Department of Stomatology, School of Dentistry, University of São Paulo, Sao Paulo, Brazil.
Int J Dent Hyg. 2023 Feb;21(1):128-140. doi: 10.1111/idh.12617. Epub 2022 Aug 19.
This review aimed to assess the impact of mouthwashes on the composition of the human oral microbiome.
An electronic search algorithm was adapted to MEDLINE-PubMed, Scopus, Embase and ISI Web of Science, and reference lists of relevant sources were manually searched. Inclusion criteria were controlled clinical trials published in English whose population were adult individuals who rinse with antimicrobial mouthwashes and that analysed changes in the oral microbiome by metataxonomy, metagenomics or phylogenetic microarray. Identified studies were screened and assessed following the PRISMA guidelines, and results were compiled into qualitative synthesis of the evidence.
Five controlled clinical studies were included. These studies found associations between the daily use of mouthwashes and changes in the oral microbiome, but the nature of the effect varied according to the mouthwash. Chlorhexidine (CHX) rinses lowered microbial diversity. While 7-day use of CHX led to increases in the abundance of Neisseria, Streptococcus and Granulicatella and a decrease in the abundance of Actinomyces, its prolonged use led to widespread reductions in several genera and species. Cetylpyridinium chloride-containing mouthwashes specifically lowered the abundance of gingivitis-associated genera. In contrast, N-acetyl cysteine-based mouthwashes did not promote changes in the oral microbiome.
Despite substantial heterogeneity, we found evidence to support the hypothesis that CHX and CPC mouthwashes promote changes in oral microbial structure and/or reductions in community diversity that favour the resolution of dysbiosis. However, future large population-based studies of adequate duration are needed to fully understand the extent to which antimicrobial mouthwashes modulate the microbiome.
本综述旨在评估漱口水对人类口腔微生物组组成的影响。
采用电子搜索算法对 MEDLINE-PubMed、Scopus、Embase 和 ISI Web of Science 进行检索，并手动搜索相关来源的参考文献列表。纳入标准为发表在英文期刊上的、以成年个体为研究对象的、采用抗微生物漱口水漱口并通过分类学、宏基因组学或系统发育微阵列分析口腔微生物组变化的对照临床试验。根据 PRISMA 指南筛选和评估确定的研究，并对证据进行定性综合。
纳入了 5 项对照临床试验。这些研究发现，每日使用漱口水与口腔微生物组的变化之间存在关联，但影响的性质因漱口水的不同而有所不同。洗必泰（CHX）漱口水降低了微生物多样性。虽然 CHX 连续使用 7 天会增加奈瑟菌、链球菌和颗粒链球菌的丰度，并降低放线菌的丰度，但长期使用会导致几个属和种的广泛减少。含氯化十六烷基吡啶的漱口水特异性降低了与牙龈炎相关的属的丰度。相比之下，基于 N-乙酰半胱氨酸的漱口水不会促进口腔微生物组的变化。
尽管存在很大的异质性，但我们有证据支持这样的假设，即 CHX 和 CPC 漱口水促进口腔微生物结构的变化和/或降低群落多样性，从而有利于失调的解决。然而，需要进行充分的、具有足够时长的大型基于人群的研究，以充分了解抗菌漱口水在多大程度上调节微生物组。
