Educational elements
Purpose of the lesson: Study and master oral care techniques.
Key terms: oral hygiene, methods of brushing teeth, tongue, standard method of brushing teeth.
Security questions:
5) Control of the initial level of knowledge
6) Interview on the topic
a) algorithm for oral hygiene.
b) methods of brushing teeth
c) use of floss, flossettes, flossstick, tape
d) using a toothpick
d) use of an irrigator
f) mistakes made when caring for the oral cavity
3) Control of knowledge acquisition
Presentation of educational material
Oral hygiene is a set of measures, the most important component of which is brushing your teeth. According to WHO, 92% of the population does not know how to brush their teeth. Oral hygiene for most Russian children is limited to a set of empirical manipulations using a standard toothbrush and paste.
Teeth brushing algorithm
1) Wash your hands with soap.
2) Rinse your mouth with warm water.
3) Rinse your toothbrush thoroughly with water.
4) Brush your teeth with a toothbrush and toothpaste
5) Rinse your mouth.
6) Lather the working part of the toothbrush with soap or treat it with a special solution.
7) Place the toothbrush in the box with the head up
Options are possible depending on the age of the child, the type of toothpaste, the condition of the oral cavity, the preferences of the individual, etc.
Using a toothbrush
Toothbrush movements when brushing teeth:
· Vertical (sweeping) are performed along the axis of the tooth from the gums and are intended to remove plaque from the vestibular and lingual surfaces, partially the cervical area and interdental spaces, and gums.
· Horizontal (reciprocating) are designed to remove plaque from occlusal surfaces.
· Rotational (circular) are designed to remove plaque from fissures and pits, the cervical area and massage the gums.
Carrying out the sequential steps of the standard method of brushing teeth is guided by the correct position of the brush in relation to the various surfaces of the teeth, the correct choice of the type of movements and the required number of movements on the surfaces of various groups of teeth.
There are many known methods of brushing teeth (Leonard, Bass, Fones, Reite, Charter, Smith-Bell, Stillman, Pakhomov, Bokoy).
Standard method of brushing teeth (Pakhomov G.N.). The dentition is conventionally divided into 6 segments (molars, premolars, incisors with canines). Cleaning is carried out with open dentition. The brush is positioned at an angle of 45 degrees to the tooth axis and, using 10 vertical sweeping movements, plaque is removed from the vestibular surface of the upper left molars. All segments of the upper jaw are cleaned one by one. The palatal surface is cleaned in the same way. On the lower jaw the sequence and types of movements are repeated. The chewing surface of the teeth is cleaned using back-and-forth movements.
Leonard method provides two types of movements: vertical and horizontal. The head is installed perpendicular to the axis of the tooth, and plaque is removed from the vestibular and oral surfaces using vertical movements from the gums. The occlusal surface is cleaned with reciprocating horizontal movements.
Fones method carried out with closed dentition. The toothbrush is placed perpendicular to the axis of the tooth and performed in a circular motion, while simultaneously cleaning the vestibular surfaces of the teeth of the upper and lower jaw. The lingual and chewing surfaces are also cleaned with circular movements.
Charter Method Designed for both cleaning teeth and massaging gums. It is an additional therapeutic measure for inflammatory periodontal diseases. The toothbrush is placed at an angle of 45° to the tooth axis with the bristles towards the cutting edge of the tooth. When performing light circular movements, the bristles penetrate into the interdental spaces. After three or four movements, the toothbrush is moved to a new group of teeth and the entire process is repeated. This method is recommended for school-age children who have certain manual skills. Cleaning is carried out under the supervision of a dentist.
Self-controlled teeth brushing method (Bokaya V.G.). Before cleaning, the teeth are stained. Vestibular and oral surfaces are cleaned with vertical movements with maximum grip of the gums. The vestibular surfaces are cleaned with the jaws closed in a direct bite, grasping the gums up to the transitional folds. The patient monitors the quality of cleaning by checking the presence of dye every five movements. Maximum grip of the gum ensures thorough removal of plaque and massage, while the mucous membrane acts as a dispenser for the force of cleaning movements.
A large number of methods for brushing teeth indicates the urgency of the problem. It is difficult to imagine the existence of a simple and effective method of brushing teeth that is universal for everyone. It is impossible to use a single method for adults and children, with a healthy oral cavity and its pathology, in the absence or presence of “orthodontic” problems. At the same time, compliance with certain generally accepted basic principles will optimize the process of removing plaque.
It should be noted that the clinical effectiveness of toothbrushes is to a lesser extent determined by their design features. More important factors are careful instruction in oral hygiene and proper brushing techniques.
To evaluate the effectiveness of individual oral hygiene and
To motivate the patient to improve the quality of teeth cleaning, controlled dental brushing (CDB) is carried out by the individual under the control of the hygiene index in the presence of a specialist.
Controlled teeth brushing is an integral part of a set of measures for hygienic education and upbringing (GO&E) of a child. Dental hygienists are currently engaged in developing knowledge and skills in oral hygiene among the population. However, if necessary, a dentist can participate in the process. CCH is carried out in several visits.
KChZ methodology
On your first visit A complete dental examination of the patient is carried out, the data is recorded in the medical record. In the presence of an intraoral camera, the patient is shown the identified dental “problems”, including existing microbial plaque. To enhance the effect, you can stain the plaque. The video presentation is accompanied by detailed explanations. The hygiene index is determined if no more than 5 hours have passed since brushing your teeth.
On the second visit the child brings used items and oral hygiene products. The specialist evaluates the condition of the toothbrush, floss, the characteristics of the toothpaste and their compliance with the condition of the patient’s oral cavity. The child, in the presence of his parents (if possible, without their participation in the conversation), talks about individual oral hygiene. After this, teeth are cleaned with the determination of GI before and after manipulation. The hygienist sits nearby as an observer and records all deficiencies, but does not interfere with the process. The effectiveness of brushing teeth is assessed by the difference in GI scores. When indicated, adequate items and means of oral hygiene are selected and training in the rules of oral care is carried out.
On the third visit the child comes with a new toothbrush (floss, flossstick, scraper) and toothpaste (rinse, spray). The CCR is being carried out and corrections are being made. In the future, the frequency of visits is determined by the hygienist individually.
Individual quality control of cleaning teeth is carried out by the patient or parents. For this purpose, special dyes are used: a solution of basic fuchsin, erythrosine, Schiller-Pisarev, Lugol, erythrosine containing tablets. Tablet preparations at home are preferable, as they are more hygienic and stain the entire plaque. It is better to conduct the KChZ in the evening if parents have free time.
Using floss
Flossing is a procedure for cleaning interdental spaces and contact surfaces of teeth using floss. The thread is used after each meal, usually 2-3 times a day.
Flossing technique:
Wash your hands;
Cut the floss 20–30 cm long;
Fix the ends of the floss on the middle fingers, winding it around one much larger fragment;
Using your index fingers and thumbs, the floss is carefully inserted into the interdental space;
Covering the neck of the tooth in the form of a half-loop, carefully move the thread away from the gums with sawing and vertical movements;
Renew the working part of the thread by moving the loops on your fingers;
At the end of the procedure, discard the floss;
Wash your hands.
Using a flosset or flossstick is much more convenient, easier, and helps develop the habit of flossing.
Using a toothpick
Toothpicks are used in the absence of other oral hygiene items. Method of application: place the toothpick at an angle of 45 degrees to the tooth, with the end located in the periodontal sulcus and the side pressed against the surface of the tooth. The tip of the toothpick is then moved along the tooth, following from the base of the groove to the contact point of the tooth.
Using an irrigator
Irrigators are used as an additional hygiene item to clean hard-to-reach areas of the oral cavity and massage the gums. After traditional brushing of teeth with a brush and paste, a powerful stream of water is directed into the interdental spaces, under the fixed elements of orthodontic equipment. The sequence of segment cleansing is similar to the standard method. The use of IPR in children contributes to the development of oral care habits, as it is an element of the game for them.
Tongue cleaning
Tongue hygiene involves removing plaque, mucus, and food debris using a regular toothbrush, a special toothbrush, an electric toothbrush tongue cleaner, or a scraper. Particular attention to tongue hygiene should be paid in the presence of diseases of the gastrointestinal tract, folded or “geographical” tongue. In these cases, a large amount of mucus and plaque accumulates on the tongue, which creates favorable conditions for the reproduction and activity of pathogenic microorganisms.
Tongue hygiene is carried out after brushing your teeth. A medium-hard brush moves with sweeping movements from the root of the tongue to the tip. The number of movements is variable, on average 10–12. After several movements, the brush must be rinsed under running water to remove mucus. The brush is moistened with water or toothpaste. However, the use of a foaming paste is not advisable, since a gag reflex may occur.
Using a scraper is similar to the above method. The scraper must be used carefully to avoid injury to the tongue.
To cleanse your entire mouth, the Colgate 360° Tongue Cleaner is specially designed to remove up to 36% more bacteria that causes bad breath.
Individual oral hygiene products include:
- toothbrushes;
- dental floss;
- toothpicks;
- interdental stimulators;
- devices for cleaning the tongue;
- interdental brushes;
- oral irrigators;
- tooth powders;
- toothpastes and gels;
- rinse aids
- deodorant sprays;
- chewing gum;
- care products for removable orthopedic and orthodontic structures;
- dyes for self-identification of dental plaque;
- individual dental mirror.
Rice. 9.1. Toothbrushes
Rice. 9.2. Types of toothbrushes
The variety of brushes is explained by the desire of manufacturers to ensure maximum efficiency for the purpose of ease of use, i.e. ergonomics.
Recently, there has been a trend towards smaller brush heads, as researchers believe this makes it easier to reach hard-to-clean areas. Today it is generally accepted that to effectively brush your teeth, you should use a brush whose head size allows you to simultaneously cover 2-3 teeth. If you have fixed orthopedic and orthodontic structures or with an atypical structure of the dentition, it is advisable to use special-purpose brushes with a small round head, 6-7 tufts of bristles and a multi-level brush field. This type also includes monotuft brushes, which in function are close to interdental oral hygiene products. They effectively remove
plaque in the fissures of the teeth, clean the spaces along the orthodontic arches and under the washing parts of the bridges. Such toothbrushes are also effective for cleaning the cervical area from the lingual/palatal surface of the teeth and when they are crowded (Fig. 9.3). 
The effectiveness of using toothbrushes also depends on their hardness.
There are five degrees of toothbrush hardness:
- very hard;
- hard;
- medium hardness;
- soft;
- very soft.
Modern brushes use synthetic smooth bristles and synthetic micro-textured bristles. There are many brush designs.
According to the number of rows of bristles, brushes are single-tufted, double-rowed (sulcular), three-rowed and multi-rowed.
The shape of the brush field can be flat, convex, multi-level, zigzag and reinforced (with a power protrusion).
Brushes are divided into children's, teenage and adult brushes based on the size of the working part.
According to the method of actuation - manual, automatic.
By purpose - for standard and special purposes.
Currently, mainly artificial fibers are used to make toothbrushes. This is due to the fact that artificial fiber does not have a middle channel where microorganisms can accumulate. The special rounding of the fiber tips makes them minimally traumatic. In addition, artificial fiber bristles are non-hygroscopic, while natural bristles do not have these properties.
Many modern brushes use combinations of bristles of varying stiffness to more effectively clean tooth surfaces.
The formation of a brush field due to tufts standing at an angle to each other ensures deeper penetration of opposing tufts into the interdental space. The greatest cleaning effect when using such brushes can be achieved with their vertical movements, while with horizontal movements of the brush the advantage is sharply reduced.
The toothbrush should be stored open with the head facing up, which allows it to dry well.
The Oral-B Advantage Plus toothbrush belongs to the modern generation of toothbrushes. It provides high maneuverability of the hygienic procedure due to the original location, shape and height of the bristle tufts, torpedo-shaped head and comfortable handle.
The same example is the Press control toothbrush (manufactured by Fuchs), which combines two levels of bristle cutting, a power protrusion and a flexible neck, with the help of which the force of pressing on the gums is controlled.
As for the ability of the brushes to massage the adjacent gum, this is more feasible if the tips of the bristles are rounded and polished.
The length of the working part of the brush for children should be in the range of 18-25 mm, for adults - 23-30 mm, and the width - 7-9 and 7.5-11.0 mm, respectively.
Maintaining oral hygiene is the key to healthy teeth. As a result, the process of enamel destruction may begin or develop.
The most effective way to prevent dental diseases is to follow the rules of oral care using all the products recommended by a specialist. Therefore, you shouldn’t limit yourself to simple.
Prevention includes a complex of various measures:
- and tongue twice a day;
- after meals;
- for cleaning the interdental space;
- visiting the dental office twice a year for timely detection of diseases.
Keeping your teeth, tongue and gums healthy is essential to preventing dental disease. If you do not maintain oral hygiene, a thick coating will be deposited on your tongue.
You can get rid of food debris using a brush, but if you have one, you can’t do without special tools and products. To prevent this, it is necessary to observe not only independent oral hygiene, but also resort to professional hygiene.
Individual oral hygiene methods
When it comes to hygiene, it is important not only to use suitable products, but also to know the cleansing technique.
Basic rules for cleaning the mouth:
- You need to start cleaning from the upper row of teeth:
- The teeth cleaning process should last from 3 to 4 minutes.
Teeth brushing scheme
There are several techniques for cleaning the oral cavity; the Leonard method is considered the most effective. It lies in the fact that the brush must be positioned perpendicular to the dentition. On the lower jaw, manipulations should be carried out from bottom to top, and on the upper jaw, from top to bottom.
There is also another method of cleansing the oral cavity - “Stillmann”. Its essence is that the toothbrush should be positioned at an angle of 45 degrees.
When brushing, light movements and slight pressure on the brush are necessary so that it can penetrate between the teeth for greater effectiveness. The cleaning process itself is carried out using a circular technique, provided that the jaw is closed, and the brush should not touch the gums, so as not to injure it.
- teeth are vulnerable to the effects of food, for this reason it is recommended to carry out. It is not necessary to use a brush; regular warm water is enough to rinse your mouth;
- is a prerequisite for maintaining the normal condition of the gums and teeth, since not all brushes are able to remove food debris from the space between the teeth. This also reduces the risk of occurrence. When performing the procedure for cleaning the interdental space, it is important to be careful, making gentle movements with the floss and not applying pressure, so as not to damage the gums;
- Traditional teeth cleaning must be carried out without fail: morning and evening.
Professional hygiene procedures in dentistry
Professional oral hygiene is necessary for and. To carry out this procedure, you need to visit a dentist. There are no age restrictions in professional hygiene, but the specialist must take into account the individual characteristics of the patient.
Stages of professional hygiene:
Items and personal hygiene products for the oral cavity
The main products for individual oral hygiene include:
- , and gel;
- therapeutic and prophylactic chewing gum.
If dental implantation has been performed, the selected paste should be intended for implants. If it is necessary to lighten the enamel surface, you can use the bleaching option. And to strengthen teeth, restorative pastes are used.
Additional personal oral hygiene products include:
- dental floss and toothpicks;
- scraper brushes;
- teeth whitener;
- powder or ;
- foam;
- deodorant;
Dentists' advice on choosing personal hygiene products
The choice of toothpaste is quite important for maintaining personal hygiene and maintaining healthy teeth and gums. There are a large number of these products on the market and it is usually difficult to choose a good product based only on the cost of the product.
In order not to harm your dental health, it is necessary to select a toothpaste recommended by dentists and suitable for daily hygiene procedures.
They can be therapeutic or preventive; in the first case, they are selected exclusively by the attending physician. Dentists recommend changing the toothpaste every 2 months and, if necessary, using products with different effects.
Before purchasing dental floss, you should consult a specialist. used for people with wide interdental spaces.
Flat floss can be used for severely crowded teeth. Volume flosses are used for those who suffer from and. There are also superflosses; they are threads of a more universal option, having sections of different diameters.
To prevent caries, preference should be given to products based on sodium fluoride or amino fluoride. The fluorine content in the solution should not be lower than 250 ppm.
You should not choose a mouthwash that contains , they can only be used for 2-3 weeks. Such drugs are prescribed to patients as part of or.
Motorists and children should make sure that the rinse aid is alcohol-free.
Video on the topic
About common personal oral hygiene products and how to use them in the video:
The choice of personal oral hygiene products is extremely important for the prevention of various diseases. It is best to consult your dentist to determine the most appropriate toothbrushes, toothpaste, floss, mouthwash, and other devices. They will be recommended depending on the presence of any inflammation or other oral problems.
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Individual oral hygiene is the patient’s careful and regular removal of dental plaque from the surfaces of teeth and gums using various means.
Oral hygiene is a major component of preventing dental diseases. Systematic brushing of teeth and removal of soft dental deposits contribute to the physiological process of maturation of tooth enamel.
Biologically active components included in hygiene products enrich tooth and periodontal tissues with phosphates, calcium, microelements, vitamins, increasing their resistance to harmful influences. Regular gum massage while brushing your teeth helps activate metabolic processes and improve blood circulation in periodontal tissues.
Personal oral hygiene products:
■ toothbrushes;
■ toothpastes;
■ dental floss;
■ toothpicks;
■ tongue brushes;
■ chewing gum;
■ chewable tablets;
■ mouth rinses.
Toothbrushes
A toothbrush is the main tool for removing deposits from the surface of your teeth and gums.Since ancient times, the peoples of Asia, Africa, and South America chewed the leaves and branches of aromatic plants, and used the split ends of these branches to clean the surfaces of teeth and gums. In India, to this day, some peoples use neem tree branches for this purpose. The first toothbrush, reminiscent of modern ones, made from pig bristles, appeared in China in the 14th century. In Rus', during the reign of Ivan the Terrible, after meals they used a “pig broom” or a broom stick with a tuft of bristles.
Currently, there are many models of toothbrushes, the purpose of which is to remove plaque from the smooth, occlusal and proximal surfaces of teeth.
A modern toothbrush consists of:
■ handles;
■ heads.
In some toothbrushes, the connection between the head and the handle is made flexible to make the head more flexible. Toothbrushes are different:
■ sizes;
■ properties of fibers;
■ the shape of the head and the location of the beams;
■ rigidity;
■ handle design.
Size
By size, toothbrushes are divided into:■ large;
■ average;
■ small.
This has more to do with the size of the head. If previously brushes with a large head were mainly used, now, based on scientific research, preference is given to brushes with a small head, which are easy to manipulate in the oral cavity and clean hard-to-reach tooth surfaces. Today, such brushes are recommended for use by both adults and children.
The size of the head in a children's brush should be 18-25 mm, in a brush for adults - no more than 30 mm.
Fiber properties
Synthetic fibers are predominantly used to make toothbrushes.At the same time, there are still brushes made from natural bristles on sale. This material is naturally inferior to synthetic fibers in quality.
Its disadvantages are the presence of a middle channel filled with microorganisms, the difficulty of keeping the brush clean, the impossibility of perfectly smooth processing of the ends of the bristles, and the difficulty of giving it a certain rigidity.
Synthetic fiber bristles were initially made with sharp ends, but it was later discovered that they could injure soft tissue. If the bristles have a sharp end, are unfibered, or are hollow, then bacteria and viruses can multiply on their surface and in the depths. For this reason, the ends of the bristles are now rounded.
Head shape
In the lateral projection, several profiles of the toothbrush head can be distinguished:■ flat;
■ concave;
■ convex;
■ multi-level.
It is better to clean the vestibular surfaces of the teeth with a brush with a concave shape of the working part of the head, while with a convex shape it is better to clean the lingual surfaces.
Brushes with bristles located at different levels are more effective than flat brushes in removing plaque, especially from the proximal surfaces of teeth.
Fiber bundle arrangement
In the brush head, the bristles are organized into tufts, which are usually arranged in 3 or 4 rows. This arrangement allows for better cleaning of all surfaces of the teeth.As a rule, the tufts of bristles have different heights: longer (softer) along the periphery, shorter in the center.
Each group of beams contributes to a more thorough removal of plaque in a particular area of the dentition. Straight high fibers clean plaque in interdental spaces; short ones - in fissures. Bundles of fibers located in an oblique direction, penetrating into the periodontal sulcus, remove plaque from the cervical area.
Toothbrushes with a V-shaped arrangement of fiber bundles are recommended for cleaning plaque from the contact surfaces of teeth in people with wide interdental spaces.
Some toothbrush models have a power projection to better clean the molars, especially the distal surfaces of the last molars, and penetrate deeply into the interdental spaces.
Often, toothbrushes have an indicator - two rows of tufts of fibers colored with multi-colored food dyes that fade with use. The signal to replace the brush is when the bristles become discolored by half their height. This usually occurs after 2-3 months with daily brushing of teeth twice a day.
Rigidity
The stiffness of the brush depends on the composition of the fiber, the diameter and length of the bristles, and the number of bristles in the tuft.There are several degrees of toothbrush hardness:
■ very hard;
■ hard;
■ average;
■ soft;
■ very soft.
Recommendations for patients on the use of a toothbrush of varying degrees of hardness are purely individual. The most widely used brushes are medium-hard brushes. Typically, children's toothbrushes are made from very soft or soft fiber. Toothbrushes of the same degree of hardness are recommended for use in patients with periodontal disease. Hard and very hard toothbrushes can only be recommended to people with healthy periodontal tissues, however, if the cleaning method is incorrect, they can injure the gums and cause abrasion of hard tooth tissues.
It should be noted that medium-hard and soft brushes are most effective, because... Their bristles are more flexible and penetrate better into interdental spaces, dental fissures and subgingival areas.
Handle design
The shape of the handle of toothbrushes can be straight or curved at different angles, but its length should be sufficient to ensure maximum comfort when brushing your teeth. The design of a toothbrush handle is currently also being developed using special computer programs to take into account all ergonomic requirements.There are toothbrushes in which, when brushing your teeth (for 2-3 minutes), the original color of the handle changes. It is advisable to recommend this model of toothbrush to children, which makes it possible to teach the child to brush their teeth correctly. Toothbrushes that have a rattle built into the handle have the same property. With correct (vertical) movements of the brush, a sound is made, and with horizontal (incorrect) movements, the toothbrush is “silent”.
Toothbrushes produced by well-known companies meet modern requirements and take into account the achievements of science and technology. The result is the appearance of toothbrushes of original design.
In 1998, a new model of toothbrush was developed - Oral-B eXceed, which uses microtextured fiber that cleans plaque over the entire surface of the bristles. In the head of this brush, the tufts have different heights and are located in two directions, at different angles to the base. In this case, tufts with a forward slope penetrate between the teeth and loosen plaque, while tufts with a backward slope remove plaque due to sweeping movements.
Intersecting bundles of bristles allow you to remove plaque not only from smooth, but also from the proximal surfaces of the teeth, as well as from the adjacent gums.
The Colgate Total toothbrush has three groups of bristles: short inner bristles remove plaque from the surface of the teeth, long inner bristles from between teeth, and long outer bristles, located at an angle, remove plaque from the gingival groove and massage the gum.
A distinctive feature of Intradent toothbrushes is bristles impregnated with sodium fluoride.
In Fuchs toothbrushes, the bristles have several microvilli on the side surfaces and are rounded at the ends. These brushes attach the bristles without using metal or drilling holes, which avoids gaps where bacteria can accumulate. Thanks to this system of replaceable heads, the life of the brushes is increased.
In addition to regular toothbrushes, electric toothbrushes are becoming increasingly popular these days. Previously, electric toothbrushes were recommended only for people with disabilities or people who had insufficiently developed teeth brushing skills. However, studies conducted to date have convincingly proven the superiority of electric toothbrushes in removing plaque.
Special children's models have been developed for children.
G.M. Barer, E.V. Zoryan
Basic:
v toothbrush
v dental floss
v toothpick
Additional:
v irrigators
v interdental stimulators
Toothbrush is the main tool for removing deposits from the surface of teeth and gums. It is known that the peoples of Asia, Africa, and South America used devices similar to a toothbrush as early as 300-400 BC. e. Toothbrushes began to be used in Russia around the 18th century.
Currently, there are many models of toothbrushes, the purpose of which is to remove plaque from the smooth and occlusal surfaces of teeth.
A toothbrush consists of a handle and a working part (head) with tufts of bristles located on it. Types of toothbrushes differ in the shape and size of the handles and working part, the location and density, length and quality of the bristles. Toothbrushes use natural bristles or synthetic fiber (nylon, setron, perlon, dederlon, polyurethane, etc.). However, compared to synthetic fiber, natural bristles have a number of disadvantages: the presence of a middle channel filled with microorganisms, the difficulty of keeping brushes clean, the impossibility of perfectly smooth processing of the ends of the bristles, and the difficulty of giving it a certain rigidity.
A toothbrush made of natural bristles is best used for hyperesthesia and increased tooth abrasion. Artificial bristle brushes should be used in the absence of pathological changes in the hard tissues of the tooth. They are better at removing plaque from molars. Currently, preference is given to brushes made of artificial fiber.
The effectiveness of using a toothbrush is determined by the correct individual selection, taking into account its rigidity, the size of the brush field, the shape and frequency of fiber bushing.
There are five degrees of toothbrush hardness:
very hard (“extra-hard” type) - used for cleaning dentures when the enamel is mature and there is a tendency to increased formation of dental plaque
· rigid (type “hard”)
medium hardness (medium type)
· soft (“soft” type) – used for cleaning baby teeth, teeth with low-mineralized enamel, in case of inflammatory diseases of periodontal and oral mucosa in the acute stage in order to avoid their injury
· very soft (type “sensitive”)
Based on the number of rows of bristles, brushes are:
· single-beam
two-row (sulcular)
· three-row
· multi-row
The shape of the brush field can be:
· convex
· multi-level
zigzag
· reinforced (with power protrusion)
Based on the size of the working part, brushes are divided into:
· children's
· teenage
· adults
Recommendations for patients on the use of a toothbrush of varying degrees of hardness are purely individual. The most widely used brushes are medium-hard brushes. Typically, children's toothbrushes are made from very soft or soft fiber. Toothbrushes of the same degree of hardness are recommended for use in patients with periodontal disease. Hard and very hard toothbrushes can only be recommended to people with healthy periodontal tissues; however, if the cleaning method is incorrect, they can injure the gums and cause abrasion of hard tooth tissues.
It should be noted that medium-hard and soft brushes are most effective, since their bristles are more flexible and better penetrate into the interdental spaces, dental fissures and subgingival areas.
The size of the working part determines the ability of the toothbrush to clean all surfaces of the teeth, even hard-to-reach ones. Nowadays (for both adults and children) it is recommended to use brushes with a small head that are easy to manipulate in the mouth. Its dimensions for children are 18-25 mm, for adults - no more than 30 mm, while the fibers are organized into bundles, which are usually arranged in 3 or 4 rows. This arrangement of fibers allows you to better clean all surfaces of the teeth.
There are many models of toothbrushes with different shapes of the working part.
Toothbrushes with a V-shaped arrangement of fiber bundles are recommended to be used to clean plaque from the contact surfaces of teeth in people with wide interdental spaces. In most cases, the working part of toothbrushes has tufts of bristles of different heights: longer (softer) along the periphery, shorter ones in the center.
New models of toothbrushes have a power protrusion for better cleaning of molars and deep penetration into the interdental spaces, as well as an active recess that allows you to clean all surfaces of the teeth and massage the attached gum area. Some toothbrush heads consist of a combination of tufts of bristles, varying in height and positioned at different angles to the base. Each group of beams contributes to a more thorough removal of plaque in a particular area of the dentition. Straight high fibers clean plaque in interdental spaces; short ones - in fissures. Bundles of fibers located in an oblique direction, penetrating into the dental-gingival sulcus, remove plaque from the cervical area. New models of toothbrushes often have an indicator - two rows of tufts of fibers colored with multi-colored food dyes. As the brush is used, it becomes discolored. The signal to replace the brush is discoloration at 1/2 the height of the bristles, which usually occurs after 2-3 months with daily brushing of the teeth twice.
Toothbrush handle shapes can also be different: straight, curved, spoon-shaped, etc., however, its length should be sufficient to ensure maximum comfort when brushing your teeth.
There are toothbrushes in which, when brushing your teeth (within 2-3 minutes), the original color of the handle changes. It is advisable to recommend this model of toothbrush to children, which makes it possible to teach the child to brush their teeth correctly. Toothbrushes that have a rattle built into the handle have the same property. With correct (vertical) movements of the brush, a sound is made, and with horizontal (incorrect) movements, the toothbrush is “silent”.
Electric toothbrushes(Fig. 9) - with their help, circular or vibrating automatic movements of the working part are carried out, this allows you to thoroughly remove plaque and at the same time massage the gums. The use of an electric toothbrush can be recommended for children, the disabled, or patients with insufficient dexterity.
Rice. 9. Electric toothbrushes
Contraindications to brushing your teeth with an electric brush are::
1) degree 3 tooth mobility;
2) hypertrophic gingivitis;
3) stomatitis;
4) periodontal surgical interventions;
5) operations, incl. oncological, in the oral cavity.
Additional oral hygiene products include toothpicks, dental floss, special toothbrushes and brushes.
Toothpicks(Fig. 10) are designed to remove food debris from the interdental spaces and dental plaque from the lateral surfaces of the teeth. When using toothpicks, they are placed at an angle of 45° to the tooth, with the end of the toothpick in the gingival groove and the side pressed against the surface of the tooth. The tip of the toothpick is then moved along the tooth, following from the base of the groove to the contact point of the teeth. If a toothpick is used incorrectly, injury to the interdental papilla and changes in its contour may occur. This in turn leads to the formation of space, a gap between the teeth. Toothpicks are made of wood and plastic; their shape can be triangular, flat or round; sometimes toothpicks are flavored with menthol.
Rice. 10. Using a toothpick
Flosses(dental floss) are designed to thoroughly remove plaque and food debris from contact surfaces of teeth that are difficult to reach with a brush.
Dental floss is classified according to its cross-sectional shape:
· round
· flat
For surface treatment:
Waxed – used for crowded teeth, large amounts of tartar or overhanging edges of fillings
· unwaxed - thin and easier to penetrate into interdental spaces with tightly spaced teeth
· superflosses – threads with one-sided thickening. This thread has a hard tip and a combination of unwaxed fragments and wider nylon fiber. With its help, you can clean the contact surfaces of teeth, as well as more thoroughly remove food debris and plaque from orthopedic and orthodontic structures.
According to the presence of impregnation:
· without special impregnation
· impregnated with therapeutic and prophylactic substances (menthol, menthol-fluorine, fluorine, etc.)
By fiber:
multi-fiber - dental floss consists of many fibers
low fiber
· monofilament
By structure:
· ordinary
bicomponent - a thread that, in addition to nylon, includes another fiber - Pebax
Method of using thread(Fig. 11). A thread 35 - 40 cm long is wound around the first phalanx of the middle fingers of both hands. Then carefully insert a tensioned thread (using index fingers on the lower jaw and thumbs on the upper jaw) along the contact surface of the tooth, trying not to injure the periodontal papilla. With a few strokes, the threads remove all soft deposits. Consistently clean the contact surfaces on all sides of each tooth. If used improperly, the gums can be damaged, so the use of threads is possible only after preliminary training of the patient. Children can use floss on their own starting at the age of 9 - 10 years. Before this age, parents are recommended to clean the contact surfaces of children’s teeth.
Rice. 11. Using floss
Currently, fluoride-impregnated threads have begun to be used. This type of hygiene product allows you to further strengthen the enamel in hard-to-reach places for brushing your teeth and help prevent caries.
In addition, there are superflosses(Fig. 12) - threads with one-sided thickening. These threads allow you to clean the contact surfaces of the teeth, and also contribute to a more thorough removal of food debris and plaque from the orthopedic and orthodontic structures existing in the oral cavity.
Rice. 12. Applying superfloss
Interdental brushes(Fig. 13, 14) are intended for cleaning wide interdental spaces, spaces under fixed orthodontic arches (in particular, in the presence of braces), areas under the washing parts of bridges and spaces between implanted implants and dentures, exposed bifurcations and trifurcations of teeth. The brush is made of nylon bristles fixed to a thin wire base. The shape of the working part of the brush can be conical or cylindrical. Cleaning with a brush is carried out in a reciprocating motion in a clockwise direction. The bristles of the brush have a massaging effect on the papillary and marginal parts of the gums.
Rice. 13.Dental brushes for cleaning the contact surfaces of teeth
Rice. 14. Using an interdental brush
Interdental stimulators They are elastic cones made of rubber or soft plastic of varying degrees of hardness. They are designed to massage the gingival papillae and clean the interdental spaces. With light pressure on the gingival papilla, the stimulator is moved into the interdental space with progressive circular movements.
Interdental stimulators are indicated for oral care in cases of progressive retraction of marginal gums, wide interdental spaces, the presence of chronic periodontal diseases or factors predisposing to their development.
Oral irrigators, or hydromassages(Fig. 15), provide cleaning of the oral cavity with a constant or pulsating stream of liquid under pressure, which significantly improves the quality of oral hygiene, improves blood circulation in periodontal tissues due to the effect of hydromassage of the gums.
Oral irrigators have the form of nozzles that precisely deliver a stream of liquid under pressure. The strength of the fluid flow is adjustable. When irrigators operate in the “jet” mode under pressure, food debris and partially soft plaque are washed away from the surface of the teeth, from the interdental spaces, from the gums, tongue, and oral mucosa. When working in the “shower” mode, the gums, oral mucosa and tongue are massaged, which helps normalize peripheral blood circulation.
Basic rules for oral irrigation:
v the procedure should be carried out after cleaning the mouth with a toothbrush, once a day in the evening is enough. The procedure usually lasts for 5-20 minutes;
v use warm water or solution (approved liquids to fill the irrigator reservoir). Direct the jet at an angle of 90 degrees (at right angles) to the gum surface;
v difficult-to-clean areas should be treated longer than accessible ones.
Rice. 15.Individual irrigator for oral care
Toothpastes designed for cleaning teeth. They contain substances that have a cleansing (abrasive) effect to better remove plaque from all surfaces of the teeth.
Types of toothpastes:
· hygienic - designed to remove dental plaque and deodorize the oral cavity. Can be used by people with intact teeth and periodontal disease
· therapeutic and prophylactic - eliminate certain factors that contribute to the occurrence of diseases of the teeth and periodontal tissues
· medicinal - contain active components that act directly on a specific pathological process in the oral cavity
The properties of toothpaste and the composition of its active components allow it to be prescribed reasonably in each specific situation.
For inflammatory periodontal diseases (gingivitis and periodontitis), toothpastes that prevent the formation of plaque are recommended.
For dystrophic periodontal diseases (periodontal disease), it is recommended to use toothpastes that have a remineralizing effect on the hard tissues of the tooth.
The main components of toothpastes are abrasive, gelling and foaming substances, as well as fragrances, dyes and substances that improve the taste of the paste. The effectiveness of teeth cleaning depends on the abrasive components of the pastes, which provide a cleansing and polishing effect.
Abrasive substances react with inorganic compounds of tooth enamel. In this regard, along with the classic abrasive compound - chemically precipitated chalk, dicalcium phosphate dihydrate, dicalcium phosphate monohydrate, anhydrous dicalcium phosphate, tricalcium phosphate, calcium pyrophosphate, insoluble sodium metaphosphate, aluminum hydroxide, silicon dioxide, zirconium silicate, and polymer compounds of methyl methacrylate are widely used. Often, not one abrasive substance is used, but a mixture of two components, for example, chalk and dicalcium phosphate, chalk and aluminum hydroxide, dicalcium phosphate dihydrate and anhydrous dicalcium phosphate, etc.
Foaming agents in toothpastes include surfactants such as alizarin oil, sodium lauryl sulfate, sodium lauryl sarcosinate and sodium tauride fatty acids. The components of the toothpaste must be harmless, non-irritating to the oral mucosa and have a high foaming ability.
Recently, gel-like toothpastes based on silicon oxide compounds and having a high foaming ability have found use. Gel pastes are pleasant to the taste and have different colors due to added dyes, but the cleaning ability of some of these pastes is lower than pastes containing a chalk base or dicalcium phosphate.
Toothpastes may contain biologically active components, which makes it possible to use them as the main means of preventing dental caries and periodontal diseases.
The most widely used therapeutic and prophylactic agent is fluoride-containing toothpastes. These pastes are recommended for children and adults to prevent dental caries.
Sodium and tin fluorides, monofluorophosphate, sodium fluoride acidified with phosphates, and, more recently, organic fluorine compounds (aminofluorides) are added to toothpastes as anti-caries additives.
Fluorides increase the resistance of teeth to acids formed by plaque microorganisms, enhance the remineralization of enamel and inhibit the metabolism of plaque microorganisms. It has been established that an indispensable condition for the prevention of caries is the presence of an active (unbound) fluoride ion.
Toothpastes for adults contain from 0.11% to 0.76% sodium fluoride or from 0.38% to 1.14% sodium monofluorophosphate. In children's toothpastes, fluoride compounds are found in smaller quantities (up to 0.023%). The combination of sodium fluoride and calcium and silicon-containing abrasives in some toothpastes is a special “Fluoristat” system.
To reduce the amount of plaque and inhibit the growth of tartar crystals, toothpastes include components such as triclosan, which has an antibacterial effect on gram-positive and gram-negative bacteria, and a copolymer that promotes the prolonged action of triclosan for 12 hours after brushing. The entry of fluoride into tooth enamel increases its resistance to acid demineralization due to the formation of structures more resistant to dissolution. Pastes containing potassium and sodium phosphates, calcium and sodium glycerophosphates, calcium gluconate, and zinc oxide have a pronounced anti-caries effect. A similar effect is achieved by toothpastes containing derivatives of chitin and chitosan, which have an affinity for proteins and are able to inhibit the adsorption of Streptococcus mutans, mitis, sanguis on the surface of hydroxyapatite. Components included in some toothpastes, such as Remodent 3%, calcium glycerophosphate 0.13%, synthetic hydroxyapatite (from 2% to 17%), help reduce the increased sensitivity of enamel by closing the entrance holes of the dentinal tubules.
The use of medicated toothpastes is a simple and accessible form of prevention and treatment of periodontal diseases. They contain biologically active substances: enzymes, vitamins, microelements, salts, antiseptics, medicinal herbs.
Toothpastes containing brine of the Pomorie estuaries as an active component improve blood supply to periodontal tissues, their trophism, and have a preventive and therapeutic effect.
Toothpastes with additives based on medicinal herbs have an anti-inflammatory effect: chamomile, St. John's wort, cloves, yarrow, calamus, calendula, sage, ginseng root extract. Toothpastes containing lavender extract have a moderate bactericidal effect on streptococci and staphylococci, and a pronounced effect on the fungi Candida albicans.
To accelerate the regenerative processes of the mucous membrane, biologically active components are introduced into toothpastes - enzymes, oil solutions of vitamins A and E, carotoline.
Recently, therapeutic and prophylactic toothpastes have been widely used to help reduce gum bleeding and have a weak analgesic, pronounced anti-inflammatory and regenerative effect. These pastes contain several medicinal plants. For example, sage, peppermint, chamomile, echinacea, myrrh and ratania; a complex mixture combining chlorophyll, vitamin E and medicinal plant extracts.
Mouth rinses, or dental elixirs, are additional means of oral hygiene. Usually used after brushing your teeth for 30 s - 1 min. One rinsing procedure requires 10 ml of solution. Some rinses should be diluted with water in the proportion recommended by the manufacturer.
Most rinses can be divided into 3 groups:
deodorizing rinses and sprays
· rinses that reduce the formation of dental plaque due to antibacterial action
· rinses that affect the mineralization of hard dental tissues due to the content of fluoride compounds
Dental elixirs are intended for rinsing the mouth. They improve the cleaning of dental surfaces, prevent the formation of plaque, and deodorize the oral cavity. Biologically active components are usually added to the composition of elixirs.
Elixir "Xident" contains sodium fluoride, the drug xidifon, which, being a regulator of calcium levels in the body, prevents the formation of plaque and tartar. It has an anti-caries, anti-inflammatory and disinfectant effect.
The elixirs “Lesnoy”, “Paradontax”, “Salviathymol”, which contain complexes of herbal additives - infusions of herbs of sage, chamomile, myrrh, echinacea, have pronounced anti-inflammatory and deodorizing properties.
Regular use of "Plax" rinse with active ingredients (triclosan, sodium fluoride) before brushing your teeth helps to effectively remove plaque and reduce dental caries.
Elixir "Sensitive", which contains tin fluoride, has an anti-caries effect and helps reduce the increased sensitivity of tooth enamel.
Chewing gum- a product that allows you to improve the hygienic condition of the oral cavity by increasing the amount of saliva and the rate of salivation, which helps cleanse tooth surfaces and neutralize organic acids secreted by plaque bacteria.
Chewing gum exerts its effect on oral tissues in the following ways:
Increases the rate of salivation;
Stimulates the secretion of saliva with increased buffer capacity;
Helps neutralize plaque acids;
Favors the rinsing of hard-to-reach areas of the oral cavity with saliva;
Improves the clearance of sucrose from saliva;
Helps remove food debris.
The composition of chewing gum includes: a base (to bind all the ingredients), sweeteners (sugar, corn syrup or sugar substitutes), flavorings (for a good taste and aroma), softeners (to create the appropriate consistency during chewing).
One of the most important properties of chewing gum is its ability to increase salivation three times compared to the resting state, and saliva also enters hard-to-reach interdental areas.
Currently, chewing gum containing sweeteners, especially xylitol, whose anti-cariogenic effect was first shown by research at the University of Turku, Finland, has a predominant effect. Xylitol supplied with chewing gum remains in the oral cavity for a long time and has a beneficial effect.
It is worth dwelling on objections to the use of chewing gum that mention stomach diseases and lesions of the temporomandibular joint. If chewing gum is used correctly, such pathology will not occur.
Based on the results of numerous studies, the following recommendations for the use of chewing gum can be offered:
Chewing gum should be used by both children and adults;
It is better to use chewing gum that does not contain sugar;
Chewing gum should be used, if possible, after every meal and sweets;
To avoid undesirable consequences, chewing gum should be used no more than 20 minutes after eating;
It must be remembered that uncontrolled and indiscriminate use of chewing gum many times during the day can be harmful.
Self-monitoring of the quality of teeth cleaning is an important aspect of maintaining oral hygiene. For this purpose, dyes are used in the form of tablets or solutions containing fuchsin (Fig. 16). The tablets are chewed for 30 seconds with active tongue movement. Solutions have the same effect when rinsing. When the contents of the oral cavity are spat out and the mouth is rinsed again, the surfaces of the teeth are examined. Tooth staining indicates the presence of plaque. There are two possible options for detecting plaque. In one case, dyes are applied before brushing teeth, and then subsequently clean the painted surfaces. In another case, to check the quality of the cleaning, it is advisable to brush your teeth using the usual method and then use a dye. With this sequence, the patient identifies those tooth surfaces that are not cleaned and require careful brushing. To identify plaque, the dye is used before bedtime. Self-monitoring of the quality of teeth brushing should be carried out systematically.
Rice. 16.Tablets for staining microbial plaque on the surface of teeth
