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prevention International magazine for oral health No. 1, 2017

practical prevention | guided biofilm therapy Centuries ago, dentistry identified mineral deposits, such as tartar or calculus, as the main cause of dental disease. Further research then recognised bacterial infections in the roots and the periodontium as the cause of periodontitis. So, what was the logical conclusion? Calculus (tartar) was removed completely. Today, we know that calculus has a porous surface that provides a niche environment for bacteria and endotoxins. Endotoxins are not absorbed into the calculus, so it can be easily removed. However, extensive removal of calculus is contraindicated and counterproductive. A shift in biofilm management BY DR KLAUS-DIETER BASTENDORF, SCIENTIFIC ADVISOR, SWISS DENTAL ACADEMY Dr Klaus-Dieter Bastendorf When I started out as a dentist over 40 years ago, prophylaxis was still in its in- fancy. At my university, there was minimal literature on everyday oral hygiene. An eye-opening moment for me was during a visit to see Prof. Jan Lindhe in Gothen- burg. There, we studied cases of peri- odontitis that caused almost everyone to cry out: full dentures! We then saw images of the same patients ten years later—they still had their natural teeth, solely thanks to prophylaxis. The thing that made me opt for prophylaxis in dentistry was the birth of my first daughter. I would never have been able to forgive myself if she developed a dental disease. This private passion for preventive dentistry and the vision of Prof. Axelsson and Prof. Lindhe have stayed with me to this day. Although my children and grandchildren’s teeth are healthy, I do see a lot of unhealthy teeth in people in my own generation. 40 years ago, there was a limited understanding of biofilm, individual di- agnostics and individual prophylaxis. We removed calculus twice a year, but only introduced individual diagnostics and treatment in 1994. Today, we know the value of prophylaxis. One major reason is that we have a greater understanding of the causes of the most prevalent dental illnesses. The trigger for cavities, gingi- vitis, periodontitis, peri-implant mucositis and peri-implantitis is always biofilm and not calculus. However, the amount of bio- film is not the determining factor, rather, it is the biofilm’s ecological make-up, type and balance. Biofilm is a microbial, “organised” collection of microorganisms. The mi- croorganisms are embedded in a matrix of extracellular polymer substances that the microorganisms produce themselves. Microorganisms in biofilm show a differ- ent phenotype regarding growth rate and gene expression compared to suspended living cells. Dental plaque is a kind of bio- film and since biofilm forms an adhesive layer, special attention is required to de- stroy and/or remove it. Classic… Currently, there are two technologies available for the manual destruction of oral biofilm, everyday manual biofilm management and professional manual september 2017 51

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