1. DENTAL PLAQUE
BY DR. MANISHA MISHRA

2. Dental Plaque
Yellowish white soft, tenacious, amorphous material deposited on tooth surface
Formation
Adherent layer of mucinous material from saliva
Colonisation of layers by diffusion of micro organisms
w/n 48 hrs whole layers constitute of microorganisms

3. Plaque deposition occurs in interproximal surface of posterior teeth i
Plaque deposition occurs in interproximal surface of posterior teeth i.e,labial and gingivial for lower and labial and palatal for upper teeth.
Types:
Supragingival
Infragingival
Composition:
70-90%-Microorganisms
10-30%-Inorganic and Organic substances

4. Dental Plaque
Heavy staining and calculus deposits exhibited on the lingual surface of the mandibular anterior teeth, along the gumline.

5. Plaques initially populated by following:
Organisms:
Gram positive Cocci/Bacilli
Gram negative Cocci and Bacilli
Fungus—Candida albican,Actinomycosis israelli

6. 1.Gram positive cocci—
Streptococcus-mutans,viridans,mitis,milleria,salivaris,pyogens,Staph- aureus,albus
2.Gram negative cocci—
NG,NM,NC
3.Gram positive bacilli—
Lactobacillus- acidiphilus,fermentation,odentolyticus
4.Gram negative bacilli—
H.influenzae,B.pertusis,Fusiform bacteria

7. Other than organisms:
Inorganic—Calcium,Sodium, Potassium,Phosphorus
Organic— Protein,Lipid, desquamated essential FA,Leucocytosis,Cells.

8. Growth of plaque
Multiplication of existing bacteria
Addition of new bacteria
Accumulation of metabolic products of bacteria
Food debris from diet
Plaque leads to:
Acids released from dental plaque lead to demineralization of the adjacent tooth surface, and consequently to dental caries.
Saliva is also unable to penetrate the build-up of plaque and thus cannot act to neutralize the acid produced by the bacteria and remineralize the tooth surface.
They also cause irritation of the gums around the teeth that could lead to gingivitis, periodontal disease and tooth loss.
Plaque build up can also become mineralized and form calculus (tartar).

9. Inadequate removal of plaque caused a build up of calculus (dark yellow color) near the gums on almost all the teeth.
DENTAL PLAQUE

10. Prevention
1. Mechanical – Brushing , Flossing
Brush your teeth twice daily using a fluoride-based toothpaste.
Floss your teeth daily, or use an interdental cleaner.
2. Chemical – Mouth wash
3. Food intake –
Coarse, Dry (Avoid 3s sweet, sticky, soft)
Eat a balanced diet.
Avoid using tobacco products.
Limit the number of snacks you eat throughout the day.
4.Gingival massage

11. Dental Calculus (TARTAR)
Hard deposit formed on the tooth (due to mineralisation of dental plaque)
Plaque converted to calculus in 50 – 60 days
Classification
Supragingival – coronal to gingival margin
Subgingival – below the crest of gingival margin

12. Supragingival calculus:
Colour=Yellowish to white ,Blackish
Consistency=clay like
Maximum occurs in Upper buccal region of molar teeth,lingual and interproximal surface of lower to anterior teeth.
Subgingival calculus:
Dense brown to greyish black in colour

14. Composition:
70-90%=Inorganic material
10-30%=Organic material
Calculus formation can result in a number of clinical manifestations:
including bad breath
receding gums and
chronically inflamed gingiva.

15. Prevention
As in Plaque (oral hygiene)
Treatment
Scaling
1. Manual and
2. Ultrasonic scaling

16. DENTAL CARIES

17. Dental caries
Irreversible progressive bacterial damage to the hard structures of the tooth characterised by demineralization resulting in the formation of a cavity
Etiology
--Decalcification by bacterial acid followed by destruction of all other tooth tissue
No theory is universally accepted
Acidogenic theory
Proteolysis chelation theory
Proteolytic theory

19. Acidogenic theory
Dental caries is a sugar-dependent infectious disease.
Acid is produced from metabolism of carbohydrate by plaque bacteria, which results in a drop in pH at the tooth surface.
In response, calcium and phosphate ions diffuse out of enamel, resulting in demineralization.
This process is reversed when the pH rises again.
Caries is therefore a dynamic process characterized by episodic demineralization and remineralization occurring over time.
If destruction predominates, disintegration of the mineral component will occur, leading to cavitation.

20. Proteolytic theory
In addition to acid, proteolytic substances produced by plaque bacteria breakdown the organic portion of enamel and dentine

21. Proteolysis Chelation theory
Bacterial attack on enamel is initiated by keratinolytic bacteria causing breakdown of enamel protein
Organic and inorganic portion of enamel undergoes demineralization by formation of chelates

23. Saliva and caries
Saliva acts as an intra-oral antacid, due to its alkali pH at high flow-rates and buffering capacity.
In addition saliva:
⇓ plaque accumulation and aids clearance of foodstuffs.
Acts as a reservoir of calcium, phosphate, and fluoride ions, thereby favouring remineralization.
Has an antibacterial action because of its IgA, lysozyme, lactoferritin, and lactoperoxidase content.

24. CARIOGENIC BACTERIA:
Streptococcus mutans
Streptococcus viridans
S. salivaries
S. mitis
S. sanguis
Lactobacillus

25. Properties of bacteria
Ability to produce acid by fermentation of sugars
Ability to polymerise sugars into long chain polysaccharides which make
plaque adhere firmly to the tooth surface and
Bacteria to one another
Lactic acid (main) and other is acetic acid

26. Prerequisites for development of dental caries
Dental plaque containing cariogenic bacteria
Bacterial substrate: sugar
Susceptible tooth surface
If pH < 5 then demineralization occurs

27. Enamel caries
The initial lesion is visible as a white spot. This appearance is due to demineralization of the prisms in a sub-surface layer, with the surface enamel remaining more mineralized.
With continued acid attack the surface changes from being smooth to rough, and may become stained.
As the lesion progresses, pitting and eventually cavitation occur.

28. DENTINE CARIES:
Dentine caries comprises demineralization followed by bacterial invasion,
but differs from enamel caries in the production of secondary dentine and the proximity of the pulp.

29. Diagnosis
Early diagnosis is important
Good eyesight (and a clean, dry, well-illuminated tooth)
Whitish or blackish spots
Cavity

30. Investigation
radiographs are useful in the detection of occlusal caries.

31. Management
If lesion confined to enamel , institute preventive measures and keep under review.
If lesion has penetrated dentine radiographically, a restoration is indicated unless serial radiographs show that it is static.
Removal of diseased enamel and dentine
Removal of pits and fissures
Restoration by filling
Posterior teeth
Cement & silver amalgam
Anterior teeth
Acid etch technique
RCT –Root canal treatment

32. Restoration showing amalgam

33. Criteria for restoration:
Restoration should be watertight
Form of the tooth should be maintained so that occlusion is normal
Pulp should be protected with insulating cement lining

34. Prevention
Maintenance of oral hygiene
Proper brushing
Regular scaling
Avoid soft, sticky and sweet diet
Reduce bacterial load
Mouthwash with 0.2% chlorhexidine, betadine
Denial of substrate to plaque bacteria
Use saccharine( an artificial sweetener) as bacteria cannot utilize it
Complete removal of plaque by dentist
Scaling

35. Fluoride addition
Inhibits demineralization and promotes remineralization of early caries.
Fluoride enhances the degree and speed of remineralization and renders the remineralized enamel more resistant to subsequent attack.
Decreases acid production in plaque by inhibiting glycolysis in cariogenic bacteria.
An ⇑ concentration of fluoride in plaque inhibits the synthesis of extracellular polysaccharide.

36. Systemic fluoride
Water fluoridation in a concentration of 1 ppm (1 mg F /litre) gives a caries reduction of 50%.
Fluoride tablets
depends upon drinking water content
1 tab contains 2.2 mg of Na Fluoride
<2 yrs : half tab
2-12 yrs: 1 tab
> 12 yrs: half tab

37. Milk with 2.5-7 ppm F has been tried successfully.
Salt is cheap and effective for rural communities in developing countries where water fluoridation is not feasible

38. Fluorosis (or mottling) occurs due to a long-term excess of fluoride.
It is endemic in areas with a high level of fluoride occurring naturally in the water.
Clinically, it can vary from faint white opacities to severe pitting and discoloration.