1

Biofilm Disclosing and

PHPPHP

Presented by:Michelle R. Mould, RDH, MSDH

Disclosing Agents

Dye in form of liquid, tablet, lozenge

Visually identify biofilm Attaches to biofilmAttaches to biofilmRinses off biofilm-free surfaces

Instruction, evaluation, research

Acceptable Disclosing Agents

Color must contrast with normal colors in oral cavity

Must not rinse off immediately

Taste should not make patient uncomfortable

Acceptable Disclosing Agents

Question regarding possible allergies to dye

Solution thin enough to readily cover toothSolution thin enough to readily cover tooth surface and flow into interproximal areas (diffusibility)

Antiseptic disclosing agents

Erythrosin Most widely usedF.D. & C. #3 or #28Solutions contain alcoholStains gingiva

Disclosing Agents

FluoresceinF.D. &C. Yellow #8Must have special UV light in order to make the agent visible on teeth

Two-toneF.D.&C. Green #3 and Red #3

Disclosing Agents (older formulations)Iodine Solutions

Less desirable due to unpleasant flavor of iodineSkinner’s solution, diluted tincture of iodineAvoid iodine if patient has shellfish allergy

Mercurochrome PreparationspMercurochrome SolutionFlavored Mercurochrome Disclosing Solution

Bismarck Brown

Merbromin

2

ApplicationSolutions for Direct Application

Apply lubricant to prevent staining of lipsUse cotton swab to apply solution to teethAvoid composites, veneers, PFM’sAllow patient to rinse gently and then examine

Rinsing AgentsHave patient rinse with solution and then examine

TabletHave patient chew tablet, swish for 30-60 seconds and rinse

Examination

Clean tooth surfaces will not retain disclosing agent

Pellicle will only stain slightly

Two-tone agentTwo-tone agent

Red = newer biofilm (<24 hours)

Blue = older biofilm (>24 hours)often associated with calculus deposits

Important Points…..Avoid use on tooth colored restoration

coat restoration with lubricant or skip tooth completely

Don’t disclose before placing sealants

Disclosing solutions contain alcohol don’t keep longer than than 2 or 3 months or evaporation will occur

Don’t contaminate solution by dipping a swab directly into the bottle of solution

Patient Education

Allow the patient to observe areas missed through a mirror

Especially helpful with children

Biofilm Measurement (subjective)

IndexNumeric scale used to quantify amount of biofilm present

Descriptions

Localized

Helpful during repeated appointments for patient motivation

Several plaque indices

Generalized

L, M, H

PHP-modifiedPatient Hygiene Performance Index (modified)

Teeth3, 8, 14, 19, 24, 302nd molar used if 1st is missing, crowned, or partially erupted

mesial middle

cervical

distal

Adjacent central used missing incisor

Divide surfaces into 5 sections

F + L = 10 surfaces/tooth

incisal

3

PHP (modified)Count divisions that have plaque

Calculate score10 surfaces/tooth6 teethMax = 60

Report as percentDivide maximum score by total # surfaces

Ideally, PHP should decrease as OH improves