Anti‐plaque agents. Rationale and prospects for prevention of gingivitis and periodontal disease

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Abstract
Oral health surveys have shown that even in countries with established patterns of oral hygiene habits, most individuals have relatively poor gingival health. This is due to a low interest in complying with oral health procedures. A number of factors are apparent when investigating compliance to oral hygiene habits, viz only approximately 50% of the population brushes twice a day or more, brushing time is probably much too short and use of dental floss is not very prevalent. Studies of the effect of motivation on oral hygiene suggest that improvements can be achieved, but these are not maintained unless motivation is continuously reinforced. This suggests that topically applied anti‐plaque agents should be used to augment mechanical plaque control. A number of product forms are available to delivery anti‐plaque agents i.e., mouthrinses, dentifrices, aqueous gels, and additionally floss, chewing gum and lozenges. Any product form should provide a physically, chemically and microbiologically stable environment for the agent concerned. It should facilitate optimal bioavailability of the agents at the site of action and encourage patient compliance. Anti‐plaque agents for topical administration should have the following properties: high intrinsic efficacy against a broad spectrum of oral organisms, toxicological and ecological safety, oral substantivity, no adverse reactions and good chemical stability. A number of classes of anti‐plaque agents have been identified such as positively charged organic molecules, metal salts, phenols, enzymes, peroxides, sugar substitues, fluorides and surface modifying agents. In order to achieve optimal bioavailability, the agent to be dosed should be compatible with the product form used. The 2 major product forms are rinses and dentifrices. With respect to rinses as the product form, the formulation excipients are generally compatible with positively charged organic agents, phenolic agents and some metal salts. In the case of dentifrice formulations, interactions of the agent with the product excipients limit compatibility to some metal salts and non‐charged phenolic agents, triclosan being a well researched example. The combination of metal salts, in particular zinc, and the phenolic agent triclosan has been shown to represent a further powerful route to enhance systems for daily plaque control.