Dental plaque is a non-mineralized film made up of bacteria. Dental plaque starts collecting on proximal surfaces, at gum line. It adheres firmly to the teeth, calculus, fixed and removable restorations. Later, it is usually found on lingual mandibular molars, on rough surfaces of teeth, malpositioned teeth, carious lesions and generally on areas which are not cleaned daily by patient. We talk about supragingival plaque. Subgingival plaque is found in shallow or deep pocket, in overhanging margins of fillings that extended into pockets.

Plaque develops when food is left on the teeth. Common foods that contribute to plaque formation are those which contain carbohydrates, simply sugars and starches. These are usually found in cakes, sweets, fruit, and soft drinks.

Human being has a lot of bacteria in the oral cavity. Bacteria that collect on the surfaces of the teeth and create a bacterial film. Plaque develops of food in the oral cavity mixed with saliva, bacteria, and together produce acid as a result. In the beginning the plaque is translucent. Later, it acquires stains that make it visible. Stained plaque is usually yellow, green, or brown. The tooth with thick plaque appears dingy, with a matted fur-like surface. Food debris and Materia Alba (a loosely adherent mass of bacteria) may collect over the plaque.

The patient can check the plaque at home or see his/ her dental hygienist. Dental hygienist does the tactile examination. Dental hygienist (DH) can feel slippery coating. When calcification has started, the plaque is slightly rough and can be taken away by an explorer passed over the surface. Plaque adheres to the explorer tip. When no plaque is visible it can be detected with disclosing agent, gel or tablet, it contains dye which turns violet colour to indicate plaque.

Plaque can be removed with daily proper brushing and flossing. Patient should use a quality toothbrush, interdental toothbrush or floss with an anti-plaque toothpaste. He should know a suitable brushing technique. The process can be completed with a mouthwash.

Indices and scoring methods are used to determine and record the state of health of the patients. It helps patient to recognize an oral problem, can show the effectiveness of oral brushing techniques, and motivate in preventive care. Dental hygienist can choose from wide range of versions.

The others are specialized to:

If the patient doesn´t brush and floss his teeth regularly, minerals from his saliva are deposited into the plaque film causing it to harden within 24 to 72 hours. It turns into tartar, also called dental calculus. The average time of formation the primary soft deposit to the mature mineralized stage takes about 12 days. It depends in individual tendency, roughness of the tooth surface, and personal care.

Patient has a greater risk of developing tartar with braces, dry mouth, crowded teeth, smoking, and aging.

Unlike translucent plaque, the tartar is visible. It is not only aesthetically unpleasant, but even it can irritate the gums and lead to gingivitis. It is also very difficult to remove it. Plaque can be removed with proper brushing and flossing but patient has to go to see a dentist or dental hygienist to remove tartar, because calculus build-up on the teeth is strongly bonded to the enamel. Professional treatment of calculus includes scaling and polishing. DH uses scaler, curettes, and file, and other professional tools, e. g. air flow, ultrasound for treatment of prophylaxis. This treatment lasts around 30 minutes. The teeth are cleaned with air, or water or bicarbonate jet. This may be combined with ultrasonic staining for calculus which needs to be removed. Calculus should be professionally removed twice a year.

There are several methods of coping with the problem of plaque and calculus. The patient must understand the importance of individual daily bacterial plaque removal, because plaque is significant in the formation of dental calculus, and maintenance smooth teeth as much as possible.

Dental hygienist should teach her patients: