Quality Resource Guide

Dentifrices and Mouthrinses to Reduce Plaque and Gingivitis 3rd Edition

www.metdental.com

Mouthrinses

Three

systematic

reviews

and

one

meta-

analysis were found that evaluated the efﬁcacy

of anti-plaque, anti-gingivitis mouthrinses. The

systematic reviews concluded that there is strong

evidence supporting the efﬁcacy of chlorhexidine

and essential oils as anti-plaque, anti-gingivitis

mouthrinses.

The evidence for cetylpyridinium

chloride (CPC) was weaker due to few clinical

trials testing the same formulations of CPC.

There was one meta-analysis of studies from

a manufacture of Delmopinol, but it was not a

systematic review of the literature. The report

based on the meta-analysis concluded that

Delmopinol was an effective anti-plaque, anti-

gingivitis agent.

6,30

Evaluation of clinical relevance by estimating

percent reduction due to the active agents

and changes over time in the placebo groups,

demonstrated that the clinical effect of both

chlorhexidine

and

essential

oil

containing

mouthrinses met or exceeded reductions over

time for placebo groups.

Again, the results for

CPC were less consistent, but were similar to

reductions over time in the placebo groups. The

author concluded that these results suggest that

the clinical beneﬁts of anti-plaque, anti-gingivitis

mouthrinses are similar to the beneﬁts of oral

prophylaxis and oral hygiene instructions at six-

month recall appointments.

A more extensive review was conducted in 2015

by Serrano,

et al.

Their analysis differed from

previous ones

that

they

did

not

specify which

agents were better than others evaluated. They

stated, “No specific recommendations can be

made based on the results of the present review,

as no direct comparisons among products were

performed.”

They further stated that: “The clinician

should take into account when prescribing or

recommending these products, the results of the

described meta-analysis, in terms of magnitude

of the effect, number of available studies,

consistency of the results and heterogeneity. In

addition, adverse effects, economical costs and

the clinical indication should also be taken into

account.”

The first systematic analysis by Gunsolley of

mouthrinses

concluded that the largest body of

studies supported the efficacy of mouthrinses

containing essential oils. A smaller body of studies

supported a strong antiplaque, antigingivitis

effect from mouthrinses containing 0.12 percent

chlorhexidine. Results for mouthrinses containing

cetylpyridinium chloride varied and depended

on the product’s formula. Few of the studies

evaluated the relative efficacy of the different

agents. The studies compared mouthrinses

containing active agents with control mouthrinses,

as well as, in some cases, with mouthrinses

containing other active agents. Four studies

compared mouthrinses containing essential oils

with chlorhexidine mouthrinses. In all cases, 0.12%

chlorhexidine exhibited a greater antiplaque effect

than did mouthrinses containing essential oils

(the effect for essential oils was about 60% of that

for the chlorhexidine mouthrinse). However, the

data suggested efficacy of controlling gingivitis

to be similar for chlorhexidine and essential

oil containing mouthrinses. Three subsequent

systematic reviews verified the findings from the

first review. The systematic reviews concluded

that there is strong evidence supporting the

efﬁcacy of chlorhexidine and essential oils as anti-

plaque, anti-gingivitis mouthrinses. The evidence

for cetylpyridinium chloride (CPC) was weaker due

to few clinical trials testing the same formulations

of CPC.

32,33,34

Delmopinol

Delmopinol is a surfactant which coats the tooth

surface and reduces the ability for bacteria to

attach to these surfaces as well as to each other.

It is available as a 0.2% solution containing 1.5%

alcohol. Side effects include staining which can

be removed by a dental prophylaxis. Plaque

reductions range from 9.3-35% and gingivitis

reductions averages 18%.

There was one

meta-analysis of studies from a manufacturer of

Delmopinol, but it was not a systematic review

of the literature. The report based on the meta-

analysis concluded that Delmopinol was of value

as an effective anti-plaque, anti-gingivitis agent.

The ability of various mouthrinse ingredients (as

well as some dentifrices) to adhere to the organic

pellicle of teeth, oral mucosa, salivary proteins and

bacteria, is referred to as substantivity. Following

a 30 second rinse with chlorhexidine, a drug with

high substantivity, 30% of the drug is retained

and is slowly released over time, enhancing the

product’s efficacy.

Table 1 - Comparison of Dentifrices for Plaque and Gingivitis Reduction

Product

# Studies

# Patients

% Plaque

% Gingivitis

Tooth Staining

ADA

Seal of Acceptance

Triclosan/Copolymer/Fluoride

2000

12-59

19-42

Yes

Stannous Fluoride

847

0-40

17-35

Yes

Although tooth staining has occurred with stannous fluoride products, clinical studies of this product reported no staining.