1- Removal of soft deposits (dental plaque, materia alba and
2- Gingival massage keratinization and improve
circulation protection against microorganisms
3- Prevention of calculus formation.
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
** Tooth Brushing Methods:-
•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
•Exert gentle vibratory pressure using short back-and-forth
motions without dislodging the bristles tips (horizontal
•Perform about 20 strokes in each position.
•Used a soft brush in this method.
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
- 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.
Electrical Tooth Brushes
• Useful for: Children, hand-capped, and patients with
• 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.
II- Interproximal Cleaning Aids:-
• 1- Dental Floss:
Effective for flat or convex proximal tooth surfaces with full
• 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.
2- Interdental Brushs:
•Small cone-shaped or tapered brushes.
•Used in large open embrasures.
•Inserted interdentally and moved back and forth in facio-
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.
4- Rubber Tips:-
•Produce gingival massage.
•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.
* The most effective antimicrobial agent in plaque and
•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
- Alter taste sensation (temporary).
- Increase supragingival calculus formation.
•0.2%- 0.12% mouth washes Twice/day.
2- Essential Oils
Thymol Menthol Eucolyptal Methyl Salicylate
•Can plaque and gingivitis.
•Mechanism of action: alter bacterial cell wall & adherence to
•Substantivity low substantivity.
•Adverse effects Burning sensation, Bitter taste.
•Used twice daily
3- Quaternary ammonia compounds
e.g. Cetylpyridinium and Benzalkonium.
•Mechanism of action: - bacterial cell wall permeability lysis
- bacterial adhesion.
•Side effects Burning sensation, staining.
•0.45% cetylpyridinium, twice/day mouth washes.
- Anticarious more than
- Derived from bl. Root
- 0.01% mouthwashes and
-No benefits on
plaque, used in
•Abrasive agent e.g. calcium carbonate, calcium oxide
•Detergent agent e.g. sodium lauryl sulfate.
•Thickening agent: carboxymethyl cellulose and amylase.
•Humidifier and water.
•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.
•Upon the completion of the quadrants, you
should polish the teeth when it is necessary
GOAL OF POLISHING
To remove soft
extrinsic stain with
minimal trauma to
hard and soft
tissues and minimal
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
– Fine pumice ~ mildly abrasive
– Course pumice ~ not for use on natural teeth
Tin Oxide ~ Putty powder, Stannic Oxide
– Metallic restorations and teeth
Effects of Polishing
Effect on tooth
– 3 minutes of polishing with
pumice = 4 microns of
– Dentin abrades 5-6 times
faster than enamel
– Avoid decalcified areas
– Heat production – pulp
damage with fast, heavy
Effect on gingiva
– 2 minutes with rubber cup
= total removal of sulcular
Contraindications to Polishing
Exposed root surfaces .
Gold, porcelain, composite restorations
and implants .
Highly inflamed tissues
•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.
Recommendation for plaque
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.
Education and instruction :
The patient should be given a new
toothbrush , interdental cleaner and
Tooth brushing should be demonstrated in
the patient’s mouth while he observes with a
Repeat the demonstration and instruction process
with dental floss and interdental cleaning aids.
Periodically recording the state of gingival health
and amount of plaque.