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Dental Plaque and Periodontal diseases

1. LOE 1965 paper: Experimental Gingivitis in Man


(1) Produce gingivitis by withdrawing the oral hygiene
Purpose
(2) Change of microbial flora
Method & 12 23 oral hygiene PI baseline
material
GI PI(bacterial study)
(1) 3 people < 10 days9 people 15 - 21 days
Result
(2) PI0.43 - 1.67
(3) GI0.29 - 1.05 a
(1) Initial: 90-100% G(+) cocci and rods
Smear
(2) 1-7 days: 50-70%
(3) Developed gingivitis: 45-60%
(1)
(2) 15-21 gingivitis
Discussio
(3) Increase the age of plaque
n
(4) gingivitis
(5) Plaqueessential in the production of gingivitis
2. Dental deposits
Dental plaque bacterial aggregation on the teeth or other solid oral structure

(1) Formation of dental pellicle coating of the tooth surface


(2) Initial colonization by bacteria
a. G(+) facultative, e.g., Actinomyces viscosus, Streptococcus sanguis
b. Adhesins: fibrous protein (fimbriae) bind to proline-rich PT on dental pellicle
(3) Secondary colonization and plaque maturation
e.g., Prevotella intermedia, Prevotella loescheii, Prophyromonas gingivalis
Phase I (1 day)
80-90% G(+) cocci, rods
Phase II (2-4
Rods, filamentous, leptothix,
days)
Fusobacterium
Phase III (6-8
Vibrios, spirochetes
days)
Rate of plaque formation: 1-30 days
- Maturation: multiplication and coaggreagation of bacterial species that do
not initially colonize tooth and gingival epithelial surfaces
- Coaggregation: stereochemical interaction of protein and CHO on bacterial
cell wall
e.g., (F. nucleatum + S. Sanguis/P. gingivalis), (P. loescheii + A. Viscosus)

(1) Tooth surface, (2) Filling materials, (3) Crowns, (4) Orthodontic appliance, (5)
Denture
plaque formation
(1) Absence of food intakes
(2) Consistency of food: hard, friction, fibrous
(3) composition

(1) Microorganism, (2) Epithelial cell, (3) Leukocyte, (4) Macrophage, (5) matrix
Plaque matrix
- plaque volume 25%
-
a. Altered glycoprotein from saliva and crevicular fluid
b. Bacterial destransm levans and other sugar polymers
c. Bacterial metabolites and extracellular enzymes
d. Bacterial cell wall, cytoplasmic constituents
-
a. Organic CHO(30%), protein(30%), lipid
b. Inorganic Ca, Mg, phosphorus

Supragingival plaque

Subgingival plaque

biofil
m

Gray, yellowish gray


At or coronal to the gingival margin

Apical to the gingival margin


cuticle

Acquired pellicle
Attached to gingival epithelial and
tooth surfaces (adhesion on pellicle
mass growth and maturation )
2-4 hours. Irreversible bactieral
colonization
Gram(+) facultative cocci

* subgingival plaque
Attached zone
G(+)
No extend junctional epithelium
Associated root caries, calculus, root
resorption

Attached to gingival epithelial and


tooth surfaces, but also loosely
adherent within the sulcus
Gram(-) anaerobic bacilli and
spirochetes
(surface layer facing soft tissue
contain many motile spirochetes,
text-tube brush form)
* Attached zone / Unattached
zone
Unattached zone
G(-)
Contact with sulcular and junctional
epithelium
Periodontal pathogen

Subgingival plaque, Tooth associated


(1) Cocci, fulamentous, fusiform
(2) May penetrate cementum
(3) Associated calculus, root caries, root resorption
Subgingival plaque, epithelium associated
(1) Loosely adhere to junctional epithelium or in pocket lumen
(2) Mobile and G(-)
(3) May penetrated epithelium and CT
(4) Associate gingivitis and periodontitis
Material alba

Food debris
Acquired
pellicle

Cuticle

Calculus

soft accumulation of bacteria and tissue cell that lack of organized structure of
dental plaque
Yellow, grayish white soft sticky deposit
Microorganism, desquamated epithelial cell, leukocyte, salivary of PT, lipids
Less adherent can be flushed away by water spray
(1) Dental plaque is not a derivative of food debris
(2) Not an important cause of gingivitis
an acellular, bacteria free, granular and heterogenous material coating of
variable thickness
derived from saliva and crevicular fluid, also from bacterial and host tissue cell
products
selective adsorption of environmental macromolecules electrostatic, van der
Waals force

(1) Thin pale during stain


(2) Mechanical cleaning to remove
(3) Reform on surface within minutes
Primary: reduced ameloblast
Secondary:
(1) Remains of epithelium, attachment with deposit from gingival exudate (Frank
1970)
(2) Secretory product of adjacent epithelial cell (Schroeder 1977)
an adherent calcified/calcifying mass that forms on the surface of natural
teeth/dental prosthesis

(1) Always covered by plaque


(2) Keep plaque in close contact with gingiva
(3) Interfere the removal of plaque

(4) Contain bacterial toxic product


(5) Contributory factor

Inorganic component (70-90%)


Ca3(PO4)2 75.9%, CaCO3 3.1%, Mg3(PO4)2
(Ca 39%, PO43- 19%)
2/3 inorganic componenet is in
crystalline
(1) Hydroxyapatite 58%
(2) Magnesium whitlockite 21%
(posterior)
(3) Octacalcium phosphate 21%
(4) Brushite 9% (lower anterior)

Organic component
(1) PT-polysaccharide complex
(2) Desquamated epithelial cell
(3) Leukocytes
(4) microorganism

Prevelance:
(1) supragingival calculus reaching a maximum at 25-30 y/o
(2) subgingivally no teeth without calculus by age 30
(3) increase with age
(4) Norway: molar and lingual of lower anterior teeth with 80% at teenage, no
increase with age

Mineral
source

Supragingival calculus
White, whitish yellow
Hard, clay like
Easy detach
Saliva

Subgingival calculus
Dark brown, greenish black
Hard, flint like
Firm attach
Gingival fluid

Maxillary molar (Stensens


duct)
Mandibular incisor (Whartons
duct)

Theory of mineralization of calculus


(1) Saturation of calcium & phosphate
rise of PH (loss of CO2, formation of ammonia)
(2) Super-saturated solution
Colloidal PT supersaturated saliva stagnation colloid settle out
Enzyme: organic phosphate free phosphate ion by phosphatase
Fatty ester free fatty acid by esterase, binding Mg, Ca
Rate of calculus formation:
(1) Mineral deposit of soft plaque: 1-14 days, 4-8 hours
(2) Calcifying plaque: 2 days 50% mineralized; 12 days 60-90%
(3) Daily increment: 0.1-0.15% of dry weight
Other factors:
(1) Fault dentistry:
overhang of restoration, dental cement retained, poor designed prosthesis,
surface roughness
(2) Food impaction
(3) Mouth breathing
(4) Toothbrush trauma
(5) Trauma from occlusion
(6) Smoking
(7) Systemic condition: DM
3. Microbiology of oral cavity
birth
Oral cavity is sterile
6-10 hours
Facultative flora, e.g., S. Salivarius
10 days
Anaerobes in someone
5 months
Anaerobe in most
tooth
Anaerobe in 100% (tooth eruption bacteria )

eruption
Preschool
child

Same as adult, except spirochete, P. melaninogenius ( enamel )

4. Microorganism in saliva
(1) 750 million per mm
(2) G(+) facultative cocci (streptococci 45%), fungi, virus, mycoplasma
5. Flora (healthy gingiva v.s. gingivitis)
Normal flora (healthy gingivae)
Streptococci, Actinomyces (85%)
Non-motile : motile = 40 : 1
G(-) P. intermedius, P. gingivalis

Flora in gingivitis
(initial) Streptococci to Actinomyces
(gingivitis with bleeding) A. viscosus,
bacteroids
GI: 3
P. gingivalis 31.8%

6. Pregnant gingivitis:
P. intermedia, associated with estrogen, progesterone
7. Acute Necrotizing Ulcerative Gingivitis (ANUG)
Treponema 32%,P. melaminogenicus 26%, Selenomonas 6%, Fusobacterium 3%
8. Periodontitis
(1) G(-) anaerobes, motile
(2) Non-motile : motile = 1 : 1
(3) P. gingivalis 40%, Spirochetes 30%
(4) Attachment loss associate spirochetes
9. Flora associated early-onset form periodontitis
(1) Juvenile periodontitis:
Actinobacillus actinomycetemcomitans, Haemophilusm, P. gingivalis, Fusobacterium
nucleatum, Eikenella corrodens
(2) Child periodontitis:
Fusobacterium, Selenomonas Wolinella, Capnocytophaga
10. Rapidly progressive periodontitis
P. gingivalis, P. melaninogenius, Wolinella Haemophilus, Spirochetes

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