Summary of Lecture Summary of Lecture # # 33

Dental CariesDental Caries

Definition of tooth cavitation: localized , post-Definition of tooth cavitation: localized , post-eruptive pathological process involving bacterial eruptive pathological process involving bacterial acid demineralization of hard tooth tissue resulting acid demineralization of hard tooth tissue resulting in the formation of a cavity.in the formation of a cavity.

Types of caries lesionsTypes of caries lesions Stages of dental cariesStages of dental caries

Dental CariesDental Caries

Progression of caries depends on:Progression of caries depends on:

1.1. Ions concentrationIons concentration

2.2. pHpH

3.3. Salivary flowSalivary flow

4.4. Buffering actionBuffering action

Dental CariesDental Caries

Ecology of dental caries:Ecology of dental caries:- Before teeth eruption the number of MS is very Before teeth eruption the number of MS is very

lowlow- The source of infection of infant by MS is from The source of infection of infant by MS is from

caregiver (usually the mother) by mouth-to-caregiver (usually the mother) by mouth-to-mouth transmission via kissing or sharing spoon mouth transmission via kissing or sharing spoon during feedingduring feeding

Periodontal DiseasePeriodontal Disease

Toothbrushes and Toothbrushes and Tooth-brushing Tooth-brushing MethodsMethods

October 24, 2007October 24, 2007

Abdullah S. Al-Swuailem BDS, MS, MPH, Dr PHAbdullah S. Al-Swuailem BDS, MS, MPH, Dr PH

Toothbrushes and Toothbrushes and Tooth-brushing Tooth-brushing MethodsMethods History:History:- Arabs used roots of Arak tree (Siwak)Arabs used roots of Arak tree (Siwak)- Chinese are credited for inventing the Chinese are credited for inventing the

toothbrushes consisting of a handle with toothbrushes consisting of a handle with bristles (618-907 AD)bristles (618-907 AD)

- Williams Addis (England, 1780) Williams Addis (England, 1780) manufactured the first modern toothbrush: manufactured the first modern toothbrush: handle made of bone with holes for placement handle made of bone with holes for placement of natural hog bristlesof natural hog bristles

Toothbrushes and Toothbrushes and Tooth-brushing Tooth-brushing MethodsMethods History:History:- During World War II, nylon bristles During World War II, nylon bristles

replaced natural bristlesreplaced natural bristles- There was a variation of handle size, There was a variation of handle size,

angulation and length of the toothbrushangulation and length of the toothbrush

Toothbrushes and Toothbrushes and Tooth-brushing Tooth-brushing MethodsMethods

Replacement of toothbrushes at 3- to-4 Replacement of toothbrushes at 3- to-4 months intervals is provoked by reports months intervals is provoked by reports of contamination of toothbrushes after of contamination of toothbrushes after oral or medical bacterial /viral infectionoral or medical bacterial /viral infection

Toothbrushes and Toothbrushes and Tooth-brushing Tooth-brushing MethodsMethods Manual toothbrushes design:Manual toothbrushes design:- size: large, medium, and smallsize: large, medium, and small- Texture: hard, medium, soft or extra softTexture: hard, medium, soft or extra soft- Bristle design: flat or multi-level bristles Bristle design: flat or multi-level bristles

(more effective)(more effective)- Bristles cut bluntly have sharp ends and Bristles cut bluntly have sharp ends and

toothbrushes made with such bristles are toothbrushes made with such bristles are more abrasive than end-rounding tipsmore abrasive than end-rounding tips

Handle design: Handle design:

Powered toothbrushesPowered toothbrushes- More effective in plaque removalMore effective in plaque removal- May result in gingival recessionMay result in gingival recession- There is an increase in the use of There is an increase in the use of

powered toothbrushes due reduction of powered toothbrushes due reduction of pricesprices

- Heads are usually smaller than manual Heads are usually smaller than manual toothbrushes toothbrushes

Toothbrushes and Toothbrushes and Tooth-brushing Tooth-brushing MethodsMethods

Patient’s motivationPatient’s motivation

Toothbrushes and Toothbrushes and Tooth-brushing Tooth-brushing MethodsMethods

Toothbrushes and Toothbrushes and Tooth-brushing Tooth-brushing MethodsMethods Function of a toothbrush and Function of a toothbrush and

toothbrushing:toothbrushing:

1.1. Carry dentifrice to tooth surfacesCarry dentifrice to tooth surfaces

2.2. Remove the dental plaqueRemove the dental plaque

3.3. Clean teeth of food, debris and stainClean teeth of food, debris and stain

4.4. Massage the gingival tissuesMassage the gingival tissues

Toothbrushes and Toothbrushes and Tooth-brushing Tooth-brushing MethodsMethods Tooth-brushing MethodsTooth-brushing Methods- Bass, Stillman, ChartersBass, Stillman, Charters- Roll or scrubRoll or scrub- Individualized tooth brushing techniques for Individualized tooth brushing techniques for

each patienteach patient- Reciprocating horizontal scrub techniqueReciprocating horizontal scrub technique- Rotary motion (Fones’s technique) Rotary motion (Fones’s technique) - Simple up- and – down motion (Leonard's Simple up- and – down motion (Leonard's

technique)technique)

Toothbrushes and Toothbrushes and Tooth-brushing Tooth-brushing MethodsMethods Tooth-brushing methods:Tooth-brushing methods:- Stillman technique: Stimulate gingival tissues Stillman technique: Stimulate gingival tissues - Charters technique: toothbrushes placed at Charters technique: toothbrushes placed at

90 degrees to long access of the teeth, so that 90 degrees to long access of the teeth, so that the bristles are gently forced between teeththe bristles are gently forced between teeth

- Bass technique: the toothbrush is placed in Bass technique: the toothbrush is placed in the gingival sulcus at a 45 degree angle to the the gingival sulcus at a 45 degree angle to the long access of teeth. Vibratory movement of long access of teeth. Vibratory movement of toothbrush (back-and-forth strokes)toothbrush (back-and-forth strokes)

Toothbrushes and Toothbrushes and Tooth-brushing Tooth-brushing MethodsMethods Toothbrushing Time and Frequency:Toothbrushing Time and Frequency:- After every meal? Or regularly as After every meal? Or regularly as

advised by American Dental Association advised by American Dental Association (ADA)?(ADA)?

- Patients tend always to overestimate Patients tend always to overestimate their brushing time and frequencytheir brushing time and frequency

Toothbrushes and Toothbrushes and Tooth-brushing Tooth-brushing MethodsMethods Toothrushing procedures:Toothrushing procedures:- Occlusal surfaceOcclusal surface- Anterior lingual areasAnterior lingual areas Techniques for young childrenTechniques for young children- Methods?Methods?- SupervisionSupervision Techniques for AdultsTechniques for Adults