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prevention International magazine for oral health No. 1, 2018

biofi lm | Controlling dental plaque biofi lm There are currently two primary ways of controlling den- tal plaque biofilm and establishing a healthy oral microbi- ome for the non-orthodontic patient: professional biofilm management and individual manual biofilm management. Professional biofilm management commonly involves the removal of subgingival dental plaque and calculus with the use of hand scalers, followed by tooth surface polishing with rotary rubber cups and brushes. By re- moving this biofilm from periodontal pockets that have formed, hand scaling is able to reduce gingival inflam- mation that may be present and prevent further damage caused by its potential progression to periodontitis. Dentists may choose to use an ultrasonic scaler in- stead if they wish to remove supragingival dental plaque biofilm. These scalers feature a metal tip that vibrates at 20–45 kHz and follows a curved linear, elliptical or fig- ure eight path. The tip is cooled with a water spray, in which bubbles form and collapse as a consequence of the ultrasonic waves of energy passing through. This ef- fect, called cavitation, facilitates removal of dental plaque and calculus. When used by an experienced professional, an ultra- sonic scaler can be faster and can cause less hand and wrist fatigue than with a manual hand scaler. If used in- correctly, however, it can cause heat damage to the tooth. Recent developments In the inaugural issue of prevention magazine, Dr Klaus-Dieter Bastendorf, a scientific adviser for the Swiss Dental Academy, outlined recent developments in the materials and technology for professional biofilm man- agement. With the introduction of piezoceramic instru- ments and low-abrasion powders made of erythritol or glycine, Bastendorf argues, modern professional biofilm management is now safer, minimally invasive and more comfortable for both the patient and dental practitioner. In addition, the ability to disrupt both sub- and supragin- gival biofilm in one procedure improves the efficiency of these procedures, making it more likely that patients will return for regular professional cleaning. Recommendations for oral self-care The easiest way for individuals to remove dental plaque biofilm build-up themselves is through a consistent oral hygiene routine. Regular use of a soft-bristled toothbrush, dental floss and interdental brushes is essential. By dis- rupting the established layers of bacteria through effec- tive cleaning, the protective layer of biofilm on the teeth— the pellicle—will be able to reorganise and perform more capably. “Control of dental plaque biofilm begins with daily oral hygiene,” asserts Marsh. “Meticulous cleaning of the teeth and associated gingival tissue removes the bulk of the biofilm that has developed in the time since the last oral hygiene session.” Working together Regardless of the type of preventative measures taken in controlling biofilm, it is essential that dental profession- als cooperate with and motivate their patients to take charge of their own oral health. “The dentist and dental hygienist should work together as a team in evaluating, treating and maintaining the oral health status of the patients,” says Dr Rajiv Saini. “There should be a greater emphasis on the modification of behaviour of patients by providing them with education, scientific facts and research data.” Do’s sentiments on this relationship strongly reflect Saini’s. “Dental professionals should advise patients about effective oral hygiene and the impact of their diet and lifestyle choices on their oral health, such as the risks of a high carbohydrate diet or smoking for tooth decay,” she recommends. “There is increasing evidence of the link between oral health and general health, and maintain- ing a good oral microbiome may be in our best interest.” prevention 1 2018 35

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