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Plaque

Overview

Plaque is a soft, sticky, colorless, or whitish coating that houses bacteria and forms on the surfaces of teeth. 
&nbsp;

Dental plaque is present in everyone to some extent. It is the &lsquo;fuzzy&rsquo; feeling on the surface of the teeth that one feels when they run their tongue over the teeth. It indicates that the teeth are unclean.

Plaque is essentially a population of live bacteria encircled by a gluey polymer coating, which is why scientists refer to it as a &quot;biofilm&quot;. The microorganisms in the mouth may connect to surfaces thanks to the coating&#39;s adhesive properties and develop into thriving microcolonies.

Plaque-causing oral microorganisms are present in everyone&#39;s mouth. However, the consumption of carbohydrate-rich foods, such as cakes, candies, soft drinks, or milk helps the bacteria thrive. As a result, the bacteria produce acid that can degrade tooth enamel, causing cavities and gingivitis. According to research, plaque-induced gingivitis is the second most common oral disease<a href="#accordion">[11]</a>. It affects more than 75% of people worldwide<a href="#accordion">[11]</a>.

Therefore, regular dental checks are essential because plaque can lead to gum disease, tartar, and cavities. Plaque development reaches its peak in 4 days if oral hygiene is ignored or stopped<a href="#accordion">[1]</a>. 
&nbsp;

There are no known types of plaque. 
&nbsp;

Signs and Symptoms

Signs and symptoms of plaque are: 
&nbsp;

<ul>
	<li>Fuzzy or slimy feeling covering the surface of the teeth</li>
	<li>Bad breath or halitosis</li>
	<li>Swollen, red, or painful gums which bleed after brushing 
	&nbsp;</li>
</ul>

Causes

Plaque is created when oral bacteria and foods high in sugar or starch, such as milk, juice, soft drinks, bread, pasta, and fruit, come into contact. These microorganisms exude acids that dissolve the carbohydrates in food and beverages. If the teeth are not brushed soon after eating or drinking, bacteria, acids, and carbohydrates may combine to form plaque, a sticky, white coating on the teeth. These acids gradually erode tooth enamel, which causes tooth decay. Additionally, plaque can form on the tooth roots beneath the gum line, weakening the bone that supports the tooth. 
&nbsp;

Diagnosis

Plaque is often colorless or light yellow. During an oral examination, a dentist might use a small mirror to detect plaque on the teeth. Plaque can also cause cavities, for which the dentist will likely order an X-ray. 
&nbsp;

Treatment

The following measures can help manage or treat plaque:<a href="#accordion">[4]</a> 
&nbsp;

<ul>
	<li>Maintain good oral hygiene by brushing twice a day and flossing at least once daily to remove plaque from between the teeth that may not be visible to the naked eye.</li>
	<li>Dental pit and fissure sealant<a href="#accordion">[3]</a>- The pits and fissures present especially at the top of the larger teeth (molars) are most vulnerable to plaque and food accumulation due to morphological complexity. Cleaning becomes challenging, making these pits and fissures the site of caries onset. As a preventative measure sealant is used to form a protective thin layer over these nooks and crannies on the tooth surface, preventing plaque formation and reducing chances of tooth decay.</li>
	<li>Dry mouth medication to increase saliva production.</li>
	<li>Fluoride treatment to slow the growth of bacteria causing plaque buildup and stop tooth decay</li>
	<li>Prescription toothpaste along with antibacterial mouthwash. According to a 2019 review, plaque can be removed effectively using toothpaste containing baking soda<a href="#accordion">[5]</a>.</li>
	<li>Removal of calculus by visiting the dentist. Scaling twice a year helps keep calculus buildup under control.</li>
</ul>

&nbsp;

<h5>Brushing Technique</h5>

A good brushing technique not only keeps the mouth clean but also prevents plaque buildup and gum diseases. According to the American Dental Association, one should brush for 2 minutes, twice a day.<a href="#accordion">[10]</a> 
&nbsp;

Step 1: Apply some water to the brush to lubricate it. A pea-sized quantity of toothpaste should be applied to the toothbrush head.

Step 2: To clean the front teeth, place the toothbrush in the mouth at a 45-degree angle to the gums and use soft, short strokes.

Step 3: Brush the outside of the teeth, paying special attention to the top chewing surfaces and the rear molars.

Step 4: To clean the inside of the upper front teeth, turn the toothbrush upside down. To access the inside of the lower front teeth, turn it back around.

Step 5: Brush the tongue to remove any plaque or bacterial buildup that may have gotten caught there while brushing.

Step 6: The toothpaste, saliva, and water residue should be spat out into a clean sink. Last but not least, rinse the mouth with cool water. 
&nbsp;

There are several complications that plaque can cause: 
&nbsp;

<ol>
	<li>&nbsp; Calculus - If plaque is not removed, it can calcify or harden over time to cause tartar (calculus). Calcification occurs between 1-14 days of plaque formation and reaches 60-90% of calcification by 12 days<a href="#accordion">[2]</a>. Calculus can not be removed at home by brushing or flossing, so a visit to a dentist is required. It can cause further complications, like swelling and bleeding of the gums called gingivitis, and a more advanced gum disease called periodontitis that attacks the bone around the teeth.<a href="#accordion">[4]</a> 
	&nbsp;</li>
	<li>&nbsp; Cavities&nbsp;- During plaque formation, the acids produced by the bacteria destroys the enamel covering of the teeth<a href="#accordion">[6]</a>. Cavities form as microscopic gaps or holes in the enamel are brought on by this degradation. The germs and acid can reach the dentin, the next layer of the teeth if portions of the enamel have been worn away. Compared to enamel, this layer is softer and less acid resistant. Sensitivity is brought on by small tubes in the dentin that connect directly to the tooth&#39;s nerve. The bacteria and acid that cause tooth decay keep migrating through the inner tooth substance (pulp), which is home to nerves and blood vessels, as tooth decay progresses. The bacteria cause swelling and irritation of the pulp. Inside a tooth, there is nowhere for the swelling to grow, thus the nerve is compressed and hurts as a result. Even the bone outside the tooth root may experience discomfort. </li>
</ol>

&nbsp;

If the damage to the structure has not reached the pulp, a simple filling can be done, but if the damage has reached the pulp, then a root canal treatment will be the choice of treatment. If a significant amount of tooth structure is lost from decay, which cannot be restored, the dentist will need to extract the remains of the tooth. 
&nbsp;

<ol start="3">
	<li>&nbsp; Other Diseases - A growing amount of studies also show that oral bacteria and inflammation are related to other issues, such as <a href="https://merisehat.pk/disease/dementia">dementia </a>and heart attacks, and may be harmful to your general health.</li>
	<li>&nbsp; <a href="https://merisehat.pk/disease/gingivitis">Gingivitis</a> And Periodontitis&nbsp; - Gum disease can also be brought on by plaque accumulation. Gingivitis is characterized by sore, swollen, and occasionally bleeding gums. Periodontal gum disease that is severe can develop over time. The underlying bone supporting the teeth is destroyed by germs when gum tissue pushes away from the tooth.<a href="#accordion">[7]</a> 
	&nbsp;</li>
</ol>

The risk factors that contribute to plaque formation on teeth are: 
&nbsp;

<ul>
	<li>Crowding&nbsp;- Overlapping of teeth (crowding) is tougher to clean as people are not able to access all the surfaces of the teeth with a brush or floss. People with overcrowding need to visit a dentist for regular scaling, and possible long-term treatment which may require correction with braces.<a href="#accordion">[8]</a></li>
	<li>Mental Health Problems&nbsp;- People who suffer from mental health issues or are neurodivergent may have trouble keeping up with an oral hygiene regimen. This can result in plaque and calculus buildup.<a href="#accordion">[9]</a></li>
	<li>Improper or rushed cleaning of teeth. 
	&nbsp;</li>
</ul>

Some preventive measures to control plaque are:

<ul>
	<li>Flossing at least once a day. People can use floss or a water flosser. The ideal time to floss is right before brushing the teeth.</li>
	<li>Brushing twice a day. Brush for 2 minutes each, twice a day with fluoride toothpaste.</li>
	<li>Chewing sugar-free gum - If one is unable to brush following a meal, they can chew sugar-free gum.</li>
	<li>Regular visits with the dentist.</li>
	<li>Using a mouthwash.</li>
	<li>Avoiding foods like sweets, candy, sodas, and citric juices. 
	&nbsp;</li>
</ul>

Doctors often advise using electric toothbrushes as they are thought to be more successful at eliminating plaque<a href="#accordion">[5]</a>. 
&nbsp;

Key Points

<ul>
	<li>Plaque is a soft, sticky, colorless, or whitish coating that houses bacteria and forms on the surfaces of teeth, roots of the teeth, and along the gum line. </li>
	<li>Dental plaque is present in everyone to some extent. It is the &lsquo;fuzzy&rsquo; feeling on the surface of the teeth that one feels when they run their tongue over the teeth.</li>
	<li>Plaque-causing oral microorganisms are present in everyone&#39;s mouth. However, the consumption of carbohydrate-rich foods, such as cakes, candies, soft drinks, or milk helps the bacteria thrive. As a result, the bacteria produce acid that can degrade tooth enamel, causing cavities and gingivitis.</li>
	<li>During an oral examination, a dentist might use a small mirror to detect plaque.</li>
	<li>Plaque buildup can result in cavities, gingivitis, and<a href="https://merisehat.pk/disease/tooth-decay"> tooth decay</a>.</li>
	<li>A growing amount of studies also show that oral bacteria and inflammation are related to other issues, such as dementia and heart attacks, and may be harmful to a patient&rsquo;s general health.</li>
	<li>A good brushing technique not only keeps the mouth clean but also prevents plaque buildup and gum diseases. According to the American Dental Association, one should brush for 2 minutes, twice a day.</li>
	<li>If a significant amount of tooth structure is lost from decay and cannot be restored, the dentist will need to extract the remains of the tooth. 
	&nbsp;</li>
</ul>

[1] Johansson Ingegärd, Somasundaran P. the cleaning of teeth. In: Handbook for Cleaning, Decontamination of Surfaces. Amsterdam: Elsevier; 2007.

[2] Balaji VR, Niazi TM, Dhanasekaran M. An unusual presentation of dental calculus. J Indian Soc Periodontol. 2019;23(5):484-486. doi:10.4103/jisp.jisp_680_18

[3] Sreedevi A, Brizuela M, Mohamed S. Pit and Fissure Sealants. [Updated 2022 Sep 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.

[4] Dental plaque: What is it, causes, how to remove, Prevent & Treat. Cleveland Clinic.

[5] Stanborough RJ. Dental plaque: What it is, what causes it, and how to get rid of I. Healthline.

[6] Cavities/Tooth Decay. Mayo Clinic. 19 January,2023.

[7] Tooth plaque causes, prevention, and treatments. WebMD.

[8] Is there a link between teeth crowding and gingivitis? WebMD.

[9] Kisely S. No Mental Health without Oral Health. Can J Psychiatry. 2016;61(5):277-282. doi:10.1177/0706743716632523.

[10] Watson K. How to brush your teeth with a standard or electric toothbrush. Healthline.

[11] Idrees MM, Azzeghaiby SN, Hammad MM, Kujan OB. Prevalence and severity of plaque-induced gingivitis in a Saudi adult population. Saudi Med J. 2014;35(11):1373-1377.