Structural requirements of guanide, biguanide, and bisbiguanide agents for antiplaque activity

The bactericidal efficacy of 16 guanide, biguanide, and bisbiguanide agents was studied in vitro against intact preformed plaques of four oral (plaque-forming) microorganisms: Streptococcus mutans, S. sanguis, Actinomyces viscosus, and A. naeslundii. The activities of these agents were examined in relation to their molecular configurations. These studies indicated that the bis- and biguanide configurations are important for efficacy, as is the length of the alkyl side chain. No structural moiety determined efficacy by itself. Furthermore, the activities of these agents were studied to determine the minimal conditions (concentration, duration, and frequency) of treatment required for likely clinical efficacy. At least six agents were judged to have equal or greater efficacy than the reference agent, chlorhexidine digluconate. A plaque bactericidal index was derived for the most potent agents, and comparison to the bactericidal properties of chlorhexidine was expressed as a chlorhexidine coefficient.