SCIENCE
Natural alternatives to chlorhexidine Ozan Karadal, Turkey
Dental caries
A
ccording to the World Health Organization (WHO, 2020), dental caries is the most prevalent oral health disease. As estimated in the WHO’s 2020 Oral Health Report, more than 2 billion people across the world likely suffer from dental caries. Dental caries or cavities are caused by harmful bacteria in the oral microbiota, and concentrated in dental plaque, such as Streptococcus mutans. This is a gradual process, with bacteria metabolising carbohydrates consumed throughout the day. During the bacterial metabolism of sugar substrates, acid is produced, and if this acid is not
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promptly cleared, it can lower the pH of the oral cavity to below the critical level of 5.5, creating conditions that favour increased bacterial activity and tooth-tissue demineralisation (Touger-Decker and Loveren, 2003). Though caries-related tooth destruction takes time, once it extends beyond the enamel, it is a cumulative process, and without restorative intervention, will result in cavitation eventually followed by tooth loss.
Prevention
It
is in the patient’s best interests to avert the initiation and progression of tooth decay. The main methods to prevent this are to simply practice effective daily oral
hygiene maintenance, ensure visits to the dentist at the appropriate recall interval, and to reduce the intake and frequency of sugary and acidic foods. To achieve satisfactory oral health, one must tip the balance in favour of tooth-tissue remineralisation, through brushing with a fluoridated toothpaste, cleaning interdentally, with less snacking in between meals and more fibre-rich foods (Touger-Decker and Loveren, 2003). In addition to brushing, mouth rinses, whether advised daily or weekly, play an important role in oral disease prevention. Traditionally, mouth rinses are fluoridated or contain chlorhexidine (CHX) at varying concentrations. Although CHX mouthwashes are shown to be effective in inhibiting the microbial colonisation of clean enamel and reducing plaque formation, CHX is not always preferred or well-tolerated due to its negative effects on tooth colour and sense of taste after prolonged use (Rugg-Gunn, 2013). Because of these unwanted side effects, scientists globally are in the search for effective and natural substances with greater biocompatibility to substitute CHX.
Alternatives to chlorhexidine
Numerous studies have been conducted throughout the years in regard to finding an alternative with greater efficacy and fewer side effects. Though there is much yet to be explored, the results of some
