Bacterial Plaque and Its Relation to Dental Diseases

Cassie Nauholz
Preventive Dentistry
Fall 2014

Daily oral hygiene is something, that for most people, becomes part of our daily routine.
Whether its just brushing, or flossing and brushing, most of us have the basic knowledge to
know why we should make oral hygiene part of our daily lives. What most people arent aware
of, is what is happening in our mouths when we dont brush or floss and what can happen if we
arent making this a habit every day. There are many diseases that can take place in the mouth
which can ultimately lead to other systemic problems in our body. If we take care of the main
culprit, bacterial plaque, we will have a clean and healthy mouth.
Bacterial plaque, also known as biofilm, is a sticky, colorless, non-mineralized colony of
microorganisms that forms on our teeth when they have not been brushed. There are more than
600 distinct microbial species that are found in dental biofilm (Wilkins, 2013). Plaque is
composed of 20% organic and inorganic solids and 80% water (Clark, 2014). After minutes of
removal, acquired pellicle forms in the mouth and on the teeth that the plaque can adhere to. This
is where the multiplication and colonization of biofilm begins. This causes growth and
maturation in the biofilm which then leads to a matrix formation. After someone has brushed
their teeth, this process can begin within one hour and the maximum amount of plaque can be
reached in 30 days or less if untouched. Biofilm is directly involved with inflammatory diseases
of the hard and soft tissue (Clark, 2014). If left alone, it can effect the teeth, bone, and gingiva.
The three main diseases untreated plaque can lead to are caries, gingivitis and periodontitis.
Bacterial plaque is made up of four predominant bacteria during the various levels of maturation.
These four bacteria are: bacilli, cocci, spirilla and vibrios. If left untouched for 1-2 days, this is
where we would see epithelial cells and a few cocci. During days 2-4 there are more cocci
present as well as bacilli. If still no removal of bacteria after 4-7 days, the biofilm near the
margin of the gingiva thickens and filamentous bacteria, leukocytes, and fusobacteria are present.

Going on to days 7-14, vibrios and spirochetes start to appear, white blood cells increase, and we
being to see signs of inflammation. After 14-21 days, the bacterial plaque is densely packed and
arranged perpendicular to the tooth surface. In the older biofilm, vibrios and spirochetes are
prevalent along with cocci and filamentous forms. This is when gingivitis is evident in the
mouth. Leaving this plaque on the teeth not only effects the gingiva, but also has an effect on the
teeth. If left untouched, caries will start to form and a decay process will begin.
Plaque plays a role in the initiation and progression of dental caries (Wilkins, 2014).
There are three things needed for caries to exist. The first is a tooth, second bacteria (plaque),
and third is food. Caries is considered a disease of the enamel, dentin and cementum
characterized by demineralization of the mineral components and dissolution of the organic
matrix cause by plaque (Wilkins, 2012). The process of demineralization is triggered by the
increase in the acidity in plaque (Higham, 2014). The two bacteria involved in this process are
streptococci and lactobacilli (Wilkins, 2012). These bacteria that are present on the tooth convert
the glucose, fructose, and sucrose into acids through glycolysis. This causes a decrease in the pH
of the tooth, making the saliva and plaque more acidic. This acid dissolves the calcium phosphate
of the enamel and dentin and causes decay in the tooth. If left untreated, a cavity can work its
way through the enamel and dentin, into the pulp of the tooth, and down into the root. This is
when a root canal is necessary for treatment or if worse, removal of the tooth. Our diets can play
an important role in controlling caries by what we eat, when we eat it, and how often we eat.
Every time a fermentable carb is consumed, acid production begins immediately and 1-2 hours
are required for the oral cavity to return to its normal pH of 6.2-7.0 (Stegeman, Carroll, &
Schierling). This is why it is recommended to eat a snack or meal all at once, rather than over a
long period of time. This allows our mouths to have the time to return to their normal pH. This

helps decrease the risk for caries as well as decay. Avoiding food or drinks that contain a lot of
sugar can also decrease our risk for caries. When we eat foods that contain a lot of sugar and our
pH levels are lower than normal our plaque becomes acidic and this leads to demineralization.
Calculus is also something that has a relationship to plaque. It is plaque that has
mineralized and cemented itself to the teeth. It is formed through the deposit of calcium and
phosphate salts in plaque. It cannot be removed from toothbrushing or flossing, it must be
removed at the dentist office. Calculus is another place where plaque can be found, as it is
covered with biofilm. It is composed of 70-90% inorganic components, and the rest organic
components and water (Clark, 2014). There are two places which calculus can be found. The first
place is supragingival. Supragingival calculus is often white, creamy yellow, or gray and can be
found on the clinical crown coronal to the margin of the gingiva (Wilkins, 2012). It usually has a
bulky shape and a hard texture that is covered with plaque. The amount of calculus depends on
the person and their oral hygiene, diet and tendencies. Two common places supragingival
calculus can be found are on the facial side of the maxillary molars and on the lingual side of the
mandibular anteriors (Clark, 2014). This is because these teeth are located near salivary glands.
Another place where calculus is found is subgingival. Subgingival calculus can be found apical
to the margin of the gingiva as well as at the bottom of pockets to the contour of soft tissue.
Often times subgingival calculus is a light to dark brown, dark green or black. It is more flat on
the tooth than supragingival calculus and is more hard and more dense as well (Wilkins, 2012).
The amount of subgingival calculus is also different from person to person depending on a
variety of different reasons, mainly depending on a persons daily oral hygiene habits. It is
commonly found on the proximal surfaces of teeth and is usually lightest on the facial aspects of
the teeth. Calculus does not cause periodontal disease but it is a contributing factor. It acts as a

place for plaque to adhere and gather. If calculus is not taken care of and removed, the plaque
that sticks to the calculus can be the cause of periodontal disease.
The first inflammatory dental disease caused by plaque is gingivitis. Gingivitis is the
inflammation of the gingival tissues. It is the most common human disease, but is also the easiest
to treat and control (Clark, 2014). Many people will not notice they have gingivitis because it is
often painless and unrecognizable. Some clinical characteristics of gingivitis are redness,
swelling, drainage of fluid from the sulcus, and hemorrhage. Gingivitis can be directly related to
plaque on the teeth. It is an inflammatory response to the plaque that occurs within 2-4 days of
irritation (Wilkins, 2012). The most common cause of gingivitis is poor oral
hygiene(Gingivitis, 2014). There are also many factors that can increase the risk of gingivitis.
Some of these factors include: tobacco use, diabetes, old age, decreased immunity, some
medications, dry mouth and hormonal changes. Gingivitis is reversible but if not treated, it can
lead to periodontitis which is irreversible.
Periodontitis is the clinical tooth attachment loss to the gingiva, alveolar bone loss and
gingival inflammation. It is preceded by gingivitis and is caused from a shift in the plaque
bacteria (Clark S., 2014). The toxins, that are produced by the bacteria in plaque, stimulate a
chronic inflammatory response (Types of Gum Disease, 2014 ). This causes the tissues and
bone that support the teeth to break down and become destroyed. The gums then separate from
the teeth and form pockets that become infected. As the disease progresses, the pockets deepen
and the gum tissue and bone is more and more effected. Some clinical characteristics of
periodontal disease are bluish-red tissue, deepened sulcus, loss of bone, enlarged tissue and
swelling, sulcular bleeding, and mobility of teeth. There are many different forms of
periodontitis. Some of these include chronic periodontitis, aggressive periodontitis, periodontitis

as a manifestation of systemic disease and necrotizing periodontal disease. Aggressive

periodontitis usually occurs in patients who are clinically healthy. The common signs of
aggressive periodontitis are rapid attachment loss, bone destruction and familial aggregation.
Periodontitis as a manifestation of systemic disease usually occurs young in age. It can be related
to systemic diseases such as heart disease, respiratory disease and diabetes. Necrotizing
periodontal disease is an infection characterized by necrosis of gingival tissues, periodontal
ligaments and alveolar bone. It is usually found in individuals with HIV, malnutrition and
immunosuppression. The most common form of periodontal disease is chronic periodontitis. It is
prevalent in adults and more common in males than females (Clark, 2014). Chronic periodontitis
is characterized by bone loss, pocket formation and/or gingival recession. There are three
different classifications of chronic periodontitis that can be classified by radiographs. These
classifications are slight, moderate and advanced. Slight to moderate are often treated in general
dental practice if no health concerns are present (Clark, 2014). Advanced periodontal disease on
the other hand should be referred to a specialist for diagnosis before scaling and root planing
(Clark, 2014). Even though periodontal disease is irreversible, it can be prevented with good oral
hygiene.
Prevention of all oral diseases are easy with good daily oral hygiene. Plaque, calculus,
caries, gingivitis and periodontal disease can all be prevented if we brush and floss at least once a
day, every day. Everyone is different and some may require different oral hygiene plans than
others, but as long as we are consistent we can maintain good oral health. Nutrition also plays a
big role in prevention of bad oral hygiene. Some good tips to follow are reducing sugar in our
diets, drinking water after eating to rinse away food debris, using straws if drinking beverages
that can stain our teeth, eating snacks all at once rather than continually snacking throughout the

day, chewing gum that contains xylitol, and avoiding tobacco use. Not only can these habits
better our oral hygiene, but also our entire bodies. Preventing periodontal disease also prevents
us from other systemic diseases that can be detrimental to our health. Just by removing plaque,
we can maintain a clean healthy smile as well as a healthy lifestyle.