Plaque control

1. Mechanical plaque control
PRESENTED BY: MANOJ M. PARADHI
1st YEAR PG
Dept. Of Periodontics
And Oral Implantology

2.  Introduction
 Mechanical plaque control:
Toothbrushes:
• Manual toothbrushes
-Tooth brushing techniques
• Powered toothbrushes
• Sonic and ultrasonic toothbrushes
• Ionic toothbrushes
 Dentifrices
 Interdental cleaning aids:
• Dental floss
• Interproximal/interdental brushes
 Aids for gingival stimulation:
• Gingival massage
• Water irrigation devices
Tongue scrapers

3. Introduction
• Mechanical plaque control is the removal of microbial plaque and the
prevention of its accumulation on the teeth and adjacent gingival
surface by the use of mechanical oral hygiene aids.
• It is an effective way of treating and preventing gingivitis,
periodontitis.

4. The Toothbrush
• Acc. To ADA “Toothbrushes are designed to
promote cleanliness of the teeth and oral
cavity”.
• The bristles tooth brush appeared about the
year of 1600 in China and later was patented in
America in 1857.
• Types of toothbrushes:
• Manual toothbrushes
• Powered toothbrushes
• Sonic and ultrasonic toothbrushes
• Ionic toothbrushes

5. •0bjectives of toothbrushing:
1) To clean teeth and interdental spaces
2) To prevent plaque formation
3) To disturb and remove plaque
4) To stimulate and massage gingival tissue
5) To clean the tongue
•Outcome of tooth brushing depends on following
factors (Frandsen, 1986):
•Design of the brush
•Skill of the individual using the brush
•Frequency and duration of brushing

6. • Parts of toothbrush –
• Handle: Part grasped in hand during
toothbrushing.
• Head: Working end of a toothbrush
that holds the bristles.
• Brushing plane: The surface formed
by the free ends of bristles.
• Shank: Connects the head and
handle.
Manual toothbrushes

7. • ADA given specification of toothbrushes:
• Length : 1 to 1.25 inches
• Width : 5/16 to 3/8 inches
• No. of rows : 2 to 4 rows of bristles
• No. of tufts : 5 to 12 tufts per row
• No. of bristles : 80 to 85 bristles per tuft

8. • Powered tooth brush was invented in
1939.
• The heads of these toothbrushes
oscillate in a side to side motion or in a
rotary motion.
• Indications:
(1) Hospitalized patients whose teeth are
cleaned by the caregivers.
(2) Physical and mental disability patients
(3) Patient with orthodontic appliances.
Powered toothbrushes

9. Sonic and ultrasonic toothbrushes
• These types of toothbrushes produce
high frequency vibrations (1.6Mhz),
which lead to the phenomenon of
cavitation and acoustic micro streaming .
• This phenomenon aids in stain removal as
well as disruption of the bacterial cell
wall (bactericidal).

10. Ionic toothbrushes
•The ionic toothbrushes changes the
surface charge of a tooth by influx of
positively charged ions.
•The plaque of similar charge is repelled
from the tooth surface and is attracted by
the negative charged bristles of
toothbrush.

11. Dentifrices

12. Composition of Dentifrices
Agents Material used functions
Polishing / Abrasive agents Calcium carbonate
Dicalcium phosphate dihydrate
Alumina
Silicas
This agents have a mild abrasive action, which aids in
elimination plaque and removing stains from the tooth surface
Binding / Thickening agents Water soluble agents:
Alginates
Sodium carboxymethyl cellulose
water insoluble agents:
Magnesium aluminium silicate
Colloidal silica
Sodium magnesium silicate
Agents which controls stability and consistency of a tooth
paste
Detergents / surfactants Sodium lauryl sulfate Produce a foam which aids in the removal of food debris and
also dispersion of the product within the mouth
Humectants Sorbitol
Glycerine
Polyethylene glycol
Aids in reducing the loss of moisture from the toothpaste

13. Agents Material used Function
Flavoring agents Peppermint oil
Spearmint oil
Oil of wintergreen
They render the product pleasant to use
and leaves a fresh taste in the mouth
Sweeteners and colouring agents saccharin sweetener
Antibacterial agents Triclosan , delmopinol ,metallic ions ,
zinc citrate trihydrate
Anticaries agents Sodium mono fluorophosphates
Sodium fluoride
Stannous fluoride
Anticalculus agents Pyrophosphates
Zinc citrate
Zinc chloride
Desensitizing agents Sodium fluoride
Potassium nitrate
Strontium chloride

14. Tooth brushing techniques
Acc. to Green JC (1966):
•Roll Technique: Modified Stillman or Roll technique
•Vibratory Technique: Stillman , Charters & Bass technique
•Circular Technique: Fones technique
•Vertical Technique: Leonard’s method
•Horizontal Technique: Scrub brush method
•Physiologic Technique :Smith method

15. The bass method or sulcus cleaning method
Most widely accepted & effective method.
TECHNIQUE:
• The bristles are placed at 45° angle to
the long axis of teeth.
• Exert gently vibratory pressure ,using
short back and forth motion without
dislodging tip of bristles.
• On lingual aspect of the anterior teeth ,
the brush is inserted vertically and the
heel of the brush is pressed into the
gingival sulci and proximal surfaces at
45°angle .
• Occlusal surfaces cleaned by pressing
bristles against pit and fissures.

16. INDICATIONS FOR BASS METHOD OR SULCUS CLEANING METHOD :
• For open interproximal areas, cervical areas beneath the height of
contour of enamel and exposed root surfaces.
• Recommended for routine patients with or without periodontal
involvement.

17. Modified bass technique
TECHNIQUE:
•It is a combination of vibratory and
circular movements of bass technique
with the sweeping motion of the roll
technique.
•Tooth bristles are held at 45° to the
gingiva and gently vibrated by back
and forth motion, it then swept over
the sides of the teeth toward their
occlusal surface in a single motion.

18. INDICATIONS
• As a routine oral hygiene measure.
• Intrasulcular cleansing

19. Stillman's technique
TECHNIQUE:
• Brush end where placed partly on the gingiva and the cervical areas of the tooth
and directed apically .
• Handle was given slight rotary motion and partly on the brush ends maintained
in position on tooth surface.
• The procedure is repeated systematically on adjacent teeth .
INDICATIONS:
• This method was design for massage and stimulation of gingiva as well as for
cleaning the cervical areas.

20. TECHNIQUE:
• Bristles are pointed apically with an oblique
angle to the long axis of tooth.
• Bristles are positioned partly on cervical aspect
of the teeth and partly on the adjacent gingiva
activated by short back and forth motion and
simultaneously moved in coronal direction
• Following 20 strokes, the procedure is repeated
systematically on adjacent teeth .
• A soft toothbrush is indicated for these
technique .
Modified Stillman's technique

21. •INDICATIONS :
• Bacterial plaque removal from cervical areas below the height
of contour of crown.
•Recommended for cleaning in areas with progressing gingival
recession and root exposure.

22. Fones method or circular /scrub method
TECHNIQUE:
• The child is asked to Stretch his arms such that they are parallel to the floor.
• And then asked to make a big circle using the whole arm to draw circle in the air.
• The circle are reduced in diameter until very small circle is made in front of
mouth.
• Now child is ready to make circles on the teeth with the toothbrush, making sure
that the teeth and gums are covered.
INDICATIONS :
• Young children
• Physically handicapped individuals
• Patients who lack of dexterity.

23. Vertical method – Leonard's method
TECHNIQUE:
• Bristles placed at 90°angle to facial surface of teeth.
• Bristle motion is vertically up & down on facial surface
with clinched teeth.
• Teeth are placed edge to edge to keep the brush slipping
over the occlusal or incisal surface.
INDICATIONS
Convenient and effective for small children with deciduous
teeth.

24. Charter’s method
TECHNIQUE:
• Bristles are placed at an 45° angle directed coronally
• Bristles are activated by mild vibratory strokes with
the bristle ends lying interproximaly.
• A soft, multi-tufted tooth brush is indicated for this
technique.
INDICATIONS:
• Individuals having open inter dental spaces with
missing papilla and exposed root surfaces.
• For patient who had periodontal surgery.
• Patient with moderate interproximal gingival
recession.

25. Scrub brush method
• These method of brushing requires vigorous horizontal, vertical and
circulatory motions.
• It is the virtual free style of brushing scene.
DISADVANTAGE :
• Not very effective at plaque removal
• Tooth abrasion and gingival recession

26. Roll technique
TECHNIQUE:
• Bristles are placed direct apicaly and lightly rolled
across the tooth surface towards the occlusal
surfaces.
INDICATIONS:
• Children
• Adult patient with limited dexterity

27. Physiologic method –Smith method
• The physiological method described by Smith and advocated by Bell
• Based on the principle that the toothbrush should follow the physiologic pathway
that is followed by food when it traverses over the tissue during mastication.
TECHNIQUE :
• The bristles are pointed incisally or occlusally and then moved along and over the
tooth surface and gingiva.
• The motion is gently sweeping from incisal or occlusal surfaces over to facial
surface and progressing towards and over to gingiva.
ADVANTAGES:
• Natural self cleansing mechanism
• Supra gingival cleaning is good

28. Maintenance of tooth brushes
•Stored toothbrushes in dry areas .
•Toothbrushes should be kept in open air with head in
upright position with no contact with other brushes.
•The useful life of an average toothbrush is 2–3 months.

29. Interdental cleaning aids
• Use to remove plaque from inter proximal tooth
surface.
• Factors to be considered for selection of the
Interdental cleaning aids:
-Type of gingival embrasure
-Alignment of teeth
-Fixed prosthesis/orthodontic appliances
-Open furcation areas
-Contact areas

30. Dental floss
• Dental floss indicated to remove plaque from
interproximal tooth surfaces.
• Various forms:
oMultifilament –twisted / non-twisted.
oThick/thin
oWaxed/non waxed

31. Dental floss :
• Functions –
Remove plaque from interdental areas
Stimulate and massage gingiva
Improve oral hygiene
Reduce gingival bleeding
Helps in locating subgingival calculus deposits,
overhanging margins of restoration and proximal
carious lesions.

32. Interproximal/Interdental brushes
• They are cone shaped or cylindrical brushes
made of bristles mounted on handle.
• Indication:
For cleaning large , irregular or concave
tooth surface adjacent to wide interdental
spaces.
• They are inserted through interproximal
spaces and move back and forth between
the teeth with short strokes.

33. GINGIVAL MASSAGE
• The mechanical stimulation of gingiva either by toothbrushing or
interdental cleansing with various aids or simple finger massage leads
to
l . Increased keratinization.
2. Increased blood flow.
3. Increased flow of gingival crevicular fluid within the
gingival sulcus.
• This results in an over all improvement in the gingival health

34. Oral irrigation
Water irrigation devices(water pik):
• Indications –
-Inaccessible interdental areas around
Orthodontic/prosthetic appliances
-Deep gingival sulcus
-Delivers antimicrobial agents
(eg.chlorhexidine)
• Disadvantages –
-Expensive
-If excessive pressure used, fluid and air is
forced into underlying tissues & cause
damage to tissues.

35. • The most common oral irrigators have a built-in pump and reservoir.
• Conventional plastic tips are used for daily supragingival irrigation at home by the patient.
Left , Tip for cleaning dorsal surface of the tongue
Right ,Tip for gingival irrigation.
• Soft rubber tip is used for daily subgingival irrigation by the patient at home.

36. Tongue scrapers
• The process of removal of debris from the
tongue with some form of scraper designed.
• Tongue scrapers are made of soft flexible
plastic material.
• Tongue cleaning Device is placed at the
dorsum of the tongue and pulled forwards
with light pressure.

37. Conclusion
• Mechanical plaque control is the key to success of periodontal therapy
and achieving the dental health.
• The clinician must evaluated patient plaque control by means of
gingival and plaque indices to motivate the patient about periodontal
health.
• Common devices to be recommended to the patient are soft bristle
tooth brush, floss, interproximal brushes.
• Thoroughness and frequency of brushing are probably more
important than a specific toothbrushing method

38. REFERENCES
• Carranza, Newman. Textbook of clinical periodontology. 11th
edition. WB Saunders, 2011. page 625-633.
• Preventive and community dentistry, Soben peter,4th
edition,2009.page 121-132.
• Esther M. Wilkins Clinical practice of dental hygienist (8th ed)
page 351-367.