Guided Biofilm Therapy and the Systemic Link

How many times have you asked your patients if their medical history has changed, and their response is, “It has changed, but it has nothing to do with dentistry”? How about the patient I saw last month for her prophy, who said “No” when I asked her for any changes in her medical history and she is wearing a hospital wrist band due to the heart condition she was just treated for? There is an abundance of evidence from scholarly articles linking oral health to systemic health.1 Its effect on one another is generally not a positive one.

Oral Health is nothing to be flippant about, especially when it comes to your patient’s overall health. According to the Oral Health in America 2022 Bulletin, reported by the National Institute of Dental and Craniofacial Research, there are nearly “60 adverse health conditions” proven to be affected by your oral health.1 If a patient has periodontal disease along with a heart condition, respiratory disease or diabetes, chances are these conditions are negatively affected by the bacteria that causes periodontal disease. The body’s natural defenses with sufficient oral hygiene, can normally keep these metastatic pathogens and their toxins from causing harm. When patients are inflicted with the type of bacteria that causes periodontal disease, those anaerobic gram-negative bacteria can reach certain levels causing infection.1 These transient bacteria escape into the circulatory system reaching vital organs, leading to unfavorable conditions.

What can our patients do to improve or avoid these situations? Start with good oral hygiene. As clinicians, we can assist our patients in obtaining adequate oral hygiene by recommending adjunctive tools suitable for their personal needs. If our patients do not meet us halfway and follow our recommendations, their chances of disease escalate.

Disrupting plaque biofilm is the key to patient health.1 We must disorganize these pathogens to achieve a symbiotic relationship between the microorganisms and the patient.2 Generally, these microorganisms live in harmony, but the presence of professional and patient disruption, along with the patient’s immunological response to these pathogens, determine whether there is symbiosis or dysbiosis.

Guided Biofilm Therapy is an 8-step science backed protocol and treatment.3 It simply removes and disrupts plaque biofilm. If you are not familiar with this technology, you may be wondering “What is Guided Biofilm Therapy and why do we need it?” Guided Biofilm Therapy is a systematic, predictable solution for dental biofilm management in professional prophylaxis using state of the art AIRFLOW®, PERIOFLOW® and PIEZON® technologies.3 The AIRFLOW PROPHYLAXIS MASTER (AFPM) is Swiss technology developed in the 1980’s, and is the system used to provide Guided Biofilm Therapy to remove plaque biofilm, calculus, and stains.

The GBT approach includes eight steps:

    • Step 1: Assessment, pre-rinse for aerosol control, review medical history and check for any contraindications.
    • Step 2: Disclose to make biofilm is visible.
    • Step 3: Motivate by reviewing disclosed biofilm and recommend appropriate oral hygiene tools.
    • Step 4: AIRFLOWING removes all plaque biofilm, stains, and young calculus supra and subgingivally up to 4mm.
    • Step 5: PERIOFLOW disrupts gram-negative anaerobic biofilm communities and subgingivally in pocket depths greater than 4mm. PERIOFLOW is an adjunct to manage furcations and implant maintenance. Not all patients qualify for this step in the protocol if there are no pocket depths beyond 4mm.
    • Step 6: PIEZON removes the remaining calculus supra and subgingivally up to 10 mm with the PS instrument.
    • Step 7: Check for any residual calculus or remaining biofilm and for carious lesions.
    • Step 8: Schedule the next recall and ask the patient how their teeth feel.3

A study by Cochrane Oral Health divided 1700 adults, who do not have periodontal disease, into 3 groups. One group had a prophylaxis once a year, another group had prophylaxis twice a year, and the last group did not receive prophylaxis at all over the course of two to three years. This research confirmed there was little or no difference in gingivitis, probing depths, or quality of life when comparing frequency in a professional dental prophylaxis.5

Guided Biofilm Therapy is an enhanced comprehensive dental prophylaxis aimed at removing biofilm in difficult areas to reach such as crowded teeth, interproximal areas, orthodontic brackets, supra and subgingivally around all teeth and implants. Our traditional method only removes approximately 50% of the plaque biofilm according to Stiftung Warentest, an independent German consumer group.6 The eight-steps of GBT are protocols based on individual patient diagnosis and risk assessment. It is a very comfortable treatment given in the least invasive way. GBT is a “Game Changer.”3

Let’s say a new patient walks in your office and presents with cardiovascular disease. Their periodontal assessment shows your patient has Stage II, Class B periodontal disease. Sixty percent of their teeth have bleeding on probing. What this means is that every time they brush, floss, eat and/or have a dental prophylaxis and have bleeding gums, the periodontal pathogens are entering their circulatory system reaching areas such as the lungs, heart, stomach, joint replacements and other critical areas or organs. These pathogens may not cause these diseases but can have a destructive nature to diseases present. Patients with diabetes mellitus that are not well controlled have higher levels of glucose in salivary and crevicular fluids leading to bacterial growth that causes periodontal disease. However, untreated periodontal disease can lead to higher levels of blood glucose making diabetes difficult to control.4 Poor oral health in pregnancy increase chances of low term birth weight in babies and complications for the mother.2

By utilizing Guided Biofilm Therapy, we are reducing the number of periodontal pathogens present in the oral cavity which in turn, substantially reduces the number of these pathogens entering the blood stream. Periodontal, mucositis, peri-implant diseases and dental decay caused by dental biofilm plays a major role in not only our oral health, but also in our overall health.7

Guided Biofilm Therapy is poised to become the new standard of care in prophylaxis, periodontal and peri-implant therapy. There is little scientific evidence supporting our traditional methodology of performing prophylaxis. Sarah Chapman, whose blog is Evidently Cochrane, has found no concrete evidence.8 A data review by Susan Perry blogs “Many Dental Procedures Lack Scientific Backing” agrees there is none.9 When I search for Guided Biofilm Therapy, I find years of robust research dating back to the 1980’s supporting GBT. 3

If you would like to know more, please contact EMS for your demo today at


  1. Oral Health Across the Lifespan: Working-Age Adults National Institute of Dental and Craniofacial Research Jocelyne Feine, DDS, MS, HDR 2022
  2. Association Between Periodontal Pathogens and Systemic Disease Fiona Q. Bui, Cassio Luiz Coutinho Almeida-da-Silva, Jessica Lui Jocob Woodward, Homer Asadi, David M. Ojcius Department of Biomedical Sciences- University of the Pacific, Arthur Dugoni School of Dentistry, San Fransisco, CA, USA Immunobiology Program, Biophysics Institute, Federal University of Rio de Janeiro, Rio de Janerio, Brazil
  3. Guided Biofilm Therapy Electro Medical Systems (EMS)
  4. Diabetes and Gum (Periodontal) Disease4 Michael Kapner MD, Rita Sather MD, L Renee Watson MSN RN, The Staywell Company Cedars-Sinai Diabetes and Gum (Periodontal) Disease 2000-2022 The StayWell Company, LLC
  5. Independent Research Healthcare Organization, Thomas Lamont, Helen V Worthington, Janet E. Clarkson, Paul V Beirne. 27 December 2018
  6. In a Professional Prophylaxi6 Zahnreinigung-Ws-Profis-uebersehen, Stiftung Warantest, N#1 German Independent Testing Institute. 2016
  7. Novel Approach to Dental Biofilm Management through Guided Biofilm Therapy 7 Deepti Schrivastava, Valentino Natoli, Kumar Chandran Srivastava, Ibrahim A Alzoubi, Ahmed Ismall Nagy, My Othman Hamza, Khalid Al-Johani,Mohammad Khursheed Alam, Zohib Khurshid 2021
  8. Routine Dental Care: Does the Evidence Give Us Something to Smile About -Blog Sarah Chapman November 29, 2018
  9. Many Dental Procedures Lack Scientific Backing, Data Review Finds -Blog 5 Routine Scale and Polish for Periodontal Health in Adults Susan Perry April 22, 2019

Kendra Fox RDH
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