Formation of Dental Plaque

Dr. Marcel Hallare

Dental plaque may be readily visualized on teeth after 1 to 2 days with no oral hygiene measures Plaque is white, grayish, or yellowish and has globular appearance Comprised of bacteria in a matrix of salivary glycoproteins and extracellular polysaccharides like glucans and fructans

This matrix makes it impossible to rinse plaque away with water Mechanically removed by means of hand instruments, the toothbrush or other oral hygiene aids Plaque is typically observed on the gingival third of the tooth surface where it accumulates without disruption by the movement of food and tissue over the tooth surface during mastication

Plaque deposits also form preferentially in supragingival and subgingival calculus, cracks, pits, fissures in the tooth structure under overhanging restorations and around malaligned teeth Mouth breathing leads to dehydration of the oral cavity, rendering the plaque tougher and stickier and protective function of saliva is reduced

Rough areas at the cementoenamel junction enhance plaque retention Location and rate of plaque formation vary among individuals, and determining factors include oral hygiene, as well as host factors such as diet or salivary flow rate In the absence of oral hygiene measures, plaque will continue to accumulate until a balance is reached between the forces of plaque removal and those of plaque formation

Process of Plaque Formation

1. Formation of the pellicle coating on the tooth surface 2. Initial colonization by bacteria 3. Secondary colonization and plaque maturation

Formation of the Dental Pellicle

All surfaces of the oral cavity including all tissue surfaces as well as surfaces of teeth and fixed and removable restorations are all coated with a glycoprotein pellicle The pellicle is derived from components of saliva and crevicular fluid, as well as from bacterial and host tissue cell products and debris The mechanism involved in enamel pellicle formation include electrostatic, van der Waals, and hydrophobic forces

The hydroxyapatite surface has a predominance of negatively charged phosphate groups that interact directly or indirectly with positively charged components of salivary and crevicular fluid macromolecules Pellicles function as a protective barrier, providing lubrication for the surfaces and preventing tissue dessication Also provides a substrate to which bacteria in the environment attach

Initial Colonization of the Tooth Surface

Within a few hours bacteria are found on the dental pellicle Initial bacteria colonizing the pelliclecoated tooth surface are predominantly gram-positive facultative microorganisms such as Actinomyces viscosus and Streptococcus sanguis

Initial colonizers adhere to the pellicle through specific molecules, termed adhesins on the bacterial surface that interact with receptors in the dental pellicle The plaque mass matures through the growth of attached species as well as the colonization and growth of additional species In the ecologic succession of the biofilm, there is a transition from the early aerobic environment characterized by gram-positive facultative species to a highly oxygen-deprived environment in which gram-negative anaerobic microorganisms predominate

Secondary Colonization and Plaque Maturation

Secondary colonizers are the microorganisms that do not initially colonize clean tooth surfaces, including Prevotella intermedia, Prevotella loescheii, Capnocytophaga species, Fusobacterium nucleatum, and Porphyromonas gingivalis

These microorganisms adhere to cells of bacteria in the plaque mass Coaggregation is the ability of different species and genera of plaque microorganisms to adhere to one another This process occurs primarily through the highly specific stereochemical interaction of protein and carbohydrate molecules located on the bacterial cell surfaces in addition to the less specific interactions resulting from hydrophobic, electrostatic, and van der Waals forces