Dental plaque and how to remove it
Plaque is a sticky film of bacteria that irritates gums and can lead to decay. UK guidance says brushing with fluoride toothpaste and cleaning between teeth daily keeps it under control. Tartar needs a dental team.
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If a dentist or hygienist has told you that plaque is behind your sore gums or a decaying tooth, it can sound like a verdict on your brushing. It is closer to a natural process that causes trouble when too much of it stays on the teeth.
What is dental plaque?
The NHS describes plaque as a film of bacteria that coats your teeth if you do not brush them properly. It is more organised than a smear of germs. The government toolkit for dental teams, from the Department of Health and Social Care and NHS England, calls it a highly organised film of bacteria held in a matrix. The bacteria support each other as a community, and that community can shelter them from the body’s immune system and from chemical agents.
A 2006 review by the UK researcher Philip Marsh explains how this builds up. Plaque forms in an ordered sequence, from the first bacteria attaching to the tooth surface to a mixed community of many species. The review also says plaque is natural, and that as a biofilm it is less susceptible to antimicrobial agents. As for removing it, the toolkit says the physical action of brushing is what does it.
What does plaque do to gums and teeth?
In a healthy mouth, the toolkit says, small amounts of bacteria cause only minimal inflammation. Trouble starts when the balance between plaque and your immune system is disrupted.
Gums
The NHS says gum disease is caused by a build-up of plaque. If you do not remove it by brushing and cleaning between your teeth, it builds up and irritates your gums. The toolkit calls gum inflammation that stays within the gum gingivitis. It can be reversed by reducing plaque at and below the gum edge. Gingivitis and periodontitis are separate conditions: gingivitis is a risk factor for periodontitis, but not everyone with gingivitis goes on to develop it.
Periodontitis damages the tissues that hold teeth in place. The toolkit describes it as irreversible, and says it will recur and worsen without good plaque control. It adds that the early stages of gum disease may cause no symptoms.
Some things raise the risk. The toolkit lists tobacco as a risk factor for gum disease, and says the main self-care goals for everyone are good plaque removal and avoiding tobacco. The NHS lists not smoking among the things you can do to prevent gum disease. The Oral Health Foundation adds that smoking can cover up a gum problem, because it restricts blood flow to the mouth. Our guide to smoking and your mouth has more on this.
The NHS says to see a dentist and dental hygienist for regular check-ups, especially if you are pregnant or have type 2 diabetes. On diabetes, the toolkit says to assume an increased risk of gum disease for anyone who has it. See our guide to diabetes and your mouth.
Teeth
Tooth decay starts in a similar way, according to the NHS: bacteria form the sticky layer called plaque, which damages the surface of the teeth over time. The NHS says decay is often caused by too much sugary food and drink and by not cleaning your teeth regularly, and that it may cause no symptoms at first.
Marsh’s review describes the link with sugar. Some plaque bacteria turn sugars into acid quickly, acid can dissolve minerals from enamel, and people who regularly eat food and drink high in fermentable sugar tend to carry more of these bacteria in their plaque. Our guide to sugar and your teeth goes into that in more detail.
Brushing does a slightly different job for each, the toolkit explains.
| What you are protecting | What the toolkit points to |
|---|---|
| Gums | Physically removing plaque, including at the gum edge and between teeth |
| Teeth, against decay | The fluoride in your toothpaste |
How do you remove plaque at home?
UK guidance sets out a short routine.
- The NHS advises brushing with fluoride toothpaste twice a day for about 2 minutes: last thing at night, and on one other occasion.
- The NHS says to clean every surface of every tooth: inside, outside and chewing surfaces. The toolkit adds the line where tooth meets gum.
- Spit out the excess toothpaste afterwards. The NHS advises against rinsing straight away, because rinsing washes away the fluoride left on your teeth.
- Clean between your teeth every day with interdental brushes or floss. The Cochrane review notes that it is difficult for toothbrushes to reach between teeth, which is why this step is often recommended on top of brushing.
On timing, the toolkit says there is no high-quality evidence about when in the day to brush for gum health, and suggests last thing at night plus one other time in line with decay prevention. It also says thorough cleaning may take at least 2 minutes, so that every surface gets reached, and that disclosing agents, which show up the areas of the mouth being missed, can help guide more effective brushing.
If your gums bleed, the Oral Health Foundation says to keep brushing: plaque left behind makes the inflammation worse, and after a few days of thorough cleaning your gums should stop bleeding. It adds that you may need a softer brush while your gums are inflamed. The NHS lists bleeding gums as a reason to see a dentist, so keep brushing and book a check-up. Our guide to bleeding gums covers other reasons gums bleed.
Choices people ask about
| Question | What the evidence says |
|---|---|
| Electric or manual brush? | Either works if every surface is cleaned (NHS). Moderate-certainty evidence favours powered brushes for plaque and gingivitis, but the practical importance is unclear (toolkit). |
| Which bristles? | A small head with medium or soft bristles suits most adults (NHS). Medium and soft bristles are less likely than hard ones to cause gum lesions, on low-certainty evidence (toolkit). |
| Floss or interdental brushes? | Interdental brushes may reduce gum inflammation more than floss, on low certainty evidence. Results for plaque were mixed (Cochrane 2019). |
| Mouthwash? | A fluoride mouthwash can help prevent decay, but use it at a different time from brushing (NHS). |
For gum health, the toolkit says daily cleaning between the teeth should have started by age 18, or earlier if the gums are inflamed. An interdental brush should fit snugly between the teeth, the NHS says, and your dentist or hygienist can advise you on how to clean between your teeth. The NHS does not advise wooden toothpicks, which can damage the gums.
The Cochrane review included 35 studies of adults. It rated the evidence low to very low certainty, says the effects it saw may not be clinically important, and notes that most outcomes were measured in the short term.
What can a dental team do?
Plaque that stays on the teeth can harden. The Oral Health Foundation says it can turn into a hard deposit called tartar, also called calculus, which needs professional scaling by a dentist or hygienist to remove.
In the early stages of gum disease, the NHS says your dentist will give advice on keeping your teeth clean, for example with interdental brushes, advise you to stop smoking if you smoke, and advise you to get your teeth cleaned by a hygienist. If it is serious, the NHS lists deep cleaning under the gums, antibiotics, removing some teeth and gum surgery among the options.
The government toolkit says no clinical benefit of routine scale and polish has been shown for adults with good gum health. It says professional care plays an important role for people with advanced gum disease. How often you need a clean is a question for your dentist.
When to see a dentist
- you or your child has gum disease and other symptoms such as very sore and swollen gums, teeth becoming loose or falling out, ulcers or red patches in your mouth, or a lump in your mouth or on your lip: the NHS says to ask for an urgent dentist appointment
For an emergency or out of hours, the NHS says to call your dentist first, as an answerphone message may tell you what to do. If you do not have a dentist or cannot get an emergency appointment, it says to call 111.
- your gums bleed when you brush your teeth or eat hard foods
- your gums are painful and swollen
- you have bad breath
- your child has sore, bleeding gums
- you have not had a check-up for 2 years, or 1 year if you are under 18
The toolkit notes that early gum disease may cause no symptoms, and the NHS advises regular check-ups even if you have no problems.
What we would do
At TG’s Dental Suite, a new patient exam looks at your teeth, gums and soft tissues, with small X-rays where needed to check for anything not visible to the eye. If there is plaque or tartar to remove, a dental hygiene appointment starts with your hygienist checking your gum health and looking for plaque build-up or early signs of gum disease. Then comes a clean and scale to remove the build-up, followed by a polish. Your hygienist can also advise on your own brushing and flossing routine.
If you would like your technique checked, or your gums have been bleeding, book an appointment and say so when you do.
Want us to take a look?
Book an appointment at whichever of our five practices suits you. We will check what is going on and talk you through your options.
Questions this guide answers
Is plaque the same as tartar?
No. Plaque is a soft film of bacteria. The Oral Health Foundation says that if it is not cleaned off by daily brushing and cleaning between your teeth, it can turn into a hard deposit called tartar, which needs scaling by a dentist or hygienist to remove.
Does an electric toothbrush remove more plaque than a manual one?
The government toolkit for dental teams cites moderate-certainty evidence that powered brushes reduce plaque and gingivitis more than manual ones, but says the clinical relevance is unclear and that either type can clean teeth effectively. The NHS says both work equally well if you clean every surface with fluoride toothpaste.
Do I need to clean between my teeth as well as brush?
The NHS and the government toolkit both recommend cleaning between your teeth every day, with interdental brushes or floss. A 2019 Cochrane review found low to very low certainty evidence that this may reduce gingivitis or plaque more than brushing alone, and that interdental brushes may reduce gum inflammation more than floss, although results for plaque were mixed.
Should I stop brushing if my gums bleed?
No. The Oral Health Foundation says to keep brushing, because plaque left behind makes the inflammation worse, and that gums should stop bleeding after a few days of thorough cleaning. The NHS lists bleeding gums as a reason to see a dentist, so keep brushing and book a check-up, and tell your dental team if the bleeding has not settled.
Sources (8)
- How to keep your teeth clean
- Gum disease
- Tooth decay
- Delivering better oral health: an evidence-based toolkit for prevention, chapter 5: periodontal diseases
- Delivering better oral health: an evidence-based toolkit for prevention, chapter 8: oral hygiene
- Why are my gums bleeding?
- Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal diseases and dental caries
- Dental plaque as a biofilm and a microbial community: implications for health and disease
