GOOD morning

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Plaque control methods

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Aim of the lecture:
Students should be able to understand in detail about various
plaque control methods

Objectives of the lecture:

Students should be able to enumerate
1. Plaque detection and disclosing agents
2. Mechanical plaque control
3. Toothbrush & methods of tooth brushing
4. Dental Floss & other dental aids
5. Chemical plaque control
6. Dentifrices
7. Chlorhexidine
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 Plaque detection BY disclosing agents

Plaque is relatively invisible, Disclosing agents are the dyes used to

make the supragingival plaque visible
• Erythrosin – It’s a Disclosing agent which makes plaque appear red
in colour
• Two tone dye – A solution containing combination of two dyes.
Mature (old) plaque is stained blue and new plaque is stained red

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Plaque control means the removal of dental
plaque on a regular basis and the prevention of
its accumulation on the teeth and adjacent
gingival surfaces.

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1) Tooth brushes

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 Toothbrush

American Dental
Association (ADA)
Parts of tooth brush
specifications
• Brush length: 1-1.25 inches

• Brush width: 5/16-3/8 inches

• 2-4 rows
• 5-12 tufts per row

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 Powered toothbrushes

• Powered toothbrushes are not generally superior to

manual ones
• Powered toothbrushes have been shown to improve oral
health:
 Children and adolescents
 Children with physical or mental disabilities

 Hospitalized patients
 Patients with fixed orthodontic appliances
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 methods of tooth brushing
• Sulcular: Bass
• Roll: Rolling stroke, modified Stillman
• Vibratory: Stillman, Bass, Charters
• Circular: Fones technique – indicated for children
• Vertical
• Horizontal
• Scrub-brush
Most Accepted Method Of Tooth Brushing for adults –
Modified Bass Technique

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 The Bass Method
• Position the filaments up
toward the root at a 45° angle
to the teeth.
• Place the brush with the
filament tips directed into the
gingival sulcus.
• Using a vibratory stroke brush Bass Method
back and forth with very short
strokes for the count of ten.
• Reposition the brush to the
next group of teeth.
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 The Roll Method – Modified Stillman’s technique
• Direct the filaments toward the root of the
tooth.

• Place side of the brush on the gingiva and

have the plastic part of the brush even with
the tooth.

• When the plastic portion is even with the

tooth press the filaments against the gingiva
and roll the brush over the teeth.

• The wrist is turned slightly and the filaments

follow the contours of the teeth.
• Indicated in gingival recession 12
 The Charter’s Method
• Position the filaments toward the
chewing surface of the tooth
• Place the sides of the filaments
against the enamel and angle
them at a 45° to the tooth.
Vibrate the filaments gently but
firmly, keeping the filaments
against the tooth.
• Indicated for patients after
periodontal surgery
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 Interdental cleaning

• Dental floss and tape

• Toothpicks
• Interproximal brushes
• Single-tufted brush

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 Dental floss

• Multifilament vs. monofilament

• Waxed vs. unwaxed
• 12-18 inches for use
• Stretch: thumb and forefinger
• Up-and-down stroke

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 DENTIFRICES

COMPONENTS
• Abrasive: silica, alumina, dicalcium phosphate, and calcium carbonate

• Detergent: sodium lauryl sulfate

• Thickeners: silica and gums

• Sweeteners: saccharine

• Humectants: glycerine and sorbitol

• Flavors: mint, peppermint

• Actives: fluorides, triclosan and stannous fluoride

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 Oral irrigation devices

Supragingival irrigation

Subgingival irrigation

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CLASSIFICATION OF ANTIPLAQUE
AGENTS
1. Antiseptic agents
2. Antibiotics
3. Single enzymes or combination of enzymes
4. Non-enzymatic dispersing , denaturing or modifying
agents
5. Agents that can interfere with attachment of all or
some oral bacteria to pellicle surface

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 Antiplaque agents

1. Antiseptic agents
Phenolic compounds
 Longest running product in this group is Listerine
[combination of phenol-related essential oils , thymol
and eucolyptol, mixed with menthol and methyl
salicylate in a 26.9% hydroalcoholic vehicle].

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 Antiplaque agents

 Listerine has become the first over-the-counter mouth rinse to

be accepted by the Council of Dental Therapeutics for its

effect in controlling plaque and gingivitis.

 Twice daily rinsing with listerine is effective

in reducing gingivitis .

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 Antiplaque agents

1. Antiseptic agents
Phenolic compounds
 Triclosan is a phenolic, non ionic, antimicrobial agent.
 Causes leakage of cellular constituents thereby
causing bacteriolysis.
 Used along with zinc citrate to enhance retention in
oral cavity.

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 Antiplaque agents

2. Quaternary Ammonium Compounds

Cetylpyridinium chloride [CPC] usually at 0.005% ,
0.075% and 0.10% with and without domiphen bromide
and Benzethonium chloride. It is used twice daily
Side effects : tooth staining , burning sensation and
calculus formation.

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3. Bis-biguanides
• Chlorhexidine has ability to bind strongly to many sites in
the oral cavity.
• It is the substantivity which enables it to function as a
form of slow release device.

• The soft tissues provide a much greater area for binding,

this same binding property enables chlorhexidine to bind
to the bacterial surfaces and affect adherence , as well as
to initiate bacterial destruction.
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3. Bis-biguanides
An oral rinse with chlorhexidine (0.12% or 0.2%), an
antibacterial agent, has been found to be effective in
reducing supragingival plaque and gingivitis.
Another related positive attribute of chlorhexidine is its
lack of activity against specific bacteria enzymes or
receptors. By acting by a generalised pertubation of
bacterial membrane, there is much less opportunity for
development of bacterial resistance.
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3. Bis-biguanides -chlorhexidine
Pin cushion effect:

Bacterial cell wall negatively charged

Dicationic positively charged

chlorhexidine

Chlorhexidine attracted towards inner

cell membrane
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3. Bis-biguanides
Pin cushion effect:

Leakage of low molecular wt compounds

Vital cell elements leak and harmful

elements gain entry

Bacteriostatic effect

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3. Bis-biguanides
Pin cushion effect:

Increased concentration of Chlorhexidine

Progressive damage to cell membrane

Large molecular wt compounds leach out

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3. Bis-biguanides
Pin cushion effect:

Coagulation and precipitation of cytoplasm

Chlorhexidine enter cell and cause coagulation of

protein

Vital cell activity ceases,

cell death
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• 3. Bis-biguanides

Chlorhexidine side-effects
1) an increase in staining of teeth and other oral surfaces

2) an increase in calculus formation

3) an alteration in taste perception
4) Oral irritation and local allergy-type symptoms

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4.Herbal extract

Sanguinarine , employed as an antiplaque , antigingivitis agent

in both mouth rinse and tooth paste is a an alkaloid extract from

the root plant , Sanguinaria canadensis.

Long term use or overdosage of sanguinarine may

cause nausea, vomiting, stomach pain, diarrhea, visual changes,

paralysis, fainting, and collapse. 32

5. Antibiotics
 Only three antibiotics have been the subject of study
against plaque and gingivitis – Nidamycin ,
Vancomycin and Kanamycin.
 Side effects include the potential development of
resistant bacterial strains and patient hypersensitivity.

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6. Subantimicrobial dose doxycycline
• It is a 20-mg dose of doxycycline hyclate that is taken
twice daily for periods of 3–9 months as an adjunct to
root surface instrumentation in the treatment of
periodontitis.
Effect of doxycycline
• Downregulates expression of key inflammatory cytokines
• Scavenges and inhibits production of reactive oxygen
species produced by neutrophils.

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THANK YOU

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