What is plaque?

Plaque is a naturally occurring sticky film that is made up of saliva, remnants of what we eat, and microbes (bacteria) of which the majority are beneficial to our health while a few are not. Plaque makeup varies greatly between people based on genetics and of course the meal they consumed! The microbes in plaque and saliva feed on the sugars in the saliva that come from sugary food and drinks and…“fermentable carbohydrates”, sugars from food such as bread. The good microbes in saliva compete with the bad microbes for the food (sugar) resources in the plaque and thereby keep the bad microbes from multiplying.

Is plaque bad?

That depends on whether it is allowed to stay on your teeth.  Plaque is easily removed as some comes off with chewing or simply drinking water, but always best to brush whenever possible. Plaque contains microbes (bacteria) that feed off of the fermentable sugars in saliva. A byproduct of this microbial food fest is the production of acids that if left unchecked attack tooth enamel and become irritants to gum tissue.

Does plaque cause gum disease?

Plaque is considered to be the initiator of gum disease as it will eventually calcify (harden) into dental tartar known by your dentist as calculus. While plaque receives a lot of bad press, the fact is that no one has ever lost a tooth from plaque! The pathway to periodontal disease from plaque formation is not completely understood by science, but plaque is not the cause as teeth lost to advanced periodontal disease will not have any plaque on them, but will always have a lot of tartar buildup on the surface that harbors and protects the bad bacteria. It is tartar buildup that sets the stage for gum disease. We like to say that “plaque causes gum disease like the sun causes global warming!”

What is Tartar?

Tartar is formed from the dead bacteria in plaque mixed with free calcium from your saliva that forms calcium phosphate salt. Teeth are made of calcium phosphate so the tartar (a salt) is ionically attracted to tooth enamel (sort of an electrostatic attraction). The issue with tartar is that it is both rough and porous, providing a perfect structure for sticky plaque to adhere to, die and subsequently build more tartar. It also provides a secure habit for bad bacteria to colonize and thrive in. Tartar that is not removed will expand and  grow down into the gum line shielding and protecting the bad bacteria from even the most potent of germ killing mouth wash such as prescription Peridex (chlorhexidine).

What are good and bad bacteria?

Microbes (bacteria) represent a very basic yet diverse form of life that often make their greatest contribution or impact on their environment through the byproducts they produce. Some bacteria thrive in an oxygen rich environment (aerobic bacteria) while other strains survive in an environment with no oxygen and are called anaerobic bacteria. Anaerobic bacteria have many uses in industry ranging from the manufacture of citric acid to smoothing out the taste of red wine. However before we continue with good versus bad bacteria, we need to clarify how bacteria are classified. Under a microscope bacteria look pretty much the same with the exception of some basic shapes; rods, spirals commas, or corkscrew. Thanks to a Dutch scientist Hans Gram, we can now better identify a particular bacterium. Dr Gram discovered that different bacteria stain differently when subjected to a process that involves crystal violet color stain. This became known as Gram staining. To this day bacterium are classified as “Gram Negative” for bacteria that did not absorb the violet stain or “Gram Positive” for those that did absorb the stain. Bacteria do not technically have skin rather they are surrounded by a somewhat permeable cytoplasm…essentially molecules in close formation. This outer wall permeability allows stain to be absorbed readily. The saliva in our mouth contains over 300 strains of bacteria of which the vast majority are Gram positive that benefit us by helping our immune system deal with opportunistic bacteria and viruses.

It is the few Gram negative bacteria that we are most concerned about. Gram negative bacteria have an additional outer membrane that resists Gram staining. This outer membrane adds a layer of protection to help it survive in harsh conditions. As if that were not enough Gram negative bacteria also produce a chemical on the outer membrane called LPS that also adds an additional level of protection. LPS is also a toxin to humans and causes inflammation and other issues when introduced into the blood stream. Gram negative bacteria are the bad bacteria and are very tough hombres that are hard to kill…they are the Terminators of the oral bacteria world and are the main players in periodontal disease and tooth loss.  On top of that they are an inefficient processor of sugar and as they multiply and grow they create tremendous waste products such as Volatile Sulphur Compounds (VSC’s) that cause bad breath.

I have Red, Sore, and Bleeding Gums…what caused it?

For some of us, we pass through life with no real oral health issues, however for the majority of us usually by the age of 65, end up with some form of gum disease that manifests itself as red, sore, or bleeding gums, and sadly tooth loss not to mention the myriad of diseases that are linked to poor oral health such as heart disease and Alzheimer’s. Unfortunately, the delicate balance of pH (acidity), saliva levels, plaque & tartar buildup, along with the balance of good and bad bacteria in otherwise healthy mouths can be disrupted by a number of things including:

Poor Oral Hygiene

• Simple brushing following meals is still the gold standard of home care and we don’t do it frequently enough or long enough. Plaque that is missed in brushing with be hardening by the next day into tartar and chances are there is already bad Gram negative bacteria starting to multiply in or under the tartar buildup. Interestingly, studies have shown that if you take someone’s toothpaste away and have them brush with water only, they will brush longer and more effectively. The thought is that the minty flavor tricks our minds into thinking we cleaned our teeth effectively when in fact we have not brushed long enough!

 Lifestyle

• What we consume such as sugary food and drink (soda, beer, wine) along with bread products create a firestorm of bacterial activity that raise the acid levels in saliva as they process the calories. Bacteria grow exponentially in a calorie rich environment, quickly consuming available sugars, multiplying and then dying off thus forming dental tartar.

 
Oral Care Products

Germ Killing (antimicrobial) mouth washes are like a nuclear bomb going off in your mouth indiscriminately killing the good bacteria that have been keeping the bad ones in check. The very tough Gram negative bacteria living in the gum tooth pockets are likely to be unhurt by the attack and are then allowed free rein to consume available food sources unchallenged. What’s more, the millions of dead bacteria pile up and form additional tartar that only serve to protect the bad bacteria from further attack. It is well known that germ killing rinses such as prescription Peridex (chlorhexidine) mouthwash prescribed to you by your dentist builds tartar and thus its use should be limited. This limited use requirement was established by the manufacturer during clinical studies.

Medical Conditions

Medical conditions can play a role in poor oral health. For example inadequate saliva supply disrupts the natural checks and balances of oral flora. More serious conditions such as diabetes, and autoimmune disorders can wreak havoc on oral health. These conditions need to be brought to the attention of your dental professional who can come up with a treatment plan.

The Solutions!

How do I get rid of bad breath?

If you have chronic bad breath, then you likely have tartar buildup and some form of gum disease that is supporting bad bacteria (Gram negative bacteria) that live in the tartar and give off Volatile Sulphur compounds (VSC’s). Germ killing mouth rinses will only temporarily mask the odor and will actually make things worse as the good bacteria killed by the rinse will form additional tartar buildup.

Brush, floss and use Periogen in an oral irrigator twice a day (morning and before bed) to reduce the tartar in the gum pockets that the bacteria are living in. You should see significant improvement within two weeks.  Avoid using leading brand germ killing mouth rinses. If things don’t improve consider a trip to your dentist.

How do I get rid of red sore gums?

If you have red or sore gums, then you likely have gingivitis or gum disease that is supporting bad bacteria (Gram negative bacteria) that live in the tartar and produce inflammatory toxins along with Volatile Sulphur compounds (VSC’s). Leading brand germ killing mouth rinses will do nothing to solve your problem as they do not reduce tartar. They will make things worse as the good bacteria killed by the rinse will form additional tartar buildup. The bad bacteria are living in and below the tartar and are protected and shielded from the rinse.

Brush, floss and either swish with Periogen as directed or use in an oral irrigator twice a day (morning and before bed) to reduce the tartar in the gum pockets that the bacteria are living in. You should see significant improvement within two weeks.  Avoid using leading brand germ killing mouth rinses. If things don’t improve go see your dentist.

How do I stop bleeding gums?

If you have bleeding gums, then you likely have tartar buildup and some form of gum disease that is supporting bad bacteria (Gram negative bacteria) that live in the tartar and produce inflammatory toxins along with Volatile Sulphur compounds (VSC’s). Leading brand germ killing mouth rinses will do nothing to solve your problem as they do not reduce tartar. They will make things worse as the good bacteria killed by the rinse will form additional tartar buildup. The bad bacteria are living in and below the tartar and are protected and shielded from the rinse. Not even dentist prescribed Peridex mouth rinse can get to them!   

Brush, floss and use Periogen in an oral irrigator twice a day (morning and before bed) to reduce the tartar in the gum pockets that the bacteria are living in. You should see significant improvement within two weeks.  Avoid using leading brand germ killing mouth rinses. If things don’t improve go see your dentist.

How do I keep my implant healthy?

 Implants are highly susceptible to infection from tartar buildup. In fact, implants are twice as likely to be lost to periodontal disease as the natural tooth! They need extra care.

Following your implant procedure and once your dentist clears you for a normal routine, you should swish with Periogen daily or use in an oral irrigator to keep it healthy.

My implant is red and sore, what should I do?

Implants are highly susceptible to infection from tartar buildup. Without treatment, peri-implantitis sets in and can lead to loss of the implant. The fact is that an implant is twice as likely to be lost to periodontal infection as was the natural tooth! They need to be taken care off.

Use Periogen as directed in an oral irrigator and irrigate the area twice a day. You should make an appointment with the dental professional that did the procedure to ensure that the structures around the implant are sound. Periogen is an excellent home adjunct for keeping implants health and we have the studies to prove it!

What is the best home oral care routine?

Brush, floss, and if you are prone to tartar buildup or you have red, sore, bleeding gums, or bad breath use a tartar reducing mouth rinse such as Periogen. Leading brand mouth rinses do not reduce tartar and may contribute to its formation. If you cannot brush after a meal, drink some water to rinse away some of the carbohydrate food sources that oral bacteria thrive on. 

How do I take care of orthodontia?

Swish as directed with Periogen or use in an oral irrigator to keep tartar from forming. If you already have some tartar or redness, Periogen in an oral irrigator should progressively remove it. 

My dentist says I need a deep cleaning.

A dental deep cleaning is a highly invasive procedure used to remove subgingival tartar that has formed deep in gum pockets around teeth. Usually performed in quadrants, the gums are numbed with Novocain and the dentist will insert an instrument into the gum pocket (along the gum tooth margin) and carefully scrape out tartar so as not to damage the cementum around the tooth. Remember that the dentist cannot actually see into the dental pocket so the procedure is not perfect with research showing that most dentists get only about 70% of the tartar. However, with that much tartar gone you will see a clinical improvement in your symptoms. Why do we say it is an invasive procedure? Dental deep cleanings release a tremendous amount of bacteria into your bloodstream (known as bacteremia) that was residing in the gum pockets including Gram negative anaerobes. That is why people with heart valve issues or compromised immune systems will usually be prescribed anti-biotics. How much bacteria is released? One study from the NIH compared the bacteria released in a dental deep cleaning to that released during a tonsillectomy!

Periogen, used as directed in an oral irrigator, can go a long way in reducing subgingival tartar buildup and keeping your gums healthy.