Plaque control for handicap children

1. PLAQUE CONTROL FOR
HANDICAP CHILDREN
Presented by:
Dr.Shadman Zakir
Department of paediatric dentistry
Sapporo Dental College & hospital

2. What is dental plaque
• Dental plaque is a specific but highly variable
structural entity resulting from colonization
and growth of microorganism consisting of
various species and strains embedded on
extracellular matrix.

3. IMPORTANCE OF PLAQUE CONTROL:
Plaque control is the removal of plaque and the
prevention of its accumulation on teeth and adjacent
gingival surface.Plaque control is the key to
prevention and successful treatment of periodontal
disease.Removal of microbial plaque leads to
resolution of gingival inflammation in its early
stage,and cessation of plaque control measures leads
to its recurrence.Plaque control measures leads to its
recurraence.Plaque control is accomplished by
professional plaque removal and by patient
performed oral hygiene practice or both.

4. The purpose of preventive dental survice for
person with disabilities Including personal
oral hygiene procedures,are no different
than those of the general
population.However te physical,cognitive
and behavioral Limitations presented by
severe disabled individuals require
modification Of usual preventive practices
including the choice of material and
Techniques utilized.Although the dentist
,maintains overall responsibility for
preventive as well as restorative services.

5. Oral hygiene aids:
Devices used in the mouth to control
Plaque should be selected on an individual
basis and training in their use is necessary to
prevent damage to oral tissues.There ase a
wide variety of oral care products available
for use.When deciding on the appropriate
devices to be tried,the following should be
considerd:
oAbility of the idividual performing daily
oral hygiene.
oTime constraints placed on staff or
caregiver.
oLevel of personal cooperation.
oPhysical and environmental condition
where oral care is provided.
oDegree of patient involvement.

6. TOOTH BRUSH:
•The choice of a toothbrush for persons with often the same
as for the general population.
•Usually a soft nylon bristle,rounded end,multi-tuftted brush
with long strong neck is prefered choice.
•As with the individual the proper application of toothbrush is
far more important than toothbrush choice.
•Several studies have found the autometic toothbrush to be
superior to manual brushes for some individual.
Autometic toothbrush

7. •Tooth brush modification:
The most common tool for effective mechanical control of dental plaque is a
toothbrush but the presence of physical or cognitive disabilities can create
deficulities in both holding and manipulating the thoothbrush,that’s why it should be
adjusted or adapted.
The aim of toothbrush adaptation is to provide a handle with a stable grip,whilst its
shape enables the person to feel how to manipulate the brush in the mouth
adequately during cleaning.
Grasp:For people who cannot grasp and hold,the objective is to fasten the brush
handle to the hand.this can be achieved by using a velcro strap with a pocket on the
palm side into which the toothbrush can be inserted.

8. Fixed finger:
For a patient whos finger is permanently fixed or fixed with the
fist,toothbrushes with variation in the grip and handle in all
size and shape are available comercialy.
Gripped toothbrush

9. Limited hand clouser:
Objective is to enlarge the diameter of the brush handle
to fit in the hand.the simplest method of improving the
grip is to inserting the handle in another material to
improving its size shape and characteristics.

10. Manipulation:
• Those patient who can
position the
toothbrush but can not
manipulate it
sufficiently to clean all
the surface of the
tooth,double or tripple
headed brushes are
useful.such as super
brush.

11. Limited arm movement:
• For the group of
people with
limited arm and
hand
movement.the
objective is to
lengthen the
handle of the
brush with a
material strong
enough to
maintain the
contact with
tooth surface.

12. Dentifrices:
• For many severely disabled patients,the foaming
caused by toothpaste with saliva obstructs
visualization of the areas to be brushed and can
stimulate gagging.
• Some individual may ingest excessive amount of
toothpaste.
• An alternative way is the toothbrush can simply be
moistened with water or flavorful mouthwash.
• Some comercially available dentifrice are non
foaming with a pleasant taste.

13. Mouth wash:
• The use of antimicrobial agents,especially
chlorhexidine mouth rinse,has been proven
effective in reducing the severity of plaque
accumulation and gingivities.
• Since the usual method of rinsing and
expectorating is difficult for the person with
severe disabilities,alternative methods such
as a spray or applicationby swab is oftern
indicated.

14. mouthwash

15. Flossing:
• flossing is very essential for maintaining oral
hygiene.Its the best interdental cleaning
aid.there are two methods for flossing one is
spool method and another is loop
method.the loop method is the method of
choice for handicap patient.

16. Flouride application:
• Professionally prescribed stanous flouride
gels are more effective anti plaque agent the
comercially available flouride mouthwash.
• Foam or plastic tray is contraindicated due to
lack of patient co-operation and frequent
bruxism.
• The application of flouride gel by tooth brush
after normal brushing is method of choice.

17. CONCLUSION:
• Controlling dental plaque is very much essential for
maintaining a good oral health. the handicap
children often cant control the plaque by their own
so the parents have to be extra careful in this
case.The dental surgeons role is to properly educate
the parents and train them so then they can
perform accordingly.
REFERENCE:
Text book of paediatric dentistry,nikhil marwah