Plaque control/certified fixed orthodontic courses by Indian dental academy

Plaque ControlPlaque Control
INDIAN DENTALINDIAN DENTAL
ACADEMYACADEMY
Leader in continuingLeader in continuing
Dental EducationDental Education
www.indiandentalacademy.comwww.indiandentalacademy.com

CONTENTSCONTENTS
►DefinitionDefinition
►Mechanical plaque controlMechanical plaque control
►Brushing techniquesBrushing techniques
►Chemical plaque controlChemical plaque control
►ReferencesReferences www.indiandentalacademy.com

DefinitionDefinition
► Plaque Control is the removal of microbialPlaque Control is the removal of microbial
plaque on a regular basis and prevention ofplaque on a regular basis and prevention of
its accumulation on the teeth and adjacentits accumulation on the teeth and adjacent
gingival surfaces.gingival surfaces.
► Retards the formation of calculus.Retards the formation of calculus.
www.indiandentalacademy.com

Classification
►Plaque control
► Mechanical Chemical
Procedures Procedures

►Mechanical PlaqueMechanical Plaque
controlcontrol

Mechanical plaque control aids
► Toothbrushes
a)Manual toothbrush b) Electric toothbrush
► Interdental aids
a) Dental Floss b) Triangular toothpicks
c) Interdental brushes
► Aids for gingival stimulation
a) Rubber tip stimulator b) Balsa wood edge
► Others
Water irrigation devices
► Aids for edentulous or partially edentulous patients
a) Denture and partial clasp brushes b) Cleansing Solutions

► Mechanical Aids – Most dependable means
► Periodontally healthy patient - Plaque growth removed at
the very least every 48 hours

ToothbrushesToothbrushes
► Most widely used oral hygiene aidsMost widely used oral hygiene aids
► History –History –
► First introduced in china 1600 B.C.First introduced in china 1600 B.C.
► Introduced into western world 1640Introduced into western world 1640
► William Addis(1780) - “One of the earlyWilliam Addis(1780) - “One of the early
toothbrushes”toothbrushes”

► CraftmenCraftmen (Early 19(Early 19thth
century)century)
Removable brush headsRemovable brush heads
could be fitted.could be fitted.
► Powered toothbrushes (After 1960)Powered toothbrushes (After 1960)

Parts of toothbrushParts of toothbrush
► Handle – Part grasped in handHandle – Part grasped in hand
► Head – Working end that hold bristlesHead – Working end that hold bristles
► Tufts – Clusters of bristlesTufts – Clusters of bristles
► Brushing plane – Surface formed by bristle endsBrushing plane – Surface formed by bristle ends
► Shank – Section connecting head & handleShank – Section connecting head & handle

Types of toothbrushTypes of toothbrush
► Manual toothbrushManual toothbrush
► Powered toothbrushPowered toothbrush
► Sonic and ultrasonicSonic and ultrasonic
► IonicIonic

Manual ToothbrushManual Toothbrush
►The European Workshop on MechanicalThe European Workshop on Mechanical
plaque control:plaque control:
►Handle size – User’s age & dexterityHandle size – User’s age & dexterity
►Head size – Patient’s mouthHead size – Patient’s mouth
►Nylon filaments – 0.009 inch in diameterNylon filaments – 0.009 inch in diameter
►Soft bristle configurationSoft bristle configuration

Bristle MaterialBristle Material
► NaturalNatural Bristles from hogsBristles from hogs
► ArtificialArtificial Filaments from nylonFilaments from nylon
► Both types Remove PlaqueBoth types Remove Plaque
► Nylon Filaments are clearly superiorNylon Filaments are clearly superior
► Natural bristles - Fraying, Breaking, Contamination,Natural bristles - Fraying, Breaking, Contamination,
Loss of ElasticityLoss of Elasticity

Powered ToothbrushesPowered Toothbrushes
► Invented inInvented in 19391939
► The first Powered toothbrushThe first Powered toothbrush
was designed to mimic handwas designed to mimic hand
toothbrushing technique usingtoothbrushing technique using
back and forth motions.back and forth motions.

Mechanism Of Action:
It is suggested that
hydrodnamic shear forces that may disrupt plaque, are the
likely mechanism of action for these powered brushes.

►Wejden et al (1998)Wejden et al (1998)

Indications of PoweredIndications of Powered
BrushesBrushes
► Young childrenYoung children
► Handicapped patientsHandicapped patients
► Hospitalized Patients who need to have their teethHospitalized Patients who need to have their teeth
cleaned by someone elsecleaned by someone else
► Patients with orthodontic appliancesPatients with orthodontic appliances
► Individuals lacking manual dexterityIndividuals lacking manual dexterity

Sonic and UltrasonicSonic and Ultrasonic
toothbrushestoothbrushes
High frequency vibrationsHigh frequency vibrations
Stain removalStain removal
Disrupt bacterial cellwallDisrupt bacterial cellwall

Ionic ToothbrushIonic Toothbrush
Change surface chargeChange surface charge
Influx of positive ionsInflux of positive ions

TOOTHBRUSHING METHODSTOOTHBRUSHING METHODS
► The common methods of tooth brushing are:The common methods of tooth brushing are:
A) THE BASS METHODA) THE BASS METHOD
B) FONES METHODB) FONES METHOD
C) CHARTERS METHODC) CHARTERS METHOD
D) HORIZONTAL SCRUBD) HORIZONTAL SCRUB
E) MODIFIED BASS TECHNIQUEE) MODIFIED BASS TECHNIQUE

THE BASS METHODTHE BASS METHOD
► Introduced in early 1950sIntroduced in early 1950s
► Aim- cleaning buccal & lingual cervical areas, GingivalAim- cleaning buccal & lingual cervical areas, Gingival
sulcussulcus
Bristle - 45 degreeBristle - 45 degree
Apical directionApical direction
► Horizontal vibratory motionHorizontal vibratory motion

► Approximately 20 strokes should be completed in theApproximately 20 strokes should be completed in the
same position.same position.
ADVANTAGE:ADVANTAGE:
► The short back and forth motion - easy to master.The short back and forth motion - easy to master.
► Concentrates cleaning action on Unclean able areasConcentrates cleaning action on Unclean able areas
Recommended for:Recommended for:
Any Patient with or without periodontal involvement.Any Patient with or without periodontal involvement.

Fones methodFones method
►Stretch the arm parallel to floorStretch the arm parallel to floor
►Make big circles in airMake big circles in air
►Circles are reduced to smallCircles are reduced to small
circles near the mouthcircles near the mouth
►Make circles in the teethMake circles in the teeth
with toothbrushwith toothbrush

►Advantage –Advantage –
►Equal or better potential than bassEqual or better potential than bass
techniquetechnique
►EasyEasy
►Indicated for patients who lack manualIndicated for patients who lack manual
dexteritydexterity

THE CHARTERS METHODTHE CHARTERS METHOD
► Soft or medium multituffed brush placed at 45 angle toSoft or medium multituffed brush placed at 45 angle to
the long axis of the teeth.the long axis of the teeth.
► The sides of the bristles -flexed against the gingiva,The sides of the bristles -flexed against the gingiva,
► back and forth vibratory motion,back and forth vibratory motion,
► The technique is designed to gently massage the gingiva,The technique is designed to gently massage the gingiva,
Recommended for cleaning areas of healing wounds afterRecommended for cleaning areas of healing wounds after
periodontal surgery.periodontal surgery.

The horizontal scrubbing methodThe horizontal scrubbing method
►Most commonly used by people who haveMost commonly used by people who have
never received professional instructionsnever received professional instructions
►Brush – At 90 degree to toothBrush – At 90 degree to tooth
►Back and forth motionBack and forth motion

►Disadvantages –Disadvantages –
►IneffectiveIneffective
►Tooth abrasionTooth abrasion
►Gingival recessionGingival recession

Modified bass techniqueModified bass technique
►Vibratory and circular motions + SweepingVibratory and circular motions + Sweeping
motionsmotions
►Bristles at 45 angle to gingivaBristles at 45 angle to gingiva
►Back and forth motionBack and forth motion
►Indication – Routine oral hygieneIndication – Routine oral hygiene
Intrasulcular cleaningIntrasulcular cleaning

Interdental Cleaning AidsInterdental Cleaning Aids
► Any tooth brush, regardless of the brushing methodAny tooth brush, regardless of the brushing method
used, does not completely remove interdental plaque.used, does not completely remove interdental plaque.
► A) Dental flossA) Dental floss
► B) Triangular toothpicsB) Triangular toothpics
► C) Interdental brushesC) Interdental brushes

Dental FlossDental Floss
► Most widely recommended tool for removing plaque fromMost widely recommended tool for removing plaque from
proximal tooth surface.proximal tooth surface.
►Choice of Dental FlossChoice of Dental Floss Depends on –Depends on –
► Tightness of tooth contactsTightness of tooth contacts
► Roughness of Proximal SurfacesRoughness of Proximal Surfaces
► Patient’s Manual DexterityPatient’s Manual Dexterity
► Presence of orthodontic appliance or fixed prosthesisPresence of orthodontic appliance or fixed prosthesis

Piece of floss long enough to grasp securely
Wind the floss around your middle fingers of
each hand, leaving 1” to 2” length in between.

Floss is streched tightly
between thumbs and fingers.
Passed Gently through
each contact area using
a zig-zag motion.
DO NOT SNAP FLOSS
BETWEEN THE
TEETH.
Thumbs up
for upper
Pointer fingers
down for lower

Once floss is apical to
contact area b/w teeth,
wrapped around the side
of the tooth & slipped
under marginal gingiva.
floss Is moved up-and-
down several times. Slide floss across the
interdental gingiva and
procedure is repeated on
proximal surface of
adjacent tooth.Arrows show direction.

Interdental BrushesInterdental Brushes
The interdental brushes were considered to be easier toThe interdental brushes were considered to be easier to
use than dental floss.use than dental floss.
► Inserted through proximal surface and moved back-Inserted through proximal surface and moved back-
and-forth b/w teeth with short stroke.and-forth b/w teeth with short stroke.
► For best cleaning – Diameter of brush larger thanFor best cleaning – Diameter of brush larger than
gingival embrassure to be cleanedgingival embrassure to be cleaned..

Interdental BrushesInterdental Brushes
► They are cone shapedThey are cone shaped
or cylindric brushes made of bristlesor cylindric brushes made of bristles
mounted on a handle .mounted on a handle .
They are mainly suitables forThey are mainly suitables for
cleaning large, irregular, or concavecleaning large, irregular, or concave
tooth surface adjacent to widetooth surface adjacent to wide
interdental space.interdental space.

TECHNIQUE:TECHNIQUE:
► Inserted InterproximallyInserted Interproximally
► Short back and forth strokesShort back and forth strokes
► Diameter of the brush shouldDiameter of the brush should
be slightly larger than the gingival embrasurebe slightly larger than the gingival embrasure
► Single Tufted Brush - Lingual surface of MandibularSingle Tufted Brush - Lingual surface of Mandibular
Molars and PremolarsMolars and Premolars

Triangular toothpicsTriangular toothpics
►Soft, triangular wooden toothpics placedSoft, triangular wooden toothpics placed
interdentally,interdentally,
►Moved in-and-out.Moved in-and-out.
►Disadvantage – Can be used only on facialDisadvantage – Can be used only on facial
surface of anterior region of mouth.surface of anterior region of mouth.

WOODEN OR RUBBER TIP
► A device that results in plaque removal & Gingival massage.
► Rubber tip is placed in embrassure
► Used in circular motion.
► Without handle: access is easier from the buccal surface,
primarily in the anterior and bicuspid areas.
► Both rubber/plastic tips can be rinsed and reused.

►Advantage –Advantage –
►Plaque removalPlaque removal
►Epithelial thickeningEpithelial thickening
►Increased keratinizationIncreased keratinization
►Increased mitotic activity in epitheliumIncreased mitotic activity in epithelium

Toothbrushing initiation andToothbrushing initiation and
frequencyfrequency
► Modern dental profession – Regular toothbrushingModern dental profession – Regular toothbrushing
From 2-3 yrs.From 2-3 yrs.
► British Dental Association – “As soon as 1British Dental Association – “As soon as 1stst
toothtooth
appearsappears
► A tiny fluoride spot should be used.A tiny fluoride spot should be used.
► By 2 yrs. – Infant toothbrush ought to be used.By 2 yrs. – Infant toothbrush ought to be used.

► AAPD (1999) –AAPD (1999) –
► Oral hygiene counseling to parents – BirthOral hygiene counseling to parents – Birth
to 24 monthsto 24 months
► Include the child – 24 months to 12 yearsInclude the child – 24 months to 12 years
► Only the child – From 12 yearsOnly the child – From 12 years

Dental cleaning guidelines , byDental cleaning guidelines , by
ageage
► Nowak & Crall, (1994)Nowak & Crall, (1994)
► Birth-3yrs. –Birth-3yrs. –
► Before tooth eruption – Gauze cloth wrappedBefore tooth eruption – Gauze cloth wrapped
around fingeraround finger
► After eruption – Smallest toothbrushAfter eruption – Smallest toothbrush
pea sized fluoridated toothpastepea sized fluoridated toothpaste

►3 – 6 yrs. –3 – 6 yrs. –
► Optimum time to adopt habit of cleaningOptimum time to adopt habit of cleaning
►Mouth cleaning should be after meal &Mouth cleaning should be after meal &
before bedtimebefore bedtime
►At least mouth rinse should be encouraged.At least mouth rinse should be encouraged.
► All primary teeth are presentAll primary teeth are present
► Interdental spaces are closingInterdental spaces are closing
► Important to clean inaccessible areas.Important to clean inaccessible areas.

►6 -12 yrs. –6 -12 yrs. –
►Most important period toMost important period to
encourage toothbrushing atencourage toothbrushing at
bedtimebedtime
►Slightly large brushesSlightly large brushes
►Child should be taught to useChild should be taught to use
Toothpaste and expectorate properlyToothpaste and expectorate properly

►Motor skills required for flossing should beMotor skills required for flossing should be
learnedlearned
►Child should visit dentist annuallyChild should visit dentist annually

►12 yrs – adolescences -12 yrs – adolescences -
►Full dental information should be supplied.Full dental information should be supplied.
►Dental health education should beDental health education should be
incorporated in regular school curriculumincorporated in regular school curriculum

►Possibility of malodor should be stressed.Possibility of malodor should be stressed.
►Small brushes should be recommended.Small brushes should be recommended.

Chemical PlaqueChemical Plaque
ControlControl

Chemical Plaque ControlChemical Plaque Control
► Chemical plaque control agents – Adjunct to mechanicalChemical plaque control agents – Adjunct to mechanical
plaque controlplaque control
► Defective host defenceDefective host defence
► Mentally or physically handicappedMentally or physically handicapped
► Surgical proceduresSurgical procedures

Classification of chemical plaqueClassification of chemical plaque
control agentscontrol agents
► 11stst
generation antiplaque agents – reduce plaque 20-50%generation antiplaque agents – reduce plaque 20-50%
► Eg: Antibiotics, Phenols, Quaternary ammonium compounds.Eg: Antibiotics, Phenols, Quaternary ammonium compounds.
► 22ndnd
generation antiplaque agents - reduce plaque 70-90%generation antiplaque agents - reduce plaque 70-90%
Better retained by oral tissues, exhibit slow releaseBetter retained by oral tissues, exhibit slow release
properties. Eg: Bisbiguanides (Chlorhexidine)properties. Eg: Bisbiguanides (Chlorhexidine)
► 33rdrd
generation antiplaque agents – Block binding ofgeneration antiplaque agents – Block binding of
microbes to tooth and to each othermicrobes to tooth and to each other
Eg: DelmopinolEg: Delmopinol

Antibiotics – Vancomycin
Erythromycin
Kanamycin
Disadvantages – Hypersensistivity
Bacterial resistance
Quaternary ammonium compounds – Surface active agents
Gram +ve bacteria
MOA - +ve charged molecule disrupt cellwall
Eg: Benzathonium chloride, Acetylpyredinium chloride

Bisbiguanides –
Chlorhexidine gluconate (0.2%) – Cationic Bisbiguanide
Gram +ve & Gram –ve
bacteria
Yeast, Fungi & Viruses
MOA:
1.Antiplaque action -
Prevent pellicle formation – Blocking acidic groups on
salivary glycoproteins
Prevent adsorption of bacterial cell – Bind to bacteria

Prevent binding of mature plaque – Precipitate
agglutination factors in
saliva
2. Antibacterial action –
Bacteriostatic at low concentration
Bactericidal at high concentration
Pin cushion effect – One charged end + Tooth surface
Other + Bacteria

Antibacteria action –
Bacterial cell wall
(Sulphate, Phosphate)
Dicationic chlorhexidine
Alters integrity of cell membrane
Binds to phospholipid of inner cell membrane
Increases permiability
Vital elements leak out
Harmful gain entry (Sublethal stage)www.indiandentalacademy.com

Coagulation of cell content –
Increased conc. Of Chlorhexidine
Progressively greater damage to cell membrane
Large molecular weight compounds are lost
Free chlorhexidine molecules enter the cell
Coagulation of cytoplasm
Vital cell activity ceases
( Cell Death)www.indiandentalacademy.com

Adverse effects of Chlorhexidine –
•Brownish staining of teeth
•Loss of taste sensation
•Rarely hypersenitivity
•Chronic use – Oropharyngeal carcinoma

Chemical Plaque ControlChemical Plaque Control
is merely an adjunctis merely an adjunct
and not a substituteand not a substitute
for mechanical plaquefor mechanical plaque
controlcontrol www.indiandentalacademy.com

THANK YOU.THANK YOU.

REFERENCES
Fermin A. Carranza, Textbook of periodontology Periodontal
microbiology, ninth edition: 96-110
Soben Peter, Essentials of Preventive and Community
Dentistry, Plaque control, Second edition: 447 – 467
Aders Thylstrup, Textbook of cariology, Formation,
composition and Ultrastructure of microbial eposits on the
tooth surface 56-73
John linde, Textbook of periodontology, Oral biofilms and
calculs 184-206

MAX A. Listgarten, The structure of dental plaque,
Periodontology 2000, 1994, 5: 52-65
L. M. Silverstone, Dental caries, Etiology, Pathology &
prevention, The formation, structure and microbial
composition of dental plaque 70-102.

Plaque control/certified fixed orthodontic courses by Indian dental academy

Recommended

Recommended

More Related Content

What's hot

What's hot (19)

Similar to Plaque control/certified fixed orthodontic courses by Indian dental academy

Similar to Plaque control/certified fixed orthodontic courses by Indian dental academy (20)

More from Indian dental academy

More from Indian dental academy (20)

Recently uploaded

Recently uploaded (20)

Plaque control/certified fixed orthodontic courses by Indian dental academy