lingual embrasures and carry it into the interproximal space with dental floss or dental tape.
At the end of the polishing, carefully floss the patient's teeth. This is an excellent opportunity to begin your oral hygiene instruction. Have the patient watch you with a hand-held mirror. When flossing is complete, rinse and remove any debris remaining in the mouth. Once the teeth have been cleaned of plaque and calculus, topical fluoride can be applied professionally if the procedure is indicated in the current treatment plan.
Topical fluoride can be administered by three different methods. The first method involves the application of fluoride solution. This type of fluoride must be painted on the teeth with a cotton tip applicator. The second method of fluoride application is the use of a concentrated fluoride rinse. The third method is the tray technique, which is used to apply fluoride gels. Gel application is generally regarded as the most effective means of topical fluoride treatment. We will focus our attention on fluoride gel application.
A variety of trays are available for fluoride gel application. The use of disposable trays reduces the chance of cross contamination and eliminates the need to clean and sterilize reusable ones. Trays come in several arch sizes to ensure optimal fit for each patient. The tray should provide complete coverage of all erupted teeth without going beyond the most distal tooth surface in the arch. Custom-fitted trays can be made that require less gel and promote contact of the gel with the teeth. The extra time and expense of custom fluoride tray fabrication will limit the use to specific patients who require daily application of fluoride gel.
Reexamine the mouth to estimate the size of the dental arches and identify any features such as malposed teeth or bony tori that will influence tray selection. Select a maxillary tray and try it into the patient's mouth. Make sure all teeth will be contacted by the gel. Remove it and do the same for the mandibular arch. Refer to the manufacturer's instructions for the amount of gel required for each tray. A narrow strip of material along the bottom of the tray is normally adequate. This technique will minimize the amount of gel required and will reduce the chance that excess gel will be swallowed by the patient. The patient's teeth must be dried and kept as dry as possible until trays are inserted. Dry each arch separately before placing the tray into the patient's mouth.
First place the mandibular tray. Retract a corner of the mouth with your finger. Insert one end of the tray in the mouth at an angle and then rotate the other end of the tray into the mouth. Insert the saliva ejector before placing the maxillary tray. Place the maxillary tray in a similar fashion and ask your patient to close his or her teeth together gently. Refer to the manufacturer's instructions for the amount of time the gel remains in the mouth. Generally, application is no longer than 4 minutes. After the trays have been removed, allow your patient to expectorate (spit) any remaining fluoride from the mouth. Instruct the patient not to rinse, drink, eat, or smoke for at least 30 minutes.
A vital part of any preventive dentistry program is the education and motivation of patients in proper oral hygiene. During the appointment you must take the time to explain the harmful effects of bacterial plaque and demonstrate proper tooth brushing and flossing techniques. It is recommended that you review Dental Technician, Volume 1, chapter 5, "Oral Pathology," and chapter 8, "Nutrition and Diet," as this information also plays an important role in oral hygiene.
The atmosphere you create for your oral hygiene instruction will influence your ability to communicate with the patient. Position yourself in front of the patient so that you can look directly into the eyes and observe the patient's responses to your instructions. You may want to repeat or clarify points that the patient's response suggests he or she does not understand or if the patient questions what you have said. In most cases, sitting on the dental stool and facing the patient from the front is a good instructional position. This position allows you to view the patient's facial expression. Being at the same eye level as the patient also helps you establish rapport, since you are not talking "down" to them.
Talk directly to your patient and smile occasionally. If you stare at the wall or some other inanimate object during your presentation, the patient will get the impression that you are not sincere or interested. Use simple words, and explain any scientific or technical terms with which the patient may not be familiar. Your patient may not know thatContinue Reading