MAINTENANCE OF PROSTHETIC
If your patient has a prosthetic appliance, tell him
or her to take the removable appliance out of the mouth
after meals and thoroughly brush it. Patients should
use a good prosthetic appliance brush and their
preferred dentifrice or soap and water. Have the patient
follow the dentist's instructions regarding how long to
leave the appliance out of the mouth while sleeping to
give the tissues proper rest and how to take care of the
appliance when it is not worn.
Plaque accumulates on the surfaces of abutments
and beneath the pontics of fixed partial dentures
(bridges). Floss threaders are thin plastic devices that
help the patient direct the floss into these areas. Fixed
partial dentures should also be cleaned at least once
ORAL HYGIENE AIDS
Toothpicks, interdental proximal brushes, oral
irrigators, and mouthwashes are aids to oral hygiene.
They may be used in addition to, but not in place of,
tooth brushing and flossing. These products will be
recommended by a dentist or dental hygienist and
should bear the ADA seal of approval.
APPLICATION OF PIT AND FISSURE
A pit and fissure sealant is a plastic resin-like
material that is applied to the tooth surface and
hardened. The plastic resin bonds into the depressions
and grooves (pits and fissures) of the chewing surfaces
of back teeth. Sealants are highly effective in
preventing pit and fissure caries in premolars and
molars. The sealant acts as a barrier protecting enamel
from plaque and acids. Figure 3-34 illustrates a before
and after drawing of a sealant on a tooth. Acid-etch
resin sealants are classified into three types, based on
the method by which they are cured (hardened):
Chemically or self-cured
As a basic dental assistant, you may receive
training in expanded functions to place pit and fissure
sealants as described in BUMEDINST 6600.13.
Check with your command on certification
requirements. Pit and fissure sealants may only be
placed by certified personnel. Only a dental officer can
Figure 3-34.Before and after applying a sealant on a tooth.
authorize and recommend what teeth require sealants.
This will be noted on the patient's treatment plan.
The following clinical guidelines should be
followed for successful sealant application:
Ensure the patient's treatment plan indicates
what teeth require sealants.
Ensure the proper eye and clothing protection are
in place for you and the patient.
The teeth must be isolated to prevent saliva
contamination of the surfaces to be sealed. The
isolation must provide adequate access to observe the
field and to reach the tooth surfaces with the appropriate
instruments. A rubber dam is the preferred method of
isolation, but if a rubber dam cannot be used, cotton roll
isolation can be effective.
The tooth surfaces should be cleaned with a
prophylaxis brush or rubber cup and a cleansing agent
containing no oil or other substance that cannot be
completely and quickly washed away using an air/water
syringe with high-speed evacuation.
When the teeth are effectively isolated from
saliva contamination, the tooth surfaces are dried and
then etched by an application of a 30 to 50 percent
phosphoric acid solution for 15 to 20 seconds. Etching
should cover all the areas to be sealed.
The acid should be washed away with water.
The surfaces are then carefully re-dried and inspected to
ensure that the area intended for sealant has a "frosted"
appearance. The absolute avoidance of contamination
with saliva or air-line moisture or oil is critical from the
time of acid removal and drying, until the sealant is