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PLAQUE CONTROL

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INTRODUCTION
Plaque Control
Plaque control is the removal of microbial plaque & the prevention of its accumulation on the teeth & adjacent gingival tissues. It also deals with the prevention of calculus formation. Accomplished by  Professional plaque removal  Patient performed oral hygiene  Chemical plaque control Interferes with  initiation,  development and  progression of periodontal disease. 26/08/12

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RATIONALE FOR PLAQUE CONTROL
 Plaque – Gingivitis
 Gingivitis doesn’t always progress to Periodontitis  Inflammatory changes in Gingivitis provides an ecological niche for pathogenic changes of plaque  Facilitates Subgingival colonization that could lead to periodontal destruction
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 Mechanical  Chemical

METHODS OF PLAQUE CONTROL

Performed in office Performed at home

 

Dentrifice Mouthwash Pre brush rinse

 Combined
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MECHANICAL PLAQUE CONTROL AIDS:
• The various aids used for mechanical plaque control can be listed as follows: Tooth brushes
Manual tooth brush Powered toothbrushes Sonic and ultrasonic toothbrushes Ionic toothbrushes

Interdental aids • Dental Floss • Triangular tooth picks – Hand held tooth picks – proxapic

– Interdental brushes • Proxabrush system • Bottle brushes • Single tufted brushes (Flat or Tapered) – Yarn – Superfloss – Perio-aid • Aids for Gingival stimulation – Rubber tip stimulator – Balsa wood edge .

• Others – Gauze strips – Pipe cleansers – Water Irrigation device • Aids for edentulous or partially edentulous patients – Denture & partial clasp brushes – Cleansing solutions .

PERFORMED IN OFFICE ULTRASONIC SCALING HAND SCALING 26/08/12 ORAL IRRIGATION 8 .

PERFORMED AT HOME  Tooth brushing    Tooth brush Dentrifices Brushing techniques  Interdental cleaning   Dental floss Other Interdental aids  Oral irrigation   26/08/12 Supragingival Subgingival 9 .

very hard. • Present day -. – Natural bristles made from hog's hair are usually very sharp and unkind to soft tissues. 26/08/12 10 .C.nylon bristles of varying quality. • Chinese fabricated toothbrushes made with bone or ivory fitted with natural hog bristles.TOOTHBRUSH HISTORY • Twigs of lenstick wood and aromatic twigs • Gold tooth picks -. end rounded by a polishing process. and abrasive to both cervical root surfaces and gingival tissues.D. 1600 A.3000 B. – These are expensive. affixed to plastic handles of diverse designs. sharp.

Durable and inexpensive 4.Types Of Tooth Brushes:  Manual toothbrushes Powered toothbrushes Sonic and ultrasonic toothbrushes Ionic toothbrushes Ideal characteristics of toothbrush are – 1.Easily and effectively manipulated 2.Readily cleaned and aerated 3. shape and texture 1.Should conform patient requirement in size .Designed for efficiency and cleanliness 26/08/12 11 Manual toothbrush: .

12 Parts of toothbrush: Handle Head 26/08/12 The part grasped in the hand during tooth brushing The working end of a tooth brush that holds the bristles or filaments Tufts Clusters of bristles or filaments secured into head TUFT S N HA S K HANDL E HEAD .

13 26/08/12 Parts of toothbrush: Brushing Plane The surface formed by the free ends of the bristles or filaments Shank The section that connects head & handle TUFT S K AN SH HANDL E HEAD .

breaking. Contamination with microbial debris. The bristles are tubular in form & are more susceptible to fraying.TOOTH BRUSH BRISTLES • Hard & soft • Natural & synthetic • Multi-tufted & space tufted 1. Softening & loss of elasticity .Natural Bristles – Obtained from hair of hog or wild boar.

2. Synthetic Bristles – Nylon bristles which are uniform in size & elasticity. resistant to fracture & doesn’t get contaminated .

0.4mm) • Length of bristle α 1/stiffness • Number of filaments in tuft α stiffness 26/08/12 • Curvature of filaments – Curved filaments may be 16 .3mm for hard brushes 0.The stiffness of bristles vary based on the following factors • Diameter of bristles α Stiffness (Diameter of bristle for soft brushes 0.2mm for medium brushes .

5 inches •Length of brushing plane: 1-1.TOOTHBRUSH DIMENSIONS •Total length: 6.25 inches •Width of brushing plane: 5/16-3/8 inch •Filament height: 7/16 inch •Rows of bristles: 2-4 •Tufts per row : 5 to 12 WHATEVER MAY BE THE DESIGN OF THE TOOTHBRUSH.0-7. 26/08/12 17 . THE FACT IS THAT THE USER IS THE ONLY ONE RESPONSIBLE FOR USING ANY TOOTHBRUSH MOST EFFICIENTLY.

• TOOTHBRUSH MODIFICATIONS: Long & contoured handles Double angulation of the & neck 26/08/12 18 .

TOOTHBROSH HEAD MODIFICATION: Concave Surface Conventional Flat Multitufted Deep Grooved Surface 26/08/12 Special Indicator Bands 19 .

Three basic types of tooth brushing actions: 1) Rotation in a arc of about 60o so that the bristles brush the teeth in a sweeping action similar to the roll method. 26/08/12 and • 20 .POWERED TOOTHBRUSHES Electrically powered toothbrushes were invented in 1939. All powered toothbrushes rely on mechanical contact between the bristles and the tooth to remove plaque. 2) Back and forth horizontal action as used in the horizontal scrub method.

INDICATIONS • Young children • Handicapped patients • Patients with prosthodontic or endosseous implants • Orthodontic patients • Elderly patients dependant on care providers • Patients on supportive periodontal therapy .

which leads to the phenomenon of cavitation and acoustic micro streaming. • This aids in stain removal as well as disruption of the bacterial cell wall. 26/08/12 22 .SONIC AND ULTRASONIC TOOTHBRUSHES: • Produce high frequency vibrations (1-6 MHz) .

• It is attracted by the negatively charged bristles of the toothbrush 26/08/12 23 .IONIC TOOTHBRUSHES: • Change the surface charge of a tooth by influx of positively charged ions. • Plaque with a similar charge is thus repelled from the tooth surface .

DENTIFRICES  Aid in cleaning & polishing the tooth surface  Pastes /Powders/Gels  Proper use of dentifrice can enhance the cleaning action of tooth brush up to 40 times  Can also be used as vehicles to deliver chemotherapeutic agents to inhibit plaque / calculus /root hypersensitivity  Fluoridated tooth pastes – role in caries prevention 26/08/12 24 .

Spearmint oil. Abrasives: Eliminates plaque.g.• Ingredients • 1. polishing of tooth surface e. Alumina. Silica • 2.g. 25 . Sodium Lauryl Sulphates • 3. Calcium Carbonate. Flavouring Agents: Helps individual to get liking for brushing 26/08/12 e. Peppermint oil. Surfactant agent: Provides foam and removes debris e.g.

desensitizing 26/08/12 26 agents and whitening agents • . Carrageenates and Sodium Carboxymwthyl Cellulose or water insoluble substances like Magnasium Alluminium Silicate Therapeutic Agents: Excellent vehicle for delivery of anti-plaque agents. Sorbitol. Polyethyl Glycerol • Binders: Control stability and consistency of toothpaste e. Alginates. antitarter agents. Glycerine.• Humectants: Helps to reduce the loss of moisture from the paste e.g.g.

TECHNIQUES OF TOOTHBRUSHING 26/08/12 27 .

Methods of tooth brushing can be categorized primarily according to the pattern of motion when brushing : 26/08/12 28 .

29 • • 26/08/12 .BASS TECHNIQUE • Placement of the toothbrush bristles at a 45° angle to the long axis of the teeth Gently pressing the ends of the bristles into the gingival sulcus and interproximal areas while the brush is vibrated in a back and forth short stroking motion. 2-4 teeth and their interproximal spaces cleansed at one time.

26/08/12 30 .MODIFIED BASS TECHNIQUE • This technique combines the vibratory and circular movements of the bass technique with the sweeping movement of Roll technique. • The two methods are performed separately rather combining them. • So the difference in Bass and modified Bass is that roll technique being added in the later.

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The spherical pathway is limited to the mucobuccal space. 26/08/12 32 . This technique is said to be effective for young children with minimal manual dexterity.• CIRCULAR SCRUB / FONES TECHNIQUE Bristles at 90°. and the entire brush head is moved in a circular scrubbing motion using light pressure. • No deliberate attempts at intra sulcular cleansing is made.

• Technique stresses interproximal cleansing and the massaging effects of 26/08/12 the bristles on the 33 .MODIFIED STILLMANS' TECHNIQUE • Placement of the bristles at 45° to the long axis of the teeth on the gingival margin. • The brush is vibrated mesiodistally as the brush head is rotated toward the coronal surface.

CHARTER'S TECHNIQUE • Starts with bristles placed at a 45° angle to the teeth. but they are firmly pushed into the interproximal spaces with a slight rotary and vibratory action. • Occlusal surfaces are brushed using a rotary movement. • Main action depends on the massaging effects of the sides of the bristles. 26/08/12 34 .

of posteriar molars • Factors in selection of an inter dental cleaning aid – – – – – Type of gingival embrasures Alignment of teeth Fixed prosthesis/ orthodontic appliances Open furcation areas Contact areas 35 26/08/12 .INTERDENTAL CLEANING AIDS  Special efforts have to be made & special devices have to be used for the removal of the plaque from the inter-dental areas esp.

I II III Types of embrasure Type I Condition of gingiva in embrasure Cleaning aid recommended Embrasure occupied Superfine and thin dental by completely floss healthy gingiva Slight to moderate Medium or coarse . thick recession of gingiva dental floss / Spiral interdental brushes Type II 26/08/12 36 .

DENTAL FLOSS Indicated to remove plaque from interproximal surfaces with type 1 gingival embrasures • Dental floss may be available in various forms – Multifilament – twisted /non twisted – Bonded/ non bonded 26/08/12 37 .

FUNCTIONS OF DENTAL FLOSS: • Removal of adherent plaque & food debris from the inter-proximal embrasure & under the pontics of FPD • Polishing of the tooth surface during removal of the plaque & debris • Stimulating &massaging the inter-dental papillae • Helping in locating the following – Sub gingival calculus deposits – Overhanging margins of the restorations • Improving oral hygiene • Reducing gingival bleeding • Vehicle for application of polishing or therapeutic 26/08/12 38 agents to inter-proximal & sub gingival area .

Take a floss 12-18 inches long. 26/08/12 39 . Spool method Requires manual dexterity. Maxillary: Grasp floss firmly with thumb and index finger of each hand (1/2” btw fingers) Mandibular: Direct floss down with the index fingers. Wrap around the right middle finger 2-3 times and then around left middle finger. c. a.Flossing Technique: 1. b.

Grasp for maxillary arch 26/08/12 Grasp for mandibular arch 40 .

3 or 4 strokes. Pass through contact using a gentle seesaw motion. h. Move the floss up and down. e. f. Remove floss using a seesaw motion.d. Wrap it tightly around the tooth in a “C” shape. Pass floss below the gingival margin. 41 . 26/08/12 i. Fulcrum on the cheek or in the mouth. g.

Circle or Loop method • In this method a loop or circle of the floss is made from about 45 cm (18inch) long piece • both ends are tied securely with the three knots. • All the fingers except the thumbs of both the hands are placed within the loop • the floss is held by both the hands having 2.5cms (1 inch) floss between fingers of both the hands. 42 26/08/12 .2.

• A floss holder should posses following features : 1) one or two rigid forks 2) an effective and simple mounting mechanism 26/08/12 43 .• Flossing can be made easier by using a floss holder. • They are helpful for the patients lacking manual dexterity.

• Powered flossing devices are also available. • The devices have been shown to be safe and effective • but no better at plaque removalthan finger flossing 26/08/12 44 . • These devices have a single bristle that moves in a single motion.

which may be mounted on to specifically designed handles to make its use in the post. areas of the mouth more comfortable • They may also be used to clean furcation areas & root concavities .INTER INTERDENTAL BRUSHES: • In case of type 2 gingival embrasure inter-dental brushes have proven to be the best choice for plaque removal from inter proximal tooth surfaces • Their design is similar to that of a bottle brush.

Unitufted brushes • Employed in the type 3 gingival embrasures • Also used to carry antimicrobial agents (Chlorhexidine) into the inter proximal areas 26/08/12 46 .

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EFFECTS OF IMPROPER TOOTH BRUSHING 26/08/12 48 .

broken bristles of filaments 26/08/12 49 . » Punctate lesions that appear as red pinpoint spots – Precipitating factors » Horizontal or vertical scrubbing tooth brushing method with pressure » Over vigorous placement and application of tooth brush » Penetration of gingiva by filament ends » Use of tooth brush with frayed.GINGIVAL ALTERATION • Acute alterations (Lacerations) » Scuffled epithelial surface with denuded underlying C.T.

GINGIVAL ULCERATION • Chronic alterations » Usually appear on the facial gingiva because of the vigour » Area most commonly involved are around canines or teeth in labio or bucco version 26/08/12 50 .

• Recession » Appearance : margin of the gingiva has receded towards the apex and the cementum is exposed » Predisposing anatomic factors Malposition of teeth Narrow Band of attached gingiva can’t withstand pressures of Precipitating factors : brushing Repeated use of vigorous rotary. vertical or horizontal tooth brushing techniques over a long period of time Use of long brisk strokes with excessive 26/08/12 51 .

RECESSION 26/08/12 52 .

Abrasion of the teeth – It is defined as the pathologic wearing away of tooth substance through some abnormal mechanical process • Contributing factors – Hard tooth brush – Horizontal brushingExcessive pressure during brushing – Abrasive agent in the dentifrice • Appearance – Saucer shaped or wedge shaped indentation with smooth shiny surfaces 26/08/12 53 .

ABRASION OF TEETH 26/08/12 54 .

there by removing soft deposits from the teeth & also mechanically stimulating the gingiva . They are inserted into the gingival embrasures with base of the triangle oriented towards the gingiva • The wooden tip then may be repeatedly moved in & out of the embrasure .Wooden Tips: • These devices are manufactured from orange wood & are triangular in cross section.

Gauze Strip: • Indications for use: -for proximal surfaces of widely spaced teeth -for surfaces of teeth next to edentulous areas -distal and mesial surfaces of abutment teeth -distal portion of denture supported implants 26/08/12 56 .

-increased keratinization and -epithelial thickening. • Improved gingival health due to plaque removal.simple finger mssaging 26/08/12 57 .Gingival Massage • Gingival massage leads to -improved circulation. • Accomplished by -rubber tip -tooth brushing .interdental cleaning or . • Also used to recontour gingival papilla following periodontal therapy.

TO BE CONTINUED… 26/08/12 58 .