Can Gingival Health Be Controlled by Antibacterial Agents?

SUMMARIES periodontology Can gingival health be controlled by antibacterial agents?

Antibacterial agents in the control of supragingival plaque B M Eley Br Dent J 1999; 186: 286–296

Abstract This review considers the main agents which have been used as In brief antibacterial agents in mouthwashes and other vehicles to inhibit G Several antiseptics such as bisguanide antiseptics, quaternary the growth of supragingival plaque. The agents discussed are ammonium compounds, phenolic, hexetidine, povidone iodine, bisguanide antiseptics, quaternary ammonium compounds, triclosan, delmopinol, salifluor, metal ions, sanguinarine, propolis phenolic antiseptics, hexetidine, povidone iodine, triclosan, and oxygenating agents have been shown to possess antibacterial delmopinol, salifluor, metal ions, sanguinarine, propolis and and plaque inhibiting activity. oxygenating agents. The plaque inhibitory, anti-plaque and anti- gingivitis properties of these agents are considered along with G A few agents such as tricolsan, Listerine, delmopinol and salifluor their substantivity, safety and possible clinical usefulness. Clinical may also have anti-inflammatory properties. trials of these agents that have been published are also reported. The possible clinical uses of antiseptic mouthwashes are finally G Only one group of antiseptics, the bisguanide antiseptic, have considered along with some advice about assessing manufacturers substantivity and therefore can remain active in the mouth for long claims. Throughout this review the terms plaque inhibitory, anti- enough periods to prevent the development of gingivitis and hence plaque and anti-gingivitis have been used according to the are true antiplaque agents. clarification of terminology suggested by the European Federation G of Periodontology at its second workshop. This defines a plaque True anti-plaque agents in mouth washes can be used to prevent inhibitory effect as one reducing plaque to levels insufficient to the development of gingivitis in situations where normal oral hygiene is not possible but should not be used to treat existing prevent the development of gingivitis; an anti-plaque effect as one gingivitis or periodontitis because they are unable to penetrate which produces a prolonged and profound reduction in plaque thick plaque or to pass into the gingival crevice. sufficient to prevent the development of gingivitis; and anti- gingivitis as an anti-infammatory effect on the gingival health not necessarily mediated through an effect on plaque.

Comment A number of reviews on chemical plaque A large section of any review on chemical paste may also retard progression of peri- control have appeared over the years in spe- plaque control is naturally devoted to odontitis. cialist journals, however there is some need chlorhexidine. So much information has As issues of concern to both clinicians and for an update for the general practitioner been accrued over the years on the bis- manufacturers, the effects of alcohol in with particular reference to clinical usage. guanide, it is difficult to know what to mouthwashes on oral health has to be men- This review goes some way in fulfilling this include in a review and what to leave out. tioned. The health risk of cancer and physi- need. Once again it needs to be re-empha- Topics of scientific interest such as its mode cal effects on composite and glass ionomer sised that antimicrobials in toothpastes and of action, safety and side effects are impor- restorations has not yet been fully evaluated. mouthrinses affect supragingival plaque tant. However from a clinical point of view Certainly antibacterial mouthwashes and and thus are of value only at inhibiting or indications for clinical usage are most use- toothpastes have a part to play in oral controlling gingivitis. Insufficient quanti- ful to the practitioner. health. Indications for use of mouthwashes ties and limited penetration below the gum In view of the side effects of chlorhexi- in specific clinical situations is needed and margin precludes their use in the treatment dine and in particular its propensity for this review will help the practitioner by cat- of periodontitis. producing extrinsic staining, alternative egorising mouthwashes according to their There are presently a large number of agents have been sought after. There are properties and effectiveness. Moreover, the mouthwashes and toothpastes available to numerous less effective antibacterial practitioner will be in a better position to the public which claim a benefit to gum agents. Delmopinol and salifluor are worth assess manufacturer’s claims. health. In discussing these claims certain mentioning as examples of more recently terminology has been used which has ini- developed products with some potential tially caused some confusion in evaluating future value. effectiveness. This review defines terms A considerable section is devoted to tri- J Moran such as antiplaque, plaque inhibitory closan and is understandable in view of the Senior Lecturer and Honorary Consultant action and anti-gingivitis activity according current marketing of triclosan containing Bristol Dental School & Hospital to guidelines agreed by the European Fed- products. Any review on triclosan must eration of Periodontology. Subsequently, spend considerable time on triclosan tooth- the review on individual antibacterial paste and its effects on plaque and gingival agents is easier to comprehend when evalu- health. If recently published articles are ating effectiveness of individual agents. accepted, it is apparent that triclosan tooth-

284 BRITISH DENTAL JOURNAL, VOLUME 186, NO. 6, MARCH 27 1999