It All Begins with Plaque
In the oral cavity, bacteria exist within a complex biofilm called dental plaque. This biofilm forms on the surface of teeth, dental implants, and prostheses such as crowns, bridges, and dentures. Plaque formation is a continuous process and occurs in everyone, unless completely edentulous or without dental prostheses.
Key Characteristics of Plaque:
- Contains various bacterial species within an organised matrix.
- Protects bacteria from the host’s immune system and chemical agents.
- Grows in complexity and pathogenicity the longer it remains undisturbed.
Plaque often forms a whitish-yellow layer that adheres firmly to teeth and prostheses, primarily around gum margins and between teeth. Initially, plaque develops above the gum line, but as periodontal disease progresses, it accumulates below the gums.
Impact on Oral Health:
- Periodontal Disease: Bacteria produce chemicals that trigger inflammation and disease.
- Dental Caries: Plaque bacteria break down dietary sugars into acids, leading to tooth decay.
Prevention Tip:
Avoiding plaque build-up is key to maintaining oral health. Cleaning regularly with tools like The Teeth Keeper Interdental Brushes and The Precision Brush ensures effective removal, even between teeth.
Read our blog on Achieving Oral Health and Well-being for detailed plaque control strategies.
Risk Factors That Favour Plaque Accumulation
Certain conditions make it easier for plaque to accumulate or harder to remove effectively. Below are some common factors:
1. Calculus (Tartar)
- Hardened plaque forms rough surfaces that trap more biofilm.
- Appearance: Yellow above the gum line; brown-black below the gums.
- Requires professional removal by a dental hygienist or periodontist.
2. Poor Dexterity
Individuals with limited manual skills—such as young children, the elderly, or those with arthritis—may struggle with effective plaque removal.
- Solution: Ergonomically designed brushes like The Teeth Keeper Interdental Handle make access to all areas easier.
3. Anatomical Variations
Grooves, concavities, and gum recession create hard-to-clean areas that harbour plaque.
- Professional guidance or specialised tools, like The Precision Brush, can help.
4. Teeth Malposition
Crowded, rotated, or overlapping teeth increase plaque retention.
- Orthodontic treatment may be recommended.
- Use of precision brushes, such as The Precision Brush can aid in cleaning difficult areas.
Case Example:
A case of crowded and rotated teeth resulting in inflammation
5. Gum Hyperplasia
Swelling or overgrowth of gums, caused by medications (e.g., amlodipine) or hormonal changes, makes plaque control difficult.
- Regular professional cleaning and specialised brushes for tight areas.
- Medication adjustments may be required under medical supervision.
Case Example:
Gingival hyperplasia caused by the blood pressure medication, amlodipine
6. Poorly Designed Dental Restorations
Improperly fitted fillings, crowns, or bridges trap plaque and complicate cleaning.
- Restorations should be evaluated and modified for easier hygiene practices.
Systemic Risk Factors
These factors alter an individual’s biological response to plaque, complicating periodontal disease management.
1. Family History of Periodontitis
Genetic predisposition increases susceptibility to periodontal disease. Preventive care and plaque control are critical for those with family history.
2. Smoking
- Smokers are six times more likely to develop periodontal disease.
- Smoking impairs healing and exacerbates bone loss.
- Stopping smoking significantly improves treatment outcomes and overall health.
3. Diabetes
- Poor glycaemic control increases risk and severity of periodontal disease.
- Regular HbA1c tests are essential for monitoring.
- Improved oral health positively impacts diabetes management and vice versa.
4. Stress
Although evidence is limited, stress may worsen symptoms in unstable periodontitis cases. Maintaining high levels of plaque control mitigates these effects.
Other Risk Factors
- Alcohol and Poor Nutrition: Potential contributors to periodontal health issues.
- Bruxing (Teeth Grinding): Leads to occlusal trauma, further complicating periodontitis. Mouthguards can help protect teeth.
References:
Chapter 5: Periodontal diseases GOV.UK. Available at: https://www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention/chapter-5-periodontal-diseases#risk-or-susceptibility-and-protective-factors (Accessed: 01 February 2025).
Risk factors, SDCEP. Available at: https://www.periodontalcare.sdcep.org.uk/guidance/assessment/patient-history/risk-factors/ (Accessed: 01 February 2025).