Plaque Control Measures
Dr Hidayathulla Shaikh
objectives
At the end of the lecture student should know
• Define plaque
• Discuss disclosing agents
• Discuss different types of mechanical plaque control
methods
 Tooth brushes and dentifrices
 Inter dental aids
 Aids for gingival stimulants
• Discuss different types of chemical plaque control
methods.
• Explain different types of brushing techniques.
DEFINITION
• Plaque is defined as the soft deposits that form the biofilm
adhering to the tooth surface or other hard surfaces in the
oral cavity including removable and fixed restorations.
• It has got a definite internal feature. It plays the major role in
development and maintaining gingival and periodontal
diseases. Calculus is formed when the plaque is calcified.
• So it is very important to remove and prevent formation of
the plaque.
WHAT IS PLAQUE CONTROL?
• The procedure of removal of the microbial plaque and prevention of its
accumulation on the teeth & adjacent gingival surface is called plaque control.
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AIMS OF PLAQUE CONTROL
To prevent Dental Caries.
To prevent Periodontal Disease.
To prevent Gingivitis.
Maintenance of oral hygiene.
Prevention of halitosis.
Esthetic appearance.
Provide favorable environment for healing.
MODE OF CONTROL
Mainly by two ways
1.Oral Prophylaxis
2.Oral Hygiene
Professionals perform oral prophylaxis by scaling, root planning etc.
Maintenance of oral hygiene by the patient can be done in
two ways:(I) Mechanical aids.
(II) Chemical agents.
(I) Mechanical aids
1.Tooth brushes.
(a) Manual
(b) Electrical
2.Interdental aids
(a)Dental Floss
(b)Triangular Toothpicks
-Handheld Triangular Toothpicks
-Proxapic
(c)Interdental Brushes
-Proxabrush System
-Bottle Brushes
-Single Tufted Brushes
(d)Yarn
(e)Superfloss
(f)Perio-aid
3.Aids for gingival stimulation
(a)Rubber Tip Stimulator
(b)Balsa wood edge
4.Others
(a)Gauze Strips
(b)Pipe Cleansers
(c)Water Irrigation Devices
5.Aids for edentulous or partially edentulous patients
(a)Denture and partial clasp brushes
(b)Cleansing solution
(II) Chemical agents:
These can be broadly classified in to 3 generations.
 First generation (antibiotics, quaternary ammonic
compounds, phenolic compound, sanguanarine etc.)
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Second generation (chlorhexidine or bisguanines)
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Third generation (delmopinol)
Tooth Brush
One of most commonly used mechanical aids in plaque
control is toothbrush.
The tooth brush should have the following characteristics:Its size shape & texture should be comfortable to the patient
It should be readily cleaned.
It should be durable and inexpensive.
It should have round end bristle.
ADA SPECIFICATION OF A TOOTHBRUSH
Brushing Surface
• 1 to 1.25 inches in length
•5/16 to 3/8 inches in width
•2.54 to 3.2 cm surface area
•2 to 4 rows of bristles
•5 to 12 tufts per row
Selection of tooth brush :• Patient’s mental ability, motivation, willingness to use tooth
brush.
• Status of gingival and periodontal health.
• Malocclusion (Crowding, spacing etc.)
• Shape of the tooth, exposed root surface.
• Personal preference.
TOOTH BRUSHING
TECHNIQUES
• The Roll Technique:
Modified Stillman
• The Vibratory technique:
Stillman, Charters & Bass Method
• The circular technique:
Fones Method
• The vertical technique:
Leonard’s Method
• The Horizontal technique:
Scrub Brush method
• The Physiological Technique
Smiths method
BRUSHING METHODS
BASS METHOD
Technique :
The bristles are placed at a 450 angle to the gingivae and moved in small
circular motions. Strokes are repeated around 20 times, 3 teeth at a
time.
On the lingual aspect of anterior teeth the brush is inserted vertically.
The bristle are then activated. Occlusal surfaces are cleansed by pressing
the bristles firmly against the pits and fissures and then activating the
bristles.
Advantages:
• Effective method for removing plaque
• Easy to learn
• Recommended for routine patient with or without periodontal
involvement
Disadvantages
• Time consuming
• Overzealous brushing may convert the very short stokes into a scrub
brush technique and cause injury to the gingiva
Modified Stillman method
Technique:
The bristles are pointed apically with an oblique angle to the long
axis of the tooth. The bristles are positioned partly on the cervical
aspects of teeth and partly on the adjacent gingiva.
The bristles are activated by short back and forth
motions and simultaneously moved in a coronal direction. Following
20 strokes, the procedure is repeated.
Disadvantages
• Time consuming
• Improper brushing can damage the epithelial attachment .
Charter’s Method
Technique :A soft/medium multitufted tooth brush is
indicated for this technique. Bristles are
placed at an angle of 450 to the gingiva with
the bristles directed coronally.
The bristles are activated by
mild vibratory strokes with the bristle ends
lying interproximally
Disadvantage :• Brush ends do not engage the gingival sulcus.
• In some areas the correct brush placement is
limited or impossible.
SCRUB BRUSH METHOD
This method of brushing requires vigorous horizontal, vertical
and circular motions.It is the virtual freestyle of the brushing
scene.
Disadvantages
1.Ineffective at plaque removal
2.Tooth abrasion and gingival recession
3.Detrimental to general oral health
Powered tooth brushes :This kind of tooth brushes are
recommended for :•
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Patient lacking fine motor skills.
Small children.
Handicapped patient.
Hospitalized patient.
Patient with orthodontic
appliances.
• Patient who prefer them.
INTERDENTAL CLEANING AIDS
Dental floss :
• It is thread used as an inter-dental cleaning aid which
functions through frictional force.
• It can be made of silk , nylon, Teflon type material etc.
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Type :
It can be thick , medium, thin and extra thin.
It can be twisted and untwisted or waxed and
unwaxed.
Selection of floss depends on :Tightness of the contact area of the two teeth.
Roughness of the tooth surface.
Patient’s mental ability.
Indication :• It is recommended for cleaning the inter-proximal
embrasure area where recession of inter-dental
papillae has not taken place.
Limitations :
• Care recommended for cleaning the
inter-dental tissue.
• Time consuming procedure.
• Irregular or concave tooth surfaces &
furcation areas cannot be cleaned.
Method of using dental floss
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There are two methods –
1. Spool method
2. Circle or Loop method
INTERDENTAL BRUSHES
• Dental floss cannot effectively clean the
concave root surface of furcation areas
when there is recession of gingival. So
special type of aids are recommended for
cleaning these areas.
• Miniature bottle or spiral brushes are
recommended for cleaning the narrow
space between teeth where there is
minimal or moderate degree of gingival
recession
• These also can be useful in cleaning the
bridges, orthodontic appliances or for
application of medication in narrow space
between teeth
TOOTH PICKS
• These are pieces of soft wood of 5-7.5cm lengths. They are
triangular in cross section. The base of the triangle should rest on
the gingiva and the sides should make contact with the proximal
areas of the tooth surface. It moves in and out of the embrasure.
• It is recommended for cleaning the inter-dental area where
recession has taken place. In normal healthy condition it should be
avoided as it may damage the inter-dental papilla.
• It should be moistened with water or saliva before use.
• It should be advised to those patient who follow the instruction of
their dentist. Improper use by uncooperative patient may damage
the gingiva.
Mouthrinsing :
• Ideally the patient should brush his
teeth after every meal.
• But when this is not possible
patient can at least rinse his mouth
after taking some food.
• This will help in removal of loose
food debris and thus retard the
formation of plaque.
Dentifrices:
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Dorland described it as a preparation for cleaning and polishing the teeth.
A dentifrice contains :
Abrasive (15 - 45%) = CaCo3, Ca. phosphate etc
Detergents (1 - 5% foaming agents) = Sodium Lauryl sulphate etc
Anticariogenic agent = Sodium Fluoride, Stannous fluoride
Desensitising agent = Strontium Chloride, Sodium Fluoride
Humectant (20 - 45%) = Glycol, sorbitol
Flavoring agent (1%)= Mint
Sweetening agent (2%) = Sorbitol, Saccharine
Coloring agent (.5%) as per manufacturers choice
Preservative (.5%) Benzoic acid
Dentifrice contain fluoride and according to ADA the flouride content should
be 800-1100 ppm.
CHEMICAL METHOD
According to Glemo (1974) an antiplaque agent should have the following
properties:• Inhibit plaque formation
• Elimination of exiting plaque.
• Inhibition of calcification of plaque.
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According to Bral & Brountein (1988) an antiplaque agent should have the
following properties.
Eliminate pathogenic bacteria and prevent development of resistant
bacteria.
Should be safe for oral cavity.
They should reduce plaque and gingivitis and prevent mineralization of
plaque to calculus.
Should not stain the tooth and alter the taste.
Easy to use
Inexpensive
Chemicals used as antiplaque agent can be divided in to three
generation .
A. First Generation :1.Antibiotics
2.Phenolic Compound
3.Fluorides
4.Peroxide
5.Sanguanarine
B.
Second Generation agents :-
1.
Chlorhexidine
C. Third generation drug:1.
Delmopinol
Mechanism of Action of chlorhexidine:
1.
Antiplaque action of Chlorhexidine
a) prevents pellicle formation
b) prevents adsorption of bacterial cell wall onto the tooth
surface by binding to the bacteria.
c) prevents binding of mature plaque by precipitating
agglutination factors in the saliva and displacing calcium from the
plaque matrix.
2.
Antibactrial action :
Chlorhexidine shown different effects at different concentrations
i.e.
a) Bacterio static at low concentrations
b) bacteriocidal at high concentrations.
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.
Disclosing Agents
A disclosing agent is a preparation in liquid tablet
or lozenge from which contains a dye of other
coloring agent.
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Agents used for disclosing plaque
Iodine preparations
Mercurochrome preparations
Bismark brown (Easlick’s disclosing solution
Merbromin
Erythrosine
Fast green
Fluorescin
Two tone solutions
FD & C green No. 3
FD & c red No
Basic Fuchsin
Recommendation for plaque control instruction
 For a successful long-term Plaque control patients active cooperation is
very important. Patients education, motivation play very important role in
this regard.
 Daily mechanical removal of plaque and use of chemical agents are most
important practical means for improving oral hygiene.
 This process require motivation on the part of the patient, education and
instruction followed by encouragement and reinforcement.
Motivation
Motivation for effective plaque control is one of the most important
element for long term success.
Change the habit of life time – it is required to adopt successful self
determined daily plaque control regimes.
Behavioral changes- required to adjust the hierarchy of one’s belief,
practice and value.