The importance of controlling bacterial biofilm re-growth in patients with gingivitis

Date: December 2021

Author: Louise Sinclair

Effective biofilm control plays an essential role in good oral health, particularly in the prevention of dental caries and periodontal disease. As much of this work happens at home, we discuss how dentists can guide their patients to maintain adequate oral hygiene and also biofilm control between morning and evening toothbrushing.

The role of biofilm in dental diseases

According to the European Federation of Periodontology (EFP), periodontal disease and dental caries are the most common non-communicable diseases worldwide. Both diseases are mediated by bacterial biofilm accumulation, and as such, a thorough and consistent approach to biofilm control is needed.

Strategies for successful biofilm control

1. Establish consistent hygiene habits

Mechanical biofilm removal — twice-daily brushing and daily interdental cleaning — forms the basis of good oral hygiene and successful biofilm control. However, bacterial regrowth and biofilm formation begins in as few as two hours after brushing. If mechanical cleaning is inadequate or inconsistent, bacterial biofilm can quickly reach problematic levels.

It is important that patients are educated on the need for thorough oral hygiene and the importance of those twice-daily brushings. If necessary, provide coaching on proper toothbrushing and interdental cleaning techniques, and refer them to patient-friendly home resources like Colgate’s Oral Care Center or Mouth Healthy.

Early biofilm accumulation is not easily visible to patients, so consider using plaque disclosing agents to show them exactly what’s hiding on their teeth. Plaque disclosers can also be used after brushing or in future appointments to illustrate to the patient the positive impact of their efforts.

2. Introduce chemical biofilm control

Chemical biofilm control is an effective adjunct to mechanical biofilm removal, helping to inhibit bacterial re-growth in between brushings. However, many toothpastes and mouth rinses do not provide any chemical control — a missed opportunity for gingivitis and caries prevention.

Recommend that your patient uses a fluoride toothpaste with proven antibacterial ingredients and long-lasting biofilm protection, such as meridol Parodont Expert. In one clinical study, participants with gingivitis brushed twice-daily for three months, using either Parodont Expert with amine fluoride, or a control product with sodium monofluorophosphate (NaMFP). Parodont Expert was significantly more effective at reducing biofilm in both the short and long term, as demonstrated by a <50% reduction in Mean Plaque Index scores at three months. Other options include the use of other toothpastes containing proven antibacterial ingredients as well as mouthrinses.

3. Highlight the signs of gingivitis

It is common for patients not to notice or be concerned about the early signs of gingivitis, with some even believing that signs like bleeding are a normal occurrence. It is important not only to educate the patient on the signs of gingivitis, but to also highlight the need for prompt action to manage biofilm.

Encourage your patients to proactively monitor for signs like inflammation, redness, soreness and bleeding, and offer supportive educational resources like the EFP’s patient-facing gum health guide. Point out to the patient that gingivitis can be reversed now, but it is the “last stop” for preventing irreversible tissue loss should it progress to periodontitis.

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