Dentists Be Damned

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The advancement of technology through the application of molecular techniques for identification and analysis of complex bacterial communities have demonstrated the diversity of the oral microbiota and the presence of numerous strains not previously described. Dental plaque is formed by the initial adhesion of pioneer bacterial species to film acquired from enamel, followed by secondary co-aggregation of these bacteria to other microorganisms of different genera and species. This mature dental plaque has some characteristics of multicellular organisms, such as cooperation mechanisms to obtain nutrients, resistance to environmental and communication stresses in order to regulate their growth (Marsh and Martin, 2009).

The understanding of the dental plaque structure as a microbial biofilm sheds light on the clinical relevance of antimicrobials usage (Zanatta et al, 2007). Biofilms have a more tolerant phenotype to antimicrobial agents, stress and host defenses than planctonic cultures, making them difficult to control (Socransky and Haffajee, 2002). This means that the effectiveness of agents used to prevent dental caries, specifically those compounds targeted to combat cariogenic pathogens, should be evaluated in biofilms rather than in traditional liquid cultures (Tenover, 2006). According to Wade (2010), high concentrations of Chlorhexidine (CHX) nearly eliminate all cells, and this is not interesting for microbiota balance in the oral biofilm. Successful antimicrobial agents are able to maintain the oral biofilm at levels compatible with oral health but without disrupting the natural and beneficial properties of the resident oral microflora (Marsh, 2010).

In this chapter, the etiology of dental caries will be briefly introduced focusing on the role of biofilms for initiation and progression of this disease. It will be followed by a thorough review of literature taking into account recent and novel antimicrobial strategies for biofilm control. Recent advances in anti-plaque agents, including those chemoprophylactic, antimicrobial peptides (anti-quorum sensing approach) and probiotics/replacement therapy will be analyzed. Both the discovery of new and effective drugs to control pathogenic biofilms as well as new delivery systems for oral environment will be the future focus of this research field.

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