This document discusses various methods of dental plaque removal and prevention. It describes the history of toothbrushes and different brush designs. It outlines brushing techniques like the Bass and Modified Stillman methods. Interdental cleaning methods like flossing and interdental brushes are also explained. Oral irrigation devices and chemical plaque control using chlorhexidine are summarized as well.

1. Presented by
Dr. Janaki K T
MDS Sr. Lecturer

2. DEFINITION
Removal of dental plaque on a regular basis and
prevention of its accumulation on the teeth and
adjacent gingival surfaces

3. TOOTH BRUSH
First bristle tooth brush appeared - 1600 in china
ADA -- dimensions of Brushes
brushing surface : 1 - 1.25 inches long
5/16 - 3/8 inch wide
2 - 4 rows of bristles
5 - 12 tufts per row

4. MANUAL TOOTH BRUSHES FROM 19TH AND 20TH CENTURIES

5. FRESH & GO - 2 IN ONE TOOTH BRUSH
Can be used for 30 brushings – with the turn of a knob

6. POWERED TOOTHBRUSHES
Invented in 1939
advised for :
Children and adolescents
Children with physical or mental disabilities
Hospitalized patients
Older adults who need to have their teeth
cleaned by caregivers
Patients with fixed orthodontic appliances

7. POWERED TOOTH BRUSH

8. ORTHODONTIC TOOTH BRUSH

9. BLUE LIGHT EMITTING TOOTH BRUSH

10. BRISTLE MATERIAL : TWO
NATURAL -- HOG ARTIFICIAL -- NYLON
In terms of –
Homogeneity of material
Uniformity of bristle size
Elasticity
Resistance to fracture
Repulsion of water and debris
nylon filaments are superior

11. Because of tubular form, natural bristles are :
susceptible to fraying
breaking
contamination with diluted microbial debris
softening
loss of elasticity

12. Diameters of bristles
Soft brushes -- 0.2 mm
Medium brushes -- 0.3 mm
Hard brushes -- 0.4 mm

13. BASS recommended :
-- a straight handle and
-- nylon bristles 0.2mm in diameter and
-- 10.3mm long with
-- rounded ends arranged in
-- three rows of tufts
-- Six evenly spaced tufts per row with
-- 80 to 86 bristles per tuft
For children the brush is smaller with
thinner [0.1mm ] and shorter [8.7mm] bristles

14. DENTIFRICES
Aid in cleaning and polishing tooth surfaces
Used mostly in the form of pastes

16. COMPOSITION
Abrasives -- silicon oxides
-- aluminum oxides
-- granular polyvinyl chlorides
Humectants
Soap or detergent
Flavoring agents
Sweetening agents
Therapeutic agents -- fluorides
-- pyrophosphates
Coloring agents
Preservatives

17. The proper use of dentifrice can enhance the
abrasive action of toothbrush by 40 times
Tooth powders contain about 95% abrasives
and are 5 times more abrasive than pastes

18. Used as chemotherapeutic agents to inhibit
-- plaque
-- calculus
-- caries
Tartar control toothpastes which contain
pyrophosphate reduced the formation of
new supra gingival calculus by more than 30%

19. VIGOROUS TOOTH BRUSHING WITH DENTIFRICE

20. TOOTH BRUSHING METHODS
ACCORDING TO THE PATTERN OF MOTION :
ROLL -- Roll method
-- Modified still man technique
VIBRATORY -- Stillman
-- Charters
-- Bass techniques
CIRCULAR -- Fones technique
VERTICAL -- Leonard technique
HORIZANTAL -- Scrub technique

21. The scrub technique is probably the simplest
and most common method of brushing
The sulcus cleansing technique is most
frequently taught to the patient with periodontal
disease using a vibratory motion to improve
access in the gingival areas

22. COMMON METHODS OF BRUSHING
BASS
MODIFIED STILLMAN
CHARTERS

23. BASS METHOD : sulcus cleansing method
TECHNIQUE
Place the head of a soft brush parallel with
the occlusal plane covering 3 - 4 teeth beginning
at the most distal tooth in the arch
Place the bristles at the gingival margin by
establishing an angle of 45 degrees to the
long axis of the teeth

24. Exert gentle vibratory pressure using short
back-and-forth motions without dislodging the
tips of the bristles
This motion forces the bristles ends into the
gingival sulcus as well as partially into the
inter proximal embrasures
The pressure should produce perceptible
blanching of the gingiva

25. Complete approx 20 strokes in the same position
Lift the brush move it to the adjacent teeth
and repeat the process for the next 3-4 teeth
Continue around the arch brushing 3 teeth at a time
Use the same method to brush the lingual surfaces

26. To reach the lingual surfaces of anterior teeth
insert the brush vertically

27. BRUSH POSITION ON OCCLUSAL SURFACES
FOR
ALL THE TECHNIQUES

28. Advantages :
Easy to master because it is a simple
movement familiar to most patients who brush
using a scrub technique
It concentrates the cleaning action of the teeth
where microbial plaque is most likely to have
accumulated
Recommended for :
Patient with or without periodontal diseases

29. MODIFIED STILLMAN METHOD
TECHNIQUE
The brush is 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
Apply pressure against the gingival margin to
produce a perceptible blanching

30. Then move the brush about 20 short back-and-
forth strokes while simultaneously moving it
coronally along the attached gingiva, the gingival
margin, and the tooth surface
A soft or medium multi tufted brush should be
used to minimize trauma to the gingiva

31. To reach the lingual surfaces of the maxillary
and mandibular incisors the handle of the brush
can be held in a vertical position engaging the
end of the brush
The sides rather than the ends of the bristles
do the work
Recommended :
In areas with progressing gingival recession

32. CHARTERS METHOD
Place a soft or medium multi tufted brush on
the teeth with the bristles pointed toward the
crown at a 45-degree angle to the long axis of
the
teeth
The sides of the bristles should be flexed
against the gingiva and a back- and - forth
vibratory motion used to brush

33. This technique is designed to gently massage the
gingiva so the bristle tips should not drag across
the gingiva
Recommended
In areas of healing wounds after perio. surgery

34. COMPARISION
BASS
MOD.STILLMAN CHATERS

35. INTERDENTAL CLEANING AIDS
DENTAL FLOSS
INTERDENTAL CLEANERS

36. DENTAL FLOSS
Widely recommended for removing plaque from
proximal tooth surfaces
Available as multifilament nylon yarn that is
-- twisted or non-
twisted
-- bonded or non-bonded
-- waxed or un-waxed
-- thick or thin

37. TECHNIQUE
Start with a piece of floss long enough to
grasp securely; 12 -- 18 inches is sufficient
Stretch the floss tightly between the thumb
and fore-finger or between both forefingers
Pass it gently through each contact area with
a firm back-and-forth motion

38. Once the floss is apical to the contact area
wrap the floss around the proximal surface of
one tooth and slip it under the marginal gingiva
Move the floss firmly along the tooth up to
the contact area and gently down into the sulcus
gain repeating this up-and-down stroke

39. Flossing is made easier by using a floss holder

40. A floss holder should possess
One or two forks that are rigid to keep the
floss taut when penetrating into tight contact area
An effective and simple mounting mechanism
to hold the floss firmly in place
Disposable single-use floss holders with
pre- threaded floss are available
Powered floss devices are also available

41. INTERDENTAL CLEANING DEVICES
Recommended for :
Proximal cleaning of teeth with large,irregular
contact spaces
1. Interdental Brushes 2. Wooden Tips
Conical Cylindrical Round Triangular

42. 1. INTERDENTAL BRUSHES
Technique :
Interdental brushes of any style are inserted
through interproximal spaces and moved
back-and-forth between the teeth with short Strokes
For efficient cleaning it is best to select the
diameter of brush that is slightly larger than the
gingival embrasure

43. 2.WOODEN TIPS
Used with or without a handle
Without a handle With a handle
Stim –U- Dent Perio-Aid O
anterior teeth throughout the mouth

44. Stim-U-Dent : Technique --
Soft triangular wooden picks are placed in the
interdental space in such a way that the base of
the triangle rests on the gingiva and the sides
are in contact with the proximal tooth surfaces
The pick is then repeatedly moved in and out
of the embrasure removing soft deposits from the
teeth and mechanically stimulating the papillary
gingiva

45. Perio-Aid : Technique
The deposits are removed by using either the
sides or the tip of the toothpick
Particularly useful for cleaning along the
gingival margin and into periodontal pockets

46. CLASSIFICATION – GINGIVAL EMBRASURES
Type 1- no gingival recession : Dental floss
Type 2- moderate papillary recession:Interdental brush
Type 3- complete loss of papillae : Unitufted brush
Type 1 Type 2 Type 3

47. GINGIVAL MASSAGE
Produces:
Epithelial thickening
Increased keratinization
Increased mitotic activity
The improved gingival health associated with
interdental stimulation is more likely the result of
plaque removal rather than gingival massage

48. ORAL IRRIGATION DEVICES
SUPRAGINGIVAL IRRIGATION
Work by directing a high-pressure steady or
pulsating stream of water through a nozzle to
the tooth
surfaces
A device with a built-in pump generates the
pressure

49. Uses :
Clean non-adherent bacteria and debris from
inaccessible areas around orthodontic appliances
and fixed prostheses
Useful in delivering antimicrobial agents into
periodontal pockets

50. Technique :
The common home-use irrigator tip is a plastic
nozzle with a 90degree bend at the tip attached
to a pump providing pulsating beads of water
at speeds regulated by a dial
Patients should be instructed to aim the
pulsating jet across the proximal papilla, hold it
there for 10-15seconds, then trace along the
gingival margin to the next proximal space
The irrigator should be used from both the
buccal surface and lingual surface

51. SUBGINGIVAL IRRIGATION
Performed by placing the irrigation tip into the
periodontal pocket
This is achieved by using a soft rubber tip at
home or a canula in the dental office
SOFT RUBBER TIP CANULA TIP

52. CHEMICAL PLAQUE CONTROL
CHLORHEXIDINE
Antiseptic properties
Antiplaque properties
Two daily rinses with 10ml of 0.2% chlorhexidine
almost completely inhibited the development of
plaque, calculus and gingivitis

53. Side effects :
Brown staining of teeth and tongue
Altered taste sensation
Ulceration if used in high concentration