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Oral Prophylaxis, Toothbrushing, Flossing 2

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ORAL PROPHYLAXIS The prevention of disease is generally described as prophylaxis and the procedure that is done to prevent dental disease is dental (oral) prophylaxis. In a laymans term, this is simply referred to as cleaning of the teeth where the primary purpose is to identify and eliminate undesirable substances from the surfaces of the teeth such as plaque, stains, calculus, and food debris.

ORAL PROPHYLAXIS The frequency of need for dental prophylaxis varies with the individual and is primarily determined by the patients own personal oral hygiene efforts. In the majority of cases, this is done twice a year, some patients only on a yearly basis, and still others, every 2 to 4 months.


DISCOLORING PHASE The disclosing phase is an important part of patient education and aids the operator in the scaling and polishing phases. A disclosing agent contains a dye or other coloring agent prepared in liquid, tablet, or lozenge form. After use, the soft deposits pick up the color of the agent. The dye can be rinsed off readily from plaque-free surfaces.

DISCOLORING PHASE Coat the patients lips with lubricant to prevent staining the lips. Dry the teeth with compressed air and retract the cheek or tongue. Paint the disclosing solution on the patients teeth with cotton swab or small cotton pellet held by a pair of cotton pliers to carry the solution to the teeth. If a disclosing tablet is to be used, instruct the patient to chew or swish the tablet around for 30 to 60 seconds and not to swallow the tablet to achieve its purpose. Rinse and show the results to the patient with a hand mirror and a mouth mirror.

SCALING PHASE Removal of calculus from all tooth surfaces coronal to the junctional epithelium. Subgingival scaling is calculus removal of calculus below the margin of the gingiva. Supragingival scaling is removal of calculus above the margin of the gingival. Root planning is the process by which residual calculus and portions of cementum or dentin are removed to produce a smooth hard root surface. It reduces residual inflammation following subgingival scaling by elimination of plaque and calculus removal of altered cementum, and enhancing the patients plaque control.


The primary objective of scaling and root planing is to restore gingival tissues to health.

INSTRUMENTS Curets. The most effective instruments for complete removal of calculus and for smoothing of root surface Sickle. The design feature of the sickle limits its use in subgingival areas because of its sharp pointed tip, straight cutting edges, sharp back of blade and bulky blade. It is difficult to adapt to curved surfaces. Hoe. The hoe is used primarily for removal of large supragingival deposits and limited amounts of subgingival calculus. It has one straight cutting edge with a blade angulated at 99 degrees to 100 degrees to the shank. The sharp points on the blade can traumatize tissue and it cannot be adapted to curved tooth surfaces. It is most effectively used on the buccal and lingual surfaces and proximal surfaces adjacent to the edentulous areas.

INSTRUMENTS Files. A file is an instrument with multiple cutting edges. The primary function of the file is to fracture very heavy, tenacious calculus. Because of its blade size, straight cutting edges, limited tactile sensitivity, and sharp corners on blades its use is restricted to supragingival and subgingival areas where the tissue can easily be displaced. Ultrasonic scaling device. An adjunct to the conventional hand scaling procedure for gross removal of calculus. This is composed of an electric power generator that delivers highfrequency vibrational energy (20000 to 40000 cycles per second) to a handpiece into which specially designed tips are inserted.


POLISHING PHASE Polishing is primarily a super-toothbrushing of the teeth. This procedure removes the residual plaque and stain and leaves a smooth surface on the enamel. Polishing can be accomplished by the use of hand instruments (porte polisher), engine driven rubber cups and brushes, or air polishing methods.

POLISHING PHASE After the scaling phase (&/or root planning), the teeth are polished by a slow-monivg prophylaxis angle with a rubber cup starting from the distal surface of the most posterior tooth of a quadrant and moving forward toward the anterior. Each tooth is worked on from the gingival toward the incisal/occlusal third of the tooth.

FLOSSING PHASE The best way to be sure that plaque is removed between the teeth is by the use of dental floss. Scalers and rubber cups cannot completely clean the tight contact area between the teeth.

FLOSSING PHASE Break off about 18 inches of floss. Wind most of it around one middle finger. Wind the remaining floss around the same finger on the other hand. This finger takes up the floss as it is used

FLOSSING PHASE Hold the floss tightly between your thumbs and forefingers. Guide the floss between your teeth, using a gentle rubbing motion. To avoid injuring your gums, never snap the floss between the teeth.


When the floss reaches the gumline, curve it into a "C" shape against one tooth. Gently slide it into the space between the gum and the tooth.

FLOSSING PHASE If you have difficulty handling the floss, you may find it helpful to use a floss holder or other interdental cleaners, which include special picks, sticks or narrow brushed that reach between teeth

FLOSSING PHASEHold the floss tightly against the tooth. Gently rub the side of the tooth, moving floss away from the gum using an up-and-down motion


TOOTHBRUSH TECHNIQUES There are several different acceptable tooth brushing methods because each patient has different needs. Not one method is perfect for all patients. Some patients may use more than one method


BASS METHODPosition the filaments up toward the root at a 45 angle to the teeth. Place the brush with the filament tips directed into the gingival sulcus.

STILLMANS METHOD Like the Bass Method the filaments are placed at a 45 angle to the tooth. Unlike the Bass Method the filaments are placed half in the sulcus and half on the gingiva. The same stroke is used as the Bass

ROLL METHOD Direct the filaments toward the root of the tooth. Place side of the brush on the gingiva and have the plastic part of the brush even with the tooth. When the plastic portion is even with the tooth press the filaments against the gingiva and roll the brush over the teeth. The wrist is turned slightly and the filaments follow the contours of the teeth.

CHARTERS METHOD Position the filaments toward the chewing surface of the tooth Place the sides of the filaments against the enamel and angle them at a 45 to the tooth. Vibrate the filaments gently but firmly, keeping the filaments against the tooth. Reposition on the next set of teeth.



Place the toothbrush at a 45degree angle against the gums


Move the brush back and forth gently in short (tooth-wide) strokes.


Brush the inner, outer and chewing surfaces of the teeth

BASIC BRUSHINGUse the "toe" (the top part) to clean the inside surface of the front teeth. Use a gentle up-anddown motion


Brush your tongue to remove bacteria and freshen your breath

MORE TIPS Besides brushing twice a day, it's important to clean teeth with floss or an interdental cleaner. This helps remove plaque and particles from between teeth that a toothbrush can't reach.

Eating a balanced diet, limiting snacks and scheduling routine dental visits will help you keep your smile healthy for years to come.


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