Delivery Challenges for Fluoride, Chlorhexidine and Xylitol

Delivery Challenges for Fluoride, Chlorhexidine and Xylitol
Published online 2006 June 15
John DB Featherstone1
BMC Oral Health
PubMed Central

Copyright © 2006 Featherstone.; licensee BioMed Central Ltd.

1Department of Preventive and Restorative Dental Sciences, University of California at San Francisco, San Francisco, CA, USA

Corresponding author.
John DB Featherstone: jdbf@ucsf.edu

Supplement
Biotechnology and Biomaterials to Reduce the Caries Epidemic
Rebecca L Slayton, James D Bryers, Peter Milgrom
http://www.biomedcentral.com/content/pdf/1472-6831-6-S1-info.pdf

Conference
Biotechnology and Biomaterials to Reduce the Caries Epidemic
13Ò15 June 2005
Seattle, USA

This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

AbstractThe progression or reversal of dental caries is determined by the balance between pathological and protective factors. It is well established that a) fluoride inhibits demineralization and enhances remineralization, b) chlorhexidine reduces the cariogenic bacterial challenge, and c) xylitol is non-cariogenic and has antibacterial properties. The challenge that we face is how best to deliver these anti-caries entities at true therapeutic levels, over time, to favorably tip the caries balance. High caries risk people, including children with Early Childhood Caries (ECC), are a special challenge, since high cariogenic bacterial activity can override fluoride therapy. Current fluoride and chlorhexidine varnishes deliver all their activity within about 24 hours. Early studies with experimental slow release fluoride devices retained elevated levels of fluoride for months in a therapeutic range but have not been pursued. Preventive dentistry has largely ignored the benefits of reducing the bacterial challenge, partially due to primitive and inadequate delivery systems. For example, Chlorhexidine applied as a rinse partially reduces some bacteria but not others that are hiding within the biofilm. Better antibacterials and better delivery systems are needed. Xylitol delivered by gum or lozenge appears to be effective clinically in reducing cariogenic bacteria and caries levels, but novel systems that deliver therapeutic amounts when needed would be a major advance, especially for young children. Reducing the cariogenic bacterial challenge and enhancing the effect of fluoride by the use of new sustained-delivery systems would have a major effect on dealing with caries as a disease.

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