Mechanical Plaque Control Pedo

8/17/2019 Mechanical Plaque Control Pedo

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SEMINAR ON

MECHANICAL PLAQUE CONTROL


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1. Definition – Plaque, Calculus, material alba.

2. Plaque formation

3. Identification of plaque (Disclosing agent)

. Plaque control (a) !ec"anical (b) C"emical

#. !ec"anical plaque control

(a) $oot"brus"

(b) Dentifrice

(c) Interdental cleaning aids

(i) Dental floss

(ii) Interdental cleaning de%ices

& Interdental brus"es& 'alsa ood edge toot" pic

& $oot" pic in special "older

& *au+e stripe, pipe cleaner -arns

(d) ral irrigation

CONTENTS


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Plaque :Its defined as a "ig"l- specific %ariable structural entit-

formed b- sequential coloni+ation of micro&organisms on t"e toot"

surface, epit"elium restorations.

MECHANICAL PLAQUE CONTROL

Its also defined as t"e soft disposition t"at forms t"e biofilm ad"ering to

toot" surface or ot"er "ard surface in t"e oral ca%it- including remo%al and

fi/ed restoration.

Plaque is differentiated from ot"er deposits suc" as calculus and material

alba. on t"e toot" surface.

OR


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a cu us

Its "ard deposit t"at forms b- minerali+ation of dental

plaque and is generall- co%ered b- a la-er of unminerali+ed

plaque.

`


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Material alba

It refers to soft accumulation of bacteria and

tissues cell t"at lacs t"e organi+ed structure of dental

plaque and easil- remo%ed it" ater spra-


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Composition

Plaque begins to form it"in a minute on a cleaned toot"surface. It begins as a film formed from sali%a products "ic"stic firml- to t"e toot" enamel. $"is film t"en becomescolonised b- bacteria it"in t"e sali%a. $"ere areappro/imatel- 100 million bacteria per ml of sali%a and #00different species present

Plaque c"anges o%er a time period of 1&12 da-s as differentbacteria colonise it. It e%entuall- becomes a tig"tl- paced

mass of mo%ing bacteria called a biofilm. $"e longer plaque ispresent, t"e more "armful t"e biofilm becomes.


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Figure 1. Electron microscop o! t"e !orm#tion o! pl#$ue.


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Plaque formation is di%ided into 3 p"ases

1. ormation of dental pellicle

2. Initial coloni+ation on t"e toot" surface.3. 4econdar- coloni+ation and plaque maturation.

Plaque Foratio!


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A. Su"ra#i!#i$al "laque %. Sub #i!#i$al "laque

• ound at or abo%e t"e

gingi%al margin

• 5lso called as marginal

plaque

• belo t"e gingi%al

margin beteen t"e

toot" t"e gingi%al

sulcular tissue.

&e!tal "laque 'i$i'e'i!to


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Nae Pre"aratio!

Iodine preparation 4inner solution

Iodine cr-stal – 3.3g , Potassium Iodine&1.0g

, +inc Iodide – 1.0g

6ater distilled – 17.0 ml

*l-cerin – 17.0ml

Diluted tincture of

iodine

$incture of iodine –

21.ml

6ater – 1#.0 ml!ercuroc"romepreparations

• !ercuroc"rome &1.#g• 6ater – 30 ml

• il of peppermint – 3 drops

• 5rtificial non&calorigenic seetener'ismar bron

89aslic:s disclosing

agent;

• 'ismar bron – 3.0 g

• 9t"-l alco"ol 10 ml

• *l-cerin – 120 ml• la%oring agent – 1 drop

9r-t"rosine or direct topical application

9r-t"rosine – 0. ,f.d.

-ello no. <

I'e!ti(icatio! o( "laque 'e"osits!ain ob@ecti%e is to identif- t"e plaque and distinguis" from

calculus and ot"er deposits present on teet".


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Su"ra#i!#i$al "laque&isclose )it* '+e

Su"ra#i!#i$al "laque

&isclose )it* '+e


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Plaque co!trol

Its defined as t"e remo%al of microbial plaque

pre%ention of its accumulation on t"e teet" ad@acent

gingi%al tissue. It also deals it" pre%ention of calculus

formation.

Ob,ecti$es o( "laque co!trol -

1. Primar- role in remo%al of soft deposits on teet" and

gingi%al tissue.

2. *ingi%al stimulation (gingi%al massage)

3. Aegular effecti%e plaque control "as to alled effecton t"e tissue.

. Belps in increasing gingi%al tone, surface

eratini+ation, gingi%al %ascularit- and gingi%al

circulation.


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Plaque co!trol ca! be 'o!e b+ t)oet*o'

Mechanical plaque control Chemical plaque control

In t"is t-pe

mec"anical met"ods

are used in

plaque control

9g, toot"brus"es

Dental floss etc.

In t"is t-pe

speciali+ed c"emical

are used in

Controlling plaque9g, c"lor"e/idine

5l"e/idine


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Mec*a!ical "laque co!trol

5. $oot" brus" (a) !anual

(b) Poer dri%en'. Dentifrices

C. Interdental 5ids (a) Dental floss

(b) Interpro/imal clearing de%ices (1) 'alsa ood edge toot" plaque

(2) Interdential brus"es

(3) *au+e strips

() Pipe cleaner

(#) arns

D. ral irrigation


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Toot* %rus*es

& 1?2< toot"brus"es made from Borse:s Bair

& 1


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I'eal "ro"erties o( toot*brus*es or toot* brus*

selectio!

1. $oot" brus" s"ould be able to reac" and efficientl- clean

most area to teet".

2. Fo 4ingle toot" brus" is adequate for all patient.

3. Proper brus" s"ould pro%ide eas- accessibilit- to all area

t"e mout".

. 4mall "anded brus"es are often "elpful

#. 9as- for patient to manipulate

7. 'rus"es s"ould be compatible it" recommended brus"ing

tec"nique.

?. 'ot" natural and n-lon bristles are satisfactor-.


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1. Fatural bristles from Bog.

2. 5rtificial filament made predominantl- of F-lon.

F-lon filament is superior due to its "omogeneit- of material, unfortunate of

brittle si+e resistance to fracture and repulsion of ater and debris

Aounded bristles mae feer scratc"es on t"e gingi%a t"an flat cut bristle it"

s"arp end

4oft bristle are more fle/ible, clean beneat" t"e gingi%al margin and eac" bristle

reac" furt"er into pro/imal surface.

Bard bristles results in gingi%al recession.

%er+ealous brus"ing also result in gingi%al recession.

!ost toot" brus"es ear out in 3 mont"s.

Brushes with wear reminder are current available, the blue dye on bristle type with

use and can be helpful in reminding patient to replace their tooth brush.

Handle should fit palm of hand it may be straight or angled.

T)o t+"es o( aterial use' i! toot* brus*

Co!clusio! For most patient short headed brushes with straight cut rounded ended soft to

medium nylon bristle arranged in !" row of tuffs are recommended.


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G In 1=3= poered toot" brus" in%ented to mae plaque control easier.

G Its mainl- recommended for

(a) Indi%idual lacing motor sills(b) Bandicapped patient

(c) Patient it" ort"odontic applied

(d) 6"osoe%er ants to use

$"ere are man- poered toot" brus"es some it" reciprocal of bac and bacmotions and some it" combination of bot" some are circular and elliptical

motion.

Poered toot" cleaner resembles a dental prop"-la/is and "and piece it" rotar-

rubber cap.

Patient s"ould be lustrated for proper use.

Po)ere' toot* brus*

I! c*il're! - 'raun – oral ' inds toot"brus" D10 is most effecti%e. It "as

oscillator- round brus" "ead so causes no soft tissue damage. It also pla-s music at 1

min. inter%al for monitoring brus"ing time.


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. !an- met"od of toot" brus"ing "a%e been described

but no one met"od of toot" brus"ing it adequate to meet t"e

need of all patients.

Selectio! o( et*o' 'e"e!'s o! t*e i!'i$i'ual

Certain criteria s"ould be assessed "en selecting a

toot"brus" and toot"brus" tec"nique for t"e indi%idual

patient.

Toot* brus*i!# et*o'

/ Patie!t cli!ical situatio! :


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/. Patie!t cli!ical situatio! :

0a1State o( #i!#i$al a!' "erio'o!tal l tissue i! re#ar' to *ealt*

is.

$issue stage (contour, tone, te/ture, si+e)

Papillar- contour (open filed embrasure space)

Pocet or sulcus dept".

%&'An#tomic#l limit#tions

4i+e and contour of t"e dental arc".

Position inclination and contour of t"e indi%idual teet".

Presence of edentulous areas.

2. Patie!t "erso!al situatio!

Patient le%el of manual de/terit-.

!oti%ational le%el, abilit- and illingness of patient toact on

recommended procedure.


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%rus*i!# seque!ce a!' tii!#

Aegardless of t"e toot" brus"ing met"od selected a

sequence of brus"ing s"ould be gi%en to t"e patient.

Patient is instructed to start it" molar region of one

arc" around t"e opposite side t"an continue bac

around t"e lingual or facial surfaces of t"e same arc".

4ame procedure is t"e folloed for ot"er arc".

ast surface to be brus" are occlusal.

Patient instructed to stroe eac" area ten time of

spend 10 seconds per area t"en mo%e on to ne/t area.


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Met*o' %ristle "lacee!t Motio! A'$a!ta#e3

'isa'$a!ta#e

4crub Bori+ontal on gingi%al margin 4crub in anterior position direction

eeping brus" "ori+ontal

9as- to learn best suited

fro c"ildren

'544 5pical toards gingi%al into sulcus at

#0 to toot" surface

4"ort bac and fort" %ibrator-

motion "ile bristles remain insulcus.

Cer%ical plaque remo%al

9asil- learned*ood gingi%al stimulation

C"arter:s Coronall- #o, sides of bristles "alf

on teet" and "alf of gingi%a

4mall circular motions it" apical

mo%ements toards gingi%al margin

Bard to learn and position

brus"

Clears inter pro/imal

*ingi%al stimulationones Perpendicular to t"e toot" 6it" teet" in occlusions, mo%e

brus" in rotar- motion o%er bot"arc"es and gingi%al margin

9as- to learn

Inter pro/imal areas notcleaned

!a- cause traumaAoll 5picall-, parallel to toot" and t"en

o%er toot" surface

n buccal and lingual inard

pressure, t"en rolling of "ead to

seep bristle o%er gingi%a toot"

Doesn:t clean sulcus area

9as- to learn

good gingi%al stimulation

4tillman:s n buccal and lingual, aplicall- at an

ablique angle to long a/is of toot".

9nds rest on gingi%a and cer%ical

part.

n buccal and lingual slig"t rotar-

motions it" bristle ends

stationar-

9/cellent gingi%al

stimulation

!oderate de/terit-

required

!oderate cleaning of

interpro/imal area!odified

stillman:s

Pointing apicall- at and angle of #o

to toot" surface

5ppl- pressure as in stillmans:s

met"od but %ibrate brus" and also

mo%e occlusall-

9as- to master

*ingi%al stimulation


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C"#rters met"o(

)#ss met"o(


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&e(i!itio!s

It:s substance used it" toot" brus" to remo%e bacterial

plaque, material alba and debris from t"e gingi%a and teet".

It:s used from bac 1#00 'c b- 9g-ptian Bippocrates

as Ist to recommended t"e use of dentifrices.

&ENTIFRICES

COMPOSITION


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COMPOSITION

/. &eter#e!t - /.24

4odium laur-l sulp"ate

Use – $o loer surface tension

Penetrate and loosen surface deposits and strains9mulsif- debris for eas- remo%al b- toot"brus"

Contribute to t"e foaming action2. Clea!i!# a!' "olis*i!# a#e!ts 5 265764

Calcium carbonate, calcium p-rop"osp"ate bicalcium p"osp"ateUses- 5ct as abrasi%e agents for cleaning and polis"ing ob@ecti%es.

Polis"ing agent is used to produce a smoot" s"ining toot" surfacet"at resists discoloration, bacterial accumulation andretention.

8. %i!'ers - /.24

rganic "-drop"ilic colloids, alginates, magnesium aluminium silicate,

colloidal silica.

Use - $o pre%ent separation of t"e solid liquid ingredients

during storage.Contribute to stabilit and consistenc to toot" aste.

7 Huecta!ts : 26 764


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7. Huecta!ts : 265764

*l-cerin 2 4orbitol

Use - 5dded to retain moisture

Pre%ent "ardening on e/posure to air.

$o stabili+e preparation

9. Preser$ati$es

5lco"ol, formalde"-de H dic"lorinated p"enols

Use - $o pre%ent bacterial grot" and to prolong s"elf life.

. S)eet!er : 2584

4orbitol and gl-cerinse – $o import a pleasant fla%or for pt. acceptance

;. Fla$ori!# a#e!t : /5/94Peppermint 2 cinnamon, ment"olUse - $o mae t"e dentifrices desirable.

$o mae ot"er ingredients t"at ma- "a%e less pleasant fla%or.


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III I!ter'e!tal clea!i!# ai's


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III. I!ter'e!tal clea!i!# ai's

It "as been noticed t"at regardless of brus"ing, t"ere

incomplete remo%al of plaque from interpro/imal areas of

toot" in indi%idual it" "ealt"- periodontal condition orin periodicall- in%ol%ed patient it" open embrasure.

'ecause of ma@orit- of dental and periodontal disease:s

originate in interpro/imal area, interdental plaque

remo%al is necessar-.

It i!clu'es

1. Dental floss

2. Interdental cleaning de%ices

(a) Interdental brus"es

(b) 'alsa ood edge toot" pic

(c) $oot" pic in special "older

(d) *au+e stripe H pipe cleanness and -arns

l (l


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&e!tal (loss

In 1


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T+"es o( (loss

1. $isted and non&tisted

2. 'anded and non&banded

3. $"in t"ic

. !icrofilament and multifilament

#. 5cc. $o 5D5 specification

T+"e I5 nbonded dental floss composed of -arn "a%ing no

additi%e

T+"e II5'onded dental floss composed of -arn "a%ing no

additi%es. t"er t"an binding agent or agent for cosmeticperformance

T+"e III5'onded or unbounded "a%ing drug for t"erapeutic

usage.

T * i


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Tec*!ique

/. Stri!# - (loss et*o'

se 1< inc"es floss. 6rap 2&3 inc"es of floss around

middle finger or left "and and similarl- to rig"t

"and.

2. Circle - (loss et*o'

$ae floss tie a double learnt to secure it. $"e si+e of circle

is lie an orange. Position t"e not to t"e left side of

oring area and place middle, little rings finger of bot"

"and on t"e inside of circle to eep it taut. Aotate counter

cloc ise for fres" segments.


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APPLICATION

Bold floss firml- in a

diagonalEoblique position

*uide t"e floss past contact area

it" a gentle motion

Control floss to pre%ent snappingt"roug" t"e contact area onto t"e

gingi%al tissues

Pass t"e floss beteen gingi%almargin, cur%e to adapt t"e floss

around t"e toot", press, and side

up and don o%er t"e toot"

surface.

Flossi!# ca! be a'e easier b+ usi!# a (loss *ol'er -


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Flossi!# ca! be a'e easier b+ usi!# a (loss *ol'er -

loss "older s"ould "a%e –

1. ne or to for t"at enoug" to eep t"e floss tent

e%en "en its mo%ed pass tig"t contact area

2. 5n effecti%e and simple mounting mec"anisms


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I t ( t l l i ( i


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Inter(ent#l cle#ning (e*ices

or cleaning in narro gingi%al embrasures t"at areoccupied

b- intact papilla and bordered b- tig"t contact +one. Dental

floss in probabl- t"e most effecti%e dental "-giene aids.

'ut conca%e root surface and fraction cannot be reac"ed

it" dental floss.

$"erefore special cleaning aid are a%ailable cleaning for t"ese

surface. $"ese are

Inter dental brus"es 'alsa – ood edge toot" pic

$oot"pic in special "older

*au+e strips, pipe cleaners and -arns.

I!ter 'e!tal brus*es


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$"ese are cone s"aped brus"es made of bristle mounted on

"andle.

4ingle tufted brus"es or small conical brus"es. Interdental brus"es area particularl- suitable for cleaning

large, irregular or conca%e toot" surface ad@acent to ide

interdentall- space. or best cleaning efficienc- t"e diameter of brus" s"ould

slig"tl- larger t"an gingi%al embrasure so t"at bristle can

e/ert pressure on t"e toot" surface.

4ingle tufted brus"es are "ig"l- effecti%e on lingual surfaceof mandible molar and premolar. 6"ere toot" brus" is often

impeded b- t"e tongue and for isolated area of deep

recession.

I!ter 'e!tal brus*es


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6edge toot" pic is made of soft ood and is triangularin s"ape contour to interdental spaces.

Its effecti%e in remo%ing plaque and debris, stimulating

t"e gingi%al recourting t"e interental papilla.

Contraindicated areas "en interdental papilla is present

in interdental gingi%al embrasure space. It ma- cause

tissue in@ur-.

Plastic tip area also a%ailable.

%alsa )oo' )e'#e toot* "ic?

Tec*!ique


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&isa'$a!ta#e - Its "ard to insert from lingual space.

Tec*!ique$oot" pic is firstl- moistened in mout" to soften it. Its t"an

placed interpro/imall- it" t"e base of t"e triangle toards t"e

gingi%al at slig"t angle toards t"e cron.

$"en toot" pic pressed firml- against t"e pro/imal surface of

t"e ad@acent toot".

$oot"pic is t"an mo%ed in and out or up and don depending on

t"e si+e of t"e interdental space.


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8 Toot* "ic? i! s"ecial *ol'er


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8. Toot* "ic? i! s"ecial *ol'er

4mall rounded polis"ed toot" pics can be placed in

special plastic "andle.

$"is "andle allo more fle/ibilit- in placing t"e

toot"pic from t"e lingual aspect and in ot"er area it"

limited access.

7. @aue stri"s a!' "i"e clea!ers a!' +ar!s

$"is are effecti%e cleaning aid in special situations.

Pipe cleaners are effecti%e for cleaning open furcation

area. *au+e strips and four pla- cotton -arn are effecti%e

aids for cleaning t"e pro/imal surface of teet" ad@acent

to edentulous area and open embrasure space.

Or l irri ti !


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It:s targeted application of a pulsated or stead- stream of

ater for remo%ing debris. It can be done b- patient or t"e clinician.

ral irrigation cleans ad"erent bacteria and debris from

t"e oral ca%it- more effecti%el- t"an do toot"brus" and

mout" rinse.

Oral irri#atio!

ItBs 'eli$ere' b+


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Po)er 'ri$e! 'e$ice No!5"o)er 'ri$e! 'e$ice

*enerats an intermittent or

pulsating @et of fluid.

5n ad@ustable dial for regulation

of pressure is pro%ided along it"

a "and "eld interc"angeable tipt"at rotates 370o for application

at t"e gingi%al margin.

It:s attac"ed to a "ouse"old

ater suppl- and deli%ered

t"roug" a "and "eld

interc"angeable tip t"at can be

used for application at t"e gingi%almargin.

&isa'$a!ta#e - ncontrolled

ater pressure&eli$er+ et*o'

$arget of t"e oral irrigation in t"e loosel- attac"ed sub gingi%al

bacterial plaque.

6"en pulsated irrigant is directed perpendicular to t"e long a/is

of t"e toot", B-droinetic acti%it- is started.

It s 'eli$ere' b+

Proce'ure


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Co!trai!'icatio! 5d%ance periodontitis !edicall- compressed patient lie euemia, 5ID4,

diabetes, 'leeding, disorder

Proce'ure

Direct t"e @et tip toards t"e interdental area almost touc"ing

t"e toot" surfaceH"old tip at rig"t angle to t"e long a/is of t"e

toot"

4tart on t"e lo pressure and increase graduall- depending on

t"e condition of t"e gingi%al tissue comfort.

ollo a definite pattern across t"e mout", ma/illar- arc" first

t"an t"e mandibular arc" appl-ing for #&7 sec. at eac"

interdental area.

A'$a!ta#e


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A'$a!ta#e -

Belp in remo%ing debris from ort"odontic appliances and

fi/ed prost"esis.J 6"en used it" toot" brus"ing, t"ese de%ices can "a%e

a beneficial effect on periodontal "ealt" b- retarding

t"e accumulation of plaque and calculus and b- reducing

gingi%al inflammation.


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CFC4IF

G 5ll patients required regular use of toot" brus" , eit"er manualor electric , at least once per da-.

G Dental floss s"ould be use in all interdental spaces t"at arefilled it" gingi%a.

G Interdenatl aids suc" as interpro/imal brus"es , ooden tips,rubber tips or toot" pics s"ould be use in all area "ere t"etoot" brus" and floss tec"nique can not adequatel- remo%e t"eplaque.

G 4ub gingi%al irrigation ma- be good c"oice for reduction of

inflammation and deep pocets.G Aeinforcement of dail- plaque control practices and routine %isitto t"e dental office for maintenance care are essential tosuccessful plaque control and long term success of t"erap-


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Mechanical Plaque Control Pedo

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