Sickle Scalers - Plaque and Biofilm Flashcards
- 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)
Dental plaque
- Hard calcified deposit of plaque that has become mineralized
- Not easily removed with homecare tools
Calculus
Are the following mineralized or non-mineralized? •Dental plaques •Acquired pellicle •Plaque biofilm •Materia alba •Food particles
Non-mineralized
Are the following mineralized or non-mineralized?
•Calculus
Mineralized
Phases of ______ Accumulation
- Formation of pellicle on tooth surface
- Initial adhesion/attachment of bacteria
- Colonization/plaque maturation
Dental Plaque
- 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
Acquired pellicle
- 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
Pellicle
•Dense, non-calcified, organized mass of bacterial colonies enclosed in a gel-like intercellular matrix
Plaque Biofilm
_____ 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
•Initial colonizers
_____ colonizers: Pi, Pg, Capnocytophaga species, spirochetes, motile rods, gram (-) anaerobic organisms •These colonizers are the etiologic initiators of caries and periodontitis
•Secondary colonizers
Day ____ of biofilm formation:
gram (+) cocci
1
Day ____ - ____ of biofilm formation:
filamentous forms grow on cocci; intercellular matrix forms and connects colonies
2-4
Day ____ - ____ of biofilm formation:
filamentous forms increase; rods and fusobacteria appear
4-7
Day ____ - ____ of biofilm formation:
vibrios and spirochetes appear; gram (-) species increase; clinical inflammation visible
7-14
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
14-24
- 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
Intercellular Plaque Matrix
______: viscous, sticky substances that anchor bacteria to pellicle and stabilize plaque mass
DEXTRANS
_____: energy source of dental plaque
LEVANS
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
adapt
T/F: Plaque cannot be removed by spraying water
True
What are the 4 factors affecting plaque accumulation?
- Mechanical removal (forces from mastication, toothbrushing, tongue movement, etc.)
- Availability of nutrients
- Undisturbed environment
- Interaction between bacteria and host immune response
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
Materia Alba
Is plaque a derivative of food debris?
NO
•_______ is rapidly liquefied by bacterial enzymes and cleared from the mouth by salivary flow/muscles of mastication
Food debris
- 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
Calculus
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
Calculus
•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
Supragingival calculus
Where are the areas where supragingival calculus is common due to salivary ducts ending there?
Linguals of lower anteriors
Buccal of 3 and 4
•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
Subgingival Calculus
What are the 4 main crystalline forms of calculus?
hydroxyapatite
whitlockite
octacalcium phosphate
brushite
What days of plaque formation can calculus buildup occur?
1-14 days
What are the mineral sources of supragingival calculus?
Saliva
What are the mineral sources of subgingival calculus?
gingival crevicular fluid (GCF)
inflammatory exudate
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”)
Anterior Sickle Scaler
When adapting, the shank and handle should be _____ to the long axis of the tooth
parallel
_____ stroke:
•Light grasp, minimal pressure (think perio explorer)
Exploratory stroke
_____ stroke:
•Tighten grasp, apply lateral pressure to tooth on coronal stroke
Working stroke
____ angulation will result in burnished calculus and/or tissue laceration
Over angulation (>90 °)
_______ will result in burnished calculus
Under angulation (<45 °)
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
Posterior sickle scaler
For posterior sickle scalers, the _____ is parallel to the long axis of the toothInsert at line angle and scale into the interproximal
Terminal shank
