Quality Resource Guide

Dentifrices and Mouthrinses to Reduce Plaque and Gingivitis 3rd Edition

www.metdental.com

a data base of 29 studies in 5000 patients. This

analysis showed that patients who use an essential

oil mouthrinse for 6 months were 5 times as

likely to have a healthy mouth, 7.5 times to have

more plaque free sites, and 2.2 times to have

less bleeding sites.

Adverse effects reported

have been a burning sensation during use. It is

available in a 21.9-26.9% alcohol vehicle. A non-

alcohol essential oil containing mouthrinse is also

available and data suggests efficacy in control

of plaque and gingivitis comparable to product

containing alcohol.

However, more studies are

needed to establish efficacy. This product should

be used undiluted as directed by the manufacturer

(20 ml for 30 sec) as a rinse twice daily. This

mouthrinse, and some generic copies of it are ADA

accepted and FDA approved for the reduction of

plaque and gingivitis. Due to their alcohol content,

these rinses are not recommended for use in

children under age 12.

Cetylpyridinium Chloride

Cetylpyridinium chloride (CPC) is classified as a

quaternary ammonium compound.

Mouthrinses

with concentrations of 0.05%, 0.07%, and 0.045%

are

available

the

U.S. marketplace. Like

chlorhexidine, the activity of CPC is altered by

charged particles sometimes found in dentifrices.

The 0.07% product has no alcohol. The others

are available in a 14% to 18% alcoholic vehicle.

Studies of the 0.07% CPC mouthrinse have shown

reductions in gingivitis up to 38% and reductions in

plaque accumulation up to 36%.

One study compared the 0.07% CPC mouthrinse

to an essential oil mouthrinse and found similar

reductions in gingivitis.

However, two more recent

6 month studies found an essential oil mouthrinse

to be more effective than one containing 0.07%

CPC.

42,43

Side effects from CPC rinses have been

reported, including staining of teeth and soft tissue

irritation.

These products are not accepted by the

ADA for the reduction of plaque and gingivitis.

Stannous Fluoride

Some studies have suggested that a stannous

fluoride mouthrinse may be of value in the

reduction of plaque accumulation and gingivitis

development, while other studies have found little

or no benefit. In view of the conflicting reports,

considerable reservation has been voiced on the

efficacy of a stannous fluoride mouthrinse as

an antiplaque/antigingivitis agent.

Side effects

associated with this agent include taste alteration

and staining of teeth. It is marketed mainly as a

non-alcoholic solution. It is not ADA accepted or

FDA recognized in a mouthrinse formulation for

reduction of plaque or gingivitis.

A more recent report of three systemic reviews

of mouthrinses

stated: “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.” The report

also stated: “Evaluation of clinical relevance by

estimating percent reduction due to the active

agents and change 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.”

Summary/Conclusions

The current market of mouthrinses and dentifrices

produces a myriad of options for the consumer

and the dental care provider. Several strategies

may be used to make good decisions. This

QRG provides a brief review of research on

mouthrinses and dentifrices to help dental

professionals recommend the correct mouthrinse

and dentifrice for a patient’s specific issues. The

most effective non- prescription products usually

carry the ADA seal.

The effectiveness of any mouthrinse is tied to the

use of the agent as prescribed. This means the

directions for proper dose, duration of time in the

mouth, and frequency of use, must be carefully

followed by the patient. If a patient misses a

dose, he or she should use the agent as soon as

possible; doubling the dose will offer no benefit.

To receive the greatest antiplaque or anti-caries

benefit, the patient should brush and rinse before

retiring to bed.

After using a mouthrinse, the patient should not

rinse with water or drink anything for at least

30 minutes. Immediately drinking or rinsing

with water will increase the drug’s clearance

from the mouth and reduce its effectiveness.

Changes in taste sensation may also occur if

the mouth is rinsed with water immediately after

mouthrinse use. Alcohol containing mouthrinses

should be kept out of the reach of young

children, as their ingestion of 4 or more ounces

of rinses containing alcohol could cause alcohol

intoxication.