Periodontal Plaque Control Chapter 43
Chapter 43
Focuses on Plaque Biofilm Control for the Periodontal Patient
The Toothbrush
Design and Effectiveness
Manufacturers claim superiority based on bristle placement and design.
Study comparison of four toothbrushes showed no significant difference in plaque biofilm removal.
Usage Factors
The effectiveness of toothbrushes is impacted by:
Hard toothbrushes
Vigorous horizontal brushing
Use of abrasive dentifrices
Bristle Characteristics
Rounded bristle ends are gentler on gums compared to flat-cut bristles.
Two bristle materials:
Natural bristles (hog hair)
Artificial filaments (nylon)
Bristle hardness:
Proportional to diameter squared
Inversely proportional to bristle length squared
Powered Toothbrushes
Historical Development
Invented in 1939 to mimic brushing motions.
Modern versions feature oscillating and rotating motions.
Sonic vibrations do not affect bacterial viability.
Benefits
Show improvement in oral health for:
Children
Individuals with disabilities
Hospitalized patients
Those with braces
No routine benefits for:
Patients with rheumatoid arthritis
Motivated children
Chronic periodontitis patients
Dentifrices
Composition
Common forms: pastes, powders, gels
Key ingredients include:
Abrasives
Water
Humectants
Flavoring agents
Therapeutic agents
Fluoride Benefits
Proven effective in caries prevention with a concentration of 1000-1100 ppm.
"Calculus control" toothpastes contain pyrophosphates to reduce new calculus formation.
Toothbrushing Methods
Various brushing techniques include:
Roll
Modified Stillman
Vibratory
Bass
Charters
Circular
Fones
Vertical
Horizontal
Scrub
Bass Technique
Proper positioning of the brush:
Brush head parallel to occlusal plane covering 3-4 teeth.
Bristles angle at 45-degree to gingival margin.
Use gentle vibratory pressure with short back-and-forth motions.
Interdental Cleaning Aids
Importance
Toothbrushes do not fully remove interdental plaque biofilms.
Purpose: remove microbial plaque, not just food debris.
Common aids include:
Dental floss
Interdental brushes
Rubber tips
Wooden/plastic tips
Dental Floss
Available in various types (waxed, unwaxed, flavored, etc.), but studies show no significant differences in plaque removal.
Selection factors include:
Tightness of tooth contacts
Roughness of surfaces
Patient dexterity
Interdental Brushes
Most effective for removing plaque in non-filled papilla spaces.
Brush size should be larger than the gingival embrasures.
Gingival Health and Massage
Massaging gums can improve health but is not essential for restoration.
Oral Irrigation
Types
Supragingival & Subgingival irrigation techniques.
Use pulsating streams of water for removing non-adherent biofilm.
Chlorhexidine solution enhances the effect.
Caries Control
Root Caries Issues
Increased risk for periodontal patients due to attachment loss.
Fluoride's role: prevents and reverses the caries process through topical effects.
Chemical Plaque Biofilm Control
ADA approved agents:
Prescription chlorhexidine
Non-prescription essential oil mouth rinse
Chlorhexidine shows significant antibacterial results.
Disclosing Agents
Help visualize plaque for better control of hygiene routines.
Can be used in office or distributed for home use.
Maintenance of Oral Hygiene
Importance of Frequency
Average daily care is insufficient (removes only 40% of plaque).
Regular visits and patient education increase compliance.
Patient Education
Understanding disease etiology and compliance is essential for effective plaque control.
Instruction and Demonstration Techniques
Educational Approach
Practical, hands-on instructions are necessary for effective learning and compliance.
Use rubber tips and disclose plaque for demonstration purposes.
Final Notes
Importance of patient motivation and education in long-term success of periodontal therapy.