Plaque control

oral hygiene practice by different methods of plaque control

1. Plaque control BY M.J.RENGANATH MDS 1 ST YEAR

2. Plaque control is the regular removal of microbial plaque and the prevention of its accumulation on the teeth and adjacent gingival surfaces . Microbial plaque is the major etiology of periodontal diseases Patient cooperation in daily plaque removal is critical to long-term success of all periodontal treatment.

3. In 1965, Löe et al conducted the classic study- relationship between plaque accumulation and the development of experimental gingivitis in humans. Stopped brushing and other plaque control procedures, resulting in the development of gingivitis in every person within 7 to 21 days. The composition of the plaque bacteria also shifted so that gram negative organisms predominated, and these changes were shown to be reversible.

4. Plaque formation begins on the interproximal surfaces where the toothbrush does not reach. Masses of plaque first develop in the molar and premolar areas, followed by the proximal surfaces of the anterior teeth and the facial surfaces of the molars and premolars. Patients consistently leave more plaque on the posterior teeth than the anterior teeth, with interproximal surfaces retaining the highest amounts of plaque, exactly the places in which periodontal infections begin.

5. Plaque control measures Mechanical: Toothbrushing Interdental cleansing aids Chemical: Prescription Chlorhexidine Nonprescription essential oils Other products

6. Tooth brush Chewstick as tooth brush by Chinese about 1600BC. Hippocrates given commentaries on removing deposits from teeth(460-377BC) First bristle toothbrush was introduced by Chinese in sixteenth century.

7. Oral health- regular personal plaque removal. Mechanical removal of oral biofilm via toothbrushing is the most widely accepted. The most commonly used device-the manual toothbrush , Well designed to remove plaque from the facial, lingual, and occlusal tooth surfaces

8. ADA specification: The head of the brush should be 1 inch to 11/4 inches long. 2 – 4 rows of bristles. 5/16 inch to 3/8 inches wide. 5 – 12 tufts per row. 80 – 86 bristles per tuft.

9. Hardness: Depends on material, diameter and length. Nylon bristles are more flexible. • Soft : 0.007 inches to 0.009 inches • Medium : 0.010 inches to 0.012 inches • Hard : 0.013 inches to 0.014 inches • Extra hard : 0.015 inches

10. Brushing techniques S.no Technique Method Indications 1. Modified Bass Directed apically at a 45˚angle to long axis of tooth Sulcular cleansing Periodontalhealth Periodontal disease Periodontal maintenance 2. Stillman Directed apically & angle similar to Bass method; placed partly on cervical portion of teeth and partly on adjacent gingiva; short back&forth vibratory strokes & moved occlusally with light pressure. Progressive gingival recession Gingival stimulation 3. Charter Directed toward the crown of the tooth; placed at the gingival margin and angled 45˚ to the long axis of tooth; short back&forth vibratory strokes. Orthodontics Temporary cleaning of surgical sites Fixed prosthetic appliance

11. S.no Technique Method Indications 4. Rollstroke Directedapicallyand rolledocclusallyinaverticalmotion . 5. Fones Filamentsareactivatedinacircularmotion . Youngchildrenwithprimaryteeth Otherwisenot recommended

12. Powered Toothbrushes They were introduced in 1939 . Powered toothbrushes are recommended for: 1. Individuals lacking fine motor skills. 2 . Small children or handicapped or hospitalized patients 3 . Patients with orthodontic appliances. 4 . Patients who prefer them.

13. Various types of motions used in powered toothbrushes are: 1. Reciprocal or back and forth. 2 . Circular. 3 . Elliptical or combination.

14. Dentifrices These are the aids for cleaning and polishing of teeth surfaces. They are used in the form of powders, pastes and gels . Composition: Abrasives : CaCO3, Ca3 ( PO4)2 Humectants : glycerine, sorbitol, mannitol, propylene glycol Thickening agents : sodium carboxy -methyl cellulose

15. Preservatives: benzoic acid Foaming agents : sodium lauryl sulphate . Flavoring and sweetening agents : peppermint, saccharine, sorbitol, mannitol . Desensitising agents : sodium fluoride, potassium nitrate. Anticaries agents : sodium monofluorophosphate , sodium fluoride. Anticalculus agents : pyrophosphates or zinc compounds.

16. Interdental Cleaning Aids Toothbrush does not completely remove interdental plaque Dental floss and interdental cleaners such as wooden or plastic tips and interdental brushes.

17. Factors determining the selection of interdental aids: Type 1: The interdental papilla fills up the embrasure . Dental floss is advised Type 2: Moderate papillary recession, miniature interdental brushes and wood tips are recommended. Type 3: Complete loss of papilla ( seen in diastema ). Unitufted brushes are recommended.

18. Dental floss Most commonly recommended method of removing plaque. Made from nylon filaments or plastic monofilaments, and can be waxed, unwaxed , thick, thin, and even flavored. Unwaxed floss is preferred over waxed.

19. method Spool method: 12-18 inches taken About 4 inches wound around middle finger 1-2 inches held tightly between index fingers.

20. Loop method: Loop of floss is made about 12-18 inches with 3 knots. Passed through contact area, firm back and forth motion. Lack of dexterity, old age. Floss holders are also available.

21. Interdental brushes Interdental brushes are available in various sizes and shapes. Conical or tapered (like an ever- green tree ) Designed to be inserted into a plastic, reusable handle that is angled to facilitate interproximal adaptation. Interproximal brushes are equal to or more effective than floss for plaque biofilm removal.

22. Insert bristles into embrasure at a 90-degree angle to tooth surface (long axis of the tooth). Move brush using in and out motion from facial and/or lingual surfaces of appropriate area.

23. Wooden tips Manufactured from orange wood Triangular in cross section. Base of the triangle oriented towards the gingiva Repeatedly moved in and out of the embrasure. Restricted to facial aspects of anterior teeth.

24. Unitufted brush Small brush with single, short tuft of bristles. Indicated in type 2 and type 3 embrasures. Used with a rotatory motion similar to Bass technique.

25. Gingival massage Massaging the gingiva with a rubber tip or other device can lead to: improved circulation increased keratinization epithelial thickening . Place side of rubbertip interdentally and slightly pointing coronally (45˚), Move in and out with a slow stroke, rubbing the tip against the teeth.

26. Water irrigation devices Valuable supplement for mechanical plaque control Removes unattached plaque and debris. Built in pump and reservoir Also used with antimicrobial agents.

27. Chemical plaque control Ideal adjunct to mechanical plaque control that includes: Prescription chlorhexidine rinse Nonprescription essential oil rinse Antibiotics Quaternary ammonium compounds Enzymes

28. chlorhexidine Cationic Bisbiguanide . Superior antiplaque activity – ‘ Substantivity ’ Low concentration: bacteriostatic High concentration: bactericidal Single rinse: antibacterial activity in saliva for about 5 hours

29. Prevents pellicle formation- blocking acidic groups on salivary glycoprotein reducing glycoprotein adsorption on tooth surface. Prevents adsorption of bacterial cell wall on tooth surface- binding to the bacteria Prevents binding of mature plaque- precipitating agglutination factors in saliva & displacing calcium from plaque matrix

30. Non prescription essential oil rinses Long history of use and safety Demonstrated plaque reductions in long term clinical studies Eg : Thymol , Eucalyptol, Menthol, Methyl salicylate. Listerine

31. antibiotics Vancomycin , Erythromycin, Niddamycin and Kanamycin have been used. Bacterial resistance and hypersensitivity reactions.

32. enzymes Would be able to breakdown already formed matrix of plaque and calculus Certain proteolytic enzymes are bactericidal to microorganisms. Effective when applied topically in the mouth. Eg : Mucinase

33. Quaternary ammonium compounds Effective against developing plaque, predominant gram + ve organisms. + vely charged molecule reacts with – vely charged cell membrane phosphates, disrupts cell wall of microorganisms Eg : Benzathonium chloride.

34. Other agents Triclosan : Phenol derivative, recently included. Broad spectrum of activity against both gram + ve and – ve bacteria. Acts on microbial cytoplasmic membrane, inducing leakage of cellular constituents, causing bacteriolysis . Delays plaque maturation and also inhibits formation of Prostaglandins and leukotrienes .

35. Delmopinol : Morpholino ethanol derivative Interferes with plaque matrix formation and reduces bacterial adherence. Causes weak binding of plaque to tooth surface, thus aiding in easy removal of plaque by mechanical procedures Pre-brushing mouthrinse .

36. S.Aparna et al Journal of Periodontology: September 2012 The aims of this study are as follows: 1) to evaluate the antibacterial efficacy of honey against oral bacteria and compare the same with 0.2% chlorhexidine ; and 2) to compare antiplaque efficacy in vivo with chlorhexidine . The in vivo results revealed that plaque formation was inhibited/reduced by chlorhexidine and honey rinses. Concluded that  Honey has antibacterial action against tested oral microorganisms and also has antiplaque action.

37. M.P.C . Van Leeuwen, D.E .  Slot and   G.A. Van der Weijden Journal of Periodontology: February 2011 . No significant difference with respect to reduction of gingival inflammation was found between EOMW and chlorhexidine mouthwash In long-term use, the standardized formulation of EOMW appeared to be a reliable alternative to chlorhexidine mouthwash with respect to parameters of gingival inflammation.

38. conclusion Periodontal disease- majority of missing teeth Only possible solution to the problem is prevention. Proper oral hygiene practices- controls periodontal disease. Patient education.

39. references Clinical periodontology and implant dentistry- Jan Lindhe (5 th edition ) Carranza’s clinical periodontology- 11 th edition Dental hygiene theory and practice- Michele Leonardi Darby and Margaret M. Walsh (3 rd edition) Essential Oils Compared to Chlorhexidine With Respect to Plaque and Parameters of Gingival Inflammation: A Systematic Review - M.P.C. Van Leeuwen, D.E. Slot and   G.A. Van der Weijden Journal of Periodontology: February 2011, Vol. 82, No. 2, Pages 174-194 A Comparative Evaluation of the Antibacterial Efficacy of Honey In Vitro and Antiplaque Efficacy in a 4-Day Plaque Regrowth Model In Vivo: Preliminary Results- S.Aparna et al Journal of Periodontology: September 2012, Vol. 83, No. 9, Pages 1116-1121

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