Dental Tribune Middle East & Africa Edition

DENTALTRIBUNE Middle East & Africa Edition Trends & Applications 3 The use of physical and chemical com- ponentsfororalhygienedatesbacktoap- proximately 3000 years before Christ. Throughout history, man has devel- oped tools to take care of teeth and pre- vent bad odour1. Later, with the emer- gence of microbiology, it was found that those responsible for bad breath and the most common oral diseases were bacte- ria, and removing them with antiseptics was proposed. Until now, a series of compounds with the ability to eliminate microorganisms have been tested; however, it has been discov- ered that not all of them can be used in the oral cavity, because they can potentially damagesofttissues,mucosaorteeth,orbe- cause they have an unpleasant taste or smell. These difficulties still exist today and should be resolved in order to come up with effective oral hygiene tools. Aseries of compounds that are capable of combating dental plaque exist and have been classified as follows: Antisepticagentsthatpreventprolifer- ation and/or eliminate microorganisms that form plaque. Antibiotics capable of inhibiting or killing specific bacterial groups. Enzymes or enzyme combinations that can break up or disperse the extracellular matrix of the biofilm or act upon the commu- nity physiology. Non-enzymatic,dispersing,denatural- ising or modifying agents that can alter plaque structure or the metabolic activity of plaque. Agents that can interfere with the adhe- sion of the acquired pellicle. Currently,agreatnumberoftoothpastes and mouthwashes are available on the mar- ketthatarepresentedasproductsthatareef- ficient in maintaining optimal oral health. Dif- ferent antigingivitis and antiplaque products are formulated with active ingredients such as triclosan (toothpastes), stannous fluoride (toothpastes),acombinationofessentialoils (mouthwashes), alcohol (mouthwashes), chlorhexidine (CHX) (mouthwashes and toothpastes) and cetylpyridinium chloride (CPC) (mouthwashes and toothpastes). Pros and Cons of CHX, alcohol and CPC Currently, the majority of mouthwashes useCHX,alcoholandCPCastheiractivein- gredientsoramixtureofthese.However,dif- ferent studies have found that alcohol can present some adverse effects, such as oral oroesophagealcancerandthedeterioration of synthetic dental reconstruction materials and is contraindicated in patients with mu- cositis, immunocompromised patients, pa- tients undergoing head and neck irradia- tion, sensitised patients and inchildren2,3. DIFFERENTSTUDIESHAVESHOWN THAT MOUTHWASHES CONTAINING CHX, CPC AND A COMBINATION OF BOTH ACT EFFICIENTLY AS AN- TIPLAQUEAGENTS ON HALITOSISAND ON GINGIVITIS. Different studies have shown that mouthwashes containing CHX, CPC and a combination of both act efficiently as an- tiplaque agents on halitosis and on gingivi- tis4,5,6.CHXisprobablythemostfrequently used molecule in different health disciplines duetoitsexcellentantibacterialeffect7.Par- ticularlyintheoralcavity,itshowsthebestre- sults for treating periodontal disease. How- ever,itistrue that it does possess some ad- verse effects, such as promoting the for- mation of calculus, tooth staining and a bitter taste. Also, some clinicalstudieshave describedthatitmaycausemucosalirritation anddesquamation1.BecauseofCHX’sside effects,certainmoleculessuchasCPChave become very important. Currently, new for- mulations are being developed to improve the effectiveness of CPC either alone as the main active ingredient or in mouth- washes combined with CHX. DIFFERENTSTUDIESHAVESHOWN THAT CPC IN DIFFERENT CONCENTRA- TIONS IS EFFECTIVE IN REDUCING SUPRA AND SUBGINGIVAL DENTAL BACTERIALPLAQUE Nowadays, CPC is being used in vari- ous applications in the food industry, since it is capable of eliminating pathogens such as Salmonella spp. and Campylobacter spp., aswellaskillingStaphylococcusspp.bacte- ria in proportions of 1:50000 in merely 10 minutes.Itisalsousedinthepharmaceutical and cosmetic industries and as a cleaning and disinfecting agent9,10,11. Cetylpyridinium Chloride (CPC) N-hexadecylpyridiniumchlorideorCPC is classified as a cationic quaternary ammo- nium surfactant, is soluble in alcohol and in aqueous solutions; it can act as a detergent and as an antiseptic, it is non-oxidizing and non-corrosiveandhasaneutralpH8.Itsmo- lecular structure is made up of a polar and a non-polar region, as shown in figure 1. Thismoleculehasbactericidalandbac- teriostatic activity against Gram positive and Gram negative bacteria, although evidence suggests that it is moreeffectiveagainstthe first ones. It is thought that its mechanism of action on bacteria is at the plasma mem- brane level (Mandel, 1988) where the posi- tivechargecreatesanattractionbetweenthe molecule and the negative charge of the phospholipidsthatmakeupthebacterialcell membrane. Once the molecule attaches to the membrane, the non-polar side of the CPCpenetratesandaltersthe cellular mem- brane. This alteration causes an osmotic imbalance and causes loss of cytoplasmic material and then cell death. Even though it can also stain enamel, it does this at a much lower degree than CHX. Different in vitro and in vivo studies have proven that CPC at different concentrations iseffectiveinreducingsupraandsubgingival dentalbacterialplaque,whichinturnalsore- duces inflammatory response12,13. Like- wise,workcarriedoutbyRoldánetalin2003 clearly describes that a formulation with CPC, CHX and Zinc Lactate has very good results, significantly eliminating anaerobic microorganisms, such as F. nucleatum and P. intermedia from the tongue surface and from the saliva. Similarly, a clinical study comparingdif- ferent mouthwashes showed a reduction in anaerobicmicroorganismsinpatients’saliva samples. This same study also measured the quantity of volatile sulphur compounds (re- sponsible for the bad odour of halitosis) and proved that they were reduced considerably when using mouthwashes with CPC as one of its active ingredients14. In a review from year 2008, van den Broek et al compared results from different clinical studies where the activity of different mouthwashes against halitosis was tested. They point out that studies in which prod- ucts like HALITA, whichcontainsCPC,CHX and Zinc Lactate in its formula are the ones that yielded the best results. Other clinical studies have tested mouthwashes with different formulations andconcentrationsofCPC15,16.Ingeneral, their results show that this compound, by it- self at different concentrations has an- tiplaque effects. It has also been combined with Sodium fluoride, alcohol and CHX with theintentionofreducingtheconcentrationof the two latter compounds because of their adverse effects. Thus, it has been proven that CPC can be used as a treatment for certain oral pathologies, like for instance, mucositits, especially in patients who haveundergone irradiationforheadandneckcancerorthose who suffer from periodontitis or gingivitis. Dr. Rubén León Director of R&D at Dentaid. B.S. in Biol- ogy and PhD in Genetics. What research has Dentaid carried out on the CPC molecule? At Dentaid, a number of studies have been performed using this molecule, that have led to the confection of diverse formu- lations that currently aid in human oral hy- giene. Also, among these, we have studies on antimicrobial activity, stability studies of the formulations for replacing ethanol in mouthwashes and improving CPC’s bioavailability. We have also carried out different clini- cal studies with national and foreign univer- sitiesthathaveshownthatproductscontain- ing this molecule are among the most effi- cient on the market. Having proven the properties of this molecule,howisDentaidapplyingitinits products? Dentaid has developed a line of prod- ucts that contain CPC among its active in- gredients, products that are meant for care and treatment of pathologies like periodonti- tis, gingivitis, halitosis or maintenance in pa- tients that have been treated for periodonti- tis. Currently, a group of products is being developed where this molecule has greater bioavailability. “Dentaid has developed a line of prod- ucts that contain CPC among its active in- gredients” Cetylpyridinium Chloride, An innovative molecule Exclusive Distributor : Pharmapal Drug Store Tel +971 4 2675001, PO Box 37345 Dubai, United Arab Emirates www.pharmapaluae.com