3. introduction
• The emergence of a new philosophy and dentistry based on
prevention rather than repair and replacement has been
one of the most significant developments in the history of
dentistry. Due to this preventive philosophy ,the dentistry
for children now focuses to a very extent on inculcating
sound dental practices in each child patient for a healthy
dentition to last for life.In order to realize this goal the
home oral hygiene and plaque control become the most
important aspects of patient and parent education which a
pedodontists can provide.In this presentation,this aspect of
preventive dentistry is being highlighted in particular
reference to a child patient.
4. Plaque control
• It is the regular removal of dental plaque and the prevention of
its accumulation on the teeth and adjacent gingival surfaces.
• It is the key to prevention and successful treatment of
periodontal disease.
• although 100% plaque control is not possible , the tolerance of
some inflammation suggests that the host response can
effectively handle a degree of inflammation.
• Under certain conditions that are not evident, however,some
periodontal site undergo tissue destruction and loss.therefore,
the patient and the therapist must constantly be diligent and
persistent in plaque removal.this includes continuing education
and motivation using a variety of devices and tecniques.
5. Goals of plaque control
• 2 broad goals are:
• A) use of mechanical and chemical agents on a
personal day to day basis to eliminate
supragingival plaque along with dietary control to
prevent the onset of dental caries.
• B) mechanical removal of subgingival plaque
through professional means periodically so as to
maintain predominantly gram-positive flora
associated with gingival health.
6. Mechanical plaque control
a)Gauze piece for use in infants
b)Manual toothbrush & dentifrices
c)Electronic & powered toothbrush
d) Dental floss
e) Disclosing agent
f) Tongue scrapers
g) oral irrigators
7. GAUZE PIECE FOR USE IN INFANTS
A moist gauze piece wrapped around the finger can be
ideal for cleaning gumpads in children
8. Toothbrush
• Most widely used oral hygiene aids
• Principal instruments in general use for
accomplishing the goals of plaque control.
• Has been described as “the most classic and
principal method employed in oral hygiene.”
• Acc. To ADA’s council on Dental therapeutics “the
toothbrush is designed primarily to promote
cleanliness of teeth and oral cavity”.
9. Toothbrush development timeline
3000BC Egyptians use small branches with frayed ends to clean teeth
1400AD Chinese invent bristle toothbrush, made of Siberian wild boar hair fixed
to a bamboo or bone handle.
1600AD European travelers to china bring back toothbrush, replace wild boar hair
with softer horse hair.
1885AD Companies began to mass produce manual toothbrushes.
1938 First nylon bristles introduced
1950 Nylon bristles were made softer
1960 1ST electric toothbrush introduced in U.S.
1987 1ST rotary action electric toothbrush for home used introduced.
2000 Low-price power toothbrushes become popular.
10.
11. Parts o f a toothbrush
• Handle: part grasped in the hand during tooth brushing
• Head : working end of a toothbrush that holds the bristles or filaments
• Tufts : clusters of bristles or filaments secured into head
• Brushing plane : the surface formed by the free ends of the bristles/filaments.
• Shank : the section that connects head and handle
Toothbrushes should be able to reach and effectively clean most areas of teeth.
Type of brush is a matter of individual preferences.
2 kinds of bristle material use: natural bristles from logs ; artificial filaments of
nylon, both types remove plaque but nylon filament are superior in
homogenicity of material, uniformity of bristle size; # resistances ; repulsion of
water and debris.
12. - Generally toothbrushes very in size, design as well as in length and arrangements
of bristles hardness, to overcome this variation ADA given specification of
toothbrushes.
- ----------------------------------------------------------
› Length : 1 to 1.25 inches
› Width : 5/16 to 3/8 inches
› Surface area : 2.54 to 3.2 cm
› No. of rows : 2 to 4 rows of brushes
› No. of tufts : 5 to 12 per row
› No. of bristles : 80 to 85 per tuft
› Diamt. for soft brushes: .007 inch; for medium brushes- .12 inch ;
› for hard brushes - .014 inch
Toothbrush
13. • For a pediatric usage it is preferable to use a toothbrush with a head
size fitting conveniently the oral cavity of child.
• Brush handle should be of length appro. Enough to be held by child,
angulation of head be such that child can carry the brush to his
posterior teeth easily.
• Acc. To Bass recommendation, smaller brush with thinner Diamt.-
0.005 inch/0.1 m; shorter length: 0.344 inch/8.7m
• Oral B cross action toothbrush has the most superior properties
among all manual brushes.
• The ideal time to replace a toothbrush is 3 months or moment when
bristles appear worn out
14. Frequency and duration of brushing
• Generally, adults take not more than 45 secs to brush; children
even less.
• It is recommended to clean the teeth for at least 1-2 mins.
• Brushing twice is recommended.
• If only once brushing is practiced, best to do it before going to
sleep.
• Use of disclosing solution to check the thoroughness of brushing
is recommended in children.
• Jenkins suggested that tooth brushing before a meal is optimal.
Brushing of teeth 5 or more mins after eating may remove
remineralizing effects of saliva.
15. Powered toothbrush
• Level of oral hygiene achieved by an individual is dependent on
technique, motivations, dexterity and perseverance. Since the
behavioral practices can’t be modified, the greatest potential
for improving oral hygiene will come from advancements of
brush design that enhance plaque removal .
• So, powered toothbrushes were devised in 1939.they have 3
motions back and forth , circular and elliptical and are mostly
recommended for:
• Individual lacking motor skill
• Handicapped patients
• Patients who have orthodontic appliances
• Whosoever wants to use
16.
17. Manual and powered toothbrushes
• Characteristic manual powered
• Brushing duration 20-40 sec 1-3min
• Teeth brushed at a time multiple one/multiple
• Brush head motion cross & multiple minimal
• Brush head strokes 40-100/min 10-40/min
• Brush head load 150-1000grams 50-250 grams
• Brush head speed zero 1000s/min
18. Electric toothbrushes are still the most effective in visually disabled grp.
however ,becoz of cheaper cost ,easier availability ,use, the oral B cross
action toothbrush with criss - cross bristles could be a suitable alternative.
( Asmita Sharma,et al 2012)
No evidence of a statistically significant difference between powered and
manual brushes. However, rotation oscillation powered brushes significantly
reduce plaque and gingivitis in both the short and long-term
(C. Deery , et al 2003)
Electric toothbrush have not been shown to provide benefits routinely for
children who are well-motivated brushers , or patients with chronic
periodontitis.
( Heasman, 1999)
19.
20. Method Bristle placement Motion Advantage/
disadvantage
Scrub Horizontal on gingival margin Scrub in anterior position direction
keeping brush horizontal
Easy to learn & best suited
for children
BASS Apical towards gingival into sulcus at
450 to tooth surface
Short back and forth vibratory
motion while bristles remain in
sulcus.
Easily learned
Good gingival stimulation
Cervical and sulcus plaque
removal
Charter's Coronally 45o, sides of bristles half on
teeth and half of gingiva
Small circular motions with apical
movements towards gingival margin
Hard to learn and position
brush
Clears inter proximal
Gingival stimulation
Fones Perpendicular to the tooth With teeth in occlusions, move brush
in rotary motion over both arches
and gingival margin
Easy to learn
Inter proximal areas not
cleaned
May cause trauma
Roll Apically, parallel to tooth and then
over tooth surface
On buccal and lingual inward
pressure, then rolling of head to
sweep bristle over gingiva & tooth
Doesn't clean sulcus area
Easy to learn
good gingival stimulation
Stillman's On buccal and lingual, aplically at an
oblique angle to long axis of tooth.
Ends rest on gingiva and cervical
part.
On buccal and lingual slight rotary
motions with bristle ends stationary
Excellent gingival
stimulation
Moderate dexterity required
Moderate cleaning of
interproximal area
22. 1- The bristles are placed onto the attached
gingiva & cervix of teeth at 45 degrees to
the long tooth axis.
2- Apply pressure & activate the brush
coronally with 20 short back-&-forth mov.
Modified Stillman’s Technique
24. BRUSHING TECHNIQUE USED COMMONLY IN CHILDREN
• FONE’S TECHNIQUE
• HORIZONTAL SCRUB TECHNIQUE
• BASS METHOD
25. dentifrices
• A substance used with a
toothbrush or other
applicator to remove the DP,
material alba , debris, stains
from teeth, tongue and
gingiva for cosmetic,
therapeutic or preventive
purposes
26. Component % Added Use Example
Detergent 1.2%
• To lower surface tension
• Penetrate and loosen surface deposits and strain
• Emulsify debris for easy removal by the toothbrush
• Contribute to the foaming action
Sodium lauryl sulphate
Cleaning and
polishing
20 to 40 %
• A dentifrice may have a combination of agents in
abrasive system to accommodate both cleaning and
polishing objective
• Abrasive is used to clean
• A polishing agent is used to produce a smooth, shining
tooth surface that resists discoloration, bacteria
accumulation and retention
Calcium carbonate,
calcium pyrophosphate,
bicalcium phosphate
Binders 1 to 2 %
• To prevent separation of the solid and liquid
ingredients during storage
• Contribute to the stability and consistency of the
toothpaste
Organic hydrophilic
colloids, alginates,
magnesium aluminium
silicate, colloidal silica
Humectants 20 to 40 %
• These are added to retain moisture
• Prevent hardening on exposure to air
• To stabilize the preparation
Glycerin, Sorbitol
27. Component % Added Uses Example
Preservatives
• To prevent bacterial growth and to prolong shelf
life
Alcohols,
formaldehyde and
dichlorinated phenols
Sweetener 2 to 3 %
• To impart a pleasant flavor for patient’s
acceptance
Sorbitol and glycerin
Flavoring agent 1 to 15 %
• To make the dentifrices desirable
• To mask other ingredients that may have less
pleasant flavor
Peppermint,
cinnamon, menthol
Therapeutic
agent
1 to 2 %
• For medicinal value Fluoride
Coloring agent 2 to 3 %
• Added for attractiveness
Water 20 to 30 %
• Main transport medium
28. fluoride dentifrices
• Recommendations for use of fluoridated dentifrices in children
• Age type of dentifrice frequency of brushing
• 6 months non-fluoridated twice daily in morning or at night; in
to 3 yrs. very young child brushing without
denti.is also acceptable
3-7 yrs. non-fluoridated once daily every morning
fluoridated once daily at night before going
to bed.
>7 yrs. fluoridated twice daily brushing
29. • For pediatric use it is best to select fluoridated toothpaste
for any child above 36 months of age, having low abrasive
content, is flavored , accepted by ADA.
• No fluoridated toothpaste should be used till 36 months
of age due to incr. risk of systemic ingestion in children.
• Till child is 7 yrs. of age only pea size quantity of dentifrice
should be dispensed for brushing.
• Parents should be counseled on their child’s caries risk,
frequency & supervision of tooth- brushing.
30. • Among the individual methods of fluoride delivery (fluoride toothpastes and
rinses), the use of fluoride toothpastes is by far the most important because it
combines the use of fluoride with the mechanical removal of the biofilm. There is
unequivocal evidence that fluoride toothpastes are efficient to control caries and
have played an important role in the caries decline observed in both
developed19 and developing countries. (Fluoride: its role in dentistry§ ;Braz Oral
Res. 2010;24(Spec Iss 1):9-17)
• Toothpastes containing 1,000-1,500 ppm F (also named conventional fluoride
toothpastes) have proven highly effective to control caries, by many high-
quality, randomized and controlled studies conducted in the last decades.(source:
same as above)
• Toothpastes with increased fluoride concentration(e.g. 5,000 ppm F) have been
launched aiming to control root caries, considering that dentine is more caries-
prone than enamel. There is some evidence that these toothpastes are more
effective than the conventional ones in such cases, but a review of the literature
on this subject is still lacking.(same as above)
31. • F toothpastes are not able to control caries under a high cariogenic
challenge (biofilm accumulation and exposure to sucrose 8 times/day).
The lower fluoride availability in the biofilm fluid and solids, either soon
after or 10 to 12 hours after the use of a low fluoride toothpaste, may
explain these results. (Low-fluoride toothpaste and deciduous enamel demineralization under
biofilm accumulation and sucrose exposure. Eur J Oral Sci. 2010 Aug;118(4):370-375. )
• A recent systematic review of the literature confirmed that the
effectiveness of fluoride toothpastes is proven in conventional strength
formulations, but not in low fluoride ones. (Fluoride toothpastes of different
concentrations for preventing dental caries in children and adolescents. Cochrane Database Syst
Rev. 2010 Jan 20;(1):CD007868)
• Brushing with F dentifrice at night to remineralize daily mineral losses appears
to be more effective than brushing in the morning to inhibit the demineralizing
episodes of the day. It is possible that use at night may reduce F clearance and
increase its availability, causing lower mineral loss.(Timing of fluoride toothpaste use
and enamel-dentin demineralization ;Braz Oral Res. 2011 Sep-Oct;25(5):383-7 )
32. • The best recommendation on the use of fluoride toothpastes by young children,
considering the balance of benefits and risks, is that a small amount of
dentifrice should be used. For example, by recommending the use of 0.3 g of
toothpaste per brushing (similar to the size of a pea), the amount of fluoride
ingested would still fall within the safe limit considering fluorosis risk involving
aesthetic issues. {Fluoride intake by Brazilian children from two communities with fluoridated
water. Community Dent Oral Epidemiol. 2003;31(3):184-91.}
• In fact, since the anticaries effect of fluoride is concentration-dependent (the
concentration of free fluoride in the mouth), and the fluorosis risk is dose-
dependent (the dose of fluoride circulating in the blood according to the child’s
weight), a reduction in the amount of toothpaste used by young children would
reduce the risk of dental fluorosis without significantly affecting its anticaries
benefit. It is thus a recommendation that can be made for all children,
irrespective of their social or caries-risk status.{How much toothpaste should a child
under the age of 6 years use? Eur Arch Paediatr Dent. 2009Sep;10(3):168-74.}
33. interdental cleaning aids
Any tooth brush , regardless of the brushing method, does not
completely remove interdental plaque. Even for patients with wide-
open dental embrassures. ( Gjermo, 1970, Schmid 1976).
The majority of dental and periodontal disease's originate in
interproximal area, interdental plaque removal is necessary
Tissue destruction associated with perio. Disease often leave large
open spaces, between teeth and exposed roots with anatomic
concavities and furcations which are difficult to clean and access
with the toothbrush.
The purpose of Interdental cleaning aids is to remove plaque, not to
dislogde food wedged between teeth.
34.
35. Interdental brush (proxy brush):
Interdental brush are conical shape
brushes made of bristles mounted
on a handle, single tufted brushes,
or small conical brushes.
They are suitable for cleaning large,
irregular, or concave tooth surfaces
adjacent to wide interdental
spaces.
They are inserted interproximally
and are activated with short back
and forth strokes in between the
teeth.
36. • They are used with back and forth strokes
between teeth.
• For most efficient cleaning, the diameter of
the brush must be slightly larger than the
embrasures to be cleaned.
37. • Single tufted brushes are slightly effective on lingual surface of mand.
Molar & PM; regular toothbrush is often impeded by tongue.
Waerhaug in 1976 evaluated the effect of interdental brushes on 67
teeth which scheduled for extraction.
› Teeth were cleaned prior to extraction and then stained and examined
after extraction.
› The results indicated that plaque can be removed from 2 to 2.5mm
subgingivally using the interdental brush
38. Wooden tips
• Are used either with / without a handle.
• Soft triang. W.t like stim-u- dent are placed in
interdental space in gingiva,slide with contact
the proximal tooth surface.
• Repeatedly moved in & out of embras.,
removing soft deposit for teeth and
mechanically stimulating the gingiva.
• Use is limited to facial surfaces.
39. Dental floss: (df)
• 1st paper on DF was published by PARMLY in 1819.
• In 1882, CODMAN AND SHURTUFF made 1st commercial floss of
silk.
• In 1948, BASS recommended nylon floss is superior to silk.
• Size of DF: 300-1500 D(denier)
• Floss is constructed with help of individual filaments 2 -3D thick
40. Dental floss:
Dental floss is the most widely
recommended method for removing
proximal plaque.
The floss is wrapped around each proximal
surface and is activated with repeated up
and down stroke.
Floss should pass gently through the contact
area. Do not snap the floss pass the contact
area as it may injure the interdental papilla.
41. Dental floss :types
• 1) twisted & non-twisted
• 2) bonded & non- bonded
• 3) thin & thick
• 4) microfilament & multifilament
• Acc to ADA specification:
• Type I- unbonded dental floss composed of yarn having no
additives.
• Type II- Bonded DF composed of yarn having no additives other
than binding agent or agent for cosmetic performance.
• Type III- Bonded or unbonded having drug for therapeutic usage.
42. Dental floss :types
• unwaxed, waxed, tape floss,, and
Superfloss.
• Waxed floss contained wax to
facilitate passing the floss
through the contact and alleviate
fraying.
• Tape floss contain criss-cross
fiber and eliminate fraying.
•
• Superfloss is the web-like
material which improved
proximal cleaning efficiency.
43. • Flossing can be made easier by using a floss holder –
• Floss holder should have –
1. One or two fork that enough to keep the floss tent even when its
moved pass tight contact area
2.An effective and simple mounting mechanisms
44. There are no significant difference between various types of floss to
remove dental plaque , they all work equally well ( Grossman 1979, Keller 1969).
Graves et al. in 1989 evaluated in a 2 week clinical trial the efficacy of
unwaxed dental floss, dental tape, waxed floss, and tooth brushing alone in
reduction of interproximal bleeding.
The result showed that the dental tape and dental floss were equally effective
in reducing interproximal bleeding and twice effective as tooth brushing
alone.
45. Lambert et al. in 1982 compare the waxed and unwaxed floss to determine
the efficacy to remove plaque and their effect on gingival health during a
home oral program.
The results showed there was no statistical difference between the types of floss
in regards to their ability to remove plaque or prevent gingivitis.
Wunderlich et al. in 1982 reported there is no difference between wax and
unwaxed floss in maintaining gingival health.
A comparsion study between dental floss and interdental brush in patients
with sever to moderate periodontitis , showed that interproximal brushes
remove slightly more interproximal plaque and that the patients found them
easier to use. (Christou,1998)
46. Wong and Wade study in 1985,
which they compared the
effectiveness of Super floss and
waxed dental floss as proximal
surface cleansing agent in 34
subject.
Superfloss was found to be
superior (50%) to waxed dental
floss(45%) in removing proximal
plaque but neither was 100%
efffective.
47. Flossing for children
• Not all children can floss effectively.
• Ability to floss is a function of age & manual dexterity.
• Ability to manipulate floss and remove plaque is highly dependent on
hand & eye coordination and age.
48. APPLICATION
Hold floss firmly in a diagonal or oblique position
Guide the floss past contact area with a gentle motion
Control floss to prevent snapping through the contact area onto the gingival tissue
Pass the floss between the gingival margin, curve to adapt the floss around the
tooth, press, and side up and down over the tooth surface
49. DISCLOSING AGENTS
• A disclosing agent is a preparation in
liquid, tablet or lozenge from which
contains a dye or other coloring agents
• A disclosing agent is used for
identifying bacterial plaque
• When applied to the teeth, the agents
imparts its colour to soft deposits but
can be rinsed easily from clean tooth
surface
50. IDEAL PROPERTIES
• Intensity of colour
• Duration of intensity
• Taste
• Irritation to mucous membrane
• Diffusibility
• Astringent and antiseptic property
51. Agents used for disclosing plaque
a. Iodine preparations
• Skinners iodine solution
• Diluted tincture of iodine
b. Mercurochrome preparations
• Mercurochrome soln 5
• Flavored mercurochrome disclosing solution
c. Bismark brown
d. Mebromin
e. Erythrosine
f. Fast green
g. Fluoresin
h. Two tone solutions
i. Basic fuschin
52. Oral irrigation
• Oral irrigation device include the use of
water picks.
• The high pressure, pulsating stream of
water through a nozzle is directed to the
tooth surface and subgingivally, washing
away debris and plaque containing
bacteria.
• They are helpful surrounding orthodontic
appliance, and when used as an adjucntive
treatment in shallow pocket depth.
• Patients reqiure antibiotic premedication
should not use oral irrigation.
• Not commonly recommended for pediatric
usage.
53. • Eakle et al. in 1986 showed that the oral irrigator deliver an aqueous
solution into the periodontal pocket and will penetrate an average to
approximately half the depth of the periodontal pockets.
• Penetration of 90 degree angle stream of water is about 70% for pocket
less than 3mm, 44% for moderate pocket (4 to 7 mm) and 68% for deep
pocket ( greater than 7mm).
• For 45 degree angle, the result is 54%, 45%, and 58% respectively.
54. • When used as adjuncts to
toothbrushing , irrigation
devises, can have a
beneficial effect on
periodontal health by
reducing the accumulation
of plaque and calculus and
decreasing inflammation
and pocket depth.
• ( Robinson and Hoover,
1971)
55. Ciancio in 1989 evaluate the efficacy of an
antimicrobial rinse delivered by an oral irrigation
device twice daily.
The results showed that irrigation with or without
an antimicrobial agent was effective in reducing the
plaque, suggesting that oral irrigation may be
beneficial on oral health and the use of the
chemotherapeutic agent will lead to greater
reduction in plaque and gingival bleeding and to
moderate decreases in total bacteria counts
detected by phase contrast microscopy
56. Tongue scrapers
• May be flat ,flexible ,plastic sticks which help in cleaning the rough
dorsal surface of tongue.
• Additionally, gauze piece can also be used as tongue scraper.
• It should be routinely recommended for all the patients.
57. Toothette
• It is a swab of sponge attached to a stick .
• Used in oral cleaning in hospitals and in patients having extremely
fragile tender gingiva or mucosal lesions.
• Also helps to deliver moisture and swab cleaning of the oral cavity.
