Plaque control


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Preventive Periodontics

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Plaque control

  1. 1. Khalid S. Hassan Assist. Prof. Periodontology
  2. 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. 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
  4. 4. ** 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.
  5. 5. 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.
  6. 6. 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.
  7. 7. Charters method
  8. 8. 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.
  9. 9. Electrical Toothbrushing Technique
  10. 10. 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.
  11. 11. 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.
  12. 12. 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.
  13. 13. Chemical Plaque Control (Mouth-rinsing)
  14. 14. 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.
  15. 15. 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
  16. 16. 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.
  17. 17. 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.
  18. 18. POLISHING •Upon the completion of the quadrants, you should polish the teeth when it is necessary
  19. 19. GOAL OF POLISHING  To remove soft deposits and extrinsic stain with minimal trauma to hard and soft tissues and minimal discomfort for patient
  20. 20. 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
  21. 21. 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
  22. 22. Contraindications to Polishing  NO Stain.  Exposed root surfaces .  Gold, porcelain, composite restorations and implants .  Highly inflamed tissues  Communicable disease
  23. 23. 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.
  24. 24. 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.
  25. 25. 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.