Professional dental hygiene

Assessment of hygienic status: basic index

To obtain an objective clinical picture, the clinician uses special indices after preliminary staining of the tooth surfaces.

The basic hygiene index (HI) is calculated using a simple formula: HI = K / n, where K is the total sum of scores obtained in evaluating each tooth, and n is the number of examined teeth.

Criteria for assessing the stained area:

• 1 point — complete absence of staining;
• 2 points — 1/4 of the surface is pigmented;
• 3 points — 1/2 of the surface is stained.

The final result is interpreted using a hygiene quality scale: from 1.1 to 1.5 points — good status; 1.6–2.0 — satisfactory; 2.1–2.5 — unsatisfactory; 2.6–3.4 — poor; 3.5–5.0 — very poor.

Simplified OHI-s index (Green-Vermillion, 1969)

The methodology for this index involves staining six adjacent teeth. An alternative approach is selecting one or two teeth from different groups in the upper and lower jaws. The clinician evaluates the vestibular and oral surfaces.

Assessment is performed using a three-point system depending on the plaque volume:

• 0 points — no staining;
• 1 point — 1/3 of the surface is affected;
• 2 points — 1/2 of the surface is affected;
• 3 points — 2/3 of the surface is affected.

In situations where plaque is distributed unevenly, the uneven plaque rule is applied: the score is assigned based on the largest volume, or the clinician calculates the arithmetic mean of two or four surfaces. The calculation formula in this method is as follows: the sum of the scores is divided by 1. If the final score is equal to one, the hygienic status is considered ideal. Any value exceeding 1 is interpreted as poor.

Methods and means of deposit removal

The process of dental deposit removal is broadly divided into two directions: personal and professional hygiene. Personal hygiene is maintained by the patient using brushes, dental floss, toothpicks, toothpastes, and irrigators.

Professional cleaning in the dental office is carried out through four main methods:

1. Mechanical.
2. Physical.
3. Chemical.
4. Combined.

To remove soft deposits, the clinician uses brushes, toothpastes, and irrigators. The final and mandatory stage of professional hygiene is tooth surface polishing. To achieve enamel smoothness, specific instruments are used: rubber and silicone heads, cups, as well as polishing brushes and pastes.

Dental office equipment and classification of manual instruments

To properly perform the procedure, the workplace must be equipped with medicaments, dental deposit removal devices, sonic and ultrasonic scalers. Manual instruments (excavators and curettes), which are assembled into a small or large prophylactic kit, play an important role.

Main types of manual instruments:

• Scalers — available with straight and curved blades, as well as in the form of chisels, files, or hoes.
• Curettes — divided into universal and area-specific.

Any manual dental instrument anatomically consists of three elements: the handle (held by the clinician), the shank, and the working end.

Anatomy of the shank and working end of the instrument

The shank is the connecting link between the handle and the working end. It is of two types:

• Functional shank — necessarily has two bends. Its length varies depending on the clinical task. A short shank is used for working in the anterior region and removing supragingival calculus. A long shank is necessary for access to posterior teeth and working in deep pathological periodontal pockets. There is also a medium-length shank.
• Terminal shank — is the local section from the first bend to the working end itself. Its main function is to ensure proper contact of the instrument with the tooth surface.

Working end directly contacts the tissues. Its structure includes the face (F), lateral surface (I), cutting edge (C), and back (B).

Class and exam questions

What else to study on this topic

• Features of using area-specific and universal curettes.
• Specifics of working with a long shank in pathological periodontal pockets.
• Differences between sonic and ultrasonic scalers.
• Algorithm for applying the chemical method of dental deposit removal.
• Rules for selecting medicaments for professional hygiene.

Other topics in "Chapter 13. Dental Deposits"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.