Dental plaque is a film made up of bacteria and their by-products which covers the surfaces of all the structures in the mouth. Just like in the gut/digestive system, the mouth is comprised of a variety of microflora (bacterial species) which acts in equilibrium. Ideally, the bacteria of the mouth should be balanced and could be considered free from disease. However, when the factors affecting plaque are disturbed or unbalanced, it can lead to a shift from normal.

There are many factors which affect dental plaque including some of the following:

Inadequacy of plaque removal causing retention and maturation of bacteria

• Brushing technique
• Brushing frequency
• Flossing habits

Diet Intake

• Beverages; particularly sweetened, acidic and caffeinated drinks

Immune System

• Compromised natural defence against bacteria

Saliva Flow

• Food removal from the mouth
• Hydration; consistency and volume produced (caffeine reduces saliva flow)
• Quality of saliva; can be altered by medications, damage to saliva ducts and autoimmune conditions

Smoking

• Increases pathogenic bacteria
• Smoke inhalation and heat alters the oral environment
• Odour causing bad breath

Side Effects to Medication

• Altering the saliva composition and compromising plaque-fighting mechanisms

There are two main categories of plaque based on where it is found in the mouth

Supra gingival plaque	Sub gingival plaque
Located above the gum line Found on the enamel surfaces of the teeth Can be removed by brushing and flossing Causes staining on the teeth Related to tooth decay, cavities and toothaches Can grow beneath the gums if not removed with oral hygiene	Located below the gum line Found on the root surfaces of teeth Can only be removed by professional scaling and deep cleaning. Related to bleeding gums, gum disease and loss of bone supporting the teeth Aggressive bacterial species, particularly in smokers Initiates the immune system

Why is it harmful?

Dental plaque is harmful as it is the basis of what causes the two major oral diseases:

Periodontal disease (gum disease)

• Imbalance in plaque builds up beneath the gum, remains undisturbed for a period of time and induces the body’s response to permanently reduce bone support, leading to mobility and tooth loss, if untreated
• Causes the inflamed gums to peel back from the surface of the tooth, causing periodontal packets and gingival recession, appearing ‘long in the tooth’.
• Bad bacteria can enter the bloodstream via the gums and potentially lodge in the arteries of the heart, increasing the chance and potential severity of heart disease

Dental caries (tooth decay)

• Dental plaque remains undisturbed on the surface of a tooth
• The bacteria ferment sucrose to form acid which dissolves the minerals of enamel. Frequent exposure to sugars escalates this process to significantly weaken the enamel enough to form a cavity.
• Once the bacteria enters the inner surface of the tooth, it has the potential to damage the nerve and cause sensitivity. This sensitivity can progress to aches, pains and possibly infection.

How to avoid plaque

• Twice daily brushing, using a soft brush
• Daily interdental cleaning with floss or interdental brushes
• Keep hydrated with plenty of water
• Avoid sweetened beverages and snacks in between meals
• Get your teeth professionally cleaned twice a year
• Screening for gum disease
• Consult with your dentist about medications and your immune system
• Have your saliva tested
• Quit smoking
• Maintain gum disease with the help of an Oral Health Therapist