Plaque control involves both mechanical and chemical methods to remove plaque from teeth and gingiva. Mechanical methods include toothbrushing, flossing, and interdental cleaning aids. Various toothbrushing techniques like Bass, Stillman, and Charters methods are used to effectively clean different tooth and gingival areas. Powered toothbrushes provide better access and plaque removal than manual brushes. Chemical methods involve use of antimicrobial agents like chlorhexidine, triclosan, quaternary ammonium compounds, and essential oils to control plaque. Professionally delivered oral irrigation helps disrupt and remove plaque below the gumline.

1. PLAQUE CONTROL

2. Plaque control – removal of microbial
plaque and prevention of its
accumulation on teeth and adjacent
gingival tissues

3. Mechanical plaque control
Tooth brushes & dentifrices
Interdental aids- a. Dental floss
 b. Interdental brushes
 c. wooden tips
Aids for gingival stimulation – a.gingival
massage
B.water irrigation devices
Tongue cleaners

4. Objectives –Tooth Brushing
 To clean teeth and interdental spaces of food
remnants, debris, stains etc.
 To prevent plaque formation
 To disturb and remove plaque
 To stimulate and massage the gingival tissue
 To clean the tongue

5. Types
Manual
Powered
Sonic and ultrasonic
Ionic

6. Manual Tooth Brushes
 Should confirm to individual patient requirement
in shape, size and texture
 Should be easily and effectively manipulated
 Should be readily cleaned and aerated and
impervious to moisture
 Should be durable and inexpensive

7. Tooth Brush Designs
Bristle material-natural,artificial
Natural – fray,break,soften & lose their
elasticity
Bristle ends-rounded,flat cut

8. Diameter:
Soft-0.007 inch(0.2mm)
Medium-0.012inch(0.3mm)
Hard-0.014 inch(0.4mm

9. Parts of Tooth Brush
Handle
Head
Tufts
Brushing plane
shank

11. ADA Specification
Brushing surface-1-1.25 inches(25.4-
31.8mm) length
5/16 -3/8 inch (7.9 -9.5 mm) wide
2-4 rows of bristles
5-6 tufts per row

12. Powered Tooth Brushes
Circular or elliptic motion& oscillating
,rotating motion
Mechanical contact, low frequency acoustic
energy generates dynamic fluid movement
Hydrodynamic shear forces disrupt plaque

13. Indication
Children with physical or mental disabilities
Hospitalized patients inclu.older patients
who need to have their teeth cleaned by
caregivers
Pts. With ortho appliances

14.  Patient motivation and compliance improved
 More access in interproximal and lingual tooth
surfaces
 No specific brushing technique needed
 Less brushing force used
 Brushing timer incorporated

15.  Sonic and ultrasonic brushes produce high
frequency vibrations (1.6 MHZ) leads to
phenomenon of cavitation and acoustic
microstreaming
 31,000 strokes

18.  Ionic brushes change the surface charge of a
tooth by an influx of positively charged ions.The
plaque with the similar charge is thus repelled
from the tooth surface and attracted by the
negatively charged bristles of the toothbrush

20. Bass Technique
 Bristles at gingival
margin pointing at 45º
to long axis of teeth

22. Charters method
Bass method

23. Indications
 Adaptable for open interproximal areas,
cervical areas
 Recommended for routine patients with
or without periodontal involvement

24. Advantages
 Effective method of
removing the plaque
 Provides good gingival
stimulation
 Easy to learn
Disadvantages
 May cause injury to
gingival margin
 Time consuming
 Dexterity requirement too
high

25. Stillman Technique
 Bristles partly on
gingiva and partly on
cervical portion of
teeth at oblique angle
to long axis of tooth
directed apically
 In gingival recession

26. Indications
 Plaque removal from
cervical areas and
proximal surfaces
 Gingival massage
 In areas of gingival
recession to prevent
abrasive tissue
destruction
Disadvantages
 Time consuming
 Improper brushing can
damage epithelial
attachment

27. Fones Method or circular/scrub method
Indications :
 Young children
 Handicapped individuals
 Lack dexterity

28. Advantages
 Easy to learn
 Shorter time required
Disadvantages
 Possible trauma to
gingiva
 Interdental areas are not
properly cleaned

29. Charter method
Indications
 FPD & FA
 Following periodontal
surgery

30. It is the substance used with brush for removing bacterial
plaque,materia alba & debris from tooth surface & gingiva .
DENTIFRICES

31. composition
Abrasive – silica, alumina, dicalcium
Po4,Ca Co3
Detergent – sodium lauryl sulfate
Thickener – silica & gums
Sweetener – saccharine
Humectants –glycerine,sorbitol
Flavors –mint,peppermint
Actives – F ,triclosan , Chx

32. Interdental Cleaning Aids

33. Interproximal Embrasure Spaces
Type1-no gingival recession-dental floss
Type 2- moderate loss of interdental
papilla –interproximal brush
Type 3-interproximal space with no
papillae-single tufted brush

35. Dental Floss
Twisted or non twisted
Bonded or non bonded
Waxed or unwaxed
Thick or thin
Monofilament or multifilament

36. Functions
 Removal of plaque in interproximal embrassure
and under pontics
 Polishing the tooth surface
 Stimulating and massaging the interdental
papilla
 Locating overhanging margins of restorations

37. Disadvantages
Time consuming
Requires skill
Risk of tissue damage

38. Flossing technique
Spool method
Circle or loop method

39. Flossing Technique - spool

40. Circle or Loop Method

41. Floss Holders
 Pts. Lacking manual
dexterity
 Care givers assisting
handicapped and
hospitalized pts.

42. Powered Flossing Devices
 Single bristle moves
in circular motion

43.  These are cone shaped brushes made of bristle mounted on
handle.
 Single tufted brushes or small conical brushes.
 Interdental brushes are particularly suitable for cleaning
large, irregular or concave tooth surface adjacent to wide
interdental space.
Interdental Brushes

45. Wooden or Rubber Tips
Wooden tips-with or without handle
Triangular wooden tips-used in anterior
region
Rubber tips-conical ,mounted on handles
DA-wooden tips do not reach posterior
areas

46. Gingival Massage
Produces epithelial thickening
Increased keratinization
Increased mitotic activity in epithelium and
conn.tissue

47. It's targeted application of a pulsated or steady stream of
water for removing debris.
 It can be done by patient or the clinician.
 Oral irrigation cleans non-adherent bacteria and debris
from the oral cavity more effectively than do
toothbrush and mouth rinse.
Oral irrigation

48. Disrupt plaque
Deliver antimicrobials
lavage

49. Professionally Delivered Irrigation
Rationale:
 After scaling bacteria left behind during
mechanical debridement could be eradicated
by an antimicrobial solution applied into the
pocket

50. Efficacy of Irrigation
Penetration - delivered by blunt canula
placed 1-3mm into the pocket
Concentration – sufficient to kill the
bacteria
Duration –affected by GCF,half life of drug
– 1.3 mts

51. Mechanism of Action
Occurs through the direct application of a
pulsed or steady stream of water or other
solution
Pulsation rate-1200 per minute
Impact zone
Flushing zone

52. Supragingival irrrigation –pt of delivery
coronal to gingival margin – 50%
penetration of soln subgingivally
Subgingival irrigation – PD of < 6mm -90%
PD > 6mm -64%

53. Indications –home use
Gingivitis
Periodontal maintenance pts.
Implants
Crown & bridges
Ortho. Appliances
Intermaxillary Fixation
Diabetes

54. Outcomes
Removal of plaque
Reduction in calculus
↓ in BOP
↓ probing depth
↓Periodontal pathogens
 ↓ inflammatory mediators

55. Chemical plaque Control
Preventing bacterial attachment using
antiadhesive agents
Stop or slow bacterial proliferation using
antimicrobials
Remove established plaque – plaque
reducing
Alter the pathogenicity of plaque – anti
pathogenic

56. ANTIBOITICS
Penicillin ,Vancomycin,Erythromycin,
Niddamycin and kanamycin were used as
antiplaque agents.
Risk to benefit ratio high

57. Enzymes
Dextranase, mutanase – disrupt plaque
matrix,dislodge bacteria -poor
substantivity, mucosal erosion
Glucose oxidase, amyloglucosidase –
enhance host defense mechanism-
catalyze the conv.of thiocyanate to
hypothiocyanite thr. Salivary lacto-
peroxidase system

58. Bisbiguanides
Effective antiseptic for plaque inhibition
and prevention of gingivitis

59. QUATENARY AMMONIUM COMPOUNDS
Cetylpyridinium and benzethonium chloride
have been found to inhibit plaque.
Cationic antiseptics - + vely charged
molecules react with – vely charged cell
membrane disrupts cell wall
They are alcohol free mouth rinses but seem to
have less antimicrobial action compared to
Chlorhexidine

60.  CPC - .05%
Substantivity – 3-5 hours

61. Phenols &Essential Oils
Thymol,Eucalyptol,Menthol & Triclosan
Antibacterial action & antiinflammatory –
due to anti-oxidative activity

62. Triclosan
 Non ionic antimicrobial triclosan,a trichlora-2-
hydroxy phenyl ether
 Plaque inhibitory action - antimicrobial
substantivity - 5 hrs
 .1% triclosan -10mg dose twice per day
 Effect of triclosan enhanced by addition of zinc
citrate or co-polymer poly vinyl ether maleic acid

63. Natural Products
Sanguinarine –antimicrobial
DA – increases the likelihood of
precancerous lesions

64. Flourides
Amine flouride,stannous fluoride – little
effect on plaque formation & gingivitis

65. Metal Salts
Cu,sn,zn
Cu –causes staining
Zn salts –reduce VSCs

66. Oxygenating agents
Hydrogen peroxide, peroxy borate ,
peroxycarbonate
Used in Rx of NUG

67. Detergents
Sodium lauryl sulfate – antimicrobial &
plaque inhibitory activity
Substantivity – 5 – 7 hours

68. Amine alcohols
Octopinol – antiplaque agent
Delmopinol -.1% , .2%

69. Povidone iodine 1% - substantivity 60 mts
Affects thyroid fn.

70. Salifluor
Salifluor ,salicylanide – antibacterial ,anti-
inflammatory properties

71. BISBIGUANIDES
 Chlorhexidine is dicationic bisbiguanide –
symmetrical molecule -4 chlorophenyl rings & 2
biguanide groups
 Available forms – digluconate, acetate, Hcl salts
 Used as broad spectrum antiseptic.

72. MECHANISM OF ACTION
 The superior antiplaque activity of Chlorhexidine
is due to its property “substantivity”
 Presistent bacteriostatic action – 12 hours
 Bactericidal at high concn. Bacteriostatic at low
cocn
 Aerobic & anerobic bacteria reduced by 80-90%

73.  At low conc it increases the permeability causing
the leakage of intracellular components
including potassium.
 At high concentration it causes precipitation of
bacterial cytoplasm and cell death.

75. PIN CUSHION EFFECT
 One charged end of Chlorhexidine molecule
binds to the tooth surface and the other remains
available to initiate the interaction with the
bacterial membrane as the microorganism
approaches the tooth surface

76. Side effects
 Brown discoloration of teeth, restorations &
dorsum of tongue
 Taste affected – salt
 Oral mucosal lesion
 Unilateral or bilateral parotid swelling
 Enhanced supragingival calculus formation –
due to precpn of salivary proteins

77. Chlorhexidine Staining:-
The mechanisms proposed are:-
Degradation of the chlorhexidine molecule
to release parachloraniline.
Catalysis of Maillard reactions.
Protein denaturation with metal sulphide
formation.
Precipitation of anionic dietary
chromogens.

78. Precautions:-
 Anionic substances such as sodium lauryl
sulphate based toothpaste reduce the plaque
inhibition of chlorhexidine.
 For this reason, chlorhexidine mouth rinses
should be used at least 30 minutes after other
dental products.
 For best effectiveness, food, drink, smoking, and
mouth rinses should be avoided for at least one
hour after use.

79. CHLORHEXIDINE
Mouth Rinses -10 ml of a 0.2% &15 ml of
.12%
Gel – 1%
Sprays - .1% & .2%
Tooth paste – 1%

80. Periochip – controlled release local drug
delivery system
Incorporated in gelatine
Releases Chx for 7 -10 days

81. First Generation Anti Plaque Agents:
These are capable of reducing plaque
upto 20-50 %. They exhibit poor
retention within the mouth.
Ex. Antibiotics, Phenols, Quaternary
Ammonium compounds and
Sanguanarine

82. Second Generation Anti Plaque
Agents:
They produce an overall plaque
reduction of about 70-90% and these
are better retained than those of the first
generation.
Ex. Bisbiguanides (Chlorhexidine)

83. Third Generation Anti Plaque Agents:
They block binding of microorganisms to
the tooth or to each other. They have poor
retention capacity when compared to the
Second generation Chlorhexidine.
Ex. Delmopinol