Beruflich Dokumente
Kultur Dokumente
ON
DENTAL
PLAQUE
Submitted by:
Aditi Chandra
MDS- 2012
Departmen
t of Conservative
Dentistry
and Endodontics
DEFINITION
Dental plaque:
Soft deposits that form the biofilm adhering to the tooth
surface or other hard surfaces in the oral cavity, including
removable and fixed restorations. Bowen,1976
Bacterial aggregation on the teeth or other solid oral
structures. Lindhe, 2003
Dental plaque is a specific but highly variable structural
entity , resulting from sequential colonization of
microorganisms on the tooth surfaces, restorations and other
parts of oral cavity , composed of salivary components like
mucin, desquamated epithelial cells, debris and
microorganisms , all embedded in extracellular gelatinous
matrix. WHO, 1961
CLASSIFICATION
By location on tooth:
supra gingival plaque
sugingival plaque
Coronal
marginal
unattached
attached
Tissue
tooth
Epithelium
COMPOSITION
Dental plaque is primarily composed of microorganisms. One
gram of plaque contains approx. 2 x 1011 bacteria. It has been
estimated that more than 325 different bacterial species may be
found in plaque.
Previous
Classification
New Classification
Reference
Bacteroides gingivalis
Porphyromonas
gingivalis
Shah and
Collins,1988
Bacteroides
endodontalis
Porphyromonas
endodontalis
Bacteroides
intermedius
Prevotella
intermedia
Bacteroides
melaninogenicus
Prevotella
melaninogenica
1990
Bacteroides loescheii
Prevotella loescheii
Wolinella recta
Campylobacter
rectus
Vandamme, et al.,
1991
Wolinella curva
Camplyobacter
curvus
Vandamme, et al.,
1991
Anaerobic
Streptococcus mutans
Gram-Positive Streptococcus sanguis
Actinomyces viscosus
Gramnegative
Spirochetes
Actinobacillus
actinomycetemcomita
ns
Capnocytophypa speci
es
Eikenella corrodens
Porphyromonas
gingivalis
Fusobacterium
nucleatum
Prevotella intermedia
Bacteroides forsythus
Campylobacter rectus
Treponema denticola
(Other Treponema specie
s)
Structure of biofilm:
A biofilm community comprises bacterial microcolonies, an
extracellular slime layer, fluid channels, and a primitive
communication system. As the bacteria attach to a surface and to
each other, they cluster together to form sessile, mushroomshaped microcolonies that are attached to the surface at a narrow
base. Each microcolony is a tiny, independent community
containing thousands of compatible bacteria. Different
and p.gingivalis) that attach along the surface of the rod shaped
cells.
The environmental parameters of the subgingival region differs
from those of supra gingival region. Morphologic and
microbiologic studies of sub gingival plaque reveal distinctions
between the tooth associated and tissue associated regions of
subgingival plaque.
The associated plaque is characterized by gram positive rods and
cocci including bacteria such as streptococcus mitis, sanguis, and
a. viscous, a. naselundii.
The apical border of plaque mass is separated from junctional
epithelium by a layer of host leukocytes and the bacteria of this
tooth associated region show an increased concentration of gram
ve rods.
The portion of plaque adjacent to the tissue surfaces is more
loosely organized and contain primarily gram ve rods and cocci
as well as large numbers of filaments, flagellated rods and
spirochetes. Host tissue cells (WBCs and epithelial cells) are also
found. P.gingivalis, p.intermedia, c.orchracea are main organisms.
Bacteria found in tissue associated plaque (p.gimgivlis) are also
found in host tissues. Thus the physical proximity is important in
tissue invasion.
The transition from gram positive o gram negative in dental
plaque is paralleled by a physiologic transition in the developing
plaque. The early colonizers
(streptococci and
actinomyces) utilize oxygen and lower the reduction oxidation
potential of the environment, which then favors the growth of
anaerobic organisms. Gram positive species utilize sugar as an
energy source and saliva as a carbon source. The bacteria that
predominate in the mature plaque are anaerobic and use amino
acids and small peptides as energy source. Many physiologic
interactions among different bacteria are found in plaque. Lactate
CLINICAL SIGNIFICANCE
The different regions of plaque are significant to different
processes associated with disease of teeth and periodontium. Eg:
marginal supragingival plaque is of prime importance in the
development of gingivitis. Supragingival and tooth associated
subgingival plaque are critical in calculus formation and root
caries. Tissue associated subgingival plaque is important in the
DETECTION OF PLAQUE
1. Direct vision : Thin plaque may be translucent & therefore not visible
Stained plaque may be acquired e.g tobacco stained
Thick plaque tooth may appear dull & dirty
2. USE OF EXPLORER : Tactile Examination when calcification has started it
appears slightly rough, otherwise it may feel slippery due to
coating of soft , slimy plaque
After removal Of Plaque when no plaque is visible, an
explorer can be passed over the tooth surface & when
plaque is present it will adhere to explorer tip. This technique
is used when evaluating plaque index.
3. Use of disclosing solutions
PLAQUE CONTROL
Definition:
Removal of microbial plaque and the prevention of its
accumulation on the teeth and adjacent gingival surfaces.
(Dorothy Perry and Maxoschmid 1996)
Classification:
1. Mechanical methods
2. Chemical methods
TOOTHBRUSHES
Manual toothbrushes:
2 to 4 rows of bristles
Charters method:
Technique:
Position the filaments toward the chewing surface of the
tooth
Place the sides of the filaments against the enamel and
angle them at a 45 to the tooth.
Fones Technique:
Indicated for young children who want to do their own brushing,
but do not have the muscle development for the technique which
requires more co-ordination.
Technique:
A tooth brushing technique that uses large, sweeping,
scrubbing circles over occluded teeth, with the toothbrush
held at right angles to the tooth surfaces.
With the jaws parted, the palatal and lingual surfaces of
the teeth are scrubbed in smaller circles.
Occlusal surfaces of the teeth are scrubbed in an
anteroposterior direction.
Electric toothbrushes:
They are also known as automatic, mechanical or powered
toothbrushes.
In subjects not highly motivated to oral health care, as well as in
those having difficulty in mastering a suitable handbrush, "the
use of an electric brush with its standard movements may
result in more frequent and better cleansing of the teeth".
Motions:
Back and forth
Circular
Elliptic
Combinations
Cleaning action by:
1. Mechanical contact between the bristles and the tooth
2. Low-frequency acoustic energy generates dynamic fluid
movement and provides cleaning slightly away from the
bristle tips.
Frequency of oscillation may be around 40 Hz.
They are indicated in handicapped individuals and in dental care
of hospitalized patients, with limited manual dexterity. It is also
beneficial for patients undergoing orthodontic treatment.
Types of floss
multifilament
Bonded / non bonded
Thick / thin
2nd generation:
3rd generation:
1. Antibiotics
2. Phenols
3.
Quaternary 4. Sanguanarine
ammonium
compounds.
Bis-biguanides
( Chlorhexidine )
Delmopinol
Irrigative
Chewing gum
Varnishes
Gel
Lozenges
2ND GENERATION
Bisbiguanides:
These include Chlorhexidine gluconate 0.2 %, Alexidine, Cationic
Chlorophenyl biguanide.
Suggested for oral use by Schroder in 1969. It has a pH 3.5. It is
a cationic effective against gram +ve, gram-ve, fungi, yeasts &
viruses. Its superior action is due to its property of sustain
availability i.e. substantivity.
Mechanism Action:
1. Prevents pellicle formation by blocking acidic groups on
salivary glycoproteins thereby reducing glycoprotein
adsorption on to the tooth surface
2. Prevents adsorption of bacterial cell wall on to the tooth
surface
3. Prevents binding of mature plaques
Antibacterial action of chlorhexidine: It shows two actions:1. Bacteriostatic at low concentrations
Bacterial cell wall (-ve charge)
2. Bactericidal action
Cell death
3RD GENERATION
Delomopinol:
It inhibits plaque growth and reduces gingivitis.
Mechanism of action:
Interfere with plaque matrix formation & also reduces
bacterial adherence
It causes weak binding of plaque to tooth, thus aiding in easy
removal of plaque by mechanical procedures
It is therefore indicated as a pre brushing mouth rinse.
CONCLUSION
More than 500 bacterial strains have been identified in dental
biofilm. Experts agree that most forms of periodontal disease are
caused by specific pathogens, particularly gram-negative
bacteria. The recognition that dental plaque as a biofilm helps to
explain why periodontal diseases have been so difficult to prevent
and to treat. Periodontal pathogens within a biofilm environment
behave very differently from free-floating bacteria. The protective
extracellular slime matrix makes bacteria extremely resistant to
antibiotics, antimicrobial agents, and host defense mechanisms.
Mechanical removal is the most effective treatment currently
available for the control of dental plaque biofilms.
REFRENCES
CLINICAL PERIODONTOLOGY - CARRANZA ( 10th edition)
CLINICAL PERIODONTOLOGY AND IMPLANT DENTISTRYLINDHE
ESSENTIALS OF PREVENTIVE AND COMMUNITY DENTISTRYSOBEN PETER
( 3RD edition)
SHAH HN, COLLINS DM: PROPOSAL FOR RECLASSIFICATION
OF BACTEROIDES ASACCHAROLYTICUS, BACTEROIDES
GINGIVALIS, AND BACTEROIDES ENDODONTALIS IN A NEW
GENUS, PORPHYROMONAS. INTERNATIONAL JOURNAL OF
SYSTEMATIC BACTERIOLOGY 1988; 38(1):128-131.