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Preclinc > Soft / Hard Deposit and Stain > Flashcards

Soft / Hard Deposit and Stain Flashcards

1
Q

Acquired Pellicle

A

Tenacious membranous layer that is acellular & organic. Forms over exposed tooth surfaces, restorations and calculus.

Thickness = 0.1 to 0.8 micrometers

Greatest near ging. margin

Composed primarily of glycoproteins
Forms w/in minutes after tooth surfaces have been cleaned.

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2
Q

Types of Acquired Pellicle

A

Surface, unstained: clear, insoluble, not ready visable with disclosing solution. When stained with disc. agent, appears thin with thicker darker stain of dental biofilm.

Surface, stained: take on an extrinsic stain and become brown/gray/other colors.

Subsurfaces: embedded in tooth structure, esp where tooth is demineralized.

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3
Q

Acquired pellicle significance

A
  1. Protective barrier against acid
  2. Lubrication - keeps surfaces moist,
  3. Aid in adherence of microbes - participates in biofilm formation
  4. Mode of calculus attachment

Good and bad

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4
Q

Acquired pellicle to Biofilm sequence

A

Fromationof pellicle > bacterial multiplication and colonization > biofilm growth and maturation > matrix formation

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5
Q

Biofilm composition

A

Dense nonmineralized complex mass of bacterial colonies in a gel.
20% organic - carbs and protein - and inorganic - calcium, phosphate, magnesium, fluoride
80% water

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6
Q

Microbe shapes

A

Bacilli - rod shaped
Cocci - Spherical
Vibrio - comma shaped

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7
Q

Biofilm progression

A

Day 1-2: gram+ cocci (streptococcus mutans and streptococcus sangius)

Day 2-4: same, increase gram+ rods and filaments

Day 4-7: same and gram- spirochetes and vibrios

Day 7-14 same, increase in gram- and anaerobic organisms.

Day 14-21: same, densely packed filmanets

If biofilm undesturbed, gingivitis in 2-3 weeks

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8
Q

Distribution of Biofilm - Location

A

›Supragingival – coronal to GM

›Gingival – external surfaces of oral epithelium and attached ging

›Subgingival – btwn perio attachment and GM, w/in sulcus

›Fissure – pits and fissures

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9
Q

Distribution of Biofilm - by Surfaces

A

›formation begins at GM (esp proximal)

›Spreads over ging 1/3 toward middle 1/3 of crown

›Palatal surfaces may have least biofilm due to activity of tongue

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10
Q

Factors that influence Biofilm accumulation

A

Crowded teeth

Rough surfaces

Areas difficult to clean ›Overhangs, under ledges of calculus, carious lesions

Out of occlusion ›Tooth unopposed or not used during mastication

Bacterial multiplication ›Thickness results from constant cell division of bacteria w/in biofilm

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11
Q

Detection of Biofilm

A

Direct Vision

Explorer / probe

Disclosing agent

Clinical record - location and extent

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12
Q

Sig of Biofilm

A

Role in initiation of dental diseases
›Caries
›Periodontal infections

Formation of dental calculus

General oral cleanliness depends on daily removal of biofilm

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13
Q

Dental caries - Microorganisms in biofilm

A

›Streptococcus mutans prominent in carious process initiation

›Lactobacilli have significant role in progression of carious lesion

›Decreased salivary flow (xerostomia) + increased dietary carbohydrate frequency promote growth

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14
Q

Dental caries - pH of biofilm

A

mouth pH is 6.2

›Acid immediately forms when cariogenic substance in biofilm

›1-2hrs required for pH to return normal if biofilm left undisturbed

›Amount of demineralization depends on length of time and frequency acid with pH below critical is in contact with tooth surface

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15
Q

Dental caries - the carious lesion

A

›Begins as subsurface demineralization.

›Acid from bacterial action on tooth surface passes through microchannels in the enamel, demineralization occurs

white spot can be seen clinically
›Early and continuous use of fluoride for remineralization is necessary.

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16
Q

Effect of diet on biofilm

A

Cariogenic foods
›Dental caries
›Effect of sucrose on amount, pH of biofilm

Food intake ›Food particles not needed for biofilm formation

Texture of diet ›Friction of mastication only affects occlusa and incisal 1/3

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17
Q

PD infections

A

The disease process
›Biofilm of various periodontal diseases has own complex of subging pathogenic microorg

Periodontal infection and total body health
›subgingival invasive pathogens initiate periodontal infections
›bacteria and toxic products produced have access to the circulation throughout body.

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18
Q

Material Alba

A

Forms over Biofilm

Loosely adherent mass of bacteria & cellular debris

Bulky, soft deposit (resembles cottage cheese)

Product of informal accumulation of:
›living and dead bacteria, desquamated epithelial cells, disintegrating leukocytes, salivary proteins, and possibly a few particles of food debris

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19
Q

Material Alba Effects and Prevention

A

Effects:
›Surface bacteria in contact with gingiva contribute to gingival inflammation.
›Demineralization and early noncavitated lesions seen frequently under materia alba.

Prevention:
›Materia alba can be removed with a water spray or oral irrigator, whereas dental biofilm cannot.
›Clinical distinction of materia alba, food debris, and dental biofilm is necessary, but patient instruction for the removal is same.

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20
Q

Food Debris

A
  • Loose food particles that collect around cervical 1/3 & proximal embrasures
  • Cariogenic foods contribute to caries
  • Adds to general unsanitary condition of mouth
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21
Q

Calculus

A
  • Mineralized plaque that attaches to acquired pellicle
  • Made up of inorganic and organic components and water.
  • Provides rough, irritating surface for bacteria to exist (biofilm to adhere)
  • Physical irritant for gingiva
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22
Q

Supraging Calculus - Location, Frequent sites, other names

A

–Location
›On clinical crown coronal to GM
›Implants, complete and partial dentures

–Most frequent sites of distribution
›lingual surfaces of mand ant and facial max first and second molars
›Crowns of teeth out of occlusion
›teeth that are neglected during daily biofilm removal
›Surfaces of dentures, dental prostheses, and tongue piercing barbells.

–Other names for supragingival calculus
›Supramarginal. Extragingival. Coronal.

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23
Q

Subging Calculus - Location, Frequent sites, other names

A

–Location
›Clinical crown apical to GM and extending nearly to clinical attachment on the root surface
›On dental implants

–Distribution
›may be generalized or localized on single teeth or a group of teeth.
›Heaviest deposits related to areas most difficult for pt to access during OH procedures.

-Other names for subgingival calculus
›Submarginal. Serumal

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24
Q

Composition of Calculus

A

–Inorganic content
›main components are calcium (Ca), phosphorus (P), carbonate (CO3), sodium (Na), magnesium (Mg), potassium (K)

–Trace elements
›chlorine (Cl), zinc (Zn), strontium (Sr), bromine (Br), copper (Cu), manganese (Mn), tungsten (W), gold (Au), aluminum (Al), silicon (Si), iron (Fe), fluorine (F)

–Fluoride in calculus varies

–Crystals
›At least 2/3 of inorganic matter of calculus is crystalline, principally apatite.
›Predominating is hydroxyapatite same crystal present in enamel, dentin, cementum, and bone.

25
Q

Composition of Calculus (2)

A

–Calculus compared with teeth and bone
›Dental enamel most highly mineralized tissue in body and contains 96% inorganic salts
›Dentin contains 65%
›Cementum and bone contain 45% to 50%
›Mature calculus 70% to 90% inorganic content

–Organic content
›various types of nonvital microorganisms, desquamated epithelial cells, leukocytes, and mucin from the saliva

26
Q

Calc formation

A

Pellicle formation

Biofilm maturation

Mineralization

27
Q

Mineralization

A

Early calc formation

Germ-free animal studies

Sources of minerals - saliva; subging - sulcus fluid

Crystal formation

Mechanisms of mineralization

28
Q

Structure of Calc

A

–Layers
›Forms in layers that are parallel with tooth
›layers separated by line of pellicle
›Form around tooth in supraging calculus
›Form irregularly from crown to apex on root in subgingival calculus

–Surface
›Rough, detected by explorer or probe

–Outer layer
›Partly calcified
›Surface is a thick, mat-like, soft layer of biofilm
›Outer surface on subging is in contact w/ diseased pocket epithelium.

29
Q

Formation of Calc timeline

A

–Average time 12 days, within a range from 10 days for rapid calculus formers to 20 days for slow calculus formers

–Mineralization can begin as early as 24 to 48 hours when OH neglected

–Depends on individual

–Strongly influenced by roughness of tooth and pt’s OH

–Instruction and counseling
›Estimation of time for individual can be helpful when planning instruction, counseling and tx plan

30
Q

Modes of Calc attachment

A

–Acquired pelliclev - comes off easily

–Minute irregularities in tooth surface
›Mechanical locking into undercuts, harder to remove

–Direct contact
›Calcified intercellular matrix and tooth surface

31
Q

Objectives of DH practice

A

–Nonsurgical periodontal therapy
›Removal of calculus to have biologically acceptable smooth surfaces

–Clinical care
›Comprehensive understanding of the characteristics, origin, development, and methods of prevention of calculus is essential

–Patient learning for success of tx

–Classification and distribution of calculus
›by location on tooth (supra and sub)

32
Q

Characteristics of a Supragingival Examination and Subgingival Examination

A

Supragingival examination
›Direct examination
›Use of compressed air

Subgingival Examination
›Visual examination
›Gingival tissue color change
›Tactile examination
Probe
Explorer
›Radiographic examination
›Perioscopy
33
Q

Classification of stains

A

By location
›Extrinsic – external surface of tooth
›Intrinsic – w/in tooth

By source
›Exogenous – develop form sources outside tooth
›Endogenous – develop from w/in tooth

34
Q

Recognition and ID of stains

A

More than one type of stain may occur and more than one etiologic factor may cause the stains of an individual’s dentition.
›Medical/dental history
›Food diary
›Oral hygiene habits

35
Q

Procedures for stain removal

A

Stains occurring directly on tooth surface

Stains incorporated within tooth deposits are removed with deposit

36
Q

Precautions taken when removing stains

A

Prevent:
›abrasion of the tooth surface or gingival margin

› removal of a layer of fluoride-rich tooth surface

›overheating with a power-driven polisher

37
Q

Extrinsic stain and clinical appearance

A

Removable

Results from presence of certain bacteria, or other substances such as tobacco, beverages, food, metals

Clinical appearance:
Yellow stain distributed across teeth

38
Q

Green stain - NEED ANSWER

A

Clinical appearance
Distribution on tooth surface

Composition

Occurrence

Recurrence

Etiology

Clinical approach

Other green stains

39
Q

Black Line Stain - NEED ANSWER

A

Other names

Clinical features

Distribution on tooth surfaces

Composition and formation

Occurrence

Recurrence

Predisposing factors

40
Q

Tobacco stain - NEED ANSWER

A

Clinical appearance

Distribution on tooth surface

Composition

Predisposing factors

41
Q

Other brown stains include

A

Brown pellicle

Stannous fluoride

Foodstuffs

Antibiofilm agents

Betel leaf

42
Q

Orange and Red stains - NEED ANSWER

A

Clinical appearance

Distribution on tooth surfaces

Occurrence

Etiology

43
Q

Metallic Stains

A

Metals/metallic salts from industrial sources

Metallic substances contained in drugs

44
Q

Endogenous Intrinsic Stain

A

Stain within tooth structure from internal source.

i.e. pulpless teeth, tetracycline, tooth development

45
Q

Imperfect tooth development

A

Hereditary: genetic
›Amelogenesis imperfecta
›Dentinogenesis imperfecta

Enamel hypoplasia
›Systemic
›Localized

Dental fluorosis

Other systemic causes

46
Q

Exogenous Intrinsic Stain

A

Stain within tooth structure from outside source

i.e. stain in dentin from carious lesion, amalgam, endo tx

47
Q

Procedures for stain removal

A

Stains occurring directly on tooth surface

Stains incorporated within tooth deposits are removed with deposit

48
Q

Precautions taken when removing stains

A

Prevent:
›abrasion of the tooth surface or gingival margin

› removal of a layer of fluoride-rich tooth surface

›overheating with a power-driven polisher

49
Q

Extrinsic stain and clinical appearance

A

Removable

Results from presence of certain bacteria, or other substances such as tobacco, beverages, food, metals

Clinical appearance:
Yellow stain distributed across teeth

50
Q

Green stain - NEED ANSWER

A

Clinical appearance
Distribution on tooth surface

Composition

Occurrence

Recurrence

Etiology

Clinical approach

Other green stains

51
Q

Black Line Stain - NEED ANSWER

A

Other names

Clinical features

Distribution on tooth surfaces

Composition and formation

Occurrence

Recurrence

Predisposing factors

52
Q

Tobacco stain - NEED ANSWER

A

Clinical appearance

Distribution on tooth surface

Composition

Predisposing factors

53
Q

Other brown stains include

A

Brown pellicle

Stannous fluoride

Foodstuffs

Antibiofilm agents

Betel leaf

54
Q

Orange and Red stains - NEED ANSWER

A

Clinical appearance

Distribution on tooth surfaces

Occurrence

Etiology

55
Q

Metallic Stains

A

Metals/metallic salts from industrial sources

Metallic substances contained in drugs

56
Q

Endogenous Intrinsic Stain

A

Stain within tooth structure from internal source.

i.e. pulpless teeth, tetracycline, tooth development

57
Q

Imperfect tooth development

A

Hereditary: genetic
›Amelogenesis imperfecta
›Dentinogenesis imperfecta

Enamel hypoplasia
›Systemic
›Localized

Dental fluorosis

Other systemic causes

58
Q

Exogenous Intrinsic Stain

A

Stain within tooth structure from outside source

i.e. stain in dentin from carious lesion, amalgam, endo tx

Preclinc (6 decks)

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