Studies

A new study on Perio plus: Even low concentrations of CHX with additives are more effective against biofilm than pure CHX

A study recently published by researchers from the University of Bern in Switzerland brought important findings on one of the most frequently used ingredients in dental care – chlorhexidine digluconate (CHX), and the relatively newly discovered Citrox, both of which occur in Curaprox’s Perio plus range of mouthwashes, toothpaste and oral gel. According to the study, Perio plus formulations have a stronger effect on plaque regrowth than solutions with the same amount of CHX but no additional ingredients.

How do CHX and Citrox act in favour of oral health?

CHX is an effective and broad-spectrum biocide, antiseptic and disinfectant agent that combats a wide range of gram-negative and gram-positive bacteria, yeasts, fungi, and many other kinds of microorganisms. The beneficial effects of CHX are confirmed as having a significant effect on dental plaque formation and accumulation, and therefore are used in prophylaxis and treatment of dental caries, gingivitis and periodontitis. There are various concentrations of this formula in many specialised oral care products, suitable for both short- and long-term use.

A lesser-known ingredient is Citrox, which is a formulation of soluble bioflavonoids obtained from bitter oranges, with a documented broad-spectrum of antimicrobial, antiviral and antifungal activities against microorganisms present in the mouth. Furthermore, Citrox is praised for its non-toxicity, non-allergenicity, having no taste-alteration properties, and no negative effect on teeth colorisation.

The study by the University of Bern shows that Citrox combined with poly-L-lysine and CHX in the formulation of Perio plus supports the anti-biofilm activity, and that this mixture can be even more effective than pure CHX of the same concentration.

The study aimed to analyse, in vitro, new formulations with Citrox and CHX regarding their antibacterial activity against planktonic bacteria, and their potential to inhibit biofilm formation or act on existing biofilms.

What formulations have been tested?

The experiment was based on testing five oral health care products with CHX: four rinsing formulations and one gel – all of which were from the Perio plus product line by Curaden.

The mouthwashes contained: 

And the gel formulation:

All of the tested Perio plus products contained CHX, Citrox and poly-L-lysine, xylitol, and PVP-VA.

The negative control was 0.9% w/v NaCl solution; the positive controls were CHX solutions without additives at three different CHX concentrations.

How the researchers approached the analysis

Fifteen different bacterial strains were used in the experiments, in two settings – the first set was designed to mimic cariogenic biofilm and the second was designed to emulate periodontal biofilm. The cariogenic biofilm was formed of all streptococcal strains, A. naeslundii and L. acidophilus. The periodontal biofilm consisted of S. gordonii, A. naeslundii, Fusobacterium nucleatum, C. rectus, P. micra, E. corrodens, P. intermedia, C. gingivalis, P. gingivalis, T. forsythia, F. alocis, and T. denticola.

Two different experimental designs were conducted – the application of a mouth rinse after mechanical removal of biofilm to show the influence on biofilm formation, and the application on an established biofilm.

Key findings: Even low concentrations of CHX with additives are effective

The results have shown that Perio plus CHX formulations were effective against the selected oral bacteria responsible for biofilm masses that are known to cause periodontal disease. The most important finding is that even the low-concentration CHX formulations with additives slowed down cariogenic biofilm formation to a greater extent than additive-free solutions with the same or even higher concentration of CHX.

The exact strength of anti-biofilm properties depended on the CHX concentration contained in the tested formulations. In the case of the 0.2% CHX concentration (Perio plus forte), there was a proven effect even in its activity on already existing biofilm.

New approach for home-based fighting against dental plaque

The findings of the study demonstrated that the unique formula of Perio plus is clinically proven to be more effective than CHX alone in means of limiting the formation of oral biofilm. Overall, the activity of the these advanced CHX formulations and solutions was highly effective in the case of reducing biofilm formation, but less so on periodontal biofilm that has already formed.

Therefore, it is important to emphasise the importance of proper mechanical removal of biofilm by scaling and root planing in the initial therapy of periodontitis. For more-effective home treatment, these procedures can be followed with the application of tested Perio plus CHX and Citrox formulas, since it has been clinically proven that they are beneficial in the fight against oral microorganisms that cause many common dental diseases.

New findings about the Perio plus products and their effect on biofilm:

  • Perio plus forte mouth rinse (0.2% CHX) and Perio plus focus gel (0.5% CHX) were the only solutions out of all those tested that significantly reduced the activity of cariogenic biofilm
  • Perio plus forte killed all cariogenic bacteria in established biofilm
  • Perio plus protect mouth rinse (0.12% CHX) was equally as effective as a pure concentration of 0.2% CHX in delaying biofilm growth
  • All products from the Perio plus range can also reduce biofilm masses that are known to cause periodontal disease

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