Preventive Research Paper

Heather

Wilhelmi
November 2014
Biofilm is known by most patients as bacterial plaque. Plaque is a
dense, organized bacterial system, embedded in an inter-microbial matrix,
held together by glucan (Clark, S. 2014, 101). Biofilm is a colony of
microorganisms, complex and well organized (Clark, S. 2014). Within 20
minutes of brushing a shield of saliva proteins called an acquired pellicle
covers our teeth. This is a natural process that happens with everyone.
(Clark, S. 2014, 101). This pellicle is intended to protect our teeth from the
acids in our mouth. However, everyones mouth has bacteria. Bacteria
attaches to the pellicle where it communicates through chemicals to
multiply, grow and mature. These bacteria are covered by a protective
matrix that can be destroyed by brushing and flossing to mechanically
remove the bacteria. Everyones bacteria varies in type and amount making
it very complex. Each person has over 1,000 bacteria in their mouth at any
given time. (Clark, S. 2014, 101). The most common areas for biofilm to
develop is in cracks and crevices on the tooth structure including the
interproximal areas.
The primary plaque causing bacteria is strep mutans. On day one-two
of plaque formation gram positive cocci attach to the pellicle, streptococci
dominating. Next rods replace these and the bacteria increases in numbers.

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By day 7-14 WBCs increase, more gram negative and anaerobic organisms
appear. Signs of inflammation are present. On days 14-21 vibrios and
spirochetes are prevalent in older biofilm. Gingivitis is evident clinically.
(Clark, S. 2014, 101). Vibrios and spirochete microorgansms are facultative
bacteria meaning that they are harder to destroy because they can move
around and adapt under any condition to survive.
Plaque can lead to gingivitis, cause decay/caries and eventually
periodontal disease. It is critical to prevent and control plaque. His can be
done in many ways. Mainly brush and floss will remove plaque. Rinsing with
water after eating and chewing gums with xylitol will help also.
Caries is a life-long disease of the tooth enamel, dentin, and/or
cementum affecting 95% of the population (Clark, S. 2014, 101). The World
Health Organization has defined dental caries as a localized, post-eruptive,
pathologic process of external origin involving softening of the hard tooth
tissue and proceeding to the formation of a cavity. (Wilkins, E. 2014, p.261).
Most patients refer to this as a cavity. Caries is more accurate. Caries is a
symptom of periodontal disease. The primary bacteria involved are strep
mutans which create biofilm. Lactobacilli also are found in large numbers in
the biofilm (Wilkins, E. 2014, p. 263).
Caries is an infectious disease and can be transmitted to others. Strep
mutans are usually transmitted from a loved one. For example as parents
you may drink from the same cup or eat off the same spoon which can

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transfer the bacteria from you to your child.

To develop caries a person

must have strep mutans, sucrose, and a susceptible tooth.

After eating or drinking something with sucrose in it, acids are formed.
These acids can break down the calcium and phosphorus on our teeth. Early
detection can be found with air sprayed on tooth and later stages are visible
chalky rough surfaces on the tooth. If demineralization is found it can be remineralized with fluoride. Careful identification of cavitated versus noncavitated lesions is essential to avoid exploring a re-mineralizing area
(Wilkins, E., 2014, p. 266). These eventually break away causing a hole
leaving a restoration the only option.
The pH of a normal mouth is 6.2-7.0. It takes approximately 30
minutes after eating or drinking for the pH level to recover to normal.
Individuals can control this different ways. They can rinse with water after
eating/drinking to neutralize the acid, chew gum containing xylitol, and brush
with fluoride toothpaste to re-mineralize the structure. One important way
to help prevent caries is to eat or drink and be done to allow the mouth to
recover. If a person snacks or sips on a drink frequently the mouth is not
able to return to a normal pH level. This is more critical than the quantity of
what a person eats.
Calculus is formed through deposit of calcium and phosphate salts in
bacterial plaque (Clark, S., 2014, 104). This happens when plaque is not
removed. Patients refer to it as tartar. This can happen in as little as 4 hours

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of developing plaque. Calculus continues to form pushing the plaque further

against the gums and calculus can harbor bacteria. Calculus can irritated
the gingiva. This being said, calculus does not cause periodontitis, but it
does contribute by pushing the plaque to the gingiva. Plaque is the main
cause of periodontitis (Clark, S., 2014, 104).
Calculus forms supragingival and subgingival. Supragingival is found
on the crowns of teeth, above the margin of gingiva and is abundant near
the openings of salivary glands (Clark, S., 2014, 104). Subgingival calculus is
below the gingival margin and can attach to the dentinal tubules. It can be
detected with an explorer and removed with a curette or sickle scaler by
physically breaking it off the tooth (Clark, S., 2014, 104). Due to the waste
and dead cells subgingival the calculus can be black or dark green in color. It
is important to clean all of this, not leaving any pieces behind. Otherwise,
that rock in our shoe, as Shaunda stated in preventative lecture, could
cause an infection in the sulcus.
Common areas for calculus are interproximal and on the tooth surfaces
located by the salivary glands in our mouth. This does vary per person
because some people are heavy formers due to the composition of the
bacteria in their mouth.
Antibacterial products, such as pro health or total rinses, can help to
prevent calculus formation. Anti-calculus products, like tartar control
toothpastes, now called whitening toothpastes, can be used also. These are

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more abrasive. Anti-calculus dentifrice should be used with caution, they

can cause sensitivity (Clark, S., 2014, 104).
Gingivitis is the inflammation of gingival tissues (Wilkins, E., 2014, p.
247). Gingivitis can include redness, swelling, bleeding, exudate, and
sensitivity (Clark, S., 2014, 107). This is the most common disease in
humans and the easiest to treat and control (Clark, S., 2014, 107). In the first
few days that plaque is pushed against the gingiva blood vessels will dilate
causing the initial inflammation. Having gingivitis does not mean a person
will develop periodontitis and should not be confused with other diseases or
infections of the gingiva. Many examples are given in the Oral soft tissue
diseases literature. Gingivitis can be reversed within 7 days of plaque
control. Calcium and Phosphate salts in plaque develop calculus which
pushes plaque against the gingiva irritating it and causing gingivitis. Some
drugs can cause gingival disease that are not gingivitis. For example Dilantin
is given as an anti-seizure medicine to epileptic patients. Dilantin,
phenytoin, can cause gingival hyperplasia, observed during the first 6
months of therapy appearing as gingivitis (Wynn, R., Meiller, T., & Crossley,
H. 2014, p. 1165).
Periodontal disease refers to a group of diseases that affect the tissue
around the teeth.
It can range from a superficial inflammation of the gingiva to the destruction
of supporting bone and the periodontal ligament (Iannucci, J. & Howerton, L.,
2014, p. 413). According to the definition given in Preventative Class
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Periodontitis is a set of periodontal diseases and is preceded by gingivitis.

It is the inflammatory destruction of the periodontium. The inflammation
causes the gingiva to pull away from the teeth, possibly having a blue tint
due to the lack of oxygen supply. This leaves spaces for infections that will
result in worsening gingival inflammation, deepened probing depths, loss of
alveolar bone due to resorption, tissue and eventually tooth mobility and
loss.

The accumulation of plaque will cause periodontitis if not controlled.

Bacteria involved in periodontal disease are anaerobic and can adapt to

survive under any condition.
The effects of certain medications, tobacco use, and various medical
conditions are all considered risk factors for periodontal disease (Iannucci, J.
& Howerton, L., 2014, p. 419). Systemic disease can be a risk factor for
developing periodontitis. However, with these systemic conditions if the oral
health is good they may never develop periodontitis. Diabetes can increase
susceptibility to periodontal infections. Greater periodontal attachment loss
in patients with osteoporosis (Wilkins, E., 2014, p. 254).
Prevention is the key. Ways to prevent, reduce or eliminate disease
can vary based on each patients individual needs. It is critical to get a
complete history and evaluate all aspects of the current conditions and
options available. All people have different bacteria and amounts of
bacteria, as well as different lifestyles and anatomy. Oral disease prevention
includes brush/flossing regularly. Consuming less sucrose is helpful, but

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controlling the frequency is critical. No matter what is being consumed,

apple or candy, finish eating/drinking it timely to allow the mouth to recover.

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References

Clark, S. (2014). Preventive Dentistry, Kirkwood C.C.

Iannucci, J. & Howerton, L. (2014). Dental Radiography Principles and
Techniques (4th ed.)
Newland, J., Meiller, T., Wynn, R., & Crossley, H. (2014) Oral Soft Tissue
Diseases (6th ed.)
Wilkins, E.M. (2014). Clinical Practice of the Dental Hygienist (11th ed.)
Wynn, R., Meiller, T., & Crossley, H. (2014). Drug Information Handbook for
Dentistry (20th ed.)

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