Dental plaque is specific deposits that are tightly adjacent to the crown of the tooth or the gingival edge, formed in the oral cavity from bacteria, saliva, food residues, tissue detritus. Dental plaque contributes to a change in the color of the enamel, a feeling of roughness of the surface of the teeth, the appearance of bad breath. The diagnosis includes a consultation with a dental hygienist, a visual examination of the oral cavity after staining the teeth with special dyes, and an assessment of the hygiene index. To remove dental plaque, they resort to mechanical brushing of teeth with toothbrushes and pastes, as well as to the procedure of professional oral hygiene.
Meaning
Dental plaque – adhesive layers on the surface of tooth enamel, which are based on clusters of microorganisms and their metabolic products. Dental plaque is formed on the crown of the tooth (especially on the contact surfaces, fissures, recesses, pits, cervical region, interdental spaces), as well as along and below the gingival margin. Pathology in dentistry refers to non-mineralized dental deposits and can occur at any age. Its surface is covered with mucoid mucoid film, so dental plaque is not washed off with saliva and water, but can be partially removed during meals. A few hours after complete removal, dental plaque reappears. With the existence of more than 1-3 days (an average of 48 hours), dental plaque matures and due to the huge concentration of bacteria that secrete aggressive enzymes, substances that dissolve calcium, and endotoxins, it acquires pathogenic potential.
Causes
Dental plaque occurs during the period of rest of the chewing and speech apparatus in the absence or inadequate quality of hygienic care for the teeth and oral cavity. The speed and degree of dental plaque formation are influenced by the correctness and thoroughness of oral hygiene, the anatomical structure of teeth (including the presence of fillings, prostheses, orthodontic devices and structures), microbial contamination of the oral cavity, the level of self-cleaning processes (amount, viscosity of saliva, pH and protective properties of oral fluid), the nature of the diet and the intensity of chewing, the state of the gastrointestinal tract, smoking.
Dental plaque forms faster during sleep, with insufficient chewing, hyposalivation, xerostomia, with excessive consumption of refined carbohydrates (sucrose, glucose, fructose, lactose and starch), foods with a high protein content and low fat content, soft food consistency, taking iron preparations.
Pathogenesis
In the occurrence of dental plaque, the main role is played by microorganisms living in the oral cavity (streptococci, veilonella, neisseria, diphteroids, lactobacilli, staphylococci, leptotrichia, fusobacteria, actinomycetes, yeast-like fungi, etc.). The process of plaque formation proceeds in several stages. The tooth surface is covered with a very thin (up to 1 micron thick) structureless film – a pellicle consisting of electrostatically interconnected acidic proteins, glycoproteins, enzymes, serum proteins and saliva immunoglobulins. Being semi-permeable, the film participates in metabolic processes with oral fluid. Due to the secretion of specific highly adhesive heteropolysaccharides (glycans, levans and dextrans), microorganisms from the oral cavity are easily adsorbed on the surface of the pellicle to form a soft plaque that does not have a permanent internal structure. Due to its porous structure, the smallest remnants of food, destroyed epithelial cells, leukocytes, macrophages can penetrate into it. The accumulation of microbial deposits is carried out due to the division and adhesion of new colonies, the accumulation of their waste products.
Dental plaque consists of 50-70% of the volume of a dense layer of bacteria. The microbial composition of plaque is changing rapidly, initially aerobic forms dominate, then anaerobes begin to prevail. In the process of anaerobic glycolysis, cariesogenic microorganisms produce a large amount of organic acids (lactic, pyruvic, formic) from carbohydrates supplied with food, which, by close and prolonged contact with tooth enamel, demineralize hard tissues. Due to the limitation of the diffusion process in mature plaque, neutralization of these acids does not occur. The microorganisms themselves are resistant to the acid formed. Over time, there are qualitative changes in plaque, it mineralizes with the formation of tartar.
Classification
By localization, there is a supra-gingival plaque (located on the open surface of the tooth) and a subgingival plaque located below the gingival margin (in the gingival groove or gingival pocket).
Depending on the anatomical and topographic areas of attachment, the supra-gingival plaque can be dento-gingival (formed on the smooth surfaces of the tooth in the gingival margin) and proximal (formed on the contact surfaces); subgingival – tooth-attached (to the tooth surface) and epithelial-attached (to the gum epithelium). In the gingival groove, a zone of loose subgingival plaque is also isolated.
Symptoms
Plaque is manifested by a change in color and loss of gloss of tooth enamel, a feeling of roughness of the tooth, bad breath (halitosis). Plaque can be white, green and brown. Usually there is a soft plaque in the form of a whitish or slightly yellowish viscous mass, a thin layer covering the surface of the tooth. Most often, white plaque accumulates in the cervical region of the crown, interdental spaces, fissures of the chewing surfaces, along the gingival margin, around fillings, on orthopedic and orthodontic structures.
Pigmented plaque is formed due to enamel staining when drinking coffee, strong tea. The appearance of brown plaque may be associated with smoking – exposure to nicotine and tar. The smoker’s plaque is difficult to clean with a regular toothbrush and paste.
Brown plaque in non-smokers can occur with a large number of fillings made of copper amalgam, as well as in workers who manufacture products made of copper, brass and bronze. In children, brown plaque on temporary teeth may appear when an excess of unrepaired iron secreted by saliva and sulfur formed in the oral cavity during the breakdown of proteins are combined.
Green plaque appears when chlorophyll-containing microorganisms (for example, Lichen clentalis fungus) develop in the oral cavity. Green plaque is observed mainly on the labial and buccal surfaces of the frontal group of teeth of the upper jaw, occurs in persons of any age, more often in children and young patients.
The long-existing plaque undergoes mineralization (calcification) and leads to the formation of solid deposits (tartar), to profound changes in the tissues of the tooth – the development of caries, pulpitis. As it moves under the gingival margin, plaque causes damage to the epithelium of the gingival groove, irritation of the surrounding supporting tissues, the development of inflammatory periodontal diseases (gingivitis and periodontitis) and tooth loss.
Diagnostics
You can diagnose dental plaque yourself at home, using a conventional mirror or during an examination of the oral cavity at the dentist.
If there are signs of dental deposits, it is important to determine their type (soft plaque, tartar). To visualize plaque, special dyes (fuchsin, erythrosine, bismarck brown) are used in the form of solutions, rinses, tablets that color the areas affected by plaque in a bright color.
Quantitative and qualitative assessment of dental plaque is carried out on the basis of the Fedorov–Volodkina hygienic index, calculated in points according to the intensity of staining of deposits with iodine-potassium iodide solution (Schiller-Pisarev liquid).
Treatment
Timely removal of soft dental plaque contributes to the improvement of the oral organs, prevention of dental diseases and periodontal disease. The simplest and most effective way to remove soft plaque is mechanical brushing with toothpaste, brushes and other hygiene products. Dense plaque and smoker’s plaque can be removed when treating teeth with hard brushes and special fine pastes. It is possible to use an oral irrigator to clean hard-to-reach areas (interdental spaces, dentoalveolar folds), braces, crowns, bridges, dentures.
In case of massive accumulations of plaque, which cannot be removed at home by yourself, it is necessary to visit a dental hygienist for professional oral hygiene, including the stages of ultrasonic scaling, cleaning with an Air-flow device, polishing with abrasive paste and deep fluoridation of tooth enamel. Sometimes chemical or photo-bleaching may be required to restore the normal color of tooth enamel.
Prognosis and prevention
Dental plaque is not only an aesthetic disadvantage, because it is potentially dangerous, leads to the formation of tartar, the development of caries, pulpitis, gingivitis, periodontitis, premature loss of teeth. Therefore, plaque removal should be part of daily hygienic oral care.
Measures to prevent the accumulation of dental plaque are thorough and proper brushing of teeth with a toothbrush and paste 2 times a day, the use of dental floss and special brushes for interdental spaces, mouthwash for 15-30 seconds. after each meal, the passage of regular professional oral hygiene.
Prevention of dental plaque in children begins to be carried out from the moment of the appearance of the first milk tooth; to correct hygienic measures, a visit to a pediatric dentist is necessary after the child is 1.5 years old. It is important to exclude or limit the consumption of simple sugars, smoking.
Literature
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