Transcript Prevention of Periodontal Disease

Prevention of Oral Disease – 2
Dr Omar Alkaradsheh
Reference
Prevention of Oral Disease
Murray, Nunn, Steele
4th Edition
2003
Aims and Objectives of Course
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knowledge and confidence to incorporate the
theories of prevention into patient care and
treatment planning
Use of evidence-based practices in prevention of
oral diseases
Identifying different risk groups to give patients
the best care possible
Course Outline
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Prevention of Periodontal Disease
Prevention of Tooth Wear - Erosion
Prevention of Dental Trauma
Prevention of Oral Mucosal Diseases
Prevention in the Ageing Dentition
Preventing an Impairment
Preventing Non-Accidental Injury
Introduction to Dental Public Health
Prevention of Periodontal Disease – 1
Mechanical Plaque Control
Dr. Omar Alkaradsheh
Aims
1.
2.
3.
Aetiology
Implications and importance of
preventing periodontal disease
Preventive methods
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Mechanical plaque removal
Chemical plaque removal
Periodontal Disease
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Group of infections that affect the
supporting structures of the teeth
Gingivitis – inflammation restricted
to the gingival marginal
Periodontitis – resorption of the
supporting connective tissue
attachment and apical migration
of the junctional epithelia
What causes Periodontal Disease?
DENTAL PLAQUE
Non mineralized, bacterial
aggregation on the teeth and
other solid structures in the
mouth
bacterial cells (70%)
protein
extracellular polysaccharides
epithelial cells
white blood cells
Dental Calculus?
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Result of mineralization within plaque
(70-90% inorganic content)
Not in itself causative of periodontal disease
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provides a rough PLAQUE retaining surface
distorts the gingival crevice and increases stagnation
areas – allows greater bacterial proliferation within
the crevice
Factors affecting PD
1.
Local factors
2.
Host factors
Local factors that increase plaque
accumulation
Iatrogenic
Rough surfaces
 Overhanging restorations
 Removable partial dentures
 Fixed orthodontic appliances
 Space maintainers (band and loop, etc.)
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Host Factors modifying the immune
response
1.
Smoking
Periodontitis is 2 – 5 times more severe
amongst smokers compared to non-smokers
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2.
Nicotine
Diabetes (type 1 and 2)
2 - 3 fold increase risk of periodontitis
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related to degree of diabetic control, presence of
complications and duration of the syndrome
Aims
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Aetiology
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Implications and importance of prevention
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Preventive methods
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Mechanical plaque removal
Chemical plaque removal
Implications for prevention
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Chronic gingivitis is
reversible if effective plaque
control is introduced
GINGIVITIS and
PERIODONTITIS can be
prevented by adequate
plaque control
Preventive strategy should
be customized for each
individual – variation in
susceptibility
Why prevention is important?
1.
Gingivitis is common in both children and
adults
Children - 26%- 63%
(UK Children Dental Health Survey, 1993)
Adults – almost 100% 1 mm attachment/bone loss
Prevalence and severity of PD increases with age
Why prevention is important (cont)
2.
Important cause of tooth loss
Scotland - 55% caries
17% PD
3.
Time-consuming and difficult to treat
4.
Potential source of systemic bacteraemia
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Infective Endocarditis, coronary heart disease
Stroke
Low-birth weight preterm infants
Diabetes
Aims
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Aetiology
Importance of preventing periodontal
disease
Preventive methods
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Mechanical plaque removal
Chemical plaque removal
Mechanical Plaque Control
Mechanical Plaque Control
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Self Care
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Toothbrushing
Interdental cleaning
Professional
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Scaling/Root planing
Polishing
Toothbrushes
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The first true bristled brush was invented in China in 1498 for
the Emperor using animal hair (pigs)
By the early 1800’s bristled brushes were in general use
Nylon bristles were introduced around 1938
1960’s – development of power toothbrushes (electric)
Requirements of a Satisfactory
Toothbrush
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Have good cleaning ability
Cause minimal damage to soft and hard dental
tissues
Having a reasonable lifespan (good wear
characteristics)
Non-toxic
Manual toothbrushes
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Handle size appropriate
to the user’s age and
dexterity
Head size appropriate
for the user’s mouth
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Adult – 2.5 cm
Child – 1.5 cm
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Compact arrangement of soft, end rounded
nylon filaments not larger than 0.009 inches in
diameter
Hard brushes should never be recommended
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lacerate the gingiva, gingival recession and tooth
abrasion
Diameter is too large to enter the gingival crevice
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Bristle patterns that enhance plaque removal in
approximal spaces and along gum margin
Filaments arranged at different heights and angles
significantly more effective at reducing plaque and
gingivitis than flat trim brushes
(Balanyk et al., 1993)
Requirements of a Satisfactory
Brushing Technique
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Technique should clean all tooth surfaces,
especially interdental and gingival crevice
Movement of the brush should not injure the
soft or hard tissues
Simple and easy to learn
Well-organized so that each part of the
dentition is brushed in turn and no area
overlooked
Brushing Techniques
1.
Vertical
2.
Horizontal
3.
Roll Technique
4.
Vibrating (Bass, Stillman, Charter)
5.
Circular
6.
Scrub
Brushing Technique
Bass technique most
recommended by dentists
Brushing Technique
4.
Bass technique
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aims to clean the gingival
crevice
brush held at 45° to the
axis of the teeth so that
the end pointing into the
gingival crevice
Brushing Techniques
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Research shows no
particular method
superior to any other
Modify the patients
method
Emphasize need to repeat
the procedure on all tooth
surfaces
Powered toothbrushes
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Oscillating, rotating or
counter-rotational
movements
Oscillating/rotating
(Braun Oral B) more
effective in removing
plaque and reducing
gingivitis than a manual
toothbrush (2003)
Ultrasonic toothbrushes (Sonicare)
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high frequency vibration
(30,000 – 40,000 brush
strokes/min)
Two mechanisms of actions
1. Conventional - scrubbing
effect
2. Vibratory motion –
impact energy to oral
fluid that surround the
teeth – fluid pressure
and shear forces
Which toothbrush?????
Manual vs. Electric
Which electric???
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Manual vs. Electric
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Electric toothbrushes remove more plaque than manual
toothbrushes
Electric toothbrush is recommended for individuals who
are unable to maintain effective plaque control
 Physical or learning disability
 Fixed orthodontic appliances
 Institutionalized patients depend upon care providers
A manual toothbrush is appropriate for most people
Which electric toothbrush?
Oscillating/rotating
(Braun Oral B)
performs better than
Ultrasonic (Sonicare)
(Strate et al., 2005)
Brushing in Children
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Start brushing as
soon as the first tooth
erupts
Preschool children
need help with
brushing
Frequency and duration of brushing
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Effective plaque removal every second day
has been shown to prevent gingivitis
(Lang et al., 1973)
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Twice daily brushing is consistent with
maintaining good gingival health
2 - 3 minute duration is recommended
Replacing toothbrush
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Splaying of the toothbrush is the most obvious
sign of toothbrush wear
Renewal is usually recommended after 3 months
use
Interproximal Cleaning
Periodontal conditions are worst in
interdental areas
Plaque Removal
Interproximal cleaners
1.
Dental floss
2.
Interspace brush
3.
Interdental brush
4.
Wood points (toothpicks)
5.
Irrigation devices
Dental Floss
1.
Waxed/Unwaxed
2.
Tape
3.
Superfloss
4.
Flosette
Dental Floss
1.
Waxed/Unwaxed
2.
Tape
3.
Superfloss
4.
Flosette
Flossing technique??
Dental Floss
1.
Waxed/
Unwaxed
2.
Tape
3.
Superfloss
4.
Flosette
Dental Floss
1.
Waxed/Unwaxed
2.
Tape
3.
Superfloss
4.
Flosette
Toothpicks
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Effective only when
sufficient interdental
space is available
Triangular toothpicks are
superior to round or
rectangular
Incorrect use may cause
gingival lesions
Interspace Brush
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Used for tipped,
rotated or displaced
teeth, teeth with
gingival recession
Limited value except
for surfaces adjacent
to an extraction space
Interdental brush
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Superior to floss for
cleaning open spaces
May be used for
cleaning around fixed
orthodontic appliances
Irrigation Devices
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A steady or pulsating
stream of water
through a nozzle under
pressure
Eliminate food residue
accumulated
interdentally
Irrigation Device (cont.)
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NOT A SUBSTITUTE
FOR BRUSHING
Time-consuming and
messy
Used to deliver
chemical agents to
the oral cavity
Mechanical Plaque Control
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Self Care
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Toothbrushing
Interdental cleaning
Professional
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Scaling/Root planing
Polishing
Scaling and Root Planing
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Scaling sufficient to remove plaque
and calculus from enamel leaving a
smooth clean surface
Root surfaces - Root planing
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calculus may be embedded in cemental
irregularities
Contamination of toxic substances in
cementum – biologically unacceptable to
gingival tissue
Recall intervals
Aim
1. Prevent recurrence and progression of PD
2. Prevent tooth loss
3. Increase probability of diagnosing and treating in a timely
manner other oral disease
1. Reinforcement of oral hygiene instruction
2. Supragingival scaling or root planing as necessary
Frequency?
3 month recall is favoured by most clinical trials
Professional Cleaning - Polishing
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Polishing enamel – reorientation of surface
crystals to create a smoother surface
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Experimental studies shown polishing inhibits
formation of pellicle, plaque and calculus
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No evidence that periodontal health improves
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Removal of fluoride from superficial layers of
enamel is a significant drawback
Mechanical plaque control in
special needs patients
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Mental disability
Physical disability
toothbrush handles
enlarged using soft rubber
balls to give improved hand
grip
people who would
otherwise require
assistance with
toothbrushing
modified handle (using
silicone putty) for ease of
grip
TePe interdental brush
showing handle for easy
holding
Boy with Asperger’s
syndrome using a largehandled electric toothbrush
Toothpaste pump and
dispenser
person with a disability such
that they can no longer
perform this task
Aims
1.
2.
3.
Aetiology
Implications and importance of
preventing periodontal disease
Preventive methods
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Mechanical plaque removal
Chemical plaque removal
Conclusion
Mechanical plaque removal is the backbone
of periodontal disease prevention
Thank you