In dentistry, what is the name given to hardened dental plaque?
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Dentistry Dental plaque
Dentistry is a branch of medicine that is involved in the study, diagnosis, prevention, and treatment of diseases, disorders and conditions of the oral cavity, commonly in the dentition  but also the oral mucosa, and of adjacent and related structures and tissues, particularly in the maxillofacial (jaw and facial) area.  Although primarily associated with teeth among the general public, the field of dentistry or dental medicine is not limited to teeth but includes other aspects of the craniofacial complex including the temperomandibular and other supporting structures.  The term dentistry comes from odontology (from Ancient Greek ὀδούς (odoús, "tooth")) – the study of the structure, development, and abnormalities of the teeth. Because of their substantial overlap in concept, dentistry is often also understood to subsume the now largely defunct medical specialty of stomatology (the study of the mouth and its disorders and diseases) for which reason the two terms are used interchangeably in certain regions.

Dentistry is important for overall health . Dental treatment is carried out by the dental team, which often consists of a dentist and dental auxiliaries (dental assistants, dental hygienists, dental technicians, and dental therapists). Most dentists work in private practices (primary care), although some work in dental hospitals and hospitals (secondary care) and institutions (prisons, armed forces bases, etc.).

The history of dentistry is almost as ancient as the history of humanity and civilization with the earliest evidence dating from 7000 BC. Remains from the early Harappan periods of the Indus Valley Civilization ( BC) show evidence of teeth having been drilled dating back 9,000 years.  It is thought that dental surgery was the first specialization from medicine.

Dental treatment 

Dentistry usually encompasses very important  practices related to the oral cavity. Oral diseases are major public health problems  due to their high incidence and prevalence across the globe with the disadvantaged affected more than other socio-economic groups. 

The majority of dental treatments are carried out to prevent or treat the two most common oral diseases which are dental caries (tooth decay) and periodontal disease (gum disease or pyorrhea). Common treatments involve the restoration of teeth, extraction or surgical removal of teeth, scaling and root planing and endodontic root canal treatment.

All dentists in the United States undergo at least three years of undergraduate studies, but nearly all complete a bachelor's degree.  This schooling is followed by four years of dental school to qualify as a "Doctor of Dental Surgery" (DDS) or "Doctor of Dental Medicine" (DMD). Dentists need to complete additional qualifications or continuing education to carry out more complex treatments such as sedation, oral and maxillofacial surgery, and dental implants.

By nature of their general training they can carry out the majority of dental treatments such as restorative (fillings, crowns, bridges), prosthetic (dentures), endodontic (root canal) therapy, periodontal (gum) therapy, and extraction of teeth, as well as performing examinations, radiographs (x-rays) and diagnosis. Dentists can also prescribe medications such as antibiotics, sedatives, and any other drugs used in patient management.

Dentists also encourage prevention of oral diseases through proper hygiene and regular, twice yearly, checkups for professional cleaning and evaluation. Conditions in the oral cavity may be indicative of systemic diseases such as osteoporosis, diabetes, or cancer. Many studies have also shown that gum disease is associated with an increased risk of diabetes, heart disease, and preterm birth. The concept that oral health can affect systemic health and disease is referred to as "oral-systemic health".

Education and licensing 

Dr. John M. Harris started the world's first dental school in Bainbridge, Ohio, and helped to establish dentistry as a health profession. It opened on 21 February 1828, and today is a dental museum.  The first dental college, Baltimore College of Dental Surgery, opened in Baltimore, Maryland, USA in 1840. The second in the United States was the Philadelphia College of Dental Surgery, established in 1852.  In 1907 Temple University accepted a bid to incorporate the school.

Studies showed that dentists graduated from different countries,  or even from different dental schools in one country,  may have different clinical decisions for the same clinical condition. For example, dentists graduated from Israeli dental schools may recommend more often for the removal of asymptomatic impacted third molar (wisdom teeth) than dentists graduated from Latin American or Eastern European dental schools. 

In the United Kingdom, the 1878 British Dentists Act and 1879 Dentists Register limited the title of "dentist" and "dental surgeon" to qualified and registered practitioners.  However, others could legally describe themselves as "dental experts" or "dental consultants".  The practice of dentistry in the United Kingdom became fully regulated with the 1921 Dentists Act, which required the registration of anyone practising dentistry.  The British Dental Association, formed in 1880 with Sir John Tomes as president, played a major role in prosecuting dentists practising illegally.

In Korea, Taiwan, Japan, Finland, Sweden, Brazil, Chile, the United States, and Canada, a dentist is a healthcare professional qualified to practice dentistry after graduating with a degree of either Doctor of Dental Surgery (DDS) or Doctor of Dental Medicine (DMD). This is equivalent to the Bachelor of Dental Surgery/Baccalaureus Dentalis Chirurgiae (BDS, BDent, BChD, BDSc) that is awarded in the UK and British Commonwealth countries. In most western countries, to become a qualified dentist one must usually complete at least four years of postgraduate study;  within the European Union the education has to be at least five years. Dentists usually complete between five and eight years of post-secondary education before practising. Though not mandatory, many dentists choose to complete an internship or residency focusing on specific aspects of dental care after they have received their dental degree.

Specialties  

Some dentists undertake further training after their initial degree in order to specialize. Exactly which subjects are recognized by dental registration bodies varies according to location. Examples include:

* Dental public health – The study of epidemiology and social health policies relevant to oral health
* Conservative dentistry and endodontics: The art and science of restoring the tooth form and function when destructed by carious and non carious lesions affecting the teeth, before involvement of pulp or root canal is termed as conservative dentistry. When the root canal are involved, the speciality is known as endodontics. This speciality degree is awarded in India
* Endodontics (also called endodontology) – Root canal therapy and study of diseases of the dental pulp and periapical tissues.
* Forensic odontology – The gathering and use of dental evidence in law. This may be performed by any dentist with experience or training in this field. The function of the forensic dentist is primarily documentation and verification of identity.
* Geriatric dentistry or Geriodontics – The delivery of dental care to older adults involving the diagnosis, prevention, and treatment of problems associated with normal aging and age-related diseases as part of an interdisciplinary team with other health care professionals.
* Oral and maxillofacial pathology – The study, diagnosis, and sometimes the treatment of oral and maxillofacial related diseases.
* Oral and maxillofacial radiology – The study and radiologic interpretation of oral and maxillofacial diseases.
* Oral and maxillofacial surgery (also called oral surgery) – Extractions, implants, and surgery of the jaws, mouth and face.The scope of Oral and maxillofacial surgery is variable. In some countries, both a medical and dental degree is required for training, and the scope includes head and neck oncology and craniofacial deformity.
* Oral biology – Research in dental and craniofacial biology
* Oral Implantology – The art and science of replacing extracted teeth with dental implants.
* Oral medicine – The clinical evaluation and diagnosis of oral mucosal diseases
* Orthodontics and dentofacial orthopedics  – The straightening of teeth and modification of midface and mandibular growth.
* Pediatric dentistry (also called pedodontics) – Dentistry for children
* Periodontology (also called periodontics) – The study and treatment of diseases of the periodontium (non-surgical and surgical) as well as placement and maintenance of dental implants
* Prosthodontics (also called prosthetic dentistry) – Dentures, bridges and the restoration of implants. Some prosthodontists further their training in "oral and maxillofacial prosthodontics", which is the discipline concerned with the replacement of missing facial structures, such as ears, eyes, noses, etc.
* Special needs dentistry (also called special care dentistry) – Dentistry for those with developmental and acquired disabilities.
* Veterinary dentistry, a speciality of veterinary medicine – The field of dentistry applied to the care of animals.  

History 

Tooth decay was low in pre-agricultural societies,  the growth in farming society about 10,000 years ago correlated with an increase with the rate of cavities.  An infected tooth from Italy partially cleaned with flint tools, between 13,820 and 14,160 years old, represents the oldest known dentistry.  The Indus Valley Civilization (IVC) has yielded evidence of dentistry being practised as far back as 7000 BC.  An IVC site in Mehrgarh indicates that this form of dentistry involved curing tooth related disorders with bow drills operated, perhaps, by skilled bead crafters. The reconstruction of this ancient form of dentistry showed that the methods used were reliable and effective.  The earliest dental filling, made of beeswax, was discovered in Slovenia and dates from 6500 years ago. 

A Sumerian text from 5000 BC describes a "tooth worm" as the cause of dental caries.  Evidence of this belief has also been found in ancient India, Egypt, Japan, and China. The legend of the worm is also found in the writings of Homer, and as late as the 14th century AD the surgeon Guy de Chauliac still promoted the belief that worms cause tooth decay. 

Recipes for the treatment of toothache, infections and loose teeth are spread throughout the Ebers Papyrus, Kahun Papyri, Brugsch Papyrus, and Hearst papyrus of Ancient Egypt.  The Edwin Smith Papyrus, written in the 17th century BC but which may reflect previous manuscripts from as early as 3000 BC, discusses the treatment of dislocated or fractured jaws.  In the 18th century BC, the Code of Hammurabi referenced dental extraction twice as it related to punishment.  Examination of the remains of some ancient Egyptians and Greco-Romans reveals early attempts at dental prosthetics.  However, it is possible the prosthetics were prepared after death for aesthetic reasons.

Ancient Greek scholars Hippocrates and Aristotle wrote about dentistry, including the eruption pattern of teeth, treating decayed teeth and gum disease, extracting teeth with forceps, and using wires to stabilize loose teeth and fractured jaws.  Some say the first use of dental appliances or bridges comes from the Etruscans from as early as 700 BC.  In ancient Egypt, Hesi-Re is the first named "dentist" (greatest of the teeth). The Egyptians bound replacement teeth together with gold wire. Roman medical writer Cornelius Celsus wrote extensively of oral diseases as well as dental treatments such as narcotic-containing emollients and astringents.   The earliest dental amalgams were first documented in a Tang Dynasty medical text written by the Chinese physician Su Kung in 659, and appeared in Germany in 1528. 

Historically, dental extractions have been used to treat a variety of illnesses. During the Middle Ages and throughout the 19th century, dentistry was not a profession in itself, and often dental procedures were performed by barbers or general physicians. Barbers usually limited their practice to extracting teeth which alleviated pain and associated chronic tooth infection. Instruments used for dental extractions date back several centuries. In the 14th century, Guy de Chauliac invented the dental pelican  (resembling a pelican's beak) which was used to perform dental extractions up until the late 18th century. The pelican was replaced by the dental key which, in turn, was replaced by modern forceps in the 20th century.

The first book focused solely on dentistry was the "Artzney Buchlein" in 1530, and the first dental textbook written in English was called "Operator for the Teeth" by Charles Allen in 1685. 

In the United Kingdom there was no formal qualification for the providers of dental treatment until 1859 and it was only in 1921 that the practice of dentistry was limited to those who were professionally qualified. The Royal Commission on the National Health Service in 1979 reported that there were then more than twice as many registered dentists per 10,000 population in the UK than there were in 1921. 

Modern dentistry 

It was between 1650 and 1800 that the science of modern dentistry developed. The English physician Thomas Browne in his A Letter to a Friend ( pub. 1690) made an early dental observation with characteristic humour:

The French surgeon Pierre Fauchard became known as the "father of modern dentistry". Despite the limitations of the primitive surgical instruments during the late 17th and early 18th century, Fauchard was a highly skilled surgeon who made remarkable improvisations of dental instruments, often adapting tools from watch makers, jewelers and even barbers, that he thought could be used in dentistry. He introduced dental fillings as treatment for dental cavities. He asserted that sugar derivate acids like tartaric acid were responsible for dental decay, and also suggested that tumors surrounding the teeth and in the gums could appear in the later stages of tooth decay.  

Fauchard was the pioneer of dental prosthesis, and he discovered many methods to replace lost teeth. He suggested that substitutes could be made from carved blocks of ivory or bone. He also introduced dental braces, although they were initially made of gold, he discovered that the teeth position could be corrected as the teeth would follow the pattern of the wires. Waxed linen or silk threads were usually employed to fasten the braces. His contributions to the world of dental science consist primarily of his 1728 publication Le chirurgien dentiste or The Surgeon Dentist.  The French text included "basic oral anatomy and function, dental construction, and various operative and restorative techniques, and effectively separated dentistry from the wider category of surgery".

After Fauchard, the study of dentistry rapidly expanded. Two important books, Natural History of Human Teeth (1771 ) and Practical Treatise on the Diseases of the Teeth (1778), were published by British surgeon John Hunter. In 1763 he entered into a period of collaboration with the London-based dentist James Spence. He began to theorise about the possibility of tooth transplants from one person to another. He realised that the chances of an (initially, at least) successful tooth transplant would be improved if the donor tooth was as fresh as possible and was matched for size with the recipient.  These principles are still used in the transplantation of internal organs. Hunter conducted a series of pioneering operations, in which he attempted a tooth transplant. Although the donated teeth never properly bonded with the recipients' gums, one of Hunter's patients stated that he had three which lasted for six years, a remarkable achievement for the period. 

Major advances were made in the 19th century, and dentistry evolved from a trade to a profession. The profession came under government regulation by the end of the 19th century. In the UK the Dentist Act was passed in 1878 and the British Dental Association formed in 1879. In the same year, Francis Brodie Imlach was the first ever dentist to be elected President of the Royal College of Surgeons (Edinburgh), raising dentistry onto a par with clinical surgery for the first time. 

Priority patients 

UK NHS priority patients include patients with congenital abnormalities (such as cleft palates and hypodontia), patients who have suffered orofacial trauma and those being treated for cancer in the head and neck region. These are treated in a multidisciplinary team approach with other hospital based dental specialities orthodontics and maxillofacial surgery. Other priority patients include those with infections (either third molars or necrotic teeth) or avulsed permanent teeth, as well as patients with a history of smoking or smokeless tobacco with ulcers in the oral cavity. Dental plaque is a biofilm or mass of bacteria that grows on surfaces within the mouth. It is a sticky colorless deposit at first, but when it forms tartar it is brown or pale yellow that is commonly found between the teeth, front of teeth, behind teeth, on chewing surface, along  the gumline, or below the gumline cervical margins.  Dental plaque is also known as microbial plaque, oral biofilm, dental biofilm, dental plaque biofilm or bacterial plaque biofilm. While plaque is commonly associated with oral diseases such as caries and periodontal diseases (gum diseases), its formation is a normal process that cannot be prevented. 

Dental plaque can give rise to dental caries (tooth decay) – the localised destruction of the tissues of the tooth by acid produced from the bacterial degradation of fermentable sugar – and periodontal problems such as gingivitis and periodontitis. Its progression and build up is what leads to oral problems, hence it is important to disrupt the mass of bacteria and remove it daily.  Plaque control and removal is achieved with correct tooth brushing and use of interdental aids such as dental floss and interdental brushes. 

Removal of dental biofilm is important as it may become acidic causing demineralization of the teeth (also known as caries) or harden into calculus (dental) (also known as tartar).  Calculus cannot be removed through toothbrushing or with interdental aids and can only be removed through professional cleaning.  Therefore, removal of the dental biofilm will prevent the development of caries and gum diseases.

Plaque formation

Dental plaque is a biofilm that attaches to tooth surfaces, restorations and prosthetic appliances (including dentures, bridge (dentistry)) if left undisturbed. Understanding the formation, composition and characteristics of plaque helps in its control.  An acquired pellicle is a layer of saliva that is composed of mainly glycoproteins and forms shortly after cleaning of the teeth or exposure of new teeth.  Bacteria then attaches to the pellicle layer, forms micro-colonies, and matures on the tooth which can result in oral diseases. The following table provides a more detailed (six step) explanation of biofilm formation:

Components of plaque

In the oral cavity, there are different types of bacteria that normally present in the mouth. These bacteria and leukocytes, neutrophils, macrophages, and lymphocytes are part of the normal oral cavity and contribute to the individual's health. Approximately 80–90% of the weight of plaque is water. While 70% of the dry weight is bacteria, the remaining 30% consists of polysaccharides and glycoproteins.  Streptococcus mutans and anaerobes are the initial colonisers of the tooth surface, and play a major role in the establishment of the early biofilm community. 

Bacteria

The microorganisms that form the biofilm are mainly Streptococcus mutans and anaerobes, with the composition varying by location in the mouth. Examples of such anaerobes include fusobacterium and actinobacteria. These microorganisms present in dental plaque are all naturally present in the oral cavity, and are normally harmless. However, failure to remove plaque by regular tooth brushing means that they are allowed to build up in a thick layer and cause dental disease. Those microorganisms nearest the tooth surface ferment dietary sucrose; it is in this state that they start to produce acids.

The bacterial equilibrium position varies at different stages of formation. Below is a summary of the bacteria that may be present during the phases of plaque maturation.
*Early biofilm: primarily gram-positive cocci
*Older biofilm (3–4 days): increased numbers of filaments and fusiforms
*4–9 days undisturbed: more complex flora with rods, filamentous forms
*7–14 days: vibrios, spirochetes, more gram-negative organisms 

Supragingival biofilm

This is dental plaque that forms above the gums. This is the first kind of plaque that forms after you've brushed your teeth. It commonly forms in between the teeth, in the pits and grooves of the teeth and along the gums. It is made up of mostly aerobic bacteria, meaning these bacteria need oxygen to survive. As plaque remains on the tooth for a longer period of time, anaerobic bacteria begins to form in this plaque.

Subgingival biofilm

Subgingival biofilm is plaque that is located under the gums. It occurs after the formation of the supragingival biofilm by a downward growth of the bacteria from above the gums to below. This plaque is mostly made up of anaerobic bacteria, meaning that these bacteria will only survive if there is no oxygen. As this plaque attaches in a pocket under the gums, no oxygen in the mouth can reach this bacteria meaning it will thrive if not removed.

The extracellular matrix contains proteins, long chain polysaccharides and lipids.

The most common reasons for ecosystem disruption are the ecological factors discussed in the environment section. The bacteria that exhibits the most fit plasticity for the change in environment dominates the given environment. Often, this could lead to opportunistic pathogens that lead to dental caries and periodontal disease. Pathogens that have the potential to cause dental caries flourish in acidic environments. Pathogenic bacteria that have the potential to cause periodontal disease flourish in a slightly alkaline environment. 

Environment

The mouth is a warm and moist environment that is able to support the growth and development of dental plaque.  The main ecological factors that contribute to plaque formation are pH, saliva, temperature and redox reactions.   The normal pH range of saliva is between 6 and 7 and plaque biofilm is known to flourish in a pH between 6.7 and 8.3.   This indicates that the natural environment of the mouth provided by saliva is ideal for the growth of bacteria in the dental plaque. Saliva acts as a buffer, which helps to maintain the pH in the mouth between 6 and 7. In addition to acting as a buffer, saliva and gingival crevicular fluid contain primary nutrients including amino acids, proteins and glycoproteins. This feeds the bacteria involved in plaque formation. The host diet plays only a minor role in providing nutrients for the resident microflora. The normal temperature of the mouth ranges between 35–36 °C and a two degree (°C) change has been shown to drastically shift the dominant species in the plaque.  Redox reactions are carried out by aerobic bacteria. This keeps the oxygen levels in the mouth at a semi-stable homeostatic condition, which allows the bacteria to survive.

Consequence of plaque build up

Gingivitis

Gingivitis is a common result of plaque build up around the gingival tissues. The bacteria found in the biofilm elicit a host response resulting in localized inflammation of the tissue.  This is characterized by the cardinal signs of inflammation including a red, puffy appearance of the gums and bleeding due to brushing or flossing. 
Gingivitis due to plaque can be reversible by removal of the cause, plaque. However if left for an extended period the inflammation may begin to affect the supporting tissues, this progression is referred to as periodontal disease or periodontitis.  The gingivitis response is a protective mechanism, averting periodontitis in many cases.

Periodontitis

Periodontitis is an infection of the gums which leads to bone destruction around the teeth in the jaw. Periodontitis occurs after gingivitis has been established, but not all individuals who have gingivitis will get periodontitis.   Plaque accumulation is vital in the progression of periodontitis as the bacteria in plaque release enzymes which attack the bone and cause it to break down, and at the same time the osteoclasts in the bone breakdown the bone as a way to prevent further infection. This can be treated with strict oral hygiene such as tooth brushing and cleaning in between the teeth and as well as surgical debridement completed by a dental professional. 

Caries

Dental caries is an infectious disease caused primarily by Streptococcus mutans, characterized by acid demineralization of the enamel, which can progress to further breakdown of the more organic, inner dental tissue. Everybody is susceptible to caries but the probability of development depends on the patient’s individual disease indicators, risk factors and preventive factors. Factors that are considered high risk for developing carious lesions include: 
*Low  fluoride exposure
*Time, length, and frequency of sugar consumption
*Quality of tooth cleaning
*Fluctuations in salivary flow rates and composition
*Behavior of the individual
*Socioeconomic status of the individual
*Quality and composition of biofilms. 

Acids released from dental plaque lead to demineralization of the adjacent tooth surface, and consequently to dental caries. Saliva is also unable to penetrate the build-up of plaque and thus cannot act to neutralize the acid produced by the bacteria and remineralize the tooth surface.

Detection of plaque build up

Plaque detection is usually detected clinically by plaque disclosing agents. Disclosing agents contain dye which turns bright red to indicate plaque buildup.

There are two main methods of detecting dental plaque in the oral cavity; through the application of a disclosing gel/tablet and/or visually through observation. It is important for an individual to be aware of what to look for when doing a self assessment for dental plaque. It is important to be aware that everyone has dental plaque, however there are varying levels of severity and consequences of not removing the dental plaque biolfilm.

Plaque disclosing gel

Plaque disclosing products, also known as disclosants, make plaque clinically visible. Clean surfaces of the teeth do not absorb the disclosant, only rough surfaces. Plaque disclosing gels can be either completed at home or in the dental clinic. Before using these at home or in the dental clinic check with your general practitioners for any allergies for Iodine, food colouring or any other ingredients that may be present in these products. These gels provide a visual aid in assessing plaque biolfim presence and can also show the maturity of the dental plaque.

Disclosing tablets

Main article: Disclosing tablet

Disclosing tablets are similar to that of disclosing gels. However they are placed in the mouth and chewed on for approximately one minute. The remaining tablet or saliva is then spit out. Disclosing gels will show the presence of the plaque, but will often not show the level of maturity of the plaque. Disclosing tablets are often prescribed or given to patients with orthodontic appliances for use before and after toothbrushing to ensure optimal cleaning. These are also helpful educational tools for young children or patients that are struggling to remove dental plaque in certain areas.

Disclosing gels and tablets are useful for individuals of all ages in ensuring efficient dental plaque removal.

Visual or tactile detection of dental plaque

Dental biofilm forms on the tooth only minutes after brushing. It can be difficult to visualise dental plaque on the hard tissue surfaces, however a rough surface can be felt after eating or before toothbrushing if there is a thick deposit of dental plaque. It is often felt as a thick, fur-like deposit that may present as a yellow, tan or brown stain. They are commonly found on teeth or dental appliances such as orthodontic brackets and the tongue. The most common way dental plaque is assessed, is through dental assessment in the dental clinic where dental instruments are able to scrape up some plaque.

The most common areas where patients find plaque are between the teeth or along the cervical margins.
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 In dentistry, what is the name given to a hardened dental plug? 

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