dental hygine

7/30/2019 dental hygine

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NATIONAL DENTAL COLLEGE

AND HOSPITALDERA BASSI

DEPARTMENT OF PEDODONTICS

AND PREVENTIVE DENTISTRY

SEMINAR

Maintenance of oral hygiene in

children

SUBMITTED BY:

PARVEEN BATHLA

PG student


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Introduction

NEED FOR MAINTENANCE OF ORAL HYGIENE IN CHILDREN

Oral health hygiene, especially for children is a topic of constant concern. Mainly due to the factthat their dental health standards are not always the best. There are number of aspects that

need to be taken care of while ensuring optimal oral health in children.

Primary dentition is more prone to dental caries than permanent dentition in children. This isdue to following reasons:-

Less thickness of enamel in primary teeth. Lesser hydroxyapetite crystals in enamel in decidous teeth. Non availability of fluorides. More cariogenic challenges. Nursing caries.

DENTAL PLAQUE

It is a sticky, soft & colourless film of bacteria that constantly build up the surface of teeth &gums.

Microorganisms of dental plaque are all naturally occurring in the oral cavity & are harmless. It is an example of biofilm. Plaque on teeth is colourless & therefore difficult to see & remove during brushing its

thicker build up.

Plaque develops naturally on teeth & forms the part of the defense system of host by helping toprevent colonization of enamel by exogenous microorganisms.

Goals for Plaque Control

Initial step of formation of dental plaque is the formation of acquired pellicle which is a thin filmderived from glycoproteins & is free from microorganisms. According to various studies dental plaque is associated with the pathogenicity of various dental

diseases.

Plaque control should have 2 broad goals:


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o use of mechanical & chemical agents to eliminate supragingival plaque.o Mechanical removal of subgingival plaque through professional means periodically so as

to maintain gram positive flora associated with gingival health.

EARLY ESTABLISHMENT OF ORAL HYGIENE

Early establishment of oral hygiene procedures along with the development of non cariogenicdietary habits should begin during infancy itself.

They can be achieved through the counseling of parents & their education both prenatally &postnatally.

1) Prenatal care: It is very important to strengthen the developing primary dentition during first trimester of IU

life.

Child gets calcium, phosphorous & other minerals during odontogenesis from the mothers bloodstream. Hence a nutrious balanced diet is recommended for the expectant mothers.

Prenatal fluoride supplement to mother in the dosage of 0.25-1% has been shown beneficial forthe protection of primary teeth from caries.

Medications like tetracycline for infection control should be avoided during pregnancy as itcauses the discolouration of the primary teeth of infant.

Postnatal care:

Performed in 6-12 months of age. It includes:-

Mothers diet- The lactating mother must take a well balanced diet rich in supplements of

minerals & vitamins.

Timing of first dental visit- First visit to the dentist-within 6 months of the eruption of first primary teeth

but not later than 12 months of age.

Dentist obtain the medical & the dental history including the prenatal &postnatal periods.

Check for any inflammation or other oral diseases.


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Provide anticipatory guide to parents or caregivers regarding dental and oralenvironment, fluoride status, non nutritive oral habits, injury prevention &

effect of diet on dentition.

Diet Management- It is recommended that nocturnal feeding should be discontinued after the

eruption of the first tooth. After each feeding gum pads should be cleaned with

wet gauge.

The hole in the nipple of the bottle should not be too large to give the free flowof milk. Should be just wide enough so that child has to exert force to draw milk

through it.

Cleaning of teeth- Parent, adult & older sibling must assume total responsibility for cleaning the

teeth of infants atleast once in a day. Oral hygiene neglect can lead to

deteriorated oral health.

Teeth cleaning must be done in comfortable location & in pleasantenvironment.

Use of Toothpastes for infants are objectionable because of the taste & foamingaction.

Teething, Oral habits & Oral Conditions- Parents should be educated regarding the process of teething, natal & neo-natal

teeth.

Parents should be guided about the oral habits like thumb sucking, tonguethrusting etc.

Other oral conditions such as tongue tie should also be taken into consideration.Complications during teething:-

When the first tooth tears the gingiva & starts to erupt, a local inflammatory process occurs,which is characterized by

Redness Tenderness Swelling


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Fever Loss of function

As process continues child puts different objects in mouth because chewing such objectsprovides relief to child.

If the object is not cleaned, the already inflamed gums provides an excellent opportunity forharbouring of microorganisms & inflammation persists.

If relief is not given, child become wakeful, fretful, restless & fearful.Treatment:-

Education of the members of the family is needed regarding the process & complications whichmay arise.

Gentle massage of the affected area using clean finger or a gauge piece lightly soaked withsaline should be done.

Ask your doctor if you can give your baby infants acetaminophen (brand name: Tylenol). Do not give baby aspirin. Aspirin can cause Reyes syndrome, a serious illness that can lead to

death in children under 18 years old.

Analgesic gels like 20% benzocaine may provide relief. Teething rings & toys may be used as they may help the child by providing something to bite on.

ORAL HYGIENE IN & TODDLERS

Keeping your baby's teeth clean is very important. Primary teeth have thinner enamel than adult teeth and are more vulnerable to

the bacteria that cause decay.

Decay in a baby's tooth is swift and destructive. It quickly penetrates the enamel, then the dentin, and then infects the nerve.

Begin by gently wiping his gums with a clean, wet washcloth or gauze after he has a feeding. Ashe starts to sprout teeth, the feeling of the wet washcloth on his itchy, irritated gums will be

very soothing. Wiping his gums will help eliminate decay-causing bacteria and will help him get

used to having his teeth brushed later on.

Once he has a tooth, between 6 and 12 months, introduce an infant toothbrush. Make sure ithas soft, rounded bristles so it won't scratch his gums. Brushing with just water is fine, but if

your dentist recommends toothpaste, use a very small amount, about the size of a pea.


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Baby teeth eventually fall out, so why should it matter if they are lost early? Most dentists believe that baby teeth should remain in the mouth as long as possible, to serve

as placeholders for succeeding tooth.

Parents can also utilize a knee to knee position, in which one parent assists by wrapping childslegs around his/her body and gently holding down the childs arms. Whatever the position,

caretaker visibility in the mouth and infant comfort are important.

WINDOW OF INFECTIVITY

Acquisition ofStreptococcus mutans in young children most likely takes place during a "windowof infectivity" from 19 to 31 months of age.

ORAL MAINTAINANCE IN CHILDREN

Encourage your children to eat regular nutritious meals and avoid frequent between-mealsnacking.

Protect your childs teeth with fluoride. Use a fluoride toothpaste. If your child is less than 7 years old, put only a pea-sized amount on

their toothbrush.

If you live in an area where the tap water doesn't contain fluoride, your doctor may prescribedaily fluoride tablets when your child is about 6 months old. Fluoride helps make teeth strong by

hardening the tooth enamel.

If you miss a dose, don't give your child extra fluoride to make up. Just as with swallowedtoothpaste, too much oral fluoride can cause stains on child's teeth.

COMMON ORAL HYGIENE AIDS USED IN CHILDREN

Mechanical Aidsi. Gauge pieces for use of infants.ii. Manual toothbrush & Dentifrices.

iii. Electronic powered toothbrushes.iv. Dental floss.v. Disclosing agents.

vi. Tongue scrappers.vii. Oral irrigators.


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Chemotherapeutics Aids-i. Antiseptics mouthwashes.ii. Antibiotics

iii. Enzymesiv. Plaque modifying agents.v. Sugar substitutes.

vi. Plaque attachment interference agents.Manual toothbrush & dentifrices--

This is one of the most commonly used methods of plaque control. Large range of toothbrushes available in the market based on following

variables:

Diameter of fibers- soft (0.16-0.22mm), medium (0.23-0.29mm), hard(>0.30mm)

Length of the bristles No. of bristles No. & arrangement of bristles as tufts Length of toothbrush head Angulation of head Shape of the bristle head Design of the handle

Start by using a soft bristled toothbrush with a pea sized amount of toothpaste. Avoidusing toothpaste that contains fluoride until child is able to consciously avoid swallowing

it.

Proper brushing takes at least two minutes. To properly brush your teeth, use short, gentlestrokes, paying extra attention to the gumline. Concentrate on thoroughly cleaning each section

as follows:

Clean the labial surfaces of your upper teeth, then your lower teeth


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Clean the lingual surfaces of your upper teeth, then your lower teeth. Use gentle up-and-downstrokes of brush.

Clean the occlusal surfaces of the posteriors. Hold the brush flat and brush back and forth. Last but not the least brushing the tongue is also important.

BRUSHING TECHNIQUES USED COMMONLY IN CHILDREN

1) Horizontal Scrub technique2) Fones Method3) Bass Technique4) Modified Bass Technique5) Roll Method6) Stillmans technique7) Charters Method:8) Modified Charters Method

Horizontal scrub Technique-

In this technique brush is held firmly in hand & is used back & froth on the teeth. It has been found that most of children tend to use this technique naturally.

Fones technique

(circular method)

Brush is placed perpendicular to teeth. Large circular motion of brush over clenchedteeth to simultaneously cover both upper and lower teeth.

It was Previously popular but is not advised nowadays as it has proven to cause toothabrasion.

Bass Technique/ Sulcular Vibration Brushing-

Directly push the filaments of the brush toward roots of teeth at 45 degree angle, presslightly but not enough to bend filaments of brush.

Bass technique concentrates on cleaning the teeth in those areas and for this there is nospecific requirement of a different special toothbrush.


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The areas cleaned with this technique specifically include - Gingival surface adjacent to the tooth Cervical 3rd of the tooth, adjacent to the gingival margin and including the

proximal surfaces

Interdental gingiva The Bass technique is indicated-

For removal of bacterial plaque adjacent to gums & gingival margin. For spaces between teeth, and on the exposed root surfaces with gum disease. For patients who recently had got periodontal surgery done. For brushing on tooth crowns, dental bridges, braces etc.

Modified bass technique-

Circular movement which will cover gum as well as tooth surface. It massages the gumsStillman technique-

Position your tooth brush as in bass technique, press the filaments of your tooth brushtill the gum blanches, turn your wrist through an angle of 45 degree and proceed to

vibrate and roll against each tooth.

Roll technique-

Soft brush is placed at the point where teeth and gums meet, held at about a 45 degreeangle to your teeth.

While brushing, roll the bristles in a round motion about 20 times before moving on tothe next adjacent teeth.

Lift the brush, position it and repeat. It is the most commonly used method, it is an easy method but it neglects the gum

margins.

Charters method-

Brush is angled 45 degree downwards, with half the bristles of the brush over the gum &half over the crown.

Vibratory movement along with circular motion is done.


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Indicated in Individuals having open inter dental spaces with missing papilla and exposed

root surfaces.

Those wearing F.P.D. or orthodontic appliances. For patients who have had periodontal surgery. Patients with moderate interproximal recession

Disadvantages- Brush ends do not engage the gingival sulcus to remove subgingival bacterial

accumulations.

In some areas correct brush placement is limited or impossible, so modificationsbecome necessary which add complexity to procedure.

Modified Charters method-

Modification is to include occlusal surfaces (i.e. bitting surfaces).DENTRIFICES

Dentifrices are used for mechanical removal of plaque with toothbrushes. Dentifrices contain abrasives, surfactants, antiplaque substances, stain removers & can be

fluoridated for anticariogenic properties.

No fluoridated toothpaste should be used till 36 months of age due to the risk of ingestion. Till the child is 7 years of age only a pea sized quantity of dentifrices should be dispensed for

tooth brushing.

ELECTRIC/POWERED TOOTHBRUSHES

First introduced in 1960. These are high-tech rechargeable models as well as low cost battery-powered toothbrushes. Brush head & bristle designs are more advanced, based on oscillating, vibrating or ultrasonic

technology.

Children enjoy the fun of using an electric toothbrush. It will result in a more thorough cleaningof their teeth, particularly at an early age.

They provide 10-49% greater plaque removal than normal toothbrushes.


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In order to increase the plaque control by the patient it is very important to increase thevisualization of plaque by the patient so as to educate & facilitate the patient.

Available as liquid preparation or as chewable tablets. They stain soft tissues & pellicle as well as plaque.

ORAL IRRIGATORS

These are chemo-therapeutic agents used to dislodge plaque particularly from interdental areasTONGUE SCRAPPERS

These may be flat, flexible, plastic sticks which help in cleaning the rough dorsal surface of thetongue.

Gauge can also be used as tongue scrapper. Tongue cleaning should be routinely recommended for all the parents.

CHEMOTHERAUPEUTIC AIDS

They are recommended for the children Having orthodontic treatment With high risk of caries Suffering from dry mouth Under gone radiation therapy

Antiplaque or antimicrobial mouthwash is used to inhibit bacterial plaque formation & preventto resolve chronic gingivitis.

Care should be taken that they are not accidentally swallowed, especially by children to avoidtoxicity.

Commonly used mouthwashes are- Chlorhexidine Listerine

ORAL HYGIENE INSTRUCTIONS FOR VARIOUS AGE GROUPS

Toddlers (1-3 years old)-

This is the best age to introduce toothbrush if it has not been done earlier.


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Only non-fluoridated dentifrices should be recommended. Flossing can also be used. Brushing should be done by the parents using lap to lap position of the child. Timely visit to the dentist.

Preschool children (3-6 years old)-

Fluoridated dentifrices can be introduced after 3 years of age. Brushing in this age should be supervised by the parents. Only pea sized amount of toothpaste should be used. Fluoride gels or rinses can be introduced in this age group in limited manner. Other chemotherapeutic aids should be avoided.

3) School going children (6-12 years old)-

Children now possesses the dexterity to brush on his own. Use of fluoride gels, rinses & other chemotherapeutic aids can be recommended at this

age group.

4) Adolescent (12-18 years old)-

Patient compliance is the most important area of concern at this age. Dentist need to continually guide the patient for mechanical & chemotherapeutic

plaque control.

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