Medicine:Teeth cleaning

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Short description: Oral hygiene practice

Teeth cleaning is part of oral hygiene and involves the removal of dental plaque from teeth with the intention of preventing cavities (dental caries), gingivitis, and periodontal disease. People routinely clean their own teeth by brushing and interdental cleaning, and dental hygienists can remove hardened deposits (tartar) not removed by routine cleaning. Those with dentures and natural teeth may supplement their cleaning with a denture cleaner.

Brushing, scrubbing and flossing

Brushing

Careful and frequent brushing with a toothbrush helps to prevent build-up of plaque bacteria on the teeth.[1] Electric toothbrushes were developed, and initially recommended for people with strength or dexterity problems in their hands, but they have come into widespread general use. The effectiveness of electric toothbrushes at reducing plaque formation and gingivitis is superior to conventional manual toothbrushes.[2]

How to Brush[3]

Ensuring effective brushing is important in getting rid of food and bacteria properly.

Step 1) Place a pea sized amount of toothpaste on the brush and hold at a 45 degree angle.

Step 2) In small circular and back and forth motions, move the brush gently along teeth and gums.

Step 3) Brush all surfaces inside the mouth, including the tongue. Ensure that the back sides of the teeth (top and bottom rows) are being cleaned by brushing vertically in up and down motions.

Tip) It is recommended to use a 2/2 strategy which includes brushing two minutes in the morning and two minutes at night as a minimum standard for healthy gums and teeth.

Flossing

In addition to brushing, cleaning between teeth may help to prevent build-up of plaque bacteria on the teeth. This may be done with dental floss or interdental brushes.

80% of cavities occur in the grooves, or pits and fissures, of the chewing surfaces of the teeth,[4] however, there is no evidence currently showing that normal at-home flossing reduces the risk of cavities in these areas.[5]

Special appliances or tools may be used to supplement toothbrushing and interdental cleaning. These include special toothpicks, oral irrigators, and other devices. A 2015 Cochrane review found insufficient evidence to determine whether the interdental brushing decreases the levels of plaque when compared to flossing.[6]

Professional teeth cleaning

Dental hygienist polishing a person's teeth

Teeth cleaning (also known as prophylaxis, literally a preventive treatment of a disease) is a procedure for the removal of tartar (mineralized plaque) that may develop even with careful brushing and flossing, especially in areas that are difficult to reach in routine toothbrushing. It is often done by a dental hygienist. Professional cleaning includes tooth scaling, tooth polishing, and debridement if too much tartar has accumulated. This involves the use of various instruments or devices to loosen and remove deposits from the teeth. The American Dental Association has designated the code D1110 for adult prophylaxis or dental cleaning and has also designated the code D1120 for the same procedure in children.

As to the frequency of cleaning, research on this matter is inconclusive. That is, it has neither been shown that more frequent cleaning leads to better outcomes nor that it does not. A review of the research literature on the question concluded "[t]he research evidence is not of sufficient quality to reach any conclusions regarding the beneficial and adverse effects of routine scaling and polishing for periodontal health and regarding the effects of providing this intervention at different time intervals".[7] Thus, any general recommendation for a frequency of routine cleaning (e.g. every six months, every year) has no empirical basis.[8][9]

Complications

Overly vigorous or incorrectly performed brushing or flossing may cause injury to the gingiva (gums). Improper or over-vigorous brushing may cause sore gums, damage to tooth enamel, gingivitis, and bleeding gums. Dentists and dental hygienists can instruct and demonstrate proper brushing or flossing techniques.[10]

Aerosols generated during dental cleaning procedures may spread infection.[11] During the COVID-19 pandemic on 12 August 2020, the World Health Organization recommended that routine dental checkups be delayed in areas of community transmission.[12] Characteristics and detection rate of SARS-CoV-2 in alternative sites and specimens related to dentistry has been extensively reviewed.[13]

Disinfection

Antiseptics help reduce the number of microorganisms present in the oral cavity.[14] Antiseptics are recommended for both daily home care regimens and for use in the dental office setting. These products are used as a preprocedural rinse to reduce bacterial counts prior to routine dental treatments and injections.[15]

A common antiseptic rinsing agent used in the dental office is a 0.2% chlorhexidine product which provides a lowered bacterial count for more than 60 minutes.[16]

Acidity and decay relationship

The regulation of acid production and exposure in the oral cavity is of the utmost importance to maintain healthy enamel. When enamel, cementum, and /or dentin are subjected to an increased number of acidogenic and aciduric bacteria in dental biofilm, the demineralization process begins. When acidogenic and aciduric bacteria predominate the oral flora, there is an increased risk of developing caries.[15]

Reducing acid exposure

Dietary habits:

  • Reduce fermentable carbohydrate intake frequency
  • Limit snacking between meals and in the middle of the night
  • Avoid acidic beverages between meals
  • Use xylitol gum or mints between meals

History

Historically, professional tooth cleaning was sometimes referred to as odontexesis (literally "tooth-scraping")[17] or odontexis ("scraping off"),[17] and the instruments involved odontoglyphs.[18]

Dr. Alfred C. Fones, known as the "father of dental hygiene," was the first to develop the role of a dental hygienist into the current concept of a dental educator and dental professional. The dental hygienist is qualified, same as a dentist, to perform routine dental cleanings.[18]

References

  1. ↑ "Effective Tooth Brushing and Flossing.". 13 November 2007. http://www.webmd.com/oral-health/effective-tooth-brushing-and-flossing. 
  2. ↑ "Powered versus manual toothbrushing for oral health". The Cochrane Database of Systematic Reviews 2014 (6): CD002281. June 2014. doi:10.1002/14651858.CD002281.pub3. PMID 24934383. 
  3. ↑ American Dental Association (2005). "How to Brush". https://www.ada.org/~/media/ADA/Science%20and%20Research/Files/watch_materials_brush.pdf?la=en. 
  4. ↑ "Fluoride in caries prevention: is the effect pre- or post-eruptive?". Journal of Dental Research 69 Spec No (2_suppl): 751–5; discussion 820–3. February 1990. doi:10.1177/00220345900690S145. PMID 2179337. 
  5. ↑ "Dental flossing and interproximal caries: a systematic review". Journal of Dental Research 85 (4): 298–305. April 2006. doi:10.1177/154405910608500404. PMID 16567548. 
  6. ↑ "Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults". The Cochrane Database of Systematic Reviews (12): CD009857. December 2013. doi:10.1002/14651858.CD009857.pub2. PMID 24353078. 
  7. ↑ "Insufficient evidence to understand effect of routine scaling and polishing". Evidence-Based Dentistry 6 (1): 5–6. 2005. doi:10.1038/sj.ebd.6400317. PMID 15789039. 
  8. ↑ "How Often Should I Go to the Dentist for a Teeth Cleaning?". Ask the Dentist. 19 August 2010. http://askthedentist.com/how-often-should-i-go-to-the-dentist-for-a-teeth-cleaning/. 
  9. ↑ Lamont, Thomas; Worthington, Helen V.; Clarkson, Janet E.; Beirne, Paul V. (2018-12-27). "Routine scale and polish for periodontal health in adults". The Cochrane Database of Systematic Reviews 12 (4): CD004625. doi:10.1002/14651858.CD004625.pub5. ISSN 1469-493X. PMID 30590875. 
  10. ↑ "Toothbrushing Mistakes You Make and How to Fix Them". 12 November 2007. http://www.webmd.com/content/tools/1/slide_brush_teeth.htm. 
  11. ↑ "Airborne spread of disease--the implications for dentistry". Journal of the California Dental Association 32 (11): 901–6. November 2004. doi:10.1080/19424396.2004.12224042. PMID 15651466. 
  12. ↑ "Delay routine dental checkups in areas of COVID spread: WHO" (in en). Reuters. 2020-08-12. https://www.reuters.com/article/us-health-coronavirus-who-dental-idUSKCN2571WJ. 
  13. ↑ "Characteristics and Detection Rate of SARS-CoV-2 in Alternative Sites and Specimens Pertaining to Dental Practice: An Evidence Summary". Journal of Clinical Medicine 10 (6): 1158. March 2021. doi:10.3390/jcm10061158. PMID 33802043. 
  14. ↑ "Efficacy of preprocedural mouth rinsing in reducing aerosol contamination produced by ultrasonic scaler". J Periodontol (85): 4. 2014. 
  15. ↑ 15.0 15.1 Wilkins' Clinical Practice of the Dental Hygienist (13 ed.). Jones and Bartlett. 2021. pp. 422. ISBN 978-1-496-39627-3. 
  16. ↑ Boyd, Linda D. (2021). Wilkins' clinical practice of the dental hygienist. Lisa F. Mallonee, Charlotte J. Wyche, Esther M. Preceded by: Wilkins (13 ed.). Burlington, MA. ISBN 978-1-4963-9627-3. OCLC 1096288166. https://www.worldcat.org/oclc/1096288166. 
  17. ↑ 17.0 17.1 The Vocabulary of Dentistry and Oral Science: A Manual for the Study of Dental Nomenclature. Bureau of Library and Indexing Service, American Dental Association. 1958. 
  18. ↑ 18.0 18.1 Wilkins' Clinical Practice of the Dental Hygienist (13 ed.). Jones and Bartlett. 2021. pp. 4. ISBN 978-1-496-39627-3. 

External links

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