Periodontology Mechanical Plaque Control Question And Answers

Mechanical Plaque Control

Home care, oral hygiene, oral physiotherapy, personal oral hygiene, and personal plaque control are all terms used to describe those methods (tooth brushing, use of interproximal aids, chemical agents for plaque control) used by the patient to remove dental plaque and prevent its accumulation on tooth surface and restoration.

• The daily disruption of dental plaque, at and coronal to the gingival margin, is critical in countering the potential of the plaque to cause gingival inflammation.
• Plaque control is based on the non-specific plaque hypothesis, which suggests that the control of periodontal disease depends on control of plaque accumulation.

Read And Learn More: Periodontology Important Question And Answers

Question 1. What are disclosing agents?
Answer:

• Disclosing agents form an important aspect of plaque control by staining plaque and aiding the patient in developing an efficient system of plaque removal.
• These agents contain a dye or other coloring agent used to locate and identify bacterial plaque on teeth, tongue, and gingiva.
• They are available in form of liquid, tablet, lozenges, and wafers.

Types of disclosing agents:

1. Type 1: Liquids
2. Type 2: Other forms (example: wafers).

• They are used for the identification of bacterial plaque, which is invisible to the naked eye.
• When applied to teeth it imparts a color to the soft deposits. It can provide a valuable visual aid in patient instruction and oral hygiene instruction programs.

Properties of an acceptable disclosing agent include:

1. The intensity of color: It should contrast with normal color of oral cavity.
2. Duration of intensity: The color should not be rinse of with the ordinary rinsing method or be removable by saliva.
3. Taste: Taste should be pleasant and motivate the patient.
4. Not be irritating to the oral mucosa.
5. The diffusibility solution should be thin enough so that it can be applied readily to the exposed surfaces of teeth, imparting an intensive color to plaque.
6. Old and new plaque should stain differently.

Agents used for disclosing plaque are as follows:

• Iodine solution: For example, Skinner’s solution, tincture of iodine
• Aniline dyes
• Red erythrosine: It is available as rinses, topical application, and tablets. New plaque stains pink and old plaque stains blue
• 1,3 Tetrazolium compound with methylene blue. The new plaque is stained blue and the old plaque is stained red.
• Bismark brown
• Fluorescein dye: The stained plaque should be viewed in UV light
• Mercurochrome preparations: The solution is directly applied with cotton pellets onto the teeth surface and the patient asked to rinse the mouth.
• Tablets and wafers are chewed and swished for 30–60s and spitted out. The disadvantage is that it can cause staining of filings.
• As these disclosing agents may stain the skin vaseline is applied on the lips before their use.

Question 2. Discuss the mechanical plaque control measures.
Answer:

Home Care Dental Cleansing Aidsl: There are a number of aids that can be used in home dental care cleansing:

1. Toothbrush (manual or electric)
2. Interdental aids
   • Dental floss (unbounded, unwaxed, or waxed)
     • Variable diameter floss
     • Perio-aid (round toothpick holders).
   • Triangular toothpicks
     • Hand-held triangular toothpicks
     • Proxapic.
   • Brushes
     • Proxabrush system
     • Bottle brushes
     • Single tufted brushes (flat or tapered).
3. Others
   • Gauze strips
   • Pipe cleaners
   • Rubber-tip stimulator
   • Water irrigation device
   • Floss holders.

Question 3. Write a note on toothbrushes.
Answer:

• Tooth brushing is the most commonly used mechanical method to remove supragingival plaque from the occlusal surfaces and broad, flat tooth contours.
• The ADA has described the range of dimensions of acceptable brushes. The brushing surface should be 1–1.25 inches.
• (25.4–31.8 mm) long and 5/16 to 3/8 inch (7.9–9.5 mm) wide, and have two to four rows of bristles and 5–12 tufts per row.
• Bristle hardness is proportional to the square of the diameter and inversely proportional to the square of the bristle length.
• Diameter of commonly used bristles ranges from 0.007 inch (0.2 mm) for soft brushes to 0.012 inch (0.3 mm) for medium brushes and 0.014 inch (0.4 mm) for hard brushes.
• Bass recommended straight handle and nylon bristle 0.001 inches (0.2 mm) in diameter and 0.406 inches (10.3 mm) long with rounded ends arranged in 3 rows of tufts, six evenly spared tufts/row with 80–86 bristles per tufts.
• For children, the brush is smaller, with thinner (0.005 inch or 0.1 mm) and shorter 0.344 inch (8.7 mm) bristles.

Question 4. Describe Tooth Brushing Techniques.
Answer:

A number of toothbrush techniques have been described:

1. Roll method
2. Modified Stillman technique
3. Vibratory: Stillman, Charters, Bass technique
4. Circular: Fones technique
5. Vertical: Leonard’s technique
6. Horizontal: Scrub technique.

• The Bass Technique: The bristle of a soft, multi-tufted toothbrush is angulated at 45° angle to long axis of the teeth with the bristle tips directed towards the gingival sulcus. Light pressure is applied, and the bristles are worked with a vibratory motion.
• The Bass Technique Advantages: The Bass method has the following distinct advantages over other techniques:

1. The short back-and-forth motion is easy to master because it requires the same simple movement familiar to most patients who are accustomed to the commonly used scrub technique.
2. It concentrates the cleaning action on the cervical and interproximal portions of the teeth, where microbial plaque is most detrimental to the gingiva.
3. The Bass technique can be recommended for the routine patient with or without periodontal involvement.

Modified Stillman Method

• The modified Stillman method of brushing permits good cleansing and gingival massage. Recommended in areas with progressive gingival recession and root exposure to prevent abrasive tissue destruction.
• Bristles are pointed apically with an oblique angle to the long axis of the tooth. Bristles are positioned partly on the cervical aspects of teeth and partly on the adjacent gingiva.
• Bristles are activated by short back-and-forth motions and simultaneously moved in a coronal direction.
• The benefits of the modified Stillman method are as follows:

1. The gingiva is mechanically stimulated.
2. The gingival third of the tooth is contacted with a short vibratory motion over the surface, and plaque is removed between the gingival margin and the height of the contour.
3. The tips of the bristle tend to reach the interproximal areas and to clean and stimulate the interdental papillae without injury.

The Charters Method

• A soft or medium, multi-tufted brush is placed on the tooth with bristles pointed towards the crown at a 45° angle to the long axis of the teeth. The sides of the bristles are flipped against the gingiva, and the back-and-forth vibratory motion is used to massage the gingiva.
• The Charters method is especially suitable for gentle plaque removal and gingival massage.
• When using a soft brush, this technique can be recommended for temporary cleaning in areas of healing wounds after periodontal surgery.

Roll Technique

• The Roll technique is easily performed and is used by many people. It is most appropriate when the patient is in normal health.
• In this technique, the bristles are placed well on the gingiva at a 45° angle. Press the sides of the bristles against the tissue and simultaneously roll them incisal or occlusal against the gingival and teeth, similar to the turning of a latch key.

Question 5. What are powered toothbrushes?
Answer:

• Powered toothbrushes mimic the action of manual toothbrushes and also make tooth brushing faster and efficient. They are also known as automatic, mechanical, powered, or electric toothbrushes.
• Most brushes have small removable heads of synthetic fibers which exhibit rotating, reciprocating, and circular motion.
• Damage to the tissues is rare because the brush action tends to stop on the application of excessive pressure.
• These brushes can be used by the general population but they are specifically recommended for patients who are handicapped and those who lack digital dexterity.
• In oscillating brushes, the bristles rotate vigorously in an arc of approximately 60°.
• The brush is held lightly against the teeth so that the bristles move in a gently sweeping arc from the incisal edge to the attached gingiva and back again.
• Another type provides a reciprocating horizontal movement. When a reciprocating type of brush is used in a Bass-like stroke, the bristles are believed to enter into the sulci better and to cleanse them better.
• A third type (elliptical) combines the oscillating with the reciprocating motion and a fourth types uses a rotary motion of the bristles.

Question 6. Discuss dentifrices and its composition.
Answers:

Dentifrices: ADA defines dentifrice as a substance used with a toothbrush for the purpose of cleaning the accessible surface of the teeth.

Dentifrices Composition

Question 7. What is inter-dental cleansing?
Answer:

• Only some cleansing of the inter-dental area is possible with a toothbrush and hence effective plaque removal is not accomplished with a toothbrush alone.
• This is because it is impossible to get the toothbrushes completely into the inter-dental region.
• Anatomy of the inter-dental area is a major factor in the initiation and control of periodontal disease, as well as in the selection of an inter-dental cleaning device.
• Proper cleaning of the inter-dental area is therefore critical since this area is most susceptible to the initiation of periodontal disease.

Inter Dental Cleansing Aids

• It has been shown that toothbrush, regardless of the brushing method used, does not completely remove inter-dental plaque, either in individuals with healthy periodontal conditions or in periodontally involved patients with open embrasures.
• Because the majority of dental and periodontal diseases appear to originate in interproximal areas, inter-dental plaque removal is crucial to augment the effects of tooth brushing.
• The purpose of inter-dental cleaning is to remove plaque, not to dislodge fibrous threads of food wedged between two teeth.
• Although inter-dental cleaning will dislodge food fragments, chronic food impaction should be treated by correcting proximal tooth contact and plunger cusps.
• To achieve optimal plaque control, tooth brushing should be supplemented with a more effective method of inter-dental cleaning.
• The specific aids required for this procedure depends on various criteria such as a size of inter-dental spaces, the presence of open furcations, tooth alignment, and the presence of orthodontic appliances or field prosthesis.
• Among the numerous aids available, dental floss and inter-dental cleaners such as wooden or plastic tips and inter-dental brushes are the most commonly recommended.
• The use of interdental cleansing aids depends upon the type of embrasures.

1. Type 1: Papilla completely fills up the interproximal space and tight contact between adjacent teeth. Aid-dental floss
2. Type 2: Moderate papillary recession, with papilla filling up the interproximal space to some extent but not up to the contact point. Aid-interdental brush
3. Type 3: Complete loss of papillae, papilla apical to the labial CEJ. Aidunitufted brush

Question 8. Wire a note on dental floss and flossing techniques.
Answer:

Dental Floss

Dental flossing is the most widely recommended method of removing plaque from proximal tooth surfaces. Types of floss is available are

1. Multi-tufted nylon yarn that is
2. Either twisted or nontwisted,
3. Bonded or non-bonded,
4. Waxed or unwaxed, and
5. Thick or thin.

There are also monofilament flosses made of a Tefln-type material that do not fray. A variety of individual factors, such as the tightness of tooth contacts, the roughness of proximal surfaces, and the patient’s manual dexterity, not the superiority of any one product, determine the choice of dental floss.

• Even though dental floss has the ability to remove plaque in the interdental areas, and it is frequently recommended by clinicians, routine use of dental floss by the public remains limited.
• Despite the assortment available and its wide recommendation, studies show that only about 18% of adults floss regularly.
• In healthy, properly contoured interproximal gingival tissues, dental floss can be correctly inserted 2–3.5 mm below the tip of the papillae without causing damage to the periodontal ligament or the gingiva.
• It is important to monitor carefully a patient’s subgingival technique since a detachment of the crevicular epithelium can occur.
• Placement of the floss and activation of the flossing motion are important since aggressive or uncontrolled movements or too much pressure can cause laceration of the tissue.
• Floss should not be snapped through the contact areas. Repeated trauma can result in soft tissue clefting.

Dental FlossTechnique: Spool method or loop method

• A piece of floss around 12 to 18 inches is wrapped around the fingers (Spool technique) or the ends may be tied together in a loop.
• The floss is stretched tightly between the thumb and forefinger and passed gently through each contact area with a firm back-and-forth motion.
• The floss is passed apical to the contact area between the teeth, wrapped around the proximal surface of one tooth, and slipped under the marginal gingiva.
• It is moved firmly along the tooth up to the contact area and gently down into the sulcus again repeating the up-and-down stroke two or more times.
• The same action is repeated throughout the entire dentition.

Dental Floss Limitations

1. Difficulty in mastering the technique
2. The time-consuming nature of the procedure
3. Damage to the interdental gingival tissues causing discomfort.

Question 9. Write briefly on interdental brushes.
Answer:

• In patients with exposed interdental root surfaces, plaque removal with dental floss may be more difficult or less effective.
• Interdental brushes have been designed to alleviate the difficulties of interproximal plaque removal in these situations.
• These brushes consist of nylon filaments, twisted onto a wire to form a tapered (Christmas tree) or nontapered form (bottleneck shape).
• Filaments extend from this coated wire at right angles, forming a circular shape that, when pushed into the interdental space, distorts to move fully contact the root surface and reach nylon inaccessible to floss.
• Various brush sizes and handles design are available and may be tailored to meet the patient’s needs.

Interdental Brushes Indications

• Exposed root surface, with anatomic variation; open interdental spaces; exposed furcation areas, under pontics, bridge embrasures; fixed orthodontic appliances and in implant maintenance.
• Some interproximal brushes are constructed like test tube brushes in various shapes.
• Other types consist of replaceable brushes that insert into handles. They are made in a variety of shapes to facilitate cleansing in the posterior areas of the dentition.
• They are inserted interproximal and are activated with short back-and-forth strokes in between the teeth.
• Since twisted brushes are highly effective on the lingual surfaces of mandibular molars and premolars, where a regular toothbrush in often impeded by the tongue and for isolated areas of deep recession it is generally recommended for these situations.