Gera István
Semmelweis Egyetem Fogorvostudományi Kar Parodontológiai Klinika, Budapest.
Fogorv Sz. 2008 Jun;101(3):91-9.
Most microorganisms in the oral cavity attach to surfaces and form matrix-embedded biofilms. Biofilms are structured and spatially organized, composed of consortia of interacting microorganisms. The properties of the mass of biofilm are different from that of the simple sum of the component species. The older the plaque (biofilm) is the more structurally organized and become more resistant to environmental attacks. The bacterial community favors the growth of obligatory anaerobic microorganisms. The most effective means of the elimination of matured biofilm is the mechanical disruption of the interbacterial protective matrix and removal of bacterial colonies. The antiseptic agents are primarily effective in the prevention of biofilm formation and anticipation of the maturation of the bacterial plaque. Bacteria in matured biofilms are less susceptible to antimicrobial agents because several physical and biological factors protect the bacterial consortia. To kill bacteria in a matured, well organized biofilm, significantly higher concentration and longer exposition are required. Antiseptic mouthrinses in a conventional dose and time can only reach the superficial bacteria while the bacteria in the depth of the biofilm remains intact. Therefore, the efficacy of any antiseptic mouthwash depends not just on its microbicidal properties demonstrated in vitro, but also on its ability to penetrate the organized biofilm on the teeth. Recent studies have demonstrated that both bisbiguanid compounds and essential oils are capable of penetrating the biofilm, and reduce established plaque and gingivitis. The essential oils showed high penetrability and were more effective on organized biofilm than stannous fluorides or triclosan copolymer antiplaque agents.
口腔中的大多数微生物附着于表面并形成嵌入基质的生物膜。生物膜具有结构化和空间组织化的特点，由相互作用的微生物群落组成。生物膜整体的特性不同于其组成物种简单相加的特性。菌斑（生物膜）形成的时间越长，其结构组织性越强，对环境攻击的抵抗力也越强。细菌群落有利于专性厌氧微生物的生长。消除成熟生物膜最有效的方法是机械破坏细菌间的保护性基质并清除细菌菌落。防腐剂主要在预防生物膜形成和阻止细菌菌斑成熟方面有效。成熟生物膜中的细菌对抗菌剂不太敏感，因为多种物理和生物因素保护着细菌群落。要杀死成熟、结构良好的生物膜中的细菌，需要显著更高的浓度和更长的暴露时间。常规剂量和时间的抗菌漱口水只能接触到表层细菌，而生物膜深处的细菌仍保持完整。因此，任何抗菌漱口水的功效不仅取决于其在体外显示的杀菌特性，还取决于其穿透牙齿上有组织的生物膜的能力。最近的研究表明，双胍类化合物和精油都能够穿透生物膜，并减少已形成的菌斑和牙龈炎。精油显示出高穿透性，并且在有组织的生物膜上比氟化亚锡或三氯生共聚物防菌斑剂更有效。
