The 2nd SEPA-DENTAID Symposium was held this past March 15 in Madrid, focusing on oral biofilm and its impact on periodontal and peri-implant diseases, as well as on its oral and systemic repercussions. Addressed to dental hygienists, the event gathered over 1,000 participants. 

After the successful 1st symposium held in 2012, DENTAID and SEPA decided to organise this second scientific event for oral healthcare professionals in order to discuss oral biofilms in depth: what they are, how they are organised, what their implications are in relation to oral and overall health and the best preventive strategies to follow. 

The event, held simultaneously with the Expodental trade fair, was moderated by Doctors Antonio Bujaldón and Xavier Calvo and boasted lectures by Doctors Vanessa Blanc, Marta Escribano, Juan Puchades, Silvia Roldán, Laurence Adriaens, Andrés Pascual, Isabel Santa Cruz and Gerardo Gómez. 

The eight speakers swiftly and appealingly explained how oral biofilms affect gingivitis, periodontitis, halitosis, peri-implant mucositis and peri-implantitis. They also discussed the influence of these biofilms on pregnant women and on cardiovascular risk. And they emphasised the role of dental hygienists in controlling biofilm as essential for preventing and treating oral disease. 

Relevant Facts 

In parallel with the symposium, some disturbing data were revealed regarding oral health in our country. Some 17% of Spaniards believe that they only need to visit the dentist when they have a problem, and although the remaining 83% claim to understand the importance of annual check-ups, only 43% of them actually follow through. Other important facts: 67% of all Spaniards do not brush their teeth three times per day as is recommended, which explains the fact that 85-90% of adults over 35 years of age experience gingival inflammation. 

Cardiovascular diseases 

Dr Gerardo Gómez explained how, according to clinical studies, people with periodontal disease are at increased risk for suffering a coronary event. And bacterial pathogens from subgingival biofilm and the resulting inflammatory response are directly involved in the development of the atherosclerotic lesion, leading to an increased risk for cardiovascular phenomena in the patient. Several studies have also shown an improvement in the cardiovascular status of periodontitis patients following intense periodontal treatment or of those who are maintained through preventive therapy. The association between heart disease and periodontitis could open up a new path for preventing and treating coronary disease. 

Gingivitis 

Dr Marta Escribano discussed the role of oral biofilm in gingivitis, the most common form of gum disease, affecting between 50 and 60% of the adult population and an astonishing 80% of children and adolescents. The emergence and growth of this supragingival biofilm are what trigger an inflammatory response in the gums, which is characterised by increased vascularisation and the arrival of cells from the immune system, which organise a defensive response against these bacteria. The treatment of gingivitis should focus on removing biofilm and preventing its recurrence through proper oral hygiene. Therefore, in order to prevent this condition, it is very important for dental hygienists to properly instruct patients on correct oral hygiene methods. 

Periodontitis 

Inflammatory disease of the tooth support tissues caused by specific microorganisms or by specific groups of microorganisms, resulting in progressive destruction of the periodontal ligament and of the alveolar bone with the formation of periodontal pockets, gingival recession or both. That is how Dr Juan Puchades defined periodontitis, which, according to the World Health Organization, is the second most common oral disease after tooth decay. For preventing this disease, the doctor pointed out the need to establish four major strategies: mechanical treatment to eliminate or reduce biofilm, the use of antimicrobials, photodynamic therapy as an adjunct in periodontal maintenance patients, and lastly, bacterial replacement therapies (replacing the microorganisms present in the biofilm). 

Peri-implantitis 

In his lecture, Dr Andrés Pascual focused on how peri-implant mucositis can progress and cause bone tissue destruction, thereby evolving into peri-implantitis. In this case, although the bacteria that grow on the biofilm structure are similar to those found on tooth structures, they are not identical. The dental implant industry has developed surfaces with characteristics that promote faster and better osseointegration, although these tend to be rough and textured, favouring the growth of biofilms when they are exposed to the oral environment. The problem is that disinfection of these surfaces is a difficult task, and many suggested and tested methods have not obtained the desired results. Handling this clinical condition is one of the biggest challenges dentistry faces today. Prevention seems to be the only possible solution. Hence the importance of performing an adequate initial diagnosis of patients and identifying their risk factors before planning any treatment that may include rehabilitation with dental implants. 

Peri-implant Mucositis 

Dr Laurence Adriaens addressed the issue of peri-implant mucositis, whose prevalence in the current population varies between 50 and 90% of all implants and up to 79% of all implant patients. People with poor oral hygiene, a history of periodontitis and smoking habits are those who show greater predisposition to having this disease, and so it is imperative that their periodontitis be treated and under control before placing implants. Treatment involves the use of mechanical instruments, either with or without the aid of chemical products, after first having disrupted the biofilm in order for these to be effective. The main challenge of this treatment is controlling the infection and preventing progression of the disease to more severe conditions, such as peri-implantitis. 

Pregnancy-induced Alterations 

Dr Isabel Santa Cruz presented the chronic infections caused and perpetuated by bacteria residing in subgingival biofilms as one of the possible causes of preterm delivery. Pregnancy gingivitis is the most common stage of periodontal disease during pregnancy, as it affects nearly 50% of women in their second and third trimesters. It can be prevented by maintaining optimum dental hygiene over the nine months, and receiving regular check-ups and professional cleanings. Scientific studies show a reduction in preterm delivery and low birth weight infants when women with gingivitis are treated during pregnancy. Periodontal treatment is safe for mother and foetus. The best preventive strategy is for women to have the best periodontal health possible when they become pregnant. 

Oral Biofilm 

Dr Vanessa Blanc defined oral biofilm as a sessile microbial community characterised by a first group of cells that irreversibly binds to a substrate or interface, becomes embedded in a matrix of extracellular polymeric substances that they themselves produce, and exhibits an altered phenotype with respect to growth rate and gene expression. Biofilms, which are responsible for multiple infectious diseases throughout the body, can develop from planktonic cells or other biofilm, where the oral cavity is one of the most heavily colonised sites in the body: tongue, tonsils, teeth, gingival sulcus, etc. Currently, the most effective way of eliminating it is by using physical methods (ultrasounds, curettes, irrigators, brushes, floss or tongue cleaners), together with chemical substances (in the form of mouthwashes or gels) applied after mechanically disrupting the biofilm. 

Halitosis 

In 90% of all cases, the offensive or unpleasant odours that emanate from the oral cavity have intraoral causes. This was stated by Dr Silvia Roldán, who also confirmed that the prevalence of this disorder is approximately 30% in adult populations. Biofilm is present in the gingival sulcus, periodontal pockets and saliva, among other areas, but it seems that lingual biofilm is the most important production site for oral malodour. And although not all bacterial species in this biofilm have been successfully characterised, the species that are most associated include: Atopobium parvulum, Eubacterium sulci, Fusobacterium periodonticum, a Dialister phylotype, a Streptococcus phylotype, Solobacterium moorei, Lysobacter spp, S. salivarius. In order to control this tongue coating, the use of tongue cleaners, etc, needs to be combined with the use of mouthrinses containing antibacterial agents, such as chlorhexidine and cetylpyridinium chloride, as these reduce the levels of halitosis-producing bacteria on the tongue. Mouthrinses containing chlorine dioxide and zinc are also effective for neutralising malodourous sulphur compounds.