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Healthy Plaque Dental Caries


Patients view plaque as an enemy beyond their control, gluing to teeth like barnacles stick to the hull of a ship. They believe that the scraping chisels of a dental hygienist are needed to fight this mythological demon. Many believe hygienists exist mainly for the purpose of eliminating plaque. The truth is that healthy plaque may be essential for maintaining clean, strong teeth. Healthy plaque fights away intruding bacteria, provides essential ingredients for enamel to heal itself, and also protects vital cells from temperature and chemical changes that occur during eating and drinking.
In order for teeth to remain healthy, comfortable, and cavity free you need to develop and maintain protective plaque on your teeth. Instead of striving to remove every vestige of plaque from teeth with aggressive chemicals and abrasives, it may be more valuable to assess, test, monitor, and adjust the surface film on your teeth to ensure that it is healthy.
In 2005 I was fortunate enough to be at a dental conference where pictures of plaque were magnified on video monitors for all of us to see in detail from our chairs.2 Examining the composition of plaque made me realize how its removal without cause may be more harmful than we have imagined. The monitors showed that the cells in plaque communicate and depend on each other, with waste products from one providing food for another. We could see cells moving about in groups, encased in bubble-shaped spaces. Other cells were on their own, working their way between the fibers like spiders in a web. Liquids and foods could pass through the plaque layers to reach bacteria deep inside. In thin layers of healthy plaque, air was also able to flow in and out among the layers.3
I think of healthy plaque as a kind of bed comforter that will cover and protect your teeth. Imagine that bed bugs invade the inside of your comforter. Suddenly you have a very different situation, and the comforter is no longer protective but a source of risk and damage. Imagine if the bugs produced harmful liquids that could seep through the quilt and harm you.
I would suggest that instead of depending on dental professionals removing the film of plaque from your teeth sporadically, it would be better to focus on maintaining the health of good tooth plaque every day. Harmful germs must be prevented from infecting this film, and from multiplying. As harmful plaque bacteria mature, they change in nature, and some can form noxious liquids that damage teeth and gums. Harmful bacteria appear to grow in tightly packed rows which form overlapping layers, creating a barrier that prevents oxygen from reaching the deeper layers. Especially harmful to teeth are so-called anaerobic plaque bacteria, which grow in low-oxygen areas. Anaerobic bacteria are usually found close to the tooth surface, deeply buried under layers of infected plaque. These bacteria are very aggressive and produce quantities of acid that causes extreme harm to teeth as it seeps out and attacks the tooth surface underneath.
In the early 1970s dentists noticed that if infected plaque was not brushed away from teeth, the white, foamy layer grew thicker each day. As plaque layers thicken, the tooth surface under them slowly changes color. When tooth enamel has been covered with infected plaque for three weeks, the tooth surface underneath it turns white. When this plaque layer is wiped away, the shape of the white area on the tooth surface corresponds exactly to the shape of the area previously covered by the plaque.4 Called white spot infections, these areas develop consistently every twenty-one days when infected plaque, fueled with starch or sugar from the diet, is not cleaned off a tooth surface. After twenty-one days, the weakened tooth begins to crumble and cave in, and a cavity will result.
Working from this observation, the Karlstad program of 1974 was born.5 The program was based on the idea that if plaque could be removed before the twenty-first day, cavities would never form. The hypothesis was that cavities could not form if three things occurred: (1) patients controlled their sugar intake; (2) they received fluoride treatments; and (3) plaque was removed regularly (definitely before the twenty-first day). Because the researchers had little confidence in patients’ ability to clean their teeth, specially trained staff gave the participants tooth cleanings at three-week intervals. The interval between cleanings was later extended to three months, and in this way the idea of hygienists giving periodic professional cleanings was born and has been followed ever since. Interestingly, the Karlstad study showed that despite sugar control, fluoride, and cleanings, cavities were not completely prevented.

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