Does Biofilm Cause BII? And Do You Need Antibiotics Before a Dental Cleaning?

Great question, and there's a lot to unpack here. It ties together two things people worry about a lot: biofilm on breast implants, whether it causes BII (breast implant illness), and whether a routine dental cleaning could put a biofilm on your implant and therefore requires antibiotics. Let's go through the actual evidence.

Honest answer: we don't know for sure. BII is almost certainly multifactorial, and in most patients, biofilm is probably not the driver. Here's how we know biofilm alone can't be the whole story.

Biofilm is extremely common, even in women with no symptoms at all. We've done studies testing implants as they come out of women without any symptoms, and roughly 50% of them have biofilms. If half of asymptomatic women have biofilm, it's hard to pin BII on biofilm by itself.

What about studies comparing symptomatic and asymptomatic women?

• There was one study that tested women with BII symptoms versus those without, and found a higher percentage of biofilm in the symptomatic group. But, and this matters, they didn't test for biofilm the way we typically do, and this finding hasn't been reproduced in other studies.
• There was a better study, in my opinion, that compared women with BII symptoms and women without, looked at biofilm levels, and really found no difference between the groups.

So the stronger evidence points away from biofilm being the explanation for BII. Which brings us to the practical question everyone actually asks.

Probably not. It is not the current accepted recommendation for women with breast implants to take a prophylactic dose of antibiotics around the time of a dental cleaning. (I go deeper on this in antibiotics before dental cleanings with implants.)

The reason is straightforward: spreading bacteria from your mouth onto your implant is not something we typically see. And importantly, the bacteria we find in an implant biofilm are not the bacteria that live in your mouth. The biofilm around an implant is made of local bacteria from the area, and it most likely got there at the time of surgery, not from a dental visit years later. This is exactly why how meticulously the implant is handled in the OR matters so much.

"Probably not" isn't "never." Your surgeon may feel differently in specific situations, and might put you on antibiotics for a routine cleaning if:

• Your implant hasn't been in very long, so you don't yet have that nice protective scar-tissue capsule around it
• You are immunosuppressed
• You have poor oral hygiene and they're doing a deeper cleaning
• You have an infected tooth or similar active issue

Outside of circumstances like these, most people don't need antibiotics for a standard teeth cleaning.

This is the part I really want to land, because it reframes the whole question. People treat "just take an antibiotic to be safe" as a free, no-downside move. It isn't.

Even a single dose of antibiotics is not benign. Antibiotics:

• Have significant potential complications
• Alter your gut flora

It is genuinely not as simple as "take an antibiotic, no big deal." Everyone in medicine should be striving to be a good antibiotic steward, giving antibiotics only when they're truly indicated, precisely because unnecessary use carries real risk to you and contributes to resistance.

Finally, on BII itself, I want to be straight with you: we don't know exactly what causes it. So if anyone tells you it's definitely caused by one specific thing, biofilm, a particular "toxin," anything, they don't know what they're talking about. We have no idea with that kind of certainty. It's almost certainly multifactorial, affecting a group of patients with a variety of different underlying issues. Beware of anyone selling you false certainty about it, or misusing weak studies to prove a point.

• Biofilm is common (about 50% of asymptomatic women have it), and the better evidence shows no difference in biofilm between women with and without BII symptoms, so biofilm is probably not what causes BII.
• You probably don't need antibiotics before a dental cleaning, because mouth bacteria getting onto your implant isn't something we typically see, and implant biofilm is local bacteria from surgery, not oral bacteria.
• Your surgeon may still recommend antibiotics in specific cases (new implant, immunosuppression, poor oral hygiene with a deep cleaning, an infected tooth).
• Antibiotics aren't harmless, so we should only use them when truly indicated.
• And no one actually knows the single cause of BII, it's multifactorial, so distrust anyone who claims certainty.