1. Supplemental Oral Hygiene Measures November 14, 2007 Abdullah S. Al-Swuailem BDS, MS, MPH, Dr PH

2. Supplemental Oral Hygiene Measures Learning Objectives: Learning Objectives: - Know the rationale for using supplemental oral hygiene measures - Identify factors that may influence selection of SOH devices - State the purposes, indications, contra- indications, techniques, advantages, and limitations of different SOH devices

3. Supplemental Oral Hygiene Measures rationale: rationale: - Toothbrushing is ineffective in cleaning interproximal areas. - Incomplete plaque removal can increase the rate of new plaque accumulation - Cleaning teeth interproximally means less plaque and calculus and therefore less incidence of dental caries and periodontal disease

4. Supplemental Oral Hygiene Measures Dental floss Dental floss - Can be used in a variety of conditions: sound teeth, teeth with restorations or orthodontic appliances, pontics, around implants - May aid the clinician in identifying presence of calculus, restorations with overhanging margins and m-d caries - Maybe use as a vehicle for the application of chemotherapeutic agents - (Fig 7-2)

6. Supplemental Oral Hygiene Measures Dental floss (Fig 7-3) Dental floss (Fig 7-3) - Unwaxed DF: thin, slip easily through tight contacts, may tear if calculus or overhanging restoration is present. - Waxed DF: usually recommended for cases where tear is a frequent phenomenon (N.B. need to remove the cause if possible) - Waxed dental tape: broad and flat, used in persons with no or light contact - DF maybe colored and flavored - Therapeutic agents, such as baking soda and fluoride, maybe impregnated to the DF - Superfloss Fig 7-4 - Limitation of DF: may not clean interproximal areas with concavity (Fig 7-5)

8. Supplemental Oral Hygiene Measures Dental flossing methods Dental flossing methods - 10-21% of population use dental flossing - Young children with open contacts may not need dental flossing - It is maybe necessary for parents to perform dental flossing for the their children ( less than 10 years old) - Spool method: Fig 7-6 - Loop method : Fig 7-7 - Insertion and cleaning using a DF: Fig 7-8 - Improper use of DF: Fig 7-9, 10, 11

11. Supplemental Oral Hygiene Measures Dental flossing methods Dental flossing methods - Dental floss holder:  Recommended for individuals with: - Physical disability - Poor manual dexterity - Large hands - Limited mouth opening - A strong Gag reflex - Low motivation for traditional flossing - Fig 7-12, 7-13

13. Supplemental Oral Hygiene Measures Dental flossing methods Dental flossing methods - Dental floss threader:  Recommended for the following circumstances: - Through embrasure areas under tight contacts - Interproximal areas of teeth splinted with crowns - Under pontics - Around orthodontic appliances - Fig 7-15 A

15. Supplemental Oral Hygiene Measures Other interproximal cleaning devices: Other interproximal cleaning devices:  Wooden or plastic triangular sticks Fig 7-16, 17  Toothpicks Fig 7-17  Toothpick holder Fig 7-18  Interproximal brushes Fig 7-20, 21,22,24  Other Interproximal devices: - Rubber and plastic tip Fig 26,27 - Knitting yarn Fig 29 - Gauze strip Fig 30 - Automated Interproximal cleaner Fig 31

20. Supplemental Oral Hygiene Measures Tongue cleaners: Fig 32, 33, 34 Tongue cleaners: Fig 32, 33, 34 Rinsing Rinsing Irrigation devices Fig 35 Irrigation devices Fig 35 Implant maintenance Implant maintenance Denture maintenance Denture maintenance