HOW TO CONTROL PLAQUE

PRESENTED BY: DR. AAKIFA JAVED ARIAN

ALTAMASH INSTITUTE OF DENTAL MEDICINE

PLAQUE: Plaque is a soft deposit that form the biofilm adhering to the tooth surface.

It cannot be rinsed but removed by brushing. Plaque is a firmly adherent mass of bacteria

in a mucopolysaccharide matrix.

What Do We Mean By PLAQUE CONTROL

Plaque Control is the removal of dental/ microbial plaque and the

prevention of its accumulation on the teeth and adjacent gingival tissues.

It also deals with the prevention of calculus formation.

Plaque is the major etiology of PERIDONTAL Disease & is related to Dental CARIES; therefore, gaining patient cooperation in daily plaque REMOVAL is success of ALL periodontal and dental treatment.

Remember……..!!!

Plaque:• Plaque is a white, sticky substance that builds up every day around your teeth and gums, and on dental appliances.• Plaque can be removed with daily brushing, flossing, and rinsing with an antiseptic mouthwash.• If plaque is not removed it hardens into calculus.

Calculus:• Once plaque has been allowed to remain it calcifies. Only a dental professional can then remove calculus.

Plaque

Calculus

Brush

Plaque builds within hours. Brushing your teeth helps oral health because it removes plaque from the surfaces of your teeth and gums.

Floss

Because periodontal disease often begins in areas your toothbrush cannot reach, it’s important to remove plaque from between teeth and just below your gumline by flossing.

Rinse

Daily rinsing with an antiseptic mouthwash may add to the benefits of brushing and flossing by reducing plaque between crowded teeth and around hard-to-reach molars.

Methods of Plaque Control:

1. Mechanical Plaque Control Methods.

2. Chemical Plaque Control Methods.

Mechanical Plaque Control Aids:1) ToothBrushes:

Manual ToothbrushElectrical Toothbrush 2) Interdental Aids:

Dental FlossTriangular Tooth PicksInterdental BrushesSuperflossPerio-Aid

3) Aids for Gingival

Stimulation:

Rubber Tip Stimulator

5) Aids for Completely or Partially Edentulous Patients:

Denture & Partial Clasp BrushesCleansing Solutions

4) Others:Gauze StripsPipe Cleansers

water Irrigation Device

Chemical Plaque Control Agents

The Chemical agents which act on the Plaque ultrastructurally and prevent the formation of Plaque are usefull in Prevention than in a cure.

Chemical Plaque Control Agents are:

1. Dentifrices/ Toothpastes

2. Mouth Rinses i. Chlorhexidine Rinse

ii. Essential Oil Rinse

DO YOU KNW……..??

Chemical inhibitors of plaque & calculus that are incorporated in mouthwashes or dentifrices play important roles in plaque control.

TOOTHPASTE / DENTIFRICESToothpaste called as dentifrice, is an inclusive term used to describe a powder, paste or gel, used with a toothbrush to aid in the removal of

plaque, biofilm, materia alba, and stain from teeth and soft tissue.

PURPOSE Cleaning Polishing Removal of stains Reduce incidence of tooth decay

Toothpaste Contents Abrasives (20%-40%) Flavor- (2%) pleasant and must be associated with a “clean”

feeling. E.g. Mint flavor Colouring agent (2%) Binders (2%) Humectants (20%-40%) Detergents (1%-2%) Flavoring agent (2%) Preservatives (<1%) Sweetening agents (2%) Water (20%-40%)

Abrasive Also called as polishing agent Solid, insoluble particles Potential for fluoride interaction Causing abrasion Remove debris and residual strain from teeth

Examples of Abrasives: Aluminium oxide Calcium pyrophosphate Carbonates like sodium bicarbonate, calcium carbonate silicas

Binders To provide consistency and shape. Keep the solid phase properly suspended in the liquid phase . Prevent the toothpaste from drying out. Contribute to the creamy consistency of the toothpaste and hence,

control the viscosity. Provide body to the dentrifice, especially after extrusion from the tube

onto the toothbrush.Examples of Binders: Polymers like Carboxymethyl Cellulose (CMC) Alginate Gums

Humectants Used in toothpaste to prevent loss of water and subsequent hardening

of the product upon exposure to air. Affect taste perceptionExamples: Glycerine Sorbitol Polyethylene glycol Mannitol Propylene glycol

Sweeteners and Flavors Sweeteners: sodium saccharin, sorbitol, mannitol, xylitol Flavors: improve taste of toothpasteE.g: peppermint, spearmint, wintergreen, menthol, cinnamon

Surfactants Function: Produce foam and aid in the removal of debris. Emulsifies flavoring agents. High level may cause mucosal irritation. May react with other toothpaste components.Examples: Sodium Lauryl Sulfate Sodium N-Lauryl Sarcosinate Polyethylene glycol (PEG)

Fluoride Actives

Function: Increases resistance to enamel solubility. Restricted usage level (for adults it must be within 1000 to

1450 ppm and for children not more than 1000ppm)Examples: Sodium fluoride Sodium monofluorophosphate Stannous fluoride

Preservatives and SolventsFunction of Preservatives: prevent the growth of micro organisms such as mold and bacteria in the

toothpaste. Non-irritating Compatible with other ingredients Examples: alcohols, sodium benzoate, dichlorinated phenols

Function of Solvents: dissolves the ingredients and allows them to be mixed. Water is the most common solvent used.

Therapeutic Agents

Anti-caries agents: sodium fluoride and sodium monofluorophosphate

Anti-plaque: Sodium Lauryl Sulphate, Triclosane, Zinc and Stannous ions

Anti-calculus: Pyrophosphate

Anti-dentin hypersensitivity: Potassium salts

Whitening agents: Papain, Dimethicone

Different types of toothpaste Anti-Caries / Cavity Protection toothpastes contain fluoride to stop tooth

enamel decalcification and protect teeth from tooth decay and cavities.

Plaque & Gingivitis Prevention toothpastes have additional antibacterial ingredients to fight the growth of bacteria and the formation of dental plaque.

Tooth Whitening toothpastes have either higher abrasion value than normal tootpastes to mechanically remove food, smoking and other stains from teeth, or/and special ingredients as Peroxide for teeth bleaching and whitening.

Sensitivity toothpastes contain desensitising agents to relief those with tooth sensitivity problems from the acute pain when teeth are exposed to hot or cold temperatures or sweet and sour foods.

Tartar Control toothpastes contain pyrophosphates that reduce new tartar build-up (but they can't remove the existing tartar).

Fresh Breath toothpastes contain enhanced flavoring agents along with antibacterials to fight halitosis and provide fresher breath.

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Some toxic components of a toothpaste

• Fluorides: in higher levels cause fluorosis Appear as tiny white streaks or specks Severe form- mottling of enamel, pitting and cracking of teeth, black and

brown stains.• Titanium dioxide: if inhaled can cause lung damage

• Sodium saccharin: FDA lists it as a possible carcinogen

MOUTH RINSES

Chlorhexidine Rinse:This agent has the most positive antibacterial results to date.Have pronounced antiseptic properties.Inhibit the development of plaque, calculus and gingivitis.

Side Effects:Brown staining of the teeth, tongue and silicate resin restorationsTransient impairment of taste perception.

Chlorhexidine Preparation contains: 12% alcohol

Essential Oil Rinse:Reduces plaque 2o-35% and gingivitis reduction of 25-35%

Essential Oil Preparation Contains: Thymol Eucalyptol Menthol Methyl Salicylate Alcohol (up to 24% depending on the preparation)