Chapter 17: Dental Soft Deposits, Biofilm, Calculus, and Stains

soft deposits

acquired pellicle, dental biofilm, materia alba, and food debris

acquired pellicle

a thin, acellular tenacious film formed by proteins, carbohydrates, and lipids

acquired pellicle

forms over tooth surfaces and prosthesis

100, 1000

acquired pellicle thickness varies ___ to ___ nm

gingival margin

acquired pellicle thickest near ___ and areas that are undisturbed from activities

30, 90

acquired pellicle formation occurs immediately after eruption or immediately following a cleaning and is fully developed in ___-___ minutes

selective

initial attachment of bacteria to the pellicle is by ___ adherence

biofilm production

innate characteristics of the pellicle itself is what determines the adhesive interactions, resulting in planktonic bacteria and ____

salivary proteins

___ have a high affinity for the hydroxyapatite tooth surface and initiates pellicle formation

insolubule

acquired pellicle is highly ___ does not dissolve in saliva or fluids

supragingival pellicle

___ is clear, translucent, insoluble, and not readily visible until application of disclosing solution

supragingival pellicle

can take on extrinsic stain

with disclosing solution, the stain is pale in comparison to the stain from biofilm

supragingival

subgingival pellicle is continuous with the ___ pellicle and can become embedded in tooth structure especially in demineralized areas or abrasion

protects, lubricates

what are the good qualities of pellicle? __ and __

nidus

what are the bad qualities of pellicle? acts as a ___ of attachment for bacteria and subsequent calculus

resistant

pellicle is insoluble, but NOT ___ to rigorous patient oral self care

matruation

the use of abrasive pastes, whitening products, and acidic foods, and beverages interfere with the pellicle formation and ___ of pellicle

permanent teeth

___ are the ONLY nonshedding surface in the body that develops biofilm

dynamic

biofilm is ___, it's a structured community of microorganisms and is encapsulated in a self-produced extracellular polymeric substance

matrix

forming a ___ around mcirocolonies and protecting them from the environment of your mouth, your immune system, and antimicrobial agents

dental biofilm

___ adheres to the pellicle in all hard and soft surfaces in the mouth, including restorations and prosthetics

700

there are over ___ distinct microorganisms in the oral cavity

stage 1

___ biofilm formation: initial attachment of planktonic bacterial cells to the acquired pellicle

planktonic

Describes bacteria that are freely floating in water.

reversible

during stage 1 of biofilm formation the process is ___ with daily home care routines

stage 2

___ biofilm formation: multiplication and colonization: microcolonies multiply in layers growing upward and outward (3D)

irreversible

during stage 2 with growth, the colonies produce the EPS and are now ___ with home care routines

rough

during stage 2 of dental biofilm formation, creates a ___ surface, accelerating growth of the biofilm

gram positive

generally bacteria in the first few hours are ___ during stage 2 of biofilm formation

stage 3

matrix formation: EPS continues to be secreted as bacteria multiply

decrease

stage 3 biofilm formation through adaption, antimicrobial resistance becomes higher, ___ the effectiveness of common antimicrobial agents

stage 4

___ of biofilm formation: biofilm growth, cell-to-cell communication (quorum sensing) is developing more and now microorganisms known when to leave the biofilm and find new sites

stage 5

___ of biofilm formation: maturation, release of planktonic cells occurs in order to colonize new areas of acquired pellicle

this can occur in single cells or even in clumps

high

microbial density is very ___ and increases as biofilm ages and matures resulting in increased risks of developing caries and gingivitis

negative anaerobic bacteria

undisrupted biofilm for approximately 7 days, ___ growth is favored resulting in increased risk of those diseases

1, 2

days ___-___: early biofilm

2, 4

days ___-___: ESP starts to be secreted

6, 10

days ___-___: this is when gram negative anaerobic bacteria proliferate, and EPS is now forming 3D structres

10, 21

days ___-___: this is when gingivitis is now clinically present

supragingival

___ biofilm is mostly comprised of gram-positive aerobic bacteria and has two layers

first layer

___ of supragingival biofilm adheres to that acquired pellicle

second layer

___ of supragingival biofilm forms on top of the basal layer

4, negative

subgingival biofilm has ___ layers and is made up of mostly gram-___ anaerobic organisms

20, 80

only ___% of biofilm is made up of microorganisms and EPS, while the other ___% is water (composition differs for people and even location)

inorganic elements

___ of dental biofilm

calcium and phosphorous (along with Mg) are more concentrated in biofilm than in saliva

fluoride concentration in biofilm is higher in the presence of fluoridated water and after the use of fluoride

organic elements

___ of dental biofilm

carbohydrates are formed by bacterial metabolism of dietary sucrose and starch

glucans contribute to the adherence and tenacious nature of biofilm

proteins bind with the glucans and lead to further growth of biofilm

supra, sub

distribution of biofilm can be __ or __ gingival and in fissures on the tongue

gingival margins, proximal

formation dental biofilm begins at the ___ and ___ surfaces, then starts to extend coronally if left undisturbed

lingual, posterior, proximal

biofilm is the heaviest on ___, ___, and ___ surfaces

anterior

___ surfaces have the least biofilm

influence biofilm accumulation

crowded teeth accumulates readily (effective control will prevent), rough surfaces, on occlusal of teeth that are not occluding with another tooth

direct vision

detection of biofilm can be done with ___ using disclosing solution, biofilm that has been stained or when you see a "fuzz

on teeth

explorer, probe

detection of biofilm can be done with the use of an ___ or ___

5.5, 6.4

critical pH is ___ for enamel and ___ for dentin and cementum

calculus

undisrupted biofilm becomes calcified = ___

materia alba

___ is a soft and white and is clinically visible even without the use of disclosing solution

living, dead bacteria

materia alba is comprised of several components: ___ and ___, desquamated epithelial cells, disintegrating leukocytes, salivary proteins, and food debris

easily

materia alba is ___ removed with as little effort as tongue action

prevented

materia alba can be ___ with home care - brushing, flossing, mouthrinse

cervical, proximal

after food consumption, food remnants may be left behind, this most often occurs in the ___ third and ___ embrasures

vertical food impaction

___ happens during chewing as food is forced into those open contact areas due to mobility or occlusal irregularities ( such as plunger cusp)

plunger cusp

a cusp of a tooth that tends to forcibly wedge food into interproximal areas, causing an impaction

nonmineralized

calculus is covered with a layer of ___ biofilm containing live bacteria

supragingival

___ calculus develops on clinical crowns coronal of the gingiva (also on implants and prosthetics)

lingual, buccal

the most common areas for supragingival calculus to develop are the ___ surfaces of lower anterior teeth and the ___ surfaces of the maxillary first and second molars

subgingival

___ calculus develops on crowns of teeth and root surfaces apical of the gingival margin

may develop generalized or localized

heaviest

subgingival calculus ___ deposits occur in areas that are hard for patients to access during personal care

inorganic

___ elements of calculus: fluoride is present in dental calculus and is higher in subgingival than supragingival

70, 80, 20, 30

mature calculus is __-__% inorganic and only ___-___% organic

calculus formation

___ starts with pellicle formation, biofilm formation, then mineralization

24, 72

mineralization occurs if biofilm is left undisturbed for __-__ hours

layers

the structure of calculus forms in ___ that are parallel to the tooth surface

rough

surface of calculus will be ___ in nature and detectable with your explorer

calculus

crusty, spiny or nodular

ledge or ring

thin, smooth veneers

fingers and fernlike formation

individual calculus islands or sport

supra and subgingival seposits

12

formation of calculus on average is around ___ day but begins as early as 24 to 48 hours when patient's daily oral care is inadequate

perpetuates

layer of biofilm ___ the inflammatory state

direct examination

with supragingival calculus, you will see it directly and indirectly with mirror and with subgingival calculus you can sometimes see the dark edges at or just below the gingival margin

compressed air

you will use you air/water syringe to blow a puff of air and use proper lighting

supragingival calculus will appear chalky

exploring

your explorer 11/12 will be used to detect calculus as you feel for textural changes

radiographs

radiographic exams may detect calculus

dental endoscope

___ used within pockets and furcations can be used to detect calculus that is otherwise undetectable

extrinsic stain

___ occurs on external surfaces of the tooth and will be removed by either brushing or scaling and/or polishing

intrinsic stain

___ occurs within the tooth surface and cannot be removed, however sometimes it can be improved by certain whitening procedures

exogenous stain

___ develop from sources outside the tooth and can become either extrinsic or intrinsic

endogenous stain

___ develop from within the tooth and are always intrinsic, generally stains that develop in the dentin and are visible through the enamel

tenacious

when extrinsic stains are ___ avoid excessive polishing and use the least abrasive agent to get the job done

intrinsic stains

___, regardless of if the endogenous or exogenous, you will not be able to remove with scaling or polishing (recommend whitening)

yellow stain

___ is dull and yellowish that can be localized or generalized

common in all ages and occurs mostly when personal care is neglected

usually dietary sources

green stain

___ can be light or yellowish green to very dark green and occurs at any age but primarily found in children

black line stain

__ is a highly retentive black or dark brown stain that is at the gingival margin third of the tooth and can develop at any age

tobacco stain

is light brown to dark leathery brown and can stain biofilm calculus or become exogenous intrinsic

occurs in cervical third of lingual surface

betel nut stain

are ground and mixed with other ingredients such as flavoring or tobacco and then chew or "quid" is made

swimmer stain

is a stain that develops after frequent exposure to pools that are disinfected with chlorine or bromine and can be yellowish or dark brown on facials of maxillary and mandibular incisors

orange and red stains

___ appear on the cervical third, are most often on anterior teeth and are possibly from that chromogenic bacteria

metallic stain

___ from dust can be several different colors, based on what the metal exposure is

primary on anterior

cervical third most commonly

develops in industrial workers

metallic stains from drugs

can be black or brown and be generalized

if medication is taken through a straw or in a tablet/capsule, these stains can be prevented

endogenous intrinsic stains

___ can develop from pulpless or traumatized teeth, genetics, hypoplasia, fluorosis, or tetracycline/minocycline

exogenous intrinsic stain

___ develop from developmental defects, acquired defects (tooth wear/gingival recession), dental caries, or restorative materials

amalgam

gray to black discoloration to tooth structure around the restoration