Definitions and Descriptions

The best prevention against caries is fluoride prophilaxis: it consists in a daily assumption by means of the diet, of a given quantity of a salt known as Sodium Fluoride. It is well known that fluoride taken this way, produces teeth which are extremely more resistant to caries. In particular, what happens is that the enamel crystals, composed by a Calcium aggregate known as Hydroxylapatite, modify themselves while forming, transforming themselves into FluorHydroxylapatite, a much more resistant crystal against the action of lactic acid.

But to obtain these more sturdy teeth, it's necessary that the fluoride may enter into the composition of the enamel while this is forming, even before the tooth's eruption. This is why fluoride prophilaxis has to be done "from the inside" by means of the diet starting from the very first infancy for it to have the best effect.

 

The WHO (World Health Organization) protocol consists in:

from 0 to 2 years 0.25 mg daily

from 2 to 4 years 0.50 mg daily

from 4 to 12 years 1 mg daily

 

Products for fluoride prophilaxis are many and not expensive. For the newborn, lately there's also the choice of drops, instead of the traditional tablets. A useful information is to get the fluoride well separated from milk because if they get mixed, the treatment looses effectiveness.

About the opportunity of adult fluoride intake, opinions differ: as a matter of facts, adults have an already formed enamel and therefore fluoride does not affect its structure, however it may have some benefical effect on dentine.

Fluoride assuption in pregnant women makes sense but is difficult in dosage, because part of the intaken fluoride is absorbed by the mother instead of the foetus, and anyway the actual quantity of fluoride passing the placenta is practically not measurable with precision. Generally the standard protocol is more than enough, even if a more careful management may indicate a prophilaxis on the pregnant woman also.

The aim of oral hygene is the removal of bacterial plaque and the maintainance of dental health. It is performed with mechanical aids which are: toothbrush, dental floss, dental conebrush (for special cases), and with appropraite products like tooth paste and mouthwashing solutions.

a) The toothbrush

The toothbrush should have synthetic bristles (nylon), generally of medium hardness, with the exception of special indications or contra-indications (i.e. thin gingival tissues and exposed toothnecks). The brush's bristles must never be natural because animal fibers capture much more bacteria on them. The brush is used by letting the bristles's top touch the tooth, and not their body, starting from the tooth's neck and producing a movement towards the tooth itself, in a certain sense as if wanting to press or "squeeze" the gum itself from the base up. This movement must be performed with the right force and in a way never to harm the gum. The operation has to be replied for all the teeth on all of their sides, interior (toungue and palate) and exterior (labial). To accelerate the procedure, it's possible to assimilate the technique to a "small circles" movement, performed around the teeth's necks and extending them to the whole surface. Last, the chewing surface of the teeth is reached and cleaned.

 

A full mouth cleaning also implies tongue brushing, because the organ hosts many microorganisms. By removing residuals and bacteria from the tongue's back, the patient contributes to a most complete mouth cleaning, reduction of bacteria which might be available for plaque forming and provides for a lower risk of bad breath. For this aim the classic toothbrush or the special tongue scraper can be used.

b) The Toothpaste

Plaque removal is a mere mechanical matter, at the point that (theoretically) a bare water wetted toothbrush would be enough; the toothpaste is not essential for the sake. However, performing a tooth brushing with the aid of a toothpaste includes certain advantages too: toothpastes contain various substances that can help to have a better result. Fluoride can help to reinforce the enamel and reduce teeth's sensibility, while other substances contribute with their antiseptic or tensioactive action.

In general, toothpastes can be divided between paste or gel consistency. Gels are, in absolute terms, less abrasive for the tooth's surface, while pastes contain abrasive additives, therefore you must pay great attention to the granulmetry of a toothpaste when purchasing one. Theoretically, granulometry is a value that has to be printed on the tube, but not every brand applies to this prescription. A toothpaste which -rubbed between fingertips- gives back a "sandy" sensation, might be more abrasive and (for example) should not be suggested in case of very bare dental collars.

A) Dental Floss

The use of dental floss contributes to the gum's health by removing plaque and reducing blood spills in the interproximal spaces. It has been shown that there is no actual difference of effectiveness in removing plaque between the use of a waxed or an unwaxed floss.

In general, the presence of wax allows a better sliding of the floss through the point of cantact between teeth, preventing eventual soft tissue damage or floss fraying.

In some cases, the flossing can be done before the brushing because the brushing itself may give the wrong impression of having completed the cleaning task and thus provoke the lack of use of the floss.

Floss will be used according to the following instructions: after having rolled two extremities on the medium fingers, having left 2 cm of distance between them, the floss must be positioned between two teeth. Move the floss to and fro starting form that position, leading it to pass the point of contact and reach the tooth's base in a delicate way. Curve the floss in a C shape embracing one tooth first and then the other, let the floss slide on the two surfaces and finally extract it passing the point of contact for the second time.

Superfloss is a particular kind of dental floss which has the characteristic of having a rigid end built to allow the use under special conditions like bridges or orthodontic gear.

 

b) Interdental Brush

In particular interdental areas where the use of normal dental floss is impossible because of the presence of bridges and so on, the use of this special instrument is useful. It consists of a stick on top of which a fluffy tool with radial bristles is placed - it somehow resembles the instruments used to clean bottles inside. Various shapes (cylindrical or conical) and various dimensions are available. The one best sliding through the space and better brushing the surfaces will be used.

 

c) Monotuft Brush

It's a brush consisting of a single tuft of bristles or a small grouping of bristles. It's indicated to clean very open interproximal areas, on implant pillars, or for areas too difficult to reach with a normal brush.

 

d) The Mouthwash

It's coadiuvating in the general oral hygene, but it's not necessary. Mouthwashes containing fluoride contribute to reinforce the enamel's surface, while those based on chlorexidine (available in various concentrations) have an antiseptic action.This last feature is very useful during the treatment of certain specifical diseases like gengivitis or pyorrhea. Also, the patient having had a gum surgery, may use a clorexidine 2% concentrated mouthwash.

According to italian laws, the operator performing a professional dental hygene must have a 3 years university degree as a dental hygenist, or must be a doctor in dentistry. For no reason ever, anyone performing this speciality can be a simple dental assistant.

The dental hygenist is a professional that, cohoperating together with the dentist, operates in the field of prevention, promoting the general health of the patient; in the educational field by specifically instructing and motivating, and in the therapeutic field, acting all the necessary measures aimed to fight the mouth's diseases.
It's necessary to aknowledge that any clinical service, dental care or dental hygene, have little success probability if there's a lack of cohoperation from the patient regarding daily personal care and regularity in the professional checks.
A dental hygene is performed normally every 6 months, but the hygenist or the dentist will suggest customized periods according to the patient's specific needs.
A dental hygene session consists in the deep removal of plaque and dental calculus (the last cannot be removed by means of the usual homecare techniques!)

The sequence presented here is not rigid and may of course vary from operator to operator, however the essential guidelines and the instruments used are those being described.

 

a) Plaque revelator

It's a colorizing substance that has the effect of showing plaque by painting it in various colors (generally red). The effect of a revelator rinse is to color the tongue completely (where most of the plaque is seated) and the teeth's necks It helps to indicate the areas where we have more plaque presence.

 

b) Plaque ablator

This is an elctro-mechancal instrument provided with interchangeable metal points vibrating following an ultrasound generator. The tip's vibration, applied to dental calculus, causes it to break loose, freeing the dental surface. More types and models exist, all of them generally well tolerated. To make their task easier, these instruments are provided with a water irrigation allowing the detached fragments to float easily towards the surgical aspirator, thus offering more comfort to the patient. In very special cases, the hygene session can be done with help of a little anaesthesia.

 

c) Courette

It's a steel instrument being used manually by the hygenist designed to remove smaller calculus pieces positioned where the ablator cannot reach. Various designs and dimensions are available, and every operator does his own choice, according to the specific task they have to accomplish. Some prefer to use them instead of the ablator also.

In general it's an instrument allowing a better finishing, because further than detaching calculus, it performs what is defined as "root planing", a smoothening of the root that is: this particular operation makes the dental root more even and less prone to form new calculus.

 

d) Rubber points and pastes

According to the hygenist's preferences, rotating instruments called rubber points and brushes may be used in association with polishing pastes. These small tools, help to complete the tooth cleaning by furtherly preventing plaque sticking and new calculus formation.

 

e) Other instruments

The hygenist may also use mouthrinses to coadiuvate her job (usually containing clorexidine) and, of course, dental floss to free spaces between teeth from the calculus residuals or paste remnants etc.