Biofilm Control Strategies in Dental Health - Antibiofilm Agents: From Diagnosis to Treatment and Prevention - page 291

5 Physical Methods to Control Oral Biofilms
5.1 Mechanical Plaque Control
One of the most commonly used, simpler and more efficient strategies for oral
biofilm control is the physical removal of dental plaque by mechanical methods.
Mechanical plaque control is highly effective for the prevention and control of
periodontal disease, but it requires a well motivated patient who uses the devices in
a proper fashion for a sufficient duration of time and with adequate frequency,
which is seldom the case. The toothbrush is the most effective device for the
removal of dental plaque without requiring professional cleaning. Flossing and
interdental cleaning with brushes can remove plaque from proximal tooth surfaces,
and there is evidence that it can reduce caries (Andlaw 1978 ) and gingivitis
incidence (Iacono et al. 1998 ). Tooth brushing is usually accompanied by the use
of a toothpaste that contains an antimicrobial agent. Common antimicrobial agents
added to toothpastes are fluoride salts and triclosan. The efficacy of fluoride
toothpaste in reducing dental caries is well established (Andlaw 1978 ; Barbier
et al. 2010 ), while triclosan has been proven effective in controlling plaque growth
(Mandel 1994 ; Phan and Marquis 2006 ; Teles and Teles 2009 ). Triclosan is a
polychloro phenoxy phenol that inhibits fatty acid biosynthesis in bacteria and is
used as a disinfectant in a large variety of products (Wright and Reynolds 2007 ).
Even with good oral hygiene, accumulation and mineralization of plaque can
occur. In these cases professional cleaning is necessary and is usually performed
using manual, sonic, or ultrasonic scalers to remove calculus and plaque to maintain
oral health.
Once a pathogenic biofilm has colonized the teeth, causing either caries or
periodontitis, dental plaque removal has to be performed by specialized profes-
sionals to guarantee the complete removal of the pathogenic community. Common
procedures used in treating periodontitis are scaling and root planing. This consists
of removal of plaque and calculus inside the periodontal pocket, between the gums
and the teeth, eliminating as much as possible of the oral community, thus restarting
the process of colonization by health-associated organisms.
Although these mechanical methods are highly efficient in controlling oral
biofilms, they are hampered by the fact that few people follow a thorough tooth-
brush protocol that guarantees removal of most of the accumulated dental plaque,
especially in interdental sites, the elimination of the oral biofilm is extremely
difficult. The development of alternative antibacterial therapeutic strategies,
which complement mechanical cleaning with other methods that control microbial
growth in the oral cavity, therefore becomes important.