SEMINAR ON

MECHANICAL PLAQUE CONTROL

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 CONTENTS

1. Definition – Plaque, Calculus, material alba.

2. Plaque formation
3. Identification of plaque (Disclosing agent)
4. Plaque control (a) Mechanical (b) Chemical
5. Mechanical plaque control
(a) Toothbrush
(b) Dentifrice
(c) Interdental cleaning aids
(i) Dental floss
(ii) Interdental cleaning devices
- Interdental brushes
- Balsa wood wedge tooth pick
- Tooth pick in special holder
- Gauze stripe, pipe cleaner & yarns
(d) Oral irrigation www.FourthMolar.com
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 MECHANICAL PLAQUE CONTROL

Plaque :Its defined as a highly specific variable structural entity

formed by sequential colonization of micro-organisms on the tooth
surface, epithelium & restorations.

OR

Its also defined as the soft disposition that forms the biofilm adhering to
tooth surface or other hard surface in the oral cavity including removal and
fixed restoration.
Plaque is differentiated from other deposits such as calculus and material
alba. on the tooth surface.

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Calculus
`
Its hard deposit that forms by mineralization of dental

plaque and is generally covered by a layer of unmineralized

plaque.

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Material alba

It refers to soft accumulation of bacteria and

tissues cell that lacks the organized structure of dental

plaque and easily removed with water spray

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Composition

Plaque begins to form within a minute on a cleaned tooth

surface. It begins as a film formed from saliva products which
stick firmly to the tooth enamel. This film then becomes
colonised by bacteria within the saliva. There are
approximately 100 million bacteria per ml of saliva and 500
different species present

Plaque changes over a time period of 1-12 days as different

bacteria colonise it. It eventually becomes a tightly packed
mass of moving bacteria called a "biofilm". The longer plaque is
present, the more harmful the biofilm becomes.

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Figure 1. Electron microscopy of the formation of plaque.

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 Plaque Formation

Plaque formation is divided into 3 phases :

1. Formation of dental pellicle
2. Initial colonization on the tooth surface.
3. Secondary colonization and plaque maturation.

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 Dental plaque divided into

A. Supragingival plaque B. Sub gingival plaque

• Found at or above the • below the gingival

gingival margin margin between the

• Also called as marginal tooth & the gingival

plaque sulcular tissue.

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 Identification of plaque deposits
Main objective is to identify the plaque and distinguish from
calculus and other deposits present on teeth.

Name Preparation
Iodine preparation Skinner solution Diluted tincture of iodine
Iodine crystal – 3.3g , Potassium Iodine-1.0g ,Tincture of iodine – 21.ml
zinc Iodide – 1.0g Water – 15.0 ml
Water distilled – 16.0 ml
Glycerin – 16.0ml
Mercurochrome • Mercurochrome -1.5g
preparations • Water – 30 ml
• Oil of peppermint – 3 drops
• Artificial non-calorigenic sweetener
Bismark brown [Easlick's • Bismark brown – 3.0 g
disclosing agent] • Ethyl alcohol 10 ml
• Glycerin – 120 ml
• Flavoring agent – 1 drop
Erythrosine For direct topical application
Erythrosine – 0.8g, water – 100 ml, Alcohol
(95%) – 10.0 ml, Oil of peppermint - 2 drop
Plak light system Sodium fluorescein, glycerin – 0.75% ,f.d. &
yellow no. 8 www.FourthMolar.com
 Supragingival plaque
Disclose with dye

Supragingival plaque
Disclose with dye

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Plaque control
Its defined as the removal of microbial plaque &
prevention of its accumulation on the teeth & adjacent
gingival tissue. It also deals with prevention of calculus
formation.

Objectives of plaque control –

1. Primary role in removal of soft deposits on teeth and
gingival tissue.
2. Gingival stimulation (gingival massage)
3. Regular effective plaque control has to walled effect
on the tissue.
4. Helps in increasing gingival tone, surface
keratinization, gingival vascularity and gingival
circulation. www.FourthMolar.com
 Plaque control can be done by two
method

Mechanical plaque control Chemical plaque control

In this type In this type

mechanical methods specialized chemical

are used in are used in

plaque control Controlling plaque

Eg, toothbrushes Eg, chlorhexidine

Dental floss etc. Alhexidine

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* Mechanical plaque control
A. Tooth brush (a) Manual
(b) Power driven
B. Dentifrices
C. Interdental Aids (a) Dental floss
(b) Interproximal clearing devices
(1) Balsa wood wedge tooth plaque
(2) Interdential brushes
(3) Gauze strips
(4) Pipe cleaner
(5) Yarns
D. Oral irrigation www.FourthMolar.com
 Tooth Brushes
- 1728 toothbrushes made from Horse's Hair
- 1857 manual brushes panted in America
- Generally toothbrushes very in size, design as well as in
length and arrangements of bristles hardness to overcome
this variation ADA given specification of toothbrushes.
Length - 1 to 1.25 inches
Width - 5/16 to 3/8 inches
Surface area - 2.54 to 3.2 cm
No. of rows - 2 to 4 rows of brushes
No. of tufts - 5 to 12 per row
No. of bristles - 80 to 85 per tuft
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  Ideal properties of toothbrushes or tooth brush
selection
1. Tooth brush should be able to reach and efficiently clean
most area to teeth.
2. No Single tooth brush is adequate for all patient.
3. Proper brush should provide easy accessibility to all area
the mouth.
4. Small handed brushes are often helpful
5. Easy for patient to manipulate
6. Brushes should be compatible with recommended brushing
technique.
7. Both natural and nylonwww.FourthMolar.com
bristles are satisfactory.
 Two types of material used in tooth brush

1. Natural bristles from Hog.

2. Artificial filament made predominantly of Nylon.
 Nylon filament is superior due to its homogeneity of material, unfortunate of
brittle size resistance to fracture and repulsion of water and debris
 Rounded bristles make fewer scratches on the gingiva than flat cut bristle with
sharp end
 Soft bristle are more flexible, clean beneath the gingival margin and each bristle
reach further into proximal surface.
 Hard bristles results in gingival recession.
 Overzealous brushing also result in gingival recession.
 Most tooth brushes wear out in 3 months.
 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.

Conclusion
 For most patient short headed brushes with straight cut rounded ended soft to
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medium nylon bristle arranged in 3-4 row of tuffs are recommended.
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 Powered tooth brush
• In 1939 powered tooth brush invented to make plaque control easier.
• Its mainly recommended for
(a) Individual lacking motor skills
(b) Handicapped patient
(c) Patient with orthodontic applied
(d) Whosoever wants to use

 There are many powered tooth brushes some with reciprocal of back and back
motions and some with combination of both some are circular and elliptical
motion.
 Powered tooth cleaner resembles a dental prophylaxis and hand piece with rotary
rubber cap.
 Patient should be lustrated for proper use.

In children – Braun – oral B kinds toothbrush D10 is most effective. It has

oscillatory round brush head so causes no soft tissue damage. It also plays music at 1
min. interval for monitoring brushing time.
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 Tooth brushing method

. Many method of tooth brushing have been described

but no one method of tooth brushing it adequate to meet the
need of all patients.

Selection of method depends on the individual

Certain criteria should be assessed when selecting a
toothbrush and toothbrush technique for the individual
patient.

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1. Patient clinical situation :
(a) State of gingival and periodontal l tissue in regard to health is.
 Tissue stage (contour, tone, texture, size)
 Papillary contour (open & filed embrasure space)
 Pocket or sulcus depth.

(b) Anatomical limitations

 Size and contour of the dental arch.
 Position inclination and contour of the individual teeth.
 Presence of edentulous areas.

2. Patient personal situation

 Patient level of manual dexterity.
 Motivational level, ability and willingness of patient to act on
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recommended procedure.
Brushing sequence and timing

 Regardless of the tooth brushing method selected a

sequence of brushing should be given to the patient.

 Patient is instructed to start with molar region of one

arch around the opposite side than continue back

around the lingual or facial surfaces of the same arch.

Same procedure is the followed for other arch.

 Last surface to be brush are occlusal.

 Patient instructed to stroke each area ten time of

spend 10 seconds per area then move on to next area.

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 Method Bristle placement Motion Advantage/
disadvantage
Scrub Horizontal on gingival margin Scrub in anterior position directionEasy to learn & best suited fro
keeping brush horizontal children
BASS Apical towards gingival into sulcus atShort back and forth vibratory Cervical plaque removal
450 to tooth surface motion while bristles remain in sulcus. Easily learned
Good gingival stimulation
Charter's Coronally 45o, sides of bristles half onSmall circular motions with apical Hard to learn and position
teeth and half of gingiva movements towards gingival margin brush
Clears inter proximal
Gingival stimulation
Fones Perpendicular to the tooth With teeth in occlusions, move brush Easy to learn
in rotary motion over both arches and Inter proximal areas not
gingival margin cleaned
May cause trauma
Roll Apically, parallel to tooth and thenOn buccal and lingual inward pressure, Doesn't clean sulcus area
over tooth surface then rolling of head to sweep bristle Easy to learn
over gingiva & tooth good gingival stimulation
Stillman's On buccal and lingual, aplically at anOn buccal and lingual slight rotary Excellent gingival stimulation
ablique angle to long axis of tooth.motions with bristle ends stationary Moderate dexterity required
Ends rest on gingiva and cervical part. Moderate cleaning of
interproximal area

Modified Pointing apically at and angle of 45o toApply pressure as in stillmans's Easy to master
stillman's tooth surface method but vibrate brush and also Gingival stimulation
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move occlusally
Bass method

Charters method
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 DENTIFRICES
Definitions
It's substance used with tooth brush to remove bacterial
plaque, material alba and debris from the gingiva and teeth.
It's used from back 1500 Bc by Egyptian &Y Hippocrates
was Ist to recommended the use of dentifrices.

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COMPOSITION
1. Detergent – 1.2%
Sodium lauryl sulphate
Use – To lower surface tension
Penetrate and loosen surface deposits and strains
Emulsify debris for easy removal by toothbrush
Contribute to the foaming action
2. Cleaning and polishing agents - 20-40%
Calcium carbonate, calcium pyrophosphate bicalcium phosphate
Uses– Act as abrasive agents for cleaning and polishing objectives.
Polishing agent is used to produce a smooth shining tooth surface
that resists discoloration, bacterial accumulation and
retention.
3. Binders – 1.2%
Organic hydrophilic colloids, alginates, magnesium aluminium silicate,
colloidal silica.
Use – To prevent separation of the solid & liquid ingredients
during storage. www.FourthMolar.com
4. Humectants : 20-40%
Glycerin : Sorbitol
Use – Added to retain moisture
Prevent hardening on exposure to air.
To stabilize preparation
5. Preservatives
Alcohol, formaldehyde ; dichlorinated phenols
Use – To prevent bacterial growth and to prolong shelf life.
6. Sweetner : 2-3%
Sorbitol and glycerin
Use – To import a pleasant flavor for pt. acceptance
7. Flavoring agent : 1-15%
Peppermint : cinnamon, menthol
Use – To make the dentifrices desirable.
To make other ingredients that may have less pleasant flavor.
8. Therapeutic agent 1-2 %
Fluoride
Use – For medical value
9. Coloring agent 2-3% -
Added for all activeness
10. Water 20-40% www.FourthMolar.com
Main transport medium
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III. Interdental cleaning aids
It has been noticed that regardless of brushing, there
incomplete removal of plaque from interproximal areas of
tooth in individual with healthy periodontal condition or
in periodically involved patient with open embrasure.
Because of majority of dental and periodontal disease's
originate in interproximal area, interdental plaque
removal is necessary.
It includes
1. Dental floss
2. Interdental cleaning devices
(a) Interdental brushes
(b) Balsa wood wedge tooth pick
(c) Tooth pick in special holder
(d) Gauze stripe ; pipe cleanness and yarns
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Dental floss
 In 1882 codman and shurtuff made silk dental floss

 In 1948 bass nylon dental floss

 Its recommended method of removing plaque from

proximal surface

Size of floss – 300-1500 denier (D)

Floss is constructed with the help of individual

filaments 2 to 3D thick.

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Types of floss
1. Twisted and non-twisted
2. Banded and non-banded
3. Thin & thick
4. Microfilament and multifilament
5. Acc. To ADA specification
Type I- Unbonded dental floss composed of yarn having no
additive
Type II-Bonded dental floss composed of yarn having no
additives. Other than binding agent or agent for cosmetic
performance
Type III-Bonded or unbounded having drug for therapeutic
usage. www.FourthMolar.com
Technique
1. String – floss method
Use 18 inches floss. Wrap 2-3 inches of floss around
middle finger or left hand and similarly to right
hand.
1. Circle – floss method
Take floss tie a double learnt to secure it. The size of circle
is like an orange. Position the knot to the left side of
working area and place middle, little rings finger of both
hand on the inside of circle to keep it taut. Rotate counter
clock wise for fresh segments.
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 APPLICATION
Hold floss firmly in a
diagonal/oblique position

Guide the floss past contact area

with a gentle motion

Control floss to prevent snapping

through the contact area onto the
gingival tissues

Pass the floss between gingival

margin, curve to adapt the floss
around the tooth, press, and side
up and down over the tooth
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surface.
Flossing can be made easier by using a floss holder –
Floss holder should have –
1. One or two fork that enough to keep the floss tent
even when its moved pass tight contact area
2. An effective and simple mounting mechanisms

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 Interdental cleaning devices

 For cleaning in narrow gingival embrasures that areoccupied

by intact papilla and bordered by tight contact zone. Dental
floss in probably the most effective dental hygiene aids.
 But concave root surface and fraction cannot be reached
with dental floss.

Therefore special cleaning aid are available cleaning for these

surface. These are :
 Inter dental brushes
 Balsa – wood wedge tooth pick
 Toothpick in special holder
 Gauze strips, pipe cleaners and yarns.
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 Inter dental brushes
 These are cone shaped brushes made of bristle mounted on
handle.
 Single tufted brushes or small conical brushes.
 Interdental brushes area particularly suitable for cleaning
large, irregular or concave tooth surface adjacent to wide
interdentally space.
 For best cleaning efficiency the diameter of brush should
slightly larger than gingival embrasure so that bristle can
exert pressure on the tooth surface.
 Single tufted brushes are highly effective on lingual surface
of mandible molar and premolar. Where tooth brush is often
impeded by the tongue and for isolated area of deep
recession. www.FourthMolar.com
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 Balsa wood wedge tooth pick

 Wedge tooth pick is made of soft wood and is triangular

in shape contour to interdental spaces.
 Its effective in removing plaque and debris, stimulating
the gingival recourting the interental papilla.
 Contraindicated areas when interdental papilla is present
in interdental gingival embrasure space. It may cause
tissue injury.
 Plastic tip area also available.

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 Technique
Tooth pick is firstly moistened in mouth to soften it. Its than
placed interproximally with the base of the triangle towards the
gingival & at slight angle towards the crown.

Then tooth pick pressed firmly against the proximal surface of

the adjacent tooth.

Toothpick is than moved in and out or up and down depending on

the size of the interdental space.

Disadvantage – Its hard to insert from lingual space.

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3. Tooth pick in special holder
 Small rounded polished tooth picks can be placed in
special plastic handle.
 This handle allow more flexibility in placing the
toothpick from the lingual aspect and in other area with
limited access.

4. Gauze strips and pipe cleaners and yarns

 This are effective cleaning aid in special situations.
 Pipe cleaners are effective for cleaning open furcation
area.
 Gauze strips and four play cotton yarn are effective
aids for cleaning the proximal surface of teeth adjacent
to edentulous area and open embrasure space.
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 Oral irrigation

It's targeted application of a pulsated or steady stream of

water for removing debris.
 It can be done by patient or the clinician.
 Oral irrigation cleans adherent bacteria and debris from
the oral cavity more effectively than do toothbrush and
mouth rinse.

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It's delivered by
Power driven device Non-power driven device
Generats an intermittent or It's attached to a household water
pulsating jet of fluid. supply and delivered through a hand
An adjustable dial for regulation of held interchangeable tip that can
pressure is provided along with a be used for application at the
hand held interchangeable tip that gingival margin.
rotates 360o for application at the Disadvantage – Uncontrolled water
gingival margin. pressure

Delivery method
 Target of the oral irrigation in the loosely attached sub gingival
bacterial plaque.
 When pulsated irrigant is directed perpendicular to the long axis
of the tooth, Hydrokinetic activity is started.
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 Procedure

Direct the jet tip towards the interdental area almost touching
the tooth surface;hold tip at right angle to the long axis of the
tooth

Start on the low pressure and increase gradually depending on

the condition of the gingival tissue comfort.

Follow a definite pattern across the mouth, maxillary arch first

than the mandibular arch applying for 5-6 sec. at each
interdental area.
* Contraindication
 Advance periodontitis
 Medically compressed patient like Leukemia, AIDS,
diabetes, Bleeding, disorder
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Advantage –

* Help in removing debris from orthodontic appliances and

fixed prosthesis.

* When used with tooth brushing, these devices can have

a beneficial effect on periodontal health by retarding
the accumulation of plaque and calculus and by reducing
gingival inflammation.

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 CONCLUSION

• All patients required regular use of tooth brush , either manual

or electric , at least once per day.
• Dental floss should be use in all interdental spaces that are
filled with gingiva.
• Interdenatl aids such as interproximal brushes , wooden tips,
rubber tips or tooth picks should be use in all area where the
tooth brush and floss technique can not adequately remove the
plaque.
• Sub gingival irrigation may be good choice for reduction of
inflammation and deep pockets.
• Reinforcement of daily plaque control practices and routine visit
to the dental office for maintenance care are essential to
successful plaque control and long term success of therapy

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 REFERENCES

CLINICAL PERIODONTOLOGY – NEWMAN

-TAKEI
-CARRANZA
COMPREHENSIVE PEDIATRIC DENTISTRY – NIKHIL
MARWAH
TEXTBOOK OF PEDODONTICS – SHOBHA TENDON
IMAGES FROM NET - GOOGLE

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