A DMAHDM-herbal hybrid gargle for orthodontic-associated complications via oral microbiota regulation, inflammation inhibition, and enamel protection.

Orthodontic appliances are indispensable for achieving therapeutic efficacy, but their complex and irregular architecture compromises oral hygiene, increasing susceptibility to dental caries and periodontal diseases. Conventional gargles primarily target antibacterial effects; however, their prolonged use may disrupt the balance of the oral microbiota, and remains insufficient for controlling periodontal inflammation and preventing enamel demineralization. Herein, a bioactive hybrid gargle integrating Dimethylaminohexadecyl methacrylate (DMAHDM) and Lonicera japonica extract (LJE) was developed. The combined use significantly downregulated the expression of pro-inflammatory cytokines and attenuated alveolar bone loss via activation of the peroxisome proliferator-activated receptor (PPAR) signaling pathway. Moreover, in addition to its potent antibacterial activity, this novel gargle exhibits a distinctive capacity to regulate the oral microbiota by modulating the relative abundances of Bacteroidetes and Actinobacteria, thereby promoting a more balanced and stable microbial community. It also effectively inhibited enamel demineralization, preserved calcium and phosphorus content, and maintained enamel hardness, while prolonged exposure exerted no adverse influence on the mechanical properties of orthodontic materials. The biocompatibility over a 60-day period was also systematically evaluated and confirmed. Collectively, these findings highlight the novel hybrid gargle as a promising therapeutic paradigm for the clinical management of orthodontic-associated complications, including periodontal diseases, dental caries, and enamel demineralization.