Plaque Control PDF

Plaque control Dr. Omer Jafar Naghshbandi D.D.S ; M.S , Diplomate Of The American Board Of Periodontology  Special Thanks whoever taught me a word make me his servant Dr. Raul caffesse Dr. Jim Simon What is dental plaque ? Dental plaque is a soft sticky and colorless depo...

Plaque control Dr. Omer Jafar Naghshbandi D.D.S ; M.S , Diplomate Of The American Board Of Periodontology  Special Thanks whoever taught me a word make me his servant Dr. Raul caffesse Dr. Jim Simon What is dental plaque ? Dental plaque is a soft sticky and colorless deposit that accumulates on the teeth Plaque control Is the removal of microbial plaque and prevention of its accumulation on teeth and adjacent gingival tissues. Formation of the pellicle Attachment of the bacteria to the pellicle Bacterial accumulation and colonization Plaque growth and maturation Matrix formation  PLAQUE CONTROL MECHANICAL CHEMICAL PLAQUE PLAQUE CONTROL CONTROL MECHANICAL PLAQUE CONTROLAIDS 1.Toothbrushes and dentifrices 2.Interdental aids a)Dental floss b)Interdental brushes c) Wooden tips 3.Aids for gingival stimulation a)Gingival massage b)Water irrigation devices 4.Tongue scrapers TOOTHBRUSHES Described as “most classic and principal method employed in oral hygiene”. According to ADA’s Council on Dental Therapeutics, “Toothbrush is designed primarily to promote cleanliness of teeth and oral cavity.” Types of Toothbrushes 1. Manual 2. POWERED 3. SONIC & ULTRASONIC 4. IONIC 1) Manual Toothbrushes Should confirm to individual patient requirement, size, shape and texture. Be readily cleaned. Be easily and effectively manipulated. Be durable and inexpensive. Be designed for utility efficiency and cleanliness. Parts of Toothbrush: Brushing surface: Surface formed by free ends of bristles/filaments Tufts Tuft: Cluster of bristles/filaments secured Head: working end that holds into head bristles/filaments Shank: Section that connects head & handle Handle: Part grasped in hand during brushing Toothbrush bristles: Types Hard & Soft Natural (hair of wild boar or hog) & Synthetic (nylon) Multi-tufted & Space –tufted Stiffness of bristles depends on Diameter of bristles Length of bristles Number of filaments in a tuft Curvature of filament  ADA Specification Of Toothbrush Brushing surface: - Brush length:1 – 1.25 inches - Brush width 5/16 to 3/8 inches - 2 to 4 rows of bristles - 5 – 12 tufts/row Toothbrush modifications: - Long & contoured handles - Double angulation of handle & neck Head modifications: - Concave surface Deep Grooved Design - Conventional Flat Multi-tufted Special Indicator Bands  2) POWERED TOOTHBRUSHES They are also known as automatic, mechanical and electrical toothbrushes. These brushes mimic the action of the manual toothbrushes. The heads of these toothbrushes oscillate in a side-to- side motion or in a rotary motion. Indications of powered toothbrushes:  Young children  Handicapped patients  Individuals lacking manual dexterity.  Patients with prosthodontic and endosseous implants.  Orthodontic patients  Patients on supportive periodontal therapy.  Advantages of powered toothbrushes:  It increases patient motivation resulting in better patient compliance.  Increased accessibility in interproximal and lingual tooth surfaces.  No specific brushing technique required.  Uses less brushing force than manual toothbrush.  Brushing timer is incorporated in some brushes to help the patient in brushing for the required duration. 3) Sonic & Ultrasonic toothbrushes Produces high frequency vibrations (1.6 MHz), which lead to phenomenon of cavitation and acoustic microstreaming. This aids in stain removal as well as disruption of bacterial cell wall. 4) Ionic toothbrushes: Change surface charge of a tooth by influx of positively charged ions. Plaque with similar charge is repelled from the tooth surfaces. These plaque are attracted by negatively charged bristles of toothbrush  BASS METHOD Most widely accepted and most effective method for plaque removal. Indications  For all patients for dental plaque removal adjacent to and directly beneath the gingival margins.  Particularly adaptable for open inter proximal areas, cervical areas, beneath the height of contour of enamel and exposed root surface.  Recommended for routine patients with or without periodontal involvement.  The bristles are placed at a 45 degree angle to the gingiva and moved in a circular stroke. Strokes are repeated around 20 times, 3 teeth at a time. On the lingual aspect of the anterior teeth, the brush is TECHNIQUE: inserted vertically and the heel of the bristle is passed into the gingival sulcus. Advantages: Effective method for removing plaque Provides good gingival stimulus Easy to learn Disadvantages: Overzealous brushing can cause injury to gingival margin. Time consuming. Dexterity requirement is too high for certain patients. DENTIFRICES  According to American Dental Associations Councils on Dental therapeutics “a dentifrice is a substance used with a tooth brush for the purpose of cleaning the accessible surfaces of the teeth.”  APPLICATION OF DENTIFRICE Amount of toothpaste or Should be dispersed in Children under 6years of gel - pea sized dab on the between bristles rather age should only be given top half of tooth brush. than on top half of the half of the amount of toothbrush dentifrice as compared to adults.  Natural toothpaste Toothpaste for Whitening children toothpaste  INTERDENTAL CLEANING AIDS Special efforts have to be made and special devices have to be used for the removal of plaque from interdental areas especially for posterior molars. Factors in selection 1. Type of gingival embrasures 2. Alignment of teeth 3. Fixed prosthesis or orthodontic appliances 4. Open furcation areas 5. Contact areas Dental floss Indicated to remove plaque from inter proximal surfaces. Available in various forms: Multifilament Twisted/ non-twisted Bonded/non-bonded Thick/thin Waxed/non waxed  Functions of dental floss Removal of adherent plaque and food debris from the interproximal embrasures and under the pontics of FPD. Polishing of tooth surface during the removal of plaque and debris. Stimulating and massaging the interdental papillae. Helping in locating - Subgingival calculus deposits - Overhanging margins of the restorations - Proximal caries  Improving oral hygiene. Reducing the gingival bleeding Vehicle for application of polishing or therapeutic agents to inter proximal and subgingival area TECHNIQUE OF USING DENTAL FLOSS 1. The spool method 2. The circle or loop method SPOOL METHOD  About 12-18 inches long floss is taken and about 4 inches from each end is wound around the middle finger of each hand.  In the both hands the last three fingers are folded and both hands are moved apart.  In this way about 1-2 inches of floss is held tightly between the index fingers of both the hands. CIRCLE OR LOOP METHOD: In this method, a loop or circle of the floss is made from about12-18 inches long piece and both the ends are tied securely with the three knots. All the fingers except thumbs of both hands are placed within the loop. The floss is held tightly by both hands having about 1-2 inches of floss between the fingers of both the hands.  TECHNIQUE?  The floss is gently passed through each contact area with a firm back and forth motion.  Once the floss is apical to the contact area, it is wrappe around the proximal surface of one tooth and slipped gently under the marginal gingiva  Then the floss is moved firmly along the tooth up to the contact area and gently down to the sulcus again, repeating this strokes for 2-3 times.  INTERPROXIMAL/ INTERDENTAL BRUSHES  They are cone shaped or cylindrical brushes.  They are particularly suitable for cleaning large,irregular or concave tooth surfaces adjacent to wide interdental spaces.  They are inserted through wide interdental spaces and moves back and forth motion with short strokes  Powered interdental tooth brushes are also available.  WOODEN TIPS Manufactured from orange wood and are triangular in cross section. They are inserted into gingival embrasures with base of the triangle oriented towards the gingiva.  Gingival massage  Mechanical stimulation of the gingiva either by tooth brushing or interdental cleansing with various aids or simple finger massage leads to 1. Increased keratinization 2. Increased blood flow 3. Increased flow of GCF within the gingival sulcus WATER IRRIGATION DEVICES(WATER PIK) Valuable supplement for mechanical plaque control measures. Beneficial in the removal of unattached plaque and debris. Mainly composed of a built -in pump and a reservoir. Also used to deliver the antimicrobial agents Eg: chlorhexidine sub gingivally  TONGUE SCRAPERS Defined as process of removing debris from the surface of tongue with some form of scraper designed for this purpose Techniques Brushing Tongue cleaning devices CHEMICAL PLAQUE CONTROL Ideal adjunct to mechanical plaque control procedures. The ADA has accepted two agents as plaque control agents: Prescription chlorhexidine rinse. Nonprescription essential oil rinse. IDEAL REQUISITES OF AN ANTIPLAQUE AGENT 1. Should significantly reduce plaque and gingivitis. 2. Should prevent the growth of pathogenic bacteria. 3. Should prevent the development of resistant bacteria. 4. Should be compatible with the oral tissues. 5. Should not stain teeth or alter taste. 6. Should exhibit good retentive property. 7. Should be inexpensive and easy to use. CHLORHEXIDINE Cationic bisbiguanide. Effective against gram+, gram-, fungi, yeast & viruses Both anti plaque and anti bacterial properties. Chlorhexidine inhibits plaque by:  Preventing pellicle formation by blocking acidic groups on salivary glycoproteins.  Preventing adsorption of bacterial cell wall onto the tooth surface by binding to the bacteria.  Preventing binding of mature plaque by precipitating agglutination factors in the saliva and displacing calcium from the plaque matrix. NON PRESCRIPTION ESSENTIAL OIL RINSES These products have long history of use and safety and also demonstrated plaque reduction in long term clinical studies. Eg: Thymol, Eucalyptol, Menthol  TRICLOSAN Phenol derivative recently included in mouth rinses and tooth paste Synthetic, non-ionic, topical antimicrobial agent Broad spectrum- both gram +ve and gram -ve.  DELMOPINOL Morpholino ethanol derivative. Inhibit plaque growth and reduce gingivitis. Interferes with plaque matrix formation and also reduces bacterial adherence. METALLIC IONS Metal ions have a plaque inhibitory capacity. Salts of ZINC and COPPER are most commonly used. Metallic salts act by reducing the glycolytic activity in micro organisms and delay bacterial growth. QUATERNARY AMMONIUM COMPOUNDS Cationic antiseptics & surface active agents More active against gram positive than gram negative organisms. E.g: Benzathonium chloride SANGUINARINE Benzophenanthridine Derived from plant alkaloid. Sanguinaria canadensis. Good retentive properties Effective against gram with dental plaque when negative organisms. used as a mouth wash  ENZYMES Used as a active agents in antiplaque preparation because they can breakdown already formed matrix of plaque and calculus. Eg: Mucinase  ANTIBIOTICS  Vancomycin , Erythromycin, Nidamycin and Kanamycin have used as a agents for plaque control.  Use of these agents have reduced considerably due to bacterial resistance & hypersensitivity reactions  DISCLOSING AGENTS  It is a preparation in liquid, tablet or lozenge form which contains a dye or other colouring agent.  Used for the identification of bacterial plaque, which might otherwise be invisible to naked eye.  Provide a valuable visual aid in patient instruction. Mechanism: When applied to the teeth, the agent imparts its color to soft deposits but can be rinsed easily from clean tooth surfaces. After staining, the deposits that can be distinctly seen provide a visual aid in patient instruction. Utility of Disclosing Agents  Personalized patient instruction & motivation  Self-evaluation by the patient  To evaluate effectiveness of oral hygiene maintenances  Preparation of plaque indices  In research studies with regard to effectiveness of plaque control devices Ideal Properties of Disclosing Agents  Intensity: should be distinct staining  Duration of intensity: Color shouldn’t rinse off easily  Taste: Not have unpleasant taste  Does not cause irritation: to mucus membrane  Diffusibility: Thin solution so that it can be applied readily  Astringent & antiseptic properties  Agents used for disclosing plaques Iodine preparations Mercurochrome preparations Bismark Brown (Easlick’s disclosing solution) Merbromin Erythrosine Fast green Fluorescin Two tone solutions Basic fuchsin  Application of Disclosing Agents  Disclosing solution may be directly applied onto the tooth surface using cotton pellets or it may be rinsed after proper dilution  Tablets, wafers – chewed swished around the mouth for 30-60 secs and rinsed.  CONCLUSION Regardless the means to achieve the goal, mechanical plaque control is the key to the success of periodontal therapy and achieving dental health. The clinician must evaluated patient plaque control by means of gingival and plaque indices to motivate the patient toward the common goal, the optimal periodontal health.