Mechanical dental plague

Research for oral medicine

Prepared & Presented By:

Shaza Usama Adel 20170463
Rovan Mohammed 20170362
Shahenda Mohammed 20170298 1
Rawan Ibrahim 20172879 (1)
The different types of toothbrushes available are:

1-Manual Toothbrush :
The manual toothbrush is the most popular type of toothbrush that is available in ou
r homes. Bristle Stiffness, Head Type, Bristle Pattern and Handle Size are the four ke
y formats of manual toothbrushes. 

Bristle hardness: 
For most individuals, soft bristles are sufficient, but medium-and hard bristled
toothbrushes are also available.
The benefit of using a tougher toothbrush is that it removes more residue, but if you
 wear your enamel, it can irritate your gums and even wear it away.

Head shape: 
Rounded or squared off are conventionally shaped toothbrush heads. 
Diamond-shaped toothbrushes tend to hit the back and sides of the molars more
efficiently. 

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Bristle pattern: 
In cleaning teeth, different bristle patterns are successful. Popular varieties of
polishing Cups include wavy, crisscross, tapered and bristles. Depending on your
dental needs, your preference should focus on what feels most comfortable.

Handle design : 
The four wide classes of handles for toothbrush include: straight, contra-angle, non-
slip grip and flexible. The handle you choose should allow you to comfortably reach
every tooth surface, including the very back of your mouth.

2. Electric Toothbrush:
An electrical toothbrush rotates the bristles and cleans areas that are difficult to rea
ch. These brushes tend to be more costly but when brushing but when brushing,
there are simple ones. You just press the button  and allow the toothbrush to do its
job. To help you brush more efficiently, some even have timers.
Compared to a manual brush, the multidirectional power brush has been found to 
reduce the occurrence of gingivitis and plaque as compared to standard side-to-
side brushes.
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3. Inter-dental brush:
An interdental brush is a small brush, usually disposable, either equipped with a reusa
ble angled plastic handle or an integral handle, used for brushing between teeth and
between the wires of dental braces and teeth. 
An interdental brush is often called an interproximal brush. In short, the cleaning of 
The interdental space is used (biggap) In combination with tooth brushing, the use of 
interdental brushes has been shown to minimize both.
The amount of plaque and the occurrence of gingivitis relative to toothbrushing.

4. Sulca brush:
Cleaning along the gumline next to the teeth is specifically used. In order to allow
closer adaption to the gums, the bristles are generally formed in a pointed arrow
pattern. For cleaning particular hard-to-reach area  such as between crowns,
bridgework and crowded teeth, a Sulca brush is Suitable.

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5. End-tuft brush:
It is a small round brush head composed of seven tufts of soft nylon bristles that 
are tightly packed, trimmed so that the bristles in the middle can reach deeper into 
small spaces. The brush handle is ergonomically built for a firm grip, providing the 
power and precision required to clean where most other cleaning aids can not be
reached, such as the back of the wisdom teeth (third molars),orthodontic structures
(braces crowded teeth, and surfaces of the teeth that are next to missing teeth).

7. Ecological toothbrushes:
Using biodegradable materials such as wooden handles, bamboo or pig bristles and/or
replaceable heads, they are toothbrush made. They try to stop pollution-boosting
plastic. Since the commercially available toothbrush made of plastic is used by most
people living today, pollution rises every time we replace our toothbrush. A lot of
push is given to the ecological toothbrush to protect our nature.

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What are the brushing techniques ?!

 Horizontal Reciprocating Motion Technique .

 Vibratory Motion Technique .

 Rotary Brushing Technique .

 Roll stroke brushing technique .

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Horizontal Reciprocating Motion Technique

 This is the most commonly used brushing technique because It’s easy of using.
The bristles are placed at a right angle to the long axis of the tooth and gentle
horizontal scrubbing movement of the brush is performed.
 The advantage of this technique is It’s simplicity. The disadvantage is cervical
abrasion of the teeth which is particularly seen in patients who do vigorous
brushing and use hard tooth brushes.

Vibratory Motion Technique

 It is one of the effective type of the brushing technique. In this type bristles are
placed directly apically 45 degree angle to the tooth surface or parallel to the
tooth surface. Press the bristles slightly so that they enter the gum line. Vibrate
the brush back and forth with the 10 to15 strokes for each position and move
next to the teeth.
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Rotary Brushing Technique:
 It is the simplest way for children tooth brushing. place the toothbrush on a set
of the teeth then activate the bristles by slightly pressing against the teeth 4-5
times on each set of the teeth and move to the next.

Roll stroke brushing technique:

 It’s the way in which one doesn’t need any practicing where the
bristles are pointed apical towards the root and is placed on the
gingival margin then the stroke is given to the roll brush occlusal
cleaning inter-proximal areas & the tooth surface in one stroke.

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Adjunctive Aids

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Introduction
• A patient’s ability to achieve good mechanical plaque control is vitally so
important. Scaling and root planing without efficient plaque control throughout
the healing/maintenance phase results in subgingival recolonization within 4–8
weeks. However, good supragingival plaque control seems to be adequate in
preventing recurrence thanks to subgingival recolonization. Poor oral hygiene is
a significant risk factor for ineffective periodontal surgery ,stability of guided
tissue regeneration results , and peri-implant disease.
• Toothbrushing is the most common method of mechanical plaque removal, as
we still not be very good at it. A review by van der Weijden et al. found that in
patients with gingivitis, self-performed mechanical plaque removal with a
manual toothbrushing was not sufficiently effective .
• More frequent toothbrushing (up to twice daily) was shown to significantly
improve gingival heath. Brushing alone remove up to 60% of overall plaque at
each time of cleaning. A more recent review by Slot et al. estimated that the
efficacy of plaque removal by brushing averages around 42% .
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• Brushing is also concept to be greater finest for cleaning facial surfaces of
tooth in comparison to interproximal surfaces. this is widespread because
interdental sites gift highest threat of plaque accumulation anteriorly or
posteriorly in the mouth.
• Accordingly, interproximal surfaces of molars and premolars are the websites
of residual plaque, are at better risk of growing periodontal lesions and caries.
Clinically, gingivitis and periodontitis are normally stated in interproximal
regions than facial & lingual elements.
• To useful resource in plaque control, diverse interdental cleaning aids are
used. these include dental floss, interdental brushes, timber interdental aids,
and oral irrigators. A recent have a look at with the aid of Marchesan et al.
presents convincing data to help the usage of interdental cleaning gadgets for
promoting right oral fitness outcomes. The interdental cleaning is related to
much less periodontal disease, much less coronal and interproximal caries, and
less lacking teeth; a better frequency of interdental cleaning four–7 times
according to week turned into also related to much less interproximal
periodontal disease 11
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 Dental Floss
• The use of floss is commonly recommended in order to prevent gingivitis and
plaque. A study claims that up to 80% of plaque can be eliminated with flossing
& may confer a particular benefit in individuals with orthodontic devices.
However, a scientific evidence demonstrating the clinical benefit of flossing as
an adjunct to routine toothbrushing alone remains limited & this study is the
American dental association.
• Routine use of dental floss is low, ranging between 10%-30% among adults. The
low compliance observed among adults could be because of flossing. studies
showed that few people floss efficiently, and sufferers find flossing hard,
especially in regions with tight contact points. consequently, it become
observed that unmonitored flossing does now not bring about reduction in
gingival inflammation.
• The outcomes of a Cochrane assessment conducted in 2011 discovered a
susceptible and very unreliable evidence” that flossing is related to a small
discount in plaque, even though with a considerable lowering gingivitis.
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Adjunctive Use of Interdental Brushes
• Interdental brushes had been investigated in 1976, where it became
determined that they were effective in removing plaque as a long way as 2–
2.five mm underneath the gingival margin.

• They encompass a relevant metallic wire core, with gentle nylon filaments
twisted around. The effectiveness of interdental brushes is properly
documented. one of the consensus discoveries from the ecu Federation of
Periodontology 2015 stated that “cleansing with interdental brushes is the only
technique for interproximal plaque elimination, continuously associated with
more plaque elimination than flossing or wood sticks.

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Choosing an Appropriate Interdental Brush
• There are many factors to be considered when selecting an interdental brush
that may affect its efficiency . The first one is that size matters and also its
softness as well as hardness that may affect badly on the periodontium.
• In 2011, Imai et al. performed a research which used a measuring tool to
decide the best-fitting interdental brush for proximal sites. A color-coded
probe had been inserted horizontally from the buccal aspect till the snug, with
the resulting color on the probe related to the matching color of interdental
brush. The reduced number of bleeding sites was accredited to the use of a
suitable size of interdental brush, that resulted in effective disturbance of
proximal biofilm compared to one size for all proximal spaces.
• Another factor to consider is the type of the interdental brush. Straight
interdental brushes may be more efficient in interproximal plaque elimination
than angled interdental brushes with a long handle. 

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Wooden Interdental Aids

Wood sticks are designed for mechanical elimination of proximal plaque, carried
out with the aid of friction against proximal enamel surfaces. comparatively fewer
studies investigating wood sticks or toothpicks exist. just like interdental brushes,
Wood sticks are capable of remove plaque up to 2–3 mm subgingivally through
miserable the papilla They in shape great into interdental areas with a triangular
go-section and have to no longer be pressured with toothpicks.

Toothpicks are round, permitting only factor touch with the teeth surface and they
may be greater desirable for putting off food particles. however, established
similar efficacy of supragingival plaque removal to wood sticks.

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Interdental cleansing
devices

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Introduction
• For the preservation of good oral hygiene and the prevention of periodontal
diseases and caries, the regular disruption and removal of dental plaque is
necessary. Although regular twice daily toothbrushing is a common habit, many
individuals are unable to reach the interdental area with toothbrushes. Many of
interdental aids are being used and their use depends on the size of the
interdental space as well as the ability of the patients to use it.

• Interdental cleaning or interproximal cleaning, known as the proximal surfaces

of teeth, is part of oral hygiene where the aim is to clean the areas between
the teeth. This is to remove the dental plaque in areas that cannot be reached
by a toothbrush. Interproximal cleaning's aim is to avoid the development of
interproximal caries and periodontal disease. In order to minimalize the
frequency of caries and periodontal diseases, the combined use of tooth
brushing and mechanical and manual interdental cleaning devices has been
proven.
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Floss:
One of the most widely used interdental cleaners is Floss. Traditionally, it is made
of waxed nylon wrapped in a box of plastic. Since some inter-proximal plaques can
be removed by dental floss, frequent regular dental flossing decreases the risk of
inter-proximal caries and periodontal diseases.
Floss holders or floss picks may be used as an alternative for patients who lack
mobility or adherence.

Interdental Brushes:
Interdental brushes typically consist of a central metal wire core with twisted soft
nylon filaments and are available in various sizes to accommodate the different
spaces between the teeth.
To maximize efficiency and effectiveness, certain factors such as material,
geometry and size of the brush can be chosen:
1. Material: metal wire can be sensitive to some patients, so it may be preferable
to rubber.
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2- Geometry: Compared to angled interproximal plaque removal, straight
interdental brushes are considered more effective.
3- Size: This varies depending on the space between individual teeth. The lack of
efficiency of the interdental cleaning aid can account for the failure to use an
acceptable size.
• This specifically designed toothbrush can be efficiently used to clean the small
gaps between the teeth, as well as the gums and the areas around braces,
wires, or other dental utilizations (sometimes called an interproximal brush or
proxabrush). Since it has a handle not unlike a standard toothbrush, it is easy to
use for many individuals with limited dexterity. Moreover, numerous clinical
studies have shown its effectiveness in plaque reduction and gingivitis control
(gum inflammation).
• An interdental brush's cleaning surface is similar in shape to a small conical
pipe cleaner. From a thin central wire, which is small enough to pass through a
very narrow space, its short bristles radiate. The brushes are existing with both
coated and uncoated wire and come in many widths to suit the specific dental
anatomy of an individual. They may also be used for the application of
antibacterial or desensitizing agents to definite areas of the teeth or gums
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when needed. ( 19 )
Oral Irrigators:
 These devices (sometimes referred to as water jets or water picks),
which have been available to customers for over 50 years, can also play
a role in interdental hygiene. While their popularity has gone up and
down over the decades, several studies have shown that they provide a
safe and efficient way to dilute plaque-generated acids. In order to
remove food particles from hard-to-clean interdental spaces, as well as
in certain subgingival pockets (below the gum line), irrigation devices
typically use pulsed or steady jets of pressurized water.
 Proper brushing and flossing are still generally considered the gold
standard of at-home oral hygiene. But if you regularly have trouble
flossing, or if you are at increased risk of developing dental or
periodontal disease, then it may be right for you to use these
interdental cleaners.
 The common mechanical instruments used for interdental cleaning are
oral irrigators (also called water flossers). To remove debris and
bacteria both above and below the gums, it utilizes a combination of
pulsation and pressure facilitated by water or air. The use of oral
irrigators, when used with tooth brushing, decreases gum inflammation 20
(gingivitis) by removing loosely adherent plaque. ( 20 )
Summery
Interdental cleansing aids play a crucial role in optimizing gingival health and
preventing oral sickness. primarily based at the effects of this overview,
interdental brushes provide an extensive advantage over brushing as a
monotherapy. Using floss might not gain similar results if not efficiently carried
out. regarding gingival and plaque indices, interdental brushes may be superior to
dental floss in at the least one parameter, with the introduced benefits of
affected person consolation and recognition.

They're mainly indicated in periodontal patients, who're probable to have widened

embrasures. Rubberpiks were shown to be comparable to interdental brushes for
decreasing gingivitis and plaque.

The biphasic mode of motion of oral irrigators can also result in qualitative
modifications in subgingival plaque.
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 References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6630384/

https://dentalhealthgroup.ca/different-types-of-toothbrushes-finding-the-best-option-for-you/

https://www.drgutierrezdds.com/articles/dear_doctor/509291-interdental-cleaning-devices

https://books.google.com.eg/books?id=ffSa010zJRAC&pg=PA387&dq=brushing+techniques&hl=e
n&sa=X&ved=2ahUKEwiF4djs4LTtAhWTShUIHfB3BMwQ6AEwAHoECAEQAg

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Thank You

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