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Cited by 60Oral microbiology and periodontitis researchAntifungal resistance and susceptibilityDental Health and Care Utilization

In vitro effects of commercial mouthwashes on several virulence traits of Candida albicans, viridans streptococci and Enterococcus faecalis colonizing the oral cavity.

Open access
Ardizzoni, Andrea, Pericolini, Eva, Paulone, Simona, Orsi, Carlotta Francesca, Castagnoli, Anna, Oliva, Ilaria, Strozzi, Elena, Blasi, Elisabetta·2018·PLoS ONE
DOI 10.1371/journal.pone.0207262PMC PMC6237365
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Abstract

Oral microbiota consists of hundreds of different species of bacteria, fungi, protozoa and archaea, important for oral health. Oral mycoses, mostly affecting mucosae, are mainly caused by the opportunistic pathogen Candida albicans. They become relevant in denture-wearers elderly people, in diabetic patients, and in immunocompromised individuals. Differently, bacteria are responsible for other pathologies, such as dental caries, gingivitis and periodontitis, which affect even immune-competent individuals. An appropriate oral hygiene can avoid (or at least ameliorate) such pathologies: the regular and correct use of toothbrush, toothpaste and mouthwash helps prevent oral infections. Interestingly, little or no information is available on the effects (if any) of mouthwashes on the composition of oral microbiota in healthy individuals. Therefore, by means of in vitro models, we assessed the effects of alcohol-free commercial mouthwashes, with different composition (4 with chlorhexidine digluconate, 1 with fluoride, 1 with essential oils, 1 with cetylpyridinium chloride and 1 with triclosan), on several virulence traits of C. albicans, and a group of viridans streptococci, commonly colonizing the oral cavity. For the study here described, a reference strain of C. albicans and of streptococci isolates from pharyngeal swabs were used. Chlorhexidine digluconate- and cetylpyridinium chloride-containing mouthwashes were the most effective in impairing C. albicans capacity to adhere to both abiotic and biotic surfaces, to elicit proinflammatory cytokine secretion by oral epithelial cells and to escape intracellular killing by phagocytes. In addition, these same mouthwashes were effective in impairing biofilm formation by a group of viridans streptococci that, notoriously, cooperate with the cariogenic S. mutans, facilitating the establishment of biofilm by the latter. Differently, these mouthwashes were ineffective against other viridans streptococci that are natural competitors of S. mutans. Finally, by an in vitro model of mixed biofilm, we showed that mouthwashes-treated S. salivarius overall failed to impair C. albicans capacity to form a biofilm. In conclusion, the results described here suggest that chlorhexidine- and cetylpyridinium-containing mouthwashes may be effective in regulating microbial homeostasis of the oral cavity, by providing a positive balance for oral health. On the other side, chlorhexidine has several side effects that must be considered when prescribing mouthwashes containing this molecule.

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  • Mouthwash containing chlorhexidine (0.02%) or CPC can impair both the biofilm formation of viridans streptococci and the adhesion, proinflammatory effects, and immune escape abilities of Candida albicans.

    “Mouthwash containing chlorhexidine (CHX, 0.02%) or CPC have the ability to impair both the biofilm formation of viridans streptococci and the adhesion, proinflammatory effects, and immune escape abilities of Candida albicans (Ardizzoni et al., 2018).”

    From Oral Microbiome and SARS-CoV-2: Beware of Lung Co-infection (2020) · cites this paper as Ardizzoni et al., 2018

  • Povidone iodine (0.23-1%), cetylpyridinium chloride (0.05-0.10%), and hydrogen peroxide (0.5-1.5%) all effectively reduce the number of oral microbiota.

    “Povidone iodine (PV-I, 0.23∼1%), cetylpyridinium chloride (CPC, 0.05∼0.10%), and hydrogen peroxide (0.5∼1.5%) all effectively reduce the number of oral microbiota (Ardizzoni et al., 2018; Eggers et al., 2018; Li and Meng, 2020).”

    From Oral Microbiome and SARS-CoV-2: Beware of Lung Co-infection (2020) · cites this paper as Ardizzoni et al., 2018

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Authors
Ardizzoni, A., Pericolini, E., Paulone, S., Orsi, C. F., Castagnoli, A., Oliva, I., Strozzi, E., & Blasi, E.
Affiliations
University of Modena and Reggio Emilia (IT)
Corresponding author
Ardizzoni, Andrea
ORCID
Venue
PLoS ONE
Publisher
Public Library of Science (PLoS)
Published
2018-11-15
Volume
13
Issue
11
Pages
e0207262
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0207262
PMC
PMC6237365
OpenAlex
W2901658451
Cited by
58
References
60
Citations by year
2026: 2 · 2025: 3 · 2024: 9 · 2023: 8 · 2022: 10 · 2021: 13 · 2020: 8 · 2019: 5
FWCI
7.46
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • IRIS UNIMORE (University of Modena and Reggio Emilia) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Recordati S.p.A.
Topics
  • Health Sciences › Dentistry › Periodontics › Oral microbiology and periodontitis research
  • Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
  • Health Sciences › Dentistry › Periodontics › Dental Health and Care Utilization
Keywords
mouthwash, Candida albicans, Streptococcus viridans, Enterococcus faecalis, oral microbiota, chlorhexidine, cetylpyridinium chloride, triclosan, essential oils, fluoride, biofilm formation, bacterial adhesion, inflammatory cytokines, phagocyte killing, Streptococcus mutans, Streptococcus salivarius, oral hygiene, polymicrobial biofilms, oral colonization, dental caries, periodontitis, gingivitis
MeSH terms
Animals, Anti-Infective Agents, Local, Candida albicans, Cell Adhesion, Cell Line, Epithelial Cells, Homeostasis, Humans, Mouth, Mouthwashes, Phagocytosis, Enterococcus faecalis, Virulence, Microglia, Biofilms, Viridans Streptococci, Mice

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