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DENTAL PLAQUE
Dental Plaque-A Host associated
biofilm.
Calculus.
4
Materia alba:
Refersto soft accumulations
of bacteria and tissue cells
that
lack the organized structure
of
dental plaque, and it is easily
displaced with a water
spray.
5
CALCULUS:
It is a hard
deposit that
forms by
mineralization
of dental plaque,
and it is
generally covered by a layer
of unmineralized plaque.
6
Cuticle:
It is an electon dense material present in
between subgingival plaque and the tooth.
It contains:
Remains of epithelial attachment lamina.
It represents:
Secretory product of the adjacent
epithelial cells.
7
TYPES:
Dental Plaque
Supragingival
Periimplant plaque
Plaque Subgingival plaque
8
SUPRAGINGIVAL PLAQUE
11
Difference between tooth and
tissue associated plaque:
TOOTH ASSOCIATED TISSUE ASSOCIATED
FACES THE SOFT TISSUE.
ADHERS TO THE ROOT CEMENTUM.
M.O.PRESENT IN AN LACK A DEFINITE
INTERMICROBIAL MATRIX. INTERMICROBIAL MATRIX.
CONTAINS GRAM VE RODS
DOMINATED BY FILAMENTS ,BUT AND COCCI AS WELL AS
RODS AND COCCI ALSO OCCUR. SPIROCHETES AND
FLAGELLATED RODS.
APICAL BORDER IS DOMINATED BY DOMINATED BY
GRAM VE RODS. SPIROCHETES ,COCCI AND
CRITICAL IN CALCULUS RODS .
FORMATION AND ROOT CARIES. IMPORTANT IN THE TISSUE
DISTRUCTION AND
DIFFERENT FORMS OF
PERIODONTITIS
12
Tooth Similar to supragingival plaque
attached Associated with calculus formation,
plaque root caries and root resorption
Epithelial
Similar to subgingival plaque
associated periodontitis
plaque
It is found on artificial
surfaces exposed to
the oral
environment.e.g.(oral
implants)
Structure resembles
that encountered in
the subgingival
environment.
15
Composition of dental plaque:
Dental plaque is composed
primarily of microorganisms.
1 gm of plaque consists of
approx 1.2x1011 bacteria
and nonbacterial species.
Mycoplasma species
Yeasts
Protozoa
Viruses
17
Plaque matrix:
The intercellular matrix
accounts for
approximately 20%-30% of the
plaque mass.
It consists of:
1. Organic material.
2. Inorganic materials.
3. Degenerating or dead
bacteria
4. Few host cells like:
Epithelial cells
Macrophages
Leukocytes
18
Sources of intermicrobial matrix:
Plaque microorganisms
Saliva
Gingival crevicular fluid
Types of intermicrobial matrix:
Fibrillar:in the matrix between gram positive cocci
Granular
Homogenous
May be characterized by the presence of small vesicles
surrounded by trilaminar membrane .Mostly seen in the
case of gram-ve bacteria.
19
Functions of intercellular matrix:
Acts as a barrier.
Protects the resident bacteria.
Confers specialised properties on
bacteria.
Contains nutrient chanals
Maintains the integrity .
20
Organic constituents:
Protein-polysacchride complexes
Lipids
Carbohydrates such as:
1. Dextran
2. Mutan
3. Levan
4. Galactose
5. Methylpentose
Albumin
Murramic acid(obtained from bacterial remnants.)
21
The carbohydrate content of plaque matrix
is as follows:
Hexosamine - 4%
Methylpentose - 3.1%
Galactose - 2.6%
23
Plaque bacteria:
At the outset :
facultative cocci and rods
(Neisseria, Nocardia and
Streptococcus) are seen.
Streptococcus sanguis
predominate.
24
Second to third day :
Increase
in numbers and percentage
(from approximately 7 to 30 per cent),
of which approximately 15 per cent are
anaerobic rods.
25
Fourth to fifth day :
Fusobacterium
Actinomyces and
Veillonella
26
As the plaque matures:
After eleven days:
spirella and spirochetes appear in small
numbers.
Filamentous organisms continue to increase
Actinomyces Naeslundii increases from 1 to
14 per cent from the fourteenth to the
twenty-first day.
Streptococci diminish from approximately 50%
to 30-40%.
Rods ,particularly the filamentous form
increase to 50%.
27
PLAQUE GROWS BY:
MULTIPLICATION OF
BACTERIA.
ADDITION OF BACTERIA.
ACCUMALATION OF
BACTERIAL PRODUCTS.
28
Mature plaque
2.51011 bacteria per gram (by total
microscopic count).
Anaerobes comprise 4.6 1010 per gram of
plaque.
Facultative and anaerobic bacteria consist of
approx. 40% gram positive cocci ,10% gram -ve
cocci,40%
gram +ve rods ,and 10% gram ve rods.
29
Bacterial Enzymes and Toxins
Hyaluronidase an enzyme produced by
Streptococci .
Bacterial collagenases- produced by
clostridial species and pophyromonas
melaninogenicus .
Lipopolysaccharide (LPS), an endotoxin.
Other Bacterial Cell Wall Products:
Lipoproteins.
Murray dipeptide .
Lipid A .
Teichoi acids.
30
BACTERIAL BEHAVIOUR IN
BIOFILMS
Bacteria growing in microbial
communities adherent to a surface do not
behave the same as bacteria in a
planktonic.
31
SUPRAGINGIVAL PLAQUE:
Tooth surfaces ,enamel, and exposed
cementum are covered by a thin layer of
acquired pellicle.
First cellular material adhering to the
pellicle are:
1. Ccocoid bacteria
2. Epithelial cells
3. Polymophonuclear leukocytes.
32
Factors modifying the number of
bacteria in early plaque deposits:
Procedure applied to the sample before
examination.
Presence of gingivitis.
34
Surface Microroughness:
35
Individual variables influencing
plaque formation:
Rate of plaque formation varies between different subjects.Two
Groups are considered :
1. Heavy plaque formers.
2. Light plaque formers.
Diet
Chewing fibrous foods
Smoking
Presence of copper amalgam
Tongue and palate brushing
Stability of bacteria in saliva.
36
Variation within the
dentition:
Early plaque formation can be seen
in:
1. In the lower jaw than in the upper
jaw.
2. In the molar areas.
3. On the buccal tooth surfaces .
4. In the interdental areas .
37
Impact of gingival inflammation:
38
Impact of patients age:
39
Spontaneous tooth cleaning:
There is only negligible difference in
plaque extension before and after eating.
40
Contt
43
Shortcomings:
Some individuals with constant amount of
plaque & calculus never developed destructive
periodontitis.
Individuals who did present with periodontitis
demonstrated considerable site specificity in
the pattern of the disease.
Some sites were not affected, where as
advanced disease was found in adjacent sites.
44
Unified theory:
Given by Theilade in 1986.
IT is the modern version of the two
theories.
Any composition of plaque in
sufficient quantity in the gingival
crevice causes gingivitis but only in
some cases does it lead to
periodontitis.
45
Ecological plaque hypothesis:
46
STRUCTURE OF DENTAL PLAQUE:
47
Plaque as a true Biofilm :
Plaque like a Biofilm has an organized strucure.
48
Like biofilms other modes of gene transfer
are also seen:
Conjugation
Transformation
transposon transfer
Electrostatic forces.
Hydrophobic forces
52
Functions of the Pellicle:
Protective.
Helps to reduce toothwear.
Restricts the diffusion of acids products of
sugar breakdown.
It can bind various inorganic ions e.g.,
calcium, phosphate & fluoride & contains
antibacterial factors including IgG,IgA,IgM,
complement and lysozyme
Nidus for a bacteria attachment of calculus
53
Initial Adhesion and
Attachment of Bacteria:
Phase 1 : Transport to the
surface.
Phase 2 : Initial adhesion.
Phase 3 : Attachment.
Phase 4 : Colonization of
the surface and biofilm
formation.
54
Phase 1 : Transport to the surface.
It involves the initial transport of the
bacterium to the tooth surface .
Random contacts may occur, through
Brownian motion or through active bacterial
movement (chemotatic activity),or by
sedimentation.
55
Phase 2 : Initital adhesion
The second stage results
in an initial, reversible
adhesion of the bacterium,
initiated by the interaction
between the bacterium
and the surface.
Long-range and short-
range forces, including van
der waals attractive forces
and electrostatic repulsive
forces.
56
Phase 3 :
Attachment
58
Growth Dynamics of Dental
Plaque :
60
Gingivitis model:
61
Plaque Architecture :
Inthe first few days:
plaque appears as a dense meshwork
of cocci with occasional rod.
62
On the inner surface:
they are aligned in a perpendicular
palisade arrangement in tuft-like groups
separated by cocci.
66
Microbial complexes:
These show the presence of specific microbial groups
within dental plaque .
Shown by Socransky in the year 1998.
Done on the basis of cluster analysis and community
ordination techniques.
Yellow complex consists of members of the genus
Streptococcus.
Green complex consists of Capnocytophaga
species,Actinobacillus actinomycetemcomitams
,E.corrodens and Campylobacter concisus.
PURPLE complex consists of v.paruvla and actinomyces
odontolyticus.
67
Orange complex
consists of :
Camplyobacter gracilis,
C. rectus,C.showe,
E.nodatum,F.nucleatum,
P.intermedia,P.nigresence
And S.constellatus.
Red complex consists of:
B.forsythus,P.gingivalis,T.denticola.
These two complexes are comprised of the species
thought to be the major etiologic agent of periodontal
disease. 68
The Role of Ingested
Nutrients in Plaque Formation
:
Dental plaque is not a food residue, and the rate of
plaque formation is not related to the amount of
food
consumption.
Dental plaque forms more rapidly during sleep.
Forms rapidly on soft diets.
Hard chewy food retard it.
Dietary supplements of sucrose increase plaque
formation and affect its bacterial composition.
Plaque formation can also occur on:
High protein diets and
Carbohydrate free diets but in small amounts.
70
Significance of Site specificity of
plaque
Marginal plaque : is of prime importance
in the development of gingivitis.
Supragingival plaque & tooth associated
are critical in calculus formation & root
caries.
Tissue associated subgingival plaque is
important in the soft tissue destruction
that characterise different forms of
periodontium. 71
Gingival and periodontal disease
producing:
72
CONCLUDING THOUGHTS:
Many different biofilms exist in nature ;some are useful and
others are associated with harmful effects.Dental plaque is a
naturally occurring biofilm that has the potential to cause
disease.Dental plaque has many properties in common with
biofilms found in other locations.It is rightly said that the