Controlling plaque

Controlling plaque
Since the late 19th century dental researchers have attempted to understand the microbial nature of oral diseases. In this time, the view of plaque and its constituent microorganisms have moved from specific plaque hypothesis to a non-specific plaque hypothesis before returning to the theory of specific periodontal pathogens in plaque. Plaque biofilm is the cause of the two most common oral diseases: caries and periodontal disease. More than 500 bacterial strains may be found in dental plaque,1 having evolved to survive in the environment of the tooth surface, gingival epithelium, and oral cavity.

New research

The link between periodontal disease and heart disease has long been recognised, but in recent months, scientists at the University of Bristol, working with the Royal College of Surgeons in Ireland, have claimed to have established one reason why periodontal disease may increase the risk of heart disease. In the study held at the University of Bristol,2 scientists suggest that bacteria enters the bloodstream via sore gingival tissue and deposit a clot-forming protein. Their work in this study highlights that once the Streptococcus bacteria (responsible for causing dental plaque biofilm and periodontal disease) is released into the bloodstream, it creates a protein known as PadA, which forces platelets in the blood to stick together and clot. This platelet clumping has the potential to cause small blood clots, growths on the heart valves and even inflammation of blood vessels that can block the blood supply to the heart and brain.

These new findings reinforce the importance of maintaining high levels of oral hygiene and the need to control the build up of plaque biofilm. The past two decades have witnessed newer scientific methods that have changed the view of dental plaque, resulting in scientists now regarding it as a biofilm.3 This recent acknowledgment that subgingival plaque is in fact a biofilm enables an increased level of understanding concerning its persistence and resistance to the host’s
defence system.

Due to the structure of plaque biofilm, mechanical removal is the most effective method currently available for its control. Mechanical plaque biofilm control involves the removal of microbial plaque, as well as the prevention of accumulation on the teeth and adjacent gingival surface by the use of a toothbrush and other mechanical hygiene aids.

Dental adjuncts

The most common adjunct to brushing is traditional dental floss, widely recommended for removing proximal plaque. However, many people, particularly those with impaired manual dexterity, struggle to effectively use dental floss and require an alternative. Recently a systematic review showed that adding dental floss to toothbrushing regimes did not produce any additional benefits for the patient, further supporting the need for effective alternatives.4

In 1962, therapeutic domestic dental technology made a significant advancement when a Colorado-based dentist sought to apply irrigation to diseased gingivae that could clean deeper than brushing and flossing. The result? The first ever water-pulsating device for use         in dentistry.

Water Flossers, also known as oral irrigators or dental water jets produce a pulsating stream of water, which causes a rapid compression and decompression phase that disrupts and removes bacteria and detritus from the periodontal pocket, or sulcus. Water Flossers have proven to be incredibly effective in combating periodontal disease in several areas. Subgingival penetration assists in reducing plaque and subgingival pathogens, in addition to calculus, gingivitis and bleeding.

References

1. Neild-Gehrid JS. Dental Plaque Biofilm. www.dentalcarestamford.com, accessed 6th September 2010

2. http://www.bbc.co.uk/news/health-11182666 Key reasons ‘found’ for gum and heart disease link accessed 5th September 2010

3. Marsh PD, Bradshaw DJ. Dental plaque as a biofilm. J Industrial Microbiology 1995;15: 169-175.

4. Berchier CE, Slot DE, Haps S, Van der Weijden GA. The efficacy of dental floss in addition to a toothbrush on plaque and parameres of gingival inflammation: a systematic review. Int J Dent Hyg 2008; 6(4): 265-279.

About the author

Deborah M. Lyle, RDH, MS received her Bachelor of Science degree in Dental Hygiene and Psychology from the University of Bridgeport and her Master of Science degree from the University of Missouri, Kansas City.  She has 18 years clinical experience in dental hygiene in the United States and Saudi Arabia with an emphasis in periodontal therapy.

 

 

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