What Is Plaque?
Just what is plaque?
Why do we get cavities?
How does brushing and flossing really work?
Plaque is a layer of bacteria that grows on our teeth all the time. There are over 400 different kinds of bacteria that have been found in plaque. These bacteria form a thin layer of growth on every tooth starting right after you brush your teeth.
Here's what happens. Lets say your teeth are perfectly clean. You have just brushed and flossed with perfect technique, or maybe you had a professional cleaning with your hygienist. Right away bacteria start growing on your teeth. These early bacteria are not so bad - they do not release acid and therefore do not start cavities in your teeth. Over time the bacteria layer, the plaque, grows and changes. The obvious change is that of "thickness" of the plaque. Plaque gets thicker and thicker over time.
At first it is invisible. After a few hours you can find a thin layer of white bacteria plaque if you know what to look for. After 15-18 hours, the plaque gets so thick that it is easily seen on the teeth. THIS is when it changes. The development of old plaque (18 hours or more) allows the growth of really bad bacteria. We call these bacteria "anaerobic", which means they thrive best when there is no oxygen around. There is no oxygen underneath thick, old plaque. These anaerobic bacteria are the bad guys. They are the ones that make old food go bad and make milk sour. They are the bacteria that release acid that dissolves cavities into your teeth. These are the bacteria that cause bad breath. These are the bacteria that trigger your body's immune response, which we will talk more about below.
How Cavities Form
When the plaque gets thick enough (around 15-18 hours of growth) the anaerobic bacteria thrive. To grow and thrive, these bacteria digest the foods available to them, like sugar in our diet. But they digest it differently than we do - they release lots of acid when they eat, and this acid then eats into our teeth, causing cavities over time.
How Gum Disease Starts
Thick, established, 15-18 hour old plaque also causes gum disease. Plaque is so yucky that your body's immune system fights hard to keep the bacteria from invading your gums. It usually succeeds, but over time the gums pay a price. They can become swollen, puffy, and filled with extra blood. Many people see bleeding in their mouths when they brush, or when they floss, or both. This bleeding is not due to the brush cutting into your gums, or the floss slicing through "just a little." Rather, bleeding gums represents the release of built up immune system swelling. I always compare bleeding gums to a wet sponge. You can step on the sponge and the water splats out, but the sponge is uncut. That's what happens when you brush or floss against swollen gums - the surface blood, that is there because of your normal body immune response, is squeezed out a little bit. This is normal, but it is not healthy.
So What Do I Do?!?
All you have to do to avoid the acid attack on your teeth, and the gum disease swelling, is to remove all the plaque before it gets thick. Brush for two minutes and floss between your teeth every twelve hours (twice a day) so that the plaque never gets thick enough to be toxic. By removing the plaque with brush and floss, you "restart the clock" of plaque development. You buy yourself another 12 hours of health, during which the plaque that is just starting to come back cannot hurt you.
Note that you must remove the plaque before it gets thick, even if your gums are bleeding during your routine. The bleeding in your gums represents the damage that old plaque has already caused. If you remove the plaque often, before it gets old and thick, then the trigger that makes your gums bleed is gone. Five days later your gums will stop bleeding altogether. Freed from the toxic influence of old plaque, your gums will toughen themselves up and become healthy.
Let me repeat that in another way, because it is important. If your gums are suffering from plaque induced inflammation, then proper brushing will totally clear up the inflammation, but it will take five days (about) for you to witness the change. I see many patients who have trained themselves not to brush the gumline areas because of the bleeding they see. We now know that they are wrong to avoid those areas. Just keep brushing and flossing even though there is bleeding, and eventually you will find that you can brush and floss with no bleeding whatsoever. It works for everybody. Patients with bleeding gums also find that it helps to brush 3 or 4 times a day until the bleeding in the gums clears up - then go back to twice a day.