This document discusses methods for plaque control and oral hygiene instruction. It describes techniques for mechanical plaque removal including toothbrushing and flossing, as well as chemical plaque control using mouthwashes. Toothbrushing techniques like the Bass and Stillman methods are outlined. The goals of polishing teeth are discussed along with contraindications. Recommendations are provided for motivating and educating patients on proper plaque control methods.

1. Khalid S. Hassan
Assist. Prof. Periodontology

2. Plaque Control
(Oral Physiotherapy)
Objectives
1- Removal of soft deposits (dental plaque, materia alba and
food debris)
2- Gingival massage keratinization and improve
circulation protection against microorganisms
3- Prevention of calculus formation.
Methods
Mechanical Chemical

3. Mechanical Plaque Control
I- Tooth Brushing:-
Design of Toothbrush:-
-Firm handle with modest angulations between head and the handle.
-2.5 cm length of head
-15-16.5 cm length of handle
-10mm height of bristles and 0.2mm thickness
-2 to 3 rows of bristles
-Smooth and rounded ends of the bristles
-Bristles may be synthetic or natural
-Nylon bristles are superior to natural , as they resist breaking and contamination
with microbial debris.
-Tooth brush must be replaced periodically

5. ** Tooth Brushing Methods:-
Bass Method:
•Intrasulcular method (Professional method).
•Efficient for removing dental plaque from gingival third and
from shallow gingival sulcus.
•Place the bristles at the gingival margin with angle of 45 degree
to the long axis of the teeth and the bristles pointed to the
crevice.
•Exert gentle vibratory pressure using short back-and-forth
motions without dislodging the bristles tips (horizontal
direction).
•Perform about 20 strokes in each position.
•Used a soft brush in this method.

9. Modified Stillman Method:-
•A soft or medium brush can be used with this method.
• Recommended for patients with gingival recession to
prevent abrasive tissue destruction.
•The sides of the bristles are placed against the gingiva
and teeth with a 45 degrees angle to the long axis
of the teeth.
•Pressure is applied laterally against the gingival
margin to produce blanching.
•Brush is activated by short back-and-forth strokes in
coronal direction.

11. Charters Method
- A soft or medium brush can be used.
-Recommended for temporary cleaning in areas
of healing after periodontal surgery.
-The bristles pointed toward the crown at a 45
degree angle to the long axis of the teeth.
-The bristle tips not move across the gingiva.
-The brush is activated with short back-and
forth strokes in coronal direction.

13. Charters method

14. Electrical Tooth Brushes
• Useful for: Children, hand-capped, and patients with
orthodontics treatment.
• Less abrasive to tooth surfaces and restoration.
• Do not require special techniques of application.
• Place the brush head next to the tooth at the gingival
margin and proceed systematically around the dentition.
• Not superior to manual type.
• Expensive.

15. Electrical
Toothbrushing Technique

16. II- Interproximal Cleaning Aids:-
• 1- Dental Floss:
Effective for flat or convex proximal tooth surfaces with full
embrasures.
• Waxed, unwaxed or tufted types.
• Tufted and waxed are indicated for rough
restoration and tight contact
• Cut about 12cm and anchored around one finger
of each hand.
• Gentle placing at the base of gingival sulcus then
moved in an up-and down along the tooth surface
,right and left.

20. 2- Interdental Brushs:
•Small cone-shaped or tapered brushes.
•Used in large open embrasures.
•Inserted interdentally and moved back and forth in facio-
lingual direction.
3- Tooth Picks:-
•Made from soft-wood and is triangular in shape.
•Used in open contact.
•Tooth pick moved in-and-out or up-and down direction.
•Tooth pick can be placed in special plastic handles to reach
areas with limited access.

26. 4- Rubber Tips:-
•Produce gingival massage.
•Induce epi.keratinization.
•Rubber tip is inserted interproximally at a 45 degree angle with the tip
pointing in an occlusal direction.
•Activated by applying pressure with a vibratory or rotary motion.
III- Oral Irrigation:-
•With water and antiseptic mouth rinses.
•Supra or sub-gingival irrigation.
•Hand or mechanized irrigation.

27. Chemical Plaque Control
(Mouth-rinsing)

28. Chlorhexidine:-
* The most effective antimicrobial agent in plaque and
gingivitis
•Mechanism of action:- pellicle formation, alteration of
bacterial cell wall lysis of bacteria and bacterial
adhesion to tooth surfaces.
• Has not produced any resistance of oral microorganisms.
•Substantivity: high Substantivity.
•Side effects:- Staining of teeth , tongue and resin
restorations,
- Alter taste sensation (temporary).
- Increase supragingival calculus formation.
•0.2%- 0.12% mouth washes Twice/day.

29. 2- Essential Oils
** Contains:-
Thymol Menthol Eucolyptal Methyl Salicylate
•Can plaque and gingivitis.
•Mechanism of action: alter bacterial cell wall & adherence to
tooth surface.
•Substantivity low substantivity.
•Adverse effects Burning sensation, Bitter taste.
•Used twice daily

30. 3- Quaternary ammonia compounds
e.g. Cetylpyridinium and Benzalkonium.
•Mechanism of action: - bacterial cell wall permeability lysis
- bacterial adhesion.
•Substantivity Good.
•Side effects Burning sensation, staining.
•0.45% cetylpyridinium, twice/day mouth washes.
Other Products
Stannous fluoride
- Anticarious more than
antiplaque formation
Sanguinarine
- Derived from bl. Root
plant
- 0.01% mouthwashes and
dentifrices
H2O2
-No benefits on
plaque, used in
NUG or
periocoronal
abscess.

31. Dentifrices
•Abrasive agent e.g. calcium carbonate, calcium oxide
or/silicate.
•Detergent agent e.g. sodium lauryl sulfate.
•Thickening agent: carboxymethyl cellulose and amylase.
•Coloring agents.
•Humidifier and water.
•Fluoride.
•Anticalculus agents e.g. zinc citrate.
•Antiplaque agents e.g. chlorhexidine and triclosan.
•Antibiotics eg. Pinicillin.
•The paste is applied between the bristles rather than on the top.

32. POLISHING
•Upon the completion of the quadrants, you
should polish the teeth when it is necessary

33. GOAL OF POLISHING
 To remove soft
deposits and
extrinsic stain with
minimal trauma to
hard and soft
tissues and minimal
discomfort for
patient

34. Common Abrasive Agents
 Silex ~ Silicone dioxide
– Superfine Silex can be used for heavy stain
removal from enamel
 Pumice ~ powdered pumice
– Superfine pumice ~ least abrasive – remove
heavy stains
– Fine pumice ~ mildly abrasive
– Course pumice ~ not for use on natural teeth
 Tin Oxide ~ Putty powder, Stannic Oxide
– Metallic restorations and teeth

35. Effects of Polishing
 Effect on tooth
structure
– 3 minutes of polishing with
pumice = 4 microns of
enamel loss
– Dentin abrades 5-6 times
faster than enamel
– Avoid decalcified areas
– Heat production – pulp
damage with fast, heavy
pressure
 Effect on gingiva
– 2 minutes with rubber cup
= total removal of sulcular
epithelium

37. Contraindications to Polishing
 NO Stain.
 Exposed root surfaces .
 Gold, porcelain, composite restorations
and implants .
 Highly inflamed tissues
 Communicable disease

38. Disclosing Agents
•Used to stain the teeth for patient education and
motivation for oral home care.
•Used to locate areas with plaque accumulation.
•Available in tablets and liquid forms.
•Produce, blue, purple or red stains when
attached to plaque on tooth surface.
•Examples: Bismark Brown solution, erythrosine
and sodium fluorescein dye.

41. Recommendation for plaque
control instruction
 Motivation :to be successfully periodontal
therapy, the patient is required to;
1- Understand the concepts of
pathogenesis, treatment and prevention
of periodontal diseases.
2-Adopt a successful, self-administered
daily plaque control regimen.
3-Changes in his habits and accommodate
with the new oral hygiene visits.
4-Regular periodontal maintenance visits.

42. Education and instruction :
 The patient should be given a new
toothbrush , interdental cleaner and
disclosing agent.
 Tooth brushing should be demonstrated in
the patient’s mouth while he observes with a
hand mirror.
 Repeat the demonstration and instruction process
with dental floss and interdental cleaning aids.
 Periodically recording the state of gingival health
and amount of plaque.