Dental Plaque

What is Dental Plaque:-

Dental plaque is biofilm (usually colorless) that builds up on the teeth. If not
removed regularly, it can lead to dental cavities (caries) or periodontal problems (such
as gingivitis).
The microorganisms that form the biofilm are almost entirely bacteria (mainly
Streptococcus mutans and anaerobes), with the composition varying by location in
the mouth. Examples of such anaerobes include fusobacterium and Actinobacteria.h
The microorganisms present in dental plaque are all naturally present in the oral
cavity, and are normally harmless. However, failure to remove plaque by regular
tooth brushing means that they are allowed to build up in a thick layer. Those
microorganisms nearest the tooth surface convert to anaerobic respiration; it is in this
state they start to produce acids.

.
Bacterial dental plaque

• Acids released from dental plaque lead to demineralization of the adjacent

tooth surface, and consequently to dental caries. Saliva is also unable to
penetrate the build-up of plaque and thus cannot act to neutralize the acid
produced by the bacteria and remineralize the tooth surface.
• They also cause irritation of the gums around the teeth that could lead to
gingivitis, periodontal disease and tooth loss.
• Plaque build up can also become mineralized and form calculus (tartar).

What causes dental plaque on teeth:-

Dental plaque is comprised of colonies of bacteria and other
microorganisms mixed with bacteria by-products, dead cells and
food residuals.

Tooth plaque formation starts immediately after a tooth is

cleaned. The micro organisms of dental plaque are all naturally
present in the oral cavity, and are normally harmless.

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 Failure to remove dental plaque by regular toothbrushing allows
its build up in a thick layer. As it matures, different types of micro
organisms appear. At the lower layers of plaque, nearest the tooth
surface, the composition of dental plaque changes in favour of
anaerobic bacteria.

Their anaerobic respiration is producing acids which

consequently lead to:
demineralization of the adjacent tooth surface, and dental caries.
Irritation of the gums around the teeth (gum inflammation),
leading to gingivitis (red, swollen, bleeding gums), periodontal
disease and tooth loss.
Tooth plaque build up can also become mineralized and form
calculus.

The main health problems of the oral cavity can be related to the
accumulation of dental plaque on teeth.

Mechanism of Plaque Formation:-

The attachment, growth, removal and reattachment of bacteria to
the tooth surface is a continuous and dynamic process. However,
several distinct processes can be recognised:
1. Absorption of salivary proteins and glycoproteins, together
with some bacterial molecules, to the tooth surface to form a
conditioning film (the acquired pellicle).
2. Long-range (>5Onm), non-specific interaction of microbial cell
surfaces with the acquired pellicle via van der Waals attractive
forces.
3. Shorter-range (10-20nm) interactions, in which the interplay
of van der Waals attraction forces and electrostatic repulsion
produces a weak area of attraction that can result in
reversible adhesion to the surface.
4. Irreversible adhesion can occur if specific inter-molecular
interactions take place between adhesins on the cell surface
and receptors in the acquired pellicle.
5. Secondary or late-colonisers attach to primary colonisers
(coaggregation), also by specific inter-molecular interactions.
6. Cell division of the attached cells to produce confluent growth,
and a bioflim.

What are the symptoms of plaque-associated

gum disease:-
• Mild gingivitis does not cause any symptoms and so you
may not realise that you have it. The gums look slightly
swollen and reddened.

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 • Moderate gingivitis can cause more marked swelling and
reddening of the gums. The gums often bleed a little when
you clean your teeth. Discomfort or pain from the gums is rare
if you only have gingivitis.
• Periodontitis often does not cause any symptoms until an
affected tooth becomes loose. However, in some cases,
symptoms develop and may include:
○ halitosis (bad breath)
○ a foul taste in your mouth
○ some pus formation in small pockets between teeth and
gums
○ pain and difficulty eating
○ Affected teeth becoming loose and eventually falling out
if not treated.
An examination by a dentist to detect the presence and depth of
gum pockets is needed to confirm the diagnosis of periodontitis.

Factors can affect plaque formation:-

1) Oral hygiene.
2) Orthodontic or prosthetic appliance as they may interfere with
oral hygiene.
3) Structure and position of the tooth. Roughness of enamel
whether development or acquired encourages plaque
accumulation.
4) Diet greatly affects plaque formation. Rough fibrous diet and
the movement of mastication reduce plaque, while a sucrose
rich diet encourages plaque deposition through sticky
polymers.

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 Dental calculus:-
Calculus is the hard residue ranging from yellow to brown forming on teeth when oral
hygiene is incomplete or improper. Calculus is formed from Plaque (a soft sticky
substance that accumulates on teeth; composed largely of bacteria and food
substances suspended in saliva) which can build up and become hard. This hard
plaque is known as tartar or calculus. Brushing and flossing alone cannot remove
calculus. A dentist or hygienist must remove it manually to stop the disease process.
Although plaque and calculus have different characteristics a relationship exists
between them. It is the host to a complex micro-system of microorganisms that cause
inflammatory diseases of the gingival & periodontal tissues. Plaque can be removed
from tooth surfaces by direct brushing. It is possible to have a mouth with plaque but
no calculus. Calculus is formed by the deposition of mineral salts in plaque. It is hard
and firmly adherent to the tooth surfaces on which it forms and it cannot be removed
by brushing. Calculus acts as a focal point for plaque accumulation bacteria and
hinders complete removal of plaque. Both plaque and calculus play an important role
in gum disease. As gums ”pull away” from the teeth as a result of gum-disease
pockets begin to form between the teeth and gums. Plaque and calculus fill these
pockets until eventually the jawbone supporting the teeth are destroyed. Calculus
deposits can be classified as s light moderate or heavy.
Calculus forms in various areas of the mouth. The terms Supra-gingival calculus and
subgingival calculus are given to the most common areas of calculus build up.
Supra-gingival calculus is found on the tooth surface next to the tongue (lingual) on
the mandibular incisors and on the buccal surfaces (area near the cheek) of maxillary
molars. Subgingival calculus forms on root surfaces below the gingival margin and
can extend deep into periodontal pockets. A more irregular subgingival cemental
surface allows deposits to form into the cemental irregularities. This makes the
attachment of the subgingiva calculus more tenacious and difficult to remove.
Subgingival calculus can often be seen on radiographs but explorer detection is
needed to evaluate the amount of calculus present.
Rate of calculus formation varies from person to person but the following can certain
factors can increase the rate of calculus formation. These factors are Elevated salivary
PH.

· Elevated salivary calcium concentration.

· Elevated bacterial protein and lipid concentration.
· Elevated concentration of protein and urea in submandibular salivary gland
secretions.
· Low individual inhibitory factors.
· Higher total salivary lipid levels.

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Treatments to remove or prevent calculus
Build up are numerous and include surgical and non-surgical procedures. A surgical
approach is when full thickness tissue flaps are reflected to expose the root surfaces
and gain direct access to them. A non-surgical approach is when access to the root
surfaces is via the periodontal pockets.
The efficacy of subgingival plaque and calculus removal utilizing a non-surgical
approach is limited.
Procedures to remove calculus include the following:-
· Scaling:
The meticulous removal from the root surfaces of the teeth to remove plaque calculus
and stains from these surfaces.
· Root Planing:
A treatment procedure designed to remove cementum or surface dentin that is rough
impregnated with calculus or contaminated with toxins or microorganisms.
· Periodontal Debridement:
This includes the removal of plaque and calculus both above and below the gingiva.
· Prophy / Prophylaxis:
A preventive procedure to remove local irritants to the gingiva including
debridements of calculus and removal of plaque.

How can I prevent plaque-associated gum

disease:-
Good oral hygiene (mouth hygiene) helps to keep plaque down and
usually prevents gum disease. (Good oral hygiene also helps to
prevent tooth decay.) Good oral hygiene means:
• Brush your teeth - for two minutes, at least twice a day.
Studies show that powered toothbrushes with a rotation-
oscillation action (where the brush rapidly changes direction
of rotation) remove plaque and debris better than manual
brushes.
• Floss your teeth at least three times a week to remove plaque
from between teeth.

Also:
• See a dentist or dental hygienist for advice if you cannot use a
toothbrush.
• Children should be taught good oral hygiene as young as
possible.
• Have regular dental checks. A dentist can detect excessive
build up of plaque and remove calculus. Early or mild gingivitis

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 can be detected and treated to prevent the more severe
periodontitis.
• If you smoke, you should aim to stop smoking.
The measures above are usually sufficient. However, many people
also use an antiseptic mouthwash each day to help prevent gum
disease.

What is the treatment of plaque-associated

gum disease:-
If you have gingivitis:
The measures described above to prevent gum disease will often
clear mild gingivitis. If gingivitis is more severe, in addition your
dentist or doctor may advise an antiseptic mouthwash (and/or
antiseptic toothpaste, gel, or spray). These help to kill bacteria in
the mouth and help to clear up any gum infection.

Chlorhexidine is a commonly used antiseptic mouthwash. If you are

advised to use chlorhexidine, you should rinse your mouth well with
water between brushing your teeth and using chlorhexidine. This is
because some ingredients in toothpaste can inactivate
chlorhexidine. Chlorhexidine may also stain teeth brown when used
regularly. This staining is likely to need to be removed by a dentist
or dental hygienist. Staining can be reduced by:
• Brushing teeth before (but not after) using the chlorhexidine.
• Avoiding drinks that contain tannin within 2-3 hours of using
chlorhexidine (for example, tea, coffee, and red wine).
• Using the 1.2% solution instead of higher strength solutions.

If you have periodontitis:

You should see a dentist. In addition to the measures described
above to treat gingivitis you may need specialist dental treatment.
Various procedures may be done, depending on the severity of the
condition and other factors. For example, in one procedure a dentist
may clean a 'pocket' next to a tooth where infection is present.
Following this, a dentist may smooth out the surface of the tooth
next to the gum. This helps the gum to close back onto the tooth,
and for any 'pocket' to disappear.

Control of
dental plaque:-
1. Oral
hygiene.

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2. Diet: Plaque increase considerably in the presence of
carbohydrates, especially sucrose. Limiting dietary
carbohydrates has a dramatic effect on plaque volume.
3. Physical removal of plaque: e.g. tooth brushing, use of
dental floss and interdental wooden wedges.
4. Ultrasonic scaling devices: A) These remove plaque and
calculus mechanically.
B) Ultrasonic vibration
disturbs bacteria in sub gingival plaque.

5. Antiseptics: chloromexidine and providine-iodine reduce

bacteria. Its action may extend for
some time.

I Hope you Healthy teeth

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 References
• http://en.wikipedia.org/wiki/Dental_pl
aque
• http://users.forthnet.gr/ath/abyss/dep
1211.htm
• http://images.google.com.eg/images?
hl=ar&q=dental+plaque&um=1&ie=
UTF-
8&ei=V9TVSaXzK8WNjAfJjoH4Dg&sa
=X&o
• http://www.dentistry.leeds.ac.uk/ORO
FACE/PAGES/micro/micro2.html
• http://www.dentalfind.com/glossary/c
alculus.html
• http://www.privatehealth.co.uk/disea
ses/infections/dental-plaque-and-
gum-disease/

The main reference

is

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Medical microbiology and immunology
book
By

DR. Salwa E. youssef.

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