Plaque Control: A Comprehensive Guide to Oral Hygiene

Posted on Aug 23, 2024 in Biology

Plaque: An entity formed by the colonization and growth of microorganisms of varying strains and species that accumulates on the surface of teeth, gingiva, and other restorations.

Plaque Control: Plaque control is the removal of microbial plaque and the prevention of its accumulation on the teeth and adjacent gingival surfaces.

Disclosing Agents: 1. Plak-lite mirror fluorescing solution

      Plaque Control: . Mechanical plaque control – Tooth brushing – Interdental aids – Oral physiotherapy – Oral irrigation

2. Chemical plaque control – Adjuncts to mechanical plaque control

Toothbrushes: 1 – 1.25 inches (25.4 to 31.8 mm) long—-5/16 to 3/8 inches (7.9 to 9.5 mm) wide ——-2 to 4 rows of bristles —–5 to 12 tufts per row —–80-85 bristles per tuft

Objectives of Mechanical Plaque Control: 1. Remove and/or disturb plaque. 2. Remove food debris and stain. 3. Stimulate gingival tissue. 4. Apply therapeutic agents.

TOOTH BRUSH: Super soft – 0.1 mm –Soft – 0.2 mm –Medium – 0.3 mm –Hard – 0.4 mm

–Soft… patients with dentinal hypersensitivity –Hard bristles associated with more gingival recession


TOOTHBRUSHING METHODS:

 Horizontal brushing (scrub): Most commonly used technique, since it is the simplest. The occlusal, lingual, and palatal surfaces of the teeth are brushed with the mouth open, and the vestibular surfaces are cleaned with the mouth closed.

Vibratory technique (Stillman technique): Partly on the gingival margin and partly on the tooth surface….

Roll technique (modified Stillman technique): The head of the brush rotates progressively in an occlusal direction…. Recommended for cleaning areas with progressing gingival recession and root exposure to prevent abrasive tissue destruction.

Bass technique: Useful in removing plaque not only at the gingival margin, but also subgingivally.  Recommended for routine patients with or without periodontal involvement.

Charters technique: Directed towards the occlusal surface.  For cleaning in areas of healing wounds after periodontal surgery.

Frandsen (1986)…”Improvement in oral hygiene is not  dependent upon the development of better brushing methods but upon improved performance by the persons using any one of the accepted methods.

Wolf and Rateitschak: 1. Oral surfaces. 2. Facial surfaces. 3. Occlusal surfaces. 4. Interdental areas with special oral hygiene aids.

TOOTH BRUSHING TRAUMA; Painful ulceration of the gingiva. Bacteremia. Wedge-shaped defects in the cervical area of root surfaces. Gingival recession.

  • ELECTRIC TOOTH BRUSHES; Recommended for…. Young children and adolescents, Handicapped patients who lack the dexterity of manual brushing. Fixed orthodontic appliance users. Hospitalized patients.  The brush is moved systematically around the mouth. Better plaque removal in approximal areas.
  • IONIC TOOTH BRUSH;; Has a 3-V lithium battery in the handle that supplies a +ve electrical charge to the metal handle and a –ve charge to the bristles…Van Swol et al – 1996 – using a manual ionic toothbrush – significant improvement in the plaque and gingival indices as compared with controls. SPECIAL TOOTHBRUSHES;; Denture brush ..Orthodontic brush – 2 types – Single row brushes – allow to clean the area above and below the band. 3 row brush – has a shorter center row of bristles..
  • DENTIFRICES;; A substance used with a toothbrush or other applicator to remove bacterial plaque, materia alba, and debris from gingiva and tooth, for cosmetic and sanitary purposes and for applying specific agents to the tooth surfaces for preventive and for therapeutic purposes–Abrasive/polishing agent….20-40%: calcium carbonate, calcium phosphate, or sodium phosphate.  Modern abrasives such as silica, alumina, and aluminium hydroxide are very hard substances..Abrasiveness depends on particle size and homogeneity.
  • REQUIREMENTS for DENTIFRICES;; Sufficiently abrasive..should have a margin of safety. Enhances action by 40 times. Abrasion more prevalent on max than mand and more on left than right. Beneficial against supragingival dep not for subgingival calculus.
  • Uses :Cosmetic ..Cosmetic-therapeutic,,Therapeutic ,,Desensitising toothpastes-Potassium nitrate, Strontium chloride, Formalin ,Sodium fluoride.


  • Single-tufted brush ; A single-tufted brush……furcation areas, distal surfaces of the most posterior molars and oral or lingual tooth surfaces with an irregular gingival margin. Lingual surfaces of mandibular molars. Palatal and distal surfaces of maxillary molars.
  • RUBBER TIP Recommended for cleaning, stimulating, and massaging the gums. Dual-angled head helps reach every corner of your mouth.
  • Modifications of Floss;;Teflon…..poly tetra fluoro etylene (PTFE) floss..Fibreless floss,,,Prevents fraying…..fixed orthodontic cases.
  • ADA recognizes that only mouthrinses containing CHX & Listerine formula are effective in controlling plaque & gingivitis  
  • Chemicals influence plaque quantitatively & qualitatively 1 Prevent bacterial adhesion 2 Stop or slow bacteria proliferation, using antimicrobials 3 Remove established plaque, sometimes termed “chemical toothbrush”…… hypochlorites,  5 Alters the pathogenicity of plaque…not attempted because of an incomplete understanding of microbial etiology of gingivitis & periodontitis.
  • Principles of Chemical Plaque Control; Inhibition of plaque development…Elimination & dissolution of already existing plaque..Inhibition of calcification of plaque…Inhibition of microbial colonization of tooth surface…Alteration of pathogenic plaque into a lesser or non pathogenic one.
  • Rationale of Chemical Plaque Control;Mechanical therapy alone may not control infection,,,Poor plaque control increases the rate of re-infection…Root surfaces, tongue, tonsils & other niches harbor pathogenic bacteria.
  • Indications;Poor mechanical plaque control,,Extensive splinting,,,Extensive fixed bridge work…Intraoral fixation…Orthodontic patients…Over dentures, abutments & implants…Post surgically.
  •  Modes of Delivery of Chemical Agents;Routine oral hygiene aids….Mouthrinses..Dentifrice.Gels,,Chewing gum,,Lozenges & Chewable tablets..Varnish…Irrigators / Sprays…Periodontal Dressings.


  •     2) Mouthrinses;;Acc to Kornman
  • 1st generation mouthrinses…reduced plaque by 20-50% when used 4 times daily, have antibact activity & have no substantivity. E.g. Cetylperidinium chloride, benzalkonium chloride, phenolic compounds.
  • 2nd generation mouthrinses…reduced plaque by 70-90% when used 1-2 times/day & have antibact activity as well as effective substantivity lasting 12-18 hours or longer. E.g Chlorhexidine, triclosan with copolymer or zinc citrate.
  • 3rd generation mouthrinses….they have selective effect on specific bact that are essential to disease development.              
  • 3) Toothpastes
  • 4) Gels
  • ) Chewing gum
  • Lozenges & Chewable tablets       
  • Irrigators

Ideal Properties of Mouthrinses:Antimicrobial spectrum appropriate for site of application

Exhibit selective activity for some essential microbial biochemical reactions that is not a reaction of the host—-Rapidly effective—–Bactericidal instead of bacteriostatic—–Be stable & not inactivated by body fluids or infec exudates—–Good therapeutic index—–Have low surface tension to facilitate penetration

Varnish: Polymer based matrix that slowly release the agent onto the surface to which it is applied & also to saliva


Main purpose is to prevent root caries


Types :chlorzoin 2-EC40 3-cervitic


Types of irrigant : Cavimed…designed to concurrently irrigate & scale by delivering an antimicrobial agent


Pitchel (1980)…. Direct irrigation at gingival margin was superior to mouth rinsing in gaining access interdentally


Criteria for Usage- Kornmann ;;Substantivity – prolonged contact time bet substance & substrate

Safety/selectivity – tested in animal studies—–Stability – stable at room temp.—–Efficacy – Bactericidal therapeutic guidelines as determined by MIC of the agent for a fixed no. of bact which have been assoc with dental dis——Favourable cost : benefit——Vehicle should be designed to avoid accidental overdosage

Mode of Action of phenols & essential oils  – Cell wall disruption (high conc–– Inhibition of bact enzymes (low conc)–– Anti-inflammatory property—  – Acc to Goodson it has prostaglandin synthethase inhibitory activity


Disadvantages:  – Initial burning sensatio  — Bitter taste—  – Occurrence of minimal tooth sensitivity



Quatenary Ammonium Compounds:


Disadvantages    – Tooth staining—   – Burning sensation of soft tissues—    – Inc calculus formation—   – Desquamative lesions (high conc)



Oxygenating agents :Disadvantages – pathologic changes in pre-neoplastic lesions     – inhibits collagen syn—    – inhibits glucose metabolism in bone



CHLORHEXIDINE


PROPERTIES

Strong base & dicationic at pH>3.5(Albert & Sargeant 1962) Broad antibacterial activity ( gm+ve, gm-ve bact, yeast, dermatophytes & lipophilic viruses) Low toxicity Strong affinity for binding to skin & mucous membrane. Diff effects at diff conc

SIDE EFFECTS

Dulling of taste sensation Bitter taste

Burning sensation of mucosa


-Dryness & soreness of mucosa….precipitation of mucin layer….reduced immune defense

Epithelial desquamation

ADVERSE REACTIONS of chx:

Bronchospasm     — Skin irritation—-  Parotitis                           11) Utricaria

3)                Pruritis                                                 12) Vesicular rash

4)                Dental pain                                         13) Wheezing

5)                Dyspnea

INDICATIONS:Adjunct to OH & professional prophylaxis

  1. Post oral surgery including periodontal surgery & root planing
  2. In pts with jaw fixation
  3. For OH & ging health benefits in mentally & physically handicaped
  4. Medically compromised individuals predisposed to oral infec
  5. High caries risk pts

CONTRAINDICATIONS

  • Anterior tooth restorations

Anti Calculus agents:

  1. Pyrophosphate
  2. Zn salts
  3. Diphosphonates   4- .   Calcium lactate

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