Dental Soft Deposits & Biofilm

• Dental soft deposits, biofilm, calculus, and stains have a significant impact on oral health.

Dental Biofilm

• Biofilm poses a primary risk for gingivitis, periodontal disease, and caries.
• Periodontal disease and dental caries do not cause each other.
• Biofilm is transmissible.

Soft Deposits

• Acquired enamel pellicle
• Microbial biofilm
• Materia alba
• Food debris

Acquired Pellicle

• Acellular tenacious film made of proteins, carbohydrates, and lipids.
• It begins to form within 30-90 minutes.
• It forms on restorations, crowns, tooth surfaces, dentures, mouthguards, calculus and ortho appliances.
• Types include I-x, and subgingival, which is a continuation of supra and embeds with tooth structure.
• It can be removed with abrasive toothpastes, whitening products and acidic foods/drinks.
• Protection plays an important role in the maintenance of the oral cavity.
• Lubricates and keeps the surfaces moist, preventing drying.
• Nidus (to multiply) of attachment for bacteria participates in biofilm formation.
• Functions as a mode for calculus attachment.
• Extrinsic stain can gradually become brown, grey, or other colors.

Dental Biofilm

• The matrix is composed of polysaccharides, proteins, and other compounds.
• Adheres to the pellicle coating on all hard and soft oral structures, including teeth, existing calculus, and fixed and removable restorations.
• Found less frequently on palatal surfaces and maxillary anterior teeth.
• Oral microbiome is composed of microorganisms, their genetic makeup and environments of the oral cavity.

Stages in the Formation of Biofilm

• Stage 1: Formation of planktonic (white blood cells).
• Stage 2: Bacterial multiplication and colonization.
• Stage 3: Matrix formation.
• Stage 4: Biofilm growth.
• Stage 5: Maturation.

Changes in Biofilm Microorganisms

• Days 1-2 consist of gram-positive cocci.
• Days 2-4 (72 hours) capable of initiating the inflammatory process.
• Days 6-10 consist of gram-negative anaerobic bacteria.
• Days 10-21 (2-3 weeks) gingivitis develops.

Supragingival Biofilm

• Is made up of 2 layers.
• Gram-positive aerobic bacteria.
• The first layer is composed of streptococci.
• Coronal to the gingival margin.

Subgingival Biofilm

• Is made up of 4 layers.
• Gram-negative anaerobic bacteria.
• The first layer is composed of Actinomyces.
• Located between the periodontal attachment and the gingival margin.

Composition of Dental Biofilm

• Biofilm is approximately 20% organic and inorganic solids, the other 80% is water.
• Composed of inorganic elements such as calcium, phosphorus and fluoride.
• Composed of organic elements such as carbohydrates and proteins.

Clinical Aspects of Dental Biofilm

• Supragingival Biofilm is coronal to the gingival margin.
• Subgingival Biofilm located between the epithelial attachment and the gingival margin, within the sulcus or pocket.
• Biofilm can be detected with direct vision, an explorer and disclosing agent.

Significance of Dental Biofilm

• Biofilm plays a major role in the initiation and progression of dental caries and periodontal diseases.
• Biofilm is essential to the formation of dental calculus, which is essentially mineralized dental biofilm.
• Cariogenic Microorganisms in Biofilm are Mutans streptococci & Mutans streptococci.
• Critical pH for enamel demineralization averages 4.5 - 5.5.
• Critical pH for dentin demineralization is 6.0-6.7.

Materia Alba

• Soft, loosely attached, whitish tooth deposit with cottage cheese-like texture.
• An unorganized accumulation of living and dead bacteria, epithelial cells, leukocytes, salivary proteins, and food debris.
• Removed with a water spray, oral irrigator, or tongue action.

Calculus

• Mineralized dental biofilm, mineralized be crystals of calcium and phosphate.
• A hard, tenacious mass on the clinical crowns of natural teeth, dental implants, dentures, and other dental prostheses.

Supragingival Calculus

• Most frequently found on the mand ant teeth & facials of max 1st and 2nd molars.

Subgingival Calculus

• Clinical crown apical to the gingival margin (CEJ/pocket formation).
• Generalized or localized.

Calculus Composition

• Major Inorganic Components include Calcium (CA), Phosphorus (P), Carbonate (CO3), Sodium (NA), and Magnesium (Mg).
• Fluoride is higher in subgingival than supragingival calculus.

Calculus Crystals

• Two-thirds of the inorganic content is crystalline apatite.
• Compared to teeth and bone:
  • Dental enamel is the most highly mineralized tissue in the body.
  • Enamel - 95-97% inorganic salts.
  • Dentin - 65%.
  • Cementum and bone - 45-70%.
  • Mature calculus - 70-80% inorganic content.

Calculus Formation

• Occurs in 3 steps: pellicle formation, biofilm formation, and mineralization.
• Mineralization consists of crystal formation, namely, hydroxyapatite, octacalcium phosphate, whitlockite, and brushite.
• Kidney stones patients may be more prone to calculus.

Calculus Formation

• Affected by salivary flow, salivary supersaturation with calcium phosphate salts, and inhibitors and promoters of calculus formation
• Supersaturation of saliva and plaque biofilm is the driving force for mineralization.
• Calculus Inhibitors for supragingival calculus include pyrophosphate and zinc salts.
• Heavy calculus formers have higher salivary levels of calcium and phosphorus than do light calculus formers.
• Light calculus formers have higher levels of pyrophosphate.
• Mineralization can begin as early as 24 to 48 hours when a patient's personal daily oral hygiene is inadequate.
• The formation of calculus formation increases with age.

Structure of Calculus

• The surface of a calculus mass is typically rough.
• It is detectable with the use of an explorer or probe

Attachment of Calculus

• The ease or difficulty of calculus removal is related to the manner of attachment of the calculus to the tooth surface.
• Dentin irregularities include cracks, lamellae, and carious defects by mechanical locking into undercuts.
• Difficult to be certain all calculus is removed when it is attached since the calculus becomes locked into the irregularities such as pitted enamel and carious defects.

Significance of Dental Calculus

• Calculus is considered a predisposing factor to perio pocket formation.
• The cornerstone of nonsurgical periodontal therapy is the daily control of biofilm by the patient, supplemented by definitive professional calculus removal, to reduce or eliminate gingival inflammation and bleeding on probing.

Clinical Characteristics of Calculus

• Supragingival can be seen directly or indirectly, using a mouth mirror.
• Small amounts of calculus may be invisible when they are wet with saliva.
• With adequate light and drying with air, small deposits usually become visible.
• Subgingival may be seen at or just beneath the gingival margin.
• Can be detected by explorer or probe.
• Dental Endoscopy can detect otherwise undetectable calculus, especially burnished or veneer-type calculus.

Prevention of Calculus

• Personal dental biofilm control.
• Regular professional continuing care.
• Use anticalculus dentifrice and mouthrinse.
• Chemotherapeutic anticalculus agents, such as pyrophosphates, zinc citrate, and pyrophosphates plus triclosan.
• Only suggest products with the ADA seal of acceptance.

Dental Stains and Discolorations

• Occur in three general ways such as adhering directly to surfaces, in calculus and soft deposits or incorporated within tooth structure or restorative material.
• Extrinsic occur on the external surface of the tooth and may be removed by procedures.
• Intrinsic occur within the tooth surface and CANNOT be removed by scaling or polishing.

Stains

• Extrinsic most frequently are coffee, tea, and tobacco, bacteria stains, food debris and some medications.
• Intrinsic caused by Endodonic therapy and pulpless or traumatized teeth.
• Yellow localized/ generalized, all ages and dietary.
• Green stain, Light or yellowish green to very dark, poor oral hygiene and biofilm retention and chromogenic bacteria, Chlorophyll preparations and drugs
• Black line is retentive, forms along the gingival third near the gingival margin and is caused primarily by of actinomyces and dietary habits.
• Tobacco is light to dark leathery and Cervical ⅓ primary on the linguals and caused by tar.
• Brown Pellicle is from chemical alteration of pellicle from tea, coffee or soy and Stannous fluoride.
• Caused by metals include iron (brown or green), Nickel (green), cadmium (yellow or brown), copper amalgam (blue green).
• Stains from disturbances in tooth development include enamel hypoplasia (damage during development) and dental florosis (excessive fluoride).
• Tetracycline and antibiotics create discolorations in teeth.
• Exogenous Intrinsic stains are tobacco, silver nitrate, restorative material or Amalgam.