The document discusses various mechanisms for plaque control, including mechanical and chemical methods. It describes techniques for toothbrushing and the use of interdental aids. It also covers plaque control considerations for special patient groups like those with implants, orthodontics, or who use prosthetics. Key agents for chemical plaque control discussed are chlorhexidine and other antimicrobial mouthwashes. Patient education is emphasized as important for proper plaque removal.

2. MECHANISMS OF
PLAQUE CONTROL
DR. MEMUNA KAUSAR SATTI

3. OVERVIEW
 Dental Plaque
 Mechanical plaque control
 Chemical plaque control
 Plaque control in Paediatric patients
 In Orthodontic patients
 In Patients with implants
 In prosthodontic patients
 Patient education and motivation

4. DENTAL PLAQUE
 Dental plaque is defined as the soft deposits that form the bio film
adhering to the tooth surface. Plaque is composed of organic, inorganic
materials derived from saliva, gingival crevicular fluid & bacterial product
 PLAQUE CONTROL is the removal of microbial plaque and prevention of its
accumulation on teeth and adjacent gingival tissues.
 Supra- & sub-gingival plaque control

5. PLAQUE CONTROL
 Objectives of plaque control are
 Removal of soft deposits
 Gingival massage keratinization and improve circulation
 Prevention of calculus formation
 METHODS
Mechanical methods
Chemical methods

8. MECHANICAL PLAQUE CONTROL
 Tooth brushes
 Interdental cleaning aids
 Irrigation devices
 Tongue cleaners

10. TOOTHBRUSHES
 Primary means of controlling supragingival dental plaque buildup
 Meticulous mechanical removal of plaque by tooth brushing, combined
with the removal of interdental plaque once every 24 hr, is adequate to
prevent the onset of gingivitis as well as of interdental caries
 MANUAL TOOTHBRUSHES
 POWERED TOOTHBRUSHES

13. TOOTHBRUSHES
PARTS

15. TOOTH BRUSHING TECHNIQUES
 Horizontal brushing (scrub)
 Leonard method (vertical)
 Bass method
 Modified Stillman method (roll)
 Charters method
 Methods of cleaning with powered toothbrushes

16. BASS TECHNIQUE
 Efficient for removing dental plaque from gingival third and from shallow
gingival sulcus.
 Place the bristles at the gingival margin with angle of 45 degree to the
long axis of the teeth and the bristles pointed to the crevice.
 Exert gentle vibratory pressure using short back-and-forth motions
without dislodging the bristles tips (horizontal direction).
 Perform about 20 strokes in each position.
 Used a soft brush in this method.

17. MODIFIED STILLMANNS TECHNIQUE
 A soft or medium brush can be used with this method.
 Recommended for patients with gingival recession to prevent abrasive
tissue destruction.
 The sides of the bristles are placed against the gingiva and teeth with a 45
degrees angle to the long axis of the teeth.
 Pressure is applied laterally against the gingival margin to produce
blanching.
 Brush is activated by short back-and-forth strokes in coronal direction.

18. CHARTERS TECHNIQUE
 A soft or medium brush can be used.
 Recommended for temporary cleaning in areas of healing after periodontal
surgery
 The bristles pointed toward the crown at a 45 degree angle to the long
axis of the teeth.
 The bristle tips not move across the gingiva.
 The brush is activated with short back-and forth strokes in coronal
direction.

19. ELECTRICAL TOOTHBRUSHING
 Useful for Children, hand-capped, patients with orthodontics treatment,
individuals lacking manual dexterity, Prosthodontic or endosseous
implants and Patients on supportive periodontal therapy.
 Less abrasive to tooth surfaces and restoration.
 Do not require special techniques of application.
 Place the brush head next to the tooth at the gingival margin and proceed
systematically around the dentition.
 Not superior to manual type.
 Expensive.

21. INTERDENTAL CLEANING AIDS
 Dental Floss
 Effective for flat or convex proximal tooth surfaces with full embrasures.
 Waxed, unwaxed or tufted types.
 Tufted and waxed are indicated for rough restoration and tight contact
 Cut about 12cm and anchored around one finger of each hand.
 Gentle placing at the base of gingival sulcus then moved in an up-and
down along the tooth surface ,right and left.

22. INTERDENTAL CLEANING AIDS
 Interdental Brushes
 Small cone shaped or tapered brushes.
 Used in large open embrasures.
 Inserted interdentally and moved back and forth in facio - lingual direction.
 Tooth Picks OR Wooden tips
 Made from soft-wood and is triangular in shape.
 Used in open contact. Tooth pick moved in and out or up and down
direction. Tooth pick can be placed in special plastic handles to reach areas
with limited access.

23. INTERDENTAL CLEANING AIDS
 Rubber Tips
 Produce gingival massage.
 Induce epithelial keratinization.
 Rubber tip is inserted interproximally at a 45 degree angle with the tip
pointing in an occlusal direction.
 Activated by applying pressure with a vibratory or rotary motion.

24. IRRIGATION DEVICES
 Oral Irrigation
 With water and antiseptic mouth rinses. Supra or sub-gingival irrigation.
 Hand or mechanized irrigation

25. TONGUE SCRAPPERS
 Tongue scraper is an oral hygiene device designed to clean the bacterial
built up, food debris, fungi and dead cells from the surface of the tongue
bacteria and fungi that grow on the tongue may cause halitosis due to
production of sulphur compound

27. RECENT ADVANCES
 Sonic ultrasonic toothbrushes
 Chewable toothbrushes
 Ionic toothbrushes
 Ozone toothbrushes

28. SEQUELAE OF INCORRECT USE
 The incorrect use of mechanical plaque removal devices cause
 Gingival erosion
 Toothbrush stiffness
 Gingival recession
 Cervical abrasion
 Ulcerations

30. VEHICLES FOR DELIVERY OF
CHEMICAL AGENTS
 TOOTHPASTES
 MOUTHRINSES
 SPRAYS
 IRRIGATORS
 CHEWING GUMS

31. ANTIADHESIVE AGENTS
 Act at pellicle surface to prevent initial attachment of primary plaque
forming bacteria
 Amine alcohol, Delmopinol interferes with bacterial matrix formation and
reduction of bacterial adherence.
 Minimal activity against microbes.
 0.1% and 0.2% in mouth rinse, effective as a plaque inhibitor and
antigingivitis agent.
 ADVERSE EFFECTS: Transient numbness of tongue
 Tooth staining
 Burning sensation of mouth

32. ANTIMICROBIAL AGENTS
 Inhibit plaque formation through one of the two mechanisms, e.g.
CHLORHEXIDINE
 BACTERIOSTATIC Before the attachment of bacteria or after attachment
and before division of bacteria
 BACTERICIDAL Destroys microorganisms either attached or already
attached bacteria

33. ANTIPATHOGENIC AGENTS
 These agents inhibit the expression of pathogenecity of plaque
microorganisms without necessarily destroying the microorganism.

34. PLAQUE REMOVAL AGENTS
 Hypochlorites, remove bacterial plaque, are commonly used in domestic
environment
 Toxic when applied within oral cavity
 Nearest success was achieved with enzymes e.g. Dextranase, Mutanase.

35. CHLORHEXIDINE
 The most effective antimicrobial agent in plaque and gingivitis
 Mechanism of action: causes bacterial cell wall lysis and prevents bacterial
adhesion to tooth surfaces.
 Has not produced any resistance of oral microorganisms.
 Property of Substantivity: slow release over long time period
 Side effects:- Staining of teeth , tongue and resin restorations, Alter taste
sensation (temporary)and Increase supragingival calculus formation.
 Use in 0.2%- 0.12% mouth washes Twice/day.

36. DENTRIFICES
 Ingredients are Abrasive agent e.g. calcium carbonate, calcium oxide or
silicate
 Detergent agent e.g. sodium lauryl sulfate.
 Thickening agent carboxymethyl cellulose and amylase.
 Coloring agents.
 Humidifier , water.
 Fluoride, Anticalculus agents e.g. zinc citrate, Antiplaque agents e.g.
chlorhexidine and triclosan , Antibiotics eg. Penicillin.
 The paste is applied between the bristles rather than on the top.

37. DENTRIFICES
 POLISHING Upon the completion of the quadrants, you should polish
teeth whenever necessary
 GOAL OF POLISHING To remove soft deposits and extrinsic stain with
minimal trauma to hard and soft tissues and minimal discomfort for
patient

38. DISCLOSING AGENTS
 Used to stain the teeth for patient education and motivation for oral home
care.
 Used to locate areas with plaque accumulation.
 Available in tablets and liquid forms.
 Produce, blue, purple or red stains when attached to plaque on tooth
surface.
 Examples: Bismark Brown solution, erythrosine and sodium fluorescein dye.

39. PLAQUE CONTROL IN PATIENTS WITH
IMPLANTS

40. PLAQUE CONTROL IN
PROSTHODONTIC PATIENTS
 OVERDENTURES: Control accumulation of plaque on exposed dentin of
abutment teeth.
 Use of fluoride and chlorhexidine gel controls caries development and
maintains healthy periodontal conditions.
 Adequate denture wearing habits
 R.P.D AND COMPLETE DENTURE : Use separate toothbrush for dentures
and natural teeth.
 Immerse dentures in liquid cleanser after brushing.
 Store the denture in water when not in use

41. PLAQUE CONTROL IN ORTHODONTIC
PATIENTS
 Cleaning behind arch wires, by attempting to get the bristles, and floss into
these areas The electric toothbrush with short pointed bristles are effective
 Plaque removal efficiency can be improved by Bonding on molars , than
banding. Remove excess composite around brackets, especially at gingival
margin.
 Minimize the length of the second phase of treatment with fixed
appliances by correcting significant skeletal and alignment problems in
mixed dentition

42. PLAQUE CONTROL IN PEDIATRIC
PATIENTS
 Parent or guardian of a patient under age of 7 years should brush child’s
teeth, as child does not have enough manual dexterity to brush effectively.
 Disclosing plaque and showing this to patient or parent can be useful
educational and motivational tool.

43. PATIENT EDUCATION AND
MOTIVATION
 Take more fibrous foods
 Avoid sticky foods in between meals
 Brush regularly after meals
 Meet your dentist for every 6 months or 1 year interval