The document discusses mechanical plaque control methods, highlighting the significance of dental plaque, disclosing agents, and the use of various toothbrush types and techniques for effective removal. It explains the characteristics of ideal toothbrushes, various brushing techniques, and interdental cleaning aids like dental floss and interdental brushes. Additionally, it covers gingival massage, water irrigation devices, and tongue cleaning methods to improve overall oral hygiene and health.

1. MECHANICAL
PLAQUE CONTROL
MANEESHA MENON M
21 PART1

2. INTRODUCTION
01
DISCLOSING AGENTS
02
MECHANICAL PLAQUE CONTROL
03
CONTENTS

3. Dental plaque is defined as a structured, resilient, yellow-grayish
substance that adheres tenaciously to the intraoral hard surfaces,
including removable and fixed restorations.
Plaque control includes the usage of mechanical procedures as well as
chemical agents, which retards plaque formation.
INTRODUCTION

4. It is a preparation in liquid , tablet or lozenge form which
contains dye or other coloring agent, used for the
identification of bacterial plaque.
PROPERTIES
• Intensity of color
• Duration of intensity
• Taste
• Irritation to mucous membrane
• Diffusibliity
• Astringent and antiseptic properties
DISCLOSING AGENTS

5. AGENTS USED FOR DISCLOSING PLAQUE
Iodine preparation: >skinners iodine solution
>Diluted tincture of iodine
Mercurochrome preparations:>mercurochrome solution
50%
>flavored
mercurochrome disclosing solution
>Bismark brown
>erythrosin
>Fast green
> Flouresecin
> two tone solutions
> basic fuchsin

6. USES OF DISCLOSING AGENT
 Personalized patient instruction and motivation
Self evaluation by the patient
 To evaluate the effectiveness of oral hygiene
measures
 In search studies with regard to effectiveness of
plaque control

7. The various aids used for mechanical plaque control are:
Toothbrushes and dentifrices
 Interdental aids: dental floss
:interdental brushes
:wooden tips
 Aids for gingival stimulation: gingival massage
: water irrigation devices
 Tongue scrapers
MECHANICAL PLAQUE CONTROL

8. MANUAL TOOTHBRUSHES
IDEAL CHARACTERISTICS:
 It should confirm to individual patient requirement to size,
shape and texture.
should be easily and effectively maipulated
Should be readily cleaned and aerated
should be impervious to moisture
should be durable and inexpensive
TOOTHBRUSHES

9. PARTS OF TOOTHBRUSH
 Handle- part grasped in hand
 Head - the working end and holds bristles
 Tufts- clusters of bristles / filaments secured in
to the head
 Brushing plane -surface formed by free ends of
the bristles
 Shank-connects head and handle

10. TOOTHBRUSH BRISTLES
• It can be
hard/soft,natural/synthetic,multitufted
/ space tufted.
• Stiffness of bristles vary based on :
i. Diameter of bristles
ii. Lengh of bristles
iii. Number of filaments in a tuft
iv. Curvature of filament

11. ADA SPECIFICATION OF A TOOTHBRUSH
Brushing surface :
1-1.25 inches in length
5/16 to 3/8 inches in width
2 to 4 rows of bristles
5-12 tufts/row

12. MODIFICATIONS
• Long and contoured handle
• Double angulation of the handle and neck
• Concave surface of the brushing plane
• Special indicator bands
POWERED TOOTHBRUSHES
• Introduced by Fredrick Tornberg, in 1939.
• Also known as automatic , mechanical or electric toothbrushes.
• The heads of the toothbrush oscillate in a side-to-side motion or in
rotary motion.
• Frequency of oscillation is 40Hz in an ordinary powered tooth
brush.

13. INDICATIONS OF POWERED TOOTHBRUSHES
 Young children
 Handicapped patients
 Individuals lacking manual dexterity
 Patients with orthodontic or endosseous implants
 Orthodontic patients
 Institutionalised patients including elderly
 Patients with supportive pdl therapy.
ADVANTAGES
Increases patient motivation resulting in better patient compliance
 Accessibility in interproximal and lingual areas
 No specific brushing technique required
 Use less brushing force than manual toothbrushes

14. SONIC AND ULTRASONIC
TOOTHBRUSHES
These types of toothbrushes produce produce
high frequency vibrations (1.6MHz), which lead
to phenomenon of cavitation and accoustic
micro streaming. This phenomenon aids in
stain removal as well as disruption of the
bacterial cell wall.
IONIC TOOTHBRUSHES
• Ionic toothbrushes change the surface charge
of a tooth by an influx of positively charged
ions.
• The plaque with similar charge is thus
repelled from the tooth surface and is
attracted by negatively charged bristles of

15. A dentifrice is a substance used with a toothbrush for the purpose
of cleaning the accessible surfaces of teeth.
Gel needed for effective cleaning is a pea sized dab on the top half
of brush
For children under 6 years it should be half the amount of
dentrifice as compared to adults.
It minimizes plaque buildup
Anticaries action
Removal of stains
Mouth freshener.
DENTIFRICES

17. BASS METHOD /SULCUS CLEANING METHOD
It is most widely accepted and most effective method for the removal of dental
plaque present adjacent to and directly underneath the gingival margin.
INDICATIONS:
 Particularly adaptable for open interproximal areas ,cervical areas beneath the
height of contourof the enamel and exposed tooth surfaces.
Recommended for routine patients with or without periodontal involvement.
TOOTHBRUSHING TECHNIQUES

18. TECHNIQUE:
Bristles placed at a 45˚ angle to the gingiva and moved in small
circular motions.
Strokes are repeated around 20 times , 3teeth at a time.
On lingual aspect of anterior teeth , brush is inserted vertically
and heel of brush pressed into the gingival sulci
On occlusal surface bristles are pressed firmly against pits and
fissures

19. ADVANTAGES
Effective method of removing plaque
Provides good gingival stimulation
Easy to learn
DISADVANTAGES
Overzealous brushing may convert the “very short strokes” into
scrub technique
Cause injury to gingival margin
Time consuming
Dexterity requirement is too high for certain patients.

20. INDICATIONS
 As a routine oral hygiene measure
Intrasulcular cleansing
TECHNIQUE:
This technique combines the vibratory and circular movements
of the Bass technique with the sweeping motion of Roll
technique.
Toothbrush is held that the bristles are 45˚ to the gingiva.
Bristles gently vibrated by moving the brush handle in a back &
forth motion.
Bristles are then swept over the sides of tooth towards the
occlusal surfaces in a single motion.
MODIFIED BASS TECHNIQUE

22. ADVANTAGES
Excellent sulcus cleaning
Good interproximal & gingival cleaning
Good gingival stimulation
Dexterity of wrist is required.

23. INDICATIONS:
Plaque removal from cervical areas below the height of
contour of the enemel & from exposed proximal surfaces.
General application for cleaning tooth surfaces & massage
of the gingiva
Recommended for cleaning in areas with progressive
gingival recession & root exposure.
TECHNIQUE
Bristles are pointed apically with an oblique angle to the
long axis of the tooth.
Bristles are positioned partly on the cervical aspect of
teeth & partly on the adjacent gingiva.
Bristles activated by short back & forth motion and
simultaneously moved in coronal direction.
Strokes are repeated around 20 times.
MODIFIED STILLMAN’S
TECHNIQUE

24. DISADVANTAGES
Time consuming
Improper brushing can damage the epithelial
attachment.

25. FONES METHOD / CIRCULAR SCRUB METHOD
INDICATIONS:
Physically or emotionally handicapped individuals
Patients who lack dexterity
TECHNIQUE
Child is asked to stretch his/ her arms that they are parallel to the
floor asked to make big circles using the whole arm to draw circles in
the air.
The circles are reduced in small diameter until very small circles are
made infront of mouth

26. ADVANTAGES
Easy to learn
Shorter time is required
DISADVANTAGES
Possible trauma to gingiva
Interdental areas are not properly cleaned
Detrimental for adults especially who use the
brush vigorously.

27. VERTICAL METHOD-LEONARDS METHOD
Leonard advocated a vertical stroke in which maxillary &
mandibular teeth are brushed seperately.
TECHNIQUE
Bristles are placed 90˚ angle to the facial surface of teeth.
With the teeth edge to edge ,brush vigorously , without great
pressure with a stroke mostly up & down on tooth surfaces with
a slight rotation or circular movement after striking the gingival
margin with force
ADVANTAGE
Most convenient and effective for small chiidren
DISADVANATAGE
Interdental spaces of permanent teeth are not properly cleaned.

28. CHARTER’S METHOD
INDICATIONS
Individuals having open interdental spaces with missing pappilla
and exposed root surfaces.
Those wearing FPD or orthodontic appliances
For patients who have periodontal surgery
Patients with moderate interproximal recession.
TECHNIQUE
A soft/medium multi-tufted tooth brush is indicated in this
technique.
Bristles are placed at an angle of 45˚ to the gingiva with the
bristles diercted coronally.
The bristles are activated by mild vibratory strokes with the bristle
ends lying interproximally

29. ADVANTAGE
Massage & stimulation for marginal and
interdental gingiva.
DISADVANTAGE
Brush ends donot engage the gingival sulcus to
remove subgingival bacterial accumulation
In some areas the correct brush placement is
limited or impossible ,therefoer modifications
become necessary which add to the complexity of
the procedure.
Requirements in dexterity are high.

30. SCRUB BRUSH METHOD
This method of brushig requires vigorous
horizontal, vertical and circular motions. It is
the virtual free style of the brushing scene .
DISADVANTAGE
Not very effective at plaque removal
Tooth abrasion and gingival recession.

31. THE ROLL TECHNIQUE
This method of brushing is also known as the Rolling Stroke
method or ADA method or the Sweep method.It works fairly well
for patients with anatomically normal gingival tissues.
INDICATIONS
Children
Adult patients with limited dexterity
Useful for preparatory instruction for modified Stillman’s
technique since the initial brush placement is the same
TECHNIQUE
The bristles are placed at a 45˚angle and lightly rolled across the
tooth surfaces towards the occlusal surfaces.
It rquires some flexibility around the wrist.

32. ADVANTAGE
Provides gingival massage and stimulation
DISADVANTAGE
Brushing too high during initial placement can lacerate the alveolar
mucosa.
Tendency to use quick, sweeping strokes resulting in no brushing for
cervical third of tooth
Replacing the brush with filament directed in to the gingiva may produce
punctuate lesions.

33. PHYSIOLOGIC METHOD- SMITH METHOD
It was described by Smith and advocated later by Bell.
Baesd on the principle that toothbrush should follow the
physiologic pathway that is followed by food .
TECHNIQUE
Bristles are pointed incisally or occlusally, then moved along and
over the tooth surfaces and gingiva
The motion is gentle sweeping from incisal/occlusal surfaces over
to facial surfaces and progressing towards and over the gingiva.
ADVANTAGE
Natural self cleansing mechanism
Supragingival cleaning is good.
DISADVANTAGE
Interdental spaces and sulcular areas of teeth are not properly
cleaned.

34. They are adjunctive devices, used to remove plaque from
interproximal tooth surfaces .
Factors in selection of an interdental cleaning aid :
I. Type of gingival embrassure
II. Alingment of teeth
III. Fixed prosthesis/ orthodontic appliances
IV. Open furcation area
V. Contact areas
INTERDENTAL CLEANING AIDS

35. Type of embrasures and interdental aids
 TYPE I-The gingival papilla fills up the
embrasure space completely
dental floss is used.
 TYPEII-The gingival papilla partially fills the
embrasure space.Due to papillary recession.
interdental brushes and toothpicks are used.
 TYPEIII-The embrasure space is not filled.The
gingival papilla has recedeed extensively or
completely lost.unitufted brushes are used.

36. DENTAL FLOSS
Indicated to remove plaque from interproximal tooth surfaces.
TYPES OF DENTAL FLOSS
• Multifilamented -twisted/ non twisted
• Bonded/unbonded
• Thick/thin
• Waxed / unwaxed
FUNCTIONS
Removal of plaque & debris from interproximal areas and under
the pontics of FPD
Polishing of tooth surface
Stimulating &massaging interdental pappillae
Locating subgingival calculus deposits ,overhanging margins of
restoraion ,proximal cairous lesons
Vehicle for application of polishing and therapeutic agents

37. TECHNIQUE OF USING DENTAL FLOSS
SPOOL METHOD:
12-18 inches of floss is taken & about 2 inch
from each end is wound around the middle
finger of each hand.
Last three fingers are folded & closed and
both hands moved apart.
In this way 1-2 inches of floss is held tightly
between the index finger of both hands

38. CIRCLE/LOOP METHOD
Loop of floss is made about 12-18 inches longpiece and both ends
sre tied.
All the three fingers except thumbs of both the hands are placed
within the loop & floss is held tightly by both hands.
Floss holder can also be used , in patients lacking manual
dexterity.
Floss is gently passed through contact area with a firm back&forth
motion .
Once the floss is apical to contact area , it is wrapped around the
tooth & slipped gently under the marginal gingiva.
Then moved firmly along the tooth upto the contact area & gently
down to the sulcus again.
Repeating the strokes for 2-3 minutes

39. INTERDENTAL BRUSHES
They are cone/ cylindrical brushes made of bristles mounted
on a handle.
For cleaning large ,irregular /concave tooth surfaces
adjacent to wide interdental spaces .
By inserting into interdental spaces, moved back&forth
between teeth with short strokes.
WOODEN TIPS
They are manufactured from orange wood & triangular in
cross section.
Repeatedly moved in& out of the embrassure for removing
soft deposits from teeth
Also mechanically stimulating gingiva.
Use restricted to facial aspect of anterior teeth.

40. GINGIVAL MASSAGE
Mechanical stimulation of gingiva by toothbrushing / simple finger
massage leads to :
I. increased keratinization
II. increased blood flow
III. increased flow of GCF within the gingival sulcus
 Results in overall improvement of gingival health
WATER IRRIGATION DEVICES
 Mainly beneficial in the removal of unattached plaque & debris
composed of a built in pump and a reservior
 Also be used to deliver antimicrobial agents eg: chlorhexidine
subgingivally.
 Transient bacteremia reported especially in presence of
inflammation

41. It is the processof removing debris from
thesurfaceoftongue with some form of scraper
designed for this purpose.
Soft flexible plastic scrapers, metal scrapers & soft
toothbrush are used for this purpose.
TONGUE SCRAPERS

42. thankyou