Hypochlorous Acid (HOCl) mouth rinse preserves the commensal (good) oral bacteria. It also is surprisingly efficacious at killing oral pathogens-even the really bad guys.1-5 What makes HOCl a super-hero is its compatibility with our physiological needs.11,13 Our fragile, essential oral microbiome can be affected by many things including oral products, antibiotics, diet, health which can indirectly contribute to chronic disease states. Medical and dental practitioners are in the position to sound the alarm, educate patients about this and offer solutions.
There is emerging knowledge of the ability to harness these natural occurring, disinfecting signaling molecules to more stable and usable forms. Hypochlorous acid (HOCl) makes it possible to do less harm than other disinfectants that kill in a broader spectrum, because of their ability to selectively kill pathogens while not harming commensals.
WHAT IS HYPOCHLOROUS ACID (HOCl)?
Hypochlorous Acid (HOCl), often called by other names such as E-Water, is one of the most powerful disinfectants available today and yet it is one of the safest. It consists of one oxygen atom, one chlorine atom and one hydrogen atom. Hypochlorous acid (HOCl) is produced by all mammals naturally to fight infection. It is generated by neutrophils, white blood cells, when an invading pathogen is detected. In the body, the HOCl produced by neutrophils lasts about a second. We now can capture this molecule in stable solutions and dissolved solid tablets. Commercial products are readily available to produce this in our dental offices.
AN EFFECTIVE DETERGENT WITHOUT SUDS
HOCl is made by mixing the correct amounts of water, non-iodized salt and an acid such as vinegar and running electricity through it to produce two new molecules: hypochlorous acid(HOCl) and sodium hydroxide. (Depending on the unit type employed, sodium hydroxide may not be present). Sodium hydroxide is used in many oral care products already as it has detergent properties but is very gentle at these levels. Sodium hydroxide has many uses and is often put into toothpaste. It cleans safely without all the bubbles. One can adjust the concentration of HOCl by dilution with water, to an appropriate level for the desired use.
Hypochlorous acid (HOCl) kills bacteria, viruses, fungi, mold and spores. It appears to not kill “good” bacteria. Since HOCl has no charge, it is not repelled by negatively charged pathogenic bacteria. It is an excellent product for the breakdown of biofilms.5,7,16
Hypochlorous Acid (HOCl) works by several mechanisms:
It reacts with protein sulfhydryl groups to inactivate proteins. It also reacts with protein amino groups for chloramines to cleave proteins. It inhibits glucose oxidation starving bacterial and viral pathogens of nutrient uptake. It causes post-translational modifications to proteins like cysteine and methionine and it oxidizes bacterial and viral walls and cytoplasm. HOCl is a powerful oxidizer having an oxidation reduction potential of approximately 1000.16
HOCl does not harm “good bacteria’. Most bad bacteria carry a negative charge and hence repel anti.microbials.6 HOCl can attach and penetrate the cell wall since it is neutral. The negative effect of HOCl on good bacteria is minimal. Sodium hypochlorite, peroxide etc. carry a negative charge and are repulsed by bad bacteria.
Articles indicate excellent efficacy for HOCl in the oral microbiome, including in the presence of saliva, which inactivates many other anti-microbials. HOCl has demonstrated excellent efficacy against fusobacterium nucleatum, strep mutans, spirochetes, porphyromonas gingivalis, etc in the presence of saliva.
Uses of HOCl in Dentistry:
HOCl has the widest and safest use application in dentistry of any disinfectant. It is a potent hard surface disinfectant, a dental water line disinfectant, an effective hand sanitizer and has multiple use applications in the oral cavity. It kills the pathogens responsible for gingivitis, periodontitis and decay. It can be used for root canal therapy. It disinfects effectively while not disturbing the normal oral microbiome. The only application not approved is for sterilizing dental instruments. It is not affected by saliva like many other oral disinfectants and does not lower the salivary pH. Dental offices may purchase the product commercially with a 1-2 year shelf life or generate it themselves in the dental office, providing only about a two week shelf life.7,10
HOCl is not only recognized in Canada but is also on the list of recommended products for COVID-19 disinfection as safe and effective.1 Many products exist for air and surface disinfection with HOCl, limited products are also available for oral hygiene, tongue scrapping, ENT and even ophthalmology use.
WHAT IS THE CONNECTION BETWEEN NITRIC OXIDE (N1O1) PRODUCTION AND HOCl?
It is essential to have a healthy oral microbiome to effectively produce N1O1, especially in your older years. IF N1O1 is thought to be the Holy Grail of health, think of HOCl as an essential molecule to protect and support N1O1 in a most natural way. To understand the significance of introducing HOCl, one needs to appreciate the important role of oral bacteria in the pathway producing Nitric Oxide (N1O1). HOCl is unique in that it is a signaling molecule, produced naturally by our own neutrophils, which protects the mechanism that allows our bodies to inherently produce Nitric Oxide (N1O1).12-14
