Disclosing Agents
Biofilm Disclosing
and
PHP
„
Dye in form of liquid, tablet, lozenge
„
Visually identify biofilm
‰
‰
Presented by:
Michelle R. Mould, RDH, MSDH
Acceptable Disclosing Agents
„
Attaches to biofilm
Rinses off biofilm-free surfaces
Instruction, evaluation, research
Acceptable Disclosing Agents
„
Color must contrast with
normal colors in oral
cavity
„
Question regarding possible allergies to
dye
„
Must not rinse off
immediately
„
„
Taste should not make
patient uncomfortable
Solution thin enough to readily cover tooth
surface and flow into interproximal areas
(diffusibility)
„
Antiseptic disclosing agents
Disclosing Agents
„
Erythrosin
‰ Most widely used
‰ F.D. & C. #3 or #28
‰ Solutions contain alcohol
‰ Stains gingiva
„
Fluorescein
„
‰
F.D. &C. Yellow #8
‰
Must have special UV light in order to make
the agent visible on teeth
Two-tone
‰ F.D.&C. Green #3 and Red #3
Disclosing Agents (older formulations)
„
Iodine Solutions
‰ Less desirable due to unpleasant flavor of iodine
‰ Skinner’s solution, diluted tincture of iodine
‰ Avoid iodine if patient has shellfish allergy
„
Mercurochrome Preparations
p
‰ Mercurochrome Solution
‰ Flavored Mercurochrome Disclosing Solution
„
Bismarck Brown
„
Merbromin
1
Application
„
Solutions for Direct Application
‰
‰
‰
‰
„
Apply lubricant to prevent staining of lips
Use cotton swab to apply solution to teeth
Avoid composites, veneers, PFM’s
Allow patient to rinse gently and then examine
Rinsing Agents
‰
„
Examination
Clean tooth surfaces will not retain disclosing agent
„
Pellicle will only stain slightly
„
Two-tone agent
Have patient rinse with solution and then examine
Tablet
‰
‰
Red = newer biofilm (<24 hours)
‰
Blue = older biofilm (>24 hours)
„ often associated with calculus deposits
Have patient chew tablet, swish for 30-60 seconds and
rinse
Important Points…..
„
„
Patient Education
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
Biofilm Measurement (subjective)
„
Allow the patient to
observe areas missed
through a mirror
„
Especially helpful with
children
PHP-modified
Patient Hygiene Performance Index (modified)
„
Index
‰
‰
‰
Numeric scale used to
quantify amount of
biofilm present
Helpful during repeated
appointments for
patient motivation
Several plaque indices
„
Descriptions
Teeth
„
‰
‰
‰
Localized
‰
Generalized
‰
L, M, H
‰
3, 8, 14, 19, 24, 30
2nd molar used if 1st is
missing, crowned, or
partially erupted
Adjacent central used
missing incisor
cervical
mesial
middle
distal
incisal
Divide surfaces into 5
sections
„
‰
F + L = 10 surfaces/tooth
2
PHP (modified)
„
Count divisions that have
plaque
„
Calculate score
‰
‰
‰
„
Report as percent
‰
„
10 surfaces/tooth
6 teeth
Max = 60
Divide maximum score by total
# surfaces
Ideally, PHP should
decrease as OH improves
3