Life on Earth – Arifa Sultana Mylan

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  Posted by: manpreet.boora      4th October 2017

Bacteria grow in biofilms on a wide variety of surfaces. Distinct from simple unicellular organisms or planktonic bacteria, biofilms are living microbial communities. They often consist of hundreds of species of bacteria with many different physiological needs, which proliferate, attach and adhere to form a micro-colony with fluid channels, a communication system and an extracellular layer of slime or matrix material to protect itself from antibiotics, antimicrobials and host defence mechanisms.[1] In this way, many strains of bacteria are able to grow and survive in a self-supporting, well-nourished, cohesive network, which is probably why biofilms have been described as the most successful forms of life on earth.[2]

Biofilms facilitate bacterial survival in a variety of environments and are evident in many, if not most, environmental, industrial and medical bacteria-related problems.[3] They can be found living in urinary catheters, contact lenses, prosthetic devices and implants including stents, pacemakers and artificial joints. In fact, it was recently announced by the National Institutes of Health (NIH) that more than 60% of all microbial infections involve biofilms.[4]

It was relatively recently that dental bacterial plaque was recognised as a biofilm. As dental professionals are well aware, bacterial plaque adheres to tooth surfaces, restorations, prosthetics and dental implants. While it may help to prevent colonisation by exogenous species, it is also responsible for many of the diseases common to the oral cavity including dental decay, gingivitis periodontitis, and peri-implantitis.

Biofilm also flourishes in the adenoids, sinuses, within the crypts at the base of the tongue and on the palatine tonsils. Research indicates that the palatine tonsils may influence the growth and control of oral bacteria[5] but certainly, these soft tissues have crevices and pockets that trap food debris, mucus and high concentrations of bacteria, which when left undisturbed, calcifies and forms tonsilloliths or tonsil stones.

It has been noted that tonsilloliths are not simply stones but living biofilms[6] formed and structured in a similar way to dental bacterial plaque. Tonsil stones are fairly common but are also somewhat elusive; they can be lodged deep within the crypts of the tonsils. Some patients, however, notice white dots resembling breadcrumbs at the back of the throat and due to shared nerve networks, may experience referred pain in the ear. Tonsilloliths are essentially harmless but many individuals report irritation, a constant feeling of something stuck in the throat, a metallic taste or even difficulty or pain when swallowing. Most commonly, however, as tonsilloliths harden and decay, sufferers almost always have unpleasant smelling breath.

Tonsil stones contain a significantly high density of bacteria, which produce foul smelling volatile sulphur compounds (VSCs). This means that if a person with tonsil stones exhales, it is likely that a bad odour will be emitted. In fact, there is evidence to suggest that the presence of a tonsillolith can increase the risk of halitosis by up to 10 times.[7] While tonsil stones can indeed be troublesome, unpleasant smelling breath is embarrassing, especially in social situations. In addition, as with many biofilms, tonsilloliths are notoriously difficult to get rid of.

A mouthwash that contains Chlorhexidine (CHX) can help to break down tonsil stones and hinder their development. CHX is bacteriostatic (inhibits bacterial growth) and bactericidal (kills bacteria). It works rapidly and binds to the oral tissues, allowing its antimicrobial effects to be sustained for several hours. In low concentrations CHX is able to damage bacterial cell walls, attack the inner membranes causing component leakage and, subsequently, cell death.[8] It can inhibit the adherence of microorganisms to a surface and prevent the growth and development of biofilms. Therefore, when dental professionals encourage patients to add CB12 mouthwash to their oral health routine, it can prevent the accumulation of bacterial biofilms, such as dental plaque and tonsil stones, and also address associated halitosis effectively.

As well as CHX, CB12 mouthwash also contains zinc acetate. Tests have shown that a combination of zinc acetate and CHX is able to convert the sulphur content of offensive smelling VSCs into odourless, insoluble sulphides with long-lasting effects.[9] CB12 has a patented formula, which targets and neutralises VSCs and prevents halitosis for up to 12 hours.

Additionally, CB12 was developed by dentists and contains fluoride to help strengthen tooth enamel and prevent dental decay. It is the ideal adjunct to a regular brushing and interdental cleaning routine and can effectively both break down biofilms and prevent oral malodour in one hit.

As some of the most successful forms of life on earth, biofilms need to be addressed efficiently to preserve good oral health. It is the role of dental professionals to educate patients about these microbial communities and recommend the most effective methods and solutions to tackle them properly.


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[1] Nield-Gehrig J.S, RDH, MA Dental Plaque Biofilms. [Accessed 28th June 2017]

[2] Fleming H-C et al. The Biofilm Matrix. Nature Reviews Microbiology 2010 September. 8, 623-633. [Accessed 28th June 2017]

[3] Hentzer M et al. Pharmacological inhibition of quorum sensing for the treatment of chronic bacterial infections. J Clin Invest. 2003 Nov 1; 112(9): 1300–1307. [Accessed 28th June 2017]

[4] Lewis K. Riddle of biofilm resistance. Antimicrob. Agents Chemother. 2001;45:999–1007. [Accessed 28th June 2017]

[5] JB Weise, et al. A newly discovered function of palatine tonsils in immune defece: the expression of defensins. The Polish Ontolaryngology. 2002 56(4) 409-413. [Accessed 28th June 2017]

[6] Stroodley P et al. Tonsillolith: not just a stone but a living biofilm. Otolaryngol Head Neck Surg. 2009 Sep;141(3):316-21. [Accessed 28th June 2017]

[7] Rio AC et al. Relationship between the presence of tonsilloliths and halitosis in patients with chronic caseous tonsillitis. Br Dent J. 2008 Jan 26;204(2):E4. [Accessed 28th June 2017]

[8] Chlorhexidine Facts. About Chlorhexidine: Mechanism of Action.

[9] Thrane PS et al. Zn and CHX mouthwash effective against VSCs responsible for halitosis for up to 12 hours. Journal of the British Society of Dental Hygiene and Therapy, Dental Health Vol 48 2009 No 3 of 6. [Accessed 28th June 2017]



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