Reducing Biofilm: What Do Xylitol, Cranberries, Grape Seed, Root Beer and Raisins Have in Common with Brushing and Flossing? By Shirley Gutkowski, RDH, BSDH, FACE The days of brushing and flossing will never be gone. Educating those who wear braces about the importance of removing oral biofilm, commonly called plaque, with mechanical means is the basis of good oral hygiene and good health. People with orthodontic appliances struggle with effec-tive biofilm removal using traditional methods. But, you knew that. I nstead of thinking about teach-ing brushing and flossing, think about the process in terms of biofilm reduction. How would that look? Today we have ways of reducing biofilm that can either augment traditional methods, or replace them. These methods are mechanical, chemical and biological. The idea of reduc-ing biofilm can open doors of discussion and give your patients the feeling that you understand their pain. Arguably the most effective is xylitol to combat biofilm. It’s fun, it’s tasty, and it’s effective. Some dentists are still reluctant to recom-mend xylitol chewing gum to their patients wearing brackets and bands. For these dentists, other ways of achieving the benefits from chewing gum four to five times a day with this miraculous sugar will have to be found. Xylitol helps by interfering with the early colonizers ability to produce the sticky extrapolymeric substances (EPS). Xylitol is of a molecular weight that allows it to enter into the biofilm, and the biofilm inhabi-tants see it as a food. This alone makes xylitol more versatile than most other biofilm reducing agents. Although the adhesion produc-ers need sucrose to build the EPS, they prefer xylitol, and this leads to their doom. Xylitol gums up the Krebs Cycle taking the place of fructose. 1, 2 However, this food does nothing to provide energy to the germ, thus starving it to death. Without enough replenishment of the EPS, the biofilm begins to break apart. With the protection gone, all the inhabitants are vulnerable to death. Today there are many products that use a sprinkling of xylitol allowing them to make a comment about its contents on the label. And since xylitol is a food, not a drug, there will never be a “thera-peutic dose.” In the future as more and more products contain xylitol, not all will be counted in the necessary four to five daily applica-tions. For example, many fluoride varnishes contain xylitol, and prophy pastes will likely be next. 12 July/August 2011 JAOS
Journal of the American Orthodontic Society July-August 2011-Buyer's Guide: Page 12
