Biofilm and oral microbiome are important factors to consider when treating patients. Oral microbial biofilm has been associated with dental caries, periodontal disease, and endodontic infections. In August 2019, the Eur J Clin Microbiol Infect Dis reviews the importance and relevance of the oral microbial biofilm in health and disease.1
The oral ecosystem of humans is considered one of the most diverse microbiomes in the body. Many of the bacteria, viruses, protozoa, archaea, and fungi are commensal and necessary to maintain homeostasis. Problems arise when there is a shift or disturbance in the balance of the microbiome. When pathogenic microbes outnumber commensal microbes, disease ensues. Many factors contribute to this shift including, genetics, weakened immune system, diet, environmental factors, oral hygiene, and saliva composition and flow.
Biofilm is often seen in a negative light, but it can be very beneficial. Biofilm can block the proliferation of oral pathogens assisting in the prevention of disease. However, it can also hide pathogens preventing the body’s immune system and saliva from eliminating the pathogen. This is the very reason individualized oral hygiene methods should be reviewed and implemented. Recognizing dysbiosis in the oral microbiome due to a shift in microbes in biofilm requires critical thinking and is crucial in preventing and treating dental disease.
A good example of customized preventative care is nutritional counseling. Nutritional counseling is often overlooked when pressed for time, though this is a very important part of preventative care. When counseling patients on carbohydrate intake, consider discussing how the composition of the patient’s biofilm may be contributing to their caries rate. Carbohydrates are not necessarily the enemy, the bacteria that causes fermentation of carbohydrates are the issue that should be addressed. Reducing carbohydrate intake will, of course, reduce caries risk, however what if we focused on achieving homeostasis of the microbiome to reduce caries risk?
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