Plaque Control Short And Long Essay Question And Answers

Plaque Control

Plaque Control Important Notes

1. Chlorhexidine

• Chemically it is biguanidohexane with antiseptic properties
• Daily rinses with 10 ml of 0.2% aqueous solution effectively inhibit the development of plaque, calculus, and gingivitis
• The minimum concentration of chlorhexidine needed to inhibit plaque is 0.12%
• Chlorhexidine inhibits gram +ve, gram -ve organisms, and yeasts
• It is bacteriostatic at low concentrations and bacteriocidal at high concentrations
• Chlorhexidine causes local reversible side effects
• Side effects:
• Yellow-brown staining of teeth
• Mucosal soreness
• Desquamation
• Altered taste sensation

2. Types of brush

3. ADA’s specification of toothbrush

• Tooth head should be
• 1-1/4 inch in length
• 5/16-3/8 inches in width
• 2-4 rows of bristles
• 5-12 tufts per row
• 80-86 bristles per tuft

4. Brushing techniques

4. Bass technique

• In it, the bristles are placed at the gingival margin at an angle of 45° to the long axis of the tooth
• This force the bristle ends into the gingival sulci and interproximal embrasures
• Produces blanching of the gingiva
• Helps in the cleaning of the cervical third of the tooth, gingival sulci, and interproximal areas.

Read And Learn More: Periodontics Question and Answers

5. Interdental cleansing aids

6. Composition of gentrifies

• Abrasives – CaCO3, Calcium phosphate
• Humectants – Maintains moisture
• Glycerine, sorbitol
• Preservatives – Benzoic acid
• Thickening agents – methylcellulose
• Foaming agents – Sodium lauryl sulfate
• Flavoring agents – Mint
• Sweetening agents – Mannitol, Saccharine
• Desensitizing agents – Sodium fluoride
• Anticalculus agent – Pyrophosphates

7. Anti-plaque mouth rinses

• Chlorhexidine
• Cetyl pyridine
• Essential oils
• Sanguinarine
• Sodium benzoate

8. Oral irrigating devices

• They disrupt and detoxify the bacterial plaque
• They effectively clean the nonadherent bacteria and debris in periodontal pockets
• Water and dilute chlorhexidine can be used as irrigating agents

9. Disclosing agents

• Disclosing agents stain bacterial deposits on teeth, tongue, and gingiva
• They help in the education and motivation of the patients
• It is a simple way to instruct the patients in the dental office
• Some disclosing agents are:
  • Erythrosin
  • Bismark brown
  • Two-tone solution
  • Mercurochrome
  • Malachite green

10. Chemical plaque control

• It is adjuvant to mechanical plaque control
• It is used
  • After periodontal surgery
  • In poorly motivated patients
  • Medically compromised patients
  • Prophylactic rinse during scaling
  • In gingival enlargements
  • In patients with fixed appliances
  • Mentally and physically handicapped patients

11. Local drug delivery system

Agents used for it are

• Activity tetracycline containing fibers
• Atridox-10% doxycycline
• Periocline- 2% minocycline
• Periochip – a small chip containing 2.5 mg of chlorhexidine

Plaque Control Long Essays

Question 1. What is plaque control? Describe various measures of plaque control.
Answer:

Plaque Control:

• It is the removal of dental plaque on a regular basis and the prevention of its accumulation on teeth and adjacent gingival surfaces.

Measures Of Plaque Control:

Plaque Control Mechanical:

Types based on the diameter of bristles:

1. Soft-0.007-0.009 inches
2. Medium -0.010 -0.012 inches
3. Hard-0.013-0.014 inches
4. Extra hard-0.015 inches

Based on use:

• Manual
• Automatic/Powered
• Frequency of brushing – every 12 hours
• Frequency of change of brush every 3 months
• Length of brushing time
• Initially 10-20 minutes
• Later 3-5 minutes

2. Dentrifices:

1. Used in the form of powders, pastes, and gels
2. Composition

• • Abrasives – CaCO3, Calcium phosphate
  • Humectants – Maintains moisture
  • Periodontics
  • Glycerine, sorbitol
  • Preservatives – Benzoic acid
  • Thickening agents – methylcellulose
  • Foaming agents – Sodium lauryl sulfate
  • Flavoring agents – Mint
  • Sweetening agents – Mannitol, Saccharine
  • Desensitizing agents – Sodium fluoride
  • Anticalculus agent – Pyrophosphates

3. Interdental Cleaning aids:

Use: In periodontally involved patients, open embrasures

• Various aids:
  • Dental floss
  • Interdental brushes
  • Wooden tips
  • Yarns, gauze strips

4. Gingival massage:

• Devices used
  • Toothbrush
  • Rubber tip stimulator
  • Interdental cleaning devices

Gingival massage Effects:

• Epithelial thickening
• Increased Keratinization
• Increased mitotic activity

5. Oral irrigation:

• Clean non-adherent bacteria and debris
• Disrupt and detoxify subgingival plaque
• Delivers antimicrobial agents into periodontal pockets
• Irrigator tips: Cannula type, soft rubber tip

Chemical Plaque Control.

Oral irrigation Use: As an adjunct

• Prevents recurrence of disease

Oral irrigation Classification:

1. First generation:

• Reduces plaque score by 20-50%

Example: Antibiotics

2. Second generation:

• Reduces plaque score by 70-90%

Example: bisbiguanides

3. Third generation:

• Effective against specific organisms

Chemicals:

1. Antibiotics Penicillin
   • Erythromycin
2. Enzymes – Lipase
   • Amylase
3. Quarternary Ammonium Compounds – Benzalkonium chloride
4. Bisbiguanides – Chlorhexidine
5. Metallic salts – Copper, Zinc
6. Herbal extracts
7. Phenols
8. Hydrogen peroxide
9. Fluorides
10. Others Triclosan

Question 2. Define oral hygiene and gingival physiotherapy. Describe various aids available for plaque control
Answer:

Oral Hygiene:

• The cleanliness of the oral cavity is appraised in terms of the extent of accumulated food debris, plaque, mate- ria alba, and tooth surface stains

Gingival Physiotherapy:

• Mechanical stimulation of the gingiva either by toothbrush- ing or interdental cleansing with various aids or simple finger massage leads to
  • Increased keratinization
  • Increased blood flow
  • The increased flow of GCF within the gingival sulcus

Measures Of Plaque Control:

Mechanical measures

1. Toothbrush:

• The frequency of brushing should be once every 12 hours
• Frequency of change of brush- every three months
• Length of brushing time
  • Initially-10-20 minutes
  • Later-3-5 minutes

2. Dentrifices:

• Used in the form of powders, pastes, and gels

Dentrifices Composition:

• Abrasives- calcium carbonate, calcium phosphate
  • Mechanically clean the teeth
  • Removes stained pellicles from the tooth surface
  • Restores natural lustre
  • Aids in eliminating plaque from the tooth surface
• Humectants
  • Maintains moisture
  • Glycerine, sorbitol
• Preservative- benzoic acid
  • Prevents microbial growth
• Thickening agent-methyl cellulose
  • Binds the solids to form a homogenous paste and ease dispersion of paste in the mouth
  • Controls stability and consistency of tooth-paste
• Foaming agents- sodium lauryl sulfate
  • Produces foam which aids in the removal of food debris
  • Antimicrobial property
• Flavoring agents-Mint
  • Render the product pleasant to use
• Sweetening agents- mannitol, saccharine
  • Imparts sweetness and makes it pleasant
• Desensitizing agents- sodium fluoride
• Anticalculus agent-pyrophosphates

3. Interdental cleaning aids:

Interdental cleaning aids Use:

• In periodontally involved patients
• Open embrasures

Interdental cleaning aids Various Aids:

• Dental floss
• Interdental brushes
• Wooden tips
• Yarns, gauze strips

4. Gingiva massage:

Gingiva massage Devices Used:

• Toothbrush
• Rubber tip stimulator
• Interdental cleaning devices

Gingiva massage Effects:

• Epithelial thickening
• Increased keratinization
• Increased mitotic activity

5. Oral irrigation:

• Clean non-adherent bacteria and debris
• Disrupt and detoxify subgingival plaque
• Delivers antimicrobial agents into periodontal pockets

Oral irrigation Irrigation Tips:

• Cannula type
• Soft rubber tip

Chemical plaque control

Oral irrigation Uses:

• As adjunct
• Prevents recurrence of disease

Oral irrigation Classification:

1. First generation:

• Reduces plaque score by 20-50%
• Example: antibiotics

2. Second generation:

• Reduces plaque score by 70-90%
• Example: bisbiguanides

3. Third generation:

• Effective against specific organisms

Chemicals Used:

• Antibiotics- Penicillin, Erythromycin
• Enzymes- Lipase, Amylase
• Quaternary ammonium compounds- Benzalkonium chloride
• Bisbiguanides- Chlorhexidine
• Metallic salts- Copper, zinc
• Herbal extracts
• Phenols
• Hydrogen peroxide
• Fluorides
• Others- Triclosan

Question 3. What is oral physiotherapy? Describe the indications, contraindications, advantages, and disadvantages of modifying Stillman’s method.
Answer:

Oral Physiotherapy

• It is mechanical stimulation of the gingiva either by toothbrushing or interdental cleansing with various aids or simple finger massage leads to
• Increased keratinization
• Increased blood flow
• The increased flow of GCF within the gingival sulcus

Modified Stillman’s Technique:

Modified Stillman’s Technique Indications:

• In gingival recession
• Dental plaque removal from cervical areas below the height of the contour of the enamel
• Gingival massage

Modified Stillman’s Technique:

Modified Stillman’s Technique Advantages:

• Prevents abrasive tissue destruction

Modified Stillman’s Technique Disadvantages:

• Time-consuming
• Improper brushing can damage the epithelial attachment

Question 4. Define plaque. Describe the formation and maturation of plaque. Add a note on the chemical method of plaque control.
Answer:

Plaque Definition:

• Plaque is defined clinically as a structurally resilient, yellowish-grey substance consisting of bacterial agree- nations that adhere tenaciously to teeth and other in- intraoral hard surfaces such as restorations

Formation of Plaque:

1. Formation of an organic pellicle
   • A thin, saliva-derived layer called acquired pellicle covers the tooth surface and it consists of numerous components including glycoproteins, proline-rich proteins, phosphoproteins, and histidine-rich proteins. enzymes and other molecules that can function as adhesion sites for bacteria
   • This involves the adsorption of positively charged salivary crevicular fluid and other environmental macromolecules to negatively charged hydroxyapa- tite surfaces of teeth
   • Its formation on the teeth surfaces forms the sub- strate for colonization and subsequent proliferation of micro-organisms
2. Initial adhesion and attachment of bacteria

• • Formation of the organic pellicle aids in the adherence of certain bacteria to the tooth surface
  • These are the initial colonizers
  • Bacterial adherence occurs through specific at-attachments
  • With the multiplication and growth of the primary colonizers, the extra-cellular matrix also increases through the accumulation of bacterial products

Plaque Maturation:

• Initial colonizers make use of available oxygen, leading to the reduced oxygen level
• This becomes favorable for anaerobic bacteria to grow
• These organisms then adhere to the cell surface receptors of the initial colonizers
• Hence the plaque matures

Chemical Plaque Control

Chemical Plaque Control Uses:

• As adjunct
• Prevents recurrence of disease

Chemical Plaque Control Classification:

1. First generation
   • Reduces plaque score by 20-50%
   • Example: antibiotics
2. Second generation
   • Reduces plaque score by 70-90%
   • Example: bisbiguanides
3. Third generation
   • Effective against specific organisms

Plaque Control Chemicals Used:

• Antibiotics- Penicillin, Erythromycin
• Enzymes- Lipase, Amylase
• Quaternary ammonium compounds- Benzalkonium chloride
• Bisbiguanides- Chlorhexidine
• Metallic salts-Copper, zinc
• Herbal extracts
• Phenols
• Hydrogen peroxide
• Fluorides
• Others- Triclosan

Plaque Control Short Essays

Question 1. Chlorhexidine.
Answer:

Chlorhexidine Indications:

• As an adjunct to the mechanical method
• Immediately after pack removal
• After oral surgical procedures
• In patients with fixed appliances
• For handicapped patients
• Drug-induced gingival enlargements
• Medically compromised patients
• Acute infections
• As prophylactic rinse

Chlorhexidine Adverse Effects:

• Staining of teeth
• Burning sensation
• Impaired taste sensation
• Rarely, parotid swelling

Chlorhexidine Mechanism:

Chlorhexidine Efficient concentration

• 10 ml of 0.2%

Question 2. Brushing Techniques.
Answer:

Question 3. Modified Bass Techniques.
Answer:

• Placement of head – 45° to the long axis of teeth
• Initial most posterior teeth

Modified Bass Techniques Method:

Question 4. Dentrifices
Answer:

• Used in the form of powders, pastes, and gels

Dentrifices Composition:

• Abrasives- calcium carbonate, calcium phosphate
  • Mechanically clean the teeth
  • Removes stained pellicles from the tooth surface
  • Restores natural lustre
  • Aids in eliminating plaque from the tooth surface
  • Humectants
  • Maintains moisture
  • Glycerine, sorbitol
  • Preservative- benzoic acid
  • Prevents microbial growth
  • Thickening agent-methyl cellulose
  • Binds the solids to form a homogenous paste and ease dispersion of paste in the mouth
  • Controls stability and consistency of toothpaste
  • Foaming agents- sodium lauryl sulfate
  • Produces foam which aids in the removal of food debris
  • Antimicrobial property
  • Flavoring agents- Mint
  • Render the product pleasant to use
  • Sweetening agents- mannitol, saccharine
  • Imparts sweetness and makes it pleasant
  • Desensitizing agents- sodium fluoride
  • Anticalculus agent-pyrophosphates

Question 5. Merits and limitations of toothbrush (or) Uses and abuses of toothbrush
Answer:

Merits Or Uses Of Toothbrush:

• Cleans teeth and interdental spaces and prevents plaque formation
• It disturbs and removes plaque
• Stimulates and massages gingival tissues
• Increases patient motivation
• Increased accessibility in interproximal and lingual tooth surfaces

Limitations Or Abuses Of Toothbrush:

• Horizontal or vertical scrubbing toothbrushing method with pressure results in a scuffled epithelial surface with denuded underlying connective tissue
• Overuse of toothbrush results in punctuate lesions that appear as red pinpoint spots
• Penetration of gingiva by filament ends due to the use of a toothbrush with frayed broken bristles results in diffuse redness and denuded attached gingiva
• Gingival recession exhibits receded margin of the gingiva
• Gingival contour exhibits rolled out, bulbous, hard, firm marginal gingiva

Plaque Control Short Question And Answers

Question 1. Chemical Plaque Control.
Answer:

Chemical Plaque Control Uses:

• As adjunct
• Prevents recurrence of disease

Chemical Plaque Control Classification:

1. First generation:

• Reduces plaque score by 20-50%

Example: Antibiotics

2. Second generation:

• Reduces plaque score by 70-90%

Example: bisbiguanides

3. Third generation:

• Effective against specific organisms

Chemical Plaque Control Chemicals:

1. Antibiotics Penicillin
   • Erythromycin
2. Enzymes – Lipase
   • Amylase
3. Quarternary Ammonium Compounds – Benzalkonium chloride
4. Bisbiguanides – Chlorhexidine
5. Metallic salts – Copper, Zinc
6. Herbal extracts
7. Phenols
8. Hydrogen peroxide
9. Fluorides
10. Others Triclosan

Question 2. Modified Stillman method.
Answer:

Question 3. Charter’s method.
Answer:

Charter’s method Indication: After surgery

Question 4. Powered Toothbrush.
Answer:

Powered Toothbrush Indications:

• Patient lacking motor skills
• Handicap
• Hospitalized patients
• Patient with the orthodontic appliance

Powered Toothbrush Types Of Motion:

1. Reciprocating – back-and-forth movement
2. Arcuate Up and down movement
3. Elliptical – Combination

Question 5. Dentrifices.
Answer:

• Used in the form of powders, pastes, and gels

Dentrifices Composition:

• Abrasives- calcium carbonate, calcium phosphate
• Humectants
  • Maintains moisture
  • Glycerine, sorbitol
• Preservative- benzoic acid
• Thickening agent-methyl cellulose
• Foaming agents- sodium lauryl sulfate
• Flavoring agents-Mint
• Sweetening agents- mannitol, saccharine
• Desensitizing agents- sodium fluoride
• Anticalculus agent-pyrophosphates

Question 6. Interdental cleaning aids
Answer:

Interdental cleaning aids Use:

• In periodontally involved patients
• Open embrasures

Interdental cleaning aids Various Aids:

• Dental floss
• Interdental brushes
• Wooden tips
• Yarns, gauze strips

Question 7. Adverse effects of chlorhexidine.
Answer:

• Staining of teeth
• Burning sensation
• Impaired taste sensation
• Rarely, parotid swelling

Question 8. Desensitizing agents
Answer:

Agents Used:

• Dentrifices
• Varnishes
• Fluoride compounds

Mode Of Action:

Question 9. List three chemical plaque control agents.
Answer:

• Antibiotics- Penicillin, Erythromycin
• Enzymes- Lipase, Amylase
• Quaternary ammonium compounds- Benzalkonium chloride
• Bisbiguanides- Chlorhexidine
• Metallic salts- Copper, zinc
• Herbal extracts
• Phenols
• Hydrogen peroxide
• Fluorides
• Others- Triclosan

Question 10. Interdental brushes
Answer:

• Made of bristles mounted on a handle
• Suitable for cleaning large, irregular, or concave tooth surfaces
• Inserted interproximal and are activated with short back-and-forth strokes
• The diameter of the brush should be slightly larger than the gingival embrasures
• Single-tufted brushes are highly effective on the lingual surfaces of mandibular molars and premolars

Question 11. Oral irrigation devices.
Answer:

• Direct high-pressure, steady, or pulsating stream of water through a nozzle to the tooth surfaces is applied

Oral irrigation devices Uses:

• Clean nonadherent bacteria and debris
• Removes non-structured debris from inaccessible areas
• Used as adjuncts to tooth brushing

Oral irrigation devices Advantages:

• Retards accumulation of plaque and calculus
• Reduces gingival inflammation

Oral irrigation devices Types:

1. Home use irrigator tip:

• Soft rubber tip
• The plastic nozzle is bent at 90 degrees at the tip
• Attached to a pump

2. Subgingival irrigator:

• Cannula type- office use
• Soft rubber tip- home use
• Effective penetration of irrigant up to 70%

Question 12. Perio-aid
Answer:

• Wooden toothpicks on a handle are known as period-aid They can be used on facial or lingual surfaces throughout the oral cavity
• Deposits are removed by using either the side or the end of the tip.
• The device is particularly efficient for cleaning along the gingival margin and into periodontal pockets

Question 13. Functions of gentrifies
Answer:

• Removal of food debris, and stains and minimizing the build-up of plaque
• Anticaries action
• Mouth freshener
• The use of triclosan with copolymer Gantrez in toothpaste reduces plaque and gingivitis
• It reduces periodontitis
• Aid in cleaning and polishing tooth surfaces

Question 14. Indications of chlorhexidine
Answer:

• As an adjunct to mechanical methods
• Immediately after pack removal
• After oral surgical procedures
• In patients with fixed appliances
• For handicapped patients
• Drug-induced gingival enlargements
• Medically compromised patients
• Acute infections
• As prophylactic rinses

Question 15. Abuses of toothbrush
Answer:

• Horizontal or vertical scrubbing toothbrushing method with pressure results in a scuffled epithelial surface with denuded underlying connective tissue
• Overuse of toothbrush results in punctuate lesions that appear as red pinpoint spots Penetration of gingiva by filament ends due to use of a toothbrush with frayed broken bristles results in diffuse redness and denuded attached gingiva
• Gingival recession exhibits receded margin of the gingiva
• Gingival contour exhibits rolled out, bulbous, hard, firm marginal gingiva

Question 16. Ideal toothbrush
Answer:

• It should fulfill an individual patient’s requirements in size, shape, and texture
• Should be easy and efficiently manipulated
• Should be readily cleaned and aerated
• Should be durable and inexpensive
• Should be designed for utility, efficiency, and cleanliness

Question 17. Gingival massage
Answer:

• It is mechanical stimulation of the gingiva either by toothbrushing or interdental cleansing with various aids or simple finger massage leads to
• Increased keratinization
• Increased blood flow
• The increased flow of GCF within the gingival sulcus

Question 18. Proxabrush
Answer:

• Proxy brushes are small interdental brushes used in type 2 embrasures
• In type 2 embrasures, dental floss is less effective in these cases because interproximal gingival recession usually leads to the exposure of concave root depressions

Question 19. Objectives of brushing teeth
Answer:

• To clean teeth, tongue, and interdental spaces of food
• remnants, debris, stains, etc
• To prevent plaque formation
• To disturb and removes plaque
• To stimulate and massage gingival tissue

Question 20. Dental Floss.
Answer:

Dental Floss Types:

1. Twisted or non-twisted
2. Bonded or non-bonded
3. Waxed or un-waxed
4. Thick or thin

Dental Floss Technique:

Question 21. Disclosing agents.
Answer:

• They are prepared in liquid, tablet, or lozenge form that contains a dye or other coloring agent.
• It is used to identify bacterial plaque deposited for in-construction, evaluation, and research

Disclosing agents Purpose:

• Patient’s education
• Evaluate the effectiveness of the treatment
• Evaluate plaque indices
• Self-evaluation

Disclosing agents Requirements:

• Color should contrast normal color of the oral cavity
• It should not rinse off immediately
• It should not have bad taste
• It should not cause any irritation
• It should be thin enough

Disclosing agents Agents:

• Iodine containing preparations
• Bismarck brown
• Merbromin
• Erythrosin
• Fast green
• Two-tone

Question 22. Atridox
Answer:

• It is 10% Doxycycline
• It is biodegradable
• Used as a mixture in syringes

Atridox Advantages:

• Used in periodontal chemotherapy
• Used as a local drug delivery system
• Used as an adjuvant to mechanotherapy

Question 23. Anticalculus agents.
Answer:

• Calculus control kinds of toothpaste also known as tartar control toothpaste.
• Dentrifices that are widely used as an aid in oral hygiene containing either soluble pyrophosphate or zinc compounds have demonstrated a 10 – 50% reduction in calculus.
• Pyrophosphatase and zinc compounds are thought to produce their anti-calculus effects by absorbing small hydroxy apatite crystals, thus inhibiting growth as larger and more organized crystals.
• The inhibitory effects reduce the deposition of new supragingival calculus but will not affect existing calculus deposits.
• Before starting the use of anti-calculus agents, patients’ teeth must be cleaned & completely free of supragingival calculus to achieve the greatest effect from the toothpaste.

Plaque Control Viva Voce

1. The advantage of natural bristle is it removes plaque efficiently
2. The diameter of bristles in a medium toothbrush is 0.012 inch
3. There are 80-86 bristles per tuft in toothbrush
4. Electrically powered toothbrushes were invented in 1939
5. Dentrifices enhance the abrasive action of the toothbrush by 40 times
6. Dentrifices that provide adequate plaque control with minimum abrasion are preferable
7. Dentrifices are aids for cleaning and polishing tooth surfaces
8. Tartar control toothpaste is effective against the formation of new supragingival calculus
9. The scrub technique is the simplest and most common
10. The scrub technique fails to remove plaque from inter-dental areas
11. The modified Stillman technique is used in gingival recession
12. The least efficient toothbrushing technique is the roll technique because the removal of marginal plaque does not occur
13. Charters technique is used in areas of healing wounds after periodontal surgery
14. Dental floss is used for interproximal cleaning
15. Dental floss is the most effective dental hygiene aid for narrow gingival embrasure
16. Wax floss will leave a coating on interproximal sur- faces to which debris may stick
17. Thick floss may cause difficulty to floss in tight contact areas
18. The diameter of the interdental brush should be larger than the gingival embrasure to be cleaned
19. Oral epithelium of the gingival shows increased keratinization, blood circulation, and epithelization in response to gingival massage
20. Triclosan is more effective in combination with zinc citrate
21. Disclosing agents are capable of staining bacterial deposits on the surfaces of teeth, tongue, and gingival
22. The two-tone dye contains FDC green and red. Mature plaque is stained green and newly formed plaque is stained red.
23. In subgingival irrigation, an irrigant penetrates 75- 93% of the depth of the periodontal pocket
24. 400 ml of 0.02% chlorhexidine gluconate once daily is used for supragingival irrigation