Plaque, gingivitis, periodontitis and other oral diseases are caused by bacteria forming a biofilm on the teeth called plaque. Attached below are detailed descriptions of the role of bacteria, biofilm, and plaque that results in the formation of gingivitis and periodontitis. In addition, we have also detailed the approach taken by traditional toothpastes to tackle plaque formation in comparison to the breakthrough benefits of Livionex Dental Gel.

BACTERIA

Populations of microbes (such as bacteria and yeasts) inhabit the skin, mucosa and intestines. Their role forms a significant part of normal human physiology. However, if microbes grow in numbers beyond their typical ranges (often due to a compromised immune system), or if they populate atypical areas of the body (such as through poor hygiene or injury), it can trigger varied diseases. It is estimated that there are at least ten times as many bacteria as human cells in the body (approximately 10^14 versus 10^13), and a mass estimated to account for 1-3% of total body mass.

BIOFILM

A biofilm is any group of microorganisms (typically bacteria) which stick to each other on a surface. Part of the mechanism that allows microorganisms to adhere to a surface is due to a self-produced matrix of Extracellular Polymeric Substance (EPS). Biofilm EPS, which is also referred to as slime (although not everything described as slime is a biofilm), is a polymeric conglomeration generally composed of extracellular DNA, proteins, and polysaccharides on which the bacteria stick. Biofilms may form on living or nonliving surfaces and can be prevalent in natural, industrial or hospital settings. The microbial cells growing in a biofilm are physiologically distinct from planktonic cells of the same organism, which, by contrast, are single cells that may float or swim in a liquid medium.

Biofilms have been found to be involved in a wide variety of microbial infections in the body; by one estimate 80% of all infections are due to biofilms. Infections in which biofilms have been implicated include common problems such as urinary tract infections, catheter infections, middle-ear infections, formation of dental plaque, gingivitis, coating contact lenses, and less common but more lethal infectious processes such as endocarditis, infections in cystic fibrosis, and infections of permanent indwelling devices such as joint prostheses and heart valves. More recently, it has been noted that bacterial biofilms may impair cutaneous wound healing and reduce topical antibacterial efficiency in healing or treating infected skin wounds.

Research indicates that bacteria in biofilms are up to 2000 times harder to kill than in the planktonic form.

PLAQUE

The oral cavity contains the only known anatomical aspect of the human body that does not have a regulated system of shedding surfaces: the teeth. This allows microorganisms to adhere to the surface of the teeth for long periods of time. These multiple species of bacteria become dental biofilm. Dental biofilm, more commonly referred to as dental plaque, is composed of about a thousand species of bacteria that take part in the complex ecosystems of the mouth. The natural, non-frequent regulation of tooth shedding plays a large role in making dental biofilm the most diverse biofilm in the human body despite the relatively small size of the teeth. At first, the biofilm is soft enough to come off by using the fingernail. However, it starts to harden within 48 hours, and in about 10 days the plaque becomes dental calculus (tartar), which is hard and difficult to remove.

Dental plaque can give rise to dental caries (tooth decay); the localized destruction of the tissues of the tooth by acid produced from the bacterial degradation of fermentable sugars. It can also cause periodontal problems such as gingivitis and chronic periodontitis. For this reason, the main goal of all toothpastes and dental gels is to remove dental plaque.

GINGIVITIS

The symptoms of gingivitis are somewhat non-specific and manifest in the gum tissue as the classic signs of inflammation:

  • Swollen gums

  • Bright red or purple gums

  • Gums that are tender or painful to the touch

  • Bleeding gums or bleeding after brushing and/or flossing

  • Bad breath (halitosis)

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Additionally, the stippling that normally exists on the gum tissue of some individuals will often disappear. The gums may appear shiny when the gum tissue becomes swollen and stretched over the inflamed underlying connective tissue. The majority of adults have some degree of gingivitis, which can lead to serious dental problems, including tooth loss. According to the British Medical Journal (BMJ), "Gingivitis is the mildest form of periodontal disease and affects 50% to 90% of adults worldwide. It is ubiquitous and affects males and females, young and old. As defined by gingival bleeding adjacent to >1 teeth, about half of the US population has gingivitis".

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According to the US Centers for Disease Control (CDC) approximately 47% of all adults above 30 years of age residing in the USA suffer from some form of periodontitis. That is approximately 65 million adults!

 

 

PERIODONTITIS

According to the American Academy of Periodontology, untreated gingivitis can advance to periodontitis. With time, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the body in essence turns on itself, and the tissues and bone that support the teeth are broken down and destroyed. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms. Eventually, teeth can become loose and may have to be removed.

TRADITIONAL TOOTHPASTES

Traditional toothpastes use detergents and abrasives to remove plaque from the teeth. Some anti-gingivitis toothpastes also use antimicrobials that reduce the number of bacteria in the plaque. The fact that so many people suffer from gingivitis proves that the ability of typical toothpaste to remove plaque is very limited. Various studies have shown that regular brushing (after not having brushed for 48 hours) brings down the Plaque Index from an index of about 4 on a 5 point scale to about 2, where it remains roughly stable, despite regular brushing. This remaining plaque is characterized by being on the margin of the gums, and interproximally (between teeth). This plaque is generally addressed by visits to dental hygienists, by regular flossing and the use of toothpicks.

The epidemic size prevalence numbers of gingivitis and periodontitis even in a developed country like USA point to the inadequacy of home hygiene care despite the widespread use of toothpaste.

LIVIONEX DENTAL GEL

Livionex Dental Gel contains no abrasives or detergents. It uses Activated Edathamil to penetrate and disrupt the ability of biofilm to bind to the tooth surface. It has been clinically proven to be up to 2.5x more effective at cleaning teeth than a leading toothpaste. Users regularly report the same slick feeling as when they get a professional cleaning. Studies show that this plaque reduction leads to significant benefits in associated gum health.