Completing professional dental cleaning on a regular basis has become an established element of preventive dental care in many dental practices and is an integral part of the practice concept. In addition to providing mechanical cleaning, patients are continually motivated in this respect to maintain and optimise their own daily dental and oral care. The positive effect of regular routine check-ups and dental cleaning on long-term oral health has been described in detail in specialist literature. Moreover, the willingness of patients to allow trained hygienists to carry out dental cleaning has increased enormously in the last few years. In order to meet the expectations of patients, which have grown as a result, a consistent overall concept is required for the completion of this task, as well as competent collaboration between an appropriately trained hygienist and the dentist.
The role of the dentist here is to provide a detailed initial diagnosis as well as explanatory information. The dentist must decide which treatment measures are required as part of dental cleaning, as well as how often these are to be carried out. The intervals depend on carious activity, the periodontal situation, and on the brushing routine at home.
Moreover, appointments for treatment at more regular intervals may also be appropriate for older patients or those with physical limitations. An individual treatment plan is drawn up in consultation with the patient.
Dental cleaning is carried out by dental hygienists, although care must be taken to ensure that supervision by the dentist is provided at all times. Further responsibilities include familiarising the patient during treatment with all the treatment measures, as well as making them aware of the importance of the individual treatment steps. This can help in establishing significant patient motivation. As part of a closing discussion, attention can be drawn to the patient’s individual problem areas (figs 1 and 2) and information provided regarding appropriate dental brushing techniques, cleaning measures and nutritional recommendations.
The treatment sequence in professional dental cleaning
A well-structured treatment sequence establishes patient confidence and trust in the treatment. Materials that are high quality and properly adapted to one another play a crucial role. With the Flairesse range, DMG offers a selection of inter-compatible prophylaxis products to support treatment during a preventive care appointment. When cleaning is carried out correctly and the products are used appropriately, excellent, predictable results can be achieved.
1) Mechanical removal of hard plaque
In order to be able to effectively remove mineralised plaque and calculus, initial mechanical cleaning is required. This can be carried out using ultrasonic scalers or hand instruments (scalers, curettes, and so on).
In order to prevent damage to healthy tooth substance this must be carried out with extreme care and caution. It is essential that hygienists have completed extensive professional training. The use of powder sprays to remove discolouration on the teeth is a contentious issue in some dental practices. If used incorrectly they can cause irritation and bleeding of the adjacent gingiva, air pockets in tissue (emphysema) or defects in the enamel. However, if used correctly at the appropriate level of pressure, and when less abrasive powder combinations are selected, extremely effective cleaning can be achieved.
2) Removal of soft plaque and discolouration
In order to remove soft plaque and extrinsic discolouration a prophylaxis polishing paste, such as the initial component of the Flairesse prophylaxis range, is appropriate (fig 3).
The prophylaxis paste is available in a variety of grit sizes and can therefore be easily adapted to suit individual needs and the degree of tooth discolouration.
For smooth surfaces in the anterior and posterior area it is recommended that the paste be applied and worked-in using polishing cups (fig 4). In doing so, the corresponding maximum rotational speed of the contra-angle should be observed. For areas that are more difficult to reach in the occlusal posterior region, such as deep fissures or pits, the paste can be worked-in using a polishing brush.
Application can be carried out using a single dose or through removal from a tube under sterile conditions. The special feature of the paste is its highly viscous consistency that considerably reduces the risk of spray during use.
The other components used in the paste are fluoride and xylitol, the properties of which are described in greater detail below.
3) Remineralisation of the tooth substance and anti-cariogenic effect
Demineralisation of the tooth substance can occur as a result of acid exposure from drinking beverages with a low pH value or due to the presence of acidifying cariogenic bacteria. This can lead to carious lesions or erosion. The buffer capacity of saliva can compensate for such initial molecular defects in the substance and remineralise the
enamel.
In order to effectively support natural remineralisation as part of professional dental cleaning, following the initial
polishing treatment additional remineralisation of the enamel can be achieved in a further step using a specially developed prophylaxis gel or prophylaxis foam. The prophylaxis foam is dispensed into a tray and then placed in the patient’s mouth for one minute. The prophylaxis gel can be rubbed into the dried tooth substance using a
polishing cup or also applied using a tray (figs 5 and 6).
As both of the products mentioned here contain fluoride substances, it should be ensured that a maximum dose of 4g per treatment is not exceeded. In addition, application should only be carried out under the supervision of a dentist and it must be ensured that no toxic quantities of fluoride are swallowed. This is particularly important in the case of children.
Effective fluoridation during the preventive care appointment is recommended. The type of application can be determined individually. The absorption of fluoride into the tooth substance counteracts demineralisation and encourages remineralisation.
Patients with a high level of carious activity should undergo the application of fluoride gel several times each year as the effect in terms of preventing caries correlates with the frequency and intensity of application. The risk of excessive fluoridation, which can have negative consequences such as fluorosis, should of course always be taken
into consideration. An exact analysis of pre-existing basic fluoridation measures (fluoride content of drinking water, salt fluoridation, and use of fluoride toothpastes) must be carried out individually, while taking carious activity into consideration.
A further component of all the products in the Flairesse range is xylitol. The effect of xylitol as an anti-cariogenic agent has been investigated in numerous scientific publications. As bacteria (the primary cause of the development of carious lesions) cannot metabolize xylitol, a reduction in bacterial concentration can be achieved. Xylitol can thus
be seen to have a positive anticariogenic effect.
In order to ensure optimum remineralisation, the patient should neither eat nor drink for 30 minutes after treatment (fig 7).
4) Treatment of hypersensitive tooth surfaces
When their dental history is being recorded, some patients report having hypersensitive tooth surfaces. They often suffer corresponding discomfort, generally in the form of a pulsating pain, particularly when eating or drinking hot or cold foods or beverages. This generally occurs when the cervix of the tooth or the root dentine is exposed, or in the case of cervical defects.
If further restorations are not required, based on the dentist’s diagnosis, the purely conservative approach of sealing the exposed dentine tubules is indicated.
The Flairesse prophylaxis system offers the option of using a fluoride varnish. This is applied to the corresponding enamel or dentine surfaces once dental cleaning has been completed or as part of routine conservative treatment (fig 8). Due to the high concentration of sodium fluoride, this may only be carried out under the supervision of a dentist and following corresponding diagnosis. Following treatment, the patient should avoid any other prescription
medications that contain fluoride for a period of 24 hours, in order to avoid excessive fluoridation.
Hypersensitive teeth following preparation as part of prosthetic treatment may be a further indication for using the varnish. Hypersensitivity can occur as a result of fluid displacement within the dentine tubules – particularly following disinfection of the tooth cavity using a high strength alcohol solution. This is effectively reduced by the fluoride varnish. The fluoride varnish also facilitates successful treatment of incipient carious lesions in enamel (white spot lesions). With regular dental check-ups, full remineralisation can generally be achieved.
Summary
Professional dental cleaning has become an integral part of modern preventive dentistry. The motto “Prevention is better than cure – and better than drilling” is now firmly established in the minds of many people from early childhood thanks to comprehensive explanatory information and the provision of group based preventive care. A well-structured preventive care concept for the dental practice that delivers predictable, reproducible results on the one hand, and yet allows room for individual treatment measures on the other, builds patient trust and confidence. A concept of this kind requires high quality products that are tailored to suit the individual treatment steps.
References available on request.