mechanical plaque control

1. Mechanical Plaque Control

2. • Introduction
• Historical Perspective of Toothbrush
• Various Designs of Toothbrushes
• Manual Toothbrushes
• Powered Toothbrushes
• Orthodontic Toothbrushes
• Novel Toothbrushes
• Various Toothbrushing Methods
• Dentifrices
• Interdental Cleaning Aids

3. INTRODUCTION
• Plaque control is the prevention of the accumulation of dental plaque and other deposits
on the teeth and adjacent gingival surfaces.
• The regular use of oral hygiene practices is a requisite for proper supragingival plaque
elimination.
• The conventional toothbrush is the cleaning device most frequently used to remove
dental plaque.
• The effectiveness of a self-care mechanical plaque control depends on motivation,
knowledge, provision of oral hygiene instructions, type of oral hygiene aids used and
manual dexterity.

4. HISTORICAL PERSPECTIVE OF TOOTHBRUSH
• 1600 - Bristle toothbrush appear in China
• 1728 - Pierre Fauchard in his book ‘The Surgeon Dentist’ advocated wet sponges and
specially prepared herb roots
• 1780 - William Addis of England made the first toothbrush
• 1840 - England, France and Germany started producing bristle toothbrush
• 1857 - H.N. Wadsworth patented the first American toothbrush 1900 - Celluloid handles
were used
• 1919 - AAP defined specifications
• 1938 - Nylon was first applied to toothbrush construction
• 1939 - Synthetic were substituted for natural materials

6. VARIOUS DESIGNS OF TOOTHBRUSHES
Manual Toothbrushes
• Toothbrushes vary in size, design, and bristle hardness, length and arrangement.
• Parts of toothbrush
Handle:
• It is the part that is grasped in the hand during toothbrushing.Handles are usually made of plastic
which is sufficiently rigid and durable.
• The dimension of the handle of an adult is 6 inches, junior - 1/6thsmaller than adult size and child
is 1/3rdsmaller than adult size.
• The handle should be thick enough to allow firm grip and good control.
Shank:
It is the section that connects the head and handle. there may be twist, curve or angle in the shank
with or without thumb rests.

7. Head:
• It is the working end which consists of tufts of bristles.
• The length of head is approximately 1 to 1¼ inch and the width - 5/16 to 3/8 inch. Bristle length /
height - 7/16 inches.
• Brushing plane refers as the trim which is characteristic arrangement of the tips of the filaments at
the brushing surface.
• It may range from filaments of equal length i.e flat planes to those with variable lengths such as bi-
level, dome shaped. Bristles in adult toothbrush are usually 10-11 mm long. But the entire filament
should have rounded end because it causes least trauma to the tissues.

8. Powered Toothbrushes
Electrically powered toothbrushes were invented in 1939.
There are number of designs available with different forms of movements: arcuating, reciprocating
and vibrating.
The most recent electric toothbrushes have reciprocating, rotating circular head which are designed to
clean each tooth surface separately, e.g. Phillips Sonicare, Braun/Oral and Colgate Actibrush. They
are also called as mechanical, automatic/ electric brushes. Speed varies from low to high among
different models.
Indications:
i. Those who wear orthodontic appliances
ii. Children and adolescents
iii. Those undergoing complex restorative and prosthodontic treatment iv. Those with dental
implants
iv. Patients with physical or mental disabilities
v. Hospitalized patients, elder ones who need to have their teeth cleaned by caregivers
vi. Poorly compliant periodontal maintenance patient

9. Orthodontic Toothbrushes
The head of the brush features soft bristles that are shorter down the
center, with hedges of taller bristles on either side, allowing the brush to
pass over the appliance without causing abrasion to the teeth. It is also
called as bi-level toothbrush.
Novel Toothbrushes
the design of the brush head has been changed and multiple tufts of
bristles are angled in different directions. Thus, when the head is located
horizontal to the tooth surface, there are bristles angled in the direction
of the approximal tooth surfaces.

10. VARIOUS TOOTHBRUSHING METHODS
i. Roll: a. Roll method b. Modified Stillman
ii. Vibratory: a. Stillman b. Charter c. Bass
iii. Sulcular: Bass
iv. Simultaneous Sulcular: Collis
v. Circular: Fones
vi. Vertical: Leonard
vii. Horizontal: Scrub
viii. Physiologic: Smith

11. Bass method
also called as intrasulcular method.
introduced by Charles Cassedy Bass in 1948, utilizes a soft multitufted brush with bristles 0. 007’’ in
diameter.
Indications:
• For open interproximal areas, cervical areas beneath the height of contour of the enamel and
exposed root surfaces.
• Recommended for any patient with or without periodontal involvement.
Technique:
Beginning at the most distal tooth in the arch, place the head of a soft brush parallel with the occlusal
plane, with the brush head covering three to four teeth. Place the brush with the filament tips directed
straight into gingival sulcus and interproximal embrasures.
The filaments will be directed at approximately 45° to long axis of the tooth. Correct application of
brush should produce perceptible blanching of gingiva.

12. Vibrate the brush back and forth with very short strokes without
disengaging the tips of the filaments from the sulci.
Complete approximately 20 strokes in the same position. Apply the brush
to the next group of 2 or 3 teeth with overlap placement. Insert the brush
vertically to reach the lingual surface of anterior teeth.
Press the heel of the brush into the gingival sulcus area and proximal
surfaces at a 45 degree angle to the long axis of the teeth and brush with
multiple short vibratory strokes.
On the occlusal surfaces press the bristles firmly into the pits and fissures
and brush with about 20 short back-and-forth strokes. Entire stroke is
repeated at each position around the maxillary and mandibular arches,
both facially and lingually.

13. Modified Stillman Method
by Paul R Stillman in 1932.
Indications: In areas with progressing gingival recession and root
exposure to minimize abrasive tissue destruction.
Technique:
• The brush should be placed with the bristle ends resting partly on
the cervical portion of the teeth and partly on the adjacent
gingiva, pointing in an apical direction and at an oblique angle to
the long axis of the teeth.
• Sides of the bristles are placed against the teeth and gingiva
while moving the brush with short, back and-forth strokes in a
coronal direction.
• The occlusal surfaces of molars and premolars are cleaned with
the bristles placed perpendicular to the occlusal plane and
penetrating into the grooves and interproximal embrasures.

14. Charters Method
first described by Leonard Koecker in 1819. However, it was William J
Charters, in 1932 who endorsed and documented this technique.
Indications:
a.Cleaning in areas of healing wounds after periodontal surgery.
b.Cleaning in orthodontic appliances patient.
c.Remove bacterial plaque from abutment teeth and under the gingival
border of a fixed partial denture(bridge) or from the undersurface of
sanitary bridge.
Technique:
Hold brush with filaments towards the occlusal or incisal plane of the
teeth to be brushed, angle the filaments at 45° to the long axis of teeth.
The sides of the bristles should be flexed against the gingiva, and a back-
and forth vibratory motion used to brush. The technique was designed to
gently massage the gingiva, so the bristle tips should not drag across the
gingiva.

15. Fones Method
Indications:
School children/young children because of simplicity.
Dr. Fones advocated this circular method.
Occlude the teeth and lightly press bristles of toothbrush against posterior teeth and gingiva.
Revolve brush head in a fast circular motion, using a large diameter circles. Continue circular motion.
Hold maxillary and mandibular teeth apart and use same circular motion on maxillary lingual
surfaces and then on mandibular lingual surfaces.
Disadvantages:
• May traumatize soft tissues
• Does not clean teeth adequately especially interproximal areas

16. • DENTIFRICES
• Dentifrices aid in cleaning and polishing tooth surfaces. They are used mostly in the form of
pastes, although in the appropriate amount carry the ADA seal of approval for caries control and
can be relied on to provide caries protection.
• Recommendations
• Dentifrices increase the effectiveness of brushing but should cause a minimum of abrasion to root
surfaces.
• Products containing fluorides and antimicrobial agents provide additional benefits for controlling
caries and gingivitis.
• Patients who form significant amounts of supragingival calculus benefit from the use of a calculus
control dentifrice.

18. Therapeutic Ingredients:
a. Fluoride agents: Fluorides currently used in dentifrices are sodium fluoride,
sodium monofluorophosphate, and stabilized stannous fluoride.
b. Plaque-inhibiting agents: Sanguinaria, chlorhexidine, lactoperoxidase,
triclosan, zinc and stabilized stannous fluoride are the plaque - inhibiting agents
used in dentifrices.
c. Desensitizing agents: Fluorides agents have been claimed to have desensitizing
properties and are contained in specialized dentifrices (e.g. stannous fluoride);
nonfluoride agents commonly used in desensitizing agents include strontium
chloride, potassium nitrate, and sodium citrate.

19. d. Tartar control agents: Interfere with the calcium phosphate bond in the calculus
matrix, thus allowing easier removal of soft calculus during toothbrushing; effective
only on formation of supragingival calculus on enamel surfaces.
1. Pyrophosphate system: Pyrophosphate has a negative charge, attracts positively
charged calcium ions, and interferes with calculus formation.
2. Zinc system: Zinc has a positive charge, attracts negatively charged phosphate
ions, and interferes with calculus formation.
• Whitening agents: Several dentifrices are marketed for their ability to remove
stains; several whitening dentifrices have low abrasive levels; may be effective for
maintenance of cosmetic restorations.

20. INTERDENTAL CLEANING AIDS
Interdental cleaning aids are interdental brushes, dental floss, interdental tips, wooden tips, rubber
tips, plastic tips and dental tape.
The various factors, which should be taken into consideration while recommending an interdental
cleaning methods are type and size of the interproximal embrassure,
type 1 embrassures no gingival recession, dental floss is been used;
type 2 embrassures where there is moderate papillary recession, interdental brush is used;
type 3 embrassures there is complete loss of papillae, there unitufted brush is used.
Other factors are contour and consistency of gingival tissues, tooth position and alignment, ability
and motivation of patient, presence of orthodontic appliance or fixed prostheses and presence of
furcation lesion

23. • The advantages of interdental brushes over dental floss are that: Interdental brushes clean
concave root surface and furcations more efficiently than dental floss and are much easier to
use than dental floss.
• When floss is placed over a concave surface in furcation region, contact is not possible and thus
supplementary interdental devices are needed to completely remove plaque and deposits.
• When dentifrices are used, dental tape may be better than floss in retaining the dentifrices
against the tooth. In single tufted brush, there is present a group of small tufts 3 to 6 mm in
diameter which may be flat or tapered.
• These are recommended in furcation areas, distal surfaces of the most posterior molars. These
brushes are adaptable around and under fixed partial dentures, pontic and implant abutment
easily. The end of tuft is directed into interproximal area and along the gingival margin.

28. Tongue scraper
It may be made of plastic, stainless steel or other flexible metal.
It is indicated in high caries risk, periodontal risk patients and patients suffering from halitosis.
Rationale behind tongue cleaning is that periodontal pathogens produce Volatile Sulphur compounds
(VSC) which is responsible for halitosis and accumulates mostly within the filiform papillae and on
the back of the tongue.
The tongue brush/scrapers are placed as far back on the tongue as possible (Fig. 37.26). Once the
scraper is in position, gently drag it forward and repeat 2 or 3 times or until tongue is clean.

29. • ORAL IRRIGATION
Supragingival Irrigation
• Oral irrigators for daily home use by patients work by directing a high-pressure,
steady or pulsating stream of water through a nozzle to the tooth surfaces. Most
often, a device with a built-in pump generates the pressure.
• Oral irrigators clean nonadherent bacteria and debris from the oral cavity more
effectively than toothbrushes and mouth rinses. Irrigators are particularly helpful
for removing debris from inaccessible areas around orthodontic appliances and
fixed prostheses.

30. • Subgingival irrigation
• Subgingival irrigation performed both in the dental office and at home by the
patient, particularly when antimicrobial agents are used, has been shown to
provide some site-specific therapy.
• It is performed by aiming or placing the irrigation tip into the periodontal pocket,
attempting to insert the tip at least 3 rim, using a sort rubber tip°’.
• Subgingival irrigation performed with an oral irrigator using chlorhexidine diluted
to one-third strength, performed regularly at home and after scaling, root planing,
and in-office irrigation therapy, has produced significant gingival improvement
compared with controls.