Dental researchers have attempted to understand the microbial nature of oral diseases over the past 130 years. A lot of progress has been made particularly in the last decade with findings from the human microbiome project, enabled by major technological advancements, to identify over 700 microbial species present in the mouth alone. Building on the past knowledge of biofilms and how these microbes interact with each other, research has now evolved from numerous previous hypotheses to several new ones such as the keystone plaque hypothesis suggesting that certain keystone pathogens are responsible for the initial tip towards a dysbiotic plaque biofilm. Additionally, the new IMPEDE model takes the keystone concept one step further by suggesting that inflammation is the driver of the ultimate dysbiosis that leads to periodontitis rather than the pathogenic microbes themselves, providing a better understanding of how disease occurs. These new discoveries have created a paradigm shift in how we manage plaque biofilms with the ultimate goal being restoration of a state of symbiosis which means not destroying the beneficial species.