Dental Plaque 2

PLAQUE CONTROL
CONTENTS
1. PLAQUE DEFINITION
2. CLASSIFICATION OF PLAQUE
3. COMPOSITION OF PLAQUE
4. DETECTION OF DENTAL PLAQUE
5. PLAQUE CONTROL
a) MECHINICAL PLAQUE CONTROL
b) CHEMICL PLAQUE CONTROL
6. PLAQUE PREVENTION
PLAQUE
 PLAQUE can be defined as the soft deposits
that form the biofilm adhering to tooth surface
or other hard surfaces in the oral cavity
including removable or fixed restorations.
 Forms immediately after a tooth surface is
cleaned it takes 4-9 days for it to fully mature.
 If not removed regularly it can lead to dental
cavities or periodontal problems such as
gingivitis.
 Plaque develops naturally in teeth and forms
part of the defense systems of the host by
helping to prevent colonization of enamel by
exogenous microorganisms.
CLASSIFICATION OF
DENTAL PLAQUE :
 Dental plaque is usually classified into two types
depending on its location on the tooth surfaces.
 Supragingival:
At and above the dentogingival junction.
 Supragingival plaque is most commonly found at:
1. gingival third of the crown of the tooth.
2. interproximal areas.
3. pits and fissures and also other such surface
irregularities.
SUPRAGINGIVAL PLAQUE
 Subgingival:
Below the dentogingival junction. Usually
divided into a tooth adherent, epithelial adherent
and non-adherent zones. Other differences between
supra and subgingival plaque include:
 Only Supragingival plaque can be seen by naked
eyes.
 Subgingival plaque is comparatively thin.
 Supragingival plaque acquires nutrition from
saliva and host diet in the oral cavity.
 But subgingival plaque acquires nutrition only
from the host cells and gingival crevicular fluid.
SUBGINGIVAL PLAQUE
COMPOSITION:
 Dental plaque is composed of primarily of
microorganisms, Plaque contains
approximately 1.000.000.000.000 bacteria per
gram.
 The average adult has about 10 mg plaque,
that is approximately 10.000.000.000 bacteria.
 The plaque mass consist, consist of organic and
inorganic materials derived from saliva,
gingival crevicular fluid and bacterial products.
 Organic constituents of the matrix include
polysaccharides, proteins, glycoprotein's, and
lipid material.
 The inorganic constituents of plaque is
predominately calcium and phosphorus, with
trace amounts of the other minerals such as
sodium , potassium, and fluoride.
DETECTION OF DENTAL
PLAQUE :
 Detection of dental plaque can be done by using
products that stain the plaque on the teeth.
 These acids can also be used to see how thoroughly

one brushes and flosses his teeth.
 These products are:
 DISCLOSING TABLETS
 DISCLOSING SOLUTIONS
 DISCLOSING SWABS
DISCLOSING TABLETS:
 It is chewed and allowed to mix with patients

saliva swish the mix around the mouth for
around 30 sec and then ask the patient to split
out.
DISCLOSING SOLUTIONS:
 Ask the patient to put some disclosing solution

in the mouth and swish for around 30 seconds
and split it out.
DISCLOSING SWABS:
 Apply the swab to all the tooth surfaces in

the mouth and wait for 30 seconds.
 These swabs are capable of staining

bacterial deposits on the surface of the teeth.
 PLAQUE STAINED USING A HARMLESS
PINK DYE
PLAQUE CONTROL
 There are two basic approaches for plaque control

1.MECHINICAL
a) individual
b) professional-for sub gingival plaque
control
2.CHEMICAL
a) individual
b) professional
MECHINICAL PLQUE
CONTROL
 TOOTH BRUSHES
toothbrushes are the most widely used oral
hygiene aids.
 TYPES OF TOOTH BRUSHES
 Manual tooth brushes

 Powered tooth brushes
 Sonic and ultra sonic toothbrushes
MANUAL TOOTH BRUSHES
 IDEAL CHARACTERISTICS
• Easily and effectively manipulated

• Durable and inexpensive
• Designed for utility efficiency and cleanliness
• Tooth brush bristle material should be of natural
bristle from hogs or artificial bristle from nylon
MANUAL TOOTH BRUSHES
DIAMETER
 SOFT – 0.007 inch, have gained importance
 MEDIUM – 0.012 inch
 HARD – 0.014 inch
soft bristles are more flexible

hard bristles causes gingival recession
POWERED TOOTH BRUSHES
 These were first introduce in 1960’s the heads

of these tooth brushes oscillate in a side to side
motion or in rotary motion.
 MACHANISUM OF ACTION
acoustic micro steaming hydro
dynamic shear forces that may disrupt the
plaque are the likely mechanism of action for
these powered tooth brushes.
POWERED TOOTH BRUSHES
ADVANTAGES
 Increased accessibility in inter proximal and
lingual tooth surfaces
 No specific brushing technique is required
 Use less brushing force then manual tooth
brushes
 Brushing timer is incorporated in some brushes
to help the patient in brushing for required
duration
SONIC AND ULTRA SONIC
BRUSHES
 These types of tooth brushes produce high

frequency vibrations (1.6 MHz) which lead to
the phenomenon of cavitations and acoustic
micro steaming, this phenomenon aids in stain
removal as well as disruption of bacterial cell
wall.
SONIC AND ULTRA SONIC TOOTH BRUSH
TOOTH BRUSHING
TECHNIQUES
 BASS METHOD
 MODIFIED STILLMANS METHOD
 CHARTERS METHOD
 FONES METHOD (OR)
CIRCULAR SCRUB METHOD
 VERICAL (OR) LEONARDS METHOD
 PHYSIOLOGICAL (OR) SMITH METHOD
INTERDENTAL CLEANING
AIDS
 DENTAL FLOSS
These types of inter dental cleaning aids are indicated
to remove plaque from interproximal surfaces. dental
floss may be available in various forms.
 Multifilament – twisted / non twisted

 Bonded / non – bonded
 Thick / thin
 Waxed / nonwaxed
DENTAL FLOSS
METHODS OF USING
DENTAL FLOSS
 Mainly there are 2 methods
1.spool method
about 45 cms (18 inches) long floss is
taken and about 10 cms (4 inches) from each
end is wound around the middle finger of the
each hand. In both the hands the last 3 fingers
are folded and closed and both the hands are
moved apart. In this way 5cm (2 inches) long
floss is held between the index fingers of booth
the hands.
CIRCLE OR LOOP METHOD
 In this a loop or circle of the floss is made from

about 45 cms (18 inches) long pieces and both
ends are tied securely with the 3 knots. All the
fingrs except the thumbs of both the hands are
placed with the loop and floss is held by both
the hands having about 2.5 cm (1inch ) floss
between fingers of both the hands.
DENTIFRICES
 Dentifrices aid in cleaning and polishing tooth

surfaces.
 They are used mostly in the form of pastes and
tooth powders and gels are also available.
 Dentifrices are made up of abrasives such as
silicon oxides, aluminum oxides, water,
humectants, soap or detergent, flavoring and
sweetening agents and therapeutic agents.
DENTIFRICES
WOODEN TIPS
 These devices are triangular in cross section.
 They are inserted into gingival embrasures with
base of triangle towards the gingiva.
 This design aids in the proper fit of wooden tip
within the inter dental space.
 The wooden tip may be repeatedly moved in
and out of the embrasure, there by removing
soft deposits from the teeth and also
mechanically stimulating the gingiva.
SOME OF THE INTERDENTAL
AIDS AVALIBLE ARE
 Interdental brushes.
 Powered interdental brushes.
 Untufted /single tufted brushes.
 Irrigation devices
 Gingival physiotherapy.
 Tongue scraping.
CHEMICAL PLAQUE
CONTROL
 Chemical plaque control agents have proven to

be an ideal adjunt to mechanical plaque control
procedures especially in individuals with a
defective host defense mechanism mentally or
physically handicapped and in patents who have
undergone surgical procedures post operatively.
CLASSIFICATION
 I GENERATION
over all plaque reduction – 20% to 50%; substantivity –
poor; e.g.: phenols, antibiotics; sanguanarine.
 II GENERATION
over all plaque reduction – 70% to 90%; substantivity –
better; e.g.: bisbiguandles(cholorohexidine).
 III GENERATION
they block binding of micro-organisms to the tooth or to
each other; substantivity is less when compare to
chlorohexidine:; e.g. delmopinol.
I GENERATION
 TRICLOSAN:
- it is phenol derivative.
- it is synthetic, non-ionic and used as a
topical antimicrobial agent.
- it has broad spectrum of activity against
both gram positive and gram
negative bacteria.
 METALIC IONS
- salts of zinc and copper are the ones most
commonly used.
 QUATERNARY AMMONIUM COMPOUNDS
- they are cationic antiseptics.
- they lend to be more active against gram
positive than gram negative organisms.
 SANGUINARINE
- it is a benzophenathridine alkaloid.
- it is used as mouth rinse.
 ANTIBIOTICS
- vancomycin, erythromycin, nidamycin and kanamycin.
II GENERATION
 CHLORHEXIDINE GLUCONATE (0.2%)

- it is a cationic bis biguanide against gram
positive and gram negative organisms.
- it has both antiplaque action and antibacterial
action.
ADVERSE EFFECT OF CHX
 Brown staining of teeth on restorations which
may be associated with precipitation of
melanoidins from saliva.
 Loss of taste sensation.
 Rarely hyper sensitivity.
 Stenosis of parotid gland.
 ENZYMES
e.g.: mucinase, mutanuse, lacto peroxidase.
CHEMICAL PLAQUE CONTROL
AGENTS
III GENERATION
 DELMOPINOL
- it is a morpholino thanol derivative.
- inhibit plaque and reduces gingivitis.
 ANTICALCULUS AGENTS
- dentifrices containing either soluble pyro
phosphate or zinc compounds have
demonstrated 10-15% reduction in calculus.
PLAQUE PREVENTION

Plaque needs to be removed daily. It can be
removed by using a toothbrush and interdental
cleaning aids. Calculus needs to be professionally
removed by a dentist or hygienist. Plaque cannot
be removed by rinsing with water, using water
sprays or eating fibrous foods. Professional
assistance is often required for efficient plaque
removal.
 Plaque removal alone will not prevent dental
caries and only a reduction in sugar intake will
help to achieve this.
THANK YOU
THANK
YOU

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PLAQUE CONTROL

 These acids can also be used to see how thoroughly

 These products are:

 It is chewed and allowed to mix with patients

 Ask the patient to put some disclosing solution

 Apply the swab to all the tooth surfaces in

 These swabs are capable of staining

 There are two basic approaches for plaque control

 TYPES OF TOOTH BRUSHES

 Manual tooth brushes

• Easily and effectively manipulated

soft bristles are more flexible

 These were first introduce in 1960’s the heads

 These types of tooth brushes produce high

 Multifilament – twisted / non twisted

 In this a loop or circle of the floss is made from

 Dentifrices aid in cleaning and polishing tooth

 Chemical plaque control agents have proven to

 CHLORHEXIDINE GLUCONATE (0.2%)

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