Course info

Oral Hygiene

 

Introduction

Oral hygiene is important for a healthy mouth, tongue, gums and teeth.

Tooth structure

Basics

Dental plaque

Dental plaque is a soft deposit that forms on the surface of teeth full of bacteria. It can usually be removed by tooth brushing and cleaning between teeth.

 

Calculus

Calculus or tartar is hardened calcified plaque that sticks to teeth. It can only be removed by a dentist using special instruments.

Common oral health problems

Soreness in the mouth is usually due to mucosal inflammation, ulcer formation or teeth problems.

 

Childhood teething

Baby teeth usually start to erupt through the gums between the ages of six months and two-and-a-half years.

Symptoms: pain causing irritability, swollen red gums, raised temperature.

Treatment: teething gel containing local anaesthetics like choline salicylate 8.7% (not use more often than every three hours), paracetamol, ibuprofen.

 

Mouth ulcers

Symptoms: small (< 5mm), painful, shallow, grey-white, round single or group sores inside oral cavity. Most disappear by themselves within 7 to 14 days.

Causes: family history, stress, lack of vitamin B, iron and folic acid, trauma / mistakenly bitten mouth, food (spicy food and chocolates).

Treatment: simple ones disappear within 7 to 14 days. To accelerate the process and reduce symptoms gels containing steroids and antiseptic are useful.

Types:

a. Aphthous ulcers – it tends to start in childhood or adolescence and are recurrent. Those ulcers are small, round or ovoid with circumscribed margins, erythematous haloes and yellow or grey floors.

 

b. Gingivostomatitis – it is due to primary infection of herpes simplex virus (HSV-1). Good fluid intake, avoidance of salty or acidic foods and topical benzydamine or chlorhexidine mouthwash are usually enough.

c. Cold sores – it is due to reactivation of latent HSV-1 which has remained dormant in the trigeminal ganglion. Usually it is a self-limiting condition (7-10 days) managed with use of topical antiviral treatment (acyclovir 2%).

 

d. Geographic tongue – this is a common idiopathic condition affecting up to 10% of children and adults. Map-like red areas can be seen on tongue papillae. Zinc supplements and avoidance of spicy foods may help.

Oral thrush

Oral thrush is a fungus infection caused by candida.

Symptoms: creamy, white patches on the inside of the mouth with red, irritated areas.

Causes: steroids inhalers use, antibiotic intake, low immune system, dentures use, diabetes, infancy.

Treatment: 1ml of nystatin drops, 4x-day. Remind nystatin should be hold in the mouth for as long as possible and then swallowed. Eating or drinking for half an hour after taking the dose should be avoided to allow the product to work in the mouth for longer before being washed away. People wearing dentures should remove it at night, clean, apply nystatin drops on it and leave overnight. Breastfeeding mothers may also need treatment if the baby has oral thrush.

Gingivitis

Gingivitis is gum inflammation.

Symptoms: swollen, red, easily bleeding gums.

Causes: plaque building up on the teeth.

Consequences: can lead to periodontal disease.

Treatment: mouthwash containing 0,2% of chlorhexidine. Mouth rinse with water between brushing teeth and mouthwash is important to prevent chlorhexidine inactivation due to toothpaste ingredients.

Caution: chlorhexidine may stain teeth brown therefore drinks containing tannins should be avoided within 2-3 hours of using it (e.g.: tea, coffee, and red wine).

 

Periodontitis
Periodontitis is inflammation of the tissues that surround the teeth, i.e., periodontium and/or supporting bone.

Symptoms: halitosis, pain, difficulty eating and pus between tooth and gum.

Causes: age, smoke, bad hygiene, malnutrition, diabetes.

Consequences: since a gap develops between the tooth and gum, if untreated, the tooth may slowly loosen and eventually fall out.

Treatment: a visit the dentist to make a treatment plan that might include antibiotic and anti-inflammatory.

Halitosis

Halitosis is bad breath smell.

Causes: production of volatile sulphur compounds due to dental abscesses, periodontal disease, tooth decay, stomach acid reflux, spicy foods, garlic, low levels of saliva (specially while sleeping causing bad morning breath), nasal congestion, crash dieting, protein-only diets.

Treatment: regular use of antimicrobial toothpastes and mouthwashes.

 

Xerostomia

Xerostomia is dry mouth due to a lack of saliva.

Causes: medicines (e.g.: diuretics, anticholinergics), radiation therapy, dehydration, diabetes, anxiety.

Treatment: stimulation of salivation by cool drinks, partly frozen melon chunks, sugar-free chewing gum and preparations of artificial saliva (Bioxtra^®) containing mucin or lactoperoxidase.

 

Toothache
Causes: dental decay due to bacteria that break down sugars and produce acid that causes tooth enamel corrosion exposing teeth nerve endings responsible for pain feeling. Toothache can also occur because of broken teeth, a lost filling, impacted wisdom teeth, a recently restored tooth, following a tooth extraction, or due to sinusitis.

Treatment: paracetamol, ibuprofen, naproxen.

 

Tips for oral hygiene

· use a soft toothbrush and brush teeth for two minutes twice a day;

· brush gently around the back and front of the teeth, including where the teeth meet the gums;

· throw out toothbrushes every three months or if the bristles are splayed out;

· spit out after toothbrushing and don't rinse (toothpaste ingredients will help protect them);

· floss or use an interdental brush daily (minimum three times per week);

· fluoride mouthwashes may be used in adults and children older than six who are at high risk of dental caries;

· eat a healthy diet, limit sugar intake, and avoid sipping sweet drinks for prolonged periods;

· discourage snacking and grazing throughout the day;

· visit the dentist regularly (every six months). 

A pea-sized portion of toothpaste is enough!

Toothpastes

Toothpastes can help remove dental plaque.

There are many different types available and their function depends on the active ingredients they contain.

 

Fluoride toothpaste

Active Ingredients: Fluoride as Sodium Fluoride (NaF), Stannous Fluoride (SnF₂) or Monofluorophosphate (MFP₂) and Xylitol.

Dosage: for adults 1,000 parts per million (ppm) and for children 500 parts per million (ppm) of fluoride + 10% of Xylitol.

Function: preventing dental caries since an appropriate amount of fluoride can promote the remineralisation (redeposit the lost minerals) of the tooth and repair early dental caries. Fluoride strengthens teeth and inhibits the growth of dental plaque.

 

Desensitizing toothpaste

Active Ingredients: Potassium Nitrate or Arginine + Calcium Carbonate + MFP.

Dosage: 5% of Potassium Nitrate, corresponding to 2% of Potassium ion or 8% Arginine + 1450ppm MFP.

Function: reduce tooth sensitivity by helping to seal off the microtubules inside the exposed dentine such as exposed root surface due to toothbrush abrasion.

Caution: not suitable for children and not recommended for long-term use.

 

Anti-calculus / Tartar Control toothpaste

Active Ingredients: Pyrophosphate, Zinc Citrate, Triclosan/Copolymer.
Function: delay of dental plaque calcification, thus reducing the rate of calculus formation.

 

Anti-plaque / Anti-gingivitis toothpaste

Active Ingredients: Triclosan/Zinc Citrate, Triclosan/Copolymer (PVME/maleic acid), Stannous Fluoride.

Dosage: 5% of Triclosan + 0,75% of Zinc Citrate or 0,45% SnF₂.

Function: plaque accumulation inhibition, reducing toxic effects of bacterial toxin on the periodontal tissues, and thereby reducing chances of getting periodontal disease.

 

Whitening toothpaste

Active Ingredients: Oxidizing agents such as Hydrogen Peroxide or Carbamide Peroxide.

Dosage: radioactive dentin abrasives under 250 are safe and effective.

Function: abrading the stains on the tooth surface, giving a whitening effect.

Caution: Long-term use of whitening toothpaste will roughen the tooth surfaces, and stains will deposit on tooth surfaces more readily. Tooth whitening agents containing concentrated peroxide may lead to gingival inflammation, swelling and bleeding.

Mouth rinse

There are different types of mouth rinse.

Fluoride mouth rinse

Active Ingredients: Sodium Fluoride (NaF).

Dosage: 230ppm/0,5% of NaF (1min/daily) or 900ppm/0.2% of NaF (1min/week).

Function: extra protection against dental caries.

Anti-plaque mouth rinse

Active Ingredients: Triclosan, Thymol, Cetylpyridinium Chloride (CPC).

Function: plaque accumulation inhibition, thus reducing the chance of gingivitis.

Plaque-control mouth rinse

Active Ingredients: Chlorhexidine Gluconate.

Dosage: 0,12% of Chlorhexidine Gluconate.
Function: antimicrobial effect, preventing periodontal disease.

Caution: long term use stain teeth and alter taste sensation.

Desensitizing mouth rinse

Active Ingredients: Potassium Nitrate.

Function: seal the dentinal tubules at the sensitive site reducing tooth sensitivity.

Caution: not intended for long term use.

Gingivitis mouth rinse

Active Ingredients: Chlorhexidine Gluconate or Iodine.

Dosage: 0,2% of Chlorhexidine Gluconate or 1% Iodine.
Function: antimicrobial effect, reducing inflammation.

Caution: long term use of chlorxedine stain the teeth, pregnant women should not use mouth rinse containing iodine.

Denture cleaning tablets

Active Ingredients: Alkaline Peroxide.

Function: when it water those tablets form bubbles that can help removing food debris and plaque that are adhered on the denture.

 

Dental floss

Dental floss is used to remove dental plaque from the adjacent surfaces of the teeth.

There are different types of floss:

According to floss coating:

1. Waxed floss: coated with wax which makes it easier for the floss to slide into the adjacent tooth surface.

2. Mint floss: flavoured with mint for a feeling of freshness.

3. Fluoride coated floss: extra protection against dental caries.

 

According to floss shape:

1. Flattened floss: to increase the contact surface with the tooth.

 

2. Ultra floss: spongy and soft floss specially useful to clean around appliances and between wide spaces.

 

3. Round floss: the thinner type of floss.

 

4. Super floss: with segments of stiff-end threaded spongy floss and regular floss. This type is easy to slide through the gap between teeth and fixed orthodontic appliances and to floss underneath the bridge.