Page 3 - IDX-DecisionTree-Booklet-Digital

Overview & Rationale:

Biofilm Ecology and Oral Health

Subgingival Biofilm Complexes
According to Socransky’s classification, the subgingival
biofilm can be grouped into distinct “color-coded” microbial
complexes that reflect virulence, colonization sequence, and
disease progression.

Purple complex – high-risk organisms associated with
aggressive or refractory forms of disease and implications
for increased risk of systemic health complications.

Red complex – strongly linked to advanced
inflammation, attachment loss, and tissue destruction.

Orange complex – transitional organisms that bridge
early colonizers with more pathogenic species.

Green complex – generally health-associated
organisms that help maintain balance but may
indicate early dysbiosis when elevated.

The key therapeutic goal is to disrupt pathogenic biofilms, reduce
total microbial burden, promote a healthier microbial balance,
and prevent recolonization.

Mechanical therapy (scaling and root planing) remains
foundational. Adjunctive therapies such as local irrigation or
antiseptics, systemic or local antimicrobials, and host-modulating
strategies are indicated when clinical or molecular findings show
moderate to high microbial levels. Evidence supports adjunctive
systemic antimicrobials in deeper or refractory cases.
Because oral biofilms are polymicrobial and cooperative, early
and transitional species can enable recolonization by more
virulent complexes. A comprehensive approach addressing all
elevated groups is recommended to sustain microbial stability
and long-term oral health.