Additional oral hygiene products. Oral hygiene products (toothpastes, gels, powders, elixirs)

toothpicks designed for effective cleaning of interdental spaces and plaque from the contact surfaces of the teeth. They are made of wood (disposable) and plastic (washable). According to the shape of the working part, they are flat, round and triangular. Toothpicks have anatomical shape, which corresponds to the shape of the interdental spaces and are pointed at both ends.

When using a toothpick, it is placed at an angle of 45 degrees with the side that is pressed against the surface of the tooth. After that, the tip of the toothpick is moved along the tooth, while directing it from the base of the groove to the contact point of the teeth. If the toothpick is not advanced correctly, the interdental papilla may be injured.

Dental floss (floss). Dental floss or floss is designed to clean the interdental spaces. Their use is recommended to everyone, tk. the structure of the toothbrush does not allow it to sufficiently penetrate into the interdental spaces.

Dental floss is divided into the following groups:

1. according to the shape of the cross section:

flat (interdental tapes)

round

2. Surface treatment:

waxed

unwaxed

3. by the presence of impregnation:

without special impregnation

impregnated with therapeutic and prophylactic substances (propolis, menthol, etc.)

4. by destination:

· for individual application

for use in the dental office.

There are also disposable devices for tensioning dental floss - the so-called floss. They are made of durable inflexible material, they have a handle with a U-arm, on which there are two branches - a thread is stretched between them.

Flat flosses and tapes are more comfortable and easier to penetrate into hard-to-clean interdental spaces, thus covering more of the tooth surface.

Waxed threads have a higher sliding ability, while easily penetrating into the interdental spaces, more resistant to tearing and splintering, and easier to use. However, in terms of cleansing properties, waxed threads are inferior to unwaxed ones.

Rules for the use of dental floss: a thread 30-40 cm long is pulled out of the cassette and wound around the middle finger of the left hand. The rest of the thread is wound on middle finger right hand so that the distance between the hands is approximately 10 cm. At the same time, approximately 2 cm of thread is pulled between the thumb of the right hand and the index finger of the left hand. Then, slowly and carefully, the thumb of the right hand is brought to the teeth of the right side of the upper jaw, and the dental floss is inserted into the interdental space. After that, the thread is pressed against the surface of the tooth and with the help of 4-5 movements up and down cleans it from soft plaque. Consistently carry out the cleaning of the contact surfaces on all sides of each of the teeth.

There is also a unique thread - superfloss., designed for patients with bridges, crowns, implants and orthodontic structures, consisting of three parts, passing one into another:

1st part - hard fiber for superfloss under or between structures;
2nd part - wide nylon fiber to remove plaque and food debris;
3rd part - regular floss for cleaning normal interdental spaces.

Interdental stimulants.

Interdental stimulators are used for oral care and are used to massage the gum papillae and clean the interdental spaces. They are elastic cones made of rubber or soft plastic of varying degrees of hardness and colors. Stimulators are mounted on special holders, or fixed on the handle of a toothbrush. The conical shape of the interdental stimulator allows it to be used with progressive retraction of the marginal part of the gums, wide interdental spaces, as well as in the presence of chronic diseases periodontal. With light pressure on the gingival papilla, circular movements are carried out, while advancing the interdental stimulator with translational-circular movements into one of the interdental spaces.

Brushes.

Interdental brushes are used to clean wide interdental spaces, spaces under fixed orthodontic constructions, spaces between implants and prostheses, as well as washing areas of bridges.

The brush consists of a handle and a working part. The shape of the working part of the brush can be cylindrical or conical. They differ in the size of the stiffness of the bristles. Currently, special probes have been developed to determine required size brush in each individual case. The diameter of the working part can vary from 1.7 to 14 mm.

Brushes can be attached using special holders. These holders provide sufficient fixation and quick change of brushes. Using a brush allows you to clean the interdental spaces from food debris and plaque with reciprocating and clockwise rotation movements.

Irrigators.

Irrigators combined the functions of a shower for oral cavity and hydro massagers. The process of cleaning the oral cavity with a constant or pulsating liquid jet under a certain pressure significantly improves the quality of oral hygiene, and also has a massaging effect and healing effect. At the same time, a jet of warm water is supplied through the tip from a water tap, and pressure is created by a compressor. Water or various drugs (romazulan, stomatofit, chlorhexidine, etc.) are used as a washing liquid. The procedure time for the gum of one jaw is 5-10 minutes; at home, daily use of the irrigator is indicated for 30 days, 4 times a year for persons who have fixed orthopedic and orthodontic structures and also in periodontal diseases.

Liquid oral hygiene products. Modern classification of liquid oral hygiene products (ZSHGPR) industrial production includes:

elixirs

rinse aids

fresheners (aerosols) and deodorants

water for the oral cavity

balms and tonics for gums

To folk remedies used official medicine in the form of liquid oral hygiene products (LSHPR) include:

Elixirs are:

· hygienic ("Mint", "Freshness", etc.) have mainly aromatic effect. They contain tannin, dyes in a water-alcohol solution.

therapeutic and prophylactic:

a) anti-inflammatory drugs (propolis, eucalyptus, St. John's wort, etc.)

b) vitamin preparations(ascorbic acid, vitamin B 1, etc.)

c) compounds of fluorine and hydroxyapatite (fluoristat, sodium fluoride, etc.)

Elixirs have the following effects:

anti-inflammatory

anticarious

deodorant

bactericidal

cleansing

refreshing

The number of drops of the elixir used depends on the purpose of its use:

for deodorizing and prophylactic purposes - 15 - 25 drops

for medicinal purposes - 30 - 50 drops

for cauterizing effect - 60 - 100 drops

Examples of therapeutic and prophylactic elixirs are: "Santoin" (Walmark), "Profdourid-M" (Voko Cuzhaven). These elixirs are used to rinse the mouth 1-2 times a day (morning and evening) after brushing your teeth.

Chewing gum.

Chewing gums help to clean the surfaces of the tooth and neutralize organic acids that are secreted by plaque bacteria, enhance the remineralization of tooth enamel, refresh the oral cavity well, free from food debris, detritus and saliva sediment.

The main components of modern chewing gum are:

chewing base, the content of which ranges from 20 to 30% (natural latexes, resins, paraffin, talc);
sweeteners make up to 60% (xylitol, sorbitol, mannitol, saccharin, aspartame);
flavors, fragrances or flavorings up to 10%;
antioxidants;
dyes;
stabilizers (glycerin);
shaping components (talc);
glazing agents;
small amount of liquid.

Chewing gum should be used by both adults and children;

It is useful to use therapeutic and prophylactic chewing gums that do not contain sugar;

· a positive preventive effect is achieved by chewing gum for no more than 5-10 minutes 3-4 times a day after meals;

Do not use gum for those who have problems with the function of the temporomandibular joint, as well as for people who have violations of the integrity of the oral mucosa and gastrointestinal tract.

4. List of practical work, visual aids and TCO:

Educational and methodical literature.

Visual aids: tables, diagrams, dummies, simulators, posters, slides.

5. Practical work:

- Title of practical work: preventive examination, questioning and collection of anamnesis;

filling out the patient card.

- Objective: Learn how to do preventive maintenance.

- Methodology for performing work:

Necessary materials: examination card, ballpoint pen, gloves, mask.

Work order: questioning survey quality composition food,

preventive examination, filling out the examination card.

Results of the work and evaluation criteria: well-filled survey card.

6. List of questions to check the initial level of knowledge:

1. Basic oral hygiene products.

3. Timing of eruption of temporary and permanent teeth.

2. Teeth brushing methods.

7. List of questions to check the final level of knowledge:

1. Additional oral hygiene products ,

2. Indications and methods of using liquid oral hygiene products,

3. Varieties of electric oral hygiene items,

4. Classification of chewing gums,

5. Mistakes made during personal oral hygiene.

8. Timeline of the lesson:

9. Independent work of students:

1. Write down the indications for the use of liquid oral hygiene products.

2. Draw an electric toothbrush and describe its structure.

3. Sketch the irrigator and indicate the elements of the structure.

4. Write down the classification of chewing gums.

10. List educational literature to the lesson:

1. Kuzmina E.M. Prevention dental diseases. Moscow, 2003

2. Muravyannikova Zh.G. Dental diseases and their prevention.

3. Maksimovsky M.Yu., Sagina O.V. Fundamentals of prevention of dental diseases.

4. Arutyunov S.D. Prevention of caries.

5. Skorikova L.A., Volkov V.A., Lapina N.P., Bazhenova N.V., Erichev I.V. Propaedeutics of dental diseases. Krasnodar, 2005

6. Maksimovsky M.Yu. Therapeutic dentistry. Moscow, 2002

ACTIVITY #8

1. Topic of the lesson:

“Classification of dental deposits, the significance of these formations in the development of dental diseases. Means for preventing the formation of plaque. Dyes for the determination of plaque. Methods for detecting plaque.

2. The purpose of the lesson:

The student must know:

1. Classification of dental deposits.

2. The mechanism of formation of dental deposits.

3. What is the cuticle and pellicle of the tooth?

4. Means that prevent the formation of plaque.

The student must be able to:

1. Conduct a patient survey

2. Conduct an examination of the oral cavity

3. Be able to fill in the medical record of a dental patient.

The student must be familiar with:

With the classification of dental deposits,

With the role of dental plaque in the development of major dental diseases,

With agents that prevent the formation of dental plaque,

With methods for detecting dental deposits.

I. Drugs that reduce the sympathetic effect on the cardiovascular system

II. M-cholinomimetic agents (anticholinesterase agents, AChE) a) reversible action

II. Drugs affecting mainly the receptors of the efferent innervation of the heart

Class III - Drugs that slow down repolarization (Potassium channel blockers)

Liquid oral hygiene products- additional or alternative means intended to carry out hygiene procedures in the oral cavity, prevention and treatment of dental diseases.

In most cases, the HSGPR complements standard care behind the oral cavity (toothbrush and paste) and increase its effectiveness. In situations where conventional oral care is difficult or impossible (OOM, periodontal disease, jaw fractures, postoperative period, trismus, microstomia), liquid forms are alternative means of oral hygiene.

Classification of liquid oral hygiene products (according to the mechanism of action):

1) Hygienic.

2) Therapeutic and prophylactic simple.

3) Therapeutic and prophylactic complex:

a) combined;

Anti-inflammatory (herbal extracts, triclosan, chlorhexidine);

Anti-caries (sodium fluoride);

Antimicrobial (triclosan);

Antifungal (formalin, borax);

Antiplak (cetylperidium chloride, listerine, chlorhexidine);

Antitartar (enzymes);

Desensitizing (tricalcium phosphate, potassium nitrate);

- bleaching (carbamide peroxide);

b) complex:

Anti-caries and anti-inflammatory (herbal extracts, sodium fluoride);

Anti-carious and anti-plaque (cetylperidium chloride, sodium fluoride);

Anticarious and desensitizing (sodium fluoride, potassium nitrate).

Spray- an additional hygienic agent for oral care. Spray - deodorant is designed to refresh the oral cavity and is available in the form of an aerosol. Spraying can be carried out in two ways: with the help of gas ("Corident Fresh") and mechanically ("Nur 1 Tropfen", "Mintorol"). The second option is preferable because liquefied gas negatively affects the ingredients of the drug. The basis of the spray is a water-alcohol solution and extracts of medicinal herbs (mint, chamomile, myrrh, sage). Refreshing sprays are compact and easy to use. The duration of the spray is about 1 hour. Frequent use of deodorants is not desirable.

Rinses and elixirs- liquid products intended for hygienic procedures in the oral cavity, prevention and treatment of dental diseases.

The term “rinse aid” is generally accepted in most countries. In Russia long time only “dental elixirs” were produced, but today domestic manufacturers offer consumers both elixirs and rinses.

The basis of most rinses is a water-alcohol solution. The alcohol content in them ranges from 6-27%, in elixirs - at least 30%. On sale, ready-made solutions are more common, more convenient to use. Concentrated options require prior dilution with water, which is not always possible.

Dry rinses are few and are represented by powders that require dilution in water.

Currently, the choice of conditioners is very large.

Hygiene rinses designed to cleanse the mouth and freshen mouth breath.Plax (Classic mint. Fresh mint), Reach (Fresh mint), Lacalut (Fresh) President (Classic), Colgodul (Mint), Ogal-B (Advantage).

Therapeutic and prophylactic rinses divided into simple, combined and complex.

Therapeutic and prophylactic anti-inflammatory rinses:

"Forest Balsam" (fir extract, sage extract) (Russia) contains extracts of fir, sage and echinacea, aloe juice. It has a regenerating and tonic effect on periodontal tissues.

R.O.C.S. (Russia) contains kelp extract, xylitol, calcium glycerophosphate, magnesium chloride.

"President Profi" (Italy) contains chlorhexidine, extract of sage, chamomile and echinacea.

"Peridex" (USA) contains 0.12% chlorhexidine. Recommended from 14 l
"Albadent" with mummy (Russia). Shilajit is a natural biostimulant with

Elixir "Fir" (Russia) improves the microcirculation of periodontal tissues, stimulates local immunity, has a pronounced anti-inflammatory effect.

"Bioelixir" contains propolis. It has a deodorizing, antiseptic, anti-inflammatory, regenerating, analgesic effect. It is recommended for the prevention of lesions of the oral mucosa. Produced in aerosol packaging.

"Flower" and "Meadow" contain extracts of horsetail and coltsfoot. It is used for effective refreshment of the oral cavity, prevention of inflammatory lesions of the mucous membrane.

Therapeutic and prophylactic anti-caries elixirs:

Balm "Children's Albadent" (Russia) with strawberry flavor. Contains sodium monofluorophosphate and calcium glycerophosphate. It is used during teething and enamel maturation. Recommended from 6 years of age. Balm "Spring F" (Russia) contains sodium monofluorophosphate and calcium glycerophosphate.

Therapeutic and prophylactic antimicrobial rinses:

Rinse aid "Eludril" (France). Contains chlorhexidine. It has a pronounced antiseptic effect.

Therapeutic and prophylactic anti-plaque rinses:

Rinse aid "Elgydium" (France). Contains chlorhexidine, sodium citrate, sodium borate, dimethicone.

Therapeutic and prophylactic anti-tartar rinses:

"Xident" contains fluorine and ksidifon - a highly effective regulator of calcium levels in the body, which inhibits the crystallization of poorly soluble calcium salts, preventing the appearance of tartar. It has an anti-inflammatory, disinfectant effect, has a delicate aroma of wild strawberries.

Therapeutic and prophylactic whitening rinses:

Balm "Albavit" (Russia) with carbamide peroxide.

· “Agys Double White” conditioner (Belgium) is poured into two insulated bottles. One contains a bleaching agent, the second is a refreshing and antibacterial. Prior to use, the substances are isolated, which increases their effectiveness.

· Beverly Hills Formula rinse (Great Britain) contains carbamide peroxide.

Therapeutic and prophylactic rinses are complex:

· Balm "Spring-plus" and "Formula of transformation" (Russia). Contains neovitin, xylitol, menthol, mint, citric acid. It has anti-inflammatory, anti-caries, antimicrobial, light whitening effect.

· PerioMed mouthwash (USA) contains 0.63% stannous fluoride. Effectively eliminates dental plaque in the subgingival region, prevents the formation of dental plaque, provides active enamel mineralization, reduces hypersensitivity teeth. Recommended from 6 years old.

Corsodyl (Germany) contains 0.2% chlorhexidine. It has a powerful bactericidal, fungicidal, antiprotozoal, antiviral effect.

· "Biotene white Calcium" - contains 4 antibacterial enzymes and kalysh. Designed for the prevention of caries and periodontal disease.

How to use liquid oral hygiene products
The user of the HSSHR should follow the manufacturer's recommendations. Products of world leaders are always accompanied by written instructions or detailed information on the product packaging (bottle, box, etc.). Rinses have "age" restrictions, so before buying a drug, a dentist's consultation will not be superfluous.

The method of using the drug depends on the purpose of the procedure and the type of product (spray, elixir, rinse).

The spray is sprayed into the mouth. Used as needed to freshen the breath.

To deodorize the oral cavity, 7-10 drops of a hygienic elixir or concentrated rinse are diluted with 1/2 cup of warm water. For the prevention of dental diseases, 15-20 drops are enough, for treatment - 30-50 drops.

The multiplicity of fluoride-containing rinses is determined by the concentration of the active ingredient: 0.05% solutions are used daily, 0.1% - once a week, 0.2% - once every two weeks.

Ready-made conditioners are more convenient to use. The required amount of the solution is poured into the cap-do-congestion of the vial. For a single application, 10-15 ml of liquid is sufficient. Rinse is carried out for 30 seconds. before brushing your teeth or after. The use of rinse aid before brushing contributes to the mechanical removal of plaque with a toothbrush. The use of the drug after cleaning prevents the fixation of bacteria and plaque on the surface of the enamel. When using products with chlorhexidine, an interval between brushing and rinsing should be at least 30 minutes. It is possible to apply ISHPR after eating if it is impossible to use a toothbrush and paste.

The frequency of replacement of the elixir is 3-4 months. Long-term use elixir leads to adaptation of microflora

oral cavity and reduce the effectiveness of the drug. More significant effect noted when using the elixir together with a brush and paste, floss, toothpick.

Dry rinses are prepared immediately before use by dissolving the powder in warm water.

Note: the use of high-alcohol SHGPR in children is contraindicated. Funds from low content alcohol are applicable from 6 years. Whitening rinses are used in children over 12 years of age.

Chewing gum- an additional hygiene product intended for deodorization of the oral cavity, prevention and treatment of dental diseases.

I). Drugs that block adrenoreceptors (blockers).

II). Drugs affecting the renin-angiotensin system.

II. Acute disorders of memory and consciousness caused by alcohol and drugs

III). Vasodilator drugs of direct myotropic action (myotropic agents).

ZHSGPR - these are any liquid forms, natural and artificial, designed to perform hygienic procedures in the oral cavity, prevent and treat dental diseases; their properties are determined by the composition, which is selected depending on their purpose. In Russia, liquid forms are used quite rarely, irregularly and by a limited number of people. A survey conducted in the Republic of Bashkortostan showed that only 12% of the surveyed children and adolescents and 23% of adults use liquid oral hygiene products. Dentists do not often advise their patients on the use of ISGPR. The composition of liquid products varies depending on their intended purpose, method of application, type of production. Depending on these properties and characteristics, there are:

1. Folk remedies used by official medicine:

Decoctions are prepared at home, have astringent, tanning, anti-inflammatory, desensitizing, refreshing, deodorizing effects. Decoctions are used in the form of rinses, baths, lotions, applications.

Infusions of herbs and plants in alcohol are prepared industrially.

2. ZhSGPR industrial production:

Elixirs are a homogeneous transparent liquid containing biologically active substances, having a smell and color characteristic of elixirs of this name. Elixirs have the following composition: vegetable extract, essential oil, food flavoring, polyvylpyrrolidone, sodium lauryl sulfate, food colors, ethyl alcohol, sodium fluorate, sodium benzoate, distilled water.

The most common domestic elixirs were "Forest", "Mint", "Effect" and others. The Mirka-M enterprise produces the Fir elixir, which improves the microcirculation of periodontal tissues, stimulates local immunity, and has a pronounced anti-inflammatory effect. Currently, therapeutic and prophylactic elixirs containing biologically active substances and active antioxidants are being produced. So, developed at the Department of Therapeutic Dentistry in St. Petersburg: "Osinka", "Elam", "Spring", "Phytodent" have different components. The tooth elixir "Aspen" included aqueous extract aspen bark, which contains vitamins, glycosides, tannins, essential oils, phytoncides, amino acids, macro- and microelements, coumarins, flavonoids. The elixir "Elam" includes an aqueous extract of kelp, rich in micro- and macroelements, derivatives of chlorophyll and carotenoids, amino acids. Dental elixirs "Spring" and "Phytodent" contain a copper derivative of chlorophyll. Elixirs have anti-inflammatory and regenerative effects.

Dental elixirs are advisable to use for rinsing the mouth and baths at a dilution of 40-50 drops (2.0-2.5 ml) per glass of water. It is recommended to hold each portion in the mouth for 10-15 seconds. The course is at least 10-12 procedures performed daily. The duration of the procedure is 10-15 minutes. It is recommended to use for the prevention and treatment of periodontal diseases. The number of drops of the elixir depends on the purpose of its use: for deodorizing and prophylactic purposes - 15-25 drops, for medicinal purposes - 30-50 drops, for a cauterizing effect - 60-100 drops.

Rinse aids are the world's most common form of LSGPR. There are two types of rinses: containing alcohol (from 5 to 27%) and non-alcoholic.

Alcoholic rinses have the following composition: water, alcohol, sorbitol, poloximer, cetylpyridium chloride, sodium saccharin, benzoic acid, dopimen bromide, fragrances, dyes. Alcohol is a preservative that keeps the rinse aid from spreading germs and thus determines the shelf life of the product.

Rinsers "Polion-Mirta" and "Starfish" (St. Petersburg) contain biologically active substances and, above all, antioxidants. "Polyon-Myrtle" contains chamomile extract, oil tea tree, ascorbic acid, carotene, vitamin E, trace elements, sodium fluoride. Starfish rinse is based on extracts of fucos algae, which contain biologically active substances: vitamins C, group B, carotenoids, fucoidan, salts alginic acid, macro- and microelements. Fucoidan solutions have a pronounced antithrombotic effect similar to that of heparin. Rinse aids contain minimal amount alcohol (1.5-3%). This allows them to be used for daily mouth rinses in the amount of 5.1-7.0 ml per glass of warm water. The duration of the procedure is 10 minutes. The course is at least 10-12 procedures for persons with periodontal diseases.

Non-alcoholic rinses contain water, sorbitol, vegetable or herbal extracts and oils, fragrances (mint, menthol), citric acid, sodium citrate. These rinses can be recommended for use by teenagers, children, people who do not drink and deny alcohol. Nur 1 Tropfen Medical Mouthwash Concentrate with triple action contains natural medicinal herbs and disinfectants that prevent the formation of tartar and prevents inflammation and bleeding of the gums. The concentrate neutralizes acids that destroy tooth enamel and refreshes the oral cavity. In acute inflammation, undiluted concentrate is used for rubbing into the gums.

Firm "Laciede Inc." (USA) has developed and manufactures the "Biotin" system, which enhances and supplements the natural protective properties of saliva. The composition of this system, in addition to the antibacterial part, includes Biotine mouthwash with calcium and Oralbalance saliva substitute gel. The mouthwash is alcohol-free, cleans and refreshes the mouth, contains four antibacterial enzymes that enhance the natural defense system of saliva, does not stain teeth, has antibacterial action maintains a healthy balance of microflora in the mouth. Oralbalance is a long-acting moisturizing gel that protects dry tissues of the oral cavity from irritation, itching, burning, and neutralizes unpleasant odors. The "Biotin" system is recommended for xerostomia, periodontal diseases, diabetes mellitus, in persons who have undergone radiation therapy and chemotherapy.

^ INTERDENTAL ORAL HYGIENE PRODUCTS

The first hygiene item is a toothpick or wooden stick(tooth pick, toothpick). The ancient Egyptians used toothpicks quite regularly. Archaeological excavations have revealed toothpicks that were used 3000-2500 years ago, some of them are in various museums around the world. In the Bronze Age, bronze toothpicks appeared, which were found in ancient burials in France, Switzerland, and Central Europe. For the Athenians back in 200 BC, taking care of the cleanliness of the body was very important, the use of toothpicks after each meal was a familiar ritual for every inhabitant. Among the Roman patricians, hygiene was introduced into the rank of law; they regularly, after each meal, used toothpicks to clean the interdental spaces. In the Talmud (the code of laws and rules of the Jews) there are also references to toothpicks made of wood and reeds. The famous Persian physician Avicenna used a golden pike not only to clean the gaps between his teeth, but also as a bookmark for books. For Muslims, the use of a toothpick is part of their religious ritual. This is reflected in proverbs and sayings: "One of the advantages of a toothpick is that it makes the devil angry", "It is pleasing to God and hateful to Satan." In Europe, the toothpick first appeared in Spain, and somewhat later, at the beginning of the 16th century, in France. In England, toothpicks appeared much later, during the time of Queen Elizabeth.

Real origin aids interdental hygiene began only in the middle of the 20th century. Interdental hygiene products include toothpicks, flosses, flosses, electric flosses, superflosses, dental tapes, toothbrushes for cleaning interdental spaces.

Rice. 6. A set of toothpicks

Toothpicks are the oldest representatives of interdental hygiene products. The shapes and types of toothpicks are varied: pikes, sabers, sharpened at one or both ends. Toothpicks are made from wood, plastic, bone. Currently, preference is given to toothpicks made from soft varieties of trees: fir, Karelian birch. The diameter of a modern wooden toothpick is made in the form of a triangle or has a flat, round shape. Preference is given to triangular-shaped wooden toothpicks, which repeat the shape of the interdental space, due to which food is better removed without causing injury to soft tissues, massaging the interdental papilla. The toothpick is intended for single use.

Flosses are designed to thoroughly remove plaque and food debris from hard-to-brush contact surfaces of teeth. Floss consists of nylon fiber, which is 144 strands of nylon twisted together (old production technology) or glued together using a Pebax polymer coating (new technology proposed by Oral-B). Flosses can be waxed and unwaxed, round and flat, conventional and bicomponent in structure, monofilament, low-fibre and multi-fibre in fiber. Flosses are made without impregnation and with impregnation (menthol, menthol-fluoride, fluoride, etc.).

Oral-B has developed a completely new group multifilament, bicomponent floss: unwaxed (Unwaxed), mint waxed (Mint Waxed), waxed. A fundamentally new technology for cleaning interdental spaces is implemented in dental floss "Satinfloss" and "Satintape" (Oral-B). These threads are characterized by such a structure that is resistant to abrasion, raveling and tearing. The floss easily penetrates between the teeth, has a very persistent refreshing mint taste.

Floss is called multi-fiber if the floss consists of many fibers. A bicomponent thread is called a thread, which, in addition to nylon, includes another fiber - pebax. The main components of modern dental floss are microcrystalline wax (if the floss is waxed), glycerin, hydrogenated castor oil, saccharin or saccharic acid, flavor or masking additive (mint) and a number of other components that are determined by the type of floss.

Superfloss - a more specific interdental hygiene product, is a textured nylon fiber in the form of a mixture of nylon and polyurethane. The composition of the dental tape does not differ from floss, but is 3 times wider. It has a wax coating impregnated with polyethylene glycol, sorbitol, sodium saccharin, fragrance. All of them are aimed at making the tape more elastic, better penetrating ability, preventing premature drying, brittleness, and improving taste.

Rice. 7. Floss Options

Flossets - floss holders, are made of plastic. used in
their flosses are identical to the actual flosses. Flossets can be one
orose and reusable.

The New Braun Oral-B Interclean™ Interdental Plaque Remover (Braun and Oral-B) is an electric interdental cleaner with batteries and interchangeable tips that hold plastic cannula interdental filaments. The thread runs at a speed of 100 cleaning strokes per minute. The floss removes soft plaque and contributes to the destruction of hard tartar on the contact surfaces of the teeth, in the interdental spaces and periodontal sulcus. Interclean and is effective for cleaning plaque in the interdental spaces, which helps to reduce bleeding gums and the intensity of gingivitis, safe to use. Interclean makes interdental cleaning easy and simple, allowing you to use it daily without restrictions. And, finally, another option for cleaning the interdental spaces is the combined use of an electro- and hydro-factor (Hydrofloss).

Rice. 10. Apparatus "Hydrofloss"

Interdental hygiene products include toothbrushes for cleaning interdental spaces (single-beam and small-beam manual toothbrushes, brushes). In a single-bunched toothbrush, there is one bundle of bristles on a very small head, in a small-bunched toothbrush there are 6-7 bundles of bristles arranged in 2 rows of 3 or in a circle and one in the center. The bristles are made of nylon fiber, the handle is made of high-impact polystyrene, polypropylene, copolymer.

Toothbrushes are made from the same materials as regular toothbrushes. The brush is made of twisted wire with short bristles fixed between twists of the wire. Preference is given to brushes that have a plastic coating on the wire to avoid the formation of galvanic currents. This structure has a brush "Oral-B Interdental Kit".

^ LIQUID ORAL HYGIENE (LIQUID)

1. Folk remedies used by official medicine:

decoctions are prepared at home, have astringent, tanning, anti-inflammatory, desensitizing, refreshing, deodorizing effects. Decoctions are used in the form of rinses, baths, lotions, applications.
infusions of herbs and plants in alcohol are prepared industrially.

2. ZhSGPR industrial production:

The most common domestic elixirs were "Forest", "Mint", "Effect" and others. The Mirka-M enterprise produces the Fir elixir, which improves the microcirculation of periodontal tissues, stimulates local immunity, and has a pronounced anti-inflammatory effect. Currently, therapeutic and prophylactic elixirs containing biologically active substances and active antioxidants are being produced. So, developed at the Department of Therapeutic Dentistry in St. Petersburg: "Osinka", "Elam", "Spring", "Phytodent" have different components. The tooth elixir "Aspen" includes an aqueous extract of aspen bark, which contains vitamins, glycosides, tannins, essential oils, phytoncides, amino acids, macro- and microelements, coumarins, flavonoids. The elixir "Elam" includes an aqueous extract of kelp, rich in micro- and macroelements, derivatives of chlorophyll and carotenoids, amino acids. Dental elixirs "Spring" and "Phytodent" contain a copper derivative of chlorophyll. Elixirs have anti-inflammatory and regenerative effects.

Rinse aids are the world's most common form of LSGPR. There are two types of rinses: containing alcohol (from 5 to 27%) and non-alcoholic.

Rinsers "Polion-Mirta" and "Starfish" (St. Petersburg) contain biologically active substances and, above all, antioxidants. "Polyon-Myrtle" contains chamomile extract, tea tree oil, ascorbic acid, carotene, vitamin E, trace elements, sodium fluoride. Starfish rinse is based on extracts of fucos algae, which contain biologically active substances: vitamins C, group B, carotenoids, fucoidan, alginic acid salts, macro- and microelements. Fucoidan solutions have a pronounced antithrombotic effect similar to that of heparin. Rinses contain a minimum amount of alcohol (1.5-3%). This allows them to be used for daily mouth rinses in the amount of 5.1-7.0 ml per glass of warm water. The duration of the procedure is 10 minutes. The course is at least 10-12 procedures for persons with periodontal diseases.

Firm "Laciede Inc." (USA) has developed and manufactures the "Biotin" system, which enhances and supplements the natural protective properties of saliva. The composition of this system, in addition to the antibacterial part, includes Biotine mouthwash with calcium and Oralbalance saliva substitute gel. The mouthwash is alcohol-free, cleans and refreshes the mouth, contains four antibacterial enzymes that enhance the natural defense system of saliva, does not stain teeth, has an antibacterial effect, and maintains a healthy balance of microflora in the mouth. Oralbalance is a long-acting moisturizing gel that protects dry tissues of the oral cavity from irritation, itching, burning, and neutralizes unpleasant odors. The "Biotin" system is recommended for xerostomia, periodontal diseases, diabetes mellitus, in persons who have undergone radiation therapy and chemotherapy.

Balms and tonics for gums have the following composition: extract of sage, horseradish, horse chestnut, soda, silicon, fluorite, silver, kieserite, rose essential oil, tea tree oil. Recommended for people with periodontal disease.

Sprays or deodorants have the following composition: water, preservative, dye, fragrance. They can be hygienic and treatment-and-prophylactic. The composition of therapeutic and prophylactic sprays includes extracts and oils of herbs and plants, strong antiseptics. Such sprays are recommended for inflammatory diseases of the oral mucosa and periodontal diseases, as they have antimicrobial and anti-inflammatory effects.

CJSC "Mirra" (Russia) produces gel-spray "Dentonic" for the prevention of periodontal diseases. The composition of "Dentonic" includes natural components of herbal extracts and an antioxidant complex of vitamins C, R. Spray has anti-inflammatory, regenerating, enveloping effects, stimulates local immunity by enhancing the processes of cellular energy exchange and respiration.

^ CHEWING GUM

It is authentically known that chewing gum was originally used only in Central America. For the first time, Europeans saw chewing gum in 1518, when the conquistadors invaded the Aztec empire (James P., Thorpe N., 1994). At the end of the 19th century, independently of each other, with a difference of several years, chewing gum was proposed: first by Thomas Adams Jr., later by William Wrigley Jr. H. Knighton in 1942 first reported the cleansing action of chewing gum. AT recent times increased interest in the use of chewing gum as a means of deodorizing properties and therapeutic and prophylactic efficacy.

Chewing gum of a traditional composition has cleansing properties, has a refreshing and deodorizing effect. The composition of chewing gums began to include abrasives, for example, sodium and calcium phosphates, calcium carbonate, kaolin, etc. Proposed chewing gum, preventing the deposition of plaque.

Over the past 15-20 years, in countries such as the USA, Great Britain, Germany, Japan, France, the production of chewing gums containing biologically active additives(remineralizing components, vitamins, enzymes, surfactants, extracts of medicinal plants).

Modern chewing gum consists of the following ingredients:

chewing base (20-30%), represented by various resins and paraffin, which allow the gum to soften easily at oral temperature;
sweeteners (60%) - glucose or food sugar, or sweeteners;
flavoring additives;
composition stabilizers (usually glycerin);
flavors;
emulsifiers;
dyes.

According to the classification of S.B. Ulitovsky (1999) single out simple, hygienic and prophylactic chewing gums.

Simple chewing gums (sugar-containing) help clean teeth from plaque, stimulate salivation, and have a caries-producing effect by lowering the pH of saliva. Hygienic chewing gums contain simple sweeteners, help to clean teeth from plaque, stimulate salivation, and are neutral with respect to the organs and tissues of the oral cavity.

Prophylactic (modern) chewing gums have a more complex composition, which includes several sweeteners and pro-Z crystals. These gums have cleansing properties, neutralize the acid in the mouth and restore the pH of the oral fluid. Sugar-free prophylactic chewing gums are therapeutic and prophylactic oral hygiene products and must be certified as such. Mandatory certification of prophylactic chewing gums was introduced by the Ministry of Health and the State Standard of Russia and is carried out in order to block the path of low-quality products and help the consumer figure out which products will improve his health and are guaranteed not to harm him. When certifying chewing gums, specialists conduct thorough studies of their properties, including laboratory and clinical ones. The central body for certification of oral hygiene products in the Russian Federation is the Profident Center. So, in this center, the products of the leading manufacturers of chewing gums were certified: the Wrigley company - chewing gums "Wrigley`s Spearmint", records "Wrigley`s Doublemint", "Orbit Peppermint", dragee "Orbit Winterfresh", dragee "Orbit for children ", etc. and firms "Dandy" - "Dirol Effect with carbamide", "Stimorol without sugar", etc. According to certification, all chewing gums of these firms do not contain sugar.

What qualities can be identified as the most basic in terms of classifying this chewing gum as a therapeutic and prophylactic oral hygiene product? This is, first of all, the absence of sugar and its replacement with sweeteners - xylitol and sorbitol, their combinations and derivatives. Sweeteners that are part of chewing gum can have an anti-caries effect due to:

antimicrobial action sweeteners;
increase the buffer capacity of saliva;
a decrease in the production of organic acids in the oral cavity (Makinen K.K. et al., 1998).

Another property that makes it possible to attribute chewing gum to the category of therapeutic and prophylactic is the presence of additional ingredients in it that enhance their anti-caries effect. An example of such ingredients are fluorides, calcium salts. The first publications evaluating the clinical efficacy of chewing gum with calcium and phosphate preparations appeared more than 30 years ago. American researchers have found that chewing gum with dicalcium phosphate used has a positive effect on the content of calcium and phosphates in saliva. In a study by Chow L.C. et al. (1994) studied the effectiveness of chewing gum with other mineral supplements (monohydrate-monocalcium-phosphate and an equimolar mixture of tetracalcium phosphate with dicalcium phosphate anhydride). It was established that both experimental chewing gums lead to a significant significant increase in the concentration of calcium and phosphates in saliva, as well as to an increase in the degree of saliva supersaturation as a result of 16-minute chewing. The results obtained gave the authors reason to express an opinion about the benefits of chewing gum with calcium and phosphorus compounds for increasing the mineralizing properties of saliva. Currently, there are convincing data on the anti-caries efficacy of fluoride-containing chewing gum (Hattab F.N. et al., 1989). However, the use of this approach for the prevention of caries has a very significant limitation: chewing gum in the minds of the population is perceived more as a confectionery product, and not medicine. Therefore, it is practically impossible to control the daily dose of fluorine-containing chewing gum, and, consequently, the intake of fluoride into the body. These chewing gums should only be used on the advice of a physician and should be restricted to wide distribution. retail network(Soloveva A.M., 2001). One example of chewing gum with fluoride is Fluorette gum from Fertin A/S (Denmark). Soluble calcium salt - calcium lactate is part of the chewing gum "Orbit for children" and provides cariogenic potential of foods (Kashket S., Yaskell T., 1997). The introduction of calcium lactate into the composition of chewing gum increases its remineralizing potential. The preventive action of chewing gum is primarily based on the influence on the mineralizing potential of saliva.

saliva plays important role in maintaining enamel homeostasis and caries prevention:

buffering properties of saliva provide neutralization of organic acids in the oral cavity and dental plaque;
the source of enamel remineralization is the oversaturation of saliva with calcium and phosphates;
The mechanism of participation of saliva in enamel homeostasis is the saturation of dental plaque with buffer systems and minerals.
saliva cleanses the oral cavity of food debris, contains proteins that prevent the growth of colonies of cariogenic bacteria.
Eating sugar-free gum after a meal has:
non-specific effect - stimulates the secretion of saliva;
specific effect - due to the content of anti-caries additives.

It has been established that the peak of salivation activation when using chewing gums is observed 1 minute after the start of chewing, reaching a rate of 5.1 ml/min, which is 10-12 times higher than the initial level of unstimulated secretion. However, as a result of the washing out of flavoring fillers, already after 10 minutes of continuous chewing, the rate of stimulated secretion decreases to the levels characteristic of mechanical stimulation. However, according to most researchers, even after 20 minutes, the secretion rate remains significantly increased. So, Dawes C. and MacPherson L.M. (1993) found that after 20 minutes the rate of stimulated secretion when chewing gum is 1.25 ml/min, which is 2.7 times higher than the initial level. The rate of secretion does not depend on the type of flavoring flavor. The more intense the flow of saliva, the higher the rate of self-purification. If the chewing gum itself does not contain sugars, but is based on sweeteners, then its use contributes to the accelerated clearance of sugars from the oral cavity and an increase in saliva pH. Acid-producing bacteria in plaque quickly ferment a range of carbohydrates into acidic end products. Changes in the pH of dental plaque that develop after the intake of carbohydrates into the oral cavity are called the Stefan curve. After exposure to sugars (lightly fermentable carbohydrates) on the plaque, the pH decreases rapidly after 5-20 minutes, and then begins to slowly return to its original level, fully recovering after 30-60 minutes. The use of chewing gum after a meal contributes to a change in the shape of the Stefan curve - there is a rapid increase in the pH of dental plaque in the first minutes after the start of chewing. This effect in most expressed when using sweeteners that are not amenable to fermentation by oral bacteria (Manning R.H., Edgar W.M., 1993).

One of the most important functions of saliva is to maintain a neutral or slightly alkaline pH value in the oral cavity (buffer properties of saliva). Saliva is buffered by bicarbonates. Their concentration in unstimulated mixed saliva is at the level of 1 mmol/L. When chewing gum, the concentration of bicarbonates in stimulated mixed saliva rises to 15 mmol/L. Thus, the preventive effect of chewing gum is based primarily on the stimulation of salivation, which contributes to the accelerated removal of sugars from the oral cavity and an increase in saliva pH, as well as activation of enamel remineralization.

However, chewing gum cannot fully provide mechanical cleansing of the oral cavity from food debris: plaque from fissures, interdental space and gingival sulcus can only be removed with a toothbrush and floss. That's why sugar-free gum is only part of a complete hygiene routine that includes toothpastes, brushes, flosses, rinses, mostly hard foods, and regular dental checkups.

Recently, works have appeared in the literature that reflect negative sides uncontrolled use of chewing gums (S.B. Ulitovsky, 1997; N.K. Loginova et al., 1998). Thus, it has been established that as a result of the uncontrolled use of chewing gums, various pathological conditions: allergic reactions, hyperplasia of the salivary glands and, as a result, dryness of the oral mucosa, muscle fatigue, dysfunction of the temporomandibular joint, development of congestive hyperemia in periodontal tissues, bad influence on the digestive organs.

In this regard, given the widespread use of chewing gums among the population, especially the growing population, and the lack of complete information about the properties and rules for their use, the educational and educational role of dentists is increasing. It is necessary to orient consumers of these products to the fact that:

it is useful to chew sugar-free preventive gum;
the best guarantee of gum quality is a certificate confirming that this gum is a therapeutic and prophylactic oral hygiene product;
when buying chewing gum, you need to carefully read the information on the package, paying attention to who the manufacturer is, what is the composition and expiration date;
chewing gum should be used only after meals for 10-15 minutes 3-4 times a day;
they don't replace mandatory application other means of oral hygiene;
chewing gum is not an alternative to brushing your teeth;
gum should not be chewed by those who have problems with the function of the temporomandibular joint, as well as people with damage to the integrity of the oral mucosa, pathology of the gastrointestinal tract.

^ MISTAKES IN ORAL CARE

Most adults and children have the impression that they clean their teeth very well and thoroughly, use effective means oral hygiene. However, an epidemiological survey of the children's population of the CIS shows that in 63% of people the state of oral hygiene is assessed as poor or very poor. This is due to a variety of reasons, one of which is improper oral care.

All mistakes made during brushing your teeth can be divided into the following groups:

Short brushing time. It takes at least 3 minutes to effectively clean your teeth. However, most children, adolescents and adults spend 30-60 seconds on the procedure.
Non-compliance with the technique of brushing teeth: the predominance of horizontal movements over sweeping and circular, cleaning only the cutting edge and chewing surface, insufficient cleaning of the lingual and palatine surfaces of the teeth, lack of cleansing of the tongue, retromolar and cervical areas of the teeth.
Brushing your teeth before meals (in the morning before breakfast, not after; in the evening before dinner).
No or very infrequent use of interdental oral hygiene products. Floss should be used after every meal, not just once a day.
Non-compliance with the method of using interdental oral hygiene products, which leads to injury to the gums, their bleeding, and soreness.
The use of hygienic SGPR instead of therapeutic and prophylactic ones. Hygiene products are recommended for persons without pathology of the oral cavity. In a situation where different age groups the prevalence of dental caries is from 80 to 100%, periodontal diseases from 60 to 100%, the majority of the population needs the use of therapeutic and prophylactic agents.
Wrong choice of toothbrushes by size. If the teeth are small, then you can use a children's or teenage toothbrush, if the teeth are large, then for them the most common brushes should have a 35-40 head size.
Wrong choice of toothbrushes according to the degree of stiffness of the bristles. The majority of the population needs toothbrushes with medium bristles. Processing a brush with artificial bristles with boiling water makes it completely unusable.
Failure to comply with the terms of use of the toothbrush. Even high-quality toothbrushes last 2-3 months, after which they must be replaced with new ones.
No intermediate hygiene measures during the day, after meals. There is a golden rule of oral hygiene "Eat a bite - brush your teeth."

These errors are due to the lack of knowledge in children, adolescents, parents, lack of skills in oral care, the wrong choice and use of oral hygiene products.

The dentist should be aware of oral hygiene products, be able to give recommendations on right choice and use of funds. The dentist must educate patients in a motivated attitude to oral hygiene as an integral part of the health of the body, teach patients how to brush their teeth.

^ PROFESSIONAL ORAL HYGIENE

For the first time, professional cleaning as a component of a program for the prevention of dental caries and inflammatory periodontal diseases was proposed by Axelsson and Lindhe (1970) in the so-called "Karlstadt model" (Sweden). This prevention program included the following components: nutritional advice, topical fluoride, regular brushing training, and professional cleaning.

Professional oral hygiene - evidence-based system preventive measures performed by a dentist, dental hygienist, aimed at improving the organs and tissues of the oral cavity and preventing the occurrence and progression of dental diseases.

Professional hygiene consists of a series of sequential activities that the dentist performs together with the patient:

determination of dental and hygienic status;
conducting a sanitary-educational conversation;
individual selection of oral hygiene products and items, training in their use;
checking the technique of brushing teeth with its subsequent correction by a doctor;
consistent and thorough removal of dental deposits by a doctor;
monitoring the effectiveness of improved brushing technique.

Almost all these stages are carried out as follows: first, the patient visits the doctor 4 times with an interval of 2-3 days. Then the intervals between visits increase to 15, 30, 60 days, depending on the hygienic condition of the patient's oral cavity.

On the first visit, the doctor examines the oral cavity, registers the condition of his teeth and gums in the patient's outpatient record, evaluates the state of oral hygiene using hygiene indices (Fedorov-Volodkina, Green-Vermillion, PHP, etc.). In case of unsatisfactory oral hygiene, the doctor in front of a mirror demonstrates to the patient dental deposits on his teeth using tools (excavator, smoother) and plaque indicators: solutions of iodine, erythrosine, fuchsin, Plavivo (Voco), tablets Dent (Japan) and Dinal (Russia) ).

On the same visit, the doctor conducts a conversation with the patient about the role of plaque in the development of dental caries and periodontal disease, conducts an individual selection of oral hygiene products and items, and gives recommendations on oral care (time, duration, frequency of brushing teeth). For complete cleaning of the contact surfaces of the teeth and interdental spaces, the doctor recommends the use of interdental products (dental floss - floss, toothpicks). Then carefully removes dental deposits and polishes teeth and fillings using abrasive pastes.

On the second visit, the patient comes with a new toothbrush and toothpaste recommended by the doctor. Teeth cleaning is checked and hygiene indexes are determined. If necessary, the technique of brushing teeth is corrected. The doctor on the model with a toothbrush, and then in the patient's mouth demonstrates the technique of brushing teeth, teaches how to use toothpicks and floss. If necessary, the final removal of plaque and calculus is carried out in adults and children. Grinding and polishing of the necks and accessible areas of the roots of the teeth. On the second visit, remineralizing therapy is performed using calcium-containing and fluorine-containing agents, superficial or deep fluoridation.

At the third visit, the effectiveness of the improved brushing technique is monitored. The doctor monitors the quality of brushing with the help of plaque indicators. Recently, to evaluate the effectiveness of brushing teeth, a tableted diagnostic tool for the hygienic condition of the oral cavity "Dinal", manufactured by CJSC "StomaDent", has been used. Method of application: chew the tablet for 1 minute and distribute it with the tongue over the surface of the teeth without swallowing. Rinse your mouth. Brightly colored areas on the surface of the teeth indicate the presence of soft plaque. Dinal contains erythrosin, basic magnesium carbonate, MCC, saccharin, vanillin, polyvinylpyrrolidone, magnesium stearate.

During the same visit, the dentist or hygienist polishes the fillings, carries out preventive procedures, checks the occlusion and performs selective grinding of all teeth. Children, according to indications, undergo fissure sealing (by invasive or non-invasive methods). Adult patients strictly according to the indications are carried out therapeutic and preventive measures: teeth whitening, treatment of hyperesthesia of hard dental tissues.

At the fourth and, if necessary, subsequent visits, oral hygiene is monitored and corrected.

At each visit, a doctor or a specially trained assistant carefully removes plaque and tartar, especially from hard-to-reach surfaces of the teeth, until the oral cavity is brought into an ideal hygienic condition, which the patient himself must maintain in the future.

There are three methods for removing tartar:

mechanical (instrumental);
chemical;
ultrasonic.

For professional hygiene apply:

Periodontal bellied probe;
Manual scalers;
Curettes;
Scalers ultrasonic;
rubber caps;
Rotating circular brushes;
Preventive polishing pastes;
Dental floss, polishing strips coated with aluminum oxide;
Remineralizers.

A periodontal button probe is used to determine the condition of periodontal tissues, the depth and relief of the periodontal pocket, to detect subgingival dental deposits, to assess the smoothness of the root surface after curettage.

Manual scalers are used to remove supra- and subgingival hard dental deposits. Scalers are symmetrical instruments with a different tip of the working part. Sickle hooks have a triangular or trapezoidal cross section, two cutting edges with a cutting angle of 70° and a sharp tip. Crescent hooks can be straight or curved. The blade of straight crescent hooks is straight and located at right angles to the handle, while curved hooks have a curved arc. The handle (the area where the tool handle goes into the blade) can be straight or angled. Straight hooks are used to remove tartar from all surfaces of the upper and lower teeth. mandible, effective in the frontal group of teeth. Hoe-shaped hooks are curved in a plane and have a shape that prevents reaching the bottom of the periodontal pocket and injuring periodontal tissues, but their sharp edges can form deep scratches on the surface of the roots. The cutting edge has an angle of 45°. The blade is angled 99 - 100° to the handle. Such hooks can penetrate to a depth of 2-3 mm under the gingival margin. Scaler - a file (or rasp) has multiple cutting edges located at an angle of 90-105 ° to the handle. The tool is designed to remove massive mineralized dental deposits by scraping them from the surface of the teeth. The shape of the so-called Zeffing bit allows it to be used to remove tartar from the proximal surfaces of the anterior and anterior-lateral teeth. The cutting edge has an angle of 45°. Spade-shaped scalers are designed to remove supragingival calculus from the vestibular and oral surfaces of the teeth.

Unlike pointed scalers, curettage spoons (curettes) have a rounded end and can be used in the presence of periodontal pockets to remove subgingival, including bifurcation, dental deposits without damaging periodontal tissues. They are also used to remove mild supragingival deposits, necrotic infected root cementum, and to remove granulation tissue and periodontal pocket epithelium. The curette shaft can be flexible, medium flexible and rigid. Rigid instruments are used to remove dense (mainly supragingival) calculus, but they are ineffective in detecting (probing) calculus due to the lack of feedback tactile sensations. Curettes of medium flexibility are designed to remove moderate mineralized deposits and provide good tactile sensations when probing. Flexible instruments are effective in determining calculus and removing mild calculus, mainly subgingival localization. There are universal curettage spoons and special or zone-specific ones, designed to treat hard-to-reach areas of the tooth surface, usually in the presence of a periodontal pocket. As a rule, universal curettes have medium rigidity, special curettes can be flexible ("thin") or rigid. All types of curettes must be balanced to work effectively. A balanced tool is one whose working tip is on the longitudinal axis of the handle. Universal curettes have two sharp cutting edges and rounded tips. The cutting surfaces are located at an angle of 90° to the tooth surface. Such curettes, due to their shape, can be used in all quadrants of the bite and on all surfaces of the teeth (both medial and distal) without changing the instrument. According to their shape, they are divided into curettes for anterior and posterior teeth. Special (zone-specific) Gracie curettes are designed to effectively treat a specific tooth surface. Separate instruments have been developed for anterior and posterior (posterior) teeth, palatine/lingual and vestibular surfaces. The working part of special Gracie curettes is sharpened on one side only, and thus have one cutting edge located at an ideal angle to the tooth surface for efficient work. Along with this, special curettes differ from universal ones in the structure of the handle. The angle between the handle of the instrument and the working part in universal curettage spoons is 80°, in special ones - 60-70°. This angle allows the tool to work in specific areas of the tooth surface, in particular, such as bi- or trifurcation or deep root surfaces. Gracie Special Curette Spoons are digitally marked for easy optimal choice tool for processing a certain surface of the teeth. So, tools 1 and 2 are designed for processing the vestibular surface of incisors and canines, 3 and 4 - the oral surface of the same teeth, 5 and 6 - for cleaning the vestibular and oral surfaces of premolars, 7 and 8 - for cleaning the vestibular and oral surfaces of premolars and molars , 9 and 10 - for cleaning the vestibular and oral surfaces of the molars, as well as hard-to-reach areas of the root surface, 11 and 12 - for treating the mesial surface of premolars and molars, 13 and 14 - for treating the distal surface of the same teeth. Gracie curettes can be finished (thinner instruments that provide effective root smoothing and removal of deposits in deep pockets), "pro" (with a shorter and stiffer working part for removal of supragingival deposits). Curettes Gracie "After Five" have a working part 3 mm longer, which allows penetration into pockets deeper than 5 mm, the blades are thinner for better penetration deep into the pocket and minimal tissue trauma. The "Mini Five" curette has a working part 3 mm longer, the blade length is two times shorter than the standard Gracie and "After Five" curettes, the blades are thinner.

Special curettes of the Tarjeon modification differ from the standard Gracie curettes in the shape of the blade section, which provides a sharper cutting edge and easier sharpening of the instrument, as well as in a thinner blade, which facilitates access to deep periodontal pockets.

Vision curettes are designed to work in deep and narrow periodontal pockets. They have a shorter and more curved blade, 5mm and 10mm markings on the blade, and a "+" mark on the handle to identify the direction of the blade. Furcation curettes are designed for treatment of bi- and tri-furcations of teeth in the presence of periodontal ones. the width of their blade is 0.9 or 1.3 mm. Instruments are bucco-lingual and mesially-distal.

Langer curettes combine the characteristics of universal curettes (the angle of the cutting edge to the tooth surface is 90°) and the Gracie curette (shape of the working part). These instruments, like standard curettes, can be used on both medial and distal surfaces of the tooth without changing the instrument. They are for the front teeth (sextant) and lateral (back) teeth. Varieties of Langer's curettes are instruments with an elongated neck to reach shallower or deeper periodontal pockets - the "Mini Five" and "After Five" curettes.

Tools for removing tartar must be sharp. Therefore, each time after use, they must be sharpened by running the tool along the surface of the grindstone. Dull or damaged tools are pre-ground with coarse stones. Stones such as Arkansas are used for final polishing. To prevent damage to the stone and to avoid excessive overheating during the grinding process, the surface of the stone is coated with a special grinding oil. Sanded by hand or with a grinder. Sharp one-sided instruments (Gracie curettage spoons) are sharpened with outside, sharp bilateral tools (hooks) - on both sides. The angle between the surfaces of the grinding stone applied to the side surface of the tool and the cutting edge should be 100-110°. The tool is sharpened by alternately moving the stone up and down the surface of the fixed tool. In order to avoid the formation of notches on the tool, the final movement is carried out in a downward direction. Sharpening can be carried out using an automatic sharpening device. The sharpness of sharpening is controlled with a plexiglass stick. A well-sharpened instrument does not reflect light. Before removing dental plaque, you should always choose an instrument that, in its shape, best matches the features of the surface of the crown, neck and root of the tooth and ensures a snug fit of the instrument edge to the surface. The angle between the tool edge and the tooth surface should be approximately 80°.

To remove deposits from implants and treat especially sensitive exposed root surfaces, the so-called soft scalers - curettes and hoe-shaped hooks with a non-metallic (heavy-duty plastic) working part have been developed, since metal instruments can easily damage the surface of the implanted implant.

A variety of tools and their working parts allows you to remove tartar from all surfaces of the teeth. The working parts of the instruments must be sharp and correspond to the curvature of the root surface. In the process of work, the doctor must follow a certain sequence:

1) antiseptic treatment of the oral cavity with non-irritating preparations using a syringe or spray device of a dental unit. The intended area of intervention and interdental spaces are especially carefully treated. For irrigation of the oral cavity, antiseptic solutions are used (chlorhexedine, furatsilin, metrogil, propolis, etc.) or infusions of medicinal herbs (St. John's wort, chamomile, sage, calendula, eucalyptus);

2) anesthesia: anesthetics and the type of anesthesia are selected individually depending on the general condition of the patient, tolerability, the nature and extent of the intervention;

3) treatment of the gingival margin and the cervical region of the teeth with an iodine-containing solution.

If dental deposits are quite strong, applications of proteolytic enzymes of proteolysis for 7-10 minutes or special gels can first be applied in the area of their removal. After application, the fixation of dental plaque becomes less stable. If necessary, local or injection anesthesia should be performed. The tool during removal should be firmly fixed in the hand in the position of a writing pen. The doctor's working hand is fixed on the jaws or teeth of the patient, and the movements of the hand with the instrument are additionally limited by the fingers of the left hand. If the teeth are mobile, they should be held with fingers, counteracting the direction of the pressure force of the working tool or fixed along the axis. Tartar removal begins from the cervical region of the tooth, gradually moving towards the apex. To do this, an appropriate instrument is brought under the stone and, with sliding force movements, it is separated from the hard tissues of the tooth upwards or to the sides. Stone removal alternates with antiseptic washing of interdental spaces and periodontal pockets. To make it easier to break off a stone from a tooth, sometimes a tool is used as a lever, and a finger serves as a fulcrum. Tartar must be removed from all surfaces of the tooth until a smooth surface appears. In this case, together with the stone, the surface layers of the affected cement of the tooth stone are removed. After removing the stone, it is necessary to polish the hard tissues of the tooth and fillings with an abrasive polishing paste. Silicon dioxide is predominantly used as an abrasive. Polishing is done with rotating brushes, and smooth surfaces - with soft rubber caps filled with polishing paste. Both the brushes and the caps are driven by a mechanical handpiece micromotor (5000 rpm). Then the polished surfaces of the crown, neck and root of the tooth must be covered with fluorine-containing varnish: Profilac ("Stomatdent"), Fluorprotector ("Vivadent"), Fluramon ("Voco") or applications of remineralizing solutions: 10% calcium gluconate solution, 2% sodium fluoride solution , 1% solution or gel of fluocal ("Septodont"), an enamel-proofing liquid, proposed by Professor Knapvost (Germany).

To combat plaque, to dissolve it, medications can be used, which are divided into 5 groups. The first group is desorbents, drugs that disrupt the adsorption of bacteria on the tooth surface: these include fluorine preparations and monofluorophosphates in low concentrations. They desorb albumin, salivary glycoproteins and bacteria from the surface of tooth enamel. Good desorbents are also glycerophosphates, fluorine-containing polyelectrolytes, tin and sodium fluoride. The second group - surfactants, drugs with bactericidal and bacteriostatic effects: chlorhexidine, catamine, polyene antibiotics. They prevent the formation of tartar, and also "detach" bacteria, thereby reducing the thickness of dental plaque. Antibiotics and antiseptics belong to the group of drugs that inhibit the formation and growth of the organic matrix of plaque due to their bactericidal and bacteriostatic action. The third group - solvents, drugs that destroy tartar: EDTA, hydroquinone, weak acids. The fourth group - special films that prevent the attachment of dental plaque and plaque: 2% undecic acid, 20% undecic zinc, pepper, clove and cinnamon oils. When applied to the tooth surface, an impenetrable hydrophobic barrier is formed. Oil films are kept on the teeth until the next meal. The fifth group of drugs are enzymatic and non-enzymatic agents that have good cleansing properties as a result of exposure to the organic matrix of dental plaque: protease dextranase, mucinase, hyaluronidase, RNase, DNase, urea preparations, copper sulfate, sodium percarbonate. All of the above drugs are able to stop and reduce the formation of plaque and tartar, stabilize the growth of dental plaque, inhibit the calcification of microbial residues, and reduce the virulence of microorganisms.

And still highest value in the elimination of oral microorganisms has brushing teeth.

In the last decade, ultrasound has been used to remove tartar. There are four types of impact on dental plaque:

1. Low frequency impact (Sonic). The tip of the tool carries out circular oscillatory movements up to 1 mm with a frequency of 1500-1700 Hz. Application efficiency this method very low. In this case, trauma to periodontal tissues is possible, therefore, the Sonic device is used only when removing supragingival dental deposits. Its use in the field of open cement is contraindicated.

2. Ultrasonic treatment (ultrasonic, magnetostrictive scalers). Vibration of the tip of the tool is electrical with a frequency of 25000-30000 Hz due to the vibration of thin metal plates when a low-voltage electrical signal is applied. Ultrasonic exposure generates heat.

3. Piezoceramic (crystal) transmission system (piezoelectric scalers). The tip of the tool moves only in a linear direction (back and forth) with a frequency up to 45000 Hz. Piezo scalers are more comfortable because they don't generate heat. Working with them requires a certain skill: the stronger the pressure of the tool, the less effective.

4. Ultrafine (powder-jet, sand-jet) impact (Air Flow, EMS, Switzerland), Cavi-Set (Dentsply). Unlike the kinetic energy of moving tools, this method consists in the directed supply of an aerosol jet stream containing water and an abrasive agent. Due to the ability to control the water supply to the tip, the possibilities of using this method are expanding not only for removing dental deposits, but also for treating fissures before sealing, removing deep enamel pigmentations, and preparing surfaces for composite restorations and orthopedic structures.

If, when using these devices, sufficient water supply is not ensured, then the heating of the working part can reach 200 ° C. Such temperatures can lead to injury to the tissues of the teeth and gums. The most optimal method is the internal supply of water to the working part of the tool. Water not only cools, but also, by spraying with ultrasonic waves, washes away the removed deposits, cleaning the treated area. The resulting aerosol removes from the patient's oral cavity a large number of microorganisms. Therefore, it is necessary to wear a mask and goggles while working. The tools used have a different shape of the working part. A thin tool with rounded edges should be used. However, if used incorrectly, even such an instrument can damage the teeth. Effective zone action of the tool passes along its longitudinal axis. Do not treat the tooth directly with the tip of the ultrasonic tip, as this can lead to chipping of enamel and dentin. Care must be taken when processing the edges of the fillings. At frequent use the working part of the tool wears out, and in order to avoid breakage, the tool must be replaced 2 times a year. When removing dental plaque, the working part of the instrument must be guided along the tooth without pressure. The separation of tartar occurs due to ultrasonic vibrations, and not due to pressure on the instrument. If, after treatment with ultrasonic devices and pneumoscalers, islands of tartar remain on the surface of the tooth, then subsequent processing is carried out with hand tools designed to clean any tooth surface.

To prevent the formation of new plaque, the cleaned surfaces of the teeth are subject to polishing using rubber cups, brushes and polishing pastes. The most optimal is the use of tips with a cone head, operating at low speed. In this case, grinding and preliminary polishing of the necks and accessible areas of the roots of the teeth is first carried out with flexible abrasive tools (Mylar discs and strips with an abrasive coating, tapes, flosses and brushes). Then proceed to the final polishing using brushes, rubber caps and polishing abrasive pastes: Unit Dose, Prophy Paste (Oral-B), Detartrine (Septodont), Nupro (Dentsply), Klunt (Voco), Remot (Lege Artis), Polident- set and Polident set for children (CJSC VladMiva). At the beginning of polishing, a coarse polishing paste is used, which is applied with a rubber cup. Then the processing is carried out with a medium-grained paste, due to which the irregularities formed by the previous paste are smoothed out. It should be noted that the order of alternation of polishing pastes must be strictly observed. Only in this way can a cleanly polished surface be obtained. In conclusion, the final polishing is carried out with a fine-grained fluoride-containing paste. Flat surfaces of teeth should be polished with rubber cups, and brushes should be used to polish cusps. Interdental surfaces are cleaned with special means. Cleaning of contact surfaces is carried out with the help of threads and fine-grained paste, strips. For polishing wider interdental areas, special interdental brushes are used.

CJSC "VladMiva" (Belgorod) offers a set of polishing pastes for professional hygiene: Polydent-set and Polident-set for children. Polishing pastes "Polydent" are intended for:

Polident No. 1- for rough treatment of the enamel surface, mechanical removal of tartar residues;
Polident No. 2- for removing soft plaque and antiseptic treatment of enamel after removal of tartar;
Polident No. 3- for fine polishing of the enamel surface, fluorination and calcination of tooth enamel and its protection from subsequent biochemical influences.

A set of polishing pastes "Polident" for pediatric dentistry is intended for:

Polident No. 1- for polishing permanent teeth in children after mechanical removal of tartar. The paste effectively removes hard and soft plaque, as well as pigmentation of various origins;
Polident No. 2- to remove hard and soft plaque, age spots and polish milk teeth.

Pastes "Polident" for pediatric dentistry have abrasive properties, protect the enamel, create a pleasant feeling of freshness in the oral cavity. The pastes contain an abrasive, an antiseptic, flavor additives, a paste-forming agent and a filler. The size and quality of grains of hard and soft abrasive contribute to the effective removal of plaque from permanent and milk teeth without damaging the enamel and preventing the occurrence of pigmentation. Paste "Polident" with fluorine protects the enamel and reduces the likelihood of caries. The required amount of paste is applied to a circular brush. The pre-dried tooth surface is treated at medium speed with medium pressure. Then you need to wash off the paste from the surface of the tooth brush with water.

For the chemical removal of hard dental deposits, the Softening Gel (CJSC VladMiva) is intended. The specific properties of the drug are due to the acid contained in it, which partially dissolves the salts that form hard plaque. This allows less trauma to the tooth enamel and oral mucosa than with the usual removal of tartar. The essential oils that make up the gel give a feeling of freshness. The gel is applied strictly on dental plaque, avoiding contact with the mucous membrane. Withstand 3-5 minutes, then rinse with water, then produce the removal of tartar.

After removing dental deposits and polishing the surface of the teeth, various methods of fluorization are used. This step is mandatory. To do this, use fluorine-containing gels, pastes, varnishes, rinses: Fluocal (Septodont), Fluoridin (Voco), Fluor protector (Vivadent), Belak F (CJSC VladMiva), Bifluorid 12 (Voco), Fluramon (Voco), Pro Fluorid M (voco). Deep fluoridation is carried out using an enamel-sealing liquid according to the method of Professor Knappvost (Germany).

The most popular among liquid hygiene products are rinses. Mouthwashes are ready-made solutions for rinsing the mouth. Solutions are non-alcoholic or contain from 5% to 27% ethyl alcohol which acts as a preservative. Alcohol-free products can be used by a wider range of people: children and adolescents, adults who cannot tolerate alcohol, with dryness of the oral mucosa.

Rinsers have a therapeutic and prophylactic effect. They may contain fluorides - for the prevention of caries: extracts of medicinal plants, essential oils, antiseptics (chlorhexidine, cestylpyridine chloride) - to reduce the formation of plaque, prevent and treat inflammation of the gums; potassium salts, aminofluorides - to reduce tooth sensitivity.

Rinses are recommended to be used daily after brushing your teeth and rinsing your mouth with water. For one procedure, 10-15 ml of an undiluted solution is sufficient, which is used to rinse the mouth for 30 seconds. For greater effectiveness, alternate the use of rinses with different active ingredients. The duration of the use of antiseptics is determined by the dentist.

Oral elixirs are also intended for rinsing the mouth. They have a higher alcohol content (from 30% to 60%) and are used diluted. To prevent inflammation of the gums and deodorize the oral cavity, 15-25 drops are added to a glass of water at room temperature, and 30-50 drops for treatment.

Oral concentrates contain enough high percent ethyl alcohol. In a diluted state, they are used for rinsing with a prophylactic purpose, and in an undiluted state, for treatment (by direct application to the inflamed area of the oral mucosa).

Mouth foams are designed for additional cleansing of teeth after brushing them with toothpaste. Can be used after meals when a brush is not available. They usually include enzymes that facilitate the removal of plaque, as well as therapeutic and prophylactic components (calcium compounds, fluorides, plant extracts, etc.). The foam is distributed on the surface of the gums and teeth and remains in the mouth for 2-3 minutes, then the mouth is rinsed with water.

Mouth sprays contain fragrances that freshen the breath. If plant extracts, essential oils or antiseptics are added to the sprays, it is advisable to use them for inflammatory diseases of the oral cavity. Balms and tonics for gums have the form of an emulsion. These are more medicinal than hygienic. They are applied to the gum (preferably with a very soft toothbrush) when it is inflamed. It must be remembered that liquid oral hygiene products are an addition to brushing and toothpaste.