Professional Documents
Culture Documents
Preventive Dentistry
colonies within a matrix. A biofilm may contain water, amino acids, carbohydrates, proteins,
lipids, food particles, and a variety of bacteria depending on its stage in formation. (Bacterial
Plaque, 2017).
Bacterial plaque forms via predictable, complex interactions. The formation of bacterial
plaque, begins with single celled, planktonic bacteria. These bacteria cells are free in the mouth,
but begin to attach to the tooth’s pellicle. These planktonic bacterial cells are predominately
gram-positive cocci, streptococci. They can be disrupted and removed from the tooth’s surface
If these cells are not disrupted, the second and third stages of biofilm formation will
commence. The bacteria form a stronger bond to the teeth and colonize. These beginning
colonies of bacteria multiply in a layered form. They also produce their very own matrix called
glucans and fructans. This EMS ensures an irreversible attachment of the bacterial plaque to
the tooth. This protects the colony and allows it to continue to grow. The bacteria in these
stages are still primarily gram-positive cocci, but the number of rod and filamentous forms is
During the fourth stage of formation, the biofilm continues to grow. New layers of
bacteria continually adhere to the attached biofilm. This bacterial organization now begins to
planktonic cells in hopes they will spread and colonize in other areas of the mouth. In these
final stages of biofilm formation, some very scary, motile, gram-negative vibrios and spirochete
The strong calcified structures of a tooth, the enamel, dentin and cementum, can be
carbohydrates are taken into the biofilm and the pH in the mouth changes because an acid is
produced. With repeated exposure, or without removing the biofilm, this acid will break down,
soften or demineralize a tooth. This leads to the formation of a cavity and is the beginning of
involving the bacteria that cause cavities. Two groups of acid-forming bacteria are the main
culprits in the caries process. Strep Mutans and Lactobacilli. Strep Mutans are gram-positive,
round bacteria and the initiators of decay. They help to form the sticky environment necessary
for the biofilm to thrive. W, 436. Lactobacilli are associated with progression of tooth decay.
(Loesche, 1996). They are very tolerant of living in acidic environments and are capable of
producing their own acid. This lactic acid aids in further softening, breakdown of the tooth
However, in order for remineralization to occur, the pH in the mouth must be above 5.5. When
eating, acid is formed from the bacterial plaque and the pH in the mouth typically drops below
5.5. (Dental Caries, 2014). Between meals, the pH in the mouth returns to normal allowing
minerals lost during eating to be replenished by the saliva. (Loesche, 1996). Frequent snacking
or consumption of sugar allows less time for the pH of the moth to be above 5.5 and thus, less
time for remineralization to occur. Putting the tooth in a state of consistent mineral loss. The
sustained acidic pH also creates a habitable environment for Strep Mutans and Lactobacilli.
(Loesche, 1996). This frequency, rather than quantity of sugar intake, is overwhelmingly linked
Calculus is a contributing factor for a variety of oral issues including the demineralization
and the caries process. When plaque is not removed, it hardens into calculus, calcified plaque.
This can occur after just 24 hours. Calculus is adhered so strongly, that it can no longer be
removed by brushing. Calculus and plaque have a strong relationship. Although plaque is the
Calculus provides a suitable surface for plaque to adhere and allows the plaque to travel below
the gum line. Supragingival calculus is found above the gum line and commonly near openings
of salivary glands. It is commonly a white or tan color and contains minerals such as; phosphate,
calcium carbonate, magnesium, sodium, potassium, and traces of fluoride, zinc and strontium.
Subgingival calculus is found below the gum line. It can be seen as black or dark green in color.
Subgingival calculus forms in rings or ledges and contains many of the same minerals, with an
When bacterial plaque or calculus is present along or below the gingival margin,
gingivitis can result. Gingivitis is inflammation of the gingival tissue. In its initial stages, swelling
and irritation of the gums is present, but often painless and goes unnoticed by the patient.
There may be a color change of the gingival tissue from a healthy pink to red. The body feels
there is an infection and sends white blood cells to clear it. This can result in bleeding, swelling
and exudate. Thankfully, gingivitis is reversible. Bacterial plaque is the cause, so removing it
with 7 days of proper brushing and flossing will heal the gingiva and return them to a normal,
However, if the bacterial plaque is not removed, the body’s immune response will take
over and serious periodontal disease can develop. As previously stated, calculus aids bacterial
plaque in moving below the gum line by providing it with an affinitive surface to proliferate.
This causes more irritation to the gingiva and worsens gingivitis. The tight gum to tooth
adherence is loosened, pockets form and the root may become exposed to demineralization. As
the gingivitis process continues the gums may appear to be maroon or blue in color, rather than
red or healthy pink, due to the increased amount of blood and dead, oxygen depleted cells.
(Clark, 2017).
structures in the mouth. The alveolar bone of the jaw has all the teeth of the mouth anchored
connective tissue and collagen fibers that span from the alveolar bone of the jaw to the
cementum surrounding the root of each tooth. The periodontal ligament itself is very strong. It
is tightly adhered to the cementum and alveolar bone of the tooth sockets which keeps the
teeth firmly in their place. (IQWig, 2014). The junctional epithelium surrounds each tooth just
below the sulcus on the cementum. It forms a tight seal and helps to control bacterial passage.
Progressive destruction of the periodontal ligament and bone loss can be seen with
periodontitis. Periodontitis is caused by bacterial plaque and biofilm collecting on the teeth and
within the oral cavity. Periodontitis leads to periodontal diseases. These are infectious diseases
that arise when oral home care is not sufficient and periodontitis is present. (Wilkins, 2017, p.
312). The inflammatory response to the bacterial plaque can occur in as little as 2-4 days. Like
gingivitis, no clinical signs may be seen initially. After 1-2 weeks, the bacterial plaque and
biofilm have begun to mature and grow. This allows the clinical signs of gingivitis and bleeding
on probing to be evident. Even at this stage, reversal of this process is possible with the
removal of the dental biofilm. But, if not removed, the process will continue and worsen.
Destruction of the alveolar bone and destruction of the connective tissue comes next. The
strong connective tissues of the periodontal ligament are no match for the bacteria developing
from the biofilm. The pocket of detached gingiva around the tooth gets deeper. The exposed
cementum covering the root of the tooth is weakened. The junctional epithelium tries its best
to keep its seal, but it is forced lower and lower on the tooth. At this point, a deep pocket of
greater than 4mm or significant recession of the gingiva is present. The tooth has little to hang
on to and becomes mobile. (Wilkins, 2017, p. 317-319). Throughout the process, the patient
may report sensitivity, tenderness, bleeding of the gums when eating or brushing, bad breath
adults, it is all preventable and reversible. (Eke, 2012). The bacterial plaque in dental biofilm is
the cause of it all. Those tiny microbes cause the bleeding, the inflammation, the destruction.
They are rude, so get rid of them. Mechanical brushing with a soft bristled brush 1-2 times each
day with the brush at a 45 degree angle to the gingiva, ideally, daily flossing, down into the
sulcus, between each tooth, and seeing a dental office for deep cleanings and evaluations every
6 months will help. It is also beneficial to alter your diet. Adjust your fermentable carbohydrate
intake frequency and order of consumption. Include fluoride in your daily water consumption.
Chew gum with xylitol after a meal or snack to help prevent some bacteria from sticking to your
Implementing these prevention techniques can help you stay ahead of bacterial plaque.
Works Cited
Badet C, Thebaud NB. Ecology of Lactobacilli in the Oral Cavity: A Review of Literature. The
Open Microbiology Journal. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2593047/.
Published April 29, 2008. Accessed November 12, 2017.
Eke PI, Dye BA, Thorton-Evans GO, Genco RJ. Prevalence of Periodontitis in Adults in the
United States. American Academy of Periodontology.
https://www.perio.org/consumer/cdc-study.htm. Published September 4, 2012. Accessed
November 12, 2017.
Foundation DH. Dental Caries (Tooth Decay) » Causes of oral ill health » Introduction » Dental
Health Foundation. Dental Health Foundation.
https://www.dentalhealth.ie/dentalhealth/causes/dentalcaries.html. Published November
20, 2014. Accessed November 12, 2017.
IQWiG. How does the periodontium work? National Center for Biotechnology Information.
https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072803/. Published June 13, 2014.
Accessed November 12, 2017.
Loesche WJ. Microbiology of Dental Decay and Periodontal Disease. Medical Microbiology. 4th
edition. https://www.ncbi.nlm.nih.gov/books/NBK8259/. Published January 1, 1996.
Accessed November 12, 2017.
Miller MB, Bassler BL. Quorum sensing in bacteria. Annual review of microbiology.
https://www.ncbi.nlm.nih.gov/pubmed/11544353. Published 2001. Accessed November
12, 2017.
Wilkins EM. Clinical Practice of the Dental Hygienist. 12th ed. Philadelphia, PA: Wolters
Kluwer; 2017.