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

Read And Learn More: Periodontics Question and Answers

2. Types Of Brush

Plaque Control 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

Plaque Removal Techniques

4. Brushing Techniques

Plaque Control Brushing techniques

4. BassTechnique

  • In it, the bristles are placed at the gingival margin at an angle of 45° to the long axis of the tooth
  • This forces 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.

5. Interdental cleansing aids

Plaque Control 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 Removal Techniques

Plaque Control Long Essays

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

Plaque Control:

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

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.

Plaque Removal Techniques

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:

Plaque Control 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

Dental Plaque Prevention

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

Dental Plaque Prevention

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:

Plaque Control Mechanism

Chlorhexidine Efficient concentration

  • 10 ml of 0.2%

Question 2. Brushing Techniques.
Answer:

Plaque Control Brushing position and Brushing motion

Dental Plaque Prevention

Question 3. Modified Bass Techniques.
Answer:

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

Modified Bass Techniques Method:

Plaque Control Modified bass techniques

Plaque Control Modified bass 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

Dental Plaque Prevention

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

Plaque Reduction

Question 2. Modified Stillman method.
Answer:

Plaque Control Technique

Plaque Control Modified stillman method

Question 3. Charter’s method.
Answer:

Plaque Control Charter,s method..

Charter’s method Indication: After surgery

Plaque Control Charter,s method

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

Desensitizing Agents Mode Of Action:

Plaque Control 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

Plaque Reduction

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

Plaque Reduction

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:

Plaque Control Techniques

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:

  • Atridox is 10% Doxycycline
  • Atridox 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

Plaque Reduction

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.

Leave a Comment