maneesha_phd.pptx mechanical plaque control

Mechanical plaque control

1. MECHANICAL PLAQUE CONTROL MANEESHA MENON M 21 PART1

2. INTRODUCTION 01 DISCLOSING AGENTS 02 MECHANICAL PLAQUE CONTROL 03 CONTENTS

3. Dental plaque is defined as a structured, resilient, yellow-grayish substance that adheres tenaciously to the intraoral hard surfaces, including removable and fixed restorations. Plaque control includes the usage of mechanical procedures as well as chemical agents, which retards plaque formation. INTRODUCTION

4. It is a preparation in liquid , tablet or lozenge form which contains dye or other coloring agent, used for the identification of bacterial plaque. PROPERTIES Intensity of color Duration of intensity Taste Irritation to mucous membrane Diffusibliity Astringent and antiseptic properties DISCLOSING AGENTS

5. AGENTS USED FOR DISCLOSING PLAQUE Iodine preparation : > skinners iodine solution >Diluted tincture of iodine Mercurochrome preparations :>mercurochrome solution 50% >flavored mercurochrome disclosing solution > Bismark brown > erythrosin >Fast green > Flouresecin > two tone solutions > basic fuchsin

6. USES OF DISCLOSING AGENT Personalized patient instruction and motivation Self evaluation by the patient To evaluate the effectiveness of oral hygiene measures In search studies with regard to effectiveness of plaque control

7. The various aids used for mechanical plaque control are: Toothbrushes and dentifrices Interdental aids: dental floss :interdental brushes :wooden tips Aids for gingival stimulation: gingival massage : water irrigation devices Tongue scrapers MECHANICAL PLAQUE CONTROL

8. MANUAL TOOTHBRUSHES IDEAL CHARACTERISTICS: It should confirm to individual patient requirement to size, shape and texture. should be easily and effectively maipulated Should be readily cleaned and aerated should be impervious to moisture should be durable and inexpensive TOOTHBRUSHES

9. PARTS OF TOOTHBRUSH Handle- part grasped in hand Head - the working end and holds bristles Tufts- clusters of bristles / filaments secured in to the head Brushing plane -surface formed by free ends of the bristles Shank-connects head and handle

10. TOOTHBRUSH BRISTLES It can be hard/soft,natural/synthetic,multitufted/ space tufted. Stiffness of bristles vary based on : Diameter of bristles Lengh of bristles Number of filaments in a tuft Curvature of filament

11. ADA SPECIFICATION OF A TOOTHBRUSH Brushing surface : 1-1.25 inches in length 5/16 to 3/8 inches in width 2 to 4 rows of bristles 5-12 tufts/row

12. MODIFICATIONS Long and contoured handle Double angulation of the handle and neck Concave surface of the brushing plane Special indicator bands POWERED TOOTHBRUSHES Introduced by Fredrick Tornberg, in 1939. Also known as automatic , mechanical or electric toothbrushes. The heads of the toothbrush oscillate in a side-to-side motion or in rotary motion. Frequency of oscillation is 40Hz in an ordinary powered tooth brush.

13. INDICATIONS OF POWERED TOOTHBRUSHES Young children Handicapped patients Individuals lacking manual dexterity Patients with orthodontic or endosseous implants Orthodontic patients Institutionalised patients including elderly Patients with supportive pdl therapy. ADVANTAGES Increases patient motivation resulting in better patient compliance Accessibility in interproximal and lingual areas No specific brushing technique required Use less brushing force than manual toothbrushes

14. SONIC AND ULTRASONIC TOOTHBRUSHES These types of toothbrushes produce produce high frequency vibrations (1.6MHz), which lead to phenomenon of cavitation and accoustic micro streaming. This phenomenon aids in stain removal as well as disruption of the bacterial cell wall. IONIC TOOTHBRUSHES Ionic toothbrushes change the surface charge of a tooth by an influx of positively charged ions. The plaque with similar charge is thus repelled from the tooth surface and is attracted by negatively charged bristles of toothbrush.

15. A dentifrice is a substance used with a toothbrush for the purpose of cleaning the accessible surfaces of teeth. Gel needed for effective cleaning is a pea sized dab on the top half of brush For children under 6 years it should be half the amount of dentrifice as compared to adults. It minimizes plaque buildup Anticaries action Removal of stains Mouth freshener. DENTIFRICES

16. BASS METHOD /SULCUS CLEANING METHOD It is most widely accepted and most effective method for the removal of dental plaque present adjacent to and directly underneath the gingival margin. INDICATIONS: Particularly adaptable for open interproximal areas ,cervical areas beneath the height of contourof the enamel and exposed tooth surfaces. Recommended for routine patients with or without periodontal involvement. TOOTHBRUSHING TECHNIQUES

17. TECHNIQUE: Bristles placed at a 45 ˚ angle to the gingiva and moved in small circular motions. Strokes are repeated around 20 times , 3teeth at a time. On lingual aspect of anterior teeth , brush is inserted vertically and heel of brush pressed into the gingival sulci On occlusal surface bristles are pressed firmly against pits and fissures

18. ADVANTAGES Effective method of removing plaque Provides good gingival stimulation Easy to learn DISADVANTAGES Overzealous brushing may convert the “very short strokes” into scrub technique Cause injury to gingival margin Time consuming Dexterity requirement is too high for certain patients.

19. INDICATIONS As a routine oral hygiene measure Intrasulcular cleansing TECHNIQUE: This technique combines the vibratory and circular movements of the Bass technique with the sweeping motion of Roll technique. Toothbrush is held that the bristles are 45 ˚ to the gingiva. Bristles gently vibrated by moving the brush handle in a back & forth motion. Bristles are then swept over the sides of tooth towards the occlusal surfaces in a single motion. MODIFIED BASS TECHNIQUE

20. ADVANTAGES Excellent sulcus cleaning Good interproximal & gingival cleaning Good gingival stimulation Dexterity of wrist is required.

21. INDICATIONS: Plaque removal from cervical areas below the height of contour of the enemel & from exposed proximal surfaces. General application for cleaning tooth surfaces & massage of the gingiva Recommended for cleaning in areas with progressive gingival recession & root exposure. TECHNIQUE Bristles are pointed apically with an oblique angle to the long axis of the tooth. Bristles are positioned partly on the cervical aspect of teeth & partly on the adjacent gingiva. Bristles activated by short back & forth motion and simultaneously moved in coronal direction. Strokes are repeated around 20 times. MODIFIED STILLMAN’S TECHNIQUE

22. DISADVANTAGES Time consuming Improper brushing can damage the epithelial attachment.

23. FONES METHOD / CIRCULAR SCRUB METHOD INDICATIONS: Physically or emotionally handicapped individuals Patients who lack dexterity TECHNIQUE Child is asked to stretch his/ her arms that they are parallel to the floor asked to make big circles using the whole arm to draw circles in the air. The circles are reduced in small diameter until very small circles are made infront of mouth

24. ADVANTAGES Easy to learn Shorter time is required DISADVANTAGES Possible trauma to gingiva Interdental areas are not properly cleaned Detrimental for adults especially who use the brush vigorously.

25. VERTICAL METHOD-LEONARDS METHOD Leonard advocated a vertical stroke in which maxillary & mandibular teeth are brushed seperately. TECHNIQUE Bristles are placed 90 ˚ angle to the facial surface of teeth. With the teeth edge to edge ,brush vigorously , without great pressure with a stroke mostly up & down on tooth surfaces with a slight rotation or circular movement after striking the gingival margin with force ADVANTAGE Most convenient and effective for small chiidren DISADVANATAGE Interdental spaces of permanent teeth are not properly cleaned.

26. CHARTER’S METHOD INDICATIONS Individuals having open interdental spaces with missing pappilla and exposed root surfaces. Those wearing FPD or orthodontic appliances For patients who have periodontal surgery Patients with moderate interproximal recession. TECHNIQUE A soft/medium multi-tufted tooth brush is indicated in this technique. Bristles are placed at an angle of 45 ˚ to the gingiva with the bristles diercted coronally. The bristles are activated by mild vibratory strokes with the bristle ends lying interproximally

27. ADVANTAGE Massage & stimulation for marginal and interdental gingiva. DISADVANTAGE Brush ends donot engage the gingival sulcus to remove subgingival bacterial accumulation In some areas the correct brush placement is limited or impossible ,therefoer modifications become necessary which add to the complexity of the procedure. Requirements in dexterity are high.

28. SCRUB BRUSH METHOD This method of brushig requires vigorous horizontal, vertical and circular motions. It is the virtual free style of the brushing scene . DISADVANTAGE Not very effective at plaque removal Tooth abrasion and gingival recession.

29. THE ROLL TECHNIQUE This method of brushing is also known as the Rolling Stroke method or ADA method or the Sweep method.It works fairly well for patients with anatomically normal gingival tissues. INDICATIONS Children Adult patients with limited dexterity Useful for preparatory instruction for modified Stillman’s technique since the initial brush placement is the same TECHNIQUE The bristles are placed at a 45 ˚ angle and lightly rolled across the tooth surfaces towards the occlusal surfaces. It rquires some flexibility around the wrist.

30. ADVANTAGE Provides gingival massage and stimulation DISADVANTAGE Brushing too high during initial placement can lacerate the alveolar mucosa. Tendency to use quick, sweeping strokes resulting in no brushing for cervical third of tooth Replacing the brush with filament directed in to the gingiva may produce punctuate lesions.

31. PHYSIOLOGIC METHOD- SMITH METHOD It was described by Smith and advocated later by Bell. Baesd on the principle that toothbrush should follow the physiologic pathway that is followed by food . TECHNIQUE Bristles are pointed incisally or occlusally, then moved along and over the tooth surfaces and gingiva The motion is gentle sweeping from incisal/occlusal surfaces over to facial surfaces and progressing towards and over the gingiva. ADVANTAGE Natural self cleansing mechanism Supragingival cleaning is good. DISADVANTAGE Interdental spaces and sulcular areas of teeth are not properly cleaned.

32. They are adjunctive devices, used to remove plaque from interproximal tooth surfaces . Factors in selection of an interdental cleaning aid : Type of gingival embrassure Alingment of teeth Fixed prosthesis/ orthodontic appliances Open furcation area Contact areas INTERDENTAL CLEANING AIDS

33. Type of embrasures and interdental aids TYPE I-The gingival papilla fills up the embrasure space completely dental floss is used. TYPEII-The gingival papilla partially fills the embrasure space.Due to papillary recession. interdental brushes and toothpicks are used. TYPEIII-The embrasure space is not filled.The gingival papilla has recedeed extensively or completely lost. unitufted brushes are used.

34. DENTAL FLOSS Indicated to remove plaque from interproximal tooth surfaces. TYPES OF DENTAL FLOSS Multifilamented -twisted/ non twisted Bonded/unbonded Thick/thin Waxed / unwaxed FUNCTIONS Removal of plaque & debris from interproximal areas and under the pontics of FPD Polishing of tooth surface Stimulating &massaging interdental pappillae Locating subgingival calculus deposits ,overhanging margins of restoraion ,proximal cairous lesons Vehicle for application of polishing and therapeutic agents

35. TECHNIQUE OF USING DENTAL FLOSS SPOOL METHOD: 12-18 inches of floss is taken & about 2 inch from each end is wound around the middle finger of each hand. Last three fingers are folded & closed and both hands moved apart. In this way 1-2 inches of floss is held tightly between the index finger of both hands

36. CIRCLE/LOOP METHOD Loop of floss is made about 12-18 inches longpiece and both ends sre tied. All the three fingers except thumbs of both the hands are placed within the loop & floss is held tightly by both hands. Floss holder can also be used , in patients lacking manual dexterity. Floss is gently passed through contact area with a firm back&forth motion . Once the floss is apical to contact area , it is wrapped around the tooth & slipped gently under the marginal gingiva. Then moved firmly along the tooth upto the contact area & gently down to the sulcus again. Repeating the strokes for 2-3 minutes

37. INTERDENTAL BRUSHES They are cone/ cylindrical brushes made of bristles mounted on a handle. For cleaning large ,irregular /concave tooth surfaces adjacent to wide interdental spaces . By inserting into interdental spaces, moved back&forth between teeth with short strokes. WOODEN TIPS They are manufactured from orange wood & triangular in cross section. Repeatedly moved in& out of the embrassure for removing soft deposits from teeth Also mechanically stimulating gingiva. Use restricted to facial aspect of anterior teeth.

38. GINGIVAL MASSAGE Mechanical stimulation of gingiva by toothbrushing / simple finger massage leads to : increased keratinization increased blood flow increased flow of GCF within the gingival sulcus Results in overall improvement of gingival health WATER IRRIGATION DEVICES Mainly beneficial in the removal of unattached plaque & debris composed of a built in pump and a reservior Also be used to deliver antimicrobial agents eg: chlorhexidine subgingivally. Transient bacteremia reported especially in presence of inflammation

39. It is the processof removing debris from thesurfaceoftongue with some form of scraper designed for this purpose. Soft flexible plastic scrapers, metal scrapers & soft toothbrush are used for this purpose. TONGUE SCRAPERS

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