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Methods to Control Oral Biofilms



Oral biofilms are a part of human lives. They are a complex network of polymicrobial communities encased in an exopolymer matrix on dental and mucosal surfaces. Our mouth is home to diverse microbes and bacteria like Streptococcus gordonii, Streptococcus mutans, P. gingivalis, etc. These microbes are present as planktonic species or form biofilm on the tooth surface. But a majority of bacteria is found in the form of biofilms. These oral biofilms are also referred to as dental plaque. Most of the microbes present are healthy bacteria, but some are pathogenic which can result in oral infections and diseases. If these oral biofilms are not controlled in time it may lead to several oral infections/diseases like gingivitis and periodontitis. Organisms that cause infections are diverse, e.g., Pseudomonas, Vibrio, Escherichia, Salmonella, Listeria, Streptococcus, and Mycobacteria are responsible for biofilm-induced infections. Some studies prove this to be an endemic which can lead to several gum diseases. Numerous antiplaque and antimicrobial agents (e.g., ammonium compound, essential oils, etc.) have been discovered and used to prevent oral biofilms. Recent research shows excessive use of antimicrobial agents to control oral biofilms but only a few are effective. The objective is to provide clinical and microbiological benefits that facilitate better health, while at the same time maintaining the natural microbial ecology of the mouth. This perspective provides a review of different agents used for the control of oral biofilms.


The basic mechanical/ physical technique to control biofilms is brushing the teeth. But recent studies have shown that brushing alone is not sufficient and should be accompanied by some cleanser. However, most individuals find this difficult to maintain, which later results in strong plaque and requires professional help. Hence, oral care products are now being formulated with antiplaque and antimicrobial agents to control this problem. Numerous chemical amalgams like chlorhexidine, fluorine and their combinations have been used in the control of oral biofilms and infectious diseases caused by these biofilms.

The chemical, chlorhexidine is considered an antimicrobial agent and is used in oral rinses which proved to be effective. The rinses were used in case of oral diseases like gingivitis. Nevertheless, this came with some bad side effects like discoloration of teeth, burning sensation, etc. Under chemical strategies, a study published in the Journal of Clinical Oral Investigation had shown the use of alkaline peroxide to clean dentures that were available in the form of tablets. In the study, acrylic resin dentures with a multi-species biofilm were immersed in an alkaline peroxide enzyme-containing cleanser for 7 days. The study concluded that alkaline peroxide was effective and eradicated some microbes like F. nucleatum and V. dispar in just one day.

Natural ways to control oral biofilms include herbal-based mouth rinses also used to prevent oral infections. These herbal mouth rinses are available commercially and are alcohol-free. One of these mouth rinses contains Centella asiatica, Echinacea purpurea, and Sambucus nigra. These natural products have anti-inflammatory and antimicrobial properties which prove to be effective against biofilms. The use of essential oils is another biological method to control oral biofilms. Some essential oils used in mouth rinses are menthol, thymol, and eucalyptol. These have proven to be the most effective by reducing the levels of plaque and gingivitis. Given this, recent advances show the use of medicinal plants as one of the strategies to control oral biofilms. These medicinal plants are a rich source of bioactive compounds present in seeds, roots, etc, and can fight against biofilms. Medicinal plants proven to be effective against biofilms are Eucalyptus globus Labill and Lippia alba.

In the study of biofilms, significant advancements have been made since the early 1990s. While many techniques are used to control oral biofilms, no method is guaranteed to eliminate them. Our challenge is to continue developing products that are as effective as possible without harmful side effects, while at the same time ensuring normal oral flora is maintained.

Reference (Aug-21-A6)

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