15/10/2020
Plaque!
Non‐surgical removal of plaque and calculus has been part of the initial phase of the management of patients with gingivitis and periodontitis for decades. It consists of patient motivation and oral hygiene instruction as well as mechanical removal of supra and subgingival plaque deposits. The purpose of this review was to assess recent changes. The article reports on changes in our understanding of plaque as a biofilm, developments in patient plaque control, chemical plaque control and scaling instruments. It also comments on full‐mouth disinfection, the use of lasers and host modulation. Modern technology has made removal of microbial deposits by the patient and dental professionals more efficient. However, other advancements need to be used in conjunction with mechanical debridement at this time.
The initial phase of periodontal treatment should also include removal of caries with temporary or permanent restoration depending on the prognosis of the teeth. In addition, plaque retentive factors such as restoration or crown margins, dentures and orthodontic retainers need to be addressed. Polishing of restorations and removal of staining will decrease the rate and amount of plaque build‐up in subjects with good oral hygiene. Hopeless teeth should ideally be removed and endodontically‐involved teeth dressed and temporized. In the experience of the author, sometimes non‐surgical management is undertaken to better ascertain the patient’s motivation and interest, or to gauge the prognosis of teeth, especially when deciding which teeth to extract.
Plaque is a biofilm
A fundamental change in the last decade is our understanding that plaque is a biofilm. A biofilm is a microbial community attached to an environmental surface, which is usually encased in an extracellular polysaccharide or slime matrix and forms where there is sufficient moisture and nutrients.The protection provided by the glycocalyx prevents ingress of the host immune response, but also antibiotics and antiseptics. Therefore, it is necessary to disturb the biofilm when prescribing antimicrobials to allow greater access, but also to increase the multiplication rate of the bacteria making the antibiotic much more effective.