Sickle Scalers - Plaque and Biofilm

Question 1

• a naturally acquired bacterial biofilm that develops on teeth
• Multi-species biofilm
• Sticky, colorless film which constantly forms over teeth
• Removed with mechanical force such as toothbrushing/flossing)

Answer 1

Dental plaque

Question 2

• Hard calcified deposit of plaque that has become mineralized
• Not easily removed with homecare tools

Answer 2

Calculus

Question 3

Are the following mineralized or non-mineralized?
•Dental plaques
•Acquired pellicle
•Plaque biofilm
•Materia alba
•Food particles

Answer 3

Non-mineralized

Question 4

Are the following mineralized or non-mineralized?

•Calculus

Answer 4

Mineralized

Question 5

Phases of ______ Accumulation

1. Formation of pellicle on tooth surface
2. Initial adhesion/attachment of bacteria
3. Colonization/plaque maturation

Answer 5

Dental Plaque

Question 6

• Originates from the saliva
• Thin, structureless membrane; coats all surfaces in the oral cavity within 1 minute of being removed
• Acellular in nature; consists primarily of glycoproteins
• Colonization of acquired pellicle serves as a nutrient for bacteria
• Takes approximately 7 days for it to develop into its condensed, mature structure

Answer 6

Acquired pellicle

Question 7

• Protective
• Provides a barrier against acids, thus reducing dental caries attack
• Lubrication
• Keeps surfaces moist, prevents drying
• Nidus for bacteria
• Key role in development of plaque
• Aides in the attachment of calculus

Answer 7

Pellicle

Question 8

•Dense, non-calcified, organized mass of bacterial colonies enclosed in a gel-like intercellular matrix

Answer 8

Plaque Biofilm

Question 9

_____ colonizers: gram (+) aerobic and facultative organisms (actinomyces, streptococcus) attached to pellicle
•Approximately 47-85% cocci during first 4 hours
•Most abundant colonization occurs on proximal surfaces, fissures and gingival sulcus

Answer 9

•Initial colonizers

Question 10

_____ colonizers: Pi, Pg, Capnocytophaga species, spirochetes, motile rods, gram (-) anaerobic organisms •These colonizers are the etiologic initiators of caries and periodontitis

Answer 10

•Secondary colonizers

Question 11

Day ____ of biofilm formation:

gram (+) cocci

Answer 11

1

Question 12

Day ____ - ____ of biofilm formation:

filamentous forms grow on cocci; intercellular matrix forms and connects colonies

Answer 12

2-4

Question 13

Day ____ - ____ of biofilm formation:

filamentous forms increase; rods and fusobacteria appear

Answer 13

4-7

Question 14

Day ____ - ____ of biofilm formation:

vibrios and spirochetes appear; gram (-) species increase; clinical inflammation visible

Answer 14

7-14

Question 15

Day ____ - ____ of biofilm formation:
gingivitis clinically evident
•Plaque is composed of densely packed vibrios, spirochetes and filamentous bacteria
•Biofilm is well-established; channels established to distribute nutrients, remove wastes, allow free-flowing bacteria to form new colonies

Answer 15

14-24

Question 16

• Matrix that surrounds the bacteria within the plaque biofilm
• Composed of inorganic and organic components that originate from the bacteria
• Major components: polysaccharides derived from bacterial metabolism of CHO
• Minor components: salivary glycoproteins

Answer 16

Intercellular Plaque Matrix

Question 17

______: viscous, sticky substances that anchor bacteria to pellicle and stabilize plaque mass

Answer 17

DEXTRANS

Question 18

_____: energy source of dental plaque

Answer 18

LEVANS

Question 19

Plaque organisms ______ to adverse conditions including varying pH, temperature, ionic strength, absence of nutrients, competing organisms, and inflammatory/immune response
These conditions affect the prolonged existence of the biofilm

Answer 19

adapt

Question 20

T/F: Plaque cannot be removed by spraying water

Answer 20

True

Question 21

What are the 4 factors affecting plaque accumulation?

Answer 21

• Mechanical removal (forces from mastication, toothbrushing, tongue movement, etc.)
• Availability of nutrients
• Undisturbed environment
• Interaction between bacteria and host immune response

Question 22

White, cheese-like accumulation
Consists of salivary proteins, bacteria, desquamated epithelial cells/disintegrating food debris
Lack organized structure/not complex
Easily displaced with water spray

Answer 22

Materia Alba

Question 23

Is plaque a derivative of food debris?

Answer 23

NO

Question 24

•_______ is rapidly liquefied by bacterial enzymes and cleared from the mouth by salivary flow/muscles of mastication

Answer 24

Food debris

Question 25

* Plaque that becomes mineralized by calcium and phosphate salts from the saliva * Plays a major role in periodontitis because it keeps plaque close to the gingival tissues and makes it difficult to remove the irritant (plaque) * It is NOT the irritant-plaque is

Answer 25

Calculus

Question 26

Cannot be removed with a toothbrush, floss, etc. Must be removed professionally •Can be difficult to remove subgingival without causing damage to the root surface •Formation can be accelerated by factors such as smoking and mouth breathing

Answer 26

Calculus

Question 27

•Coronal to the gingival margin•White or yellowish in color•Derives minerals from the saliva•Commonly found on the lingual aspect of the lower anteriors and buccal aspect of maxillary molars (adjacent to salivary gland ducts)•Approximately 30% mineralized

Answer 27

Supragingival calculus

Question 28

Where are the areas where supragingival calculus is common due to salivary ducts ending there?

Answer 28

Linguals of lower anteriors | Buccal of 3 and 4

Question 29

•Located below the crest of marginal gingiva; not clinically visible•Explorer and radiographs are best for detecting•Derives minerals from inflammatory exudate•Dense, dark brown or black due to blood components and/or bacterial degradation•Can be tenacious and firmly attached to the tooth•Approximately 60% mineralized

Answer 29

Subgingival Calculus

Question 30

What are the 4 main crystalline forms of calculus?

Answer 30

hydroxyapatite whitlockite octacalcium phosphate brushite

Question 31

What days of plaque formation can calculus buildup occur?

Answer 31

1-14 days

Question 32

What are the mineral sources of supragingival calculus?

Answer 32

Saliva

Question 33

What are the mineral sources of subgingival calculus?

Answer 33

gingival crevicular fluid (GCF) | inflammatory exudate

Question 34

``` Used in the anterior region to remove supragingival calculus deposits Instrument Design: ◦Straight, rigid shank ◦2 cutting edges on each working-end ◦Pointed tip (hence “sickle”) ```

Answer 34

Anterior Sickle Scaler

Question 35

When adapting, the shank and handle should be _____ to the long axis of the tooth

Answer 35

parallel

Question 36

_____ stroke: | •Light grasp, minimal pressure (think perio explorer)

Answer 36

Exploratory stroke

Question 37

_____ stroke: | •Tighten grasp, apply lateral pressure to tooth on coronal stroke

Answer 37

Working stroke

Question 38

____ angulation will result in burnished calculus and/or tissue laceration

Answer 38

Over angulation (>90 °)

Question 39

_______ will result in burnished calculus

Answer 39

Under angulation (<45 °)

Question 40

Same as the anterior scaler, but with a bend in the shank (complex design) for access in the posterior region This instrument is meant to scale interproximal regions of posterior teeth, supra-and subgingival (slightly below the tissue) if spurs of interproximal calculus are present Not designed for scaling deep periodontal pockets -Designed for interproximals not really used for direct facial and linguals

Answer 40

Posterior sickle scaler

Question 41

For posterior sickle scalers, the _____ is parallel to the long axis of the toothInsert at line angle and scale into the interproximal

Answer 41

Terminal shank