Michael Sultan: “Seeing the Plaque Problem”

Health & Hygiene
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Michael Sultan: “Could plaque visualisation be the key to reducing dementia?”

Products that identify plaque in the mouth are nothing new. Disclosing solution/tablets are a mainstay in practices when you want to show patients what’s going on in their mouths, and there have been a number of technologies introduced in recent years that have helped patients to visualise their oral health more clearly.

Such products also exist for home use. Not so long ago there was a fad for mouthwashes that revealed plaque. There is now a toothpaste that highlights plaque after brushing, designed to make effective removal easier. But does visibility actually make a difference when it comes to patient habits?

Plaque is bad news for dental health. Decay, gum disease – the effects of plaque build-up are evident. But what about its effects on systemic health? It’s becoming more evident that plaque bacteria have a huge impact on general health. For example, elevated levels of plaque bacteria have been connected to higher risks of heart disease and stroke [1]. Other research has suggested a correlation between periodontitis and Alzheimer’s disease and dementia [2].

These links between oral and systemic health are due to c-reactive proteins (CRPs) which are in our bloodstreams and react to inflammatory response. Usually, this isn’t a problem as inflammation is resolved during the natural healing process. However, with gum disease plaque acid is constantly causing an inflammatory response and CRPs can quickly cause issues, building up in the bloodstream and blocking arteries or gathering in the brain.

With gum disease such a risk factor, could making plaque visible really make a difference? Browsing through the news recently, I stumbled across a piece that described some research undertaken by Florida Atlantic University's Schmidt College of Medicine, Marshfield Clinic Research Institute, and the University of Wisconsin School of Medicine and Public Health.

They performed a randomised trial to discover once and for all whether using a plaque-revealing toothpaste could help reduce the number of CRPs in a person’s system. The results suggested that there was indeed a good case for plaque-identifying toothpaste, and that the use of it significantly lowered levels of CRPs in participants. However, as with many such studies, it will require larger trials to ensure this evidence is conclusive [3].

Perhaps the most compelling argument for accepting the results is rather simple – if people can see a problem, they want to solve it. Plaque bacteria is easy to ignore because you can’t really see it clearly, unless there is a huge build up. If remaining plaque is clearly highlighted after brushing we can see there is still work to be done, encouraging patients to clean their teeth with more care.

It's unlikely that someone would ignore a strange rash or a tumour developing, and making plaque visible works in much the same way. If you can see something is not right, you want to find out more about it, and correct it if possible.

Humans are visual problem solvers [4]. Faced with a conundrum we instantly reach for a pen and paper in order to jot down notes, brainstorm or write down key points. We find information easier to process on a visual level, so revealing plaque on teeth is an approach that appeals to our natural problem-solving methods, and is therefore more effective.

Unfortunately, not everybody will be inspired to good oral hygiene habits. For some people visualisation isn’t enough – think of how many cases present with clearly decayed teeth or with other highly visual problems which they wilfully ignore until pain sets in.

However, if it encourages just a small number of people to remove oral plaque more effectively, these products have got to be a good idea. This way, we can not only, hopefully, improve the nation’s oral health, but also their general health by helping to lessen the chances of strokes, heart diseases and even dementia.


Michael Sultan is the founder and Principal of EndoCare, a leading endodontic specialist practice and referral centre. For more information, visit www.endocare.co.uk. He is interested in all aspects of healthcare and is a regular contributor to Dental Review.


1] Harvard Health Publishing. Heart Disease and Oral Health: Role of Oral Bacteria in Heart Plaque. Link: https://www.health.harvard.edu/press_releases/heart-disease-oral-health [Last accessed March 2020].

2] NHS. Gum Disease Linked To Increased Risk of Alzheimer’s Disease. Link: https://www.nhs.uk/news/neurology/gum-disease-linked-increased-risk-alzheimers-disease/ [Last accessed March 2020].

3] Science Daily. Could This Plaque Identifying Toothpaste Prevent a Heart Attack or Stroke? Link: https://www.sciencedaily.com/releases/2020/02/200224100554.htm [Last accessed March 20202].

4] NRICH. Thinking Through, And By, Visualising. Link: https://nrich.maths.org/6447 [Last accessed March 2020].