Revisiting Oral Antiseptics, Microorganism Targets and Effectiveness
Abstract
:1. Introduction
2. Major Oral Antiseptics in Current Clinical Practice
3. Oral Antiseptics and Oral Conditions
3.1. Dental Caries
3.2. Periodontal Diseases
3.3. Peri-Implant Diseases
3.4. Candidiasis
3.5. Herpes Simplex Virus
3.6. Halitosis
4. Oral Antiseptics and Systemic Diseases
5. Oral Antiseptics in the Prevention of VAP
6. Oral Antiseptics in the Prevention of Cross-Infection
7. Current Concerns about Oral Antiseptics
8. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Oral Antiseptics | Classification | Most Common Formulations | Mechanism of Action | Spectrum | Adverse Effects |
---|---|---|---|---|---|
Povidone-Iodine (PVP-I) | Iodophor solution containing a water-soluble complex of iodine and polyvinylpyrrolidone (PVP) | Local topical solution (7.5%, 10%) Spray (5%) PVP iodine solution Fe-150 [55,56] | Inhibits microbial protein synthesis (oxidizing amino acids and nucleic acids) High bactericidal and virucidal activity profile [56,57] | Broad antibacterial spectrum: Gram-positive and Gram-negative; Bacteria spores, fungi, protozoa and several viruses [56,58] | Thyroid dysfunction Allergic dermatitis, after prolonged skin contact and pruritus Metabolic acidosis Acute renal failure Serious adverse effects are not common [55,56,57,58] |
Chlorhexidine (CHX) | Cationic surfactant, bisbiguanide | Oral rinses, aerosols and spray formulations (0.12–0.2%) Gels (0.12–1%) Dental varnishes (1%, 10%, 40%) Toothpaste, gels for cleaning teeth and dental flosses [10,28] | Cationic molecule attaches nonspecifically to negatively charged membrane phospholipids of bacteria. It increases the permeability of the cell membrane Impediment of the bacteria membrane’s ability to spontaneously form microdomains Low concentrations (0.02–0.06%): bacteriostatic activity: Affects the change in the osmotic balance of the bacteria cell. This leads to the release of potassium, phosphorus and other low-weight molecules Higher concentrations (>0.12%): bactericidal Cell death by cytolysis. Cytoplasmic coagulation and precipitation [10,59,60] | Wide: more effective against Gram-positive bacteria and weaker against Gram-negative ones. Active against fungi and some lipophilic viruses [10,61,62,63] | Type I and type IV hypersensitivity reactions followed by severe anaphylaxis Taste alteration (hypogeusia) Pain in mouth and tongue Xerostomia Burning sensation Discoloration of tongue Long-term use: swelling of the parotid gland, oral paresthesia; mild desquamation of the oral mucosa and ulceration/erosions; calculus and extrinsic tooth staining [10,28,62] |
Triclosan (TRC) | Nonionic phenolic derivative | Toothpaste and mouthrinses 0.3% [64,65] | Inhibition of the enzyme enoyl-acyl reductase (ENR) transporter protein, anti-inflammatory effects: it acts in the inhibition of the cyclooxygenase/lipoxygenase pathways, host-derived inflammatory mediators such as interleukin (IL) 1b, IL-6, tumor necrosis factor, and prostaglandins; damage the bacterial inner membrane [53,66] | Wide, antimicrobial with activity against Gram-positive and Gram-negative bacteria and fungi [65,67] | Taste alterations and mucosal irritations. Long-term use: antibiotic resistance [54] |
Benzethonium chloride (BTC) and Benzalkonium chloride (BAC) | Cationic surfactants from quaternary ammonium salts | BTC mouthrinse 0.2% BAC mouthrinse 0.1%, 0.05% [68,69,70] | Though it has not been exactly determined, it is generally accepted that a long, lipophilic alkyl chain penetrates bacterial cell membranes by binding to the cell wall components to produce leakage of the cytoplasmic material, autolysis, and cell death of bacteria [71,72] | Broad: antimicrobial properties against bacteria, fungi and viruses, except for bacterial endospores [73,74] | Detention of human gingival fibroblasts cell cycle Apoptosis [50] |
Cetylpyridinium chloride (CPC) | Monocationic quaternary ammonium | Mouthrinses and toothpaste: 0.05–0.10% [75] | Binds to the phosphate groups of lipids in the cell walls of bacteria. It penetrates the cell and causes membrane damage, which leads to leakage of cell components, disruption of bacterial metabolism, inhibition of cell growth and, finally, cell death [52] | Broad antimicrobial spectrum: most effective against gram-positive pathogens and yeast in particular [52,76] | Very limited: tooth staining, ulcers, gingival irritation, burning sensations [76,77,78] |
Essential oils—volatile or ethereal oils (EOs) e.g.,: Menthol and eugenol | Complex mixture of odoriferous, volatile organic compounds produced by aromatic plants | External application is the most effective way to use the majority of EOs (e.g., mouthwashes) [79] | Against bacterial pathogens: Denaturation of bacterial proteins, modifying the permeability of the outer membrane of Gram-negative bacteria and the chelation of cations present in the bacterial cytoplasm, rendering the enzymes inactive. The antibacterial activity of essential oils has severe effects as they may seize the growth of the bacteria (bacteriostatic) or kill bacterial cells (bactericidal). Against fungal pathogens: establish a membrane potential across the cell wall and disrupt the assembly of ATP or disintegration of mitochondrial membrane, interfering with the electron transport system (ETS) [79,80,81,82] | Wide spectrum of antibacterial, antifungal, antiviral and insecticidal fungi and yeast; also, potential to inhibit the growth of drug-resistant microbial strains and antioxidant and anti-inflammatory properties [81,82] | Regarded as GRAS (generally regarded as safe) grade chemicals by The U.S. Food and Drug Administration (FDA) Local skin irritation Allergic contact dermatitis Phototoxicity from reaction to sunlight (some oils) [79,82] The majority of the effects are mild, but there have been cases of serious toxic reactions: neurotoxicity, abortions and pregnancy abnormalities, bronchial hyperreactivity, hepatotoxicity, prepubertal gynecomastia, premature thelarche and their endocrine disrupting properties leading to the induction of premature breast growth in young adolescents [15,79,80,81,82,83] |
Delmopinol (DEL) | Amino-alcohol | Oral rinse: 0.2% [84,85] | Increases the humidity of tooth surfaces, binds to hard and soft oral tissues as well as to bacterial surfaces, displaces components from the pellicle and interferes with the build-up and cohesion of plaque by reducing glucan synthesis and glucan viscosity. It may also diminish cell-to-cell adhesion [84,85] | Low antimicrobial properties, prevents plaque formation and possesses plaque dissolving properties [86] | Paraesthesia Numbness and altered taste sensations in the oral mucosa Staining [54] |
Octenidine (OCT) | Cationic surfactant, Bispyridinamin | Oral rinses: 0.10 (most used), 0.15, and 0.20% [51,87,88] | Bactericidal action by binding to the negatively charged microbial cell membranes and to soft and hard oral surfaces. It disrupts the phospholipid bilayer and destroys the enzyme systems, causing the cell wall, which results in cytoplasmic leakage and cell death [89,90,91] | Gram-positive and Gram-negative organisms, as well as yeasts [89,92] | Tooth and tongue discoloration Dysgeusia [51,87] |
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Garrido, L.; Lyra, P.; Rodrigues, J.; Viana, J.; Mendes, J.J.; Barroso, H. Revisiting Oral Antiseptics, Microorganism Targets and Effectiveness. J. Pers. Med. 2023, 13, 1332. https://doi.org/10.3390/jpm13091332
Garrido L, Lyra P, Rodrigues J, Viana J, Mendes JJ, Barroso H. Revisiting Oral Antiseptics, Microorganism Targets and Effectiveness. Journal of Personalized Medicine. 2023; 13(9):1332. https://doi.org/10.3390/jpm13091332
Chicago/Turabian StyleGarrido, Lisetty, Patrícia Lyra, Joana Rodrigues, João Viana, José João Mendes, and Helena Barroso. 2023. "Revisiting Oral Antiseptics, Microorganism Targets and Effectiveness" Journal of Personalized Medicine 13, no. 9: 1332. https://doi.org/10.3390/jpm13091332