Plaque start to form on the teeth through a thin biofilm after minutes of using toothbrush, after few hours bacteria start to attach to this biofilm, multiply and grow. Using toothbrush and floss twice daily will prevent plaque growth and maturation and keep the gingiva and teeth healthy. (See the link: what happen if you did not clean your teeth?) There are some diseases that decrease the immunity and aggravate the gingival inflammation to bacteria (e.g. Diabetes). In these cases, the response of the patient to periodontal treatment is influenced by controlling the medical condition. Smoking decreases the blood flow in the gingiva and immunity causing more destruction of the periodontal tissue and bone and decreases the response to therapy. There are some medical diseases that cause periodontal destruction without presence of plaque. To know the cause of periodontal destruction in these cases, the periodontist should do proper investigations and arrangement with the physician to discover the cause and formulate a treatment plan to control it. How I maintain healthy teeth and gingiva?