Dental plaque forms naturally on teeth and is of benefit to the host by helping to prevent colonization by exogenous species. The bacterial composition of plaque remains relatively stable despite regular exposure to minor environmental perturbations. This stability (microbial homeostasis) is due in part to a dynamic balance of both synergistic and antagonistic microbial interactions. However, homeostasis can break down, leading to shifts in the balance of the microflora, thereby predisposing sites to disease. For example, the frequent exposure of plaque to low pH leads to inhibition of acid-sensitive species and the selection of organisms with an aciduric physiology, such as mutans streptococci and lactobacilli. Similarly, plaque accumulation around the gingival margin leads to an inflammatory host response and an increased flow of gingival crevicular fluid. The subgingival microflora shifts from being mainly Gram-positive to being comprised of increased levels of obligately anaerobic, asaccharolytic Gram-negative organisms. It is proposed that disease can be prevented or treated not only by targeting the putative pathogens but also by interfering with the processes that drive the breakdown in homeostasis. Thus, the rate of acid production following sugar intake could be reduced by fluoride, alternative sweeteners, and low concentrations of antimicrobial agents, while oxygenating or redox agents could raise the Eh of periodontal pockets and prevent the growth and metabolism of obligately anaerobic species. These views have been incorporated into a modified hypothesis (the "ecological plaque hypothesis") to explain the relationship between the plaque microflora and the host in health and disease, and to identify new strategies for disease prevention.

Microbial ecology of dental plaque and its significance in health and disease.

1. Introduction to dental anatomy 2. Development and eruption of the teeth 3. The primary (deciduous) teeth 4. Forensics, comparative anatomy, geometries, and form and function 5. Orofacial complex: form and function 6. The permanent maxillary incisors 7. The permanent mandibular incisors 8. The permanent canines, maxillary and mandibular 9. The permanent maxillary premolars 10. The permanent mandibular premolars 11. The permanent maxillary molars 12. The permanent mandibular molars 13. Pulp chambers and canals 14. Dento-osseous structures, blood vessels and nerves 15. The temporomandibular joints, teeth, and muscles and their functions 16. Occlusion

Wheeler's Dental Anatomy, Physiology and Occlusion

Background: To understand the relationship between our bacterial microbiome and health, it is essential to define the microbiome in the absence of disease. The digestive tract includes diverse habitats and hosts the human body’s greatest bacterial density. We describe the bacterial community composition of ten digestive tract sites from more than 200 normal adults enrolled in the Human Microbiome Project, and metagenomically determined metabolic potentials of four representative sites. Results: The microbiota of these diverse habitats formed four groups based on similar community compositions: buccal mucosa, keratinized gingiva, hard palate; saliva, tongue, tonsils, throat; sub- and supra-gingival plaques; and stool. Phyla initially identified from environmental samples were detected throughout this population, primarily TM7, SR1, and Synergistetes. Genera with pathogenic members were well-represented among this disease-free cohort. Tooth-associated communities were distinct, but not entirely dissimilar, from other oral surfaces. The Porphyromonadaceae, Veillonellaceae and Lachnospiraceae families were common to all sites, but the distributions of their genera varied significantly. Most metabolic processes were distributed widely throughout the digestive tract microbiota, with variations in metagenomic abundance between body habitats. These included shifts in sugar transporter types between the supragingival plaque, other oral surfaces, and stool; hydrogen and hydrogen sulfide production were also differentially distributed. Conclusions: The microbiomes of ten digestive tract sites separated into four types based on composition. A core set of metabolic pathways was present across these diverse digestive tract habitats. These data provide a critical baseline for future studies investigating local and systemic diseases affecting human health.

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Composition of the adult digestive tract bacterial microbiome based on seven mouth surfaces, tonsils, throat and stool samples

This article describes the subgingival microflora of the healthy periodontium, gingivitis, advanced adult periodontitis, and juvenile periodontitis. A total of seven to nine subjects were examined in each of the four periodontal clinical entities listed. The individual bacteriological samples included material from the base of a single periodontal pocket. The sampling, the treatment of the samples, and the bacteriological cultivations were carried out using continuous anaerobic techniques.

Briefly, the healthy gingival sulcus harbored a scant microflora dominated by Gram-positive organisms (85%), usually Streptococcus and facultative Actinomyces species. The development of gingivitis was accompanied by a marked increase in the total number of Gram-negative organisms. Fusobacterium nucleatum, Bacteroides melaninogenicus ss. intermedius, Haemophilus species, and other Gram-negative organisms comprised about 45% of the total gingivitis isolates. Streptococcus and facultative and anaerobic Actinomyces species constituted the majority of the Gram-positive gingivitis isolates. The micro-flora of advanced adult periodontitis was comprised mainly of Gram-negative anaerobic rods (about 75%), B. melaninogenicus ss. asaccharolyticus and F. nucleatum being the most predominant isolates. The deep pocket microflora in juvenile periodontitis was also made up mainly of Gram-negative organisms (about 65%), but was of a nature different from that of adult periodontitis, being predominated by isolates of Bacteroides species and other organisms of unknown species.

The present article also concerns factors of importance for the colonization of Gram-negative anaerobic rods in the oral cavity and periodontal pockets. In vitro experiments showed that cells of B. melaninogenicus ss. asaccharolyticus and other Gram-negative organisms attached in high numbers to epithelial cells, hydrosyapatite (HA) surface, and Gram-positive bacteria when suspended in phosphate-buffered saline; however, the bacterial attachment to epithelial cells and HA was strongly inhibited in the presence of human saliva and serum. In contrast, saliva and serum had little effect upon the attachment of Gram-negative bacteria to Gram-positive bacterial cells. These findings agreed well with data from an in vivo study, in which streptomycin-labeled cells of B. melaninogenicus ss. asaccharolyticus were introduced into the mouth of two volunteers. A significantly higher number of B. melaninogenicus cells was recovered from dental plaque than from the other oral surfaces studied.

The present series of studies has pointed to certain Gram-negative organisms as potential pathogens in rapidly progressing periodontal lesions. The available data on oral microbial ecology suggest that the presence of dental plaque containing Gram-positive organisms may be essential for the attachment and colonization of several Gram-negative species after their initial introduction into the mouth and the periodontal pocket area. The clinical relevance of these findings is discussed.

Subgingival microflora and periodontal disease

Statement of problem. One common test of single-unit restorations involves applying loads to clinically realistic specimens through spherical indenters, or equivalently, loading curved incisal edges against flat compression platens. As knowledge has become available regarding clinical failure mechanisms and the behavior of in vitro tests, it is possible to constructively question the clinical validity of such failure testing and to move toward developing more relevant test methods. Purpose. This article reviewed characteristics of the traditional load-to-failure test, contrasted these with characteristics of clinical failure for all-ceramic restorations, and sought to explain the discrepancies. Literature regarding intraoral conditions was reviewed to develop an understanding of how laboratory testing could be revised. Variables considered to be important in simulating clinical conditions were described, along with their recent laboratory evaluation. Conclusions. Traditional fracture tests of single unit all-ceramic prostheses are inappropriate, because they do not create failure mechanisms seen in retrieved clinical specimens. Validated tests are needed to elucidate the role(s) that cement systems, bonding, occlusion, and even metal copings play in the success of fixed prostheses and to make meaningful comparisons possible among novel ceramic and metal substructures. Research over the past 6 years has shown that crack systems mimicking clinical failure can be produced in all-ceramic restorations under appropriate conditions. (J Prosthet Dent 1999;81:652-61.)

Clinically relevant approach to failure testing of all-ceramic restorations.

In normal chewing the forces exerted on the occlusal surface seldom exceeded 10 to 15 pounds, as recorded by an eight-channel force transmitter in a removable fixed partial denture. Ninety-five percent of forces were less than 3.5 pounds for subject A, 2.0 pounds for subject B, and 10.0 pounds for subject C. The chewing frequency and the places of maximal force on the occlusal surface were relatively constant. The electromyographic chewing patterns could be considered normal in all circumstances. There was a remarkable statistically significant day-to-day variation in force values. The forces also changed for different kinds of food. The differences between maximum and minimum force values were highest in voluntary, nonfunctional movements.

Functional occlusal forces: an investigation by telemetry.

The role of microbial flora in the initiation of perio­ dontal disease is not completely understood, but there is strong supportive evidence that bacterial plaque is an important etiologic factor in human periodontal dis­ ease. Changes in the ecology of bacterial plaque have been related to the initiation of inflammatory changes in the gingival tissues by Löe, et a l 1 who showed that the appearance in developing plaque of two anaerobic or­ ganisms was accompanied by the first clinical evidence of inflammation in previously normal gingiva. R i t z 2 re­ ported similar population shifts in developing human dental plaque with the initial predominant organisms being aerobic, while after seven days the predominant organisms were anaerobic. Further he suggested that these changes in plaque ecology were related at least in part to a lowering of the oxidation reduction potential of the environment.2

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Oxidation reduction potential of developing plaque, periodontal pockets and gingival sulci.

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Correlation Between Plaque and Gingivitis

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A Study of Periodontal Hazards of Third Molars

In eighteen subjects assigned for immediate complete upper and lower dentures, roentgen cephalometric recordings were made before extraction of the residual anterior dentition and 3 weeks, 3 months, 6 months and 1 year after denture insertion. The cephalometric analysis was based on electronic measurements of linear and angular morphological variables and computer head plots generated from 177 reference points (Walker, 1967), derived for each subject for each of the five observation stages. The reduction of the alveolar ridges was most rapid during the first 3 months of denture wear and particularly during the post-extraction period of 3 weeks. The reduction in anterior height of the lower ridge was on average twice as great as that of the upper ridge. The ridge resorption and the accompanying settling of the dentures on the basal seats, measured from lead shots inserted in the dentures, brought about an upward rotation of the mandible with a resulting decrease in occlusal vertical dimension and reduction in overjet of the dentures. In accordance with the amount of ridge reduction, these changes showed great individual variation.

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Major M. Ash

Papers

Functional occlusal forces: an investigation by telemetry.

Oxidation reduction potential of developing plaque, periodontal pockets and gingival sulci.

Correlation Between Plaque and Gingivitis

A Study of Periodontal Hazards of Third Molars

Roentgen cephalometric analysis of ridge resorption and changes in jaw and occlusal relationships in immediate complete denture wearers