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口腔是一个充满各种微生物的环境，而牙菌斑就像是由不同细菌组成的“细菌社区”，这些“社区”定居于牙面、牙与牙之间或者在假牙（义齿、修复体）表面。由于“社区”扎根很牢固，所以不能被水冲去或者漱掉，只能由机械方法清除。
目录
1疾病介绍
从专业角度来讲，牙菌斑是基质包裹的互相粘附、或粘附于牙面、牙间或修复体表面的软而未矿化的细菌性群体，为不能被水冲去或漱掉的一种细菌性生物膜。
当牙菌斑量较少时，肉眼是很难观察到的，通常用菌斑指示剂可以很好地显示。
2形成过程
牙菌斑，即“细菌社区”的建立、成熟需要经历三个阶段：
首先唾液中的营养物质吸附在牙齿表面，构成“社区”肥沃的“土壤”，即获得性薄膜形成。这个过程在刚清洁过的牙面上，数分钟内便可形成，1-2小时迅速增厚。
“土壤”形成之后，便可吸引细菌来定居，同时为细菌提供营养，即细菌粘附和共聚。首先会有先驱菌来定居，开垦土壤，建立社区的基本设施，之后便会吸引更多的其他细菌来定居，一个“新兴社区”就诞生了。
“新兴社区” 如果没有人为的破坏，很快会发展壮大，成为一个“成熟的社区”，即菌斑成熟。众多细菌集结在一起，互相提供营养物质，同时汲取唾液中的养分，细菌大量增 殖，“社区”结构也更加紧密，可以共同抵抗外界的干扰，这是用漱口的方法是无法清除的。一般9天就可以发展为拥有各种细菌的复杂、成熟“社区”。
3危害
牙菌斑主要对牙和牙龈构成危害，也就是口腔最常见的两种疾病：龋病和牙周病。
龋病俗称“虫牙”，这里的“虫”指菌斑中的细菌。牙菌斑牢固地附着在牙面上，细菌摄入唾液中的糖，分解糖产酸，这些酸会破坏牙齿，最终成洞。
当牙菌斑靠近牙龈时，细菌产生的毒素和其他有害物质会刺激牙龈（俗称“牙肉”、“牙床”），产生炎症，即牙龈炎。如果不加控制，任其发展，牙龈炎有可能会发展为不可逆的牙周炎，引起牙槽骨的破坏，最终导致牙齿松动、脱落。
4牙菌斑的清除
口腔不可能成为一个无菌的环境，也不能把所有的细菌都消灭。因为消灭细菌之后，又会有真菌袭来，造成更严重的、很难控制的后果。因此我们必须坚持不懈地与牙菌斑作斗争，使这些“社区”维持在一个较低数量，防止“社区”发展壮大，甚至最终钙化，形成牙石。当牙石形成之后，使用日常口腔护理的方法是不能清除掉的，只能寻求专业人士的帮助，用专门的器械清除。
清除牙菌斑和打扫房间类似，墙缝及各种缝隙往往是最难清洁的地方，而牙齿的“缝隙”一个是牙与牙龈之间，一个是牙与牙之间。清洁不同的部位需要用到不同的方法，以下将一一介绍：
清洁牙与牙龈之间
刷牙
刷牙是众所周知的口腔护理方法，也是清除牙菌斑最基本和最主要的方法。首先要坚持早晚刷牙，而晚上刷牙尤其重要。牙面上的食物残渣没有及时清除，为细菌提供了极其丰富的营养物质，细菌可以大量增殖，同时产生更多的有害物质，而睡眠中，唾液分泌减少，不能很好地中和、稀释这些有害物质，因而会对牙齿造成严重的危害。
1.关于牙刷、牙膏的选择：牙刷一般建议选用软毛牙刷，避免对牙齿或牙龈造成损伤，而近年来含药物的牙膏种类较多，主要功效有防龋、抑菌、止血、脱敏及减轻口臭等。但药物仅起辅助作用，主要靠机械清扫作用，正如洗衣服时，洗衣粉只起辅助作用，关键在于揉搓。
2.刷牙的方法：刷牙的方法有数十种之多，关键在于牙刷到位，面面俱到。现仅介绍最常用的水平颤动法（又称Bass法）。如图：
一般的方法刷牙后，在牙齿与牙齿之间常余留菌斑，需要用其他方法来补充，来清除残留的菌斑。根据牙缝的大小不同可以使用牙线、牙签或间隙刷。
清洁牙与牙之间
一、牙线
牙线是最常推荐使用的清除牙与牙之间的菌斑的方法，效果很好，适用于大多数人。但对于牙龈退缩严重，
且牙根面呈凹陷外形的人不适用，这类患者应用间隙刷清洁牙与牙之间。如图：
二、牙签
对于牙龈乳头有退缩，牙间隙增大的情况下，可以用牙签来清洁牙与牙之间。应选用硬质木制或塑料的光滑无毛刺的牙签，将间隙两侧的牙面上的菌斑“刮”净。注意不要损伤牙龈。对于无牙龈乳头退缩的人，不适宜使用牙签。
使用牙签是否会使牙缝变大：牙缝变大是牙周炎组织破坏所致，并非牙签引起。牙龈因炎症而肿大，似乎充满牙间隙，在治疗后或者使用牙签、清除菌斑后，牙龈乳头的炎症消退而表现为退缩，使牙缝“变大”。
三、间隙刷（牙缝刷）
牙与牙之间有间隙，牙齿邻面外形不规则或牙根面为凹面时，清除菌斑的最佳方法是间隙刷，又叫牙缝刷。选用直径适宜的间隙刷，将刷头顺牙龈乳头的方向伸入到牙间隙处，做前后移动，将菌斑刷除。一般在每晚睡前刷牙后使用间隙刷即可。
四、其他
其他工具如家用冲洗器，可产生一定压力的水流，用于日常的口腔冲洗，有利于清除牙刷等措施不易到达的部位。家用冲洗器的应用不能替代刷牙，但可作为刷牙的补充手段
牙结石是牙面上矿化或正在矿化的菌斑及软垢，一旦形成后不能用刷牙的方法除去，需专业人员通过牙周洁治的方法去除。牙结石是牙周病发展的一个重要致病因素。不注意养成良好的口腔卫生习惯，即使彻底洁治后，牙结石很容易很快再次沉积在牙齿表面。
目录
1疾病简介
牙石是一种沉积于牙面或修复体表面的矿化或正在矿化的菌斑及软垢，来自于唾液或龈沟液中的钙盐等无机盐逐渐沉积其中而形成，一旦形成后不能用刷牙的方法除去。
2发病原因
牙 结石形成的速度、形态和硬度因人而异，一般来说新生的牙结石需要十二至十五小时。快速形成的牙结石要比慢慢形成的牙结石要软且碎。所有刚形成的牙结石都是 软软的，经过一段时间的钙化就会慢慢的变硬。因此在牙结石形成之初，使用口腔清洁法或刷牙法，都很容易清除牙结石，等到钙化之后就不易清除了。
3发病机制
牙 石是牙龈出血、牙周袋加深、牙槽骨吸收和牙周病发展的一个重要致病因素，主要表现在①牙石本身坚硬粗糙，机械刺激牙龈；②牙石表面常易堆积未矿化的菌斑， 刺激牙龈造成炎症；③牙石多孔结构也易吸附大量的细菌毒素；④牙石的存在会妨碍日常口腔卫生措施的实施。所以，在治疗中务必彻底去除牙石。
然而需要强调的是，牙石对于牙周组织的危害主要来自于其表面堆积的菌斑。牙石表面没有堆积菌斑，如消毒后的牙石并不 会引起炎症和脓肿。而即使没有牙石的存在，仅仅菌斑也可以引起牙龈炎或牙周炎。没有及时去除的牙菌斑会在口中逐渐钙化，形成牙石，新的牙菌斑又很快在粗糙 的牙石上堆积，并向牙周深层组织蔓延，形成恶性循环，不断刺激牙龈，引起牙龈红肿，龈沟开始变深，牙周袋形成。因此在预防牙石形成的措施中首先应预防菌斑 形成或菌斑矿化，牙石的预防取决于菌斑的预防。
4临床表现
以龈缘为界，根据牙石沉积的部位，分为龈上牙石和龈下牙石。
龈上牙石，又称唾石，是位于龈缘以上临床牙冠表面上的牙石，肉眼可以直接看见。其矿化物质来源于唾液，因此在唾液腺 导管开口处相应处的牙面上常常沉积较多，即在腮腺导管开口处相应的上颌第一磨牙颊面，颌下腺和舌下腺导管开口处相应的下颌前牙舌面容易沉积牙石。龈上牙石 多呈黄色或白色，也可以由于吸烟或食物着色而呈深色。
龈下牙石又称为血石，沉积于龈缘之下，附着在龈沟或牙周袋内的根面，肉眼不可以直接看见，大块龈下牙石可以在X线片上显示。其矿化物质来源于龈沟液，一般呈褐色或黑色，与牙面的附着较龈上牙石更牢固。
5诊断鉴别
检查诊断
龈上牙石直接或通过口镜观察牙面上的龈上牙石和软垢的覆盖面积，进行检查诊断。如一侧牙石沉积明显过于另一侧，甚至咬合面可见，则患者可能有偏侧咀嚼习惯。
龈下牙石需由专业人员结合使用探针，在龈沟内沿牙面从远中划向近中，探查龈下牙石情况。或用气枪将牙龈缘吹开，有助 于观察龈下石。有时在X线上也可以观察到邻面牙石。结合使用探针，在龈沟内沿牙面从远中划向近中，探查龈下牙石情况。或用气枪将牙龈缘吹开，有助于观察龈 下牙石。有时在X线上也可以观察到邻面牙石。还应注意观察牙石在口腔中的整体分布情况。
检查评估指数：
牙石指数（calculus index，CI）
0-无龈上、龈下牙石
1-龈上牙石覆盖牙面不超过1/3
2-龈上牙石覆盖牙面超过1/3，但不超过2/3或牙颈部有散在龈下牙石。
3-龈上牙石覆盖牙面超过2/3或龈下牙石连续而厚。
6疾病鉴别
龈下牙石检查时要注意结合解剖位置、邻牙和已暴露的牙根表面特点，与釉牙骨质界、有的牙根本身的波浪状形状、充填物或修复体边缘相鉴别，判断是否为真正的龈下牙石。
7疾病治疗
2009年9月中华人民共和国卫生部办公厅颁布的《中国居民口腔健康指南》中提倡每年洁牙一次。
牙结石附着在牙齿上，影响美观，也影响镶牙修复的效果，有了牙结石，活动假牙（又称可摘义齿）就会与牙面不密合，容易导致食物残屑积存在假牙上，引起口腔发炎。所以结石较多的人，镶牙前也要去洁牙。
洁牙后如不注意，牙石又会很快形成，所以洁牙后要继续防治。注意正确的刷牙方法，有助于减少牙石的形成；洁牙后，过了一段时间局部仍会流血，则要请口腔科医生小心检查是否已有牙周病或牙龈深部尚有残余的牙结石存在，需要深层次洁牙——龈下洁治。
8疾病预后
不注意养成良好的口腔卫生习惯，即使彻底洁治后，牙结石很容易很快再次沉积在牙齿表面。
9疾病预防
刷牙是预防牙结石形成的一种简便而又行之有效的方法。一般人刷牙通常只能去除70%左右的菌斑，个人口腔护理除刷牙外，还应使用其他清洁工具：牙线、牙间隙刷等。洁牙后必须进行认真的个人口腔护理，保持口腔的清洁环境，否则及时经常洗牙，牙结石也可以卷土重来。
牙结石的沉积是由少到多，逐渐形成的。经常刷牙可将刚刚开始沉积于牙面的牙垢、牙结石及时刷掉。所以应该坚持刷牙，如若等到牙结石沉积很厚、附着很紧密时，就刷不掉了，必须由口腔专业人士协助才能去除。
另外由于精细食物粘性重糖分高，极易沉积于牙面，因此，应告诫儿童少吃精细食品，或吃后必须刷牙漱口。特别是睡前吃诸如饼干、蛋糕等精细食品，不仅容易形成牙结石，而且还会造成龋齿。所以平时一定要养成刷牙和保持口腔卫生的良好习惯。[1-2]
Dental plaque is a biofilm, usually a pale yellow, that develops naturally on the teeth. Like anybiofilm(生物膜), dental(牙科的) plaque is formed by colonizing(移于殖民地) bacteria trying toattach(依附) themselves to the tooth‘s smooth surface.[1] It has been speculated(推测) that plaque forms part of the defense systems of the host by helping to prevent colonization of microorganismsthat may be pathogenic.[2][3]
The oral cavity contains the only known anatomical(解剖的) aspect(方面) of the human body that does not have a regulated(调节) system of shedding(脱落) surfaces: the teeth. This allowsmicroorganisms(微生物) to adhere(坚持) to the surface of teeth for long periods of time.[4] These multiple species(物种) of bacteria become dental(牙科的) biofilm(生物膜). Dental biofilm, more commonly referred to as dental plaque(匾), is composed(构成) of about a thousand species of bacteria that take part in the complex(复杂的) ecosystems(生态系统) of the mouth. The natural, non-frequent regulation of tooth shedding plays a large role in making dental biofilm the mostdiverse(不同的) biofilm in the human body despite(尽管) the relatively small size of the teeth.
The human oral cavity is also called the human oral microbiome. This is because the human oralcavity(腔) can contain several environments at a given moment that could vary(变化) from tooth to tooth.[5] Additionally(附加的) it has been estimated(估计的) that 25,000 species of bacteriareside(住) in the mouth.[6] This is in contrast(对比) to the previously estimated 700+ species.[5]Studies have found that out of the 25,000 species(物种) that exist in the oral cavity(腔), about 1,000 species can exist as part of the dental(牙科的) biofilm(生物膜) ecosystem(生态系统).[7] This is also in contrast(对比) to the previous estimate(估计) of more than 500 species as part of the dental biofilm.[8] These 1,000 species have the ability to change their environment through a series of biotic(生物的) relationships.
At first, the biofilm is soft enough to come off by using the fingernail. However, it starts toharden(变硬) within 48 hours, and in about 10 days the plaque(匾) becomes dental calculus(tartar), which is hard and difficult to remove.[citation needed]
Dental plaque can give rise to dental caries (tooth decay(腐烂))—the localised(限局性的)destruction(破坏) of the tissues(纸巾) of the tooth by acid(酸) produced from the bacterial(细菌的) degradation(退化) of fermentable sugars[2][3]—and periodontal problems such as gingivitis andchronic periodontitis.
目录
- 1 Basic plaque formation
- 2 Microorganisms
- 3 Environment
- 4 Biotic relationships
- 5 Components of plaque
- 6 Consequence(结果) of plaque(匾) build up
- 7 Detection(侦查) of plaque build up
- 8 See also
- 9 References
- 10 External links
Basic plaque formation
Microscopic(微观的) view of some of the bacteria of whichplaque(匾) is composed(构成). Numbered ticks are 10 µmapart(相距).
The mechanisms(机制) of plaque formation(形成) include:[2][3]
- Adsorption of proteins(蛋白质) and bacteria to form a film on the tooth surface.
- The effect of van der Waals and electrostatic forces between microbial(微生物的) surfaces and the film to create reversible adhesion to the teeth.
- Irreversible adhesion(粘附) due to intermolecular(分子间的) interactions(相互作用) between cell surfaces and the pellicle(薄膜).
- Secondary(第二的) colonisers attach(依附) to primary colonisers by intermolecular interaction.
- The cells divide and generate(形成) a biofilm(生物膜).
Microorganisms
As previously mentioned there are about 1,000 out of the 25,000 species of bacteria that areinvolved(包含) with the formation(形成) of dental(牙科的) biofilm. Due to this fairly large number there is fierce competition among the bacteria present on dental biofilm for nutrients(营养物)present in the mouth. Only about fifty percent of the 1,000 species have been cultured for study.[7] Scientists at the Forsyth Institute in Cambridge, Massachusetts have begun the Human Oral Microbiome Project to identify bacteria and study the complex(复杂的) ecosystems(生态系统) of the mouth. On their website, one can find information about the identified(被识别的) organisms(有机体)as well as the method being utilized(利用) to identify the organisms.
Environment
The ecological(生态的) factors(因素) provided by the environment of the oral cavity(腔) are directly proportional(比例的) to the species(物种) richness(丰富) and species biodiversity(生物多样性) of the microorganisms(微生物) that reside(住) on the teeth.[4] The main ecological factors are pH, saliva, temperature and redox reactions.[4][9] The majority of microbial(微生物的)organisms(有机体) prefer neutral(中立国) pH levels (pH 7). Saliva(唾液) acts as a buffer,maintaining(维持) the pH in the mouth between 6.75 and 7.25.[4] In addition to acting as abuffer(缓冲区), saliva is also a main source of nutrients(营养物) for the thousands of bacteria(note: gingival crevicular fluid is also a nutrient(营养的) source but a smaller one ). A two degree (°C) change has been shown to drastically(彻底地) shift(移动) the dominant(显性的)species(物种) in the plaque(匾).[9] The normal temperature of the mouth ranges between 35–36°C (Marsh). Redox reactions are carried out by aerobic bacteria. This keeps the oxygen levels in the mouth at a semi-stable homeostatic(自我平衡的) condition. This allows other bacteria to survive(幸存), which will be discussed in the next section.[9]
Biotic relationships
The microorganisms(微生物) in the oral cavity live with one another in commensal or mutualisticsymbiotic relationships.[4] Typically, anaerobic bacteria would succumb(屈服) to high levels of oxygen, but with the redox(氧化还原剂) reactions(反应) discussed in the previous section they are able to survive(幸存). This commensal(共餐者) relationship allows a mixture of aerobic(需氧的) andanaerobic(厌氧的) bacteria to live in the same area. The formation(形成) begins by the adsorptionof early colonizers(移于殖民地) onto an acquired pellicle through chemical processes.[10] Anacquired pellicle is a layer of saliva(唾液) that is composed(构成) of mainly glycoproteins and forms shortly after cleaning of the teeth or exposure(暴露) of new teeth.[10] These bound earlycolonizers(移于殖民地) manipulate(操纵) the environment for the immediate benefit(利益) of other bacteria. Once the environment has been manipulated other bacterial(细菌的) colonizers are able to co-adhere to the early colonizers. This is done repeatedly resulting in layers of bacteria. Once new bacterial cells co-adhere to one another they gain the ability to communicate to one another. They are able to communicate to one another through a biochemical(生物化学的) process calledquorum(法定人数) –sensing.[7] Quorum –sensing virtually(事实上) allows all the bacteria to benefit from one another. This ability can allow a bacterium to feel the presence(存在) of other bacteria around it. Due to this communication, bacteria have the ability to change their genotype(and thus their phenotype) as a result of population concentration(浓度) and/or environmental(环境的) changes to remain as competent(胜任的) competitors.[11] These relationships tend(照料) toexhibit(展览) homeostasis(体内平衡) until there is some type of disruption(破坏) in theecosystem(生态系统).
The most common reasons for ecosystem disruption are the ecological(生态的) factors(因素) that were discussed in the environment section. The bacteria that exhibits the most fit plasticity for the change in environment dominates(控制) the given environment. Often, this could lead toopportunistic(机会主义的) pathogens that lead to dental caries and periodontal disease. Pathogensthat have the potential(潜能) to cause dental caries flourish(兴旺) in acidic(酸的) environments.Pathogenic bacteria that have the potential(潜能) to cause periodontal disease flourish(兴旺) in a slightly alkaline(碱性的) environment.[12]
Components of plaque
Plaque(匾) consists of microorganisms(微生物) and extracellular(细胞外的) matrix(矩阵).
The microorganisms that form the biofilm(生物膜) are mainly Streptococcus mutans and anaerobes, with the composition varying(变化) by location in the mouth. Examples of such anaerobes(厌氧性生物) include fusobacterium and actinobacteria.
The extracellular(细胞外的) matrix(矩阵) contains proteins(蛋白质), long chain polysaccharides(多糖) and lipids(脂质).
The microorganisms(微生物) present in dental(牙科的) plaque(匾) are all naturally present in the oral cavity(腔), 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. Those microorganisms nearest the tooth surface ferment dietary(规定的食物) sucrose(蔗糖); it is in this state that they start to produce acids(酸).
- Acids released from dental plaque lead to demineralization of the adjacent(邻近的) tooth surface, and consequently(因此) to dental caries. Saliva is also unable to penetrate(渗透)the build-up of plaque and thus cannot act to neutralize(抵销) the acid produced by the bacteria and remineralize the tooth surface.
- They also cause irritation(刺激) of the gums(口香糖) around the teeth that could lead togingivitis, periodontal disease and tooth loss.
- Plaque(匾) build up can also become mineralized(矿物化) and form calculus (tartar).
Consequence(结果) of plaque build up
Plaque is a haven(港口) for oral micro-organisms(微生物) and continues to build up in the oralcavity(腔) until it can mineralize in to calculus(结石) (also known as tartar) or cause plaqueassociated(关联的) gum disease.
Detection(侦查) of plaque build up
Plaque detection is usually detected(察觉) clinically(临床地) by plaque disclosing(公开) agents. Disclosing agents contains dye which turns bright red to indicate(表明) plaque buildup(增强).