Guided Biofilm Therapy as effective prevention tool

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Not wellness but medical care: GBT as effective prevention in everyday practice

Guided Biofilm Therapy is suitable for both primary prophylaxis and secondary prophylaxis for periodontitis and peri-implantitis therapy. (Image: EMS)

Some 2,500 years ago, Hippocrates already knew that prevention is more important than curative therapy. In the modern-day context, Benz stated that prevention is the most effective dental treatment we have developed in 150 years of scientific dentistry.1 Yet, it is doubtful whether the often-cited paradigm shift away from restoration to prevention has really taken place.2 The following article discusses the standing of prevention in contemporary dentistry and positions systematic prophylaxis-guided biofilm therapy within the prevention landscape.

According to a 2019 survey by the German INSA opinion research institute, less than half (41%) of respondents had had their teeth professionally cleaned in the last 12 months.3 A survey conducted in the same year by the German forsa market research institute showed that only three in five citizens (about 60%) attended professional dental cleaning at least once a year.4 How can this apparent discrepancy between dentists’ knowledge of prevention and its implementation in everyday practice be explained? Are the systematic prophylactic protocols offered for prevention out of date? Or is it because a paradigm shift is necessary at the financial level in parallel with the professional level?

Fig. 1: AIRFLOW Prophylaxis Master—the Swiss original. (Image: EMS)

Fig. 1: AIRFLOW Prophylaxis Master—the Swiss original. (Image: EMS)

Professional paradigm shift

If prevention is to be successfully integrated into everyday practice, a new systematic prevention protocol based on the state of the art in science and technological progress is required.

Scientific progress: Biofilm is a biological challenge

Today, the ecological plaque hypothesis according to Marsh is accepted worldwide as explaining the aetiology of the major oral diseases.5 According to this hypothesis, dysbiotic sub- and supragingival biofilm is the main cause of these diseases, which are caries, gingivitis, periodontitis, peri-implant mucositis and peri-implantitis.

A change in the environmental conditions from symbiosis to dysbiosis takes place in the biofilm. This ecological shift leads to a disturbance of homeostasis. Dental diseases are the result of the inflammatory host response to microbial biofilm. Because we know the cause of most oral diseases, there can only be one objective for dentistry: to preserve oral health lifelong. This objective can be achieved by combining individualised home and professional oral hygiene measures.6

Technological progress: Aids for biofilm management

In general, we distinguish between home and professional biofilm management, and chemical and mechanical aids are available for both. Professional tooth cleaning or more precisely, professional mechanical plaque removal, is a central component of systematic prevention. Mechanical professional biofilm management can be performed with hand instruments such as scalers and curettes, with mechanical aids such as sonic scalers and ultrasonic scalers, with air–powder–water jet devices (air polishing and AIR-FLOWING; Fig. 1) and with rubber cup polishing. The terms “air polishing” and “AIR-FLOWING” are often used synonymously, but they differ considerably and must be distinguished from each other: both work according to the same principle of powder–water jet technology. AIR-FLOWING is a technically, physically and chemically coordinated system (AIRFLOW Prophylaxis Master device, AIRFLOW MAX handpiece, PERIOFLOW handpiece, minimally invasive erythritol-based AIRFLOW PLUS powder) and is the only system that operates with a constant and regulated powder flow rate and laminar flow.

For all aids, the same objectives apply: effective and targeted removal of biofilm, modification of biofilm, effective and targeted removal of dental calculus, preservation of the tooth substance, and patient and practitioner comfort. Comparison of the aids according to these objectives shows that AIR-FLOWING is superior to all other aids in effective targeted removal of supra- and subgingival biofilm.7–12 Recent work has shown that it is possible to modify biofilm and restore symbiosis with AIR-FLOWING and piezoceramic ultrasound (PIEZON NO PAIN technology and PS instrument).13, 14 Calculus can be removed more specifically and more effectively with piezoceramic ultrasound than with hand instruments.15–17 AIR-FLOWING and modern ultrasonic systems are also superior to hand instruments in terms of tooth substance preservation18–21 and practitioner22 and patient comfort.23–28

Systematic prevention: Guided Biofilm Therapy

To meet today’s requirements, EMS, in collaboration with practitioners and universities, has developed the Guided Biofilm Therapy (GBT) prevention protocol, which is based on sound scientific knowledge and the newest technological developments. It provides systematic prevention in eight modular steps (Fig. 2). GBT is a systematic, modular, risk-oriented, evidence-based, individualised prevention and treatment protocol which is applicable to all cases regardless of the patient’s oral and general health and to all age groups. GBT is strictly oriented towards the principles of modern medicine, seeking to be preventive, predictive, personalised, participatory and ethical.

Fig. 2: The eight steps of the GBT protocol for systematic prophylaxis. (Image: EMS)

Fig. 2: The eight steps of the GBT protocol for systematic prophylaxis. (Image: EMS)

Financial paradigm shift

From a professional point of view, the future of dentistry belongs to prevention. Prevention is also becoming increasingly popular among the public. It has become fashionable to be fit and healthy. Having a focus on prevention promotes the image of dental practices that provide causal, needs-based individual preventive therapy in a professional and results-oriented manner. In addition, it is an ideal tool for patient acquisition and loyalty. If preventive services are provided economically, they reduce the dentist’s business risks and can form the basis for the financial future of the practice, as they make the practice more independent of legal arbitrariness. It is thus all the more incomprehensible that not all dental practices offer individual, needs-oriented systematic prevention as a service. One explanation may be that dentists did not learn to run their practices according to business management principles either at university or in their postgraduate education and training.

A healthcare system that funds disease and not health

According to a 2022 report by the German National Association of Statutory Health Insurance Dentists, the distribution of expenditure for dental treatment in Germany showed that costs for therapeutic measures covered by health insurance made up more than 95%.28 That preventive care—except for very young patients—is exclusively the domain of private dental services in Germany speaks for a public healthcare system that finances illness and not health.

Thus, it is also obvious that a large part of the turnover in the dental practice is generated by prosthetic and conservative surgical services. One of the main arguments of a lack of focus on preventive dentistry is the alleged unwillingness of patients to contribute towards payment for such care. However, this alone cannot account for the lack of emphasis on and take-up of prevention. Preventive services for children (early screening and individual prevention services) are fully covered by statutory health insurance, yet are only utilised up to a maximum of 75%. The rate is even lower for children under the age of 5.

“Dental health is not a matter of course, but is the result of efforts by the patient and the practitioner and their team.”

Dental health should not be taken for granted

This means that the economics of prevention faces a major challenge: dental health is not a matter of course, but is the result of efforts by the patient and the practitioner and their team. This objective can only be achieved if the patient is willing to contribute to this effort. If the patient does not perceive the benefit, it is difficult to involve them in the preventive treatment plan. Therefore, the first hurdle is communication with the patient, and the second step is financial attractiveness. This is where the prevention economy begins and the practitioner is challenged not only as a dentist but primarily as an entrepreneur.

GBT: Not wellness but necessary medical care

Presenting the benefits to the patient through education offers a good and easy entry point for communication. The guiding principle should be that systematic prevention with GBT is not a wellness treatment and offers far more than perfect tooth cleaning; GBT is a medically necessary, preventive and therapeutic dental measure. Providing care in collaboration with the patient emphasises the added value for the patient and their oral health, placing at centre the patient’s interests through individual, painless treatment by well-trained staff.

The utilisation of prophylaxis is not a sure-fire success. It requires a prevention plan which can address the individual needs of each patient: for example, a pregnant woman will need different preventive care than a 70-year-old woman with dentures or a patient with periodontal disease. If this individual tooth preservation therapy is offered to and communicated as such to the patient, then each patient will be properly informed of their own individual need for prevention and can become collaboratively involved in the prophylaxis plan.

Conclusion

Since the publication of the study by Axelsson and Lindhe, there has been no question that systematic prevention is at the heart of dentistry. New evidence on links between oral medicine, general health and quality of life has brought the importance of systematic oral prevention into even sharper focus.

Editorial note:

This is a shortened and edited version of the article titled “Nicht Wellness, sondern Medizin: GBT als effective Prävention in Praxisalltag”, which was published in Issue 9/2023 of ZWP Zahnarzt Wirtschaft Praxis. More information about GBT can be found at www.ems-dental.com/en/guided-biofilm-therapy. The complete list of references can be found here.

AIRFLOW Dental biofilm EMS Guided Biofilm Therapy Periodontology Prevention

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