Dental plaque as a biofilm: the significance of pH in health and caries.

Dental plaque is an example of a biofilm; its presence is natural and it supports the host in its defense against invading microbes. In health, the microbial composition of dental plaque is diverse and remains relatively stable over time (microbial homeostasis). The predominant microorganisms prefer host molecules (eg, salivary mucins) and a neutral pH for growth. Under certain circumstances, this microbial homeostasis can break down and diseases such as caries can occur. In dental caries, there is a shift toward increased proportions of acid-producing and acid-tolerating species, such as mutans streptococci and Lactobacilli, although other species with relevant traits can participate in demineralization. Strategies to control caries include effective oral hygiene practices to reduce biofilm development, and adoption of a low-sugar diet to restrict periods of acidic challenge to teeth. These conventional approaches also should be augmented by interference with the factors that enable the cariogenic bacteria to outcompete the organisms associated with health. Evidence suggests that regular conditions of low pH in plaque select for mutans streptococci and Lactobacilli. Therefore, the suppression of sugar catabolism and acid production by the use of metabolic inhibitors in oral care products, the consumption of nonfermentable sweeteners in snacks, the stimulation of saliva flow, and/or other strategies that maintain supragingival plaque at a pH around neutrality will assist in the maintenance of microbial homeostasis in plaque.