You are on page 1of 7

Jessica Fox

Preventive Dentistry

Bacterial Plaque and It’s Relation to Dental Diseases

Bacterial Plaque, also known as biofilm, is a mass of microorganisms and bacterial

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

with mechanical brushing. (Wilkins, 2017, P. 258).

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

an extracellular polymeric substance or EMS. This matrix is made up of sticky polysaccharide,

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

increasing. (Wilkins, 2017, p. 259).

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

communicate via chemical signal molecules. (Miller, 2001).


In the fifth stage of biofilm formation, the formed bacterial matrix releases their own

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

bacteria accumulate. (Clark, 2017).

The strong calcified structures of a tooth, the enamel, dentin and cementum, can be

softened or broken down by this process. This is called demineralization. Demineralization

occurs when the tooth is exposed to fermentable carbohydrates. These fermentable

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

the caries process. (Wilkins, 2017, p. 265).

Caries is a disease process leading to decay of the teeth. It is a chemical reaction

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

surface, and deeper lesions. (Badet, 2008).

Demineralization and remineralization are constantly occurring in the oral cavity.

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

to an increase in caries. (Dental Caries, 2014).

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

cause of periodontal diseases and periodontitis, calculus is a significant contributing factor.

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

increase in calcium, magnesium and fluoride. (Clark, 2017).

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,

healthy state. (Clark, 2017).

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).

Gingivitis leads to periodontitis. Periodontitis is inflammation of the supporting

structures in the mouth. The alveolar bone of the jaw has all the teeth of the mouth anchored

to it by each tooth’s periodontal ligament. (Cavanagh, 2017). This ligament is made up of

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

and loose teeth.

It is important to remember that, while periodontitis effects almost half of American

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

teeth and initiating the decay process.

Implementing these prevention techniques can help you stay ahead of bacterial plaque.
Works Cited

Bacterial Plaque. 8th ed. Elsevier Health Sciences; 2008. https://medical-


dictionary.thefreedictionary.com/bacterial plaque. Accessed November 8, 2017.

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.

Cavanagh J. Dental Anatomy. 2017.

Clark S. Preventive Dentistry. 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.

You might also like