By,

Dr. Dineshwarran A/L Rajendran

Contents

Plaque

Mechanical Plaque Control

Chemical Plaque Control

Summary

PlaqueWhat is Dental Plaque?

A soft and thin biofilm that consists of microorganisms and their byproducts, organic and inorganic compounds, and salivary proteins that form in the oral cavity and adhere to teeth, prostheses and oral surfaces.

Dental Plaque

Dental Caries

Periodontal Disease

The attachment of the acquired pellicle, a thin film of salivary proteins.

Within a few days, gram-positive cocci colonize the tooth surface.

Additional bacterial types such as Veillonella sp., a gram-negative anaerobe, Actinomyces, gram positive rod, and Capnocytophaga gram negative rod contribute to early-colonization of plaque.

Prevotella intermedia and filamentous Fusobacterium species colonize the plaque between the first week and third weeks as an anaerobic environment becomes established.

Late colonization with Porphyromonas gingivalis, Treponema sp(spirochetes) occurs during and after the third week, if the plaque grows undisturbed

Plaque

Plaque Control

The regular removal of microbial plaque and the prevention of its accumulation on the teeth and adjacent gingival surfaces.

The level of plaque which maintains a healthy gingiva and doesn’t progress into gingivitis.

In Periodontal Therapy,

It is very critical in every phase that plaque control must be maintained.

Classic Study

In 1965, Loe and his colleagues demonstrated -

The cause and effect relationship between microbial plaque accumulation and development of experimental gingivitis

Summary: When plaque was allowed to accumulate, gingivitis developed within 7 to 21 days. When plaque control was initiated, the gingivitis was reversed to clinical gingival health within 1 week.

Mechanical Plaque Control Toothbrushes

- Toothbrushing techniques

- Powered toothbrush

Dentifrices

Interdental Cleaning Aids

- Dental floss

- Interdental brush

- Wooden/ Rubber tips

Toothbrushes

History:

Toothbrushing tools date back to 3500-3000 BC when the Babylonians and the Egyptians made a brush by fraying the end of a twig

The Chinese are believed to have invented the first natural bristle toothbrush using pig hair and bamboo stick(handle).

Toothbrush Designs in the

Past

ToothbrushesModern Toothbrush Design:

Bristle Hardness:Soft brush: 0.007 inch(0.2 mm)Medium brush: 0.012 inch(0.3 mm)Hard brush: 0.014 inch(0.4 mm)

ADA Specifications:

• Length : 1 to 1.25 inches

• Width : 5/16 to 3/8 inches

• Surface area : 2.54 to 3.2 cm

• No. of rows : 2 to 4 rows of brushes

• No. of tufts : 5 to 12 per row

• No. of bristles : 80 to 85 per tuft

Single-tufted brushes highly effective on the lingual surface of mandibular molars and premolars, where the tongue often impedes a regular toothbrush, and may provide access to furcation areas and isolated areas of deep recession

Soft, nylon bristle toothbrush clean effectively when used properly ,remain effective for a reasonable time and tends not to traumatize the gingiva or root surfaces

Soft bristle are more flexible, clean beneath the gingival margin, and reach farther into the proximal tooth surfaces

Toothbrushes need to be replaced every 3-4 months

Recommendations:

Importantly, There is no need for excessive force / vigorous brushing as it can lead to gingival recession, wedge-shaped defects of cervical areas and painful ulcerations

Effects of Faulty Toothbrushing

Techniques

Wedge-shaped cervical area defects

Traumatic ulcers

Toothbrushes

Toothbrushing methods:

Roll: Modified Stillman technique

Vibratory: Stillman, Charters and Bass technique

Circular: Fones technique

Vertical: Leonard technique

Horizontal: Scrub technique

Bass Technique

• Most often recommended – Emphasizes sulcularplacement of bristles, adapting the bristle tips to gingival margin to reach supragingival plaque and accessing subgingival plaque to possible extent

How to use the technique?

Place the head of a soft brush parallel with the occlusal plane

Place the bristles at the gingival margin, establishing an angle of 45 degrees to the long axis of the teeth

Exert gentle vibratory pressure, using short back and-forth motions without dislodging the tips of the bristles

Bass method

Modified Stillman Technique

Placement of the sides of the bristles against the teeth and gingiva while moving the brush with short, back-and-forth strokes in a coronal direction.

Indication: Cleaning in areas with progressing gingival recession & root exposure to prevent further tissue destruction.

Charters Technique

The bristles be pressed against the sides of the teeth and gingiva, the brush is moved with short circular or back-and-forth strokes

Indications: - Individual’s having open inter-dental spaces with missing papilla & exposed root surfaces

- For patients who have had periodontal surgery

ToothbrushesPowered Toothbrushes

-invented in 1939

Its mainly recommended for: Individual lacking motor skills Hospitalized patients whose teeth are cleaned by

caregivers Special needs patient(physical & mental disability) Patient with orthodontic applied

Variations:

Reciprocal of Back and Back motions

Circular and Eliptical motions

Combination of both

Dentifrices

They aid in cleaning and polishing tooth surfaces

Appear in forms of paste, powder and gel

Contents:

Abrasive: silica, aluminium, dicalcium phosphate and calcium carbonate

Detergent: sodium lauryl sulphate

Thickeners: silica and gums

Sweeteners: saccharine

Humectants: glycerin and sorbitol

Flavors: mint & peppermint

Actives: flourides,triclosan, stannous fluoride

Interdental Cleaning Aids

The majority of dental and periodontal disease’s originate in interproximal area.

Tissue destruction associated with periodontal often leave large, open spaces between teeth and exposed roots with anatomic concavities and furcations which are difficult to clean and access with toothbrush.

Dental Floss

Most widely recommended method for removing proximal

plaque

Types: unwaxed, waxed, tape floss, superfloss, ePTFE floss

Method:

The floss is wrapped around each proximal surface and is activated with repeating up and down strokes

Floss should pass gently through contact area. Do not snap the floss pass the contact area as it may injure the interdental papilla

Powered flossThese devices have a single bristle that moves in a circular motion.

Floss with Holder

Interdental Brush

Cone-shaped or cylindrical brushes made of bristles mounted on a handle

Method:

Inserted through interproximal spaces and moved back and forth between the teeth with short strokes.

For most efficient cleaning, select the diameter of brush that is slightly larger than the gingival embrasures to be cleaned

Dental Floss vs Interdental Brush

Wooden/ Rubber Tips

Wooden tips

Used either with or without a handle

Access is easier from the buccal surfaces for those tips without handles, primarily in the anterior and bicuspid areas.

Disadvantage- It is very hard to access surfaces other than the facial surfaces in the more anterior region of the mouth. Only used in large gingival embrasure.

Rubber tips

Usually mounted on handles or the ends of toothbrushes and can easily be adapted to all proximal surfaces in the mouth.

Wooden Toothpick

Rubber Tips

Chemical Plaque Control Oral Rinses

Chlorhexidine rinse

Essential Oil rinse

Disclosing Agents

Oral Rinse

Chlorhexidine

Action Increase bacterial membrane permeability followed by

coagulation of cytoplasmic macromolecules

Has substantivity ability of substance to adhere to thestructure to be released for long time

Side effects Brown discoloration

Altered taste

Oral mucosal erosion

Oral RinseEssential Oil

Eg: Thymol, Eucalyptol, Menthol

Action: By altering bacterial cell wall

Disclosing Agents

A preparation in liquid, tablet or lozenge form capable of staining bacterial deposits on the surfaces of teeth, tongue, and gingiva using its colouring properties.

Eg. Erythrosine, Basic fuchsin, Fluoresin

Summary All patients require the regular use of a toothbrush at least twice

a day. Should emphasize access to gingival margins of all accessible

tooth surfaces and extension as far onto the proximal surfaces as possible.

Dental floss should be used in all interdental spaces. Interdental aids like interdental brush, wooden pics should be

used when toothbrush and floss cannot adequately remove the plaque.

Chemical agents such as chlorhexidine and essential oils can be used as adjunctive to the mechanical methods and not on its own.

Reinforcement of daily plaque control practices and routine visits to dental office for long term success of plaque control-therapy.

Thank You!