Development of Bacterial

Plaque
Nelson P. Angeles, DMD, MEM
 FACTORS THAT DETERMINE
THE PATHOGENECITY OF THE
PLAQUE

HOST RESISTANCE
HOST DIET
ORAL HYGIENE
STATUS OF THE DENTITION
COMPOSITION OF THE ORAL FLORA
 Streptococcus Mutans the single
most important organism in the
initiation of enamel caries and is
considered to be a virulent cariogen.

Streptococcus Sanguis a superior

competitor to tooth colonization will
prevent streptococcus mutants from
dominating in a certain niche in the
absence of a high sucrose diet
 Actinomyces Viscosus the
bacteria which initiates root caries

Lactobacillus bacteria that initiate

dentinal caries
Bacteria
 Sites and Macro morphology

Site
Developmental Pits and Fissure
Smooth Enamel Caries
Root Surface Caries
 Your mouth is a busy place. Bacteria - tiny
colonies of living organisms are constantly
on the move on your teeth, gums, lips and
tongue.
 Having bacteria in your mouth is a normal
thing. While some of the bacteria can be
harmful, most are not and some are even
helpful.
 Certain types of bacteria, however, can
attach themselves to hard surfaces like the
enamel that covers your teeth. If they're
not removed, they multiply and grow in
number until a colony forms. More
bacteria of different types attach to the
colony already growing on the tooth
enamel. Proteins that are present in your
saliva (spit) also mix in and the bacteria
colony becomes a whitish film on the
tooth. This film is called plaque, and it's
what causes cavities.
Sugar plays a harmful role in tooth decay. The
bacteria that form together to become plaque
use sugar as a form of energy.
 They multiply faster and the plaque grows
in size and thickness. Some of the bacteria
turn the sugar into a kind of glue that they
use to stick themselves to the tooth
surface.
This makes it harder for the bacteria to get
washed away with your saliva.
 Severe Dental Decay

The hard, outside covering of your teeth is called enamel. Enamel

is very hard, mainly because it contains durable mineral salts, like
calcium. Mineral salts in your saliva help add to the hardness of
your teeth. Mineral salts, however, are prone to attack by acids.
Acid causes them to break down.
 The plaque that forms on your teeth and doesn't
get washed away by saliva or brushed away by
your toothbrush produces acid as it eats up
sugar. This acid is produced inside the plaque
and can't be easily washed away by your saliva.
The acid dissolves the minerals that make your
tooth enamel hard. The surface of the enamel
becomes porous - tiny holes appear. After a
while, the acid causes the tiny holes in the
enamel to get bigger until one large hole
appears. This is a cavity.
It's important to see your dentist before a cavity
forms so that the plaque you can't reach with
your toothbrush or floss can be removed.
 Nerve fibres, the way that pain is sent through
the body, aren't present in tooth enamel. While
the acid is attacking the enamel, you can't feel a
thing.
Once the acid has begun to create a cavity and
attacks the dentin under the enamel, the nerve
fibres begin to send out a message that
something is wrong. But by then, you have tooth
decay.
That's why it's important to have regular,
preventive dental check-ups. Don't wait until it
hurts!
 Histological Structure of
Carious Lesion
Zone 1 (Translucent or Deepest Zone)
represents the advancing front f the
lesion
Zone 2 ( Dark Zone )
there is a loss of crystalline structure
which suggests demineralization and
remineralisation
Zone 3 ( Body Zone )
the largest portion of the carious lesion
the caries process enters the enamel
surface via the striae of retzius, and the
inter-prismatic substance and rod cores
are then preferentially attacked.

Zone 4 (Surface Zone )

unaffected by the caries attack
 Advanced Carious Lesion
1. Most superficial layer of infected dentin
is the Necrotic Zone. Necrotic dentin is
wet, mushy and easily removable mass.

2. The deeper infected dentin dry and

leathery. Easily removed by hand
instruments and flakes of in layers
parallel to the DEJ.
3. Slow Advancing Lesion
it is expedient to remove softened
dentin down to the readily identifiable
zone of sclerotic dentin.

4. Rapidly Advancing Lesions

there is little evidence to indicate the
limits of the infected dentin whether by
texture or color change
 Other terms for Carious
Dentin
Infected Dentin is both softened and
contaminated with bacteria. Includes the
superficial necrotic tissue and the outer
layer of very soft dentin.

Affected Dentin is often dentin not yet

invaded by bacteria. The inner dentin is
capable of re-mineralization, provided the
pulp remains vital
 Dental Caries is diagnosed by:
Visual Changes in tooth surface,
texture and colour
Tactile Sensation when an explorer
is placed into a pit or fissure and theres a
catch or resistance or tug back.
Radiographs periapical, bitewing,
panoramic, occlusal, cephalometric
Transillumination by placing a
mirror or light source on the lingual side
of the tooth
 What to do when there is Pulp
Exposure
1. INDIRECT PULP CAPPING
is resorted to which involves the
placing of mixed calcium hydroxide on thin
layer of dentin remaining over the
pulp.
2. DIRECT PULP CAPPING
involve placing calcium hydroxide
directly on the exposed pulp tissue.
 CARIES TREATMENT
A. PREVENTIVE METHOD
1.Oral Hygiene
2.Fluoride Treatment
- it enhances the precipitation of
fluora-apatite from calcium and
phosphate ions present in saliva,
- incipient, non cavitated, carious
lesions are remineralized by the
same process,
- it has an antimicrobial activity
3. Occlusal Sealants
- they mechanically fill deep pits
and fissures with acid-resistant
resin
- they deny S. mutans and other
cariogenic organisms their
preferred habitat
- they render pits and fissures
more cleanable
 Fluoride is a natural element that can be
found in many things, like the water we
drink and the food we eat. Decades ago,
scientists began to notice that children
who lived in places where fluoride
occurred naturally in the water, had fewer
dental cavities.
 Fluoride that is absorbed by your body is
used by the cells that build your teeth to
make stronger enamel. Topical fluoride -
fluoride that is applied to the outside of
the enamel - makes the crystals that form
enamel more durable. Tooth enamel
crystals that have fluoride are much more
resistant to acid. They are less likely to
breakdown and cause the tooth surface to
become porous.
 If your dentist recommends a fluoride
treatment during your next dental visit,
you'll be receiving topical protection. The
fluoride your dentist puts in your mouth
will help make the crystals in your tooth
enamel stronger. Always use a toothpaste
with fluoride.
 What is a pit & fissure sealant?
How is it applied?

The top surfaces of your teeth - where the

chewing takes place - aren't smooth and
flat. They are cris-crossed with tiny hills
and valleys - called pits and fissures. These
are places where plaque can build up safe
from your toothbrush and dental floss.
Some of the pits and fissures are so narrow
that even a single bristle from your
toothbrush can't get deep enough to clean
them out.
 One method of preventing cavities from
developing in the pits and fissures is to
seal them off with a special varnish called
a pit and fissure sealant. If your dentist
determines that you need a pit and fissure
sealant to help protect your teeth from
decay, some special steps are taken to
prepare the teeth first. Your dentist will
clean the tooth first, then apply a mild acid
solution to 'etch' the surface and make it
easier for the pit and fissure sealant to
stick. (The etching solution is the blue gel
in the sealant video below).
 The whole procedure is quick and painless.
Keeping the area dry and away from your
saliva during the application is very
important. If the tooth gets wet, the
sealant might not stick properly. Once
everything is ready, your dentist 'paints'
the sealant right over the pits and fissures
on the tooth surface. (Do you see it being
painted on with a cotton swab in the
video?). A special kind of light cures the
sealant and makes it ready for use.
 What's dental floss made of?
How does it work?
 Brushing alone isn't enough to clean all of
the plaque from the surface of your teeth.
Inter-proximal areas (those places in
between your teeth) and below the gum
line are two spots where the toothbrush
can't reach and plaque can build up. These
are areas that are more susceptible to
cavities. Daily flossing and regular visits to
your dentist are the only effective ways to
remove this plaque.
 Dental fact:

Did you know that failing to floss means

up to 35% of your tooth surface goes
unclean?
Dental floss is a man-made fibre (usually
made of nylon) that comes on a spool. Ask
your parents or your dentist how to
correctly use dental floss if you're not sure.
 Why do we brush our
teeth?

Brushing your teeth is one of the most

effective ways of removing plaque from the
exposed surfaces of your teeth.
What's the best kind of brush
to use?

Contrary to what you might think, a gentle

brushing with a soft-bristle toothbrush is
just as effective (and less damaging!) than
a vigorous scrubbing with a stiff-bristle
toothbrush.
 Your tooth enamel is relatively thin. Years
of aggressive brushing can begin to wear
away the enamel and make the teeth
sensitive. (Remember, the enamel on your
teeth does not contain nerve fibres, but the
dentin layer underneath does.

Brushing too hard can also damage your

gums.
 There are different styles of tooth
brushing. The important thing to
remember is that an effective brushing
cleans every exposed tooth surface in a
gentle, massaging motion.
 How long do you take to brush your teeth?
Most people think they brush for at least a
minute or two, but in reality they brush for
30 seconds or less.

Time yourself and see how you do. An

effective brushing takes 2 - 3 minutes.
 Visit your dentist regularly for preventative
checkups and cleanings. Your dentist is trained to
see the hidden problems you can't.
 Floss your teeth once everyday. Dental floss
reaches many areas that your toothbrush can't.
It's important to eat a well-balanced diet and
avoid excessive snacking between meals -
especially sticky, sweet things like candy.
Keep an eye on your gums for signs of gum disease.
Puffy, red or tender gums, gums that bleed or
persistent bad breath are signs that you need to see
your dentist right away.
 Brush your teeth carefully at least once a day.
Remember, a thorough job takes 2 1/2 to 3 minutes.
 Prevention is
better than cure.
Nelson P. Angeles, DMD,
MEM