Plaque control

:The etiology of periodontal disease is

Secondary factors:
Initiating (primary)
factor:
Local predisposing
factors
Bacteria in dental plaque
Systemic modifying
Dental calculus
factors.
 Plaque-
A sticky film that forms on your teeth from
the bacteria, food, and saliva in your
mouth.
In the BEFORE
picture, you can see the
buildup of plaque on
these teeth with the aid
of a disclosing
.agent

The AFTER picture

shows the removed
.plaque
-calculus
Plaque that is not
removed will sit on the
teeth and below the
gingiva, will harden or
mineralize, thus forming
.calculus
 Plaque Control
 the removal of microbial plaque and the prevention
of its accumulation on the teeth and adjacent
gingival surfaces.
 retards the formation of calculus.
 an effective way of treating and preventing gingivitis
and is therefore a critical part of all the procedures
involved in the prevention of periodontal disease.
 Plaque control

Chemical plaque
Mechanical cleansing
inhibitors incorporated
with a toothbrush and
in mouthwashes or
other cleansing aids.
dentifrices.
 Toothbrushes

size

design length
Vary
in

Arrangm
ent of hardness
bristles
:Patients always ask

 What's the best toothbrush?

 When should I replace the
toothbrush?
 How often should I brush my
teeth?
 What is the best methods to brush
my teeth?
 toothbrushes
 Material
 Bristle end
 Tufts
 Hardness
 Length and angulation
 Specially designed tooth brushes
 Types of Toothbrush
Two types of bristle material are used:
- Natural bristles from hogs
- Artificial filaments made of nylon.
 Both types remove plaque, but nylon bristle
brushes predominate in the market????????

Natural bristles Nylon bristles

fray, break, soften in a wet retain their firmness
environment, and lose their longer, are more uniform
elasticity quickly. in size and shape and
easier to keep clean.
 Types of Toothbrush
Bristle ends:
 Rounded bristle-ends
 Flat-cut bristles-ends

Rounded bristle ends cause

fewer scratches on the
gingiva (safer) than flat-cut
bristles with sharp ends
 Types of Toothbrush

 Toothbrush bristles are

grouped in tufts that are
usually arranged in three or
four rows.
 Four-row brushes (multi-
tufted) contain more bristles
and therefore tolerate more
working pressure without
flexing.
 Types of
toothbrushes

Soft medium Hard

more flexible, clean slightly

below the gingival margin seem to cleanse
and proximal surfaces. better than soft
seem to cleanse better than bristles associated with
hard bristles because of the
( soft brush may more gingival
"matting effect" produced recession
by the combination of soft not completely
bristles and dentifrice remove heavy
increasing tooth/ dentifrice plaque)
contact
 Types of Toothbrush
 A handle should be long enough to fit
the palm of the hand.
 Straight handles are most common.
 Handles with contra-angle shanks may
provide the grasping hand with a better
feeling of touch and improve posterior
access for plaque removal.
 The stretching of the lip when brushing
facial molar surfaces is less with contra-
angle handles than with straight
handles.
 Specially design toothbrush

It is meant to •
clean three tooth
surfaces : the
outer, inner and
occlusal surfaces
simultaneously
Denture brush - specially designed to
clean complete and partial denture
surfaces including clasps
End-tuft brush- permits easier
access to difficult to reach areas
Orthodontic toothbrush - special v-trimmed bristles
designed to effectively clean around braces
?What's the best toothbrush -1

Round-ended,
soft-to-medium
nylon bristles
arranged in three or four tuft
rows is recommended.
When should I replace the -2
?toothbrush
 With regular use of a brush, this should occur
within three months.
 If a brush is "worn out" after one week, tooth
cleaning is usually performed too vigorously
 if the bristles are still straight after six
months, the brushing is either done too gently
or the brush has not been used every day.
How often should I brush my-3
?teeth

Brush twice daily

Techniques of toothbrush

 The Bass method (sulcus

cleansing)
 The modified Stillman method
 The Charters method
 The Bass method (sulcus cleansing)

 Place the head of a soft brush parallel with the occlusal

plane, with the brush head covering three to four teeth,
beginning at the most distal tooth in the arch.

 Place the bristles at the gingival margin, pointing at a 45-

degree angle to the long axis of the teeth.

 Exert gentle vibratory pressure, using short, back and forth

motions without dislodging the tips of the bristles. This
motion forces the bristle ends into the gingival sulcus area
as well as partly into the interproximal embrasures. The
pressure should be firm enough to blanch the gingiva
 The Bass method
A, Proper position of the brush in the mouth aims the
bristle tips toward the gingival margin.
B The ideal placement, which permits slight
subgingival penetration of the bristle tips.
 The Bass method
 Positioning the powered toothbrush head and
bristle tips so that they reach the gingival margin is
critical to achieving the most effective cleaning
results.
When we brush the inner surfaces of
front teeth, we should hold the
toothbrush straight using gentle motion
scrubbing from the gingival margin
.towards the crowns of the teeth
Finally, we brush the occlusal
surfaces of the teeth with the
toothbrush moving backward and
.forward
The modified Stillman method

 Bristle ends resting partly on the cervical portion of

the teeth and partly on the adjacent gingiva, pointing
in an apical direction at an oblique angle to the long
axis of the teeth.
 Pressure is applied laterally against the gingival
margin so as to produce a perceptible blanching.
 The brush is activated with 20 short back-and-forth
strokes and is simultaneously moved in a coronal
direction along the attached gingiva, the gingival
margin, and the tooth surface.
 This process is repeated on all tooth surfaces,
proceeding systematically around the mouth.
 The modified Stillman method
The Stillman method is
therefore recommended
for cleaning in areas with
progressing gingival
recession and root
exposure in order to
prevent abrasive tissue
destruction.
 The Charters Method
 The bristles are pressed
sideward against teeth and
gingiva. The brush is
activated with short circular
or back-and-forth strokes.
 recommended for
temporary cleaning in areas
of healing gingival wounds,
e.g., following gingivectomy
or flap surgery.
Powered (electric) toothbrushes

Each tuft of bristles rotates individually 

The entire brush head rotates in
clockwise direction
Powered (electric) toothbrushes

Powered toothbrushes have been shown to

improve oral health for
(1) Children and adolescents,
(2) Children with physical or mental disabilities,
(3) Hospitalized patients who need to have their
teeth cleaned by caregivers
(4) patients with fixed orthodontic appliances.
 Powered (electric) toothbrushes
 Powered toothbrushes remove
plaque as well as, if not slightly
better than, manual
toothbrushes.
 Patients sometimes are reluctant
to purchase power
toothbrushes because of the
relatively high cost compared
with manual toothbrushes.
 Less expensive models are now
available and have been shown
to be as effective as the higher-
priced models.
 Interdental cleaning aids
 Removal of inter-proximal plaque more
important than cleaning facial and lingual
tooth surfaces because the prevalence of
inflammation is highest.
 It has been shown that a toothbrush, does
not completely remove interdental plaque
accumulation.
 For optimal plaque control, toothbrushing
should therefore be supplemented with a
more effective way of interdental cleaning.
 Dental
Floss

Interdental
cleaning
aids

Interdental Wooden or
brushes rubber tips
 Dental Floss
 most widely recommended method of cleansing proximal
surface.
available as a multifilament:
 waxed or unwaxed,
 and thick or thin.
 Dental Floss
Unwaxed floss  Waxed dental floss
 finer than waxed floss and  was thought to leave a waxy
therefore passes more easily film on proximal surfaces,
between teeth with tight thus contributing to plaque
contact. accumulation and gingivitis.
 produces a distinct squeaking
sound when moved over a
tooth surface devoid of soft
deposits. This acoustic
phenomenon can serve as a
practical indicator of a clean
tooth surface.
Floss at least once a day, preferably before
going to bed
Use an arm’s length piece of floss
Wrap around middle fingers leave ½” between
fingers, and use index fingers as your guide
• Don’t snap into the
gingiva, instead use a
gentle see-saw motion
• Once in between the
teeth, wrap floss around
the tooth in a “c”
formation and move in
up/down motion
Use a sawing motion, gently slide the floss towards
the gingiva between two teeth.
When the floss is at the gingival margin, wrap it
around one tooth making a "C" shape and gently
slide it up and down against the tooth. Then wrap
around the adjacent tooth and repeat the sliding
motions.
Cleaning of Fixed Bridges

As dental plaque also accumulates

under the surface of the bridges,
patients wearing bridges should
use superfloss to clean the area
daily.
 Floss holder
 The manipulation of dental floss can be simplified by using a
floss holder.
 Powered flossing devices are also available. The devices have
been shown to be safe and effective, but no better at plaque
removal than finger flossing.
Floss holder - for holding floss
comfortably and securely
 Interdental brushes
 suitable for cleaning large, irregular, or concave tooth
surfaces adjacent to wide interdental spaces.
 Wooden tips
 with or without a handle.
 Plastic tips that resemble wooden or rubber tips are also available.
 Both rubber and plastic tips can be rinsed and reused and are easily
carried in a pocket.
 Wooden tips
The tip is inserted between
the teeth, with the triangular
portion resting on the
gingival papilla. The tip is
moved in and out to remove
plaque;
However, it is very difficult
to use on posterior teeth and
from the lingual aspect of all
teeth.
Interproximal embrasure spaces vary greatly in patients with periodontal disease.
Tongue cleansing
Chemical plaque inhibitors

Fluorides
Chlorhexidine
Antibiotics such as erythromycin,
penicillin, spiramycin and
metronidazole
 Chlorhexidine gluconate

almost completely inhibit the

development of dental plaque,
calculus, and gingivitis.


 Chlorhexidine gluconate
 At low concentration, the CHX is
bacteriostatic.
 At higher concentration the CHX is
bacteriocidal.
 one of the safest antiseptics known.
 It has not so far shown any evidence of
systemic toxic activity in humans, nor
produced any appreciable resistance of oral
microorganisms.
Chlorhexidine gluconate

Reversible side effects:

1. Brown staining of teeth, tongue, and

silicate and resin restorations,
2. Transient impairment of taste perception,
and discrete desquamation of the oral
mucosa
 Enumerate different toothbrush designs

 Enumerate interdental cleaning aids