Oral Biofilm: Development Mechanism, Multidrug Resistance, and Their Effective Management with Novel Techniques

Abstract

Biofilms are formed by the congregation of one or more types of microorganisms that can grow on a firm surface. Dental plaque is one of the most commonly forming biofilms in the oral cavity and appears as a slimy layer on the surface of the teeth. In general, the formation is slow, but biofilms are very adaptive to the changing environment, and a mature biofilm can cause many health-related problems in humans. These biofilms remain unaffected by antibiotics as they do not allow the penetration of antibiotics. Moreover, the increased level of virulence and antibiotic resistance of microorganisms in the oral biofilm or dental plaque has made its clinical management a serious challenge worldwide. Chlorhexidine-like antimicrobial drugs have been partially effective in removing such organisms; however, the precise and continuous elimination of these microorganisms without disturbing the normal microbial flora of the oral cavity is still a challenge. This review paper focuses on the process of oral biofilm formation, related complications, development of drug-resistant bacteria in these biofilms, and their effective management by the use of different novel techniques, available from various published research and review articles.

Figure 1

Schematic Description of Stages 1–3 of Biofilm Formation. Stage 1: Entry of multidrug-resistant pathogenic bacteria, commensals, and oral microflora. Stage 2: The salivary pellicle begins to form as the commensals and pathogenic bacteria congregate, laying the foundation for biofilm development. Stage 3: The bacteria rapidly multiply and begin to adhere, and dysbiosis begins.

Figure 2

Schematic Description of Stages 4 and 5 of Biofilm Formation. Stage 4: The biofilm matures, there is an exchange of drug-resistant genes, and complete dysbiosis. Stage 5: With the full maturation of the biofilm, new multidrug-resistant bacteria are released into the oral cavity, spreading the oral biofilm.