SEMINAR ON

MECHANICAL PLAQUE CONTROL

CONTENTS
1. Definition Plaque, Calculus, material alba.
2. Plaque formation
3. Identification of plaque (Disclosing agent)
4. Plaque control (a) Mechanical (b) Chemical
5. Mechanical plaque control
(a) Toothbrush
(b) Dentifrice
(c) Interdental cleaning aids
(i) Dental floss
(ii) Interdental cleaning devices
- Interdental brushes
- Balsa wood wedge tooth pick
- Tooth pick in special holder
- Gauze stripe, pipe cleaner & yarns
(d) Oral irrigation

MECHANICAL PLAQUE CONTROL

Plaque :Its defined as a highly specific variable structural entity
formed by sequential colonization of micro-organisms on the tooth
surface, epithelium & restorations.

OR
Its also defined as the soft disposition that forms the biofilm adhering to
tooth surface or other hard surface in the oral cavity including removal and
fixed restoration.
Plaque is differentiated from other deposits such as calculus and material
alba. on the tooth surface.

Calculus

Its hard deposit that forms by mineralization of dental

plaque and is generally covered by a layer of unmineralized
plaque.

Material alba
It refers to soft accumulation of bacteria and
tissues cell that lacks the organized structure of dental
plaque and easily removed with water spray

Composition
Plaque begins to form within a minute on a cleaned tooth
surface. It begins as a film formed from saliva products which
stick firmly to the tooth enamel. This film then becomes
colonised by bacteria within the saliva. There are
approximately 100 million bacteria per ml of saliva and 500
different species present
Plaque changes over a time period of 1-12 days as different
bacteria colonise it. It eventually becomes a tightly packed
mass of moving bacteria called a "biofilm". The longer plaque is
present, the more harmful the biofilm becomes.

Figure 1. Electron microscopy of the formation of plaque.

Plaque Formation

Plaque formation is divided into 3 phases :

1. Formation of dental pellicle
2. Initial colonization on the tooth surface.
3. Secondary colonization and plaque maturation.

Dental plaque divided

into
A. Supragingival plaque

B. Sub gingival plaque

Found at or above the

below the gingival

gingival margin

margin between the

Also called as marginal

tooth & the gingival

plaque

sulcular tissue.

Identification of plaque deposits

Main objective is to identify the plaque and distinguish from
calculus and other deposits present on teeth.
Name
Iodine preparation

Preparation

Skinner solution
Iodine crystal 3.3g , Potassium Iodine-1.0g
, zinc Iodide 1.0g
Water distilled 16.0 ml
Glycerin 16.0ml
Mercurochrome -1.5g
Mercurochrome
Water 30 ml
preparations
Oil of peppermint 3 drops
Artificial non-calorigenic sweetener
Bismark brown 3.0 g
Bismark
brown
Ethyl alcohol 10 ml
[Easlick's
disclosing
Glycerin 120 ml
agent]
Flavoring agent 1 drop
Erythrosine
For direct topical application
Erythrosine 0.8g, water 100 ml, Alcohol
(95%) 10.0 ml, Oil of peppermint - 2 drop
Plak light system
Sodium fluorescein, glycerin 0.75% ,f.d. &
yellow no. 8

Diluted tincture of
iodine
Tincture of iodine
21.ml
Water 15.0 ml

Supragingival plaque
Disclose with dye

Supragingival plaque
Disclose with dye

Plaque control
Its defined as the removal of microbial plaque &
prevention of its accumulation on the teeth & adjacent
gingival tissue. It also deals with prevention of calculus
formation.
1.
2.
3.
4.

Objectives of plaque control

Primary role in removal of soft deposits on teeth and
gingival tissue.
Gingival stimulation (gingival massage)
Regular effective plaque control has to walled effect
on the tissue.
Helps in increasing gingival tone, surface
keratinization, gingival vascularity and gingival
circulation.

Plaque control can be done by two

method
Mechanical plaque control

Chemical plaque control

In this type

In this type

mechanical methods

specialized chemical

are used in

are used in

plaque control

Controlling plaque

Eg, toothbrushes

Eg, chlorhexidine

Dental floss etc.

Alhexidine

* Mechanical plaque control

A. Tooth brush

(a)

Manual

(b)

Power driven

B. Dentifrices
C. Interdental Aids (a)
(b)

Dental floss
Interproximal clearing devices

(1) Balsa wood wedge tooth plaque

(2) Interdential brushes
(3) Gauze strips
(4) Pipe cleaner
(5) Yarns
D. Oral irrigation

Tooth Brushes
- 1728 toothbrushes made from Horse's Hair
- 1857 manual brushes panted in America
- Generally toothbrushes very in size, design as well as in
length and arrangements of bristles hardness to overcome
this variation ADA given specification of toothbrushes.
Length

1 to 1.25 inches

Width

5/16 to 3/8 inches

Surface area

2.54 to 3.2 cm

No. of rows

2 to 4 rows of brushes

No. of tufts

5 to 12 per row

No. of bristles

80 to 85 per tuft

 Ideal properties of toothbrushes or tooth brush

selection
1. Tooth brush should be able to reach and efficiently clean
most area to teeth.
2. No Single tooth brush is adequate for all patient.
3. Proper brush should provide easy accessibility to all area
the mouth.
4. Small handed brushes are often helpful
5. Easy for patient to manipulate
6. Brushes should be compatible with recommended brushing
technique.
7. Both natural and nylon bristles are satisfactory.

Two types of material used in tooth brush

1. Natural bristles from Hog.
2. Artificial filament made predominantly of Nylon.
Nylon filament is superior due to its homogeneity of material, unfortunate of

brittle size resistance to fracture and repulsion of water and debris

Rounded bristles make fewer scratches on the gingiva than flat cut bristle with

sharp end
Soft bristle are more flexible, clean beneath the gingival margin and each bristle

reach further into proximal surface.

Hard bristles results in gingival recession.

Overzealous brushing also result in gingival recession.

Most tooth brushes wear out in 3 months.

Brushes with wear reminder are current available, the blue dye on bristle type with
use and can be helpful in reminding patient to replace their tooth brush.
Handle should fit palm of hand it may be straight or angled.

Conclusion

For most patient short headed brushes with straight cut rounded ended soft to
medium nylon bristle arranged in 3-4 row of tuffs are recommended.

Powered tooth brush

(a)
(b)
(c)
(d)

In 1939 powered tooth brush invented to make plaque control easier.

Its mainly recommended for
Individual lacking motor skills
Handicapped patient
Patient with orthodontic applied
Whosoever wants to use

There are many powered tooth brushes some with reciprocal of back and back

motions and some with combination of both some are circular and elliptical
motion.
Powered tooth cleaner resembles a dental prophylaxis and hand piece with rotary
rubber cap.
Patient should be lustrated for proper use.

In children Braun oral B kinds toothbrush D10 is most effective. It has

oscillatory round brush head so causes no soft tissue damage. It also plays music at 1
min. interval for monitoring brushing time.

Tooth brushing method

.

Many method of tooth brushing have been described

but no one method of tooth brushing it adequate to meet the

need of all patients.
Selection of method depends on the individual
Certain criteria should be assessed when selecting a
toothbrush and toothbrush technique for the individual
patient.

1. Patient clinical situation :

(a)State of gingival and periodontal l tissue in regard to health
is.

Tissue stage (contour, tone, texture, size)

Papillary contour (open & filed embrasure space)

Pocket or sulcus depth.

(b)Anatomical limitations

Size and contour of the dental arch.

Position inclination and contour of the individual teeth.

Presence of edentulous areas.

2. Patient personal situation

Patient level of manual dexterity.

Motivational level, ability and willingness of patient to act on

recommended procedure.

Brushing sequence and timing

Regardless of the tooth brushing method selected a

sequence of brushing should be given to the patient.

Patient is instructed to start with molar region of one

arch around the opposite side than continue back
around the lingual or facial surfaces of the same arch.
Same procedure is the followed for other arch.

Last surface to be brush are occlusal.

Patient instructed to stroke each area ten time of

spend 10 seconds per area then move on to next area.

Method
Scrub
BASS

Charter's

Bristle placement
Horizontal on gingival margin

Motion

Advantage/
disadvantage

Scrub in anterior position direction

Easy to learn & best suited

keeping brush horizontal

fro children

Apical towards gingival into sulcus at

Short back and forth vibratory

Cervical plaque removal

450 to tooth surface

motion while bristles remain in

Easily learned

Coronally 45 sides of bristles half

sulcus.
Small circular motions with apical

Good gingival stimulation

Hard to learn and position

on teeth and half of gingiva

movements towards gingival margin

brush

o,

Clears inter proximal

Fones

Roll

Stillman's

With teeth in occlusions, move

Gingival stimulation
Easy to learn

brush in rotary motion over both

Inter proximal areas not

arches and gingival margin

cleaned

Apically, parallel to tooth and then

On

May cause trauma

Doesn't clean sulcus area

over tooth surface

pressure, then rolling of head to

Easy to learn

On buccal and lingual, aplically at an

sweep bristle over gingiva & tooth

On buccal and lingual slight rotary

good gingival stimulation

Excellent gingival

ablique angle to long axis of tooth.

motions

stimulation

Ends rest on gingiva and cervical

stationary

Perpendicular to the tooth

buccal

and

with

lingual

bristle

inward

ends

part.

Moderate dexterity
required
Moderate cleaning of

Modified

Pointing apically at and angle of 45o

Apply pressure as in stillmans's

interproximal area
Easy to master

stillman's

to tooth surface

method but vibrate brush and also

Gingival stimulation

move occlusally

Bass method

Charters method

DENTIFRICES
Definitions
It's substance used with tooth brush to remove bacterial
plaque, material alba and debris from the gingiva and teeth.
It's used from back 1500 Bc by Egyptian &Y Hippocrates
was Ist to recommended the use of dentifrices.

COMPOSITION
1. Detergent 1.2%
Sodium lauryl sulphate
Use To lower surface tension
Penetrate and loosen surface deposits and strains
Emulsify debris for easy removal by toothbrush
Contribute to the foaming action
2. Cleaning and polishing agents - 20-40%
Calcium carbonate, calcium pyrophosphate bicalcium phosphate
Uses Act as abrasive agents for cleaning and polishing objectives.
Polishing agent is used to produce a smooth shining tooth surface
that resists discoloration, bacterial
accumulation and
retention.
3. Binders 1.2%
Organic hydrophilic colloids, alginates, magnesium aluminium silicate,
colloidal silica.
Use To prevent separation of the solid & liquid ingredients
during storage.
Contribute to stability and consistency to tooth paste.

4. Humectants : 20-40%
Glycerin : Sorbitol
Use
Added to retain moisture
Prevent hardening on exposure to air.
To stabilize preparation
5. Preservatives
Alcohol, formaldehyde ; dichlorinated phenols
Use
To prevent bacterial growth and to prolong shelf life.
6. Sweetner : 2-3%
Sorbitol and glycerin
Use
To import a pleasant flavor for pt. acceptance
7. Flavoring agent : 1-15%
Peppermint : cinnamon, menthol
Use
To make the dentifrices desirable.
To make other ingredients that may have less pleasant flavor.
8. Therapeutic agent 1-2 %
Fluoride
Use For medical value
9. Coloring agent 2-3% Added for all activeness
10. Water 20-40%
Main transport medium

III. Interdental cleaning aids

It has been noticed that regardless of brushing, there
incomplete removal of plaque from interproximal areas of
tooth in individual with healthy periodontal condition or
in periodically involved patient with open embrasure.
Because of majority of dental and periodontal disease's
originate in interproximal area, interdental plaque
removal is necessary.

It includes
1. Dental floss
2. Interdental cleaning devices
(a) Interdental brushes
(b) Balsa wood wedge tooth pick
(c) Tooth pick in special holder
(d) Gauze stripe ; pipe cleanness and yarns

Dental floss

In 1882 codman and shurtuff made silk dental floss

In 1948 bass nylon dental floss

Its recommended method of removing plaque from

proximal surface
Size of floss 300-1500 denier (D)
Floss is constructed with the help of individual
filaments 2 to 3D thick.

Types of floss
1. Twisted and non-twisted
2. Banded and non-banded
3. Thin & thick
4. Microfilament and multifilament
5. Acc. To ADA specification
Type I- Unbonded dental floss composed of yarn having no
additive
Type II-Bonded dental floss composed of yarn having no
additives. Other than binding agent or agent for cosmetic
performance
Type III-Bonded or unbounded having drug for therapeutic
usage.

Technique
1. String floss method
Use 18 inches floss. Wrap 2-3 inches of floss around
middle finger or left hand and similarly to right
hand.
2. Circle floss method
Take floss tie a double learnt to secure it. The size of circle
is like an orange. Position the knot to the left side of
working area and place middle, little rings finger of both
hand on the inside of circle to keep it taut. Rotate counter
clock wise for fresh segments.

APPLICATION
Hold floss firmly in a
diagonal/oblique position
Guide the floss past contact area
with a gentle motion
Control floss to prevent snapping
through the contact area onto the
gingival tissues
Pass the floss between gingival
margin, curve to adapt the floss
around the tooth, press, and side
up and down over the tooth
surface.

Flossing can be made easier by using a floss holder

Floss holder should have
1. One or two fork that enough to keep the floss tent
even when its moved pass tight contact area
2. An effective and simple mounting mechanisms

Interdental cleaning devices

For cleaning in narrow gingival embrasures that areoccupied
by intact papilla and bordered by tight contact zone. Dental
floss in probably the most effective dental hygiene aids.
But concave root surface and fraction cannot be reached
with dental floss.
Therefore special cleaning aid are available cleaning for these
surface. These are :
Inter dental brushes
Balsa wood wedge tooth pick
Toothpick in special holder
Gauze strips, pipe cleaners and yarns.

Inter dental brushes

These are cone shaped brushes made of bristle mounted on
handle.
Single tufted brushes or small conical brushes.
Interdental brushes area particularly suitable for cleaning
large, irregular or concave tooth surface adjacent to wide
interdentally space.
For best cleaning efficiency the diameter of brush should
slightly larger than gingival embrasure so that bristle can
exert pressure on the tooth surface.
Single tufted brushes are highly effective on lingual surface
of mandible molar and premolar. Where tooth brush is often
impeded by the tongue and for isolated area of deep
recession.

Balsa wood wedge tooth pick

Wedge tooth pick is made of soft wood and is triangular

in shape contour to interdental spaces.
Its effective in removing plaque and debris, stimulating
the gingival recourting the interental papilla.
Contraindicated areas when interdental papilla is present
in interdental gingival embrasure space. It may cause
tissue injury.
Plastic tip area also available.

Technique

Tooth pick is firstly moistened in mouth to soften it. Its than

placed interproximally with the base of the triangle towards the
gingival & at slight angle towards the crown.
Then tooth pick pressed firmly against the proximal surface of
the adjacent tooth.
Toothpick is than moved in and out or up and down depending on
the size of the interdental space.

Disadvantage Its hard to insert from lingual space.

3. Tooth pick in special holder

Small rounded polished tooth picks can be placed in

special plastic handle.

This handle allow more flexibility in placing the

toothpick from the lingual aspect and in other area with

limited access.
4. Gauze strips and pipe cleaners and yarns

This are effective cleaning aid in special situations.

Pipe cleaners are effective for cleaning open furcation

area.

Gauze strips and four play cotton yarn are effective

aids for cleaning the proximal surface of teeth

to edentulous area and open embrasure space.

adjacent

Oral irrigation
It's targeted application of a pulsated or steady stream of
water for removing debris.
It can be done by patient or the clinician.
Oral irrigation cleans adherent bacteria and debris from
the oral cavity more effectively than do toothbrush and
mouth rinse.

It's delivered by
Power driven device

Non-power driven device

Generats an intermittent or

It's attached to a household

pulsating jet of fluid.

water supply and delivered

An adjustable dial for regulation

through a hand held

of pressure is provided along with

interchangeable tip that can be

a hand held interchangeable tip

used for application at the gingival

that rotates 360o for application

margin.

at the gingival margin.

Disadvantage Uncontrolled

Delivery method

water pressure

Target of the oral irrigation in the loosely attached sub gingival

bacterial plaque.
When pulsated irrigant is directed perpendicular to the long axis
of the tooth, Hydrokinetic activity is started.

Procedure
Direct the jet tip towards the interdental area almost touching
the tooth surface;hold tip at right angle to the long axis of the
tooth
Start on the low pressure and increase gradually depending on
the condition of the gingival tissue comfort.
Follow a definite pattern across the mouth, maxillary arch first
than the mandibular arch applying for 5-6 sec. at each
interdental area.

* Contraindication
Advance periodontitis
Medically compressed patient like Leukemia, AIDS,
diabetes, Bleeding, disorder

Advantage
* Help in removing debris from orthodontic appliances and
fixed prosthesis.
*

When used with tooth brushing, these devices can have

a beneficial effect on periodontal health by retarding
the accumulation of plaque and calculus and by reducing
gingival inflammation.

CONCLUSION
All patients required regular use of tooth brush , either manual
or electric , at least once per day.
Dental floss should be use in all interdental spaces that are
filled with gingiva.
Interdenatl aids such as interproximal brushes , wooden tips,
rubber tips or tooth picks should be use in all area where the
tooth brush and floss technique can not adequately remove the
plaque.
Sub gingival irrigation may be good choice for reduction of
inflammation and deep pockets.
Reinforcement of daily plaque control practices and routine visit
to the dental office for maintenance care are essential to
successful plaque control and long term success of therapy

REFERENCES
CLINICAL PERIODONTOLOGY NEWMAN
-TAKEI
-CARRANZA
COMPREHENSIVE PEDIATRIC DENTISTRY NIKHIL
MARWAH
TEXTBOOK OF PEDODONTICS SHOBHA TENDON
IMAGES FROM NET - GOOGLE