ORAL HYGIENE

Oral hygiene is the practice of keeping the mouth and teeth clean to prevent dental problems, especially the common dental cavities and gingivitis, and bad breath. There are oral pathologic conditions in which a good oral hygiene is required for healing and regeneration of the oral tissues. These conditions included gingivitis, periodontitis, dental traumas such as subluxation, oral cysts, and after wisdom tooth extraction.

a.      Teeth cleaning

Teeth cleaning is the removal of dental plaque and tartar from teeth to prevent cavities, gingivitis, and gum disease. Severe gum disease causes at least one-third of adult tooth loss.

Tooth decay is the most common global disease affecting every family. Over 80% of cavities occur inside pits and fissures on chewing surfaces where brushing cannot reach food left trapped after every meal or snack and saliva or fluoride have no access to neutralise acid and remineralise demineralised tooth, unlike easy-to-reach surfaces, where few cavities occur.

Fissure sealants dentists apply over grooves in chewing surfaces of back teeth prevent food becoming trapped and halt the decay process. An elastomer strip has been shown to force sealant deeper inside all opposing chewing surfaces at the same time and can also force fluoride toothpaste inside chewing surfaces before brushing to remineralise demineralised teeth.

Since before recorded history, a variety of oral hygiene measures have been used for teeth cleaning. This has been verified by various excavations done all over the world, in which chew sticks, tree twigs, bird feathers, animal bones and porcupine quills were recovered. Many people used different forms of teeth cleaning tools. Indian medicine (Ayurveda) has used the neem tree (a.k.a. daatun) and its products to create teeth cleaning twigs and similar products for millennia. A person chews one end of the neem twig until it somewhat resembles the bristles of a toothbrush, and then uses it to brush the teeth. In the Muslim world, the miswak, or siwak, made from a twig or root with antiseptic properties has been widely used since the Islamic Golden Age. Rubbing baking soda or chalk against the teeth was also common.

Generally, dentists recommend that teeth be cleaned professionally at least twice per year. Professional cleaning includes tooth scaling, tooth polishing, and, if too much tartar has built up, debridement. This is usually followed by a fluoride treatment. However, there is no good evidence that scaling and polishing is cost-effective.

Between cleanings by a dental hygienist, good oral hygiene is essential for preventing tartar build-up which causes the problems mentioned above. This is done by carefully and frequently brushing with a toothbrush and the use of dental floss to prevent accumulation of plaque on the teeth.

Plaque

Plaque is a yellow sticky film that forms on the teeth and gums and can be seen at gum margins of teeth with a food dye. The bacteria in plaque change carbohydrate such as sugar, in food, to acid that demineralises tooth eventually causing cavities after repeated attacks over a number of years where demineralisation exceeds saliva and fluoride remineralisation. Thorough daily brushing and flossing removes plaque and can prevent tartar from forming on the teeth.

Plaque can also cause irritation to the gums, making them red, tender, or bleeding easily. In some cases, the gums pull away from the teeth, leaving cavities inhabited by bacteria and pus. If this is not treated, bones around the teeth can be destroyed. Teeth may become loose or have to be removed as with periodontal (gum) disease in mostly adults. Eating a balanced diet and limiting snacks can prevent tooth decay and periodontal disease. Nutritious foods such as raw vegetables, plain yogurt, cheese, or a piece of fruit are considered good snack foods to grab

Flossing

The use of dental floss is an important element of oral hygiene, since it removes the plaque and the decaying food remaining stuck between the teeth. This food decay and plaque cause irritation to the gums, allowing the gum tissue to bleed more easily. Acid forming foods left on teeth also demineralise teeth eventually causing cavities. Flossing for a proper inter-dental cleaning is recommended at least once per day, preferably before brushing so fluoride toothpaste has better access between teeth to help remineralise tooth,^[7] prevent receding gums, gum disease, and cavities between the teeth.

It is recommended to use enough floss to enable easy use, usually ten or more inches with three to four inches of taut floss to put between teeth. Floss is then wrapped around the middle finger and/or index finger, and supported with the thumb on each hand. It is then held tightly to make taut, and then gently moved up and down between each tooth. It is important to floss under visible areas by curving the floss around each tooth instead of moving up and down on gums, which are much more sensitive than teeth. However, bleeding gums are normal upon first usage of floss, and will harden with use.^[8] One should use an unused section of the floss when moving around different teeth. Removing floss from between teeth requires using the same back-and-forth motion as flossing, but gently bringing the floss up and out of gaps between teeth. Whilst Flossing as been advocated for some time now it would be fair to say this is often a difficult and rather messy business. Recently interdental brushes have been available and some are doing an excellent job. Especially those with a fine handle that can be twirled a few revolutions between the fingers and so clean more efficiently these spaces. Dentist can measure the space between one teeth and so recommend the right size to fit all, this off course would be the size that would enter the smaller space. But it can also be beneficiary to get thicker one for the larger interdental space.

b.      Tongue cleaning

Cleaning the tongue as part of daily oral hygiene is essential, since it removes the white/yellow bad-breath-generating coating of bacteria, decaying food particles, fungi (such as Candida), and dead cells from the dorsal area of the tongue. Tongue cleaning also removes some of the bacteria species which generate tooth decay and gum problems.

c.       Gum care

Massaging gums with toothbrush bristles is generally recommended for good oral health. Flossing is recommended at least once per day, preferably before bed, to help prevent receding gums, gum disease, and cavities between the teeth.

d.      Oral irrigation

Some dental professionals recommend oral irrigation as a way to clean teeth and gums.

Oral irrigators reach 3–4 mm under the gum line. Oral irrigators use a pressured, directed stream of water to disrupt plaque and bacteria.

e.       Food and drink

Foods that help muscles and bones also help teeth and gums. Breads and cereals are rich in vitamin B while fruits and vegetables contain vitamin C, both of which contribute to healthy gum tissue. Lean meat, fish, and poultry provide magnesium and zinc for teeth. Some people recommend that teeth be brushed after every meal and at bedtime, and flossed at least once per day, preferably at night before sleep. For some people, flossing might be recommended after every meal.

·         Beneficial foods

Some foods may protect against cavities. Fluoride is a primary protector against dental cavities. Fluoride makes the surface of teeth more resistant to acids during the process of remineralisation. Drinking fluoridated water is recommended by some dental professionals while others say that using toothpaste alone is enough. Milk and cheese are also rich in calcium and phosphate, and may also encourage remineralisation. All foods increase saliva production, and since saliva contains buffer chemicals this helps to stabilize the pH to near 7 (neutral) in the mouth. Foods high in fiber may also help to increase the flow of saliva and a bolus of fibre like celery string can force saliva into trapped food inside pits and fissures on chewing surfaces where over 80% of cavities occur, to dilute carbohydrate like sugar, neutraluise acid and remineralise tooth like on easy to reach surfaces. Sugar-free chewing gum stimulates saliva production, and helps to clean the surface of the teeth

According to World Dental, these are the top ten beneficial foods for teeth.

§  Green tea contains polyphenol antioxidant plant compounds that reduce plaque and help reduce cavities and gum disease. Tea may help reduce bad breath. Tooth enamel is strengthened because green tea contains fluoride which promotes healthy teeth.

§  Milk and yogurt are good for teeth because they contain low acidity, which means that wearing of teeth is less. They are also low in decay-inducing sugar. Milk is a good source of calcium, the main component of teeth and bones.

§  Cheese contains calcium and phosphate, which helps balance pH in the mouth, preserves (and rebuilds) tooth enamel, produces saliva, and kills bacteria that cause cavities and disease.

§  Fruits such as apples, strawberries and kiwis contain Vitamin C. This vitamin is considered the element that holds cells together. If this vitamin is neglected, gum cells can break down, making gums tender and susceptible to disease.

§  Vegetables: Vitamin A, found in pumpkins, carrots, sweet potatoes and broccoli, is necessary for the formation of tooth enamel. Crunchy vegetables may also help clean gums.

§  Onions contain antibacterial sulfur compounds. Tests show that onions kill various types of bacteria, especially when eaten raw.

§  Celery protects teeth by producing saliva which neutralizes acid that causes demineralisation and cavities. It also massages the teeth and gums.

§  Sesame seeds reduce plaque and help build tooth enamel. They are also very high in calcium.

§  Animal food: beef, chicken, turkey, and eggs contain phosphorus which, with calcium, is one of the two most vital minerals of teeth and bone.

§  Water cleans the mouth and produces saliva that deposits essential minerals into the teeth. It keeps gums hydrated and washes away particles from the teeth.

·         Detrimental foods

Sugars are commonly associated with dental cavities. Other carbohydrates, especially cooked starches, e.g. crisps/potato chips, may also damage teeth, although to a lesser degree since starch has to be converted by enzymes in saliva first.^{[citation needed]} Sugars that are higher in the stickiness index, such as toffee, are likely to cause more damage to teeth than those that are lower in the stickiness index, such as certain forms of chocolate or most fruits.

Sucrose (table sugar) is most commonly associated with cavities. The amount of sugar consumed at any one time is less important than how often food and drinks that contain sugar are consumed. The more frequently sugars are consumed, the greater the time during which the tooth is exposed to low pH levels, at which point demineralisation occurs (below 5.5 for most people). It is important therefore to try to encourage infrequent consumption of food and drinks containing sugar so that teeth have a chance to be repaired by remineralisation and fluoride. Limiting sugar-containing foods and drinks to meal times is one way to reduce the incidence of cavities. Sugars from fruit and fruit juices, e.g., glucose, fructose, and maltose seem equally likely to cause cavities.^{[citation needed]}

Acids contained in fruit juice, vinegar and soft drinks lower the pH level of the oral cavity which causes the enamel to demineralize. Drinking drinks such as orange juice or cola throughout the day raises the risk of dental cavities tremendously.

Another factor which affects the risk of developing cavities is the stickiness of foods. Some foods or sweets may stick to the teeth and so reduce the pH in the mouth for an extended time, particularly if they are sugary. It is important that teeth be cleaned at least twice a day, preferably with a toothbrush and fluoride toothpaste, to remove any food sticking to the teeth. Regular brushing and the use of dental floss also removes the dental plaque coating the tooth surface.

Chewing gum assists oral irrigation between and around the teeth, cleaning and removing particles, but for teeth in poor condition it may damage or remove loose fillings as well. Chewing sugar free chewing gum that contains xylitol may be good for teeth.^{[citation needed]}

f.       Other

Smoking and chewing tobacco are both strongly linked with multiple dental diseases. Regular vomiting, as seen in bulimia nervosa, also causes significant damage.

Mouthwash or mouth rinse with saline (salty water), fluoridated solution or the antiseptic chlorhexidine gluconate solution improve oral hygiene. Dental chewing gums claim to improve dental health.

Retainers can be cleaned in mouthwash or denture cleaning fluid. Dental braces may be recommended by a dentist for best oral hygiene and health. Dentures, retainers, and other appliances must be kept extremely clean. This includes regular brushing and may include soaking them in a cleansing solution such as a denture cleaner.

g.      Oral hygiene and systemic diseases

Several recent clinical studies suggest oral disease and inflammation (oral bacteria & oral infections) may be a potential risk factor for serious systemic diseases, such as:

• Cardiovascular Disease (Heart attack and Stroke)
• Bacterial Pneumonia
• Low Birth Weight/Extreme High Birth Weight
• Diabetes complications
• Osteoporosis

prevention is better than cure so we recommend doing the following:
1 - clean your teeth regularly for a period of 3 minutes per day (can be divided into
Two or three) after meals.
2 - Visiting the dentist twice a year for the work of inspection and cleaning of the teeth
League.
3 - Reduce the sugars in the food while reducing the drinking soft drinks and juices with added sugar.
4 - Reduce eating between meals, taking into account eating sugary materials, such as nuts and cheese when you feel hungry between meals and the economy of eating sugars and sweets only immediately after the main meals, to reduce the exposure period the teeth of the acids and licorice.

THE PURPOSE OF ORAL HYGIENE

A. Increase self-confidence

Tooth decay and gum disease often related  with mouth smell and  also can greatly affect with the self confidence. If mouth free of gum disease and cavities so the quality of life can also be better. Because a person can eat well, sleep better, and concentrate without dental pain, or mouth infections that can distract.

2. Lower risk of heart disease

Chronic inflammation of gum disease has been related with the development of cardiovascular problems such as heart disease, clogged arteries, and stroke. The relationship between chronic inflammation of gum disease with heart disease has been proven by many studies. Many research results show that oral health can help protect your overall health.

3. Maintain memory

According to the Journal of Neurology, Neurosurgery & Psychiatry, adults with inflammation of the gums (gingivitis) showed poor results on tests of memory and other cognitive abilities than those with healthy gums and mouth. Gingivitis can show symptoms such as swelling of the gums and bleeding gums. People with gum disease are more likely to perform poorly on tests for memory and verbal skill tests commonly used in everyday life.

4. Reduce the risk of infection and inflammation in the body

Poor oral health has been associated with the development of infection in other parts of the body. The results have shown a link between gum disease and rheumatoid arthritis. Rheumatoid arthritis, an autoimmune disease that causes inflammation of the joints. Mechanism of destruction of connective tissue between gum disease and rheumatoid arthritis are the same. Eat a balanced diet, check with your dentist regularly, and good oral hygiene can help reduce the risk of tooth decay and gum disease. Make sure to brush your teeth 2 times a day and flossing once a day. Using mouthwash or antibacterial toothpaste can also help reduce the bacteria in the mouth that can cause gingivitis.

5. Helps stabilize blood sugar for those who have diabetes

People with uncontrolled diabetes often have gum disease. Having diabetes can make a person less able to fight infections, including gum infection that can lead to serious gum disease. Some experts have found that, if you have diabetes, it is likely to develop gum problems more severe than in people without diabetes. Reduce the risk of gingivitis to protect the oral health can help control blood sugar levels for diabetics.

6. Maintain the health of babies for pregnant women

Women may experience increased gingivitis during pregnancy. Some studies show an relation between gum disease and preterm birth and babies born with low weight. Not all studies have found a close relationship, but it never hurts to maintain oral health. If you are pregnant, then you should visit a dentist or dental gum disease specialist (periodontist) as part of prenatal care.

THE PROSEDUR OF ORAL HYGIENE

ICU’s patient

Oral care system procedures

1.      Using the oral care foam stick dipped inpovidone-iodine mouthwash and the spray bottle,plaque and food remaining on the teeth or oral mucosa are dislodged. (About 1 minute.) This should be done gently, as the oral mucosa of elderly people is thin and easily damaged.

2.      The tongue is cleaned by lightly scrubbing back-to-front using the spatula-shaped brush for about 10 repetitions. (About 30 seconds.) Care should be used not to harm the tongue. Since a dirty tongue is a cause of mouth odor, maintaining cleanliness is important.

3.      The tooth surfaces are cleaned with the electric toothbrush while also using the gargle as needed. The mucosa is cleaned as required. (About 2 minutes, 30 seconds).

4.      The mouth amply rinsed with the mouthwash. (About 1 minute.) The Gayle receptacle is used to catch the expelled mouthwash. Sufficient care should be used to avoid aspiration. The person whose teeth are being cleaned should be in a sitting position when gargling, if at all possible.

5.      The dentures of those who have them are cleaned and disinfected.

PROCEDURE FOR ORAL CARE
FOR PATIENTS WHO ARE INTUBATED OR TRACHED IN CCTC

Perform Oral Assessment:

• Perform hand hygiene and don non-sterile gloves, facemask and shield.
• To fully inspect oral cavity, use a flashlight and a 4 X 4 gauze to facilitate lifting/moving of the tongue
• Inspect top, sides and undersurface of tongue. Assess lips, back of throat and mucous membranes for any bleeding, odor, discharge or evidence of skin breakdown or ulceration
• Inspect teeth to observe for breakage, missing teeth, dental carries or recent trauma. Consider need for dentistry consult.
• Remove any partial or full plates or dentures.
• Palpate along cheeks, gum line and neck glands for signs of swelling, enlarged lymph nodes or abscess.
• Review ETT or NG tube placement and assess for associated ulcers/early pressures; discuss with RRT if tube repositioning is needed
• Document findings in AI record