Disclosing Agents & Dental Floss- Preclinic Theory

What is the definition of disclosing agents?

a preparation in liquid, tablet, or gel form which contains a dye or other coloring agent.

What are the purposes of disclosing agents?

1. Patient education in the location of soft deposits makes it easy for patient to see plaque.

2. Self evaluation at home (daily or periodic checks).

3. Professional evaluation of home care- to determine need for revisions.

4. Preparation of plaque indices- scale that numerically determines presence of plaque on teeth (10% or less).

5. Research studies to gain new information- effectiveness of specific devices for plaque control.

What are the properties of disclosing agents?

1. Distinct staining- good contrast between plaque and tooth.

2. Duration of color- color should not rinse off for the period of time required to give OHI, but gone by end of appointment.

3. Pleasant taste

4. Non-irritating- ask patient if they have allergies to ingredients.

5. Diffusibility- thin enough to apply readily, but thick enough for plaque to absorb it.

6. Astringent or Antiseptic- inhibits growth of microorganisms and discloses at the same time.

What are the 4 types of disclosing agents?

1. Erythrocin (F D & C Red No. 28, EX: Butler Red Cote or Trace 28)

2. Fluorescein dye (F D & C Yellow No. 8)

3. Two-tone dyes (F D & C Red No. 28 and Green No. 3)

4. 3 tone dyes

What are the advantages of Erythrocin dye?

available in liquid, tablet, or swab; most widely used agent

What are the disadvantages of Erythrocin dye?

tends to stain soft tissues; making post application evaluation of the gingiva difficult

What are the advantages of Fluorescein dye?

not interfering with gingival evaluation or leaving visible stain on oral tissue

What are the disadvantages of Fluorescein dye?

plaque stained with sodium fluorescein is visible only with the use of a special light source; more expensive

What are the advantages of Two-tone dyes/3 tone

combination solution; has the advantage of differentiating mature (stains blue) from new bacterial plaque (stains red).

mature = thick, dense plaque, more damage

new = thin

very old=light blue

what are the advantages to Two-tone dyes?

discloses bacterial plaque but will not stain gingival tissues

What are dyes used in the past that are rarely used today?

iodine, basic fuchsin, merbromin (Mercurochrome), and Bismarck Brown

What are the disadvantages of dyes used in the past?

iodine solution is a particular problem since it causes severe allergic reactions in sensitive individuals.

What are the most common areas that disclosing agents dye?

-interproximal spaces

-gingival margins

What are the different methods for application?

-Painting (direct application)

-Rinsing

-Use of tablets

How do you paint on disclosing agent?

1. Dry teeth

2. Apply gel or solution with cotton tipped applicator. Paint on facial & lingual surfaces of teeth.

3. Rinse with water (tri-syringe)

4. Examine and record the distribution of soft deposits

(absorb leftover dye with 2x2 to prevent mess)

How do you rinse using disclosing agent?

1. Place several drops of concentrated solution in a paper cup, add water.

2. Instruct patient to swish the solution around in the mouth.

3. Rinse with water

4. Examine and record the distribution of soft deposits.

How do you use disclosing agent tablets?

1. Instruct the patient to chew the tablet.

2. Dissolve tablet in saliva and swish around the mouth.

3. Rinse with water

4. Examine and record the distribution of soft deposits.

What are the precautions when using disclosing agent?

-restorative materials easily stained (temporary)

-avoid contamination of solution (double dipping)

-Erythrosin solutions can evaporate

-avoid staining lips

-avoid before a sealant application

-provide appropriate protective drape

What is the purpose of dental floss?

-plaque and food debris removal

-polish proximal surfaces

-stimulate interdental papilla

-identify subgingival calculus or margins of restorations (fraying/stuck floss)

What are the precautions of dental floss?

-pressure in col area (underneath contact area, no keratin = sensitive)

-prevention of floss cuts

What is the location of floss cuts?

facial or lingual surfaces directly beside or in the middle of an interdental papilla

What is the causes of floss cuts?

-piece of floss is too long

-snapping the floss through the contact

-not adapting the floss around the teeth- "C" shape

-not using a rest to prevent undue pressure

What are the types of floss?

-waxed

-unwaxed

-tape/ribbon/tufted

What are the advantages of waxed floss?

-won't cut the tissue as easily

-facilitates movement

-won't tear or shred

-wax gives strength and durability

What are advantages of unwaxed floss?

-thinness

-larger surface area for cleaning

What are the disadvantages of unwaxed floss?

-frays easily

-cuts tissue easily

-difficult to manage (no rigidity)

What are the advantages of tape/ribbon/tufted floss?

-recommended when there is wide embrasures where interdental papillae have been lost

-plaque removal from mesial and distal abutments and under pontic of a fixed partial denture or orthodontic appliance

What are the disadvantages of tape/ribbon/tufted floss?

-too large for some contacts

What is another name for tufted floss?

Superfloss threader or Variable diameter floss

What is the frequency and time of flossing?

-1x per day

-before brushing (AM or PM)

What is the recommended floss for normal contacts?

waxed/unwaxed (their preference)

What is the recommended floss for tight contacts/crowded?

waxed floss

What is the recommended floss for open contacts/embrasures?

tape or tufted floss

What is the recommended floss for poor manual dexterity?

waxed floss

What is the recommended floss for overhanging margins?

waxed floss

Where is your thumb and index finger when flossing the right maxilla?

right thumb- facial

left index finger- lingual

Where is your thumb and index finger when flossing the left maxilla?

left thumb- facial

right index finger- lingual

Where are both of your index fingers when flossing the mandible?

pointed down