Contemporary Hygienist – winning the biofilm battle

This month, Claire Berry and Faye Donald explain the life cycle of biofilm and share the secret to winning this ongoing 'battle'.This month, Claire Berry and Faye Donald explain the life cycle of biofilm and share the secret to winning this ongoing ‘battle’.

I like to think of biofilm as a nemesis rather than an enemy. An enemy is one you have the possibility to overcome, whereas a nemesis is impossible to defeat.

Why is it a nemesis? Because it will always re-develop after its removal, so the notion that its removal is finite is wrong.

The biofilm lifecycle will always continue, so teaching our patients about it will help them to understand what we are asking of them with regards their home care, and to see why a hygienist recall is imperative in order to maintain optimal health.

Beating biofilm requires a team work approach.

The life cycle of biofilm

Let’s look at the life cycle of biofilm. Within 20 minutes of removal, early colonisers start the process of attaching to the tooth surface again. By processing the sugars we eat, they produce an acidic environment that is favourable for other bacterial species. They attach onto the pioneering microorganisms and the biofilm starts to form.

All the while, a sticky matrix maintains the microorganisms, facilitating the environment to allow the biofilm to mature. Maturity transforms it to become pathogenic, capable of initiating disease and host destruction/tissue damage.

We need to remind ourselves that this lifecycle will never stop and this makes all of us susceptible to a biofilm-related disease. The aim of home care is to turn over this lifecycle in the early stages of development, preventing it from progressing into a mature state. This requires skill, dexterity, commitment and priority.

Do all patients show all of these attributes? Often not.

The need for professional management

It’s not that we don’t trust patients when it comes to biofilm control at home. It’s just that there are so many areas that are inaccessible, and with biofilm quickly maturing when left to stagnate, it’s important that patients are made aware of the need for professional biofilm management to complement their efforts at home.

Hygienists catch what the patients inadvertently miss and they press the reset button on the biofilm lifecycle and disease process. Optimal oral health can only be achieved when biofilm is meticulously controlled and one’s oral health is regularly monitored to ensure pathogenic bacterial load remains suppressed.

How can we work with patients to win the biofilm battle?

1. Increasing professional mechanical biofilm removal

This can be done with a hygienist at a bespoke recall that is decided based on assessment. Don’t be afraid to make this an even more regular recall if issues like dexterity or compliance are apparent.

Contemporary Hygienist (CH) co-founder Claire says: ‘I have some patients on a four week recall because we have worked out that that’s what it takes to keep disease at bay for them. Recalls are not a one size fits all when it comes to helping them professionally manage their biofilm.’

2. Disclosing to ensure 100% removal

Meticulous biofilm removal in treatment can be maximised by making sure that issues have been highlighted.

CH co-founder Faye tells us: ‘we may inadvertently leave biofilm behind if we can’t see it, which can be considered an injustice for our periodontal patients.’

3. Prescriptive and explicit mechanical home care

Suggest tools and techniques that are tailored to the patient’s needs. When patients were asked what they most want to take away from seeing a dental professional, the most frequent response was prescriptive advice.

They want to know exactly what toothpaste to use, what toothbrush etc.

4. Chemical adjuncts to manage biofilm growth

For example, stannous fluoride and stannous chloride found in some toothpastes can be beneficial at controlling biofilm alongside mechanical cleaning.

5. Considering systemic issues that might aggravate biofilm growth

For example, uncontrolled diabetes increases salivary sugar content which promotes biofilm to flourish. Or the way menopause effects oestrogen receptors, causing xerostomia and an increase in biofilm maturation.

6. Supplements or probiotics to holistically suppress biofilm

These work by aiding the immune system, blocking bacterial colonisation and preventing the metabolism of the bacteria.

It’s a topic area that is seeing more traction and research. We have seen the benefits probiotics have had on gut microbiome, now it’s time to see what it can do for the oral microbiome.

Read previous Contemporary Hygienist columns:

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