NATIONAL DENTAL COLLEGE AND HOSPITAL

DERA BASSI

DEPARTMENT OF PEDODONTICS AND PREVENTIVE DENTISTRY

SEMINAR Maintenance of oral hygiene in children

SUBMITTED BY: PARVEEN BATHLA PG student

Introduction
NEED FOR MAINTENANCE OF ORAL HYGIENE IN CHILDREN Oral health hygiene, especially for children is a topic of constant concern. Mainly due to the fact that their dental health standards are not always the best. There are number of aspects that need to be taken care of while ensuring optimal oral health in children. Primary dentition is more prone to dental caries than permanent dentition in children. This is due to following reasons: Less thickness of enamel in primary teeth. Lesser hydroxyapetite crystals in enamel in decidous teeth. Non availability of fluorides. More cariogenic challenges. Nursing caries. DENTAL PLAQUE It is a sticky, soft & colourless film of bacteria that constantly build up the surface of teeth & gums. Microorganisms of dental plaque are all naturally occurring in the oral cavity & are harmless. It is an example of biofilm. Plaque on teeth is colourless & therefore difficult to see & remove during brushing thicker build up. its

Plaque develops naturally on teeth & forms the part of the defense system of host by helping to prevent colonization of enamel by exogenous microorganisms.

Goals for Plaque Control Initial step of formation of dental plaque is the formation of acquired pellicle which is a thin film derived from glycoproteins & is free from microorganisms. According to various studies dental plaque is associated with the pathogenicity of various dental diseases. Plaque control should have 2 broad goals:

o o

use of mechanical & chemical agents to eliminate supragingival plaque. Mechanical removal of subgingival plaque through professional means periodically so as to maintain gram positive flora associated with gingival health.

EARLY ESTABLISHMENT OF ORAL HYGIENE Early establishment of oral hygiene procedures along with the development of non cariogenic dietary habits should begin during infancy itself. They can be achieved through the counseling of parents & their education both prenatally & postnatally.

1) Prenatal care: It is very important to strengthen the developing primary dentition during first trimester of IU life. Child gets calcium, phosphorous & other minerals during odontogenesis from the mothers blood stream. Hence a nutrious balanced diet is recommended for the expectant mothers. Prenatal fluoride supplement to mother in the dosage of 0.25-1% has been shown beneficial for the protection of primary teeth from caries. Medications like tetracycline for infection control should be avoided during pregnancy as it causes the discolouration of the primary teeth of infant. Postnatal care: Performed in 6-12 months of age. It includes: Mothers diet The lactating mother must take a well balanced diet rich in supplements of minerals & vitamins.

Timing of first dental visit First visit to the dentist-within 6 months of the eruption of first primary teeth but not later than 12 months of age. Dentist obtain the medical & the dental history including the prenatal & postnatal periods. Check for any inflammation or other oral diseases.

Provide anticipatory guide to parents or caregivers regarding dental and oral environment, fluoride status, non nutritive oral habits, injury prevention & effect of diet on dentition.

Diet Management It is recommended that nocturnal feeding should be discontinued after the eruption of the first tooth. After each feeding gum pads should be cleaned with wet gauge. The hole in the nipple of the bottle should not be too large to give the free flow of milk. Should be just wide enough so that child has to exert force to draw milk through it.

Cleaning of teeth Parent, adult & older sibling must assume total responsibility for cleaning the teeth of infants atleast once in a day. Oral hygiene neglect can lead to deteriorated oral health. Teeth cleaning must be done in comfortable location & in pleasant environment. Use of Toothpastes for infants are objectionable because of the taste & foaming action.

Teething, Oral habits & Oral Conditions Parents should be educated regarding the process of teething, natal & neo-natal teeth. Parents should be guided about the oral habits like thumb sucking, tongue thrusting etc. Other oral conditions such as tongue tie should also be taken into consideration.

Complications during teething: When the first tooth tears the gingiva & starts to erupt, a local inflammatory process occurs, which is characterized by Redness Tenderness Swelling

 Fever Loss of function As process continues child puts different objects in mouth because chewing such objects provides relief to child. If the object is not cleaned, the already inflamed gums provides an excellent opportunity for harbouring of microorganisms & inflammation persists. If relief is not given, child become wakeful, fretful, restless & fearful.

Treatment: Education of the members of the family is needed regarding the process & complications which may arise. Gentle massage of the affected area using clean finger or a gauge piece lightly soaked with saline should be done. Ask your doctor if you can give your baby infants acetaminophen (brand name: Tylenol). Do not give baby aspirin. Aspirin can cause Reyes syndrome, a serious illness that can lead to death in children under 18 years old. Analgesic gels like 20% benzocaine may provide relief. Teething rings & toys may be used as they may help the child by providing something to bite on.

ORAL HYGIENE IN & TODDLERS Keeping your baby's teeth clean is very important. Primary teeth have thinner enamel than adult teeth and are more vulnerable to the bacteria that cause decay. Decay in a baby's tooth is swift and destructive. It quickly penetrates the enamel, then the dentin, and then infects the nerve. Begin by gently wiping his gums with a clean, wet washcloth or gauze after he has a feeding. As he starts to sprout teeth, the feeling of the wet washcloth on his itchy, irritated gums will be very soothing. Wiping his gums will help eliminate decay-causing bacteria and will help him get used to having his teeth brushed later on. Once he has a tooth, between 6 and 12 months, introduce an infant toothbrush. Make sure it has soft, rounded bristles so it won't scratch his gums. Brushing with just water is fine, but if your dentist recommends toothpaste, use a very small amount, about the size of a pea.

Baby teeth eventually fall out, so why should it matter if they are lost early? Most dentists believe that baby teeth should remain in the mouth as long as possible, to serve as placeholders for succeeding tooth. Parents can also utilize a knee to knee position, in which one parent assists by wrapping childs legs around his/her body and gently holding down the childs arms. Whatever the position, caretaker visibility in the mouth and infant comfort are important.

WINDOW OF INFECTIVITY Acquisition of Streptococcus mutans in young children most likely takes place during a "window of infectivity" from 19 to 31 months of age.

ORAL MAINTAINANCE IN CHILDREN Encourage your children to eat regular nutritious meals and avoid frequent between-meal snacking. Protect your childs teeth with fluoride. Use a fluoride toothpaste. If your child is less than 7 years old, put only a pea-sized amount on their toothbrush. If you live in an area where the tap water doesn't contain fluoride, your doctor may prescribe daily fluoride tablets when your child is about 6 months old. Fluoride helps make teeth strong by hardening the tooth enamel. If you miss a dose, don't give your child extra fluoride to make up. Just as with swallowed toothpaste, too much oral fluoride can cause stains on child's teeth.

COMMON ORAL HYGIENE AIDS USED IN CHILDREN Mechanical Aids i. ii. iii. iv. v. vi. vii. Gauge pieces for use of infants. Manual toothbrush & Dentifrices. Electronic powered toothbrushes. Dental floss. Disclosing agents. Tongue scrappers. Oral irrigators.

 Chemotherapeutics Aidsi. ii. iii. iv. v. vi. Antiseptics mouthwashes. Antibiotics Enzymes Plaque modifying agents. Sugar substitutes. Plaque attachment interference agents.

Manual toothbrush & dentifrices- This is one of the most commonly used methods of plaque control. Large range of toothbrushes available in the market based on following variables: Diameter of fibers- soft (0.16-0.22mm), medium (0.23-0.29mm), hard (>0.30mm) Length of the bristles No. of bristles No. & arrangement of bristles as tufts Length of toothbrush head Angulation of head Shape of the bristle head Design of the handle Start by using a soft bristled toothbrush with a pea sized amount of toothpaste. Avoid using toothpaste that contains fluoride until child is able to consciously avoid swallowing it.

Proper brushing takes at least two minutes. To properly brush your teeth, use short, gentle strokes, paying extra attention to the gumline. Concentrate on thoroughly cleaning each section as follows: Clean the labial surfaces of your upper teeth, then your lower teeth

Clean the lingual surfaces of your upper teeth, then your lower teeth. Use gentle up-and-down strokes of brush. Clean the occlusal surfaces of the posteriors. Hold the brush flat and brush back and forth. Last but not the least brushing the tongue is also important.

BRUSHING TECHNIQUES USED COMMONLY IN CHILDREN 1) Horizontal Scrub technique 2) Fones Method 3) Bass Technique 4) Modified Bass Technique 5) Roll Method 6) Stillmans technique 7) Charters Method: 8) Modified Charters Method Horizontal scrub Technique In this technique brush is held firmly in hand & is used back & froth on the teeth. It has been found that most of children tend to use this technique naturally.

Fones technique (circular method) Brush is placed perpendicular to teeth. Large circular motion of brush over clenched teeth to simultaneously cover both upper and lower teeth. It was Previously popular but is not advised nowadays as it has proven to cause tooth abrasion.

Bass Technique/ Sulcular Vibration Brushing Directly push the filaments of the brush toward roots of teeth at 45 degree angle, press lightly but not enough to bend filaments of brush. Bass technique concentrates on cleaning the teeth in those areas and for this there is no specific requirement of a different special toothbrush.

The areas cleaned with this technique specifically include Gingival surface adjacent to the tooth Cervical 3rd of the tooth, adjacent to the gingival margin and including the proximal surfaces Interdental gingiva

The Bass technique is indicated For removal of bacterial plaque adjacent to gums & gingival margin. For spaces between teeth, and on the exposed root surfaces with gum disease. For patients who recently had got periodontal surgery done. For brushing on tooth crowns, dental bridges, braces etc.

Modified bass technique Circular movement which will cover gum as well as tooth surface. It massages the gums

Stillman technique Position your tooth brush as in bass technique, press the filaments of your tooth brush till the gum blanches, turn your wrist through an angle of 45 degree and proceed to vibrate and roll against each tooth.

Roll technique Soft brush is placed at the point where teeth and gums meet, held at about a 45 degree angle to your teeth. While brushing, roll the bristles in a round motion about 20 times before moving on to the next adjacent teeth. Lift the brush, position it and repeat. It is the most commonly used method, it is an easy method but it neglects the gum margins.

Charters method Brush is angled 45 degree downwards, with half the bristles of the brush over the gum & half over the crown. Vibratory movement along with circular motion is done.

Indicated in Individuals having open inter dental spaces with missing papilla and exposed root surfaces. Those wearing F.P.D. or orthodontic appliances. For patients who have had periodontal surgery. Patients with moderate interproximal recession

Disadvantages Brush ends do not engage the gingival sulcus to remove subgingival bacterial accumulations. In some areas correct brush placement is limited or impossible, so modifications become necessary which add complexity to procedure.

Modified Charters method DENTRIFICES Dentifrices are used for mechanical removal of plaque with toothbrushes. Dentifrices contain abrasives, surfactants, antiplaque substances, stain removers & can be fluoridated for anticariogenic properties. No fluoridated toothpaste should be used till 36 months of age due to the risk of ingestion. Till the child is 7 years of age only a pea sized quantity of dentifrices should be dispensed for tooth brushing. Modification is to include occlusal surfaces (i.e. bitting surfaces).

ELECTRIC/POWERED TOOTHBRUSHES First introduced in 1960. These are high-tech rechargeable models as well as low cost battery-powered toothbrushes. Brush head & bristle designs are more advanced, based on oscillating, vibrating or ultrasonic technology. Children enjoy the fun of using an electric toothbrush. It will result in a more thorough cleaning of their teeth, particularly at an early age. They provide 10-49% greater plaque removal than normal toothbrushes.

They requires less brushing force, hence prevent gum recession.

Indicated in disabled patients who lacks their ability to brush. It is effective with fixed orthodontic appliances.

DENTAL FLOSS It is most important to clean between the teeth to prevent decay and gum disease. Plaque and food particles stick to the teeth in embrasures. Normal tooth brushing cannot reach these tooth surfaces. Dental floss is the most efficient way to clean between teeth. Different types of floss are available, such as regular floss, dental tape and super floss. Floss is also available on a plastic holder, in the shape of a bow. It forms "the string of the bow" and it makes flossing very manageable. Few tips for flossing as demonstrated below: Use a 12-15inch (30-40cm) length of floss. Wrap the floss around your middle fingers. Hold the floss between thumb & forefinger of each hand. Leave about 2 inches (5cm) of floss between the hands. The floss must be taut when it is used. Gently guide the floss across contact point between the teeth. When the floss is in position between the teeth, rub it up & down a few times against each tooth surface, one after the other. This is then repeated for all the teeth in the mouth. A sharp downward thrust of the floss will damage the gum. So care must be taken.

PLAQUE DISCLOSING AGENTS Dye based products containing iodine, erythrosine, gentian violet, basic fuschin, fast green, flourescien or a tone dye are used.

In order to increase the plaque control by the patient it is very important to increase the visualization of plaque by the patient so as to educate & facilitate the patient. Available as liquid preparation or as chewable tablets. They stain soft tissues & pellicle as well as plaque.

ORAL IRRIGATORS These are chemo-therapeutic agents used to dislodge plaque particularly from interdental areas

TONGUE SCRAPPERS These may be flat, flexible, plastic sticks which help in cleaning the rough dorsal surface of the tongue. Gauge can also be used as tongue scrapper. Tongue cleaning should be routinely recommended for all the parents.

CHEMOTHERAUPEUTIC AIDS They are recommended for the children Having orthodontic treatment With high risk of caries Suffering from dry mouth Under gone radiation therapy Antiplaque or antimicrobial mouthwash is used to inhibit bacterial plaque formation & prevent to resolve chronic gingivitis. Care should be taken that they are not accidentally swallowed, especially by children to avoid toxicity. Commonly used mouthwashes are Chlorhexidine Listerine ORAL HYGIENE INSTRUCTIONS FOR VARIOUS AGE GROUPS Toddlers (1-3 years old) This is the best age to introduce toothbrush if it has not been done earlier.

 Only non-fluoridated dentifrices should be recommended. Flossing can also be used. Brushing should be done by the parents using lap to lap position of the child. Timely visit to the dentist.

Preschool children (3-6 years old) Fluoridated dentifrices can be introduced after 3 years of age. Brushing in this age should be supervised by the parents. Only pea sized amount of toothpaste should be used. Fluoride gels or rinses can be introduced in this age group in limited manner. Other chemotherapeutic aids should be avoided. 3) School going children (6-12 years old) Children now possesses the dexterity to brush on his own. Use of fluoride gels, rinses & other chemotherapeutic aids can be recommended at this age group. 4) Adolescent (12-18 years old) Patient compliance is the most important area of concern at this age. Dentist need to continually guide the patient for mechanical & chemotherapeutic plaque control.