Steps in plaque formation
When it comes to plaque formation, there are stages to consider when treating and educating patients chairside. Association is when the dental pellicle forms on the tooth and provides the bacteria a surface to attach to. Pellicle forms within seconds of the saliva touching the tooth after they are cleaned or after eating. Adhesion is the second step in plaque formation and occurs when the bacteria loosely binds to the pellicle. This pellicle can provide nutrients to the bacteria that increases the rate of calculus production.
Proliferation is when the bacteria spread throughout the mouth and begin to multiply. When patients have xerostomia, bacteria are able to proliferate at a quicker rate. Clinical studies are now demonstrating a link between an increase in the proliferation of bacteria with a lower salivary pH. This stage can be disrupted with proper brushing and interproximal care. The biofilm formation on the enamel surface forms when the protective “slime layer” is formed during the production of microcolonies. While the bacteria reside in the microcolonies, a form of complex groups that use metabolic advantages, such as living without oxygen. The growth or maturation takes place when the biofilm develops a primitive circulatory system.
Virulence is defined as the pathogen’s ability to do damage to its host. The factors of periodontal pathogens can be divided into three aspects: the characteristics that promote the colonization or adhesions of bacteria, the toxins and enzymes that degrade the host tissue, and the mechanisms that protect the pathogen from the host.
In order to fully understand the virulence of the bacteria, it is essential to identify the type of bacteria that is present in the patient’s mouth. Understanding the composition of the bacteria will aid in the correct treatment. For example, if the patient had P. gingivalis, we know the bacteria is anaerobic, has an association in elevated periodontal lesions, and the removal of the bacteria through effective and meticulous home care results in healthy gingiva.
In comparison, spirochetes are much more difficult to treat, they are highly mobile and associated with acute necrotizing ulcerative gingivitis (ANUG). Therefore, clinicians should not delay their recommendations for adjunctive therapies such as laser treatment, subgingival irrigation, or localized antibiotic therapy.
When we are working with patients it is important not to become complacent with the patient’s gingival health. We know that healthy gums do not bleed, therefore it is essential to identify which bacteria is present will allow us to properly recommend treatment. It is time to start treating periodontal disease systemically!