 In a healthy human being the interdental gingiva fills the

interproximal area between the teeth. It is also known as

the gingival embrasure. Types of gingival embrassures are:
Type of Embrassure Condition of gingiva Recommended cleaning aid

Type 1 Healthy interdental Superfine and thin dental floss

papilla
Type 2 75% of embrassure Medium or thick dental floss
occupied by the gingiva
Type 3 50% of embrassure Pointed, small and spiral
occupied by the gingiva interdental brush
Type 4 25% of embrassure Thick spiral interdental brush or
occupied by the gingiva fine unitufted brush
Type 5 Complete loss of Bristle ended unitufted or thick
interdental papilla spiral interdental brush
 TYPES OF INTERDENTAL AIDS:
It is used to remove plaque from the interproximal surfaces of
the tooth with type 1 gingival embrassure.

Types of dental floss are:

-Twisted/ Non twisted
-Bonded/ Non bonded
-Thick/ Thin
-Waxed/ Non waxed
 SPOOL METHOD  LOOP METHOD
These are used in type 2
gingival embrasures.
They are cone or cylindrical
shaped made of bristles
mounted on a handle.
They are suitable for
cleaning furcation areas
and root concavities
Wooden tips are used in
areas the toothbrush
cant reach.
They are used to clean
too surface after eating.
They are used with or
without handle.
Rubber and plastic tips can
be rinsed and reused.
 Gingival stimulators cause
epithelial thickening. They
increase keratinization and
increase blood circulation
These are used in type 4
and type 5 gingival
embrassures.
They are used to clean large,
irregular or concave tooth
surfaces adjacent to the
interdental spaces
 Floss holder is a
supplementary tool for
flossing. It is suitable for
parents or caregivers in
helping children or
individuals with special care
needs to clean the adjacent
surfaces of teeth. Floss
holder comes in a 'knife'
shape or a 'Y' shape. A new
thread of dental floss can be
reattached to the floss
holder every time after use
if it is a non-disposable one.
 INTER- THE NUMBER OF
CONTRA- COMMON PROBLEMS
DENTAL DESCRIPTION INDICATIONS INDICATIONS EXPERIENCED
TIMES IT CAN BE
PRODUCT USED

Floss Handle with - Type I Type II and - Unable to Can be used a

holder two prongs in embrasures. Type III maintain tension number of
Y or F Shape - Recommended embrasures of floss against times,
for individuals tooth and fully however floss
that lack manual wrap around is to be
dexterity, who are tooth side. changed after
physically - Need to set a each use
challenged, or fulcrum/finger
who have a strong rest (e.g. cheek,
gag reflex. chin) to avoid
- Floss holders trauma to gums
may assist and floss cuts.
caregivers
1. Toothpicks are sliver-like
pieces of wood or plastic
used for cleaning in
between the teeth after
eating.
2. They can be flat or round,
plain, brightly coloured or
fringed with plastic.
3. They can even be
flavoured or fluorinated.
4. Wide toothpicks, such as
Stim-U-Dent, are useful
for wide spaces between
teeth, while narrow
toothpicks, which are
harder to find, can fit
between tiny gaps.
Most widely used oral ADA Specifications of
hygiene aids. toothbrush:
 According to ADA : Brushing surface:
The toothbrush is 1-1.25 inches in length
designed primarily to 5/16-3/8 inches in width
promote cleanliness 2 to 4 rows of bristles
oral. 5-12 tufts/row
 TO PREVENT
CLEAN TEETH AND PLAQUE
I N T E R D E N TA L
S PA C E S O F F O O D F O R M AT I O N .
REMNANTS, TO DISTURB AND
D E B R I S , S TA I N S , REMOVE PLAQUE
E T C

OBJECTIVES

T O S T I M U L AT E
AND MASSAGE TO CLEAN THE
G I N G I VA L TONGUE.
TISSUE
 TYPES OF TOOTHBRUSHES:
1. Manual toothbrushes
2. Powered toothbrushes
3. Sonic and Ultrasonic toothbrushes.
4. Ionic toothbrushes.

 There is no clear cut evidence that one particular

type of tooth brush is superior to the others.
 However, soft filament brushes are better in view
of damage than the hard filaments may cause.
 Ideal Characteristics:
 Should confirm to
individual patient
requirement in size, shape
and texture.
 Should be easily and
effectively manipulated.
 Should be readily cleaned
and aerated and should
be impervious to
moisture.
 Should be durable and
inexpensive.
1. Handle = The part
grasped in the hand during
tooth brushing.
2. Head = The working end
of a tooth brush that holds
the bristles or filaments.
3. Tufts = Clusters of
bristles or filaments
secured into the head.
4. Brushing Plane = The
surface formed by the free
ends of the bristles or
filaments.
5. Shank = The section that
connects head and handle.
 Toothbrush Bristles:
1. Can be hard or soft,
natural or synthetic, multi-
tufted or space tufted.
2. Natural bristles =
Obtained from hair of hog
or wild boar. Tubular in
form, more susceptible to
fraying, breaking,
contamination with
microbial debris, softening
and loss of elasticity.
3. Synthetic bristles = Made
of nylon, are uniform in
size and elastic, resistant
to fracture and do not get
contaminated.
 Also known as
automatic, mechanical or
electric toothbrushes.
 - Heads of these
toothbrushes oscillate in
a side-to-side motion or
in a rotary motion.
 - Frequency of
oscillations is around 40
Hz in an ordinary
powered toothbrush.
1. Young children.
2. Handicapped patients.
3. Individuals lacking manual dexterity.
4. Patients with prosthodontics or endosseous
implants.
5. Orthodontic patients.
6. Institutionalized patients including the elderly who
are dependent on care providers.
7. Patients on supportive periodontal therapy.
 • Increases patient
1. motivation resulting in
better patient compliance.

• Increased accessibility in
2. inter proximal and lingual
tooth surfaces.

• No specific brushing
4. • Uses less brushing force
than manual brushes.
3. technique required

• Brushing timer is
incorporated in some
5. brushes to help the patient
in brushing for the required
duration.
 Produce high frequency vibrations (1.6 MHz),
which lead to the phenomenon of cavitation and
acoustic micro streaming.
 This phenomenon aids in stain removal as well
as disruption of the bacterial cell wall
(bactericidal).
 Change the surface charge of the tooth by an influx
of positively charged ions.
 Plaque with similar charge is repelled from the tooth
surface and is attracted by negatively charged bristles.
  A number of tooth brushing techniques have
achieved acceptance by the dental profession.

 Each technique has been designed to achieve a

definite goal.
 - THE FOLLOWING ARE SOME OF THE DESCRIBED
METHODS:
A. Widely accepted and most
effective for removal of
dental plaque present
adjacent to and directly
underneath the gingival
margin.

B. Indications:

1. For open inter proximal

areas, cervical areas and
exposed root surfaces.

2. For routine patients with

or without periodontal
involvement.
 C. Technique:
1. Bristles placed at 45 degree angle to the gingiva
and moved in small circular motions.
2. Strokes repeated around 20 times, 3 teeth at a
time.
3. Lingual Surfaces Of Anterior Teeth : The brush is
inserted vertically and the heel of the brush is
pressed into the gingival sulk and proximal
surfaces at a 45 degree angle.
4. Occlusal Surfaces : Cleaned by pressing bristles
against the pits and fissures and the activating
the brush.
 • Effective method for
1. removing plaque.

• Provides good
2. gingival stimulation.

3. • Easy to learn.
 • Overzealous brushing may convert

1. the “very short strokes” into a scrub

brush technique and may cause
injury to the gingival margin.

2. • Time consuming.

3. • Dexterity requirement is too high

for certain patients.
A. Indications:
 As a routine oral hygiene measure.
 Intrasulcular cleansing.

B. Technique:
 Combines vibratory and circular movements of the Bass
method with sweeping motion of the Roll technique.
 The toothbrush is held at 45 degrees to the gingiva.
 Bristles are gentle vibrated by moving the brush handle
in a back and forth motion.
 The bristles are then swept over the side of the teeth
towards their occlusal surfaces in a single motion.
 • Excellent sulcus
1. cleaning.

• Good inter proximal

2. and gingival cleaning.

• Good gingival
3. stimulation

• Dexterity of the
1. wrist is
required.
A. Indications:
 Plaque removal from
cervical area below height
of contour and from
exposed proximal surfaces.
 General cleaning of tooth
surfaces and massage of
the gingiva.
 Cleaning in areas with
progressing gingival
recession and root
exposure to prevent
abrasive tissue destruction.
1. • Time consuming.

• Improper brushing
can damage the
2. epithelial
attachment
 C. Technique:
1. Bristles are pointed apically with an oblique angle to
the long axis of the tooth.
2. The bristle are positioned partly on the cervical
aspect of teeth and partly on the adjacent gingiva.
3. The bristles are activated by short back and forth
motions and simultaneously moved in a coronal
direction.
4. Following 20 strokes the procedure is repeated n the
adjacent teeth.

 A SOFT TOOTHBRUSH IS INDICATED FOR THIS

TECHNIQUE.
A. Indications:
 Open interdental
spaces with missing
papilla and exposed
root surfaces.
 Wearing FPDs or
orthodontic appliances.
 Patients who have had
periodontal surgery.
 Patients with moderate
inter proximal gingival
recession.
 . Technique:
1. Bristles are placed at an angle of 45 degrees to
the gingiva with the bristles directed coronally.
2. The bristles are activated by mild vibratory
strokes with the bristle ends lying inter
proximally.

 A SOFT / MEDIUM MULTI-TUFTED TOOTHBRUSH

IS INDICATED FOR THIS TECHNIQUE.
 • Massage and
stimulation for
1. marginal and
interdental gingiva. • Brush ends do not engage the
1. gingival sulcus to remove sub
gingival bacterial
accumulations.
• In some areas the correct brush
placement is limited or impossible,
2. therefore modifications become
necessary which add to the
complexity of the procedure.

• Requirements in digital
3. dexterity are high.
A. Also known as Rolling
Stroke method or ADA
method or Sweep
method.

B. Indications:
 Children.
 Adult patients with
limited dexterity.
 For preparatory lesson
for Modified Stillman’s
technique since the initial
brush placement is the
same.
 C.Technique:
1. The bristles are placed
at a 45 degree angle and
lightly rolled across the
tooth surface towards
the occlusal surfaces.

 THIS TECHNIQUE
REQUIRES SOME
FLEXIBILITY AROUND
THE WRIST.
 • Provides gingival
1. massage and
stimulation.
• Brushing too high during
1. initial placement can lacerate
the alveolar mucosa

• Tendency to use quick,

2. sweeping strokes resulting in
no brushing for the cervical
third of the tooth

• Replacing the brush with the

3. filament tips directed into the
gingiva may produce
punctuate lesions
DEFINITION
According to American Dental Association Council on
Dental therapeutics,
TYPES AND FORMS

TYPES FORMS

 COSMETIC  PASTES
DENTIFRICES:  TOOTHPOWDER
 It must clean and polish  GELS
teeth.
 THERAPEUTIC
DENTIFRICES:
 Must reduce disease
process(caries, gingivitis,
calculus, sensitivity)
FUNCTIONS

Minimize plaque build

Anti-caries action.
up.

FUNCTIONS

Removal of stains. Mouth freshener

APPLICATION

1.Dentifrice should preferably

dispersed in between the bristles
than on the tips of the tooth brush.

2.Amount of toothpaste or gel used

for effective cleaning is per sized dab
on top half of the toothbrush

3.Children under 6 years of age should

be given half amount of dentifrice than
that of an adult.
COMPOSITION

INGREDIENTS FUNCTIONS
 Polishing/Abrasive  Has mild abrasive action,
agents(calcium carbonate, helps in reducing plaque,
alumina , silica etc.) removing stains from the
teeth.
 Binding agents(colloidal silica,  Agents which control
sodium magnesium silicate
etc.)
stability and consistency of
the toothpaste.
 Detergents/ surfactents  Produces foam and helps
(sodium lauryl surface) in removal of food debris.
COMPOSITION
INGREDIENTS FUNCTIONS

 Humectants(sorbitol ,  Reduces loss of

glycerin etc) moisture from
toothpaste.
 Flavoring  They render the
agents(peppermint oil, oil product pleasant to use
of wintergreen etc.)
and leave a fresh taste in
the mouth after use
 sweetener
 Sweetening
agent(saccharin)
ADVERSE EFFECTS

Detergents and flavoring

oils are irritating to the Abrasives interfere
stomach and cause abdominal absorption of
vomiting the fluorides.

Parents should make

sure a pea sized portion It is only when substantial
of fluoride paste should quantities of paste is eaten by
children who may experience the
be there on the phenomenon of pica that is acute
toothbrush and also toxicity of fluoride dentifrices may
remind the child to be considered.
rinse and spit.
RECENT DEVELOPMENT
 TOOTH PASTES FOR CHILDREN

 NATURAL TOOTHPASTES(HERBAL
TOOTHPASTES)

 WHITENING TOOTHPASTES(CONTAINS
HIGHLY SILICA ABRASIVES NOT
RECOMMENDED FOR REGULAR USE)
HISTORY
 Meswak (also referred to as Miswak) is
a toothpaste brand that was launched in India by Balsara
Hygiene in 1998.
 The toothpaste is marketed as a herbal toothpaste as it is
made from extracts of the Salvadora persica plant.
USES
The medical benefit with Miswaak has been extensively
recorded. A number of research have indicated that
Miswaak, when used properly, is a superb anti-microbial
toothbrush for dental hygiene and gum infection cure,
minimizing plaque and gingivitis, teeth whitening and
relieving smelly breath, whilst giving you a nice mouth odor.

It has established that the Miswaak has effective ingredients

which aren't generally present in toothpastes with anti
cariogenic and anti-inflammatory hypoglycemic functions.
ADVANTAGES
 Strengthens gums.  Triggers teeth to sparkle.
 Triggers appetite.
 Blocks tooth decay.
 Removes yellowish colur
 Eliminates slime.
of teeth.
 Enhances memory.
 Clears the voice.
 Remedy to headaches.
 Improves eye sight.
 Produces aroma in the
 Helpful for the health of
mouth.
the whole body.
 Helps relieving
toothaches.
INGREDIENTS FUNCTION

 Sodium  Anti caries

Monofluorophosphate
 Sodium Saccharin  Sweetening agent
 Sodium Laurylsulphate  Foaming agent
 Calcium Carbonate  Abrasive
 Flavoring agents
 RDA : Radioactive Dentin Abrasion
 It is a method which is considered a useful tool for the
determination for the relative dentin abrasive level of
dentifrice and abrasive powder.
 It involves using standardize abrasive compound against
the test samples
 The determination of this value is done by determining
the activity while cleaning debris which is radioactively
marked by mild neutron irrigation
 The values obtained depend on:
 size
 quality
 surface structure of the abrasive used
• low abrasive levels
0-70
• medium abrasive
levels 70-150
• High abrasive levels
100-150
• Extreme high
abrasive levels 150-250
 Acidulated phosphate fluoride was introduced by
Brudevold and hi co workers at the Forsyth
Dental Centre, Boston, Massachusettes in 1960s.
• For aqueous preparation-Paint-on technique.
• For gel preparation-tray method.

• Recommended at 6-12 month intervals between

applications.
• The patient should sit upright in the chair.

• Oral prophylaxis is done.

• The teeth to be treated are completely isolated and
thoroughly dried with air.
• Clinical application of APF gels should be done using
trays that fit the patient s upper and lower dental
arches. A disposable foam-lined tray is preferred.

• To reduce ingestion of fluoride ,a minimum amount of

fluoride gel that will permit complete coverage of
tooth surfaces should be dispensed. Usually the amount
is less than 5ml.

• After the trays have been properly positioned ,saliva

ejector is used to evacuate the stimulated saliva and
excess fluoride.
• It is reapplied every 15-30 second so as to keep
the teeth moist with the fluoride solution
throughout the four-minute period.

• The patient should be told not to swallow the

gel but to exert slight pressure using the cheeks
and tongue as well as light biting forces in order
to cause the gel to flow interproximally.

• The fluoride gel should be in the mouth for 4

minutes and then the remaining oral fluid
should be expectotarated.

The patient is instructed not to eat, drink or rinse his

mouth for at least 30 minutes
• When APF is applied to the teeth, it initially leads to
dehydration of hydroxy appetite crystals which further on
hydrolysis forms an intermediate product called
dicalcium phosphate dihydrate(DCPD).

• This DCPD is highly reactive with fluoride ion and starts

forming immediately when APF is applied.

• Fluoride penetrates into the crystals more deeply

through the openings produced by shrinkage and leads to
formation of fluorapatite.
• The amount and depth of fluoride deposited as
fluorapatite is dependent on the amount and
depth at which DCPD gets formed.

• For the conversion of whole of DCPD so

formed into fluorapatite, deeper penetration
and continuous supply of fluoride is required.

• Because of this reason , APF is applied every 30

seconds and the teeth has to be kept wet for 4
minutes.
• Because high fluoride concentration and low pH favor fluoride
deposition, acidification of the fluoride solution with phosphoric
acid was found to suppress enamel as well as formation of
Calcium fluoride and provide a more effective treatment.

• The intermediate product formed is dicalcium phosphate

dihydrate and calcium fluoride is the principle reaction
product.

• Calcium fluoride that forms is partly lost by dissolution in the

saliva, but there is evidence that a substantial amount is
retained, probably by transformation to fluorapatite.
 • Requires only 2 applications a
1. year and is thus suited for
most dental office routines.

• The gel preparation can be

2. self applied and thus the cost
of application also gets
reduced.

• It has the ability to deposit

3. fluoride in enamel to a deeper
depth than neutral sodium
fluoride or stannous fluoride.
4.
• APF is stable and need
not be freshly prepared
for each patient.

• Practical difficulties like the teeth should be

kept wet for 4 minutes, so repeated
applications necessitates the use of suction
1. thereby minimizing the use in the field , this
also increases the chair side time making this
method more expensive.

2. • It is acidic , sour and bitter in taste.

• It cannot be stored in glass
3. containers.

• Repeated or prolonged exposures of

prolonged porcelain or composite
4. restorations to APF can resulyt in the loss of
materials,surface roughening and possible
cosmetic changes.
. It is used to promote oral hygiene, it serves as an abrasives
and assists in suppressing halitosis.
INGREDIENTS FUNCTION

 Calcium carbonate  Abrasive

 Removal of plaque and
calculus.
 Sorbitol  Humectant
 Emulsifier
 Sweetner
 Sodium Lauryl Sulfate  Foaming agent
 Silica  Abrasive
INGREDIENTS FUNCTION

 Titanium dioxide  White pigment for

whitening of toothpaste
 Provides opacity
 Sodium Silicate  Abrasive
 Carageenan  Prevents constituents
from separating
 Thickener
 Stabilizer
INGREDIENTS FUNCTION

 Titanium dioxide  White pigment for

whitening of toothpaste
 Provides opacity
 Sodium Silicate  Abrasive
 Carageenan  Prevents constituents
from separating
 Thickener
 Stabilizer
 Brush
thoroughly at
least twice a day.
 Potassium nitrate
 Sodium
Monofluorophosphate
 Strontium
acetate/chloride,
 Pleasantly flavored base
 Colour
 Fluoride
 Bioactive glass
(NovaMin technology.)
 The potassium ion depolarizes the nerve and stops
it from firing. The nerve impulses are thus desensitized and there is no pain. Clinical
studies show potassium nitrate progressively reduces the pain of sensitivity over a
period of weeks. As long as a toothpaste with potassium like Sensodyne is used twice
daily in brushing, the nerve response will gradually be reduced and sensitivity pain is
relieved.
These compounds share a
similar chemical structure to calcium. Strontium based toothpastes (acetate and
chloride) are therefore able to replace some of the lost calcium and block the exposed
tubules in the dentinal tissue. This helps prevent the movement of the fluid within the
tubules in response to a sensitivity stimulus that could otherwise cause tooth pain.
: Newer products contain calcium sodium phosphosilicate
(brand name NovaMin). NovaMin sticks to an exposed dentin surface and reacts with it
to form a mineralized layer. The layer formed bonds with the tooth, and is therefore
strong and resistant to acid. The continuous release of calcium over time is suggested to
maintain the protective effects on dentin, and provide continual occlusion of the dentin
tubules.
 As an antiseptic, intended to reduce plaque load ,
susceptibility to caries and bad breath.
 Oral hygiene routine
 Anti cavity mouth washes use fluoride to protect against
decay.
 COMPOSITION
 Mouth washes can contain :

 Chlorhexidine Gluconate
 Cetylpyridinium chloride
 Hexetidine
 Benzoic acid
 Methylsalicylate
 Triclosan
 Benzalkonium chloride
 methylparaben
 hydrogen peroxide
 sometimes fluoride, enzymes and calcium.
 COMPOSITION
 They include essential oils like:
 Thymol
 Eucalyptol
 Menthol

 Water

 Sorbitol
 Sucralose
 Sodium Saccharin
 Xylitol
 Sodium benzoate
 Alcohol containing mouthwashes – halitosis after dry
mouth.
 Soreness , ulceration , redness – allergy to some
ingredients
a) Aphthous stomatitis
b) Allergic contact stomatitis
Example brands of common commercial mouthwashes
Cēpacol
Colgate
Corsodyl
Dentyl pH
Listerine
Oral-B
Sarakan
Scope (mouthwash)
Tantum verde
 COMPOSITION:
AMOUNT

 Chlorhexidine Gluconate solution IP

 Diluted to chlorhexidine gluconate 0.2% w/v
 In pleasantly flavoured aqueous base q.s.

 Color: Brilliant Blue FCF

 Prevention of plaque in absence of brushing

Prevention and treatment of gingivitis Prevention of oral candidiasis

Controlling secondary bacterial Aid in treatment of mouth and

infections for aphthous ulcers throat infections.
 Chlorhexidine is a broad spectrum biocide effective
against gram positive and gram negative bacteria.

 After a single rinse with Chlorhexidine , saliva itself

exhibits antibacterial activity for about 5 hours and
suppresses salivary bacterial counts for over 12 hours.
 Following several rinses , bacterial count reduces by 80-
90%.
 • Preventing pellicle formation by blocking acidic
groups on salivary glycoproteins.
1. • This reduces adsorption of glycoproteins on to
the tooth surface.

• Preventing adsorption of bacterial cell wall onto

2. the tooth surface by binding to the bacteria.

• Preventing binding of mature plaque by precipitating

3. agglutination factors in the saliva and displacing
calcium from the plaque matrix.
 1.For treatment and prevention , swish
in the mouth for one minute.

2.Do not wash mouth , eat or drink

thereafter for 20 minutes.

3.For prolonged use, take 1:1 dilution

of CMW with plain water.

Chlorhexidine should not be used before/immediately after

using a toothpaste as interaction with anionic surfectants
found within the formulations , will reduce efficacy of the
chlorhexidine
 Brownish staining of
Loss of taste
teeth and
sensation
silicate/resin cements

ADVERSE
EFFECTS

Rarely
Stenosis of parotid
hypersensitivity has
gland
been reported
 Antiseptic mouthwash , promoted with the slogan:

 Named after Joseph Lister.

 Listerine was actually developed in 1879 by Joseph
Lawrence.
 Listerine mouthwash reaches areas in the mouth a
toothbrush cannot. It fights germs that cause bad breath
,plaque and gum problems.
 COMPOSITION:

 Purified water
 Alcohol
 Benzoic acid
 Poloxamer 407
 Methyl salicylate
 Sodium benzoate 0.06%
 Essential Oils:
1. Menthol
0.042%
2. Thymol
3. Eucalyptol 0.064%
0.092%
INGREDIENTS FUNCTION

 EUCALYPTOL  Flavoring agent

 MENTHOL  Local anesthetic
 Counter irritant
 METHYL SALICYLATE  Fragrance
 THYMOL  Antiseptic property
1.Use undiluted 20ml
2.Rinse for 30 seconds

3.Do not swallow

4.Do not rinse mouth with water or eat
and drink for next 30 min

5.Use twice daily

 Mouthwash:- It is a liquid
used for mouth rinsing by
gargling or swilled in the
mouth by contraction of
periodontal muscle.
 May be antiseptic,
antibacterial, antifungal,
analgesic etc
.
 Water
 Glycerin
 Cetylpridinium chloride  Fights germs causing plaque
 Sorbitol prevents gingivitis and bad
 Propylene glycol breath cleans hard to reach
areas , gum line , braces
 Citric acid ,crowns prostheses .
 Metanol
 Sodium saccharin
 Potassium sorbate
 Sodium fluoride  Fluoride strengthens teeth &
 Flavour prevents cavities .
 Poloxamer 407
 225ppm of fluoride .No
ethanol
• Do not dilute
• Fill cap to 20 ml

• Rinse for 30 sec gargle and rinse

• Do not swallow

• Keep out of reach of children below

the age and of 6 years
 The community periodontal index of treatment needs
was developed for the “ joint working committee” and
the “ World Health Organization” and the “ FDI”.
 The Index was developed primarily to survey and
evaluate periodontal treatment needs rather than
determining past and present periodontal status i.e the
recession of the gingival margin and alveolar bone.
1.Simplicity

2.Speed

3.International
uniformity
Does not record the position of the gingival
margin

Does not provide assessment of the past

periodontal breakdown.

CPITN is not a diagnostic tool and should not

be used for planning of specific clinical
treatment for individual patients
 The probe was designed for two purposes ,namely
measurement of pocket depth and detection of
subgingival calculus
 The probe is particularly designed for gentle manipulation
of the often very sensitive soft tissues around the teeth
 The pocket depth is measured through the colour coding
with a black mark starting at 3.5mm and a ball tip of
0.5mm diameter that allows easy detection of subgingival
calculus
 This feature facilitates identification of the base pocket
thus decreasing the tendency for the false reading by over
measurement
 A variant of this basic probe has two additional lines at
8.5mm and 11.5mm from the working tip
 The additional lines may be of use when performing a
detailed assessment and recording of deep pockets for
the purpose of preparing a treatment plan for the
complex periodontal therapy
 The joint committee of who/fdi has advised the
manufactures of cpitn probes to identify the instruments
as either 'cpitn-e' for the epidemiological probe with 3.5
mm and 5.5mm markings or 'cpitn-c ' for the clinical
probe with additional 8.5mm and 11.5mm markings
 The probing forces can be divided into a 'working component'
to determine pocket depth and a 'sensing component'- to
detect subgingival calculus
 The probe is inserted between the tooth and the gingiva , and
the sulcus depth or pocket depth is noted against the colour
code or measuring lines
 The direction of the probe during insertion should , whenever
possible be in the same plane as the long axis of the tooth
 For the ' sensing ' subgingival calculus, the lightest possible
force which will allow movement of the probe ball point along
the tooth surface is used .
 Pain to the patient during probing is in most cases
indicative of the use of a too heavy probing force
 The working force should not be more than 20gms -a
practical test for establishing this force is to gently insert
the probe point under the finger nail without causing pain
or discomfort
 Walking of the probe should be done with short upwards
and downward movements
 It should be probed in at least six points , the
mesiobuccal , mid buccal ,distobuccal and the
corresponding sites on the lingual surface .
 The aim is to determine the highest score applicable to each
sextant with the least number of measurements
 First decide whether the sextant can be validly scored. The
requirement is that more than one functional tooth is present
 If 'no' then score 'X' and move to the next sextant . If 'yes'
examine index teeth or all teeth for the presence of 6mm or
deeper pockets, 4 or 5 mm pockets, calculus, bleeding only, in
that order
 Determine appropriate highest score for that sextant . Once
the highest scored has been determined there is no need to
examine for the presence of the lower score in that sextant .
 The index teeth are excluded from the CPITN scoring
when the decision has been made to extract for any
cause
 Remember that two or more functioning teeth must be
present in a sextant for it to quality for scoring
 If in a posterior sextant, one of the two index teeth is not
present or has to be excluded, then the recording is
based on the examination of the remaining teeth
 If both index teeth in a posterior sextant are absent or
excluded from the examination, all the remaining teeth in
that sextant are examined and the highest score is
recorded .
 In an anterior maxillary sextant if tooth 11 is excluded,
substitute 21, if 21 is also excluded then identify the worst
score for the remaining teeth . Similarly, substitute tooth 41 if
tooth is missing
 In subject under 20 years age , if the first molar is not present
or has to be excluded the nearest adjacent premolar is
examined
 If all the teeth in a sextant are missing or only missing or only
one functional tooth remains the sextant is coded as missing
 A single tooth in a sextant is considered as a tooth in the
adjacent sextant and subject to the rules for that sextant . If
the single tooth is an index tooth , then the worst index tooth
score is recorded .
 Also called as dentist’s mirror which is used in
dentistry.
 The most important functions are:
 in certain locations of the mouth
where the visibility is difficult or impossible
 light onto desired surfaces where direct
light view is not possible.
 of soft tissues, such as tongue and
checks to gain better visualization of the teeth.
 1.Front surface reflecting mirror
 2.Rare surface reflecting mirror

 1.Plane or Flat surface

 2.Concave surface

 1.One sided
 2.Two sided
 Latex
 Nitrile rubber
 Vinyl and neoprene
 They come unpowdered, or powdered with cornstarch
to lubricate the gloves, {making them easier to put on the
hands}
 Due to the increasing rate of latex allergy among health
professionals, and in the general population, gloves made of non-
latex materials such as vinyl, nitrile rubber, or neoprene have
become widely used.
 Chemical processes may be employed to reduce the amount
of antigenic protein in Hevea latex, resulting in alternative natural-
rubber-based materials such Vytex Natural Rubber Latex.
 However, non-latex gloves have not yet replaced latex gloves in
surgical procedures, as gloves made of alternative materials generally
do not fully match the fine control or greater sensitivity to touch
available with latex surgical gloves.
 Other high-grade non-latex gloves, such as nitrile gloves, can cost
over twice the price of their latex counterparts, a fact that has
often prevented switching to these alternative materials in cost-
sensitive environments, such as many hospitals.
 Nitrile gloves are made up of synthetic rubber.
 It has no latex protein content and more resisted to tear.
Also it is very resistant to many chemicals and is very safe
for people who allergic to latex protein.
 We can say that nitrile glove is the most durable type of
disposable gloves.
 Although nitrile gloves are known for its durability, extra
care should be taken while handling with tarnish silver
and high reactive metals because those substances can
react with sulfur, an accelerant in nitrile gloves.
It is derived from the species of plant of genus “
NICOTIANA” of the potato family
Major varieties include:
1. • a) Nicotiana
Rustica

• b) Nicotiana
2. Tabacum

Tobacco leaves are picked and subjected to different

types of curing and manufacturing processes
 TYPES OF
TOBACCO
PRODUCTS

Smoked Smokeless
tobacco tobacco
Smoked tobacco preparations include:
Bidi
Chillum
Chutta
Cigarettes
Dhumti
Hookah
Hookli
Smokeless tobacco preparations include:
 Khaini
 Manipuri tobacco
 Mawa
 Mishri / masheri
 Paan
 Zarda
 Snuff
 Gutkha
 Pan masala
 Gudhakhu
CONSTITUENTS EFFECT
 Nicotine  Causes addiction
 Increases blood pressure
 Carbon monoxide  Impairs oxygen transport
by binding with Hb.
 Tar  Carcinogen
 Stains teeth , fingers, lungs
 Nitrogen oxide
of smokers
 Hydrogen cyanide
 Metals and radioactive
compounds.
 EFFECT

 Nicotine  Causes addiction and

increases Blood pressure.
 Carbon monoxide  Impairs oxygen transport
to body by binding with
haemoglobin.

 Tar
 Major contributor to
Slows wound healing.
oral disease.

ILL EFFECTS

Cancer of oral cavity,

Promotes periodontal
tongue, larynx, pharynx
disease, halitosis and
, esophagus, stomach ,
oral infections.
uterus, cervix and lung.
Smoking is also known
to cause lung disease Passive smoking can also
cause respiratory infections,
(emphysema and chronic worsening of asthma, poor
bronchitis as well as lung infection
cardiovascular disease

ILL EFFECTS

Contributes to low weight

Reduced fertility and sexual
babies or stillborn babies in
impotence in men
expecting mothers
ESTIMATED TO
CONTAIN

a) 1-1.4mg of nicotine.
b)19-27mg of tar.
About 51% of them are
filter tipped
Filter length averages=
12mm
Filters of Indian cigarettes
comparatively trap LESS
nicotine
It is a gram of tobacco cured in
the sun / dry heat
The tobacco is generally
treated with variety of
sugars , flavoring and
aromatic ingredients
Most popular form of
tobacco consumed in
India
About 34% of total
tobacco manufactured
used in making Bidi’s
Bidi produces smaller
volume of smoke than
cigarette as they contain
coarsely ground tobacco
compared to finely cut
tobacco in cigarettes
It is about 0.2-0.3 grams
of sundried tobaccco
flakes
Rolled in a rectangular
piece of
TEMBURNI(diospyros
ebenum) or
TENDU(diospyros
melanoxylon) leaf tied
with a thread
About 60% of weight is
made up of leaf wrapper
It is available is lengths of
about 60mm (regular)
and 80mm (long)
Nicotine content=1.7-3mg
Tar=45-50mg
 It is a mixture of betel leaf
with lime+ areca nut+
clove+ cardamom+ mint+
tobacco
The areca nut is the seed
of the areca palm (Areca
catechu), which grows in
much of the tropical
Pacific, Asia, and parts of
east Africa. It is
commonly referred to
as betel nut, as it is
often chewed wrapped
in betel leaves (paan)
Paan refers to betel leaf (from piper betel wine) itself
and often to quid
The quid contains areca nut (raw, baked or boiled), lime
and according to local customs, aniseed, catechu
(kattha),cardamom, cinnamon, coconut cloves, sugar
and tobacco