As the depth of the vertical space between the tooth and the gum reaches 5mm, a change occurs. This plaque eventually transforms into calculus, and the process continues, resulting in deposits under the gum, and an increase in pocket depth. Gingival attachment begins to loosen further as the bacterial plaque continues to invade the space created by the swelling it causes. This results in an ulceration in the lining of the tissue, which begins to break down the attachment of the gum to the tooth. Once bacterial plaque has infiltrated the pocket, the transformation from biofilm into calculus continues. Because tooth brush and floss cannot reach the bottom of a gum pocket 4–5 mm deep, bacteria stagnate in these sites and have the opportunity to proliferate into periodontal disease-causing colonies. At a depth of 4 mm or greater, the vertical space between the tooth and surrounding gum becomes known as a periodontal pocket. The swelling of the tissue may also result in deeper reading on periodontal probing, up to 4 mm. Thus, bleeding is generally accepted as a sign of active oral infection. This is the body's attempt to clear the infection from the tissues. As the gingivitis stage continues, the capillaries within the sulcus begin to dilate, resulting in more bleeding when brushing, flossing, or at dental appointments. In healthy individuals, the sulcus is no more than 3 mm deep when measured with a periodontal probe. Vertical space is created between the tooth and the gum, allowing new bacterial plaque biofilm to begin to migrate into the sulcus, or space between the gum and the tooth. Īs the gingival tissue swells, it no longer provides an effective seal between the tooth and the outside environment. It is the first step in the decline of periodontal health, and the only step which can be fully reversed to restore one's oral health. Gingivitis is characterized by swelling, redness and bleeding gums. This infection of the gum causes the gum disease known as gingivitis, which literally means inflammation of the gingiva, or gums. Because of the proximity of this area to the gum tissue, the bacterial plaque begins to irritate and infect the gums. Plaque accumulation tends to be thickest along the gumline. Calculus cannot be removed by brushing or flossing. Commonly known as 'tartar', calculus provides a base for new layers of plaque biofilm to settle on and builds up over time. Through this absorption of calcium and phosphorus from the saliva, oral biofilm is transformed from the soft, easily removable form into a hard substance known as calculus. However, if, after 24 hours in the oral environment, biofilm remains undisturbed by brushing or flossing, it begins to absorb the mineral content of saliva.

In general, the more effective one's brushing, flossing, and other oral homecare practices, the less plaque will accumulate on the teeth. Materia alba is similar to plaque but it lacks the organized structure of plaque and hence easily displaced with rinses and sprays.Īlthough everyone has a tendency to develop plaque and materia alba, through regular brushing and flossing these organized colonies of bacteria are disturbed and eliminated from the oral cavity. This matrix makes it impossible to remove the plaque by rinsing or using sprays. It is an organised biofilm that is primarily composed of bacteria in a matrix of glycoproteins and extracellular polysaccharides.

Plaque is a soft yellow-grayish substance that adheres to the tooth surfaces including removable and fixed restorations.

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