PLAQUE CONTROL FOR

THE PERIODONTAL PATIENT

SINGLE-TUFTED/END-TUFTED BRUSH

Single-tufted brushes are designed with smaller brush heads that have a small group
of tufts or a single tuft. The tuft may be 3–6 mm in diameter and can be fl at or
tapered. The handle can be straight or contra-angled. Angulated handles permit easier
access to lingual and palatal aspects. The filaments are directed into the area to be
cleaned and activated with a rotating motion. Single-tufted toothbrushes are designed
to improve access to distal surfaces of posterior molars, tipped, rotated or displaced
teeth, to clean around and under fixed partial dentures, pontic, orthodontic
appliances, or precission attachment, and to clean teeth affected by gingival recession
and irregular gingival margin or furcation involvement.
WOODEN OR RUBBER TIPS
Wooden tooth-picks used on handles improve access to all areas and have been shown to
be as effective as dental floss in reducing plaque and bleeding scores in subjects with
gingivitis. Triangular wooden tips are also available; this design is most useful in the
anterior areas when used from the buccal surfaces of the teeth. Rubber tips are conical
and are mounted on handles or the ends of toothbrushes; they can be easily adapted to
all proximal surfaces in the mouth. Plastic tips that resemble wooden or rubber tips are
also available and are used in the same way. Both rubber and plastic tips can be rinsed
and reused and are easily carried in a pocket or purse.
Rubber tips should be placed into the embrasure space, resting on the gingiva, and used
in a circular motion. They can be applied to interproximal spaces and other defects
throughout the mouth and are easily adaptable to lingual surfaces.

Recommendations
• Often a toothbrush and dental floss are not sufficient to clean interdental spaces
adequately, so it is extremely important to find an interdental device that the patient likes
and will use.

• Many interdental cleaning aids are available for patients. The patient might need to try
several devices before finding one that is acceptable and cleans adequately.

• In general, the largest brush or device that fits into a space will clean most efficiently
GINGIVAL MASSAGE

Massaging the gingiva with a toothbrush or an interdental cleaning devices produces

epithelial thickening, increased keratinization, and increased mitotic activity in the
epithelium and connective tissue. The increased keratinization occurs only on the oral
gingiva and not on the areas more vulnerable to microbial attack: the sulcular epithelium
and the interdental areas where the gingival col is present. Epithelial thickening,
increased keratinization, and increased blood circulation have not been shown to be
beneficial for restoring gingival health. Improved gingival health associated with
interdental stimulation is much more likely the result of microbial plaque removal than
gingival massage.
DENTAL WATER JET

The dental water jet was introduced in 1962. This device, also called an oral irrigator, has
been demonstrated to be safe and effective. The daily use of oral irrigation has been shown
to reduce dental plaque, calculus, gingivitis, bleeding, probing depth, periodontal
pathogens, and host inflammatory mediators. It has been reported that a pulsating stream
of water is better than a continuous flow. The pulsating, hydrodynamic forces produced by
irrigators can rinse away food debris from interdental spaces and plaque-retentive areas.
Irrigation is not, however, a mono-therapy but an adjunct designed to supplement or
enhance other home care methods (brushing and flossing) intended for mechanical plaque
removal.
TONGUE CLEANERS

The dorsum of the tongue, with its papillary

structure and furrows, harbors a great number
of micro-organisms. It forms a unique ecologic
oral site with a large surface area. The tongue
is said to act as a reservoir which permits the
accumulation and stagnation of bacteria and
food residues. Therefore, tongue brushing has
been advocated as part of daily home oral
hygiene together with tooth-brushing and
flossing.