DENTAL BIOFILMS: PATHOGENESIS, CLINICAL SIGNIFICANCE, AND CONTEMPORARY STRATEGIES FOR INFECTION CONTROL

Background: Dental biofilms are organized microbial communities that develop on tooth surfaces and other oral structures. Their composition and metabolic activity are closely associated with the development of dental caries, gingivitis, and periodontitis. The structural organization of biofilms, their extracellular matrix, and interactions among microorganisms contribute to their persistence and reduced susceptibility to antimicrobial agents. Objective: This review aims to describe the biological characteristics of dental biofilms, explain their roles in major oral diseases, and evaluate established and emerging approaches to biofilm control in clinical dentistry. Methods: A narrative review of relevant scientific literature was conducted using publications on oral microbiology, biofilm formation, periodontal disease, antimicrobial tolerance, and emerging antibiofilm strategies. The review draws on peer-reviewed articles published in established scientific journals and professional guidance from the American Dental Association. It is not a systematic review, and no quantitative meta-analysis was performed. Results: Dental biofilms are dynamic, multispecies microbial ecosystems embedded in an extracellular polymeric matrix. Their pathogenic potential depends on microbial composition, environmental conditions, dietary substrate availability, host immune responses, and oral hygiene. In cariogenic biofilms, repeated carbohydrate fermentation and acid production promote enamel demineralization. In periodontal disease, dysbiotic subgingival communities interact with the host immune system and contribute to connective tissue destruction and alveolar bone loss. Mechanical biofilm disruption remains central to prevention and treatment. Fluoride-based caries prevention, professional periodontal instrumentation, and individualized oral hygiene are established interventions. Antimicrobial photodynamic therapy, biofilm-disrupting enzymes, nanoparticles, probiotics, bacteriophages, and cold atmospheric plasma are being investigated, but the strength of clinical evidence varies considerably. Conclusion: Effective dental biofilm management requires an understanding of microbial ecology and host–microbe interactions rather than an exclusive focus on individual bacterial species. Established preventive and therapeutic measures remain fundamental, while emerging technologies require further well-designed clinical trials to establish their efficacy, safety, and long-term benefits.