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Chemical plaque control: Amine fluoride/stannous fluoride the
active substances of choice
Clinical studies prove the success of gingivitis prophylaxis
using amine fluoride/stannous fluoride. Thanks to its good
tolerability, this combination of active substances is
recommended for long-term use.
Münchenstein, April 4, 2004 – Nearly all commercially
available mouthrinses display good to very good antibacterial
and thus potentially plaque-inhibiting properties in vitro. For
long-term use, however, the combination of active substances
amine fluoride/stannous fluoride contained in meridol is to be
recommended. It possesses marked substantivity. Its plaqueand inflammation-inhibiting properties in vivo have repeatedly
been clinically confirmed. This is the result of a literature
analysis published in two parts by Brecx, Netuschil and
Hoffmann in the International Journal of Dental Hygiene. The
team of authors from the Technical University Dresden
(Germany) investigated which mouthrinses can be used to
complement
mechanical
plaque
removal.
The
meaningfulness of various study designs and possible side
effects were taken into consideration.
When examining the efficacy of mouthrinses it must be taken
into consideration that bacteria organised in a biofilm are
clearly more resistant to antimicrobial active substances than,
for example, planktonic bacteria present in the saliva. To
achieve plaque inhibition, the active substances in a
mouthrinse must be present at concentrations clearly above
the minimum inhibiting concentration of the active substance
in vitro. This applies to the amine fluoride/stannous fluoride in
meridol® mouthrinse.
A general requirement for a mouthrinse is that long-term
disturbances of ecological equilibrium in the oral cavity should
be avoided. The active substances chlorhexidine (CHX) and
triclosan (when using additional zinc salt or copolymer to
enhance their effect) also have good plaque-reducing and
-inhibiting properties. At a concentration of 0.2 percent
chlorhexidine drastically reduces bacterial counts on dental
surfaces. It should thus not be used for prolonged periods
and should only be used if there is an appropriate situation,
e.g. if mechanical oral hygiene cannot be performed or can
only be performed incompletely.
“The older and thicker the dental plaque, the greater the
number of anaerobic, pathogenic bacteria,” the authors
explain. “If the mouthrinse can reduce the plaque thickness or
prevent plaque maturation and the shift to anaerobic
conditions, then a more aerobic biofilm will develop.” meridol®
mouthrinse with amine fluoride/stannous fluoride has this
capacity, facilitating promotion of healthy oral flora. “Used as
a complement to brushing, in several studies it displayed
marked and significant clinical efficacy against plaque and
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meridol® mouthrinse contains
the combination of active substances
amine fluoride/stannous fluoride, which
is preferred by experts for long-term use.
gingivitis.”
Mouthrinses should be used as a complement to brushing,
thus it is sensible to use toothpaste and mouthrinse
containing the same active substance, e.g. amine
fluoride/stannous
fluoride.
Mouthrinses
containing
chlorhexidine may lead to incompatibility with the anionic
detergent sodium lauryl sulphate frequently used in
toothpastes. As well as the cationic tenside amine fluoride,
meridol® toothpaste contains a further non-ionic tenside, and
can be combined with a rinse containing CHX without any
problems.
The alcohol content of mouthrinses was a further aspect
taken into consideration by the authors. Alcohol is often used
as a solubiliser – in the opinion of Brecx, Netuschil and
Hoffmann without reason: “From a chemical standpoint, use
of alcohol is superfluous. And with justifiable alcohol
concentrations, neither in vitro nor in vivo has an antibacterial
effect with respect to biofilm bacteria been established. Only
at very high concentrations is plaque growth influenced.” Thus
alcohol-free preparations are preferable, especially since
ethanol at high concentrations can cause painful side effects,
and since a connection with the development of cancer of the
oral cavity cannot then be excluded, at least not totally.
meridol® mouthrinse is alcohol-free.
Of the many mouthrinses available, the authors can only
recommend two products: a mouthrinse with 0.2%
chlorhexidine for short-term use and a mouthrinse with amine
fluoride/stannous fluoride as a complement to daily brushing
for long-term use.
Source:
Netuschil L, Hoffmann T, Brecx M. How to select the right
mouthrinses in periodontal prevention and therapy. Part I:
Test systems and clinical investigations. Int J Dent Hygiene 1
(2003) 143-150.
Brecx M, Netuschil L, Hoffmann T. Part II: Clinical use and
recommendations. Int J Dent Hygiene 1 (2003) 188-194.
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