An unhealthy biofilm in the oral cavity is the cause of virtually all oral cavity problems and is the primary cause of
Biofilm in general is a collective of microorganisms living together in layers and bound together by proteins and carbohydrates that act as a binder. This structure is not stationary but is constantly changing. The micro-organisms work together and can help and support each other.
The biofilm in the oral cavity consists of bacteria (as well as fungi and viruses) bound together with proteins and carbohydrates from saliva and fluid filtered out of the bloodstream. The latter is important because it means that, for example, hormones, sugars, and medicines that are in the bloodstream can affect the biofilm. In the oral cavity, most bacteria are bound up in the biofilm, where they are better protected from outside factors. In some cases, bacteria can enter the bloodstream and circulate in the body as single organisms, called planktonic bacteria.
No matter what we do, we always have a biofilm in the oral cavity, just as we do in the rest of the gastrointestinal tract, indeed on all mucous membranes and moist surfaces, in the vagina, groin, and armpits, and to some extent in the scalp. We need the biofilm because it is protective, but it must have the right composition of micro-organisms and we can influence that. The solution is not just to kill bacteria. It can be done in an initial treatment phase at the dentist, but it should not be continued at home.
It is very important to understand that if you try to eradicate the bacteria in the oral cavity with a constant intake of chemicals such as mouthwashes, you will end up with a very painful condition called mucositis, which is caused by the overgrowth of fungi. So we don’t need to get rid of the bacteria, we “just” need to create a healthy environment that supports a healthy biofilm of beneficial bacteria.
New studies are emerging all the time that show how important oral biofilm is not just for our dental health, but for our whole health. Diseases such as Alzheimer’s, cardiovascular disease, arthritis, and many other serious illnesses are shown to be triggered by an unhealthy oral biofilm.
Sound too amazing? We have about 9 meters of the gut, full of bacteria, so it can be hard to imagine that the oral cavity can mean so much. One thing is for sure and that is that you CAN NOT underestimate the importance of the biofilm in the gut because virtually all chronic diseases are caused by a bacterial imbalance in the gut. BUT, all bacteria found in the gut are brought in via the oral cavity. The gut contains up to 1,500 different bacteria, but is 9m long, the oral cavity can have up to 700 different bacteria and is only 25cm, so the biodiversity, or competition if you like, is many times greater.
A crucial factor in the oral cavity is that teeth are our only permanent structure surrounded by mucous membranes throughout our adult lives. The cells on the mucous membranes are constantly being shed – indeed daily, so there are limits to what biofilm layers can build upon them.
Teeth, on the other hand, are permanent, so this can cause a problem. If we had followed the same evolutionary logic as crocodiles, which keep getting new teeth, we as a society would save €750 billion a year in the EU on dental treatment. But we only have one set of permanent teeth after our baby teeth.
The interface between teeth and mucosa is a perfect problem area. Since the teeth are attached to the bone and the mucosa lies like a “silicone lining” against the teeth, the interface, which is the gum line, usually a few millimeters deep, is a place where bacteria thrive. If the wrong bacteria get in, inflammation occurs, this is what we call gingivitis, which 85% of adults are familiar with. The inflammation that occurs breaks down the surrounding tissue, making the gum pockets deeper and deeper, and attracting more aggressive bacteria called anaerobic bacteria, which live only where there is no oxygen (or very little oxygen).
On top of this, there is a constant leakage from the bottom of the gum pockets of what we call gingival-crevicular-fluid (GCF), which is an extract of plasma in the blood vessels. It contains nutrients for the bacteria and, in some cases, hormones that can stimulate the bacteria’s growth. Some bacteria are highly stimulated by estrogen, which is why there is a link between the menstrual cycle, pregnancy, and gingivitis.
The clinically scientifically proven approach to best control oral biofilm consists of 4 steps:
1) Mechanical cleaning of tooth and root surfaces. This does not change the bacterial composition as such but makes it more difficult for the bacteria to build up a thick biofilm.
2) Removal of as much bacteria as possible in the dental pockets. The dentist or dental hygienist does this most effectively and most gently for the patient with light-activated disinfection, which is a powerful light that activates a bactericidal substance. It has an effect locally where the dentist treats and, unlike antibiotics, does not affect the bacterial flora systemically.
3) Bacteria come back immediately and we need to control them. The dentist or dental hygienist will therefore add natural oral bacteria, called a probiotic ProlacSan®, to your dental pockets.
4) The same strains of bacteria should be taken as a lozenge once a day after brushing. After that, the patient should go for the usual follow-up visits to the dentist.
Elmevej 8, Glyngøre
7870 Roslev
Danmark
Phone: +45 32 57 30 00
Email:info@cmsdental.dk