Plaque and Calculus
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This document provides information on periodontal diseases including their etiology, plaque, calculus, and periodontal abscesses. It discusses how plaque biofilm builds up in 4 stages and leads to gingivitis. It then explains how the inflammatory response creates an environment for more bacteria to colonize and cause periodontitis. It details the formation of supragingival and subgingival calculus from mineralization of plaque. Finally, it provides information on diagnosing and treating periodontal abscesses.
Plaque and Calculus
- 2. CONTENT 1 Aetiology of Periodontal Diseases 2 Plaque 3 Calculus 4 Periodontal Abscess 5 Treatment
- 3. AETIOLOGY OF PERIODONTAL DISEASES Primary etiology of all forms of periodontal diseases = Plaque Biofilm: a thin layer of microorganisms adhering to the surface of a structure, which may be organic or inorganic, to gether with the polymers that they secrete. Dental biofilm- a biofilm is a layer of bacteria attached to the supragingival or subgingival surface of a tooth. Plaque - the visible accumulation of a supragingival or subgingival biofilm. Tartar is what accumulates on your teeth when plaque is not removed. If plaque is left on your teeth for too long, it will harden into tartar and is much more difficult to remove. In fact, tartar can only be removed by a dental professional–you can't get rid of it with regular brushing and flossing
- 4. AETIOLOGY OF PERIODONTAL DISEASES Plaque Biofilm cause gingivitis by inducing inflammatory host response. That inflammatory response – gingival pocket – ideal environment – for further bacterial colonization. In Gingival Pocket – extremely low oxygen – develops of anaerobes and several other – periodontal diseases. In 1996, three species (bacteria) – cause periodontitis = Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Tannerella forsythia. Virulence Factors: pathogens use a number of mechanisms to exert damage to host tissues: adherence, proteases, bone resorption factors, cytotoxic metabolites, leukotoxins, and induction of the inflammatory response via cytokines and chemotaxins.
- 5. PLAQUE Plaque Biofilm or dental biofilm – is an adherent mass of diverse micro-organisms in a muco- polysaccharide matrix. It cannot be rinsed off but can be removed by brushing. Pellicle: one essential function of human saliva is the formation of the acquired dental pellicle, a thin coating layer of high tenacity covering all solid surfaces in the oral cavity. It is composed of proteins and glycoproteins (It consists of an aggregation of cells, proteins, and polymers). It lubricates the tooth surface and serves as a barrier and buffer to demineralizing agents. The growth and development of biofilm are characterized by 4 stages: initial adherence, lag phase, rapid growth, and steady state. Biofilm formation begins with the adherence of bacteria to a tooth surface, followed by a lag phase in which changes in genetic expression (phenotypic shifts)occur. Four stages of dental plaque biofilm growth: (1) bacterial attachment to a surface, (2) microcolony formation, (3) biofilm maturation and (4) detachment (also termed dispersal) of bacteria which may then colonize new areas
- 6. PLAQUE The process of biofilm formation in the oral cavity is divided into four stages: 1. acquired pellicle formation; 2. initial adhesion; 3. coaggregation; 4. maturation and diffusion.
- 7. PLAQUE Compositions of plaque: 20 to 30% Intercellular Matrix & 80% Microorganisms. Intercellular Matrix: Organic & Inorganic Microorganisms: one gram of plaque contains approximately 2*𝟏𝟎𝟏𝟏 bacteria More than 500 distinct microbial species found in dental plaque. Nonbacterial Organisms: MYCOPLASMA, YEAST, PROTOZOA, VIRUSES
- 8. FORMATION OF PLAQUE Pellicle Formation on Tooth Surface Initial Adhesion and Attachment Colonization and Plaque Maturation
- 9. FORMATION OF PLAQUE `A fully established pellicle is found within 30 min. Within 24 hr, the pellicle is around 0.1- 0.8 µm in diameter. Derived from components of saliva and crevicular fluid as well as bacterial and host tissue cell products and food debris. FUNCTIONS OF DENTAL PELLICLE: 1. Protective Barrier 2. Lubrication 3. Preventing Tissue Desiccation 4. Substrate to Which Bacteria Attaches
- 10. FORMATION OF PLAQUE What Happen in First hour of Plaque Formation? Bacteria adhere to pellicle, and pellicle coats the enamel. (1Hr) Gram positive rods and cocci are laid down in the first hour. (1Hr) 24 to 48Hr Bacteria multiply and form mini-colonies in layers upon the pellicle. (24-48Hr) The bacteria adhere and increase in mass and thickness. (24-48Hr) 4 to 7 Days As the plaque thickens at the cervical area, the deeper layers incorporate more filaments and fusiforms, eventually turning gram negative. (4-7days) The coronal plaque is a more simple early arrangement of rods and cocci. (4-7days) Bleeding on probing and erythema can be seen. (4-7days) The plaque becomes more gram negative and anaerobic in the deeper layers. The signs of inflammation are more pronounced. (7 to 14days)
- 11. CALCULUS Calculus (Tartar) is a calcified deposit found on teeth or prosthesis and is formed by mineralization of plaque deposits. The mineral content of supragingival calculus derives from saliva, that for subgingival is from gingival crevicular fluid. It is classified as supragingival or subgingival, according to its relation to the gingival margin. Supragingival Calculus: most often found opposite the openings of the salivary ducts, i.e. 76┴67 opposite the parotid (Stensen’s) duct or the lingual surfaces of the lower anterior teeth. It is usually creamy-coloured, but can become stained a variety of colors. Subgingival Calculus: is found underneath the gingival margin and is firmly attached to tooth roots. It tends to be brown or black, is extremely tenacious, and is most often found on interproximal and lingual surfaces. It is associated with subsequent periodontitis. With gingival recession it can become supragingival.
- 13. CALCULUS Composition: consists of up to 80% inorganic salts, mostly crystalline, the major components being calcium and phosphorus. Formation: is always preceded by plaque deposition, the plaque serving as an organic matrix for subsequent mineralization. Initially, the matrix between organisms becomes calcified with, eventually, the organisms themselves becoming mineralized. Subgingival calculus usually takes many months to form, whereas friable supragingival calculus may form within 2 weeks.
- 14. DEVELOPMENT OF PERIODONTAL DISEASES
- 15. DEVELOPMENT OF PERIODONTAL DISEASES
- 16. DEVELOPMENT OF PERIODONTAL DISEASES
- 17. PERIODONTAL ABSCESS This is a localized collection of pus within the tissues adjacent to a periodontal pocket. It occurs either due to the introduction of virulent organisms into an existing pocket or low drainage potential. Clinically there may be swelling, pus from pocket or sinus, pain tenderness to percussion, and signs of periodontitis. Periapical Abscess Periodontal Abscess Non-Vital Usually Vital TTP vertically Pain on lateral movement May be mobile Usually mobile Loss of lamina dura on X-ray Loss of alveolar crest on X-ray
- 18. PERIODONTAL ABSCESS Emergency Treatment: Incision and drainage under LA; systemic antibiotics like, metronidazole 200-400mg &/or amoxicillin 250-500mg for 5 days if systemic involvement. Further Treatment: Mechanical debridement after the problem has settled to avoid iatrogenic damage to healthy periodontal tissues adjacent to the lesion.