drg. Puspito Ratih H., MDSc, Sp.

Perio

ENDAPAN LUNAK
 Rongga mulut sebagai biotipe
 Gigi  habitat koloni bakteri  pit dan fisur,
permukaan halus, servikal, root canal . Karies
 Poket periodontal, dorsum lidah, tonsil
 Permukaan gigi  S. Sanguis, S mutans, A
viscosus
 Dorsum lidah S. salivarius, A. naeslundii
 Lesi karies  Lactobacillus spp
 Subgingival  Spirochetes, batang anaerob
obligat, gram negatif
Kolonisasi

 Oral cavity provides comfortable conditions

 warm 36 C, lembab, nutrisi, permukaan
Mekanisme pertahanan

 Aliran saliva
 GCF
 Epitel
 Self cleansing mastication
 Personal OH
 Both bacteria and the surface to be colonized
are electronegatively charged
 Adhesi bacteria  lectin like adhesin (protein
recognoze struktur KH pelikel dan
hydrophobic adhesin
 Adhesin also bridge electrostatic force and
enable contact to surface of the substrate
 Ig A (aglutinin)  recognized antigenic
properties in fimbrae dan block them
 Kolonisasi bakteri tergantung potensial
reduksi. Tekanan oksigen, antagonis dan
sinergis mo
Biofilm dental plak

 MO pada biofilm bervariasi ec

 Typical bacteria population colonize firm
surface in humid environment
 Struktur ekstraseluler (polisakarida) mo
melindungi bakteri dan merangsang
pertubuhan bakteri lainnya
 Perbedaan ph, tekanan oksigen, potensi
reduksi
 Bakteri pada biofilm mempunyai sifat
 Kerjasama metabolit
 Resisten fagositosis neutrofik, atibiotik
Plak supragingival

 Terbentuknya plak / agregasi bakteri pada

permukaan gigi  mo patogen
 Dalam bbrp menit-2jam  pembentukan
plak, deposisi glikoprotein saliva pada
permukaan gigi dan permukaan kasar RM
acquired pelike
 Bakteri pada peikel (4 jam)  streptococci (S.
mitis), S sanguis, S oralis), batang gram
positif (A. Viscosus)
 S mutan  lectin like adhesin berikatan
dengan α galactoside receptor glikoprotein
saliva
 Ekstraseluler glucans  akumulasi bakteri
 Plak dental stabil dengan adanya polisakarida
ekstraseluler (disintesis S mutan, s sanguis, s
orlis, s salivarius
 Agregasi streptococci dan Actinomyces
 Kolonisaqsi bakteri pada permukaan plak
 Proliferasi bakteri dalam 24 jam
 Akumulasi plak tidak terganggu  komposis
lebih banyak dan ompleks
 Streptococci >>>, anaerob obligat dan
fakkutatif, Gram negatif, (veillnonela), batang
anaerob gram negatif (fusobactreium,
prevotella, porphyromonas
 F nucleatum berperzn pembentukan biofilm
ec multigeneric coaggregation
 Pembentukan dan maturasi plak tdd 4 fase
 Bbrp menit-jam  pembentukan pelikel
 Hari ke 1  gram positif cocci dan batang
 Hari ke 2-4  Actynomyces >>>, gram
negatif cocci dan batang
 1 minggu  spirocehta, motile rod
Kolonisasi subgingival

 kedalaman Sulkus gingiva >> dan inflamasi

 subgingival space  proliferasi JE apikal
ec hilangnya pewrlekatan
 ± 500 spesies bakteri
 Periodontal patogen subgingiva : Garm
negatif, anaerob obligate
 Subgingival = kondisi nyaman bakteri
 Proteksi dari OH dan aliran saliva  selektif
kolonisasi bakteri
 GCF mengandung nutrisi dan GF utk patogen
periodontal yi amino dan as lemak, α2
globulin utk T denticola
 Hemin, Fe, vit K gram negatif, anaerob spt
prevotella dan phorphyromonas black
pigmenting
 P intermedia, P nigrescens, P melagonenica
 dpt menggantikan hormon streoid
(etrasdiol dan progesteron) utk vit K 
kehamilan
Material alba

 Akumulasi mo, sel epitel, leukosit, protein

saliva, lemak, partikel makanan.
 Berwarna putih kebau-abuan atau kuning,
lunak, lengket, dan < adhesi dibandingkan
plak
 Efek iritasi ec bakteri dan produknya
debris

 Sisa makanan yang dapat dibersihkan dng

mekanik lidah, pipi dan bibir, aliran saliva.

 Staining
 Deposit pigmen pada permukaan gigi ec
merokok, kopi, teh, obat kumur, makanan
 Bio film constitutes
 A biofilm is an aggregate of microorganisms in
which cells are stuck to each other and/or to a
surface. These adherent cells are frequently
embedded within a self-produced matrix of
extracellular polymeric substance (EPS). Biofilm
EPS, which is also referred to as "slime," is a
polymeric jumble of DNA, proteins and
polysaccharides.
Biofilm is a complex
substance.
 A biofilm is a complex
aggregation of
microorganisms growing
on a solid substrate.
Biofilms are characterized
by structural
heterogeneity, genetic
diversity, complex
community interactions,
and an extracellular matrix
of polymeric substances.
 Biofilms found in Nature everywhere where
is there is moisture
 More properly known as biofilm, slime cities
thrive/life wherever there is water - in the kitchen,
on contact lenses, in the gut linings of animals.
When the urban sprawl /kddkn is extensive, bio
films can be seen with the naked eye, coating the
inside of water pipes or dangling slippery and
green, from plumbing." (Coghlan 1996)
Biofilm supports the Bacterial growth

 Biofilm are a common mode of bacterial growth

in nature and their presence has an enormous
impact on many aspects of our lives, such as
sewage treatment, corrosion of materials, food
contamination during processing, pipe collapse,
plant-microorganisms interaction in the
biosphere, the formation of dental plaque, the
development of chronic infections in live tissue
(mastitis, Otitis, pneumonia, urinary infections,
osteomyelitis) or problems related to medical
implants.
Formation of Biofilms

 Biofilms may form on

living or non-living
surfaces, and
represent a prevalent
mode of microbial life
in natural, industrial
and hospital settings
Biofilms increases Antibiotic
resitance
With
microorganisms are
highly resistant to
antimicrobial
treatment and are
tenaciously bound
/kuat to the surface
Mechanisims of Biofilm
formation
 Formation of a biofilm begins
with the attachment of free-
floating microorganisms to a
surface. These first colonists
adhere to the surface initially
through weak, reversible van
der Waals forces. If the
colonists are not
immediately separated
from the surface, they can
anchor themselves more
permanently using cell
adhesion structures such
as pili
Factors Influencing Rate and Extent of Biofilm Formation

 Indwelling medical device when contaminated with

microorganisms, several variables determine whether
a biofilm develops. First the microorganisms must
adhere to the exposed surfaces of the device long
enough to become irreversibly attached. The rate of
cell attachment depends on the number and types of
cells in the liquid to which the device is exposed, the
flow rate of liquid through the device, and the
physicochemical characteristics of the surface
Steps in Biofilm Development

 Biofilm development can

be divided into several key
steps including
attachment, micro colony
formation, biofilm
maturation and dispersion;
and in each step bacteria
may recruit different
components and
molecules including
flagella, type IV pili, DNA
and exo polysaccharides.
Stages of biofilm
development.
Steps in Biofilm formation
Bacteria associated with Biofilms differ

 Bacteria living in a biofilm can have

significantly different properties from free-
floating bacteria, as the dense and protected
environment of the film allows them to
cooperate and interact in various ways. One
benefit of this environment is increased
resistance to detergents and antibiotics, as
the dense extracellular matrix and the outer
layer of cells protect the interior of the
community.
Biofilms major cause of Nosocomial
infections
 Microbial biofilms,
which often are formed
by antimicrobial-
resistant organisms,
are responsible for 65%
of infections treated in
the developed world.
Biofilms a Great threat to Implants

 A significant number of people are affected

by biofilm infections which develop on
medical devices implanted in the body such
as catheters (tubes used to conduct fluids in
or out of the body), artificial joints, and
mechanical heart valves. When implanted
material becomes colonized by
microorganisms, a slow developing but
persistent infection results.
Biofilms a Growing concern in Modern
Medicine

 Prosthetic device infections, such as those

involving artificial heart valves, intravascular
catheters, or prosthetic joints, are prime
examples of biofilm-associated infections.
With the increasing use of such devices in the
modern practice of medicine, the prevalence
of these infections is expected to increase.
Dental plaque

 Dental plaque is a
yellowish biofilm that
build up on the teeth. If
not removed regularly,
it can lead to dental
caries.
Dental plaques
 The formation of
dental plaque bio films
includes a series of
steps that begins with
the initial colonization
of the pellicle and ends
with the complex
formation of a mature
bio film.
Formation of Dental Biofilms

 Additionally, through the

growth process of the
plaque bio film, the
microbial composition
changes from one that is
primarily gram-positive
and streptococcus-rich to a
structure filled with gram-
negative anaerobes in its
more mature state.
Cell-cell signaling (ex. quorum sensing), and communication
with different bacteria enhance Biofilm formation
Biofilms everywhere

 They're everywhere: on
your shower curtain, on
medical devices implanted
in patients, on rocks in
rivers and streams, and in
your nose. While the sheer
number of different
organisms a biofilm may
contain makes it a
challenge to study,
CDC – on Biofilms

 Biofilms form on the surface of catheter lines

and contact lenses. They grow on
pacemakers, heart valve replacements,
artificial joints and other surgical implants.
The CDC (Centers for Disease Control)
estimate that over 65% of Nosocomial
(hospital-acquired) infections are caused by
biofilms.
General Properties of a Biofilm
 Protection from host defenses and
predators
 Protection from desiccation
 Protection from antimicrobial
agents
 Novel gene expression and
phenotype
DENTAL PLAQUE:
 Persistence in flowing systemsBacteria in a biofilm mode of growth
 Spatial and environmental
heterogeneity
 Spatial organization facilitating
metabolic interactions
 Elevated concentration of nutrients
 Cell-to-cell communications Marsh, Oral ecology and its impact on oral microbial dive
in: Oral bacterial ecology. The molecular basis (2000) pp
 Steps in biofilm formation

A. Conditioning film formation

(“pellicle”)

B. Mass transport

C. Initial adhesion

D. Co-adhesion

E. Anchoring through slime excretion

F. Growth
Microbes adhere to surfaces and embed themselves in
slime to form a multicellular layer:
a BIOFILM.

Costerton and Stewart, Scientific American 2002

 Clinical consequences
of the biofilm mode of growth
Caries

Periodontitis

S. mutans Periodontal
(diet) pathogens
 SET-UP of this TALK:

1. Chemical plaque control

2. Mechanical plaque control

3. Plaque control in orthodontics

 Oral antimicrobial

Adsorption to oral Penetration into Mixing

hard and soft plaque and with saliva
tissues pockets

Pellicle
Slow release
surface
modification
- Bacterial
Reduced
detachment
bacterial
- Growth inhibition
adhesion
- Bacterial killing
Chemical plaque control
The enamel surface becomes covered within seconds by a salivary conditioning film (“pellicle”)

hence oral surface effects should be measured on film covered enamel surfaces.
Adsorption to oral hard and soft tissues in vitro and in vivo

can be monitored from hydrophobicity alterations

of teeth and mucosa, measured by water contact angles.