Keynote Address: Antimicrobials in Caries Prevention and Control

Recent insights in oral biofilm interactions with health and disease have challenged the antimicrobial concept in caries prevention. Traditionally, broad spectrum agents have been used to suppress specific pathogens such as S. mutans although many other aciduric and acidogenic species are prevalent in the ecologically stressed biofilm. Extensive research is available on chlorhexidine and the current evidence for its efficacy based on RCT´s and systematic reviews is reviewed. The general use of CHX-rinses, gels or varnishes cannot be recommended to prevent or reduce the incidence of coronal caries while repeated local applications of CHX-varnish may have some beneficial effects on root caries as an adjunct to fluoride in elderly special need patients and post-radiotherapy. As there seem to be no consensus regarding the established antimicrobial methods for caries prevention and control, research on novel strategies such as anti-adhesins, antimicrobial peptides, probiotics and metabolic inhibitors needs to be intensified.