Control of bacterial plaque

- Chemical control
- Mechanical control
o Individual
o professional

Chemical control
Chemical substances can act controlling plaque in different ways:

• Antiadhesive agents: avoid adhesion of plaque.

• Antimicrobial agents: avoids plaque proliferation

Removing plaque that is already established

Altering plaque pathogenicity

Activity in vivo  substantivity

― Prolonged retention in oral surfaces (teeth and mucosa)

― Maintenance of antimicrobial activity once they are fixed to surface

― Slow liberation at the correct dose

Antiplaque agents
Definition: used to inhibit or prevent the formation of plaque on the teeth

1. Chlorhexidine

• Most frequently used antimicrobial agent for caries and gum disease.

• Streptococcus mutans: it’s sensitive to it.

• Substantivity: 12 hours.

Chlorhexidine

1. CLX (c+ charge) joins cell wall (- charge)

2. It alters cell membrane permeability

3. Filtration of intracell. components

4. At bactericidal dose: cytoplasm precipitates and cell die

Mouthwash

•CHX at 0.12 - 0.2%: plaque control and gum disease prevention.

•0,12%: 15ml during 30-45´´ every 12hrs

• 0,2%: 10ml during 30-45´´ every 12hrs

•Don´t use in patients with untreated gingivitis or gum disease  it hides the illness.

Gels & varnishes

•Anticaries agents

•Reduction of S. mutans in plaque and saliva

In the dental practice:

At home:

Sprays

•CHX 0.2% 2 times/day helps to inhibit bacterial plaque formation.

•Useful in disabled people.

Toothpastes

•CHX 0.12 and 0.2%: plaque and gingivitis control.

•Action mechanism can be affected by the interaction with other components.

Secondary effects

• No severe effects

• Staining of teeth surfaces, tongue and restorations

• Alters taste of food

• Desquamations

• Bigger tendency to calculus formation

2. Triclosan

• Frequently found on toothpastes and mouthwashes for plaque and gingivitis control.

• It can be used long term in combination with usual oral hygiene habits.
• No desired effects: tinction, mucosa irritations…

• Easy formulation for toothpastes

• Substantivity:

• 3 hours in oral mucosa

• 5 hours in bacterial plaque

• Combined with copolymers of metoxietilen and maleic acid (Gantrez copolymer) and Zinc
citrate, increases substantivity and effectivity.

Possible side effects (SEE NEW ARTICLES):

- Endocrine disruptor
- Antibiotic resistances

Our recommendations (Triclosan):

3. Hexetidine

• Cationic agent

• Usual concentration: moderate antiplaque results

• Higher concentrations: increases risk of mucosa lesion and staining.

4. Cetylpyridinium chloride

Broad spectrum antiseptic against gram + and gram- bacteria, viruses and fungi similar to
chlorhexidine in vitro; More effective against gram +.

It has a good oral pH absorption

Substantivity in the oral cavity: 3-5h

It performs an antiplaque activity and against the proinflammatory toxins released by bacteria,
thus preventing the appearance of gingivitis.

FDA: safe and effective antimicrobial for the control of plaque-induced gingivitis, when
formulated in a concentration range of 0.045% to 0.1%.

Properties:

Indications:
 - Prevention of gingivitis and peri-implant mucositis

- Patients susceptible to inflammation and bleeding gums

- Prevention in patients with caries risk

- Patients with poor plaque control

- Orthodontic patients

5. Others

Ex:

-Vit E, B5, B12, B3…

-Allantoin

-Zinc (oxide, lactate…)

-Chitosan

-Q10 extract

-Natural extracts (aloe vera, pomegranate, papaya, echinacea)

Mechanical control
Individual plaque control technique:

Manual toothbrushing

Aim : bacterial plaque removal, as well as food rests and staining adhered to the dental surface

Toothbrush design: head, handle, bristles

―Artificial bristles(nailon o poliéster) smaller than 0,23mm diametre

―Round ends

―Change it every 3 months

―Tuft disposition:

• Straight cut

• Multilevel

• Angulated tuft insertion

Bass technique (VIDEO)― Inclination: 45º. ― Place bristles into sulcus. ― Lenght: 2-3 teeth. ―
Short vibrational movements (10- 15sec). ― Move bristles towards occlusal sulcus. ― Vertical
position for lingual and palatal surfaces. ― Oclusal surfaces: antero - posterior movements.

Electrical toothbrush

• First launched in the 70´s (horizontal movements)

• Nowadays: big range of heads and movements

ETB vs MTB? : which is best?

Electrical toothbrush types:

• Lateral movement

• Circular movement with opposite oscillation

• Rotatory-oscillatory movement

• Circular movement

• Ultrasonic  frequency above 20 kHz

• Ionic  transmits an electrical charge to the tooth

Efectivity of ETB

- Useful i areas where acces is difficult.

1. Reduced manual hability • Mental or psysical disability • Elderly patients • Children

2. Particular oral situations • Implants • Orthodontics

Dental floss

AIMS:

1. Removal of B.P . on teeth, restorations, orthodontic aparatology, prosthodontics, gum and

interproximal áreas.

2. Massage of interdental papilae.

3. Detection of subgingival calculus, overfilled restorations and even interproximal caries.

4. Reduction of gingival bleeding and inmflammation.

5. Improves general oral health

6. Prevention and and controls halitosis

HOW TO USE IT:

What is the correct sequence? Brushing or flossing?

Interproximal toothbrushes

Opened interdental spaces due to:

• Loss of periodontal support

• Diastemas

Types: * Conical * Cilindrical

Also good for: Fixed orthodontics, Implant supported prosthesis

Others:

- Oral irrigators
- Tongue cleaners
- Interspace brush

Professional plaque control

1. Patient’s clinical history

2. Accurate oral examination  caries diagnosis

3. Plaque index registration

4. Evaluation of patientt’s risk level, regarding main oral pathologies.

5. Oral higiene instruction and motivation. Diet advice, fluoride and antimicrobial products
recommendation.

6. Oral cancer detection

7. Plaque and calculus removal, supra and subgingivally. Removal of staining and overfilled
restorations.

8. Polishing of dental restorations

9. Polishing of interdental spaces

10. Fissure sealants if indicated.

11. Professional application of fluoride

12. Schedule next visit according to diagnosis and risk

Every 6 months. Biggest caries/gum disease susceptibility: 2- 4 months

O´Leary index Evaluates the presence of bacterial plaque in the four surfaces of the teeth

PI = Stained surfaces x 100 / Total surfaces

- Hand instruments
- Ultrasound equipment: Breaks up calculus through vibratory movements.

Adv/disadv: Chart given in class

Contraindications: chart given in class

- Surface polishing

Performed with substances that present higher or lower abrasion ability on tooth surface.

Can be done with either a cup or a brush between 6000 and 10000 rpm, eliminating a very thin
enamel layer.

Paste composition

1. Abrasive agent: pumice (sodium silicate, potasium and aluminium), zirconia silicate.

2. Particle size: extrafine, fine, medium and thick.

3. Other ingredients: perfums, edulcorants, fluoride.