Mechanical plaque control new

Plaque control

1. Mechanical plaque control PRESENTED BY : MANOJ M. PARADHI 1 st YEAR PG Dept. Of Periodontics And Oral Implantology

2. Introduction Mechanical plaque control: Toothbrushes: Manual toothbrushes -Tooth brushing techniques Powered toothbrushes Sonic and ultrasonic toothbrushes Ionic toothbrushes Dentifrices Interdental cleaning aids: Dental floss Interproximal/interdental brushes Aids for gingival stimulation: Gingival massage Water irrigation devices Tongue scrapers

3. Introduction Mechanical plaque control is the removal of microbial plaque and the prevention of its accumulation on the teeth and adjacent gingival surface by the use of mechanical oral hygiene aids. It is an effective way of treating and preventing gingivitis, periodontitis.

4. The Toothbrush Acc. To ADA “Toothbrushes are designed to promote cleanliness of the teeth and oral cavity”. The bristles tooth brush appeared about the year of 1600 in China and later was patented in America in 1857. Types of toothbrushes: Manual toothbrushes Powered toothbrushes Sonic and ultrasonic toothbrushes Ionic toothbrushes

5. 0bjectives of toothbrushing : To clean teeth and interdental spaces To prevent plaque formation To disturb and remove plaque To stimulate and massage gingival tissue To clean the tongue Outcome of tooth brushing depends on following factors (Frandsen, 1986): Design of the brush Skill of the individual using the brush Frequency and duration of brushing

6. Parts of toothbrush – Handle: Part grasped in hand during toothbrushing. Head: Working end of a toothbrush that holds the bristles. Brushing plane: The surface formed by the free ends of bristles. Shank: Connects the head and handle. Manual toothbrushes

7. ADA given specification of toothbrushes : Length : 1 to 1.25 inches Width : 5/16 to 3/8 inches No. of rows : 2 to 4 rows of bristles No. of tufts : 5 to 12 tufts per row No. of bristles : 80 to 85 bristles per tuft

8. Powered tooth brush was invented in 1939. The heads of these toothbrushes oscillate in a side to side motion or in a rotary motion. Indications: (1) Hospitalized patients whose teeth are cleaned by the caregivers. (2) Physical and mental disability patients (3) Patient with orthodontic appliances. Powered toothbrushes

9. Sonic and ultrasonic toothbrushes These types of toothbrushes produce high frequency vibrations (1.6Mhz), which lead to the phenomenon of cavitation and acoustic micro streaming . This phenomenon aids in stain removal as well as disruption of the bacterial cell wall (bactericidal).

10. Ionic toothbrushes The ionic toothbrushes changes the surface charge of a tooth by influx of positively charged ions. The plaque of similar charge is repelled from the tooth surface and is attracted by the negative charged bristles of toothbrush.

11. Dentifrices

12. Composition of Dentifrices Agents Material used functions Polishing / Abrasive agents Calcium carbonate Dicalcium phosphate dihydrate Alumina Silicas This agents have a mild abrasive action, which aids in elimination plaque and removing stains from the tooth surface Binding / Thickening agents Water soluble agents : Alginates Sodium carboxymethyl cellulose water insoluble agents: Magnesium aluminium silicate Colloidal silica Sodium magnesium silicate Agents which controls stability and consistency of a tooth paste Detergents / surfactants Sodium lauryl sulfate Produce a foam which aids in the removal of food debris and also dispersion of the product within the mouth Humectants Sorbitol Glycerine Polyethylene glycol Aids in reducing the loss of moisture from the toothpaste

13. Agents Material used Function Flavoring agents Peppermint oil Spearmint oil Oil of wintergreen They render the product pleasant to use and leaves a fresh taste in the mouth Sweeteners and colouring agents saccharin sweetener Antibacterial agents Triclosan , delmopinol ,metallic ions , zinc citrate trihydrate Anticaries agents Sodium mono fluorophosphates Sodium fluoride Stannous fluoride Anticalculus agents Pyrophosphates Zinc citrate Zinc chloride Desensitizing agents Sodium fluoride Potassium nitrate Strontium chloride

14. Tooth brushing techniques Acc. to Green JC (1966): Roll Technique : Modified Stillman or Roll technique Vibratory Technique: Stillman , Charters & Bass technique Circular Technique: Fones technique Vertical Technique : Leonard’s method Horizontal Technique : Scrub brush method Physiologic Technique : Smith method

15. The bass method or sulcus cleaning method Most widely accepted & effective method. TECHNIQUE : The bristles are placed at 45 ° angle to the long axis of teeth. Exert gently vibratory pressure ,using short back and forth motion without dislodging tip of bristles. On lingual aspect of the anterior teeth , the brush is inserted vertically and the heel of the brush is pressed into the gingival sulci and proximal surfaces at 45°angle . Occlusal surfaces cleaned by pressing bristles against pit and fissures.

16. INDICATIONS FOR BASS METHOD OR SULCUS CLEANING METHOD : For open interproximal areas, cervical areas beneath the height of contour of enamel and exposed root surfaces. Recommended for routine patients with or without periodontal involvement.

17. Modified bass technique TECHNIQUE: It is a combination of vibratory and circular movements of bass technique with the sweeping motion of the roll technique. Tooth bristles are held at 45 ° to the gingiva and gently vibrated by back and forth motion, it then swept over the sides of the teeth toward their occlusal surface in a single motion.

18. INDICATIONS As a routine oral hygiene measure. Intrasulcular cleansing

19. Stillman's technique TECHNIQUE: Brush end where placed partly on the gingiva and the cervical areas of the tooth and directed apically . Handle was given slight rotary motion and partly on the brush ends maintained in position on tooth surface. The procedure is repeated systematically on adjacent teeth . INDICATIONS: This method was design for massage and stimulation of gingiva as well as for cleaning the cervical areas.

20. TECHNIQUE : Bristles are pointed apically with an oblique angle to the long axis of tooth. Bristles are positioned partly on cervical aspect of the teeth and partly on the adjacent gingiva activated by short back and forth motion and simultaneously moved in coronal direction Following 20 strokes, the procedure is repeated systematically on adjacent teeth . A soft toothbrush is indicated for these technique . Modified Stillman's technique

21. INDICATIONS : Bacterial plaque removal from cervical areas below the height of contour of crown. Recommended for cleaning in areas with progressing gingival recession and root exposure.

22. Fones method or circular /scrub method TECHNIQUE : The child is asked to Stretch his arms such that they are parallel to the floor. And then asked to make a big circle using the whole arm to draw circle in the air. The circle are reduced in diameter until very small circle is made in front of mouth. Now child is ready to make circles on the teeth with the toothbrush, making sure that the teeth and gums are covered. INDICATIONS : Young children Physically handicapped individuals Patients who lack of dexterity.

23. Vertical method – Leonard's method TECHNIQUE : Bristles placed at 90°angle to facial surface of teeth. Bristle motion is vertically up & down on facial surface with clinched teeth. Teeth are placed edge to edge to keep the brush slipping over the occlusal or incisal surface. INDICATIONS Convenient and effective for small children with deciduous teeth.

24. Charter’s method TECHNIQUE: Bristles are placed at an 45 ° angle directed coronally Bristles are activated by mild vibratory strokes with the bristle ends lying interproximaly . A soft, multi-tufted tooth brush is indicated for this technique. INDICATIONS : Individuals having open inter dental spaces with missing papilla and exposed root surfaces. For patient who had periodontal surgery. Patient with moderate interproximal gingival recession.

25. Scrub brush method These method of brushing requires vigorous horizontal, vertical and circulatory motions. It is the virtual free style of brushing scene. DISADVANTAGE : Not very effective at plaque removal Tooth abrasion and gingival recession

26. Roll technique TECHNIQUE: Bristles are placed direct apicaly and lightly rolled across the tooth surface towards the occlusal surfaces. INDICATIONS : Children Adult patient with limited dexterity

27. Physiologic method –Smith method The physiological method described by Smith and advocated by Bell Based on the principle that the toothbrush should follow the physiologic pathway that is followed by food when it traverses over the tissue during mastication. TECHNIQUE : The bristles are pointed incisally or occlusally and then moved along and over the tooth surface and gingiva. The motion is gently sweeping from incisal or occlusal surfaces over to facial surface and progressing towards and over to gingiva. ADVANTAGES: Natural self cleansing mechanism Supra gingival cleaning is good

28. Maintenance of tooth brushes Stored toothbrushes in dry areas . Toothbrushes should be kept in open air with head in upright position with no contact with other brushes. The useful life of an average toothbrush is 2–3 months.

29. Interdental cleaning aids Use to remove plaque from inter proximal tooth surface. Factors to be considered for selection of the Interdental cleaning aids: -Type of gingival embrasure -Alignment of teeth -Fixed prosthesis/orthodontic appliances -Open furcation areas -Contact areas

30. Dental floss Dental floss indicated to remove plaque from interproximal tooth surfaces. Various forms: Multifilament –twisted / non-twisted. Thick/thin Waxed/non waxed

31. Dental floss : Functions – Remove plaque from interdental areas Stimulate and massage gingiva Improve oral hygiene Reduce gingival bleeding Helps in locating subgingival calculus deposits, overhanging margins of restoration and proximal carious lesions.

32. Interproximal/Interdental brushes They are cone shaped or cylindrical brushes made of bristles mounted on handle. Indication : For cleaning large , irregular or concave tooth surface adjacent to wide interdental spaces. They are inserted through interproximal spaces and move back and forth between the teeth with short strokes.

33. GINGIVAL MASSAGE The mechanical stimulation of gingiva either by toothbrushing or interdental cleansing with various aids or simple finger massage leads to l . Increased keratinization. 2. Increased blood flow. 3. Increased flow of gingival crevicular fluid within the gingival sulcus. This results in an over all improvement in the gingival health

34. Oral irrigation Water irrigation devices(water pik ): Indications – -Inaccessible interdental areas around Orthodontic/prosthetic appliances -Deep gingival sulcus -Delivers antimicrobial agents ( eg.chlorhexidine ) Disadvantages – -Expensive -If excessive pressure used, fluid and air is forced into underlying tissues & cause damage to tissues.

35. The most common oral irrigators have a built-in pump and reservoir. Conventional plastic tips are used for daily supragingival irrigation at home by the patient. Left , Tip for cleaning dorsal surface of the tongue Right ,Tip for gingival irrigation. Soft rubber tip is used for daily subgingival irrigation by the patient at home .

36. Tongue scrapers The process of removal of debris from the tongue with some form of scraper designed. Tongue scrapers are made of soft flexible plastic material. Tongue cleaning Device is placed at the dorsum of the tongue and pulled forwards with light pressure.

37. Conclusion Mechanical plaque control is the key to success of periodontal therapy and achieving the dental health. The clinician must evaluated patient plaque control by means of gingival and plaque indices to motivate the patient about periodontal health. Common devices to be recommended to the patient are soft bristle tooth brush, floss, interproximal brushes . Thoroughness and frequency of brushing are probably more important than a specific toothbrushing method

38. REFERENCES Carranza, Newman. Textbook of clinical periodontology. 11 th edition. WB Saunders, 2011. page 625-633. Preventive and community dentistry, Soben peter,4 th edition,2009.page 121-132. Esther M. Wilkins Clinical practice of dental hygienist (8th ed) page 351-367.