Table of Contents

Dental teeth 07

Plaque – what is it?

Plaque is the sticky deposit that continually forms on the surface of the teeth. If this “biofilm” is not removed regularly, there is a risk of caries and gum problems.

What exactly is plaque?

The oral cavity is home to a myriad of microorganisms. Many of them mean no harm – they are even beneficial to humans. However, if certain bacteria settle on the teeth, this is called bacterial plaque. If this is not removed regularly and thoroughly, caries, gingivitis or even periodontitis can result.

Dental plaque, also called dental biofilm or bacterial plaque, describes an accumulation of bacteria on the tooth surface. This bacterial community is embedded in a mucus layer composed of components of saliva, food debris and bacterial substances. It offers the microorganisms protection from external influences.

Initially, plaque is harmless to the teeth. However, if the biofilm remains attached to the tooth surface for a longer period of time, more and more bacteria settle. Some of these bacteria now produce acids (especially lactic acid), for example, which extract minerals from the tooth enamel and can thus lead to cavities (caries). How much acid is produced depends on the particular type of bacteria and on the amount of sugar available. This is because these oral cavity dwellers break down sugars from food into acids.

In addition to these acids, certain toxins secreted by the bacteria are also among the problematic substances: they can cause gum disease.

How does bacterial plaque develop?

Tooth plaque continuously develops anew, even directly after brushing the teeth. A distinction is made between the following phases in the development of the biofilm:

1. First, the saliva wets the freshly cleaned teeth and the so-called pellicle (protein-containing layer on the teeth) is formed. Three to six hours later, the first bacteria (pioneer bacteria) already adhere to the saliva layer. They form a single layer of cells and excrete only water and carbon dioxide. These substances do not yet pose a problem for the tooth enamel.
2. If this biofilm persists, the bacteria that have settled will multiply. In addition, new bacterial species accumulate and a complex, multi-layered bacterial community develops.   
3. In the lower part of the dental plaque there is a lack of oxygen. This is where bacteria that do not need oxygen to survive (anaerobic bacterial species) thrive. These make the biofilm a threat to dental health, as their metabolism produces acids, for example, which attack the tooth enamel. This is why we also speak of a pathogenic, i.e. disease-causing, biofilm.   
4. If the plaque is still not removed, mineralized, hard tartar develops from the soft plaque.

Where is dental plaque found particularly frequently?

Dental plaque can be removed by thorough dental hygiene. Therefore, it is rarely found on the easily cleanable chewing surfaces of the teeth. Rather, dental biofilms are found in the "hiding places" of the tooth environment:

• Interdental spaces
• Gumline
• dimples of the teeth
• filling and crown margins

Plaque: Causes & Risk Factors

Poor dental hygiene is the most common cause of bacterial plaque. But there are other factors that promote the formation of plaque.

What are the causes of bacterial plaque?

Saliva contains numerous microorganisms – including those that play a role in the development of caries and gum disease. These can collect on the surfaces of the teeth or at the gum line and form bacterial plaque. Since one has little control over the composition of one’s oral flora, it is difficult to avoid colonization with the harmful bacteria. Nevertheless, there are risk factors that favor the formation of plaque.

Risk factors at a glance:

  • Individual composition of the bacterial flora in the mouth
  • Poor dental hygiene
  • High-sugar diet
  • Too little saliva (dry mouth)
  • Some medications (e.g. some blood pressure-lowering preparations or sleeping pills)
  • Weakness of the immune system (due to e.g. permanent stress, smoking or lack of sleep)

Cause number 1 for plaque: Poor dental hygiene

Bacterial plaque on the surfaces of the teeth can usually be removed well by careful brushing. However, areas that are difficult or impossible to reach with a conventional toothbrush are often a problem. These include the interdental spaces. They can only be cleaned thoroughly by regular use of dental floss or interdental brushes. If this “deep cleaning” is not carried out, the risk of caries and gum disease increases.

Therefore: Bacterial plaque should be removed regularly. Twice-daily tooth brushing is part of the basic program. During daily dental care, also think about the interdental spaces and use dental floss or interdental brushes at least once a day. Antibacterial mouth rinses serve as a useful supplement.


A diet rich in sugar promotes bacterial growth

Sugar is one of the main food sources for harmful oral cavity inhabitants. If it is available in sufficient quantities, the bacteria multiply and secrete more enamel-threatening acids and gum-irritating toxins.Therefore, candy bars, colas and the like should only be consumed in small quantities or avoided altogether. Sticky sweets are particularly problematic. Since they stick to the teeth for a long time, harmful bacteria can feed on them for a particularly long time. 


Other risk factors for bacterial plaque

Our saliva fulfills numerous functions. For example, it not only makes the ingested food slippery and thus transportable, but also supports the neutralization of tooth-damaging acids. In addition, saliva is also important, for example, for the remineralization of teeth and the defense against pathogens. If there is a lack of saliva in the mouth, these functions can only be performed to a limited extent. The defense function is also impaired, so that bacteria can multiply more easily. Drugs that have a negative influence on saliva production (e.g. some blood pressure-lowering preparations or sleeping pills) can also promote the formation of dental plaque.

Those who suffer from a weakened immune system do not have the necessary defense mechanisms against harmful microorganisms in the mouth. As a result, harmful bacteria can spread in the mouth and wreak havoc. So make sure you lead a healthy lifestyle.


Why is the removal of plaque so important?

Regular and thorough removal of bacterial plaque is an important prerequisite for keeping teeth and gums healthy in the long term. This is because the bacteria it contains not only produce acids that attack tooth enamel, but also toxins that can trigger gum problems. In this way, the development of the following diseases is favored:

  • Dental caries
  • Gingivitis
  • Periodontosis

Caries: The bacteria in the plaque metabolize existing sugars and in return secrete acids that attack the enamel and lead to demineralization of the tooth. As a result, the enamel loses its substance and cavities appear. If the treatment fails, the caries continues to advance towards the root of the tooth. Then root canal treatment or removal of the tooth may become necessary.

Gum disease: The bacteria contained in plaque produce toxins that irritate the gums and thus trigger inflammatory processes. If the inflammation of the gums (gingivitis) is not adequately treated, the entire periodontium can become inflamed (periodontosis or medically: periodontitis). If periodontal disease also remains untreated, the gums recede and the other tissues that anchor the tooth to the bone are gradually destroyed. Tooth loss can be the result.

Removing plaque – this is how it works

As long as the bacterial plaque is “fresh” and no minerals are embedded (tartar), you can easily remove it by thoroughly cleaning your teeth:

Brushing your teeth 2 times a day: Brush your teeth in the morning and in the evening. Use a fluoride-containing toothpaste for this purpose. Fluorides are considered an important building block in the prevention of tooth decay. Rinse your toothbrush under running water after each brushing. Important: Replace your toothbrush with a new one every two months.

Clean interdental spaces: Bacterial plaque accumulates primarily in areas that are not reached or are poorly reached with a conventional toothbrush. Therefore, a thorough cleaning of the interdental spaces is irreplaceable. For this purpose, you should use dental floss or interdental brushes at least once a day.

Antibacterial mouth rinses: Mouth rinses with antibacterial agents can be useful as a supplement.

Note: Not sure if you really removed all plaque when brushing your teeth? A simple test can help you to check the “cleaning result”. With the help of special staining agents, which are available in the form of tablets or mouth rinses, the remaining plaque can be made visible. This allows weak points in the toothbrushing technique to be identified.


Tips against dental plaque

Reduce sugar Diet plays an important role in dental health. This is because if the harmful plaque bacteria have a lot of food available in the form of sugar, they produce acids and toxins. These can cause tooth decay or gum disease. It is therefore important to deprive the bacteria of the basis of their life and to reduce sugar-rich foods and beverages.

Tip: Teeth should be brushed after a sweet snack. If this is not possible immediately, a glass of water is a good interim solution – because this dilutes the sugar in the mouth and rinses sugar residues from the teeth. However, brushing the teeth should then be made up for soon.

Thorough dental hygiene Can you remove plaque yourself? Yes, of course – this is possible and even necessary so that harmful bacteria do not “spread”. However, the prerequisite is that the plaque has not yet deposited any minerals (tartar). This happens when plaque is not removed over a long period of time. Therefore, regular and thorough oral hygiene is important:

  • Brush your teeth 2 times a day (Important: Use fluoride toothpaste).
  • Clean interdental spaces at least 1 time a day
  • Antibacterial mouth rinses can be used as a supplement

Good to know: New plaque is constantly forming – even just a few hours after brushing.

Regular dental checkups Dental check-ups can reveal areas that are overlooked during daily teeth cleaning. Professional cleaning specifically removes the hidden plaque. In addition, tooth surfaces are polished and fluoridated. These measures are important for the prevention of caries and gum disease. Therefore, it is recommended to have a professional dental cleaning once or twice a year.

Stimulate salivary flow Our saliva performs numerous important tasks. For example, it neutralizes acids that are harmful to tooth enamel and is also involved in the defense against harmful oral bacteria. If there is not enough saliva available, plaque can form more easily. Therefore, you should drink enough water to ensure adequate saliva production. Chewing gum (sugar-free and containing xylitol) or a diet rich in fiber also promote saliva production.

Strengthen the immune system Bacteria & Co are kept in check by a powerful immune system. This also applies to the microbial co-inhabitants in the oral cavity. Therefore, you should avoid factors that weaken the immune system. These include smoking, stress, too little sleep and an unbalanced diet.

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