MAINTENANCE OF PROSTHETIC APPLIANCES

MAINTENANCE OF PROSTHETIC APPLIANCES If your patient has a prosthetic appliance, tell him or her to take the removable appliance out of the mouth after meals and thoroughly brush it. Patients should use a good prosthetic appliance brush and their preferred dentifrice or soap and water. Have the patient follow the dentist's instructions regarding how long to leave the appliance out of the mouth while sleeping to give the tissues proper rest and how to take care of the appliance when it is not worn. Plaque accumulates on the surfaces of abutments and beneath the pontics of fixed partial dentures (bridges). Floss threaders are thin plastic devices that help the patient direct the floss into these areas. Fixed partial dentures should also be cleaned at least once daily. ORAL HYGIENE AIDS Toothpicks, interdental proximal brushes, oral irrigators, and mouthwashes are aids to oral hygiene. They may be used in addition to, but not in place of, tooth brushing and flossing. These products will be recommended by a dentist or dental hygienist and should bear the ADA seal of approval. APPLICATION OF PIT AND FISSURE SEALANTS A pit and fissure sealant is a plastic resin-like material that is applied to the tooth surface and hardened. The plastic resin bonds into the depressions and grooves (pits and fissures) of the chewing surfaces of back teeth. Sealants are highly effective in preventing pit and fissure caries in premolars and molars. The sealant acts as a barrier protecting enamel from plaque and acids. Figure 3-34 illustrates a before and after drawing of a sealant on a tooth. Acid-etch resin sealants are classified into three types, based on the method by which they are cured (hardened): Ultraviolet light-cured Chemically or self-cured Visible light-cured As a basic dental assistant, you may receive training in expanded functions to place pit and fissure sealants as described in BUMEDINST 6600.13. Check with your command on certification requirements. Pit and fissure sealants may only be placed by certified personnel. Only a dental officer can Figure 3-34.—Before and after applying a sealant on a tooth. authorize and recommend what teeth require sealants. This will be noted on the patient's treatment plan. The following clinical guidelines should be followed for successful sealant application: Ensure the patient's treatment plan indicates what teeth require sealants. Ensure the proper eye and clothing protection are in place for you and the patient. The teeth must be isolated to prevent saliva contamination of the surfaces to be sealed. The isolation must provide adequate access to observe the field and to reach the tooth surfaces with the appropriate instruments. A rubber dam is the preferred method of isolation, but if a rubber dam cannot be used, cotton roll isolation can be effective. The tooth surfaces should be cleaned with a prophylaxis brush or rubber cup and a cleansing agent containing no oil or other substance that cannot be completely and quickly washed away using an air/water syringe with high-speed evacuation. When the teeth are effectively isolated from saliva contamination, the tooth surfaces are dried and then etched by an application of a 30 to 50 percent phosphoric acid solution for 15 to 20 seconds. Etching should cover all the areas to be sealed. The acid should be washed away with water. The surfaces are then carefully re-dried and inspected to ensure that the area intended for sealant has a "frosted" appearance. The absolute avoidance of contamination with saliva or air-line moisture or oil is critical from the time of acid removal and drying, until the sealant is 3-19