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Dental Tribune Middle East & Arica Edition

DENTALTRIBUNE Middle East & Africa Edition Trends & Applications 5 The use of physical and chemi- cal components for oral hy- giene dates back to approxi- mately 3000 years before Christ. Throughout history, man has developed tools to take care of teeth and prevent bad odour1. Later, with the emergence of microbiology, it was found that those responsi- ble for bad breath and the most common oral diseases were bacteria, and removing them with antiseptics was proposed. Until now, a series of com- pounds with the ability to elimi- nate microorganisms have been tested; however, it has been dis- covered that not all of them can be used in the oral cavity, be- cause they can potentially dam- age soft tissues, mucosa or teeth, orbecausetheyhaveanunpleas- ant taste or smell. These difficul- tiesstillexisttodayandshouldbe resolvedinordertocomeupwith effective oral hygiene tools. A series of compounds that are capable of combating dental plaque exist and have been clas- sified as follows: Antiseptic agents that pre- vent proliferation and/or elimi- nate microorganisms that form plaque. Antibiotics capable of in- hibiting or killing specific bacte- rial groups. Enzymes or enzyme combi- nations that can break up or dis- perse the extracellular matrix of the biofilm or act upon the com- munity physiology. Non-enzymatic, dispersing, denaturalising or modifying agents that can alter plaque structure or the metabolic activ- ity of plaque. Agents that can interfere with the adhesion of the acquired pel- licle. Currently, a great number of toothpastes and mouthwashes are available on the market that are presented as products that are efficient in maintaining opti- mal oral health. Different antigingivitis and antiplaque products are formulated with ac- tive ingredients such as triclosan (toothpastes), stannous fluoride (toothpastes), a combination of essentialoils(mouthwashes),al- cohol(mouthwashes),chlorhex- idine (CHX) (mouthwashes and toothpastes) and cetylpyri- dinium chloride (CPC) (mouth- washes and toothpastes). Pros and Cons of CHX, alcohol and CPC Currently, the majority of mouthwashes use CHX, alcohol and CPC as their active ingredi- ents or a mixture of these. How- ever, different studies have found that alcohol can present some adverse effects, such as oral or oesophageal cancer and the deterioration of synthetic dental reconstruction materials andiscontraindicatedinpatients withmucositis,immunocompro- mised patients, patients under- going head and neck irradia- tion, sensitised patients and in children 2,3. DIFFERENT STUDIES HAVESHOWNTHATMOUTH- WASHES CONTAINING CHX, CPC AND A COMBINATION OF BOTH ACT EFFICIENTLY ASANTIPLAQUEAGENTSON HALITOSIS AND ON GIN- GIVITIS. Different studies have shown that mouthwashes containing CHX, CPC and a combination of both act efficiently as antiplaque agents on halitosis and on gin- givitis4,5,6. CHX is probably the most frequently used molecule in different health disciplines due to its excellent antibacterial effect7. Particularly in the oral cavity, it shows the best results for treating periodontal disease. However, it is true that it does possess some adverse effects, such as promoting theformation of calculus, tooth staining and a bitter taste. Also, some clinical studies have described that it maycausemucosalirritationand desquamation1. Because of CHX’s side effects, certain mole- cules such as CPC have become very important. Currently, new formulations are being devel- oped to improve the effective- ness of CPC either alone as the main active ingredient or in mouthwashes combined with CHX. DIFFERENT STUDIES HAVE SHOWN THAT CPC IN DIFFERENT CONCENTRA- TIONS IS EFFECTIVE IN RE- DUCING SUPRA AND SUB- GINGIVAL DENTAL BACTER- IAL PLAQUE Nowadays, CPC is being used in various applications in the food industry, since it is capable of eliminating pathogens such as Salmonella spp. and Campy- lobacter spp., as well as killing Staphylococcus spp. bacteria in proportions of 1:50000 in merely 10 minutes. It is also used in the pharmaceutical and cosmetic industries and as a cleaning and disinfecting agent9,10,11. Cetylpyridinium Chloride (CPC) N-hexadecylpyridinium chloride or CPC is classified as a cationic quaternary ammonium surfactant, is soluble in alcohol and in aqueous solutions; it can act as a detergent and as an anti- septic, it is non-oxidizing and non-corrosive and has a neutral pH8. Its molecular structure is made up of a polar and a non-po- lar region, as shown in figure 1. This molecule has bacterici- dal and bacteriostatic activity against Gram positive and Gram negative bacteria, although ev- idence suggests that it is more effective against the first ones. It is thought that its mechanism of Cetylpyridinium Chloride, An innovative molecule  page 11DT