Oral Hygiene Instructions,Smoking Cessation Advice,口腔衛(wèi)生指導(dǎo)戒煙建議

OralHygieneInstructions,SmokingCessationAdvice,DietAnalysis&counsellingByDr.OmarAlkaradshehB.D.S,MFDRCSI,D.Ch.Dent,FFDRCSI,EFP.OutlineIntroductionPlaquecontrolRationalePlaquecontrolmethods:MechanicalChemicalToothbrushes:ManualPoweredManualVs.PoweredHowtobrush?InterdentalcleaningDentifricesSmokingcessationadvice5AsmodelNRTDietanalysis&counsellingDietsheet/diarytipsIntroductionMostdentalandperiodontalproblemsareassociatedwithdentalplaqueaccumulation1883:Millerfoundbacterialinvolvementindevelopmentofplaque1965:Loeetal.experimentalgingivitisstudyconfirmedthedirectassociationbetweenplaqueaccumulationandgingivalinflammation.DentalCariesPeriodontalDiseasePlaqueControlRationaleforplaquecontrolConstantlyremovingplaquefromtoothsurfacesbytoothbrushinginadditiontousingFluoridatedtoothpastehavebeenproventoreduceriskandrecurrenceofdentalcaries.Plaquecontrolremoveandpreventplaqueaccumulationaroundgingivalmarginsandinterdentalareastherebypreventingperiodontaldiseaseandmaintainshealth.Theremovalofplaquealsodecreasedtherateofformationofcalculusandstains.

PlaqueControlmethodsMechanicalChemicalPlaqueControlMethods

MechanicalmethodsToothbrushManualPoweredDentifricesInterdentalAidsdentalflosstoothpickinterproximalbrushOralIrrigationsupragingivalsubgingivalToothBrushesToothbrushesDifferentsizes,designsBristle:material,length,stiffness,orientationSlightdifferenceinplaqueremovalNosignificantdifferenceininflammationreductionandresolution.ToothBrushesBristles&tuftsBristles&tuftsRoundedorflatEndsMaterial:naturalbristlesfromhogs

synthetic:nylonBristlehardnessα(D)^2/LSoft:0.2mmindiameterMedium:0.3mmHard:0.4mm:moreweareffectonenamelandgingivalrecession.RecommendationsSoft,nylonbristletoothbrushescleaneffectivelywhenusedproperly,remaineffectiveforawhileandtendnottotraumatizethegingivaorrootsurfaces.Toothbrushesneedtobereplacedevery3-4months.Ifpatientsperceiveabenefitfromaparticularbrushdesign,theyshoulduseitOralHygienemethodsCircular:

FonestechniqueVertical:

LeonardtechniqueHorizontal:

ScrubtechniqueVibratory:

Stillman,

Charters,

andBass

techniquesRoll:

Roll

ormodifiedStillmantechniqueBass/ModifiedBassBassmethod.

A,

Properpositionofthebrushinthemouthaimsthebristletipstowardthegingivalmargin.

B,

Diagramshowstheidealplacement,whichpermitsslightsubgingivalpenetrationofthebristletips.

Bass/ModifiedBassPlacetheheadofasoftbrushparallelwiththeocclusalplane,withthebrushheadcoveringthreetofourteeth,beginningatthemostdistaltoothinthearch.2.Placethebristlesatthegingivalmargin,pointingata45-degreeangletothelongaxisoftheteeth.3.Exertgentlevibratorypressure,usingshort,back-and-forthmotionswithoutdislodgingthetipsofthebristles.Thismotionforcesthebristleendsintothegingivalsulcusarea,aswellaspartlyintotheinterproximalembrasures.Thepressureshouldbefirmenoughtoblanchthegingiva

ToothBrushingTraumaThebrushingtechnique,amountofforceandtheabrasivenessofthedentifricesaffectabrasiontoagreaterdegreethanbristlehardness.Force:cervicalwedge-shapeddefectsrecessionpainfululcerationsPoweredToothBrushesOscillatingandrotatingmotionsLow-frequencyacousticenergygeneratesdynamicfluidmovementandprovidescleaningawayfromthebristletipsalsovibrationsinterferewithbacterialadherencetooralsurfaces.AdditionalinterproximalplaqueremovalhydrodynamicshearforcesPoweredToothbrushesRecommendations:Poweredtoothbrusheswithoscillatingandrotatingmotionsremoveplaqueandreducegingivalbleedingslightlybetterthanmanualtoothbrushes.Patientsneedtobeinstructedtotheproperuseofpowereddevices.Patientswhoarepoorbrushers,children,andcaregiversmayparticularlybenefitfromusingpoweredbrushes.tx.english-chManualVspoweredArecentCochranereviewshowedthatonlypoweredbrusheswithoscillatingandrotatingmotionsreducedmicrobialplaqueby11%andgingivalbleedingby6%comparedtomanualbrushes.HighpatientacceptancePoweredbrushesimprovedoralhealthin:ChildrenandadolescentschildrenwithphysicalormentaldisabilityHospitalisedpatientsincludesolderpatientswithcaregivers.PatientswithfixedorthodonticapplianceselectrictoothbrushkingPoweredToothbrushesThevariousmechanicalmotionsbuiltintopoweredtoothbrushesdonotrequirespecialtechniques.

Thepatientneedsonlyplacethebrushheadnexttotheteethatthegingivalmargin,usingatargetedhygieneapproach,andproceedsystematicallyaroundthedentition.Aroutinemethodofbrushingalltheteeth,similartothemethoddescribedformanualbrushing,shouldalsobeusedwithpoweredtoothbrushes.PoweredToothbrushesPositioningthepoweredtoothbrushheadandbristletipssothattheyreachthegingivalmarginiscriticaltoachievingthemosteffectivecleaningresults.

A,Straight-headplacement.

B,

Round-headplacement.

RecommendationsTargetedhygiene

focusesbrushingeffortsonthecervicalandinterproximalportionsoftheteeth,wheremicrobialplaqueaccumulatesfirst.Brushingwitheitheramanualorapoweredtoothbrushrequiresasystematicroutinetocleanalltheaccessibleareas.Patientswillmodifyanytechniquetotheirneedsbutmustachievethegoalofbrushinguntiltheteetharefreeofplaque.DentifricesDentifrice:atermusedtodescribeapowder,pasteorgelusedwithatoothpastetoaidinremovalofplaqueandstains.PurposeCleaningpolishingstainremovalreducetoothdecayToothPasteComponentsAbrasive:silica,alumina,dicalciumphosphate,andcalciumcarbonatemakeup20%to40%ofadentifrice.Toothpowderscontainabout95%abrasivesandarefivetimesmoreabrasivethanpastes.Water:20-40%Humectants:

20-35%glycerineandsorbitolDetergent:sodiumlaurylsulfateThickeners:silicaandgumsSweeteners:saccharineFlavors:mint,peppermintActiveagents:0-2%e.g.fluorides,triclosanandstannousfluorideTherapeuticagentsAnticaries:Fuorides:SodiumFlouride,Sodiummonoflourophosphate,StannousFlourideDesensitizingpastes:PotassiumsaltsAntiplaque:SLS,Triclosan,ZincandStannousionsAnti-calculus:pyrophosphateAnti-gingivitis:TriclosanWhiteningpastes:abrasives,papaine,dimethicon,peroxides.ChemicalPlaqueControlAntibioticsenzymesMetalionsFluoridesNaturalproductsBisguanidesantisepticsOxygenatingagentsAmineAlchoholsPhenolsandessentialoilsMouthrinseIrrigationGelSlowreleasingdeviceInterdentalCleaningInterdentalCleaningaidsDentalFlossing(floss,flossholders,poweredfloss)InterdentalbrushesWoodenorplastictipsRubbertipstimulatorsRationaleAnytoothbrush,regardlessofthebrushingmethodused,doesnotcompletelyremoveinterdentalplaque.Dailyinterdentalplaqueremovaliscrucialtoaugmenttheeffectsoftoothbrushingbecausemostdentalandperiodontaldiseasesoriginateininterproximalareas.Tissuedestructionassociatedwithperiodontaldiseaseoftenleaveslarge,openspacesbetweenteethandlong,exposedrootsurfaceswithanatomicconcavitiesandfurcations.TheseareasarebothdifficultforpatientstocleanandpoorlyaccessibletothetoothbrushDentalFlossMostwidelyrecommendedtoolforremovingplaquefromproximaltoothsurfaces.NylonfilamentsorplasticmonofilamentswaxedorunwaxedThickorthinFlavouredorunflavouredNosignificantdifferencesintheabilityofthevarioustypesofflosstoremovedentalplaque;theyallworkequallywellRecommendationsabouttypeofflossshouldbebasedoneaseofuseandpersonalpreference.Factorsinfluencingthechoiceofdentalflossinclude:Thetightnessoftoothcontacts.Roughnessofproximalsurfaces.Thepatient'smanualdexterity.Itwasreportedthatflosswaseffectiveatremovalofsubgingivalinterproximalplaqueuptoadepthof2mm.DentalFlossingDentalflossshouldbeheldsecurelyinthefingersortiedinaloop.Passitgentlythrougheachcontactareawithafirmback-and-forthmotion.Donotsnaptheflosspastthecontactareabecausethis

mayinjuretheinterdentalgingivaTheflossisslippedbetweenthecontactareaoftheteeth,iswrappedaroundtheproximalsurface,andremovesplaquebyusingseveralup-and-downstrokes.Theprocessmustberepeatedforthedistalsurfaceoftooth

DentalflossingwillowpointdentalSuperflossBridgesOrthodonticretainers/bracesAreaswithmoreopenembrasuresImplant-supportedprosthesesFlossingToolsRecommendationsThebenefitsofinterproximalcleaningusingdentalflossareundisputed.Flossingtoolsworkaswellasflossingwiththetraditionalmethod.Theflossinghabitisdifficulttoestablish.InterdentalBrushesTechniqueinsertedthroughinterproximalspacesandmovedbackandforthbetweentheteethwithshortstrokes.

Forthemostefficientcleaning,thediameterofbrushshouldbeslightlylargerthanthegingivalembrasurestobecleaned(thispermitsbristlestoexertpressureonbothproximaltoothsurfaces,workingtheirwayintoconcavitiesontheroots)ToothpicksToothpicksarecommondevicesandreadilyavailableinmosthomes.Theycanbeusedaroundallsurfacesoftheteethwhenattachedtocommerciallyavailablehandles.Oncemountedonthehandle,thetoothpickisbrokenoffsothatitisonly5-or6-mmlong.Thetipofthetoothpickisusedtotracealongthegingivalmarginandintotheproximalareasfromboththefacialandthelingualsurfaceofeachtooth.Toothpicksmountedonhandlesareefficientforcleaningalongthegingivalmargin.

Canpenetrateintoperiodontalpocketsandfurcations.ToothpicksWoodentoothpick.

A,

Thetipisacommonwoodentoothpickheldinahandleandbrokenoff.Itisusedtocleansubgingivallyandreachintoperiodontalpockets.

B,

Thetipcanalsobeusedtocleanalongthegingivalmarginsoftheteethandreachunderthegingiva.

WoodentipsTriangularwoodentipsarealsopopularwithpatients.Thetipisinsertedbetweentheteeth,withthetriangularportionrestingonthegingivalpapilla.Thetipismovedinandouttoremoveplaque;however,itisverydifficulttouseonposteriorteethandfromthelingualaspectofallteeth.

RecommendationsOftenatoothbrushanddentalflossarenotsufficienttocleaninterdentalspacesadequately,soitisextremelyimportanttofindaninterdentaldevicethatthepatientlikesandwilluse.Manyinterdentalcleaningaidsareavailableforpatients.Thepatientmightneedtotryseveraldevicesbeforefindingonethatisacceptableandcleansadequately.Ingeneral,thelargestbrushordevicethatfitsintoaspacewillcleanmostefficientlyIrrigation

Workbydirectingapulsatingstreamofwaterthroughanozzletothetoothsurface

SubgingivalIrrigation

SupragingivalIrrigationSubgingivalIrrigationRecommendationsSupragingivalirrigationreducesgingivalinflammationandiseasierforsomepatientsthanusingmechanicalinterdentalaids.

Subgingivalirrigationwithspecializedtipsfordeeppocketsandfurcationareasiseffectivewhenuseddailyaspartofthehomecareroutine.

Patientsrequiringantibioticpremedicationfordentalproceduresshouldusesupragingivaltechniques.Howtobrush?AddPea-sizetoothpastePatientisinstructedtostartwithmolarregionofonearcharoundtheoppositesidethancontinuebackaroundthelingualorfacialsurfacesofthesamearchLastsurfacetobebrushisocclusal.Patientinstructedtostrokeeachareatentimeofspend10secondsperareathenmoveontonextarea.Time:2minutes(30secperquadrent)Frequency:BrushingTwiceaday,Interdentalcleaningonceaday.PatientEducation&motivationDisclosingagents:

toimprovetheefficiencyofplaquecontrolproceduresstainingbacterialdepositsonthesurfacesofteeth,tongue,andgingiva.

cationalandmotivationaltoolsPlaqueDisclosingtabletsSmokingEffectsofSmokingIncreasestheriskofseveraltypesofcancers(Oral,lung)CardiacandrespiratoryproblemsAggravateperiodontalconditionbyactinglocallyandsystemically.EffectonresponsetoperiodontaltreatmentStaining&AestheticsDentalcariesWoundhealingBadbreathDentalimplantsDrysocketsAnti-socialbehaviourSmokingCessation5A’sModelAskAdviseAssessAssistArrangeSmokingCessationSmokingCessationNicotineReplacementtherapyUnlikethehighriskofaddictiontotobaccouse,theriskofaddictiontoNRTisverylow.NRTPrecautionsforallNicotineReplacementTherapy:Usecautioninpatientswithin2weekspost-MI,arrhythmias,orseriousorworseninganginapectoris.Studiesshownicotinereplacementtherapyissafeandeffectiveinpost-MIpatients.Combinationsofpatch,gum,andnasalsprayaregenerallysafeandeffective.Combinationofbupropionandnicotinereplacementismoreeffectivethaneitheralone.

NRTWhoShouldReceivePharmacotherapy?Pharmacotherapycanbeavaluableadjuncttocessationtreatmentformostpatientsmakingaquitattempt.Theexceptionstothisrecommendationinclude,butarenotlimitedto:?Patientswithmedicalcontraindications,suchasanMIorstrokewithinthelast2weeks?Womenwhoarepregnantorbreastfeeding.Theefficacyofthesedrugshasnotbeenestablishedforusewithadolescents.Generally,pharmacotherapyisnotindicatedinindividualswhouselessthan10cigarettesinoneday.DentistRoleinSmokingCessationThedentalteamroleistodiagnosetobaccouse,