Antibacterial agents, mouth rinses and fluorides

Chemotherapeutic agents for local use in oral cavity are regaining their popularity as new products are introduced to the market and older products are being reevaluated to maximize their efficacy in supportive periodontal therapy. Most of the products in current use are antiseptics. The use of systemically administered antibiotics (Periostat, Tetracyclines, etc.) is limited, since their numerous side effects overshadow their potential benefits.

1. Listerine
   

   The oldest oral product, Listerine, is in an antiseptic, which is a combination of the phenol-related essential oils. In general, rinsing with Listerine twice a day after brushing, results in approximately 30% reduction in plaque and gingivitis scores. It is a recommended adjunct to oral home care. Caution: Listerine contains alcohol, which may result in dry mouth in some patients, and is contraindicated in people with alcohol addiction.

   A modified version of Listerine with a different flavor and lower alcohol content has been recently introduced to the market.

2. Chlorhexidine Gluconate (Peridex, Periogard)
   

   Chlorhexidine Gluconate is a broad-spectrum antiseptic, characterized by the following:

   • controls plaque and gingivitis in the absence of oral hygiene (it is widely used after periodontal surgery)
   • high substantivity (strong binding to multiple sites in oral cavity and sustained release)
   • modest effect as an adjunct to normal oral hygiene
   • brown teeth staining with long-term use
   • increased supragingival calculus formation
   • unpleasant taste

   Current recommendations for using Peridex include post-surgical plaque control and an adjunct to toothbrushing in immunocompromised patients (AIDS, uncontrolled diabetes, etc.). It is suggested that patients rinse with Peridex twice daily for 30 seconds and allow at least 30 minutes between toothbrushing and rinsing to minimize interaction of chlorhexidine and fluoride.

3. Quaternary Ammonium Compounds (Cepacol, Scope)
   

   These agents have weaker substantivity than Peridex, and therefore are not as effective for plaque control. The only 6-month study found adjunctive use of these antiseptics resulted in 14% reduction in plaque and 20% reduction in gingivitis scores. These mouthrinses are primarily used as mouth-fresheners.

4. Herbal Extracts- Sanguinarine (Viadent)
   

   Sanguinarine is currently used in both a mouthrinse and toothpaste as an anti-plaque/gingivitis agent. Studies report only a marginal effect on reduction of plaque and gingivitis.

FLOURIDES

1. Stannous Fluoride (PerioMed oral rinse, Gel-Cam oral rinse, Gel-Cam brushing gel)
   

   Stannous fluorides have been extensively researched and used by dental professionals. Stannous fluorides are available in 0.63% (rinses) and 0.4% (gels) strengths. Stannous fluorides are more effective anti-plaque and anti-gingivitis agents than neutral sodium fluorides. Studies reported considerable improvements in gingival index (25-30%) and plaque accumulation (35-50%). Additional benefits of stannous fluoride are due to the presence of tin (Sn) ion, which contributes to both anti-sensitivity and antimicrobial effects of either rinse or gel. Remember, that sodium fluorides do not treat hypersensitivity, since they do not contain tin.

   Here is the list of indications for the use of stannous fluoride rinse or gel:

   • reduction of plaque and gingivitis
   • reduction of inflammation at the gingival margin
   • treatment of hypersensitivity
   • prevention and treatment of root caries
   • adjunct to oral home care in patients with extensive restorative work (crown and bridge, implants)
   • treatment of dry mouth

   Side effect of stannous fluoride rinses is temporary discoloration of teeth. However, please remember that the rinse will ONLY stain plaque, therefore in the presence of good oral hygiene, staining effect is negligible. A hygienist can remove stain during periodontal maintenance visits.

2. Sodium Fluoride toothpaste and gel (Prevident, Prevident 5000, Control Rx)
   

   Sodium fluoride products have been used to reduce plaque and gingival inflammation, however their efficacy is lower in comparison to stannous fluorides. They are also recommended for treatment and prevention of root caries, especially in caries-prone patients, and those with extensive crown and bridge restorative dental work.

   • Prevident gel is used in conjunction with a regular toothpaste, since it does not contain abrasive or cleansing ingredients such as pyrophosphates. It is suggested to use a separate toothbrush for applying Prevident gel after teeth have been cleaned with a regular toothpaste. To increase efficacy of the fluoride, patients are advised not to eat or drink 30 minutes after application of Prevident.
   • Prevident 5000 or Control Rx toothpaste contains both sodium fluoride and abrasives (pyrophosphate in Prevident and Microdent in Control Rx), and therefore does not require the use of a regular toothpaste in conjunction. Just like with Prevident gel it is recommended not to eat or drink 30 minutes after brushing.

DRY MOUTH PRODUCTS (BIOTENE)

The strength of the Biotene products lies in their ingredients: they contain antibacterial enzymes found naturally in human saliva. Together, these ingredients recreate the natural oral protection found in the mouth, providing antibacterial and healing properties. Only Biotène's bio-enzyme products can help maintain a healthy balance of oral flora, reducing harmful bacteria while sustaining beneficial bacteria.

1. Biotene toothpaste and oral rinse:

   • clinically proven to treat gingivitis and oral irritations
   • antibacterial
   • fights halitosis (bad breath)
   • especially helpful for bedridden or handicapped patients who may have difficulty maintaining good oral hygiene
   • gentle to dry tissues and prevents canker sores and ulcers

2. Biotene oral balance moisturizing gel:

   • very helpful in relieving severe dry mouth symptoms such as burning and sore tissues
   • works great under dentures
   • safe to swallow
   • provides up to 8 hours of comfort

In summary, all currently available antiseptic and anti-sensitivity products are used as adjuncts to professional periodontal maintenance and home care. None of them can actually substitute the need for regular supportive therapy, designed to prevent or stop periodontal disease progression as well as symptoms associated with sensitive teeth and caries. Should you have any questions regarding any of the topics discussed in this newsletter, please do not hesitate to contact Dr. Carrie Berkovich. We look forward to working with you!