This document discusses personal oral hygiene and plaque control methods. It covers various terms used, including oral hygiene and oral physiotherapy. Periodontal disease is largely preventable through behavioral choices like oral hygiene practices. Good plaque control is key to preventing and treating periodontal disease. The document reviews different home care techniques like toothbrushing and the use of interdental cleaning aids. It also discusses the frequency of plaque removal and the role of chemical plaque control agents in toothpastes and mouthwashes.

1. ORAL
PHYSIOTHERAPY

2. Introduction
 Terms that have been used to describe
those methods used by the patient to
remove plaque are
 Home care,
 oral hygiene,
 oral physiotherapy,
 personal oral hygiene, and
 personal plaque control

3. Cont…
 This presentation deals with various
aspects of personal oral hygiene but not
professional debridement.
 Periodontal disease is largely
preventable.
 Like many chronic diseases, behavioral
or lifestyle choices play a significant role
in the pathogenesis of periodontitis

4. cont…
 Risk factors involved in periodontal
disease expression
 the subgingival flora,
 genetic predisposition,
 stress,
 systemic disease and
 oral hygiene practices

5. Cont…
 The relation between oral hygiene and
periodontal disease is more complex
than might be thought.
 One of the foundations of periodontal
health and therapy is Adequate home
care.

6. BIOLOGIC RATIONALE FOR PERSONAL PLAQUE
CONTROL
 Oral hygiene, as used in this chapter,
refers largely to efforts to remove the
supragingival plaque.
 Supragingival plaque is the etiologic
agent of gingivitis

7. Cont…
 As the plaque matures and becomes thicker, the
composition of the flora shifts from gram-positive
facultative organisms to an increasingly gram-
negative anaerobic flora.
 This shift is aided by a slight swelling of the gingival
margin that renders the subgingival environment
more anaerobic and more hospitable to obligate
anaerobes.
 The subsequent inflammation results in a protein-rich
exudate that is required by many of these
asaccharolytic organisms as carbon and energy
sources

8.  accumulation of supragingival plaque may affect the
composition of the subgingival microbiota, particularly
in pockets probing less than 6 mm.
 Plaque forms more quickly in sites of gingival
inflammation.
 Good plaque control is effective in preventing
periodontal disease and halting its progress when
combined with professional therapy.

9. HOME CARE TECHNIQUES
 The goal of oral hygiene is the physical
and chemical disruption of the biofilm on
a frequent basis.
 Devices and techniques have been
used
 Toothbrush
 Home irrigation systems
 Electromechanical devices

10. TOOTH BRUSHING
Manual toothbrushes
 Brush should have bristles with rounded tips that are
soft enough to prevent damage to the teeth and
gingiva

11. Cont…
Toothbrush handles are as variable as head designs.
Brushes generally differ with regard to head size, bristle characteristics, and handle design

12. Cont…
 diameter of the bristles is often stated to be around 0.007 inch
 There is some evidence that rounded bristles are less damaging
than those with cut ends.
 Similarly, hard or stiff bristles are more damaging than softer
bristles
 brushes should be discarded at the first signs of matting.
 Some commercially available brushes have bristles that change
color after a certain amount of use, which serves as a reminder
to the patient that it is time to replace the brush

13. Manual brushing techniques
 If a patient can do a good job removing plaque without damage
to the teeth and gingival tissues, then there is no reason to
suggest a change
 Toothbrushing techniques can be grouped by the type of stroke
used.
1. Bass and horizontal scrub techniques
2. Charters technique
3. Roll technique

14. Bass and horizontal scrub techniques
 This method emphasizes sulcular brushing and, for this reason,
has long been popular among periodontists.
 the bristles are angled toward the gingival margin at a 45-
degree angle and gently introduced into the sulcus

15. Cont…
 The brush is then moved in a short
vibratory stroke

16.  It has sulcular penetration of approximately 1 mm
 Using a horizontal scrub motion may be viewed as a
modification of the Bass technique. The bristles are
positioned in a similar 45-degree relation to the
sulcus, but the brush is moved back and forth in a
scrubbing motion rather than in short, circular
vibratory strokes.

17. Charters technique
 The bristles are perpendicular to the
long axis of the teeth

18. Cont…
 The bristles are then gently forced into the interproximal embrasures,
which causes some deflection of the bristles toward the occlusal
surfaces of the teeth.
 The side of the bristles eventually rests on the surface of the gingiva,
unlike the Bass method in which the bristle tip enters the sulcus
 Charters method was supposedly good for gingival massage and was
alleged to be indicated in cases of advanced periodontitis when the
interdental embrasures are relatively open.
 It can be argued, however, that one of the various interdental brushes
might be more effective in this application.
 The Charters method also has been recommended for use in the
postsurgical healing phase, to prevent damage to the immature
attachment apparatus.

19. roll technique
The bristles are angled into the sulcus at a 45-degree angle and
overlap onto the facial gingiva. The head of the brush is then
"rolled" so that the bristles move occlusally

20. Cont…
 The modified Stillman technique is similar to the roll
technique, except that the bristle ends are placed
both into the sulcus and onto the marginal gingiva
before the rolling motion is started
 This brushing stroke is sometimes suggested for use
after periodontal plastic surgery to treat gingival
recession. The rolling motion is used to "guide" the
healing tissues coronally.

21. Cont…
 three concepts must be stressed regardless of the technique
used
1. adequate time must be set aside for brushing
2. must be systematic
3. no method of manual brushing is sufficient to remove
interdental plaque so that use of interdental aids is required.

22. Electromechanical toothbrushes
 brushes that use a powered brush head
 more effective in removal of interproximal plaque
 advantage for patients who do not floss regularly

23. Interdental Cleaning Aids
 The interdental embrasure offers a protected
sanctuary for plaque to accumulate undisturbed
 Manual toothbrushing does not generally have much
of an effect on interdental plaque and gingivitis
 The choice of aids depends largely on the size and
shape of the interdental embrasure and the degree to
which soft tissue fills the space.

24. 1. Dental floss
 The most common one
 Dental floss is available in a variety of different sizes
and configurations.
 Originally, the choice was limited to waxed and
unwaxed floss. The purpose of the wax was
ostensibly to make flossing between tight contacts
easier.
 Waxed and unwaxed floss are equally effective in
removing plaque

25. Cont…
 For some patients the use of "floss aids" may allow
easier management of the floss. These are used as
an option to wrapping of the floss around the fingers.
Although these devices do not appear to improve
effectiveness of plaque removal, some patients may
prefer them to using their fingers

26. cont…
 A piece of floss about 12 to 15 inches in length should be wrapped
around the fingers
 The floss is introduced into an interproximal space by gently moving it
buccolingually in a "sawing" motion
 It should be in C-configuration with care to not damage the papilla
The floss is guided into each
interproximal space and then
curved in a Cshape around each
tooth surface. The floss is moved
in multiple apicocoronal strokes to
remove tooth-adherent plaque.

27.  In the case of fixed partial dentures, floss cannot be
passed through the interdental contact, because this
is closed. Instead, a device known as a floss threader

28. The end of the floss threader is passed into the
embrasure space between the retainer and the pontic

29. The floss is inserted through the "eye" loop and the threader
is passed through to the lingual.

30. The floss is grasped on the facial and lingual and is passed
along the intaglio surface of the pontic.

31. The floss is moved apicocoronally along the interproximal surfaces of
the abutment teeth

32. Floss holders
 assist patients who have difficulty flossing.
Floss holders have a rigid handle with a "yoke" at the end, over which
dental floss is stretched. The patient holds the handle and passes the
floss into each interproximal space

33. The floss is worked gently past the contact point. The handle can
then be moved mesially and distally to bring the floss into contact

34. Automated interdental cleaners
 This device removes interproximal plaque by means
of rotating monofilaments

35. Toothpicks and woodsticks
 group of interproximal aids includes conventional round or flat
toothpicks, in addition to triangular toothpicks designed for
interdental cleaning,
 these aids are better for situations in which there is a slightly
receded interdental papilla

38. Interdental brushes
 consist of two components: a handle and a small,replaceable brush head.
 The brush heads are conical or cylindrical in shape.
 These brushes are best used in open embrasures with low papillary height
where the brush can fit easily in the available space without causing trauma to
the papilla.
 These devices are probably the instrument of choice for cleaning open
embrasures

39. As the interdental brush is passed buccolingually into and out of the
interdental space, the bristles clean the tooth surfaces

40. FREQUENCY OF PLAQUE REMOVAL
 The ADA recommends brushing twice a
day and cleaning between teeth with
floss (or another interdental cleaner)
once a day.
 Some patients prefer to floss in the
evening before bedtime so that the
mouth is clean while sleeping.

41. CHEMICAL PLAQUE CONTROL
 The provision of antiplaque benefits to dentifrices assists
patients in improving hygiene and reducing susceptibility to
gingivitis and caries.
 Chemical plaque control involves different mechanisms and is
mostly associated with antibacterial effects, but also includes
effects on pellicle surface chemistry to improve cleansing or
discourage renewed plaque formation.

42.  Basic ingredients include water, alcohol, cleansing agents,
flavoring ingredients and coloring agents. Active ingredients vary
depending on the type of mouthrinse, but they can be placed
into four general groups:
 Antimicrobial agents act directly on oral bacteria to help reduce
plaque, decrease the severity of gingivitis and control bad
breath.
 Fluoride helps reduce tiny lesions (tooth decay) on tooth enamel
and make teeth more resistant to decay.
 Astringent salts can serve as temporary deodorizers that mask
bad breath.
 Odor neutralizers act by chemically inactivating odor causing
compounds.

43. Schematic presentation of the different mechanisms of action of active
ingredients in dentifrice formulations for chemical plaque control

44. AGENTS FOR HYPERSENSITIVITY AND
ROOT CARIES
Root Caries
 Dentin and cementum are demineralized more easily than
enamel; the pH required for dissolution is 6.0 to 6.5, which is
less acidic than that required for coronal caries
 Major risk factors for root caries include suboptimal fluoride
exposure, recently exposed root surfaces, xerostomia,
cariogenic microflora (e.g., lactobacilli and mutans streptococci),
frequent consumption of fermentable carbohydrates, and poor
plaque control
 Root caries can be arrested by meticulous home care and
frequent application of fluoride
 Dietary analysis and reduction of fermentable carbohydrates is
of significant value

45. Dentinal Hypersensitivity
 It may be caused by toothbrush abrasion and recession caused by
traumatic brushing, resective periodontal surgery, and repeated
professional instrumentation.
 A number of agents have been used, primarily in toothpastes, to reduce
sensitivity.
 Many of these are thought to act by occluding the open orifices of the
dentinal tubules.
 Agents that have been used include strontium chloride, potassium
nitrate, potassium citrate, formaldehyde, and various fluoride
preparations. Although some patients undoubtedly derive great benefit
from desensitizing agents,

46. ORAL HYGIENE INSTRUCTION AND HEALTH
PROMOTION

47. ADVERSE EFFECTS OF ORAL HYGIENE
AIDS
 Tooth Abrasion and
 Gingival Recession