Preventive Dentistry Chapter 15 1

Preventive Dentistry Chapter 15 1
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 1

Learning Objectives Pronounce, define, and spell the Key Terms.
Explain the goal of preventive dentistry. Describe the components of a program of preventive dentistry. Assist patients in understanding the benefits of preventive dentistry. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 3

Introduction The goal of preventive dentistry is to have a healthy mouth for a lifetime. To achieve this goal, new and recurring disease must be prevented. What are the two most common types of dental diseases? Preventive dentistry: Used to achieve optimal oral health for a lifetime Ongoing process Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 4

What Is Preventive Dentistry?
Patient education Fluorides Dental sealants Proper nutrition Plaque-control program Optimum oral health can become a reality. If the patient is unwilling to cooperate or is unmotivated, has “preventive dentistry” been accomplished? Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 5

Guides for Patient Education
Listen carefully: Each patient will have different needs. The initial instruction: Explain the relationship of plaque to dental disease. Assess the patient’s motivations and needs: Combine the patient’s motivating factors with the patient’s needs. Select the home cleaning aids: Select a toothbrush, toothbrushing method, interproximal cleaning aids such as dental floss, and a toothpaste. Keep the instruction simple: Comment positively on the patient’s efforts. Patient education Requires a partnership between the patient and the dental team Used to develop and maintain good oral habits How often do we need to educate the patient on his or her oral habits? Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 6

Fig. 15-1 The mother lifts the child’s lip and looks for early signs of decay.

Fig. 15-2 The dental assistant uses the intraoral camera to aid patient education.
What is the benefit of using an intraoral camera? (To show patients a close-up view of their teeth.) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 8

Learning Objectives Discuss techniques for educating patients in preventive care. Describe the effect of water fluoridation on the teeth. Describe the effects of excessive amounts of fluoride. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 10

Dental Sealants Dental sealants are used as a means of protecting the difficult-to-clean occlusal surfaces of the teeth from decay. A dental sealant is a plasticlike coating that is applied over the occlusal pits and grooves of the teeth. Sealants cover the occlusal pits and fissures where decay-causing bacteria can live. Dental sealants are an important component in preventive dentistry. In several states, the application of dental sealants is delegated to the dental assistant as an expanded function. Sealants are generally placed on permanent teeth, but sealants can be placed on primary teeth if a child is susceptible to decay. Can sealants be placed on anterior teeth? (Yes, on the lingual pits of anterior teeth.) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 11

Fig. 15-4 This molar is protected from decay with a dental sealant
Fig This molar is protected from decay with a dental sealant. (Courtesy of 3M Espe Co, St Paul, Minn.) Sealants are white or clear. White sealants are used to visualize placement and retention. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 12

Fluoride Fluoride has been our primary weapon with which to combat dental caries for more than 40 years. Fluoride slows demineralization and enhances remineralization of tooth surfaces. Fluoride is a mineral that occurs naturally in food and water. A supply of both systemic and topical fluoride must be available throughout life to achieve the maximum cavity-prevention benefits. What is demineralization? (The removal of mineral components from mineralized tissues.) What is remineralization? (The process of restoring minerals to a mineralized tissue that has been demineralized.) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 13

Ways of Receiving Fluoride
Prescription-strength fluorides are applied in the dental office. Non–prescription-strength are sold over the counter for at-home use. Fluoridated water is available bottled or through the community. (Cont’d) How the patient receives fluoride depends on the patient’s needs. Needs vary from patient to patient. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 14

Ways of Receiving Fluoride
(Cont’d) Systemic fluoride is ingested in food, beverages, or supplements. The required amount of fluoride is absorbed through the intestine into the bloodstream and transported to the tissues where it is needed. Excess systemic fluoride is excreted by the body through the skin and kidneys and in the feces. Topical fluoride is applied directly to the teeth through the use of fluoridated toothpastes and mouth rinses and topical applications of rinses, gels, foams, and varnishes. Systemic fluroide is available in bottled water, meat, vegetables, cereals, citrus fruits, tea, and fish. Topical fluoride is included in in-office application of fluoride, fluoride rinses, and fluoride toothpastes. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 15

Fig. 15-5 Various forms of topical fluoride.
In-office fluoride comes in gel, foam, rinse, and liquid forms. Preparations are flavored for patient comfort; the patient chooses the flavor Each preparation has different contact time—check the manufacturer’s directions Topical fluoride is applied with the use of disposable trays after prophylaxis has been completed Patients are instructed not to eat or drink anything for 30 minutes after the placement of topical fluoride. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 16

How Does Fluoride Work? Preeruptive development: Before a tooth erupts, a fluid-filled sac surrounds it. Systemic fluoride present in this fluid strengthens the enamel of the developing tooth and makes it more resistant to acid. Posteruptive development: After eruption, fluoride continues to enter the enamel and alter the structure of the enamel crystals. These fluoride-enriched crystals are less acid soluble than the original structure of the enamel. Before birth, fluoride comes from the mother’s diet. Posteruptive development requires systemic and topical fluoride for the remineralization process. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 17

Safe and Toxic Levels of Fluoride
The fluorides used in the dental office have been proved safe and effective when used as recommended. Chronic overexposure to fluoride, even at low concentrations, can result in dental fluorosis in children younger than 6 years with developing teeth. Acute overdosage of fluoride can result in poisoning or even death. Acute overdosage is very rare. What is fluorosis? (Mottled enamel caused by excessive fluoride intake.) What is mottled enamel? (Discoloration of enamel—mostly white in color.) Lethal dose of fluoride varies from 2.5 to 10 grams in adults to as low as 0.25 grams in infants. When a fluoride overdose is suspected, instruct patient to drink milk. Milk will soothe irritated mucous membranes. Patient should seek medical attention immediately. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 18

Learning Objectives Describe the purpose of a fluoride-needs assessment. Identify sources of systemic fluoride. Discuss three methods of fluoride therapy. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 20

Fluoridated Water For more than 40 years, fluoride has been safely added to the communal water supply. Most major cities in the United States have fluoridated water, and efforts to fluoridate water in other communities continue. From a public-health standpoint, fluoridation of public water supplies is a good way to deliver fluoride to lower socioeconomic populations who may not otherwise have access to topical fluoride products such as fluoridated toothpaste and mouth rinses. (Cont’d) Fluoridation is a very controversial issue—many people are opposed to fluoridated water. Does your area supply fluoridated water? Do you know the levels in your area? Members of the dental team need to stay up to date with the fluoride controversy. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 21

Fluoridated Water (Cont’d) Until recently it was believed that water fluoridation was effective in preventing tooth decay as a result of systemic uptake and incorporation of fluoride into the enamel of developing teeth. It has now been proved that the major effects of water fluoridation are topical, not systemic. Topical uptake means the fluoride diffuses into the surface of the enamel of an erupted tooth rather than being incorporated into unerupted teeth during development. Fluoridated water is a source of which type of fluoride? (Systemic.) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 22

Fluoridated Water (Cont’d) Approximately 1 part per million (ppm) of fluoride in drinking water has been specified as the safe and recommended concentration to aid in the control of dental decay. This is approximately equivalent to one drop of fluoride in a bathtub of water. The levels of fluoride in controlled water fluoridation are so low that there is no danger of ingesting an acutely toxic quantity of fluoride. Some states have water that naturally contains more than twice the optimum levels of fluoride. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 23

Fluoride Precautions To prevent patients from receiving too much fluoride: Evaluate the patient’s current fluoride intake. Perform a fluoride-needs assessment. If a patient has well water (generally not fluoridated) and does not use fluoride toothpaste, should the dentist prescribe a fluoride supplement? The findings of the needs assessment determine the patient’s need for a fluoride program. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 24

Fig. 15-6 B, Moderate fluorosis.
Discoloration due to moderate fluorosis. Do any of the students have fluorosis? Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 26

Sources of Systemic Fluoride
Foods and beverages: Many processed foods and beverages are prepared with fluoridated water. Dietary fluoride supplements may be prescribed by the dentist for children ages 6 months to 16 years. NOTE: Toothpaste and mouth rinses containing fluoride should not be used as a source of systemic fluoride because with proper use any excess is spit out and never swallowed. Meat, vegetables, cereals, and citrus fruits naturally contain small amounts of fluoride; tea and fish have slightly higher levels of fluoride. Not all bottled water contains fluoride—check the label. Prescribed fluoride treatments include tablets, drops, and rinses. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 27

Fig. 15-7 Fluoride can be dispensed by the dentist in a tablet form.
These are examples of tablets that are dispensed by the dentist. What is the recommended age group for prescribed fluoride supplements? (6 months to 16 years.) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 28

Sources of Topical Fluoride
Toothpaste containing fluoride is the primary source of topical fluoride. Fluoride mouth rinses Prescription Nonprescription Brush-on fluoride gel Professional topical fluoride applications Fluoridated water Fluoride is applied to make teeth more resistant to demineralization and to assist in the remineralization of decalcified areas. Fluoride can reduce the incidence of caries by 40% to 50%. Over-the-counter rinses contain 0.05% sodium fluoride. Prescription rinses contain 0.63% stannous fluoride or 0.2% sodium fluoride. Over-the-counter gels contain 1.1% sodium fluoride. Prescription gels contain 2% sodium fluoride. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 29

Fig. 15-8 Prescription-strength (0
Fig Prescription-strength (0.2% sodium fluoride) mouth rinse and (1.1% sodium fluoride) dentifrice are effective in preventing dental decay. The illustration shows examples of fluoride rinses and fluoride toothpastes. Ask how many students use a fluoride toothpaste. Of those who do not, how many use another type of fluoride supplement? Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 30

Fig. 15-10 Training toothpaste for young children.
Training toothpastes do not contain fluoride. The duration of toothbrushing should not change. A small amount should be used. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 31

Fig Various chemotherapeutic products are available to consumers. (Courtesy of Oral-B Laboratories.) The image shows examples of rinses that are available. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 32

Learning Objectives Explain the steps in analyzing a food diary.
Compare and contrast the methods of toothbrushing techniques. Describe the process for cleaning a denture. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 34

Nutrition and Dental Caries
Without dietary sugars, dental caries will not occur. Sucrose has a greater decay-causing potential than other sugars, but maltose, lactose, glucose, fructose, and their combinations do have high caries-producing capabilities. Flour and starches are not usually decay-causing, but when starch is used in conjunction with sugar, (e.g., in cookies), the potential for caries increases. What is another term for “decay-causing?” (Cariogenic.) Patients should be asked about their dietary intake when their fluoride needs are being assessed. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 35

Sugar Substitutes Use of less fermentable and noncariogenic (caries-causing) artificial sweeteners has increased in recent years. Artificial sweeteners are an alternative to sucrose: Saccharine (“Sweet and Low”) Aspartame (“NutraSweet,” “Equal”) Sorbitol Xylitol Mannitol (Cont’d) Artificial sweeteners were initially developed for diabetics and those who struggled with obesity. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 36

Sugar Substitutes (Cont’d) Of these sugar substitutes, saccharine, aspartame, sorbitol and mannitol are noncariogenic—which means that they do not cause dental caries, Xylitol is the only one of the artificial sweeteners that actually prevents caries (anticariogenic). Products that contain xylitol are significantly better; however, they are also more expensive than products containing other types of artificial sweeteners. Xylitol is derived from birch trees, corn cobs, oats, bananas, and certain mushrooms. Studies are continually conducted to determine why xylitol prevents tooth decay. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 37

Fig. 15-12 Ford Extreme Xylitol gum and Sugar Free Dental Care gum containing xylitol and sorbitol.
Xylitol is approximately 10 times more expensive than sucrose. Xylitol gum is more expensive than Arm & Hammer gum. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 38

Dietary Analysis A dietary analysis is done to determine the patient’s current food intake as a means of assessing the need for dietary counseling. The patient maintains a food diary that includes everything he or she consumes each day for 1 week. The listing includes all meals, supplements, gum, snacks, and fluoridated water. It can be used to reveal any dietary habits that are likely to have an adverse effect on the patient’s oral health. A food diary includes the times at which food and snacks were eaten, foods sweetened with added sugars, fresh fruit vs dried fruit, and recommended daily allowance vs actual daily consumption. The diary should also include any fluoride supplements that have been used. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 39

Plaque-Control Program
Plaque can be kept under control with the use of brushing, flossing, interdental cleaning aids, and antimicrobial solutions. A goal of the program is to remove plaque at least once daily. The techniques that are selected must be based on the needs and abilities of the individual patient. What is plaque? (A soft deposit on the teeth consisting of bacteria and bacterial products.) How is plaque removed from the teeth? Once removed, it takes plaque 24 hours to reaccumulate. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 40

Oral Hygiene Aids and Methods
There are a wide variety of oral hygiene products on the market today. It is important for dental assistants to remain current on the newest products on the market so that they can advise patients, make recommendations, and answer questions. Oral hygiene aids and methods should be part of the patient-education program. Members of the dental team should be aware of different products. Which products do the students use? Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 41

The Toothbrush The two basic types of toothbrushes are:
Manual Automatic Used properly, both types are effective in the removal of dental plaque. Toothbrush When used with a fluoridated toothpaste, a toothbrush can be very effective. Many sizes are available (infant, child/teen, adult, appliances). What type of toothbrushes do the students use? Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 42

Fig. 15-14 Examples of manual toothbrushes
Fig Examples of manual toothbrushes. (From Newman M, et al, editors: Carranza's clinical periodontology, ed 10, St Louis, 2006, Saunders.) Soft-bristled brushes are recommended because they’re gentler on the gum tissue. Nylon bristles are preferred because their ends are rounded. The brush should be replaced every 8 to 12 weeks or when bristles are worn. Different sizes of handles are available. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 43

Fig Positioning the powered toothbrush head and bristle tips sot that they reach the gingival margin is critical to achieving the most effective cleaning results. A, Straight head placement. B, Round-head placement. (From Newman M, et al,, editors: Carranza's clinical periodontology, ed 10, St Louis, 2006, Saunders.) Many automatic toothbrushes are available on the market. How many students use an automatic toothbrush? Powered toothbrush Some have built-in timers. Some have pulsating or ultrasonic action. Heads are interchangeable—many people can use one unit. Larger handles are especially good for children and the elderly. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 44

Toothbrushing Precautions
The patient should be cautioned about damage that may be caused by vigorously scrubbing the teeth with any toothbrush. Over time this practice may cause abnormal abrasion (wear) of the tooth structure, gingival recession, and exposure of the root surface. The dental team can observe the toothbrushing techniques of the patient to ensure that he or she is using the toothbrush properly. The toothbrush should be sized and shaped correctly to permit sufficient cleaning and easy management (e.g., an adult should not use a child-size toothbrush). Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 45

Fig. 15-17 Observing toothbrushing technique.
As part of the patient-education program, the dental team should have the patient brush his or her teeth and give instruction on how to correct bad habits. A disclosing agent could be used after this procedure to show the patient what he or she is missing during toothbrushing sessions. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 46

Fig Improper brushing techniques can result in abrasion of the tooth surface and can cause gingival recession. (Courtesy of Dr. Robert Meckstroth.) Which teeth are involved? What instruction should be given to this patient to improve toothbrushing technique? Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 47

Toothbrushing Methods
There are several methods of toothbrushing: Bass method Modified Bass Charter method Stillman method Fones method The dental professional will recommend the method best suited to the patient’s needs. The most commonly used method is the modified Bass. What method do the students use? What is the recommended time a patient should brush his or her teeth? (3 minutes.) Patients with good plaque control due to good brushing habits should be commended—but continue to coach them. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 48

Dental Floss Dental floss or tape removes bacterial plaque and thus reduces interproximal bleeding. Dental floss is circular in shape; dental tape is flat. Floss and tape can be purchased in various colors and flavors. Floss and tape are available in waxed and unwaxed varieties. Research has shown that there is no difference in the effectiveness of waxed and unwaxed floss in removing plaque. How many students floss their teeth on a regular basis? What types of floss do they use? Flossing has been shown to be the most effective way of removing plaque from the interproximal areas. Flossing should be done before toothbrushing. Patients should use approximately 18 inches of floss. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 49

Fig. 15-19 The dental assistant helps the patient learn to floss.
Patients should be instructed to “wrap” the floss around the tooth and move in an “up and down” direction. Patients should be instructed to never floss using a “sawing” motion. Flossing aids are available to help during the procedure. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 50

Interdental Aids End-tuft brushes Bridge cleaners Automatic flossers
Perio-Aid Many different aids are available, depending on the patient’s needs. Interdental aids are used to clean under fixed bridges or orthodontic work and in open spaces. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 51

Fig. 15-21 An interdental hygienic aid. A, Anterior teeth
Fig An interdental hygienic aid. A, Anterior teeth. B, Cleaning posterior interproximal areas that are difficult to reach. A B End-tuft toothbrush Much like a regular toothbrush but with a much smaller head Soft nylon bristles Used to clean hard-to-reach areas Can be used to clean around orthodontic brackets Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 52

Fig. 15-22 A bridge threader is used as an aid to clean under a fixed bridge.
Regular cleaning under a bridge is important for the success of the bridge. The patient should be instructed on the appropriate technique for using a floss threader. The bridge cleaner is made of flexible plastic and looks like a large needle. Floss is “threaded” through the bridge cleaner; the floss threader is then “threaded” under the pontic. Floss threaders can also be used in patients with fixed orthodontics (brackets). Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 53

Fig Powered flossing devices can be easier for some patients to use than handheld floss. (From Newman M, et al, editors: Carranza's clinical periodontology, ed 10, St Louis, 2006, Saunders.) Automatic flosser Designed to help those who have difficulty using the traditional flossing technique Good for patients with arthritis Inserted interproximally and turned on Vibrations remove plaque interproximally Disposable heads Replacement heads available Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 54

Fig. 15-24 Perio-Aid. Perio-Aid Designed to hold toothpicks
Used to clean hard-to-reach areas Can be used to stimulate gingival tissue Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 55

Fig. 15-25 Denture and denture brush.
Specific brushes are available for the cleaning of dentures, partial dentures, and orthodontic appliances. Brushes can be used with toothpaste, denture cleaner, mild soap, or dishwashing liquid. This brush has stiffer bristles than a toothbrush. Dentures, partial dentures, and orthodontic appliances should be cleaned daily. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 56

Dentifrice (Toothpaste)
Dentifrice (toothpaste) contains ingredients designed to help remove food residue and abrasives to help remove stains. Highly polished tooth surfaces will stain less readily and remain clean longer. Most brands of toothpaste now contain fluoride. They also contain flavoring agents to give the mouth a fresh, clean feeling. Some toothpastes now contains a compound that reduces calculus formation when used regularly after dental prophylaxis. These toothpastes will not remove existing calculus. Only use toothpastes that have been tested and approved by the ADA. What is the ADA? (The American Dental Association.) Many different types of toothpastes are available. A pea-sized amount should be used. What types of toothpaste do the students use? Why? Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 57

Fig. 15-26 Toothpaste for children.
Toothpastes for children have “kid-oriented” flavors, such as bubble gum. Cartoons on the packaging are a good motivating factor for children. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 58

Mouth Rinses Many patients like the feeling of freshness provided by a mouth rinse. A wide variety of mouth rinses are available today, and some contain fluoride. Recovering alcoholics should select a mouth rinse that does not contain alcohol. Rinsing the mouth with water is recommended after meals and snacks when toothbrushing and interdental cleaning are not possible. Mouth rinses should be used in conjunction with other plaque-removal techniques. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 59

Fig Mouth rinses. A, Two prerinses (left) and several alcohol-free mouthrinses (right). B, Familiar brands of mouthrinses containing alcohol ranging from 8% to 27%. (Courtesy of Dr. W.B. Stilley II, Brandon, Miss.; from Daniel SJ, Harfst SA: Mosby’s dental hygiene concepts, cases, and competencies–2004 update, St Louis, 2004, Mosby.) Mouth rinses are used for cosmetic or therapeutic purposes. Rinsing can loosen debris from the oral cavity but does not remove it completely. Rinsing can give patients fresh breath. Some mouth rinses do contain alcohol. What type of mouth rinse should be avoided by a recovering alcoholic? Members of the dental team members should be up to date on new products. A B Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 60

Irrigation Devices Oral irrigators deliver a pulsating stream of water or chemical agent through a nozzle to the teeth and gingiva. Oral irrigation can be applied at home by the patient or in the dental office. Oral irrigation helps keep levels of subgingival bacterial to a minimum. In selected patients, oral irrigation can be used to supplement other oral hygiene techniques. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 61

Fig. 15-28 Irrigator (or dental water jet)
Fig Irrigator (or dental water jet). The unit shown comes with standard jet tips for general cleaning, a subgingival tip which is placed below the gingival margin, tongue cleaners to help remove odor causing bacteria, and an orthodontic tip that is ideal for cleaning around braces or other dental work. The unit accepts most mouthwashes and antimicrobial agents. (Courtesy of WaterPik Inc, Fort Collins, Colo.) An oral irrigator is used to reduce subgingival levels of bacteria. An oral irrigator should be used in conjunction with other oral hygiene techniques. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 62

General Guidelines for Home Care Products
The ADA Council on Dental Therapeutics conducts an independent review of the scientific evidence of the research claims and evaluation of home care products. When a product meets the appropriate standards, it is given the ADA Seal of Acceptance. The Seal of Acceptance provides a quality-assurance guarantee for consumers and professionals. Check the ADA's website, for current information on toothbrushes, dentifrices, interproximal aids, and products for the prevention of gingivitis and caries. Members of the dental team should be up to date on new oral health care products. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 63

Fig. 15-29 The ADA’s Seal of Acceptance.

Preventive Dentistry Chapter 15 1

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