MECHANICAL
PLAQUE
CONTROL
J
E
CBackground
TMechanical plaque control
(a) Toothbrush
I (b) Dentifrice
V (c) Interdental cleaning aids
Dental floss
E
- Interdental brushes
S
-
- tooth pik
(d) Oral irrigation
• IMPORTANT CHAPTER
• CLINICALLY VERY RELEVANT
• REQUIREMENT FOR PATIENT TEACHING
Plaque as etiologic factor
Experimental gingivitis study (1965 Löe et al. )
 The cause and effect relationship between
supragingival
plaque
and
gingivitis
was
demonstrated by Loe et al (1965).
 When plaque was allowed to accumulate, gingivitis
developed within 21 days. When plaque control was
initiated, the gingivitis was reversed (by means of
efficient plaque control, i.e., brushing and flossing)
to clinical gingival health
 The removal of microbial plaque leads to cessation
of gingival inflammation, and cessation of plaque
control measure leads to recurrence of
inflammation
The removal of plaque also decreased the
rate of formation of calculus. ( Sanders ,
1962)
Thus eliminating plaque is the key to prevent
the occurrence of periodontal disease or
halting the progression of the disease.
Masses of plaque first develop
( Lang,1973)
FACIAL
SURFACES OF
THE MOLARS &
PREMOLARS
MOLAR &
PREMOLAR
AREAS
PROXIMAL
SURFACES OF
THE ANTERIOR
TEETH
PLAQUE CONTROL
 Plaque control: The removal of dental plaque on
a regular basis and the prevention of its
accumulation on the teeth and adjacent gingival
surfaces.
 Position: supra- & sub-gingival plaque control
 Methods: mechanical & chemical
MECHANICAL PLAQUE CONTROL
OBJECTIVE:
Complete Daily Removal Of Dental Plaque
With A Minimum Of
Effort,
Time,
And Devices,
Using The Simplest Methods Possible.
Self-performed
1. Tooth brushing
2. Interdental aids
– Dental floss and tape
– Toothpicks
– Interproximal brushes
– Single-tufted brush
3. Adjunctive aids
– Dental irrigation devices
– Tongue scrapers
– Dentifrices
TOOTH BRUSH
A. Toothbrush Design
B. Methods of toothbrushing
C. Frequency
and
effectiveness
toothbrushing
D. Toothbrush wear and replacement
E. Electric toothbrushes
of
The Toothbrush
 First “toothbrush” 15th Century in China
 First modern
toothbrush - England in
1780 by William Addis
– mass produced
The Toothbrush
 Nylon toothbrush bristles 1938 in USA (Du Pont)
 First electric toothbrush 1960s (Broxodent)
 1987 – first rotary action
electric toothbrush
•
The Toothbrush
- Generally toothbrushes vary in
size, design as well as in length
and
arrangements
of
bristles
hardness.
- To overcome this variation ADA
given
specification
of
toothbrushes.
-------------------------------------------------
Toothbrush design
American Dental Association (ADA)
›Length
: 1 to 1.25 inches
›Width
: 5/16 to 3/8 inches
›Surface area : 2.54 to 3.2 cm
›No. of rows : 2 to 4 rows of brushes
›No. of tufts : 5 to 12 per row
›No. of bristles : 80 to 85 per tuft
Toothbrush bristles
• Natural: hog
• Artificial filaments:
nylon
NATURAL
ARTIFICIAL
Source
Hair of hog/ wild boar
Synthetic, plastic material
mainly nylon
Uniformity
Non uniform
Uniform
Diameter
Varies
Extra soft: 0.075mm
Hard: 0.3 mm
End shape
Irregular
Rounded
Limitations
Standardization not
possible
Wear: rapid & irregular
Collection of debris &
microorganisms due to
hollow ends
Cleaning, rinsing and
maintenance easy
Wear: Durable
Repels debris: end rounded
Resistant to accumulation
of microraganisms
Bristle hardness
Proportional to the square of the
diameter and inversely proportional to
the square of bristle length
Soft brush: 0.007 inch(0.2 mm)
Medium brush: 0.012 inch(0.3 mm)
Hard brush: 0.014 inch(0.4 mm)
For most patients:






short-headed brushes
with straight-cut,
round-ended,
soft to medium
nylon bristles
arranged in three or four rows of tufts
ARE RECOMMENDED.
TOOTH BRUSHING TECHNIQUES
• Various toothbrushing technique have
achieved acceptance by the dental profession.
• Each technique has been designed to achieve
a definite goal.
• Depending on the individual cases, the
techniques of toothbrusing may have to be
altered to achieve the maximum beneficial
effects.
The efficacy of brushing with regard to
plaque removal is dictated by three
main factors:
The design of the brush
The skill of the individual using the
brush
The frequency and duration of use
Effects and sequel of the
incorrect use of toothbrush
SEQUEL
REASON
Gingival
erosion
Toothbrush
stiffness
Gingival
recession
Gingival
abrasion
Method of
brushing
Brushing
frequency
Toothbrushing methods
1.
2.
3.
4.
5.
6.
7.
8.
Horizontal brushing (scrub)
Leonard method (vertical)
Bass method (Sulcular cleaning)
Modified Bass methods
Stillman methos (vibratory)
Modified Stillman method (roll)
Charters method
Methods of cleaning with powered
toothbrushes
How to brush?
 Patient is instructed to start with molar region of one arch
around the opposite side than continue back around the
lingual or facial surfaces of the same arch
 Last surface to be brushed are occlusal.
 Patient instructed to stroke each area ten time or spend 10
seconds per area then move on to next area.
 Time : 2 minutes ( 30 sec per quadrant )
Method
Bristle placement
Motion
Advantage/
disadvantage
Scrub
Horizontal on gingival margin
Scrub
in
anterior
position
direction keeping brush horizontal
Easy to learn & best suited
for children
BASS
Apical towards gingival into sulcus
at 450 to tooth surface
Short back and forth vibratory
motion while bristles remain in
sulcus.
Cervical plaque removal
Easily learned
Good gingival stimulation
Charter's
Coronally 45o, sides of bristles half
on teeth and half of gingiva
Small circular motions with apical
movements
towards
gingival
margin
Hard to learn and position
brush
Clears inter proximal
Gingival stimulation
Fones
Perpendicular to the tooth
With teeth in occlusions, move
brush in rotary motion over both
arches and gingival margin
Easy to learn
Inter proximal areas not
cleaned
May cause trauma
Roll
Apically, parallel to tooth and then
over tooth surface
On buccal and lingual inward
pressure, then rolling of head to
sweep bristle over gingiva & tooth
Doesn't clean sulcus area
Easy to learn
good gingival stimulation
Stillman'
s
On buccal and lingual, aplically at
an ablique angle to long axis of
tooth. Ends rest on gingiva and
cervical part.
On buccal and lingual slight rotary
motions
with
bristle
ends
stationary
Excellent gingival
stimulation
Moderate dexterity
required
Moderate cleaning of
interproximal area
Modified
stillman's
Pointing apically at and angle of 45o
to tooth surface
Apply pressure as in stillmans's
method but vibrate brush and also
move occlusally
Easy to master
Gingival stimulation
Method
Bristle placement
Motion
Advantage/
disadvantage
Scrub
Horizontal on gingival margin
Scrub
in
anterior
position
direction keeping brush horizontal
Easy to learn & best suited
for children
BASS
Apical towards gingival into sulcus
at 450 to tooth surface
Short back and forth vibratory
motion while bristles remain in
sulcus.
Cervical plaque removal
Easily learned
Good gingival stimulation
Charter's
Coronally 45o, sides of bristles
half on teeth and half of gingiva
Small circular motions with apical
movements
towards
gingival
margin
Hard
to
learn
and
position brush
Clears inter proximal
Gingival stimulation
Fones
Perpendicular to the tooth
With teeth in occlusions, move
brush in rotary motion over both
arches and gingival margin
Easy to learn
Inter proximal areas not
cleaned
May cause trauma
Roll
Apically, parallel to tooth and then
over tooth surface
On buccal and lingual inward
pressure, then rolling of head to
sweep bristle over gingiva & tooth
Doesn't clean sulcus area
Easy to learn
good gingival stimulation
Stillman's
On buccal and lingual, aplically at
an ablique angle to long axis of
tooth. Ends rest on gingiva and
cervical part.
On buccal and lingual slight
rotary motions with bristle ends
stationary
Excellent gingival
stimulation
Moderate dexterity
required
Moderate cleaning of
interproximal area
Modified
stillman's
Pointing apically at and angle of
45o to tooth surface
Apply pressure as in stillmans's
method but vibrate brush and
also move occlusally
Easy to master
Gingival stimulation
Bass method
Charters method
Tooth Brushing
Three methods widely accepted: the
modified bass method, the modified stillman
method( stillman 1932), and the charters
method( Carter’s 1948) .
Controlled studied evaluating the most
common brushing technique have shown
that no one method is superior
Recommended is Bass technique , because it
BASS OR SULCUS
CLEANING METHOD
Most accepted and effective method for the
removal of dental plaque present adjacent
to and underneath the gingival margin.
• INDICATIONS
 interproximal areas
 cervical areas beneath the height of
contour of enamel.
 exposed root surfaces.
TECHNIQUE
 The bristles are placed at a 45 degree angle to
the gingiva and moved in small circular motions.
 Strokes are repeated around 20 times,3 teeth at
a time.
 On the lingual aspect of the anterior teeth, the
brush is pressed into the gingival sulci and
proximal surfaces at a 45 angle.
 The bristles are then activated.
 Occlusal surfaces are cleaned by pressing the
bristles firmly and then activating the bristles.
Bass method
ADVANTAGES
• Effective method for removing plaque.
• Provides good gingival stimulation.
DISADVANTAGES
• Injury to the gingival margin.
• Time consuming.
• Dexterity.
MODIFIED BASS TECHNIQUE
• INDICATION:
• As a routine oral hygiene measure
• Intrasulcular cleansing.
TECHINIQUE
• Vibratary and circular movements with
sweeping motion
• Bristles are at 45 to the gingiva
• Bristles are swept over the sides of the teeth
towards their occlusal surfaces in a single
stroke.
ADVANTAGES
• EXCELLENT SULCUS CLEANING.
• GOOD INTER PROXIMAL AND GINGIVAL
CLEANING.
• GOOD GINGIVAL STIMULATION
DISADVATAGES
• DEXTERITY
MODIFIED STILLMAN’S TECHNIQUE
INDICATIONS
• DENTAL PLAQUE REMOVAL
• CLEANING TOOTH SURFACES AND GINGIVAL
MASSAGE .
DISADVANTAGE
• TIME CONSUMING
• DAMAGE EPITHELIAL ATTACHMENT.
TECHNIQUE
• Bristles are pointed apically with an oblique
angle to the long axis of the tooth
• Bristles placed on the cervical aspect of the
teeth
• Short back and forth motion moved in a
coronal direction.
CHARTER’S METHOD
INDICATIONS:
•
•
•
•
•
Persons having :Missing papilla and exposed root surfaces.
FPD and Orthodontic appliances.
Periodontal surgery.
Interproximal gingival recession.
TECHNIQUE
• A soft/medium multi-tufted tooth brush
taken
• Bristles are placed 45 to the gingiva with
bristles directed coronally.
• Mild vibratory strokes required with bristles
ends lying interproximally.
ADVANTAGES
• Massage and stimulation of gingiva.
DISADVANTAGES
• Poor removal of subgingival bacterial
accumulations.
• Limited brush placement.
• Requirements in digital dexterity are high.
The Toothbrush
 The use of hard toothbrush ,
vigorous horizontal
brushing, the use of
extremely abrasive
dentifrices may lead to
cervical abrasion of teeth
and recession of the
gingiva.( Jepson ,1998)
 Toothbrushes need to be
replaced every 3 months
The Toothbrush
Soft, nylon bristle toothbrush
• clean effectively (when used properly),
• remain effective for a reasonable time ,
• Soft bristle are more flexible and atraumatic
• clean beneath the gingival margin,
• reach farther into the proximal tooth surfaces.
Lecture II
Col area
EMBRASURE
• V-shaped spillway next
to the contact area of
adjacent teeth;
• Narrowest at the
contact and widening
toward the facial,
lingual, and occlusal
contacts
Powered toothbrushes
Invented in 1939.
Motions:
Back and forth
Circular
Elliptic
Combinations
Cleaning action by:
1. Mechanical contact between the
bristles and the tooth
2. Low-frequency
acoustic
energy
generates dynamic fluid movement and
provides cleaning slightly away from the
bristle tips.
INDICATIONS:
1. Children and adolescents
2. Children with physical or mental disabilities
3. Hospitalized patients, including older adults
who need to have their teeth cleaned by
caregivers
4. Patients with fixed orthodontic appliances.
•
Patients who can develop the ability to
use a toothbrush properly usually do
equally well with a manual or a powered
toothbrush.
• Less diligent brushers do better with
powered tooth brushes, which generate
stroke motions automatically and require
less operator effort.
DENTIFRICES
Aids in cleaning and polishing
tooth surfaces.
Composition:
1. Abrasives- silicon oxides, aluminum oxide
2. Humectants
3. Water
4. Soap or detergent
5. Flavoring and sweetening agents
6. Therapeutic agents such as fluorides and
pyrophosphates
7. Coloring agents and preservatives.
The term dentifrice is derived
from dens (tooth) and fricare (to
rub).
A simple, contemporary
definition of a dentifrice is a
mixture used on the tooth in
conjunction with a toothbrush.
Dentifrices are marketed as
Toothpowders
Toothpastes
Gels
55
Original purpose:
• Pleasant taste
• Cosmetic effect
• Remove extrinsic stains
Abrasives
Degree of abrasive hardness depends
on:
• inherent hardness of the abrasive
• size of the abrasive particle
• shape of the particle
Other variables:
• the brushing technique
• pressure on the brush
• the hardness of the bristles
• the direction of the strokes
• number of strokes
Abrasives used:
•
•
•
•
•
•
Calcium carbonate
calcium phosphate
baking soda (sodium bicarbonate)
Silicas
silicon oxides
aluminum oxides
Humectants
• Toothpaste consisting only of a toothpowder
and water results in a product with several
undesirable properties.
• Over time, the solids in the paste tend to
settle out of solution and the water
evaporates.
• This may result in caking of the remaining
dentifrice.
• To solve this problem, humectants were
added to maintain the moisture.
• Commonly used humectants are:
• Sorbitol,
• Mannitol,
• Propylene glycol
•
1.
2.
3.
•
1.
Advantages:
Long shelf life
Maintained moisture content
Nontoxic
Disadvantages
Mold or bacterial growth can occur in their
presence
Soaps
• Logical cleansing agent.
• The toothbrush bristles dislodge food
debris and plaque
• The foaming action of the soap aids in
the removal of the loosened material.
•
1.
2.
3.
4.
Disadvantages of soaps:
irritating to the mucous membrane
flavor is difficult to mask
often causes nausea
soaps are incompatible with other
ingredients, such as calcium.
Detergents
• Substitute to soaps
• sodium lauryl sulfate (SLS) is the most widely
used detergent
•
1.
2.
3.
Advantages of SLS:
Stable
Possesses some antibacterial properties
Has a low surface tension which facilitates
the flow of the dentifrice over the teeth
4. Active at a neutral ph
5. Flavor is easy to mask
6. Compatible with the current dentifrice
ingredients
Flavoring and Sweetening
Agents
• Flavor, along with smell, color, and
consistency of a product, are important
characteristics that lead to public acceptance
of a dentifrice.
• The flavor must be:
pleasant,
provide an immediate taste sensation,
relatively long-lasting
• Synthetic flavors are blended to provide the
desired taste.
• Spearmint,
• peppermint,
• wintergreen,
• cinnamon,
• other flavors give toothpaste a pleasant taste,
aroma, and refreshing aftertaste
Sweetening Agents
• In early toothpaste formulations, sugar,
honey, and other sweeteners were used.
• DISADVANTAGE: these materials can be
broken down in the mouth to produce acids
and lower plaque pH, they may increase
caries RISK.
• Replaced with:
Saccharin,
Cyclamate,
Sorbitol,
Mannitol
• Sorbitol and mannitol serve a dual role as
sweetening agents and humectants.
• Glycerin also serves as a humectant, adds to
the sweet taste.
• A new sweetener in some dentifrices is xylitol.
SPECIFIC DENTIFRICES:
Essential-Oil Dentifrices
• The essential-oil ingredients found in
Listerine mouth rinse are also available in a
dentifrice formulation.
• The clinical and laboratory data suggest a
benefit to gingival health and plaque
reduction
• This product does not carry the ADA Seal of
Acceptance
Therapeutic Dentifrices
• The most commonly used therapeutic agent
added to dentifrices is fluoride, which aids in
the control of caries.
• OTC: The original level of fluoride -restricted
to 1,000 to 1,100 ppm fluoride
• total of no more than 120 mg of fluoride in the
tube
• Requirement that the package include a
safety closure.
• Therapeutic toothpastes, dispensed on
prescription, could contain up to 260 mg of
fluoride in a tube.
• OTC safe levels:
• 0.22% sodium fluoride (NaF) at a level of
1,100 ppm,
• 0.76% sodium monofluorophosphate (MFP) at
a level of 1,000 ppm,
• 0.4% stannous fluoride (SnF2) at a level of
1,000 ppm.
• Fluoride levels were increased to 1,500 ppm
sodium monofluorophosphate in "Extra
Strength Aim," marketed OTC.
• In published studies, this product was 10%
more effective than an 1,100 ppm NaF
dentifrice.
• A recently introduced prescription dentifrice,
Colgate Prevident contains 5,000-ppm
Stannous Salts
• Stannous fluoride (SnF2), specifically the
stannous ion, has reported activity against
caries, plaque, and gingivitis.
• While SnF2 has a long record as an anticaries
agent, long-term stability in dentifrices and
mouthrinses has been questioned since
clinical antimicrobial activity has only been
demonstrated in anhydrous state.
Triclosan
• Triclosan is a broad-spectrum antibacterial
agent
• It is effective against wide variety of bacteria
• A review of the available pharmacological and
toxicological information
• Triclosan can be considered safe for use in
dentifrice and mouth rinse products.
Anticalculus Dentifrices
• Interrupt the process of mineralization of
plaque to calculus.
• Plaque has a bacterial matrix that mineralizes
due to the super saturation of saliva with
calcium and phosphate ions.
• Crystal growth inhibitors may be added to
dentifrices to provide a reduction in calculus
formation.
Antihypersensitivity Dentifrices
Active agents such as:
• potassium nitrate,
• strontium chloride,
• sodium citrate
Whiteners
• Controversial
• These dentifrices control stain via physical
methods (abrasives) and chemical
mechanisms (surface active agents or
bleaching/oxidizing agents).
LECTURE 3
Interdental cleaning aids
• Dental floss
• Interdental brushes
• Wooden or rubber tips
Embrasures
• Gingival embrasure space: a small triangular
•
•
open space
V-shaped spillway next to the contact area of
adjacent teeth
Gingival embrasure space evaluation is critical
in determining which aid will provide the most
accurate biofilm control.
TYPE I
• Embrasure is filled completely by interdental
papilla.
• Dental floss is effective
TYPE II
• The height of interdental papilla is reduced.
• Interdental brushes and wooden toothpicks
are effective.
TYPE III
• The interdental papilla is missing.
• Interdental brushes and end-tuft brushes are
effective.
PLANNING INTERDENTAL CARE
• PATIENT HISTORY OF ORAL HYGIENE
• DENTAL AND GINGIVAL ANATOMY
• PLAQUE SCORES
• SELECTION OF INTERDENTAL AIDS
DENTAL FLOSS
• Levi Spear Parmly
• REMOVES DENTAL BIOFILM
• REDUCES INTERPROXIMAL BLEEDING
• EFFICIENT IN TYPE I EMBRASURES
TYPES OF DENTAL FLOSS
•
•
•
•
Multifilament vs. monofilament
Twisted vs. untwisted
Bonded vs. unbonded
Waxed vs. unwaxed
• Monofilament: resists breakage or shredding
when passed over irregular tooth surfaces,
restorations or calculus deposits.
• Waxed: gives strength and durability during
application.
• Shredding and breakage is rare
Materials:
• Silk: loosely twisted, waxed
• Nylon: multifilaments, waxed/ unwaxed
circular (floss) or flat (dental tape)
• Expanded PTFE: monofilament, waxed
Floss Available
• Flattened floss is designed to increase the
contact surface with the tooth.
• Ultra floss is spongy and soft.
• Round floss is relatively thinner.
• Superfloss contains segments of stiffened-end
threader, spongy floss and regular floss.
• Stiffened-end threader can make it easier to
slide the superfloss through the gap between
the teeth and fixed orthodontic appliances.
• Spongy floss cleans around the appliances and
between wide spaces or to floss underneath
the bridge.
• Regular floss removes plaque from the
adjacent tooth surfaces.
How to Floss:
Using 18 inches
of dental floss,
wrap it lightly
around middle
fingers.
Firmly grasp
the dental floss
with index
fingers.
Forming a Cshape, carefully
slide the floss
up and down
between tooth
and gum line.
Gently slide the
floss in between
both sides of
teeth and
repeat until
finished.
Common Mistakes:
• Not placing the floss under the gum line - Not
placing dental floss carefully under the gum line, the
area where plaque accumulation occurs most, will
not
be
as
effective
in the prevention of dental decay and periodontal
disease.
• Rushing when flossing the teeth - One cannot
perform
proper
flossing
when
rushing
through the procedure of removing plaque. One
should take at least 2-3 minutes when flossing.
Misconception:
• Flossing is not just supposed to remove food
particles from between teeth.
• The primary function of dental floss is to
remove the invisible film of bacteria that
constantly forms between teeth i.e. plaque.
Flossing should be performed between each
tooth.
INTERDENTAL BRUSH
• Open embrasure spaces
• Type II & III
• Root concavities
Root Concavities
• They are trenchlike depression in the root
surface.
• In health, root concavities are covered with
alveolar bone.
• In periodontitis, junctional epithelium
migrates apically with bone and tissue
destruction, exposing the root concavity to
the oral environment.
Interdental brush
Steps for Use of
the Interdental Brush
• Hold brush handle between the thumb and the index
finger
• Gently insert between teeth
• Maintain brush at a 90-degree angle to the long axis
of the tooth
• Use slight pressure to adapt brush
• Slide brush in and out of the space
• Adapt brush to the mesial surface of the first
premolar
• For posterior areas, advise the patient to close his or
her mouth slightly to relax the cheek.
• It is helpful to bend the brush to facilitate insertion.
Single tufted brush
• A single tuft or group of small tufts, may be 3-6 mm
in diameter
• Flat or tapered
• Handle : straight or contra- angled
Indications:
• Type II embrasures
• Fixed dental prosthesis
• For difficult to reach
areas
INTERDENTAL TIP
• Conical or pyramidal flexible rubber tip attached to
the end of the handle of a toothbrush.
• Soft, pliable rubber tip: adapted to the interdental
area and below gingival margin
• Does not cause damage to epithelial lining.
INDICATIONS:
• Interdental embrasure type II
• Plaque removal at or just below the gingival margin.
WOODEN TIP
• Wooden cleaner is a 2 inch long device
• Made of:
basswood
birch wood
• It is triangular in cross section
• Indication: type III embrasure
GINGIVAL MASSAGE
• Advantages:
Epithelial thickening,
increased keratinization,
increased mitotic activity in epithelium and
connective tissue
alteration or removal of plaque
Oral irrigation devices
• Supragingival
irrigation
• Subgingival
irrigation
Supragingival vs. Subgingival
Irrigation
• The objective of supragingival irrigation is to
diminish gingival inflammation by disrupting
biofilms coronal to the gingival margin.
The goal of subgingival irrigation is to reduce
the number of bacteria in the periodontal
pocket space.
Dental Water Jet
• Device that delivers pulsed irrigation of water
or other solution supragingivally and
subgingivally
• Also known as dental water irrigator, home
irrigator, water flosser
Mechanism of Action
• Delivers a pulsating fluid that incorporates a
compression and decompression phase
• This creates two zones of fluid movement
called hydrokinetic activity.
• Impact zone—initial fluid contact with an
area of the mouth
Flushing zone—depth of fluid penetration
within a subgingival sulcus or periodontal
pocket
Benefits of Home Irrigation
•
•
•
•
•
Biofilm removal
Bleeding reduction
Gingival inflammation reduction
Periodontal pathogens reduction
Reduction in inflammatory and destructive
host response
Indications for Recommendation
• Individuals on periodontal maintenance
• Individuals who are noncompliant with dental
floss
• Individuals with special needs
• Individuals with dental implants
• Individuals with diabetes
• Individuals with orthodontic appliances
Precautions:
• Incidence of bacteremia is similar to other oral
healthcare devices.
• Before recommending a water jet to a patient
who is at high risk for infective endocarditis,
dental healthcare providers should consider
both the patient's overall medical and oral
health status.
• Consultation with a physician is advisable for
Irrigating Solutions
• Water
• Antimicrobial
solutions
Chlorhexidine
Essential oils
Other solutions
TONGUE CLEANING
• Daily tongue cleaning removes pathogenic
bacteria on the dorsum surface.
• Reduces bacteria in the saliva
• Improves taste sensation
• Reduces halitosis
• Removes volatile sulfur compounds, which are
gases that cause halitosis
• Manual tongue
cleaners come in a
variety of styles.
Toothbrush with a
thin head
Tongue scrapers
All types are
designed to allow
patients to reach the
Any QUESTIONS????