It's all About the Plaque (No Tartar!)

Dental professionals toss around lots of words during your dental visits.  Plaque is probably the most common word we use, yet the other day I had a client not know the difference between plaque and tartar.  So, I thought maybe we should take a step back from discussing the oral-systemic connection to review just exactly what plaque is and why it is so vital to remove it.

Have you ever woken up in the morning and felt like you teeth were wearing little fuzzy sweaters??  That film you feel on your teeth is plaque.  It is soft, invisible, alive, and growing happily on your teeth.  It is made up of bacterial colonies in a gel-like inter-microbial matrix.  Think: slime and bacteria. 

  In 1684 Anthony van Leeuwenhoek remarked on the vast accumulation of microorganisms in dental plaque in a report to the Royal Society of London: "The number of these animalcules in the scurf of a man's teeth are so many that I believe they exceed the number of men in a kingdom."  
(He scraped his teeth and looked at the plaque under his crude microscope.  I love that he called these bacteria "animalcules".)

Life cycle of  dental biofilm

 This plaque biofilm is sticky stuff.  It wants to adhere to your teeth, gums, roof of mouth, dental appliances, tongue, cheeks, and tonsil regions, and to grow more bacteria.  Dentistry now calls this a "plaque bio-film."  There are at least 750 different varieties of bacteria and other pathogens that make the mouth their home and live in the biofilm.   Most all of these microbes are not harmful.  They co-exist with us in happy harmony most of the time.  The microbe colonies grow by making bacteria babies, multiplying by dividing quite rapidly.  Plaque will form whether you eat or not.  They create a cozy, well organized community in which to live.  They even have instant messaging (before we did!) and can talk with each other through quorum sensing.  The attached bacteria "talk" to the other free floating bacteria, encouraging them to join the attached colony.   Picture a miniature New York City living under your gumline, with destructive gangs.  The bacteria have multiple layers of organization. There's a division of labor among the pathogens.  They have a toxic waste disposal system (they excrete, or "poop", acid so they need a way to get rid of it).  They have a slime layer that protects the inner bacteria from antibiotics or antimicrobials that we might try to use.  The biofilm is quite smart- if we introduce antibiotics, it makes the slime layer even thicker to protect the delicate inner bacteria.   There are river-like fluid channels that bring nutrients and oxygen to the bacterial colonies.  It truly becomes an independent microscopic community freeloading off of you, growing and mushrooming on the tooth or any other structure they've attached to.  The less you brush or floss, the more it grows.  The more it grows, the more it changes from aerobic to anaerobic- oxygen rich to oxygen poor.  Once this changeover occurs,the biofilm starts to mature.  It literally creeps down under your gumline.   "Bad" bacteria take over in this anaerobic, oxygen-less environment.  Gum tissue starts to react to the presence of these bad guys and becomes red, swollen. The microbes give off acid which causes blood cells to arrive and infection to start.  Your body reacts to the bacteria by sending in your warrior cells-- the cells that help heal: your white blood cells.  These good guys start the effort to kill the bad bacteria.  If you don't help them out, gum disease begins.  Between three to 12 weeks after the colony started forming it becomes mature and produces more gram negative bacteria.  When I look under my phase contrast microscope I see more spirochetes, thick and numerous, in this mature plaque. The "Gang" of pathogens is taking over.  The biofilm loves living under your gum line.  It's a moist, warm, dark, undisturbed place with plenty of food for them to feast on!   They love the nutrients within the fluid around the gumline. You are too good a host!  Destruction starts, infection begins, and you are no longer healthy.

Tartar build up on the back of the lower teeth

So, what's tartar?  Tartar is mineralized plaque. (Dental peeps call it calculus, so if you hear us talk about the "calculus build up", that's what we are referring to, no math done here ;) )   Think of tartar as petrified plaque.  More sticky plaque adheres to this  hard irregular tartar surface, and thus it grows ever harder, and even larger.  It becomes the coral reef of the mouth.  Bacteria love living on and in it, protected from anything you try to do.  It is often as hard as concrete and requires bladed instruments to scrape it or power scale off.  (That's what dental hygienists spend many hours learning in hygiene school.  FYI- When I went to dental hygiene school way back, I had zero idea there was even such a thing as tartar/calculus.  I had never had my teeth scaled so did not know about it.  Thus, when they handed out the red tackle box with all those shiny silver instruments, I had not idea what we'd be doing with them.  Boy was I in for a big surprise!)

It truly is all about that plaque, 'bout that plaque... (no tartar!)
If  you don't remove it, the environment in your mouth changes, it becomes too acidic and the good bacteria get overrun by the bad, and it causes gum disease and tooth decay, and bad breath, let alone infecting the rest of your body.  Let's get rid of it!

Pink means plaque, bacteria,disease

The best way to eliminate the plaque biofilm is by simply wiping (brushing, flossing, irrigating...) it away, detaching it from the surface it's attached to while it is still soft.  That's really the bottom line.  Plaque's gotta go, no matter where it resides.  From the bottom to the top of the tooth, roof of the mouth, cheeks, gums, under gums, tongue, getting it off and going down the drain is the goal.   The Gang's got to go!  For more information on how to get rid of it, see my posts Stop Flossing! and Brushing More is Not the Cure and stay tuned for more oral hygiene pearls of wisdom.

I really do like dental floss but very few folks do it correctly.  To see how good a job you do getting the plaque off, brush and floss in your regular way, then use disclosing tablets to see what  you and /or your children are leaving behind.  The tablets don't lie.  Brush and clean in-between until your get all the pink/purple color off.  It really does take a long time.  Remember, plaque is sticky and tenacious.  Clean teeth don't stain.  Go forth, conquer plaque, because it really is all about that plaque, 'bout that plaque, (no tartar!)
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Happy Brushing!
Barbara