PLAQUE CONTROL

BY

M.J.RENGANATH

MDS 1ST YEAR

•Plaque control is the regular removal of

microbial plaque and the prevention of its

accumulation on the teeth and adjacent

gingival surfaces.

•Microbial plaque is the major etiology of

periodontal diseases

•Patient cooperation in daily plaque removal is

critical to long-term success of all periodontal

treatment.

• In 1965, Löe et al conducted the classic study-

relationship between plaque accumulation and

the development of experimental gingivitis in

humans.

•Stopped brushing and other plaque control

procedures, resulting in the development of

gingivitis in every person within 7 to 21 days.

•The composition of the plaque bacteria also

shifted so that gram negative organisms

predominated, and these changes were shown

•Plaque formation begins on the interproximal

surfaces where the toothbrush does not reach.

•Masses of plaque first develop in the molar and

premolar areas, followed by the proximal

surfaces of the anterior teeth and the facial

surfaces of the molars and premolars.

•Patients consistently leave more plaque on the

posterior teeth than the anterior teeth, with

interproximal surfaces retaining the highest

amounts of plaque, exactly the places in which

PLAQUE CONTROL MEASURES

Mechanical:

• Toothbrushing

• Interdental cleansing aids

Chemical:

• Prescription Chlorhexidine

•Nonprescription essential oils

•Other products

TOOTH BRUSH

•Chewstick as tooth brush by Chinese about 1600BC.

•Hippocrates given commentaries on removing

deposits from teeth(460-377BC)

• First bristle toothbrush was introduced by Chinese in

sixteenth century.

•Oral health- regular personal plaque removal.

•Mechanical removal of oral biofilm via toothbrushing

is the most widely accepted.

• The most commonly used device-the manual

toothbrush,

•Well designed to remove plaque from the facial,

lingual, and occlusal tooth surfaces

ADA specification:

• The head of the brush should be 1 inch to 11/4 inches

long.

• 2 – 4 rows of bristles.

• 5/16 inch to 3/8 inches wide.

• 5 – 12 tufts per row.

• 80 – 86 bristles per tuft.

Hardness: Depends on material, diameter and length.

Nylon bristles are more flexible.

• Soft: 0.007 inches to 0.009 inches

• Medium: 0.010 inches to 0.012 inches

• Hard: 0.013 inches to 0.014 inches

• Extra hard: 0.015 inches

BRUSHING TECHNIQUESS.no

Technique Method Indications

1. ModifiedBass

Directed apically at a 45˚angle to long axis of

tooth

• Sulcular cleansing • Periodontalhealth• Periodontal disease • Periodontal

maintenance

2. Stillman Directed apically &angle similar to Bass method; placed partly on cervical portion of teeth and partly on adjacent gingiva; short back&forth vibratory strokes &moved occlusally with light pressure.

• Progressive gingival recession

• Gingival stimulation

3. Charter Directed toward the crown of the tooth; placed at the gingival margin and angled 45˚ to the long axis of tooth; short

• Orthodontics • Temporary cleaning

of surgical sites • Fixed prosthetic

S.no

Technique Method Indications

4. Rollstroke Directedapicallyandrolledocclusallyinaverticalmotion.

5. Fones Filamentsareactivatedinacircularmotion.

• Youngchildrenwithprimaryteeth

• Otherwisenotrecommended

POWERED TOOTHBRUSHES

• They were introduced in 1939.

• Powered toothbrushes are recommended for:

1. Individuals lacking fine motor skills.

2. Small children or handicapped or hospitalized patients

3. Patients with orthodontic appliances.

4. Patients who prefer them.

Various types of motions used in powered toothbrushes

are:

1. Reciprocal or back and forth.

2. Circular.

3. Elliptical or combination.

DENTIFRICES

• These are the aids for cleaning and polishing of teeth

surfaces.

• They are used in the form of powders, pastes and gels.

Composition:

•Abrasives: CaCO3, Ca3 (PO4)2

•Humectants: glycerine, sorbitol, mannitol, propylene

glycol

• Thickening agents: sodium carboxy-methyl cellulose

• Preservatives: benzoic acid

• Foaming agents: sodium lauryl sulphate.

• Flavoring and sweetening agents: peppermint,

saccharine, sorbitol, mannitol.

•Desensitising agents: sodium fluoride, potassium

nitrate.

•Anticaries agents: sodium monofluorophosphate,

sodium fluoride.

•Anticalculus agents: pyrophosphates or zinc

compounds.

INTERDENTAL CLEANING AIDS

• Toothbrush does not completely remove interdental

plaque

•Dental floss and interdental cleaners such as wooden

or plastic tips and interdental brushes.

Factors determining the selection of interdental aids:

• Type 1: The interdental papilla fills up the embrasure.

Dental floss is advised

• Type 2: Moderate papillary recession, miniature

interdental brushes and wood tips are recommended.

• Type 3: Complete loss of papilla (seen in diastema).

Unitufted brushes are recommended.

DENTAL FLOSS

•Most commonly recommended method of removing

plaque.

•Made from nylon filaments or plastic monofilaments,

and can be waxed, unwaxed, thick, thin, and even

flavored.

•Unwaxed floss is preferred over waxed.

METHOD

Spool method:

• 12-18 inches taken

•About 4 inches wound around middle finger

• 1-2 inches held tightly between index fingers.

Loop method:

• Loop of floss is made about 12-18 inches with 3

knots.

• Passed through contact area, firm back and forth

motion.

• Lack of dexterity, old age.

Floss holders are also available.

INTERDENTAL BRUSHES

• Interdental brushes are available in various sizes and

shapes.

•Conical or tapered (like an ever- green tree)

•Designed to be inserted into a plastic, reusable handle

that is angled to facilitate interproximal adaptation.

• Interproximal brushes are equal to or more effective

than floss for plaque biofilm removal.

• Insert bristles into embrasure at a 90-degree angle to

tooth surface (long axis of the tooth).

•Move brush using in and out motion from facial

and/or lingual surfaces of appropriate area.

WOODEN TIPS

•Manufactured from orange wood

• Triangular in cross section.

• Base of the triangle oriented towards the gingiva

• Repeatedly moved in and out of the embrasure.

• Restricted to facial aspects of anterior teeth.

UNITUFTED BRUSH

• Small brush with single, short tuft of bristles.

• Indicated in type 2 and type 3 embrasures.

•Used with a rotatory motion similar to Bass technique.

GINGIVAL MASSAGE

•Massaging the gingiva with a rubber tip or other device

can lead to:

1. improved circulation

2. increased keratinization

3.epithelial thickening.

• Place side of rubbertip interdentally and slightly

pointing coronally(45˚), Move in and out with a slow

stroke, rubbing the tip against the teeth.

WATER IRRIGATION DEVICES

• Valuable supplement for mechanical plaque control

• Removes unattached plaque and debris.

• Built in pump and reservoir

•Also used with antimicrobial agents.

CHEMICAL PLAQUE CONTROL

• Ideal adjunct to mechanical plaque control that

includes:

1.Prescription chlorhexidine rinse

2.Nonprescription essential oil rinse

3.Antibiotics

4.Quaternary ammonium compounds

5.Enzymes

CHLORHEXIDINE

•Cationic Bisbiguanide.

• Superior antiplaque activity – ‘Substantivity’

• Low concentration: bacteriostatic

•High concentration: bactericidal

• Single rinse: antibacterial activity in saliva for about 5

hours

• Prevents pellicle formation- blocking acidic groups on

salivary glycoprotein reducing glycoprotein adsorption

on tooth surface.

• Prevents adsorption of bacterial cell wall on tooth

surface- binding to the bacteria

• Prevents binding of mature plaque- precipitating

agglutination factors in saliva & displacing calcium

from plaque matrix

NON PRESCRIPTION ESSENTIAL OIL RINSES

• Long history of use and safety

•Demonstrated plaque reductions in long term clinical

studies

• Eg: Thymol, Eucalyptol, Menthol, Methyl salicylate.

• Listerine

ANTIBIOTICS

• Vancomycin, Erythromycin, Niddamycin and

Kanamycin have been used.

• Bacterial resistance and hypersensitivity reactions.

ENZYMES

•Would be able to breakdown already formed matrix of

plaque and calculus

•Certain proteolytic enzymes are bactericidal to

microorganisms.

• Effective when applied topically in the mouth.

• Eg: Mucinase

QUATERNARY AMMONIUM COMPOUNDS

• Effective against developing plaque, predominant

gram +ve organisms.

•+vely charged molecule reacts with –vely charged cell

membrane phosphates, disrupts cell wall of

microorganisms

• Eg: Benzathonium chloride.

OTHER AGENTS

Triclosan:

• Phenol derivative, recently included.

• Broad spectrum of activity against both gram +ve and –ve

bacteria.

• Acts on microbial cytoplasmic membrane, inducing

leakage of cellular constituents, causing bacteriolysis.

• Delays plaque maturation and also inhibits formation of

Prostaglandins and leukotrienes.

Delmopinol:

•Morpholino ethanol derivative

• Interferes with plaque matrix formation and reduces

bacterial adherence.

•Causes weak binding of plaque to tooth surface, thus

aiding in easy removal of plaque by mechanical

procedures

• Pre-brushing mouthrinse.

S.APARNA ET ALJOURNAL OF PERIODONTOLOGY: SEPTEMBER 2012

• The aims of this study are as follows: 1) to evaluate the

antibacterial efficacy of honey against oral bacteria and

compare the same with 0.2% chlorhexidine; and 2) to

compare antiplaque efficacy in vivo with chlorhexidine.

• The in vivo results revealed that plaque formation was

inhibited/reduced by chlorhexidine and honey rinses.

•Concluded that Honey has antibacterial action against

tested oral microorganisms and also has antiplaque

action.

M.P.C. VAN LEEUWEN, D.E. SLOT AND G.A. VAN DER WEIJDENJOURNAL OF PERIODONTOLOGY: FEBRUARY 2011.

• No significant difference with respect to reduction of gingival

inflammation was found between EOMW and chlorhexidine

mouthwash

• In long-term use, the standardized formulation of EOMW

appeared to be a reliable alternative to chlorhexidine

mouthwash with respect to parameters of gingival

inflammation.

CONCLUSION

• Periodontal disease- majority of missing teeth

•Only possible solution to the problem is prevention.

• Proper oral hygiene practices- controls periodontal

disease.

• Patient education.

REFERENCES• Clinical periodontology and implant dentistry- Jan Lindhe(5th edition)

• Carranza’s clinical periodontology- 11th edition

• Dental hygiene theory and practice- Michele Leonardi Darby and Margaret M. Walsh(3rd edition)

• Essential Oils Compared to Chlorhexidine With Respect to Plaque and Parameters of Gingival Inflammation: A Systematic Review - M.P.C. Van Leeuwen, D.E. Slot and G.A. Van der WeijdenJournal of Periodontology: February 2011, Vol. 82, No. 2, Pages 174-194

• A Comparative Evaluation of the Antibacterial Efficacy of Honey In Vitro and Antiplaque Efficacy in a 4-Day Plaque Regrowth Model In Vivo: Preliminary Results- S.Aparna et alJournal of Periodontology: September 2012, Vol. 83, No. 9, Pages 1116-1121

THANKYOU