Dental Plaque:
the Good, the Bad, the Ugly

      Alvin H. Danenberg, DDS     January 22, 2016   [printfriendly]
Dental plaque- the Good, the Bad, the UglyWhat’s that ugly stuff around Jason’s teeth in the picture to the right – the white stuff around the necks of the teeth at the gum line?


It’s called dental plaque.


If it were thick, it might look like cottage cheese around the gum margin. It could smell bad and taste awful. It also could create severe gum disease and dental decay as it did for Jason.


Interestingly, there are different stages of dental plaque:

  • A good stage
  • A bad stage
  • An ugly stage


In the good or healthy stage, both the dental plaque and the gum tissues maintain a delicate balance allowing the gum and teeth to stay healthy. This is known as homeostasis.


In the good stage of dental plaque, a sticky substance first forms on the tooth surface. This is called the pellicle. Various bacteria begin to attach to this and eventually form a complex, multilayered biofilm. This is still the good stage of dental plaque. The outer layers of the biofilm are made up of mainly aerobic types of bacteria (bacteria that live in the presence of oxygen).


However, changes may occur that transform this healthy dental plaque into a disease-producing dental plaque – a bad stage. The biological mechanism creating this change is not completely understood.


Science suggests that when we eat processed grains and sugars, bad bacteria in the gut and in the mouth can overgrow. Some of these bad bacteria in the plaque can ferment sugar, produce many types of acids, cause imbalance in necessary nutrients, and cause decay on the tooth surface. Other bad bacteria in the plaque could cause bleeding gums or gingivitis. This is the bad stage of dental plaque.


Our body’s immune system plays a significant role in determining what types of harmful bacteria develop and overgrow. One of the most aggressive types of bacteria is called Porphyromonas gingivalis (P. gingivalis). As this bug overgrows and then dies, it produces a very potent and destructive substance called LPS (lipopolysaccharide). P. gingivalis is one of the most virulent types of bacteria causing periodontitis, the advanced and very destructive form of periodontal disease. This dental plaque is now in the ugly stage. LPS creates severe inflammation that can destroy the jawbone and can seep into the bloodstream.


Research suggests that the bacteria in the gut and in the mouth are interrelated. The development and course of periodontal disease are affected by the stages of dental plaque. The stages of dental plaque appear to be determined by:

  • The foods we eat
  • The bad bacteria that overgrow
  • The strength of our immune system
  • The genes we have inherited


Good plaque helps maintain biochemical balance around the teeth. Bad plaque begins the infectious process of dental decay and early gum disease (gingivitis). Ugly plaque causes gingivitis to progress to periodontitis, which (1) destroys the jawbone, (2) causes loss of teeth, and (3) may spread to other areas of the body.


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