The power of plaque

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The authors explain that oral healthcare professionals tend to operate with a narrow focus, concentrating solely on the immediate dental concerns such as decay, crown preparations, or canal shaping and not on the big picture to investigate the causes of a specific dental problem such as an underlying systemic issues or unhealthy lifestyle habits.1

Tooth bacterial infection and teeth decay disease as an unhealthy molar with periodontitis as an infectious bacteria concept with inflammation as a 3D illustration on a blue background.

Research shows that oral disorders are the most prevalent chronic conditions globally, impacting essential oral functions, self-esteem, quality of life, and overall health.2

More than 3.5 billion people are affected by oral diseases. The number one oral disease is dental caries (cavities). Dental caries in primary teeth affect >530 million children.2

Dental caries are classified as a dietary-microbial disease influenced by behavioural, psychological, and social factors.  Specific bacterial species like Streptococcus mutans and Lactobacilli, along with ecological shifts in biofilm microbiota, contribute to caries. The ecological plaque hypothesis posits that caries results from a shift towards more cariogenic species in the biofilm.3

Fermentable carbohydrates metabolised by biofilm bacteria produce organic acids, causing a drop in pH and tooth demineralisation. If acidic conditions persist, subsurface lesions may form, progressing from reversible white spots to macroscopic cavities. Early intervention and preventive measures can arrest or reverse the process.3

Periodontal disease

Periodontal or gum disease is the second most common oral disease. It is a chronic, irreversible, and destructive inflammatory disease of the periodontal tissues including the gingival tissue, alveolar bone, cementum, and periodontal ligament. Severe periodontal disease affects ~10% of the global population.2,4

Gingivitis is the mildest form of periodontal disease. It is characterised by inflammation of the gingiva caused by the accumulation of bacteria and debris between the gum line and tooth (dental plaque).4

If left untreated, gingivitis can advance to periodontitis. In periodontitis, bacteria infiltrate deeper into the tissues and surrounding periodontium, eliciting a defensive response from the host against the invasive micro-organisms.4

Ironically, while trying to protect against the bacteria, the host's defenses inadvertently contribute to the destruction of the periodontium. This destructive process leads to the loss of attachment of the periodontium, progressing to alveolar bone loss and, potentially, resulting in the loss of the affected tooth.4

One of the main causes of periodontal disease is smoking. Smoking can increase the risk for periodontal diseases five- to 20-fold, with an odds ratio of 5.4 between smoking and chronic periodontitis. Furthermore, smoking is associated with greater levels of bone loss, attachment loss, deep periodontal pockets associated with the disease, and tooth loss.

Early and accurate diagnosis and treatment are essential to alleviating the burden of periodontitis. Identifying severe cases is particularly crucial, given their therapeutic challenges, poorer tooth prognosis, elevated risk of tooth loss, additional costs, and potential systemic implications.2

Connection between oral and systemic diseases

Many oral diseases are associated with non-communicable conditions such as cardiovascular disease, diabetes, cancers, pneumonia, obesity, and premature birth.2

Furthermore, oral and systemic diseases are interconnected. Systemic directly influence oral health through pathological mechanisms or indirectly through changes in behaviour resulting from the disease or its treatment.2

Reciprocally, alterations in oral health can have consequences on systemic well-being. The oral microbiome, housing ~700 different phylotypes and ~400 species in subgingival plaque, plays a crucial role in the onset of a systemic disease.2

Silent epidemic

Benjamin describes oral health as a ‘silent epidemic’, cautioning that if diseases are left untreated, they may cause pain, dysfunction, poor appearance, loss of self-esteem, absence from school or work, and difficulty concentrating on daily tasks.5

In 2021, the World Health Organization (WHO) took a significant step by approving a resolution addressing oral health. This resolution marks a shift toward a comprehensive approach to oral healthcare.2

The WHO urges member countries to address common risk factors for oral diseases and non-communicable diseases, such as the excessive consumption of free sugars, smoking, and harmful alcohol consumption.6

Furthermore, the resolution underscores the need to enhance the capabilities of oral health professionals and a shift from a conventional curative model to a preventive approach.6

This entails promoting oral health in family, school, and workplace settings. The recommendation also advocates for timely, comprehensive, and inclusive care within the primary healthcare system.6

Role of general practitioners in oral health

Although oral diseases require specialised care, an American study found that 14.3% of adults consult general practitioners when they experience dental problems. Similarly, a Canadian study reported an average of 1.3 visits per 100 patients per year to general practitioners for dental-related diagnoses.7

A similar analysis conducted in the United Kingdom revealed an average of 0.6 visits per 100 patients per year to general practitioners for dental consultations.7

Several barriers impede individuals with dental diseases from accessing oral healthcare professionals’ services. Barriers include for example limited public-funded dental care, out-of-pocket expenses, poor accessibility, and fear or anxiety.7

For people living in disadvantaged communities, a lack of accessible public oral healthcare services hinders proper management of oral diseases, potentially leading them to seek alternative medical services, such as general practitioners or hospital emergency departments.7

What are some of the signs and symptoms of dental caries and periodontal disease to look out for?

Patients with early dental caries may initially have no symptoms. However, as the decay advances, it can cause pain or tooth sensitivity to hot, cold or sweet food and beverages. If the tooth becomes infected, an abscess, or pocket of pus, may form, causing severe pain, facial swelling, and fever.8

The following are warning signs of periodontal disease:9

  • Bad breath or bad taste that won’t go away
  • Red or swollen gums
  • Tender or bleeding gums
  • Painful chewing
  • Loose teeth
  • Sensitive teeth
  • Gums that have pulled away from the teeth
  • Any change in the way teeth fit together when taking a bite
  • Any change in the fit of partial dentures.

How are dental caries and periodontal disease treated?

Dental caries

The approach to managing dental caries should focus on several key objectives:3

  • Detecting initial lesions
  • Assessing caries activity
  • Conducting a caries risk assessment
  • Preventing new carious lesions
  • Preserving dental tissue
  • Prolonging tooth longevity.


As mentioned, treatment requires specialised care by an oral healthcare professional. For existing caries, the initial strategy involves non-invasive procedures like remineralisation, biofilm removal, and sealing, prioritising the preservation of dental tissue over its removal. Minimally invasive methods, such as repairing rather than replacing defective restorations, are used to arrest or control cavitated lesions.3

Non-invasive procedures, like the use of fluoride-containing toothpaste, are emphasised for lesions that can be easily accessed and cleaned without the need for fillings.3

This conservative approach applies to white spot lesions, initial occlusal lesions, limited approximal lesions, and cavitated or non-cavitated root surface lesions that are reachable by cleaning equipment. Recurrent lesions adjacent to restorations are only restored if they are not easily cleansable.3

Periodontal disease

The treatment approach for periodontal disease involves a systematic process, starting with conservative measures. The initial phase includes professional dental cleaning, involving scaling and root planning to eliminate dental plaque and calculus above and below the gum line.4

Post-cleaning, oral hygiene instructions are essential, emphasising at-home routines. Subsequent re-evaluation appointments assess the periodontal condition, probing depths, and disease progression. Regular dental cleanings are imperative due to the chronic nature of periodontitis.4

Managing risk factors is essential in periodontal disease treatment. Inadequate oral hygiene is a key initiator, requiring promotion of proper self-performed oral care and professional maintenance.4

Smoking cessation should be encouraged, while glycaemic control in patients living with diabetes can improve treatment outcomes.4

In refractory cases, antibiotics may be administered locally or systemically. Chlorhexidine gluconate, an antimicrobial compound, can be used adjunctively, while minocycline hydrochloride microspheres provide similar effects.4

Systemic antibiotics, including tetracyclines and penicillins, are indicated in rare persistent cases. Severe instances may require referral to a periodontist, involving periodontal surgery to address pockets and restore lost bone and attachment.4


World Oral Health Day serves as a reminder of the intricate connection between oral and systemic health, emphasising the pivotal role of oral healthcare professionals in adopting a comprehensive approach beyond the conventional ‘tooth mechanic’ mindset.

Oral diseases, affecting >3.5 billion individuals globally, extend beyond mere dental concerns, impacting essential functions, self-esteem, and overall well-being. The link between oral and systemic diseases underscores the importance of a holistic healthcare approach.

While oral diseases necessitate specialised care, general practitioners play a significant role, with studies indicating that a notable percentage of adults consult them for dental concerns.

In commemorating World Oral Health Day, the emphasis is not only on treating oral diseases but on prevention, early detection, and collaboration between oral healthcare professionals and general practitioners.

Recognising the signs and symptoms of dental caries and periodontal disease is crucial for early intervention, while the management approaches underscore the preservation of dental tissue and prolonged tooth longevity.

As oral health is intricately connected to overall well-being, the collaboration between specialised oral healthcare professionals and general practitioners is paramount to ensure a holistic and proactive approach to oral health.


  1. Teicher R, Henschel M. The dentist as the gatekeeper of systemic health: A case report. Special Care in Dentistry, 2022.
  2. Schwarz C, Hajdu AI, Dumitrescu R, et al. Link between Oral Health, Periodontal Disease, Smoking, and Systemic Diseases in Romanian Patients. Healthcare (Basel), 2023.
  3. Rathee M, Sapra A. Dental Caries. [Updated 2023 Jun 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from:
  4. Gasner NS, Schure RS. Periodontal Disease. [Updated 2023 Apr 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from:
  5. Benjamin RM. Oral health: the silent epidemic. Public Health Rep. 2010.
  6. World Health Organization. Oral Health Resolution 2021.Pdf. [(accessed on 18 June 2023)]. Available online:
  7. Cheng AL, Eberhard J, Gordon J, et al.Encounters and management of oral conditions at general medical practices in Australia. BMC Health Serv Res, 2022.
  8. National Institute of Dental and Craniofacial Research. Tooth Decay. Updated 2023. [Internet]. Available from,%2C%20facial%20swelling%2C%20and%20fever
  9. Centres for Disease Control and Prevention. Periodontal disease. Updated 2013. [Internet]. Available from:

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