PLAQUE CONTROL

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.
 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
• 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.
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
• 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.
• 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.
• 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.
 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.
• 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.
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.
 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.
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.
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.
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.
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
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
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.
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
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.
 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.
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.
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
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.
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.
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%
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.
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.
 Patients Education and Motivation

Take Avoid sticky

more foods in
fibrous between
foods meals

Choose better tooth

Brush regularly paste & Soft brush Meet your dentist
after meals for better cleaning for every 6 months
or 1 year interval