Synthetic antimicrobial polymers in dentistry: Cationic and zwitterionic strategies for biofilm resistant

Synthetic antimicrobial polymers (SAPs) are durable, biocompatible, and tunable solutions for biofilm-mediated oral infections in dental care. This review aims to explore the types, mechanisms, and clinical applications of SAPs, emphasizing their dual role in both preventive and therapeutic strategies. Relevant English-language publications were reviewed, with search terms for each subject category entered into Medline, Web of Science and Scopus. The search identified 2752 publications, with 994 duplicate records removed, and 222 publications were included in this review. SAPs are broadly categorized as cationic or zwitterionic. Cationic polymers, such as polymeric quaternary ammonium compounds and polybiguanides, exert antimicrobial effects by electrostatically disrupting negatively charged microbial membranes, leading to pathogen lysis. In contrast, zwitterionic polymers such as poly(methacryloyloxyethyl phosphorylcholine) and poly(carboxybetaine methacrylate) resist biofilm formation by forming a hydration layer that repels microbial adhesion and protein deposition. These polymers demonstrate transformative potential in dentistry. Incorporating cationic polymers into restorative materials imparts long-lasting, contact-active antimicrobial properties, effectively preventing secondary caries. Coating removable dentures with zwitterionic polymers modifies the prosthesis surface to inhibit biofilm formation, thereby reducing the risk of stomatitis. By combining bactericidal action with biofilm resistance, SAPs are promising to enhance the efficacy of dental treatments and improve clinical outcomes. Synthetic cationic and zwitterionic polymers represent a promising frontier in oral healthcare, offering versatile integration into dental materials to address biofilm-related diseases. Their tailored design and multifunctionality position them as critical tools for advancing preventive care and ensuring treatment longevity. • Cationic and zwitterionic synthetic antimicrobial polymers are used for oral biofilm control. • Cationic polymers kill microbes in dental materials by disrupting their cell membranes. • Zwitterionic polymers prevent microbial adhesion by creating repulsive surfaces on dental materials. • Combining cationic and zwitterionic polymers can synergistically enhance antimicrobial effects. • Tailored synthetic antimicrobial polymers provide benefits for biofilm-related oral diseases.