CITROX Perio Plus+

Interview: CITROX® and polylysine allow us to reduce the amount of chlorhexidine while still maintaining the same efficacy

Chemist and Perio Plus+ developer Christoph Fiolka at the laboratory where Perio Plus+ was developed. (Photograph: CURADEN)

Despite being the most trusted and best-documented oral antiseptic, chlorhexidine has a number of side effects. That is why after a long period of tests and studies, CURADEN has developed CURAPROX Perio Plus+, a range of oral antiseptics which naturally improve chlorhexidine by reducing its side effects and enhancing its antibacterial properties. How is this done? By a combination of two organic antibacterials: CITROX® and polylysine. Chemist Christoph Fiolka is the brains behind Perio Plus+ and by far the best specialist to address how the natural ingredients of Perio Plus+ could revolutionise mouthwash therapy.

Mr Fiolka, what was the motivation for developing Perio Plus+?
Well, you must realise that one sign of a good mouthrinse is good substantivity. It has to have a long-lasting effect, so patients can rinse with the mouthwash—usually twice a day—and enjoy full protection all day. For a long time, chlorhexidine was the only component we knew of which offered this long-lasting antibacterial effect. The starting point for Perio Plus+ was when we realised that a combination of CITROX® and polylysine was doing the same thing in offering this long-lasting antibacterial effect.

What are the main ingredients of Perio Plus+?
There are a few important components. Of course, there is CITROX®, which is actually a natural antiseptic agent derived from bitter oranges, so it’s a very natural extract and something we regularly eat in daily life. Then, we added polylysine, which is another organic antibacterial. Then there is xylitol, which protects against cavities. Perio Plus+ REGENERATE, Perio Plus+ FOCUS and Perio Plus+ SUPPORT also contain hyaluronic acid, which supports tissue regeneration, and this is obviously very useful after surgery.

How do these substances naturally improve chlorhexidine?
CITROX® and polylysine not only enhance the antibacterial effect of chlorhexidine, but also reduce its side effects in Perio Plus+, as these natural antiseptics allow us to reduce the amount of chlorhexidine as a whole while still maintaining the same efficacy. As a result, we are able to bring the chlorhexidine concentration down in those products which are to be used where we really want tissue regeneration after surgery. Chlorhexidine is known to somewhat slow down the healing process, so where it is necessary, we reduce the chlorhexidine level, and add the natural antiseptics, or hyaluronic acid to support tissue generation.

What is CITROX®’s effect in the mouth?
Well, CITROX® is a blend of different components, most notably bioflavonoids. These bioflavonoids can be found in nature, where they are produced by plants to protect them against microbial infections. As a mouthrinse ingredient, CITROX® acts against and restricts bacterial growth, but the beautiful thing is that it does so naturally. Moreover the components of CITROX® are already part of our daily nutrition, so we are adapted to them and there are no side effects to be expected.

For what purpose should Perio Plus+ be used?
Perio Plus+ is definitely a problem-solver rather than something you can use every day. The range is meant for patients with oral infections or inflammation, so you can use it for the treatment of gingivitis, periodontitis or peri-implantitis or the prophylaxis of those diseases.For people who are actually healthy, correct mechanical cleaning is enough.

Lastly, what makes the CITROX® and polylysine mix so unbeatable?
Well, CITROX® alone cannot stick to gums and teeth. The polylysine does so very easily and actually holds the CITROX® in place. The result of this CITROX® and polylysine combination is a long-term antibacterial effect that makes it possible to rinse twice a day for full-day protection. Substantivity is key here.

We have received a lot of academic support from the very beginning. We collaborated closely with universities in the UK and Canada, and later with researchers in Germany and Switzerland. We will continue to research CITROX®; it is definitely an ongoing research project. Of course, we know it enhances the antibacterial effect of chlorhexidine and can be used to reduce its side effects, but there is still so much to learn about the CITROX® and polylysine combination, and this is just the starting point.

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