The Effect of Enzymes on Dental Plaque: A Randomized Controlled Trial

The extracellular matrix has been identified as an essential determinant of virulence of dental biofilms. Therefore, enzymes that degrade the matrix are a promising preventive approach for biofilm control. Laboratory studies have consistently reported significant effects of enzyme treatment on biofilm formation, but information from randomized clinical trials (RCTs) is limited. The present triple-blind RCT investigated the effect of lozenges containing 2 different concentrations of the matrix-degrading enzymes mutanase, beta-glucanase, and DNase on de novo plaque formation, gingivitis development, and the plaque microbiome in healthy adults. Eighty subjects were enrolled with random allocation to either placebo, active 1, or active 2 (3-fold enzyme concentration). All subjects completed the study without major protocol deviations. Plaque formation was assessed after 1, 7, and 14 d of intervention without self-performed oral hygiene, using the Turesky modification of the Quigley and Hein plaque index (TM-QHPI) and the planimetric plaque index and the thickness index. Gingival index (GI) scores were registered on day 14. Moreover, the microbial plaque composition was analyzed by 16S rRNA gene sequencing, and the amount of autofluorescent plaque and plaque removal with an Airfloss device was quantified. Plaque formation was significantly lower for day 7, active 1 compared with placebo and for the pooled active groups (post hoc analysis) as well as for the pooled recordings across all time points (post hoc analysis) and for autofluorescent plaque on day 7, active 2. No significant differences in plaque formation were observed for the other time points, GI scores, or plaque removal. A nonsignificant trend toward reduced species richness was found in both active groups compared with placebo. In conclusion, multienzyme treatment may promote oral health by slightly delaying plaque formation and maturation and might serve as a supplement to mechanical plaque removal. The study was registered at Clinicaltrials.gov (NCT05082103).