MECHANISMS OF PLAQUE CONTROL

DR. MEMUNA KAUSAR SATTI

OVERVIEW

Dental Plaque

Mechanical plaque control

Chemical plaque control

Plaque control in Paediatric patients

In Orthodontic patients

In Patients with implants

In prosthodontic patients

Patient education and motivation

DENTAL PLAQUE

Dental plaque is defined as the soft deposits that form the bio film adhering to the tooth surface. Plaque is composed of organic, inorganic materials derived from saliva, gingival crevicular fluid & bacterial product

PLAQUE CONTROL is the removal of microbial plaque and prevention of its accumulation on teeth and adjacent gingival tissues.

Supra- & sub-gingival plaque control

PLAQUE CONTROL

Objectives of plaque control are

Removal of soft deposits

Gingival massage keratinization and improve circulation

Prevention of calculus formation

METHODS

Mechanical methods

Chemical methods

MECHANICAL PLAQUE CONTROL

Tooth brushes

Interdental cleaning aids

Irrigation devices

Tongue cleaners

TOOTHBRUSHES

Primary means of controlling supragingival dental plaque buildup

Meticulous mechanical removal of plaque by tooth brushing, combined with the removal of interdental plaque once every 24 hr, is adequate to prevent the onset of gingivitis as well as of interdental caries

MANUAL TOOTHBRUSHES

POWERED TOOTHBRUSHES

TOOTHBRUSHESPARTS

TOOTH BRUSHING TECHNIQUES

Horizontal brushing (scrub)

Leonard method (vertical)

Bass method

Modified Stillman method (roll)

Charters method

Methods of cleaning with powered toothbrushes

BASS TECHNIQUE

Efficient for removing dental plaque from gingival third and from shallow gingival sulcus.

Place the bristles at the gingival margin with angle of 45 degree to the long axis of the teeth and the bristles pointed to the crevice.

Exert gentle vibratory pressure using short back-and-forth motions without dislodging the bristles tips (horizontal direction).

Perform about 20 strokes in each position.

Used a soft brush in this method.

MODIFIED STILLMANNS TECHNIQUE

A soft or medium brush can be used with this method.

Recommended for patients with gingival recession to prevent abrasive tissue destruction.

The sides of the bristles are placed against the gingiva and teeth with a 45 degrees angle to the long axis of the teeth.

Pressure is applied laterally against the gingival margin to produce blanching.

Brush is activated by short back-and-forth strokes in coronal direction.

CHARTERS TECHNIQUE

A soft or medium brush can be used.

Recommended for temporary cleaning in areas of healing after periodontal surgery

The bristles pointed toward the crown at a 45 degree angle to the long axis of the teeth.

The bristle tips not move across the gingiva.

The brush is activated with short back-and forth strokes in coronal direction.

ELECTRICAL TOOTHBRUSHING

Useful for Children, hand-capped, patients with orthodontics treatment, individuals lacking manual dexterity, Prosthodontic or endosseous implants and Patients on supportive periodontal therapy.

Less abrasive to tooth surfaces and restoration.

Do not require special techniques of application.

Place the brush head next to the tooth at the gingival margin and proceed systematically around the dentition.

Not superior to manual type.

Expensive.

INTERDENTAL CLEANING AIDS

Dental Floss

Effective for flat or convex proximal tooth surfaces with full embrasures.

Waxed, unwaxed or tufted types.

Tufted and waxed are indicated for rough restoration and tight contact

Cut about 12cm and anchored around one finger of each hand.

Gentle placing at the base of gingival sulcus then moved in an up-and down along the tooth surface ,right and left.

INTERDENTAL CLEANING AIDS

Interdental Brushes

Small cone shaped or tapered brushes.

Used in large open embrasures.

Inserted interdentally and moved back and forth in facio - lingual direction.

Tooth Picks OR Wooden tips

Made from soft-wood and is triangular in shape.

Used in open contact. Tooth pick moved in and out or up and down direction. Tooth pick can be placed in special plastic handles to reach areas with limited access.

INTERDENTAL CLEANING AIDS

Rubber Tips

Produce gingival massage.

Induce epithelial keratinization.

Rubber tip is inserted interproximally at a 45 degree angle with the tip pointing in an occlusal direction.

Activated by applying pressure with a vibratory or rotary motion.

IRRIGATION DEVICES

Oral Irrigation

With water and antiseptic mouth rinses. Supra or sub-gingival irrigation.

Hand or mechanized irrigation

TONGUE SCRAPPERS

Tongue scraper is an oral hygiene device designed to clean the bacterial built up, food debris, fungi and dead cells from the surface of the tongue bacteria and fungi that grow on the tongue may cause halitosis due to production of sulphur compound

RECENT ADVANCES

Sonic ultrasonic toothbrushes

Chewable toothbrushes

Ionic toothbrushes

Ozone toothbrushes

SEQUELAE OF INCORRECT USE

The incorrect use of mechanical plaque removal devices cause

Gingival erosion

Toothbrush stiffness

Gingival recession

Cervical abrasion

Ulcerations

VEHICLES FOR DELIVERY OF CHEMICAL AGENTS

TOOTHPASTES

MOUTHRINSES

SPRAYS

IRRIGATORS

CHEWING GUMS

ANTIADHESIVE AGENTS

Act at pellicle surface to prevent initial attachment of primary plaque forming bacteria

Amine alcohol, Delmopinol interferes with bacterial matrix formation and reduction of bacterial adherence.

Minimal activity against microbes.

0.1% and 0.2% in mouth rinse, effective as a plaque inhibitor and antigingivitis agent.

ADVERSE EFFECTS: Transient numbness of tongue

Tooth staining

Burning sensation of mouth

ANTIMICROBIAL AGENTS

Inhibit plaque formation through one of the two mechanisms, e.g. CHLORHEXIDINE

BACTERIOSTATIC Before the attachment of bacteria or after attachment and before division of bacteria

BACTERICIDAL Destroys microorganisms either attached or already attached bacteria

ANTIPATHOGENIC AGENTS

These agents inhibit the expression of pathogenecity of plaque microorganisms without necessarily destroying the microorganism.

PLAQUE REMOVAL AGENTS

Hypochlorites, remove bacterial plaque, are commonly used in domestic environment

Toxic when applied within oral cavity

Nearest success was achieved with enzymes e.g. Dextranase, Mutanase.

CHLORHEXIDINE

The most effective antimicrobial agent in plaque and gingivitis

Mechanism of action: causes bacterial cell wall lysis and prevents bacterial adhesion to tooth surfaces.

Has not produced any resistance of oral microorganisms.

Property of Substantivity: slow release over long time period

Side effects:- Staining of teeth , tongue and resin restorations, Alter taste sensation (temporary)and Increase supragingival calculus formation.

Use in 0.2%- 0.12% mouth washes Twice/day.

DENTRIFICES

Ingredients are Abrasive agent e.g. calcium carbonate, calcium oxide or silicate

Detergent agent e.g. sodium lauryl sulfate.

Thickening agent carboxymethyl cellulose and amylase.

Coloring agents.

Humidifier , water.

Fluoride, Anticalculus agents e.g. zinc citrate, Antiplaque agents e.g. chlorhexidine and triclosan , Antibiotics eg. Penicillin.

The paste is applied between the bristles rather than on the top.

DENTRIFICES

POLISHING Upon the completion of the quadrants, you should polish teeth whenever necessary

GOAL OF POLISHING To remove soft deposits and extrinsic stain with minimal trauma to hard and soft tissues and minimal discomfort for patient

DISCLOSING AGENTS

Used to stain the teeth for patient education and motivation for oral home care.

Used to locate areas with plaque accumulation.

Available in tablets and liquid forms.

Produce, blue, purple or red stains when attached to plaque on tooth surface.

Examples: Bismark Brown solution, erythrosine and sodium fluorescein dye.

PLAQUE CONTROL IN PATIENTS WITH IMPLANTS

PLAQUE CONTROL IN PROSTHODONTIC PATIENTS

OVERDENTURES: Control accumulation of plaque on exposed dentin of abutment teeth.

Use of fluoride and chlorhexidine gel controls caries development and maintains healthy periodontal conditions.

Adequate denture wearing habits

R.P.D AND COMPLETE DENTURE : Use separate toothbrush for dentures and natural teeth.

Immerse dentures in liquid cleanser after brushing.

Store the denture in water when not in use

PLAQUE CONTROL IN ORTHODONTIC PATIENTS

Cleaning behind arch wires, by attempting to get the bristles, and floss into these areas The electric toothbrush with short pointed bristles are effective

Plaque removal efficiency can be improved by Bonding on molars , than banding. Remove excess composite around brackets, especially at gingival margin.

Minimize the length of the second phase of treatment with fixed appliances by correcting significant skeletal and alignment problems in mixed dentition

PLAQUE CONTROL IN PEDIATRIC PATIENTS

Parent or guardian of a patient under age of 7 years should brush child’s teeth, as child does not have enough manual dexterity to brush effectively.

Disclosing plaque and showing this to patient or parent can be useful educational and motivational tool.

PATIENT EDUCATION AND MOTIVATION

Take more fibrous foods

Avoid sticky foods in between meals

Brush regularly after meals

Meet your dentist for every 6 months or 1 year interval