Targeted biofilm management is redefining the way dental hygienists approach prevention and maintenance. By combining visual detection with non-invasive removal tools like air polishing and ultrasonic instrumentation, this method allows for a more precise, comfortable, and personalized patient experience. With biofilm now understood as a major contributor to both caries and periodontal disease, its thorough yet gentle removal is essential. A structured approach-beginning with assessment and disclosing, followed by patient motivation and mechanical removal-can lead to significantly improved oral health outcomes.

Many hygienists are embracing this modality not only as a technological upgrade but as a philosophical shift. It represents a move toward precision-based care, where treatment is tailored to the individual rather than delivered as a one-size-fits-all protocol. In this article, Inside Dental Hygiene checks in with several hygienists who have implemented and embraced this approach, and who highlight its impact on patient education, engagement, and overall results. The integration of selective targeting with newer tools, they say, is helping clinicians identify biofilm with greater accuracy and treat it more effectively, making a tangible difference in both clinical results and patient satisfaction.

Beyond the operatory, targeted biofilm management is also proving to be a valuable practice builder. With the right tools, protocols, and training, hygienists can lead the charge in modernizing the preventive care experience for patients. While adopting this approach to care may require financial investment and additional training, those who have report higher levels of professional fulfillment, improved collaboration with doctors, and more loyal, motivated patients. As biofilm management continues to gain momentum, it offers an exciting opportunity to rethink the standard hygiene visit-and transform it into proactive, precise, and impactful oral health care.

Individualized Hygiene

One clinician who has long championed individualized, evidence-based hygiene is Katrina M. Sanders, RDH, BSDH, M.Ed, RF.  A practicing periodontal hygienist, speaker, and educator, Sanders sees this approach as a natural extension of the critical thinking skills hygienists have always brought to their work. "The concept itself isn't new," Sanders says. "What's changed is that we finally have the protocols, tools, and education to do it better."

Sanders traces her philosophy back to a foundational concept taught early in her career: selective polishing. Rather than polishing every tooth the same way, she was taught to disclose first, then polish only the stained or plaque-covered areas using a paste and grit appropriate to the individual's needs. "Even back then," she recalls, "we were being trained to customize care-to think critically about what each patient's mouth actually required, instead of defaulting to one-size-fits-all treatment."

That mindset, she says, has since expanded across the entire hygiene toolkit. Whether it's selecting a fine ultrasonic insert for tight spaces and light debris or using air polishing for deeper pockets, Sanders emphasizes that the tools should follow the diagnosis-not the other way around. "We're scaling smarter now," she explains. "We're disclosing first, visualizing exactly where the biofilm is, and treating only those areas. That helps protect healthy tooth structure, especially cementum, which we now understand is essential for reattachment and long-term periodontal health."

For Sanders, this individualized approach is central to what she refers to as "precision periodontics," an idea she aligns with the broader healthcare trend of "precision medicine." Sanders advocates for adapting treatment not just by anatomy or pocket depth, but by the patient's broader health context-whether they're diabetic, immunocompromised, or struggling with arthritis. "We have to stop treating people against the average standard. We should be treating the patient in front of us," she says.

In her own periodontal practice, this approach is standard for all maintenance visits and is routinely used in surgical and implant cases. "We use subgingival air polishing around every implant," Sanders says. "We know we're reaching and removing biofilm in a way that hand scaling alone can't."

A New Level of Care

Sanders also notes that this level of care can serve as a differentiator for the dental practice itself. Patients often respond positively to the upgraded experience, she says, and retention improves as a result. "When we elevate the patient experience and outcomes, they come back," she says. "They talk about it. They trust us more."

While hygienists can begin implementing targeted care themselves, Sanders strongly encourages collaboration with the practice owner. "Having your doctor's support-especially when investing in equipment or consumables-really expands what's possible," she says. "It allows the whole team to align behind a more advanced, more precise model of care."

Sanders sees this shift not as a break from tradition but a refinement of it. "This isn't about throwing out what we've always known. It's about improving how we use that knowledge," she says. "We have the opportunity now to step out of the ‘this is how we've always done it' mindset-and into something that's more effective, more respectful of tissue, and more meaningful for our patients."

For Michelle Strange, MSDH, RDH, an educator, video podcast host, and owner of her own dental hygiene practice, SmileLogic, in Broomfield, Colorado, targeted biofilm management isn't just a new technique-it represents a fundamental shift in how hygienists approach prevention and treatment. "We're not just blindly scaling every surface and hoping for the best," she says. "We're being intentional. We're seeing the biofilm, targeting it precisely, and removing it efficiently-before it becomes calculus or disease."

A Protocol Approach

Strange practices Guided Biofilm Therapy (GBT), a proprietary, evidence-based protocol developed by EMS. Described by EMS as "minimally invasive" and "maximally preventive," GBT consists of eight structured steps. Among those, Strange finds the first three-
"Assessment and Infection Control," "Disclose," and "Motivate"-to be especially impactful when working with patients on home care. "That top-of-the-appointment focus is where patient communication really changes," Strange says. "We're gathering data, disclosing the biofilm, and then having that motivational conversation right away."

Disclosing, in particular, has become a cornerstone of Strange's practice. Using GC America's Tri Plaque ID Gel, she's able to identify and categorize biofilm as new, mature, or highly acidic. "I describe it to patients as a ‘bacteria analysis.' If it lights up dark blue or purple, that's older, more pathogenic biofilm. If it's light blue, that's cavity-causing bacteria," she says. By visualizing these bacterial threats, patients become more engaged and invested in their own care. "I hand them the mirror, and they see it. It's not me telling them they need fluoride-it's them understanding why."

Strange uses the AIRFLOW Prophylaxis Master from EMS, which she says has revolutionized both comfort and clinical outcomes. Unlike traditional methods reliant on tactile detection and manual scaling, Strange says, GBT employs warm water, low-abrasive erythritol powder, and a lighter touch. "It's a real game changer for patient comfort. Especially for those with sensitivity, anxiety, implants, or restorative work-it's incredibly gentle but effective," she says.

From a clinical standpoint, the approach prioritizes early, complete removal of biofilm-the true driver of oral disease. "For so long, we were calculus hunters. But calculus is really a symptom of being too late. If we manage the biofilm earlier, we prevent the calculus from forming in the first place," Strange says. She notes that this shift has improved her efficiency, precision, and long-term patient outcomes. "My goal now is to stop scaling teeth. That's a wild thing to say as a hygienist, but this is smarter, more respectful care."

There are, however, some practical considerations. The GBT protocol requires both training and specialized equipment. "You can't just swap powders in your old prophy jet. Erythritol is much finer, and it will clog a machine not designed for it," Strange says. She emphasizes the importance of understanding the technique's philosophy and investing in hands-on learning. "It's a workflow change. There's a learning curve-but once you're on the other side, there's no going back."

Ultimately, Strange sees targeted biofilm management as a natural evolution in hygiene. "Dentistry has had so much innovation on the restorative side. This is our moment to evolve, too," she says. "We're preserving tissue, improving comfort, and communicating better. For me, that's the future of hygiene."

The Evolution of Dental Hygiene

With over 40 years of clinical experience, including 15 in periodontal practice, Nancy J. Miller, RDH, BA, has witnessed firsthand the evolution of periodontal therapy-and the growing role of air streaming in targeted biofilm management. Miller advocates for bringing precision and ease into everyday clinical hygiene, especially when working with patients who present complex challenges.

At its core, Miller explains, targeted biofilm management is about using a pressurized slurry-typically a water and powder mix like glycine or erythritol-to gently but thoroughly disrupt biofilm both above and below the gumline. "Air polishers are like mini pressure washers," Miller says. "With today's softer powders, we can get into all the nooks and crannies of the dentition and soft tissues without causing damage. It effectively strips off biofilm while leaving a biologically clean surface."

What sets this approach apart from traditional biofilm removal, Miller says, is not only its effectiveness but also the improved patient experience. According to Miller, advancements in technology-like lower PSI settings, finer powders, and internal water heating-have made the process cleaner, quieter, and far more comfortable. The old units were loud, messy, and could sting the soft tissue, she notes, while today's systems are far more refined. With proper aerosol management, they fit seamlessly into a modern clinical setting she says. "An understanding of how the newer devices operate, how the newer powders make for a more comfortable and less messy experience, and practicing with aerosol capture methods, makes this a much different and more beneficial procedure," she says.

Miller sees wide applicability for this approach across the patient population, but especially for those with implants, orthodontic appliances, or complex restorations. In one example, she describes a patient with six upper implants supporting a removable denture, along with heavy calculus accumulation on the lower arch. Air streaming allows her to effectively clean both the intricate implant surfaces and the prosthetic attachments, while also improving access for follow-up ultrasonic debridement.

One of the most notable advantages of targeted biofilm management, Miller says, is efficiency. By clearing soft debris first, clinicians can reduce time spent scaling, making room for patient education or additional therapy. And because the technique leaves the tooth surface undamaged, it helps preserve tissue and structure-key tenets of any modern, minimally invasive care model.

For practices adopting this method, Miller emphasizes the importance of hands-on instruction to ensure proper technique and equipment operation. She says that success lies in more than just having the right tools-it also comes down to training and confidence. She recommends hands-on instruction after installation to ensure clinicians understand the equipment and settings. Once the team is trained and comfortable, it becomes second nature, she says.

For practices willing to adopt the method, Miller sees strong return on investment. "It can be a practice changer in terms of thoroughness of treatment, significant time savings that can lead to better patient education and case acceptance," she says. "A patient's perception of being in an office that has the latest and greatest technology can be a practice builder."

Hitting the Target

As dental hygiene continues to evolve, targeted biofilm management offers hygienists an opportunity to elevate their role in prevention through more tailored, tissue-respecting care. Whether approached through structured, proprietary protocols like Guided Biofilm Therapy or integrated more broadly into diagnostic and instrumentation choices, the method underscores a shift in mindset: from reactive scaling to proactive, personalized management of disease.

While each clinician's journey looks different, the common thread is a commitment to precision, comfort, and clinical relevance. Today's tools-combined with thoughtful assessment and communication-allow hygienists to go beyond routine cleanings and create more meaningful, measurable outcomes for patients.

For practices, the investment in newer air polishing systems or disclosing agents isn't just about technology-it's about empowering hygienists to practice at the top of their license. For patients, it's about being seen, heard, and treated as individuals.

For those looking to streamline protocols, improve diagnostic accuracy, or rethink the hygiene model altogether, targeted biofilm management presents an option-not a mandate-for clinicians ready to move beyond "how it's always been done."