Melissa K. Turner, chief hygiene officer for Cellerant Consulting, discusses whether biofilm is dentistry’s most evil nemesis or the next revolutionary thing.
Q: How common is biofilm?
A: We educate patients about dental biofilm every hour, every day. Dental biofilm, or what we used to refer to as dental plaque, has its hands in preventive and restorative procedures and is a common factor for oral disease. From implant failures to gingival inflammation and bone loss to imperfect margins and more, oral health professionals live and breathe dental biofilm every day.
Much like the antagonist in any good story, dental biofilm continues to show up as the star nemesis in today’s clinical dentistry—we scale it, polish it, remove it, and dread it. But what do we actually know about these complex microbiological communities living within and around us? Are they always bad? Do they truly cause inflammation? Can we eliminate them completely?
Q: What exactly is dental biofilm?
A: The significance of biofilm and its correlations within the oral cavity are still very much a mystery. What we do know is that dental biofilm is directly correlated with gingival inflammation and disease, leading to restorative failures, relapses in periodontal therapy, and frustrated patients and providers. At its heart, biofilm comprises communities of micro-organisms that survive, adapt, create offspring, and grow. These communities are in constant flux, spending their days exchanging DNA, using cell-to-cell signaling, and attacking prey to compete for resources.
Q: When was biofilm discovered?
A: Prior to the 1900s, the current theory was that all microbes were planktonic—freely suspended cells. In the 1940s, it was discovered that microbes attach to surfaces and that these surface-associated cells had distinct characteristics, the ability to grow, and an ecosystem. Then, in 1978, Dr. Bill Costerton created the theory of biofilms. We now know that 95% of bacteria living in nature live in biofilms, and in 2002, the National Institutes of Health noted biofilm accounted for more than 80% of microbial infections in the body.
Q: What surfaces can biofilm grow on?
A: Biofilm needs 3 things to survive: moisture, nutrients, and a surface. Essentially, biofilm can be found anywhere those 3 components collectively exist—living tissue, indwelling medical devices, contact lenses, industrial and potable water systems, natural aquatic centers, plant and animal tissues, catheters, pacemakers, implants, fossils, deep sea vents, and more. These microbial communities play a role in our dental unit waterlines, 3-in-1 syringes, and handpieces. Within the mouth, dental biofilm is found on virtually every surface: fixed and removable prostheses, restorations, and subgingivally on hard and soft tissues.
Q: What are the 4 components of biofilm?
A: All biofilm, whether inside or outside the mouth, is composed of 4 components: communities, microbial cells, extracellular polymeric substances (EPS), and waterways. Consisting of bacteria, fungi, and protists, these microbes live within the EPS, a gooey, sticky substance primarily made of polysaccharides. One of the most important aspects of this type of microbial community is the waterways, where waste is eliminated as well as where communication, seeding, and dispersal take place.
Q: What makes biofilm adaptable?
A: Leave any liquid in a container for too long and what do you get? A slimy container and an unfortunate odor! This is partly due to the EPS—a gooey, sticky substance primarily made of polysaccharides. The EPS covering acts as a protective barrier against extreme temperatures and pH, shields against ultraviolet light, and also supplies nutrients. Harmful substances such as antimicrobials, bleach, and metals are also neutralized when they come in contact with EPS.
Q: What’s next for dental biofilm?
A: Recently, bioremediation has helped shine a different, more positive light on biofilm. Bioremediation was used to clean up the 2010 Deepwater Horizon oil spill. With bioremediation, biofilm is introduced into the environment to degrade oil molecules into less harmful compounds. Micro-organisms within the biofilm then consume the oil as their food source, thus entering the natural life cycle of the ecosystem.
Biofilm itself may remain a mystery to the dental professional, but we are great at understanding the need to reduce and control the oral bioburden by chemical and mechanical means. Regular removal of biofilm through brushing and flossing makes a significant impact, as well as reducing biofilm with xylitol, activated chlorine dioxide, and other biofilm-reducing ingredients. The introduction of restorative materials with antimicrobial properties is proving helpful, as is the utilization of salivary and plaque testing for personalized patient insights. Current biofilm research focuses on the medical-dental link and the systemic impact of pathogenic oral bacteria because oral disease often sets the stage for chronic, degenerative diseases and has definitive links to diabetes, cardiovascular disease, pneumonia, and Alzheimer’s disease.
The mystery of whether biofilm is the antagonist or protagonist in our story of oral health lies in this question: Is dental biofilm always bad? Could bioremediation have a significant impact on the treatment of oral disease? After all, if we’ve learned anything from our favorite villains—Voldemort, Darth Vader, the Joker—the best stories often blur the lines between the antagonist and protagonist!
Ms. Turner is a 20-year veteran dental hygienist and a sought-after fractional executive, consultant, dynamic speaker, and top millennial content creator. She is the founder and founding board member of multiple companies and partners with companies of all sizes—from pre-seed startups to large international brands—on brand strategy and product growth. She can be reached at melissakturner.com.
