Mechanical Plaque Control

Mechanical Plaque Control

Define plaque control. Write in detail about mechanical plaque control. 
Or
Write short answer on mechanical plaque control.
Answer. Plaque control is the removal of dental plaque on a regular basis and the prevention of its annulations on the teeth and adjacent-gingival surfaces.

Mechanical Plaque Control

Mechanical plaque control is achieved by following methods:

• Toothbrush: Manual or powered
• Interdental aids:
  • Dental floss
  • Triangular tooth picks
  • Inter – dental brushes
  • Gauze strips
• Others:
  • Rubber-tip stimulators
  • Water irrigator

Toothbrush

Toothbrush is a mechanical plaque control device.

• It may be manual or powered.

Types of Toothbrush

Toothbrushes are of following types, i.e.

• Manual toothbrushes.
• Powered toothbrushes.
• Sonic and ultrasonic toothbrushes.
• Ionic toothbrushes.
• Orthodontic toothbrushes:
  • Manual toothbrushes: It requires manual regulation.
  • Powered toothbrushes: Automated battery-driven toothbrushes with bristles moving in a side-to-side or rotary or reciprocating motion.
  • Sonic and ultrasonic toothbrushes: Toothbrushes that produce high frequency vibrations that leads to the mechanism of acoustic streaming and cavitation similar to ultrasonic scalers. These vibrations disrupt bacterial cell wall and remove plaque.
  • Ionic toothbrushes: These brushes are designed to release positively charged ions that change the surface charge of a tooth.
  • Orthodontic toothbrushes: They are designed especially for patients with orthodontic appliances. The bristles in the centre of the brush are shorter than those present at the periphery allowing it to pass over the appliance without causing abrasion of the teeth.

Manual toothbrushes

• A toothbrush consists of handle, shank and head.
• According to ADA, specification of toothbrush a head of the brush should be:
  • 1” to 1/4” long (Brushing surface).
  • 5/16” to 3/8” (7.9 to 9.5 mm) wide.
  • 2–4 rows of bristles.
  • 5–12 tufts per row.
  • 80 to 86 bristles per tuft.
    The extreme end of head is toe and close to the handle is heel.
    Size: Large, medium and small.
    Lateral profile: Flat, convex, concave and scalloped.
    Bristles: Two kind of bristle materials are used in toothbrush.

• • • Natural from hog.
    • Artificial by nylon.

mechanical plaque control

Hardness

Depends on material, diameter and length

Soft: 0.007” to 0.009” (No. 7, 8, 9)

Medium: 0.010” to 0.012” (No. 10, 11, 12)

Hard: 0.013” to 0.014” (No. 13, 14)

Extrahard: 0.015” (No. 15).

Handle design

• Handle should be fit comfortably in the palm of the hand
• It may be straight or angled.
• It may be thick or thin.

Bristles

• Bristles are of two types, i.e. nylon and natural.
• Nylon bristles are preferable brushes.
• Natural bristles are more susceptible for breakage, their contamination chances by bacteria are very high.

Powered toothbrushes

• Electrically powered toothbrushes were invented in 1939.
• Various types of motion in powered toothbrushes are:
  • Back and forth reciprocal.
  • Circular.
  • Elliptical or combination.

Powered toothbrushes are indicated for:

• Children and adolescents.
• Children with physical or mental disability.
• Hospitalized patient, including older adults who need to name their teeth cleaned.
• Patient with fixed orthodontic appliances.
• They are particularly useful for cleaning proximal surfaces and for people with limited dexterity. Toothbrushes are used with dentifrices.

Advantages of powered toothbrushes

• Increases the patient motivation.
• Cleaning in interproximal areas and on lingual surfaces is increased.
• Apply less brushing force when compared to manual toothbrush.

Interdental Aids

Interdental plaque removal is crucial because majority of dental and periodontal diseases originates in interproximal area.

• Other condition formed in periodontal and gingival diseases also demands interproximal cleansing.
• The purpose of interdental cleaning is to remove plaque. Among the numerous aids available dental floss and interdental cleaners such as wooden or plastic tips and interdental brushes are commonly recommended.
• Criteria of selection of these aids depends on type of embrasures
  Type 1. Interdental papilla completely fills embrasure space. Dental floss can be used.
  Type 2. Mild loss of interdental papilla due to slight spacing between the teeth, Interdental brushes can be advised.
  Type 3. No proximal contact between the teeth like diastema where there is no interdental papilla. Unitufted brushes are advised.

plaque control methods

Dental Floss

• It is used for cleaning in narrow gingival embrasures that are occupied by intact papilla and border by tight contact zones. It is most effective dental hygiene aid.
• There are various types of dental floss i.e.
  • Twisted or non-twisted
  • Bonded or non-bonded
  • Waxed or unwaxed
  • Thick or Thin
    • Dental floss should contact the proximal surface from line angle to line angle to clean effectively.
    • Wax dental floss leave a coating on inter proximal surfaces to which debris may stick. Thick floss causes difficulty to floss in tight contact areas.

Interdental Brushes

• It is used in area of moderate papillary recession, proximal tooth surface adjacent to open embrasure, orthodontic appliances, fixed prosthesis, dental implant and other area that are hard to reach with regular toothbrush.
• They are single-tufted brushes or small conical brushes.
• These brushes should be inserted in inter-proximal spaces and are activated by short back and forth strokes in between the teeth.

Unitufted brushes

• It is used in accessible areas such as lingual surface of mandibular molars, abutment teeth, distal surface of most posterior teeth, crowded teeth, open interproximal areas and in deep recessions. It is also indicated in fixed dental prosthetics.
• They are mainly used in Type 3 gingival embrasures

Wooden Picks

• It is used for plaque removal at or just underneath gingival margin, for concave proximal tooth surface and for exposed furcation area.
• Soft triangular wooden picks should be placed in the interdental space in the manner that base of triangle rest over gingiva and sides contact the proximal tooth surfaces and now the pick is move in and out of embrasure which remove soft deposits.
• Wooden tooth picks should be attached to the handle and then used on facial and lingual surfaces of tooth in oral cavity.
• They are the substitute for dental floss in Type 3 embrasures.

Gauze Strips

brushing and flossing plaque removal

It is used for the cleaning of proximal surface of widely spaced teeth, for the surface of teeth which lies next to edentulous space and fixed appliances.

Irrigation Device or Water Pik Device

• They are composed of built in pump and a reservoir.
• These devices remove the unattached plaque and debris.
• When these devices are used adjunct to toothbrushing they enhance the periodontal health by decreasing plaque and calculus formation.