Abstract
This chapter examines the pivotal role of bacterial biofilms in the pathogenesis of dental diseases and their impact on oral health. It reviews the molecular and cellular mechanisms underlying biofilm formation, including bacterial adhesion, extracellular polymeric substance production, quorum sensing (QS), and genetic regulation. These processes contribute to the development and persistence of oral infections. Diagnostic challenges are discussed by reviewing conventional clinical examinations and radiographic techniques alongside advanced molecular and imaging methods. However, the inherent resistance of biofilm-embedded bacteria to antimicrobials and the limitations of current diagnostic tools underscores the need for more refined approaches. Prevention and management strategies are explored, emphasizing rigorous oral hygiene practices, dietary modifications to reduce fermentable carbohydrate intake, and professional interventions including mechanical debridement and adjunctive antimicrobial therapies. Emerging therapies—such as nanoparticle-based antimicrobials, QS inhibitors, guided biofilm therapy, and photodynamic therapy—offer promising alternatives to traditional treatments. Prevention and management of biofilm-associated dental diseases requires integrated, multidisciplinary strategies, incorporating personalized medicine and advanced diagnostic technologies.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Abebe G (2021) Oral biofilm and its impact on Oral health, psychological and social interaction. Int J Oral Dental Health 7:10.23937/2469-5734/1510127
Akimbekov NS, Digel I, Yerezhepov AY, Shardarbek RS, Wu X, Zha J (2022) Nutritional factors influencing microbiota-mediated colonization resistance of the oral cavity: a literature review. Front Nutr 9:1029324. https://doi.org/10.3389/fnut.2022.1029324
Al Shayeb KN, Turner W, Gillam DG (2014) Periodontal probing: a review. Primary Dental J 3(3):25–29. https://doi.org/10.1308/205016814812736619
Alvarez S, Leiva-Sabadini C, Schuh CM, Aguayo S (2022) Bacterial adhesion to collagens: implications for biofilm formation and disease progression in the oral cavity. Critical Reviews Microbiology 48(1):83–95
Bashir S, Habib ST, Ahmad I, Malik SA (2022) A literature review on different diagnostic techniques used in oral and maxillofacial surgery. IP Int J Maxillofacial Imag 8(4):138–140
Bayani M, Raisolvaezin K, Almasi-Hashiani A et al (2023) Bacterial biofilm prevalence in dental unit waterlines: a systematic review and meta-analysis. BMC Oral Health 23:158. https://doi.org/10.1186/s12903-023-02885-4
Belibasakis GN, Charalampakis G, Bostanci N, Stadlinger B (2015) Peri-implant infections of oral biofilm etiology. In Biofilm-Based Healthcare-Associated Infections: Volume I, pp 69–84
Berger D, Rakhamimova A, Pollack A, Loewy Z (2018) Oral biofilms: development, control, and analysis. High-throughput 7(3):24
Bertolini M, Costa RC, Barão VAR, Cunha Villar C, Retamal-Valdes B, Feres M, Silva Souza JG (2022) Oral microorganisms and biofilms: new insights to defeat the main etiologic factor of oral diseases. Microorganisms 10(12):2413. https://doi.org/10.3390/microorganisms10122413
Betancourt P, Brocal N, Sans-Serramitjana E, Zaror C (2021) Functionalized nanoparticles activated by photodynamic therapy as an antimicrobial strategy in endodontics: a scoping review. Antibiotics 10(9):1064
Bizzini A, Greub G (2010) Matrix-assisted laser desorption ionization time-of-flight mass spectrometry, a revolution in clinical microbial identification. Clin Microbiol Infect 16(11):1614–1619
Bjarnsholt T, Buhlin K, Dufrene YF, Gomelsky M, Moroni A, Ramstedt M, Romling U (2018) Biofilm formation–what we can learn from recent developments. Journal Internal Medicine 284(4):332–345
Bumm CV, Folwaczny M (2021) Infective endocarditis and oral health: a narrative review. Cardiovasc Diagn Ther 11(6):1403
Butler CA, Adams GG, Blum J, Byrne SJ, Carpenter L, Gussy MG et al (2022) Breastmilk influences development and composition of the Oral microbiome. J Oral Microbiol 14(1). https://doi.org/10.1080/20002297.2022.2096287
Colombo APV, do Souto RM, da Silva-Boghossian CM et al (2015) Microbiology of oral biofilm-dependent diseases: have we made significant progress to understand and treat these diseases? Curr Oral Health Rep 2(1):37–47. https://doi.org/10.1007/s40496-014-0041-8
Colombo APV, Magalhães CB, Hartenbach FARR, do Souto RM, da Silva-Boghossian CM (2016) Periodontal-disease-associated biofilm: a reservoir for pathogens of medical importance. Microb Pathog 94:27–34
Dash A, Ragavendran C (2024) Innovative approaches to combating dental biofilms: nanotechnology and its applications. Biocatal Agric Biotechnol 61:103406. https://doi.org/10.1016/j.bcab.2024.103406
de Araujo Nobre M, Mano Azul A, Rocha E, Malo P (2015) Risk factors of peri-implant pathology. Eur J Oral Sci 123(3):131–139
de la Escosura-Muñiz A, Merkoçi A (2019) Point-of-care diagnostics for oral health: emerging biosensors and lab-on-a-chip devices. Biosens Bioelectron 141:111451
Dincer C, Bruch R, Kling A, Dittrich PS, Urban GA (2017) Multiplexed point-of-care testing—xPOCT. Trends Anal Chem 97:21–34
Do T, Devine D, Marsh PD (2013) Oral biofilms: molecular analysis, challenges, and future prospects in dental diagnostics. Clin Cosmet Investig Dent 5:11–19. https://doi.org/10.2147/CCIDE.S31005
Donovan T, Nguyen-Ngoc C, Abd Alraheam I, Irusa K (2021) Contemporary diagnosis and management of dental erosion. J Esthet Restor Dent 33(1):78–87
Dye BA, Thornton-Evans G, Li X, Lafolla TJ (2007) Dental caries and tooth loss in adults in the United States, 2011–2012. NCHS Data Brief, No. 197. National Center for Health Statistics
Esra K, Nurhan O, Yilmaz AD, Berrin O (2020) Vertical and horizontal transmission of Streptococcus mutans and effective factors: an in vivo study. J Adv Oral Res 11(2):172–179. https://doi.org/10.1177/2320206820942694
Fasoulas A, Pavlidou E, Petridis D, Mantzorou M, Seroglou K, Giaginis C (2019) Detection of dental plaque with disclosing agents in the context of preventive oral hygiene training programs. Heliyon 5(7):e02139. https://doi.org/10.1016/j.heliyon.2019.e02139
Filoche S, Wong L, Sissons CH (2010) Oral biofilms: emerging concepts in microbial ecology. J Dent Res 89(1):8–18. https://doi.org/10.1177/0022034509351812
Flemming H-C, Wingender J (2010) The biofilm matrix. Nat Rev Microbiol 8(9):623–633
Ghannoum MA, Jurevic RJ, Mukherjee PK, Cui F, Sikaroodi M, Naqvi A, Gillevet PM (2010) Characterization of the oral fungal microbiome (mycobiome) in healthy individuals. PLoS Pathog 6(1):e1000713
Gondil VS, Subhadra B (2023) Biofilms and their role in diseases. BMC Microbiol 23:203. https://doi.org/10.1186/s12866-023-02954-2
Guliy OI, Evstigneeva SS (2024) Bacterial communities and their role in bacterial infections. Front Biosci (Elite Ed) 16(4):36. https://doi.org/10.31083/j.fbe1604036
Hao Y, Huang X, Zhou X, Li M, Ren B, Peng X, Cheng L (2018) Influence of dental prosthesis and restorative materials interface on oral biofilms. Int J Mol Sci 19(10):3157. https://doi.org/10.3390/ijms19103157
Heitz-Mayfield LJ (2008) Peri-implant diseases: diagnosis and risk indicators. J Clin Periodontol 35:292–304
Heitz-Mayfield LJ, Heitz F, Koong B, Huang T, Chivers P (2023) Surgical peri-implantitis treatment with and without guided bone regeneration: a randomized controlled trial. Clin Oral Implants Res 34(9):892–910
Hojo K, Nagaoka S, Ohshima T, Maeda N (2009) Bacterial interactions in dental biofilm development. J Dent Res 88(11):982–990. https://doi.org/10.1177/0022034509346810
Hu X, Huang YY, Wang Y, Wang X, Hamblin MR (2018) Antimicrobial photodynamic therapy to control clinically relevant biofilm infections. Front Microbiol 9:1299
Huang W, Zhang Z, Tang X (2019) Bacterial signaling systems in biofilm formation: two-component systems and beyond. Crit Rev Microbiol 45(3):338–354
Ismail AI, Pitts NB, Tellez M (2015) The international caries classification and management system (ICCMS™): an example of a caries management pathway. BMC Oral Health 15(Suppl 1):59
Jakubovics NS, Goodman SD, Mashburn‐Warren L, Stafford GP, Cieplik F (2021) The dental plaque biofilm matrix. Periodontology 2000 86(1):32–56
Jepsen S, Berglundh T, Genco R, Aass AM, Demirel K, Derks J et al (2015) Primary prevention of peri-implantitis: managing peri-implant mucositis. J Clin Periodontol 42(S16):S152–S157
Joseph B, Gopalakrishnan S, Alamoudi RA, Alamoudi RA, Pachathundikandi SK, Alotaibi RN, Anil S (2022) Detection of invisible dental biofilm using light-induced autofluorescence in adult patients—a systematic review. Photodiagnosis Photodyn Ther 39:102916. https://doi.org/10.1016/j.pdpdt.2022.102916
Jung W, Jang S (2022) Oral microbiome research on oral lichen planus: current findings and perspectives. Biology 11(5):723. https://doi.org/10.3390/biology11050723
Kinane DF, Stathopoulou PG, Papapanou PN (2017) Periodontal diseases. Nat Rev Dis Primers 3, Article 17038
Klug B, Santigli E, Westendorf C, Tangl S, Wimmer G, Grube M (2016) From mouth to model: combining in vivo and in vitro oral biofilm growth. Front Microbiol 7:1448. https://doi.org/10.3389/fmicb.2016.01448
Kolenbrander PE, Palmer RJ Jr, Periasamy S, Jakubovics NS (2010) Oral multispecies biofilm development and the key role of cell–cell distance. Nat Rev Microbiol 8(7):471–480. https://doi.org/10.1038/nrmicro2381
Kozmos M, Virant P, Rojko F, Abram A, Rudolf R, Raspor P, & Bohinc K (2021) Bacterial adhesion of Streptococcus mutans to dental material surfaces. Molecules 26(4):1152
Kozak M, Pawlik A (2023) The role of the oral microbiome in the development of diseases. Int J Mol Sci 24(6):5231. https://doi.org/10.3390/ijms24065231
Kreth J, Herzberg MC (2015) Molecular principles of adhesion and biofilm formation. The Root Canal Biofilm:23–53
Krzysciak W, Jurczak A, Piątkowski J (2016) The role of human oral microbiome in dental biofilm formation. INTECH. https://doi.org/10.5772/63492
Kumar PS (2017) Diversity of oral biofilms in periodontal health and disease. In: Bostanci N, Belibasakis GN (eds) Pathogenesis of periodontal diseases. Springer International Publishing, pp 9–20
Kurtzman GM, Horowitz RA, Johnson R, Prestiano RA, Klein BI (2022) The systemic oral health connection: biofilms. Medicine 101(46):e30517. https://doi.org/10.1097/MD.0000000000030517
Lamont RJ, Koo H, Hajishengallis G (2018) The oral microbiota: dynamic communities and host interactions. Nat Rev Microbiol 16(12):745–759
Łasica A, Golec P, Laskus A, Zalewska M, Gędaj M (2024) Periodontitis: etiology, conventional treatments, and emerging bacteriophage and predatory bacteria therapies. Front Microbiol 15:1469414
Leishman SJ, Lien Do H, Ford PJ (2010) Cardiovascular disease and the role of Oral bacteria. J Oral Microbiol 2(1). https://doi.org/10.3402/jom.v2i0.5781
Leme AP, Koo H, Bellato CM, Bedi G, Cury JA (2006) The role of sucrose in cariogenic dental biofilm formation—new insight. Journal Dental Research 85(10):878–887. https://doi.org/10.1177/154405910608501002
Li YH, Tian XL (2016) Quorum sensing and bacterial social interactions in biofilms: bacterial cooperation and competition. In Stress and Environmental Regulation of Gene Expression and Adaptation in Bacteria, pp 1195–1205
Li L, Tan J, Zhang Y, Zhang L, Niu Z (2018) Polymicrobial infections in endodontic diseases: prevalence and clinical implications. J Endodont 44(12):1846–1854
Li Z, Li J, Fu R, Liu JA, Wen X, Zhang L (2023a) Halitosis: etiology, prevention, and the role of microbiota. Clin Oral Investig 27(11):6383–6393
Li Y, Zhang Y, Yang Z, Wang L, Guo X (2023b) Oral microbiota in periodontitis: Progress and challenges. Microbiol Spectr 11(2):e00056–e00023
Liccardo D, Cannavo A, Spagnuolo G, Ferrara N, Cittadini A, Rengo C, Rengo G (2019) Periodontal disease: a risk factor for diabetes and cardiovascular disease. Int J Mol Sci 20(6):1414
Manchanda S, Sardana D, Liu P, Lee GH, Lo E, Yiu CK (2021) Horizontal transmission of Streptococcus mutans in children and its association with dental caries: a systematic review and meta-analysis. Pediatr Dent 43(1):1E–12E
Mark Welch JL, Rossetti BJ, Rieken CW, Dewhirst FE, Borisy GG (2016) Biogeography of the human oral microbiome at the micron scale. Proc Natl Acad Sci 113(6):E791–E800
Mosaddad SA, Tahmasebi E, Yazdanian A, Rezvani MB, Seifalian A, Yazdanian M, Tebyanian H (2019) Oral microbial biofilms: an update. European Journal of Clinical Microbiology & Infectious Diseases 38:2005–2019
Mombelli A, Décaillet F (2011) The characteristics of biofilms in peri-implant disease. J Clin Periodontol 38:203–213
Moss SJ (1998) Dental erosion. Int Dent J 48(6):529–539
Moynihan P, Kelly S (2014) Effect on caries of restricting sugars intake: systematic review to inform WHO guidelines. J Dent Res 93(1):8–18
Moynihan P, Petersen PE (2004) Diet, nutrition, and the prevention of dental diseases. Public Health Nutr 7(1A):201–226
Nagano Y, Takahashi N, Aoki H, Inagaki T, Okuda K (2002) Identification of a multidrug transporter gene cluster in Porphyromonas gingivalis. Antimicrob Agents Chemother 46(10):3257–3260
Natto ZS, Aladmawy M, Levi PA Jr, Wang HL (2015) Comparison of the efficacy of different types of lasers for the treatment of peri-implantitis: a systematic review. Int J Oral Maxillofac Implants 30(2)
Nobbs AH, Jenkinson HF, Jakubovics NS (2011) Stick to your gums: mechanisms of oral microbial adherence. Journal Dental Research 90(11):1271–1278
Oliva A, Miele MC, Al Ismail D, Di Timoteo F, De Angelis M, Rosa L, Cutone A, Venditti M, Mascellino MT, Valenti P, Mastroianni CM (2021) Challenges in the microbiological diagnosis of implant-associated infections: a summary of the current knowledge. Front Microbiol 12:750460. https://doi.org/10.3389/fmicb.2021.750460
Ordinola-Zapata R, Bramante CM, Cavenago B, Moraes IG, Marciano MA, de Andrade FB, Gomes BPFA (2018) Antimicrobial effects of endodontic irrigants against biofilm in the apical region of the root canal. Int Endod J 51(1):98–106
Papapanou PN, Sanz M, Buduneli N, Dietrich T, Feres M, Fine DH, Flemmig TF, Garcia R, Giannobile WV, Graziani F, Hallmon WW, Hefti AF, Klinge B, Kornman KS, Lappin DF, Meyle J, Offenbacher S, Pihlstrom BL, Salvi GE et al (2018) Periodontitis: consensus report of workgroup 2 of the 2017 world workshop on the classification of periodontal and Peri-implant diseases and conditions. J Clin Periodontol 45(Suppl 20):S162–S170
Parenti A, Paccosi S, Cairo F, Defraia E (2015) Treatment of periodontitis for the prevention of endothelial dysfunction: a narrative review. Curr Vasc Pharmacol 13(6):749–758
Park SH, Fujimoto JG (2008) In vivo imaging of dental plaque using optical coherence tomography. J Biomed Opt 13(2):024005
Pitts NB, Zero DT (2016) White paper on dental caries prevention and management. Caries Res 50(Suppl 1):9–16
Prathapachandran J, Suresh N (2012) Management of peri-implantitis. Dental Res J 9(5):516
Preshaw PM, Taylor JJ (2011) How has research into cytokine interactions and their role in driving immune responses impacted our understanding of periodontitis? J Clin Periodontol 38:60–84
Ramanarayanan V, Karuveettil V, Sanjeevan V, Antony BK, Varghese NJ, Padamadan HJ, Janakiram C (2020) Measuring dental diseases: A critical review of indices in dental practice and research. Amrita Journal of Medicine 16(4):152–158
Rath A, Ning CJ, Priyadarshini HR, Teo BN, Zhen NH, Yin OW (2021) Effects of a novel dye containing toothpaste versus regular fluoridated toothpaste for supragingival biofilm reduction in patients with chronic gingivitis: A Randomized Controlled Trial. Dentistry 3000(1):a001
Ray RR (2022) Dental biofilm: risks, diagnostics and management. Biocatal Agric Biotechnol 43:102381. https://doi.org/10.1016/j.bcab.2022.102381
Reddy MS, Shetty SR, Vannala V (2019) Embracing personalized medicine in dentistry. J Pharm Bioallied Sci 11(Suppl 2):S92–S96. https://doi.org/10.4103/JPBS.JPBS_297_18
Ribeiro M, Gomes IB, Saavedra MJ, Simões M (2022) Photodynamic therapy and combinatory treatments for the control of biofilm-associated infections. Lett Appl Microbiol 75(3):548–564
Ricucci D, Siqueira JF, Bate AL, Pitt Ford TR (2019) Histologic investigation of root canal-treated teeth with apical periodontitis: a retrospective study from twenty-four patients. J Endodont 45(4):541–549
Roldán S, Herrera D, Sanz M (2003) Biofilms and the tongue: Therapeutical approaches for the control of halitosis. Clin Oral Investig 7:189–197
Romanos GE (2008) Lasers in implant dentistry: a review of the literature. Int J Oral Maxillofac Implants 23(2):229–239
Ruby J, Barbeau J (2002) The buccale puzzle: the symbiotic nature of endogenous infections of the oral cavity. Can J Infect Dis Med Microbiol 13(1):34–41. https://doi.org/10.1155/2002/732874
Ruby J, Goldner M (2007) Nature of symbiosis in oral disease. J Dent Res 86(1):8–11. https://doi.org/10.1177/154405910708600103
Sanz M, Chapple IL (2018) Clinical research on peri-implant diseases: consensus report of working group 4 of the 11th European Workshop on Periodontology. J Clin Periodontol 45(S20):S246–S266
Seviour T, Derlon N, Dueholm MS, Flemming HC, Girbal-Neuhauser E, Horn H, Lin Y (2019) Extracellular polymeric substances of biofilms: suffering from an identity crisis. Water Research 151:1–7
Sheiham A, James WPT (2014) A new understanding of the relationship between sugars, dental caries and fluoride use: implications for limits on sugars consumption. Public Health Nutrition 17(10):2176–2184
Scannapieco FA (1994) Saliva-bacterium interactions in oral microbial ecology. Crit Rev Oral Biol Med 5(3–4):203–248
Schwarz F, Derks J, Monje A, Wang HL (2018) Peri-implantitis. J Clin Periodontol 45(S20):S246–S266
Sharma N, Bhatia S, Sodhi AS, Batra N (2018) Oral microbiome and health. AIMS Microbiol 4(1):42–66. https://doi.org/10.3934/microbiol.2018.1.42
Siqueira JF, Rôças IN (2013) Microbiology and treatment of endodontic infections. J Endodont 39(3):351–362
Siqueira R, Sinjab K, Pan YC, Soki F, Chan HL, Kripfgans O (2021) Comprehensive peri-implant tissue evaluation with ultrasonography and cone-beam computed tomography: a pilot study. Clin Oral Implants Res 32(7):777–785
Steigmann L, Maekawa S, Sima C, Travan S, Wang CW, Giannobile WV (2020) Biosensor and lab-on-a-chip biomarker-identifying technologies for oral and periodontal diseases. Front Pharmacol 11:588480
Vashistha A, Sharma N, Nanaji Y, Kumar D, Singh G, Barnwal RP, Yadav AK (2023) Quorum sensing inhibitors as Therapeutics: Bacterial biofilm inhibition. Bioorganic Chemistry 136:106551
Valentini M, Filloux A (2016) Biofilms and c-di-GMP signaling: lessons from Pseudomonas aeruginosa and other bacteria. Microbiol Spectr 4(2):20
Van Der Weijden F, Slot DE (2011) Oral hygiene in the prevention of periodontal diseases: the evidence. Periodontol 2000 55(1):104
Wang C, Shahriar SS, Su Y, Xie J (2025) Versatile nanomaterials used in combatting biofilm infections. Nanomedicine 20:1–18
Williams DW, Kuriyama T, Silva S, Malic S, Lewis MA (2011) Candida biofilms and oral candidosis: treatment and prevention. Periodontol 2000 55(1):250
Wright PP, Ramachandra SS (2022) Quorum sensing and quorum quenching with a focus on cariogenic and periodontopathic oral biofilms. Microorganisms 10(9):1783
Xiao J, Fiscella KA, Gill SR (2020) Oral microbiome: possible harbinger for children’s health. Int J Oral Sci 12(1):12. https://doi.org/10.1038/s41368-020-0074-3
Yang S, Meng X, Zhen Y, Baima Q, Wang Y, Jiang X, Xu Z (2024) Strategies and mechanisms targeting Enterococcus faecalis biofilms associated with endodontic infections: a comprehensive review. Front Cell Infect Microbiol 14:1433313
Yu Y-M, Lu Y-P, Zhang T, Zheng Y-F, Liu Y-S, Xia D-D (2024) Biomaterials science and surface engineering strategies for dental peri-implantitis management. Mil Med Res 11:29
Zero DT, Fontana M, Martinez-Mier EA (2009) The biology, prevention, diagnosis, and treatment of dental caries: scientific advances in the United States. J Am Dent Assoc 140(9 Suppl):255–345
Zhang Y, Wang X, Li H, Ni C, Du Z, Yan F (2018) Human oral microbiota and its modulation for oral health. Biomed Pharmacother 99:883–893. https://doi.org/10.1016/j.biopha.2018.01.146
Zhang Z, Liu D, Liu S, Zhang S, Pan Y (2020) The role of Porphyromonas gingivalis outer membrane vesicles in periodontal disease and related systemic diseases. Front Cell Infect Microbiol 10:585917
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2025 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
About this chapter
Cite this chapter
Aryah, U.S., Prasanth, N., Stani, R., Kandanattu, B., George, N. (2025). Dental Disease Association with Bacterial Biofilm. In: Kumar, A. (eds) Bacterial Biofilm and Chronic Infections. Springer, Singapore. https://doi.org/10.1007/978-981-96-8975-0_6
Download citation
DOI: https://doi.org/10.1007/978-981-96-8975-0_6
Published:
Publisher Name: Springer, Singapore
Print ISBN: 978-981-96-8974-3
Online ISBN: 978-981-96-8975-0
eBook Packages: Biomedical and Life SciencesBiomedical and Life Sciences (R0)