The Battle Against Biofilms

Who could have imagined, nearly 350 years after Anton Von Leeuwenhhoek^[1] discovered microbial “animalcules” in dental plaque, we would continue making discoveries associated with these pathogens? Later coined biofilm by Canadian microbiologist Bill Costerton, their exploration activated the discovery of the complex composition of microorganisms and their ecosystems.

As most of us are aware, biofilm consists of layers of microorganisms that adhere to moist areas and reproduce^[2]. Biofilms are held together by sugary molecular strands or extracellular polymeric substances, allowing them to adhere to most anything. They are relevant to our profession as, prior to recent years, we’ve studied bacteria in isolation, and not in colonies as they usually exist. Based on our current knowledge, it is believed most infections, especially those of chronic nature, are the result of biofilm.

 

Dental professionals are well-informed of the presence of biofilm formation in the paranasal sinuses, on the surfaces of the teeth, and on prostheses such as implants, bridges, and removable oral devices. The challenge is to create antimicrobials capable of penetrating the thick outer matrix of specific pathogens, without disrupting the balance of microbial ecology.

 

Genome Biology^[3] recently published a new study revealing the discovery of significant fluctuating bacterial subpopulations in site-specific parts of the mouth^[4]. Researchers from Harvard and the University of Chicago narrowed down four main bacterial species commonly found in the oral cavity and used them as reference points in studying the additional variations in volunteers’ mouths.

 

The discovery confirmed there are distinct genetic formations actively linked to specific sites within the mouth. Significant bacterial variations exist between the surface of the tongue, cheeks, and teeth.  While more research is needed, the predilection of certain bacteria to targeted sites allows for expanded hypotheses that may assist in bioengineering target-specific probiotics. The ultimate goal is to improve oral and systemic health through the control and/or elimination of harmful microbes by attacking site-specific biofilm.

 

Arginine, a naturally occurring protein-building amino acid, is an area of continued research in favor of the reduction of oral biofilms. Salivary microbes metabolize arginine a plethora of byproducts, including ammonia. If produced in sufficient amounts, ammonia neutralizes saliva to an ideal pH of seven. Harmful microbes, such as candida, can not thrive in this neutral environment, thus the oral environment becomes one that facilitates health and not disease.

 

There are three products currently available in the United States containing 8% arginine bicarbonate calcium carbonate. These assist patients prone to caries, fungal infections, and dentinal hypersensitivity. Colgate Anywhere, Anytime is topically applied. Used clinically, it provides immediate desensitization to procedural instrumentation. Patients may purchase the product for sustained desensitization and pH neutralizing benefits between appointments.

 

Additional arginine containing products to recommend for patient home use, include Tom’s of Maine Rapid Relief Sensitive Toothpaste and Basic Bites. The toothpaste is most effective when used consistently and without expectoration. Basic Bites are a candy-like soft chew that promotes beneficial bacteria and protects the teeth by buffering and neutralizing harmful sugar acids. As an added benefit, it contains 20% of the RDA of calcium. If consumed twice a day, it helps maintain an optimum oral pH environment^[5].

 

With Americans spending an estimated $124 billion annually on costs related to dental care^[6], $45 billion in lost productivity, and another 34 million lost school hours, it’s easy to see the profound negative effects of poor oral care. Much of this can be averted through understanding and controlling biofilms.

 

 

^[1]https://www.cs.montana.edu/webworks/projects/stevesbook/contents/chapters/chapter001/section003/blue/page001.html

^[2] https://en.wikipedia.org/wiki/Biofilm

^[3]https://genomebiology.biomedcentral.com/

^[4]https://genomebiology.biomedcentral.com/articles/10.1186/s13059-020-02200-2

^[5] https://www.basicbites.com/professional/science/whitepaper/

^[6] https://www.cdc.gov/oralhealth/conditions/index.html

Stephanie Baker RDH BS

Stephanie Baker, RDH BS is a coach, consultant, speaker, writer, business owner (Volume 52), singer, and a Registered Dental Hygienist.  She is affectionately known as The Singing Hygienist.   Her clinical and support team experiences are the inspiration for her writing and the motivation for coaching clients to success.   She is a regular contributor to various publications within dentistry and beyond. In addition to feeding the homeless, starting a non-profit, and being involved in her church and other community organizations, she sings professionally and enjoys several creative outlets.  She resides in Florida where she enjoys the company of her husband, three children, and four beautiful grandchildren.