Plak (Plaque)

drg. Puspito Ratih H Sp Perio

Tujuan pembelajaran
Menjelaskan respon imun terhadap
plak
Menjelaskan plak (sifat fisis,
mikroorganisme)

 Ibnu Sina /Avicenna The Canon of

Medicine sekresi tubuh organisme
inang terkontaminasi cemaran
organisme asing yang tidak dilihat
mata telanjang sehingga terjadi
infeksi
Willoughby D Miller (1800an)
important causal role of oral bacteria
in the etiology of dental caries

 1970an peran plak sbg etiologi

periodontitis OH jelek akumulasi
plak >> penyakit periodontal

 Human fetus inside uterus is sterile

it passes through the birth canal
acquires vaginal and fecal
microorganism
Within 2 weeks mature microbiota
in the gut of newborn baby
Colonization of oral cavity also starts
close to the time of birth

Dental plaque is a host-associated biofilm.

The biofilm community is initially formed
through bacterial interactions with the
tooth and then through physical and
physiologic interactions among different
species within the microbial mass.

Dental plaque can be defined as the soft deposits

that
form the biofilm adhering to the tooth surface or
other
hard surfaces in the oral cavity, including removable
and
fixed restorations.
Plaque is differentiated from other deposits that may
be found on the tooth surface such as materia alba
and calculus.
Materia alba soft accumulations of bacteria and
tissue cells that lack the organized structure of
dental plaque and are easily displaced with a water
spray.
Calculus is a hard deposit that forms by
mineralization of dental plaque and is generally

Komposisi plak
Mikroorganisme 1
gr plak tdd > 500 spc
Mycoplasma, yeasts,
protozoa, virus
Matriks interseluler
(20-30% massa plak)
Organik dan anorganik
dari saliva, GCF,
produk mo

Organik
glikoprot saliva,
polisakarida mo,
albumin GCF, food
debris
Anorganik Ca, P,
Na, K, F

Dental plaque may be readily visualized on teeth after 1

to 2 days with no oral hygiene measures. Plaque is white,
grayish, or yellow and has a globular appearance.
Plaque is typically observed on the gingival third of the
tooth surface, where it accumulates without disruption by
the movement of food and tissues over the tooth surface
during mastication.
Plaque deposits also form preferentially in cracks, pits,
and fissures in the tooth structure; under overhanging
restorations;
and around malaligned teeth.
The location and rate of plaque formation vary among
individuals, determining factors include oral hygiene as
well as host

Tahapan pembentukan plak

Pembentukan pelikel
Formation of the dental pellicle on the tooth surface
is the initial phase of plaque development surfaces
of the oral cavity, including all tissue surfaces as
well as surfaces of teeth and fixed and removable
restorations, are coated with a glycoprotein pellicle.
This pellicle is derived from components of saliva
and crevicular fluid as well as bacterial and host
tissue cell products and debris.

The mechanisms involved in enamel pellicle formation

include electrostatic, van der Waals, 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.
Pellicles function as a protective barrier, providing
lubrication
for the surfaces and preventing tissue desiccation,
provide a substrate to which bacteria in the
environment attach.
The epithelial tissue cells are continually sloughed, the
bacterial
population on the tissue surfaces is continually
disrupted.

Initial adhesi bakteri

Within a few hours, bacteria are found on
the dental pellicle.
The initial bacteria colonizing the pelliclecoated tooth
surface are predominantly gram-positive
facultative microorganisms such as
Actinomyces viscosus and Streptococcus
sanguis.
These initial colonizers adhere to the pellicle
21,24,63 through specific molecules, termed
adhesins, on the bacterial surface that

Cells of A. Viscosus possess fibrous protein

structures called fimbriae that extend from the
bacterial cell surface. Protein adhesins on these
fimbriae specifically bind to proline-rich proteins
that are found in dental pellicle,63 resulting in the
attachment of the bacterial cell to the pelliclecoated 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

Kolonisasi
Secondary colonizers are the microorganisms that do not
initially colonize clean tooth surfaces, including Prevotella
intermedia, Prevotella loescheii, Capnocytophaga
spp., Fusobacterium nucleatum, and Porphyromonas
gingivalis.
These microorganisms adhere to cells of bacteria already
in the plaque mass.
Extensive laboratory studieshave documented the ability
of different species andgenera of plaque microorganisms
to adhere to one another,a process known as
coaggregation.
This process occursprimarily through the highly specific
stereochemicalinteraction of protein and carbohydrate
molecules locatedon the bacterial cell surfaces" ," in

The significance of coaggregation in oral colonization has

been documented in studies of biofilm formation in vitro'
as well as in animal model studies secondary colonizers
with early colonizers include the coaggregation of F.
Nucleatum with S. sanguis,3 5 P. loescheii with A.
Viscosus and Capnocytophaga ochracea with A.
viscosus.
Most studies of coaggregation have focused on
interactions among different gram-positive species and
between gram-positive
and gram-negative species.
In the latter stages of plaque formation, coaggregation
between different gram-negative species is likely to
predominate. Examples of these types of interactions are
the coaggregation of F. nucleatum
with P. Gingivalis or Treponema denticola

Long-standing supragingival plaque near the

gingival
margin demonstrates "corncob"
arrangement. A central gramnegative
filamentous core supports the outer coccal
cells, which arefirmly attached by

Scanning electron photomicrograph of cross section of

cementum
(C with attached subgingival plaque (AP). Area shown is
within a periodontal pocket. (Courtesy Dr. J. Sottosanti, La
Jolla, Calif.)

Faktor yang mempengaruhi

pembentukan plak

Bio film constitutes

A biofilm 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 is extensive, bio films can
be seen with the naked eye, coating the
inside of water pipes or dangling
slippery and green licin menggntg, 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, plantmicroorganisms 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 nonliving 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 freefloating 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
antimicrobialresistant
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 biofilmassociated infections. With the
increasing use of such devices in the
modern practice of medicine, the
prevalence of these infections is
expected to increase.

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 grampositive 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.

Biofilms interfere in Antibiotic

Therapy
Bacteria growing in a
biofilm are highly
resistant to antibiotics,
up to 1,000 times more
resistant than the same
bacteria not growing in
a biofilm. Standard
antibiotic therapy is
often useless and the
only recourse may be
to remove the
contaminated implant.

Biofilm and Antibiotic

resistance
A key property of bio
films is that individual
microorganisms are
bound together by a
polymeric substance
excreted by the
microorganisms.. This
protective
encapsulation is
believed to play a role
in some antibioticresistant infection.

Bacterial resitance and

Biofilms
Another area of great importance from a
public health perspective is the role of
biofilms in antimicrobial-drug resistance.
Bacteria within biofilms are intrinsically
more resistant to antimicrobial agents
than plank tonic cells because of the
diminished rates of mass transport of
antimicrobial molecules to the biofilm
associated cells or because biofilm cells
differ physiologically from plank tonic
cells