SEMINAR PESENTATION

PLAQUE CONTROL
By
Under the guidance of: Anam Dilaawez
•Dr. N D Gupta BDS 2015
•Dr. Neha Agarwal
•Dr. Pramod Kumar Yadav

DEPARTMENT OF PERIODONTICS AND COMMUNITY DENTISTRY

1
PLAQUE

Dental plaque is defined as a highly specific variable

structural entity formed by sequential colonization of
microorganism on the tooth surface, epithelium and
restorations.
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 t o l o n g - t e r m
success o f all periodontal
3
• In 1965, Löe et al conducted the classic s t u d y -
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 t o 21 days.
• The composition of the plaque bacteria also
shifted so that gram negative organisms
predominated, and the changes occurred.
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.
5
 MECHANICAL CHEMICAL PLAQUE
PLAQUE CONTROL CONTROL

6
1. Introduction
2. Mechanical plaque
control
(a) Toothbrush
(b) Dentifrice
(c) Interdental cleaning aids
- Dental floss

- Interdental brushes
- Tooth pick

(d) Oral irrigation

(e) Salvadora persica

7
It is very critical in every phase of therapy that plaque
control must be maintained .

It is an effective way of
treating and preventing
gingivitis, periodontitis,
.etc..

8
Originally, they are
varied in size, length,
hardness of the bristle,
and even in the
arrangement of the
bristle

9
-

› Length :1 to 1.25inches
› Width :5/16 to 3/8inches
› 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

10
The use of hard
toothbrush , vigorous
horizontal brushing,
the use of extremely
abrasive dentifrices
may lead to cervical
abrasion ofteeth
and recession of the
gingiva.( Jepson ,1998)
Toothbrushs need to be
replaced every 3months

11
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.

Time : 2 minutes ( 30 sec per quadrent)

12
 Method Bristle placement Motion Advantage/
disadvantag
e
Scrub Horizontal on gingival margin Scrub in anterior position Easy to learn & best suited
direction keeping brush fro children
horizontal
BASS Apical towards gingival into sulcus Short back and forth vibratory Cervical plaque
at 450 to tooth surface motio whil bristles remain removal Easily
n e i learned
sulcus n Good gingival stimulation
.
Charter's Coronally 45o, sides of bristles half Small circular motions with apical Hard to learn and position
on teeth and half of gingiva movements towards gingival brush
margin Clears inter
proximal Gingival
stimulation
Fones Perpendicular to the tooth With teeth in occlusions, move Easy to learn
brush in rotary motion over both Inter proximal areas not
arches and gingival margin cleaned
May cause trauma
Roll Apically, parallel to tooth and then On buccal and lingual inward Doesn't clean sulcus
over tooth surface pressure, then rolling of head to area Easy to learn
sweep bristle over gingiva & tooth good gingival stimulation

Stillman's On buccal and lingual, aplically at On buccal and lingual slight rotary Excellent gingival
an ablique angle to long axis of motions with bristle ends stimulation
tooth. Ends rest on gingiva and stationary Moderate dexterity
cervical part. required
Moderate cleaning
of interproximal 13
area
Bass method

Charters method
14
 Brushes presoaked in solution containing carbon
particle were used.
 The result showed that no carbon particles were
observed in the crevicular epithelium or underlying
connective tissue of any test section on either
technique.
 However, the result of this study does not eliminate the
possibility that bacteria can be introduced into the
crevicular tissue since the bacteria is smaller in size
than the carbon particle used in this study.
15
Results: during brushing, it could be noticed that the bristles
penetrate as far as 0.9 mm below the gingival margin ( Bas
technique)

16
Results:
› In both genders, smokers have higher plaque
scores.
› No association between tobacco consumption
and frequency of tooth brushing
› Poorer oral cleanliness level in smokers both before and
after tooth brushing may be explained by their shorter
brushing time.

17
• In1939powered tooth brush invented to make
plaque control easier.
• Itsmainly recommended for
(a) Individual lacking motorskills
(b) Hospitalized patients whose teeth are cleaned by the
caregivers.
(c) Special needs patient (physical and mental disability)
(d) Patient with orthodonticapplied
(e) Whosoever wants touse

 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. 18
19
 (C. Deery , et al2003)

electric toothbrush have not been shown to provide benefits

routinely for children who are well- motivated brushers , or
patients with chronic periodontitis.
( Heasman, 1999)

20
 The results showed theelectric toothbrush is
significantly better in toothbrusing efficiency.

Similar result was found in Youngblood et al. in 1985,

when they examine the effectiveness of electric
toothbrush compared to manual toothbrushing using
modified Bass technique inremovingsubgingivaland
interproximalplaque

21
The floss is wrapped around
each proximal surface and is
activated with repeated up
anddown stroke.
Floss should pass gently
through the contact area. Do
not snap the floss pass the
contact area as it may injure
the interdental papilla.

22
› Waxed floss contained wax to
facilitate passing the floss the
floss through the contact and
alleviate fraying.
› Tape floss contain criss-cross fiber
and eliminatefraying.
› PTFE floss (Glide floss) is the teflon
floss which allow passing through
very tight contact easily without
fraying.
› Superfloss is the web-like material
which improved proximal
cleaning efficiency.
23
Graves et al. in 1989 evaluated in a 2 week clinical trial the
efficacy of unwaxed dental floss, dental tape, waxed floss,
and tooth brushing alone in reduction of interproximal
bleeding.

The result showed that the dental tape and dental floss were
equally effective in reducing interproximal bleeding and
twise effective as toothbrushing alone.

24
The results showed there was no statistical difference
between the types of floss in regards to their ability to
remove plaque or preventgingivitis.

Wunderlich et al. in 1982 reported there is no

difference between wax and unwaxed floss in
maintaining gingival health.

25
Wong and Wade study
in 1985, which they
compared the
effectiveness of Super
floss and waxed dental
floss as proximal surface
cleansing agent in 34
subject.

Superfloss was found to be

superier (50%) to waxed
dental floss(45%) in
removing proximal plaque
but neither was 100%
efffective.

26
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

27
Interdental brush are
conical shape brushes
made of bristles mounted
on a handle, single tufted
brushes, or small conical
brushes.
They are suitable for cleaning
large, irregular, or concave
tooth surfaces adjacent to
wide interdentalspaces.
They are inserted
interproximally and are
activated with short
back and forth strokes in
between the teeth.

28
 › Teeth were cleaned prior to extraction and then stained
and examined after extraction.
› The results indicated that plaque can be removed from 2
to 2.5mm subgingivally using the interdental brush

A comparision study between dental floss and interdental

brush in patients with sever to moderate periodontitis ,
showed that interproximal brushs remove slightly more
interproximal plaque and that the patients found them easier
to use.
No diffrence was found in PD reduction and BI.
( Christou,1998)

29
30
Dental floss removed more plaque at lingual interproximal
surface than toothpicks.

Toothpicks combined with multi-tufted brush used on oral

surfaces were as effective in removing interproximal plaque
as dental floss.

The use of floss or tooth pick combined with single tufted

brush may reduce the amount of plaque adhering to the
proximal surfaces by an average of 50%
31
The high pressure, pulsating stream
of water through a nozzle is
directed to the tooth surface and
subgingivally, washing away debris
and plaque containing bacteria.
They are helpful surrounding
orhtodontic appliance, and when
used as an adjucntive treatment in
shallow pocket depth.
Patients reqiure antibiotic
premidication should notuse oral
irrigation.
32
When used as adjuncts to
toothbrushing , irrigation
devises, can have a
beneficial effect on
periodontal health by
reducing the accumulation
of plaque and calculus and
decreasing inflammation
and pocketdepth.

( Robinson and Hoover,

1971)

33
Penetration of 90 degree angle stream of water is about 70% for
pocket less than 3mm, 44%for moderate pocket (4 to 7 mm) and 68%
for deep pocket (greater than 7mm).

For 45 degree angle, the result is 54%, 45%, and 58%

respectively.

34
 The results showed that irrigation with or without
an antimicrobial agent was effective in reducing
the plaque, suggesting that oral irrigation may be
beneficial on oral health and the use of the
chemotherapeutic agent will lead to greater
reduction in plaque and gingival bleeding and to
moderate decreases in total bacteria counts
detected by phase contrast microscopy

35
 Miswak use is as effective , tooth brushing for
reducing plaque andgingivitis.
antimicrobial effect
association with Islam, maximum benefits may be
achieved by encouraging optimum use of the miswak
Oral hygiene may be improved by complementing
traditional miswak use with modern technological
developments such as toothbrushing

Al-Otaibi 2004

36
 In a clinical trial among adolescents in Nigeria, the
- results showed that the Massularia acuminata chewing
stick was as effective in controlling and removing dental
plaque as the toothbrush and paste

37
 ( Danielsons B, et al 1989)

Cross-sectional studies show conflicting results. A cross-

sectional study in Ghana among adults revealed higher
plaque and gingival bleeding in chewing stick users as
compared with toothbrush users.
(Norman S,1989)

Another retrospective study showed that Miswak users had

deeper pockets and more prevalence of periodontal diseases
(Gazi M,1990)

38
Ideal requisites
• Should decrease plaque & gingivitis
• Prevent pathogenic growth
• Should prevent development of resistant
bacteria
• Should be biocompatible
• Should not stain teeth or alter taste
• Should have good retentive properties
• Should be economic

39
 CLASSIFICATION

CHEMICAL PLAQUE CONTROL

AGENTS

FIRST GENERATION
(ANTIBIOTICS, SANGUINARINE)

SECOND GENERATION
(BISBIGUANIDES)

THIRD GENERATION
(DELMOPINOL)
40
TRICLOSAN

• Phenol derivative
• Is synthetic and
• ionic
Used as a topical
• antimicrobial agent
Broad spectrum of
action including both
• gram positive and gram
negative bacterias
It also includes
mycobacterium spores
and Candida species
41
 TRICLOSAN

ACT ON CYTOPLASMIC MEMBRANE

INDUCE LEAKAGE OF CELLULAR CONSTITUENTS

BACTERIOLYSIS
42
• Triclosan is included in tooth paste to
reduce plaque formation
• Used along with Zinc citrate or co-polymer
Gantrez to enhance its retention within
the oral cavity
• Triclosan delay plaque formation
• It inhibits formation of prostaglandins
& leukotrienes there by reduces the
chance of inflammation

43
 eg: Zn & Cu ions

MECHANISM OF ACTION

• It reduces the glycolytic activity in bacteria &delays

bacterial growth

44
 COMPOUNDS

• Cationic antiseptics & surface

active agents
• Effective against gram positive
organisms

45
• Positively charged molecule reacts with negatively
charged cell membrane phosphates and thereby
disrupts the bacterial cell wall structure

Eg: Benzanthonium chloride, Benzalleonium

chloride and cetylpyredinium

46
• It is a benzophenanthredine alkaloid
• It is most effective against gram –ve
organisms
• Used in mouth rinse

47
• Vancomycin,erythromycin,Niddamycin and
Kanamycin
• Due to bacterial resistance problems the use of
antibiotics has been reduced

48
CHLORHEXIDINE
GLUCONATE(0.2%)

• It is a cationic
bisbiguanide
• Effective against gram
+ve, gram –ve organisms,
fungi, yeasts and viruses
• Exhibit antiplaque &
antibacterial properties

49
Antiplaque action of chlorhexidine

 Prevents pellicle formation by blocking acidic

groups on salivary glycoproteins thereby reducing
glycoprotein adsorption on to the tooth surface
 Prevents adsorption of bacterial cell wall on to the
tooth surface
 Prevents binding of mature plaques

50
It shows two actions
1. Bacteriostatic at low concentrations

Bacterial cell wall(-ve charge)

Reacts with +ve charged chlorhexidine molecule

Integrity of cell membrane altered

CHX binds to inner membrane phospholipids & increase

permeability

Vital elements leak out & this effect is reversible

51
 increased concentration of chlorhexidine

Progressive greater damage to membrane

Larger molecular weight compounds lost

Coagulation and precipitation of cytoplasm

Free CHX molecule enter the cell & coagulates proteins

Vital cell activity ceases

cell death

52
 Brownish staining of tooth or restorations
 Loss of taste sensation
 Rarely hypersensitivity to chlorhexidine has
been reported
 Stenosis of parotid duct has also been
reported

53
Enzymes has been used as active agents in
antiplaque preparations
It is due to the fact that enzymes would
be able to breakdown already formed
matrix some plaques and calculus
Some are proteolytic and have
bactericidal action eg:Mucinase,
mutanase, dextranase etc
54
• Inhibits plaque growth and reduces
gingivitis

Mechanism of action

• Interfere with plaque matrix formation

& also reduces bacterial adherence
• It causes weak binding of plaque to
tooth, thus aiding in easy removal of
plaque by mechanical procedures
• It is therefore indicated as a pre
brushing mouth rinse
55
 Staining of tooth &
tongue
 Taste disturbances
 Mucosal soreness &
erosion
56
 Dentifrice is a substance used with a
tooth brush for the purpose of
cleaning the accessible surfaces of
the tooth

It contains
• therapeutic agent such as
fluoride to inhibit caries
• Antimicrobial agents-
chlorhexidine, cetrimide
• Anticalculus agent - Zn-
chloride

57
1. Polishing/ abrasive agents
• Ca carbonate
• Dicalcium phosphate dihydrate
• Alumina
• Silica
Functions
 Mild abrasive action aids in illuminating plaque
 Removes stained pellicle, restores natural luster,
enhances enamel whiteness

58
 a. Water soluble agents
• Alginates, Sodium carboxy methyl cellulose etc
b. Water insoluble agents
• Colloidal silica, Magnesium aluminium salts etc
Functions
 Controls stability &constitency of tooth paste

3.Detergents/ surfactants
• Sodium lauryl sulfate
Functions
 Produces foam & removes food debris
 Antimicrobial property
59
 • Sorbitol, glycerine, polyethylene glycol
Function
 reduces the loss of moisture from tooth paste

5. Flavoring agents
• Peppermint oil, spearmint oil, oil of
wintergreen

Function
 Render the product pleasant to use & leaves a
fresh taste in mouth after use
60
7. Antibacterial agents
8. Anti bacterial agents
• Triclosan, delmopinol, metallic ions & Zn-citrate
trihydrate
9. Anticaries agents
• Na fluoride, stannous fluoride
10. Active agents-fluoride
11. Anticalculus agents(crystal growth
inhibitors)
• Pyrophosphate, Zn citrate, Zn chloride
12. Desensitizing agents
• Sodium fluoride, potassium nitrate 61
Recent developments in dentifrices

• Tooth paste for children

• Natural tooth paste (herbal)
• Whitening tooth paste
• Breath freshening tooth paste
• Sodium bicarbonate tooth paste

62
• A disclosing agent is a
preparation in liquid, tablet
or lozenge from which
contains a dye or other
coloring agents
• A disclosing agent is used
for identifying bacterial
plaque
• When applied to the teeth,
the agents imparts its colour
to soft deposits but can be
rinsed easily from clean
tooth surface

63
IDEAL PROPERTIES

• Intensity of colour
• Duration of intensity
• Taste
• Irritation to mucous
membrane
• Diffusibility
• Astringent and antiseptic
property
64
b. Iodine preparations
• Skinners iodine solution
• Diluted tincture of iodine
c. Mercurochrome preparations
• Mercurochrome soln 5
• Flavored mercurochrome disclosing solution
d. Bismark brown
e. Mebromin
f. Erythrosine
g. Fast green
h. Fluoresin
i. Two tone solutions
j. Basic fuschin 65
• Periodontal disease- majority of
missing teeth
• Only possible solution to the problem
is prevention.
• Proper oral hygiene practices-
controls periodontal disease.
• Patient education.