Caring for Your Implants in Malaysia

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Interdental Brushes
Interdental Brushes

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Your dental implants are wonders of biomedical engineering, but your long-term success with them depends on good oral hygiene. Keeping your prosthesis clean will prevent inflammation of the gums. And, good hygiene will prevent loss of bone around your implants and keep your prosthesis secured.

The most important times for cleaning the abutments and teeth are in the morning and in the evening. The flow of saliva slows while you are asleep. As a result, the natural cleaning action of saliva decreases, and bacterial plaque builds up.

Many areas around the dental implants need special attention to prevent dental plaque from accumulating. If you have a single tooth implant you will brush and floss normally. If you have implant dentures or a bridge, fixed or removable, the cleaning process will require a few more steps.

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Cleaning Aids

In addition to traditional toothbrushes and toothpaste, the following cleaning instruments may also be helpful:

  • Splayed brushes
  • End-tufted brushes
  • Interproximal brushes
  • Electric toothbrushes
  • Dental floss, multi-ply yarn, cotton ribbon
  • Floss threading devices, or crochet hook
  • Rubber stimulating tips
  • Water irrigating devices
  • Mouth rinses

Toothbrushes

A standard toothbrush is adequate to cleanse the broad surface of your prosthesis as well as the side and biting surfaces of your new teeth. If you have any natural teeth present, an Malaysian Dental Association approved, fluoridated, low abrasive toothpaste should be used. In addition to a standard toothbrush, there are three unique brush designs that are especially helpful in removing bacterial plaque and debris from the surface of your prosthesis and the implant abutments.

Splayed Bristle Brushes

The splayed bristle brush, with longer bristles on each side, allows you to clean the underside of the prosthesis by rolling the bristles under the sides and bottom of the bridgework. This brush can be used in the same motions as a standard toothbrush.

End-tufted Brushes

An end-tufted brush is shaped like an artist’s paintbrush, but with stiffer bristles. It is helpful in cleaning the tongue side of your bridgework.The end-tufted brush can access the sides of the prosthesis and the area closest to your gum tissue. If the space is available, its bristles may reach under your prosthesis and clean the outer surface of your implant abutments. The greatest advantage of the end-tufted brush is cleaning the tongue side of your lower front teeth and possibly that same area of your upper teeth. 

An end-tufted brush is helpful for cleaning the "back" side of your teeth.
An end-tufted brush is helpful for cleaning the “back” side of your teeth.

Interproximal Brushes

The interproximal brush looks like a miniature Christmas tree. It has very soft and flexible bristles fastened to a plastic coated center wire. This brush is very useful for getting into tight places under your prosthesis and around the abutments. 

Interproximal brushes are helpful in cleaning the sides of abutment posts and the underside of the prosthesis.
Interproximal brushes are helpful in cleaning the sides of abutment posts and the underside of the prosthesis.

Electric Toothbrushes

Electric toothbrushes are popular hygiene aids for cleaning implant-supported bridges and dentures. Why are electric toothbrushes so effective? The speed of their strokes gives them an advantage in cleaning teeth. For example, the sonicare®, made by Philip’s Oral Healthcare, moves at 31,000 strokes per minute -about 100 times faster than we can brush manually. The high-speed bristle motion more effectively removes plaque from teeth, helping to prevent periodontal disease.

Such devices are excellent for hard to reach areas of an implant prosthesis. When using an electric toothbrush, always be careful to use gentle pressure to avoid injuring your gum tissues.

Electric toothbrushes can remove up to twice as much plaque as manual brushing.
Electric toothbrushes can remove up to twice as much plaque as manual brushing.

Dental Floss and Yarn

Despite your best efforts at brushing, you may find that toothbrushes will not reach the tight spaces between your prosthesis and your gum tissue. An example of a hard-to-reach space is your upper front teeth where cosmetic demands require the prosthesis to come in direct contact with your gum tissue. In these situations, bristles from standard and special brushes may be ineffective and using dental floss is helpful.

Various types of dental floss and soft multi-ply yarn or ribbon may be used to remove plaque from your teeth and gums. Floss threading devices that look like a crochet hook are often necessary to guide the dental floss through the narrow crevices, especially between your upper teeth and gums. 

Space is often limited between the implant abutments and may preclude the use of interproximal brushes or plastic cleansing instruments, leaving dental floss as the only alternative for plaque removal.

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Rubber Stimulating Tips

Some toothbrushes have rubber stimulating tips at the end. Stimulating your gums with a gentle massage using a soft rubber tip helps promote healthier gum tissue and also aids in plaque removal.

Water Irrigating Devices

Water irrigating devices in the form of a jet or spray are also quite helpful in washing away loose plaque and debris from under your implanted teeth. The strength of the pulsating jet spray should be mild so that it will not injure your gum tissue. There are many excellent irrigating devices; however, these devices will not remove all the bacterial plaque. These deposits must first be loosened by using special instruments, brushes, or floss. The irrigation flow or spray will then assist in washing away the loosened particles.

Mouth Rinses

Following the proper cleaning of your implants and artificial teeth, a thorough rinsing with an Malaysia Dental Association-approved anti-bacterial rinse, such as chlorhexidine, will help reduce bacterial plaque accumulations. It also helps improve the health of your gums. Scientific studies show that using these powerful mouth rinses several times a day significantly improves the health of your soft tissues, especially around your abutments by reducing bacterial plaque, which in turn lessens inflammation. Keeping your gum tissue healthy helps maintain the biologic seal around your abutments, protecting your underlying bone from bacterial invasion. Most patients who have undergone extensive implant reconstruction generally benefit from continued use of these rinses.

Cleaning Your Abutments and Prosthesis

If you have implant dentures or a bridge, the key areas to keep clean are the abutments, under the prosthesis, and the area around the gums. Doing the cleaning in front of a mirror with good lighting will be helpful. You may wish to acquire a dental mirror, a small round mirror on a handle, for checking to see if the teeth are clean.

Cleaning the Abutment Posts

Clean the sides of the abutment posts and the undersurface of the prosthesis by inserting the yarn or floss through the space next to the abutment post, around the post, and then back out the front. A floss threading device or crochet hook is helpful in passing the floss through the space and grasping it on the other side of the post to bring it forward. Then use the ribbon in a side-to-side motion to polish the back and sides from top to bottom. Adding a little toothpaste provides a very mild abrasive that will help polish the posts. Follow these procedures for each post.

Cleaning the Prosthesis

Dental floss or ribbon with a small amount of toothpaste will help you clean the underside of the prosthesis. Use the ribbon with a back-and-forth stroke, moving it from front to back. Extra-thick floss may be purchased at pharmacies and may also be used for this phase of cleaning.

Thick dental floss or cotton yarn may be helpful in removing plaque from the sides of the abutment posts.
Thick dental floss or cotton yarn may be helpful in removing plaque from the sides of the abutment posts.

As mentioned, the interproximal brush will also help in the cleaning of the sides of the abutment posts and the under surface of the prosthesis. A small amount of toothpaste used with this brush may increase its ability to clean as well.

Rinsing

Always rinse your mouth thoroughly with water to remove any food particles that have been dislodged by your flossing and brushing. You may wish to complete your routine with an anti-bacterial mouthwash.

Professional Follow-up Care

Good follow-up care is a responsibility shared by you and your dentist. The dentist plays an important role in maintaining your implants and the surrounding tissues. He or she will show you various methods for cleaning between and beneath your implant

bridges and design a custom program of oral care that you can perform at home.

At the first recall visit, your dentist will scale and polish your abutments and your prosthesis using specially designed plastic scalers. These special plastic instruments help to remove deposits of plaque without scratching the surface of your abutments. Then, a special polishing paste is used to give your prosthesis a shine. In many offices, you will see the hygienist first, and after your cleaning, the doctor will examine you. If you are having problems or if the implant bridge feels loose, notify your dentist. He or she will evaluate the situation and make sure the doctor is aware of your concerns.

Professional Hygiene and Reevaluation Visits

Your dentist will likely recommend a follow-up treatment of oral hygiene at least four times during the first year after the completion of your first implant treatment. Then, during the second year of follow-up treatment, you will probably return every four months for professional cleaning by your dentist. 

Finally, after you have learned to care for your prosthesis, implants, and gum tissue, you will likely resume standard visits to your dental professional twice a year. For some patients who have an inherent tendency to accumulate bacterial deposits very quickly, more frequent professional hygiene visits may be necessary to ensure the health of the gums and bone.

Cleaning Removable Implant-Supported Teeth

If you have a screw-retained prosthesis (teeth that are held in place with small gold screws) you are probably wondering if the prosthesis should be removed at your hygiene visit. Although removal of the prosthesis often makes cleaning the abutments a much easier task for the dental hygienist, it is certainly not necessary to l remove your teeth at each hygiene visit. Your implant teeth can be cleaned in your mouth, just as though they were your natural teeth.

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