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Dental Biofilm Removal and Whole Mouth Health

Nov 23, 2018

Author: Mandy Dennis, RDH

Dental hygienists and patients sometimes talk about dental plaque, also known as dental biofilm, so often that it becomes mundane. However, addressing dental biofilm removal includes more than just brushing and flossing. Dental hygienists play an important role in teaching patients that proper plaque removal is critical for protecting their oral and systemic health.

Start at the Beginning

Explain to your patients that dental biofilm, or plaque, is not just a thin, sticky layer clinging to their teeth. It's a whole ecosystem of good and bad bacteria! When changes in the oral environment occur, they can cause an imbalance in the ecosystem that can result in dental disease. Dimensions of Dental Hygiene emphasizes that biofilm as a whole, not a single type of bacteria, is what causes dental disease. This directly connects to the idea of Whole Mouth Health: Maintaining a healthy mouth and body means caring for your teeth and oral soft tissue by brushing, flossing and rinsing to keep biofilm in balance and protect your oral and overall health.

Do your patients understand how biofilm forms and why they should be brushing it away? Educating our patients about the impact the creamy-looking layer on their teeth has on their mouth, and that it causes tooth decay and gum disease, can help them understand why good home care is essential.

The Dental Hygienist's Role

RDH Magazine reminds dental hygienists that in addition to encouraging patients to remove supragingival biofilm with brushing and rinsing, we also need to expand the ways we talk about why and how patients should remove subgingival dental biofilm. Explain to your patients that flossing, as well as tools like interdental brushes and irrigators, assist in removing bacteria that can cause periodontal disease.

Regular dental hygiene appointments are equally important. They are an opportunity to educate patients and reinforce the importance of home care for Whole Mouth Health. If you are removing a layer of biofilm or a chunk of tartar, point it out to the patient and use it as an example of why thorough home care and regular visits are so important to help maintain oral health.

Periodontal appointments are a good time to remind your patients that procedures like scaling in the presence of gingival inflammation or periodontal maintenance aren't just a regular cleaning. Explain that these appointments accomplish the removal of bacteria below the gumline that regular home care may not take care of, and target specific root areas for scaling.

Other Factors That Affect Biofilm

Discussing good and bad bacteria can be tricky. Use what you find in your patient's mouth to start a conversation about their habits. Help your patients consider factors that affect biofilm beyond brushing and flossing, like nutrition and oral pH.

Some patients may not understand exactly how dietary choices like eating fermentable carbohydrates put them at risk for tooth decay. Explain that sugars are used by bacteria to produce acid. Why should your patient care about the acidity of their mouth? The journal Oral Diseases explains that a lower pH means a mouth that is more hospitable to decay-causing bacteria that thrive in a low-pH environment. Explain to patients that a lower pH in the mouth then encourages more bacteria that cause tooth decay. Both nutrition and regular oral care impact oral pH.

Encourage your patient to make substitutions with a healthy oral microbiome in mind, like drinking water with a neutral pH or higher instead of acidic soft drinks, or chewing sugar-free gum that contains xylitol. Discussing nutrition with your patients will help them make healthier choices and understand why it helps their oral care efforts.

So, What Now?

Some dental plaque is inevitable, but dental disease is not. Remember that not every patient will grasp how brushing, flossing and rinsing work together to help remove dental biofilm. Take the time to talk to your patients about the oral disease process and learn how you can help them implement better nutrition and oral care into their everyday routine. Make sure that your patients understand the importance of home care and Whole Mouth Health — for their oral health and their overall health. Educating your patient on how biofilm affects the entire mouth — not just the teeth — can making a lasting impression on their health.


  • Help your patients identify what is causing changes in their biofilm.
  • Educate your patients about how hygiene appointments help them maintain Whole Mouth Health.
  • Be thorough in your explanations of how biofilm removal is essential for good oral care, and encourage daily progress in brushing, flossing and using mouth rinse.

Why It's Important

There are good and bad bacteria, and the balance between them is essential. Most patients don't think about how their habits affect their oral microbiome. Educating them on the purpose of dental biofilm removal will help them achieve Whole Mouth Health.

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