Health
No More Dental Plaque – Here Comes the Biofilm!
Submitted by Christine Guilliaume
In case you haven’t heard about it yet, the new name for dental plaque is dental biofilm. After a hundred or so years of calling that sticky disease causing film that collects on your teeth, gums, tongue, and dental appliances plaque, it has been placed into a new category called bacterial biofilms.
In 2002, Dr. Bill Losterton and Dr. Paul Stoodley, the leading world experts from the Center of Biofilm Engineering at Montana State University, presented the concept of biofilm formation on the tooth surface. Using the new technology of the confocal laser microscope providing three dimensional imaging, the dental community was informed of the “ formidable collection of micro colonies on the tooth structure” as opposed to the pre-existing theory of a sticky bacteria laden residue. The Center for Biofilm Engineering published its findings in the Journal of Scientific American. In this landmark publication was the newest data collected by Dr. Losterton and Dr. Stoodley. Besides the dental biofilm, the publication listed hospital staph infection, tuberculosis, Legionnaires’ disease, and the fatal pneumonia associated cystic fibrosis as examples of biofilm activity.
During the past ten years, the dental community experts have embraced the biofilm concept due to the mounting volumes of scientific evidence. So when the dentists, dental hygienists, and dental assistants attended seminars and scientific programs, they used the term biofilm. However, when returning to their practices and patients, the new information was given using the name plaque when discussing oral health. Most of the public today still considers the crummy scrummy film on the teeth as dental plaque. Now the advertising gurus’ have taken the initiative of informing the public and the term biofilm is being used to promote oral health products in commercials.
So for the last ten years into the present, the science of biofilm activity has been a major factor for the numerous over the counter dental health products such as toothpastes, rinses, power devices, prescription products, chewing gums, and probiotics. All have incorporated new approaches to removing the biofilm and to assist in controlling the microbial populations.
Just remember that your tooth plaque is now your tooth biofilm.
What’s So New?
Oral Biofilm formation illustrates the glorious tenacity of the microorganisms that live in the mouth.
Take new born infants as an example. At birth, the mouths of newborns have oral bacteria that are somewhat sterile in nature. During the infant’s formative years, the mother will inoculate her infant with her oral bacteria. This usually occurs from the acts of loving attention close to the infant’s face and feeding the infant with a utensil used by the mother to taste the baby food. Not only are streptococcus mutans inoculated into the oral cavity, but a host of other microbes are given this opportunity. New mothers now receive additional attention by their dental hygienists and dentists for this very reason. Since all young women are potential future moms, most dental professionals have raised the bar on acceptable good oral health.
A recommendation by the American Academy of Pediatric Dentistry is that a child should be seen by the dentist when the first primary tooth erupts or by the child’s first birthday. This is done as a proactive approach to prevent the earliest possible invasion of lactobacilli microbes from colonizing within the enamel’s microscopic tooth pores. The bacterial invasion is a separate activity from biofilm activity. Biofilms can be mechanically removed. Tooth decay microorganisms must be in the presence of a toxic or antimicrobial agent to be removed in addition to replacing the mineral smear layer to prevent or arrest tooth decay.
A second item to understand about dental biofilm micro colonies are that they are waterproof and must be mechanical removed. The establishment of the micro colony is so sophisticated that the colony will create fluid flowing channels through out so that the colony cannot be moved. The micro colony is encapsulated by a gooey matrix which is resistant to liquids. The biofilm establishment is not totally invincible in that substances can pass in and out. If a person speaks, chews, drinks, and mouth breathes, pieces of the biofilm can be dislodged. But to effectively remove as much biofilm as possible, requires the lifetime skills of excellent oral hygiene.
The last tidbit of information on this newest of biofilms has to do with the “killing of the bacteria” in the dental biofilm. It is really hard to kill enough of the microorganisms living in a biofilm colony. Biofilm micro colony bacteria are 1,500 times more resistant to antibiotics. That is why daily oral hygiene habits are so important. Every time the biofilm is removed, it has to begin creation all over again. The existing bacteria which evolves into a biofilm is not as aggressive to tooth and gum tissue when it is under twenty four hours in age.
Are the Basic Oral Hygiene Methods Still Good Enough?
It depends on the individual.
Some individuals have never had a cavity, have an almost perfect bite, are in good health, do not smoke, have low alcohol consumption, eat healthy, and take no medication. Any deviation from the previous description places a different demand on what is needed to have a mouth free of dental disease.
According to the dental experts, a person should spend five to six minutes two times a day brushing to remove the biofilm micro colonies from the tooth structure above the gum line. Flossing still remains the method of choice for removing the biofilm on the tooth surface located between the teeth and beneath the gum tissue. But with an aging dentition maintaining population, interproximal aids such as floss on holders, proxabrushes, toothpicks, and irrigation devices have become necessary to properly clean biofilm and biofilm laden debris.
Years of toothbrush design deviations, softer bristles, changes in gum line with root exposure, stain formation, and tartar, have encouraged many individuals to purchase power tooth brushes. Using a power toothbrush for two minutes will result in the same biofilm removal as a manual toothbrush that is used for five to six minutes. A power toothbrush gives the advantage of placing the toothbrush in a better position for removing the biofilm colonies. The power toothbrushes which have a pulsing or sonic fluid dynamics state the ability to kill some bacteria and disturb biofilm formations up to 5mm from the bristle contact. Oscillating toothbrushes also have research to support the superiority of biofilm removal with outcomes of significantly fewer bleeding sites when the gingiva undergoes a systematic health evaluation. (The true standard of gingival health assessment utilized by gum specialists is a procedure most dental patients have when the gums around the teeth are measured with tiny gum rulers to record pocket depths.)
Toothpaste has been formulated to control the free swimming organism populations that will cluster to form the initial micro colony stage. Leading toothpaste corporations have invested heavily in providing the consumer with a product that not only assist in controlling the growth and removal of biofilms, but still provide remineralization of tooth surfaces, anti-tartar protection, stain removal, and relieve sensitivity.
However, sometimes the “detergent” factor of the new formulations will strip the protective moisture layer on the inside of the cheeks and lips. This can be a benign side effect given the benefits of assisting to clean away biofilms. But a burning sensation or discomfort should not be tolerated and switching to new toothpaste is recommended. Dry lips can be alleviated by using a Chap Stick product either before or after tooth brushing. For the “foamers”, wiping the toothpaste foam off during the brushing activity will prevent sensitive skin irritations at the corners of the mouth or outside the lip area.
Where Did All These Products Come From?
You guessed it I hope! Biofilm science of course!
Biofilm science has opened up a whole new world and everyone has a therapeutic approach. This is especially true when it comes to biofilm and tooth decay.
Under the electron microscope, the tooth has a dual component. The human tooth architecture is structured like a honeycomb of tube like crevices. Another description is it looks like very holey symmetrical Swiss cheese. A distinct and separate layer of minerals cover up the tiny pores. A tooth will be cavity free as long as the mineral layer stays intact. This layer is called the smear layer.
When the smear layer is defective or missing, then the microscopic pores in the tooth are accessible to the bacteria in the oral cavity. Lactobacilli bacteria are the ones that will invade the tiny pores and if they colonize create a larger hole. This results in a cavity.
The biofilm lives in an acidic pH environment. Acid pH causes mineral components to move out of the smear layer and tooth structure. Neutral pH reverses the mineral flow back into the tooth. There are components in saliva to defend the tooth against acid pH. There are components to assist in killing the invading bacteria to prevent decay.
Suppose there is too much acid and the saliva is overwhelmed? What happens when there is not enough of the right saliva?
In order to have access to products to assist a person for his specific needs, a multitude of oral health products exist. The introduction of the enamel and cementum smear layer alone is responsible for reformulated toothpaste, reformulated fluoride containing dentifrices and rinses. Xylitol and Sorbitol in chewing gums and mints provided a new anti-bacterial component, as well as promoting remineralization through pH neutrality and increased calcium availability in salivary flow.
Dental offices will usually establish a Patient Product Center to allow the patient to access pharmaceutical grade products. By having these on site therapies, a patient can achieve improved oral health with fewer cavities, less sensitivity, and good gum health.
Favorite stand-by toothpastes and rinses for dry mouth have been so successful that new additions are coming into existence. These dry mouth products contain ingredients which will give a feeling of moisture for comfort and some will replace specific salivary components to fight dental diseases such as tooth decay and periodontal infections
Biofilm and its influence over pH is the most important reason to use the toothbrush at least twice a day to remove the existing biofilm micro colonies and to floss once a day. If food debris stays in contact with teeth, it will be source for biofilm creation and the potentially deplete the protective salivary chemistry. This could demand a more frequent cleaning such as brushing and flossing, or flossing and thorough rinsing after eating.
Fluoride has been the longest therapeutic agent in the prevention of tooth decay. It is a replacement for the hydrogen atom in the hydroxyapatite crystal of the tooth. There are theories of the apatite crystal becoming stronger and more resistant to the acid pH and that the presence of the fluoride kills the lactobacilli microbes when the fluoride atom is released under an acid pH environment. A new dentifrice has been released which is an alternative to fluoride. It is utilizing a component of cocoa to fight tooth decay.
Busy Busy Biofilms
Alas, dental biofilm activity is not just limited to tooth surfaces. Biofilm in combination with debris such as food particles, mucous, sloughing skin cells, and microbes floating in from other areas with oral access- are responsible for most halitosis. (Sorry for such a gross description.)
Once again, the primary initiative of biofilm removal is the key component of eliminating halitosis. Cleaning the tongue by scrapping away the collection of Yuk on the top can be done with toothbrushes, special scrappers for the tongue, or a plastic spoon.
Tongue biofilm is notorious for the creation of volatile sulfur compounds (VSCs). No one wants stinky breath and no one wants to smell stinky breath. Special rinses and dentifrices may be needed to control or eliminate the VSCs, especially if the biofilm is enhanced by mucous draining from sinuses, decomposing stones in existing tonsil crevices, and inaccessible tongue plaque. These products will usually have an oxygenating agent or anti VSCs ingredient.
The Biofilm You Do Not Want To Have
As if you would want any of the dental problems you have read about so far!
As the molecular science of the body’s biochemistry continues to enlighten us daily, it is important to pay attention to genetics and inflammatory cascades. So far hypertension causes inflammation resulting in atherosclerosis and increases cholesterol; heart attacks and strokes events can be brought on by inflammation and the event itself is an inflammatory chemistry; insulin resistance is influenced by inflammation; high reactive C proteins is a result of inflammation; senile dementia is an inflammatory condition; and Alzheimer is inflammation responding brain plaque ( trigger unknown).
Biofilm in the mouth has the potential to create inflammatory responses in gum tissue. Once this occurs the unhealthy gum tissue is a direct channel for bacteria to enter the blood stream. Recent studies show that seventy percent of the bacteremias from oral inflammation occur during chewing, swallowing, speaking, and oral hygiene behavior. One tooth with periodontitis can harbor 200 million to 2 billion microbes. Oral biofilm can attach to blood vessel walls causing inflammation. Also the entry of millions of infectious microorganisms daily can compromise the immune system.
Effective biofilm removal is a significant lifetime skill to staying healthier. It should just as important to you and your family as exercising, eating right, and relaxation is to staying fit and maintaining quality of life.
I just hope you realize what a wonderful life you can achieve by getting rid of that nasty dental biofilm.
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