Dental plaque
Dental plaque is a
Progression and build-up of dental plaque can give rise to tooth decay – the localised destruction of the tissues of the tooth by acid produced from the bacterial degradation of
Plaque formation
Dental plaque is a biofilm that attaches to tooth surfaces,
Components of plaque
Different types of bacteria are normally present in the mouth. These bacteria, as well as
Bacteria
The bulk of the
The bacterial equilibrium position varies at different stages of formation. Below is a summary of the bacteria that may be present during the phases of plaque maturation:
- Early biofilm: primarily Gram-positive cocci
- Older biofilm (3–4 days): increased numbers of filaments and fusiforms
- 4–9 days undisturbed: more complex flora with rods, filamentous forms
- 7–14 days: spirochetes, more Gram-negative organisms[10]
Dental plaque as a biofilm
Dental plaque is considered a biofilm adhered to the tooth surface. It is a meticulously formed microbial community, that is organised to a particular structure and function.[11] Plaque is rich in species, given the fact that about 1000 different bacterial species have been recognised using modern techniques.[12]
A clean tooth surface would immediately be colonised by salivary pellicles, which acts as an adhesive. This allows the first bacteria (early colonisers) to attach to the tooth, then colonise and grow. After some growth of early colonisers, the biofilm becomes more compliant to other species of bacteria, known as late colonisers.[12]
Early colonisers
Source:[12]
- mainly Streptococcus species (60–90%)
- Eikenellaspp.
- Haemophilus spp.
- Prevotella spp.
- Propionibacterium spp.
- Capnocytophaga spp.
- Veillonella spp.
Late colonisers
Source:[12]
- Aggregatibacter actinomycetemcomitans
- Prevotella intermedia
- Eubacterium spp.
- Treponema spp.
- Porphyromonas gingivalis
Fusobacterium nucleatum is found between the early and late colonisers, linking them together.
Some salivary components are crucial for plaques ecosystem, such as salivary alpha-amylase which plays a role in binding and adhesion.[13] Proline-rich proteins (PRP) and statherins are also involved in the formation of plaque.[12]
Supragingival biofilm
Supragingival biofilm is dental plaque that forms above the gums, and is the first kind of plaque to form after the brushing of the teeth. It commonly forms in between the teeth, in the pits and grooves of the teeth and along the gums. It is made up of mostly aerobic bacteria, meaning these bacteria need oxygen to survive. If plaque remains on the tooth for a longer period of time, anaerobic bacteria begin to grow in this plaque.[5]
Subgingival biofilm
Subgingival biofilm is plaque that is located under the gums. It occurs after the formation of the supragingival biofilm by a downward growth of the bacteria from above the gums to below. This plaque is mostly made up of anaerobic bacteria, meaning that these bacteria will only survive if there is no oxygen. As this plaque attaches in a pocket under the gums, they are not exposed to oxygen in the mouth and will therefore thrive if not removed.[10]
The extracellular matrix contains proteins, long-chain polysaccharides and lipids.
The most common reasons for ecosystem disruption are the ecological factors discussed in the
Antibodies to the oral pathogens Campylobacter rectus, Veillonella parvula, Prevotella melaninogenica were associated with hypertension.[15]
Environment
Unlike other parts of the body, tooth surfaces are uniquely hard and non shedding. Therefore, the warm and moist environment of the mouth and the presence of teeth, makes a good environment for growth and development of dental plaque.
Consequences of plaque build-up
Gingivitis
Periodontitis
Periodontitis is an infection of the gums which leads to bone destruction around the teeth in the jaw. Periodontitis occurs after gingivitis has been established, but not all individuals who have gingivitis will get periodontitis.
Diseases linked to periodontitis
Accumulated bacteria, due to the onset of periodontitis from dental plaque, may gain access to distant sites in the body through the circulatory and respiratory system, potentially contributing to various systematic diseases and conditions. Due to the infectious nature of bacteria hosted within the oral cavity, bacteria produced cavity can spread within the system of the human body and causes adverse health conditions.
- Atheromas[27]
- Cardiovascular disease[28]
- Respiratory disease[29]
- Diabetes mellitus[30]
Caries
- Low fluoride exposure
- Time, length, and frequency of sugar consumption
- Quality of tooth cleaning
- Fluctuations in salivary flow rates and composition
- Behavior of the individual
- Quality and composition of biofilms[1]
Organic acids released from dental plaque lead to demineralization of the adjacent tooth surface, and consequently to dental caries. Saliva is also unable to penetrate the build-up of plaque and thus cannot act to neutralize the acid produced by the bacteria and remineralize the tooth surface.
Detection of plaque build-up
There are two main methods of detecting dental plaque in the oral cavity: through the application of a disclosing gel or tablet, and/or visually through observation. Plaque detection is usually detected clinically by plaque
It is important for an individual to be aware of what to look for when doing a self-assessment for dental plaque. It is important to be aware that everyone has dental plaque, however, the severity of the build-up and the consequences of not removing the plaque can vary.[1]
Plaque disclosing gel
Plaque disclosing products, also known as disclosants, make plaque clinically visible. Clean surfaces of the teeth do not absorb the disclosant, only rough surfaces. Plaque disclosing gels can be either completed at home or in the dental clinic. Before using these at home or in the dental clinic check with your general practitioners for any allergies to iodine, food colouring or any other ingredients that may be present in these products. These gels provide a visual aid in assessing plaque biofilm presence and can also show the maturity of the dental plaque.
Disclosing tablets
Disclosing tablets are similar to that of disclosing gels, except that they are placed in the mouth and chewed on for approximately one minute. The remaining tablet or saliva is then spit out. Disclosing gels will show the presence of the plaque, but will often not show the level of maturity of the plaque. Disclosing tablets are often prescribed or given to patients with orthodontic appliances for use before and after tooth brushing to ensure optimal cleaning. These are also helpful educational tools for young children or patients who are struggling to remove dental plaque in certain areas. Disclosing gels and tablets are useful for individuals of all ages in ensuring efficient dental plaque removal.
Visual or tactile detection
Dental biofilm begins to form on the tooth only minutes after brushing. It can be difficult to see dental plaque on the hard tissue surfaces, however it can be felt as a rough surface. It is often felt as a thick, fur-like deposit that may present as a yellow, tan or brown stain. These deposits are commonly found on teeth or dental appliances such as orthodontic brackets. The most common way dental plaque is assessed is through dental assessment in the dental clinic where dental instruments are able to scrape up some plaque. The most common areas where patients find plaque are between the teeth and along the cervical margins.
Treatments
Mouthwash has been a commonly used method for controlling dental plaque accumulation. Many studies have supported the fact that mouthwash containing alcohol might not be the best option. The absence of alcohol in mouthwash, has prompted many new and old mouthwash brands to develop new mouthwashes with essential oils.
In 2018, a study done on effectiveness of commercially available essential oil mouth-rinse. A placebo and a negative control was used, with the negative control being mouthwash without essential oils. Three groups of healthy volunteers were induced with experimental gingivitis, used their respective mouthwash, and monitored for three weeks. The results showed that the commercial mouthwash with essential oils did significantly better on plaque scores. Results showed that the plaque scores for the essential oil mouthwash was not low enough to prevent gingivitis. The researchers concluded that the benefit of essential oil mouthwash is questionable and requires further research.[32]
Research done by the US National Institute of Health in 2022 studied the antimicrobial properties and effects of a lemongrass essential oil mouthwash.[33] They found that the lemongrass was a natural, herbal material that was a good substitute to alcohol in mouthwash. The stability of the lemongrass allows it to have antimicrobial properties against the organisms that cause plaque. A decrease in plaque formation, lowers the chances of gingivitis occurring.
A study conducted in 2022, with a sample of 209 participants, studied the effect of using a mouthwash that contained a mixture of four essential oils versus just brushing and flossing. It showed that after 12 weeks, those who rinsed with the essential oil mouthwash had significantly reduced plaque and improved their gingivitis compared to the groups that only brushed and flossed.[34]
A meta-analysis conducted in 2021, reviewed the effectiveness of various mouthwashes and their active ingredients on plaque. The American Dental Association database was used to collect studies. A total of 22 papers were selected for the overview. Four of the papers selected, all meta-analyses, showed that essential oils had substantial antiplaque activity. The researchers concluded that essential oils and chlorhexidine are the two ingredients that are most useful in having good oral health.[35]
A study involving 20 participants found that mouthwash containing Magnolia grandiflora bark extract performed significantly better than placebo at reducing the prevalence of Streptococcus mutans.[36]
Plaque in dogs and cats
Dental plaque is also extremely common in domestic animals such as dogs and cats. However, the bacteria associated with canine and feline plaque appear to be different from those of humans.[37][38] It consists of causing periodontal inflammation and triggers the animal’s immune system. Two common distinctions that derive from periodontal are gingivitis which is the inflammation and periodontitis that involves the reactions of gingivitis causing severe gum disease such as periodontitis that can ultimately cause the loss of the tooth.[39]
The periodontal disease is most attracted to the age and weight that the animals are currently in. The older and heavier they are the more likely they will catch the disease. A study of 9 female and 5 male dogs varying breeds and ages from 1-14 emphasize the relation of Periodontal with age and no relation regarding breed or sex. A total of 50% of them were detected with the disease.[40]
The antibiotics that are a common usage for animals are antimicrobials ranging from clindamycin, amoxicillin-clavulate and amoxicilin. These antimicrobials are common to use in dental procedures for animals in the United States. A study was done were a total of 818,150 dogs and cats that resulted in the evident promotion of antimicrobials in retaining periodontitis. Other studies have been done that establishes food debris to not being a concerning factor regarding the cause of dental plaque. In a 4 year study on a Beagle dog has been put to eat a strict diet without any oral hygiene that led to the accumulation of gingivitis in just a few weeks. However, some dogs were put in the similar diet with hygiene precautions of daily brushing their teeth showed no signs of gingivitis.[41]
Dog and Cat Owner's Ideas of What Is Causing Dental Problems
Animal's oral health are viewed differently by their owners. Some believe that dry animal foods or even if moistened negatively impact the dental health of animals. There are others that believe marrowbones can lead to fractures and discomfort while others believe it can strengthened their oral health.
Difference in breeds are also familiar occurrences where owners disagree on. Many comprehend that distinctive breeds are more prone for health issues compared to others while when it comes to periodontitis is a smaller factor. There are sayings of "my dog has good teeth for their age" supports the idea as animals grow older the worse their dental features are as well as with their weight.[42]
It is important to take care of your pets not only keeping them clean and providing them with healthy foods but also orally clean to avoid discomfort and diseases.hence veterinarians often recommend oral healthcare products for affected pets.
See also
- Dental disease
- Flossing
- Gingiva
- Oral hygiene
- Oral microbiology
References
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External links
- A Biofilm Primer Archived 2018-07-16 at the Wayback Machine