Dental Plaque and Gum Disease

What is dental plaque and gum disease?

• Dental plaque is a soft deposit that forms on the surface of teeth. It contains many types of bacteria (germs). You can remove plaque by good oral hygiene (see below).
• Calculus, sometimes called tartar, is hardened calcified plaque. It sticks firmly to teeth. Generally, it can only be removed by a dentist or dental hygienist with special instruments.
• Gum disease (periodontal disease) means infection or inflammation of the tissues that surround the teeth. Depending on the severity, gum disease is generally divided into two types - gingivitis and periodontitis.
  • Gingivitis means inflammation of the gums. There are various types. However, most cases of gingivitis are caused by plaque.
  • Periodontitis occurs if gingivitis becomes worse and progresses to involve the tissue that joins the teeth to the gums (the periodontal membrane).

The rest of this leaflet is about the common problems of plaque and plaque-associated gum disease. (There are other uncommon types and causes of gingivitis and periodontitis which are not dealt with further.)

What causes plaque-associated gum disease?

The reason why gum disease develops in some people and not others is not clear. Almost everyone develops some dental plaque, but only some people develop gum disease. Dental plaque contains many different types of bacteria (germs) and some types of bacteria are associated with developing gum disease. The gums can often resist the invasion of bacteria. It is thought that infection is more likely to develop if your defence or resistance against bacteria is reduced in some way.

The following increase your risk of developing plaque-associated gum disease.

• Poor oral hygiene when a lot of plaque and large numbers of bacteria build up.
• Smoking (which may alter your resistance to gum infection).
• If you have a poor immune system. For example, if you have an illness which makes your immune system less effective, or if you are on chemotherapy, etc.
• If you have diabetes.

What are the symptoms of plaque-associated gum disease?

• Mild gingivitis does not cause any symptoms and so you may not realize that you have it. The gums look slightly swollen and reddened.
• Moderate gingivitis can cause discomfort and more marked swelling and reddening of the gums. The gums often bleed a little when you clean your teeth.
• Periodontitis can cause:
  • halitosis (bad breath).
  • a foul taste in your mouth.
  • some pus to form in small pockets between teeth and gums.
  • pain and difficulty eating.
  • affected teeth to become loose. They may eventually fall out if not treated.

How can I prevent plaque-associated gum disease?

• Good oral hygiene (mouth hygiene) helps to keep plaque down and will usually prevent gum disease. (Good oral hygiene also helps to prevent tooth decay.) Good oral hygiene means:
  • Regular brushing of teeth to clear plaque and debris - at least twice a day. A fluoride toothpaste is recommended.
  • Daily flossing to remove plaque from between teeth.
  • For those who are unable to use a toothbrush, regular rinsing with an antiseptic mouthwash.
• Children should be taught good oral hygiene as young as possible.
• Regular dental checks. A dentist can detect excessive build up of plaque and remove calculus. Early or mild gingivitis can be detected and treated to prevent the more severe periodontitis.
• If you smoke, you should aim to stop smoking.

The measures above are usually sufficient. However, many people also use an antiseptic mouthwash each day to help prevent gum disease.

What is the treatment of plaque-associated gum disease?

If you have gingivitis
The measures described above to prevent gum disease will often clear mild gingivitis. If gingivitis is more severe, in addition your dentist or doctor may advise an antiseptic mouthwash (and/or antiseptic toothpaste, gel, or spray). These help to kill bacteria in the mouth and help to clear up any gum infection.

Chlorhexidine is a commonly used antiseptic mouthwash. You should rinse your mouth well with water between brushing your teeth and using chlorhexidine. This is because some ingredients in toothpaste can inactivate chlorhexidine. Chlorhexidine may also stain teeth brown when used regularly. The stain is not permanent, and can be reduced by:

• brushing teeth before (but not after) using the chlorhexidine.
• avoiding drinks that contain tannin within 2-3 hours of using chlorhexidine (for example, tea, coffee, and red wine).
• using the 1.2% solution instead of higher strength solutions.

If you have periodontitis
You need to be seen by a dentist. In addition to the measures described above to treat gingivitis you may need specialist dental treatment.

Further help and advice

See a dentist if you have a concern about your teeth or gums. The following may also be helpful.

British Dental Health Foundation
Smile House, 2 East Union Street, Rugby, Warwickshire, CV22 6AJ
Helpline: 0845 063 1188    Web: www.dentalhealth.org.uk
A national charity that has 30 years' experience promoting the benefits of good oral health to the public. It runs a free consumer Dental Helpline that is operated by a qualified dental team who provide free independent and impartial advice on all aspects of oral health. They reply in person to the general public's enquiries by phone, email and letter.

© EMIS and PIP 2004   Updated: October 2004   Review Date: November 2005   CHIQ Accredited   PRODIGY Validated