Effect of 6 months use of a dentifrice and oral rinse containing sanguinaria extract and zinc chloride upon the microflora of the dental plaque and oral soft tissues

Antimicrobial effects in oral microenvironments by a novel herbal toothpaste

Objective

This clinical study compared the antibacterial effects after brushing with a novel herbal toothpaste incorporating zinc [test] to a control fluoride toothpaste on anaerobic organisms, gram-negative bacteria and malodor bacteria of dental plaque, tongue scrapings and cheek surfaces.

Methods

This double-blind, two-cell study enrolled 44 adults [age range 19–63 years]. Subjects completed a 1-week washout and provided baseline oral samples i.e. dental plaque, tongue and cheek scrapings for microbiological analysis. Diluted samples for microbiological analyses were plated on agar to enumerate anaerobic organisms, gram-negative bacteria and malodor bacteria representing functional groups of organisms. Subjects were randomized to brush their teeth with either the test or control with the first brushing conducted under supervision in the dental clinic. Post-treatment samples were collected 12 h after 21 day hygiene with assigned toothpaste. After providing these samples, subjects brushed in the dental clinic with additional samples collected 4 h after brushing. Statistical analyses were conducted separately for each organism collected from each oral niche by t-test for within-treatment assessments and analysis of covariance (ANCOVA) for between-treatment comparisons.

Results

Treatment groups demonstrated no significant differences at baseline for anaerobic organisms, gram-negative bacteria and malodor bacteria in any oral niche (p > 0.05). The test demonstrated reductions between 42 and 68% for anaerobic bacteria in oral niches, 12 h after brushing with reductions increasing to 46–80%, 4 h after brushing. Similarly, the test demonstrated reductions between 49 and 61% for gram-negative bacteria of oral niches that increased to 54–69% at the 4 h post-brushing evaluation. Reductions in malodor organisms of 22–42% were noted 12 h after brushing that increased to 60–72%, 4 h after brushing.

Conclusions

In comparison to control, brushing with a novel herbal toothpaste demonstrated significant reductions in functional bacterial groups from distinct oral niches 12 h after brushing with additional microbial reductions 4 h after brushing.

Rise and fall of oral health products with Canadian bloodroot extract

The rhizome of Sanguinaria canadensis (SC, bloodroot) contains an active principle with antimicrobial, antiinflammatory, antioxidative and immunomodulatory effects. For this reason SC extract has been added to toothpastes and mouthwashes in various concentrations. When tested separately, neither the toothpastes nor the mouthwashes with SC extract had any demonstrable clinical effectiveness against dental plaque and gingivitis. Although using them together twice a day seemed more effective than using placebo, more recent studies have shown conflicting results. Preclinical safety studies up to 2000, which did not include studies longer than 6 months, were thought not to indicate any appreciable potential for harm - to the oral mucosa in particular. In 2003, the FDA Subcommittee on Oral Health Care Drug Products for Over-the-Counter Human Use concluded from a review that using SC-containing products is safe. However, for reasons unknown, the review failed to consider publications between 1999 and 2001 that suggested a possible link between the use of SC-containing products and the pre-neoplastic lesion, leukoplakia. As it happened, bloodroot had already been removed (in 2001) from the formula of one of the most widely used products in question and the brand has since then disappeared altogether from the worldwide market.

Bacteriostatic effect of Piper betle and Psidium guajava extracts on dental plaque bacteria

In this study, the bacteriostatic effect of Piper betle and Psidium guajava extracts on selected early dental plaque bacteria was investigated based on changes in the doubling time (g) and specific growth rates (micro). Streptococcus sanguinis, Streptococcus mitis and Actinomyces sp. were cultured in Brain Heart Infusion (BHI) in the presence and absence of the extracts. The growth of bacteria was monitored periodically every 15 min over a period of 9 h to allow for a complete growth cycle. Growth profiles of the bacteria in the presence of the extracts were compared to those in the absence and deviation in the g and micro were determined and analyzed. It was found that the g and mu were affected by both extracts. At 4 mg mL(-1) of P. betle the g-values for S. sanguinis and S. mitis were increased by 12.0- and 10.4-fold, respectively (p < 0.05). At similar concentration P. guajava increased the g-value by 1.8- and 2.6 -fold, respectively (p < 0.05). The effect on Actinomyces sp. was observed at a much lower magnitude. It appears that P. betle and P. guajava extracts have bacteriostatic effect on the plaque bacteria by creating a stressed environment that had suppressed the growth and propagation of the cells. Within the context of the dental plaque, this would ensure the attainment of thin and healthy plaque. Thus, decoctions of these plants would be suitable if used in the control of dental plaque.

Sanguinarine induces apoptosis of human pancreatic carcinoma AsPC-1 and BxPC-3 cells via modulations in Bcl-2 family proteins

Pancreatic cancer is associated with low responsiveness to conventional chemotherapies and its incidence nearly equals its death rate. This warrants the development of novel mechanism-based approaches for the management of pancreatic cancer. This study was designed to determine the potential of sanguinarine, a plant alkaloid known to possess strong antimicrobial, anti-inflammatory, and antioxidant activities, against human pancreatic carcinoma cells. Employing human pancreatic carcinoma AsPC-1 and BxPC-3 cells, we specifically evaluated the pro-apoptotic and cell cycle deregulatory effects of sanguinarine and evaluated the involvement of Bcl-2 family proteins and p53 as the mechanism of the biological effects of sanguinarine. Our data demonstrated that sanguinarine (at low concentrations of 0.1-10 microM; for 24 h) treatment to AsPC-1 and BxPC-3 cells resulted in a dose dependent (i) inhibition of viability and growth, (ii) colony formation ability, (iii) induction of apoptosis, and (iv) G0-G1 phase cell cycle arrest. Further, sanguinarine-treatment to AsPC-1 and BxPC-3 cells resulted in a dose dependent (i) increase in pro-apoptotic Bax, Bid and Bak proteins; (ii) decrease in anti-apoptotic Bcl-2 and Bcl-X(L) proteins; and (iii) decrease in p53 with an increase in its phosphorylation. Based on our study, we suggest that sanguinarine may be developed as an agent for the management of pancreatic cancer. Indeed, more in depth studies both in vitro as well as in vivo in appropriate relevant animal models are needed to strengthen this suggestion.

Randomized controlled clinical trials on agents used for chemical plaque control

Taking into account the limitations of the daily self-performed oral hygiene the use of chemical agents that can be incorporated in dentifrice or mouth rinse formulations has been advocated. The present review deals with randomized controlled clinical trials of >or=6 months in duration, on the use of those agents and their effects on plaque and gingival inflammation.

Effects of sanguinaria in fluoride-containing dentifrices on the remineralisation of subsurface carious lesion in vitro

OBJECTIVE

The purpose of this study was to investigate the potential cariostatic benefits of dentifrice containing both fluoride (F) and sanguinaria (SG) in a silica abrasive formula using the microbial de- and re-mineralisation cycle model.

METHODS

Samples of bovine tooth enamel were embedded in resin, polished, exposed to a lactate carbopol buffer system for 44 hours, and divided into one control and five test groups of 12 specimens each by randomised blocks with VHN stratification. Surface microhardness was compared before and after the microbial cyclic sequences.

RESULTS

VHNs for groups treated with dentifrices containing 1,000 ppm F from MFP with or without bamboo salt (BS) were significantly higher than the control. The groups treated with dentifrices containing F from NaF/silica with or without SG had significantly higher VHNs than that with F from MFP/DCPD. The VHNs treated with dentifrice containing both NaF-SG demonstrated the highest among test groups, indicating that there may be a synergistic effect in remineralising the incipient subsurface lesion.

CONCLUSION

The dentifrice containing both NaF and SG showed a significantly greater effect (p < 0.05) on the remineralisation of the enamel lesion than the other test dentifrices.

White lesions of the oral cavity

White lesions are frequently found during the examination of the oral cavity. Although some benign physiologic entities may present as white lesions, systemic conditions, infections, and malignancies may also present as white oral lesions. An appreciation of the many clinical entities that white lesions may represent is necessary if a differential diagnosis of white lesions is to be elucidated. The appreciation of subtle clinical findings associated with white lesions of the oral cavity permits clinicians to better care for their patients.

The association between Viadent use and oral leukoplakia--results of a matched case-control study

OBJECTIVES

Several oral pathologists have described oral leukoplakia of the maxillary vestibule in patients with no traditional risk factors for the condition. On questioning these patients, it was determined that Viadent mouthrinse or Viadent toothpaste was commonly used by them. A hypothesis was developed that Viadent or a component of Viadent caused the lesions. This paper evaluates the association between oral leukoplakia and use of Viadent products.

METHODS

A matched case-control study was designed to test the hypothesis that use of Viadent products increases an individual's risk of oral leukoplakia. Cases included 58 patients diagnosed with oral leukoplakia identified through the biopsy service at the Ohio State University, College of Dentistry, Oral Pathology Section. The matched control was a friend or relative of the patient. Cases and controls were administered a questionnaire about their use of Viadent, and other known risk factors for leukoplakia such as tobacco and excessive alcohol use.

RESULTS

An age difference was seen between cases and controls, the cases being older (P < .001). After controlling for confounding factors, results of exact conditional logistic regression analyses showed that use of Viadent products was a risk indicator for oral leukoplakia (odds ratio = 10.0; 95% confidence interval = 2.0, 89.2).

CONCLUSIONS

Viadent use is a risk indicator for oral leukoplakia, confirming our previous findings.

Sanguinaria-associated oral leukoplakia: comparison with other benign and dysplastic leukoplakic lesions

OBJECTIVE

This study was undertaken to compare and contrast biomarkers and ploidy data from maxillary gingiva leukoplakias associated with dentifrices and mouthrinses containing the herbal compound sanguinaria with other forms of oral benign and premalignant mucosal keratosis.

STUDY DESIGN

Representative archived specimens of benign keratosis, sanguinaria-associated keratosis, and keratosis with dysplasia were used for computerized image analysis and biomarker immunohistochemical assays to assess ploidy, DNA content, and p53 and proliferating cell nuclear antigen immunoreactivity of nuclei.

RESULTS

DNA content was significantly higher and higher numbers of cell populations with hyperploid nuclei were encountered in the dysplastic group than in the other two groups (P <.001). Sanguinaria-associated keratosis did not harbor significant numbers of p53-expressing nuclei, yet it showed a significant elevation in proliferating cell nuclear antigen-labeled nuclei in total, in the basal layer, and in the spinous layer in comparison with benign keratoses (P <.001). In addition, 1.5% of the sanguinaria-associated leukoplakia epithelial cell population was characterized by nuclei with a greater than 4-fold increase in DNA content.

CONCLUSIONS

Sanguinaria-associated keratoses show some marker and image analysis profiles similar to those of non-sanguinaria dysplastic lesions of the lip and mucosa. Preparations containing sanguinaria should be avoided until the risk for malignant transformation is determined.

Viadent usage and oral leukoplakia: a spurious association

Oral rinse and toothpaste products (Viadent) containing Sanguinaria extract have been shown through extensive clinical trials to be effective against plaque build-up and gingivitis. To establish safety, a comprehensive research program was conducted, including a series of clinical studies and a number of animal studies to evaluate acute, subchronic, and chronic toxicity, and the potential for irritation of mucosal tissues. In 1990 and 1993, an Expert Panel reported on reviews of these data and concluded that Viadent products are safe for their intended use. Despite the large database of information to support the safety of Viadent products, Damm et al. (1999) recently raised the possibility that their usage may be causally associated with development of oral leukoplakia. However, a critique of this recent report shows that it does not fulfil criteria for establishing causation. In particular, the study does not show that exposure to Viadent preceded the onset of leukoplakia, it does not demonstrate dose-response or biological plausibility, and it suffers from selection and information bias and from potential confounding. Furthermore, upon critical evaluation, the Damm et al. (1999) report on a case-series is inconsistent with the weight of available clinical evidence showing that Sanguinaria extract-containing oral health care products cause no cytotoxic or significant irritant effects in the oral mucosa in human studies of up to 6 months duration. The animal data similarly do not support a causal association between Viadent usage and oral leukoplakia in humans. These data demonstrate that Sanguinaria extract and whole Viadent formulations are without significant irritation potential and have no effects on the oral mucosa, even in studies with life-long dietary exposure to Sanguinaria extract. The mutagenicity and genotoxicity data do not indicate that Sanguinaria extract or its components are genotoxic in vivo. The results of 2 GLP-compliant rat oncogenicity studies provide no evidence of any carcinogenic effect of Sanguinaria extract. In conclusion, the available clinical and animal data provide no support for and in fact argue strongly against the hypothesis that the use of Viadent toothpaste and/or oral rinse products may be causally associated with the development of leukoplakia in humans.

Antimicrobial screening of zinc in the absence or presence of oleoresins and various resin acids

Zinc and oleoresins are the main components of several wound dressings, and are also frequently used in root canal treatment. The in vitro antibacterial effects of zinc, six highly purified resin acids and two commercial oleoresins alone or combined in varying proportions were analysed. Oleoresins are composed of approximately 90% resin acids and the most common acids were included in this study. The antibacterial activity of the various chemicals was estimated using a Bioscreen robot analyser, which allowed 24 h kinetic documentation of bacterial growth. The bacteria employed were reference species commonly occurring on human skin or of oral origin. Zinc as well as the oleoresins and the pure resin acids all showed antibacterial activity when present in growth media, but the sensitivity of the bacteria varied. The presence of resin acids and oleoresins increased the antibacterial effect of zinc to varying degrees depending on the combination and the bacterial species tested. The results of the present study indicate that zinc, resin acids, or oleoresins alone, as well as combined, show antibacterial activity against selected aerobic Gram-positive and anaerobic Gram-negative bacteria.

Antimicrobial mouthrinses: overview and update

The Seal of Acceptance of the American Dental Association's Council on Dental Therapeutics has been awarded to Listerine and chlorhexidine gluconate (Peridex). The mechanism of action of Listerine involves bacterial cell wall destruction, bacterial enzymatic inhibition, and extraction of bacterial lipopolysaccharides. Chlorhexidine has the property of substantivity, i.e. the ability to bind to hard and soft tissue with slow release. Antibacterial mouthrinses/dentifrices containing triclosan hold promise for the reduction of plaque and gingivitis but are not yet available in the United States. The quaternary ammonium compounds and sanguinarine compounds (Viadent) have some merit, but studies of their efficacy in plaque and gingivitis reduction are mixed. New products containing various fluorides and oxygenating agents may have potential for the future as antiplaque and antigingivitis agents.

Mouthrinses

Mouthrinses have been used for centuries for medicinal and cosmetic purposes, but it is only in recent years that the rationale behind the use of the ingredients has been subject to scientific research and clinical trials. Although Listerine held its position for many years in the vanguard of the anti-plaque agents, the advent of mouthrinses containing chlorhexidine was a major breakthrough in the research for a chemical means to prevent disease. Since that time, and especially in the past ten years, the number of formulations that claim to have anti-plaque, anti-calculus, and anti-caries activity has increased, and much emphasis has been placed on such substances as an adjunct to, or indeed to replace, conventional toothbrushing techniques. This review covers the literature on mouthrinses over the past five years, concentrating more on the anti-plaque, anti-gingivitis, and anti-calculus formulations. In the first section, the methods of conducting clinical trials of mouthrinses are discussed, and a plea is made for a greater degree of standardization of methodology with agreed acceptable levels of clinical benefit. Trials of established mouthrinses are considered, and the advantages and disadvantages of several newer formulations discussed. From the review, it appears that chlorhexidine has no equal in its effects on reduction of plaque and gingivitis, but major drawbacks lie in the taste and stain-producing problems. The pre-brushing rinse, Plax, does not have unqualified success in all trials, though the more recent European formulation may have promise. Newer rinses which inhibit bacterial adhesion to tooth surfaces also appear promising, and it is suggested that more work on combinations of active ingredients is necessary.

Inhibition of the formation of oral calcium phosphate precipitates: beneficial effects of Chinese traditional (kampo) medicines

Screening tests on the formation of calcium phosphate precipitates using 23 different kinds of Kampo medicines (Chinese traditional medicines) were carried out, at concentrations where the effects of chelation are not significant. Four of them, Hochu-ekki-to (TJ-41), Kyuki-kyogai-to (TJ-77), Oren-to (TJ-120) and Inchin-ko-to (TJ-135) showed an inhibitory effect on the formation of amorphous calcium phosphate (ACP). The inhibitory effect on the induction time and the rate of transformation to hydroxyapatite (HAP) varied greatly among the 23 Kampo medicines. We classified them according to their effects on increasing the induction time and/or decreasing the rate of HAP transformation. Ethane-1-hydroxy-1, 1-diphosphonate (EHDP) was used as the standard. This compound is a common toothpaste additive which decreases dental calculus formation. Two of the 23 Kampo medicines showed little or no inhibition either on the induction time or on the rate of HAP transformation. Twelve of them reduced the rate of HAP transformation by 20-40% and with 1.9- to 4.0-fold increases in the induction time. The remaining nine showed even greater activity. Keishi-ninjin-to (TJ-82), Dai-kenchu-to (TJ-100), Toki-to (TJ-102), Rikko-san (TJ-110) and San'o-shashin-to (TJ-113) showed the same inhibitory effect as EHDP. Shigyaku-san (TJ-35;5.2-fold), Dai-kanzo-to (TJ-84;4.9-fold), Oren-gedoku-to (TJ-15;12.7-fold) and Inchin-ko-to (TJ-135;9.5-fold) had a greater effect on the increase of induction time than EHDP and reduced the rate of HAP transformation by 50-60%. These results suggest that these nine kinds of Kampo medicines may have potential as anticalculus agents in toothpastes and mouthwashes.

Clinical efficacy of a dentifrice and oral rinse containing sanguinaria extract and zinc chloride during 6 months of use

The efficacy of combined use of toothpaste and oral rinse containing sanguinaria extract and zinc chloride was compared to placebo products in a 6-month clinical trial. Sixty subjects with moderate levels of plaque and gingivitis were randomly assigned to active and placebo groups. Noninvasive measures of plaque and gingivitis were assessed at baseline and at 2, 6, 8, 14, 20, and 28 weeks. Bleeding on probing was measured at baseline and 6, 14, and 28 weeks. Active group scores were significantly lower (P less than .0001) than placebo scores at each post-baseline time point for all indices, with the exception of plaque at 2 weeks. The 28 week active group scores were 21% lower than the placebo group for plaque, 25% lower for gingivitis, and 43% lower for bleeding on probing. No dental staining or taste alteration was reported in the active group. Three of 30 active group subjects exhibited minor soft tissue irritations that resolved spontaneously without discontinuation of product use. Results indicate that the test products showed good levels of safety and efficacy when administered in a combined use regimen for 6 months.