SEMINAR

ON
DENTAL
PLAQUE
Submitted by:
Aditi Chandra
MDS- 2012

Departmen
t of Conservative
Dentistry
and Endodontics
DEFINITION
Dental plaque:
Soft deposits that form the biofilm adhering to the tooth
surface or other hard surfaces in the oral cavity, including
removable and fixed restorations. Bowen,1976
Bacterial aggregation on the teeth or other solid oral
structures. Lindhe, 2003
Dental plaque is a specific but highly variable structural
entity , resulting from sequential colonization of
microorganisms on the tooth surfaces, restorations and other
parts of oral cavity , composed of salivary components like
mucin, desquamated epithelial cells, debris and
microorganisms , all embedded in extracellular gelatinous
matrix. WHO, 1961

CLASSIFICATION
By location on tooth:
supra gingival plaque
sugingival plaque

Coronal
marginal
unattached
attached
Tissue

tooth

Epithelium

COMPOSITION
Dental plaque is primarily composed of microorganisms. One
gram of plaque contains approx. 2 x 1011 bacteria. It has been
estimated that more than 325 different bacterial species may be
found in plaque.

Previous
Classification

New Classification

Reference

Bacteroides gingivalis

Porphyromonas
gingivalis

Shah and
Collins,1988

Bacteroides
endodontalis

Porphyromonas
endodontalis

Shah and Collins,

1988

Bacteroides
intermedius

Prevotella
intermedia

Shah and Collins,

1990

Bacteroides
melaninogenicus

Prevotella
melaninogenica

Shah and Collins,

1990

Bacteroides denticola Prevotella denticola Shah and Collins,

1990
Bacteroides loescheii

Prevotella loescheii

Shah and Collins,

1990

Wolinella recta

Campylobacter
rectus

Vandamme, et al.,
1991

Wolinella curva

Camplyobacter
curvus

Vandamme, et al.,
1991

SELECTED BACTERIAL SPECIES FOUND IN DENTAL PLAQUE

Facultative

Anaerobic

Streptococcus mutans
Gram-Positive Streptococcus sanguis
Actinomyces viscosus

Gramnegative

Spirochetes

Actinobacillus
actinomycetemcomita
ns
Capnocytophypa speci
es
Eikenella corrodens

Porphyromonas
gingivalis
Fusobacterium
nucleatum
Prevotella intermedia
Bacteroides forsythus
Campylobacter rectus
Treponema denticola
(Other Treponema specie
s)

Non bacterial microorganisms that are found in plaque include

mycoplasma species, yeasts, protozoa, viruses. The
microorganisms exist within an intercellular matrix that also
contains few host cells, such as epithelial cells, macrophages and
leucocytes. Intercellular matrix takes up nearly 25% of dental
plaque volume. It consists of organic and inorganic materials
derived from saliva, gingival crevicuar fluid and bacterial
products.
Organic constituents of matrix include polysaccharides,
proteins, glycoproteins and lipid material.
Polysaccharide of bacterial origin contains 95% dextrans
and 5% levans. Dextran is adhesive and helps in bacterial
colonization. Levans acts as storage of polysaccharide
providing a source of fermentable carbohydrate when
hydrolyzed.
Proteins: albumin probably originating from gcf.
Glycoproteins: important component of plaque pellicle.
Lipid material: consists of debris from the membranes of
disrupted bacteria, host cells and possibly food debris.
Inorganic component of plaque is primarily calcium and
phosphorus, with trace amounts of other minerals such as
sodium, potassium, and fluoride.
The source of inorganic constituents of supragingival plaque is
primarily saliva, as the mineral component increases the plaque
mass becomes calcified to form calculus. Inorganic component of
subgingival plaque is crevicular fluid, which is a serum
transudate. Calcification of subgingival plaque also results in
calculus formation.

The fluoride component of plaque is largely derived from external

sources such as fluoridated tooth pastes and rinses. Fluoride is
therapeutically to aid in remineralisation of tooth structure,
prevention of demineralization of tooth structure, and inhibition of
the growth of many plaque microorganisms.
The intercellular matrix forms a hydrated gel in which the
embedded bacteria exist and proliferate. This gel like matrix is a
primary characteristic of biofilms. The matrix confers specialized
properties on bacteria that exist within the biofilm, in contrast to
free floating bacteria. For eg: the biofilm functions as a barrier.
Substances produced by the bacteria within the biofilm are
retained and essentially concentrate which fosters metabolic
interactions among the different bacteria. In addition the matrix is
thought to protect resident bacteria from potentially substances
such as antimicrobial agents, which may be unable to diffuse
through the matrix to reach the bacterial cells.

DENTAL PLAQUE AS A BIOFILM

Biofilms defined as matrix enclosed bacterial populations
adherent to each other and/or to surfaces or interfaces.
(Costerton, 1994). Biofilm can be formed by a single bacterial
species or multiple bacterial species as well as other organisms &
debris. It can form on any surfaces that is wet. It can exist on any
solid surfaces that is exposed to bacteria-containing fluid.

Structure of biofilm:
A biofilm community comprises bacterial microcolonies, an
extracellular slime layer, fluid channels, and a primitive
communication system. As the bacteria attach to a surface and to
each other, they cluster together to form sessile, mushroomshaped microcolonies that are attached to the surface at a narrow
base. Each microcolony is a tiny, independent community
containing thousands of compatible bacteria. Different

microcolonies may contain different combinations of bacterial

species. Bacteria in the center of a microcolony may live in a
strict anaerobic environment, while other bacteria at the edges of
the fluid channels may live in an aerobic environment. Thus, the
biofilm structure provides a range of customized living
environments (with differing pHs, nutrient availability, and oxygen
concentrations) within which bacteria with different physiological
needs can survive. The extracellular slime layer is a protective
barrier that surrounds the mushroom shaped bacterial
microcolonies. The slime layer protects the bacterial
microcolonies from antibiotics, antimicrobials, and host defense
mechanisms. A series of fluid channels penetrates the
extracellular slime layer. These fluid channels provide nutrients
and oxygen for the bacterial micro colonies and facilitate
movement of bacterial metabolites, waste products, and enzymes
within the biofilm structure. Each bacterial microcolony uses
chemical signals to create a primitive communication system
used to communicate with other bacterial
microcolonies.

FORMATION OF DENTAL PLAQUE

Formation of plaque can be divided into 3 stages:
1. Formation of dental pellicle
2. Initial colonization by bacteria
3. Secondary colonization and plaque maturation

Formation of dental pellicle:

The surfaces of oral cavity, tissue and tooth surfaces, fixed and
removable restorations are coated with glycoprotein pellicle. This
is derived from components of saliva, crevicular fluid and
bacterial and host tissue cell products and debris. The specific
components of pellicles on different surfaces vary in composition.

Studies of early enamel pellicle reveal that its amino acid

composition differs from saliva, indicating that the pellicle forms
by selective absorption of the the environmental macromolecules.
The mechanism involved in enamel pellicle formation includes
electrostatic, van der walls and hydrophobic forces. The
hydroxyapatite surface has a predominance of negatively charged
phosphate groups that interact directly or indirectly with
positively charged components of salivary and crevicular fluid
macromolecules.
Surface receptors on the gram positive facultative cocci and rods
allow the subsequent adherence of gram negative organisms,
which have a poor ability to adhere to the pellicle. Pellicle
functions as a protective barrier, providing lubrication for the
surfaces and preventing tissue desiccation.
Initial colonization of the tooth surface by bacteria
Within a few hours bacteria are found on the dental pellicle. The
initial bacteria colonizing the pellicle coated tooth surface are
predominantly gram positive facultative microorganisms such as
actinomyces viscous and streptococcus sanguis. These initial
colonizers adhere to the pellicle through specific molecules
termed adhesions on the bacterial surface that interact with the
receptors in the dental pellicle. For eg. Cells of actinimyces
viscous possess fibrous protein structures called fimbrae that
extend from the bacterial surface protein adhesions on the
fimbrae and specifically bind to the proline rich proteins that are
found in the dental pellicle, resulting in attachment of the
bacterial cell to the pellicle coated tooth surface.
The plaque mass then matures through the growth of attached
species, as well as the colonization and growth of additional
species. In this ecologic succession of the biofilm, there is a
transition from the early aerobic environment characterized by

gram positive facultative species to a highly oxygen deprived

environment in which gram negative anaerobic microorganisms
predominate.
Secondary colonization and plaque maturation
Secondary colonizers are the microorganisms that do not initially
colonize the clean tooth surfaces, including prevotella intermedia,
prevotella toescheii, capnocytophaga species, fusebacterium
nucleatum, and porphyromonas gingivalis. These microorganisms
adhere to cells of bacteria already in the plaque mass. Extensive
lab studies have documented the ability of different species and
genera of plaque microorganisms to adhere to one another, a
process known as coaggregation.
This process occurs primarily through the highly specific stereo
chemical interaction of protein and carbohydrate molecules
located on the bacterial cell surfaces, in addition to the less
specific interaction resulting from hydrophobic, electrostatic and
van der wall forces.
The significance of coaggregation in oral colonization has been
documented in animal model studies. Well characterized
interactions of secondary colonizers with early colonizers include
the coaggregation of f. nucleatum with s. sanguis, p.loescheii with
a. viscous, capnocytophaga ochracea with a. viscous. Most
studies have focused on interactions between different gram
positive species and between gram positive and gram negative
species. In the later stages of plaque formation, coaggregation
between different gram negative species is likely to predominate.
An eg of this type of interaction is the coaggregation of
f.nucleatum with p. gingivalis.

GROWTH DYNAMICS OF DENTAL PLAQUE

Important changes in the plaque growth rate can be detected
within the first 24 hours. During the first 2 to 8 hour, the adherent
pioneering streptococci saturate the salivary pellicle binding sites
and thus cover 3% to 30% of the enamel surface. Instead of the
expected steady growth during the next 20 hours, a short period
of rapid growth is observed. After 1 day, the term is fully deserved
because organization takes place within it. Microorganisms,
packed closely together, form palisade, whereas others start to
develop a pleomorphism. Each crack is filled with one type of
microorganisms. As the bacteria densities approaches
approximately 2 to 6 million bacteria/ mm2 on the enamel surface,
a marked increase in growth rate can be observed to 32 million
bacteria / mm2. The thickness of the plaque increase slowly with
time, increasing to 20 to 30 micrometer after 3 days.

STRUCTURAL AND PHYSIOLOGIC PROPERTIES OF

DENTAL PLAQUE
A high degree of specificity is found in the interactions between
bacteria in dental plaque.
Supragingival plaque typically demonstrates a stratified
organization of the bacterial morphotepes, gram positive cocci
and short rods predominate the tooth surface, whereas gramnegative rods and filaments as well as spirochetes predominate in
the outer surface of the mature plaque mass. Highly specific cell
to cell interactions are also evident from the corn cob structures.
Corncob formations have been observed between rod shaped
bacterial cells (bacterionema matruchotti or f. nucleatum) that
form the inner core of the structure and coccal cells ( streptococci

and p.gingivalis) that attach along the surface of the rod shaped
cells.
The environmental parameters of the subgingival region differs
from those of supra gingival region. Morphologic and
microbiologic studies of sub gingival plaque reveal distinctions
between the tooth associated and tissue associated regions of
subgingival plaque.
The associated plaque is characterized by gram positive rods and
cocci including bacteria such as streptococcus mitis, sanguis, and
a. viscous, a. naselundii.
The apical border of plaque mass is separated from junctional
epithelium by a layer of host leukocytes and the bacteria of this
tooth associated region show an increased concentration of gram
ve rods.
The portion of plaque adjacent to the tissue surfaces is more
loosely organized and contain primarily gram ve rods and cocci
as well as large numbers of filaments, flagellated rods and
spirochetes. Host tissue cells (WBCs and epithelial cells) are also
found. P.gingivalis, p.intermedia, c.orchracea are main organisms.
Bacteria found in tissue associated plaque (p.gimgivlis) are also
found in host tissues. Thus the physical proximity is important in
tissue invasion.
The transition from gram positive o gram negative in dental
plaque is paralleled by a physiologic transition in the developing
plaque. The early colonizers
(streptococci and
actinomyces) utilize oxygen and lower the reduction oxidation
potential of the environment, which then favors the growth of
anaerobic organisms. Gram positive species utilize sugar as an
energy source and saliva as a carbon source. The bacteria that
predominate in the mature plaque are anaerobic and use amino
acids and small peptides as energy source. Many physiologic
interactions among different bacteria are found in plaque. Lactate

and formate by products of metabolism of streptococci and

actinomyces may be utilized in the metabolism of other plaque
microorganisms.
The host also functions as an important source of nutrients for eg
the bacterial enzymes that degrade host proteins resulting in
release of ammonia which may be used by bacteria as an energy
source.
Haeme iron from the breakdown of host hemoglobin may be
important in the metabolism of p.gingivalis. Increase in steroid
hormone is associated with significant increase in the proportion
of p.intermedia found in subgingival plaque.

NON SPECIFIC PLAQUE HYPOTHESIS

The concept that a specific bacterial species was responsible for
periodontal diseases fell out of favor for several reasons. First,
despite numerous attempts, a specific bacterial agent was not
isolated from diseased individuals. Rather, the organisms found
associated with disease were also found associated with health.
Good experimental animal model systems of periodontal disease
were not available to test the pathogenicity of specific
microorganisms (this, in fact, remains problematic today). Further,
in the mid 1900's, epidemiological studies indicated that the older
an individual was, the more likely they were to have periodontal
disease. This led to the concept that the bacterial plaque itself,
irrespective of the specific bacteria found in plaque, was
associated with disease. This concept, known as the Non-Specific
Plaque Hypothesis (Loesche, 1976), held that all bacteria were
equally effective in causing disease.

SPECIFIC PLAQUE HYPOTHESIS

Organisms that are found as part of the "normal" bacterial flora

(i.e., found in health), may function as pathogens under certain
conditions. These organisms may be altered, or increase
significantly in numbers relative to other non-pathogenic species,
to function as pathogens. This type of bacterial pathogen is
referred to as an endogenous pathogen, in contrast to an
organism that is not normally found in healthy states which is
termed an exogenous pathogen. Also, tremendous advances were
made in the 1960's and 1970's in techniques used to culture
anaerobic microorganisms (bacterial species that cannot grow in
the presence of oxygen). These advances were related to the
anaerobic culturing conditions as well as the nutrients required in
media to grow anaerobic species, which are typically very
fastidious in their nutrient requirements. The growth of anaerobic
microorganisms, and examination of their properties using in
vitro and in vivo model systems, has now led us back to the
understanding that different microorganisms have varying
potential to cause disease. Thus, the current concept of the
processes involved in the development of periodontal diseases
falls under the Specific Plaque Hypothesis (Loesche, 1976). The
Specific Plaque Hypothesis states that disease results from the
action of one or several specific pathogenic species and is often
associated with a relative increase in the numbers of these
organism found in plaque.

CLINICAL SIGNIFICANCE
The different regions of plaque are significant to different
processes associated with disease of teeth and periodontium. Eg:
marginal supragingival plaque is of prime importance in the
development of gingivitis. Supragingival and tooth associated
subgingival plaque are critical in calculus formation and root
caries. Tissue associated subgingival plaque is important in the

soft tissue destruction characteristic of different forms of

periodontitis.

DETECTION OF PLAQUE
1. Direct vision : Thin plaque may be translucent & therefore not visible
Stained plaque may be acquired e.g tobacco stained
Thick plaque tooth may appear dull & dirty
2. USE OF EXPLORER : Tactile Examination when calcification has started it
appears slightly rough, otherwise it may feel slippery due to
coating of soft , slimy plaque
After removal Of Plaque when no plaque is visible, an
explorer can be passed over the tooth surface & when
plaque is present it will adhere to explorer tip. This technique
is used when evaluating plaque index.
3. Use of disclosing solutions

PLAQUE CONTROL
Definition:
Removal of microbial plaque and the prevention of its
accumulation on the teeth and adjacent gingival surfaces.
(Dorothy Perry and Maxoschmid 1996)

Classification:

1. Mechanical methods
2. Chemical methods

MECHANICAL PLAQUE CONTROL

The various aids used for mechanical plaque control are as
follows:
1. Tooth brushes
Manual toothbrush
Electrical toothbrush
2. Interdental cleaning aids
dental floss
wooden tips or rubber tips
Interdental brushes
Proxa brushes
Bottle brushes
Single tufted brushes
3. Aids for gingival stimulation
Rubber tip stimulator
Balsa wood edge
4. Others
Guaze strips
Pipe cleaners
Water irrigation devices
5. Aids for edentulous or partially edentulous patients
Denture and partial clasp brushes
Cleansing solutions

TOOTHBRUSHES
Manual toothbrushes:

Historically the purpose of brushing was to provide massage,

Increase resistance of the gingival tissue, Increase keratinization
and Resistance to bacterial invasion.
According to The American Dental Association:
Brushing surface of 1-1.25 inches (25.4 to 31.8mm) long

5/16 to 3/8 inch (7.9-9.5mm) wide

2 to 4 rows of bristles

5-12 tufts per row

Parts of a toothbrush:
Handle: part grasped in the hand during tooth brushing.
Head: the working end of the tooth brush that holds the
filaments or bristles.
Tufts: cluster of bristles or filaments secured into head.
Brushing plane: the surface formed by the free ends of the
bristles or filaments.
Shank: section that connects head and handle.
Toothbrush bristles:
Hard and soft
Natural and synthetic
Multitufted and space tufted
Advantages of nylon filaments over natural bristles
Rinse clean and dry rapidly when left in open.
More durable and maintain their form longer.
Ends rounded and closed, repel water and debris.
More resistant to accumulation of bacteria and fungi
than are natural bristles.

Methods of tooth brushing:

Sulcular method
Bass method
Roll method
Rolling stroke
Modified Stillman
Vibratory method
Stillman
Charter
Bass
Circular method
Fones
Vertical method
Leonard
Horizontal method
Physiologic method
Smith
Scrub brush method

The Bass Method:

It is the most widely accepted and most effective method for
dental plaque removal, adjacent and directly beneath the gingival
margin.
Technique:

 Position the filaments up toward the root at a 45 angle to

the teeth.
Place the brush with the filament tips directed into the
gingival sulcus.
Using a vibratory stroke brush back and forth with very short
strokes for the count of ten.
Reposition the brush to the next group of teeth.

The modified Stillmans Method:

Technique:
Like the Bass Method the filaments are placed at a 45 angle
to the tooth.
Unlike the Bass Method the filaments are placed half in the
sulcus and half on the gingiva.
The same stroke is used as the Bass.

Charters method:
Technique:
Position the filaments toward the chewing surface of the
tooth
Place the sides of the filaments against the enamel and
angle them at a 45 to the tooth.

 Vibrate the filaments gently but firmly, keeping the filaments

against the tooth.
Reposition on the next set of teeth.

Fones Technique:
Indicated for young children who want to do their own brushing,
but do not have the muscle development for the technique which
requires more co-ordination.
Technique:
A tooth brushing technique that uses large, sweeping,
scrubbing circles over occluded teeth, with the toothbrush
held at right angles to the tooth surfaces.
With the jaws parted, the palatal and lingual surfaces of
the teeth are scrubbed in smaller circles.
Occlusal surfaces of the teeth are scrubbed in an
anteroposterior direction.

Electric toothbrushes:
They are also known as automatic, mechanical or powered
toothbrushes.
In subjects not highly motivated to oral health care, as well as in
those having difficulty in mastering a suitable handbrush, "the
use of an electric brush with its standard movements may
result in more frequent and better cleansing of the teeth".
Motions:
Back and forth
Circular
Elliptic

 Combinations
Cleaning action by:
1. Mechanical contact between the bristles and the tooth
2. Low-frequency acoustic energy generates dynamic fluid
movement and provides cleaning slightly away from the
bristle tips.
Frequency of oscillation may be around 40 Hz.
They are indicated in handicapped individuals and in dental care
of hospitalized patients, with limited manual dexterity. It is also
beneficial for patients undergoing orthodontic treatment.

INTERDENTAL CLEANING AIDS

They are adjunct devices which are used to remove plaque from
the interproximal tooth surfaces. The specific aids required for
interproximal cleaning depend on various criteria such as the size
of the interdental spaces, the presence of furcations, tooth
alignment, and the presence of orthodontic appliances and fixed
prostheses.
Dental floss:
They are indicated to remove plaque from interproximal surfaces
with type 1 gingival embrasures.

Types of floss
multifilament
Bonded / non bonded
Thick / thin

 Waxed / non waxed

Technique:
1. Spool method: about 18inches of floss is taken and about 4
inches is wound around the middle finger from each end. In
both the hands the last 3 fingers are folded and closed and
both the hands are moved apart. In this way about 2 inches
long floss is held between the index fingers of both hands.
2. Circular method: in this a loop or circle of the floss is made
from 18 inches long piece and both the ends are tied with 3
knots. All the fingers except the thumb of both hands are
placed within the loop and the floss is held by both hands
having 1inch floss between the fingers of both the hands.
Wooden tips:
Used as an ideal substitute to dental floss in type 2 gingival
embrasures. Inserted into the gingival embrasures and remove
soft deposits from teeth. Also mechanically stimulate the gingiva.
Use is restricted to facial aspect of anterior teeth.
Interdental brushes:
Best choice of plaque removal from interproximal tooth surfaces
in type 2 gingival embrasures. Design is similar to that of bottle
brush. Used in posterior areas of mouth. May also be used to
clean furcation areas and root concavities.

ORAL IRRIGATION DEVICES

Mainly beneficial in removal of unattached plaque and debris.
Composed of a built in pump and reservoir. When used as an
adjunct to tooth brushing these devices have a beneficial effect
on periodontal health by retarding plaque and calculus formation.

They may also be used to carry antimicrobial agents

subgingivally.

CHEMICAL PLAQUE CONTROL

Ideal requisites of antiplaque agent:
Should decrease plaque & gingivitis
Prevent pathogenic growth
Should prevent development of resistant bacteria
Should be biocompatible
Should not stain teeth or alter taste
Should have good retentive properties
Should be economic
Classification:
1st generation:

2nd generation:
3rd generation:

1. Antibiotics
2. Phenols
3.
Quaternary 4. Sanguanarine
ammonium
compounds.
Bis-biguanides
( Chlorhexidine )
Delmopinol

Vehicles for delivery of chemical agents:

Tooth Paste
Mouth rinses

 Irrigative
Chewing gum
Varnishes
Gel
Lozenges

1ST GENERATION AGENTS

Antibiotics:
Penicillins, Tetracycline, Vancomycin, Kenamycin, Erythromycin,
Niddamycin Spiromycin, and Metronidazole have been used as
agents for plaque control.
Mechanism of Action is both bactericidal and bacteriostatic action.
Limiting factors of systemic drug therapy is that is causes
hypersensitivity reactions and bactericidal resistance.
Phenols Related essential oils:
These include Triclosan and Listerine.
Mechanism of action: Triclosan act on cytoplasmic membrane
inducing leakage of cellular constituents and thereby causing
bacteriolysis.
Triclosan is included in tooth paste to reduce plaque formation.
Used along with Zinc citrate or co-polymer Gantrez to enhance its
retention within the oral cavity. Triclosan delays plaque formation.
It inhibits formation of prostaglandins & leukotrienes there by
reduce the chance of inflammation.
Quaternary ammonium compounds:

These include Benzanthonium chloride, Benzalleonium chloride

and Cetylpyredinium .
They are Cationic antiseptics & surface active agents and more
effective against gram positive organisms than gram negative
organisms.
Mechanism of action: Positively charged molecule reacts with
negatively charged cell membrane phosphates and thereby
disrupts the bacterial cell wall structure of microorganisms.
Sanguinarine:
It is a benzophenanthredine alkaloid which is most effective
against gram ve organisms. When used as a mouth rinse exhibits
good retentive properties with dental plaque. PH is 4.5 and
alcohol content of 11.5%.
Metal salts:
These include Zinc Salts, Tin Salts (Stannous fluoride), Sodium
fluoride and Copper salts.
Mechanism of action: It reduces the glycolytic activity in bacteria
&delays bacterial growth.

2ND GENERATION
Bisbiguanides:
These include Chlorhexidine gluconate 0.2 %, Alexidine, Cationic
Chlorophenyl biguanide.
Suggested for oral use by Schroder in 1969. It has a pH 3.5. It is
a cationic effective against gram +ve, gram-ve, fungi, yeasts &
viruses. Its superior action is due to its property of sustain
availability i.e. substantivity.

Mechanism Action:
1. Prevents pellicle formation by blocking acidic groups on
salivary glycoproteins thereby reducing glycoprotein
adsorption on to the tooth surface
2. Prevents adsorption of bacterial cell wall on to the tooth
surface
3. Prevents binding of mature plaques
Antibacterial action of chlorhexidine: It shows two actions:1. Bacteriostatic at low concentrations
Bacterial cell wall (-ve charge)

Reacts with +ve charged chlorhexidine molecule

Integrity of cell membrane altered

CHX binds to inner membrane phospholipids & increase

permeability

Vital elements leak out & this effect is reversible

2. Bactericidal action

Increased concentration of chlorhexidine

Progressive greater damage to membrane

Larger molecular weight compounds lost

Coagulation and precipitation of cytoplasm

Free CHX molecule enters the cell & coagulates proteins

Vital cell activity ceases

Cell death

Adverse effects of chlorhexidine:

1. brownish staining of tooth or restorations
2. loss of taste sensation
3. rarely hypersensitivity to chlorhexidine has been reported
4. stenosis of parotid duct has also been reported

3RD GENERATION

Delomopinol:
It inhibits plaque growth and reduces gingivitis.
Mechanism of action:
Interfere with plaque matrix formation & also reduces
bacterial adherence
It causes weak binding of plaque to tooth, thus aiding in easy
removal of plaque by mechanical procedures
It is therefore indicated as a pre brushing mouth rinse.

CONCLUSION
More than 500 bacterial strains have been identified in dental
biofilm. Experts agree that most forms of periodontal disease are
caused by specific pathogens, particularly gram-negative
bacteria. The recognition that dental plaque as a biofilm helps to
explain why periodontal diseases have been so difficult to prevent
and to treat. Periodontal pathogens within a biofilm environment
behave very differently from free-floating bacteria. The protective
extracellular slime matrix makes bacteria extremely resistant to
antibiotics, antimicrobial agents, and host defense mechanisms.
Mechanical removal is the most effective treatment currently
available for the control of dental plaque biofilms.

REFRENCES
CLINICAL PERIODONTOLOGY - CARRANZA ( 10th edition)
CLINICAL PERIODONTOLOGY AND IMPLANT DENTISTRYLINDHE
ESSENTIALS OF PREVENTIVE AND COMMUNITY DENTISTRYSOBEN PETER
( 3RD edition)
SHAH HN, COLLINS DM: PROPOSAL FOR RECLASSIFICATION
OF BACTEROIDES ASACCHAROLYTICUS, BACTEROIDES
GINGIVALIS, AND BACTEROIDES ENDODONTALIS IN A NEW
GENUS, PORPHYROMONAS. INTERNATIONAL JOURNAL OF
SYSTEMATIC BACTERIOLOGY 1988; 38(1):128-131.