Are Plaque-Disclosing Agents Useful Educational Tools?

Are plaque-disclosing agents useful tools when educating pediatric patients and their parents/caregivers about oral disease prevention and the importance of good oral hygiene?

Bacterial plaque is a soft, sticky, almost invisible biofilm containing millions of organisms that adhere to tooth surfaces, dental appliances, restorations, and oral mucosa. More specifically, oral biofilm is “a dense, transparent, nonmineralized mass of bacterial colonies in a gel-like, intermicrobial, enclosed matrix that is attached to a moist environmental surface.”¹ Unless removed, these bacteria can cause dental caries and periodontal diseases.

Oral disease prevention requires the regular disruption and removal of this biofilm.² Unfortunately, oral biofilm is often hard to visualize, especially in difficult-to-reach areas of the mouth. This creates a challenge for parents/caregivers trying to teach and assist their children in establishing effective oral hygiene habits. Studies have shown that toothbrushing habits established early remain relatively stable.^3,4

The need to teach parents/caregivers and children the consequences of leaving undisturbed biofilm on the teeth has been well established. Often, plaque may not be readily visible by the untrained eye. Hence, a parent/caregiver or child may have a false impression of the amount of biofilm or its location in the oral cavity. Inaccurate detection of oral biofilm and current oral hygiene methods may lead parents and children to untrue assumptions.

In 1914, Skinner⁵ recognized the need to identify a way to help patients visualize and appreciate the presence of plaque. He believed that it was important to convince patients that preventing dental disease was superior to repairing damaged dental structures. Skinner described the use of an iodine solution to disclose the presence of plaque on the teeth in order to associate the importance of proper oral hygiene in addition to regular professional dental care.

Arnim⁶ was influential in introducing the use of dental disclosing agents to assist in developing good oral hygiene practices. He found it was helpful to demonstrate to the patient the presence of plaque by using a disclosing agent for at-home self-evaluation. Over time, numerous agents and techniques have been developed to assess the presence of oral biofilm. Whether it is a liquid, tablet, or gel, remaining oral biofilm can be identified and measured by a disclosing agent. Dyes, such as iodine, erythrosine, fluorescein, and food coloring, have been used.⁷ The use of a disclosing agent is a valuable oral hygiene tool, as it distinctly reveals plaque on the tooth surface. More recently, a toothpaste has been marketed that includes a plaque-disclosing agent that disappears when the teeth are properly cleaned. Two-tone disclosing solutions can differentiate between new and old biofilm.⁸ Three-tone plaque disclosing agents are also available, which can identify new, mature, and acid-producing oral biofilms.⁹

Children use multiple senses to learn, and vision is important to this process. The visual impact of seeing the plaque and using a plaque-disclosing aid is invaluable. It benefits both the caregiver and child. Using a plaque disclosing agent about once a week helps reinforce good oral hygiene practices.¹⁰ Parental participation in the oral hygiene of young children is also absolutely necessary. Children should not be expected to have well-developed toothbrushing skills until they are at least 6 to 8 years old. Even then, parents/caregivers should periodically monitor their child’s oral care habits and inspect their mouth to ensure removal of accumulated plaque. Use of a disclosing agent can be an excellent educational tool.¹¹

REFERENCES

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6. Arnim S. The use of disclosing agents for measuring tooth cleanlinessJ J Periodont. 1963;227–245.
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10. Mathewson RJ, Primosch RE, eds. Oral Hygiene Education: Fundamentals of Pediatric Dentistry. 3rd ed. Chicago: Quintessence Publishing Co Inc; 1995:91.
11. Stoltzfus L. Plaque disclosing agents. Available at: deardoctor.c/​m/​inside-the-magazine/​issue-33/​plaque-disclosing-agents/​. Accessed October 22, 2019.

From Dimensions of Dental Hygiene. November 2019;17(10):46.