Plaque Control / dental implant courses by Indian dental academy

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Plaque Control

INDIAN DENTAL ACADEMYLeader in continuing Dental Education


“Dental Caries and Periodontal

diseases are the two most common

chronic diseases of the oral cavity.”


Dental Plaque is defined as a highly variable structural entity formed by sequential colonization of microorganism on the tooth surface, epithelium and restorations.

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


Plaque control includes the usage of mechanical procedures as well as chemical agents that retards plaque formation.

Mechanical ChemicalPlaque control plaque control

Personal Professional


Mechanical Plaque Control


The various aids used for mechanical plaque control can be listed as

followsToothbrushesa)Manual toothbrush b) Electric toothbrushInterdental aidsa) Dental Floss b) Triangular toothpicksc) Interdental brushesAids for gingival stimulationa) Rubber tip stimulator b) Balsa wood edgeOthersa) Gauze strips b) Water irrigation devicesAids for edentulous or partially edentulous patientsa) Denture and partial clasp brushes b) Cleansing Solutions


ToothbrushesPrincipal instrument in general use for accomplishing plaque control .Many different designs have been manufactured and promotedTypes of toothbrushes

Manual toothbrushes Powered toothbrushSonic and Ultrasonic toothbrushes Ionic toothbrush


Manual Toothbrush

Desirable characteristics of a brush recommended

by American dental association1. Confirm to individual size, shape and

texture 2. Be easily and efficiently manipulated3. Be readily cleaned and aerated; impervious

to moisture 4. Be durable and inexpensive5. Be designed for utility efficiency and

cleanliness


HandleNearly all current brush handles are plastics, which combine durability, impervious to moisture, pleasing appearance, low cost, sufficient rigidity and smooth surface textureShape

Preferred: straight handle aligned on same plane as the head; with smooth form which is easy to grasp and may be turned as needed but will not slip during manipulationVariations: A twist, curve, offset or angle in the shank may frequently be related to new ideas for advertising appeal.Bent or thickened handles


Head A. Tufts

1. Tufted Design: Five or six tufts long and two or three rows wide spaced for easy cleaning of the brush.

2. Multitufted design: ten or twelve tufts long and three or four rows wide, spaced closely to provide a smooth brushing plane and to allow the filaments to support each other for longer durability.

B. Brushing Plane

1. Preferred: straight with filaments all of equal length 2. Uneven planes


Bristles and filamentsA. Natural Bristles1. Source: Obtained from the hair of hog or wild boar2. Uniformity: varies the bristles are not consistent in

texture, size, flexibility or wearing pattern3. Stiffness: varied stiffness4. Properties:

Water absorbent: become softened and stay softened longer Bristles are hollow tubes that may harbor microorganisms


B. Nylon Filaments1. Source: manufactured according to federal specifications

governing physical properties, composition and diameter 2. Uniformity: Controlled3. Stiffnessa. Diameter: thinner filaments are softer and more resilientb. Diameter of Soft nylon brushes: 0.006-0.007inchc. Diameter of Regular nylon brushes: 0.008 inch- Soft 0.012 inch - medium

0.014 inch - Hard 0.016 inch - Extra Hard

4. Properties:a. Rinse clean and dry rapidlyb. Maintain form longer than natural bristles


Toothbrushing ProceduresMost toothbrushing methods can be classified into one of the

seven groups based on the motion applied by brush.A. Roll: Rolling stroke, modified Stillman B. Vibratory: Stillman, Charters, BassC. Circular: FonesD. Vertical: Leonard'sE. HorizontalF. Physiological: Smith'sG. Scrub-brush


Powered toothbrushesValuable alternative to manual toothbrushes.

The heads of these toothbrushes oscillate in reciprocal, side-to-side motion, back-and Forth, elliptical, rotary motion or combined.

Indications of Powered toothbrushes

Young Children, Handicapped Patients,

Individuals lacking manual dexterity

Patients with Prosthodontic or endosseous implants

Orthodontic patients, Elderly patients,

Patients on supportive periodontal therapy


Advantages of Powered toothbrushing

It increases patient motivation resulting better patientcompliance

Increased accessibility in interproximal and lingual areas No specific brushing technique requiredUses less brushing force than manual toothbrushesBrushing timer is incorporated in some brushes to help the patient in brushing for the required duration.


Sonic And Ultrasonic toothbrushes

a. Produce high frequency vibrations (1.6MHz), which leads to the phenomenon of cavitation and acoustic microstreaming.

b. b. This phenomenon aids in stain removal as well as disruption of the bacterial cell wall.

Ionic toothbrushes

Changes the surface charge of a tooth by an influx of positively charged ions.


" No specific toothbrush can be singled out as clearly superior for the routine removal of microbial deposits from the teeth."


Interdental cleaning Aids

It has been shown that toothbrush, regardless of the method used, does not completely remove interdental plaque, either in individuals with healthy periodontal conditions or in periodontally involved patients with open embrasures.The purpose of interdental cleaning is to remove

plaque, not to dislodge fibrous threads of food wedged between two teeth.


Factors in selection of an interdental

cleaning aid; Type of gingival embrasure

Alignment of the teeth

Fixed prosthesis/orthodontic appliances

Open furcation areas & Contact areas


S.No Type of Embrasure Cleaning Aid Recommended

1.Embrasures are completely occupied by healthy Interdental papilla

Superfine and thin floss, used only for cleaning sulcus

2. About 75< of embrasure is occupied by gingiva Medium or coarse and thick dental Floss

3. About 50% of the embrasure is occupied byGingiva

Thin pointed small spiral interdental Brushes

4. About 25< of the embrasure is occupied byGingiva

Thick spiral interdental brushes and fine bristle ended unitufted Brushes

5.Complete loss of Interdental papilla and gingiva from the embrasure. The level of the gingiva in the interdental space is same as the buccal and the lingual gingiva on theTeeth

Bristle ended unitufted brushes and thick spiral interdental brushes


Dental flossMost widely recommended method of removing plaque from interdental areasAvailable in many forms

Monofilament/ MultifilamentMultifilament- Twisted/Non twisted Bonded/Non BondedThick/ ThinWaxed/ Non waxed

The degree of plaque control is similar by any type of the floss therefore the choice of the type of the floss is based on individual preference.Flossing may be carried out by wrapping the floss around the fingers Spool method / circle or loop methodFloss holders have also been designed


Wooden tipsAn ideal substitute in type 2 gingival embrasureManufactured from orange wood and are triangular in cross sectionInserted in the embrasure with the base of the triangle oriented toward gingiva.Repeatedly, moved in and out of the embrasure

Interproximal/interdental brushes- Best choice in type 2 gingival embrasure


Irrigation devices (Water Pik)

Valuable supplement for mechanical plaque

control

Mainly beneficial in removal of unattached

plaque.

Composed of built in pump or reservoir


Gingival Physiotherapy

The rationale behind gingival physiotherapy is the fact that mechanical stimulation of the gingiva either by tooth brushing or interdental cleansing with various leads to1. Increased keratinization2. Increased Blood flow 3. Increased flow of GCF


Chemical Plaque control


Chemical plaque control agents have proven to be ideal adjunct to mechanical plaque control. The principle of mechanical cleaning is to remove microorganisms regularly. Chemicals could on the other hand can influence plaque quantitatively and qualitatively. These mechanisms could be

Prevent bacterial attachment using Anti-AdhesivesStop or slow bacterial proliferation using AntimicrobialsRemove established plaque termed as chemical toothpasteAlter the pathogenecity of the plaque


Ideal Requisites of an antiplaque AgentShould significantly reduce plaque and gingivitis

Should prevent growth of pathogenic bacteria

Should prevent development of resistant bacteria

Should be compatible with oral tissues

Should not stain teeth/alter taste

Should be inexpensive and easy to use


First Generation Second Generation Third Generation

Reduces Plaque Scores by 20-30%

Reduces Plaque Scores by 70-90% Under Trial

Poor Retention Better RetentionBlock binding of microorganisms to tooth surface and each other

E.g.. Antibiotics,Phenols E.g.. Chlorhexidine E.g.: Delmopinol

Classification of Antiplaque Agents


S.NO. GROUP EXAMPLE ACTION

1 Antibiotics Penicillin Vancamycin Kanamycin Antimicrobial

2 Enzymes Protease Lipase Nuclease Glucose oxidase

Plaque Removal Antimicrobial

3 Bisbiguanides Chlorhexidine Alexidine Octenidine Antimicrobial

4Quarternary Ammonium compounds

Cetylpyridinium Chloride Benzalkonium Chloride Antimicrobial

5 Phenols and Essential Oils Thymol Eucalyptol Antimicrobial

6 Natural Products Sanguinarine Antimicrobial

7 Metal Salts Tin, Zinc, Copper Antimicrobial

8 Oxygenating agents Hydrogen peroxide Antimicrobial Plaque Removal

9 Detergents Sodium lauryl Sulfate Antimicrobial Plaque Removal

10 Amine alcohols Octapinol Plaque matrix inhibition

11 Flourides Sodium Fluoride Antimicrobial


PhenolsGroup of antiseptic compounds with widespread application as disinfectants, antiseptics, antifungal and antimicrobials.Non-specific anti-bacterial action dependent on the ability of ions to penetrate the lipid component of cell wall of microorganisms.This structural damage will affect the permeability control of microorganisms in addition to several metabolic processes.

.


ListerineA phenolic antiseptic is a combination of the phenol-related essential oils, thymol and eucalyptol, mixed with menthol and

methyl salicylate in 26.9% hydroalcoholic vehicle.Its lack of profound inhibition of plaque accumulation can be attributed to its poor oral retention.

TriclosanNon-ionic antimicrobial triclosan is considered to belong to the phenols and has been used in wide numbers of medicated products including antiperspirants and soaps.It is trichloro-2-hydroxydiphenyl etherFormulated in number of toothpastes and mouthwashes


BisbiguanidesIncludes chlorhexidine and alexidineMost effective antiplaque dgents currently in use

ChlorhexidineAvailable in three forms- digluconate, acetate and hydrochloride saltsDigluconate and acetate-water solubleDeveloped in 1940 by Imperial Chemical Industries (ICI),England and marketed in 1954 as an antiseptic for skin woundsIn dentistry Schroeder first used it for presurgical disinfections of mouth in 1964.


StructureSymmetrical dicationic molecule consisting of two 4 chlorophenyl rings and two biguanide groups connected by central hexamethylene bridge.It's a dicationic at pH levels above 3.5.

MetabolismMode of action is purely topical Does not penetrate oral epitheliumPoorly absorbed in alimentary tract is excreted unchanged


Mode of action Antiplaque action & Antibacterial actionBacteriostatic at low concentrations

Alters the cell membrane integrity&

Bactericidal at high concentrations

Coagulation and precipitation of cytoplasm

Pin Cushion effectOne charged end of the chlorhexidine. molecule binds to the tooth surface and the other remains available to initiate the interaction with the bacterial membrane as the Microorganisms approaches the tooth surface.Usually prescribed as 0.2% Chlohexidine mouth rinse two times a day.


DentifricesAccording to American dental association A

dentifrice is a substance used with a toothbrush

for the purpose of cleaning the accessible surfaces

of the teeth. "

The functions of toothpaste in conjunction with toothbrushing are

Minimizing plaque build upAnticaries actionRemoval of stains Mouth freshener


CompositionA. Polishing / abrasive agentsCalcium carbonate, Bicalcium phosphate dihydrate, Alumina, SilicasFunctions:Mild abrasive action aids in plaque removalRemove stained pellicle from the tooth surface, restores

natural luster and also enhances enamel whiteness.B. Binding/thickening agents. Eg: Water soluble agents: AlginatesWater insoluble agents. Magnesium aluminium silicate, Colloidal silicaFunctionsControls stability and consistency of a toothpasteEffects ease of dispersion of the paste in the mouth


C. DetergentsEg: Sodium lauryl sulfateFunctions1. Produce the foam that aids in the removal of food debris and also dispersion of product within mouth2.Antimicrobial propertyD. HumectantsSorbitol, Glycerin Polyethylene glycolFunctionsAids in reducing loss of moisture from the toothpaste E. Flavoring agentsPeppermint oil, Spearmint oil, Oil of wintergreenF. Sweeteners and coloring agentsSaccharinG. Antibacterial agentsTriclosanH. Anticaries agentsSodium fluoride


Disclosing agentsA disclosing agent is a preparation in liquid, tablet or lozenge form which contain a dye or other coloring, agent. A disclosing agent is used for the identification of bacterial plaque which might be invisible to the naked eye.Utility of the disclosing agents

Personalized patient instruction and motivationSelf-evaluation by the patientTo evaluate the effectiveness of oral hygiene maintenancesPreparation of plaque indices In research studies


Properties of an acceptable disclosing agentColor should be in contrast with normal colors of oral cavityColor should not rinse off with ordinary rinsing methods, or be removable by the saliva for period of a time.Plesasant and comfortable taste . No irritation to oral mucosaShould have astringent and antiseptic properties

Agents used for disclosing plaque . Iodine preparationsSkinners iodineDiluted tincture of iodineMercurochrome preparations, Bismark brownTwo tone solutionStains older plaque blue and newer plaque pink.


Date post:	13-Apr-2017
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