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I like to think of biofilm as a nemesis rather than an enemy. An enemy is one you have the possibility to overcome, whereas a nemesis is impossible to defeat. Why is it a nemesis? Because it will always re-develop after its removal, so the notion that it’s removal is finite is wrong.

The biofilm lifecycle will always continue, so teaching our patients about it will help them to understand what we are asking of them with regards their home care and to see why a hygienist recall is imperative in order to maintain optimal health. Beating biofilm requires a team work approach.

Biofilm life cycle

Let’s look at the life cycle of biofilm. Within 20 minutes of removal, early colonisers start the process of attaching to the tooth surface again. By processing the sugars we eat, they produce an acidic environment that is favourable for other bacterial species. They attach onto the pioneering microorganisms and the biofilm starts to form.

All the while, a sticky matrix maintains the microorganisms , facilitating the environment to allow the biofilm to mature. Maturity see’s it transformed  to become pathogenic, capable of initiating disease and host destruction/tissue damage.

Image showing the build up of bacteria on the gum line.

One thing we need to remind ourselves of, is that this lifecycle will never stop and therefore this makes all of us susceptible to a biofilm related disease. The aim of home care is to turnover this lifecycle in the early stages of development, preventing it from progressing into a mature state. This requires skill, dexterity, commitment and priority.

Do all patients show all of these attributes? Often not.   It’s not that we don’t trust patients when it comes to biofilm control at home. It’s just that there are so many areas that are inaccessible and with biofilm quickly maturing when left to stagnate, it’s important patients are made aware of the need for professional biofilm management to complement their efforts at home.

Hygienist’s catch what the patients inadvertently miss and they press the reset button on the biofilm lifecycle and disease process. Optimal oral health can only be achieved when biofilm is meticulously controlled and one’s oral health is regularly monitored to ensure pathogenic bacterial load remains suppressed.  

6 ways we can work together with patients to come out on top of the biofilm battle:


  1. Regular professional mechanical biofilm removal with a hygienist at a bespoke recall that is decided based on assessment
  2. Meticulous biofilm removal in treatment, maximised by disclosing to ensure 100% removal. We inadvertently leave biofilm behind if we can’t see it, which can be considered an injustice for our periodontal patients
  3. Prescriptive and explicit mechanical home care using tools and techniques tailored to the patient’s  needs
  4. Chemical adjuncts to manage biofilm growth, for example stannous fluoride and stannous chloride found in some toothpastes or mouthwash containing fluoride and essential oils.
  5. Considering systemic issues that might aggravate biofilm growth. For example, uncontrolled diabetes increases salivary sugar content which promotes biofilm to flourish. Or menopause effects on oestrogen receptors, causing xerostomia and an increase in biofilm maturation
  6. Supplements or probiotics that holistically suppress biofilm by aiding the immune system, blocks bacterial colonisation and prevents the metabolism of the bacteria

Educate your clients about Biofilm

The first and potentially most productive way to attack the onset of Biofilm is through the education of your clients. This can be done whilst in consult with a member of the team, explaining what it is and how to effectively remove the majority of Biofilm through good oral hygiene.

Engaging with waiting clients – sat in the waiting area is another really important point of contact. The use of a waiting room TV system such as Envisage Dental TV will help educate people in the right place at the right time and may even lead to further conversations with the hygienist, nurse or dentist.


This article was written by Claire Berry a multi -award winning hygienist and author. Claire trained as a dental hygienist whilst serving in the Army, qualifying in 2009. Currently works in 3 practices, as well as being a key opinion leader for brands such as Oral B, Boutique and an ambassador for the BSDHT. With articles published in BDJ In Practice, The Probe, Smile magazine, DH Contact, Young Dentist magazine, as well as numerous FMC publications including a monthly hygienist blog and is on the board for Clinical Dentistry Magazine and Dental Nurse magazine