Dental caries and gum diseases are the two most common chronic diseases of the oral cavity. These diseases are dependent on the micro-organism present in the plaque. So plaque control is of prime importance for the prevention of these diseases and for good dental health. Dental plaque is defined as highly specific variable structural entity formed by sequential colonisation of micro-organism on the tooth surface. The natural physiologic forces that clean the oral cavity are inefficient in removing dental plaque. So plaque control is the procedure for removal of the plaque and the prevention of its accumulation. It is the primary level of the prevention of the gum diseases and caries. The plaque control includes both mechanical and chemical means.
Mechanical plaque control methods include tooth brushing and interdental cleaning using oral hygiene aids and professional help.
Chemical plaque control has been used only as an adjunct to mechanical means and not a substitute even though various chemicals are widely used nowadays. Mechanical methods of plaque control is the best method of choice.
Mechanical control
1. Tooth Brushes
(a) Manual
(b) Electrical
2. Interdental Cleaning & Aids
(a) Dental floss
(b) Wooden tips
(c) Oral rinsing
(d) Prophylaxis by dentist
Chemical control
• Chemical plaque control is done by using various chemicals.
• First generation agents are antibiotics, antiseptic like phenyl.
• Second generation agents commonly used are’ chlorhexidine or alexidine.
Brushing
The aforesaid chemicals are disclosing agents, which stain the plaque, seen by the patient or dentist. The tablets are kept in mouth wash.
Specifications for acceptable brushes are as follows:
Length 1-1.25 inches
Width 5/16-3/8 inches
Surface area 2.54 to 3.2 sq. cm.
Number of row 5-12 tufts per row
No. of bristles 80-85 bristles per tuft.
Two varieties of bristles are used in toothbrushes:
1. Natural bristles from hog hair.
2. Artificial nylon filaments.
Though both of these remove plaque, nylon filaments are superior in terms of homogeneity, uniformity of bristle size, elasticity, resistance to fracture and repulsion of water and debris.
Though the most desirable bristle designs are questionable, multitufted brushes show better cleaning ability and rounded ends produce fewer lacerations. Soft brushes have gained most acceptance as they are more flexible and clean the sulcus more efficiently and reach further into interproximal surface areas and result in less amount of gingival recession. The angled toothbrush gives definite advantage of increased tactile sensation and increased accessibility to (back) posterior areas. For effective cleaning, the toothbrushes must be replaced as soon as the bristles begin to fray. Usually there is a tendency to use a brush for as long as possible. Now brushes with wear reminders are available; usually a blue dye on some of the bristles that fades off with use.
Powered Toothbrushes
They are recommended for
(1) Old people.
(2) Small handicapped children & hospitalized patients.
(3) Person with dental appliance.
In praise of toothbrush
Toothbrushing is our daily routine. This part of tooth brushing is neglected accessory in our daily life. Tooth brush can’t remove tartar but it can prevent by removing the stickly film adhere to the teeth before it turns into tartar. When we have the problems of teeth and gums we blame ourselves, our sweet tooth and our parents’ gift—but we never think of the brush that failed do its job.
Choosing toothbrush
Not many people realise that the toothbrush is a very active partner in the brush and paste team. It is the most neglected accessary. Buying a good brush and using it correctly is probably the best thing.
“Uncle, I use the best and costliest paste available in the market “said Rohit to me. “Good dear, what brush do you use?” I asked. “I don’t know Sir,” replied Rohit.
You discuss the tooth paste brand and everyone will tell you the exact name, price and even scientific ingredients useful for teeth.
“Does it Matter so Much Uncle?”
Yes, just remember your brush is more important partner in the brush-paste team. Even the toothpaste is not transported to the last corners of the mouth if your tooth brush is too wide.
The fancy double bristle colour and transparent handle and the low cost attract the common people. Sometimes even for advertising sake the brush is given free with a toothpaste.
A cheap quality of brush causes gum disease or scraches on teeth. These damages are not seen immediately but as the years pass by, suddenly one fine morning you see blood on your toothbrush.
A sticky film called plaque is accumulated on your teeth as you eat or drink milk. If not cleaned, this plaque turns into tartar which is hard and even brush cann’t remove it. This is the most mischievious agent in gum disease. A proper tooth brush can remove it before tartar arises. We blame heredity, our tooth, but we never blame brush.
Always use medium brush with rounded bristles. Remember this is the best brush, for everyone we are unable to quote. This is because which brush is right for you depends upon the type of the alignment of teeth. Some people with soft brush bleeds whereas for some individual a hard brush is soft. Hard brushes do not remove tobacco stain or clean or whiten the teeth. If you decide that you do need a hard brush to remove the rotten food particles you must follow proper brushing technique and use a brush gently. Do not choose a hard brush for better durability.
How Should I Know This Brush is Damaging?
If your brush is giving a mild painful sensation after drinking cold water or taking ice-cream. The gum bleeds after brushing. If you find there is ulceration on gums & cheek.
The shape of brush handle should allow a comfortable grip. The Electric toothbrushes are available, the advantage is they follow correct direction of motion.
Some low-cost tooth brushes are made out of recycled nylon. The synthetic filaments of medium stifness should be recommended. After you take a costly brush available in the market, your duty is not over. The durability of a brush is between one & three months.
If must be thrown out mercilessly after the bristles start wearing out. Even if the brush does not look any different, the bristles lose the strength and flexibility to do a proper job. Sometimes in a week’s time a brush looks worn out which means your brushing technique is faulty.
Brushing Technique
Clean the inside and outside surface of all the upper teeth willi downward rotatory motion.
Clem Mic inside and outside surfaces of all the lower teeth wild upward rotatory motion.
Press and rotate brush gently on the gum to give gum massage
Clean the inner surfaces of front teeth with motion from inside to outside.
Clean the chewing surfaces of upper and lower molar teeth with to and fro to inside outside and outside to inside motion.
Junior Brush
Children should be given Junior’ tooth brush to suit their tender gums because of smaller tooth.
How a brush finally performs depends upon on how you use It,
Start your brushing routine with a slightly moistened tooth brush without tooth paste.The right brushing technique is to hold the brush between your fingers rather than your wrist. This shows that you are not wrestling with your teeth. Take a clean, soft, slightly moistened toothbrush. Brush the inside of your bottom teeth first.
Thoroughly spend about 30 to 45 seconds in cleaning both top and bottom inner surfaces.
Take another 30 seconds to clean the outer and chewing tooth surfaces. Then rinse your mouth and brush. Run your tongue over teeth, you will notice a slick clean feeling.
Now dab toothpaste or powder on your brush.
Principles of Brushing
Divide imaginary areas as shown in figure, to clean inner and outer surfaces of the teeth with up and down motion with firm finger grip.For rolling movements use wrist rip. Brush upper teeth gum downwards and lower teeth gum upwards. Never use side to side action.
Then place the head of a brush parallel to the chewing surface. Gently exert a pressure on the gum with short back and forth motion by dislodging the tip lip of bristles. This creates pressure on gum, cleans, the area between teeth lift the brush and move it to the next three teeth. As in one stage you can cover only three to four teeth.
In this motion the sides rather than the ends of the bristles are used.The chewing surfaces are cleaned, keeping bristles flat on the chewing surface in to and fro motion.
The total ideal time is five minutes. This includes:
• Cleaning of teeth (all the areas).
• Cleaning of the tongue.
• Cleaning & rinsing with water the floor of the mouth, the areas between teeth & cheek, lip & tongue.
• Gargling the throat areas.
Here is a simple rule. “Brush your teeth after every meal.” The new thinking is that you don’t really need to brush after every meal because bacteria take from 16 to 24 hours to start their destructive emamel-eroding action. It is enough, runs the revised dental dictum, if you brush in the morning and at night and floss after meals. More important than how often you brush, is how thorough a job you make it. The one minute scrub that most people think is quite enough is not enough.
The following principles have to be followed in brushing :
1. The handle of the brush should be grasped firmly but not so tightly to cause fatigue in the hand and wrist. To help the individual in following this principle, colour changing handled toothbrushes are advised. It is a new introduction in this field.
2. Avoid overlooking areas.
3. The correct method of brushing has to be advised depending on the dentition and the condition of the gingiva.
4. Depending on the condition of the gingiva, soft, medium or hard type of toothbursh has to be advised. (Soft means the diameter of the bristle is 0.2 mm, Medium-0.3mm & Hard-0.4 mm)
5. The effectiveness of brushing also depends on the fraying of the bristles. When the bristles become ineffective in cleaning, the brush has to be changed. The colour indicator bristle tooth brushes are advised as the new step in this field.
Another main factor which govern plaque control is the frequency of brushing. For complete plaque removal thorough toothbrushing twice a day is necessary.
Results of excessive brushing :
(1) Gingival recession.
(2) Wedge shape abrasion in the cervical areas of teeth.
(3) Trauma and ulcerations on gingiva.
(4) Bacteraemia (germs enter in circulation) Night time brushing is especially important and also the most neglected because all the food debris collected from an entire day’s munching are there nestling between your teeth, ready to be broken down by bacteria. Salivary secretion is low in night hence the food is stuck. So brush twice a day and also give a light massage to the gums and rinse with the plain water.
Choosing Toothpaste
Toothpaste primarily adds flavour to your brushing ritual, helps the toothbrush to glide more easily over dental surfaces.
If your teeth are in fine condition, plain water works just as well. There are few exceptions to this blanket statement. One is that if you live in an area with established fluoride deficiency (in the water & soil) a fluoride, fortified toothpaste can help prevent cavity formation. (There are some places in India which suffer from an excess of fluoride). The second exception : Plaque fighting toothpastes do work.They have antibacterial properties that prevent formation of plaque. Keeping down plaque formation means keeping down tartar.
Dentifrices
They are aids using along toothbrushes for cleaning and polishing tooth surfaces. They are available in toothpaste, toothpowder and as gel.
Abrasives
Abrasive action restores normal action. Calcium carbonate and silica are common.
Surfactant agents
They provide foam sodium lauryl sulphate.
Flavouring agents
They give us good flavour. Peppermint oil is commonly used.
Humectants
They reduce the loss of moisture from the paste. Glycerin is used.
Binders
They control stability and consistency of toothpaste. Alginate or magnesium aluminium silicate is used.
Therapeutic agents
Toothpaste is used as vehicle for the anti-plaque. Anti-sensitive, anti-tartar and whitening agents.
Preservatives
• Benzoaces and chlorehexidine—they are good anti-tartar anti-plaque agents.
• Inter-dental cleaning aids.
• Dental floss.
• Single tufted brush.
• Dental floss.
• Inter-dental brush.
• Untufted brush.
Inter-dental Cleaning Aid
1. Stimulent
2. Inter-dental brush
3. Cone-shaped bristle brush
4. Cone-shaped plastic brush
5. Untufted brush
6. A miniature bottle brush
7. Rubbered conical brush
Yes it is true, floss is a must. This is the agenda of the majority of dentist. The basic principle of flossing is that the floss should contact the tooth surfaces which are not visible.
Description of floss :
• It was found two decades ago. It was silk.
• Available form—twisted, non-twisted, bonded, non-bonded, thick and thin.
• Nylon has superior properties. Gore Tex is latest material.
• Use one foot daily.
• Non-dental use—shoe-laces, kite strings, cheese & cake cutter.
• Floss is available at chemist’s shop.
Carry-on old method
Since olden days the people are using babul or neem trees bark-twig for brushing the teeth. If you can get a fresh twig everyday and if you are used to these procedure, please carry on. The second procedure is a mixture of charcoal and common salt.See that your teeth and gums are not injured.
What is the Floss
This is a thread. This is used to clean the area between two teeth. The reason Is, whatsoever your brushing technique, the brush you use, the bristles do not reach the area between two teeth. Hence this method is utilized and is known as flossing.
Method of using the floss
Stretch the floss between the thumb and forefinger or in between two forefingers and pass the floss gently through contact area with a firm back and forth motion. Do not snap the floss in the contact area. Once the floss enters into the inter-dental area, move the floss firmly along the tooth upto the contact area and gently down into the sulcus. Repeat the up and down strokes. Then change the floss position towards adjacent teeth and continue the same strokes to the adjacent teeth. When the working position of the floss becomes solid, move the floss into a fresh position.
The key word of caution is ‘gentle’. Do not snap the floss into the gums and do not allow the floss to break off. Food debris will be set free. Rinse it out when you start first flossing, your gums may bleed or feel sore. That is normal as they begin to get accustomed to the new cleaning technique. But if the bleeding lasts beyond a few days, the symptom could be warning signal for gum disease.
Both waxed and unwaxed floss are equally effective for the average person. But it can cause inflammation if the wax coating is driven into the gums. Waxed or unwaxed, flavoured or plain, the choice is yours. The issue really is not what kind of floss you use but rather whether you use it.
Mouthwash
There are three kinds of mouthwash in the market.
Fresheners
They contain mint or cinnamon and just mask the bad breath temporarily till the cock-tail party is over. They make you socially acceptable for a while.
Medical mouthwashes
Nowadays a chemist’s shop is flooded with mouthwashes. They can kill some of the bacteria and stop bad odour for a few hours. They contain menthol, benzoic acid, thymol, eucalyp-tol and alcohol.
Some other products contain sodium fluoride, chlorhexidine incorporate to the extent that anti-plaque products reduce plaque build-up. They help to keep tooth decay at bay and prevent a bad breath problem from starting. But anti-plaque products cannot do anything for cavities that have already formed or for diseased gums. These mouthwashes will not cure our dental problems.
Anti-microbial mouth wash
They are also available in chemist’s shop. They have chlorhexidine gluconate as the active ingredient. But some other mouthwash contain providone iodine.
Mouthwashes using sodium fluoride should be used only under expert advise using mouthwash washers. Its use over a long period of time and in concentrated form can in fact, prove harmful. They can destory normal, useful bacteria along with the harmful ones. They can also harm the tissues of mouth.
More about mouthwash
Regular brushing and flossing is the right choice, no mouthwash can take its place. If you want to freshen yourself then you can try any mouthwash. But If you have a gum disease, it is better you show to a dentist who can prescribe the correct mouthwash to you.
Whitening of teeth
It is true that as your age advances your teeth look older. This is because of the harm done on teeth due to tobacco, tea and coffee. The uppermost layer of tooth, the enamel thins and the natural layer of dentin which is just below the enamel starts popping out. As time passes gums also lose their grip on teeth. This incidence reveals again the root portion of tooth—dentin. They have discovered methods to fight stain from super brightening toothpaste and bleaching agents.
Treatment at clinic is done by a dentist. The second method is done at home. This is cheaper and quicker. After brushing, you pour a measured amount of the solution (a dilute form of carbamide peroxide) into a tray. The tray is either custom made or you ask laboratory technician to prepare. The tray is kept with solution for several hours. And changing the solution every second hour for three times in a day, you may get the result in 65 per cent of cases.