1. Plaque Control

2. Periodontium

3. Dental plaque
A biofilm consists of complex communities of bacterial species that reside on tooth surfaces or soft tissues
species
Etiology of gingivitis and periodontitis

4. 牙菌斑生物膜的新概念
牙菌斑是一種細菌性生物膜，為間質包裹的互相黏附、或黏附於牙齒表面、牙間或復形體表面的軟而未礦化的細菌性群體。這概念強調牙菌斑生物膜是以整體生存的微生物生態群體，它不同於懸浮的單個細菌，細菌需借生物膜的獨特結構，黏附在一起生長，使細菌附著很緊難以清除，正常情況下與宿主間，保持著菌群之間的相對平衡，且保持著菌群與宿主之間的動態平衡，共生共存；另一方面牙菌斑生物膜的形成是一種適應過程，使細菌能抵抗宿主的防禦功能，進而使各種細菌能在合適的微生物環境中發揮不同的病理作用，並破壞牙周組織。

5. Biofilm concept
matrix-enclosed bacterial populations adherent to each other and/or to surfaces of interfaces

6. Plaque as etiologic factor
Experimental gingivitis study (1965 Löe et al. )

7. Plaque as etiologic factor
Oral hygiene study (1973 Lang et al.)

8. 3 hypothesis in etiology of periodontal disease
Non-specific plaque hypothesis
Ecological plaque hypothesis
Specific plaque hypothesis

9. Non-specific plaque hypothesis (1986 Theilade)
The bacterial dental plaque that accumulates to around teeth is a relatively homogenous mass that causes periodontal disease when it accumulates to the point of overwhelming the host’s defense mechanisms
A result of the overall interaction of the microflora with the host
從量的角度

10. Non-specific plaque hypothesis
Experimental gingivitis
Effect of mechanical removal of plaque

11. Ecological plaque hypothesis (1994 Marsh)
Change in a key environmental factor will trigger a shift in the balance of the resident plaque microflora and that this change might predispose a site to disease
從微生態環境的角度

12. Ecological plaque hypothesis

13. Specific plaque hypothesis (1976 Loesche)
The diverse collection of microorganisms constituting the resident plaque microflora, only a very limited number are actively involved in causing disease
Meet Koch’s postulate(modification)
從專一致病菌的角度

14. Current suspected pathogens of destructive periodontal diseases
Actinobacillus actinomycetemcomitans
Porphyromonas gingivalis
Bacteroides forsythus
Spirochetes
Prevotella intermedia
Fusobacterium nucleatum
Campylobacter rectus
Eikenella corrodens
Peptostreptococcus micros
Eubacterium species
Selenomonas species
Others
1996 American Academy of Periodontology

15. Definition
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

16. Experimental gingivitis
Dental plaque was allowed to accumulate in the absence of any plaque control procedures, resulting in the development of gingivitis in all subjects within 7-21 days.
1965 LÖe

17. Self-performed plaque control
Brushing
Interdental cleaning

18. Brushing Toothbrush Methods of toothbrushing
Frequency and effectiveness of toothbrushing
Toothbrush wear and replacement
Electric toothbrushes

19. Interdental cleaning Dental floss and tape Toothpicks
Interproximal brushes
Single-tufted brush

20. Adjunctive aids
Dental irrigation devices
Tongue scrapers
Dentifrices

21. Effects and sequelae of the incorrect use of mechanical plaque removal devices
Gingival erosion
Gingival recession
Cervical abrasion
Toothbrush stiffness
Method of brushing
Brushing frequency

22. Mechanical plaque control
The toothbrush
Powered toothbrushes
Dentifrices
Toothbrushing methods
Interdental cleaning aids
Gingival massage
Oral irrigation devices

23. Toothbrush American Dental Association (ADA)
Brush length: inches
Brush width: 5/16-3/8 inches
2-4 rows
5-12 tufts per row

24. Toothbrush bristles
Natural: hog
Artificial filaments: nylon

25. Bristle hardness
Proportional to the square of the diameter and inversely proportional to the square of bristle length
Soft brush: inch(0.2 mm)
Medium brush: inch(0.3 mm)
Hard brush: inch(0.4 mm)

26. Bass soft brush Straight handle Nylon bristle
0.007 inch(0.2 mm) in diameter
0.406 inch(10.3 mm) in length
Rounded ends
3 rows of tufts
6 evenly spaced tufts per row
80-86 bristles per tuft

27. 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.

28. Powered toothbrushes
Powered toothbrushes are not generally superior to manual ones
Powered toothbrushes have been shown to improve oral health:
Children and adolescents
Children with physical or mental disabilities
Hospitalized patients
Patients with fixed orthodontic appliances

29. Dentifrices Dentifrices aid in cleaning and polishing tooth surfaces
Paste, powder and gel

30. Dentifrices
Abrasive: silica, alumina, dicalcium phosphate, and calcium carbonate
Detergent: sodium lauryl sulfate
Thickeners: silica and gums
Sweeteners: saccharine
Humectants: glycerine and sorbitol
Flavors: mint, peppermint
Actives: fluorides, triclosan and stannous fluoride

31. Abrasion Upper arch > lower arch Left side > right side
Abrasive: powder > paste, gel (5 times)
Cementum > dentin > enamel

32. Toothbrushing methods
Horizontal brushing (scrub)
Leonard method (vertical)
Bass method
Modified Bass methods
Stillman methos (vibratory)
Modified Stillman method (roll)
Charters method
Methods of cleaning with powered toothbrushes

33. Bass method

34. 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
1986 Frandsen

35. Interdental cleaning aids
Dental floss
Interdental brushes
Wooden or rubber tips

36. Dental floss Multifilament vs. monofilament Twisted vs. untwisted
Bonded vs. unbonded
Waxed vs. unwaxed
12-18 inches for use
Stretch: thumb and forefinger
Up-and-down stroke

37. Interdental brush

38. Gingival massage
Epithelial thickening, increased keratinization, and increased mitotic activity in epithelium and connective tissue
Emphasizing the importance of altering or removing plaque rather than stimulating or thickening the keratinized surface in the plaque control program

39. Oral irrigation devices
Supragingival irrigation
Subgingival irrigation

40. Caries control for the periodontal patient
Periodontal patients require appropriate use of topical fluorides in the daily plaque control regimen to protect and remineralize both exposed root surfaces and coronal surfaces of teeth

41. Chemical plaque control
Antiadhesive
Antimicrobial
Plaque removal
Antipathogenic

42. Vehicles for the delivery of chemical agents
Toothpaste
Mouthrinses
Spray
Irrigators
Chewing gum
Varnishes

44. Mouthrinse ADA has accepted two agents for treatment of gingivitis:
Prescription solutions of chlorhexidine digluconate mouthrinse
Nonprescription essential oil mouthrinse

45. Chlorhexidine: plaque reduction 45-61%, gingivitis reduction 27-67%
Essential oil mouthrinse: plaque reduction 20-35%, gingivitis reduction 25-35%

46. Chlorhexidine
In the US: 0.12 % solution
In Europe: 0.2 % solution

47. Chlorhexidine-side effects
Brown discoloration
Taste perturbation
Oral mucosal erosion
Parotid swelling
Enhanced supragingival calculus formation
1971 Flotra

48. Disclosing agents
Solutions or wafer capable of staining bacterial deposits on the surfaces of teeth, tongue, and gingiva
Erythrosine, fuchsin
Fluorescein-containing dye

49. Frequency of plaque removal
Cleaning once a day with all necessary tools is sufficient if it is performed meticulously.
Emphasis must be placed on the efficiency of complete plaque removal at least once per day, rather than the frequency of brushing alone

50. Plaque control instruction
Motivation for effective plaque control
Education
Instruction
Encouragement
Reinforcement

51. Plaque control
Mechanical plaque control is necessary and not replaceable by chemical plaque control
Mechanical plaque control >>>>>> chemical plaque control