EFFECTIVENESS OF ANTIMICROBIAL MOUTHWASHES IN CARIES BIOFILM

Abstract

Background/aim: This article aims to explore the efficacy of antimicrobial mouthwashes in fighting caries biofilm and maintaining oral health. The emphasis is on the antimicrobial properties of mouthwashes and their role in preventing dental plaque and gingivitis. The study investigates the significance of various substances like chlorhexidine, zinc, essential oil, and fluoride in the formulation of mouthwashes. Additionally, the incorporation of propolis and xylitol in traditional mouthwashes is examined due to their antimicrobial properties and additional health benefits, assessing their potential as promising alternatives. Materials and methods: The article synthesizes information from various studies and literature, focusing on the components of mouthwashes and their effectiveness in oral health. The substances in focus are chlorhexidine, zinc, essential oil, fluoride, propolis, and xylitol, each assessed for their antimicrobial properties and benefits in preventing dental issues. Results: The findings suggest that the mentioned substances play a crucial role in the formulation of mouthwashes, each contributing to the prevention of dental plaque and gingivitis. Propolis and xylitol, in particular, are highlighted for their additional health benefits and are being investigated as potential promising alternatives to traditional mouthwash ingredients. Conclusion: The findings suggest that the mentioned substances play a crucial role in the formulation of mouthwashes, each contributing to the prevention of dental plaque and dental diseases. Propolis and xylitol are highlighted for their additional health benefits and are being investigated as potential promising alternatives to traditional mouthwash ingredients.

Keywords

• antimicrobial mouthwashes
• oral health
• dental plaque
• caries biofilm
• streptococcus mutans

References

1. Abbasi, A. J., Mohammadi, F., Bayat, M., Gema, S. M., Ghadirian, H., Seifi, H., Bayat, H., & Bahrami, N. (2018). Applications of Propolis in Dentistry: A Review. Ethiopian Journal of Health Sciences, 28(4), 505–512.
2. Abdalrahman, B. M., Holmes, H., Peck, M. T., & Basson, N. J. (2016). In vitro antimicrobial comparison of three commercially available chlorhexidine-based oral rinses. South African Dental Journal, 71(7), 304-307.
3. Addy, M., Richards, J., & Williams, G. (1980). Effects of a zinc citrate mouthwash on dental plaque and salivary bacteria. Journal of Clinical Periodontology, 7, 309-15.
4. Afseth, J., Helgeland, K., & Bonesvoll, P. (1983). Retention of Cu and Zn in the oral cavity following rinsing with aqueous solutions of copper and zinc salts. Scandinavian Journal of Dental Research, 91, 42–45.
5. Altenburger, M. J., Schirrmeister, J. F., Wrbas, K. T., & Hellwig, E. (2007). Remineralization of artificial inter-proximal carious lesions using a fluoride mouthrinse. American Journal of Dentistry, 20(6), 385-9.
6. Arabacı, T., Türkez, H., Çiçek, Y., Geyikoğlu, F., Tatar, A., Keleş, M. S., et al. (2013). Analyzing of the effects of chlorhexidine digluconate on the antioxidant enzyme levels in human peripheral blood cultures. Cumhuriyet Dental Journal, 16(3), 197-202.
7. Asadoorian, J. (2016). Therapeutic oral rinsing with commercially available products: Position paper and statement from the Canadian Dental Hygienists Association. Canadian Journal of Dental Hygiene, 3, 126–139.
8. Bacaksiz, A., & Tulunoğlu, Ö. (2012). Fluorid Kullanımı, Dental Fluorozis ve Tedavisinde Güncel Yaklaşımlar. ADO Klinik Bilimler Dergisi, 6(1), 1137-1148.

9. Baehni, P. C., & Takeuchi, Y. (2003). Anti-plaque agents in the prevention of biofilm-associated oral diseases. Oral Diseases, 9(Suppl. 1), 23-29.
10. Bağış, Y. H., & Bağış, N. (2019). Farklı Ağız Gargalarının Antibakteriyel Etkilerinin İn-Vitro Olarak İncelenmesi. Ankara Üniversitesi Diş Hekimliği Fakültesi Dergisi, 46(1), 1-6.
11. Balci, N., & Buduneli, N. (2015). Anti-Inflammatory Agents in Mouth-Rinses For Periodontal Treatment. Clinical Anti-Inflammatory & Anti-Allergy Drugs, 2(1), 14-20.
12. Basavaraj, P., & Khuller, N. (2011). Halitosis: a review. Indian Journal of Stomatology, 2(3), 183-6.
13. Basrani, B., & Lemonie, C. (2005). Chlorhexidine gluconate. Australian Endodontic Journal, 31(2), 48-52.
14. Boyd, R. L. (1993). Comparison of three self-applied topical fluoride preparations for control of decalcification. Angle Orthodontist, 63(1), 25-30.
15. Broadley, S. J., Jenkins, P. A., Furr, J. R., & Russell, A. D. (1991). Anti-mycobacterial activity of biocides. Letters in Applied Microbiology, 13(3), 118-122.
16. Christianson, D. W. (1991). Structural biology of zinc. Advances in Protein Chemistry, 42, 281–355.
17. Cummins, D. (1991). Zinc citrate/Triclosan: a new anti-plaque system for the control of plaque and the prevention of gingivitis: short-term clinical and mode of action studies. Journal of Clinical Periodontology, 18, 455-61.
18. Çağlar, M. K., & Cengiz, A. B. (1996). Pediatride Flor ve Önemi. Turkiye Klinikleri Journal of Pediatrics, 5(1), 1-9.
19. Çintan, S., & Koçak, N. A. (2019). Kimyasal plak kontrolü. In M. M. Akkaya (Ed.), Cerrahi Olmayan Periodontal Tedavi (pp. 8-14). Ankara: Türkiye Klinikleri.
20. Dalli, M., Ercan, E., Zorba, Y. O., İnce, B., Şahbaz, C., Bahşi, E., et al. (2010). Effect of 1% chlorhexidine gel on the bonding strength to dentin. Journal of Dental Science, 5(1), 8-13.
21. Daly, C. G. (2009). Prescribing good oral hygiene for adults. Australian Prescriber, 32, 72-75.
22. Davies, A. (1973). The mode of action of chlorhexidine. Journal of Periodontal Research, 8(12), 68-75.
23. Decker, E. M., Maier, G., Axmann, D., Brecx, M., & von Ohle, C. (2008). Effect of xylitol/chlorhexidine versus xylitol or chlorhexidine as single rinses on initial biofilm formation of cariogenic streptococci. Quintessence International, 39(1), 17–22.
24. Denton, G. W. (1991). Chlorhexidine. In S. S. Block (Ed.), Disinfection, Sterilization and preservation (4th ed., pp. 274-289). Philadelphia: Lea & Febiger.
25. Dodwad, V., & Kukreja, B. J. (2011). Propolis mouthwash: A new beginning. Journal of Indian Society of Periodontology, 15(2), 121–125.
26. Emilson, C. G. (1994). Potential efficacy of chlorhexidine against mutans streptococci and human dental caries. Journal of Dental Research, 73(3), 682-691.
27. Ercan, E., & Taş Özyurtseven, B. (2011). Diş hekimliğinde topikal florür uygulama metotları. Cumhuriyet Dental Journal, 13(1), 27-33.
28. Ercan, N., Erdemir, E. O., Ozkan, S. Y., & Hendek, M. K. (2015). The comparative effect of propolis in two different vehicles; mouthwash and chewing-gum on plaque accumulation and gingival inflammation. European Journal of Dentistry, 9(2), 272–276.
29. Erdemir, E. O., Şengün, A., & Ülker, M. (2007). Cytotoxicity of mouthrinses on epithelial cells by micronucleus test. European Journal of Dentistry, 1(2), 80-85.
30. Fardal, O., & Turnbull, R. S. (1986). A review of the literature on use of chlorhexidine in dentistry. Journal of the American Dental Association, 112(6), 863-869.
31. Fine, D. H., Furgang, D., Barnett, M. L., Drew, C., Steinberg, L., Charles, C. H., & Vincent, J. W. (2000). Effect of an essential oil-containing antiseptic mouthrinse on plaque and salivary Streptococcus mutans levels. Journal of Clinical Periodontology, 27, 157–161.
32. Finney, M., Walker, J. T., Marsh, P. D., & Brading, M. G. (2003). Antimicrobial effects of a novel Triclosan/zinc citrate dentifrice against mixed culture oral biofilms. International Dental Journal, 53(Suppl. S1), 371–378.
33. Gaffar, A., Blake-Haskins, J. C., Sullivan, R., et al. (1998). Cariostatic effects of a xylitol/NaF dentifrice in vivo. International Dental Journal, 48(1), 32-9.
34. Giertsen, E. (2004). Effects of mouthrinses with triclosan, zinc ions, copolymer, and sodium lauryl sulphate combined with fluoride on acid formation by dental plaque in vivo. Caries Research, 38(5), 430-5.
35. Gilbert, R. J., & Ingram, G. S. (1988). The oral disposition of zinc following the use of an anticalculus toothpaste containing 0.5% zinc citrate. Journal of Pharmacy and Pharmacology, 40, 399–402.
36. Hall, P. J., Green, A. K., Horay, C. P., de Brabander, S., Beasley, T. J., Cromwell, V. J., Holt, J. S., & Savage, D. J. (2003). Plaque antibacterial levels following controlled food intake and use of a toothpaste containing 2% zinc citrate and 0.3% Triclosan. International Dental Journal, 53(Suppl. S1), 379–384.
37. Harrap, G., Best, J., & Saxton, C. (1984). Human oral retention of zinc from mouthwashes containing zinc salts and its relevance to dental plaque control. Archives of Oral Biology, 29, 87-91.
38. Hatipoğlu, H., Güncü, G. N., & Şengün, D. (2007). Klorheksidin içeren ağız gargarasının hatalı kullanımı sonucu gözlenen deskuamatif lezyonlar: Olgu Raporu [Desquamative lesions observed as a result of incorrect use of mouthwash containing chlorhexidine: Case Report].
39. Hayacibara, M. F., Koo, H., Rosalen, P. L., Duarte, S., Franco, E. M., Bowen, W. H., Ikegaki, M., & Cury, J. A. (2005). In vitro and in vivo effects of isolated fractions of Brazilian propolis on caries development. Journal of Ethnopharmacology, 101(1-3), 110–115.
40. He, G., Pearce, E., & Sissons, C. (2002). Inhibitory effect of ZnCl2 on glycolysis in human oral microbes. Archives of Oral Biology, 47, 117-29.
41. Hernandez, E. P., Botero, T. M., Mantellini, M. G., McDonald, N. J., & Nör, J. E. (2005). Effect of ProRoot MTA mixed with chlorhexidine on apoptosis and cell cycle of fibroblasts and macrophages in vitro. International Endodontic Journal, 38(2), 137-143.
42. Hitz Lindenmüller, I., & Lambrecht, J. T. (2011). Oral care. Current Problems in Dermatology, 40, 107–115.
43. Karslı, E. D., & Taş Özyurtseven, B. (2021). Diş hekimliğinde ağız gargaraları kullanımı. In C. Alpaslan (Ed.), Diş Hekimliğinde Kanıta Dayalı İlaç Kullanımı (1st ed., pp. 34-41). Ankara: Türkiye Klinikleri.
44. Kiger, R. D., Nylund, K., & Feller, R. P. (1991). A comparison of proximal plaque removal using floss and interdental brushes. Journal of Clinical Periodontology, 18(9), 681-684.
45. Killoy, W. J. (1988). The use of local-delivered chlorhexidine in the treatment of periodontitis. Clinical results. Journal of Clinical Periodontology, 25, 953-958.
46. Kim, Y. J., Kim, Y. K., & Kho, H. S. (2010). Effects of smoking on trace metal levels in saliva. Oral Diseases, 16, 823–830.
47. Lamster, I. B., Alfano, M. C., Seiger, M. C., & Gordon, J. M. (1983). The effect of Listerine® Antiseptic on reduction of existing plaque and gingivitis. Clinical Preventive Dentistry, 5, 12–16.
48. Lang, N. P., Hotz, P., Graf, H., Geering, A. H., Saxer, U. P., Sturzenberger, O. P., & Meckel, A. H. (1982). Effects of supervised chlorhexidine mouthrinses in children. A longitudinal clinical trial. Journal of Periodontal Research, 17, 101–111.
49. Lee, S. S. (2009). Breath: Causes, Diagnosis, and Treatment of Oral Malodor (2nd ed., Vol. II). San Bernardino: Culminare Inc.
50. Lindhe, J., Lang, N. P., & Karring, T. (2008). Chemical supragingival plaque control. In M. Addy & J. Moran (Eds.), Clinical Periodontology and Implant Dentistry (5th ed., p. 748-760). Mungsgaard: Oxford.
51. Löe, H. (1973). Does chlorhexidine have a place in the prophylaxis of dental diseases? Journal of Periodontal Research Supplement, 12, 93-99.
52. Löe, H., Schiøtt, C. R., Karring, G., & Karring, T. (1976). Two years oral use of chlorhexidine in man. I. General design and clinical effects. Journal of Periodontal Research, 11(3), 135-144.
53. Lynch, R. J. (2011). Zinc in the mouth, its interactions with dental enamel and possible effects on caries; a review of the literature. International Dental Journal, 61(Suppl. S3), 46–54.
54. Maggio, B., Guibert, R. G., Mason, S. C., Karwal, R., Rees, G. D., Kelly, S., et al. (2010). Evaluation of mouthrinse and dentifrice regimens in an in situ erosion remineralisation model. Journal of Dentistry, 18(Suppl. 3), S37-44.
55. Mäkinen, K. K. (2000). The rocky road of xylitol to its clinical application. Journal of Dental Research, 79, 1352–1355.
56. Mandel, I. D. (1994). Antimicrobial mouthrinses: overview and update. Journal of the American Dental Association, 125, 2-10.
57. Marinho, V. C., Chong, L. Y., Worthington, H. V., & Walsh, T. (2016). Fluoride mouthrinses for preventing dental caries in children and adolescents. The Cochrane Database of Systematic Reviews, 7(7), CD002284.
58. Mensi, M., Cochis, A., Sordillo, A., Uberti, F., & Rimondini, L. (2018). Biofilm Removal and Bacterial Re-Colonization Inhibition of a Novel Erythritol/Chlorhexidine Air-Polishing Powder on Titanium Disks. Materials, 11.
59. Murray, M. C., Worthington, H. V., & Blinkhorn, A. S. (1997). A study to investigate the effect of a propolis-containing mouthrinse on the inhibition of de novo plaque formation. Journal of Clinical Periodontology, 24(11), 796–798.
60. Nordblad, A., Suominen-Taipale, L., Murtomaa, H., Vartiainen, E., & Koskela, K. (1995). Smart Habit xylitol campaign, a new approach in oral health promotion. Community Dental Health, 12, 230–234.
61. Ogaard, B. (2008). White spot lesions during orthodontic treatment: mechanisms and fluoride preventive aspects. Seminars in Orthodontics, 14, 183-93.
62. O'Mullane, D. M., et al. (2016). Fluoride and oral health. Community Dental Health, 33(2), 69-99.
63. Ozan, F., Sümer, Z., Polat, Z. A., Er, K., Ozan, U., & Deger, O. (2007). Effect of mouthrinse containing propolis on oral microorganisms and human gingival fibroblasts. European Journal of Dentistry, 1(4), 195-201.
64. Petersen, P. E. (2003). The World Oral Health Report 2003: continuous improvement of oral health in the 21st century--the approach of the WHO Global Oral Health Programme. Community Dentistry and Oral Epidemiology, 31(Suppl 1), 3-23.
65. Petersson, L. G., Hakestam, U., Baigi, A., & Lynch, E. (2007). Remineralization of primary root caries lesions using an amine fluoride rinse and dentifrice twice a day. American Journal of Dentistry, 20(2), 93-96.
66. Phan, T. N., Buckner, T., Sheng, J., Baldeck, J. D., & Marquis, R. E. (2004). Physiologic actions of zinc related to inhibition of acid and alkali production by oral streptococci in suspensions and biofilms. Oral Microbiology and Immunology, 19, 31–38.
67. Rosling, B., Wannfors, B., Volpe, A. R., Furuichi, Y., Ramberg, P., & Lindhe, J. (1997). The use of a triclosan/copolymer dentifrice may retard the progression of periodontitis. Journal of Clinical Periodontology, 24, 873-880.
68. Ross, N. M., Charles, C. H., & Dills, S. S. (1989). Long-term effects of Listerine antiseptic on dental plaque and gingivitis. Journal of Clinical Dentistry, 1, 92–95.
69. Russell, A. D. (1990). Bacterial spores and chemical sporicidal agents. Clinical Microbiology Reviews, 3(2), 99-119.
70. Russell, A. D., & Day, M. J. (1993). Antibacterial activity of chlorhexidine. Journal of Hospital Infection, 25(4), 229-238.
71. Saeed, M. A., Khabeer, A., Faridi, M. A., & Makhdoom, G. (2021). Effectiveness of propolis in maintaining oral health: a scoping review. Canadian Journal of Dental Hygiene, 55(3), 167–176.
72. Salli, K., Lehtinen, M. J., Tiihonen, K., & Ouwehand, A. C. (2019). Xylitol's Health Benefits beyond Dental Health: A Comprehensive Review. Journal of Oral Biosciences, 63(1), 23–34.
73. Santiago, F. S., Piana, G. M., Conti, B. J., Cardoso, E. M., Rall, V. L. M., Fernandes, A., Jr, & Sforcin, J. M. (2018). Microbiological control and antibacterial action of a propolis-containing mouthwash and control of dental plaque in humans. Natural Product Research, 32(12), 1441–1445.
74. Serrano, J., Escribano, M., Roldán, S., Martín, C., & Herrera, D. (2015). Efficacy of adjunctive antiplaque chemical agents in managing gingivitis: a systematic review and meta-analysis. Journal of Clinical Periodontology, 42(16), 106-138.
75. Spets-Happonen, S., Luoma, H., Forss, H., Kentala, J., Alaluusua, S., & Luoma, A.-R. (1991). Effects of a chlorhexidine-fluoride-strontium rinsing program on caries, gingivitis and some salivary bacteria among Finnish schoolchildren. Scandinavian Journal of Dental Research, 99(2), 130-138.
76. Spets-Happonen, S., Markkanen, H., Pollanen, L., Kauppinen, T., & Luoma, H. (1985). Salivary Streptococcus mutans count and gingivitis in children after rinsing with a chlorhexidine-fluoride solution with and without strontium. Scandinavian Journal of Dental Research, 93(4), 329-335.
77. Stoeken, J. E., Paraskevas, S., & van der Weijden, G. A. (2007). The long-term effect of a mouthrinse containing essential oils on dental plaque and gingivitis: a systematic review. Journal of Periodontology, 78, 1218–1228.
78. Tanomaru Filho, M., Leonardo, M. R., Silva, L. A., Aníbal, F. F., & Faccioli, L. H. (2002). Inflammatory response to different endodontic irrigating solutions. International Endodontic Journal, 35, 735-739.
79. Taşdemir, Z., & Alkan, B. A. (2016). Plak Kontrolü Sağlayan Antimikrobiyal Ajanlar.
80. Thomas, B., & Bishop, J. (2013). Manual of Dietetic Practice. John Wiley & Sons: Hoboken, NJ, USA.
81. Tomás, I., Cousido, M. C., Tomás, M., Limeres, J., García-Caballero, L., & Diz, P. (2008). In vivo bactericidal effect of 0.2% chlorhexidine but not 0.12% on salivary obligate anaerobes. Archives of Oral Biology, 53(12), 1186-1191.
82. Van der Weijden, G. A., Timmerman, M. F., Novotny, A. G. A., Rosema, N. A. M., & Verkerk, A. A. J. (2005). Three different rinsing times and inhibition of plaque accumulation with chlorhexidine. Journal of Clinical Periodontology, 32(1), 89-92.
83. Van Rijkom, H. M., Truin, G. J., & van’t Hof, M. A. (1996). A meta-analysis of clinical studies on the caries-inhibiting effect of chlorhexidine treatment. Journal of Dental Research, 75(2), 790-795.
84. Wåler, S. M. (1983). Effect of xylitol on dental plaque in vivo during carbohydrate challenge. Scandinavian Journal of Dental Research, 91(4), 256–259.
85. Weller, P. J. (2000). Chlorhexidine. In A. H. Kibbe (Ed.), Handbook of Pharmaceutical Excipients (3rd ed., p. 121-5). Washington DC: Pharmaceutical Press.
86. Wilken, R., Botha, S. J., Grobler, A., & Germishuys, P. J. (2001). In vitro cytotoxicity of chlorhexidine gluconate, benzydamine-HCl and povidone iodine mouthrinses on human gingival fibroblasts. South African Dental Journal, 56(10), 455-460.
87. Windisch, W. (2001). Homeostatic reactions of quantitative Zn metabolism on deficiency and subsequent repletion with Zn in 65Zn-labeled adult rats. Trace Elements and Electrolytes, 18, 122–128.
88. Zero, D. T., Raubertas, R. F., Fu, J., Pedersen, A. M., Hayes, A. L., & Featherstone, J. D. (1992). Fluoride concentrations in plaque, whole saliva, and ductal saliva after application of home-use topical fluorides. Journal of Dental Research, 71(11), 1768-75.