Strategies for combating bacterial biofilm explored at symposium

March 16, 2005
IADR conference symposium discusses role of antibacterial mouthrinse in preventing gum disease.

The critical and underappreciated role of antibacterial mouthrinse in preventing gum disease was explored recently in a symposium at the International Association of Dental Research Conference.

In a presentation on "Myth versus Reality" in treating gum disease, John Gunsolley, DDS, Professor and Chair of Endodontics and Periodontics at the University of Maryland's Baltimore College of Dental Surgery, explained how free-floating bacteria in the mouth can bond together forming a "biofilm" of plaque, which unchecked can adhere to all tooth surfaces and spread from above the gum to below the gum line. This process can lead to the initiation and progression of gingivitis.

"Patients often mistakenly think that bacteria in the mouth just cause bad breath," noted Gunsolley. "In reality, the greater worry with bacteria is that once allowed to entrench themselves below the gum line, they become more difficult to kill. Regular use of an antibacterial mouthrinse, in addition to brushing and flossing, kills bacteria while they are more vulnerable above the gum line."

While regular brushing removes the bacterial biofilm from easily accessed tooth surfaces, it's often left behind on the harder-to-reach surfaces between teeth, according to Rebecca Wilder, RDH, Associate Professor and Director of Graduate Dental Hygiene Education at The University of North Carolina Chapel Hill School of Dentistry.

According to Wilder, "The reality is, most people only brush their teeth for about 46 seconds, while the recommended brushing time is two minutes, and only 2 to 10 percent floss regularly and effectively." The adjunctive use of antibacterial mouthrinses has been found to be an effective at-home treatment for plaque control.

Surveying the currently available antibacterial mouthrinse products, Stuart Fischman, DMD, Professor Emeritus of Oral Diagnostic Sciences at the State University of New York at Buffalo School of Dental Medicine, noted that to date, only two products have received the American Dental Association's Seal of Acceptance as adjunctive agents ¿ Listerine® Antiseptic Mouthrinse and Peridex®, a prescription oral rinse for short-term use only. He also highlighted factors that should be considered in recommending or selecting an antibacterial mouthrinse.

"Because these are products that patients should use on a regular, sustained basis, aesthetic concerns are important as well as the mouthrinse's effectiveness," asserted Fischman.

"For example, ingredients such as cetylpyridinium chloride (CPC) and chlorhexidine, both may cause significant brown staining on teeth and the tongue versus an essential oil antibacterial mouthrinse such as Listerine®, which is safe for long-term daily use," cautioned Fischman.

"In addition, because of possible interactions with sodium lauryl sulfate, a commonly used ingredient in toothpaste, neither CPC nor chlorhexidine mouthrinses should be used immediately following brushing or else their effectiveness might be compromised. Chlorhexidine mouthrinse may also promote the formation of calculus or tartar above the gum line in patients using the product. This is not an issue with, for example, with an essential oil formula."

In conclusion, symposium moderator Sebastian Ciancio, DDS, Distinguished Service Professor and Chair of the Department of Periodontics and Endodontics at the University at Buffalo, State University of New York, recommended to the audience that dental professionals evaluate the evidence supporting the efficacy of the products they recommend and weigh potential side effects.

He also suggested methods for promoting patient compliance, such as keep routines uncomplicated, highlighting product instructions and providing recommendations in writing. He stressed, "The better the patient's compliance, the better his/her oral health."

This program, Biofilm Control: Science vs Perception, was jointly sponsored by the University at Buffalo School of Dental Medicine Continuing Dental Education (UB/CDE) and Health Learning Systems (HLS). This activity was made possible through an unrestricted educational grant from Pfizer Inc.