1. By,
Dr. Dineshwarran A/L Rajendran

2. Contents
 Plaque
 Mechanical Plaque Control
 Chemical Plaque Control
 Summary

3. Plaque
What 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

4.  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

5. 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.

6. 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.

7. Mechanical Plaque Control
 Toothbrushes
- Toothbrushing techniques
- Powered toothbrush
 Dentifrices
 Interdental Cleaning Aids
- Dental floss
- Interdental brush
- Wooden/ Rubber tips

8. 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).

9. Toothbrush
Designs in the
Past

10. Toothbrushes
Modern 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)

11. 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

12.  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

13. Effects of Faulty
Toothbrushing
Techniques
Wedge-shaped
cervical area defects
Traumatic ulcers

14. Toothbrushes
Toothbrushing methods:
 Roll: Modified Stillman technique
Vibratory: Stillman, Charters and Bass technique
Circular: Fones technique
Vertical: Leonard technique
Horizontal: Scrub technique

15. Bass Technique
• Most often recommended – Emphasizes sulcular
placement 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

16. Bass method

17. 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.

18. 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

19. Toothbrushes
Powered 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

20. Variations:
 Reciprocal of Back and Back motions
 Circular and Eliptical motions
 Combination of both

21. 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

23. 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.

24. 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

25. Powered floss
These devices have a single
bristle that moves in a
circular motion.
Floss with
Holder

26. 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

27. Dental Floss vs
Interdental Brush

28. 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.

29. 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

30. Chemical Plaque Control
 Oral Rinses
 Chlorhexidine rinse
 Essential Oil rinse
 Disclosing Agents

31. Oral Rinse
Chlorhexidine
 Action
 Increase bacterial membrane permeability followed by
coagulation of cytoplasmic macromolecules
 Has substantivity ability of substance to adhere to the
structure to be released for long time
 Side effects
 Brown discoloration
 Altered taste
 Oral mucosal erosion

32. Oral Rinse
Essential Oil
Eg: Thymol, Eucalyptol, Menthol
Action: By altering bacterial cell wall

33. 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

34. 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.

35. Thank You!