Biotene (typeset as ''biotène'') is an

over-the-counter Over-the-counter (OTC) drugs are medicines sold directly to a consumer without a requirement for a prescription from a healthcare professional, as opposed to prescription drugs, which may be supplied only to consumers possessing a valid prescr ...

dental hygiene Oral hygiene is the practice of keeping one's mouth clean and free of disease and other problems (e.g. bad breath) by regular brushing of the teeth (dental hygiene) and cleaning between the teeth. It is important that oral hygiene be carried out ...

product currently marketed by GSK. It comes in a number of forms, including toothpaste, mouthwash and gel.

Ingredients

Regular

The main active ingredient in its toothpastes is

sodium monofluorophosphate Sodium monofluorophosphate, commonly abbreviated SMFP, is an inorganic compound with the chemical formula Na2PO3F. Typical for a salt, MFP is odourless, colourless, and water-soluble. This salt is an ingredient in some toothpastes.Klaus Schrödter ...

, and prior to the

GlaxoSmithKline GSK plc, formerly GlaxoSmithKline plc, is a British multinational pharmaceutical and biotechnology company with global headquarters in London, England. Established in 2000 by a merger of Glaxo Wellcome and SmithKline Beecham. GSK is the ten ...

acquisition it also contained

enzymes Enzymes () are proteins that act as biological catalysts by accelerating chemical reactions. The molecules upon which enzymes may act are called substrate (chemistry), substrates, and the enzyme converts the substrates into different molecule ...

including

glucose oxidase The glucose oxidase enzyme (GOx or GOD) also known as notatin (EC number 1.1.3.4) is an oxidoreductase that catalyses the oxidation of glucose to hydrogen peroxide and D-glucono-δ-lactone. This enzyme is produced by certain species of fungi and ...

lactoferrin Lactoferrin (LF), also known as lactotransferrin (LTF), is a multifunctional protein of the transferrin family. Lactoferrin is a globular glycoprotein with a molecular mass of about 80 kDa that is widely represented in various secretory fluids, su ...

lactoperoxidase Lactoperoxidase is a peroxidase enzyme secreted from mammary, salivary and other mucosal glands including the lungs, bronchii and nose that functions as a natural and the first line of defense against bacteria and viruses. Lactoperoxidase is a m ...

and

lysozyme Lysozyme (EC 3.2.1.17, muramidase, ''N''-acetylmuramide glycanhydrolase; systematic name peptidoglycan ''N''-acetylmuramoylhydrolase) is an antimicrobial enzyme produced by animals that forms part of the innate immune system. It is a glycoside ...

PBF

The PBF (plaque

biofilm A biofilm comprises any syntrophic consortium of microorganisms in which cells stick to each other and often also to a surface. These adherent cells become embedded within a slimy extracellular matrix that is composed of extracellular ...

) product line contained additional enzymes, such as mutanase, dextranase, lysozyme,

, and glucose oxidase. The PBF products have been discontinued.

Benefits

People with

xerostomia Xerostomia, also known as dry mouth, is dryness in the mouth, which may be associated with a change in the composition of saliva, or reduced salivary flow, or have no identifiable cause. This symptom is very common and is often seen as a side ef ...

(dry mouth) may use Biotène to reduce the rate of recurrence of

dental plaque Dental plaque is a biofilm of microorganisms (mostly bacteria, but also fungi) that grows on surfaces within the mouth. It is a sticky colorless deposit at first, but when it forms tartar, it is often brown or pale yellow. It is commonly found bet ...

. However, Biotene by itself does not significantly reduce the count of ''

Streptococcus mutans ''Streptococcus mutans'' is a facultatively anaerobic, gram-positive coccus (round bacterium) commonly found in the human oral cavity and is a significant contributor to tooth decay. It is part of the " streptococci" (plural, non-italic lowercase ...

'' which is the primary initiator of the formation of dental plaque. Biotène claims to relieve symptoms of dry mouth by providing moisture. Dry mouth can be caused by multiple factors affecting the salivary gland.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. By keeping the mouth moisturised, 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. Also, by improving the lubrication of the oropharyngeal mucosa, Biotène can facilitate swallowing and decrease the chances of developing dysphagia.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". A 2017 pilot study found that perceived swallowing effort decreases significantly following application of a saliva substitute. Biotène compensates for decreased salivary composition. Lack of saliva compromises the composition and beneficial properties necessary for maintaining the health of the oral cavity and reduces antibacterial actions, which leads to disruption of the oral pH; consequently allowing cariogenic microorganisms to grow and colonise the oral cavity.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 erial on the Internet (n.d.), ited October 16, 2017 35(3): 387-393. Available from: Science Citation Index. 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, such as those found in Biotène products, reduce oral infection and enhance mouth wetting.NieuwAmerongen, A.; Veerman, E. (2003). "Current therapies for xerostomia and salivary gland hypofunction associated with cancer therapies". Support Care Cancer, 11: 226. Biotène mouth rinses have shown inhibitory effects on growth of preformed biofilms on certain tested bacterial and fungal strains. However, Biotène alone does not act via prevention of plaque build-up mechanism or antimicrobial chemotherapeutic mechanism.

Biotène brand products

The product line includes toothpaste, mouthwash, spray and gel.

Mechanism of action

The three primary enzymes in Biotène are Glucose Oxidase, Lactoperoxidase, and Lysozyme.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. 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 defences.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. 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 colonise the oral cavity. For individuals with xerostomia, a commercially available mouth rinse that can be safely used daily to aid in dry mouth relief is essential in oral health maintenance. Various commercially available mouth rinses have been tested on their inhibitory effects on biofilm formation over a 24h period. 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 mouth rinse, an antimicrobial chlorhexidine-based formulation, demonstrated significantly greater prevention of plaque regrowth when compared with water and the enzyme-based Biotène mouth rinse.

References

* 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.