The Substantivity of a Number of Oral Hygiene Products Determined by the Duration of Effects on Salivary Bacteria

Abstract

The persistence of action, or substantivity, of antimicrobial agents in the mouth appears to be a major variable influencing plaque inhibition. Such substantivity can be assessed by measuring the duration and magnitude of suppression of salivary bacterial numbers produced by antimicrobial agents. Although this has been determined for some agents, there is little information on the substantivity of the numerous products which contain these and other antimicrobial agents. This study was commissioned on the basis that efficacy cannot be assumed merely because a product contains a known active agent. Nine formulations or products were chosen: 2 rinses containing chlorhexidine or C31G, 4 rinses containing cetylpyridinium chloride (CPC) (with and without fluoride and/or alcohol), a minus-CPC control rinse, and 2 toothpastes with and without stannous fluoride. Additionally, water was used as a placebo control. Twenty health dentate volunteers took part in this blind, 10 cell randomized, single rinse, cross-over study, which was balanced for carryover. Mouthrinses were 15 ml volumes and toothpastes 3 gm in 10 ml water slurries rinsed for 60 seconds. On the day of each study volunteers suspended oral hygiene habits and at approximately 9:00 a.m. rinsed with the allocated formulation. Unstimulated saliva samples were obtained immediately before and 30, 60, 180, 300, and 420 minutes after rinsing. The samples were immediately processed for total anaerobic bacterial counts. All rinses except water and the minus CPC control rinse produced significant falls in counts to 30 minutes. Of more relevance in this inter-treatment comparison-designed study, the C31G rinse showed significant substantivity compared to water only for 60 minutes. C31G was highly significantly less substantive than chlorhexidine from 30 minutes to 420 minutes. The CPC rinses were similar and significantly more substantive than their control rinse to between 180 and 300 minutes. The stannous fluoride and control pastes were similarly substantive to 300 minutes, with the stannous fluoride paste remaining substantive compared to water to 430 minutes. Based on antimicrobial action these formulations varied considerably in substantivity and this is likely to reflect their comparative plaque inhibitory properties.

The Peritoneal Explant Test for Evaluating Tissue Tolerance to Mouthrinses

“…Substantial evidence exists for the first approach [9,10,[26][27][28] . However, there are few data as yet for the second, which could be used for an individual concentration/time combination [29][30][31][32] .…”

Substantivity of a single chlorhexidine mouthwash on salivary flora: Influence of intrinsic and extrinsic factors

“…[1][2][3][4] Apart from its antiplaque and antigingivitis activity, CHX is therefore also particularly effective for the prevention of infectious complications of oral origin. [5][6][7] However, up to now, we have not found any protocol for the administration of CHX which specifies the most effective dose in those clinical situations in which strong antibacterial activity is required; this is probably due to the absence of scientific evidence based on microbiological and clinical studies.…”

Effect of self‐performed mechanical plaque control frequency on gingival inflammation revisited: a randomized clinical trial

“…Post hoc comparisons for the mean GI change between studies indicate that the stannous fluoride dentifrice did not provide any added benefit for the 48 h interval (present: 0.33 AE 0.17 versus Pinto et al: 0.35 AE 0.22, p = 0.80). The short-term substantivity of stannous fluoride, which ranges between 6 h (Elworthy et al 1996) and 12 h (Otten et al 2012), may likely explain these observations.…”