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The ecological plaque hypothesis, a combination of the two previously mentioned hypotheses, suggests that there are certain species responsible for pathology, but are present in insufficient quantities to cause damage to a healthy individual. [13] Thus biofilm derived diseases are the result of an imbalance in the normal oral ecology. [14]
Dental plaque is considered a biofilm adhered to the tooth surface. It is a meticulously formed microbial community, that is organised to a particular structure and function. [ 12 ] Plaque is rich in species, given the fact that about 1000 different bacterial species have been recognised using modern techniques.
The primary aetiological factor for periodontal disease is plaque biofilm of dental biofilm. A dental biofilm is a community of microorganisms attached to a hard, non-shedding surface. In the oral cavity, hard non-shedding surfaces include teeth, dental restorative materials and fixed or removable dental appliance such dentures. [ 16 ]
Periodontal disease typically arises from the development of plaque biofilm, which harbors harmful bacteria such as Porphyromonas gingivalis and Treponema denticola. These bacteria infect the gum tissue surrounding the teeth, leading to inflammation and, if left untreated, progressive damage to the teeth and gum tissue. [9]
Tooth decay is caused by biofilm (dental plaque) lying on the teeth and maturing to become cariogenic (causing decay). Certain bacteria in the biofilm produce acids, primarily lactic acid , in the presence of fermentable carbohydrates such as sucrose , fructose , and glucose .
Oral hygiene practices involve the mechanical removal of plaque from hard tissue surfaces [24] Cariogenic bacteria levels in the plaque determine whether caries will occur or not, therefore, effective removal of plaque is paramount. [25] The removal of plaque inhibits demineralisation of teeth, and increases opportunities for remineralization.
The increased permeability of the JE that allows emigration of the PMN type of WBC also allows microorganisms from the dental biofilm (especially noted is P. gingivalis, and associated toxins from the exposed tooth surface) to enter this tissue from the deeper lamina propria, setting up the possibility of infection to occur. [7]
The amount of bacteria is often indicated by the level of dental plaque. [27] This feature implies that when aggressive periodontitis is present, loss of attachment and bone loss tend to occur even if the plaque level is low. High levels of Aggregatibacter (or Actinobacillus) actinomycetemcomitans and, in some populations, Porphyromonas ...
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