Oral Hygiene

Oral hygiene has the following functions (Fig 9-15):

To remove plaque as a way of preventing caries, gingivitis, and periodontitis
To remove nonbacterial deposits
To massage the gingiva
To freshen breath, eliminating bad breath

To administer active substances such as:
Fluoride for caries prevention
Vitamin A to protect the epithelium
Chlorhexidine to prevent plaque

The toothbrush, the most important oral hygiene tool, comprises a handle and a brush head that are separated by a neck. The handle is solid and long, tapering down to the head, and its surface is roughened to make it easier to hold. The bristles are inserted in tufts into the brush head and form the bristle array. Soft bacterial deposits (plaque) and food remnants are removed from teeth and gingiva with the toothbrush. Toothbrushes have the following quality characteristics (Fig 9-16):

Brush with a short head and multiple rows of bristles:

Length of bristle array: 20 to 30 mm
Width of bristle array: 7 to 11 mm
Bristle length: 10 to 12 mm

Synthetic bristles (polyamide, polyurethane):

Are even, homogenous, and non-porous
Have a smooth surface
Are perfectly hygienic
Are unbreakable
Can be precisely manufactured in terms of density and hardness

Have rounded bristle ends

Toothbrushes with a V-shaped tuft arrangement are rather unsuitable; a multitufted brush with thin synthetic filaments and a flat bristle array is better. Figure 9-17 illustrates various toothbrush designs.

Electric toothbrushes can be used as well as manual toothbrushes; they can perform rocking and swinging, forward and backward, as well as rotating movements. Electric toothbrushes are particularly suitable for patients lacking the necessary dexterity to use a manual toothbrush, including people who are bedridden or require nursing care, as well as children.

Jet irrigators are oral hygiene tools that rinse away food remnants but not plaque deposits. They can be recommended for patients with fixed orthodontic appliances or following orthodontic procedures. A jet of water that is not too powerful is directed vertically onto the gingiva, the interdental spaces, and the cervical area of the teeth. Chlorhexidine may be added to the irrigating water.

Toothpastes assist mechanical cleaning, make it easier to remove plaque, and deliver therapeutic ingredients. The cleaning is done by cleaning substances and surface-active materials, including the following:

Cleaning substances (polishing agents): calcium carbonate, silicone dioxide, calcium phosphate, metaphosphates, aluminum hydroxide
Wetting and binding agents: glycerin, sorbitol, propylene glycol, polyethylene glycol, methyl cellulose, alginate
Surface-active substances: surfactants, tensides, amine fluorides
Preservatives: alcohol, sodium benzoate, methyl paraben, p-hydroxybenzoic acid
Flavor additives: menthol, peppermint oil, eucalyptus oil, aniseed oil, fruit flavoring
Colorings and pigments
Medicinal additives: fluorides, vitamin A, plant extracts
Desensitizing agents: strontium chloride, potassium nitrate, formaldehyde
Tartar inhibitors: etidronic acid

Strongly abrasive toothpastes can lead to loss of material from enamel, cementum, dentin, fillings, or gingival epithelium. After the teeth have been brushed, people should only rinse briefly with water to prolong the anticaries effect of the fluorides in the toothpaste.

Irrigating solutions for plaque prevention contain various ingredients that have an influence on plaque growth (chemical plaque control).They may contain the following active ingredients:

Chlorhexidine (gluconate); side-effects include possible allergic reaction, reversible brown discoloration (of the mucosa, tongue, teeth, and
filling margins), and taste irritation; only suitable for temporary use
Hexetidine, sanguinarine, and cetyl pyridine chloride, which reduce plaque
Tin fluoride; fluoride accumulates for caries prevention

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