Laura Argello Preventive Dentistry Bacterial Plaque and Its Relation to Dental Diseases Clark

Bacterial plaque is a colorless deposit of bacteria from your own saliva, food and drinks consumed in your diet. It is defined as a dense and organized bacterial system that is embedded in an intermicrobial matrix and is held together by glucan. (Clark 2012 Class Notes) Plaque begins its formation when salivary glycoproteins are absorbed into the dental enamel to form acquired pellicle. Bacteria are then nurtured by the acquired pellicle, where the bacteria are able to multiply and begin colonization. As the bacteria colonize, biofilm begins to form and later produces a matrix, producing the final element: plaque. (Clark 2012 Class Notes). As the biofilm in plaque matures, so does the bacteria and microorganisms that make it up when it is left undisturbed. A clean mouth consist of epithelial cells and very few cocci bacteria. If the mouth is left unbrushed for 1 to 2 days, masses of gram positive cocci and streptococci bacteria are dominate. Four to seven days later, filamentous bacteria increase along with mixed flora, rods and fuso bacteria. Within 1 to 2 weeks, vibrios and spirochetes are present, along with cocci, and filamentous forms. (Clark 2012 Class Notes). Plaque causes just about everything. It is responsible for inflammatory dental diseases such as caries, gingivitis and periodontitis. The best way to avoid these health problems is prevention. To control plaque formation, it is essential to brush and floss regularly. Two times a day, for at least two minutes for brushing is recommended to make sure all the bacteria is disturbed. Flossing is recommended at least once a day for plaque prevention to remove the plaque accumulated in the interproximal spaces. (Clark 2012 Class Notes).

Laura Argello Preventive Dentistry Bacterial Plaque and Its Relation to Dental Diseases Clark

Caries formation begins when plaque is left undisturbed it lowers the normal pH of the mouth from a neutral 7, down to more acidic levels. Depending on how long that acidic level stays in the mouth, or until the teeth are brushed, demineralization is happening. If demineralization is left to proceed long enough, it causes white spot incipient lesions through subsurface demineralization. The acid is then able to pass through microchannels in the enamel leading to clinically visible carious lesions. (Wilkins, 2013). Mutans of streptococci and other acid forming bacteria are the predominant bacteria. Lactobacilli and streptococci bacteria are large factors of the formation of a carious lesion and components of the biofilm. Xerostomia will aid in the growth and maturation process of streptococci and lactobacilli mutans in the biofilm. (Wilkins, 2013). To prevent the formation of carious lesions food intake is a very important thing to consider. If a meal contains a high amount of sucrose, the pH is significantly lowered. If the high sucrose intake is taken in only at mealtimes it can be expected that the meal is less cariogenic than if the sucrose were taken in at frequent snack intervals throughout the day. Another way to prevent carious lesions is to have some sort of fluoride intake to remineralize the teeth along with regular brushing and flossing. (Wilkins, 2013). Calculus is divided into supragingival and subgingival calculus. Calculus is calcified dental plaque. It is composed of calcium phosphate mineral salts that are deposited between and within areas of feasible microorganisms. (Eur. J, 1997).

Laura Argello Preventive Dentistry Bacterial Plaque and Its Relation to Dental Diseases Clark

Supragingival calculus has a 70-90% content of inorganic minerals and forms from minerals in the saliva like phosphate, calcium carbonate, magnesium, sodium, potassium and traces of fluoride, zinc, and strontium. Supragingival plaque is found on clinical crowns of teen and above margins of the gingiva. It is easily located on the lingual mandibular anterior teeth and the buccal of the maxillary 1st and 2nd molars. Subgingival calculus forms as an extension of supragingival plaque. The minerals that compose subgingival calculus come from the gingival cervicular fluid (GCF). The gingival cervicular fluid contains more calcium, magnesium and fluoride than saliva. No salivary proteins are present in subgingival calculus. (Clark 2012 Class Notes). Supragingival calculus can be controlled and prevented by chemical mineralization inhibitors found in toothpastes or mouthrinses. The components in these toothpaste and mouthrinses delay plaque calcification. They are able to keep deposits in an amorphous non hardened state, making it easier to remove with regular oral hygiene. (Eur. J, 1997). Subgingival calculus is tenacious, black or dark green in color, and forms in rings or ledges on the root surfaces below the gingival margin. It is most commonly found on the interproximal spaces and randomly throughout the mouth. (Clark 2012 Class Notes) Calculus is significant to periodontitis disease because it helps in developing the deep unwanted pockets. The calculus forms a rough surface layer that allows for the collection of disease causing bacteria to thrive. The bacteria then advance the inflammation subgingivally near the deep pocket lining causing periodontitis and supragingivally causing gingivitis. (Wilkins,

Laura Argello Preventive Dentistry Bacterial Plaque and Its Relation to Dental Diseases Clark

2013). Subgingival calculus specifically, is correlated to periodontal disease in populations that do not have access to professional care. The levels of calculus present depends on hygiene habits, access to professional care, diet, age, ethnic origin, time since last visit, and medications. (Eur. J, 1997). Gingivitis is one of many outcomes of bad oral hygiene causing gingival inflammation. It accounts for about 70% of gum disease (Jaret, 2012). Many who have gingivitis do not realize it because it is painless the color difference isnt very noticeable until stage II. In stage II the gingival tissues are red rather than pink, and inflammation is clinically noticeable. It is the most common human disease and also the easiest to reverse. But if left untreated it could lead to periodontitis. Plaque is highly correlated to gingivitis because the inflammatory response is initiated within the first days of plaque coming into contact with the gingival tissues. In other words; dental plaque is the cause of gingivitis. (Wilkins, 2013). Gingivitis is clinically noticeable when the gingival color appears red rather than pink. When the gingiva is swollen rather than firm and resilient is another observable characteristic of gingivitis. Drainage gingival fluid and easy bleeding upon probing/exploring are also characteristics that point to gingivitis. (Clark 2012 Class Notes). Symptoms one can personally notice are bleeding when brushing and persistent bad breath. (Jaret, 2012). The easiest way to prevent gingivitis is to brush and floss to make sure there are no deposits of plaque left behind that could cause the initial inflammation. One may also use an

Laura Argello Preventive Dentistry Bacterial Plaque and Its Relation to Dental Diseases Clark

antibacterial mouth rinse to prevent plaque formation and improve the state of gingivitis. Smoking can damage gum tissue and cause inflammation in the oral cavity as well as other health risk in the body, it is recommended to try and quit (Jaret, 2012). Periodontitis is a group of conditions that involve inflammation of the gingiva, periodontal ligament, cementum, and supporting bone. Periodontitis is caused by the bacteria in plaque that lead to gingivitis. Characteristics of periodontitis include; swelling, bleeding, and/reddening of gingival, bad breath, unpleasant taste in mouth, receding gums and loose teeth. The deep pockets that are caused by the gingivitis lead to the bigger problems like loose teeth and eventually loss of those teeth affected by the infection. (Colgate, 2010) To prevent the development of periodontitis diseases, brushing and flossing is again the most effective method for prevention, along with routine care visits to a health care professional. (Colgate, 2010) A good overall oral health is essential to an overall general health. Having a bad oral hygiene along with gum diseases can lead to far worse conditions like diabetes, heart disease and put you at a higher risk for a stroke. To maintain a proper health it is important to have a healthy diet much like the food pyramid suggest. A proper diet that is good for the teeth as well is high in fruits, vegetables and meats. It is important to try and steer clear of foods high in carbohydrates that can lower the oral cavities natural pH level that lead to the above gum diseases if it is not neutralized.

Laura Argello Preventive Dentistry Bacterial Plaque and Its Relation to Dental Diseases Clark

Along with a healthy diet, brushing and flossing is the number one methods used to prevent and control gum disease at home. To further prevent unwanted gum diseases one should make sure to make routine visits to a dental hygienist to clean what is unreachable to the basic oral hygiene regimen.

Laura Argello Preventive Dentistry Bacterial Plaque and Its Relation to Dental Diseases Clark

Bibliography
Clark, S. (2012) Preventive Dentistry Class Notes. Kirkwood Community College.

Wilkins, Esther M. (2013). Clinical Practice of the Dental Hygienist. Philadelphia. Lippincott, Williams, and Wilkins.

Jaret, Peter. Drescher,Steve. (2012) Preventing and Treating Gum Disease. WebMD. Retrieved November 24, 2012, from http://www.webmd.com/oral-health/healthy-teeth-10/gums-problemsgingivitis

Laura Argello Preventive Dentistry Bacterial Plaque and Its Relation to Dental Diseases Clark

Eur, J. (1997) Dental calculus: recent insights into occurrence, formation, prevention, removal and oral health effects of supragingival and subgingival deposits. NCBI, 105(5 Pt 2):508-22. Retrieved November 24,2012, from http://www.ncbi.nlm.nih.gov/pubmed/9395117

Columbia University College of Dental Medicine. (2010). What is periodontitis. Oral and Dental Care Resource Center. Colgate. Retrieved November 24, 2012, from http://www.colgate.com/app/CP/US/EN/OC/Information/Articles/Oraland-Dental-Health-Basics/Common-Concerns/Gum-Disease/article/Whatis-Periodontitis.cvsp