title: Controlling the plaque biofilm.
abstract: OBJECTIVE
  To examine the effect of supragingival plaque removal in conjunction with different periodontal therapies on subgingival plaque composition in different subject populations.
  
  
  METHODS
  Four different studies are presented which examined the effect of repeated removal of supragingival plaque performed by professionals or by tooth brushing on subgingival plaque composition. The studies were performed in different populations including chronic periodontitis, periodontal maintenance and refractory subjects. For all studies, each subject was examined for clinical parameters at up to 168 sites and subgingival plaque samples were taken from the mesial aspect of each tooth and examined for their content of specific bacterial species using checkerboard DNA-DNA hybridisation techniques.
  
  
  RESULTS
  Repeated supragingival plaque removal used in conjunction with scaling and root planing only or combined with other periodontal therapies resulted in improvements in clinical parameters as well as significant decreases in the counts of subgingival species, including those associated with periodontal disease aetiology. Meticulous tooth brushing provided similar clinical and microbial improvements.
  
  
  CONCLUSIONS
  Meticulous removal of supragingival plaque has beneficial effects on clinical parameters of periodontal disease and on the nature of the microbiota that colonises both above and below the gingival margin and appropriately has been a major focus in the prevention and control of dental diseases, particularly periodontal disease.
authors.affiliation: Department of Periodontology, The Forsyth Institute, Boston MA, USA. ahaffajee@forsyth.org
authors.forename: A D
authors.initials: AD
authors.lastname: Haffajee
authors.forename: E I
authors.initials: EI
authors.lastname: Arguello
authors.forename: L A
authors.initials: LA
authors.lastname: Ximenez-Fyvie
authors.forename: S S
authors.initials: SS
authors.lastname: Socransky
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001419:Bacteria / Q000145:classification; D018441:Biofilms / Q000145:classification; D002908:Chronic Disease; D003773:Dental Plaque / Q000382:microbiology / Q000517:prevention & control*; D003777:Dental Prophylaxis; D012534:Dental Scaling; D006801:Humans; D017622:Periodontal Attachment Loss / Q000382:microbiology / Q000517:prevention & control; D010514:Periodontal Pocket / Q000382:microbiology / Q000517:prevention & control; D010518:Periodontitis / Q000382:microbiology / Q000517:prevention & control; D016745:Root Planing; D014099:Toothbrushing
chemical_list: D000900:Anti-Bacterial Agents