Soft / Hard Deposit and Stain Flashcards
Acquired Pellicle
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.
Types of Acquired Pellicle
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.
Acquired pellicle significance
- Protective barrier against acid
- Lubrication - keeps surfaces moist,
- Aid in adherence of microbes - participates in biofilm formation
- Mode of calculus attachment
Good and bad
Acquired pellicle to Biofilm sequence
Fromationof pellicle > bacterial multiplication and colonization > biofilm growth and maturation > matrix formation
Biofilm composition
Dense nonmineralized complex mass of bacterial colonies in a gel.
20% organic - carbs and protein - and inorganic - calcium, phosphate, magnesium, fluoride
80% water
Microbe shapes
Bacilli - rod shaped
Cocci - Spherical
Vibrio - comma shaped
Biofilm progression
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
Distribution of Biofilm - Location
›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
Distribution of Biofilm - by Surfaces
›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
Factors that influence Biofilm accumulation
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
Detection of Biofilm
Direct Vision
Explorer / probe
Disclosing agent
Clinical record - location and extent
Sig of Biofilm
Role in initiation of dental diseases
›Caries
›Periodontal infections
Formation of dental calculus
General oral cleanliness depends on daily removal of biofilm
Dental caries - Microorganisms in biofilm
›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
Dental caries - pH of biofilm
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
Dental caries - the carious lesion
›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.
Effect of diet on biofilm
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
PD infections
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.
Material Alba
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
Material Alba Effects and Prevention
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.
Food Debris
- Loose food particles that collect around cervical 1/3 & proximal embrasures
- Cariogenic foods contribute to caries
- Adds to general unsanitary condition of mouth
Calculus
- 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
Supraging Calculus - Location, Frequent sites, other names
–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.
Subging Calculus - Location, Frequent sites, other names
–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
Composition of Calculus
–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.
Composition of Calculus (2)
–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
Calc formation
Pellicle formation
Biofilm maturation
Mineralization
Mineralization
Early calc formation
Germ-free animal studies
Sources of minerals - saliva; subging - sulcus fluid
Crystal formation
Mechanisms of mineralization
Structure of Calc
–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.
Formation of Calc timeline
–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
Modes of Calc attachment
–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
Objectives of DH practice
–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)
Characteristics of a Supragingival Examination and Subgingival Examination
Supragingival examination
›Direct examination
›Use of compressed air
Subgingival Examination ›Visual examination ›Gingival tissue color change ›Tactile examination Probe Explorer ›Radiographic examination ›Perioscopy
Classification of stains
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
Recognition and ID of stains
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
Procedures for stain removal
Stains occurring directly on tooth surface
Stains incorporated within tooth deposits are removed with deposit
Precautions taken when removing stains
Prevent:
›abrasion of the tooth surface or gingival margin
› removal of a layer of fluoride-rich tooth surface
›overheating with a power-driven polisher
Extrinsic stain and clinical appearance
Removable
Results from presence of certain bacteria, or other substances such as tobacco, beverages, food, metals
Clinical appearance:
Yellow stain distributed across teeth
Green stain - NEED ANSWER
Clinical appearance
Distribution on tooth surface
Composition
Occurrence
Recurrence
Etiology
Clinical approach
Other green stains
Black Line Stain - NEED ANSWER
Other names
Clinical features
Distribution on tooth surfaces
Composition and formation
Occurrence
Recurrence
Predisposing factors
Tobacco stain - NEED ANSWER
Clinical appearance
Distribution on tooth surface
Composition
Predisposing factors
Other brown stains include
Brown pellicle
Stannous fluoride
Foodstuffs
Antibiofilm agents
Betel leaf
Orange and Red stains - NEED ANSWER
Clinical appearance
Distribution on tooth surfaces
Occurrence
Etiology
Metallic Stains
Metals/metallic salts from industrial sources
Metallic substances contained in drugs
Endogenous Intrinsic Stain
Stain within tooth structure from internal source.
i.e. pulpless teeth, tetracycline, tooth development
Imperfect tooth development
Hereditary: genetic
›Amelogenesis imperfecta
›Dentinogenesis imperfecta
Enamel hypoplasia
›Systemic
›Localized
Dental fluorosis
Other systemic causes
Exogenous Intrinsic Stain
Stain within tooth structure from outside source
i.e. stain in dentin from carious lesion, amalgam, endo tx
Procedures for stain removal
Stains occurring directly on tooth surface
Stains incorporated within tooth deposits are removed with deposit
Precautions taken when removing stains
Prevent:
›abrasion of the tooth surface or gingival margin
› removal of a layer of fluoride-rich tooth surface
›overheating with a power-driven polisher
Extrinsic stain and clinical appearance
Removable
Results from presence of certain bacteria, or other substances such as tobacco, beverages, food, metals
Clinical appearance:
Yellow stain distributed across teeth
Green stain - NEED ANSWER
Clinical appearance
Distribution on tooth surface
Composition
Occurrence
Recurrence
Etiology
Clinical approach
Other green stains
Black Line Stain - NEED ANSWER
Other names
Clinical features
Distribution on tooth surfaces
Composition and formation
Occurrence
Recurrence
Predisposing factors
Tobacco stain - NEED ANSWER
Clinical appearance
Distribution on tooth surface
Composition
Predisposing factors
Other brown stains include
Brown pellicle
Stannous fluoride
Foodstuffs
Antibiofilm agents
Betel leaf
Orange and Red stains - NEED ANSWER
Clinical appearance
Distribution on tooth surfaces
Occurrence
Etiology
Metallic Stains
Metals/metallic salts from industrial sources
Metallic substances contained in drugs
Endogenous Intrinsic Stain
Stain within tooth structure from internal source.
i.e. pulpless teeth, tetracycline, tooth development
Imperfect tooth development
Hereditary: genetic
›Amelogenesis imperfecta
›Dentinogenesis imperfecta
Enamel hypoplasia
›Systemic
›Localized
Dental fluorosis
Other systemic causes
Exogenous Intrinsic Stain
Stain within tooth structure from outside source
i.e. stain in dentin from carious lesion, amalgam, endo tx
