The Cutaneous Microbiome and Aspects of Skin Antimicrobial Defense System Resist Acute Treatment with Topical Skin Cleansers.

The human skin microbiome has been suggested to play an essential role in maintaining health by contributing to innate defense of the skin. These observations have inspired speculation that the use of common skin washing techniques may be detrimental to the epidermal antibacterial defense system by altering the microbiome. In this study, several common skin cleansers were used to wash human forearms and the short-term effect on the abundance of the antimicrobial peptide LL-37 and the abundance and diversity of bacterial DNA was measured. Despite small but significant decreases in the amount of LL-37 on the skin surface shortly after washing, no significant change in the bacterial community was detected. Furthermore, Group A Streptococcus did not survive better on the skin after washing. In contrast, the addition of antimicrobial compounds such as benzalkonium chloride or triclocarban to soap before washing decreased the growth of Group A Streptococcus applied after rinse. These results support prior studies that hand washing techniques in the health care setting are beneficial and should be continued. Additional research is necessary to better understand the effects of chronic washing and the potential impact of skin care products on the development of dysbiosis in some individuals.

The development of a new desensitising mouthwash containing arginine, PVM/MA copolymer, pyrophosphates, and sodium fluoride--a hydraulic conductance study.

OBJECTIVE: To investigate the ability of a novel mouthwash comprised of 0.8% arginine, PVM/MA copolymer, pyrophosphates, and 0.05% sodium fluoride in an alcohol-free base (Pro-Argin™ Mouthwash Technology) to reduce dentine permeability. METHODS: Hydraulic conductance was used to assess the dentine permeability effects of the arginine mouthwash. Aqueous solutions containing arginine and PVM/MA copolymer were studied in the initial stage of the method development. The acid resistance was tested with a cola drink challenge. Finally, a blinded study was carried out to determine the occlusion of the arginine mouthwash in comparison to a negative control mouthwash. RESULTS: Dentine discs treated with the arginine mouthwash showed an average fluid reduction of 42%, which was statistically, significantly better than the fluid reduction for the negative control mouthwash. In addition, experiments using simple solutions of arginine and PVM/MA copolymer, alone and in combination, demonstrated that the combination of the two was required to provide a relevant occlusion benefit. Finally, the occlusion provided by the arginine mouthwash was maintained after exposure to an acid challenge. CONCLUSION: The exclusive combination of ingredients in the arginine mouthwash has been proven to be efficacious in decreasing dentine fluid flow as measured by hydraulic conductance. The new mouthwash works by occlusion, due to the unique combination of arginine, PVM/MA copolymer and pyrophosphates.

Mode of action studies of a new desensitizing mouthwash containing 0.8% arginine, PVM/MA copolymer, pyrophosphates, and 0.05% sodium fluoride.

OBJECTIVE: The mode of action of an arginine mouthwash using the Pro-Argin™ Mouthwash Technology, containing 0.8% arginine, PVM/MA copolymer, pyrophosphates and 0.05% sodium fluoride, has been proposed and confirmed as occlusion using a variety of in vitro techniques. METHODS: Quantitative and qualitative laboratory techniques were employed to investigate the mode of action of the new arginine mouthwash. Confocal laser scanning microscopy (CSLM) and atomic force microscopy (AFM) investigated a hydrated layer on dentine surface. Electron spectroscopy for chemical analysis (ESCA), secondary ion mass spectroscopy (SIMS) and near-infrared spectroscopy (NIR) provided information about its chemical nature. RESULTS: CLSM was used to observe the formation of a hydrated layer on exposed dentine tubules upon application of the arginine mouthwash. Fluorescence studies confirmed penetration of the hydrated layer in the inner walls of the dentinal tubules. The AFM investigation confirmed the affinity of the arginine mouthwash for the dentine surface, supporting its adhesive nature. NIR showed the deposition of arginine after several mouthwash applications, and ESCA/SIMS detected the presence of phosphate groups and organic acid groups, indicating the deposition of copolymer and pyrophosphates along with arginine. CONCLUSION: The studies presented in this paper support occlusion of the dentine surface upon the deposition of an arginine-rich layer together with copolymer and phosphate ions from an alcohol-free mouthwash containing 0.8% arginine, PVM/MA copolymer, pyrophosphates and 0.05% sodium fluoride.

In vitro antibacterial efficacy of cetylpyridinium chloride-containing mouthwashes.

OBJECTIVE: The objective of this study was to examine the ability of three CPC-containing mouthwashes to kill planktonic bacteria in an in vitro short-exposure assay. METHODS: This blind study was conducted on two common oral bacterial species: Aggregatibacter (Actinobacillus) actinomycetemcomitans and Streptococcus mutans. The following mouthwashes were tested: two containing 0.075% CPC and 0.05% NaF in an alcohol-free base, and one containing 0.075% CPC and 0.05% NaF plus 6% alcohol. Additionally, a 0.05% NaF-only mouthwash was included as a negative control. Bacteria were exposed to one of the test mouthwashes for 30 seconds and then washed thoroughly, serially diluted, and plated on appropriate media to determine viable bacterial counts. Viable counts were converted to a log reduction in colony forming units (CFUs) relative to the negative control. RESULTS: All three test mouthwashes included in this study gave a statistically significant reduction of > 3 log CFUs relative to samples treated with the negative control. CONCLUSION: All three experimental 0.075% CPC mouthwash formulas gave a > 99.9% reduction in viable bacteria of both species following 30 seconds of treatment.

Efficacy of an alcohol-free CPC-containing mouthwash against oral multispecies biofilms.

OBJECTIVE: The aim of this work was to develop two static-model multispecies oral biofilm systems to compare the efficacy of a placebo mouthwash to an alcohol-free mouthwash containing 0.075% CPC. METHODS: Two model biofilm systems were used: a 24-well glass-bottom microplate (GM) system and a chamber slide (CS) system. These were inoculated with Schaedler media containing pooled, unfiltered saliva. During incubation at 37 degrees C in 5% CO2, Schaedler media was replaced every 24 hours. Five-day and 10-day multispecies biofilms in the GM and CS systems were then exposed to phosphate buffered saline, the placebo mouthwash, or the alcohol-free 0.075% CPC-containing mouthwash. Biofilms were visualized in three-dimensions by Confocal Laser Scanning Microscopy (CLSM), and fluorometric analyses were performed on biofilms in the GM system. RESULTS: CLSM demonstrated that regardless of the model system used, the alcohol-free 0.075% CPC-containing mouthwash solution increased the number of damaged biofilm cells. The efficacy of CPC was inversely related to the age of the biofilm. A contrariety between the two biofilm systems was that the CS system indicated that alcohol-free 0.075% CPC-containing mouthwash partially disrupted biofilms. Fluorometric analysis ofGM biofilms also demonstrated that the alcohol-free 0.075% CPC-containing mouthwash damaged biofilm cells. CONCLUSION: Two static oral multispecies model biofilms systems demonstrated that an alcohol-free 0.075% CPC-containing mouthwash had greater antimicrobial efficacy than a placebo mouthwash. The alcohol-free 0.075% CPC-containing formulation is effective against multispecies oral biofilms.

Evaluation of the antiplaque efficacy of two cetylpyridinium chloride-containing mouthwashes.

OBJECTIVE: The purpose of this clinical study was to evaluate the efficacy in reducing dental plaque regrowth of two mouthwashes containing 0.075% cetylpyridinium chloride (CPC), one with 6% alcohol and one alcohol-free, as compared to a negative control mouthwash without CPC, using the Modified Gingival Margin Plaque Index (MGMPI). METHODS: The study was a double-blind, randomized, three-way crossover, controlled design. Following a washout period, subjects reported to the dental clinic where they were instructed to brush their teeth, used their assigned mouthwash, and were scored by the examining dentist for plaque using the MGMPI method. Subjects were instructed to refrain from all oral hygiene for the next 24 hours, except for rinsing with their assigned mouthwash 12 hours post-brushing. After this 24-hour period, subjects returned to the dental clinic and were once again scored for plaque. This sequence of washout followed by mouthwash use and plaque scoring was repeated until each subject had used all three mouthwashes. An ANOVA was conducted to assess between-group differences. RESULTS: The two test mouthwashes significantly reduced plaque regrowth over a 24-hour period (p < 0.05) as compared to the negative control mouthwash. The difference between the CPC-containing mouthwashes was not significant (p = 0.4868). CONCLUSION: Two mouthwashes containing 0.075% CPC, one with 6% alcohol and the other alcohol-free, were found to be safe and effective in reducing plaque accumulation when compared a negative control mouthwash without CPC. In short-term studies, the MGMPI appears useful for evaluating the antiplaque efficacy of mouthwash products.

A comparative investigation to evaluate the clinical efficacy of an alcohol-free CPC-containing mouthwash as compared to a control mouthwash in controlling dental plaque and gingivitis: a six-month clinical study on adults in San Jose, Costa Rica.

OBJECTIVE: This study was designed to evaluate the clinical efficacy of an antiplaque alcohol-free mouthwash containing 0.075% cetylpyridinium chloride (CPC) and 0.05% sodium fluoride (NaF), as compared to a control mouthwash containing only 0.05% NaF, in controlling established dental plaque and gingivitis after three and six months of product use. METHODS: This was a single-center, parallel-group, two-cell, double-blind, randomized clinical study. Prospective adult male and female subjects from San Jose, Costa Rica reported to the clinical facility having refrained from all oral hygiene procedures for 12 hours, and from eating, drinking, or smoking for four hours prior to their visit. Qualifying subjects who presented with Gingival Index scores (Löe and Silness Index) of at least 1.0 and Plaque Index scores (Turesky Modified Quigley-Hein Index) of at least 1.5 were allowed to participate in this study. Subjects were randomly assigned to one of two treatment groups according to their baseline gingival and plaque scores. In the first treatment group (Test), subjects used an alcohol-free mouthwash containing 0.075% CPC and 0.05% NaF, whereas in the second treatment group (Control), subjects used a mouthwash containing only 0.05% NaF. Gingivitis and plaque assessments, and examinations of oral hard and soft tissues were conducted after three months and six months of product use. RESULTS: One-hundred and ten (110) subjects complied with the protocol and completed the six-month study. After six months of product use, the Test Mouthwash group exhibited statistically significant reductions from baseline with respect to Gingival (33.5%), Gingival Interproximal (34.5%), Gingival Severity (63.2%), Plaque (33.6%), Plaque Interproximal (30.0%), and Plaque Severity (73.6%) Index scores. After six months of product use, the Control Mouthwash group exhibited statistically significant increases from baseline with respect to Gingival (6.9%), Plaque Interproximal (7.2%), and Plaque Severity (32.7%) Index scores. Furthermore, after six months of product use, the Control Mouthwash group exhibited reductions from baseline with respect to Plaque (6.1%), Gingival Interproximal (3.6%), and Gingival Severity (1.1%) Index scores which were not statistically significant. After three months of product use, the Test Mouthwash group exhibited statistically significant reductions in Gingival (25.0%), Gingival Interproximal (22.3%), Gingival Severity (38.9%), Plaque (26.1%), Plaque Interproximal (22.4%), and Plaque Severity (75.0%) Index scores as compared to the Control Mouthwash group. After six months of product use, the Test Mouthwash group exhibited statistically significant reductions in Gingival (38.1%), Gingival Interproximal (37.1%), Gingival Severity (63.6%), Plaque (36.5%), Plaque Interproximal (33.2%), and Plaque Severity (78.5%) Index scores as compared to the Control Mouthwash group. CONCLUSION: The results of this double-blind clinical study support that 1) an alcohol-free mouthwash containing a combination of 0.075% CPC and 0.05% NaF produces statistically significant reductions in dental plaque and gingivitis after three and six months compared to baseline, and 2) the alcohol-free CPC mouthwash provides a statistically significantly greater level of efficacy in controlling established dental plaque and gingivitis after three and six months of product use as compared to the Control Mouthwash containing only NaF.