Biotene

Biotene (typeset as biotène) is a dental hygiene product originally manufactured by Laclede Inc. but now marketed by GlaxoSmithKline. It comes in a number of forms, including toothpaste, mouthwash and gel.

Ingredients

Regular

The main active ingredient in its toothpastes is sodium monofluorophosphate, and prior to the GlaxoSmithKline acquisition it also contained enzymes including glucose oxidase, lactoferrin, lactoperoxidase and lysozyme.

PBF

The PBF ORAL RINSE (plaque biofilm) product contains the enzymes mutanase, dextranase, lysozyme, lactoperoxidase, and glucose oxidase.[1]

Benefits

Patients with xerostomia (dry mouth) may use Biotène to reduce the rate of recurrence of dental plaque. However, Biotene by itself does not significantly reduce the count of Streptococcus mutans which is the primary initiator of the formation of dental plaque.[2]

The first benefit of Biotène is to relieve symptoms of dry mouth by providing moisturizing relief. Dry mouth can be caused by multiple factors affecting the salivary gland. Factors increasing the frequency of this occurrence in aging individuals include taking multiple medications, previous radiation treatments to the head and neck area, or usage of removable denture prosthesis.[1] By keeping the mouth moisturized, Biotène prevents various complications that can arise from prolonged dry mouth. For example, dry mouth results in the impairment of the antimicrobial properties of saliva, which increases the risk of opportunistic infections.[1] Moreover, the oral lubrication property of Biotène gel has the potential to provide relief during swallowing for individuals suffering from dry mouth. By improving the lubrication of the oropharyngeal mucosa, Biotène can facilitate swallowing and decrease the chances of developing dysphagia.[2] Evidence has shown that perceived swallowing effort was found to decrease significantly following application of a saliva substitute.[2]

Secondly, Biotène compensates for decreased salivary composition. Low salivary flow associated with dry mouth compromises the composition, and beneficial properties necessary for maintaining the health of the oral cavity. Lack of saliva reduces antibacterial actions, which leads to disruption of the oral pH; consequently allowing cariogenic microorganisms to grow and colonize the oral cavity.[3] When stimulation of salivary secretion fails, palliative oral care in the form of mouthwashes and saliva substitutes can be used to counterbalance the lack of initial salivary function. Varying saliva substitutes containing different enzymes proteins, such as those found in Biotène products, reduce oral infection and enhance mouth wetting.[4] Moreover, Biotène mouth rinses have shown inhibitory effects on growth of preformed biofilms on certain tested bacterial and fungal strains.[1,3] On the other hand, it is important to note that Biotène alone does not act via prevention of plaque build-up mechanism or antimicrobial chemotherapeutic mechanism.[3]

Finally, Biotène increases one’s quality of life. If the symptoms of dry mouth are not properly managed, the individual may experience anxiety, depression, low confidence, or embarrassment.[5] High prevalence of frail elderly individuals experience dry mouth, but it is also common in the comparatively healthy elderly primarily due to their increased use of drugs from susceptibility to disease.[6] Furthermore, saliva is an essential component of the oral cavity; lack of this fluid can manifest with symptoms such as a sticky, dry, or burning feeling in the mouth; increased risk of oral candidiasis and other oral infections, including dental caries.[3] Lubricating mouthwashes or gels, such as Biotène, can relieve pain within the oral mucosa, thus increasing the individual’s quality of life.[4] In addition, dry mouth may contribute to the development of dysphagia, or swallowing difficulty. When individuals perceive more effort with swallowing, they may avoid eating or try to limit their dietary intake in ways that do not support adequate nutrition.[2] Efficient control of dry mouth symptoms with the usage of Biotène products has the ability to reduce swallowing effort; hence improving quality of life.

Biotène brand products

The products are composed of toothpaste, mouthwash, spray and gel. Each of these play an individualized role in helping keep the oral cavity moisturized throughout the day or night. The four products are categorized by their main function.

The Biotène Moisturizing Mouth Spray and the Biotène Oral balance Moisturizing Gel are products for an individual requiring immediate relief. The Biotène Moisturizing Mouth Spray will provide instant moisturizing by directly spraying it into the mouth onto the surface of the tongue. The spray contains a high concentration of moisturizers and lubricants that provide moisturization for up to two hours, and also helps freshen the breath with its mild mint flavour. This product is to be used throughout the day as needed. The Biotène Oral balance Moisturizing Gel provides soothing relief from dry mouth by placing 1 to 2 cm of gel directly on the tongue and spreading it thoroughly inside the mouth. It provides a long-lasting relief from the feeling of dryness while sleeping, and lubricates the mouth to aid in swallowing food. The gel also has a pH similar to natural saliva, which contributes to a healthy environment for the teeth and soft tissues in the oral cavity.

On the other hand, if an individual requires a constant relief in their daily routine, the otions are Biotène Fresh Mint Toothpaste or the Biotène Moisturizing Mouthwash. The Biotène Fresh Mint Toothpaste provides extra protection for the mouth and teeth, and is specially formulated to be gentle and non-irritating. The toothpaste has a pH similar to saliva and contains fluoride, thus creating an environment protecting teeth against decay and bad breath.[5] This product is to be used with daily brushing, 2 to 4 times, or as directed by a healthcare professional. Like any other toothpaste, this product is not meant to be swallowed as it contains fluoride. Lastly, the Biotène Moisturizing Mouthwash will provide relief from dry mouth symptoms. This mouthwash is alcohol-free and immediately refreshes and moistens the mouth to help maintain a healthy oral environment by containing a high concentration of moisturizers and lubricants. Similarly to the toothpaste, the mouthwash helps maintain a neutral pH in the mouth, which contributes to the health of oral tissues. The mouthwash can be used in combination with the Biotène Fresh Mint Toothpaste. The instructions for this product are to use approximately 15mL of Biotène Moisturizing Mouthwash for 30 seconds after toothbrushing. This can be done up to 5 times per day, unless indicated otherwise by the healthcare professional.

Mechanism of action

Biotène mouthwash is especially beneficial to individuals experiencing dry mouth or having oral irritations. The main goal of Biotène products is to provide dry mouth relief. The three primary enzymes in Biotène are Glucose Oxidase, Lactoperoxidase, and Lysozyme.[8] Through antibacterial and healing properties creating a natural protection within the oral cavity, these enzymes are balanced to function to boost and replenish an individual’s salivary defenses.[9]

The reduced antibacterial actions of saliva due to the lack of saliva in some individuals can lead to disruption of the oral pH, allowing cariogenic microorganisms to grow and colonize the oral cavity. [3] For individuals with xerostomia, a commercially available mouthrinse that can be safely used daily to aid in dry mouth relief is essential in oral health maintenance. Various commercially available mouthrinses have been tested on their inhibitory effects on biofilm formation over a 24h period.[1] By slowing the formation of biofilm formation, individuals who use Biotène may reduce the risk of dental caries and other oral diseases that may occur from xerostomia and bacterial accumulation, thus aiding in improving oral and overall health for the long term. However, not all studies support the claim that Biotène makes. For instance, Peridex mouthrinse, an antimicrobial chlorhexidine-based formulation, demonstrated significantly greater prevention of plaque regrowth when compared with water and the enzyme-based Biotène mouthrinse.[3]

References

  1. ↑ "Biotene website".
  2. ↑ Lehane RJ, Murray PA, Deasy MJ (1997). "Effect of an enzymatic rinse on salivary levels of Streptococcus mutans and lactobacilli in periodontally treated patients". Periodontal Clinical Investigations. 19 (2): 17–21. PMID 9495936.

1.^ Taiji, O., Mariko, H., Kazunori, I., Shigetada, K., & Yoshinobu, M. (2017). “Microbiological assessment of effects of clinical mouth rinses on common oral microbes”. Journal Of Oral Science, 59(3), 391-395. doi:10.2334/josnusd.16-0417

2.^ Rogus-Pulia, N.M., Gangnon, R., Kind, A. et al. Dysphagia (2017). “A Pilot Study of Perceived Mouth Dryness, Perceived Swallowing Effort, and Saliva Substitute Effects in Healthy Adults Across the Age Range”. https://doi-org.login.ezproxy.library.ualberta.ca/10.1007/s00455-017-9846-7

3.^Nehme, M., Malpass, K., Butler, A., Mason, S., Kleber, C., Milleman, K., et al. “A Randomized, Crossover Trial to Evaluate the Effect of Two Mouthrinses on Plaque Regrowth in the Absence of Brushing”. International Journal Of Periodontics & Restorative Dentistry [serial on the Internet]. (n.d.), [cited October 16, 2017]; 35(3): 387-393. Available from: Science Citation Index.

4.^NieuwAmerongen, A.; Veerman, E. (2003). “Current therapies for xerostomia and salivary gland hypofunction associated with cancer therapies”. Support Care Cancer, 11: 226.

5.^Turner, M. D., & Ship, J. A. (2007). “Dry Mouth and Its Effects on the Oral Health of Elderly People”. The Journal Of The American Dental Association, 138(Supplement 1), S15-S20. doi:10.14219/jada.archive.2007.0358

6.^Ikebe, K., Matsuda, K., Morii, K., Wada, M., Hazeyama, T., Ettinger, R., et al. “Impact of dry mouth and hyposalivation on oral health-related quality of life of elderly Japanese”. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology & Endodontology [serial on the internet]. (2007, Feb), [cited October 23, 2017]; 103(2): 216-222.

7.^Warde, P., Kroll, B., O'Sullivan, B. et al. “A phase II study of Biotène in the treatment of postradiation xerostomia in patients with head and neck cancer”. Support Care Cancer (2000) 8: 203.https://doi-org.login.ezproxy.library.ualberta.ca/10.1007/s005200050286https://link-springer-com.login.ezproxy.library.ualberta.ca/content/pdf/10.1007%2Fs005200050286.pdf

8.^ Gil-Montoya, J. A., Guardia-López, I. and González-Moles, M. A. (2008). “Evaluation of the clinical efficacy of a mouthwash and oral gel containing the antimicrobial proteins lactoperoxidase, lysozyme and lactoferrin in elderly patients with dry mouth – a pilot study”. Gerodontology, 25: 3–9. doi:10.1111/j.1741-2358.2007.00197.xhttp://onlinelibrary.wiley.com.login.ezproxy.library.ualberta.ca/doi/10.1111/j.1741-2358.2007.00197.x/full

9.^Kocak, M.M., Ozcan, S., Kocak, S., Topuz, O., Erten, H. (2009). “Comparison of the Efficacy of Three Different Mouthrinse Solutions in Decreasing the Level of Streptococcus Mutans in Saliva”. European Journal of Dentistry, 3(1):57-61.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2647960/

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