The Sticky Truth - What Really Causes Tooth Plaque and How You Can Prevent It
Have you ever had that fuzzy feeling on the surface of your teeth? Or looked at your floss after you’ve used it and wondered what that white, sticky blob on it is? On the first inspection, that blob may look like a small piece of bread but as you look closer you may realise that it is something else. In fact, what you are seeing is a dental plaque, the sworn enemy of your teeth and gums, brought on by bacterial buildup.
In our mouths alone, it is documented there are in excess of 8 billion bacteria and over 300 different species. These bacteria normally live in harmony with each other (symbiosis) limiting the build-up of certain bacteria that can be harmful to us and in particular our teeth and gums.
FUN FACT: Many of these bacteria can cause tooth decay and are spreadable just like an infectious disease. So an otherwise innocent ten-second kiss can potentially spread up to 80 million bacteria between mouths!
Eating foods high in sugar like cakes, sweets, soft drinks and even fruit can lead to an increase in certain bacteria such as streptococcus mutans, which start to overpopulate the mouth and shift the normal harmonious, healthy environment into one which can predispose to dental decay and gum disease.
So what's all the fuss about this Dental Plaque thing? Time for a bit of science…
What is Plaque?
Dental plaque starts out as a sticky, colourless deposit. It is actually a ‘biofilm’ that attaches to the tooth surface, dental restorations and prosthetic appliances (dentures, crowns and bridges). Let’s assume you’ve just brushed and flossed your teeth and gums meticulously. Those ‘clean’ tooth surfaces are immediately bathed in saliva and colonised by what we refer to as salivary pellicles, the composition of which is predominantly glycoproteins. This essentially acts as an adhesive that, within hours of forming, bacteria can bind to. These initial bacteria begin to spread throughout the mouth, multiplying and maturing, eventually forming micro-colonies otherwise known as the plaque biofilm. Although over 100 different bacterial species can make up the plaque biofilm, the bulk are Streptococcus mutans and other anaerobic species. These bacteria all occur naturally in the oral cavity and are normally harmless.
Dental plaque forms because the warm and moist environment of the mouth and the presence of teeth make for a good environment for its growth and development. Our own saliva no less contains primary nutrients such as amino-acids, proteins and glycoproteins (these again!) which feed the bacteria in the early stages of plaque formation. In addition, our saliva will act to buffer the PH (acidity) of the oral cavity to levels that these bacteria thrive at.
The bacteria nearest the tooth surface typically obtain energy by fermenting dietary sugars (especially sucrose). During fermentation they begin to produce acids as a by-product and it is these acids that are capable of causing localised destruction to the tissues of the body: either in the form of destroying the hard surface coatings of the tooth (enamel and dentine) resulting in dental caries/decay or by eliciting a host-mediated inflammatory response in the gums (gingivitis, leading to periodontitis if not treated). These acid-loving and decay/gum disease-causing bacterial populations are maintained by frequent consumption of fermentable dietary carbohydrates, such as sugars and starches.
Dental plaque initially forms above the gum line within hours of tooth-brushing and is most commonly seen between the teeth, in the pits and grooves of the teeth. This is referred to as supragingival plaque and is made up of mostly aerobic bacteria, ie. those that need oxygen to survive. Plaque continues to migrate under the gum line into ‘pockets’ around the tooth, to become subgingival plaque. This is located in environments which suit the growth of anaerobic bacteria (those that thrive when there is no oxygen).
Calculus, also referred to as tartar, can form in as little as 24 hours if the dental plaque is allowed to build up. It is formed by the calcification of plaque left on the surfaces of teeth in conjunction with minerals in your saliva such as calcium. Depending on the ‘makeup’ of you saliva, in some people, it may develop more rapidly than others.
“Calculus is tough and cannot be removed by tooth brushing or with interdental cleaning aids such as flossing but only through professional cleaning. It commonly traps stains and leads to discolouration of the teeth.”
How bad is plaque and calculus?
The acid-producing bacteria that causes plaque and calculus have the ability to destroy the hard, protective coatings of your teeth leading to cavities and with it can come pain and sensitivity. This tooth pain is one of the detrimental effects of leaving dental plaque in contact with the teeth for too long. Additionally, the other serious problems that can occur are the periodontal diseases. These are also known as gum diseases and are a set of inflammatory conditions affecting the tissues surrounding the teeth. In its early stage, called gingivitis, the gums become swollen, red and may bleed. There may be associated halitosis (bad breath) and a persistent metallic taste in the mouth. Most forms of gingivitis are plaque induced.
Luckily, gingivitis is reversible with good oral hygiene practices, however without treatment, it can progress to periodontitis. Here, the persistent inflammation of the gums results in tissue destruction and bone resorption around the tooth. Ultimately it can lead to teeth becoming loose and eventually lost.
What's the bigger picture for your body?
There is growing evidence that periodontitis ( a chronic inflammatory process) is associated with various systemic diseases such as cardiovascular disease and diabetes, chronic kidney disease, certain types of cancer, cognitive impairment and adverse pregnancy outcomes. Certainly, more research is needed before we can give strong evidence of causative factors, but that should not prevent us from taking a pragmatic approach in promoting good oral health that will ultimately benefit general health. Your dental professional is ideally situated as a front line health practitioner in their ability to address shared modifiable risk factors such as smoking, diabetes control and diet advice.
How to prevent plaque from damaging your mouth:
For a healthy smile, you must practice good oral hygiene every day. Removing plaque on a daily basis lessens your chances of calculus build-up and more serious dental problems such as cavities, gingivitis and bad breath.
You can manage plaque in three ways:
Brushing and flossing every day,
Managing your diet and decreasing your sugar intake,
Visiting your dentist regularly.
The best way to prevent tooth decay and remove [plaque from your tooth surfaces is brushing and cleaning between your teeth every day. Dental professionals recommend brushing your teeth for 2 minutes twice a day (ideally once in the morning and once before you go to bed). This means each quadrant of your mouth gets 30 seconds of brushing time. When you’re finished brushing in each quadrant be sure to brush your tongue to remove odour-causing bacteria.
Here are some brushing tips:
Brush your teeth using a small-headed soft bristled toothbrush to be able to reach all areas easily.
Place your toothbrush at a 45-degree angle against the tooth/gum line.
Move your toothbrush back and forth in short, gentle stokes the same width as each of your teeth.
Brush the outer tooth surfaces, the inner tooth surfaces and then the chewing surfaces of the teeth.
Using the tip of the brush you can clean the inside surfaces of the front teeth using a gentle up and down stroke.
You might also consider using an electric toothbrush, which can be more effective at removing plaque than a traditional one.
Research shows the use of fluoridated toothpaste also helps protect your teeth from decay.
Flossing or using similar interdental cleaning aids such as mini interdental brushes will help to loosen food debris between your teeth and reach sites your toothbrush can’t get to.
Here are some flossing tips:
Taking a length of floss about 40 cm long wrapping one end around each of your middle fingers.
Hold floss tightly between your thumbs and forefingers, then gently guide the floss between two teeth until it reaches the gumline.
Move floss into a ‘C’ shape on the side of one tooth and rub the floss up and down gently, pressing it against the side of the tooth.
Repeat this process for all your teeth, taking care to floss behind the back teeth as well.
In addition to daily brushing and flossing, antimicrobial mouth rinses can reduce bacterial activity and plaque accumulation. Fluoride mouth rinses also help reduce and prevent tooth decay but should never be used to replace brushing and flossing, only accompany them.
The second way in which you can manage plaque is through your diet. Limiting plaque with diet is simple to understand but can be difficult to execute. Eating a balanced healthy diet that’s low in added sugars ( think: fresh vegetables, whole grains and lean proteins) can reduce the food source of the sugar-loving bacteria in our mouths and reduce the build up of dental plaque. Try and reduce your daily consumption of sweetened drinks and replace them with milk, yoghurt or water. Even using a straw will help reduce the contact of sweetened beverages with your teeth. If you have access to it, drink plenty of fluoridated water with meals, helping to wash away the sugar and acids and offer further protection to the teeth from decay. Aim to limit the number of snacks between meals.
Finally, be sure to visit your dentist regularly for preventative care and calculus removal. For many patients the recommended time is 6 months but some people require more regular visits, to give the dentist and hygienist the best chance of maintaining a healthy mouth. On the flipside of this, there will be a group of patients who only need to see their dentist once a year. Ask your dentist what is recommended for you and remember that the teeth are part of an ecosystem that is your body. If you neglect them, your whole body is at risk.