“Step Up Your Game” with Guided Biofilm Therapy

“There’s a new sheriff in town and the name is GBT.” Translation: a new therapy has come to be a driving force and is making profound advancements in oral health like never before. Or, how about, “Out with the old and in with the new.” It’s time to start fresh and leave the old ideas behind. These two idioms perfectly describe “Guided Biofilm Therapy” (GBT). EMS (Electro Medical Systems), a company in Nyon, Switzerland developed their AIRFLOW air polishing and Piezon PS No Pain piezo-ceramic scaling technology in the 1980’s. In 2016, GBT was introduced into the United States. It is now in over 40 countries and 10,000 certified practices worldwide. In 2017, the 4th generation AirFlow Prohylaxis Master was launched. Introduction to GBT is showing up in dental and dental hygiene programs across the US.

So, what exactly is Guided Biofilm Therapy? Simply termed, it is a systematic, predictable approach for dental biofilm management. It is safe, effective, minimally invasive, and clinically proven to remove disease causing plaque biofilm. Biofilm is a complex polymicrobial entity and can be comprised of bacteria, protozoa, viruses, and/or fungi. Beneficial bacteria live in harmony (symbiosis), until there is a change in the bacterial composition. When this occurs, dysbiosis sets in and starts the disease process, inflammation and destruction of supporting tissues follows. GBT includes a disclosing gel applied to the patient’s teeth to identify cavity-causing and gum bleeding bacteria. Patient education and thorough oral hygiene instruction are provided. The clinician uses AirFlow technology with Plus powder to safely remove supragingival and subgingival plaque biofilm (up to 4mm deep), stains, early calculus on primary and secondary natural teeth, restorations, and implants. Plus powder is an all-natural antimicrobial powder found in fruits and the human body produces a small amount. The Piezon technology is then used to remove hard deposits while minimizing the need for traditional instrumentation. No need to follow up with prophy paste. Traditional polishing scratches tooth surfaces and restorations. Studies show there is no therapeutic value to coronal polishing.

Since I have started using GBT, I have witnessed some amazing results. I use GBT technology on all patients, adults and children, if there are no contraindications, including sensitivities to ingredients and those with respiratory conditions such as asthma. For scaling and root planning, I begin with a six-point periodontal assessment. Once I have determined SRP treatment from my dental hygiene diagnosis, I start with salivary testing. My choice is OralDNA® Labs. I find the reports are easy to read and review with patients. When my patient returns for their first SRP appointment, I review the lab report from OralDNA® Labs to show the patient what periodontal pathogens are present. After a medical history review, I have patients pre-rinse to reduce aerosols. Next step is to apply disclosing gel, review oral hygiene, and remove the plaque biofilm with my AirFlow with Plus powder for probe depths up to 4mm. For pocketing exceeding 4mm, I use the PerioFlow handpiece and nozzle with Plus powder to disrupt biofilm. I then use Piezon technology with the PS, PSL and PSR instruments for supra and subgingival calculus removal. The results I am seeing are beyond what I expected. My periodontal patients are significantly improving with decreased bleeding on probing and a reduction in probing depths. Clinical studies show GBT to be as effective if not better than traditional SRP. Periodontal maintenance patients with residual pocket depths due to severe disease are now improving with a continued reduction in probing depths and BOP since I started with GBT 8 months ago.

I have a patient I have treated the past 7 years with painful oral ulcerations due to Pemphigus Vulgaris. He had heavy plaque and calculus due to the pain and his inability to properly brush. He has applied topical steroids up to 4 times a day with little success. This last time I saw him for his four-month prophylaxis, he had no lesions and was no longer using his topical steroids. His plaque and calculus levels have decreased as well. He said he has done nothing differently. The only difference in my treatment was to lightly dust his gingiva and teeth with the erythritol based Plus powder the last couple of times he was in for his prophies. Can I 100% say the improvement is due to GBT? No, but I’m 99% sure it is.

So, you know the saying “Worth its weight in gold?” My EMS Prophylaxis Master most definitely is to me. I know my patients agree. They love how it leaves their teeth feeling so clean and no more “scraping.” Studies show our current method that we have been teaching the past 30-40 years, has no real benefit for our patients. It’s time for a CHANGE.


Kaitlyn Machado, RDH, BS, Med, FADHA Today’s RDH Hygienist Spotlight with Sarah Crow, RDH, Explains Guided Biofilm Therapy April 22, 2022

Deepti Shrivastava, Valentino Natoli National Library of Medicine A Novel Approach to Dental Biofilm Management Through Guided Biofilm Therapy September 16, 2021

Dr. Jan Koch Oral Health ”Guided Biofilm Therapy” Is the Absolute Favorite Among Patients October 10, 2022

Thomas Lamont, Helen V Worthington, Janet E Clarkson, Paul V Beirne Cochrane Library Routine Scale and Polish for Periodontal Health in Adults December 2018

Kendra Fox RDH
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