Dental Prophylaxis And The Gag Reflex

Front 1

What are the purposes of prophylaxis?

Back 1

Give patient clean basis to practice home oral hygiene

Help young/anxious patients aclimitised to operating procedures

Remove extrinsic stains for aesthetic reasons

Remove plaque and debris from teeth

Localised: eg to prepare a treatment site for fissure seal placement

Front 2

What is extrinsic staining and it's causes? (specific examples)

Back 2

Extrinsic staining occurs from pigmentation of the normally colourless saliva pellicle that coats the teeth from various substances or bacteria.

Variety is the strength of attachment and degree of colour. Found more where there is low salivary flow, eg cervial, interproximal regions

Causes:
Black line - gram positive bacteria in pellicle - tenacious
Green stain - fluorescent microorganisms in pellicle. Max incisors
Dietary: wine, tea, coffee (tannins)
Tabacco: tar combustion products and tabacco juices
Chlorhexidine: 2%, brown, yellowish stains
Betal quid: brown/red
Metallic: iron containing medicines

All removal except green stains can permanently stain demineralised enamel

Front 3

What tools are used in prophylaxis?

Back 3

Rubber cup or brush on special prophy head of slow speed handpiece

Prophy pastes
Abrasive particles
Water
Humectants (humidifier/moisture retainer eg glycerine)
Binder (stop seperation/splatter)
Sweetener
Fluoride

Front 4

What are some clinical tips in carrying out prophylaxis?

Back 4

Scaling can be used first to remove calculus

Avoid gingival margin, especially with brush (risk of trauma)

Keep paste moist to minimise frictional heat

Dentine exposed areas may be particulary sensitive

Front 5

Why disclose plaque?

Back 5

Tooth brushing is an automatic process for most people and people have different levels of awarenss during brushing. Therefore they may not realise they are missing places, or even know plaque is there (whitish, see through). Showing the patient it's prescence can show them areas they are missing and provide extra motivation

Front 6

What is disclosing solution?

Back 6

Dye that is selective for soft debris, pellicle and bacteria on teeth.

Non-selective staining of gingival tissue and lips is a barrier to compliance of home disclosing

Examples are organic erythrosin dye, synthetic fluorescent dye, two tone (old and new plaque), tartrazine yellow,

Front 7

What is plaque/biofilm?

Back 7

Accumulation of bacterial collonies on the tooth surface, usually encased in a polysaccharide gel/ slime matrix

Front 8

What is the procedure of disclosing?

Back 8

Isolate area with cotton rolls, slow speed suction

Dry area with triplex

Apply disclosing solution using small cotton pellet in microbrush/tweezers for 30 seconds

Remove cotton rolls, rinse

Use mouth mirror to visualise areas with disclosed plaque, record on blue perio form

Show patient with face mirror

Discuss

Front 9

What is prophylaxis?

Back 9

The checking and correcting of restorations/prothesis overhangs/problems and the removal of supra/subgingival plaque, stains and calculus via scaling and polishing as a preventative measure to control irritants that can lead to conditions such as ginigvitis and caries

Front 10

What is the gag reflex?

Back 10

One of the noraml reflexes that protects the respiratory tract. Normally activated by contact with posterior third of tongue, fauces and pharynx, mediated by activation of the glossopharyngeal nerve

Front 11

What are the consequences of an abnoraml gag reflex?

Back 11

Social embarrassment
Poor oral hygiene
Difficulty receiving dental treatment
Avoidance of dental treatment
Difficulty retaining dentures

...leading to:

Increased oral disease
Increased extraction

Front 12

How is a gagger treated?

Back 12

Comprehensive history (triggers, first time, oral hygiene, patients treatment attempts, do they gag at just the thought or examination, what the patient wants...)

Examine the gag reflex
Do they gag on suggestion of oral exam? Can they show you where they are sensitive? Map the reflex:(Cheeks, lower before upper, buccal/labial before palatal/lingual, anteriors before posteriors, tongue last)

Front 13

What is a possible theory of the gag reflex?

Is there any consious control

Back 13

Conditioning of gag reflex to the stimulation of certain branches of the Trigeminal nerve (normally Glossopharyngeal)

ie Conditioned Autonomic reflex

Conditioned response after only one reinforcment may be a survival instinct (rapid learning of what is dangerous increases survival)

However consious control is demonstrated by a decrease in the reflex when the patient is distractred, or an increase if they are concentrating

Front 14

What is the criteria for sucess in desensitising an abnormal gag reflex?

Back 14

Reducing the gag reflex in all areas except the posterior of the tongue and fauces as this is a natural protective mechanism

Front 15

What are the 12 steps in desentising the gag reflex?

Back 15

1. Check they can breathe through nose when lying on back
2. Brushing (labial to buccal surfaces, man first)
3. Brushing (anterior to posterior, first lingual/man, then palatal/max)
4. Suckling (until reaches soft palate)
5. Tongue thrusting (far out then rapidly)
6. Mouth opening (widely, then rapidly, then with a prop)
7. Tongue touching (gently pull out)
8. Tongue retraction to side
9. Tongue brushing (while holding, anterior 2/3's)
10. Cotton Rolls (string and pin, 1 to 4)
11. Gargling
12. Chewing gum

If gagging occurs, go back a previous step