Principles of

Preventive Dentistry
Dr/ Yasmine Mortada Elmaraghy
Lecturer of pediatric dentistry and public health
DENTAL PUBLIC HEALTH

Dental public health was defined by the American Dental

Association as the science and art of preventing dental diseases

and promoting dental health through organized community

efforts, i.e. it serves the community, as a patient rather than the

individual.
 The Public Health Method: Characteristics
1. Public health work must concentrate 4. Ability to deal with all sorts of
on areas where group problems involving the host population
responsibility is recognized such and the environment.
as in the context of acute communicable
diseases
5. Dependence on biostatistical
2. Public health depends upon methods for analysis.
teamwork 6. Deals with all types of people in the
health spectrum such as healthy people
3. Prevention is a major objective of as well as with the sick.
public health programme because
prevention is ethical, has the advantage 7. Provides education to the public, a
of teamwork and cost efficiency. prime objective of public health work
and also adapts public health
programmes to community culture.
Tools of Public Health

1. Epidemiology
2. Biostatistics
3. Social sciences
4. Principles of administration
5. Preventive dentistry.
Differences between personal/private practitioner and community health dentist

Private Community health dentist

Works more or less alone Works in a team

Focus on individual patient Focus is on community

Independent decision maker Decision taken by governing body or

regarding line of treatment advisory council

Patient consent and cooperation Requires community participation

required

Payment for treatment by Funding by government authorities

individual

Emphasis on curative and Emphasis on promotive and

restorative care preventive care
Alfred C. Fones, DDS, founder of
dental hygiene
Definitions
Preventive dentistry is the science of the care
required to prevent diseases of the teeth and
supporting structures.
Principles of Preventive Dentistry

• Control of disease
• Patient education and motivation
• Development of host resistance
• Restoration of function
• Maintenance of oral health
Levels of Prevention
 This is ‘the action taken prior to
the onset of a disease which
removes the possibility that the
disease will ever occur’.
Primary
prevention Primary prevention occurs in the
pre-pathogenic period and
accomplished by health promotion
and specific protective measures.
 1.Primordial prevention

In this type, efforts are directed towards

discouraging children from adopting harmful
lifestyles (use of tobacco, adverse eating pattern,
pernicious oral habits, etc.).
The main intervention is through individual and mass
education.
2.Health promotion

It is also defined as “health education and related

organizational, economic and environmental
supports conducive to health”.

• Health education,
• Attention to genetic and environmental factors that
This influence the disease,
includes
• Attention to good physical and mental development
• Periodic selective examinations.
3.Specific protection
This includes protective measures like
1. Immunizations
2. Mouth guards
3. Ingestion of optimally fluoridated water
4. Fluoride applications
5. Sealant programs, etc.
Secondary prevention

It is defined as “the action which halts the progress

of the disease at its incipient stage and prevents
complications”.
It occurs in the early period of pathogenesis and
involves early diagnosis and prompt treatment.
Early diagnosis and prompt treatment
1. Periodic detailed oral examination with radiographs
2. Prompt treatment of incipient carious lesions using
preventive resin restoration (PRR) or any restorations
3. Extension of therapy into the vicinity of lesions for
prevention of secondary lesions
4. Attention to developmental defects
5. Interceptive orthodontics including habit interception
 Tertiary prevention

• (Pathogenesis: Late Stage of Pathogenesis)

• It is defined as “all the measures available to reduce
or limit impairments and disabilities, and to
promote the patients’ adjustment to irremediable
conditions.”
• This includes disability limitation and
rehabilitation
DENTAL PLAQUE
Dr/ Yasmine Ahmed Mortada Elmaraghy
Lecturer of pediatric dentistry and public health
Assiut University
Dental plaque: is a biofilm that
adheres tenaciously to tooth
surfaces, restorations, and
prosthetic appliances.
Formation Of Dental Plaque Biofilms
1. Pellicle formation
2. Attachment of single bacterial cells (0-4 h)
3. Growth of attached bacteria leading to the formation of distinct
microcolonies (4-24 h)
4. Microbial succession and co-aggregation leading to
Increased species diversity concomitant with continued
Growth of microcolonies (1-14 days)
5. Climax community/mature plaque (2 weeks or older).
 PELLICLE FORMATION

1. The pellicle is a thin coating of salivary proteins that attaches to the tooth
surface within minutes after cleaning.
2. This layer is thin, smooth colorless and translucent and is called as acquired
salivary pellicle.
3. Initially pellicle is bacteria free.
4. The function of salivary pellicle is mainly protective
5. The pellicle acts like double sided adhesive tape, adhering to the
tooth surface on one side and on the other side, providing a sticky
surface facilitating bacterial attachment to the tooth surface.
 Formation of Microcolonies

The first to adhere are primary colonizers,

sometimes referred to as pioneer species. These
are microorganisms that are able to stick directly
to the acquired pellicle.

Bacteria connect to the pellicle and each other with hundreds

of hair-like structures called fimbriae.

Within first few hours species of Streptococcus and these are the initial
colonizers.
 Mutans streptococci

The mutans streptococci (MS) are a group of bacterial species previously

considered to be serotypes of the single species, Streptococcus mutans.

1. Their ability to stick to tooth surfaces and production of abundant quantity of insoluble
extracellular polysaccharides from sucrose

2. Their ability to produce organic acid such as lactic acid from a number of sugar substrates

3. Ability to resist aciduric and acidogenic environment

4. Production of intracellular polysaccharide, which acts as a reserve substrate for bacteria

 Plaque encourages caries formation by:

1. Enabling bacteria to stick to the teeth.

2. Allowing acids to accumulate around the teeth.

3. Preventing the saliva from reaching the teeth surface, so stopping it from washing them
and neutralizing the acid.

4. Providing the cariogenic bacteria with a reserve energy supply, i.e. the polysaccharides
which can be used in the absence of sugars.
Dental caries
Dental caries is an infectious microbial disease that begins as demineralization of
inorganic portion of tooth, followed by destruction of organic portions, leading to
cavity formation.

Keye's Circle-current concept of

caries aetiology.
CARIES RISK FACTORS
Caries risk factors are biological factors that contribute to the level of
risk for the patient of having new carious lesions in the future or having
the existing lesions progress.
1. Role of microorganisms

A. Mutans streptococci

1. Ability to produce acid (acidogenicity)

2. Ability to withstand acid conditions
(aciduricity)
3. Ability to adhere to teeth

MS is responsible for initiation of caries (site specific by the meaning of some

tooth surfaces are colonized and others not)
Amount of SM in saliva correlated to the
amount of colonized surfaces (base of
salivary test)

Vertical transmission (Source is usually

mothers) SM not alone
responsible for caries
< 50% sensitivity
Transmission may occur at birth, but MS
reside in low numbers in reservoirs such as
tonsils or dorsum of tongue
Evidence of SM cariogenicity

Children from mothers with high levels of SM develop caries

more than children from mothers with low SM

Dose effect relationship (high levels of SM in plaque and saliva

associated with high risk)
Lactobacilli species

Lactobacillus helps in the progression of dental caries and it is

aciduric and acidogenic in nature.
It is considered as essential acidogenic bacteria causing caries.

Lactobacilli are good indicators of total carbohydrate intake

(both content and frequency)
Thus, S. mutans are implicated
in the initiation of the lesion
and Lactobacillus (specifically
L. casei) associated with
progression.
2. Role of Diet
2. Role of Diet
Frequent (>three times daily) snacking between meals:
If a person is snacking greater than 3 times daily between meals on foods or beverages that
contain sucrose, glucose, fructose, or cooked starch (cookies or bread), this increases the acid
challenge to the teeth to a high level.
Xylitol containing gum or mints should be recommended as a substitute for these snacks.
3. Dental plaque and oral hygiene

Visible heavy plaque on teeth: This indicates poor oral hygiene and/or
prolific plaque growth by the individual and is an indirect indicator that
there are likely to be high levels of cariogenic bacteria.
4. Tooth structure

• Deep pits and fissures

• Quality of enamel
• Inadequate exposure to fluoride
• Exposed roots
 5. Role of saliva

1. The buffering effect of saliva is based prominently on bicarbonate, carbonic acid

and phosphate buffer systems.
2. Lysozyme, a hydrolytic enzyme, lactoperoxidase, hemoprotein enzyme are
present in saliva, which play a role in the prevention of bacterial colonization on
tooth surface.
 5. Role of saliva

3. Rapid flow of highly buffered, mobile saliva reduces the fall in plaque pH.
Thus, less caries is associated with the rapid flow of saliva.
4. Low viscosity is also associated with low caries activity due to the rapid
clearance of sugar from the oral cavity.
6. Lower socioeconomic status

7. Orthodontic appliances:
The presence of fixed or removable appliances in the mouth such as
orthodontic brackets or removable partial dentures leads to undue
accumulation of plaque and an increase in the percent of cariogenic
bacteria.

8. Any physical or mental illness and any oral application or restoration

that compromises the maintenance of optimal oral health.
Clinical observation of white spot ,caries lesions, or restorations recently

placed because of such lesions, are best thought of as disease

indicators rather than risk factors since these lesions do not cause the
disease directly or indirectly but, very importantly, indicate the presence
of the factors that cause the disease.
DIETARY CONTROL
Dr/ Yasmine Ahmed Mortada Elmaraghy
Lecturer of pediatric dentistry and oral public health
Faculty of dentistry Assiut University
 Diet
Diet refers to the customary allowance of food
and drink taken by any person from day to
day.
 Nutrition
Nutrition is a science of how the body utilises food to meet the
requirements for development, growth, repairs and
maintenance or as the science of food and its relationship to
health.
 Balanced diet

Is a diet which contains varieties of food in such quantities &

proportions that the need for energy, amino acids, vitamins, fats,
carbohydrates & other nutrients is adequately met for
maintaining health, vitality, and general well being & also makes
provision for short duration of leanness
Diet and dental caries

The effect of diet is considered in

two heading
•Systemic effect
•Local effect
 Systemic effect
 i.e. before eruption, while the tooth is still forming.

 1-Before birth through placental circulation from mother to

fetus, which provides calcium and vitamin D for proper
development of teeth.

 2-After birth through general nutrition where the essential

nutrients are carried by the blood stream from the

digestive tract.
 Local effect

After tooth eruption

Lodgment of fermentable carbohydrates around teeth
 Diet component

Carbohydrates Protein Fats vitamins

CLASSIFICATION OF CARBOHYDRATES

Carbohydrates that are of special interest and

importance in nutrition are

Polysaccharides
Monosaccharides Disaccharides
Monosaccharides

Monosaccharides are the simplest carbohydrates and are classified

according to the number of carbon atoms in the chain,
e.g. glucose, fructose and galactose.
 Disaccharides
Disaccharides consist of a linkage of two monosaccharide units.
Disaccharides, in general, have a sweet taste, water soluble and are
crystalline solids,
e.g. sucrose, lactose and maltose.
 Polysaccharides

Polysaccharides are complex carbohydrates made up of many (more than

10) monosaccharides linked together.
Unlike sugars, these are tasteless. Some are used for storing energy and
others perform structural functions,
e.g. starch, glycogen and cellulose.
 Sugars
The sugars most commonly found in an
average diet are sucrose, glucose, fructose,
lactose, and maltose, from which some regard
sucrose as the most cariogenic.
When assessing a patient’s diet, it is essential
to differentiate between natural and added
sugars.
 Classification of Sugars

➢ Natural sugars are those intrinsically found in the structure of fresh fruits and
vegetables, milk, and dairy products.
➢ Natural sugars do not play a significant role in developing dental caries and
other non-communicable diseases. This is probably due to their protective
components (polyphenolic compounds, calcium, water, and fiber) and the
hardness of some fruits and vegetables, which stimulates saliva production.
➢ Furthermore, cow’s milk is classed as non-cariogenic. It may even protect
teeth from dental caries thanks to its high calcium and casein content.
Classification of Sugars

➢ Added sugars, also called free sugars by the WHO, are the sugars added to
foods and drinks by manufacturers or cooks and sugars present in edible
products other than fresh fruit, vegetables, milk, and grains, e.g., fruit juices,
honey, and syrups.
➢ Excessive intake of added sugars is closely linked to an extensive list of
systemic conditions, including dental caries, diabetes mellitus, obesity, and
cardiovascular diseases.
 Starchy Food
➢ Dietary starches refer to a variety of food rich in starch (a polymeric
carbohydrate), including bread, pasta, potatoes, potato products, rice, oats,
breakfast cereals, and other grains.
➢ Dietary starches are of low cariogenicity.
CARIOGENICITY OF SUCROSE
Sucrose is the arch criminal of dental caries, it continues to be the most
common form of added sugar in the diet .

➢ Sucrose induces the smooth surface lesion more than any other carbohydrates,
especially when treated with Streptococcus mutans.
➢ Sucrose is the only carbohydrate diet degraded to glucans.
➢ Cariogenicity of sucrose does not relate to the ability to increase plaque, but ability
of Streptococcus mutans to colonize smooth surface in the presence of sucrose.
➢ Glucans limit the diffusion of acids away from tooth surface
 Vipeholm study, 1954 :

they divided the participants into nine groups depending on the type of food
consumed.
1- Sucrose in solid forms (chocolate group, bread group and caramel
group) were given in different frequency and quantity. And they were given
in between meals.
2- In caramel group, 24 toffees and 48 toffees were given to one of the
groups.
 Findings
1. Significant caries increase occurred when sucrose-containing snacks were taken

between meals-time factor.

2. More the number of times sucrose was ingested more increase in caries-
frequency.
3. Sticky forms of sucrose foods, which can retain high sugar levels, were more

cariogenic than those cleaned rapidly-consistency.

4. Sucrose containing solid foods were more cariogenic than liquid types-form.
 THE BASIC STEPHAN CURVE

Describes the change in dental plaque pH in

response to a challenge

The challenge could be an inert substance placed

in the mouth with the aim of determining its effect
on plaque pH.
 Example

Dental plaque is challenge with

fermentable carbohydrates

Asking volunteer to rinse the

mouth with 10 ml of 10% sucrose
solution for 10 seconds.

Average plaque samples were

removed at intervals and the PH
recorded.
Characteristically the Stephan Curve reveals a rapid drop in plaque pH, followed
by a slower rise until the resting pH is attained.
The time course varies between individuals and the nature of the challenge

However, pH recovery can

take anything between 15
and 40 minutes depending to
a large extent on the acid-
neutralizing properties of the
individual’s saliva
The initial rapid drop
in pH
It is due to the speed
with which plaque
microbes are able to
metabolize sucrose.
 The rise in pH

The pH starts to rise after a few minutes

due to:
1. Acid by-products diffusing out of the
plaque.
2. Salivary bicarbonate diffusing into the
plaque and neutralizing the acid by-
products.
It normally takes at least 20 minutes for the
plaque pH to reach its resting value
DIETARY CONTROL
Dr/ Yasmine Ahmed Mortada Elmaraghy
Lecturer of pediatric dentistry and oral public health
Faculty of dentistry Assiut University
Preventive dietary measures
1-Reduction of the frequency of carbohydrate intake:

Frequency of Meals:

There are two measures which can be taken to reduce

the unwanted local effects of diet with respect to
caries:
1. Selecting food products that only lead to a slight
and/or short pH drop
2. Reducing number of intakes.
The Critical pH:
It means the level at which demineralization starts.

For enamel the critical pH is about 5.5-57

For a root surface, the demineralization may start

already at pH(6.2)

Many common food products containing fermentable

carbohydrates can, after consumption, lead to a pH of
about 4.
• To facilitate the patient to reduce the number of
snacks, it may be necessary to improve the
main meals.
• If the main meals are made up properly, the
desire to eat between meals is reduced.
• The goal is not to exclude sugar from the diet
but rather to make the patient eat sugar in a
"sensible way" which means reasonable
amounts and mainly at meal-times- "sugar
discipline".
 Amount and concentration of
sucrose in meals
• The issue of the carbohydrate or sugar concentration and caries
is complex.
• Experimental studies have shown that there is a correlation
between the carbohydrate rinsing or intake concentration and
enamel demineralization
• AIso, a high oral concentration of glucose facilitates diffusion
into narrow and inaccessible locations such as the villi of the
tongue, leading to slower sugar clearance from these.
In many study, a number of rinses were performed with different concentrations of glucose ranging from
1.3% to 50%.
The 0.3 and 0.5% rinses both showed the fastest clearance rate while the more concentrated rinses
showed slower rates.
The mean clearance time was 3.2 min for a 0.3% rinse and increased gradually to 27.5 min for me 50%
rinse.
 Elimination of sugars Consistency of food
During night time the saliva secretion rate is reduced, leading to a
much longer elimination time.

Eating just before bedtime is therefore not advisable

Foods that need active chewing result in increased saliva secretion,

increased buffer capacity, decreased viscosity and as a result a faster
return to a normal PH.
Sticky food stays longer on the tooth surface and is therefore more
harmful.
As understood from above, the oral clearance time or "Sugar time", i.e.
the time it takes to reduce sugar concentration in saliva to a low level (usually 0.1%
is used as the target), varies between different food products but also between
individuals, as well as for different sites in a mouth.
 Dietary recommendations:

Carbohydrates should not' be completely restricted from the diet,

but dietary recommendations can be given. These are:
1- No more than half the daily caloric intake be from
carbohydrates.
2- Select more soluble forms of carbohydrates which clear
quickly from the mouth e.g. leafy green or yellow vegetables
are good carbohydrates sources with low retention.
Avoid sticky candies and biscuits.
3- Consume carbohydrates at meals and avoid between meal snacks.
4- Protective factors
5- Sucrose Substitutes
 PROTECTIVE FACTORS AND CARIES
Some constituents of diet help to protect teeth against dental caries

Cheese is recommended as a caries preventive food

because it causes:
a. Strong stimulation of salivary flow.
b. Raises calcium concentration in plaque.
c. Raises oral pH to 7.5 within 3 minutes following
ingestion which favours remineralization.
Milk
• Cow’s milk and human milk contain lactose which may be
classified as cariogenic.
• But lactose is least cariogenic of the dietary sugars and milk
also contains calcium, phosphorus and casein which inhibit
caries.
• Evidence from animal experiments show that cow’s milk is not
only non-cariogenic, but also has an anti-cariogenic effect.
Fibrous Foods
Fibrous foods protect the teeth because they mechanically
stimulate salivary flow.
Other foods that are good gustatory and/or mechanical
stimulants to salivary flow are peanuts, hard cheese.

Black Tea
Black tea contains fluoride, polyphenols and flavanoids.
Black tea extract increases plaque fluoride concentration and
reduces the cariogenicity of a sugar rich diet.
Sucrose substitutes:
1- Replacing sucrose, glucose and fructose with artificial sweetening
agents such as: aspartame, mannitol and saccharin reduce the
cariogenicity of food.
2- Sorbitol sweetened chewing gum and candies are much less
cariogenic than those containing sucrose
3- Xylitol is used nowadays in confectionary and toothpaste
because:
- It is less cariogenic than sucrose and sorbitol.
- It inhibits certain strains of streptococci.
Addition of caries inhibiting agents:

a-Fluorides:
Addition of fluoride to foods e.g. salt, milk, bread and flour.
b-Inorganic and organic phosphates:
Act primarily by forming a protective layer on the enamel surface.
c-Dextranase:
Reduces the adherence of bacteria to tooth surface.
MECHANICAL PLAQUE
CONTROL
Dr/ Yasmine Ahmed Mortada Elmaraghy
Lecturer of pediatric dentistry and oral public
health
Faculty of dentistry Assiut University

This Photo by Unknown author is licensed under CC BY-SA.

1. Toothbrush
2. Interdental oral hygiene aids
A. Manual
A. Dental floss
B. Electrical
B. Dental floss holder
C. Ionic toothbrushes
C. Toothpicks and toothpick holder
D. Sonic and ultrasonic
D. Interproximal brushes
E. Single tuft brushes
3. Adjunctive aids F. Knitting yarn
A. Irrigation devices (water-pik) G. Gauze strip
B. Tongue cleaner H. Pipe cleaner
C. Dentifrices I. Wedge stimulators
D. Mouth rinses (mouthwash)
E. Rubber tip stimulator
F. Denture brush
MECHANICAL PLAQUE CONTROL

1. Toothbrush
A. Manual
B. Electrical
C. Ionic toothbrushes
D. Sonic and ultrasonic
Objectives of Toothbrushing
1. To clean teeth of food, stains and debris.
2. To disturb and remove plaque formation.
3. To stimulate and message the gingival tissue.
4. To apply fluoride dentifrice.
5. Cleaning of tongue.
MECHANICAL PLAQUE CONTROL

Parts of a Toothbrush
1- The head
A length of about 2.5 cm for an adult
and 1.5 cm for a child
2- The handle
3- Shank
It is the part that connects the head and
the handle.
4-Tufts
Bristles when bunched together are
known as tufts (2-4 rows)
MECHANICAL PLAQUE CONTROL

5- The Filaments
(Bristles)
• It is either natural or artificial.
• Made of either polyester or nylon
• Nylon is said to wear less rapidly than
polyester and is more hygienic.
• The bristles can be classified into three
depending upon the diameter of the
filaments:
1. Soft 0.15–0.18 mm
2. Medium 0.18–0.23 mm
3. Hard/Extra hard 0.23–0.28 mm
MECHANICAL PLAQUE CONTROL

Electric toothbrush
Rotating-oscillating and rotating-oscillating-
pulsating powered toothbrushes are distinctive in Indications:
that the brush head is meant to be moved from 1. Those with physical or learning disability
tooth to tooth instead of using it in manner like a 2. Fixed orthodontic appliances
manual toothbrush. 3. Young children
4. Aged persons
5. Institutionalized patients who depend upon
care providers for brushing
6. Arthritic patients
7. Individuals with poor dexterity
8. Poorly motivated patients
MECHANICAL PLAQUE CONTROL

Ionic tooth brush

Manual tooth brush that removes the dental plaque
not only mechanically, but mainly with ionic action.

Theory of action:
1- Plaque has a positive charge, so it clings to our negatively
charged teeth.
2- Ionic tooth brush changes the charge of the tooth surface
from negative to positive, so the tooth will reject the plaque
from its surface, which will be attracted to the bristles of the
brush.
MECHANICAL PLAQUE CONTROL

ADA recommendation
• Caregivers should begin brushing teeth as soon as they begin to erupt.
• They should continue to assist or supervise until the child is able to spit out
excess toothpaste after brushing.
• The consensus recommendation is for people to brush their teeth for two
minutes twice a day with a toothbrush that has soft bristles.
• Replace toothbrushes every three to four months or more often if the bristles
are visibly matted or frayed.
• Either manual or powered toothbrushes can be used effectively.
 Mechanical and
chemical plaque
control

Dr/Yasmine Mortada Elmaraghy

Lecturer of pediatric dentistry and dental public health
Faculty of dentistry – Assiut University
INTERDENTAL ORAL HYGIENE AIDS

As the interdental region is the most common site of plaque

retention and the most inaccessible to the toothbrush,
special methods of cleaning are needed.
A. DENTAL FLOSS
•The effective use of dental floss helps to improve the
gingival health by effectively removing dental plaque
from the interdental areas.

Types of Dental Floss

1. Flavored and unflavored
2. Waxed and unwaxed
3. Thin, tape and meshwork
4. Nylon and teflon.
Methods of Using Dental Floss
1-Spool Method
It is recommended for teenagers and adults who have
acquired the required the level of neuromuscular
coordination and mental maturity to use floss correctly
2- Loop Method
This method is particularly suited for children as well as
adults with less nimble hands or handicaps such as poor
muscular coordination or arthritis.
B. FLOSS HOLDER

Indications
1. Patient with physical disabilities.
2. Patient lacking manual dexterity.
3. Individuals with large hands.
4. Individuals with strong gag reflex.
C. TOOTHPICKS

•Toothpicks are usually made of softwood and have a

triangular, round or rectangular shape.
•Triangular are said to be superior to the rest as they
are ineffective on lingual aspect of proximal surfaces
•Indication
Interproximal open spaces
D. INTERPROXIMAL BRUSHES
•The most common are conical or tapered and designed to be
inserted into a plastic or metal reusable handle that is angled
to facilitate interproximal adaptation
Indications
1. Diastemas.
2. Exposed root furcations.
3. Orthodontic and fixed appliances.
4. Application of fluoride, antimicrobial or desensitizing
agents
 E. SINGLE TUFT BRUSHES

Single tuft or end tuft brushes are small brushes with

nylon bristles that are attached to a plastic handle
 Disclosing agents are chemical
substances that stain the plaque which
makes them clear on the enamel.

Uses of disclosing agent

1. Estimating the patients oral hygiene status
2. In educating and motivating patient and
parents regarding proper brushing habits
3. Evaluation of the patient in recall
appointments
4. At homes, patients can themselves evaluate
the oral hygiene procedure
 Disclosing agents can be dispensed as
solutions, wafers, capsules or tablets.

During routine use by the patient it is

advisable to use disclosing solutions
after brushing and flossing to evaluate
the efficiency of their brushing.

Examples
Iodine
Basic fucsin
Gentian violet
CHEMICAL PLAQUE CONTROL
 Mechanical removal of plaque biofilm remains the most widely accepted
mechanism for plaque control, the bacterial etiology of periodontal disease
justifies supportive use of antimicrobial agents.

The carriage of chemical agents into the mouth for supragingival plaque
control involves a varied range of vehicles includes:
1- Toothpaste
2- Mouthwashes
3-Chewing gum
4-Spray
5- Irrigators
TOOTHPASTES
(DENTIFRICES)
A dentifrice is usually used in
combination with toothbrushing

The purpose of facilitating plaque

removal and applying preventive and
therapeutic agents to the tooth
surfaces.

Dentifrices have been prepared in

several forms such as powders, pastes
and gels.
The most popular forms are the
pastes and gels.
Types of toothpastes
Cosmetic which cleans and removes
material alba, plaque biofilm, food debris
and stains from tooth surfaces and
polishes.

Therapeutic which transports the drug

substance to the tooth surface or the oral
tissue.
 INGREDIENTS C) DETERGENTS (Surface active
detergents)
A) THERAPEUTIC AGENT e.g:Sodium lauryl sulfate
1. Fluoride compounds These are the agents which clean
2. Anti- calculus agent the tooth surface.
3. Chemical plaque control agent They lower the surface tension,
penetrate and loosen surface deposit
and emulsify and suspend the debris
B) ABRASIVES
which is then removed from the tooth
It is the largest component of dentifrice
surface by the dentifrice.
Commonly used abrasives
1. Silica gel D) Humectants:
2. Phosphate salts It prevent loss of water and
3. Insoluble sodium metaphosphate subsequent hardening of the paste
4. Calcium and magnesium carbonates when exposed to water.
5. Aluminium oxide e.g: glycerol, sorbitol, propylene
glycol
E) Binders:
e.g: Gum Arabic
They are hydrophilic colloids that
stabilize the formulation and
prevent separation of the solid
and liquid phases during storage.
THERAPEUTIC DENTIFRICES

The beneficial effect may include:

1. Reduction and prevention of
dental caries.
2. Prevention and reversal of
gingival diseases.
3. To reduce hypersensitivity
1-ANTICARIES TOOTHPASTE
1)Fluorides
Commercially available dentifrices
contain
1. sodium fluoride [NaF] 0.22%,
2. stannous fluoride [SnF2] 0.4%
3. sodium monofluorophosphate [MFP]
0.76%.
All dentifrices currently marketed
formulated to contain either 1000 or
1100 ppm F, mostly in the form of NaF
and MFP
For childern <6 years old
Average 500 ppm
2-ANTI-PLAQUE AGENTS

Sodium Lauryl Sulfate

(SLS)

retard the regrowth of

plaque.

Triclosan
3- Antihypersensitivity tooth
paste
Potassium Salts
Potassium ions (potassium nitrate) are
thought to act by blocking action
potential generation in intradental
nerves.
strontium chloride, sodium citrate
 4-Whitening toothpastes
Whitening toothpastes simply remove surface
stains with abrasives or special chemical or
polishing agents, or prevent stain formation.
• Abrasives

• Dimethicones

• Sodium Bicarbonate

• papin
MOUTHWASHES
• Mouthwash is defined as a nonsterile aqueous solution used
mostly for its deodorant, refreshing or antiseptic effect.

• Mouthwashes or rinses are designed to reduce bacteria,

remove food particles, temporary reduce bad breathe and
provide a pleasant taste.

• Most chemical plaque control agents are formulated as

mouth rinse.
 What are the proper steps when using mouth rinses?

• Before using a mouth rinse, brush and floss teeth.

• Measure the proper amount of rinse recommended on the
container or by a dentist.
• Close lips and keep teeth slightly apart & swish liquid
around the mouth.
• The suggested rinsing time is 30 seconds to one minute.
• Finally, spit liquid from mouth.
• Do not rinse or eat for 30 minutes after using a mouthwash
in order not to decrease its effects.
 Classification of mouthwashes:

1-Therapeutic:
They contain an active ingredient that helps prevent or treat certain oral health
conditions.
2-Non therapeutic (Cosmetic):
- They are available over the counter.
- They temporarily freshen breath & mask mouth odour.
- They aid in removing food particles.