1. Dr. Abdelmonem Altarhony

2. What I can use for cleaning my teeth? Tooth brushing techniques Tooth brush types Types of tooth paste

3. - Theefficacyofbrushingwithregardsto plaqueremovaldependsupon3main factors: The design of the brush. The skill of individual using the brush. The frequency and duration of use. D Caroline Mohamed The toothbrush 3

4. To clean teeth of food, stains and debris, To disturb and remove plaque formation, To stimulate and message the gingival tissue, To aply fluoride dentifrice. Cleaning of tongue and palate. Objectives of toothbrushing 4

5. Ideals requisites of a toothbrush Handle size appropriate to user age and dexterity. Head size appropriate to the size of the patients mouth. Bristlesshouldbeofevenlengh,sothat, they canfunction simultaneously. Use of soft bristle configuration causing minimum damage to soft and hard dental tissue. The brush should be easy to keep and clean. Should be nontoxic. Having a reasonable lifespan. 5

6. Baby´sToothbrush 6

7. Handicapped patient Toothbrush adaptations The most common tool for effective mechanical control of dentalplaqueisatoothbrush.Thepresenceof cognitivedisabilitiescancreate inholdingandmanipulatinga physical and/or difficulties both toothbrush. 7

9. Polyester or nylon Nylon wear less and is more hygienic- antistatics Classified: Soft 0.15-0.18 mm ( better) Medium 0.18-0.23mm Hard/Extra hard 0.230.28mm ( do not use) Bristles 10

10. The use of hard toothbrush, vigorous horizontal brushing, the use of extremely abrasive dentifrices may lead to cervical abrasion of teeth and recession of the gingiva. 10

11. Electric toothbrush ( powered) Its mainly recommended for : (a) Individual lacking motor skills ( Aged persons, arthritic patients) (b) Hospitalized patients whose teeth are cleaned by the caregivers. (c) Special needs patient ( physical and mental disability) (d) Patient with orthodontic applied (e) Whosoever wants to use 11

12. Sonic Toothbrush The motion of these agitated fluid is capable of dislodging dental laque, even beyond where the bristles of the toothbrush actually touch. Only a sonic toohbrush can make this claim. 12

13. Ionic Toothbrush The ionic toothbrush works by temporarily reverses polarity of the tooth surface from negative (-) to positive (+), drawing plaque towards the negatively charged toothbrush head. 13

14. Tooth Brushing Techniques 14 1. Vertical (Leonard´n method) 2. Horizontal 3. Roll technique (Modified Stillman// rolling stroke) 4. Vibrating technique (Charter´s/Stillman and Bass) 5. Circular technique (Fones method)

15. The technique should clean all tooth surfaces specially the area of gingival crevice and the interdental region. The movement of the brush should not injure the soft or hard tissues. Certain methods, e.g. Vertical and horizontal scrubbing methods can produce gingival recession and tooth abrasion. The technique should be simple to use and simple to learn. The method most be well organized so that, each part of the dentition is brushed in turn and no area over looked. 20 Requirement of a satisfactory Method of tooth brushing

16. Charters method Bass method 16

17. 17

18. Charter[s enphasizes bristle action in the interproximal area 18

19. 19

20. MethodBristle placementMotionAdvantage/ disadvantage ScrubHorizontal on gingival margin Scrub in anterior position direction keeping brush horizontal Easy to learn & best suited for children BASS Apical towards gingival into sulcus at 45 0 to tooth surface Short back and forth vibratory motion while bristles remain in sulcus. Cervical plaque removal Easily learned Good gingival stimulation Charter's Coronally45 o, sidesofbristles half on teeth and half of gingiva Small circular motions with apical movements towards gingival margin Hardtolearnand position brush Clears inter proximal Gingival stimulation FonesPerpendicular to the tooth With teeth in occlusions, move brush in rotary motion over both arches and gingival margin Easy to learn Inter proximal areas not cleaned May cause trauma Rolling stroke Apically, parallel to tooth and then over tooth surface On buccal and lingual inward pressure, then rolling of head to sweep bristle over gingiva & tooth Doesn't clean sulcus area Easy to learn good gingival stimulation Stillman's On buccal and lingual, aplically at an ablique angle to long axis of tooth. Ends rest on gingiva and cervical part. On buccal and lingual slight rotary motions with bristle ends stationary Excellent gingival stimulation Moderate dexterity required Moderate cleaning of interproximal area Modified stillman's Pointing apically at and angle of 45 o to tooth surface Apply pressure as in stillmans's method but vibrate brush and also move occlusally Easy to master Gingival stimulation 20

21. Dental floss Types: unwaxed, waxed, tape floss, EPTFE floss, and Superfloss. Waxed floss contained wax to facilitate passing the floss through the contact. Tape floss contain criss-cross fiber and eliminate fraying. PTFE floss (Glide floss) is the teflon floss which allow passing through very tight contact easily without fraying. Superfloss is the web-like material which used to cleaning around fixed bridge and orthodontic appliance. 21

22.  Best done before brushing.  There are no significant difference between various types of floss to remove dental plaque, they all work equally well. ( Grossman 1979, Keller 1969).  Superflosssuperior (50%) 30

23. Interdental brush:  They are suitable for cleaning large, irregular, or concave tooth surfaces adjacent to wide interdental spaces. 23

24. - Type II and Type III embrasures, -Diastemas, -Exposed root furcations, -Orthodontic and fixed appliances, -Application of fluoride, antimicrobial or desensitizing agents. Indications 24

25. Cleaning implants 25

26. Toothpick  Tooth picks may damaging the gum. 26

27. Miswak use is as effective for reducing plaque and gingivitis. Antimicrobial effect. Oral hygiene may be improved by complementing traditional miswak use with modern technological developments such as tooth brushing. Miswak 36

28. Dental Health Education Objectives: Change in behavior Prevente the initiation and progression of dental caries and periodontal disease and make the patient as much as possible, independent of professional support.

29. Chair side Self educational program Self exam Instruction manual Motivated by the health profissional

30. Advice on Dental Hygiene and oral habits Self exam Diet influencing the plaque formation, e.g. dietary sugars, natural cleansers such as fruits and vegetables, etc. Smoking cessation.

31. The responsability thus would be : To provide information about the dental health To provide information and guidence about methods and techniques of plaque control Motivate the patient to bring about a change in his behaviour; which promotes dental health.

32. Informative leaflet

33. Go deeper in this issue by the informative paper 33

34. Make brushingteeth a family activity! 34

35. Brushing and flossing regularly Using face mirror and disclosing plaque solution for motivation 35

36. Organizing thebrushes clean Dr Caroline Mohamed50

37. Tooth paste Small quantity Dr Caroline Mohamed 51

38. Dr Caroline Mohamed52

39. Brushing tongue Dr Caroline Mohame d53

40. Dr Caroline Mohamed54 See, It is clean !!!!

41. Toothpastes A typical toothpaste contains an abrasive and a surfactant, which, together, are intended to remove loosely bound material, including plaque, pellicle and stains. Inaddition,flavorisaddedfor mouthfreshnessand particularlyfluoride,areaddedfor therapeuticagents, anticaries efficacy. Best choice: Fluoridated toothpaste/ concentration related to age and caries risk. ( 500ppm/ 1000 ppm/ 1450 ppm/ 2000 ppm) Do not use whitening toothpastes regularly

42. Homework 42

43. Thank you