In nature, the bulk of bacterial biomass is believed to exist as an adherent community of cells called a biofilm. Pseudomonas aeruginosa has become a model organism for studying this mode of growth. Over the past decade, significant strides have been made towards understanding biofilm development in P. aeruginosa and we now have a clearer picture of the mechanisms involved. Available evidence suggests that construction of these sessile communities proceeds by many different pathways, rather than a specific programme of biofilm development. A cell-to-cell communication mechanism known as quorum sensing (QS) has been found to play a role in P. aeruginosa biofilm formation. Because both QS and biofilms are impacted by the surrounding environment, understanding the full involvement of cell-to-cell signalling in establishing these complex communities represents a challenge. Nevertheless, under set conditions, several links between QS and biofilm formation have been recognized, which is the focus of this review. A role for antibiotics as alternative QS signalling molecules influencing biofilm development is also discussed.