The primary role of a hygienist is to assist people in the promotion, achievement and maintenance of good oral health. They are supervised by and work closely with a dentist. A dental hygienist trains for two years to achieve their professional qualification
Their role includes:
● Providing dietary and oral hygiene advice to all people and all ages, in the dental
surgery and in various community environments (eg playgroups, youth groups and
residential homes) in order to prevent dental caries (tooth decay) and periodontal
● Giving smoking cessation advice and support
● Providing fissure sealants to children to protect their teeth from dental caries
● Treating periodontal disease by providing scaling and polishing ie cleaning above and
below the gums to remove tartar (calculus) which has built up around the teeth, and
polish off any surface stains.
● Giving injections to enable a pain-free experience when undertaking periodontal
A regular appointment with a dental hygienist may last for 20-45 minutes. A dental hygienist will initially check medical histories to ensure that any treatment they undertake will not cause health problems.
They may dye the plaque on the teeth to highlight any areas missed when using a toothbrush and floss and will offer appropriate oral hygiene advice to supplement a patient’s daily oral hygiene regime. A hygienist will measure the gaps between gums and teeth with a rounded probe to explore whether any periodontal disease is present and will undertake any treatment necessary to prevent the disease from progressing. The gum condition will be monitored by the hygienist to ensure regular oral maintenance. They may also encourage regular 3-6 monthly scaling and polishing to ensure the routine maintenance of healthy gums where this is appropriate.
Plaque is a sticky film of bacteria that collects on all the surfaces of teeth, particularly in between them and on the surfaces close to the gums. This dental plaque is the cause of tooth decay and gum disease.
When sugar and sugary products are eaten or drunk, the bacteria that live in the plaque produce acids that dissolve the minerals in the teeth and create holes (cavities). These acids begin to dissolve tooth enamel within 20 minutes of eating. The holes are usually painless – until they grow quite large inside the tooth. Without treatment, the decayed holes could eventually result in a tooth abscess.
If the gums are receding or there is gum disease present, tooth decay can develop on the exposed roots of the teeth. The roots of teeth are made from a softer material than the tooth enamel (dentine) and so holes will develop more quickly on the roots. Root surfaces also accumulate lots of plaque.
The type of food and how often it is eaten are more important than the amount of sugar involved. Sticky foods are more harmful than non-sticky foods because they remain on the surface of the teeth for longer. Frequent snacks increase the time that the harmful acids are in contact with the surface of the tooth.
Sugary snacks and drinks should be avoided, particularly between meals. If snacks are taken, they should be foods such as fruit, toast and cheese rather than sweets, biscuits and cakes. If sweets, biscuits and chocolates are eaten, it should only be once a day and then the teeth should be brushed afterwards.
Plaque is also a contributing factor to gum disease. When it collects around the necks of teeth it causes an inflammatory reaction in the gum. The gum then swells and creates a gap (pocket) between the tooth and gum. This pocket is more difficult to clean effectively, so more plaque builds up in the area and the pocket becomes deeper. This is a continuing cycle that can lead to serious long-term problems.
These problems caused by plaque can be controlled by keeping the teeth and gums clean. This is best done by regularly brushing (twice a day for two minutes) using a toothpaste containing fluoride and flossing (once a day).
Dental plaque is quite difficult to see, but there are special tablets (disclosing tablets) available from a dentist. If chewed, they will colour the plaque to make it more visible.
The use of mouthwashes containing fluoride will provide extra protection against tooth and root decay.a
Scaling is the removal of calculus, plaque, tooth deposits and some stains. It can be done either above the gum (supra-gingival) or below the gum (sub-gingival).
Root planing is a more radical treatment. It involves the removal of dead (necrotic) substance from the surface of the tooth under the gum. Otherwise it is similar to scaling.
The treatment given will vary depending on the severity of the periodontal disease. In its least severe form, the patient may only need some oral hygiene instruction. If plaque and calculus is found above the gum scaling may be necessary. In more severe forms where plaque and calculus is found under the gum, scaling below the gum margin and root planing may be required.
Either a dentist or a hygienist can carry out the scaling and root planing. The more complex cases may be carried out by the dentist or periodontist (specialist in gums).
Scaling and root planing are done using special scaling instruments or ultrasonic devices. Hand instruments are made in various designs appropriate for reaching and removing plaque and calculus from all areas of teeth. The use of hand instrument can be time consuming.
Ultrasonic devices vibrate deposits off the tooth surface. They also use water to keep the area cool as the ultrasonic scalers can heat up. They are quicker to use and less tiring for the operator.
Depending on the amount of pre-existing plaque and calculus, scaling above the gum can take 15 to 30 minutes. Longer visits are necessary if it is a first visit and the patient has a lot of plaque and calculus.
Sub-gingival scaling and root planing visits usually last an hour. The procedure is normally requires a local anaesthetic.
Above-the-gum scaling is usually pain-free. However, if the gums are very inflamed they can be very sensitive. If so, some local anaesthetic can be used to alleviate the pain. Below-the-gum scaling and root planing are usually done under local anaesthetic, so discomfort is infrequent.
The teeth and gums can sometimes be tender a few days after scaling and root planing. Post-operative pain and sensitivity of the teeth can be treated with desensitising agents. Also, mouthwashes and desensitising toothpastes are helpful.
In the treatment of periodontal disease, the advantages of scaling and root planing outweigh the disadvantages. This is because if periodontal disease is left untreated, it will lead to tooth loss.
However, there are a few disadvantages of scaling and root planing:
Gum recession, which is usually only marked in advanced cases of periodontal disease
Fillings can occasionally be dislodged during the procedure.
Cleaning Your Teeth
Toothbrushing is carried out to remove the sticky bacteria that form a harmful film on the teeth (dental plaque). The bacteria also act on sticky sweet foods forming acid that causes tooth decay.
When buying a toothbrush choose a small-headed medium strength brush that has a comfortable handle to grip.
There are many types available, some have timers, others are battery operated, and some are mains operated. We recommend mains rechargeable electric toothbrushes with a small round head. They are very efficient at cleaning if used correctly and are good for people who have a problem with dexterity. Electric brushes should be used following the manufacturer’s instructions.
There are many different brands of toothpaste in the shops and nearly all of them contain fluoride. Fluoride is very important because it strengthens the teeth against decay. There are also toothpastes that help with sensitive teeth when eating something hot or cold and others that work against the harmful bacteria. Only a pea sized amount of paste is necessary.
Although brushing removes most of the dental plaque there is usually some left between the teeth where the brush does not reach. It is very important to use another product to remove all the plaque. There are specially-designed brushes for cleaning between the teeth that look like small bottle brushes. They come in different widths so that they fill the spaces between your teeth.
They should be pushed gently back and forth between the teeth next to the gum. They should never be forced through, as this will damage the teeth. There are also brushes that have a single tuft and these are useful to clean around crowded teeth and orthodontic appliances (braces).
Dental floss is a special thread that is used for cleaning in between the teeth. The floss comes in different widths and most people find the thicker floss (tape) easier to use. Flossing is a difficult technique and with all mouth care it is a good idea to ask for guidance from a dentist or dental hygienist. It is important to visit the dentist regularly to check that the mouth is healthy and so that any problems can be dealt with before they become serious.