2. SYNOPSIS
• THE TOOTH BRUSH
• INTERDENTAL CLEANING AIDS
Dental floss
Wooden or Rubber tips
Interdental brushes
• GINGIVAL MASSAGE
• ORAL IRRIGATION
3. PLAQUE
• Structured , resilient , yellow-
grayish substance that
adheres tenaciously to
intraoral surfaces including
removable and fixed
restorations.
• Mechanical plaque control
is the removal of microbial
plaque and prevention of
accumulation on teeth and
gingival surface by the use
of toothbrush and other
interdental aids.
• Toothbrushes and dental
floss are classified as
medical devices by US FDA
4. MERITS OF MECHANICAL
PLAQUE REMOVAL
• Effective way of treating
and preventing
gingivitisand periodontitis.
• Decreased rate of
formation of calculus.
• Basics procedure of good
oral hygiene maintenance.
• Simplest method ,
performed by any
individual.
• Less time consuming .
6. HISTORY
• In 300-500 B.C - China and India First attempt of
cleaning teeth using abrasives like crushed egg ,
crushed bone and oyesters.
• In 1600 B.C - Chinese used twigs and aromatic species
• In 3500 B.C - Babylonians used chewing sticks known as
"Miswask" or "Siwak"
• In 1600 A.D - Chinese -first tuted bristle brush
• In 1857 - Patent of toothbrush first credited to
H.N.Wardsworth, United States -HOG BRISTLE - high price
8. TYPES OF TOOTH BRUSH
ACCORDING TO
USE :
• Manual
• Electical
• Interdental
TYPE OF HANDLE :
• Non slip grip - straight
• Flexible neck
SHAPE OF HEAD
• Tapered
• Rectangular
STYLE OF BRISTLE
• Rippled
• Flat
• Dome shaped
BRISTLES
• Soft
• Medium
• Hard
9. TOOTHBRUSH
SPECIFICATION - ADA
• Brush length : 1-1.25 inches
• Brush width : 5/16 -3/8 inches
• 2-4 rows
• 5-12 tufts per row
• Surface area : 25.4 - 31.6mm long
10. BRISTLES
• Natural or artificial
• Unitufted or multitufted
• The cleaning perfomance of a toothbrush is influenced
by its degree of hardness.Use of hard bristles is
associated with more gingival recession.
• Bristle hardness is proportional to square of diameter
Soft brush - 0.2mm
Medium brush - 0.3mm
Hard brush -0.4mm
Ultra soft - 0.075mm
11. BRISTLE PATTERNS
BLOCK PATTERN
V -SHAPED PATTERN-gives
better contact to adjacent
teeth
MULTI LEVEL TRIM PATTERN-
Reaches difficult ares
CRISS-CROSS PATTERN - lifts
up plaque easily
POLISHING CUP BRISTLES-
removes stains easily
13. BRUSHING TECHNIQUE
The Bass or Sulcus cleaning method
Modified Bass technique
Modified stillmans technique
Fones or scrub method
Vertical or LEONARDS method
Charter's method
The roll technique
Physiologic or Smith method
14. The BASS Method
Position the filaments up towards the root
at 45* angle to the teeth.
Place the brush with the filament tips
directed into the gingival sulcus.
Use a vibratory stroke , brush back
and forth - short strokes for count of
ten
Reposition to next group of teeth.
INDICATION :
For open proximal areas
Cleaning of cervical ares beneath the
height of contour of enamel
15. STILLMANS METHOD
Same stroke as bass .
Same angle 45*
Filaments are placed half in
sulcus and half on gingiva.
INDICATIONS :
Gingival recession
to clean large embrasures
remove plaque from
cervical regions
16. The CHARTER'S Method
Position the filaments towards
the chewing surface of the
tooth.
Place the sides of the filaments
against the enamel and angle
them at 45* to the tooth.
Vibrate the filaments gently but
firmly,keeping the filaments
against the tooth
Reposition to next teeth.
INDICATIONS :
Effective cleaning of
interproximal areas in fixed
prosthodontic appliance and
orthodontic appliance
17. The ROLL Method
Direct the filaments towards the root of the
tooth
Place side of the brush on the gingiva and
plastic part with the tooth
When plastic portion is with tooth , press the
filaments against the gingiva and roll the
brush over the teeth.
The wrist is turned slightly and the filaments
follow the contour of the teeth.
INDICATIONS :
Used mostly in addition to other technique
18. TOOTH BRUSHING
OUTCOME DEPENDS ON
• The design of the
toothbrush
• The frequency of brushing
• Duration of brushing
• The skill of the individual.
19. TOOTH BRUSH
REPLACEMENT
• Tooth brush should be
replaced when first sign of
filament is worn.
• Average life 2-3 months
• Newer brush are more
effective in removing
plaque
20. POWERED TOOTHBRUSH
• Mimics back and forth
tooth brushing technique
• Invented in 1939
• Removes plaque in shorter
duration.
• Has better plaque removal
efficiency.
USES :
Can be used in children ,
handicapped patints ,
hospitalized patients.
Patients with orthodontic
appliances
Personal preference
Patient lacking motor skills
21. SONIC POWERED TOOTH
BRUSH
• PRODUCES HIGH
FREQUENCY VIBRATIONS
• Follows phenomenon of
cavitation and acoustic
microstreamung
• Aids in stain removal and
distruption of bacterial cell
wall
23. TOOTH BRUSHING
MISTAKES
• Pick the right tool
• Give it time
• Try not to over do it
• Make your technique
flawless
• Pick products wisely
• Change the tool frequently
24. SITUATION INTERDENTAL CLEANING METHOD
Intact interdental papilla Dental floss or woodstick
Moderate papillary recession , slight open
interdental space
Dental floss, woodstick or interdental
brush
Complete loss of papilla , wide open
interdental space
Complete loss of papilla , wide open
interdental space
Wide embrasure space , Diastema ,
furcation or posterior surface of the most
distal molar
Single tufted or end tufted brush
25. DENTAL FLOSS
• FREQUENTLY RECOMMENDED
TECHNIQUE
• LEVI SPEAR PARMLY from New
Orleans , dentist inventor of
modern dental floss.
• Unwaxed dental floss
recommended for patients with
normal tooth contacts
• Waxed dental floss - tight tooth
contact
• Powered floss - with special
handle - No significant
difference in plauqe removal
but preferred by patients due to
ease of use.
26. Take a 20-25cm long floss
Hold the ends of the floss together
27. Make a small loop around the tip of
the forefinger
Pass the ends of the floss thrugh
the loop
Make a knot
28. Use thumb and forefinger of both hands
to hold the floss.
use sawing motion to slide into the
interdental space.
Wrap around one tooth , make C
shape , gently pull down to the
deepest part of the gingival sulcus
Slide it up and down
29. Wrap around the adjacent tooth and repeat up and
down motion
Clean adjacent tiith surfaces in similar way
30. PURPOSE
• To remove plaque and
food lodged between
teeth.
• For ideal plaque control ,
brushing should be
supplemented with aids
that assist in cleaning
interproximal surfaces
31. WOOD STICKS
• Earliest habit - toothpicks
• Triangular wedge sticks are
more superior inplaque
removal
• Unlike floss , they can be
used on concave surface of
tooth root
32. INTERDENTAL TIP
• Conical or pyramidal
flexible rubber tip attached
to handle.
• Trace along the gingival
margin (1-2mm) below
• Indicated for biofilm
removal at or just below
gingival margin
• For clearing debris from
interdental areas.
33. INTERDENTAL BRUSHES
• Introduced in 1960s ,
alternative to woodsticks
• effective in plaque removal
from proximal tooth
surfaces.
• Recommended ideally for
periodontitis patients.
• Uncomfort for sensitive root
surfaces
• INDICATIONS
proximal tooth surfaces ,
orthodontic appliances
fixed prosthesis ,
periodontal splints
Exposed class IV
34. SINGLE TUFTED BRUSH
• Designed with smaller brush
heads
• Tuft is 3-6mm diameter
• Handle is straight or contra
angled.
• Angulated handles are more
easier to access palatal and
lingual surfaces.
• Filaments are directed into the
required area and activated
with rotation motion.
• Their design permits access to
eventipped , rotated or
displaced tooth. Also
effectively cleans Fixed
dentures ,
orthodonticappliances.
35. GINGIVAL MASSAGE
• Massaging with toothbrush or interdental aids produces
• Epithelial thickening
• Increased keratinization
• Increased mitotic activity
36. ADJUNCTIVE AID -ORAL
IRRIGATION
• Primary purpose of irrigation-nonspecifically
reduce the bacteria & their byproducts that lead
to initiation or progression of the periodontal
disease
• SUPRAGINGIVAL IRRIGATION-disruption & dilution
of bacteria and byproducts-treats gingivitis.
• SUBGINGIVAL IRRIGATION-interferes with complex
ecosystem and prevents initiation or further
destruction of periodontium.
37.
38. PROCEDURE OF
IRRIGATION
• HYDROKINETICS AND IRRIGATION FORCES
• Compression and pulsated decompression
phase(displacement of debris)
• Force – 80-90psi
• TIPS CLASSIFICATION –
Composition - Metal & rubber
Angulation - straight & angulated
Uses - Standardised & specialized
39. RAM AND SLOTS
CLASSIFICATION
PERSONALLY APPLIED(in patient home selfcare)
A . Non-sustained subgingival drug delivery(home
oral irrigation)
B. Sustained subgingival drug delivery(not
developed)
2.PROFESSIONALLY APPLIED(in dental office)
A. Non-sustained subgingival drug
delivery(professional pocket irrigation)
B. Sustained subgingival drug delivery
40. PERSONALLY APPLIED
• Employed in supragingival
irrigation
• Can be power or non
power driven
• Available with
interchangeble tips
• Easy to use
• Performed by any individual
. No clinical setup required
42. MERITS
• Permits patient to participate in maintaining their oral
health
• Importent role in treatment of ginigivits
• Adjunct to conventional therapy
• Study by STABHOLTZ ET AL has shown 5 % root
substantivity with tetracycline hcl , compared to 0.12 %
chlorhexidine for 12 days
43. CONCLUSION
• A cleaning device must be
used effectively on a daily
basis to distrupt regular
plaque growth
• Effective plaque control
can be achieved by right
choice of correct
armanterium for a specific
individual
• It is the dental professions
responsibility to educate
home regimen to improve
compliance and meet the
needs of even special
patient .
