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• Conditions of the Mouth
• Chlorine Dioxide
• CloSYS® vs. Chlorhexidine
• Making the Systemic Connection
• Oral Health
• Ingredients Matter

Plaque & tartar (calculus)

Dental plaque is a sticky film that forms on the surfaces inside the mouth, and is most recognizable as the biofilm that develops on teeth. Within hours of thorough cleaning, plaque is likely to develop, even in a healthy mouth. Once it forms, a biofilm develops an outer layer that protects it from being destroyed and allows the bacteria within the film to multiply and produce potentially damaging acids. Plaque can form in hard-to-reach places, so removing it through brushing, flossing and regular visits to a dental professional is recommended.

In some cases, the inner areas of undisturbed plaque will mineralize. This hardened plaque is called calculus or tartar. Calculus can form above and below the gumline. Unlike plaque in biofilm-form, calculus cannot be removed by brushing or flossing; dental professionals have special tools designed for calculus removal. Calculus is problematic: it provides a place for bacteria to grow and multiply and it can lead to infection of the surrounding tissues.

Decay / Cavities (caries)

When dental plaque is left undisturbed on the surface of teeth, tooth decay (cavities) develop. Decay is the result of demineralization of the tooth enamel by acids that have built up within the undisturbed plaque. Introducing fluoride ions to the teeth can limit the progression of the caries because fluoride has been shown to aid in remineralization of tooth enamel. Unfortunately, if decay progresses into the inner tissues of the teeth, cavities may form, pain may occur, and removal of the affected tooth may be required.

Plaque, Cavities and Strep Bacteria

Saliva leaves deposits on teeth (pellicle). Certain bacteria in the mouth stick to the pellicle divide and form colonies. This is how dental plaque forms, and plaque is the most widely recognized precursor to oral disease.

80% of bacteria that colonize dental plaque are cocci, such as Streptococcus sanguinis and Streptococcus mutans. Strep, such as these, produce acids that de-mineralize tooth enamel and lead to the development of dental caries, tooth decay, and infection of gum tissue.

In several studies, CloSYS® has been shown to kill these Strep species quickly (within 10 seconds) and thoroughly (100%). Regular use of CloSYS® can halt the presence and growth of these Strep species in the mouth. Lower amounts of these Strep can reduce plaque, inhibit de-mineralization of tooth enamel, and help stop the onset of gum disease and tooth decay.

Gingivitis

Gingivitis is the presence of gingival inflammation without the loss of connective tissue attachment. Redness, swelling and bleeding gums are signs of gingivitis. If dental plaque is left undisturbed on teeth, it causes a response by the body's immune system. The first function of the immune response is inflammation due to increased blood flow. Gingivitis is reversible with consistent oral hygiene practices, but can progress into periodontitis if such practices are not maintained.

Periodontitis

Periodontitis is a result of a group of infections that leads to the destruction of the supportive tissues of the teeth. Periodontitis is caused by plaque-induced inflammation, similar to gingivitis. An estimated 20% of American adults are affected by Chronic Periodontitis, signs of which are inflammation, the presence of deep pockets around the base of teeth, gum recession, loosening of teeth and reduction of the bone that supports the teeth. In addition to the accumulation of dental plaque, factors that may increase the chance of developing periodontitis are smoking, diabetes mellitus, emotional stress and genetic susceptibility.

Halitosis

Halitosis (bad breath) is caused primarily by the presence of certain odor-causing molecules in expired breath. These odor-causing molecules are known as volatile sulfur compounds, or VSCs. Approximately 90% of the foul odors in mouth air are caused by the VSCs hydrogen sulfide (H2S) and methyl mercaptan (CH3SH, also called methanethiol). When bacteria present in the oral cavity break down proteins, they release VSCs as a by-product. The presence of VSCs in the mouth is problematic because not only do they cause halitosis, but also they can aggravate any existing gingival inflammation from gingivitis or periodontitis.

Thrush

Thrush, or candidiasis, is a fungal infection in the mouth caused by overgrowth of certain yeast species. Signs of thrush are slightly raised bumps that have a white, cream or yellowish color. The yeast overgrowth may be a result of certain metabolic and immune disorders, use of prescription antibiotics, or physical contact with an individual already experiencing the condition.

Canker Sores (Aphthous Ulcers)

Canker sores (small, painful ulcers) can appear on the insides of the cheeks, gums and tongue. They are usually small, flat, and whitish in color with red around the outside, and typically heal themselves within 7 – 10 days. The sores can occur as a result of injury, but the exact cause of them is unknown. Some relations have been made between stress, fatigue, or chemical irritants increasing the risk of developing canker sores.

Sensitivity

Sensitivity in the teeth is often associated with extreme, often painful, reaction to hot, cold, sweet or acidic foods and beverages. Tooth sensitivity can be a sign of decay that has penetrated the enamel and decay is progressing into the inner layers (dentin and pulp) of the tooth. Sensitivity may also be caused by exposure of cementum and root tissues due to recession of gums. In some cases, injury or impact may cause a tiny crack in a tooth, exposing the inner tissues and causing hypersensitivity.

How it works

CloSYS® is a patented formula that contains stabilized chlorine dioxide. When it is exposed to the acidic areas where plaque has formed, the chlorine dioxide is released. Once released, the chlorine dioxide is available for the extermination of dental plaque-causing bacteria and VSCs.

Oxidizer

One of the ways chlorine dioxide work in the mouth is through oxidation of the sulfide bonds in VSCs.  Oxidation describes a type of chemical reaction in which the chlorine dioxide in CloSYS® reacts with the molecules that cause bad breath, destroying them. Unlike other products, CloSYS® does not cover up the unpleasant smells; it eradicates them.

Antibacterial

The chlorine dioxide in CloSYS® has been shown to quickly kill the bacteria that cause plaque, bad breath, gingivitis and periodontitis. A reduction in the amount of bacteria in the mouth has the benefit of reducing the plaque in the mouth, reducing the chance for developing gum diseases like periodontitis and gingivitis, and reducing the source for the VSCs that cause bad breath. The exact mechanism of action for ClO2 as an antibacterial agent is currently under investigation; two possible mechanisms proposed are through oxidation of the amino acid cysteine or alternatively through cell membrane penetration followed by an oxidative process that disrupts internal enzyme activity.

Chlorine Dioxide Safety

Rowpar Pharmaceuticals, Inc. produces the patented buffered stabilized chlorine dioxide formula known as CloSYS® . The active ingredient in CloSYS® is a stabilized molecular form of chlorine dioxide; no mixing is required to activate our product. Chlorine dioxide is one of the safest ingredients used in the food industry today. This active ingredient in CloSYS® is an effective and safe antibacterial agent. In vitro, CloSYS® does not interfere with fibroblastic activity, having no adverse effects on periodontal tissues.

Extensive literature related to pharmacology, toxicology, and safety of chlorine dioxide and stabilized chlorine dioxide is readily available. The Environmental Protection Agency (EPA) and the Agency for Toxic Substances and Disease Registry have both developed toxicological profiles for chlorine dioxide.

No adverse events linked to normal product use have been reported during Rowpar Pharmaceutical's sponsored clinical trial studies or since the product's release to the consumer market in 1991.

The Gold Standard Has a Challenger

Although the well-known truism holds that if it tastes good it can't be good for you, results of recent testing show that Rowpar Pharmaceuticals' CloSYS® Antiseptic Oral Rinse compares to chlorhexidine (CHX) in many key aspects of post-procedure oral hygiene - and it has a pleasant taste and does not stain teeth. In fact, CloSYS® comes unflavored with a clean taste. To add refreshing flavor, a Flavor Control™ dropper is included to adjust the flavor (natural peppermint oil) for an individual's preferred taste.

CloSYS® was shown to have robust performance comparable to or better than CHX in killing oral bacteria. Unlike CHX, CloSYS® does not interfere with fibroblasts, which are associated with the healing process; this distinction, reported by Dr. Robert Wirthlin, DDS, supports CloSYS®' benefit in facilitating the healing process1. Patients demonstrate noticeably improved oral health within a few weeks of making the rinse part of their daily routine.

Laboratory Results

The study conducted by David Drake, M.S., Ph.D., professor of microbiology and director of research in the Department of Endodontics at the University of Iowa, compared bactericidal activity of the CloSYS® rinse to that of CHX (Peridex®). Each oral rinse was tested against a select group of bacteria known to be associated with periodontal disease and dental caries. In carefully standardized conditions, the rinses were introduced to the individual bacterial strains and the effectiveness in combating these periodontal pathogens was measured.

Interestingly, the kill rate for CloSYS® surpassed that of CHX in the first minute for Actinomyces naeslundii (involved in periodontal disease and endodontic infections) and Peptostreptococcus micros (found in periodontal disease). The kill rate for Streptococcus mutans (causes caries) and Actinomyces viscosus (involved with oral infections) were higher for CHX in a first minute sample but, by five minutes, CloSYS® and CHX samples proved identical at 100 percent kill rates. With Porphyromonas gingivalis (culpable in the progression of chronic periodontitis), Actinobacillus actinomycetemcomitans (causes localized aggressive periodontitis), Actinomyces odontolyticus (responsible for deep dental caries and chronic periodontitis) and Prevotella nigrescens (found in endodontic infections), both CloSYS® and CHX achieved a 100 percent kill rate in the first minute.

CloSYS® was also observed to exceed bactericidal properties against Staphylococcus aureus, which is not necessarily an oral pathogen, but is the causative agent of staph infections. CloSYS® exhibited 100 percent kill rate within the first minute of exposure.

Performance Plus

With its strong performance against oral bacteria that cause infections of the periodontium and endodontium, as well as dental caries and staph infections, and its favorable behavior toward healing cells (fibroblasts), CloSYS® addresses a spectrum of clinical oral hygiene concerns. Finally, its agreeable taste and non-tooth-staining characteristics - especially coupled with a lower cost and over-the-counter convenience compared to its prescription counterpart - encourage patients to be fully compliant. As a non-prescription oral rinse, CloSYS® not only meets and may surpass CHX in post-procedure applications, it also can be recommended for twice-daily regular oral care as a maintenance and preventative measure. CloSYS® is now a premium standard for daily oral care.

An association between oral health and systemic health is being established with increasing scientific evidence.  Based on research, links have been established between oral diseases and conditions such as cardiovascular disease (atherosclerosis, ischemic heart disease and stroke), diabetes, preterm birth and low birth weight.

Diabetes

Diabetes mellitus is a metabolic disorder characterized by hyperglycemia (high blood sugar) following the inability of the pancreas to secrete insulin or a deficiency of insulin sensitivity, type 1 and type 2 diabetes, respectively. Periodontitis has been found to make it more complicated to control blood sugar in people with diabetes. 

Cardio

Increasing evidence indicate that there is an effect of periodontal disease on the risk of cardiovascular diseases. Heart disease and periodontal disease have similar characteristics. The following factors contribute to occurrences in both diseases: age, gender, education, finances, tobacco use, alcohol use, hypertension, stress, and social isolation. However, the most important link between heart and periodontal disease is inflammation. 

Periodontal disease is known to be one of the body’s most common chronic inflammatory conditions due to infection. The inflammation occurs as a defense mechanism against bacteria and foreign microbes occurring in the body not normal to health. Periodontal infection can cause inflammatory mediators and bacteria to enter into tissues and into the blood stream traveling to other parts of the body like the heart.

Atherosclerosis is a progressive disease involving the hardening of arteries in the heart due to artheromatous plaque. Blood flow can be prevented when plaque build up inside the artery wall occurs, in which a heart attack or stroke can result. Inflammation plays a role in the blockage of blood flow; it brings in molecules to fight infection and causes plaque growth. The growth can progress to the point when the plaque ruptures and form blood clots. 

Periodontal infections have been shown to be an independent risk factor for ischemic stroke. A study concluded that periodontitis increased the risk for stroke by inducing atherosclerosis.

Scientific evidence found that periodontal bacteria occur in plaque deposits of arteries. Animal studies determined that periodontal diseases cause plaque accumulation in coronary arteries. Human studies also suggest some evidence. Some studies indicated that people with periodontal disease were much more likely to be diagnosed with heart disease than those without periodontal disease. 

The effect of periodontal disease on developing cardiovascular diseases, however, continues to be an area of investigation and more studies are needed to establish a relationship between them.

Childbearing

Periodontal diseases are emerging as a new risk factor for premature birth and low birth weight. It may have just as much of an impact on these complications as smoking, alcohol, drug use, and genitourinary tract infections.

There is evidence to support that periodontal disease in pregnant women is an independent risk factor for preterm birth and low birth weight. The presence of severe maternal periodontitis resulted in a 7.5-fold increase risk of low birth weight. However, there is still a need for more research to confirm the association between adverse pregnancy outcomes and periodontal diseases.

Chronic Inflammation

Chronic conditions including periodontal disease, atherosclerosis, rheumatoid arthritis, coronary heart disease, and diabetes share an exacerbated inflammatory response characteristic. The increased production of proinflammatory cytokines indicate the exacerbated response, which occurs in order to repair tissue and eliminate invading microorganisms. However, the exacerbated response can result in unnecessary damage to healthy tissue throughout the body. 

Periodontal infections stimulate the body to secrete monocyte-derived cytokines and interleukins in response to fighting the infection.  Gram negative bacteria are present in periodontal infections and dental plaque, which produces endotoxin lipopolysaccharides which induces the secretion of cytokines and inflammation.  Systemic inflammation occurs as a result of the exacerbated inflammatory response to the periodontal infection. 

Periodontal infection and its role in systemic inflammation has been shown in research identifying oral pathogenic bacteria in atheroma in carotid arteries as well as prospective studies.  Research evidence from the Harvard School of Public Health show that men with periodontal disease have a 63 percent higher risk of developing pancreatic cancer.  Periodontal disease can cause inflammation throughout the body leading to the development of cancer due to exacerbated inflammation responses and generation of carcinogenic organisms from oral bacteria. 

The association of periodontal disease with chronic inflammation and pancreatic cancer needs more investigation and research to confirm the relationship. However, non-surgical periodontal therapy has been shown to have a beneficial effect on the signs and symptoms of rheumatoid arthritis.

Teeth

Maintaining healthy teeth is important for a number of reasons. Healthy teeth are free of plaque and decay, are white or ivory in color, and are held in place firmly. Follow these easy steps to keep teeth strong and free of decay:

1. Brush twice each day to remove plaque and food particles from the outer surfaces.
2. Floss each day to remove plaque and food particles in the area that the bristles of the toothbrush may miss, between teeth and past the gumline.

Visit a dentist for professional cleanings and check-ups.

Gums

Healthy gums are generally firm, pink in color* and make good contact with the teeth they support. Brushing and flossing help to keep gums healthy because plaque on and between teeth can irritate the gums. Signs of irritated gums are redness, swelling, bleeding and recession of the gumline.
     In addition to dental plaque build-up, other things that can irritate the gums are overly aggressive brushing, calculus formation, tobacco use and certain illnesses. A dental professional can evaluate the health of gums and assist in determining the source of existing gum irritation.

*Some color variation in the gums is associated with varying levels of melanin, or skin pigmentation. Melanin levels may depend on one’s ethnic background.

Tongue

A healthy tongue is pink, moist and free of lesions. The rough, irregular surface (especially the back third or so) of the tongue is an ideal place for things like food particles, bacteria and sloughed off mouth cells to become trapped. The breakdown of proteins on the tongue can lead to bad breath. Incorporating tongue cleaning into one’s daily oral hygiene regimen is recommended. Various tools are available for tongue cleaning, including but not limited to tongue scrapers and brushes.

Breath

Healthy breath is an indication of good oral hygiene. To keep breath smelling fresh, brushing, flossing and tongue cleaning is recommended. Unpleasant-smelling breath, on the other hand, can be caused by conditions that extend beyond oral care. Sometimes it can be caused by use of certain over-the-counter and prescription medications, and sometimes unpleasant breath is the result of a respiratory, metabolic, liver or kidney condition. If your breath is not fresh, and if you have maintained good oral hygiene practices, consult a dentist or physician for further assistance.

Sodium Laurel Sulfate

Sodium laurel sulfate (SLS) is a foaming ingredient (detergent) in many commercial toothpastes and other consumer products like shampoo and shower gel. It is known that SLS can cause irritation, and a few studies have investigated this irritation to shed light on the mechanism by which it occurs in the mouth. Three things were discovered: increased blood flow in the gums, shedding and increased permeability of the outer layers of cells in the gums, and elevated risk for canker sores.

Increased blood flow, in general, is a phase of inflammation; the increased blood flow due to SLS irritation could make it more difficult to stave off the inflammation of gingivitis.

The shedding of outer layers of cells (desquamation) in the gums occurred in a study of two different detergents, CAPB and SLS. SLS-containing toothpaste caused a majority of the desquamation observed during the study; CAPB-containing paste caused a few isolated cases of desquamation, while the detergent-free toothpaste resulted in no observable shedding.

Over the course of two months, patients with recurrent canker sores were observed. The study found that SLS-free toothpaste use can result in a reduction of recurrent sores.

Alcohol

Alcohol is an ingredient in some commercial mouth rinses. It is included as a solvent for inactive ingredients. At the concentrations typically used (between 10 and 30%), the antibacterial effect it has when at full-strength is severely limited. In addition to the limited antibacterial effect alcohol may have, there are some risks, physical and psychophysical, associated with use of alcohol-containing mouthrinses. Studies have shown that use of alcohol-containing mouthrinses may cause color and hardness changes in composite resins used for dental restorations. Additionally, some research has attempted to determine whether or not alcohol in mouthrinse increases the risk of oral cancer. A link has been established between alcohol-containing mouthrinse and incidence of hyperkerastotic lesions, but a definite link has not been established for oral cancer. (High levels of alcoholic beverage consumption continue to be associated with higher risk for oral cancer.) Lastly, the adverse effect most commonly associated with alcohol in mouthrinse is pain. There is a direct relationship between alcohol concentration and the degree of induced pain during use.

pH

The pH* in the mouth is relatively neutral (mean mucosal pH = 6.78), and will vary slightly between individuals and depending on the site used for measurement. The development and progression of tooth decay is a result of acids created within plaque that demineralize tooth enamel. Research has shown that the pH in the mouth can change as a result of everyday things like gum chewing and beverage consumption. Research has also shown that mouth pH tends to decrease as mouth moisture decreases, which can occur in people with dry mouth (xerostomia) but can also occur when a person breathes through their mouth. Neutral mouth pH minimizes the demineralization associated with acidity and the inflammation associated with alkalinity. Additionally, in the clinical setting, neutral mouth pH is desired for optimal therapy performance, both in-office and at home. Maintaining optimal, neutral pH within the oral cavity is important for maintaining oral health.

*pH is officially a measurement of the concentration of hydrogen atoms in a substance. The pH scale is logarithmic, which means that each numerical value represents a ten-fold change in the raw measurement. The range of the pH scale is 0 – 14; acidic substances have a low pH, basic substances have a high pH and neutral substances have pH around 7.

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