DENTAL PLAQUE

DR.HINA ADNAN

• DEFINITION:• It is a soft deposits that form the biofilm

adhering to the tooth surfaces or other hard surfaces in the oral cavity including removable and fixed restoration .

• It is a host-associated biofilm.

• Composition:• Dental plaque is composed primarily of micro-organism (85%

gram positive , 15% gram negative.)

1. Organic : protein , lipids , glycoprotein..etc)

2. Inorganic: sodium , potassium ,fluoride…etc)

Dental plaque should be differentiated from the other tooth deposits like calculus and material alba.

• Definition:• It is a soft accumulation of bacteria and tissue

cells that lack the organized structure of dental plaque and are easily displaced with

a water spray.

Material alba

• Formation of dental plaque: Dental plaque may be readily visualized on teeth after 1 to 2

days with no oral hygiene measurers.Plaque is white ,grayish or yellow and has a globular

appearance.Plaque is typically observed on the gingival third of

the tooth surface.

• Stages :

1. Stage one: (pellicle formation) : a thin bacteria-free layers forms within minutes on cleaned tooth surface. Also called acquired pellicle .

2. Stage two: ( ATTACHMENT): within hours bacteria attach to the pellicle and a slime layer forms around the attached bacteria . In early reversible colonization the main bacteria is streptococcus sanguis which normally found in the oral cavity.

• Stage three: ( IRREVIRSABLE ATTACHMENT), bacteria adhere to the first layer of colonization with irreversible attachment via specific adhesion receptor interaction.

• Stage four: (YOUNG SUPRA GINGIVAL PLAQUE) : consists mainly of gram+ cocci and rods. Some gram – cocci and rods.

• Stage five: (AGED SUPRAGINGIVAL PLAQUE) : there is an increase in the percentage of gram – anaerobic bacteria .

STAGE FOUR AND FIVE KNOWN AS Colonization and Plaque Maturation

• Stage six : (SUBGINGIVAL PLAQUE FORMATION) :

• A- tooth attach: mostly gram + with some gram – cocci and rods.

• B-epithelial attach and unattach plaque: mostly gram – rods and spirochetes.

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Classification of plaque:

• According to tooth surface: (location)

subgingival

attached unattached

Tooth associated

Tissue associated

supragingival

coronal marginal

I. Direct vision:

A. Thin plaque: may be translucent and therefore not visible , stained plaque may be acquired ( tobacco stained).

B. Thick plaque: tooth my appear dull and dirty.

Detection of plaque

• 2- Use of explorer:

when no plaque is visible an explorer can be passed over the tooth surface and when plaque is present it will adhere to explorer tip.

This technique is used when evaluating plaque index.

3- Use of disclosing solution.

1. During first 24 hrs starting from a clean tooth surface; plaque growth from clinical view point.

2. Following 3 days plaque growth increase at rapid rate then slows down.

3. After 4 days on average 30% of total tooth crown area will be covered with plaque.

4. There will be a shift towards anaerobic and gram – flora including an influx of Fusobacteria,Spiral form and Spirochetes.

Supragingival plaque – clinical aspects (DE NOVO)

1. Initial plaque formation takes place along the gingival margin and inform interdental space, lateral extension in coronal direction can be observed .

2. Plaque formation can also start from grooves, cracks or pits.

Topography of supragingival plaque

• Early plaque formation occurs faster:

1. In lower jaw compared to upper jaw.

2. In lower anterior teeth.

3. On buccal tooth surfaces compared to oral sites.

4. In interdental regions compared to strict buccal or oral surfaces.

5. Plaque formation is more rapid on tooth surfaces facing inflamed gingival margins.

(how?) bonus……• Plaque developed in older patients resulted in more gingival

inflammation.

Variation within dentition

Supra gingival plaque:

1. Occlusal surface leads to caries.

2. Gingivitis.Subgingival plaque:

1. Periodontitis

2. Other periodontal disease.

Clinical significance

1. Prevention is the first line of treatment.

2. Antibiotics.

3. Other antimicrobial substance like chemical disinfectant.

4. Chlorohexidine: longer time use is not preferable because it cause discoloration of mucus membrane.

Treatment

• Plaque + time = gingivitis• Gingivitis + time = Periodontitis• Periodontitis + time = tooth loss

conclusion

Thank you