Prophylaxis in dentistry refers to the prevention of problems regarding the teeth, the gums and the alveolar (jaw) bone. One of the fundamental tenets of medicine is that it’s better to prevent than to treat and let’s not forget this is less expensive too…
Dental prophylaxis is carried out by the patient at home – dental brushing, using dental floss, using a Waterpik – and by the dentist – supra- and subgingival scaling, sealing the occlusal grooves and pits, local fluoridations and occlusal rehabilitation.
As prophylaxis requires a collaboration between dentist and patient, a dental check is recommended twice a year.
I. Toothbrushing is the most important element in prophylaxis. To ensure it is performed correctly, the following aspects must be kept in mind:
1.1 The toothbrush you use must be chosen based on your necessities:
a. Patients with periodontal diseases should use soft toothbrushes, with rounded edges.
b. Patients with orthodontic braces should use orthodontic toothbrushes along with interdental brushes. The interdental brushes can also be used not only by the patients with prostheses or implants, but also by patients with gingival problems.
c. Patients with healthy gums should use toothbrushes of medium roughness.
Toothbrushes with hard roughness may be used for cleaning the teeth on the occlusal surfaces – the part where the food is chewed. However, they mustn’t touch the gum as they are too hard and can lead to gingival recession.
All toothbrushes have their roughness written on the pack, which can be soft, medium or hard. The toothbrush must be changed when the bristles become curved, usually every 3 months.
1.2 The technique of brushing must be correct:
The toothbrush must be placed in a 45° angle from the tooth; the bristles of the toothbrush must touch both the gum and the surface of the tooth. You should begin with brushing the exterior surface of the teeth, followed by the interior. For the brushing of the interior surface of the front teeth, the toothbrush must be placed in a vertical position behind the teeth. Finally, the brush should be placed on the horizontal surface of the teeth and it will have a motion from left to right. Ideally, brushing should be performed after every meal, but brushing performed at night before sleep is the most important.
II. Using dental-floss (flossing)
Flossing is essential for removing food debris and plaque not only between the teeth but also from around the gums. It is ideal for cleaning the places that the toothbrush can’t reach.
How is it used?
About 30 cm of floss is taken and twisted around the index fingers.,With the help of the thumb, the floss is guided between the teeth and lightly under the gum so as to avoid injury to the gum. Every tooth is cleaned individually.
III. Waterpik Water Flosser
A Waterpik is recommended for patients with prostheses on natural tooth roots or implants, fixed orthodontic braces or who are post-trauma. The device is plugged into a shaver socket and mouthwash is inserted into the reservoir, which is sprayed by a pump around the teeth and prostheses through a narrow tip. It is used before toothbrushing to eliminate food debris and allow the active substances from the toothpaste to penetrate around the teeth and gums. It provides a thorough cleaning due to the penetration with pressure of the mouthwash in areas of the mouth that the toothbrush and dental floss cannot reach (often, the dental floss used improperly can push the remains of food under the gum instead of pulling them out). Therefore, it is very effective when using around natural teeth, dental prostheses, implants and orthodontic braces.It reduces gingival inflammation and bleeding due to the thorough removal of plaque. It is recommended to read the instructions before using the Waterpik and ask your dentist if you have any further questions.
There are three types of mouthwash: 1. Cosmetic, 2. Antibacterial and 3. With Fluoride. Antibacterial mouthwash is based on chlorhexidine, which has antiseptic properties that reduce formation of dental plaque by approximately 45-60% and the occurrence of gingivitis by around 30-60% compared to other products. Mouthwashes based on chlorhexidine can have different concentrations: 0.2%, 0.12% and 0.06%. Using these mouthwashes for longer than 14-28 days can cause your teeth, fillings, prostheses and tongue to change colour, and can even lead to taste disorders. For daily usage of mouthwash based on chlorhexidine, a concentration of 0.06% is recommended. Rinsing with mouthwash in the morning and evening is highly beneficial.
IV. Supra- and subgingival scaling
Unlike dental plaque, which is a colourless deposit, calculus is a mineral complex that is easily noticed with the naked eye as it exhibits a brown-yellow colour where the gum meets the teeth. Sometimes, there can be so much calculus that it can cover the entire surface of the tooth. This can irritate the gingival tissue, which can lead to its inflammation (the gingiva becomes red and swollen and can bleed). Consequently, for patients with prostheses or implants, it is extremely harmful. The gingival inflammation can also be exacerbated by in different physiological conditions (such as menstrual period, pregnancy or menopause) or can be a symptom associated with diseases (like diabetes, hypovitaminosis, anaemia and haematological diseases). Moreover, a build up of calculus may cause dental decay.
The only way of removing the calculus is scaling. This should be performed every 4-6 months and for smokers, every 3 months.
The scaling is performed with an ultrasound device and involves removing the supra- and subgingival calculus. The subgingival calculus is hardly noticed by patients; indirect signals such as inflammation and bleeding gums can be a warning. Scaling is not harmful for the dental enamel. After scaling, the affected areas are finished with brushing and airflow (a device which generates a sodium bicarbonate and water jet, with pressure). Airflow removes dental plaque, soft formations and stains, polishing the dental surfaces with specially designed pastes. It is very efficient in removing nicotinic and tar stains which appear on smokers’ teeth. Lastly, the interdental surfaces are polished as well, using dental floss or strips.
After scaling, dental sensitivity might occur (especially in case of cold stimulus) which can last a few days or one week at most. If it is uncomfortable, patients can use toothpastes and mouthwashes with a desensitising effect.
After cleaning the teeth with airflow, any action that can cause the teeth to colour, such as smoking or consumption of food, fruits and liquids that can cause the teeth to colour (blueberries, blackberries, red wine, black tea Pepsi-Cola, Coca-Cola etc.) must be avoided for 2-3 hours.
Local fluoridation is performed in the dental clinic. The procedure is non-invasive and painless. It involves applying fluoride in a polish or gel form, either using mouth guards or directly applying on the surface of the teeth.
Fluoridation is carried out only after the dental surfaces are properly cleaned through scaling or professional brushing. The solution used in the clinic for fluoridation contains a much higher concentration of fluoride than over-the-counter toothpastes and mouthwashes.
Professional fluoridation only lasts a few minutes. After treatment, you are not allowed to rinse or consume food or liquids for at least 30 minutes to allow the teeth to absorb the fluoride. Depending on the state of your oral health and the recommendation of your dentist, you maybe advised to return for fluoridation every 3, 6 or 12 months.
This is a non-invasive procedure, which is performed on the teeth that are not affected by dental caries. It prevents the occurrence of caries by 80% and involves the application of a sealing material on the outer surfaces of the teeth, making them smooth and easier to clean.
VII. Occlusal rehabilitation
The occlusion (how the teeth bite together) can change and negatively affect oral health, especially for the patients with dental prostheses or implants, or for patients with periodontal disease. Eliminating these small changes to the occlusion is often extremely simple.