Chapter 18 Assessment of Deposits and Stain Flashcards
Materia Alba
Loose accumulation of food debris, cottage cheese texture
Disclosants
Make oral biofilm clinically visible. should be applied after oral and periodontal assessment
Oral biofilm is classified by:
Location, amount, extent
Calculus aka pyorrhea
oral biofilm that has been mineralized by calcium and phosphate salts from saliva
Supragingival calculus
mineralized oral biofilm formed above free gingival margin
Subgingival calculus
mineralized oral biofilm formed below free gingival margin, more tenacious
Exogenous stains
originates from sources outside the tooth, i.e. food, beverages, tobacco, chromogenic bacteria
Endogenous stains
originates from within the tooth, i.e tetracycline, pulpal trauma, dentinogenesis, amelogenesis
Intrinsic stains
Incorporated within the tooth structure, cannot be removed via scaling, i.e. fever, trauma, infection, fluorosis
Extrinsic stains
Affects outermost layer of tooth, can be removed via scaling, i.e. red wine, tobacco, coffee, blueberries, etc.
Different types of staining:
orange stain, black-line stain, tetracycline stain
Planktonic bacteria
Free floating
Bacterial species associated with periodontal health are?
S. mitis, S. sanguinis, S. gordonii, S. oralis
Bacteria associated with periodontitis are?
Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia, Aggregatibacter actinomycetemcomitans
What are the stages of oral biofilm formation?
- Pellicle formation
- Colonization
- Bacterial growth and maturation
- Dispersion
Acquired pellicle
A tenacious, unstructured, homogenous, insoluble, acellular protein film compromised of glycoproteins found in saliva on tooth surfaces, firm surfaces in the oral cavity, and old calculus
What happens during the colonization stage of oral biofilm?
Microorganisms attach to the acquired pellicle and begin sessile colonies.
What happens during the growth and maturation stage of oral biofilm?
Adherent bacteria secrete extracellular polysaccharides to form a water-insoluble slime matrix. The matrix is sticky and facilitates microbial adhesion
What happens during the dispersion stage of oral biofilm?
Bacteria within the interior of the oral biofilm slow their growth and become static, deep within the oral biofilm bacteria show signs of death but surface bacteria remain intact. Some bacteria detach and relocate to form in great amounts.
Chromogenic bacteria
color-producing bacteria
Green extrinsic stains
Caused by chromogenic bacteria and fungi from poor OH, can’t be scaled because of demineralized enamel, remove with toothbrush or light polish, hydro. perox.
Black extrinsic stains
Caused by iron in saliva, exposure to iron or iron-containing oral solutions, can be scaled because of calculus like nature and selectively polished
Black-line extrinsic stain
Most common in middle aged women with good OH, 1mm band, associated with bacteria and iron in saliva, scale and polish selectively
Orange extrinsic stain
Caused by chromogenic bacteria from poor OH, scale and polish selectively
Brown extrinsic stain
caused by tobacco, tars from smoking, chewing, food/beverage, tannins, scale and polish selectively
Brown extrinsic stain (chemotherapeutic agents)
Caused by stannous fluoride, chlorohexidine, or cetylpyridinium chloride mouth rinses, scale and polish selectively
Gray/brown/green extrinsic stain
caused by marijuana, scale and polish selectively
Yellow extrinsic stain
caused by oral biofilm, have pt. remove during toothbrushing
Blue-green extrinsic stain
Caused by mercury and lead dust, scale and polish selectively
Red-black extrinsic stain
Chewing betel nut, found in S. Asian cultures, cale and polish selectively
Dental fluorosis (intrinsic)
Caused by excessive fluoride ingestion during enamel development, cannot be removed by scaling or polishing.
Enamel hypocalcification (intrinsic)
Caused by high fever during enamel formation, cannot be removed by scaling or polishing
Demineralization
Acid erosion of the enamel caused by oral biofilm, cannot be removed via scaling or polishing, rec. 0.5% sodium fluoride rinses for remineralization
Tetracycline staining (intrinsic)
Use of tetracycline during tooth development, cannot be removed via scaling or polishing
What materials are recommended for deposit assessments?
Light, compressed air, mouth mirror, periodontal explorer, gauze, disclosing solution
Oral hygiene indices measure and accomplish what?
- Establish a baseline for OH and monitor progress, motivate patient
- Survey OH status within a population
- Eval. an intervention i.e. drug, device, etc.
- Monitor and establish baseline for OH in a target population
Criteria for an effective dental index
- Simple to use
- Minimal discomfort to patient
- Time efficient
- Cost effective
- Statistically valid
- Translates clinical descriptions to numeric values on a graduated scale
Oral Debris Index DI-S scoring 0
No debris or stain present
Oral Debris Index DI-S scoring 1
Soft debris covers one-third or less of the tooth surface being examined or extrinsic stains without debris are present, regardless of surface area covered.
Oral Debris Index DI-S scoring 2
Soft debris covers more than one-third of the area being examined but not more than two-thirds of the exposed tooth surface
Oral Debris Index DI-S scoring 3
Soft debris covers more than two-thirds of the exposed tooth surface
Calculus Index CI-S scoring 0
No calculus present
Calculus Index CI-S scoring 1
Supragingival calculus covers one-third or less of the exposed tooth surface being examined.
Calculus Index CI-S scoring 2
Supragingival calculus covers more than one-third but not more than two-thirds of the exposed tooth surface, or individual flecks of subgingival calculus are around the cervical portion of the tooth.
Calculus Index CI-S scoring 3
Supragingival calculus covers more than two-thirds of the exposed tooth surface, or continuous heavy band of subgingival calculus is present around the cervical portion of the tooth
Interpretation of DI-S and CI-S scores
- 0.0 = excellent
- 0.1-0.6 = good OH
- 0.7-1.8 = fair OH
- 1.9-3.0 = poor OH
Plaque Control Record
Records the presence of plaque on all individual tooth surfaces, enabling the patient to monitor progress over time.
Plaque-Free Score
Measures the location, number, and percentage of plaque-free surfaces in the entire mouth.
Plaque Index (PI)
Assesses the thickness of oral biofilm at the gingival area and general oral biofilm accumulation
Patient Hygiene Performance (PHP)
Assess the extent of oral biofilm and debris over a tooth surface as an indication of oral cleanliness
Which of the following protects oral biofilm from the host’s immune response and antimicrobial agents?
A. calcium and phosphate
B. fluid channels
C. Acquired pellicle
D. Slime layer
D. slime layer
In the early stages of oral biofilm development, it is primarily made up of which of the following forms of bacteria?
A. cocci
B. spirochetes
C. vibrios
D. motile forms
A. cocci
What best describes the stages of oral biofilm formation?
Acquired pellicle formation, bacteria adhere to tooth surface, bacteria multiply and colonize
The longer oral biofilm remains undisturbed, the greater is its pathologic potential. In periodontal disease, there is a shift in oral biofilm bacteria to higher portions of gram-negative and anaerobic bacteria. True or false?
True
Calculus is formed due to the presence of which of the following?
A. proteins
B. acid from bacteria
C. minerals in saliva
D. carbohydrates
E. organic components of saliva
C. Minerals in saliva
Which of the following provide the source for the formation of acquired pellicle?
a. minerals from saliva
b. matrix produced by oral biofilm
c. glycoproteins from saliva
d. bacterial by-products
c. glycoproteins from saliva
When oral biofilm is left undisturbed, how long before clinical signs of inflammation are present?
2-3 weeks
