Dental Plaque

(Lecture outline)
Dr.Ghada Maghaireh
Dental Caries
A carbohydrate-rich diet increases the growth rate of many oral bacteria.
It has been shown that the accumulation of dental plaque after 4 days is higher
when individuals consume a diet supplemented with sucrose compared with
a control diet without added sucrose.
A sucrose rich diet change the composition of the microflora into a more
aciduric species.
In addition, sucrose can be converted by bacteria into glucans which can
enhance plaque attachment and contribute to the plaque matrix.

Formation and Structure of Dental Plaque

The development of dental plaque can be divided into different stages:
1. Pellicle formation.
2. Attachment of single bacteria cells.
3. Growth of attached bacteria leading to the
formation of distinct microcolonies.
4. Microbial succession and co-aggregation leading to
increased species diversity with continued growth of
microorganisms.
5. Climax community /mature plaque (2 weeks or older).

Pellicle Formation
Microorganisms do not colonize directly on the mineralized tooth surface.
The teeth are always covered by a layer called “the pellicle”.
It is an acellular proteinaceous film that forms on the “naked” tooth surface
within minutes to hours.
In uncolonized areas the pellicle reaches a thickness of 0.01-1 µm within 24 h.
The major constituents of the pellicle are salivary glycoproteins,
phosphoproteins, lipids and components from the gingival cervicular fluids.

Microbial Colonization
Microbial colonization of teeth requires that bacteria adhere to the surface .
Mechanism involved in the adherence is very complex and not fully
understood.
Initial microbial colonization.
Microbial succession.
Initial Microbial Colonization
The tooth surface is initially colonized by a highly selected part of the oral
microflora, mainly S.sanguis
S.sanguis,, S.orals
S.orals,, and S.mitis
S.mitis..
Together theses three streptococci accounts for 95% of the streptococci and
56% of the total initial microflora.
Bacteria contain a recognition system on their surfaces that enables
components of the bacteria surface (adhesins) to bind to complementary
molecules (receptors) in the pellicle.

Microbial Succession
As the microbiota ages, a shift occur from a Streptococcus-dominated
Streptococcus-dominated plaque
to a plaque dominated by Actinomyces.
Actinomyces.
Such microbial shifts are known as microbial succession.
Pioneer bacteria create an environment that is either more attractive to
secondary invaders or unfavorable for themselves because of a lack of
nutrients or accumulation of inhibitory metabolic products.
As the bacterial deposits become thicker, the oxygen concentration
decreased.
Progressive shift from aerobic and facultatively anaerobic in the early stages to
a situation in which anaerobic organisms are predominant after 9 days.
After some weeks of undisturbed growth, the microbial community develops
into a climax community that harbors a broad range of bacterial species.

Dental Plaque as a microbial biofilm

Dental plaque is an example of biofilm.
The term biofilm is used to describe communities of microorganisms attached
to a surface.
Such organisms are organized into three dimensional structure enclosed in a
matrix of extracellular material derived from both the cells themselves and
the environment.
Bacteria growing into biofilms are more resistant to the effect of host defense
mechanisms and antimicrobial agents when compared to the same cells in
a liquid suspension.
So it is important to mechanically disturb the biofilm when utilizing
antimicrobial therapy.

Dental Plaque and Caries

Two main school of thought on the role of plaque in the etiology of caries.
1. The specific plaque hypothesis.
2.The non-specific plaque hypothesis.
The ecological plaque hypothesis.
The Specific Plaque Hypothesis
Only a few species of the diverse collection of organisms comprising the
plaque microflora are actively involved in the disease.
It focused efforts on controlling disease by targeting preventive measures and
treatment against a limited number of organisms.

The non-specific plaque hypothesis

Disease is the outcome of the overall activity of the total plaque microflora.
A heterogeneous mixture of microorganisms could play role in the disease.

The Ecological Plaque Hypothesis

This hypothesis propose that the organisms associated with disease may also
be present at sound sites, but at levels too low to be clinically relevant.
Disease is a shift in the balance of the resident microflora driven by a change
in local environmental conditions.
In case of dental caries, repeated conditions of low pH in plaque following
frequent sugar intake will favor the growth of acidogenic and aciduric
species, and therefore predispose a site to caries.

The Ecological Plaque Hypothesis

The hypothesis also acknowledge the dynamic relationship that exists
between the microflora and the host.
So that the impact of alterations in key host factors (such as saliva flow) on
plaque composition is also taken into account.
The disease can be controlled not only by targeting directly the pathogen (e.g.
mutans streptococci), but also by interfering with the factors that are the
shift in the balance of microflora (e.g. lowering the acid challenge).

References
Chapter #3.“The oral microflora and biofilms on teeth”.
(Dental Caries: The Disease and its Clinical Management), first edition.

The Midterm Exam includes all the first 6 lectures.

Thursday 7/4/2011 at 4:00.
10 H2, 10 H3, 10H4.