This document provides information on plaque control in pediatric dentistry. It discusses dental plaque, methods of disclosing plaque using various agents, and mechanical and chemical plaque control methods. Mechanical methods include toothbrushing, dental floss, interproximal brushes, and powered toothbrushes. Chemical methods involve using antimicrobial agents like chlorhexidine. The document also covers techniques for brushing teeth and flossing interdentally in children. Maintaining good plaque control is important for preventing dental caries and periodontal disease in pediatric patients.

1. PLAQUE CONTROL IN
PEDIATRIC DENTISTRY
MAKAL MADHAV M.P
FINAL YEAR PART II
REG NO:100020257

2. CONTENTS
• Introduction
• Dental plaque
• Disclosing agent
• Mechanical plaque control
• Chemical plaque control
• Plaque control for disabled child
• Pediatric preventive programme

3. • Dental plaque is a complex metabolically interconnected highly
organized bacterial ecosystem.

4. Steps in plaque formation
• Organic Pellicle formation
• Adherence
• Maturation
• Microbiology of plaque includes
• Streptococci,actinomyces,veillonellae

5. Plaque control
• Removal of plaque and prevention of its accumulation on teeth and
adjacent gingival surface.
• Key to prevention and successful treatment of periodontal disease
• Plaque control can be professional and patient performed
• Removal of plaque leads to resolution of gingival inflammation in
early stages and prevent reccurence

6. DISCLOSING AGENT
• A preparation in liquid tablet or lozenge, which contains a dye or
coloring agent which is used for identification bacterial plaque ,
which is invisible to naked eyes.
• INDICATIONS
• Patient education,instructions for plaque control,self
assessment,evaluation effiectiveness ,assessment of clinician,plaque
indices.

7. Properties
• Intensity of color: distinct staining of deposits
• Duration of intensity: color should not rinse of fast
• Taste : comforatable, pleasant and flavored
• Irritation :should not cause irritation to oral mucosa
• Diffusibility :solution should be thin,can be applied readily to
teeth,thick to impart color to plaque
• Astrigent and antiseptic properties

8. Agents used for disclosing plaque
Iodine preparations
 skinners iodine solution
 diluted tincture of iodine
Mercurochrome preparation
o mercurochrome solution 5%
o flavored mercurochrome disclosing solution
o Bismark brown

9. Erythrosine
Two tone solution
 FD &c blue no:1,FD & c red no:3
 Fluoresceen FD & yellow
Basic fuchsin

10. • Application
• Directly applied on tooth surface using cotton pellet or rinsed after
proper dilution
• Tablet or wafers may be chewed or swished for 30 or 60 sec and
rinsed

11. Methods of
plaque control
chemicalmechanical

12. Mechanical plaque control aids Chemical plaque control agents
Dentifrices Bis-biguanides and related compounds
Chlorhexidine
Alhexidine
Tooth brush Quaternary ammonium compound ce tylpyridinium
Dental floss Antibiotics
Pencillin,tetracycline,vancomycin,metronidazole
Oral irrigation Fluoride and inorganic ions
Stannous fluoride,chlorine dioxide ,hydrogen
peroxide,sodium bicarbonate,sodium chloride
Interproximal brushes Enzymes
Dextranase, glucose amyloglucosidase
Wooden tips Organic compound
Saguinarine,menthol/thymol,soluble pyrophosphates
Gauze piece for infants
Gingival massage
Tongue scrapers

13. DENTIFRICES
A substance used with tooth brush to remove bacterial plaque,
material alba , debris from gingiva and teeth for cosmetic ,
sanitary ,prevention and therapeutic purpose.
Function
 Minimize plaque build up
Anticarious action
 Removal of stains
 Mouth freshner

14. COMPOSTION
AGENTS MATERIALS USED FUNCTION
Polishing/Abrasive Calcium carbonate, dicalicum
phosphate dehydrate, alumina,
silica
mild abrasive action
Binding /thickening Water soluble agents
Alginates ,sodium carboxymethyl
cellulose
Water insoluble
Magnesium aluminum
silicate,colloidal silica,sodium
magnesium silicate
Stability and consistency
Detergents/surfactants Sodium lauryl sulfate Produces foam which aids in
removal of debris
Humectants Sorbitol, glycerin,polyethylene
glycol
Reducing loss moisture
Flavoring Peppermint oil,spearmint oil,oil of
wintergreen
Render product pleasant to use
and fresh taste
water Distilled water Vehicle

15. Therapeutic Tetrasodium,zncl,pyrophosphate Therapeutic action
Sweeting Saccharin Sweetener
Antibacterial Triclosan,delmopinol,metallic
ions,zinc citrate trihydrate
Anticaries Sodium monoflurophosphate
Sodium fluoride,stannous fluoride
Anticalculus Pyrophosphates,zinc citrate,zinc
chloride ,gantrez acid
Inhibits mineralization of plaque
Desensitizing Sodium fluoride,potassium
nitrate,strontium chloride

16. Recent development in dentrifices
• Tooth paste for children
• Herbal tooth paste
• Whitening tooth paste(highly abrasive)
• Fluoride tooth paste
• Sensitivity tooth paste

17. TOOTH BRUSH
• The mechanical cleaning of teeth can be traced back to ancient times.
• Oral hygiene was practiced by egypitans 5000 years ago.
• Romans used tooth picks made of bones and metals.
• It was only in 1728 tooth brush made of horse’s hair evolved,then
came manual tooth brush,and now era of powered tooth brushes

18. Ancient tooth brushes

19. ADA Specification
• Length : 1 to 1.25 inches
• Width :5/16 to 3/8 inches
• Surface area :2.54 to 3.2cm
• No rows : 2 to 4 rows
• No of tufts :5 to 12 per row
• No of bristles :80 to 85 per tuft
Diameter for
• Soft brush:0.007inch
• Medium brush:0.012inch
• Hard brush :0.014inch

20. Parts of tooth brush
• Handle :grasped in the hand during toothbrushing.
• Head : the working part and consist of tufts of bristles or filaments.
• Shank: the location that connects the head and the handle.

21. DIFFERENT TYPES OF BRISTLE PATTERN
• Block
• Wavy or v shaped
• Multilevel trim pattern
• Criss -cross pattern
• Cross action with gum stimulator

22. Types of handles
• Straight handle
• Contra-angle handle
• Flexible handle
• Grip handle

23. • Tooth brushes should be able to reach and effectively clean most area
of teeth.
• Frequency and duration of brushing
• Jenkens suggested that tooth brushing before meals is optimal,he
says that saliva is a good remineralizing agent that will neutralize and
the buffer the lowered PH of oral fluids caused by acidic foods and
fermentable carbohydrate,so teeth brushing done after meals it may
remove saliva and decrease remineralizing action.

24. Powered tooth brush
• The level of oral hygiene achieved by an individual is dependent on
technique,motivation,dexternity and preservence.
• Since behavioural practices can’t be modified the greatest potiential
for improving oral hygiene will come from advancements of brush
design that enhance plaque removal.

25. • Powered toothbrush deviced in 1939.
• They have three motion back and forth,circular,elliplical.
• Recommended for
• Individuals lacking motor skills
• Handicapped patients
• Patients under fixed orthodontic treatment.

26. Manual Vs Powered Tooth Brushes
CHARACTERISTIC MANUAL POWERED
Duration 20-40 sec 1-3 min
Teeth brushed at a time multiple One /multiple
Brush head motion Cross & multiple Minimal
Brush head speed Zero 1000 s/min
Brush head strokes 40 -100/min 10 -40/min
Brush head load 150-1000gm 50 -250 gm

27. Methods of tooth brushing
• SCRUB
• Bristle placement: horizontal on gingival margin
• Motion :anterior posterior direction keeping brush horizontal
direction
• Indication:children
• Advantage : easy to learn

28. • BASS
• Bristle placement:apcal towards gingiva into sulcus at 45degree of
tooth surface
• Motion :short back & forth vibratory motion while bristles remain in
sulcus
• Advantage
• Good gingival stimulation
• Cervical plaque removal

29. • Charters
• Bristle placement: coronally 45degree sides of bristle half on teeth
and half on gingiva
• Motion: small circular motion with apical movement towards gingival
margin
• Advantages
• Clear interproximal
• Disadvantages
• Hard to learn

30. • Fones
• Bristle placement: perpendicular to tooth
• Motion :with teeth in occlusion ,move brush in rotatory motion
• Advantage
• Easy to learn
• Disadvantage
• Trauma
• Interproximal not cleaned

31. • Roll
• Bristle placement:apically ;parallel to tooth and then over tooth
surface
• Motion:on buccal and lingual inward pressure
• Advantage
• Good gingival stimulation
• Disadvantage
• Doesn’t clean sulcus

32. • Stillmans
• Bristle placement :on buccal and lingual apically at an oblique angle
to long axis of tooth
• Motion :On buccal and lingual slight rotary motion
• Advantages
• Moderate dexternity
• Gingival stimulation

33. • Modified stillmans
• Bristle placement: pointing apically at an angle of 45 degree to tooth
surface
Motion: apply pressure as in stillmans method but vibrate brush also
movie occlussaly
Advantage
Good gingival stimulation
Easy to master

36. Dental floss
• First paper on dental floss was published by Parmly in 1819.later in
1882 codman and shurtuff made 1st commercial floss made of silk .
• Floss constructed with help of individual filament 2 to 3 D thick.
• Types
• Twisted and non twisted
• Banded and non banded
• Thin and thick
• Microfilament and macrofilament

37. • Type I – unbonded dental floss compossed of yarn having no additives
• Type II –bonded dental floss composed of yarn having no additives
other than binding agent or agent of cosmetic performance
• Type III- bonded or unbonded having drug for therapeutic usage

38. Technique
• String floss method: use 18 inches of floss wrap 2-3 inches of floss
around middle finger of left hand and similarly to right hand.

39. • Circle floss method: take floss and tie a double knot to secure it,the
size of circle is like an orange position knot to the left side of working
area and place middle ,little and ring finger of both hand on the side
of circle

40. Application
• Maxillary tooth:direct the floss by holding floss over two thumbs or a
thumb and an index finger rest a side of finger on teeth of opposite
side of the arch to provide balance and fulcrum
• Mandibular teeth:direct the floss down by holding the two index
fingers on top of the stand.one index finger holds floss on the lingual
aspect other on facial aspect

41. Insertion
• Hold floss firmly in a diagonal or oblique position
• Guide the floss past catch contact are with gentle saving motion
• Control floss to prevent snnnapping through the contact area onto
gingival tissue.

42. • Precaution
• Col area is not keratinized and is vulnerable to bacterial innovation
• Do not use long piece between the fingers when held for insertion
• Snapping the floss through contact area
• Curve the floss around teeth
• Use rest prevent injury

43. Interproximal brushes
• Cone shaped brushes made of bristles mounted on handle ,single
tufted brushes or small conical brushes.
• Cleaning interdental spaces
• Inserted interproximally and activated in short back and forth strokes
in between teeth.

44. • For best cleaning efficiency the diameter of brush should be slightly
larger than gingival embressure.
• Single tufted more effective on lingual surface of mandibular molar
and premolar

45. Wooden tips
• These are used with or without a handle
• Soft triangular wooden tips such as a stemu dent are placed in
interdental spaces.
• Repeatedly moved in and out of the embrassure removing soft
deposit for the teeth and mechanically stimulating gingiva.
• Use limited to facial surfaces

46. Gingival massage
• The mechanical stimulation of gingiva
• Simple finger massage
• Increased keratinization
• Increased blood flow
• Increased flow GCF to sulcus
• Results in overall improvement in gingival health

47. Oral irrigation device (water pik)
• Mainly beneficial in removal of unattached plaque and debris
• They are helpful removing debris from inaccessible areas around
orthodontic appliance and fixed prosthesis
• Power driven device
• Non power driven device

48. • Power driven device: generate an intermittent or pulsating jet of fluid.
An adjustable deal for regulation of pressure is provided along with a
end held interchangeable tip that rotate 360 degree.
• Non power driven device:attached to household water
supply,disadvantage uncontrolled water pressure.
• Contraindicated
• Advanced periodontitis
• Medically compromised patients like leukemia etc

49. procedure
• Direct jet to interdental area,hold tip at right angle to long axis of
tooth
• Start at low pressure and increase gradually depending condtion of
tissue
Follow a definte pattern across mouth,1st maxillary arch then
mandibular apply for 5to 6 sec in each interdental area

50. Chemical plaque control
• ADA has accepted two agents as plaque control agents
• Prescription chlorhexidine rinse
• Non prescription essential oil rinse

51. Chlorhexidine gluconate(0.2%)
• Chlorhexidine gluconate is a cationic bisbigunide which is effective
against array of microorganism(gram positive,negative, fungi,
yeast,virus)
• Chlorhexidine exhibits both antiplaque and antibacterial property.
• It is bacteriostatic at low concentration and bacteriocidal at high
concentration.

52. Mechanism of action
• The bacterial cell is negatively charged so cationic chlorhexidine
molecule is rapidly attracted to negatively charged bacterial cell
surface.
• This alters integrity of bacterial cell membrane
• Chlorhexidine attracted towards innercell membrane

53. • It binds to phospholipids on inner membrane
• Increased permeability of inner membrane
• Leakage of low molecular weight component such as potassium
• Exhibits antimicrobial action

54. • Prevents pellicle formation by blocking the acidic group on salivary
glycoproteins thus reducing the protein adsorption to tooth surface
• Prevents adsorption of bacterial cell wall on to tooth surface by
binding to the bacteria.
• Prevents binding of mature plaque precipitating agglutination factor
in saliva and displacing calcium from plaque matrix

55. • Adverse effects
• Brownish staining of teeth
• Loss taste sensation
• Stenosis of parotid duct
• Oral mucosal erosion

56. Essential oil
• These are the oldest form of mouthwash.
• Most popular one is listerine
• It is combination of phenol related essential oil,thymol and acetyl
mixed with menthol and methyl salicylate.
• It has shown plaque reduction in range 20-34% gingivitis reduction 20
-34%

57. • Mechanism of action
• Cell wall disruption and inhibition of bacterial enzymes
• Adverse effects
• Intial burning sensation and bitter taste in mouth

58. Quaternary ammonium compounds
• Commonly used are cetylpyridinium chloride at 0.05%.
• Cationic and binds to oral tissues but not strong as bisbiguanide.
• When used orally they bind strongly to plaque and tooth surface but
are released from binding site rapidly
• Mechanism of action
• Ability to rupture the cell wall and alter cytoplasmic contents.

59. • Adverse effects
• Yellow brownish discoloration of tongue and gingival margin of tooth
• Burning sensation
• Occasional desquamation

60. • Sanguinarine
• Used both mouth wash and tooth paste
• It is alkaloid extract from blood root plant sangunialic cancidense
• It contain the extract at 0.3 and 0.2 zinc chloride
• Adverse effect burning sentation
• Helps in plaque reduction and reduction in gingivitis

61. • Enzymes
• Active agents
• They can break already formed matrix of plaque and calculus
• Eg mucinax

62. • Antibiotics
• Antibiotics such as vancomycin,erythromycin,niddamycin and
kanamycin has used for plaque control.
• However due potential problem of bacterial resistance and
hypersensitivity reaction use of theses agents have been reduced
considerably.

63. Plaque control for disabled child
• For older children who are unwilling or physically unable to cooperate
the dentist should teach parent or guardian correct tooth brushing
technique
• If child is institutionalized the staff should be instructed in proper
dental care regimen

64. • Tooth brush
• Soft multi tufted nylon brushes with long handle is preffered
• Powered tooth brush will be helpful

65. • Modification
• Grasp Velcro strap with a pocket on plam side into which tooth brush
is inserted
• Fixed fingers: with griped handle

66. • Limited hand closure or reduced
dexterity;use of sponges ,soft rubberball
• Super brush

67. • Use of mouthwash especially chlorhexidine
• Fluoride application stannous fluoride gel are more effective anti
plaque agent
• Application of fluoride gel by tooth brush after normal brushing

68. • Guidelines for home care
• Wheel chair

69. • Bed or sofa

70. • Lying on floor
• Patient lies on floor with head on pillow
• Can use your arm to hold person still

71. Sitting on floor
Patient sits on floor, you sits behind person in chair
Individual leans head against your knees
If patient is uncooperative you can place leg over arms to keep patient
still

72. Pediatric preventive programme
• Prenatal period
• The counsel parent is to be done
• The importance of oral hygiene maintenance should be stressed at
each visit and myths about teething and the initation of brushing in a
infant should be cleared to the parent

73. • Infants(0-1)
• Mechanical plaque removal should be initiated by the parent after
the eruption of 1st tooth using moistened soft bristled infant size
tooth brush.
• However the cleaning and massage gum pads using wrapped
moistened gauze piece need to be taught to the parent
• Also parent should be instructed to feed the child with plain water
after milk or rinse mouth

74. • Toddlers (1-3year)
• This best age to introduce tooth brush,if not done earlier
• Non fluoridated dentrifice should be used
• Flossing can be used
• Brushing can be carried out using lap to lap postion of child

75. • Preschoolers(3-6year)
• Fluoridated dentifrice can be introduced after 3 year of age
• Only pea shaped tooth paste should be dispensed
• Parent should assist child in brushing
• Fluoride gel or rinses can be introduced

76. • School going children
• Parents need only supervise brushing this age group
• Posses dextertity to brush on his own
• Use of fluoride gel and rinses

77. • Adolescents (12-18)
• Patient compliance is most important area of concern in this age
group

78. conclusion
• Effective plaque control measures should be taken
• Guide to use plaque control measures