Approaches to

caries prevention
I.
II.
III.

Dietary control
Plaque control
Increasing the resistance of
the
tooth

II-Plaque control
Prof. Dr. Nevine waly
Prof. of Pediatric Dentistry & Dental
,Public Health, Faculty of Dentistry
Cairo University

Plaque Control
1- Mechanical
2- Chemical

1- Plaque control by
mechanical means:
A-Tooth brushing

:Manual tooth brush design

:a. The working end (head)
Contains 3-4 rows of separate
tufts of bristles.
The head is about 2.5 0.5 cm
It should be large enough to
remove plaque entirely, yet small
enough to facilitate access to all parts
of the mouth.

:b. The handle

It is the part of the tooth brush that is
grasped by the hand.
Some handles are straight or curved.
The tooth brush handle should be
easy to be grasped, free from any
sharp projections, durable, and light in
weight.

C. The shank:
It connects the head and the handle.

:d. Tufts of bristles

The nylon bristles are superior to the

natural bristles because :
Nylon filaments flex 10 times more
before breaking.
Are cleaned and dried more easily.
Do not split or abrade.
And are more resistant to accumulation
of bacteria and fungi.

Soft nylon bristles are less

traumatic to gingival tissue.
Nylon tooth brush bristles have a
uniform shape.

:Power tooth brushes

Since the 1980s, tremendous
advances have been made in the
technology of electrically powered
tooth brushes.
Products include:

The Braun Oral-B Ultra Plaque Remover:

small round head and has an
oscillating/rotating action.

The Interplak:
Has 10 tufts of two different lenghts.
Each tuft independently rotates 1.5
turns in one direction and then reverses
in the opposite direction.

The Rota-dent:
It has movement resembling
a professional dental rotary
instrument.
It has three interchangeable
hollow cup tips.

The Sonicare:
It vibrates at 31,000 brush
strokes per minute.

:Natural toothbrush
The miswak can be used any
time and anywhere without the
need for tooth paste.

The objectives of toothbrushing

:are
.Remove plaque. 1
Clean teeth of food debris and. 2
.stains
.Stimulate gingival tissues. 3
.Apply fluoride from the tooth paste. 4

Teaching an effective
:toothbrushing technique
:Motivation( 1
Explain nature of plaque and its. role in oral diseases
:Education( 2
Paint teeth with disclosing agent to .point out plaque areas
.Scrap off plaque with probe-

:Demonstration( 3
Ask patient to bring his tooth brush and .perform his usual brushing
.Errors in brushing are noted.Use life sized models for demonstration:Assessment( 4
After demonstration ask patient to brush his .teeth similarly
.Apply disclosing agent.Give further training-

Tooth brushing methods

:Rotation or Roll Method

Divide each half jaw into 3 regions .

. (ant. , middle , post)
Twisting motion on buccal & lingual.
. Surfaces of teeth
Bristles rest on alveolar mucosa pointing.
.away from occlusal surface
Maintain pressure and roll across gingiva .
.towards occlusal
.Repeat 10 times in each region.
Brush occlusal surfaces with to and .
.fro action
Hold brush vertically for lingual surfaces .
. of upper & lower incisors

:Fones Method*
.For young children .
.Put teeth into occlusion.
Circular motion on outer.
.surfaces of teeth

1- Brushing done immediately after

eating.
2- Systematic way of brushing.
3- Brushing lingual surfaces.
4- Effective brushing time is 2 to 4
min.

Disclosants
Water soluble dyes used to stain plaque to make
it obvious to patient (to facilitate instructions on
its removal ) & to dentist (during scaling &
polishing).

Desirable properties:
1.
2.
3.
4.
5.

Stains plaque selectively.

Does not stain other oral structures.
Does not discolor tooth colored fillings.
Has acceptable taste.
Has no harmful effect on mucous membrane or
body if swallowed.

Forms:
Tablets, liquid, swabs.
Red, blue or yellow.

Examples:
Basic fuchsin.

Toothpaste (Dentifrice)
- The best are those containing fluorides due to its anticaries value.
- Should be of acceptable taste, flavor, color and consistency & should
not be harmful with prolonged use.
- Components of most dentifrices are detergent, cleaning & polishing
agents, binder (thickener), humectant, flavoring agent, water, therapeutic
agent, preservative, sweetener & coloring agent.

Fluoride containing
toothpaste:

Enables the delivery of topically applied fluoride

to large number of persons.

Reduction in caries incidence (10 30%).

greater caries inhibition on proximal surfaces

than occlusal or buccolingual surfaces.

Compounds most commonly used are:

1. Stannous Fluoride (causes tooth discoloration).
2. Sodium Fluoride e.g. Crest, Close up.
3. Sodium monofluorophosphate (MFP) e.g.
Colgate, Signal II
4. Amino Fluoride (not commercially available).

1.
2.
3.

Use pea sized amount of tooth paste.

Use formulations with low fluoride concentration
(500 600 ppm) for children younger than 7 years.
Parental supervision.

In case of sensitive cervical areas use

desensitizing pastes e.g. Sensodyne.

B. Interdental care and

supplemental aids
a- Dental floss:
A tool used to disorganize and remove
microbial masses located below the gum
margins interproximally.

Types:
1.

2.

Waxed: Is recommended for patients with

very tight proximal tooth contacts.
Not efficient because it coats the tooth
surface.

2. Unwaxed: Is recommended for patients

with normal tooth contacts because it
slides through the contact area easily.
Provides effective cleaning, fibers open
and trap plaque.
3. Medicated floss: imprignated with
fluoride or chlorohexidine.

. Technique :
Cut suitable length (15 cm ), hold between
fingers, introduce from occlusal surface
through contact point down to gingival
crevice, wrap around curvature of tooth and
scrap towards the occlusal surface.

Use a floss holder:

It is recommended for patients
who lack dexterity.

b) Toothpicks:
Removes microbial masses from areas inaccessible to
toothbrush bristles.
e.g. cleaning buccal and lingual surfaces of third
molars.
cleaning periodontal pockets.
Toothpicks are used in case of wide embrassures while
dental floss in case of tight contact.

c) Rubber tip:
Used to clean interdental
spaces and massaging the
gingiva.
Located on handle of some
toothbrushes.
Placed between teeth
pointing towards occlusal
surface, press and vibrate.

d) Interdental brushes:
It is a small conical or tapered
single tufted brush designed
to be inserted into a plastic
reusable handle.
They are available in various
sizes and shapes.

Indication:
To remove plaque from interdental
spaces located posteriorly and
cleaning the exposed furcation
areas.

e) Oral rinsing:
Rinsing the mouth:
By forcing water vigorously back and forth
through the teeth.

Purpose:
1- To remove material loosened by floss and
toothbrush.
2- To remove sugar from teeth when it is not
possible to brush after intake of a diet containing
sugar.

:Water irrigator
Using a forced water stream (gentle
& intermittent) to remove oral
debris

:Purpose
.To clean pockets- 1
To clean under- 2
bridges & orthodontic
.appliances

f) Dental prophylaxis:
Removal of hard deposits on tooth surface by scaling
then smoothening and polishing the surfaces with
pumice on rubber cup.

Advantages :
1. Smooth surfaces are less susceptible to be stained or
coated with plaque.
2. Easy detection of early carious lesions.

2- Plaque control by
chemical means:

Antibiotics-1
Antibacterial agents-2
eg.chlorohexidine
Enzymes eg.dextranase-3
Fluorides-4

The ideal anti-caries agent

should have the following
:properties

Should not be used for treatment

of other diseases.
Stable in storage.
Should adsorb to teeth or plaque
without loss of activity.
Should be non-toxic, non-allergic.
Should be biodegradable
(destroyed in the GIT if ingested).

:Antibiotics
Penicillin was incorporated in the
toothpaste and a resistant strain of
bacteria was developed on its
repeated use , so it was
discontinued.

:Chlorohexidine
It is a disinfectant antibacterial agent
which is active against a wide range of
bacteria.
Since Chlorohexidine is positively
charged, so it binds to negatively
charged bacterial cell wall which
causes destruction of bacteria. Thus, it
reduces the number of bacteria in
saliva.

Since Chlorohexidine is positively

charged and the tooth surface is
negatively charged so, it adheres to
the tooth surface long enough to kill
or disable bacteria. Thus it reduces
the adsorption of the bacteria to the
teeth, inhibits pellicle formation &
reduces bulk and cohesiveness of
bacterial plaque.

Mechanism in plaque
controlling:
1. Reduce the number of bacteria in
saliva.
2. Inhibit pellicle formation.
3. Reduce the adsorption of bacteria
to the teeth.
4. Reduce the cohesiveness of
plaque bacteria.

The main advantages of chlorohexidine

compared to other anti-bacterial substances
are the adsorption and slow release in the
mouth. It can suppress strept. Mutans for 6
weeks following discontinuation.

Methods of application: topical application

as solution, mouth rinse and brushing with
gel.

Enzymes
Recently, attention has been
concentrated on enzymes, which break
down extracellular polysaccharides
(dextrans) which add to bulk &
adhesiveness of plaque.
Several studies on the effects of
dextranase mouth rinses on plaque
formation in human have been reported
some reduction in plaque accumulation.

Fluorides
It has a direct inhibitory effect on
bacteria of dental plaque so, it
inhibits the production of
extracellular polysaccharides which
add to the bulk and adhesiveness of
dental plaque.