1. PLAQUE CONTROL

2. PLAQUE CONTROL
Plaque control is the removal of microbial plaque and the prevention of its accumulation on the teeth and adjacent gingival surfaces.
Plaque control also retards the formation of calculus, that leads to resolution of gingival inflammation.

3. MODE OF PLAQUE CONTROL Mechanical plaque control Tooth brushes
Manual tooth brush
Electrical tooth brush
Interdental cleansing aids
Dental floss
Wooden tips like stim-u-dent
Perioaid
Interdental brushes like
Proxa brush
Unitufted brush
Miniature bottle brush, rubber tip, oral irrigation devices

4. Prophylaxis by professional persons
Chemical inhibitors
Mouth washes and dentifrices
Other hygiene aids
TOOTH BRUSHES
ADA has described the range of dimensions of acceptable brushes
Brushing surface 1 to 1.25 inches
2-4 rows of bristles
5-12 tufts per row
Two kinds of bristle materials used in tooth brushes
Natural bristles from hogs
Artificial filaments made prominently of nylon.

5. Soft brushes 0.2 mm Medium brushes 0.3 mm Hard brushes 0.4 mm
However in terms of
Homogenecity of material, uniformity of bristle size, resistance to fracture, repulsion of water and debris, nylon filaments are more superior.
Natural bristles are significantly, more susceptible to fraying & breaking, contamination with diluted microbial debris, softening and loss of elasticity.
Diameter of commonly used bristles.
Soft brushes 0.2 mm
Medium brushes 0.3 mm
Hard brushes 0.4 mm

6. Soft bristles are flexible to reach further into proximal area.
Hard tooth bristles is associated with more gingival recession.
To maintain cleaning effectiveness tooth brushes must be replaced as soon as the bristles begin to fray.
If the bristles are flattened after 1week, brushing is probably vigorous
If the bristles are still straight after 5 months either the brushing is done very gently (or) brush has not been used every day.

7. Interplak - rotational motion with tufts moving at 4200 rpm
Blue dye on some of the bristles are available. If the dye fades with use that can be helpful in reminding patients to replace their tooth brushes.
Powered tooth brushes
Interplak - rotational motion with tufts moving at 4200 rpm
Oral B- rotational motion with tufts moving at 2000 rpm
Rotadent - rotating brush that has single tip resembling a prophylactic brush.

8. Motions
Reciprocal
Back & Forth motion
Some with combination of both
Some with circular motion
Some with elliptical motion
Powered brushes with shaped tips designed for interproximal cleaning.
Recommended for,
Small children
Hospitalized patients
Patients with orthodontic appliances.

9. pastes tooth powder Silicon oxide
DENTIFRICES
Dentifrices are aids for cleaning and polishing tooth surfaces. Available as,
pastes
tooth powder
Dentifrices are made up of abrasives
Silicon oxide
Aluminum oxide - which eliminates plaque and removes stained pellicle from the tooth surface.

10. Surfactant agents: Helps to remove food debris
Flavoring : Pepperment oil - Winter green
Humectants : Glycerin & sorbital - helps to reduce the loss of moisture from the paste prepared.
Binders:
i. Sodium Magnesium silicate
ii. Colloidal silica
iii. Magnesium aluminium silicate dentifrices should be sufficiently abrasive for satisfactory cleaning and polishing.

11. Abrasion is more concern in patient with exposed roots
Abrasion is more concern in patient with exposed roots. Because dentin is abraded 25 times faster than cementum, 35 times faster than enamel this can lead to surface abrasion and root sensitivity.

12. TOOTH BRUSHING METHODS
Scrub Technique:
Bristles are applied at 90 to the tooth surface, moved back and forth motion, which result in tooth abrasion and gingival recession.

13. Roll Technique
Bristles are placed at 45 angle, the sides of the bristles are firmly rolled against the gingiva in a coronal direction. It is more appropriate in patient with normal health.

14. Physiologic Technique:
It requires a soft brush and brushing is done by sweeping from the coronal portion apically towards the gingival margin and the gingiva.
Fones Technique:
Brush is firmly pressed against the teeth and gingiva. The bristles are at right angles to the buccal surface and the handle parallel with the occlusal plane. Recommended for young children.

15. For Effective Plaque Control
Bass Method
Place the head of the soft bristles at the gingival margin, establishing an angle at 45° to the long axis of the teeth. Exert gentle vibratory pressure, using short back and forth motions without dislodging the tips of the bristles. Bass technique can be recommended for the routine patient with or without periodontal involvement.

16. Modified Stillman’s Method
The brush should be placed with the bristle ends resting partly on the cervical portion of the teeth and partly on the adjacent gingiva. Pointing in an apical direction, at an oblique angle to the long axis of the teeth. The brush is activated with 20 short back and forth strokes and is simultaneously

17. moved in a coronal direction along the attached gingiva, the gingival margin, and the tooth surface. This process is repeated in all tooth surface around the mouth.
It is recommended for patient with gingival recession and root exposure to prevent abrasive tissue destruction

18. Charter’s Method:
A soft or medium multitufted brush is placed on the tooth with the bristles pointed toward the crown at a 45° angle to the long axis of the teeth. The bristles are flexed against the gingiva and back and forth vibratory motion is used to massage the gingiva. Bristle tip should not move across the gingiva.
To clean the occlusal surface, bristle tips are placed in pit and fissures. This technique is recommended for gentle plaque removal and gingival massage.

19. ii) Interdental cleaners such as wooden (or) plastic tips and
INTERDENTAL CLEANING DEVICES
The purpose of interdental cleaning is to remove plaque, not to dislodge fibrous threads of food wedged in between two teeth.
Available as,
i) Dental floss
ii) Interdental cleaners such as wooden (or)
plastic tips and
iii) Interdental brushes

20. Dental Floss:
Flossing is most widely recommended method of removing plaque from the proximal tooth surface. Available as,
Multifilament nylon that is either
Twisted (or) non-twisted
bonded (or) non- bonded
waxed (or) unwaxed
Thick (or) thin
Floss must contact the proximal surface from line angle to line angle to clean effectively.

21. 12-18 inches usually sufficient
12-18 inches usually sufficient. stretch the floss tightly between the thumb and fore finger (or) between both forefingers and pass it gently through each contact area with a firm back and forth motion.

22. Interdental brushes:
These are cone shaped brushes made of bristles mounted to the handle,
Single tufted brushes
Small conical brushes.
These brushes are suitable for cleaning large irregular (or) concave tooth surface adjacent to wide interdental spaces.
Highly effective on lingual surface of mandibular molars and premolars.

23. Wooden tips:
Soft triangular wooden tooth picks such as stimudent are placed in the interdental space in such a way that the base resting on the gingiva and the sides are in contact with the proximal tooth surface.
Wooden tooth picks can be attached to a handle such as the perio aid and used on the facial (or) lingual surface throughout the mouth

24. Oral Irrigation Devices
Irrigation can be used supra gingivally (or) sub-gingivally.
Supra gingival irrigation:
It is performed with dilute antiseptic chlorhexidine. Daily use for 6 months resulted in significant reductions in bleeding and gingivitis.
The common home use irrigator tip is a plastic nozzle with a 90° bend at the tip, attached to a pump to provide pulsating pressure.

25. Subgingival irrigation:
Performed in both dental office and by the patient at home.
Particularly antimicrobial agents.
Irrigation done in dental office also called lavage (or) flushing of the periodontal pocket after scaling and root planing may be helpful in reducing bleeding and pocket depths.

26. Chemical plaque control:
Performed with, chlorhexidine and essential oil mouth wash
Chlorhexidine:
10ml of 2% aqueous solution of chlorhexidine gluconate almost completely inhibited the development of dental plaque, calculus and gingivitis.
Essential oil mouth wash:
Listerine (or) phenol mouth washes have been evaluated in
Plaque reductions 20-35%
Gingivitis reduction 25 to 35%

27. Capable of staining bacterial deposits.
Disclosing Agents:
Available as solutions and wafers.
Capable of staining bacterial deposits.
They provide the patient with an educational tool to improve the efficiency of plaque control.

28. FREQUENCY OF PLAQUE CONTROL
i) Cleaning once a day with all necessary tools is
sufficient.
ii) Complete plaque removal at least once per day rather
than the frequency of brushing alone.
iii) However, poor performance of plaque removal can
be improved by brushing twice per day.

29. Patients Education and Motivation
Take more fibrous foods
Avoid sticky foods in between meals
Choose better tooth paste & Soft brush for better cleaning
Meet your dentist for every 6 months or 1 year interval
Brush regularly after meals

30. Thank
You