1. Mechanical and chemical plaque control

2. Definition
• Plaque control: the removal of dental
plaque on a regular basis and the
prevention of its accumulation on the
teeth and adjacent gingival surfaces.
• Position: supra- & sub-gingival plaque
control
• Methods: mechanical & chemical

3. Self-performed plaque
control
• Brushing
• Interdental cleaning
• Adjunctive aids:
1. Dental irrigation devices
2.Tongue scrapers
3.Dentifrices

4. tooth brush
• 1- handle:The part grasped in the hand
during tooth brushing.
• 2- head : it is the working end of tooth
brush that hold bristles.
• 3- tufts: clusters of bristles secured
into head

5. Toothbrush bristles
• Natural: hog
• Artificial filaments: nylon which are
uniform in size & elasticity, resistant to
fracture & doesn’t get contaminated.

6. Bristle hardness
• Soft brush: 0.007 inch(0.2 mm)
• Medium brush: 0.012 inch(0.3 mm)
• Hard brush: 0.014 inch(0.4 mm)

7. American Dental Association (ADA)
• Brush length: 1-1.25 inches
• Brush width: 5/16-3/8 inches
• 2-4 rows
• 5-12 tufts per row

8. • For most patients, short-headed
brushes with straight-cut, round-ended,
soft to medium nylon bristles arranged
in three or four rows of tufts are
recommended.

9. Effects and sequelae of the
incorrect use of mechanical plaque
removal devices
• Gingival erosion
• Toothbrush
stiffness
• Gingival recession
• Cervical abrasion • Method of
brushing
• Brushing frequency

11. Brushing technique
•
•
•
•
•
•
Horizontal brushing (scrub)
Leonard method (vertical)
Bass method
Modified Stillman method (roll)
Charters method
Methods of cleaning with powered
toothbrushes

12. MODIFIED STILL MAN
Modified Stillman method. This method requires
placement of the sides of the bristles against the
teeth and gingiva while moving the brush with
short, back-and-forth strokes in a coronal
direction.

13. – Dental plaque removal from cervical areas
below the height of contour of the enamel
& from exposed proximal surfaces .
– General application for cleaning tooth
surfaces and massage of the gingiva
– Recommended for cleaning in areas with
progressing gingival recession & root
exposure to prevent further tissue
destruction.

14. Bass method
Bass method. A, Proper position of the brush in the
mouth aims the bristle tips toward the gingival
margin. B, Diagrams shows the ideal placement,
which could permit slight subgingival penetration of
the bristle tips

15. • Technique. Place the head of a soft brush parallel with the
occlusal plane, Place the bristles at the gingival margin,
establishing an angle of 45 degrees to the long axis of the
teeth. Exert gentle vibratory pressure, using short back andforth motions without dislodging the tips of the bristles. This
motion forces the bristle ends into the gingival sulcus area as
well as partially into the
interproximal embrasures. The
pressure should produce perceptible blanching of the gingiva.
Complete approximately 20 strokes in the same position.
• This repeated motion cleans the tooth surfaces, concentrating
on the apical third of the clinical crowns, the gingival sulci,
and as far onto the proximal surfaces as the bristles can
reach. Lift the brush, move it to the adjacent teeth, and repeat
the process for the next three or four teeth.

16. Advantage
The short back-and-forth motion is easy to master because
it is a simple movement familiar to most patients who brush using a
scrub technique.
It concentrates the cleaning action on the cervical and
interproximal portions of the teeth, where microbial
plaque is most likely to have accumulated.
The Bass technique is efficient and can be recommended
for any patient with or without periodontal involvement.

17. CHARTER’S METHOD
Charters method. The Charters method requires that
the bristles be pressed against the sides of the teeth
and gingiva.The brush is moved with short circular or
back-and-forth strokes

18. • INDICATIONS
• 1- Individual’s having open interdental spaces with missing papilla &
exposed root surfaces
– For patients who have had periodontal surgery
– Patients with moderate gingival recession
particularly inter-proximal (receded interdental
papillae).

19. Disadvantages
• Brush ends don’t engage the gingival
sulcus to remove sub gingival bacterial
accumulations.
• Requirements in digital dexterity are
high.

20. This brush position on occlusal surfaces of the
teeth is used with any technique, including the
Bass, Stillman, or Charters method.

21. Powered toothbrushes
• Powered toothbrushes are not generally
superior to manual ones
• The heads of these tooth brushes
oscillate in a side - to – side motion or in
a rotary motion
•

23. • 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

24. Interdental cleaning aids
• Dental floss
• Interdental brushes
• Wooden or rubber tips

25. Dental floss
•
•
•
•
•
Multifilament vs. monofilament
Twisted vs. untwisted
Waxed vs. unwaxed
12-18 inches for use
Stretch: thumb and forefinger
• wrapped around proximal surface, and removes plaque by using
• several up-and-down strokes. The process must be repeated for
the distal surface of tooth

27. • Flossing can be made easier by using a floss holder
• Although use of such devices can be more time
consuming than finger flossing, they are helpful for
patients lacking manual dexterity and for nursing
personnel
• assisting handicapped and hospitalized patients in
cleaning their teeth.
• The disadvantage of floss tools is that they must be
rethreaded whenever the floss becomes soiled or
begins to shred.

28. Floss holders

29. Powered flossing devices are also available These devices have a
single bristle that moves in a circular motion. The devices have
been shown to be safe and effective but no better at plaque
removal than finger flossing

30. Interdental brush

31. Interdental brushes
• Interdental brushes are coneshaped or cylindric brushes made
of bristles mounted on a handle or
• single-tufted brushe particularly suitable for cleaning large,
irregular, or concave tooth surfaces adjacent to wide
interdental spaces.

32. Technique
• Interdental brushes of any style are inserted through
interproximal spaces and moved back and forth between the
teeth with short strokes. For most efficient cleaning, it is
probably best to select the diameter of brush that is slightly
larger than the gingival embrasures to be cleaned. This size
permits bristles to exert pressure on both proximal tooth
surfaces, working their way into concavities on the roots.
• Single-tufted brushes are highly effective on the lingual
surface of mandibular molars and premolars, where the tongue
often impedes a regular toothbrush, and may provide access to
furcation areas and isolated areas of deep recession

34. Wooden or rubber tip
• Wooden tips are used either with or without a handle. Access
• is easier from the buccal surfaces for those tips without
• handles, primarily in the anterior and bicuspid areas.

35. • Soft, triangular wooden picks or plastic alternatives are placed
in the interdental space in such away that the base of the
triangle rests on the gingiva and the sides are in contact with
the proximal tooth surfaces The pick is then repeatedly moved
in and out of the embrasure, removing soft deposits from the
• teeth and mechanically stimulating the papillary gingiva.
• The disadvantage of the triangular toothpick is that
• it is very hard to access any surfaces other than the facial
• surfaces in the more anterior region of the mouth. Only used in
large gingival embeassure

36. • Rubber tips come mounted on handles or the ends of
toothbrushes and can easily be adapted to all proximal surfaces
in the mouth.
•
Various plastic tips are also available and can be used in a
manner similar to wooden tips.
• Both rubber and plastic tips can be rinsed and reused and easily
carried in a pocket or purse, features that are attractive to
some patients.
• Rubber tips should be placed into the embrasure space and used
in a circular motion. They can be applied to interproximal spaces
and other defects throughout the mouth and are easily
adaptable to lingual surfaces.

38. Adjunctive aids
• Dental irrigation devices
• Tongue scrapers
• Dentifrices

39. Water Flosser
• The two main physical features of water flossing action include
pulsation and pressure. Pulsation essentially regulates pressure.
• A combination of these two actions allows for disruption of
bacterial activity, the expulsion of subgingival bacteria and the
• removal of loosely lodged debris and food particles.
• The elderly who suffer from arthritis or other conditions that
compromise the use of their hands may find the Water Flosser
easy to manage and control
• These inserts are designed to address patient needs tongue
cleansing, orthodontic appliances, fixed restorative appliances,
deeper periodontal pocket areas

41. Irrigation devices
•
•
•
•
•
subgingival irrigation performed with an oral irrigator
using chlorhexidine diluted to one-third strength, performed
regularly at home after scaling, root planing, and
in-office irrigation therapy, has produced significant gingival
improvement compared with controls.

42. • Tongue scraber is an oral hygiene
device designed to clean the bacterial
builed up, food debris, fungi and dead
cells from the surface of the tongue
bacteria and fungi that grow on the
tongue may cause halitosis due to
production of sulfur compound

43. Tongue scrapers

44. Chemical plaque control
•
•
•
•
Antiadhesive
Antimicrobial
Plaque removal
Antipathogenic

45. Vehicles for the delivery of
chemical agents
•
•
•
•
•
Toothpaste
Mouthrinses
Spray
Irrigators
Chewing gum

46. Dentifrices
• Dentifrices aid in cleaning and polishing
tooth surfaces
• Paste, powder and gel

47. • Abrasive: silica, alumina, dicalcium phosphate,
and calcium carbonate make up 20% to 40% of
a dentifrice. Tooth powders
• contain about 95% abrasives and are five
times more abrasive than pastes.
• Detergent: sodium lauryl sulfate
• Thickeners: silica and gums
• Sweeteners: saccharine
• Humectants: glycerine and sorbitol
• Flavors: mint, peppermint
• Actives: fluorides, triclosan and stannous
fluoride

48. Mouthrinse
• ADA has accepted two agents for
treatment of gingivitis:
 solutions of chlorhexidine digluconate
mouthrinse
• essential oil mouthrinse thymol,
eucalyptol,menthol, and mythyl
salicylate work by altering bacterial cell
wall

49. • Chlorohexidine action:
• Increase bacterial membrane permeability
followed
by coagulation of cytoplasmic
macromolecules
• Has substantivity ability of substance to
adher to the structur to be released for
long time
• Chlorhexidine-side effects
• Brown discoloration
• Taste perturbation
• Oral mucosal erosion

50. Disclosing agents
• Solutions or wafer capable of staining
bacterial deposits on the surfaces of teeth,
tongue, and gingiva
• Erythrosine, fuchsin
• Fluorescein-containing dye