Toothbrushing cannot accomplish biofilm removal for the:
proximal tooth surfaces and adjacent gingiva to the same degree that it does for the facial, lingual, and palatal aspects.
Epithelium: the epithelium covering a col is usually:
thin and not keratinized, less resistant to infection than keratinized surfaces.
Inflammation in the papilla leads to:
enlargement, with increased inflammatory cells and edema; the col becomes deeper.
Most gingival disease starts in:
the col area.
The incidence of gingivitis is greatest in:
the interdental tissues.
with bacterial infection and loss of gingival attachment, the interdental papillae are:
reduced in height.
When this happens, proximal surfaces become exposed and:
dental biofilm can accumulate.
Concavities and grooves are predisposed to:
bacterial accumulations.
With advanced periodontitis, furcation areas of maxillary first premolars and molars:
open onto the proximal surfaces.
Objectives:
select appropriate interdental aids to help the patient reach optimum oral cleanliness and health.
Selection of interdental aids:
dependent on oral health, disease status, and the risk for future recurrence.
Research on floss, waxed vs. unwaxed:
: research has shown no difference in the effectiveness of waxed or unwaxed floss for biofilm removal. Biofilm removal depends on how floss is applied. For optimal patient compliance, the patient may use a preferred type.
Historically, floss was made of:
silk fibers loosely twisted together to form a strand and waxed for proximal surface cleaning.
Nylon:
Nylon multifilaments, waxed or unwaxed, have been widely used in circular, floss or flat, tape.
Expanded PFTE:
Plastic monofilament polytetrafluoroethylene with wax is used for proximal tooth surface biofilm removal.
Therapeutics have been added to floss such as:
whitening agents, fluoride, xylitol have been added.
Floss is made from:
silk, waxed and unwaxed nylon, and expanded PTFE.
Should you floss before or after brushing?
before.
Why floss before brushing?
Removing the interproximal plaque before brushing makes the fluoride uptake from the dentifrice superior.
Patients may not floss after brushing because:
the mouth feels clean; the need for flossing may not be appreciated; and time may be short and flossing can be postponed.
Pressure in col area:
Too great a pressure with floss one or more times daily, particularly very fine floss that tends to cut more easily than thicker floss, can be destructive to the attachment.
Prevention of floss cuts and clefts.
Causes of floss cuts and floss clefts:
Using too long a piece of floss.
Snapping the floss through the contact area.
Not curving the floss about the teeth.
Holding floss straight across the papilla.
Not using a rest to prevent undue pressure.
Location on floss cuts and floss clefts:
Straight line cuts primarily on facial and lingual or palatal surfaces directly beside or in the middle of an interdental papilla.
Tufted dental floss:
Regular dental floss is alternated with a thickened tufted portion.
Indications for use of tufted dental floss:
biofilm removal from tooth surfaces adjacent to wide embrasures where interdental papillae have been lost.
biofilm removal from mesial and distal abutments.
under pontic of a fixed partial denture.
orthodontic appliance.
Fixed partial denture:
thread tufted floss over pontic and apply to distal surface of the mesial abutment and mesial surface of the distal abutment.
Super floss:
Single, precut lengths: Super FlossTM is available in a 2-foot length composed of a 5-inch tufted portion adjacent to a 3-inch stiffened end for inserting under a fixed appliance or orthodontic attachment.
Floss holder:
A floss holder can be helpful for a person with a disability or for a parent or caregiver serving a child or patient.
Floss threader:
A floss threader is used for biofilm and debris removal around orthodontic appliances or under fixed partial dentures.
Knitting yarn indications for use:
for tooth surfaces adjacent to wide proximal spaces, dental floss may be too narrow and not remove biofilm efficiently.
mesial and distal abutments of fixed partial dentures and under pontics.
Knitting yarn floss threader:
Use a floss threader; for isolated teeth, teeth separated by a diastema, and distal surfaces of most posterior teeth.
Gauze strip indications for use:
Proximal surfaces of widely spaced teeth.
Abutment teeth proximal surfaces.
Procedure for using gauze strip:
Cut 1-inch gauze bandage into a 6- to 8-inch length, and fold in thirds or down the center.
Position the fold of the gauze on the cervical area next to the gingival crest and work back and forth several times
Hold ends in a distal direction to clean a mes
Interdental brushes are ALSO used for:
to delivery a medicament interproximal; such as a CHX or Fluoride.
Care of interdental brushes:
clean brush during use to remove debris and biofilm by holding under actively running water. Clean thoroughly after use and dry in open air. Discard before the filaments become deformed or loosened.
Interproximal Brush: Indication:
open embrasures,
orthodontic appliances,
fixed prostheses,
dental implants,
periodontal splints,
space maintainers,
concave proximal surfaces where dental floss and other interdental aids cannot reach,
Class IV furcations ,
application of
chemotherapeutic
Single tuft brushes are indicated in:
open embrasure areas where there is little or no papilla.
Interdental rubber tip indications for use:
for cleaning debris from the interdental area and for removal of biofilm by rubbing the exposed tooth surfaces. For biofilm removal at and just below the gingival margin.
Toothpick in Holder, Perio-Aid indications for use:
Patient with periodontitis: For biofilm removal at and just under the gingival margin.
Interdental cleaning, particularly for concave proximal tooth surfaces.
Exposed furcation area.
Orthodontic patient: For biofilm removal at gingival margin above applia
Wooden Interdental Cleaner:
Made of bass wood or birchwood; triangular in cross section.
Wooden Interdental Cleaner indications:
Exposed proximal surface; missing interdental papilla.
Wooden Interdental Cleaner use:
Wood must be softened with saliva prior to use.
A wooden interdental cleaner would be appropriate for biofilm removal with a patient who has what type of embrasures?
Type III.
Plaque retentive factors: IATROGENIC FACTORS
MARGINS OF RESTORATION.
CONTOURS AND OPEN CONTACTS.
MATERIALS.
DESIGN OF RPD.
Plaque retentive factors: HABITS AND SELF INFLICTED INJURIES
TOOTHBRUSH TRAUMA .
CHEMICAL IRRITATION.
MOUTH BREATHING.
TONGUE THRUSTING.
TOBBACO USE.
OTHERS.
Plaque retentive factors: ANATOMIC CONTRIBUTING FACTORS
PROXIMAL CONTACT RELATION.
ENAMEL PEARLS AND CEP.
ROOT ANATOMYCEMENTAL TEARS.
ACCESORY CANALS.
ADJACENT TEETH.
Plaque retentive factors: ASSCIATED WITH CLNICAL PROCEDURE
MALOCCLUSION AND PERIODONTAL COMPLICATION ASSOCIATED WITH THERAPY.
EXTRACTION OF IMPACTED 3RD MOLAR.
RADIATION THERAPY.