THE USE OF ANTISEPTICS

The use of antiseptics as mouth rinses

Antisepsis is the elimination of disease-causing micro-organisms, and an antiseptic is a compound that is sufficiently non-toxic to be used in a living system.1 Antiseptics can be categorised as bactericidal – which kill bacteria – or bacteriostatic, which inhibit bacterial growth.2

There are a number of delivery systems for antiseptics for dental use. These include:
– Subgingival systems e.g. chips and fibres
– Subgingival antimicrobial irrigation
– Antimicrobial rinses

Subgingival systems such as Periochip – a tiny piece of gelatin impregnated with chlorhexidine – control bacteria and hence reduce the size of periodontal pockets. The chip is placed in the pocket after root planing, where the active substance is slowly released over time.3 Subgingival antimicrobial irrigation can be used in patients with increased pocket depths. There are home-use devices that can irrigate with antimicrobial agents. A common type for home-use is a pulsed flow irrigator. There are also direct flow or steady stream irrigators.4

Antimicrobial mouth rinses can contain a variety of agents, such as zinc citrate, triclosan, stannous fluoride, cetylpyridinium chloride (CPC), chlorhexidine gluconate* and essential oils.

Compound

Mode of action

Essential Oils (LISTERINE®)

Disrupts bacterial cell wall5
Inhibit acid production2
Increases bacterial re-generation time6
Extracts bacterial endotoxins6
Penetrates plaque biofilm7

Zinc citrate

Reduces calcification of plaque8
Inhibits bacterial metabolism2

Triclosan

Non-ionic broad-spectrum agent9
Moderate plaque inhibiting properties10
Inhibits bacterial growth by blocking lipid synthesis9
Bacteriostatic at low concentrations9
Bactericidal at higher concentrations9
Reduces gingivitis10

Stannous fluoride

Anhydrous preparations display antibacterial activity in saliva, plus absorption of stannous ion onto surfaces and reduced susceptibility to plaque formation for a period of time (hours)11
Aqueous preparations show reduced antibacterial activity versus anhydrous preparations11

Cetylpyridinium chloride (CPC)

Net positive charge reacts with negatively charged bacterial cell walls, leading to increased permeability and cell death12
Broad spectrum agent;12 more effective against Gram-positive than Gram-negative micro-organisms13
Causes some plaque reduction12

Chlorhexidine gluconate

Binds to mucous constituents in saliva and is incorporated into the pellicle14
Inhibits amino acid uptake, polysaccharide synthesis and bacterial membrane functions2
Disrupts bacterial cell wall5,14

Delmopinol

Damages cell membranes2
Inhibits bacterial enzymes2

*short-term use only.

References

  1. Concise medical dictionary. 1982, Corgi.
  2. Marsh PD. Contemporary perspective on plaque control. Brit Dent J 2012; 212(12): 601–606.
  3. Periochip 2.5mg US product labeling. 
  4. Waterpik website. 
  5. Kubert D et al. Antiseptic mouthrinse-induced microbial cell surface alterations.Am J Dent1993; 6: 277–279.
  6. Fine DH et al. Effects of sublethal exposure to an antiseptic mouthrinse on representative plaque bacteria. J Clin Periodont 1996; 23: 444–451.
  7. Foster JS et al. Effects of antimicrobial agents on oral biofilms in a saliva-conditioned flowcell. Biofilms 2004; 1: 5–12.
  8. Fairbrother KJ, Heasman PA. Anticalculus agents. J Clin Periodontol 2000; 27: 285–301.
  9. Russell AD. Whither triclosan? J Antimicrob Chemother 2004; 53: 693–695.
  10. Cubells AB et al. The effect of A Triclosan/copolymer/fluoride dentifrice on plaque formation and gingivitis: a six-month clinical study. J Clin Dent 1991; 2(3): 63–69.
  11. Miller S et al. Recent advances in stannous fluoride technology: antibacterial efficacy and mechanism of action towards hypersensitivity. Int Dent J 1994; 44(Suppl 1): 83–98.
  12. Witt J et al. Antibacterial and antiplaque effects of a novel, alcohol-free oral rinse with cetylpyridinium chloride. J Contemp Dent Pract 2005; 6(1): 1–10.
  13. Pitten FA, Kramer A. Efficacy of cetylpyridinium chloride used as oropharyngeal antiseptic. Arzneimittelforschung 2001; 51(7): 588–595.
  14. Fine DH. Mouthrinses as adjuncts for plaque and gingivitis management. A status report for the American Journal of Dentistry. Am J Dent 1988; 1: 259–263.