This document discusses mechanical plaque control methods in dentistry. It begins by defining dental plaque and describing its formation. It then discusses various toothbrushes, including manual, powered, sonic/ultrasonic, and ionic varieties. Features of an ideal toothbrush and toothbrush parts are outlined. Toothpaste ingredients and functions are also summarized. The document reviews techniques for toothbrushing and describes other plaque control aids like dental floss, interdental brushes, wood sticks, and tongue scrapers. It concludes by noting statistics on toothbrushing habits in India.

1. PRESENTED
BY:
PUBLIC HEALTH DENTISTRY
MECHANICAL
PLAQUE CONTROL

2. Dental plaque is defined as a structured,
resilient,yellow-grayishsubstance that adheres
tenaciously to intraoral hard surfaces, including RPD &
FPD.
FORMATION OF PLAQUE:
• The formation of pellicle.
• Initial adhesion and attachment of bacteria
• Colonization and plaque maturation.
KEY MICROORGANISMS IN PERIODONTAL DISEASES
• Actinobacillus actenomycetemcomitans
• Tannerella forsythia
• Porphyromonas gingivalis

3. • plaque growth is negligible
1st 24
Hours
• growth increases rapidly and
then slows down
Following
3 days
• 30% of tooth crown
covered with plaque
after 4
days

4. MECHANICAL PLAQUE CONTROL AIDS
TOOTHBRUSHES AND DENTIFRICES
INTERDENTAL AIDS
AIDS FOR GINGIVAL STIMULATION
TONGUE SCRAPERS
• Dental floss
• Interdental brushes
• Wooden tips
• Gingival Massage
• Water Irrigation Devices
01
02
03
04

5. TOOTHBRUSHES
These are the most widely used oral hygiene aids. It is the principal
instrument in general use for accomplishing goals of plaque control.
According to ADA-
“The toothbrush is designed primarily to promote cleanliness of
teeth and oral cavity.”
OBJECTIVES OF TOOTH BRUSHING:
• To clean teeth and interdental spaces of food
remnants,debris and stains.
• To prevent plaque formation.
• To disturb and remove plaque.
• To stimulate and massage gingival tissue.
• To clean the tongue.

6. There is no clearcut evidence which
type of brush is superior than other.
Many authors recommend that soft
filament brushes are better in view of
the damage the hard filaments may
cause.
MANUAL
TOOTH-
BRUSHES
POWERE
D
TOOTH-
BRUSHES
SONIC AND
ULTRASONIC
TOOTH-
BRUSHES
IONIC
TOOTH-
BRUSHES

7. IDEAL CHARACTERISTICS OF A TOOTHBRUSH ARE:

8. PARTS OF A TOOTHBRUSH
HANDLE The part grasped in the hand during tooth brushing.
HEAD The working end of a toothbrush that holds the bristles or
filaments.
TUFTS Clusters of bristles or filaments secured into the head.
BRUSHING PLANE The surface formed by the free ends of the bristles or
filaments.
SHANK The section that connects head and handle.
The bristles with or without rounded ends are arranged in rows and follws a particular pattern according to brush
design.
The size of the head should be small enough for maximum maneuverability in the oral cavity.
The handle of a toothbrush should be long enough to fit the palm of the hand.
Straight handles are most common. Contra angled handles may provide the brushes with a better sense of touch.

9. They can be hard, soft, natural or synthetic, multi-tufted
or space-tufted.
Natural bristles are obtained from hair of hog or wild
boar. The bristles are tubular in formand are more
susceptible to breaking, contamination with microbial
debris,softening and loss of elasticity.
Synthetic bristles are made of nylon and uniform in size
and elasticity, resistant to fracture and don’t get
contaminated.
THE STIFFNESS OF BRISTLES VARY BASED ON :
1. Diameter of bristles: wider bristles are stiffer than
those with lesser diameter. ranges from 0.0035 to
0.0190inch
2. Length of bristles:Stiffness is inversely proportional t
its length.
3. Number of filaments in a tuft: Each filament support
adjacent filament and each tuft supports adjacent
tuft.
4. Curvature of Filaments: curve falaments may be
more flexible and less stiff than the straight.
Manual toothbrushes are
designed to reach and
efficiently clean most areas of
oral cavity.
Conventional toothbrushes
may be modified in order to
achieve enhanced plaque
removal.
TOOTHBRUSH MODIFICATIONS
• Long and contoured handle
• Double angulation of handle and
neck
• concave surface of the brushing
plane.
• Special indicator bands.

10. TYPES OF BRISTLES

11. 20% 80%
• In 1885, FREDRICK TORNBERG, a Swedish watchmaker designed the first
mechanical toothbrush followed by the first mechanical toothbrush in
1939.
• They are also known as automatic, electric or mechanical toothbrushes.
• Mimics the action of manual toothbrushes and makes it faster and
efficient.
• Heads oscillate from side-to-side motion or in a rotary motion.
• Frequency of oscillations=40Hz
1. Young children
2. Handicapped Patients
3. Individuals lacking manual dexterity
4. Patients with Prostho or endosseous
implants
5. Orthodontic patients
6. Instituitionalized patients including the
elderly who are dependant on care
providers.
7. Patients on supportive periodontal
therapy.
• increases patient motivation resulting in better patients
compliance.
• increased accessibility in interproximal and lingual tooth
surfaces.
• No specific brushing technique required.
• uses less brushing force than manual toothbrushes.
• Brushing timer is incorporated in some brushes to help
the patient in brushing for the required duration .

12. These 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).
 Change the surface charge of tooth by an
influx of positively charged ions.
 Plaque with a similar charge is thus repelled
from the tooth surface and is attracted by
the negatively charged bristles of brush.

13. According to American Dental Associations Council on Dental therapeutics-
“A dentrifice is a substance used with a toothbrush for the purpose of
cleaning the accessible surfaces of the teeth”.
Webster described the term as derived from dens(tooth) and fricare(to rub).
The functions of toothpaste in conjunction with tooth brushing are:
• minimizing plaque build up
• anticaries action
• removal of stains
• mouth freshner
Available in the form of pastes, tooth powder and gels.
APPLICATIONOF DENTIFRICES:
• For effective cleaning, pea-sized dab on the top half of
the toothbrush.
• Dentifrice should preferably be dispersed in between
the bristles rather than on the tips.
• Children under 6 years of age should be given half the
amount of dentifrice as an adult.

14. AGENTS MATERIAL USED FUNCTIONS
POLISHING/ABRASIVE
AGENTS
• CALCIUM CARBONATE
• DICALCIUM PHOSPHATE DIHYDRATE
• ALUMINA
• SILICAS
These agents have a mild
abrasive action, which aids in
eliminating plaque and
removing stains from the tooth
surface.
BINDING/THICKENING
AGENTS
WATER SOLUBLE AGENTS
• ALGINATES
• SODIUM CABOXYMETHYL
• CELLULOSE
INSOLUBLE AGENTS
• MAGNESIUM AL. SILICATE
• COLLOIDAL SILICA
Agents which controls stability
and consistency of a
toothpaste.
DETERGENTS/
SURFACTANTS
SODIUM LAURYL SULFATE Produces the foam which aids
in the removal of food debris
and also dispersion of product
within the mouth.
HUMECTANTS • SORBITOL
• GLYCERIN
• POLYETHYLENE GLYCOL
Aids in reducing the loss of
moisture from toothpaste

15. AGENTS MATERIAL USED FUNCTIONS
FLAVOURING AGENTS • PEPPERMINT OIL
• SPEARMINT OIL
• OIL OF WINTERGREEN
They render the product pleasant to use
and leaves a fresh taste in the mouth after
use.
SWEETENERS AND
COLOURING AGENTS
SACCHARIN Sweetener
ANTIBACTERIAL AGENTS TRICLOSAN,DELMOPINOL,
METALLIC IONS, ZINC CITRATE
TRIHYDRATE
ANTICARIES AGENTS SODIUM
MONOFLUOROPHOSPHATE,
SODIUM FLUORIDE, STANNOUS
FLUORIDE
ANTICALCULUS AGENTS • PYROPHOSPHATES
• ZINC CITRATE
• ZINC CHLORIDE
Anticalculus agents are mostly designed to
inhibit the mineralisation of plaque. They
are also known as CRYSTAL GROWTH
INHIBITORS.
DESENSITIZING AGENTS • SODIUM FLUORIDE
• POTASSIUM NITRATE
• STRONTIUM CHLORIDE

16. A number of toothbrushing techniques have
acheived acceptance by the dental profession.
Each technique has been designed to achieve
a definite goal. Hence, no one procedure can
be described as the best.
Depending on the individual cases, the
techniques of toothbrushing may have to be
altered to achieve the maximum beneficial
effect.

17. It is the 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 contour of the enamel and
exposed root surfaces.
• Recommendedfor routine patients with or without
periodontal involvement.

19. W
S
O T
• Effective method of removing plaque
• Provides good gingival stimulation.
• Easy to learn.
• Overzealous brushing may convert the very “short strokes” into a
scrub brush technique and cause injury to the gingival margin.
• Time consuming
• Dexterity requirement is too high for certain patients.

20. INDICATIONS:
• As a routine oral hygiene measure.
• Intrasulcular cleaning.
ADVANTAGES:
• Excellent sulcus cleaning.
• Good interproximal and gingival cleaning.
• Good gingival stimulation.
DISADVANTAGES:
• Dexterity of wrist movement.

21. This technique combines the vibratory and 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 degree to the gingiva.
Bristles are gently vibrated by moving the brush
handle in a back and forth motion.
The bristles are then swept over the sides of the
teeth towards their occlusal surfaces in a single
motion.

30. India has lowest per capita toothbrush consumption as most of the people use
fingers, neem sticks and other tools- as per a report by INDIAN MARKET
RESEARCH BUREAU on consumer usage and attitude survey.
• Only 51% of Indians brushed the teeth with toothbrush and toothpaste.
• Only 28% brushed teeth twice a day.
• Nearly 34% believed that brushing once a day was more than enough.
The study has startling facts that:
• 65% of Indians change toothbrush only after visible signs of damage
• 55% change when bristle start bending or flowering.
• 43% are compelled to change when brush looks dirty
• 32% change when bristle starts coming out.

31. These are adjunctive devices, which are used to remove plaque
from the interproximal tooth surfaces.
FACTORS IN SELECTION OF AN
INTERDENTAL AID:
• Type of gingival embrasure
• Alignment of tooth
• Fixed Prosthesis/orthodontic appliances
• Open furcation areas
• Contact areas

32. This is a type of interdental cleaning aid to remove plaque
from interproximal tooth surfaces.
FORMS OF DENTAL FLOSS:
• Multifilament-twisted/ non- twisted
• Bonded/ Non bonded
• Thick/ Thin
• Waxed/ Non waxed
DISADVANTAGES:
• It is time consuming.
• Requires skill
• Carries the risk of tissue damage if not used properly.
FUNCTIONS:
• removal of adherant plaque
and food debris from under
FPD
• stimulating and massng the
interdental papillae.
• help to locate- subgingival
calculus, overhanging
margins of
restorations,proximal caries.
• vehicle for application of
polishing or therapeutic
agents to interproximal and
subgingival area.

33. SPOOL METHOD
CIRCLE OR LOOP METHOD
• About 12-18 inches long floss taken and about 4
inches from each end is wound around the
middle finger of each hand.
• In both the hands the last three fingers are
folded are closed and both the hands are moved
apart.
• In this way about 1-2 inches of floss is held
tightly between the index fingers of both the
hands.

35. These are cone shaped or
cylinderical brushes made of bristles
mounted on a handle. They are
suitable for cleaning large, irregular
or concave tooth surfaces adjacent
to wide interdental spaces. Moved
back and forth with short strokes.
These are made from orange wood
and are triangilar in cross-
section.They are inserted into the
gingival embrasures th the base of
triangle towards the gingiva.They
remove soft deposits from the teeth
as well as stimulate the gingiva.

36. Done by toothbrushes or
interdental aids or simple
finger massage which leads
to:
1. Increase keratinization
2. Increased blood flow
3. Increased flow of gingival
crevicular fluid within
sulcus
It is a supplement for plaque control
measures. It is mainly beneficial in the
removal of unattached plaque. Irrigation
devices are composed of built in PUMP and a
RESERVOIR. These may be used to deliver
anti-microbial agents- chlorhexidine
subgingivally.
In presence of inflammation, transient
bacteremia has been reported.

37. “ The process of removing debris from the surface of the tongue with some form of
scrapper designed for this purpose.” Most tongue scrapers are made of a soft flexible
plastic. Metal scrapers are also available.
BRUSHING:
• Place the brush on the dorsum of
the tongue with the tip directed
towards the throat.
• Apply light pressure and move the
brush forward and out, repeat to
cover the entire surface.
TONGUE CLEANING DEVICES:
• The device is placed towards the
back of the tongue on the dorsal
surface, then pulled forward with
light pressure.
• Recommended for patients with
elongated papillae, deep fissures or
surface coating.

38. • Essentials of Public Health
Dentistry(community
dentistry)-by Soben Peter-7th
edition
• Newman and Caranza’s
Clinical Periodontology
• Some other websites related
to medicine and research.