Oral Health WA Dementia Training Study Centre Tuesday 22nd June 2010 - PowerPoint PPT Presentation

Loading...

PPT – Oral Health WA Dementia Training Study Centre Tuesday 22nd June 2010 PowerPoint presentation | free to download - id: 58142f-MmQ2Y



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Oral Health WA Dementia Training Study Centre Tuesday 22nd June 2010

Description:

... and fibrous enlargement of the gingiva without resorption of the underlying alveolar bone ... 2mm Enamel Gingival Mucosa Dentine Periodontal Ligament ... – PowerPoint PPT presentation

Number of Views:148
Avg rating:3.0/5.0
Slides: 111
Provided by: CliveR9
Learn more at: http://www.dtsc.com.au
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Oral Health WA Dementia Training Study Centre Tuesday 22nd June 2010


1
Oral Health WA Dementia Training Study Centre
Tuesday 22nd June 2010
  • Clive Rogers
  • BDSc, Grad Dip Ed (Pr), Cert IV Trainer
    Assessor
  • The Visiting Dentist
  • cliverogers_at_aapt.net.au

2
  • Objectives of this presentation
  • Briefly discuss the nature of and current
    knowledge about two common oral diseases tooth
    decay and gum disease
  • Introduction to the daily management care of
    tooth decay and gum disease
  • Stressing the words Briefly and Introduction
  • (A summary)

3
I appreciate the opportunity to give you any
information I can, However, Summaries in
teaching achieve very little in training primary
or foundational knowledge and hand-skills.
4
It was suggest that - I target the information
of this talk at an informed general public
level. - The informed general public has basic
knowledge of oral hygiene and are conversant with
most issues but are unaware of details/consequence
s, etc. (????) - Most importantly target the
information for care-workers about what they can
do to improve/maintain the oral health of their
clients with dementia.
5
However given the high level of oral disease in
the general public The informed general
public has a limited basic knowledge of oral
hygiene and are not conversant with most issues
and are unaware of details/consequences.
6
The understanding and competency in the knowledge
and skills required of a care-worker to implement
daily oral/dental care for people with varying
special needs in the workplace, is definitely not
general knowledge. Not every care-worker needs
to be an oral-carer. (or be an medication-carer,
or OT-carer or, physio-carer or, etc) Total
daily oral care of another person is - not easy
to understand or implement, - not able to be
learnt in one lecture, - not able to be learnt
in one day
7
  • The care of people with special needs is best
    done by a Team
  • In an effective Team
  • Members of the team have unique knowledge and
    skills.
  • There is an understanding of, and respect for
    the members of the team and their unique
    knowledge and skills.

8
It is illogical and impractical, given our
understanding of training and education
best-practices To expect care-workers, such as
nurses, to be able to learn and become
knowledgeable and skilled as oral-carers for
people with disability in a one-day (6hrs)
training session. Poor education planning -
Leads to poor education
9
I understand that I am attending this course to
be trained as a trainer. On completion of this
course I will train and support aged care workers
in the residential facility in which I am
employed, in order to maintain the daily oral
hygiene of the facilities residents  Source
Better Oral Health in Residential Care Training
(funded by the Department of Health and Ageing)
10
Two Registered nurses from each care
facility Undertake oral health assessments and
care plans. Ensuring residents daily oral
hygiene is maintained And trained as a
trainer  Source Better Oral Health in
Residential Care Training (funded by the
Department of Health and Ageing) All this to be
learnt and implemented, to the work-place
standard, for vulnerable people with special
needs, in a one-day (six hours). Impossible to
do. Disrespectful to care-workers.
11
  • A student undertaking qualification, to become a
    TAFE Certificate IV Trainer and Assessor, would
    fail
  • if in their final assignment/assessment, they
    planned a training program such as the government
    is conducting in the Better Oral Health in
    Residential Care Training .
  • If you wish to be a Trainer, I recommend that you
    undertake the Certificate IV Trainer and Assessor
    course
  • 12 day TAFE course, spread over 6mths, with
    assignments approx cost 2200

12
In the short time we have here. Outcomes of this
lecture I believe it is important that each one
of you feels you have gained something, been
empowered, learnt, or consolidated some knowledge
about your oral health. This may also in some
small way improve your knowledge and ability to
provide, facilitate, or coordinate dental care
for a person with dementia to improve their
oral/dental health.
13
What is Oral? Relating to the mouth Source
Stedman's medical dictionary 26th edition - the
teeth. - gums (gingiva), oral mucosa, hard and
soft palate, alveolar bone (tooth related bone),
floor of the mouth, any man-made appliances
(prosthetics) placed/used in the mouth both fixed
and removable crowns, bridges, full and partial
dentures, implants to name a few , etc. -
saliva and the tongue, have major roles in the
function, and health of the oral cavity .
14
What is Health? 1. The State of the organism
when it functions optimally without evidence of
disease or abnormality. 2. A state of dynamic
balance in which an individual's or group's
capacity to cope with all the circumstances of
living is at an optimal level 3. A state
characterised by anatomical, physiological, and
psychological integrity, ability to perform
personally valued family, work, and community
roles ability to deal with physical, biological,
functional, and social stress a feeling of
well-being freedom from risk of disease and
untimely death. Stedman's medical dictionary
1995
15
(No Transcript)
16
(No Transcript)
17
(No Transcript)
18
(No Transcript)
19
(No Transcript)
20
(No Transcript)
21
Within the Australian adult population oral
diseases are pervasive one in four adults have
untreated dental decay and a similar proportion
have destructive periodontal disease. They
cause symptoms ranging from pain to difficulties
eating among as many as one in five people. The
frequency of oral disease and related symptoms
are in equitably distributed being greater in
groups that are already disadvantaged. Source
Australians Dental Generations, The National
Survey of Adult Oral Health 2004-06, Australian
Government Australian Institute of Health and
Welfare. P236
22
(No Transcript)
23
(No Transcript)
24
(No Transcript)
25
(No Transcript)
26
(No Transcript)
27
(No Transcript)
28
I put to you that the most common things happen
the most often. I would also put to you that
rather than wondering - How well we are going to
care for a person with dementia, with a specific
level/type? - How well do we just care for a
person? It's the person that comes first. If
we sort out the problems that just happened for
people in general then what is left may be
related to a disability, or may not.
29
The two most common oral diseases, which affect
people in general, not just people with dementia
are Gum Disease, and Tooth Decay.
30
  • These both can, in advanced stages, affect
    general health.
  • Gum disease bacteraemia, aspiration pneumonia,
    pain.
  • Tooth decay pain, when advanced local abscess
    formation, pus draining from abscess, aspiration
    pneumonia, systemic toxicity.
  • Advanced Gum Disease, and Tooth Decay is
    commonly seen in RACF

31
As I have said given the exceptionally limited
time of this talk for such a broad topic. I
wish to focus on the major factors.
32
It is not sensible to disregard the most
significant factors in a disease, while wasting
time adjusting factors of minor significance.
33
I fully knowledge there are unique, isolated,
minor factors which can have some influence over
an individual person's dental health, which for
that individual person, may be significant to
some degree. However that is not particularly
relevant if the major factors have been ignored
in examining, diagnosing, or caring for a
person. Usually Deal with the major significant
factors first.
34
Tooth decay (Dental Caries) is preventable
In a nutshell If people who have teeth did not
put fermentable carbohydrate (sugars - especially
sucrose) in their mouth at high frequency, and at
inappropriate times throughout the day, the vast
majority all tooth decay would not develop, and
if it had developed this tooth decay would stop,
repair, and become in-active (heal).
35
However, sugar marketing, sweet food
addictions, and diet misunderstanding is the
norm. People who have teeth and a disability,
which places food selection and nutritional
control in the hands of carers, are susceptible
to tooth decay if this carer orally feeds them
sugar at a high frequency. Tooth decay is
basically a dietary disease.
36
Gum Disease Gingivitis, Periodontal disease (in
its many forms) is generally preventable.
In a nutshell If people gently and adequately
(or efficiently) cleaned, or had their, teeth/gum
interface (gingival pocket) cleaned on a daily
basis close to 100 clean, (similar to the way we
try to clean dishes after a meal or our hands and
body in the shower) the vast majority all gum
disease would not occur.
37
However, This cleaning/hygiene task is not easy
to do adequately Some people have not been taught
how to do this adequately, Some have chosen not
to learn how to do this adequately Some people
have limitations both physical and mental, which
prevent them doing this task adequately on a
daily basis, Some people just don't care or lack
the motivation or discipline, Some people have
very difficult shapes around their teeth which
are hard to clean (however they should not be
impossible to clean), Some people consult
dentists for whom gum disease and/or tooth decay
is not their strong area of understanding,
interest and/or ability. Most people who are
unable to brush their teeth because of
disability, lack a carer who has the knowledge
and skills, supported by managerial incentives,
policies, payment, and time, to do this task for
them.
38
(No Transcript)
39
(No Transcript)
40
(No Transcript)
41
(No Transcript)
42
(No Transcript)
43
(No Transcript)
44
(No Transcript)
45
How and why both these nutshells about gum
disease and tooth decay are in general accurate
requires knowledge to understand. Hopefully I
will have time to tell you some of this.
46

Periodontal probe
Surrounded by saliva
2mm
Enamel
Gingiva - pink, firm
Dentine
Gingival pocket 1-2 mm (shallow)
Periodontal Ligament
Gingival Mucosa
Bone
Nerves blood vessels suppling the Dental Pulp
inside the tooth
A Patient Guide for Tooth and Gum Care, Oral-B
(Modified)
47
Tooth decay or Dental Caries A localised,
progressively destructive disease of the teeth,
which starts at the external surface (usually the
enamel) with the apparent dissolution of the
inorganic components by organic acids that are
produced in immediate proximity to the tooth by
the enzymatic action of masses of micro-organisms
(in the bacterial plaque) on carbohydrates. Stedm
an's medical dictionary 1995
48
Tooth Decay (Dental Caries)
There are four important factors in tooth
decay          Bacteria         
Sugar          Fluoride          Saliva
49
Tooth Decay (Dental Caries)
Bacteria live in our mouths (and all over us).
They are not a problem to us unless they get out
of balance with our body. Some bacteria in the
mouth live off the sugared food we eat (decay
bacteria). They breakdown this sugar into
energy, to grow and multiply, then excrete acid
as their waste. This acid builds up in the place
where these bacteria live, that is - the plaque
on the tooth surface.
50
Tooth Decay (Dental Caries)
The acid dissolves the calcium and phosphate out
of the tooth. We cant do much about the
bacteria. We cant use a mouth rinse every day
to kill or suppress the bacteria for the same
reason we cant take antibiotics every day to
stop us getting an infection.
51
Tooth Decay (Dental Caries)
Sugar is the food that these decay bacteria use
to produce acid. If you dont feed the bacteria
in your mouth sugar you wont get decay. Its
that simple. But this is not easy to do because
there is sugar in a lot of the drinks and foods
we need to eat, to be healthy(eg fruit and
vegetables) . It is not the amount of sugar we
eat. It is how often we eat sugar.
52
Tooth Decay (Dental Caries)
The decay bacteria in our mouth take only a few
minutes to produce acid from the sugar. This
acid in the mouth takes about one hour to be
neutralised by healthy saliva. If you were to
feed the bacteria more sugar the acid level will
rise again. If you are feeding the bacteria
sugar all day long then you will have a high acid
level in your mouth all day long.
53
Tooth Decay (Dental Caries)
  • Note that with caries activity ranging from
  • inactive to low activity the buffering capacity
    of saliva is adequate and the pH recovers within
    about 20 minutes.
  • With moderate activity the pH is lower to begin
    with and recovers more slowly.
  • In the presence of extreme activity the pH falls
    for a longer time and recovers much more slowly.

Preservation and Restoration of Tooth Structure
Mount G.M, Hume W.R, 1998
54
Tooth Decay (Dental Caries)
If you took all the sugared substances you eat
and drink in a day and put it in a pile, then ate
it or drank it in one go, you would only feed the
decay bacteria in your mouth once. Your mouth
would only get acidic once in that day. If
instead you had a spoonful or sip of the sugar
from the pile every half an hour, Every half an
hour your teeth would be attacked by acid. (And
so on eg sugar every 15 min ? acid attack every
15 min. . . )
55
  • Cariogenic (decay promoting) Medication
    Additives, eg
  • Chocolate
  • Sugar syrup

Tooth Decay (Dental Caries)
56
Tooth Decay (Dental Caries)
57
Tooth Decay (Dental Caries)
If you are tooth decay active, it is important to
reduce how often you put sugar in your mouth.
Reducing the sugar frequency is important.
Not the sugar amount.
58
Tooth Decay (Dental Caries)
Tooth decay can heal. This is true. Our bodies
are dynamic - not static. Calcium and phosphate
is lost and gained from the outside surface of
your teeth (enamel/exposed dentine) every day.
If you have no, or inactive, tooth decay this
loss/gain is in balance. If you have active
tooth decay this loss/gain is out of balance and
your teeth are losing more Ca2 PO4-3 than they
are gaining. To heal tooth decay you need to
stop the frequent acid attack of your teeth, and
give them time to heal. Regain balance.
59
Tooth Decay (Dental Caries)
Preservation and Restoration of Tooth Structure
Mount G.M, Hume W.R, 1998
60
Tooth Decay (Dental Caries)
Fluoride is important in the daily prevention of
decay because it makes the tooth (enamel
exposed dentine) less able to be dissolved by the
bacterial acid. Daily use of topical (surface)
fluoride is thought to be the best way to
strengthen teeth once the teeth have developed.
Conversion of hydroxyapatite to fluorapatite. The
chemical reaction taking place at the tooth
surface.
61
Tooth Decay (Dental Caries)
The teeth will remineralise with fluoride ions,
if you use fluoride toothpaste regularly (daily).
It takes ten times more acid to dissolve
fluoride out of the tooth than calcium.
Fluoride makes the surface of the teeth
resistant to acid attack.
62
Tooth Decay (Dental Caries)
Do not swallow toothpaste! Toothpaste is for
the tooth surface (topical) use only.
63
Tooth Decay (Dental Caries)
Saliva is part of our bodies defence mechanism
against decay. It is important to have enough
healthy saliva. Healthy saliva is a buffer, or
anti-acid, which neutralises the acid the
bacteria produce. (contains Ca2 PO4-3)
64
Tooth Decay (Dental Caries)
  • Many medications (with anticholinergic effects)
    reduce saliva flow.
  • Saliva flow drops when we sleep.
  • Chewing sugarless gum can stimulate saliva.
  • It is also believed to inhibit bacterial
    growth.

65
Tooth Decay (Dental Caries)
  • Teeth cleaning.
  • Is not a significant factor in preventing tooth
    decay,
  • however
  • You can put a thin layer of fluoride, from
    toothpaste, over the teeth.

66
You will find after this information that one or
more factors relate to your tooth decay.
67
  • Your dentist can only
  • Advise you if you have tooth decay,
  • if your decay is active,
  • how to prevent decay, (???)
  • Fill the holes that tooth decay create in the
    teeth.

68
  • Fillings dont stop tooth decay.
  • Fillings mainly give back to teeth
  • Shape - to chew,
  • Cosmetics .

69
The dentist cannot stop your daily tooth decay.
  It is up to you  to stop tooth decay.
70
Gingivitis (gum disease) Inflammation of the
gingiva as a response to bacterial plaque on the
adjacent teeth characterised by erythema,
oedema, and fibrous enlargement of the gingiva
without resorption of the underlying alveolar
bone Stedman's medical dictionary 1995 In
Periodontal disease Resorption of the underlying
alveoli bone occurs.
71
Do you have gum disease? Would your gums
bleed, if soft toothbrush bristles were pushed
down into your tooth/gum interface ?
Simply If, Yes you have Gum Disease If,
No - you do not have Gum Disease
72
  • We would all like to think that we clean our
    teeth close to 100.
  • - How do we know?
  • Who has tested you at this ability?
  • As a carer f you cant clean your own teeth/gums
    close to 100 what makes you think you can do
    this task close to 100 for another person as
    their oral-carer?
  • More importantly, do this cleaning task
    adequately for other people with low and variable
    compliance.

73
I repeat It is logistically impractical for me
to be able to teach you effectively any new
hand-skills in a single session such as this, and
expect you to be proficient in the new skills.
Especially as a care-worker whose job it maybe
to be proficient at cleaning of another person
mouth (with varying levels of dental status, and
varying levels of disability/compliance factors)
and the knowledge behind all this. I do not
have the opportunity to demonstrate the
hand-skills so you all can see, you do not get a
chance to explore these hand-skills under my
guidance, you do not get a chance to practice and
reinforce these hand skills, etc.
74
Think about any hand-skills you may like to learn
such as taking blood pressure with a
sphygmomanometer, playing a musical instrument,
cooking, sewing you don't learn to do it
proficiently by just by watching (and definitely
without a lot of practice) . Anyone trying to
train you to be proficient in a hand-skill in a
single session simply does not understand
education and training. As a student you will
feel like a failure - do not. The failure is
not you. The failure is clearly the trainers -
trainers should know better than to attempt to
implement such a ridiculous single session
training plan.
75
  • Healthy gums are
  • pink,
  • firm,
  • dont bleed, and
  • clean

76
Gingiva Healthy (Gums)
Periodontal probe
2mm
Enamel
Gingiva - pink, firm
Dentine
Gingival pocket 1-2 mm (shallow)
Periodontal Ligament
Gingival Mucosa
Bone
Nerves blood vessels suppling the Dental Pulp
inside the tooth
A Patient Guide for Tooth and Gum Care, Oral-B
(Modified)
77
  • Unhealthy gums are
  • inflamed (red, heat, swelling, pain, and loss of
    function),
  • have plaque (biofilm) and
  • bleed easily.

78
Gingivitis Gum Disease
Periodontal probe
2mm
Enamel
Gingiva - red, swollen
Plaque dental biofilm
Gingival pocket 2-3 mm
Dentine
Periodontal Ligament
Gingival Mucosa
Bone (supporting the tooth)
Nerves blood vessels suppling the Dental Pulp
(inside the tooth)
A Patient Guide for Tooth and Gum Care, Oral-B
(Modified)
79
Gum Disease (Gingivitis)
Gum disease is caused and modified by three main
factors   Ø  Bacteria   Ø  Plaque (Biofilm)
Ø Cleaning the Gum/Teeth interface
80
Gum Disease (Gingivitis)
Bacteria (micro-organisms) live in our mouths,
and all over us. They are not a problem to us
unless they get out of balance with our body. The
bacteria, that cause gum disease, live off the
food we eat that stagnates on our teeth and gums.
This stagnant food mixed with bacteria is
called PLAQUE. When this plaque is mature, we
call this Dental BIOFILM. Biofilms are an
aggregate of micro-organisms with a distinct
architecture (mini ecosystem).
81
Gum Disease (Gingivitis)
The gum disease bacteria eat the food, which
stagnates in the mouth to grow and multiply,
then excrete enzymes or toxins as their waste.
These enzymes build up in the and attack the
gums. We cant do much about the gum disease
bacteria directly. We cant use a mouth rinse
every day to kill or suppress the gum disease
bacteria for the same reason we cant take
antibiotics every day to stop us getting an
infection.
82
Gum Disease (Gingivitis)
Plaque removal (disturbance) is the key to
preventing, managing, and stopping gum disease.
Unlike the decay bacteria, which take only a
few minutes to excrete the acid, that then
attacks the teeth the gum disease bacteria
usually take a few days for the biofilm to form
then to produce enough toxins to attack the gums.
This is a good thing for us because if we keep
the teeth/gum interface clean every day the
toxins never have a chance to be created,
build-up, and attack the gums.
83
Dental plaque needs to be (disturbed) removed on
a daily basis. Do not let a biofilm develop
This means that You or the daily oral health
carer are the one/s who stop and prevent gum
disease.
84
Gum Disease (Gingivitis)
  • Dental Calculus
  • the calcium deposit on the teeth
  • Occurs if biofilm is left stagnating on the tooth
  • Is the bodys (saliva) attempt to neutralise the
    toxins in the biofilm
  • Makes the tooth surface difficult to clean
  • Removing calculus is the job of the dentist or
    dental hygienist. (Act of Dentistry)
  • It is not easy to make the tooth smooth again

85
Initial Periodontal Disease
Periodontal probe
2mm
Enamel
Gingiva - red, swollen
Plaque, dental biofilm calcified deposit
Gingival pocket 3-4 mm
Dentine
Ligament Bone lost
Gingival Mucosa
Periodontal Ligament
Bone (supporting the tooth)
Nerves blood vessels suppling the Dental Pulp
(inside the tooth)
A Patient Guide for Tooth and Gum Care, Oral-B
(Modified)
86
Moderate Periodontal Disease
Periodontal probe
2mm
Enamel
Gingiva - red, swollen
Plaque, dental biofilm calcified deposit
Gingival pocket 4-5 mm
Dentine
Ligament Bone lost
Gingival Mucosa
Periodontal Ligament
Bone (supporting the tooth)
Nerves blood vessels suppling the Dental Pulp
(inside the tooth)
A Patient Guide for Tooth and Gum Care, Oral-B
(Modified)
87
Advanced Periodontal Disease
Periodontal probe
Enamel
Plaque, dental biofilm calcified deposit
Gingiva - red, swollen
Gingival pocket 5-6 mm
Dentine
Gingival Mucosa
Ligament Bone lost
Periodontal Ligament
Bone (supporting the tooth)
Nerves blood vessels suppling the Dental Pulp
(inside the tooth)
A Patient Guide for Tooth and Gum Care, Oral-B
(Modified)
88
Gum Disease (Gingivitis)
It is more important to have clean teeth and
gums 100 once a day, than clean only 70 twice
a day. The best time to brush - Not after meals
(abrasion discuss at another lecture) - This
varies from person to person depending on several
factors such as their oral disease profile, diet,
lifestyle, etc.
89
Gum Disease (Gingivitis)
Gum and teeth cleaning. The best tool to remove
the plaque from our teeth and gums is still the
toothbrush.
90
Gum Disease (Gingivitis)
What type of toothbrush is best?
An appropriate toothbrush has Soft bristles, a
Straight bristles, and Small head. The three
S S S
91
Gum Disease (Gingivitis)
What type of toothbrush is best?
Manual toothbrush vs. Electric toothbrush Too
little time to discuss effectively in this
lecture.
92
I repeat Before an oral care-worker attempts to
develop skills in brushing someone elses teeth
and gums, it is important to be able to do this
satisfactorily on themself. Many people who
brush their own teeth and gums cannot do this
task satisfactorily and have gum disease.
93
Gum Disease (Gingivitis)
How to brush your own teeth and gums. It is
hard to see in our mouth, to check as we clean
our teeth and gums. You cant see behind your
back teeth in the mirror. How well would you
clean the dishes if you were blindfolded? You
would have to be methodical and spend time wiping
every surface, if you wanted to get close to a
100 clean.
94
Gum Disease (Gingivitis)
How to brush teeth and gums.
Brushing teeth and gums is a bit like brushing
when youre painting. You want to get to every
surface evenly and with control.
95
Gum Disease (Gingivitis)
How to brush your own teeth.
  • Do you know
  • Where the food/plaque/biofilm usually stagnates?
    (In the gaps/crevices/gum pocket)
  • How many teeth you have?
  • The shape of your teeth?
  • The depth of the gingival or periodontal (gum)
    pocket around each of your teeth?

It is not really possible to effectively brush
(clean) every surface of, something that you
dont know the shape. (Painting blind)
96
Gum Disease (Gingivitis)
How to brush your own teeth.
Teeth are in lines and have grooves between them
like the grey corrugated fences. If you wanted
to paint a corrugated fence green with a brush,
which way would you brush?
97
Gum Disease (Gingivitis)
How to brush your own teeth.
Up and down, of course. You would not brush
across the fence for the obvious reason that you
would not get into the grooves.
98
Gum Disease (Gingivitis)
How to brush between your teeth.
When youre painting the fence, what technique do
you use to get the paint into a nail-hole or
crack? Dab, dab, dab. This is just the same
with the gaps between your teeth. The pivotal
article on oral hygiene called this action a
digging action or a vibratory motion.
Bass, C C An Effective Method of Personal
Oral Hygiene Journal of the Louisiana State
Medical Society, 1954 (Pp 100-112)
99
Gum Disease (Gingivitis)
How to brush between your teeth.
As the bristles go into the gap the plaque is
pushed out, or is disturbed. Between some teeth
the bristles can go right through. Do this if
you can. You dont want to make the gaps
between your teeth any bigger. Soft bristles
wont damage the gums. (only use a soft or
ultrasoft bristle toothbrush) If you cant
dig the bristles between any two teeth use
dental floss. (I have no time to effectively show
you how to use floss on yourself, let alone
another with dementia)
100
Gum Disease (Gingivitis)
How to brush between your teeth.
The first few times that you brush like this your
gums may bleed and be tender (possibly painful).
This is because you are finally cleaning the
bacteria, food, and possibly pus, off the
ulcerated mucosa at the base of the
gingival/periodontal pocket. This pocket can
heal, if you keep it clean, as with most wounds.
The gingival mucosa will, after healing,
toughen-up (keratinise) and then not hurt when
you dig the soft bristles into the
gingival/periodontal pocket daily.
101
Gum Disease (Gingivitis)
Dont use toothpicks. Toothpicks damage the gums
and make the gaps between your teeth bigger.
Then the gap will collect more food.
102
Gum Disease (Gingivitis)
How to brush between your teeth.
People made the mistake of calling the digging
technique of Basss, little circles. Sure,
you can paint a nail-hole with a little circle
action, but if the circles are any larger, you
wont get the bristles of the brush in the
nail-hole at all. You will just go around the
outside of the hole. Some silly toothpaste and
toothbrush advertising companies show actors
(pretending to be dentists) brushing their teeth
in big circles. Very, very silly. Can you
imagine painting a corrugated fence with big
circles? - Crazy.
103
Gum Disease (Gingivitis)
  • How long does it take to brush your
  • Teeth/Gum interface?
  • It should take at approximately two minutes
  • (Unless youre missing teeth).
  • between all the lower teeth.
  • the tongue-side of the lower teeth
  • the cheek-side of the lower teeth.
  • between all the upper teeth.
  • the tongue-side of the upper teeth.
  • the cheek-side of the upper teeth.
  • Look at your watch or clock and time yourself.
  • You will be surprised. Efficient cleaning takes
    time.

104
Gum Disease (Gingivitis)
  • Your dentist can
  • Advise you if your gums are healthy or not.
  • Explain how to prevent gum disease. (?????????)
  • Remove hard calcium deposits (dental calculus or
    tartar) and smooth the sides of the teeth to make
    your cleaning easier.

105
Advanced Periodontal Disease
Periodontal probe
Enamel
Plaque, dental biofilm calcified deposit
Gingiva - red, swollen
Dentine
Gingival pocket 5-6 mm
Gingival Mucosa
Periodontal Ligament
Bone (supporting the tooth)
Nerves blood vessels suppling the Dental Pulp
(inside the tooth)
106
Gum Disease (Gingivitis)
107
Gum Disease (Gingivitis)
108
Gum Disease (Gingivitis)
How well did you clean your teeth and gums
today?
109
Gum Disease (Gingivitis)
You (or the daily oral carer) are the one/s who
stop and prevent gum disease.
110
Thankyou I hope you have learnt or reinforced
something about oral health. Questions ??
About PowerShow.com