Home oral hygiene

Home oral hygiene in relation to Paeditrics.

1. HOME ORAL HYGIENE Dr. Faizan Ansari Dept. of Paediatric and Preventive Dentistry PG 1 st Year

2. CONTENTS Introduction Goals Basic steps for maintaining oral hygiene Regular dental checkups Proper diet Rinsing Instructions during pregnancy Guidelines for home oral hygiene Pre natal Counseling Post natal Counseling Dental Home Conclusion References

3. INTRODUCTION Oral hygiene includes all the processes for keeping mouth clean and healthy. Good oral hygiene is necessary for prevention of dental caries, periodontal diseases, bad breath and other dental problems . Oral health: oral health is defined as the retention throughout life of a functional, aesthetic & natural dentition of not less than 20 teeth & not requiring prosthesis ( WHO – 1982)

4. To prevent caries in children, high-risk individuals must be identified at an early age ( preferable low socioeconomic expected mothers during prenatal care ), and aggressive strategies should be adopted, including anticipatory guidance, behavior modifications (oral hygiene and feeding practices), and establishment of dental home by 1st birthday for children at high risk.

5. GOALS Eliminate sources of infection Stabilize and preserve oral tissues Restore oral function Educate patient regarding maintenance Facilitate maintenance of adequate nutrition Contribute to self-esteem and quality of life

6. BASIC STEPS FOR MAINTAINING ORAL HYGIENE Brushing your teeth (at least twice a day or after every meal) Floss your teeth regularly Proper diet Other interdental cleaning Rinsing Regular dental checkups

7. TOOTH BRUSHES Uses: Biofilm removal Application of treatment or preventive agents Halitosis control Sanitation of oral cavity Tooth brush a key to mechanical plaque control by Deepak Grover Indian journal of oral science 2012, vol3

8. ADA specifications: Brushing surface 1 to 1.25 inches in length 5/16 to 3/8 inches in width 2-4 rows of bristles 5-12 tufts per row 80-120 bristles per tuft Types of tooth brushes: Manual Powered Sonic and ultra sonic Ionic

9. Parts of a toothbrush: Handle : the part of the brush grasped in the hand during tooth brushing Head : the working end of the toothbrush that holds the bristles or the filaments. Tufts : clusters of bristles or filaments that are secured into the head. Brushing plane: the surface formed by the free ends of the bristles or the filaments. Shank : the section that connects head and handle .

10. POWER BRUSH TRIM PROFILES

11. SONIC TOOTH BRUSHES Operates at 31,000 brush strokes per minute ( 260 Hz) High-speed scrubbing strokes Cavitational effect, fluid streaming , and acoustic vibrations

12. IONIC TOOTH BRUSHES Works on the principle of changing surface charge of tooth to repel plaque even from inaccessible areas of teeth Ionic exchange, along with the normal mechanical action of the bristles on the tooth surface, enhances plaque removal. Ultra sonex is more efficacious than manual toothbrushes in removing plaque.

13. BRUSHING Always use a soft bristled toothbrush Use anti-cavity fluoride toothpaste Hold toothbrush at a 45-degree angle at the gumline , brushing in a circular motion. This sweeps plaque out of the gingival pocket. Brush teeth for a minimum of two minutes at least twice a day. Brush gums and tongue along with your teeth. Don’t brush too hard because this can cause gingival (gum) recession.

14. BRUSHING METHOD

15. INTERDENTAL CLEANING DEVICES They are available as, Dental floss Interdental cleaners such as wooden ( or) plastic tips Interdental brushes

16. DENTAL FLOSS Available as, Multifilament nylon that is either Twisted (or) non-twisted Bonded (or) non- bonded Waxed (or) unwaxed Thick (or) thin

17. PROCEDURE 12-18 inches of length are usually sufficient. Stretch the floss tightly between the thumb and fore finger (or) between both forefingers and pass it gently through each contact area with a firm back and forth motion.

18. TUFTED DENTAL FLOSS Also called as floss or yarn combination. Two commercially available variations Super floss Nufloss Clinical trial comparing the efficacy and safety of quik floss to conventional finger flossing indicates quik floss to be a safe and effective alternative plaque removal aid.

19. Knitting yarn Yarn is looped through dental floss and floss is drawn through the contact area in the usual manner. Gauze strip 6 or 8 inch length of 1 inch bandage is folded in thirds and placed around a tooth adjacent an edentulous area, a tooth with inter dental spacing or the distal surface of the most posterior tooth. A shoe shine stroke is used to clean the dental bio-film from the surface

20. Wooden tips Tooth pick in holder Wooden inter dental cleaner

21. Inter dental brushes Used in type II gingival embrasure. Their design is similar to that of bottle brush Powered inter dental brushes Uni tufted or single tufted brushes

22. DENTIFRICES A substance used with tooth brush to remove bacterial plaque, material alba, debris from gingiva and teeth for cosmetic, sanitary, prevention and therapeutic purpose. Functions: Minimize plaque build up Anticarious action Removal of stains Mouth freshener

23. USE OF DISCLOSING AGENTS A preparation in liquid, tablet or lozenge, which contains a dye or coloring agent which is used for identification of bacterial plaque , which is invisible to naked eyes. INDICATIONS : Patient education , instructions for plaque control , self assessment , evaluation effectiveness , assessment of clinician , plaque indices.

24. Properties: Intensity of color: distinct staining of deposits Duration of intensity: color should not rinse of fast Taste : comfortable, pleasant and flavored Irritation : should not cause irritation to oral mucosa Diffusibility : solution should be thin, can be applied readily to teeth, thick to impart color to plaque Astringent and antiseptic properties

25. Agents used for disclosing plaque Iodine preparations: skinners iodine solution diluted tincture of iodine Mercurochrome preparation mercurochrome solution 5% flavored mercurochrome disclosing solution Bismark brown Erythrosine Two tone solution FD & c blue no:1,FD & c red no:3 Fluorescent FD & yellow Basic fuchsin

26. Methods for application: A. Solution for Direct Application (Painting): 1. Have patient rinse to remove food particles and heavy saliva. 2. Apply water-based lubricant generously to prevent staining of the lips. 3. Dry the teeth with compressed air, retracting cheek or tongue 4. Use swab or small cotton pellet to carry the solution to the teeth 5. Apply solution generously to the crowns of the teeth only. 6. Direct the patient to spread the agent over all surfaces of the teeth with the tongue 7. Examine the distribution of the agent and request the patient to rinse if indicated .

27. B. Rinsing: A few drops of a concentrated preparation are placed in a paper cup and water is added for the appropriate dilution. Instruct the patient to rinse and swish the solution over all tooth surfaces. C. Tablet or Wafer: The patient chews the wafer (one half may be sufficient for some patients ), swishes it around for 30 to 60 seconds, and rinses.

28. Interpretation: A. Clean tooth surfaces do not absorb the coloring agent; when pellicle and dental biofilm are present, they absorb the agent and are disclosed B . Pellicle stains as a thin, relatively clear covering whereas dental biofilm appears darker, thicker, and more opaque. C. Two-Tone 1. Red Biofilm. Newly formed, thin, usually supragingival. 2. Blue Biofilm. Thicker, older, more tenacious; usually it is seen at and just below gingival margin, especially on proximal surfaces and where brush or floss is not easily applied; may be associated with calculus deposits.

29. TECHNICAL HINTS FOR DISCLOSING AGENTS Avoid using disclosing or antiseptic solutions on teeth that have tooth-color restorations because these materials may be stained by coloring agents. Do not apply a disclosing agent before a sealant is to be placed. Purchase solutions in small quantities do not keep solutions containing alcohol longer than 2 or 3 months because the alcohol will evaporate and render the solution too highly concentrated.

30. Use small bottles with dropper caps for solutions. Transfer solution to a dappen dish for use. Do not contaminate the solution by dipping cotton pliers with pellet directly into the container bottle .

31. ORAL IRRIGATION DEVICES Irrigation is targeted application of pulsated stream of water or other irrigants for therapeutic purpose. Rationale for supragingival and sub gingival irrigation is to nonspecifically reduce the microbial deposits that induce periodontal diseases. Primary objective of supragingival irrigation is to flush away the bacteria coronal to the gingival margin thereby diminishing the potential of developing gingivitis. Sub gingival irrigation is to reduce the pocket micro-flora in an effort to prevent initiation & progression of periodontitis.

32. Classification of oral irrigation Supra-gingival irrigation Sub-gingival irrigation Sub gingival irrigation was introduced by Newman et al 1982 as an adjunct to oral hygiene procedure

33. AGENTS USED FOR IRRIGATION Chlorhexidine Hydrogen peroxide Water Saline Sanguinarine Stannous fluoride Povidine-iodine Tetrapotassium peroxydiphosphate

34. DIET Avoid foods that are high in sugar content. Carbonated drinks are more acidic than non carbonated drinks; hence more dangerous. Foods like potato crisps tend to stick in the grooves; stay for an extended period and cause decay. Avoid excessive intake of fruit juices (can be very acidic). They can be diluted with water.

35. RINSING Regular rinses with a good mouthwash helps to keep your mouth clean, fresh and germ free. Daily rinses must be alcohol free (they cause dryness of oral mucosa) Fluoride rinses helps to boost the strength of newly erupted teeth. It is important to follow manufacturer’s instructions. Do not rinse the mouth with water after using mouth wash

36. EXPANDED AND FUTURE USE OF MOUTH RINSES Prophylaxis for bacterial endocarditis Aerosol production Oral candidiasis Oral mucositis After periodontal surgery Regular dental checkups

37. SIGNS OF GOOD ORAL HYGIENE Good oral hygiene results in a mouth that looks and smells healthy. Teeth are clean and free of debris. Gums are pink and do not hurt or bleed when you brush or floss. Bad breath is not a constant problem.

38. INSTRUCTIONS DURING PREGNANCY Brush teeth with fluoridated toothpaste twice a day, and floss once a day. Limit foods containing sugar to mealtimes only. Drink water or low-fat milk. Avoid carbonated beverages (pop or soda ). Choose fruit rather than fruit juice to meet the recommended daily intake of fruit. Obtain necessary oral treatment before delivery. Diagnosis (including necessary dental x-rays) and necessary treatment can be provided throughout pregnancy; however, the period between the 14 th and the 20th week of pregnancy is the best time to receive treatment. Treatment for conditions requiring immediate attention are safe during the first trimester of pregnancy. Delaying necessary treatment could result in significant risk to you, and indirectly to your baby.

39. GUIDELINES FOR HOME ORAL HYGIENE Prenatal Counseling: The goal of prenatal dental counseling is one counseling of education. Even before the baby is born, parents should be counseled on how to provide an environment that will nurture good oral health habits that contribute to life-long dental health of their child. Prenatal counseling can be quite effective because during this period, the parents are more open to health information for their children than during any other time.

40. The infant: It is generally recommended that parents begin clearing the infant’s mouth by the time first tooth erupts. It is suggested that secure and consistent physical support with slow, careful movement is to be employed at all the time. Most have suggested that the parent wraps a damp washcloth or a piece of gauze around the index finger and clean the teeth and gum pads once a day. As more teeth erupt, the parent can begin using a small tooth brush.

41. At this age, toothpaste is not necessary and may interfere with visibility for the parent. Additionally, the infant will be unable to effectively expectorate, causing unwanted toothpaste ingestion. Several methods of positioning the infants for daily oral hygiene procedures have been suggested. One effective method is to have the parent cuddle the infant in his or her arm with one of the child arms gently slipped around the parents back. In this way, the parent can stabilize the child with one hand and work with the other.

42. The toddler: The parent should be totally responsible for oral hygiene of the baby, as for the infant. Establishing a specific routine is generally most convenient for parents and encourages the young child to develop good dental habits. As more teeth begin to erupt, parents should approach brushing systematically by beginning in one area of the mouth and progressing up in an orderly fashion. This is best accomplished by the use of a dampened, soft bristled toothbrush.

43. If adjacent teeth are in contact, parents should also begin to floss these areas. Although parents still have the responsibility of performing a thorough, daily plaque removal for their babies, children at the age begin to demonstrate an interest in the procedure and a desire to take part. Parents should encourage this behavior and allow the child to attempt brushing procedures.

44. Parents should, however, be advised that the child’s efforts will be inadequate in thoroughly removing plaque. Therefore, the parent must perform a thorough plaque removal for the child at least once a day. As for the infant, it is important to the parent’s method of positioning and stabilizing the child so that the parents will have maximum visibility as well as control over the child’s movement. The position selected for home plaque removal procedures will depend on the cooperation of the child.

45. Many of the techniques employed with the infants may also be applied to the baby. One of the most effective positions is to have the parents face each other while the child is supine on the parent’s knees. In this position, one parent assumes the role of a brusher, while the other parent stabilizes the child. The preschool child is usually unable to expectorate effectively, and to any dentifrice that is placed on the toothbrush is generally ingested.

46. Repeated ingestion of large amount of dentifrice may increase the systemic fluoride intake to undesirable levels. Thus, until the child can expectorate effectively, the parent should be responsible for dispensing the toothpaste and should place only a small pea-sized portion of dentifrice on the brush for the child.

47. The Early School Age Child: Because they are beginning to develop the necessary skill, early school aged children should be encouraged to routinely attempt brushing and flossing. However, the parent must continue to maintain the major responsibility by providing a thorough plaque removal for the child each evening before bed. Disclosing agents may be particularly useful in this age group when one is teaching brushing and flossing techniques.

48. The key to the success of an oral hygiene program for the preadolescent child is to encourage parents to reinforce the instructions given in the dental office. After the child attempts plaque removal procedures, the parent can promote learning by staining the teeth with disclosing solution and showing where the improvement is needed. The child should also be praised for his or her efforts when plaque has been successfully removed. Children in this age group, generally, demonstrate the ability to expectorate and should use a fluoridated dentifrice each time they brush.

49. The Preadolescent: During preadolescence, the child will gradually assume more responsibility for his or her own hygiene. By 10 or 11 years of age, the child has often achieved the coordination necessary for effective brushing and flossing. The children in this age group require instruction on proper brushing and flossing techniques.

50. The Adolescent: The adolescent has generally attained the manual dexterity needed to properly brush and floss without direct help from an adult. Although children in this age group probably have the ability to adequately perform thorough oral hygiene procedure, they may lack the motivation to do so on a routine basis.

51. Pre Natal Counseling

52. Counseling can be provided in a number of settings, including the office, presentations to parent groups, and community-sponsored prenatal courses. The dental office is also an effective environment for prenatal counseling.

53. When the dentist or his staff notice or are informed that a female patient is pregnant, time should be arranged for counseling. Programs developed by the women's auxiliaries of local dental societies, Pamphlets and Mail letter can be sent to new parents. For the counseling session to be most effective, both parents should be involved In addition, appropriate handouts should be distributed that can be either commercially purchased or locally developed

54. Topics to be discussed: Parents education on dental diseases and oral hygiene. Change in mother’s diet and oral health. Pregnancy gingivitis. Myths and misconceptions about pregnancy and dentition must be disclosed. Parent’s dental treatment should be done. Effect of drugs and other teratogenic substances. Nutritional guidance and importance of breastfeeding

55. The development and importance of the primary teeth. Teething and possible problems An explanation of the dental disease process. The development of early eating habits. The importance of fluoride and its effect on the enamel. The danger of allowing the child to utilize a nursing bottle containing sweetened liquids after the teeth erupt into the mouth. The effect of digital sucking and abnormal tongue placement on the developing dentition.

56. The use and selection of a pacifier. Methods of cleaning the infant's teeth, including stabilization and positioning as well as the kind of cleaning devices. The age at which the infant should first be seen by the dentist. Information should also be provided to the parents about their own dental health. This is the time, the parents establish good dental health habits and continue to practice them on a daily basis.

57. Influence of Maternal health Motherhood brings oral changes reflective of the physiologic alterations of pregnancy. This is a period in which proper maternal health care and education can have a profound effect on the mother's oral health and that of her child. Maternal Diet and Nutrition affects the growth and development of fetus Maternal malnutrition – Odontoclasia Caries risk - Subclinical enamel defects Folic acid deficiency – neural tube defect Periodontal disease – Premature birth and low birth weight S . Mutans transmission can happen from mother to child.

58. Post Natal Counseling

59. Mother’s diet Lactating mothers must take a balanced diet rich in supplements of minerals and vitamins. Meals to be taken at appropriate intervals. Alcohol consumption should be avoided. Any drug to be taken only under doctor’s guidance.

60. Feeding Practices Breastfeeding: Breast milk has several advantages over proprietary formulas. However prolonged and at will breastfeeding has been associated with nursing caries (Dini et al) Exclusive breastfeeding (EBF) = only breast milk (vitamins, prescribed medicines allowed) Predominant Breastfeeding (PBF) = breast milk + non milk liquids Mixed Breastfeeding (MBF) = breast milk + solids and/or non-human milk (“partial breastfeeding”)

61. Advantages of breastfeeding: Benefits for Mother: Psychological Increases mothers’ self-confidence Increases infant bonding Economic Cost effective Lower infant medical costs

62. Benefits for Infant: Nutritional: The composition and nutrient balance of breast milk provides optimal infant nutrition Digestion: Reduced risk of obesity Immunological: Macrophages - complement, lysozyme and lactoferrin. Macrophages - high in the colostrum & in mature milk for many months. Strongest protection against infection is not only during first several months, but continues throughout the duration of breastfeeding

63. Reduced infant morbidity Reduces diarrhea, mumps, influenza virus infections etc. Lower gastrointestinal and respiratory illness, and ear infections Lower risk of allergies and asthma Infants with special needs Breastfeeding is particularly important for premature infants

64. AAP policy Breastfeeding is ideal. Exclusive breastfeeding should be practiced for the first 6 months. Iron rich solid food – 6-12 months. AAPD “Discontinue nocturnal breast feeding after 1st teeth erupts .” Clean teeth frequently Optimal Fl intake

65. 2) Bottle Feeding: It is frequently used with milk or other sweetened drinks as a pacifier at bedtime that leads to nursing caries. Parents should be advised to: Remove bottle immediately after feeding Substitute the milk or sweetened drink with water Encourage baby to stay in upright position with bottle Use nipples with smaller holes Introduce a cup as soon as possible Do not use it as a pacifier Cleaning should be done after every meal

66. DENTAL HOME The dental home is the ongoing relationship between the dentist and the patient, inclusive of all aspects of oral health care delivered in a comprehensive, continuously accessible , co-ordinated, and family-centered way. The dental home should be established no later than 12 months of age to help children and their families institute a lifetime of good oral health. – (AAPD). Nowak in 1999 described the term DENTAL HOME.

67. A dental home addresses anticipatory guidance and preventive, acute, and comprehensive oral health care and includes referral to dental specialists when appropriate. This definition was developed by the Council on Clinical Affairs and adopted in 2006. In a recent analysis by ABCD ( access to baby and child dentistry )found that children under this programme had an increased use of dental service.

68. Advantages: Includes the importance of early intervention with optimal preventive strategies chosen based on risk of patient Encourage 1st dental visit by 1yr of age. Personalized preventive approaches can be planned based on family histories, examination and the risk factors. It provides anticipatory guidance to parents

69. Services Provided by the Dental Home: Early dental visits at approximately 12 to 18 months of age. Assess the risk of the infant and toddler for future dental disease. Evaluate the fluoride status of the infant and make appropriate recommendations. Demonstrate to caretakers the appropriate method for cleaning teeth. Discuss the advantages/disadvantages of nonnutritive sucking. Provide treatment if early childhood caries is diagnosed. Be available 24 X 7 to deal with any acute dental problems. Recognize the need for specialty consultation and referrals

70. Conclusion The key to a healthy smile starts with a good preventive regime from infancy for a better oral health in adulthood. A step towards maintaining home oral hygiene is thus the first step towards a healthy disease free society

71. References Pinkham JR, Casamassimo PS, editors. Pediatric dentistry: infancy through adolescence. Saunders; 1999 . Tandon S. Textbook of Pedodontics. Paras Medical Publisher; 2009 . Damle SG. Textbook of Pediatric Dentistry. Himachal Pradesh. Koch G. Pedodontics: a clinical approach. Munksgaard; 1991. Andlaw RJ, Rock WP. A manual of paedodontics. Churchill Livingstone; 1993 . Moss SJ. Growing Up Cavity Free: A Parent's Guide to Prevention. Edition Q; 1993 . Marwah N. Textbook of pediatric dentistry. Jaypee Brothers, Medical Publishers Pvt. Limited; 2018 Oct 31.

72. Newman MG, Takei HH, Klokkevold PR. Carranza’s clinical periodontology 10th ed. St. Louis: Saunders Elsevier. 2006:1075 . Lindhe J. Clinical periodontology and implant dentistry. Lang NP, Karring T, editors. Copenhagen: Blackwell Munksgaard; 2003 Jun . American Academy of Pediatric Dentistry. Definition of dental home. Pediatr Dent 2018;40(6):12. Suresh KS, Kumar P, Javanaiah N, Shantappa S, Srivastava P. Primary oral health care in India: Vision or dream?. International Journal of Clinical Pediatric Dentistry. 2016 Jul;9(3):228.