Dental plaque is the leading culprit for many oral diseases, and without proper management, patients are at a high risk of developing gingival diseases and caries. The oral microbiota, taking the form of a sticky biofilm, is a key player in maintaining a healthy oral environment.
Certain stressors can encourage the development of oral diseases: various health conditions, lifestyle factors and habits can also cause this carefully balanced environment to skew in favour of disease development and progression. The dental team must remain vigilant when supporting patients and educating them on how they can manage biofilm at home.
The science behind biofilm
Biofilm occurs naturally on all oral surfaces, as “functionally and structurally organised communities of interacting microorganisms”. Health-associated biofilm contributes to an environment with a neutral pH, with microbes that have the ability to produce hydrogen peroxide (H202) and bacteriocins that could suppress disease-associated microorganisms and their growth.
Research postulates that the microbiomes associated with good oral health are in symbiosis with the host, however, certain stressors and stimuli can skew the balance and lead to dysbiosis. This might include the presence of sugars and a reduced salivary flow, leading to caries. Or, if a patient develops periodontal disease, this could be partly the result of changes in the patient’s immune response. Thus, the delicate composition of microbial communities can be easily disrupted, leading to an increased chance of disease and infection.
Patients with more complex needs may also be at risk of developing plaque and, subsequently, other oral complications. For instance, those living with type 2 diabetes are three times more likely to develop dental problems than people without the condition. Concerningly, pathogenic bacteria from the oral cavity have been associated with other systemic conditions, such as cardiovascular disease (CVD), pulmonary disease, certain cancers and rheumatoid arthritis (RA).
Good oral hygiene practices are fundamental in keeping the proliferation of pathogenic microbes under tight control. This is in addition to healthy lifestyle habits such as maintaining a balanced diet and avoiding certain habits like smoking, drug taking and the overconsumption of alcohol. The dental team are in the best possible position to provide information about effective oral hygiene practices, as well as tips and tricks to ensure the most thorough clean.
The importance of patient compliance
Professional intervention is vital in the fight against biofilm. While it can never be truly eradicated, attending regular hygiene appointments will ensure that as much of it is removed as possible.
Between appointments, dental professionals depend on patient compliance to maintain biofilm management and keep the risks of oral disease at bay. Twice-daily brushing with a fluoridated toothpaste should be supplemented with regular interdental cleaning, and also the addition of mouthwash if necessary. However, to access those hard-to-reach areas where bacteria thrive and biofilm can form unchecked, patients may need additional help.
Where flossing fails, whether due to pain or lack of dexterity, consider recommending a water flosser. Studies support their efficacy over traditional methods of interdental cleaning: for instance, one study found that cleaning interproximal regions with a water flosser “achieved more effective removal of interproximal biofilm’ compared to a sonic toothbrush”. The Waterpik Water Flosser is also backed extensively with clinical research, proven to remove up to 99.9 per cent of plaque from treated areas, and is twice as effective as strong floss for reducing gingival bleeding.
Alongside thorough cleaning, advise patients on the importance of following a balanced diet and avoiding sugar laden foods and drinks, which can provide sustenance for the pathogenic bacteria in the mouth.
A team effort
Protecting oral health can be relatively straightforward when patients follow the advice of the dental team – with a simple routine, they can reap the benefits of a healthy mouth and continue practising good habits in between their dental appointments. When they recognise the interplay between oral disease and oral biofilm, they will feel empowered to work effectively with the dental team to keep their oral hygiene in good shape.
References available on request.