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    Plaque Control

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    Ibrahim AbdelHadi
    - Dental plaque is a biofilm consisting of complex bacterial communities that reside on tooth surfaces. It is the primary etiologic factor for gingivitis and periodontitis. - Plaque control involves the regular removal of dental plaque through mechanical and chemical methods to prevent accumulation on teeth and gingival surfaces. Mechanical plaque control through proper toothbrushing and interdental cleaning is necessary and more effective than chemical plaque control alone. - Effective plaque removal once daily through meticulous brushing and cleaning techniques is sufficient to maintain oral health, rather than focusing solely on brushing frequency. Ongoing motivation, education and reinforcement are important for maintaining plaque control.

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    Plaque Control

    Uploaded by

    Ibrahim AbdelHadi
    120 views52 pages
    - Dental plaque is a biofilm consisting of complex bacterial communities that reside on tooth surfaces. It is the primary etiologic factor for gingivitis and periodontitis. - Plaque control involves the regular removal of dental plaque through mechanical and chemical methods to prevent accumulation on teeth and gingival surfaces. Mechanical plaque control through proper toothbrushing and interdental cleaning is necessary and more effective than chemical plaque control alone. - Effective plaque removal once daily through meticulous brushing and cleaning techniques is sufficient to maintain oral health, rather than focusing solely on brushing frequency. Ongoing motivation, education and reinforcement are important for maintaining plaque control.

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    - Dental plaque is a biofilm consisting of complex bacterial communities that reside on tooth surfaces. It is the primary etiologic factor for gingivitis and periodontitis. - Plaque control involves the regular removal of dental plaque through mechanical and chemical methods to prevent accumulation on teeth and gingival surfaces. Mechanical plaque control through proper toothbrushing and interdental cleaning is necessary and more effective than chemical plaque control alone. - Effective plaque removal once daily through meticulous brushing and cleaning techniques is sufficient to maintain oral health, rather than focusing solely on brushing frequency. Ongoing motivation, education and reinforcement are important for maintaining plaque control.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    120 views52 pages

    Plaque Control

    Uploaded by

    Ibrahim AbdelHadi
    - Dental plaque is a biofilm consisting of complex bacterial communities that reside on tooth surfaces. It is the primary etiologic factor for gingivitis and periodontitis. - Plaque control involves the regular removal of dental plaque through mechanical and chemical methods to prevent accumulation on teeth and gingival surfaces. Mechanical plaque control through proper toothbrushing and interdental cleaning is necessary and more effective than chemical plaque control alone. - Effective plaque removal once daily through meticulous brushing and cleaning techniques is sufficient to maintain oral health, rather than focusing solely on brushing frequency. Ongoing motivation, education and reinforcement are important for maintaining plaque control.

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    Plaque Control

    Periodontium

    Dental plaque
    A biofilm consists of complex communities of bacterial species that reside on tooth surfaces or soft tissues 400-1000 species

    Etiology of gingivitis and periodontitis

    Biofilm concept
    matrix-enclosed bacterial populations adherent to each other and/or to surfaces of interfaces

    Plaque as etiologic factor


    Experimental gingivitis study
    (1965 Le et al. )

    Plaque as etiologic factor


    Oral hygiene study
    (1973 Lang et al.)

    3 hypothesis in etiology of periodontal disease


    Non-specific plaque hypothesis Ecological plaque hypothesis
    Specific plaque hypothesis

    Non-specific plaque hypothesis (1986 Theilade)


    The bacterial dental plaque that accumulates to around teeth is a relatively homogenous mass that causes periodontal disease when it accumulates to the point of overwhelming the hosts defense mechanisms A result of the overall interaction of the microflora with the host

    Non-specific plaque hypothesis


    Experimental gingivitis Effect of mechanical removal of plaque

    Ecological plaque hypothesis (1994 Marsh)


    Change in a key environmental factor will trigger a shift in the balance of the resident plaque microflora and that this change might predispose a site to disease

    Ecological plaque hypothesis

    Specific plaque hypothesis (1976 Loesche)


    The diverse collection of microorganisms constituting the resident plaque microflora, only a very limited number are actively involved in causing disease Meet Kochs postulate(modification)

    Current suspected pathogens of destructive periodontal diseases


    Actinobacillus actinomycetemcomitans Porphyromonas gingivalis Bacteroides forsythus 1996 American Academy of Periodontology Spirochetes Prevotella intermedia Fusobacterium nucleatum Campylobacter rectus Eikenella corrodens Peptostreptococcus micros Eubacterium species Selenomonas species
    Others

    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

    Experimental gingivitis
    Dental plaque was allowed to accumulate in the absence of any plaque control procedures, resulting in the development of gingivitis in all subjects within 7-21 days.

    1965 Le

    Self-performed plaque control


    Brushing Interdental cleaning

    Brushing
    Toothbrush Methods of toothbrushing Frequency and effectiveness of toothbrushing Toothbrush wear and replacement Electric toothbrushes

    Interdental cleaning
    Dental floss and tape Toothpicks Interproximal brushes Single-tufted brush

    Adjunctive aids
    Dental irrigation devices Tongue scrapers Dentifrices

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

    Mechanical plaque control


    The toothbrush Powered toothbrushes Dentifrices Toothbrushing methods Interdental cleaning aids Gingival massage Oral irrigation devices

    Toothbrush
    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

    Toothbrush bristles
    Natural: hog Artificial filaments: nylon

    Bristle hardness
    Proportional to the square of the diameter and inversely proportional to the square of bristle length Soft brush: 0.007 inch(0.2 mm) Medium brush: 0.012 inch(0.3 mm) Hard brush: 0.014 inch(0.4 mm)

    Bass soft brush


    Straight handle Nylon bristle 0.007 inch(0.2 mm) in diameter 0.406 inch(10.3 mm) in length Rounded ends 3 rows of tufts 6 evenly spaced tufts per row 80-86 bristles per tuft

    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.

    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

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

    Dentifrices
    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

    Abrasion
    Upper arch > lower arch Left side > right side Abrasive: powder > paste, gel (5 times) Cementum > dentin > enamel 35 25 1

    Toothbrushing methods
    Horizontal brushing (scrub) Leonard method (vertical) Bass method Modified Bass methods Stillman methos (vibratory) Modified Stillman method (roll) Charters method Methods of cleaning with powered toothbrushes

    Bass method

    The efficacy of brushing with regard to plaque removal is dictated by three main factors: The design of the brush The skill of the individual using the brush The frequency and duration of use
    1986 Frandsen

    Interdental cleaning aids


    Dental floss Interdental brushes Wooden or rubber tips

    Dental floss
    Multifilament vs. monofilament Twisted vs. untwisted Bonded vs. unbonded Waxed vs. unwaxed 12-18 inches for use Stretch: thumb and forefinger Up-and-down stroke

    Interdental brush

    Gingival massage
    Epithelial thickening, increased keratinization, and increased mitotic activity in epithelium and connective tissue Emphasizing the importance of altering or removing plaque rather than stimulating or thickening the keratinized surface in the plaque control program

    Oral irrigation devices


    Supragingival irrigation

    Subgingival irrigation

    Caries control for the periodontal patient


    Periodontal patients require appropriate use of topical fluorides in the daily plaque control regimen to protect and remineralize both exposed root surfaces and coronal surfaces of teeth

    Chemical plaque control


    Antiadhesive Antimicrobial Plaque removal Antipathogenic

    Vehicles for the delivery of chemical agents


    Toothpaste Mouthrinses Spray Irrigators Chewing gum Varnishes

    Mouthrinse
    ADA has accepted two agents for treatment of gingivitis: Prescription solutions of chlorhexidine digluconate mouthrinse Nonprescription essential oil mouthrinse

    Chlorhexidine: plaque reduction 45-61%, gingivitis reduction 27-67% Essential oil mouthrinse: plaque reduction 20-35%, gingivitis reduction 25-35%

    Chlorhexidine
    In the US: 0.12 % solution

    In Europe: 0.2 % solution

    Chlorhexidine-side effects
    Brown discoloration Taste perturbation Oral mucosal erosion Parotid swelling Enhanced supragingival calculus formation
    1971 Flotra

    Disclosing agents
    Solutions or wafer capable of staining bacterial deposits on the surfaces of teeth, tongue, and gingiva Erythrosine, fuchsin Fluoresceincontaining dye

    Frequency of plaque removal


    Cleaning once a day with all necessary tools is sufficient if it is performed meticulously. Emphasis must be placed on the efficiency of complete plaque removal at least once per day, rather than the frequency of brushing alone

    Plaque control instruction


    Motivation for effective plaque control Education Instruction Encouragement Reinforcement

    Plaque control
    Mechanical plaque control is necessary and not replaceable by chemical plaque control Mechanical plaque control >>>>>> chemical plaque control

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