Ready or not, here I come! Hide-and-seek is a fun game, rushing about to find where everyone is hidden. Sticky bacterial plaque also hides from sight on tooth surfaces, including spaces between teeth, underneath tissue, and along gumline margins of dental restorations. Since plaque is constantly forming and building colonies, accumulation occurs rapidly when left undisturbed. Even when plaque is blanketed thick in grooves and along the gumline, plaque may still remain virtually unseen by the patient. Even when invisible to our eyes, plaque is made visible by applying a disclosing agent.
The examination for dental plaque is not solely the dental professional’s responsibility. Daily discovery and disturbing the buildup is what the patient should maintain between recare visits. Parents often ask, “Can you please talk with my child about brushing better?” A disclosing method allows us to visually show the child (and parent) what better brushing removes. Disclosing helps patients see how effective (or ineffective) their method of brushing and flossing is.
How it is done
After brushing and flossing, the disclosing solution is used. The dye stains deposits, revealing to the patient any hidden spots of missed plaque, which must then be mechanically removed. Keep in mind that the oral cancer evaluation would be better performed prior to the staining of tissues. Some residual coloration of tissues may mask tissue needing further investigation.
Several effective methods are available for disclosing the plaque.
Disclosants may be applied using a directed saturated swab, concentrated drops mixed with water for a diluted rinse, or chewing a small tablet. Once the disclosant is placed intraorally, the patients are instructed to spread the disclosing agent by swiping over the teeth with their tongues for around 30 seconds. A gentle water rinse and suction will remove most of the unnecessary disclosing agent.
The teeth are examined for the highlighted leftover plaque, and home-care instruction may then be customized. Patients are shown chairside the areas needing improvement, and this education helps improve the overall effectiveness of home care.
Red disclosing solutions are the traditional choice. These solutions demarcate soft plaque when applied. The clinician places concentrated drops of disclosant generally on or under the tongue sublingually.
These squeeze-bottle type of solutions can be messy at times. The product can stain plaque as well as the patient and clothing. The dropper solutions can be very economical since a little of the solution goes a long way.
Several two-color solutions in squeeze-dropper bottles are also available to the clinician. These solutions differentiate between new pellicle and old plaque.
Young Dental’s 2Tone stains old plaque blue and new plaque red. The selective, differential staining allows the clinician to identify problem areas where plaque has collected and has not been removed by timely brushing. Other multicolored disclosants are Plaqsearch (Oraldent) and PlaqueFinder (Pro-Dentec). The pleasantly flavored disclosants also show retained plaque in blue (and new plaque in red). The stain will fade quickly from teeth with water rinses and brushing.
Presaturated swabs provide less mess, are easily controlled, and offer convenience by just dabbing the swab onto the tooth surfaces. HurriView Plaque Indicating Swab Applicators (Beutlich Pharmaceuticals) are available as unit doses. Simply dab the red saturated swab along the tooth surface and gumline to show missed plaque.
Disclosing tablets are another method. They contain red dye, highlighting stained plaque after being first chewed. The tablets are allowed to mix with saliva before expectoration. The tablets work well for dispensing to the patient and can also be found in retail outlets without a prescription. If the patient uses the tablets regularly after brushing, modifications can be made in between recare visits, improving home-care habits as the patient identifies areas needing improvement.
Recently introduced, the GUM Plak-Check by Sunstar Butler uses a light source to make plaque glow. This handy system uses individually loaded swabs of sodium fluorescein which are applied directly onto the tooth surface. The liquid is swished throughout the mouth and is highly specific in that the disclosant will only adhere to residual plaque. By using the system’s battery-operated bluelight source, the patient can view through the built-in mirror any glowing yellow plaque.
In addition, the Plak-Check disclosant will remain nearly invisible unless the plaque is viewed under the unit’s special light. In other words, the patient will not be leaving the chair with visible residual disclosant as is the case at times with the characteristic red disclosants.
A retail version of Plak-Check is available for continued reinforcement between recare appointments. This product features a dental type of mirror that is lighted, along with a dropper style dispensing of the disclosing solution.
Plaque is difficult for our patients to see; it is similar in color to the teeth it adheres to. After the plaque remains on the surface for some time, it begins to discolor from the food, beverages, tobacco use, or even hemorrhage from the tissues. Patients may notice this pigmented plaque, or, if it is not discolored, comment that they are doing an adequate job of brushing and flossing because they do not see any leftover debris. Educating the patient about brushing and flossing more effectively to remove the “hidden” buildup is accomplished by using a product that stains the plaque, turning it into a color that allows the patient to easily visualize where the plaque rests.
The author did not receive compensation for products mentioned. For further disclosure, visit www.jbutler.com, www. youngdental.com, www.prodentec.com, and www.beutlich.com.