Oral hygiene measures1. Cleaning between the teeth
A. Wood points (tooth picks): is effective only where sufficient inter dental
space is available to accommodate it. It is used in case of bone resorption
causing spaces between the teeth.
Triangular (best one).
According to materials used, we have:
Wood resilient pick, moist in saliva and use it.
Plastic pick, not good and not preferred to be used.
B. Dental floss: needs digital skills, time consuming than wood points . Takeabout 30 cm, tie it around index finger of both hands and use it between
teeth toward the proximal surfaces of the teeth, but no downward to avoid
damaging the gingiva. There are two types:
Waxed type. Used in case of proximal box class 2 amalgam filling because it
is slippery but should not be used prior to fluoride application because it
forms a layer on the tooth surface that prevent the action of fluoride.
Unwaxed type: is used before flu oride application an in normal situation.
When teeth brushing is accompanied by flossing, more plaque tend to be
removed from the proximal surfaces than by teeth brushing alone.
C. Inter space brush (single -tufted tooth brush): It was introduced to improveaccess to tipped, rotated or displaced teeth and teeth affected by gingival
recession. The combined use of the inter space brush and wood points
compensates for the lack of effectiveness of wood points alone with lingual
embrasures. Inter space brush is of limited value on its own at cleaning
proximal surface aspect for surfaces adjacent to an extraction space.
D. Inter dental brush (bottle brush): used for cleaning of open interdentalspaces. Types include:
Large type, held by its wire handle.
Small type, prov ided with metal or plastic handle.
E. Irrigation devices: these provide a steady or pulsating stream of waterescaping through a nozzle under pressure. Oral irrigation should not be used
as a substitute for teeth brushing, and are time consuming and messy to use.
Frequency of teeth cleaning:
a) The removal of accumulated plaque must be at intervals which are
sufficiently frequent to prevent pathological effects.
b) Individuals with healthy gingiva and no history of periodontal disease can
prevent gingivitis by very thorough mechanical plaque removal every 24
c) Following the first clinical signs of inflammation, the introduction of
thorough oral hygiene measures, twice daily, achieve a resolution of
gingivitis within few days.
Natural methods of teeth cleaning Fibrous foods, like apple and carrot, because these foods contain fibrous
filaments and malic acids which stimulate the flushing of saliva .
Sugar free chewing gum that stimulate the flow rate of saliva.
Chemical methodsChemicals can help to reduce plaque formation.
Chlorhexidine: is a chemical anti -septic material that can be bactericidal in high
concentration and bacteriostatic in low concentration, can kill microorganisms and
inhibit their growth respectively, according to the concentration that has bee n used.
Is the most effective method of chemical plaque control, has a broad spectrum ofbactericidal activity against gram - positive and gram - negative organisms. The
positively charged (Ch) binds to bacterial cell wall and to various oral surfaces
includ ing the hydroxyl apatite of the tooth enamel, the organic pellicle covering the
tooth surface, mucous membrane and salivary protein. Besides acting immediately
on oral bacteria, it is retained on teeth surfaces to exert a prolonged bactericidal
effect and subsequently as its concentration falls, a bacteriostatic effect for several
hours. It interacts with bacteria, damaging permeability barrier and precipitating
cytoplasm. The pharmacodynamics of chlorhexidine in the mouth indicate that the
frequency of app lication should not be less than twice daily (0.2% aqueous mouth
rinse in 10 ml doses for 1 minute twice daily), reduce salivary bacterial count by
85 -95%. Also used to prevent plaque accumulation and gingivitis development in
subjects whose habitual mecha nical cleaning is suspended.
Types of administration:
Tooth paste (1%).
Irrigator or spray (1.5 -2.0 ml of 0.2 % solution).
Dose of mouth rinse:
10 ml of 0.2% twice daily.
15 ml of 0.12% twice daily.
5-7 days and duration of rinsing i s 2 -3 minutes.
a. Taste disturbance. It has unpleasant taste and produce disturbances in taste
sensation which may last for several hours.
b. Staining. The development of yellow brown stain on teeth, tongue and
margins of anterior restorations. There is an interaction between locally
ad sorbed chlorhexidine and factor s derived from the diet like substances in
tea and coffee. This interaction is r esponsible for the characteristic stain.
c. Desquamative lesion of the oral mucosa. Occur in small number of
individuals, perhaps due to precipitation of acidic mucins and proteins that
cover and protect the mucous membrane. This makes the epitheliumvulnerab le to mechanical trauma or to cytotoxic effect of chemicals
including chlorhexidine itself.
d. Parotid gland swelling. A few cases of unilateral or bilateral parotid gland
swelling have been reported after its use. The clinical feature is suggestive of
mechan ical obstruction of the parotid duct.
e. Supra gingival calculus formation. There is also tendency for more supra
gingival calculus to be formed. The mechanism for this effect may involve
the suppression of acidogenic plaque bacteria and the pH at the tooth surface
being raised, leading to precipitation of calcium and phosphate.
1. Scaling and root planning
Scaling alone is sufficient to completely remove plaque and calculus from
enamel, le aving a smooth clean surface which will facilitate plaque removal for the
Mechanical instrumentation of the root aims to produce a surface that is
biologically acceptable to the periodontal tissue.
Polishing enamel may result in reorientation of s urface crystal to create a
smoother surface which will facilitate plaque removal for the patient.
Supportive periodontal care. Aims:1. Prevent the recurrence and progression of periodontal disease.
2. Prevent or reduce tooth loss.
3. Increase the probability of diagnosing and treating, in a timely manner, other