Clinical Dental Hygiene
47 important questions on Clinical Dental Hygiene
Pre-eruptive (systemic) fluoride-Characteristics
Rapidly adsorbed in the stomach and small intestine.
Amount not used is excreted through kidneys.
Systemic fluoride examples
Post-eruptive (topical) fluoride
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Professionally applied-Sodium Fluoride
Tray method is most effective with rampant caries-4 min application for max efficacy, Do not eat/drink for 30 min
Recommended for bulimics
Professionally applied- Sodium Fluoride Varnishes
Used for desensitizing exposed roots and caries prevention (more effective in caries reduction than traditional topical fluorides-14% more effective than topical gels)
0.3-0.5mL-small volume/low dose
Substantivity of 24-48 hours
Recommended 2-4x/year
Effective for infants and small children=significantly less ingestion than APF gel
Professionally applied-Acidulated Phosphate Fluoride (APF)
Tray-2.5mL for adult or painting with cotton-tip applicator; available in foams or thixotropic (gel-like) form.
Professionally applied-Stannous Fluoride
Unpleasant taste-metallic (due to tin ion in compound)
Stains demineralized areas and margins of tooth-colored restorations due to the reaction of the fluoride tin ion in the compound.
Causes possible gingival sloughing.
Self-Applied Topical Fluorides
Self-Applied Topical Fluorides-Rinses
Self-Applied Topical Fluorides-Dentifrices
Toxicology of Fluoride-Certainly Lethal Dose (CLD)
Toxicology of Fluoride-Safety Tolerated Dose (STD)
Acute Fluoride Toxicity
GI-Nausea, vomiting, diarrhea
Abdominal pain
increased salivation and thirst
Systemic-symptoms of hypocalcemia
hyperreflexia, convulsions, paresthesia
Cardiac failure or respiratory paralysis
Treatment for Acute Fluoride Toxicity- >5mg/kg (toxic dose)
2. Administer fluoride-binding agent
3. Seek medical treatment
Treatment for Acute Fluoride Toxicity- >15mg/kg (Lethal Dose)
2. Induce vomiting
3. Cardiac monitoring
Chronic Fluoride Toxicity-Skeletal Fluorosis
Chronic Fluoride Toxicity-Dental Fluorosis
Oral Physiotherapy Aids-Interdental Brush
Exposed Class IV furcations
Orthodontic appliances, fixed prostheses, and dental implants
**Inner wire must be plastic coated to avoid scratching cementum.
Oral Physiotherapy Aids-Tufted Brush
Hard to access areas, such as 3rd molars and crowded teeth
Fixed prostheses such as under fixed partial dentures, pontics, and orthodontic appliances
Oral Physiotherapy Aids-Toothpick Holder (Perio aid)
Interdental cleaning-concave proximal surfaces
Gingival margins above orthodontic appliances
Oral Physiotherapy Aids-Wedge Stimulator
Oral Physiotherapy Aids-Floss Holder
caregivers providing oral hygiene care
Oral Physiotherapy Aids-Tufted Floss
Oral Physiotherapy Aids-Oral Irrigator
Dentrifices-Active Ingredients (therapeutic)--Caries
Dentrifices-Active Ingredients (therapeutic)--Tarter control
Dentrifices-Active Ingredients (therapeutic)--Antihypersensitivity
Strontium chloride
Sodium citrate
Dentrifices-Active Ingredients (therapeutic)--Antibacterial
Dentrifices-Active Ingredients (therapeutic)--Whitening
Debridement-Area specific curets (Graceys) characteristics include
face of blade is offset at 60-70 degrees to the terminal shank
**Begin stroke coronal to edge of junctional epithelium
Area specific Gracey curets (5-6)
Area specific Gracey curets (11-12)
Area specific Gracey curets (17-18)
Power Driven Scalers-Oral considerations
Exposed dentinal surfaces
Titanium implants (unless a specially designed tip is used)
Restorations (ex: composites, amalgam and/or porcelain)
Children with primary (pulp to close) and newly erupted permanent teeth (not mineralized yet)
Dentures
Power Driven Scalers-Systemic Health Conditions (evaluated before use)
Respiratory conditions (ex: cystic fibrosis, asthma, emphysema)
Difficulty swallowing
Susceptible to infection (ex: immunosuppression from disease, organ transplant, chemotherapy)
**All pacemakers manufactured are shielded.
Rubber cup polishing use
use light and consistent pressure
Rubber cup polishing considerations
demineralized areas or dental decay
tooth sensitivity
newly erupted teeth
severe gingivitis
lack of extrinsic stain and/or plaque
exposed root surfaces
respiratory conditions (ex: asthma, emphysema, cystic fibrosis)
Air polishing contraindications
spongy gingiva
respiratory conditions
restorative materials (ex: composites, glass ionomers, porcelain veneers, and luting agents)
exposed root surfaces; avoid prolonged use
immunocompromised
patients taking potassium, anti-diuretics, or steroid therapy
In-office mouth rinses
At home mouth rinses
Saline rinse-after nonsurgical periodontal therapy
Fluoride rinse-to prevent dental caries
Chlorhexidine Gluconate (CHX)-Mechanism of action
High substantivity-binds to tooth, pellicle, plaque and mucous membrane and then slowly released
Chlorhexidine considerations/side effects
Alters taste sensation (dysgeusia), including a bitter taste
Can irritate and burn oral mucosa
Increases in supragingival calculus formation-related to the dead bacteria that remain as a result of the bactericidal action
Wait 30 min after brushing before rinsing with CHX-inactivated by sodium lauryl sulfate
Other mouthrinses that control/reduce plaque and gingivitis-Essential Oils (side effects)
Most common is burning sensation associated with alcohol content
Slight extrinsic staining
Contraindicated for current or recovering alcoholics
Other mouthrinses that control/reduce plaque and gingivitis-Quaternary Ammonium Compounds (Cetylpyridinium Chloride [CPC]) --Side effects
Staining
Burning sensation
Increased supragingival calculus formation
Other mouthrinses that control/reduce plaque and gingivitis-Fluoride rinses (uses)
moderate to high risk for caries
undergoing orthodontia or wearing prosthetic appliances
experiencing xerostomia, have recession, and/or demineralization
Recommended antimicrobials for patients with plaque induced gingivitis, slight to moderate chronic periodontitis, NUG/NUP and periodontal maintenance
Recommended antimicrobials for patients with alcohol condition
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