PLAQUE CONTROL

1. PLAQUE CONTROL
MEASURES

2. Introduction
 Plaque control is the key to prevention of caries ,
gingivitis , periodontitis

3. Dental Plaque
Plaque is defined as a highly specific variable
structural entity formed by sequential
colonization of microorganism on the tooth surface,
epithelium and restoration.

4. Plaque Biofilm –
COSTERTON et al 1994

5. Plaque complexes based on frequency of accumulation
LISTGARDEN 1998
 Primary bacteria
 Secondary bacteria

6. Classification
Mechanical plaque control aids
1.Toothbrushes
Manual toothbrushes
Electrical toothbrushes
2.Interdental Aids
Dental Floss
Triangular Tooth Picks
Interdental Brushes
Yarn
Super floss
Perioaids

7. 3.Aids for Gingival Stimulation
Rubber Tip Stimulator
Balsa Wood Edge
4.Others
Gauge Stripes
Pipe Cleansers
Irrigation Device
5. Aids for edentulous or partially edentulous
Cleansing solution

8. Chemical plaque agents
1. 1st generation : eg. Antibiotics , phenols
2. 2nd generation : eg. Bisbiguanides
3. 3rd generation : eg. Delmopinol

9. MECHANICAL PLAQUE CONTROL

10. Widely used
Principal instrument
ADA
TOOTHBRUSH

11. History of tooth brush
 China--- 1600 BC
 Western countries---1640
 William Addis--- 1780
 European countries--- 1800
 Nylon--- 1938
 World war ii
 Powered tooth brush--- 1960

12. Types of tooth brush
 Manual
 Powered
 Sonic and ultra sonic
 Ionic

13. Manual tooth brush
 Ideal requisites

14. TOOTHBRUSH DESIGN

15. Tooth brush bristle
Hard and soft
Natural and artificial
Multi-tufted and space tufted

18. HANDLE DESIGN

19. Electric Toothbrush
•Fredrick johnburg– 1885
•1939
•1960

20. Frequency of oscillation
is 40 Hz

21.  Indications

22.  Advantages
Increases patient motivation
accessibility
No specific brushing technique
Use less brushing force
Brushing timer is incorporated

24. Ionic tooth brush
 Change the surface charge of tooth– positive
 Plaque is attracted by negatively charged bristle

25. Association between cleaning and caries &
periodontal disease indicate that quality rather
than the frequency may be related to disease

26. Practical & Esthetic reasons
Perception of oral freshness
Brushing twice daily

27. Maintenance of tooth brush
 Act as vehicle
 Clean with mouthwash
 Store in dry place

28. When to
change the
Toothbrush ????

29. Brushing Method
 Objectives
Remove plaque
Clean the teeth
Stimulate gingiva
Apply dentifrices

30. Roll : Rolling Stroke , Modified Stillman
Vibratory : Stillman , Bass
Circular : Fones
Vertical : Leonard
Horizontal : Scrubbing

31. Bass method(1948)
 Most widely accepted
Indication
All people
Open interproximal areas & exposed root
surface
Routine patient

32. Technique

33.  Advantages
Effective method
Gingival stimulation
Easy to learn
 Disadvantages
Time consuming
Injury to gingival margin
Dexterity requirement is too high

34. Modified
 Indication
Routine oral hygiene
Intrasulcular cleaning
 Technique
combination of vibratory motion and sweeping
motion
Bass method

35.  Advantages
Excellent sulcus cleaning
Good interproximal and gingival cleaning
Good gingival stimulation
 Disadvantages
Moderate dexterity of wrist

36. Modified Stillman's technique(1932)
 Indication
Plaque removal from cervical areas.
Cleaning tooth surface and gingival stimulation.
Gingival recession and Root exposure.

37.  Technique
Bristles are
activated by
back & forth
motion
 Disadvantages
Time consuming
Damage epithelial attachment

38. Charters method(1928)
 Indication
Open interdental spaces
Wearing FPD or ortho appliance
Perio surgery
Moderate gingival recession

39.  Technique
Bristles are
activated by
mild vibratory
strokes

40.  Advantage
massage and stimulation for marginal and
interdental gingiva
 Disadvantages
Difficult to remove sub gingival plaque
Correct brush placement is difficult
Requirement digital dexterity are high

41. Scrub brush method
 Technique
Horizontal+Vertical+Circular
 Disadvantages
Ineffective at plaque removal
Tooth abrasion and gingival recession

42. The Roll technique/ADA method
 Indication
Children
Adults with Limited dexterity
Patient with anatomically normal gingival
tissue
Technique

43.  Advantages
Provides gingival massage and
stimulation
 Disadvantages
Laceration of alveolar mucosa
Punctuate lesion

44. Fones method(1934)
 Indication
Young children
Physically and emotionally handicapped
individual
Patients who lack dexterity
 Technique

45.  Advantages
Easy to learn
Shorter time
Good stimulation
 Disadvantages
Trauma
Interdental area are not properly cleansed

46.  Leonards method/vertical method
Advantages:
Most convenient and effective for children
with dec.dent
Disadvantage :
Interdental spaces of permanent teeth of
adults are not properly cleaned
Technique :

47.  Physiologic method/smith method
principle: tooth brush should follow
the physiologic pathway that food does
when it transverse over the tissue during
mastication.

48. Advantage:
1. Natural self cleansing mechanism
2. Supragingival cleaning is good
Disadvantage:
Interdental space and sulcus areas of
teeth are not properly cleaned

49. Effect of improper tooth brushing
 Soft tissues
Laceration
Recession
 Hard tissues
Abrasion of teeth

50. Dental Floss
Rubber tip
Interdental brush
Toothpick

51. Dental floss
•Types
•Function
•Drawback

52. Flossing method

53. Floss Holder

54. Wooden or plastic triangular
stick
 Type 2 embrasure
 Balsa & Birchwood
 Triangular in c/s

55. Tooth picks
 Cave people
 Recession & blunting of papilla

56. EVA – H Holder with toothpick

57. Interproximal Brushes
 Tapered or cylindrical
 Uses:
clean
chemotherapeutic

58.  Brush is moistened
 Inserted at an angle
 Bucco-lingual direction

59. Rubber or plastic tip
 Conical, flexible
 Gingival massage
 Remove plaque & debris
from furcation, open embrasure & gingival margin
 Placed 90
 In open embrasure

60. Gauge strip
 Clean proximal surface
 2 inch gauge is folded half with
folded edge adjacent to gingiva
for adaptation
 Shoeshine

61. Tongue Cleaner
 Shorter fungiform and longer filiform papillae
 Soft bristle toothbrush
 Technique

62. Chemical plaque agents
Ideal adjunct
Prescription chlorhexidine
Nonprescription essential oil rinse. Ex: Thymol,
Menthol, Eucalyptol.
 Ideal Requisites

63.  Chlorexidine gluconate(0.2%)
Both antiplaque and antibacterial properties
Mechanism of action
Antiplaque action:
1. Prevents pellicle formation by blocking acidic
groups on salivary glycoproteins
2. Prevents adsorption of bacterial cell wall
3. Prevents binding of mature plaque by
displacing calcium from plaque matrix.

64. Antibacterial action:
Bacterial cell wall (negatively charged)
Positively charged CHX
Alters integrity of bacterial cell membrane and CHX
is attracted towards inner cell membrane
CHX binds to phospholipids in inner membrane and increases
permeability of inner membrane and leakage of low
molecular wt. compound

65. Coagulation and precipitation of cytoplasm
Free CHX molecules enters into cell and
causes coagulation of cytoplasmic membrane
Vital cell activity ceases
cell death
Vital cell elements leak out and harm substance
gain entry

66.  CHX should not be used before/immediately
after using tooth paste
 Adverse effects