Odontologia

106 CHAPTER 6.

ORAL PHYSIOTHERAPY

Oral Physiotherapy

CHAPTER 6. ORAL PHYSIOTHERAPY
The objective of oral physiotherapy (oral hygiene) is the complete daily removal of dental plaque with a minimum of effort, time, and devices, using the simplest methods possible. The patient's plaque control procedures must be modified as changes occur in the soft tissue anatomy following periodontalsurgery in order to be effective. TOOTHBRUSHING Manual Brushes Parfitt (1963) reported that the toothbrush chosen by patients, often on the recommendation of their dentist, is usually too hard or stiff. Results often show that the bristles of the hard brush only reach the most accessible surfaces of the teeth, areas normally cleaned by the mastication of food and by the friction of the soft tissues.The hard brush does not clean interproximally and debris collects between the teeth, in relatively exposed positions, and at the gingival margin. An old brush with splayed bristles causes gingival damage. In attempting to brush the teeth at the gingival margin, the splayed bristles tend to pierce the soft tissues, causing pain and bleeding. The areas most often brushed by the patient are thebuccal and labial surfaces of the upper teeth, and to a slightly lesser degree the same surfaces of the lower teeth. The palatal surfaces of the upper teeth and the lingual surfaces of the lower teeth are rarely cleaned during usual routine care. The terminal teeth in the dental arches, particularly the distal surfaces of these teeth, are difficult to reach with a toothbrush and invariably harbordebris. O'Leary et al. (1970A) studied the deposition of paniculate matter in the crevicular tissue by toothbrushing using two widely taught and accepted techniques. Thirty-eight (38) patients requiring surgical elimination of periodontal pockets brushed for 10 seconds with the roll or Bass technique at designated sites. For each toothbrushing technique, brushes had were pre-soaked in a solutioncontaining carbon particles. On completion of the brushing procedure, the test sites were immediately rinsed and biopsied. No carbon particles were observed in the crevicular epithelium or underlying connective tissue of any test section for either technique. However, the results of this study do not eliminate the possibility that bacteria are sometimes introduced into the crevicular tissue and thecirculating blood during toothbrushing, since common bacteria in crevicular tissue are considerably smaller than the carbon particles (mean size 2.5 (im) used in this study. Lang et al. (1973) studied the frequency of effective oral hygiene procedures necessary to maintain gingival health. Thirty-two (32) dental students were assigned to four groups removing plaque at 12, 48, 72, and 96 hourintervals. The oral hygiene procedures were performed using Charters' brushing technique supplemented by dental floss and interdental woodsticks. Plaque was assessed using the plaque index and gingival health by the gingival index. Results demonstrated that effective oral hygiene procedures at intervals of 48 hours are compatible with gingival health. However, if the intervals between complete removal ofbacterial plaque exceeded 48 hours, gingivitis developed. Waerhaug (1981) reported on the effect of toothbrushing on subgingival plaque formation. Thirty-two (32) upper and lower molars in 4 healthy adult monkeys were used in a split-mouth design in which all teeth were cleaned initially, and then only one side was brushed using the Bass method 3 times a week for one year. During brushing, it couldbe noted that the bristles penetrated as far as 0.9 mm (0.5 to 1.0 mm) below the gingival margin. Rotary Brushes Long and Killoy (1985) evaluated the effectiveness of the Interplak versus manual toothbrushing (modified Bass) in removing plaque in 14 orthodontic patients. Following disclosant and modified O'Leary scoring, mean post-brushing scores were 34% (range 12.5 to 52.9%) for the manual...