PLAQUE
CONTROL
OB
J Background
Mechanical plaque control
E (a) Toothbrush
C (b) Dentifrice
T (c) Interdental cleaning aids
Dental floss
I -
- Interdental brushes
V - tooth pick
E (d) Oral irrigation
S
• IMPORTANT CHAPTER
• CLINICALLY VERY RELEVANT
• REQUIREMENT FOR PATIENT TEACHING
PLAQUE
• Soft Deposits That form the Biofilm adhering
to the tooth surfaces or other hard surfaces in
oral cavity , including removable and fixed
Restorations.
• Bowen , 1976
2019/6/9
Plaque as etiologic
factor
The cause and effect relationship between
supragingival plaque and gingivitis was
demonstrated by Loe et al (1965).
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.
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 of
toothbrushing
D. Toothbrush wear and replacement
E. Electric toothbrushes
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
Bristle hardness
short-headed brushes ,
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.
BASS Apical towards gingival into sulcus Short back and forth vibratory Cervical plaque removal
at 450 to tooth surface motion while bristles remain in Easily learned
sulcus. Good gingival stimulation
Charter's Coronally 45o, sides of bristles half Small circular motions with apical Hard to learn and position
on teeth and half of gingiva movements towards gingival brush
margin Clears inter proximal
Gingival stimulation
Fones Perpendicular to the tooth With teeth in occlusions, move Easy to learn
brush in rotary motion over both Inter proximal areas not
arches and gingival margin cleaned
May cause trauma
Roll Apically, parallel to tooth and then On buccal and lingual inward Doesn't clean sulcus area
over tooth surface pressure, then rolling of head to Easy to learn
sweep bristle over gingiva & tooth good gingival stimulation
Stillman' On buccal and lingual, aplically at On buccal and lingual slight rotary Excellent gingival
s an ablique angle to long axis of motions with bristle ends stimulation
tooth. Ends rest on gingiva and stationary Moderate dexterity
cervical part. required
Moderate cleaning of
interproximal area
Modified Pointing apically at and angle of 45o Apply pressure as in stillmans's Easy to master
stillman's to tooth surface method but vibrate brush and also Gingival stimulation
move occlusally
Method Bristle placement Motion Advantage/
disadvantage
Scrub Horizontal on gingival margin Scrub in anterior position Easy to learn & best suited
direction keeping brush horizontal for children
BASS Apical towards gingival into sulcus Short back and forth vibratory Cervical plaque removal
at 450 to tooth surface motion while bristles remain in Easily learned
sulcus. Good gingival stimulation
Charter's Coronally 45o, sides of bristles Small circular motions with apical Hard to learn and
half on teeth and half of gingiva movements towards gingival position brush
margin Clears inter proximal
Gingival stimulation
Fones Perpendicular to the tooth With teeth in occlusions, move Easy to learn
brush in rotary motion over both Inter proximal areas not
arches and gingival margin cleaned
May cause trauma
Roll Apically, parallel to tooth and then On buccal and lingual inward Doesn't clean sulcus area
over tooth surface pressure, then rolling of head to Easy to learn
sweep bristle over gingiva & tooth good gingival stimulation
Stillman's On buccal and lingual, aplically at On buccal and lingual slight Excellent gingival
an ablique angle to long axis of rotary motions with bristle ends stimulation
tooth. Ends rest on gingiva and stationary Moderate dexterity
cervical part. required
Moderate cleaning of
interproximal area
Modified Pointing apically at and angle of Apply pressure as in stillmans's Easy to master
stillman's 45o to tooth surface method but vibrate brush and Gingival stimulation
also move occlusally
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.
Bass method
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.
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.
2019/6/9
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.
2019/6/9
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.
2019/6/9
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.
Powered toothbrushes
Invented in 1939.
Motions:
Back and forth
Circular
Elliptic
Combinations
The Toothbrush
Toothbrushes need to be
replaced every 3 months
DENTIFRICES
Aids in cleaning and polishing
tooth surfaces.
2019/6/9
2019/6/9
Dentifrices are marketed as
Toothpowders
Toothpastes
Gels
44
• Therapeutic toothpastes, dispensed on
prescription, could contain up to 260 mg of
fluoride in a tube.
• 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
Interdental cleaning aids
• Dental floss
• Interdental brushes
Firmly grasp
Gently slide the
Using 18 inches the dental floss Forming a C-
floss in between
of dental floss, with index shape, carefully
both sides of
wrap it lightly fingers. slide the floss
teeth and
around middle up and down
repeat until
fingers. between tooth
finished.
and gum line.
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.
• 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.
• Subgingival
irrigation
Irrigating Solutions
• Water
• Antimicrobial
solutions
Chlorhexidine
Essential oils
Other solutions
TONGUE CLEANING