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191 Clinical Dental Hygiene > Dental Biofilm and Soft Deposits > Flashcards

Dental Biofilm and Soft Deposits Flashcards

1
Q

What are the soft deposits?

A

Dental biofilm
Acquired enamel pellicle
Materia Alba
Food debris

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2
Q

What are the hard deposits?

A

Calculus- Supra/Subgingival

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3
Q

What are dental biofilm and soft deposits responsible for?

A

Patients risk factor for being diagnosed with gingivitis, inflammatory periodontal disease and dental caries

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4
Q

What is gingivitis?

A

Inflammation of gum tissue

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5
Q

What is inflammatory periodontal disease?

A

Inflammation of the tissue and gum tissue below the gum line (bone. ligament)

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6
Q

What is the acquired pellicle?

A

Thin translucent film formed of proteins, carbohydrates and lipids

Thickest near the gingival margin

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7
Q

How does the pellicle form?

A

Formation begins within minutes of eruption or removal of hard/soft deposits

Salivary proteins highly attracted to the hydroxyapatite of the tooth surface

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8
Q

What is the pellicle composed of?

A

Glycoproteins (protein based layer)

Gingival crevicular fluid

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9
Q

How does the supragingival pellicle appear?

A

Translucent and insoluble. Not readily visible without disclosing agent

Can take on extrinsic staining

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10
Q

What is the subgingival pellicle?

A

Continuous with supraginigival pellicle and can become embedded in tooth structure, especially where tooth surface has become rough or demineralized

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11
Q

What are the significances of the pellicle?

A

Provide protection
Lubrication
Nidus for Bacteria
Attachment of Calculus

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12
Q

Protective qualities of the pellicle

A

Provides a barrier against acids

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13
Q

Lubricating qualities of the pellicle

A

Keeps surfaces moist and prevents drying- increases efficiency of speech and mastication

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14
Q

Pellicle as Nidus for bacteria

A

Aids in adherence of microorganisms in biofilm formation

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15
Q

Role of pellicle in calculus attachment

A

Just one mode of attachment for calculus

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16
Q

Can the pellicle be removed?

A

Not resistant enough to withstand vigorous brushing.

Abrasive toothpastes, whitening products and intake of acidic foods and beverages can also interfere with pellicle formation

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17
Q

Composition of dental biofilm

A

Microorganisms and extracellular polymeric substance make up 20%

Other 80% is water

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18
Q

Inorganic elements of biofilm

A

Calcium and phosphorus

Fluoride

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19
Q

Organic elements in biofilm

A

Carbohydrates (Glucans: dextran, fructans or levans)

Proteins (from gingival sulcus fluid)

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20
Q

Characteristic of Biofilm

A

Encapsulated in EPS, form a matrix and micro-colonies
Matrix protects the biofilm from hosts immune system and antimicrobial agents
Water channels supply nutrients to the microcolonies
Can adhere to anything in the mouth
Main cause of malodor

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21
Q

Stage 1 of Biofilm Formation

A

Formation: Begins initial attachment to pellicle

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22
Q

Stage 2 Biofilm Formation

A

Bacterial Multiplication and Colonization: Increasing numbers, forming communities and beginning communication with each other.

Growing in layers upward and outward to create 3D plaque

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23
Q

Stage 3 Biofilm Formation

A

Matrix Formation: Anchors bacteria to the tooth. Protects bacterial community and allows it to keep growing

Can be seen supra/subgingivaly

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24
Q

What are the components of Extracellular Polymeric Substance (EPS)?

A

Polysaccharides, glucans, fructans or levans

Sticky, cement biofilm more firmly to teeth

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25
Q

Stage 4 Biofilm Formation

A

Biofilm Growth: Mass of thickness in the biofilm. Will start to cause gingivitis at this point if left undisturbed

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26
Q

Stage 5 Biofilm Formation

A

Maturation: Mature biofilm releases planktonic cells that spread and colonize other areas

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27
Q

What type of bacterial growth is promoted by the pellicle, EPS and biofilm architecture? What happens if it is left undisturbed?

A

Anaerobic gram negative bacteria

Numbers increase rapidly, chance for potential disease activity increases

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28
Q

Days 1-2 of Biofilm formation

A

Early biofilm, primarily gram positive bacteria

Streptococci

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29
Q

Days 2-4 Biofilm formation

A

Slender rods join cocci colonies and start to build on each other and layer

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30
Q

Days 4-7 Biofilm Formation

A

Increase in numbers and size and thickness

Near gingival margin. Disclosing agent will reveal nice thick layer of plaque

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31
Q

Days 7-14 Biofilm Formation

A

Inflammatory response has been activated, # of WBC’s increases

You will see swelling and inflammation of the gingival tissue

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32
Q

Days 14-21 Biofilm Formation

A

Biofilm embeds into the gingival tissue and connects to connective tissue

Can break down ligaments and bone

Bleeding will be seen when patient is brushing and flossing

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33
Q

Location of supra and subgingival biofilm

A

Middle thirds of the teeth to gingival margin and down under the gums and on pits and fissures

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34
Q

Where do we see the heaviest deposits of biofilm?

A 
Gingival 1/3 and proximal
Crowded teeth
Rough Surfaces/ Existing Calculus
Poor restorations
Mandibular anteriors
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35
Q

Where do we see the least heavy biofilm deposits?

A

Palatal surfaces of maxillary teeth

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36
Q

Significance of biofilm in dental caries

A

Cariogenic microorganisms are responsible for breaking down the enamel and eventually the dentin and cementum

Streptococcus mutans and Lactobacilli

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37
Q

What are the two types of bacteria primarily responsible for the initiation and progression of carious lesions?

A

Streptococcus mutans

Lactobacilli

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38
Q

What condition combined with cariogenic bacteria increases risk of demineralization?

A

Xerostomia (saliva can help remineralize the enamel)

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39
Q

Significan of the pH of biofilm

A

Acid formation begins immediately once a cariogenic substance is taken into the biofilm resulting in a rapid drop in pH

pH for demineralization= 5.5
For exposure on a root surface or dentin= 6.2-6.4

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40
Q

Why is it critical to remember the critical pH levels in biofilm?

A

If a patient has recession AND xerostomia they are more at risk for decay in the gingival 1/3 because pH is HIGHER than compared to enamel

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41
Q

What happens when pH drops?

A

Enamel starts to break down and that increased exposure time puts you at risk for more caries

42
Q

Effects of diet on biofilm

A

Cariogenic foods (anything sugar related) induces acid formation and causes pH to drop

43
Q

What is materia alba?

A

White, spongy, cottage cheese-like material that loosely adheres to the teeth.

When visible we know it has been growing undisturbed for a long time as it is easily removed

44
Q

What is materia alba composed of and what are its effects in the mouth?

A

Dead bacteria, epithelial cells, proteins, food, WBC’s

When in contact with gingiva, contributes to gingival inflammation

45
Q

When does food impaction occur?

A

When there is an open contact, food may be forced straight down between the teeth. In closed contacts food is just pushed to the side

46
Q

Horizontal food impaction

A

Food debris stuck between teeth

47
Q

Vertical food impaction

A

Food debris is forced into the interdental papillae or the pocket

48
Q

What is calculus?

A

Hard, calcified deposit to the tooth

Cannot be removed with routine home care

49
Q

Location and distribution of Supragingival calculus

A

Starts at gingival 1//3 and builds up

More common on anterior linguals and buccal maxillary molars because of proximity to saliva ducts

50
Q

Location and distribution of subgingival calculus

A

Located under gum line, along root surface and on implant posts

Heaviest in areas that are difficult for the patient to reach on their own

51
Q

Components of mature calculus

A

Organic and inorganic components. The more mature it is the more inorganic components it will have

52
Q

Major inorganic components of calculus

A

Calcium, phosphate, carbonate, sodium, magnesium

Trace elements: zinc, silicone, fluoride, iron, potassium

53
Q

Fluoride in calculus

A

Tends to be higher in subgingival calculus

54
Q

Crystals in calculus

A

2/3 of inorganic content will contain crystaline– predominantly a form of hydroxyapatite

Hard like bone, very difficult to remove

55
Q

Organic content of calculus

A

Microorganisms, desquamated epithelial cells, WBC’s and mucin from saliva

56
Q

Mineralization stage of calculus formation

A

Early formation. Adheres to pellicle. Colonies form and build on each other.

If left for 24-72 hours more develops close to underlying tooth surface (expands, unites)

Phosphate crystals bond to enamel and cementum

57
Q

Sources of mineral in calculus

A

From elements found in saliva (supra)

Sungingival forms with exudate (natural flora under gum tissue)

58
Q

Crystal formation

A

Typically forms w/ intracellular matrix onto tooth surface w/ bacteria and all adhere

59
Q

Mechanics of Mineralization

A

Affected by salivary flow and saturation of saliva (does it have an increase of phosphate salts?)

60
Q

Structure of Calculus

A

Forms in Layers parallel to tooth surface

Is rough and can be easily felt with explorer or probe

Outer layer highly calcified

61
Q

Types of calculus deposits

A 
Crusty, spiny, nodular
Ledge or ring
Thin, smooth veneers
Finger and fern-like formations
Calculus islands
62
Q

Calculus formation time

A

Average time for soft deposit to mature and mineralize is about 12 days

Mineralization can begin in 24-48 hrs if home care is ineffective

63
Q

Attachment of calculus

A

Can attach to the pellice, to minute irregularities on the tooth surface, or by direct contact between calcified intercellular matrix and the tooth surfce

64
Q

Attachment by means of acquired pellicle

A

Superficial attachment and can be easily removed

65
Q

Attachment to minute irregularities in tooth surface by mechanical locking into undercuts

A

In dentin: cracks, lamellae, carious defects

In cementum: Spaces left at previous locations of sharpey’s fibers, root grouping from improper scaling, cement tears

66
Q

Attachment by direct contact btw calcified intercellular matrix and the tooth surface

A

Interlocking or organic apatite crystals of the enamel and cementum w/ the mineralizing dental biofilm

67
Q

How and when will we see supragingival calculus?

A

Can be seen with direct examination. May have some color associated with it.

Compressed air will deflect the gingival margin and dry the calculus making it appear chalky and white and easier to see

68
Q

How will subgingival calculus appear upon visual examination?

A

Dark edges of calculus will be seen at gingival margin (stained)

Gentle air blast deflects the gingival margin to see into pocket

Transillumination may also be used

69
Q

Personal biofilm control in the prevention of calculus

A

Remove biofilm by brushing, flossing and other methods

demonstrate appropriate hygiene aids for patient. Follow up and commend their success. ID dietary behaviors that may enhance biofilm growth

70
Q

Regular professional continuing care in the prevention of calculus

A

Regular appointments to supplement home care

71
Q

Anticalculus dentifrice and mouthrinse in prevention of calculus

A

Dentifrices aim to inhibit calculus crystal growth, may lessen formation. DO not have an effect on existing deposits

Chemotherapeutic rinses for tartar control inhibit mineralization

72
Q

What do we document when inspecting calculus?

A

Location :supra/subgingival

Extent: Slight, moderate, heavy

73
Q

3 Ways dental stains occur

A
  • Adhere directly to surfaces
  • Contained within calculus and soft deposits
  • Incorporated within the tooth structure or restorative material
74
Q

Extrinsic staining

A

On external surface and may be removed by toothbrushing, scaling and/or polishing

75
Q

Intrinsic staining

A

Occur within the tooth surface and cannot be removed by scaling/polishing

Only removable with certain whitening procedures

76
Q

Exogenous sources

A

Develop from sources outside the tooth

Can be extrinsic or intrinsic

77
Q

Endogenous sources

A

Develop within the tooth.

Always intrinsic and usually are discolorations of the dentin

78
Q

Removal of stains on the tooth surface

A

Remove as much as possible with brushing, debridement and/or polishing

Avoid excessive polishing on tenacious stains, use least abrasive agent

79
Q

Removal of stains incorporated in tooth deposits

A

Stain can be removed with removal of calculus or soft deposit

80
Q

Removal of stains within the tooth

A

Cannot be removed by scaling/polishing

81
Q

What are directed extrinsic stains?

A

Caused by compounds, organic chromogens, attached to pellicle producing a stain

82
Q

What are indirect extrinsic stains?

A

From chemical interaction with the tooth surface

83
Q

What are the most frequently observed stains?

A

Yellow, green, black line and tobacco

84
Q

Yellow stain

A

Dull, yellowish discoloration of bio film. Generalized or localized and common to all ages. More evident when personal oral care is neglected

85
Q

Green stain

A

Light or yellowish green to dark green, in bedded in bio film. On gingival margins on flat tooth surfaces - grooves in enamel

Chromogenic bacteria and decomposed hemoglobin

86
Q

Black line stain

A

Forms along with gingival third near the gingival margin. Highly retentive, calculus like and sticky

Mostly on facial and lingual surfaces. can recur despite regular removal

Linked to bacterial growth and dietary habits and also iron supplements

87
Q

Tobacco stain

A

Diffuse staining on dental biofilm. Follows contour of gingival crest. Wide, firm, tar like.

Located on cervical third to central third of crown. May penetrate an animal and become exogenous intrinsic

Primarily on lingual surfaces

88
Q

Brown stains

A

Chemical alteration of pellicle

From poor hygiene, Stanis fluoride or anti-microbial agents such as chlorhexidine

May not be removable if from anti-microbial agents or fluoride. Weigh risk versus benefit

89
Q

Red stain

A

Possibly from chromogenic bacteria

90
Q

Metallic stains

A

From drugs or metallic salts from metal containing dust of industry

91
Q

Endogenous intrinsic stains

A
  • On Pulpless or traumatized teeth. Not all will discolor but may if not treated
  • Often from decomposed hemoglobin
  • Can also be genetic: Amelogenic imperfecta, dentinogenesis imperfecta
  • Enamel hypoplasia
  • Drug induced stains
92
Q

Drug-induced stains and discolorations

A

Tetracycline: if taken while pregnant
Monocycline: causes blue gray darkening lock to crowns. Changes development of tooth when taken

93
Q

What do exogenous intrinsic stains result from?

A

Stain into the following development and may occur when the stain penetrates enamel defect and exposed dentition to become intrinsic

Ex. Developmental defects, acquired defects, dental caries, restorative materials

94
Q

Which restorative Materials cause exogenous intrinsic stains?

A

Silver amalgam

Endodontic therapy: sealants, endodontic medicaments, Portland cement-based materials, antibiotic paste

95
Q

Other causes of exogenous intrinsic stains

A

Enamel erosion from acidic foods, eating disorders, Gerd

96
Q

What is the CCP indice?

A

Simplified oral hygiene index.
Student will assess patient for presence of plaque/dental biofilm
Student will complete simplified oral hygiene index on all patients at each appointment

97
Q

What is the purpose of the simplified oral hygiene index?

A

To assess oral cleanliness by estimating tooth surface is covered with debris and/or calculus

98
Q

Two components of the simplified oral hygiene index

A
  • simplified debris index (DI-S)

- simplify the calculus index (CI-S)

99
Q

Posterior teeth to be examined in simplified oral hygiene index

A

Facial surfaces of maxillary molars and lingual surface of mandibular molars (1st molar)

100
Q

Anterior teeth to be examined during simplified oral hygiene index

A

Facial surfaces of maxillary right and mandibular left central

101
Q

What is the procedure for scoring soft debris on the simplified oral hygiene index?

A

Run side of the tip of probe or explore across tooth surface to estimate area covered in debris. Disclosing agent may also be used

102
Q

What is the procedure for scoring calculus on the simplified oral hygiene index?

A

Use explore to estimate surface area covered by supragingival calculus. Record only definite deposits

191 Clinical Dental Hygiene (14 decks)

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