Antiplaque Biocides And Bacterial Resistance.Pdf

J Clin Periodontol 2002: 29: 965–974 Printed in Denmark . All rights reserved

Copyright C Blackwell Munksgaard 2002

0303-6979

Review

Antiplaque biocides and bacterial resistance: a review
Sreenivasan P, Gaffar A: Antiplaque biocides and bacterial resistance: a review. J Clin Periodontol 2002; 29: 965–974. C Blackwell Munksgaard, 2002. Abstract Modern dentistry emphasizes theimportance of dental plaque control to improve oral health. The use of oral care formulations with antiplaque biocides plays a crucial role in patient-directed approaches for plaque control. The antiplaque efficacies of these formulations have been extensively studied in many long-term clinical studies designed in accordance with well-accepted guidelines. The results from these studies conclusivelydemonstrate that long-term use of oral care formulations with well-known antiplaque biocides such as chlorhexidine and triclosan reduce supragingival plaque and gingivitis. This review summarizes microbiological results from clinical studies conducted with oral care formulations containing antiplaque biocides. Results from a number of long-term clinical studies conducted under real-life use conditionsindicate no adverse alterations in the bacteria found in dental plaque or emergent microbial resistance. Additionally, microbial sampling of dental plaque subsequent to extended use of antiplaque biocides reveals no increase in resistant microflora. Large numbers of common oral bacteria isolated from patients using chlorhexidine indicate no increase in microbial resistance to chlorhexidine or tocommonly used antibiotics. The effects of antiplaque biocides containing oral care formulations on dental plaque that exists naturally as a biofilm are examined. These formulations contain biocide, surfactants, polymers and other components that are effective against the biofilm. In summary, the results of studies on the real-life use of oral care formulations with antiplaque biocides show no emergenceof resistant microflora or alterations of the oral microbiota, while such formulations have been found to provide the benefits of reducing plaque and gingivitis.

Prem Sreenivasan and Abdul Gaffar
Colgate-Palmolive Company, Piscataway, New Jersey, USA

Key words: bacteria; biocides; biofilm; cetylpyridinium chloride; chlorhexidine; clinical trials; dentifrice; gingivitis; mouthwash; periodontalpocket; plaque; resistance; subgingival; triclosan Accepted for publication 19 November 2001

Biocides comprise a large group of diverse chemical agents that are effective in inactivating a variety of microorganisms. Because of their long history of safety, biocides find utility in diverse areas (Denyer 1995, McDonnell & Russell 1999) for a variety of applications. For example, they are used asantiseptics and disinfectants in hospitals, formulated in rinses or gels for prescription by dentists, and used in public health for water purification and in consumer care products, including oral care formulations (Bloomfield 1996, Eley 1999, McDonnell & Russell 1999, Rutala et al. 2000, Slots 2000, White &

McDermott 2001). Some commonly used biocides and their applications are summarized inTable 1. This article reviews the use of biocides for antiplaque effects in oral care formulations, with an emphasis on longterm clinical studies that examine the effects of antiplaque biocide formulations on the bacteria of dental plaque. Results from long-term microbiological monitoring studies examining the oral flora for biocide resistance following extended use of oral care formulations withantiplaque biocides are presented. In addition, the antibiotic susceptibility of large numbers of clinical strains of

common oral bacteria obtained from subjects following the use of chlorhexidine formulations is discussed. Antiplaque oral care formulations contain a variety of other components such as surfactants and antinucleating agents (which prevent mineralization of soft plaque). These...