Biofilm Control Strategies in Dental Health - Antibiofilm Agents: From Diagnosis to Treatment and Prevention - page 296

Table 2 Chemical agents used to treat contamination of Dental Unit Water Systems (DUWS)

Biofilm
removal

Output water
contamination Compound Treatment

Chlorexidine gluconate, chlorhexidine gluco-
nate, and alcohol

Variable Effective Intermittent

Activated chlorine dioxide Not effective Effective Intermittent

Chlorine dioxide and sodium phosphate mouth
rinse

Not effective Effective Residual or

continuous

Glutaraldehyde, glutaraldehyde, and quater-
nary ammonium salts (very toxic)

Variable Effective Intermittent

Sodium hypochlorite and citric acid Not effective Effective Intermittent

Hydrogen peroxide
Hydrogen peroxide and silver
Alkaline peroxide

Effective Effective Intermittent

Residual or
continuous

Electrochemically activated solutions Very effective Very effective Residual or

continuous

Paracetic acid Not effective Not effective Intermittent

Povidone-iodine Not effective Effective Intermittent

Sodium fluoride Partial

elimination

Effective Intermittent

Sodium perborate Not effective Variable Intermittent

EDTA Effective Effective Intermittent

Citric acid and sodium- p -toluol-
sulfonechloramide and sodium EDTA

Not effective Effective Residual or

continuous

Sodium- p -toluol-sulfonechloramide and
sodium EDTA

Not effective Effective Residual or

continuous

P -hydroxybenzoeicacidester,
polyaminoprophylbiguanid,
1,2-prophyenglycol

Not effective Effective

Adapted from O'Donnell et al. ( 2011 ). “ Management of dental unit waterline biofilms in the 21st
century”

The list of antiplaque agents used in toothpastes and mouth rinses is long. Thus, for
the purpose of this review, we will comment on the most commonly used antimi-
crobial compounds used in oral health products (Table 3 ).
As of today, the most effective antimicrobial agent for plaque control has been
chlorhexidine (Baehni and Takeuchi 2003 ). Chlorhexidine is among the most tested
compound, and its antiplaque properties are well known. One main feature of
chlorhexidine that makes it so successful in controlling plaque is that it is adsorbed
on to the enamel surface or the salivary pellicle on the teeth so that bacterial
adhesion is inhibited (Pratten et al. 1998 ;R¨ lla and Melsen 1975 ). Moreover,
once chlorhexidine attaches to the surface of the teeth it stays there for long periods
of time before it is washed out by saliva flow, thus maintaining its antiplaque
activity even long after the mouthwash has been used.
At low concentrations chlorhexidine is bacteriostatic against most oral bacteria
and can interfere with the metabolism of oral bacteria by inhibiting sugar transport
and acid production in cariogenic streptococci, various membrane functions in
streptococci, and a major protease (gingipain) in the periodontal pathogen