Dental professionals are very familiar with the term “plaque.” However, the new buzzword defining plaque is biofilm. Biofilm was first described in the late 17th century when the inventor of the microscope, Anton Von Leeuwenhoek, saw the aggregation of bacteria within his own dental plaque.4 It is understood plaque consists of a matrix of colonizing bacteria. This matrix of hundreds of bacterial species found within dental plaque is called biofilm. Biofilm consists of microbial societies with their own defense and communication systems. Infections created by these bacterial biofilms can be targeted with therapeutic agents geared towards their communication system and bacterial type.5 Some of these therapies include antimicrobial usage to eliminate bacteria or probiotics to increase the amount of beneficial bacteria. The pathogenesis of dental biofilm creating dental disease either as decalcifications, caries or periodontal disease is the most common example of disease progression caused by biofilm within the human body. This pathogenic biofilm consists of gram (+) acidogenic cocci causing dental caries and gram () anaerobic bacteria causing periodontal disease.

The ability of the bacteria within the biofilm to adjust the environment to assist them in their mission to destroy tissue is typical.6 One example of this capability can be seen with Streptococcus mutans ability to create an acidic environment causing the enamel to demineralize and allowing Lactobacillus to proliferate and cause dental caries. In studies examining carious lesions, a complex blend of Lactobacillus species were found in the advancing front of this area.7 These bacteria communicate with one another within the biofilm to assist each other in a specific mission.

WSL are the result of demineralization around the brackets or under the bands. It’s estimated between 45% and 68% of patients will develop WSL during the course of treatment. WSL can develop in as little as four weeks, although cavitation typically doesn't occur until 6 months. While most WSL can be found in the maxillary and mandibular incisors, banded teeth also have a high incidence of WSL.8