How to Build A Biofilm Although we in dentistry consider the terms biofilm and plaque to be interchangeable, they really aren’t. The term biofilm is a specific kind of sociobiological system of interactions between bacteria, virus, yeast and other living organisms. These organisms shift DNA with similar and dissimilar organisms to accommodate a dynamic environment. A biofilm has been compared to a city, a commune, a distinct organism, and even a parasite in this “What are bacterial biofilms? A six-minute montage” video found at www.youtube.com/watch?v=lpI4WCM_9pM. It’s not a colony – a homogeneous group of organisms. Although nearly all we know about bacteria is as a homogeneous group with identical DNA from PMAT cell division. Once taken from the biofilm, a single bacterium acts wholly differently than it does living in a viable biofilm. This is important news because what we thought would kill this or that bacteria type, may not. And the protec-tive coating must be dealt with, as not all antibacterial agents can pene-trate or breakdown the coating even if it can penetrate the cell wall. Another challenge is to address the dormant bacteria that live in the center of the biofilm. For instance, most antibiotics work on rapidly replicating DNA. Dormant bacteria remain dormant until the antibiotics are no longer a threat, when they reactivate and start building a new biological society. New ways of addressing the biofilm come from an array of scientific fields including medicine and dentistry. And these newer attempts at managing the biofilm start with ways of interfering with the known mechanisms of biofilm building. The earliest colonizers in dental biofilm are non-pathogenic organisms that start by attaching them-selves to hard and soft tissue. Early colonizers start to produce a polymeric matrix, Extra Polymeric Substances (EPS) covering that allows the inhabitants to hang out, talk, have sex, build, eat and do everything else inhabitants of any commu-nity may do. They help each other and their communal living rules who is invited in and when it’s time to disinvite members. This commu-nal living achieves a balance where just the right number of each type of organism lives. Adjusting any of these aspects of a biofilm can upset the stability and crash the system. And crashing the system can be pretty easy, as it turns out. 14 July/August 2011 JAOS is not the alcohol. While necessary to suspend the oils, the alcohol has little synergistic effect with the oils. For those who love the health food store product lines, steer them towards the essential oils. Our industry attracts tinkerers. Whether they tinker with cars, wood, model trains, computers or chemistry, many dentists have produced products that attempt to remove biofilm and help teeth become stronger or, rather, more acid resistant. The Carifree system, created by Drs. K. V. Kutsch and Doug Young includes a shock rinse that increases the oral pH and affects the early colonizers, which in turn cannot produce the sticky substrate of a biofilm. Dr. Lon Jones, developer of Xlear nasal spray, recommends domesticating bacteria the way we do dogs. The newest kid on the block in the realm of biofilm management is the oral probiotic. The idea is to crowd out the highly acidogenic bacteria by filling the niche in the biofilm with similar bacteria that are not acid produc-ers. In the gut, probiotics are mainly used to bolster up good bacteria because it is alleged that for some reason their numbers are diminished. In dentistry, the idea is to establish a new biofilm by incorporating biologically domesti-cated bacteria that will take the place of the acidogenic bacteria. The direct removal of biofilm with a brush or floss is time tested as effective and uninteresting to most patients, particularly those with orthodontic appliances. A jet of pulsed water can be a fun way to remove biofilm from the teeth. There are some misunderstandings in how or whether a jet of pulsed water can be beneficial. Studies continue to confirm the benefits of this method of removing the biomass from the teeth and increas-ing mucosal health. 12 The pulsing water creates a venturi (the reduc-tion in fluid pressure that results when a fluid flows through a constricted section of pipe) that pulls the bacteria from the biofilm leaving ghost cells and the EPS matrix behind. The mystery was solved
Journal of the American Orthodontic Society July-August 2011-Buyer's Guide: Page 14
