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MECHANICAL

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

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Plaque as etiologic
factor
 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
MOLAR & SURFACES OF
PREMOLAR THE MOLARS &
AREAS PREMOLARS

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 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

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 ,
 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
Toothbrushing methods
1. Horizontal brushing (scrub)
2. Leonard method (vertical)
3. Bass method (Sulcular cleaning)
4. Modified Bass methods
5. Stillman methos (vibratory)
6. Modified Stillman method (roll)
7. Charters method
8. 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 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 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.
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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.
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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.
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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

 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
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

• 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
TYPE II
TYPE III
DENTAL FLOSS

• REMOVES DENTAL BIOFILM

• REDUCES INTERPROXIMAL BLEEDING

• EFFICIENT IN TYPE I EMBRASURES


Materials:
• Silk: loosely twisted, waxed

• Nylon: multifilaments, waxed/ unwaxed


circular (floss) or flat (dental tape)

• Expanded PTFE: monofilament, waxed


How to Floss:

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.

• 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
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.
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


Oral irrigation devices
• Supragingival
irrigation

• Subgingival
irrigation
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
back of the tongue.
2019/6/9

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