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Control of Plaque Biofilms

1. The coping mechanisms of the bacteria. In biofilms provides bacteria advantage allowing the long-term survival in the furrow or pocket environment. Protective cell-free layer of mucus makes the bacteria are extremely resistant to antibiotics, anti-bacterial agents, and the body's immune response. It is likely that there are several mechanisms responsible for biofilm resistance systemic antibiotics, antimicrobials, and the immune system.

A. resistance systemic antibiotics and Antimicrobials

1. Bacteria living in biofilms extremely resistant to systemic antibiotics (in dentistry, usually in the form of tablets) and antimicrobials (hosted locally in the mouth).

2. Doses of antibiotics, which kill free floating bacteria, for example, should be increased more than 1500 times to kill plaque biofilm bacteria (and at these higher doses of antibiotics can kill the patient before biofilm bacteria!) [41].

3. Antimicrobial agents work best when used in combination with mechanical treatment that removes or destroys plaque biofilm [42].

B. protective mechanisms Biofilms

1. Extracellular layer of mucus

a. Extracellular layer of mucus, very dense and can prevent from penetration of drugs is fully immersed in the depth of biofilms.

B. A thick layer of mucus can protect against bacteria leukocytes (protective immune cells).

c. A thick layer of mucus can also block of substances released by white blood cells. As a consequence, leukocytes substances end up causing more harm surrounding tissues of the body, than to biofilm bacteria.

2. Enzymes. Some bacteria produce enzymes, antibiotics that degrade faster than the drug can penetrate into the biofilm.

3. Dormant Bacteria

a. In biofilms very thick and bacteria in the deep layers become inactive, not dead, because they are cut off from sources of nutrients. Dormant bacteria are inactive in order to survive in adverse conditions.

B. Antibiotics only work on bacteria, which are active and reproduction.

c. When the course of treatment is finished, sleeping inactive bacteria within biofilms be resumed.

2. Physical removal of plaque important Biofilms

A. control the bacteria in plaque biofilm best achieved by physical destruction plaque biofilm (such as brushing, flossing, and periodontal instrumentation).

1. Mature plaque biofilm is a very complex structure of bacterial microcolonies, extracellular layer of mucus and fluid channels.

2. It will take some time to Mature biofilm in the form. 3. Mechanical cleaning forces bacteria to start over with the original investment, the initial occupation, secondary colonization and, finally, to become Mature biofilm.

4. In areas that are cleaned regularly, Mature biofilm can't develop. Cleaner tooth surface, the less complex bacterial education.

B. tooth brush and floss cannot reach subgingival plaque biofilm, located in the pockets. For this reason, frequent periodontal instruments subgingival root surfaces or dentist, dental hygienist, is an important component in the treatment of periodontitis...

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