1) Mechanical plaque control methods like toothbrushing and the use of interdental cleaning aids are essential for maintaining oral hygiene. 2) Toothbrushing removes plaque from facial and occlusal surfaces but interdental cleaning is needed for proximal surfaces. The Bass technique is commonly recommended for toothbrushing. 3) Interdental cleaning aids include dental floss, interdental brushes, woodsticks and rubber tips which are suitable for different interdental spaces.

1. MECHANICAL PLAQUE CONTROL

2. 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.

4. 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.

5. Mechanical Plaque Control
 Toothbrushes
-Tooth brushing techniques
-Powered toothbrush
 Dentifrices
 Interdental Cleaning Aids
-Dental floss
- Interdental brush
- Wooden/ Rubber tips

6. Toothbrushes
• 1600 - Bristle toothbrush appear in China
• 1857 - H.N. Wadsworth patented the first American toothbrush
History:

8. TYPES OF TOOTH BRUSH
ACCORDING TO
USE :
• Manual
• Electrical
• Interdental
TYPE OF HANDLE :
• Non slip grip - straight
• Flexible neck
SHAPE OF HEAD
• Tapered
• Rectangular
STYLE OF BRISTLE
• Rippled
• Flat
• Dome shaped
BRISTLES
• Soft
• Medium
• Hard

9. Bristles
It is either natural or artificial
Natural bristles from hogs
Artificial filaments made of nylon are Superior
They are grouped in tufts which are arranged in 2-4 rows
The brush is either unitufted or multitufted
Soft bristles are more flexible, clean beneath gingival margin and can reach
farther onto proximal surfaces

10. Bristles…..
Bristle hardness is proportional to square of diameter
Diameter of bristle
• Soft brush = 0.2 mm
• Medium brush = 0.3 mm
• Hard brush = 0.4 mm
• Ultra soft = 0.075 mm

11. Toothbrush specification
American Dental Association (ADA)
• Brush length: 1-1.25 inches
• Brush width: 5/16 - 3/8 inches
• 2-4 rows
• 5-12 tufts per row
• Surface area : 25.4 to 31.6 mm long

12. Recommendations:
Soft, nylon bristle toothbrush clean effectively when used properly ,remain
effective for a reasonable time and tends not to traumatize the gingiva or root
Toothbrushes need to be replaced every 3-4 months
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

14. Toothbrushes
Toothbrushing methods:
Classification given by Greene J.C (1966)
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.
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
•Reposition to next group of teeth.

16. MODIFIED BASS TECHNIQUE
This method differs from bass technique in that it has sweeping motion from cervical to incisal or
occlusal surface.
INDICATION:
As a routine oral hygiene measure.
Intrasulcular cleansing.
ADAVANTAGE:
Excellent sulcus cleaning.
Good inter proximal and Gingival cleaning.
Good gingival stimulation.
DISADVANTAGE:
Dexterity of wrist is required.

17. MODIFIED BASS TECHNIQUE
Toothbrush positioned on facial and maxilloproximal surfaces of maxillary molars.
Palatal position on molars and pre molars.
• This technique combines the vibratory & circular movements of the Bass technique
with the sweeping motion of the Roll technique.
The toothbrush is held in such a way that the bristles are at 45° to the gingiva.
• Bristles are gently vibrated by moving the brush handle in a back & forth motion.
• The bristles are then swept over the sides of the teeth towards their occlusal surfaces
in a single motion.
Brush position on the occlusal surface used with Bass, Stillman, Charter's method.
Palatal position on incisors.
Intrasulcular position of the brush at 45º angle to the long axis of the tooth.

18. Bass Method

19. Stillman Technique
 Same stroke as bass .
 Same angle 45 dgree.
 Filaments are placed half
in sulcus and half on
gingiva.
INDICATIONS :
 Gingival recession
 to clean large embrasures
 remove plaque from
cervical regions

20. 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

21. Toothbrushes
Powered Toothbrushes
-invented in 1939
Its mainly recommended for:
 Individual lacking motor skills
Can be used in children .
Hospitalized patients whose teeth are cleaned by caregivers
 Special needs patient(physical & mental disability)
 Patient with orthodontic applied.

22.  Mimics back and forth tooth brushing
technique
 Removes plaque in shorter duration.
 Has better plaque removal efficiency.
Variations:
 Reciprocal of Back and Back motions
 Circular and Eliptical motions
 Combination of both

23. Sonic Powered toothbrush
These types of toothbrushes produce high
frequency vibrations (1.6MHz)which leads
to the phenomenon of cavitation and
acoustic microstreaming
This phenomenon aids in stain removal as
well as disruption of the bacterial cell wall
(bactericidal)

24. 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 gum
Sweeteners: saccharine
Humectants: glycerin and sorbitol
Flavors: mint & peppermint
Actives: flourides,triclosan, stannous fluoride

25. Detergent – 1.2%Sodium lauryl sulphate • Use – To lower surface tension -
Penetrate and loosen surface deposits and strains • Emulsify debris for easy
removal by toothbrush Contribute to the foaming action
2. Cleaning and polishing agents - 20-40% Calcium carbonate, calcium
pyrophosphate bicalcium phosphate • Uses– Act as abrasive agents for cleaning
and polishing objectives.
• Polishing agent is used to produce a smooth shining tooth surface that resists
discoloration, bacterial accumulation and retention
3. Binders – 1.2%Organic hydrophilic colloids, alginates, magnesium aluminium
silicate, colloidal silica
• Use – To prevent separation of the solid & liquid ingredients during storage

26. 4. Humectants : 20-40%Glycerin : Sorbitol • Use – Added to retain moisture •
Prevent hardening on exposure to air. • To stabilize preparation
5. Preservatives - Alcohol, formaldehyde ; dichlorinated phenols Use – To
prevent bacterial growth and to prolong shelf life
6. Sweetener : 2-3%Sorbitol ,sodium saccharin, sorbitol, xylitol Use – To import
a pleasant flavor for patient acceptance
7. Flavoring agent : 1-15%Peppermint : cinnamon, menthol • Use – To make the
dentifrices desirable To make other ingredients that may have less pleasant
flavor
8. Therapeutic agent 1-2 %Fluoride • Use – For medical value
9. Coloring agent 2-3% -Added for all activeness
10. Water 20-40%Main transport medium

27. Interdental cleaning
The toothbrush does not reach the approximal surfaces of teeth as efficiently as
it does for the facial, lingual, and ooclusal aspects nor does it reach into the
interproximal area between adjacent teeth
• Therefore measures for interdental plaque control should be selected to
complement plaque control by toothbrushing

28. DENTAL FLOSS
• FREQUENTLY RECOMMENDED TECHNIQUE
• LEVI SPEAR PARMLY from New Orleans , dentist inventor of modern dental
floss.
• Unwaxed dental floss recommended for patients with normal tooth contacts
• Waxed dental floss - tight tooth contact
• Powered floss - with special handle - No significant difference in plauqe
removal but preferred by patients due to ease of use.

29. Take a 20-25cm long floss
Hold the ends of the floss together

30. Make a small loop around the tip of
the forefinger
Pass the ends of the floss thrugh
the loop
Make a knot

31. Use thumb and forefinger of both hands to
hold the floss. use sawing motion to slide into
the interdental space.
Wrap around one tooth , make C shape , gently
pull down to the deepest part of the gingival
sulcus Slide it up and down

32. Wrap around the adjacent tooth and repeat up
and down motion
Clean adjacent teeth surfaces in similar way

34. Spool method (also called the finger-wrap method)
Cut off a piece of floss about18 to 20 inches long.
Lightly wrap each side of the piece of floss several times around each middle
finger.
Next, carefully move the floss in between the teeth with your index fingers and
thumbs in an up and down, not side-to-side, motion.
Bring the floss up and down, making sure to go below the gum line. Bend it to
form a C on the side of each tooth

35. PURPOSE
 To remove plaque and food lodged between teeth.
 For ideal plaque control , brushing should be supplemented with aids that
assist in cleaning interproximal surfaces

36. INTERDENTAL BRUSHES
• Introduced in 1960s , alternative to woodsticks
• effective in plaque removal from proximal tooth
surfaces.
• Recommended ideally for periodontitis patients.
• Uncomfort for sensitive root surfaces
• INDICATIONS
proximal tooth surfaces ,
orthodontic appliances
fixed prosthesis ,
periodontal splints
Exposed class IV

37. SINGLE TUFTED BRUSH
• Designed with smaller brush heads
• Tuft is 3-6mm diameter
• Handle is straight or contra angled.
• Angulated handles are more easier to
access palatal and lingual surfaces.
• Filaments are directed into the required
area and activated with rotation motion.
• Their design permits access to even
tipped , rotated or displaced tooth. Also
effectively cleans Fixed dentures ,
orthodontic appliances.

38. WOOD STICKS
• Earliest habit – toothpicks
• Triangular wedge sticks are
more superior in plaque
removal
• Unlike floss , they can be
used on concave surface of
tooth root

39. INTERDENTAL TIP
• Conical or pyramidal flexible rubber tip
attached to handle.
• Trace along the gingival margin (1-2mm)
below
• Indicated for biofilm removal at or just
below gingival margin
• For clearing debris from interdental
areas.

40. Interdental cleaning methods recommended
for particular situations in the mouth
Situation
• Intact interdental papillae; narrow interdental
space
• Moderate papillary recession; slightly open
interdental space
• Complete loss of papilla; wide open interdental
space
• Wide embrasure space; diastema, extraction
diastema, furcation or posterior surface of most
distal molar, root concavities or grooves
Interdental cleaning method
• Dental floss or small woodstick
• Dental floss, woodstick or small
interdental brush
• Interdental brush
• Single-tufted/end-tufted brush or
gauze strip