracture of enamel & dentine withpulp exposure.Treatment:-Preserve pulp vitality to allow closure of immature

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apex.Procedures include:Direct pulp capping. Calcium hydroxide pulpotomy.Apexification. Pulpectomy.

Treatment depends on these factors:-1. Vitality of exposed 2. Pulp Size of exposure

3. Exposure time (early, or late). 4. Root maturation.5. Tooth restorability. 6. Physical condition of patient.

Write the table page 7.

Ellis Class IVFracture of tooth with total crown amputation.Treatment:-1. Remove the fractured part.2. Remaining part can be extruded orthodontically or surgical approach required to gain access.3. Pulp therapy.4. Tooth restoration (post & core & crown).

Ellis Class V

Middle third fracture vertical fracture horizontal fracture cervical fracture.Root fracture with or without crown fractureMay be horizontal or oblique or vertical fracture.

Treatment:- Apical third root

fracture: (good prognosis)

No treatment required just follow up with X-ray up to 6 weeks. middle third root fracture:

Usually there's displacement palatal or lingual of the fractured crown root segment. Under local anesthesia digital pressure to make reduction then stabilize the fractured tooth by splinting 4-6 weeks & check the position by x-ray.

Coronal (cervical) third root fracture: (bad prognosis)Remove fractured coronal segment.If fractured part is 1-2mm infra-bony, make:

Osteoplasty to expose root.

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Orthodontic root extrusion.Cervical root fracture require splint 4 month.Root canal treatment with post and crown restoration otherwise extraction is choice.

Vertical root fracture: extraction.

Extrusion luxationDisplacement of tooth in coronal direction.Tooth is seen extruded partiality out of its socket.

Treatment:-1. Reposition tooth to normal position by digital pressure on incisal edge.Delay in treatment may cause fixation of tooth in extruded position.2. Splinting with acid etch composite.3. Endodontic treatment if toot lost its vitality.By placing Ca (OH)2 in root for 6 -12months to

prevent resorption.

Intrusion luxation

Displacement of tooth in apical direction pushed into socket.

Treatment:-1. If root incomplete tooth will erupt spontaneously.2. Immediate surgical repositioning, splinting & endodontic therapy.3. Orthodontic extrusion & repositioning takes 3-4 weeks.

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AvulsionLoss of tooth, tooth totally displaced out of socket.Treatment:-Immediate re-plantation within 30-60 minutes. Splinting, Ca (OH) 2, endodontic treatment.

Success of re-plantation depend on:-1. Time interval between injury & treatment. 2. Conditions under which the tooth has

been stored.Tooth stored on milk, saliva, lens solution or unsalted water.If not available restore it under tongue or in vestibules.

Eruption Cyst / hematomaDetention:-soft fluctuant bluish swelling associated with tooth eruptionIt is a type of dentigrous cyst

Etiology:-Unknown but may be mechanical trauma

Accumulation of blood-stained, fluid in the space around, crown of erupting tooth.

Treatment:-Unnecessary, but surgical excision may be needed in case:-

a. Cyst is responsible for delaying eruption of the tooth.

b. Parents are so worried.

PericoronitisDefinition:-Acute gingival inflammation around operculum of partially erupted tooth especially 8, 7, 6, D, E.

Etiology:-Accumulation of food debris & bacteria under

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the operculum of partially erupted, erupted tooth.

Treatment:-1. Gentle debridement & allow drainage.2. Warm saline mouth wash.3. Antibiotic prophylaxis if fever & lymphadenopathy.4. Surgical removal of operculum after inflammation decrease.5. Case improves when tooth reaches occlusion.6. If tooth not continuing eruption do extraction.

Recurrent Aphthous Stomatitis (Ulcer)

Definition:-Recurrent necrotizing ulceration which is limited to oral mucosa.

Etiology:-Unknown.May be due to delayed hypersensitivity to streptococcus sanguis.Or autoimmune reaction against oral epitheliumPredisposing factors: - trauma, psychic stress, allergy, nutritional deficiency (iron, folate, vitamin B12 deficiency).

Treatment:-No treatment needed (self limiting within 7-14days).Symptomatic treatment:-

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1. Chlorhexidine mouth wash (3-4 times / day).2. Tetracycline or achromicin 250 mg suspension mouth wash.3. Topical anesthesia or 4. Hydrocortisone lozenges.5. Case improves when tooth reaches occlusion.6. If tooth not continuing eruption do extraction.

Recurrent Herpes LabialisEtiology:-Recurrent infection with HSV-1.Occurs due to disturbance of balance between the virus & immunity due to:-1. Emotional stress.2. Decrease resistance (trauma, sunlight).3. Fever or common cold.Treatment:-1. sun-screen to prevent recurrence.2. Systemic or topical antiviral (acyclovir). Acute Herpetic Gingivo

StomatitsEtiology:-Primary infection with HSV-1at age of 1-10 years. Peak 3-5 years.Rare before1year due to maternal antibody.Treatment:-Self limiting within 10-14days but may be:-1. Supportive treatment:-Isolation from young child, bed rest, fluids as decreased dehydration & avoid sour, salty, spicy, hot foods.2. Palliative treatment: - analgesics,

antibiotic, topical anesthesia. 3. Control secondary infection:- oxytetracyclin or chlorhexidine moth wash.4. Antiviral drug (acyclovir) inhibits viral replication.

Dilantin Gingival Hyper plasia (PIGO phenytoin-induced gingival overgroth) Etiology:-Gingival enlargement following dilantin

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(phenytoin)treatment:-Anticonvulsant in epilepsy after 2-3 weeks of use.After use of cyclosporine or nifedine.

Treatment:-1. Removal of local irritating factor.2. Daily meticulous oral hygiene.3. Antihistaminic & antibiotic therapy. 4. If sever do surgical correction.

5. Consult physician to use alternative drug.

Acute Necrotizing Ulcerative Gingivitis ANUG(Vincent’s infection)

Etiology:-Spirochetes, TreponemaVincentii & fusiform bacilli.Treatment:-Non self-limiting, if not treated it spread extra orally form Noma (cancrum oris) in developing countries.1. Local therapy:-Removal of local irritating factor.Debridement of necrotic tissues.Swabbing with 3% H2O2 mouth wash.2. Systemic antibiotic:-Recommended if massive necrosis &systemic manifestation (lymphadenopathy-fever).e.g. Metronidazole, penicillin.

3. Periodontal surgery to correct gingival deformities after relief of acute symptoms.Acute oral monaliasis (Candidiasis-thrush)

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Etiology:-Caused by yeast like fungus called Candida (monilia) albicans.It is common inhabitant in oral cavity.Become pathogenic incase of:-Lower tissue resistance.Alteration between oral bacteria & fungi in mouth.Decrease oral flora due to excessive use of broad spectrum antibiotic.Infection for new born from (vaginal candidiasis)Chronic atropine candidiasis under removable orthodontic appliance.

Treatment:- Stop topical or systemic antibiotic. Maintain oral hygiene Antifungal drug “topical”

1. Nystatin (mycostatin) 7-21 day dropped in mouth for local action.2. Miconazol (Daktarin Oral Gel) smeared over affected area with clean finger.

Papillion-Lefevre Syndrome

Etiology:-Rare genetic disease (autosomal recessive trait) with sever periodontal disease & early loss of tooth.Treatment:-

Poor prognosis. Treatment as aggressive periodontitis (surgical debridement with antibiotic) Early construction of complete denture.

Band & Loop space maintainer

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Fixed, non functional, passive space maintainer.

Indication:-Single tooth. Unilateral.Posterior tooth. Upper or lower.

Band is placed on the tooth distal to the space.Loop should be wide enough (B-L) to allow eruption of 4, 5.

Crown & Loop space maintainerFixed, passive space maintainer.

Indicated when posterior abutment is:

Extensively decayed Abutment with pulp therapy

and need full coverage.

Single tooth. Unilateral.Posterior tooth. Upper or lower.

Distal Shoe Appliance

Fixed, non functional, passive space maintainer.

Indicated when single posterior tooth loss unilateral or bilateral when tooth distal to the space is not yet erupted.

e.g.Missing E before eruption of 6.So the distal shoe intra-gingival extension will direct 6 to its normal position.

Passive Lingual ArchFixed, bilateral, non functional, passive space

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maintainer.

Indication:-Bilateral or multiple loss of primary lower molars.

Used in case of lower permanent incisors are erupted.If permanent incisors not erupted and bilateral single tooth loss use bilateral band & loop.

Nance Holding ApplianceFixed, bilateral, non functional, passive space maintainer.

Indication:-Bilateral or multiple loss of primary upper molars.Disadvantage:-1. Acrylic button unhygienic 2. Palatal tissue irritation.

Missing upper primary incisors (A, B, A, B)Indicated for: modified fixed partial denture.

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Space maintainer for lower Arch

First Deciduous Molar lost Band and Loop

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Second deciduous molar lost Distal shoe Appliance(Before eruption of permanent incisors)

Bilateral Molar Loss Bilateral Band & Loop Before eruption of first permanent molar

Bilateral Molar Loss Passive lingual Arch After eruption of first permanent molar

Space maintainer for upper Arch

Bilateral Molar loss Bilateral Band & Loop

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Or Transpalatal bar

Primary Incisors Lost Modified Fixed Partial Denture

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