Identify & Destroy! Synergistic Pathogenic Biofilm Management

Synergy is the combined effect of two things being greater than either one independently. As a veteran of managing periodontal diseases, that is how I view salivary diagnostics and Guided Biofilm Therapy (GBT).   With salivary diagnostics I can identify specific pathogens thriving in my patient’s biofilm, and through the process of GBT I am able to dismantle and destroy those pathogens.  This is synergy at its best.

Quick review of pathogenic biofilm, then we can focus on GBT and salivary diagnostics: When biofilm becomes pathogenic there is a shift that takes place creating an imbalance of specific bacteria in the biofilm, thereby making healthy biofilm inflammatory, and potentially destructive to oral and overall health in susceptible individuals.   I might suggest reading that last sentence again.  It describes a process.  This process doesn’t unfold the same for everyone, and risk factors are as varied as the individuals.

The challenge for dental professionals lies in the fact that no matter how we disrupt the biofilm, it starts re-organizing almost immediately.  GBT encompasses several key aspects of managing the biofilm differently than traditional methods.  First, biofilm removal is prioritized since that is what drives disease, and is performed early in the appointment, prior to the removal of hard deposits. Thoroughly removing biofilm first (with the use of disclosing agents) enables clinicians to more effectively see and feel remaining calcified deposits, thereby reducing repetitive strokes and preventing over-instrumentation.  Most importantly, with GBT, biofilm is removed with the use of specific air polishing devices and specific powders that are safe for removal of biofilm on teeth, implants, inside periodontal pockets, and from delicate restorative materials. Erythritol in powder form is a powerful yet gentle agent to almost magically remove stains and adherent biofilms when used in AIRFLOW® air polishing devices. Remaining calcified deposits are easily removed with Piezo technology followed by site-specific hand instrumentation, as indicated.  Managing biofilms with GBT is incredibly efficient, comfortable to the patient, and minimally invasive.

Remember the shift I referred to earlier?  What is it that promotes a change from a healthy biofilm to one that is pathogenic?  Specific pathogens are implicated.  Being able to test the saliva and identify the specific pathogens present completes the clinical picture, determines how at risk the patient is for disease, and what strategies might be necessary to modify the host response in order to return the biofilm to a healthy homeostasis. Sometimes, it is surprising to see the pathogen load of patients compared to the clinical signs of disease.  They do not always match! We need to know what we’re dealing with.

Here is an example of this synergy in action.  Hypothetical: Brad presents with moderate generalized bleeding and localized 4-5 mm pockets noted on posterior teeth. He is a periodontal maintenance patient, so subgingival calculus is minimal.  Pathogenic biofilm, however, is prevalent.  Brad is a cancer survivor and he wants to keep his teeth.  Performing a MyPerioPath® test on Brad reveals he has Porphyromonas gingivalis (Pg) and Fusobacterium nucleatum (Fn) above threshold levels.  Pg is a key pathogen implicated in periodontal destruction and other adverse health outcomes, but both Pg and Fn have also been shown to increase the risks for various forms of cancer.  A treatment plan for Brad that includes testing to identify what pathogens are culprits in his disease, coupled with a plan to dismantle and remove the biofilm subgingivally, sets this patient up for success.  Performing re-evaluation salivary testing following active therapy helps clinicians ensure that dangerous periodontal pathogens have been diminished, or in some cases, identify next strategies necessary to accomplish the goal. If you are not currently identifying and attacking the enemy with a synergistic approach, perhaps it is time to reassess your strategies!

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Karen Davis RDH, BSDH
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