Download - 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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