Kelsi Phipps

Preventive Dentistry

Bacterial Plaque and It’s Relation to Dental Diseases

The health of your mouth is extremely important. In order to have a healthy mouth it is

important to know the role plaque plays in the oral cavity. Plaque is a sticky, colorless film of

food and bacteria that is constantly forming on your teeth. Plaque is directly involved with

diseases of hard and soft tissue of the mouth. This includes decay, gingivitis, and periodontitis.

Once the bacteria in your mouth combines with food, it forms an acid and that acid will start to

attack your tooth causing decay. Plaque’s composition differs from one individual to another.

Plaque’s composition is made up of organic and inorganic solids, water, and microorganisms.

The formation of plaque begins with acquired pellicle, this pellicle forms on teeth and is

composed of glycoproteins that are found in sugar and saliva. Bacteria then attaches to the

pellicle and the bacteria uses the sugars from the food and beverages we can consume along

with saliva to thrive and multiply. The biofilm matures and eventually forms plaque. The

maturation of the microorganisms starts with a gram-positive coccus. If oral hygiene is

nonexistent, the cocci get replaced by rods and begin to move from one tooth to another tooth.

After about a week, vibrios, spirochetes, gram-negative cells and white blood cells appear.

White blood cells help fight against the infection that is starting to form in the mouth. After 2

weeks, there is a lot of bacteria in the mouth and gingivitis is present.

Dental caries is a disease caused by bacterial plaque. Caries is the breakdown of enamel

or lost mineralization. The process of demineralization starts with cariogenic foods

(carbohydrates, sugars), bacteria in the mouth, and a susceptible host (tooth). An acid forms
when all three things are present. This acid will begin to breakdown the enamel causing dental

caries. Some health professionals will say to eat multiple meals a day, but every time food is

consumed the bacteria feeds off of that and starts the decay process. The two main bacteria

involved in this process is streptococci (streptococcus mutans and streptococcus sobrinus) and

lactobacillus. Bifidobacteria is the bacteria mostly involved with childhood caries. The bacteria

combines with consumed food and the acid is formed, then the demineralization process

begins. If a patient is eating multiple meals a day, demineralization is most likely happening

more frequently than remineralization. The first stage of dental caries is the initial infection,

which is usually invisible. A subsurface infection is created then a white spot is noted. Once the

white spot is noted, it is usually observed as an open cavity using no instruments for detection.

The caries process is pretty fast, so it is important that oral hygiene is a daily routine. A person

can even rinse their mouth with water after eating to get some of the food washed away

instead of having it sit on their teeth.

Not only does plaque cause dental caries, it can also cause calculus. Once plaque stays

on the teeth for so long, it can harden into tartar or calculus. Calculus is biofilm that is

mineralized with calcium and phosphorous. Calculus can be above the gum line, called

supragingival calculus or below the gum line, called subgingival calculus. Supragingival calculus

is usually bulky whereas subgingival calculus has somewhat taken the shape of the periodontal

pocket and is flattened and smooth. Having good oral hygiene at home can help prevent

calculus. Brushing at home can remove the plaque, but not calculus. Calculus has to be

removed by a dental professional. The power point from class specifically said, “90% of

treatment time is spent on removing calculus.” Calculus is hard and tenacious, hints why it
cannot be removed at home with a toothbrush or floss. Not only is calculus found on the tooth

surface, it can also be found on dentures, dental implants, and other dental appliances. Calculus

is composed of water, organic and inorganic elements. If calculus has been on a surface for a

long time, it is made up of inorganic elements. The calculus that may not have been there that

long is mostly organic elements and water. A dental professional has to look at the appearance

of the calculus, consistency and distribution before removing it. Calculus will cause

inflammation of the gums, bleeding, and could possibly lead to bone loss if it is not removed.

The bacteria that lives on the calculus will start to eat away at the bone. Once that bone is lost,

it cannot come back. As harsh as calculus may sound, it does not cause dental disease. Plaque is

what causes these dental diseases that have and will continue to be discussed. Calculus will

contribute to further diseases, such as gingivitis and periodontal disease.

Gingivitis is directly associated with the presence of plaque. Gingivitis is the

inflammation of gingival tissues. It is the most common human disease but often goes

unrecognized. It is painless and easy to control. The most common cause of gingivitis is poor

oral hygiene. A healthy patient’s gums will be pink, tight, and have a stippled texture. If a

patient has gingivitis, the gums will be red, puffy, and will bleed easily. Gingivitis occurs within

10-21 days. It is important to disrupt plaque daily. If it is not, it can harden into calculus. The

bacteria on the calculus can irritate the gums causing them to be inflamed. This is when

gingivitis is present. Gingivitis can be described as generalized or localized. Generalized

gingivitis is if at least thirty percent of the mouth has it. Localized would be less than thirty

percent of the oral cavity had gingivitis. At this stage, the disease can be reversed within 7 days

of controlled plaque. With regular dental cleanings and good home care, a patient can easily
reverse this disease. If a patient is not willing to have good oral hygiene, this disease can get

worse. It can eventually turn into periodontal disease.

Without treating gingivitis, it can lead to periodontitis. The gums are inflamed and

infected. The infection lays in the socket, it will start to pull away from the teeth and the teeth

may become loose. Teeth become mobile and some may even fall out. Bone loss is a

characteristic of periodontitis. Once the bone is lost, it cannot be replaced. It can often be

painless, so some individuals do not know they have it. That is why regular dental checkups are

so important. During periodontitis, subgingival calculus is frequently present. Some clinical

signs of periodontal disease include inflamed tissue, bleeding on instrumentation, and bluish

red tissue. Chronic periodontitis is the relation to plaque and calculus. Once plaque hardens

into calculus, that calculus needs to be removed by a dental professional. If it is not, it will

eventually lead to periodontitis. The best way to see and diagnose periodontitis is in the chronic

form. X-rays and probing measurements are very helpful aids. Probing measurements are

usually 5mm and greater on someone with periodontal disease. Along with gingivitis,

periodontitis can be generalized or localized. Clinical attachment loss is the most reliable

documentation. It is documented by the severity. Slight is 1-2mm, moderate is 3-4mm, and

severe is greater or equal to 5mm. A general practice can usually treat slight to moderate

periodontitis. If it is severe, the patient may have to go to a periodontal specialist. Periodontal

disease can be linked to systemic diseases. Someone with diabetes may have an onset of at an

early age. Diabetes is a contributing factor for periodontal disease. A person with HIV is at a

greater risk for periodontal disease due to rapid destruction. It is extremely important the

patient knows that if this disease goes untreated, their teeth will become loose and they can
have a lot of sensitivity. The patient needs to be aware they may have to visit a dental

professional more frequently than every 6 months. The patient also needs to be committed to

home care. If they do not do what they are supposed to at home, the professional care they

receive will only help them for so long.

Being educated about home care and seeing a dental professional regularly is important

in the prevention of all the diseases plaque can control. At home care would consist of brushing

at least twice a day and flossing once a day. This can help prevent the build up of plaque. The

more plaque there is, the more chances for diseases such as, caries, gingivitis, and periodontal

disease. Regular dental cleanings are usually every 6 months. The patients with advanced

diseases, such as, periodontal disease need to be made aware that their checkup appointments

might be more frequent in order to control the disease. A patient’s diet will also play an

important role in prevention. They need to be made aware of the frequency they consume

cariogenic foods. The more frequent they consume these foods, the more acid there will be and

the acid will destroy the enamel causing decay. The prevention of these diseases is very

important in maintaining a healthy mouth. The patient is in control of their own actions and will

hopefully take our, dental professionals, word and continue good prevention techniques.
 Bibliography

Clark, S. (2018) Preventive Dentistry Class Notes, Kirkwood Community College

Mayo Staff Clinic. (2017, August 04). Gingivitis. Mayo Clinic. Retrieved from
https://www.mayoclinic.org/diseases-conditions/gingivitis/symptoms-causes/syc-
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Wilkins, Esther M. (2017). Clinical practice of dental hygienist – 12th edition.

(2013, February 14). What is Dental Plaque. The College of Health Care Professionals. Retrieved
from https://www.chcp.edu/blog/what-dental-plaque

(2018). Gum Disease. Mouth Healthy. Retrieved from https://www.mouthhealthy.org/en/az-

topics/g/gum-disease