Oral mouthwashes for asymptomatic to mildly symptomatic adults with COVID-19 and salivary viral load: a randomized, placebo-controlled, open-label clinical trial

BACKGROUND

Recent randomized clinical trials suggest that the effect of using cetylpyridinium chloride (CPC) mouthwashes on the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load in COVID-19 patients has been inconsistent. Additionally, no clinical study has investigated the effectiveness of on-demand aqueous chlorine dioxide mouthwash against COVID-19.

METHODS

We performed a randomized, placebo-controlled, open-label clinical trial to assess for any effects of using mouthwash on the salivary SARS-CoV-2 viral load among asymptomatic to mildly symptomatic adult COVID-19-positive patients. Patients were randomized to receive either 20 mL of 0.05% CPC, 10 mL of 0.01% on-demand aqueous chlorine dioxide, or 20 mL of placebo mouthwash (purified water) in a 1:1:1 ratio. The primary endpoint was the cycle threshold (Ct) values employed for SARS-CoV-2 salivary viral load estimation. We used linear mixed-effects models to assess for any effect of the mouthwashes on SARS-CoV-2 salivary viral load.

RESULTS

Of a total of 96 eligible participants enrolled from November 7, 2022, to January 19, 2023, 90 were accepted for the primary analysis. The use of 0.05% CPC mouthwash was not shown to be superior to placebo in change from baseline salivary Ct value at 30 min (difference vs. placebo, 0.640; 95% confidence interval [CI], -1.425 to 2.706; P = 0.543); 2 h (difference vs. placebo, 1.158; 95% CI, -0.797 to 3.112; P = 0.246); 4 h (difference vs. placebo, 1.283; 95% CI, -0.719 to 3.285; P = 0.209); 10 h (difference vs. placebo, 0.304; 95% CI, -1.777 to 2.385; P = 0.775); or 24 h (difference vs. placebo, 0.782; 95% CI, -1.195 to 2.759; P = 0.438). The use of 0.01% on-demand aqueous chlorine dioxide mouthwash was also not shown to be superior to placebo in change from baseline salivary Ct value at 30 min (difference vs. placebo, 0.905; 95% CI, -1.079 to 2.888; P = 0.371); 2 h (difference vs. placebo, 0.709; 95% CI, -1.275 to 2.693; P = 0.483); 4 h (difference vs. placebo, 0.220; 95% CI, -1.787 to 2.226; P = 0.830); 10 h (difference vs. placebo, 0.198; 95% CI, -1.901 to 2.296; P = 0.854); or 24 h (difference vs. placebo, 0.784; 95% CI, -1.236 to 2.804; P = 0.447).

CONCLUSIONS

In asymptomatic to mildly symptomatic adults with COVID-19, compared to placebo, the use of 0.05% CPC and 0.01% on-demand aqueous chlorine dioxide mouthwash did not lead to a significant reduction in SARS-CoV-2 salivary viral load. Future studies of the efficacy of CPC and on-demand aqueous chlorine dioxide mouthwash on the viral viability of SARS-CoV-2 should be conducted using different specimen types and in multiple populations and settings.

The effect of a multicomponent oral care regimen on gingival inflammation: A randomized controlled clinical trial

BACKGROUND

Oral care regimens can be explored to improve oral health in patients with gingivitis. This study aimed to evaluate the efficacy of a multicomponent oral care regimen with a dual zinc plus arginine (DZA) toothpaste and cetylpyridinium chloride with zinc lactate (CPC + Zn) mouthwash in reducing gingival bleeding in patients with gingivitis.

METHODS

This randomized clinical trial included 94 participants with gingivitis who were randomized into two groups: the DZA/CPC + Zn group, which used a 1450-ppm fluoride toothpaste containing 0.96% zinc plus 1.5% arginine and a fluoride-containing mouthwash with 0.075% CPC and 0.28% zinc lactate, and the control group, which used a 1450-ppm fluoride toothpaste and a placebo mouthwash for 6 months. All participants were examined by a blinded examiner who measured the gingival index, plaque index, and gingival severity index. Data were analyzed using paired t test, independent t test, and analysis of covariance (ANCOVA).

RESULTS

Both groups presented statistically significant reductions in all clinical parameters compared to baseline. The DZA/CPC + Zn group exhibited significantly greater reductions in gingival index, gingival severity index, proximal gingival index, plaque index and proximal plaque index compared to the control group at 1, 3, and 6 months. Furthermore, DZA/CPC + Zn significantly decreased the percentage of patients with generalized gingivitis over a 6-month follow-up period. However, differences between the DZA/CPC + Zn and the control groups were not maintained after both groups established similar regimens with fluoride toothpaste.

CONCLUSION

The multicomponent oral care regimen consisting of DZA toothpaste and CPC + Zn mouthwash is effective in reducing gingival inflammation and supragingival biofilm in patients with gingivitis.

VesiX cetylpyridinium chloride is rapidly bactericidal and reduces uropathogenic Escherichia coli bladder epithelial cell invasion in vitro

Management of urinary tract infection (UTI) in postmenopausal women can be challenging. The recent rise in resistance to most of the available oral antibiotic options together with high recurrence rate in postmenopausal women has further complicated treatment of UTI. As such, intravesical instillations of antibiotics like gentamicin are being investigated as an alternative to oral antibiotic therapies. This study evaluates the efficacy of the candidate intravesical therapeutic VesiX, a solution containing the cationic detergent Cetylpyridinium chloride, against a broad range of uropathogenic bacterial species clinically isolated from postmenopausal women with recurrent UTI (rUTI). We also evaluate the cytotoxicity of VesiX against cultured bladder epithelial cells and find that low concentrations of 0.0063% and 0.0125% provide significant bactericidal effect toward diverse bacterial species including uropathogenic Escherichia coli (UPEC), Klebsiella pneumoniae, Enterococcus faecalis, Pseudomonas aeruginosa, and Proteus mirabilis while minimizing cytotoxic effects against cultured 5637 bladder epithelial cells. Lastly, to begin to evaluate the potential utility of using VesiX in combination therapy with existing intravesical therapies for rUTI, we investigate the combined effects of VesiX and the intravesical antibiotic gentamicin. We find that VesiX and gentamicin are not antagonistic and are able to reduce levels of intracellular UPEC in cultured bladder epithelial cells.

IMPORTANCE

When urinary tract infections (UTIs), which affect over 50% of women, become resistant to available antibiotic therapies dangerous complications like kidney infection and lethal sepsis can occur. New therapeutic paradigms are needed to expand our arsenal against these difficult to manage infections. Our study investigates VesiX, a Cetylpyridinium chloride (CPC)-based therapeutic, as a candidate broad-spectrum antimicrobial agent for use in bladder instillation therapy for antibiotic-resistant UTI. CPC is a cationic surfactant that is FDA-approved for use in mouthwashes and is used as a food additive but has not been extensively evaluated as a UTI therapeutic. Our study is the first to investigate its rapid bactericidal kinetics against diverse uropathogenic bacterial species isolated from postmenopausal women with recurrent UTI and host cytotoxicity. We also report that together with the FDA-approved bladder-instillation agent gentamicin, VesiX was able to significantly reduce intracellular populations of uropathogenic bacteria in cultured bladder epithelial cells.

Eligibility and efficacy of a CPC- and CHX-based antiviral mouthwash for the elimination of SARS-CoV-2 from the saliva: A randomized, double-blind, controlled clinical trial

AIM

This study aimed at investigating the efficacy of a 0.05% cetylpyridinium chloride-0.05% chlorhexidine (CPC-CHX) mouthwash in reducing viral load in the saliva as compared with sterile water.

MATERIALS AND METHODS

Forty SARS-CoV-2 positive patients were asked to dispense 4 mL of saliva. Half the patients rinsed for 60 s with 15 mL CPC-CHX, and the remaining patients rinsed with sterile water (control). Four millilitres of saliva were collected after 15, 30 and 60 min after rinsing. Quantitative reverse transcriptase polymerase chain reaction (RT-qPCR) and enzyme-linked immunosorbent assay (ELISA) specific for SARS-CoV-2 nucleocapsid protein were performed. For ELISA, the intact (representing the active virus) to total virus load (I/T) was calculated.

RESULTS

SARS-CoV-2 copy numbers/mL from RT-qPCR tended to decrease in the control group, whereas in the CPC-CHX group, an increase was observed after T30. However, mixed linear model analysis revealed no statistical differences between groups (p = .124), time points (p = .616) and vaccinated or non-vaccinated patients (p = .953). Similarly, no impact of group (p = .880), time points (p = .306) and vaccination (p = .711) was observed for I/T ratio values.

CONCLUSIONS

Within the limitation of this study, there was no evidence that the intervention reduced salivary SARS-CoV-2 viral load during the course of 60 min. Therefore, commonly used pre-procedural rinsing might not be clinically relevant.

Effectiveness of perioperative oral hygiene management using a cetylpyridinium chloride-, dipotassium glycyrrhizinate, and tranexamic acid-based mouthwash as an adjunct to mechanical oral hygiene in patients with maxillomandibular fixation: A randomized controlled clinical trial

OBJECTIVES

Maxillomandibular fixation requires the jawbones to remain static. Mechanical cleaning is also carried out by brushing or with a water flosser to maintain the oral cavity in a hygienic state, but this cannot be considered sufficient. Mouthwashes are used as a substitute for mechanical cleaning or in a supplementary role after such cleaning. The aim is to evaluate the effectiveness of HABITPRO mouthwash, which contains cetylpyridinium chloride, dipotassium glycyrrhizinate, and tranexamic acid in the specific environment created by maxillomandibular fixation used as an adjunct to mechanical cleaning.

MATERIAL AND METHODS

A total of 55 patients who had undergone maxillomandibular fixation were randomly allocated to either a HABITPRO group (n = 29) or a placebo group (n = 26). To investigate their oral hygiene status, their plaque control record (PCR) was reviewed, and the caries-related bacterial counts, pH, acid buffering capacity, white blood cell count, and ammonia in saliva were measured immediately before maxillomandibular fixation, on Day 10 of fixation, and immediately after fixation was released.

RESULTS

After approximately 2-3 weeks of mouthwash use, the PCR index also increased significantly in the placebo group compared with baseline, whereas it remained almost steady in the HABITPRO group. Additionally, salivary ammonia levels decreased significantly in the HABITPRO group compared to that of the placebo group.

CONCLUSIONS

Even with maxillomandibular fixation, continued gargling with HABITPRO mouthwash in the perioperative period as an adjunct to mechanical cleaning can help maintain better oral hygiene and reduce bacterial counts.

A Systematic Review of the Potential Effects of Lippia sidoides on Dental Plaque and Periodontal Diseases

Lippia sidoides is a typical shrub from Brazil that has been used in traditional medicine. This is a systematic review on the effect of L. sidoides for controlling dental plaque, gingivitis, and periodontitis. A database search through May 2021 in Medline/PubMed, SCOPUS, BVS, and Web of Science identified 711 reports of which 17 met our inclusion criteria. Five randomized controlled trials and three animal studies were included that compared L. sidoides-based products (toothpaste, mouthrinse, and gel) to cetylpyridinium chloride, chlorhexidine, and placebo products. Among the human studies, a significant antiplaque effect after treatment with L. sidoides-based products was observed in three studies and an antigingivitis effect in two studies, similar to chlorhexidine-based products. One study found superior dental plaque reduction compared to cetylpyridinium chloride mouthrinse. Only one study testing a L. sidoides gel found no antiplaque effect. Among the animal studies, an L. sidoides mouthrinse significantly reduced calculus in two studies, inflammatory infiltrate in one study, and plaque bacteria and gingivitis in one study. An L. sidoides gel significantly reduced alveolar bone loss and inflammatory response in one study in which mice were submitted to ligature-induced periodontal disease. In general, L. sidoides-based products were effective in reducing dental plaque and calculus formation, as well as clinical signs of gingivitis. As most studies present methodological limitations, these results should be interpreted carefully. Further clinical trials with greater methodological accuracy and control of biases are necessary for the use of L. sidoides-based products in humans to be viable in clinical practice.

Anti-plaque Efficacy of Herbal Mouthwashes Compared to Synthetic Mouthwashes in Patients Undergoing Orthodontic Treatment: A Randomised Controlled Trial

PURPOSE

The present study compared the antiplaque effects of two herbal mouthwashes containing Salvadora persica and Azadirachta indica, respectively, with two synthetic mouthwashes containing either chlorhexidine or cetylpyridinium.

MATERIALS AND METHODS

In this triple-blind, randomised controlled trial, 100 patients undergoing orthodontic treatment underwent scaling and polishing at baseline to obtain a plaque score of zero. In the first phase, they were given oral hygiene instructions and were provided with a standard toothpaste to be used twice daily for a period of three weeks. In the second phase, following scaling and polishing, they were randomly allocated to 4 groups according to 4 different types of mouthwash (A: chlorhexidine; B = cetylpyridinium; C = extracts of Salvadora persica miswak; D: extract of Azadirachta indica miswak) along with previously taught toothbrushing protocol for three more weeks. Plaque accumulation was scored three times according to the Modified Bonded Bracket Plaque Index: at the start, after the toothbrush-toothpaste trial, and at the end of mouthwash trial. The paired t-test was used to compare the pre-plaque and post-plaque indices in all groups. Analysis of mean differences of post-plaque indices between and within groups was performed using the post-hoc Tukey test. Qualitative variables were compared by Crosstab.

RESULTS

Eighty participants completed the study - 63 females and 17 males. There was a statistically significant decrease in mean plaque scores after using mouthwashes in all four groups at follow-up when compared to the baseline plaque score (p = 0.001). The greatest reduction of plaque score was found in group C (extract of Salvadora persica) when compared with group A, chlorhexidine (p = 0.016).

CONCLUSION

Compared to other mouthwashes, Salvadora persica miswak-based mouthwash showed a maximum reduction in the plaque scores among orthodontic patients.

Impact of modification with cetylpyridinium chloride - a potential cariogenic microbiota inhibitor, on selected physical-mechanical properties of the water-activated glass-ionomer

PURPOSE

Teeth caries is one of predominant civilization diseases. Dental fillings with antimicrobial addition might allow prevention of secondary caries. The purpose of this study was to evaluate hardness and tensile strength of cetylpyridinium chloride modified water activated glass-ionomer cement.

METHODS

Samples with diameter of 6 mm and height of 3 mm made of water-activated glass-ionomer cement were control group (0.0%). Test groups were series of samples of the same dimensions, with addition of cetylpyridinium chloride antimicrobial in concentrations of 0.5, 1.0, 1.5 and 2.0%. Two subgroups were prepared in each group to determine Vickers Hardness and Diametral Tensile Strength after 1 and 24 hours of sample storage in distilled water.

RESULTS

During hardness studies, no strong effect of antimicrobial concentration on hardness of samples was observed. Higher hardness values after 24 hours were demonstrated for all groups, compared to the samples tested after 1 hour. The exception was the group with the addition of 1% cetylpyridinium chloride, in which no statistically significant differences were observed. Diametral Tensile Strength values for samples tested after 1 hour decreased with increasing antibacterial concentration. A similar relationship was noticed for samples tested after 24 hours. No statistically signifi- cant differences were found between test samples after 1 or 24 hours.

CONCLUSIONS

There was no significant effect of cetylpyridinium chloride concentration on the hardness of the samples that significantly increased during the study. With the increase in antimicrobial concentration a decrease in diametral tensile strength value was observed, but these values did not change over time.

Effect of a toothpaste containing triclosan, cetylpyridinium chloride, and essential oils on gingival status in schoolchildren: a randomized clinical pilot study

OBJECTIVE

This randomized double-blind in vivo pilot study has evaluated the effects of a toothpaste containing fluoride (control) versus toothpaste containing fluoride, triclosan, cetylpyridinium chloride and essential oils (experimental) in controlling supragingival dental plaque and bleeding on probing in a sample of healthy schoolchildren.

METHOD AND MATERIALS

In total, 48 children (8 to 10 years) were selected and randomly divided into two groups (experimental and control), using the two different toothpastes twice a day for 2 minutes each for a 4-week period. The investigation included an evaluation of plaque quantity, using the Turesky modified Quigley-Hein method, and bleeding on probing that was recorded dichotomously. The unit of analysis was set at the gingival site level. Plaque Index and bleeding on probing were analyzed using distribution tables and chi-square test. A generalized estimating equation was used to estimate the parameters of a generalized linear model with a possible unknown correlation between outcomes.

RESULTS

In total, 40 schoolchildren completed the trial. Considering each group separately, a statistically significant difference in plaque scores was recorded for both treatments (z-test = 9.23, P < .01 for the experimental toothpaste; and z-test = 7.47, P < .01 for the control toothpaste). Nevertheless, the effect over time was higher for the experimental toothpaste than for the control one (3.38 vs 1.96). No statistically significant results were observed regarding bleeding on probing.

CONCLUSION

The 4-week use of the experimental toothpaste seems to produce higher plaque reduction compared to fluoridated toothpaste without other antibacterial ingredients. This finding has to be confirmed in a larger study.

Chemical Plaque Control Strategies in the Prevention of Biofilm-associated Oral Diseases

Dental plaque is a biofilm that forms naturally on the surfaces of exposed teeth and other areas of the oral cavity. It is the primary etiological factor for the most frequently occurring oral diseases, such as dental caries and periodontal diseases. Specific, nonspecific, and ecologic plaque hypothesis explains the causation of dental and associated diseases. Adequate control of biofilm accumulation on teeth has been the cornerstone of prevention of periodontitis and dental caries. Mechanical plaque control is the mainstay for prevention of oral diseases, but it requires patient cooperation and motivation; therefore, chemical plaque control agents act as useful adjuvants for achieving the desired results. Hence, it is imperative for the clinicians to update their knowledge in chemical antiplaque agents and other developments for the effective management of plaque biofilm-associated diseases. This article explores the critical analysis of various chemical plaque control strategies and the current trends in the control and prevention of dental plaque biofilm.

Dentin wear after simulated toothbrushing with water, a liquid dentifrice or a standard toothpaste

PURPOSE

To investigate the influence of dentifrices with and without abrasives on the wear and surface topography of human dentin following simulated toothbrushing in vitro.

METHODS

24 dentin specimens were prepared and randomly allocated to a liquid dentifrice (Garglin Gum-Guard), conventional dentifrice (333 Clinic Total Care), and control (distilled water) groups. Specimens were subjected to simulated toothbrushing of 50,000 repeated strokes under a 150 g-load. The dentin surface was profiled in each specimen using a profilometer before and after toothbrushing. The mean surface roughness (Ra) of the specimens was calculated and compared by one-way ANOVA and Tukey's post-hoc test (α = 0.05). The dentin surfaces were further examined by scanning electron microscopy (SEM).

RESULTS

The Ra values were similar between the liquid dentifrice and control groups (P > 0.05), and was significantly higher in the conventional dentifrice group (P < 0.001). On SEM examination, patent dentin tubules were observed in the conventional dentifrice and liquid dentifrice groups, but were not observed in the control group.

Randomized clinical trial of two oral care regimens in reducing and controlling established dental plaque and gingivitis

PURPOSE

To evaluate the efficacy of a test regimen (TR) integrating the use of a commercially available triclosan, PVM/MA copolymer, and sodium fluoride containing toothpaste, an alcohol-free, fluoride-free cetylpyridinium chloride (CPC) mouthwash, and a manual toothbrush with cheek and tongue cleaner compared to a negative control regimen (NCR) integrating a commercially available 0.76% sodium monofluorophosphate toothpaste, a manual toothbrush and a fluoride-free and alcohol-free non-antibacterial mouthwash in the reduction and control of established plaque and gingivitis after 4 weeks of product use.

METHOD

A 4-week, two-cell, double-blind, parallel-group, randomized clinical study was conducted in Cedar Knolls, New Jersey, USA. Recruited subjects were randomly assigned to two regimens: (1) a commercially available toothpaste containing triclosan, PVM/MA copolymer, and 0.243% sodium fluoride, a manual toothbrush with cheek and tongue cleaner, and commercially available mouthwash containing 0.075% CPC in a fluoride-free and alcohol-free base (TR), or (2) a commercially available 0.76% sodium monofluorophosphate toothpaste, a manual toothbrush with rounded/polished bristles, and a fluoride-free and alcohol-free non-antibacterial mouthwash (NCR). Subjects were examined for dental plaque and gingivitis. Gingival, Gingival Severity, Gingival Interproximal, Plaque, Plaque Severity and Plaque Interproximal Index scores were calculated. For regimen comparison, independent t-test and ANCOVA analyses were performed.

RESULTS

130 subjects were screened; 120 enrolled; and 115 subjects completed the randomized clinical trial (RCT). After 4 weeks of product use, subjects using TR exhibited statistically significant (P < 0.001) reductions of 22.3%, 27.8% and 20.4% in mean Gingival, Gingival Severity and Gingival Interproximal Index scores, respectively, as compared to subjects using NCR. After 4 weeks of product use, subjects using TR exhibited statistically significant (P < 0.001) reductions of 28.2%, 60.7% and 27.6% in mean Plaque, Plaque Severity and Plaque Interproximal Index scores, respectively, as compared to subjects using NCR.

Efficacy of CPC and essential oils mouthwashes compared to a negative control mouthwash in controlling established dental plaque and gingivitis: A 6-week, randomized clinical trial

PURPOSE

To evaluate the clinical efficacy of a mouthwash containing 0.075% cetylpyridinium chloride (CPC) in a fluoride-free, alcohol-free base and a mouthwash containing essential oils in a fluoride-free, 21.6% alcohol base as compared to a fluoride-free, alcohol-free non-antibacterial mouthwash in controlling established dental plaque and gingivitis after 6 weeks of twice daily use.

METHODS

A 6-week, parallel-group, randomized double blind clinical trial was conducted in Santo Domingo, Dominican Republic. Recruited subjects were randomly assigned to one of three treatment groups: (1) a mouthwash containing 0.075% CPC in a fluoride-free, alcohol-free base (CPC); (2) a commercially-available mouthwash containing essential oils in a fluoride-free, 21.6% alcohol base (EO); or (3) a fluoride-free, alcohol-free non-antibacterial mouthwash (NC). Subjects were instructed to rinse with the assigned mouthwash, after tooth brushing, twice daily (morning and evening). After 4 and 6 weeks of product use, subjects were examined for gingivitis (Whole Mouth Gingival, Gingival Interproximal, Gingival Severity Indexes) and plaque (Whole Mouth Plaque, Plaque Interproximal, and Plaque Severity Indexes) parameters. For treatment group comparisons, ANCOVA and post hoc Tukey's pair-wise comparisons (α = 0.05) were performed.

RESULTS

132 subjects were screened; 120 were enrolled; and 116 completed the study. After 6 weeks of product use, subjects using the CPC and EO mouthwashes exhibited statistically significant (P < 0.001) reductions of all gingival and plaque measurements compared to subjects using the NC mouthwash. Subjects using the CPC mouthwash did not exhibit a statistically significant (P > 0.05) reduction with respect to gingival severity and all plaque measures (Whole, Interproximal, and Severity) when compared to EO mouthwash. Subjects using the CPC mouthwash exhibited statistically significant (P < 0.05) reductions in Gingival Index scores of 5.1% (P = 0.005), and Gingival Interproximal Index scores of 5.5% (P = 0.016) relative to subjects using the EO mouthwash. These reductions were not considered clinically significant.

Efficacy of two fluoride-free, alcohol-free mouthwashes containing 0.075% or 0.07% CPC in controlling established dental plaque and gingivitis over a 6-week period on adults in Puerto Rico

PURPOSE

To evaluate the clinical efficacy of two commercially available, fluoride-free, alcohol-free mouthwashes containing either 0.075% or 0.07% cetylpyridinium chloride (CPC) in controlling established dental plaque and gingivitis compared to a non-antibacterial control mouthwash.

METHODS

A 6-week double-blind, randomized clinical trial was conducted in Trujillo Alto, Puerto Rico. Recruited subjects were randomly assigned to one of three treatment groups: (1) a fluoride-free, alcohol-free mouthwash containing 0.075% CPC (TG); (2) a fluoride-free, alcohol-free mouthwash containing 0.07% CPC (PC); and (3) a fluoride-free, alcohol-free mouthwash without antibacterial agent (NC). Subjects were instructed to rinse with the assigned mouthwash, after tooth brushing, twice daily (morning and evening). After 4 and 6 weeks of product use, subjects were examined for gingivitis (Whole Mouth Gingival, Gingival Interproximal, Gingival Severity Indexes) and plaque (Whole Mouth Plaque, Plaque Interproximal, and Plaque Severity Indexes) parameters. ANCOVA and post hoc Tukey's pair-wise comparisons (α = 0.05) were performed for treatment group comparisons.

RESULTS

A total of 132 subjects were screened; 120 were enrolled; and 116 completed the study. After 6 weeks of product use, participants who rinsed with the CPC-containing mouthwashes exhibited statistically significant (P < 0.05) reductions in all the gingivitis and plaque parameters evaluated, whereas in those using the non-antibacterial mouthwash, significant reductions were only observed in whole mouth and interproximal plaque scores. No statistically significant (P > 0.05) differences were observed, with respect to the gingival and plaque parameters, between the two CPC-containing mouthwashes.

The effectiveness of propolis on gingivitis: a randomized controlled trial

BACKGROUND

A randomized, double-blind, controlled clinical trial was conducted to evaluate the effectiveness of a propolis rinse on induced gingivitis by using the co-twin study design.

METHODS

Twenty-one twin pairs (n=42) were enrolled in a gingivitis study with oral hygiene promotion (14 days) and gingivitis induction (21 days). During the gingivitis induction phase, one member of the twin pair was randomly assigned to a 2% typified propolis rinse, and the other was assigned a color-matched 0.05% sodium fluoride plus 0.05% cetylpyridinium chloride rinse (positive control). Patients rinsed twice daily with 20 mL for 30 seconds for 21 days. Gingivitis was measured on days -14 (baseline), 0 (after hygiene phase), and 21 (after no-hygiene phase) by using the Papillary Bleeding Score (PBS) and by standard digital imaging of the gum tissues (G-parameter).

RESULTS

The 38 persons who completed the study (age 13-22 years) were well balanced according to PBS at baseline and G-parameter after the initial hygiene phase. After 21 days without oral hygiene, the propolis rinse and positive control rinse groups did not differ significantly for average PBS measurements or G-parameter.

CONCLUSIONS

Use of a 2% typified propolis rinse was equivalent to a positive control rinse during a 21-day no-hygiene period.

Comparison Between Two Interproximal Cleaning Procedures in Periodontitis Patients: A Six-month, Single-blind, Randomised Controlled Clinical Trial

PURPOSE

To determine whether mechanical cleaning with interdental brushes combined with the use of cetylpyridinium chloride (0.3% CPC) gel was more effective at plaque control than mechanical cleaning with interdental brushes alone.

MATERIALS AND METHODS

Forty individuals (30-70 years old) with at least 20 teeth and moderate chronic periodontitis who had no experience with interdental cleaning aids were randomly assigned to a treatment group (brush + gel, n = 20) or a control group (brush, n = 20). Both groups were examined by a dentist at baseline and at 3 and 6 months for changes in interdental plaque (interproximal plaque index [API]) levels, gingival inflammation (sulcus bleeding index [SBI]), probing depth (PD) and bleeding on probing (BOP).

RESULTS

No baseline differences in age, gender or number of teeth were observed between the two groups. During the study period, improvements in API and BOP were comparable between groups. However, improvements in SBI and PD were significantly greater in the test group than in the control group (p = 0.046 and p = 0.029, respectively).

CONCLUSION

Mechanical interdental plaque control using interdental brushes combined with the use of CPC gel significantly improved 6-month gingival and periodontal outcomes (SBI and PD) compared with mechanical cleaning with interdental brushes alone.

[Effects of cetylpyridinium chloride buccal tablets on halitosis induced by oral conditions]

OBJECTIVE

To investigate the effect of cetylpyridinium chloride buccal tablets on halitosis induced by oral conditions.

METHODS

With Porphyromonas gingivalis, Prevotella intermedia and Fusobacterium nucleatum as the testing bacteria, the minimal inhibitory concentration (MIC) of cetylpyridinium chloride buccal tablets was determined using minute amount serial dilution test. The production of volatile sulfur compounds (VSCs) was measured using sulfide detector halimeter in the anaerobic bacteria culture at 4 and 8 h after addition of the tablets. The effect of the tablets in suppressing odor production by mouth-borne halitosis bacteria was assessed using cysteine challenge test in healthy volunteers, and the effectiveness was evaluated by measuring the reduction in VSCs production and the duration of the effect.

RESULTS

Cetylpyridinium chloride buccal tablets inhibited the growth of all the 3 bacteria. The tablets obviously inhibited VSCs production by the 3 bacteria with a effect similar to chlorhexidine. Compared with distilled water gargle, the buccal tablets significantly reduced cysteine-induced VSCs production level in the healthy volunteers (P<0.05), and the effect lasted for 230 min.

CONCLUSION

Cetylpyridinium chloride tablets can obviously suppress bacteria responsible for oral halitosis and produce good effects in the treatment of halitosis induced by oral conditions.

Gingival health benefits of essential-oil and cetylpyridinium chloride mouthrinses: a 6-month randomized clinical study

PURPOSE

This randomized, single center, examiner-blind, controlled, parallel-group, 6-month clinical study compared the antiplaque/antigingivitis potential of an essential oil (EO) versus a 0.07% cetylpyridinium chloride (CPC)-containing mouthrinse. A 5% hydroalcohol solution was included as a control group.

METHODS

354 healthy volunteers (18-71 years of age) were enrolled in this clinical trial; 338 subjects completed the study. At baseline, 1-, 3-, and 6-month visits, subjects received an oral examination, gingivitis (MGI), gingival bleeding (BI) and plaque assessments (PI). Following randomization, subjects received a prophylaxis and began brushing twice daily with the provided fluoride toothpaste and rinsing twice daily with 20 mL of the assigned mouthrinse for 30 seconds.

RESULTS

All rinses were well tolerated by the subjects, with the exception of extrinsic tooth stain complaints in 13 subjects in the CPC group between the 3- and 6-month exams. Statistically significant reductions in gingivitis, bleeding and plaque were observed for both EO and CPC at all post-baseline time-points when compared to the negative control. At 6 months MGI and PI were reduced by 42.6% and 42.0% for EO and by 17.1% and 13.9% respectively, for CPC vs. control. When compared to CPC, EO was statistically significantly superior at all post-baseline time-points. EO showed increasing reductions in MGI of 10.5%, 20.3% and 30.7% as well as reductions in PI of 12.7%, 23.7% and 32.6% at 1, 3 and 6 months, respectively. When analyzing the number of healthy sites (MGI scores of 0 or 1), the beneficial effect of the EO-containing mouthrinse is 45.8% greater than using a CPC-containing mouthrinse and 59.8% greater than placebo.

Superiority of essential oils versus 0.075% CPC-containing mouthrinse: a two-week randomized clinical trial

OBJECTIVE

The objective of this randomized, examiner-blind, parallel, controlled clinical study was to compare the antiplaque/antigingivitis efficacy of an essential oil-containing mouthrinse (EO) to a new 0.075% cetylpyridinium chloride mouthrinse (CPC) using a two-week experimental gingivitis model with a 5% hydroalcohol rinse serving as the negative control.

METHODS

After signing informed consents and completing baseline examinations, 185 subjects were randomized into three groups. Subjects began supervised/recorded rinsing with 20 ml of their assigned rinse for 30 seconds twice daily for two weeks, with no mechanical oral hygiene permitted. Baseline and two-week assessments were conducted as follows: Turesky Modification of the Quigley-Hein Plaque Index (PI), Modified Gingival Index (MGI), and the Gingival Bleeding Index (BI). Analysis of efficacy variables (i.e., mean PI, mean MGI, mean BI, and proportion of bleeding sites derived from the BI) was performed using a one-way analysis of covariance (ANCOVA).

RESULTS

Among the 182 subjects who completed the study, the EO rinse showed statistically significant reductions compared to the negative control within the range previously reported in this model; PI = 36.5% (p < 0.001) and MGI = 17.5% (p < 0.001). A 43.2% reduction in proportion of bleeding sites (p < 0.001) was demonstrated. Mean PI, MGI, and proportion of bleeding sites at two weeks were statistically significantly lower for the EO rinse compared to the CPC rinse (p < 0.001), showing 27.7%, 11.9%, and 30.0% reductions, respectively.

CONCLUSION

An EO rinse provided superior antigingivitis/antiplaque efficacy compared to a 0.075% CPC rinse in this short-term clinical trial, and demonstrated efficacy within the range shown in previous studies using this model.

Treatment with a novel topical nanoemulsion (NB-001) speeds time to healing of recurrent cold sores

BACKGROUND

Current topical therapies for cold sores are only marginally beneficial due to poor skin penetration. We assessed the safety and efficacy of a novel topical antiviral nanoemulsion (NB-001) with high tissue bioavailability.

OBJECTIVES

The primary endpoint was the time to lesion healing.

METHODS

482 subjects with recurrent cold sores were randomized to self-initiate treatment with either vehicle or NB-001 (0.1%, 0.3% or 0.5%) at the first signs or symptoms of a cold sore episode. Lotion was applied 5 times per day, approximately 3 to 4 hours apart, for 4 days. Time to lesion healing was correlated with NB-001 bioavailability determined in human cadaver skin.

RESULTS

Subjects treated with 0.3% NB-001 showed a 1.3-day improvement in the mean time to healing compared to vehicle (P=0.006). This was consistent with human cadaver skin data indicating that the 0.3% nanoemulsion had the highest bioavailability, compared to 0.1% and 0.5% emulsions. No significant safety or dermal irritation concerns or systemic absorption were noted with any of the doses.

CONCLUSIONS

Topical NB-001 (0.3%) was well tolerated and highly efficacious in shortening the time to healing of cold sores. The improvement in time to healing was similar to that reported for oral nucleoside analogues, but without systemic exposure. Topical agents for recurrent herpes labialis (cold sores) reduce healing time by one half day, compared to oral therapies that speed healing by a day or more. A topical antiviral nanoemulsion was well tolerated and improved cold sore healing time by over a day compared to vehicle control. Nanoemulsion (NB-001) could represent a more efficacious topical treatment for recurrent cold sores.

Comparative antiplaque and antigingivitis efficacy of a multipurpose essential oil-containing mouthrinse and a cetylpyridinium chloride-containing mouthrinse: A 6-month randomized clinical trial

OBJECTIVE

This 6-month, examiner-blind, single-center, randomized, parallel group clinical trial compared the antiplaque and antigingivitis effects of an essential oil-containing mouthrinse with zinc chloride and sodium fluoride (EO) to a 0.05% cetylpyridinium chloride-containing mouthrinse (CPC) also with fluoride.

METHOD AND MATERIALS

Four hundred and eight gingivitis subjects were monitored for the primary outcomes of modified Gingival Index (MGI) and Plaque Index (PI) at baseline and 3 and 6 months. Subjects were randomly assigned to 6-month twice a day unsupervised use of EO, CPC, or negative control rinse in conjunction with normal brushing and flossing.

RESULTS

EO was always better than CPC at 3 and 6 months considering all parameters. All benefits allowed by EO increased from 3 to 6 months. CPC was better than the negative control at 3 and 6 months with respect to whole mouth plaque, and the proportion of more severe sites (baseline scores ≥ 3) in PI and MGI. At 6 months, CPC did not differ from negative control in relation to whole mouth MGI reduction, proximal MGI reduction, and percentages of sites improved over baseline in PI and MGI.

CONCLUSION

This new EO mouthrinse provided superior clinical benefits to CPC and demonstrated increasing plaque and gingivitis reductions over 6 months. Our findings support the regular long-term use of the EO mouthrinse and selection over a 0.05% CPC rinse for better efficacy.

Effect of an herbal mouth rinse in preventing periodontal inflammation in an experimental gingivitis model: a pilot study

BACKGROUND

Gingivitis is a chronic inflammatory condition, resulting from gingival bacteria and bacterial byproducts. Antiplaque oral rinses reduce inflammation by removing or inhibiting plaque formation. The purpose of this pilot study was to examine the anti-inflammatory effects of HM-302, a mouth rinse based on natural products, on gingival inflammation.

METHODS

A prospective, double-blinded, randomized parallel-group controlled trial involving 62 patients was conducted to assess efficacy and safety. During a 2-week period with no dental hygiene, subjects were randomized to receive either the study rinse (HM-302); a cetylpyridinium chloride (CPC) rinse; an essential oils (EO) rinse; or a water-only preparation. The gingival index (GI), plaque index (PI), and number of bleeding sites were measured at baseline and at the end of the study period.

RESULTS

Progression of gingival inflammation resulting from lack of dental hygiene was lowest in patients treated with the HM-302 rinse, and was significantly less marked than in patients treated with the water-only preparation. When compared to the CPC and EO treatments, HM-302 was the only mouth rinse that was significantlybetter than the control, with respect to both the change in absolute GI scores (p = .006) and to the percent increase in GI scores (p = .012). No serious adverse effects were noted in any of the study groups.

CONCLUSION

HM-302 is a safe and effective treatment for preventing the development of gingival inflammation in an experimental gingivitis model. Further research is needed to evaluate its long-term effects.

Evaluation of the sensitivity of a digital plaque imaging system on different tooth surfaces

OBJECTIVE

The study aimed to test the sensitivity of digital plaque imaging in distinguishing the effectiveness of test and control mouthwashes for different groups of tooth surfaces.

METHODS

The study was a double-blind, parallel, randomized, controlled clinical trial. Sixty subjects underwent scaling and polishing after recruitment, and attended their baseline examination after a washout phase of a minimum of seven days. They were then randomly assigned to one of two mouthwashes: 1) 0.05% CPC mouthwash; and 2) matching placebo mouthwash without CPC. Both groups were asked to use their assigned mouthwash and to refrain from any other oral hygiene measures for a period of eight days. At the baseline and day 8 visits, digital images of tooth surfaces were captured using Quantitative Light-induced Fluorescence (QLF) imaging, and plaque area as a percentage of the tooth surface was measured. Comparisons were carried out between the products for different groups of tooth surfaces. The data generated by the software were validated by a manual plaque outlining technique.

RESULTS

Fifty-eight (58) subjects completed the study. More plaque was detected on the facial surfaces for the whole mouth (42.88% coverage for CPC and 46.45% for placebo) than the whole mouth lingual surfaces (7.23% coverage for CPC and 11.10% for placebo). Significant differences were observed between the products for the following areas: all tooth surfaces (p = 0.032), anterior lingual (p = 0.005), posterior lingual (p = 0.003), and whole mouth lingual (p = 0.001), whereas there were no differences between the products for anterior facial, anterior (facial & lingual), posterior facial, posterior (facial & lingual), and whole mouth facial. A strong correlation (R = 0.793, p < 0.001) was observed between the data (mean difference of percentage plaque coverage) generated by the analyzing program and that from the manual plaque outlining technique.

CONCLUSION

The digital plaque imaging system was able to distinguish between the products when looking at the whole mouth. Digital imaging was better able to separate the groups when examining the lingual surfaces than facial.

Efficacy of antiplaque mouthwashes: a five-day clinical trial

The aim of this study was to evaluate and compare the efficacy of antiplaque mouthwashes. Plaque levels were determined by applying a plaque-disclosing solution using the Turesky et al modification of the Quigley Hein plaque index. The control group (n = 6) brushed twice per day with fluoride toothpaste for one minute and rinsed with water, while the study groups (n = 6) brushed once per day with fluoride toothpaste for one minute, followed by rinsing with 5.0 mL of mouthwash diluted with 10.0 mL of water for 30 seconds. The control group brushed and rinsed with water twice per day. The results indicated that cetylpyridinium chloride in combination with sodium fluoride offered maximum plaque inhibition, followed by chlorhexidine gluconate and sodium monofluorophosphate, while plaque levels increased in the control group and with the combination of chlorhexidine gluconate and sodium fluoride. The only antiplaque agents to demonstrate a statistically significant difference from the control were cetylpyridinium chloride in combination with sodium fluoride, and chlorhexidine gluconate. Increasing the fluoride concentration had no impact on antiplaque activity.

A clinical study to assess the 12-hour antimicrobial effects of cetylpyridinium chloride mouthwashes on supragingival plaque bacteria

OBJECTIVE

This randomized double-blind clinical study evaluated the antimicrobial efficacy of two mouthwashes containing (1) 0.075% cetylpyridinium chloride (CPC) + 0.05% sodium fluoride (NaF) in an alcohol-free base and (2) 0.075% CPC + 0.05% NaF in a 6% alcohol base, versus a negative control mouthwash containing 0.05% NaF in an alcohol-free base on numbers of bacteria in supragingival plaque 12 hours after a single use and 12 hours after 14 days' use.

METHODS

Enrolled subjects completed a one-week washout phase prior to providing baseline samples of supragingival plaque that were analyzed for numbers of anaerobic microorganisms. Subjects were randomized to a treatment group and instructed to rinse with 20 mL of the assigned mouthwash for 30 seconds. Post-treatment microbiological analyses were conducted on plaque samples collected 12 hours after the first use of each assigned mouthwash and after completing 14 days of twice-daily use of each assigned mouthwash. Oral examinations were completed by a dentist at each sample collection to assess soft and hard tissue oral health over the course of the study.

RESULTS

The study enrolled 188 adults (mean age 45.78 years; age range 23-69). Subjects rinsing with the CPC-containing mouthwash realized a statistically significant (p < 0.05) reduction in numbers of supragingival anaerobic bacteria at the 12-hour evaluation after a single use. In comparison to the control mouthwash, use of the CPC mouthwash in an alcohol base resulted in a 35.3% reduction in numbers of anaerobic plaque bacteria, while the CPC mouthwash in an alcohol-free base demonstrated a 34.5% reduction. Further, the analysis after twice-daily use for 14 days indicated that the CPC mouthwash in an alcohol base demonstrated a 73.8% reduction in anaerobic plaque bacteria, while the CPC mouthwash in an alcohol-free base demonstrated a 70.9% reduction in anaerobic plaque bacteria versus the control mouthwash.

CONCLUSION

The CPC mouthwash in an alcohol-free base reduced supragingival plaque bacteria by 34.5% and 70.9% compared to the control mouthwash 12 hours after a single use and after 14 days of use, respectively. In addition, the CPC mouthwash in an alcohol base reduced supragingival bacteria by 35.3% and 73.8% compared to the control mouthwash 12 hours after a single use and after 14 days of use, respectively. There were no statistically significant differences between the CPC-containing mouthwashes at either of the post-treatment time points.

Evaluation of the antiplaque efficacy of two cetylpyridinium chloride-containing mouthwashes

OBJECTIVE

The purpose of this clinical study was to evaluate the efficacy in reducing dental plaque regrowth of two mouthwashes containing 0.075% cetylpyridinium chloride (CPC), one with 6% alcohol and one alcohol-free, as compared to a negative control mouthwash without CPC, using the Modified Gingival Margin Plaque Index (MGMPI).

METHODS

The study was a double-blind, randomized, three-way crossover, controlled design. Following a washout period, subjects reported to the dental clinic where they were instructed to brush their teeth, used their assigned mouthwash, and were scored by the examining dentist for plaque using the MGMPI method. Subjects were instructed to refrain from all oral hygiene for the next 24 hours, except for rinsing with their assigned mouthwash 12 hours post-brushing. After this 24-hour period, subjects returned to the dental clinic and were once again scored for plaque. This sequence of washout followed by mouthwash use and plaque scoring was repeated until each subject had used all three mouthwashes. An ANOVA was conducted to assess between-group differences.

RESULTS

The two test mouthwashes significantly reduced plaque regrowth over a 24-hour period (p < 0.05) as compared to the negative control mouthwash. The difference between the CPC-containing mouthwashes was not significant (p = 0.4868).

CONCLUSION

Two mouthwashes containing 0.075% CPC, one with 6% alcohol and the other alcohol-free, were found to be safe and effective in reducing plaque accumulation when compared a negative control mouthwash without CPC. In short-term studies, the MGMPI appears useful for evaluating the antiplaque efficacy of mouthwash products.

The antibacterial and antiplaque effectiveness of mouthwashes containing cetylpyridinium chloride with and without alcohol in improving gingival health

This article briefly discusses the antibacterial action ofcetylpyridinium chloride (CPC) and its efficacy in the removal of bacterial plaque as an adjunct to the mechanical cleaning of tooth surfaces. It reviews new studies on the effectiveness of mouthwash formulations containing CPC against two common oral bacteria species and in disrupting plaque biofilms. Finally, this article reviews three clinical studies which support that the daily use of mouthwashes containing 0.075% CPC, with and without alcohol, represents a valuable complement to daily mechanical plaque control.

A comparative investigation to evaluate the clinical efficacy of an alcohol-free CPC-containing mouthwash as compared to a control mouthwash in controlling dental plaque and gingivitis: a six-month clinical study on adults in San Jose, Costa Rica

OBJECTIVE

This study was designed to evaluate the clinical efficacy of an antiplaque alcohol-free mouthwash containing 0.075% cetylpyridinium chloride (CPC) and 0.05% sodium fluoride (NaF), as compared to a control mouthwash containing only 0.05% NaF, in controlling established dental plaque and gingivitis after three and six months of product use.

METHODS

This was a single-center, parallel-group, two-cell, double-blind, randomized clinical study. Prospective adult male and female subjects from San Jose, Costa Rica reported to the clinical facility having refrained from all oral hygiene procedures for 12 hours, and from eating, drinking, or smoking for four hours prior to their visit. Qualifying subjects who presented with Gingival Index scores (Löe and Silness Index) of at least 1.0 and Plaque Index scores (Turesky Modified Quigley-Hein Index) of at least 1.5 were allowed to participate in this study. Subjects were randomly assigned to one of two treatment groups according to their baseline gingival and plaque scores. In the first treatment group (Test), subjects used an alcohol-free mouthwash containing 0.075% CPC and 0.05% NaF, whereas in the second treatment group (Control), subjects used a mouthwash containing only 0.05% NaF. Gingivitis and plaque assessments, and examinations of oral hard and soft tissues were conducted after three months and six months of product use.

RESULTS

One-hundred and ten (110) subjects complied with the protocol and completed the six-month study. After six months of product use, the Test Mouthwash group exhibited statistically significant reductions from baseline with respect to Gingival (33.5%), Gingival Interproximal (34.5%), Gingival Severity (63.2%), Plaque (33.6%), Plaque Interproximal (30.0%), and Plaque Severity (73.6%) Index scores. After six months of product use, the Control Mouthwash group exhibited statistically significant increases from baseline with respect to Gingival (6.9%), Plaque Interproximal (7.2%), and Plaque Severity (32.7%) Index scores. Furthermore, after six months of product use, the Control Mouthwash group exhibited reductions from baseline with respect to Plaque (6.1%), Gingival Interproximal (3.6%), and Gingival Severity (1.1%) Index scores which were not statistically significant. After three months of product use, the Test Mouthwash group exhibited statistically significant reductions in Gingival (25.0%), Gingival Interproximal (22.3%), Gingival Severity (38.9%), Plaque (26.1%), Plaque Interproximal (22.4%), and Plaque Severity (75.0%) Index scores as compared to the Control Mouthwash group. After six months of product use, the Test Mouthwash group exhibited statistically significant reductions in Gingival (38.1%), Gingival Interproximal (37.1%), Gingival Severity (63.6%), Plaque (36.5%), Plaque Interproximal (33.2%), and Plaque Severity (78.5%) Index scores as compared to the Control Mouthwash group.

CONCLUSION

The results of this double-blind clinical study support that 1) an alcohol-free mouthwash containing a combination of 0.075% CPC and 0.05% NaF produces statistically significant reductions in dental plaque and gingivitis after three and six months compared to baseline, and 2) the alcohol-free CPC mouthwash provides a statistically significantly greater level of efficacy in controlling established dental plaque and gingivitis after three and six months of product use as compared to the Control Mouthwash containing only NaF.

Superiority of an essential oil mouthrinse when compared with a 0.05% cetylpyridinium chloride containing mouthrinse: a six-month study

OBJECTIVE

To evaluate the antiplaque/antigingivitis effectiveness of an essential oils containing mouthrinse as compared to a 0.05% cetylpyridinium chloride mouthrinse.

METHOD

Generally healthy subjects with mild to moderate levels of plaque and gingivitis participated in a 6-month, examiner-blind, single centre, randomised, parallel-group controlled clinical trial. They were randomised into three mouthrinse groups--control (C), 0.05% cetylpyridinium chloride (CPC), or a fixed combination of essential oils (EO). Subjects received a dental prophylaxis at baseline and rinsed twice daily in addition to their usual oral hygiene for six months. Plaque Index and Modified Gingival Index were determined at 3 and 6 months.

RESULTS

At 6 months, the EO group exhibited statistically significantly lower mean scores for MGI and PI than CPC (32.4% and 56.2% reductions, respectively). Compared to control, EO provided statistically significantly lower mean MGI and PI scores (36.3% and 69.7 %, respectively). The CPC group showed statistically significantly lower mean MGI and PI scores than the C group (5.8% and 30.7%, respectively).

CONCLUSION

This study demonstrated the superiority of an EO rinse compared to a 0.05% CPC rinse in reducing plaque and gingivitis and confirmed that the daily use of an EO containing mouthrinse can provide a clinically significant benefit in reducing plaque and gingivitis.

Clinical investigation of the efficacy of a commercial mouthrinse containing 0.05% cetylpyridinium chloride in reducing dental plaque

OBJECTIVE

The objective of this independent, double-blind, seven-day clinical study was to assess the efficacy of a commercially available mouthrinse containing 0.05% CPC for controlling dental plaque relative to that of a control mouthrinse without 0.05% CPC.

METHODS

Adult male and female subjects from the San Juan, Puerto Rico area reported to the clinical facility, having refrained from any oral hygiene procedures for 12 hours, and from eating, drinking, and smoking for four hours, for an assessment of the oral soft and hard tissues and a baseline dental plaque evaluation. Qualifying subjects were randomly assigned into one of the two treatment groups, and were provided with their assigned mouthrinse, an adult soft-bristled toothbrush, and a commercially available fluoride toothpaste for home use. Over the seven-day period of home use, during which there were no restrictions regarding diet or smoking habits, subjects were instructed to brush their teeth for one minute twice daily (morning and evening) with the toothbrush and toothpaste supplied, to rinse their mouths with water after brushing, and then to rinse with 15 ml of their assigned mouthrinse for one minute before expectorating. The use of other oral hygiene products or procedures, such as floss or interdental stimulators, was not permitted during the study. After seven days of product use, subjects returned to the clinical facility having followed the same restrictions with respect to oral hygiene procedures, eating, and drinking as prior to the baseline examination, and the oral soft and hard tissue assessments and dental plaque evaluations were repeated. Comparisons between treatment groups with respect to baseline-adjusted Plaque Index scores at the seven-day examination were performed using Analyses of Covariance, p < or = 0.05.

RESULTS

Forty-eight subjects complied with the protocol and completed the study. Results demonstrated that, after seven days of product use and 12 hours after rinsing, both the CPC mouthrinse group and the control mouthrinse group exhibited statistically significant reductions in whole-mouth Plaque Index scores (25.3% and 6.6%, respectively), in Plaque Index scores measured at interproximal sites (51.3% and 32.9%, respectively), and in Plaque Severity Index scores (43.5% and 25.4%, respectively). Relative to the control mouthrinse, the 0.05% CPC mouthrinse group exhibited statistically significant greater reductions in whole-mouth plaque scores (15.9%), in Plaque Index scores measured at interproximal sites (23%), and in Plaque Severity Index scores (17%). As the measurements were made 12 hours after final product use, the results also demonstrate that the CPC mouthrinse provides 12-hour protection against plaque accumulation in individuals with existing plaque.

CONCLUSION

The overall results of this double-blind clinical study support the conclusion that after seven days of product use, a mouthrinse containing 0.05% CPC provides significantly greater efficacy for reducing dental plaque 12 hours after use, than does a control mouthrinse without 0.05% CPC.

A clinical investigation of the efficacy of a commercial mouthrinse containing 0.05% cetylpyridinium chloride to control established dental plaque and gingivitis

OBJECTIVE

The objective of this independent, double-blind, parallel, six-week clinical study was to assess the efficacy of a commercially available mouthrinse containing 0.05% cetylpyridinium chloride (CPC) for controlling established dental plaque and gingivitis relative to that of a control mouthrinse without CPC.

METHODS

Adult male and female subjects from the Maceió, Brazil area reported to the clinical facility, after having refrained from any oral hygiene procedures for 12 hours, and from eating, drinking, and smoking for four hours, for an assessment of the oral soft and hard tissues, and for a baseline gingivitis and dental plaque evaluation. Qualifying subjects were randomly assigned to one of the two treatment groups, and were provided with their assigned mouthrinse, and an adult soft-bristled toothbrush and toothpaste for home use. Over the six-week period of home use, during which there were no restrictions regarding diet or smoking habits, subjects were instructed to brush their teeth for one minute twice daily with the supplied toothbrush and a commercially available fluoride toothpaste, to rinse their mouths with water after brushing, and then to rinse with their assigned mouthrinse for one minute before expectorating. The use of any other oral hygiene products or procedures, such as floss or interdental stimulators, was not permitted during the study. After six weeks of product use, subjects returned to the clinical facility, having followed the same restrictions with respect to oral-hygiene procedures, eating and drinking, as with the baseline visit, and the oral soft and hard tissue assessments and gingivitis and dental plaque evaluations were repeated.

RESULTS

One-hundred and ten subjects complied with the protocol and completed the study. With regard to supragingival plaque, after six weeks of product use, the subjects using the 0.05% CPC mouthrinse exhibited statistically significant reductions from baseline in whole-mouth Plaque Index scores (32.1%), in Plaque Index scores measured at interproximal sites (31.3%), and in Plaque Severity Index scores (84.8%). Subjects using the control mouthrinse exhibited statistically significant reductions from baseline in whole-mouth Plaque Index scores (7.0%), in Plaque Index scores measured at interproximal sites (6.4%), and in Plaque Severity Index scores (24.5%). When compared to the control mouthrinse group, the 0.05% CPC mouthrinse group presented statistically significant greater reductions in whole-mouth Plaque Index scores (27.9%), in Plaque Index scores measured at interproximal sites (27.9%), and in Plaque Severity Index scores (81.1%) after six weeks of product use. With regard to gingivitis, after six weeks of product use, subjects using the 0.05% CPC mouthrinse exhibited statistically significant reductions from baseline in whole-mouth Gingival Index scores (25.0%), in Gingival Index scores measured at interproximal sites (25.3%), and in Gingivitis Severity Index scores (42.4%). Subjects using the control mouthrinse exhibited statistically significant reductions from baseline in whole-mouth Gingival Index scores (6.5%), in Gingival Index scores measured at interproximal sites (5.5%), and in Gingivitis Severity Index scores (11.6%). When compared to the control mouthrinse group, the 0.05% CPC mouthrinse group presented statistically significant greater reductions in whole-mouth Gingival Index scores (19.8%), in Gingival Index scores measured at interproximal sites (20.7%), and in Gingivitis Severity Index scores (35.5%) after six weeks of product use.

CONCLUSION

The results of this double-blind, parallel, six-week clinical study support the conclusion that a mouthrinse containing 0.05% CPC is efficacious for controlling established dental plaque and gingivitis. As measurements were conducted 12 hours after product use, the results also demonstrate that the 0.5% CPC mouthrinse provides 12-hour protection against plaque and gingivitis.

Clinical investigation of the efficacy of a commercial mouthrinse containing 0.05% cetylpyridinium chloride in preventing dental plaque

OBJECTIVE

The objective of this independent, double-blind, seven-day clinical study was to assess the efficacy of a commercially available mouthrinse containing 0.05% cetylpyridinium chloride (CPC) in preventing dental plaque build-up relative to that of a control mouthrinse without 0.05% CPC.

METHODS

Adult male and female subjects from the São Paulo, Brazil area reported to the clinical facility, having refrained from any oral hygiene procedures for 12 hours, and from eating, drinking, and smoking for four hours, for an assessment of the oral soft and hard tissues and a baseline dental plaque evaluation. Subjects qualifying for participation received a complete dental prophylaxis. Qualifying subjects were randomly assigned into one of the two treatment groups and were provided with their assigned mouthrinse, an adult soft-bristled toothbrush, and a commercially available fluoride toothpaste for home use. Over the seven-day period of home use, during which there were no restrictions regarding diet or smoking habits, subjects were instructed to brush their teeth for one minute twice daily (morning and evening) with the toothbrush and toothpaste supplied, to rinse their mouths with water after brushing, and then to rinse with 15 ml of their assigned mouthrinse for one minute before expectorating. The use of other oral hygiene products or procedures, such as floss or interdental stimulators, was not permitted during the study. After seven days of product use, subjects returned to the clinical facility having followed the same restrictions with respect to oral hygiene procedures, eating and drinking, as prior to the baseline examination, and the oral soft and hard tissue assessments and dental plaque evaluations were repeated.

RESULTS

Forty-three subjects complied with the protocol and completed the study. Results demonstrated that after seven days of product use, mean plaque levels were statistically significantly lower (p < 0.05) than the pre-prophylaxis levels for both treatment groups. The mean plaque level for the CPC mouthrinse group was 46.1% of the pre-prophylaxis plaque level, whereas the mean plaque level for the control mouthrinse group was 75.5% of the pre-prophylaxis plaque level. The results demonstrate a statistically significant reduction in plaque build-up for the CPC mouthrinse group (29.3%) as compared to the control group.

CONCLUSION

The overall results from this double-blind clinical study support the conclusion that, after seven days of product use, a mouthrinse containing 0.05% CPC provides significantly greater efficacy in preventing dental plaque build-up than a control mouthrinse without 0.05% CPC. As measurements were made 12 hours after final product use, the results also demonstrate that the CPC rinse provides 12-hour protection against dental plaque build-up.

Short-term effects of a combination product night-time therapeutic regimen on breath malodor

AIM

To evaluate the malodor reduction benefits of a therapeutic night-time oral hygiene regimen that combined antibacterial toothpaste and mouthrinse with an oscillating-rotating rechargeable power toothbrush.

METHODS AND MATERIALS

An independent clinical trial was conducted using a randomized, negative-controlled, single blind, two treatment, 4-period crossover design. After completing a 1-week acclimation period, subjects were randomly assigned to a treatment sequence consisting of the following two regimens: (1) a night-time regimen of Crest Pro-Health Night dentifrice, Crest Pro-Health Night rinse, and Oral-B Vitality Precision Clean power toothbrush and (2) a control regimen of Crest Cavity Protection dentifrice and an ADA manual toothbrush. Each treatment period started with an overnight baseline volatile sulfur compounds (VSCs) Halimeter measurement, followed by twice daily use of the assigned regimen. Post-treatment overnight malodor was assessed at 24 hours. There were 2-day washout periods between treatments. All procedures were repeated with the next assigned regimen, through four crossover periods.

RESULTS

Twenty-five subjects completed the study. Twice daily use of the therapeutic night-time regimen resulted in a significant (p>0.001) 35% reduction of mean VSC levels in the overnight breath compared to the control regimen.

CONCLUSION

One-day use of a night-time regimen consisting of a therapeutic paste, rinse, and an oscillating-rotating rechargeable power toothbrush provided a 35% reduction in overnight breath malodor compared to regular brushing.

CLINICAL SIGNIFICANCE

Combining a proven therapeutic dentifrice, mouthrinse, and advanced design toothbrush in a single regimen is an efficient means of maximizing breath odor reductions.

Antiplaque/antigingivitis efficacy and safety of a cetylpyridinium chloride/zinc gluconate mucoadhesive gel. Results of a 6-month clinical trial

This article presents the results of a controlled clinical trial evaluating a new at-home treatment to improve gingival health. Designed for overnight application at the gingival margins and in the interproximal spaces, the product is a mucoadhesive gel containing 0.10% cetylpyridinium chloride (CPC) and 0.592% zinc gluconate (ZG). The authors assessed the efficacy and safety of the CPC/ZG gel in adults with low-to-moderate gingival and plaque index scores by comparing clinical and laboratory findings for subjects using the CPC/ZG gel with those for subjects using the control gel (0% CPC and 0.592% ZG). Clinical findings at 3 and 6 months showed statistically significant improvements in two of the three major indices of gingival health in the CPC/ZG group compared with the control group. The performance of the treatment gel was supported by results of microbial analyses of plaque samples.

In vivo antiplaque efficacy of combined antimicrobial dentifrice and rinse hygiene regimens

PURPOSE

To evaluate using digital plaque image analysis the antiplaque efficacy of oral care regimens including use of antimicrobial toothpaste in combination with antimicrobial mouthrinse.

METHODS

16 subjects completed the study protocol including: (1) initial treatment phase, all subjects used a standard sodium fluoride dentifrice with 2x/day brushing, (2) second treatment phase, subjects were randomized to two treatment groups: stannous fluoride/sodium hexametaphosphate dentifrice or sodium fluoride triclosan/copolymer dentifrice; (3) third treatment phase, the group using stannous fluoride dentifrice rinsed with alcohol-free cetylpyridinium chloride mouthrinse and the group using triclosan dentifrice rinsed with essential oil mouthrinse. During each phase, plaque levels were assessed in the morning before toothbrushing (AM), post-brushing in the morning (PB) and in the afternoon (PM).

RESULTS

Stannous fluoride dentifrice was superior to triclosan dentifrice in plaque growth inhibition between toothbrushing. Both mouthrinses provided additional plaque prevention benefits when used with antimicrobial dentifrices. The cetylpyridinium chloride mouthrinse and stannous fluoride dentifrice regimen was particularly effective, building accretive efficacy over time. Average plaque reductions exceeded 50% vs. sodium fluoride dentifrice alone. Chemotherapeutic dentifrices and rinses increase plaque control used alone and particularly in combination. The stannous fluoride-cetylpyridinium chloride regimen showed the greatest benefits.

Comparison of the effects of cetylpyridinium chloride with an essential oil mouth rinse on dental plaque and gingivitis ? a six-month randomized controlled clinical trial

OBJECTIVE

To compare the effects of an experimental mouth rinse containing 0.07% cetylpyridinium chloride (CPC) (Crest Pro-Health) with those provided by a commercially available mouth rinse containing essential oils (EOs) (Listerine) on dental plaque accumulation and prevention of gingivitis in an unsupervised 6-month randomized clinical trial.

MATERIAL AND METHODS

This double-blind, 6-month, parallel group, positively controlled study involved 151 subjects balanced and randomly assigned to either positive control (EO) or experimental (CPC) mouth rinse treatment groups. At baseline, subjects received a dental prophylaxis procedure and began unsupervised rinsing twice a day with 20 ml of their assigned mouthwash for 30 s after brushing their teeth for 1 min. Subjects were assessed for gingivitis and gingival bleeding by the Gingival index (GI) of Löe & Silness (1963) and plaque by the Silness & Löe (1964) Plaque index at baseline and after 3 and 6 months of rinsing. At 3 and 6 months, oral soft tissue health was assessed. Microbiological samples were also taken for community profiling by the DNA checkerboard method.

RESULTS

Results show that after 3 and 6 months of rinsing, there were no significant differences (p=0.05) between the experimental (CPC) and the positive control mouth rinse treatment groups for overall gingivitis status, gingival bleeding, and plaque accumulation. At 6 months, the covariant (baseline) adjusted mean GI and bleeding sites percentages for the CPC and the EO rinses were 0.52 and 0.53 and 8.7 and 9.3, respectively. Both mouth rinses were well tolerated by the subjects. Microbiological community profiles were similar for the two treatment groups. Statistically, a significant greater reduction in bleeding sites was observed for the CPC rinse versus the EO rinse.

CONCLUSION

The essential findings of this study indicated that there was no statistically significant difference in the anti-plaque and anti-gingivitis benefits between the experimental CPC mouth rinse and the positive control EO mouth rinse over a 6-month period.

A meta-analysis of six-month studies of antiplaque and antigingivitis agents

BACKGROUND AND METHODS

The author conducted a systematic review of the literature to evaluate the efficacy of antigingivitis and antiplaque products in six-month trials. He searched electronic databases for six-month randomized clinical studies that evaluated both antiplaque and antigingivitis properties of dentifrices or mouthrinses. In addition, the author solicited unpublished studies from manufacturers.

RESULTS

Seventeen studies support the antiplaque, antigingivitis effects of dentifrices containing 0.30 percent triclosan, 2.0 percent Gantrez copolymer. There was no evidence of efficacy for triclosan products containing either soluble pyrophosphate or zinc citrate. Dentifrices with stannous fluoride had statistically significant, but marginally clinically significant, evidence of an antiplaque effect; however, there was both a statistically and clinically significant antigingivitis effect. The largest body of studies (21 studies) supported the efficacy of mouthrinses with essential oils. A smaller body of studies (seven) supported a strong antiplaque, antigingivitis effect of mouthrinses with 0.12 percent chlorhexidine. Results for mouthrinses with cetylpyridinium chloride varied and depended on the product's formula.

CONCLUSIONS

The studies in this systematic review provide strong evidence of the antiplaque, antigingivitis effects of multiple agents. These results support the use of these agents as part of a typical oral hygiene regimen.

Anticalculus effect of a cetylpyridinium chloride/zinc gluconate mucoadhesive gel: results of a randomized, double-blind, controlled clinical trial

OBJECTIVE

This randomized, double-blind, controlled clinical trial investigated the anticalculus effect of a cetylpyridinium chloride/ zinc gluconate (CPC/ZG) mucoadhesive gel.

METHODOLOGY

The 80 adults from the San Francisco area who fulfilled the enrollment criteria were stratified based on total Volpe-Manhold Index (VMI) scores (low, medium, or high), gender, and other demographic data. Within these strata, they were randomly assigned to the CPC/ZG gel group or the placebo gel group, and underwent a baseline oral soft tissue (OST) examination. Subjects were dispensed Oral-B Indicator 35 Compact Head soft toothbrushes and Colgate Cavity Protection MFP toothpaste, and instructed to brush twice daily using these products. Every night for three months, following the nighttime brushing and just before retiring, subjects applied their assigned treatment gel to the lingual surfaces of the six mandibular anterior teeth. They were instructed not to eat or drink until morning and to avoid using other methods of interdental cleaning between the treated teeth, except to remove impacted food. Total VMI scores and OST examination findings obtained at three months were compared with baseline findings.

RESULTS

Seventy-eight (78) of the 80 subjects complied with the protocol and completed the study. After three months of treatment, the CPC/ZG group showed a 30% decrease in mean VMI score compared with a 0% decrease in the placebo group. OST examination at three months revealed no serious adverse events in either group.

CONCLUSION

Results of this clinical trial indicate that regular use of the CPC/ZG gel, with or without the use of floss or other interdental cleaning products, yields a statistically significant reduction in calculus.

Clinical efficacy of flossing versus use of antimicrobial rinses

BACKGROUND

Dental floss is only used by a small part of the population on a daily basis. Therefore, an easy, applicable alternative is needed. This alternative could be a mouthrinse with antimicrobial activity for daily use. The aim of the present study was to evaluate the efficacy of two mouthrinses in reducing interdental plaque and gingivitis compared to dental floss.

METHODS

A total of 156 healthy volunteers were randomly assigned to the following groups: 1) toothbrushing and rinsing (0.06% chlorhexidine and 0.025% fluoride); 2) toothbrushing and rinsing (0.1% cetylpyridiniumchloride and 0.025% fluoride); 3) toothbrushing and flossing; and 4) toothbrushing only (N = 39 subjects in each group). At baseline, the modified proximal plaque index (MPPI) and papillary bleeding index (PBI) were recorded. Thereafter, subjects had to brush in the usual manner during 8 weeks. Additionally, test groups had to rinse once a day (groups 1 and 2: 30 seconds) or to floss (group 3). Eight weeks after baseline, indices were recorded again and improvements were calculated. Analysis of variance (ANOVA) and the Bonferroni test served for statistical analysis.

RESULTS

After 8 weeks, reductions for all indices were found in all groups (P <0.05). With respect to the MPPI, mouthrinse groups performed better than the control and floss groups: 1) 0.73; 2) 0.82; 3) 0.40; and 4) 0.32 (P <0.05). The PBI showed no statistically significant difference between groups: 1) 0.46; 2); 0.50; 3); 0.42; and 4) 0.37.

CONCLUSION

The results suggest that, in combination with toothbrushing, daily use of the tested mouthrinses may result in a higher interproximal plaque reduction than daily flossing.

The effect of toothbrushing regimens on the plaque inhibitory properties of an experimental cetylpyridinium chloride mouthrinse

OBJECTIVE

The objective of this study was to determine the effect of various toothbrushing regimens with a standard fluoride dentifrice on the plaque inhibitory properties of an alcohol-free, high bioavailable 0.07% cetylpyridinium chloride (CPC) mouthrinse.

MATERIALS AND METHODS

The study was a randomized, single-centre, examiner blind, four-period cross-over study involving 29 healthy subjects. Four treatment regimens were evaluated: (1) Toothbrushing with dentifrice followed by a water rinse (B-W, negative control); (2) Toothbrushing with dentifrice followed by a CPC mouthrinse use (B-CPC); (3) Toothbrushing with dentifrice followed by a water rinse and then a CPC mouthrinse use (B-W-CPC); and (4) Toothbrushing with dentifrice and waiting 60 min. prior to a CPC mouthrinse use (B-60 min.-CPC). Three days before the baseline exam of treatment periods, subjects were instructed to brush only the lingual surfaces of their teeth for up to 60 s twice daily. At baseline, subjects received a plaque exam using the Turesky modification of the Quigley-Hein index (MQH) followed by a polishing on the lingual and buccal surfaces of their teeth. During treatment periods, subjects were asked to brush only the lingual surfaces of their teeth with a standard fluoride dentifrice. Rinsing with 20 ml of the experimental CPC solution was done for 30 s twice daily. The evening before the last day of treatment periods (Day 4), subjects were asked to refrain from any oral hygiene, eating, and drinking after brushing. On Day 4, plaque was scored using the MQH Index. A 10-day wash-out of normal oral hygiene was allowed between each of the four treatment periods. The data were analysed using analysis of covariance for cross-over designs.

RESULTS

Twenty-five to 29 subjects were evaluable at any given visit. With respect to unbrushed buccal and brushed lingual surfaces, all three CPC regimens had highly significantly (p < or = 0.0006) lower mean plaque scores than the B-W regimen, reductions ranging from 20% to 38% in magnitude. With respect to unbrushed surfaces, there was a significant difference between the B-CPC regimen and the B-60 min.-CPC regimen (p < 0.01) in favour of the latter regimen. No other pairwise treatment comparisons were statistically significant for unbrushed sites. Results for brushed surfaces and all sites combined showed that both the B-W-CPC and the B-60 min.-CPC groups reduced mean plaque levels significantly (p < or = 0.013) more than B-CPC. There were no statistically significant differences between B-W-CPC and B-60 min.-CPC for measurements of brushed, unbrushed, or all sites combined.

CONCLUSIONS

Results show that the alcohol-free, 0.07% high bioavailable CPC rinse provides an additive anti-plaque benefit beyond toothbrushing with a standard fluoride dentifrice regardless of the regimen. Of the regimens, a water rinse between toothbrushing and CPC rinsing enhances therapeutic efficacy while fitting into the patient's typical oral hygiene routine.

Randomized controlled clinical trials on agents used for chemical plaque control

Taking into account the limitations of the daily self-performed oral hygiene the use of chemical agents that can be incorporated in dentifrice or mouth rinse formulations has been advocated. The present review deals with randomized controlled clinical trials of >or=6 months in duration, on the use of those agents and their effects on plaque and gingival inflammation.

Influence of Additional Active Ingredients on the Effectiveness of Non-Alcoholic Chlorhexidine Mouthwashes: A Randomized Controlled Trial

BACKGROUND

Non-alcoholic chlorhexidine mouthwashes are equally effective and have fewer potential risks than hydroalcoholic solutions. Nowadays, other active ingredients are added to these mouthwashes in an attempt to improve their effectiveness and reduce side effects. Following an experimental gingivitis model, this study examined three non-alcoholic commercial mouthwashes having 0.12% chlorhexidine digluconate (CHX) in common.

METHODS

Using a double masked, cross-over design, 30 subjects underwent three consecutive experimental phases with three mouthwashes: CHX, CHX + 0.05% sodium fluoride (CHXNaF), and CHX + 0.05% cetylpyridinium chloride (CHX-CPC). In each one of these 21-day phases, the subjects discontinued all oral hygiene measures and were treated exclusively with the experimental mouthwash randomly assigned (an oral rinse twice a day). Each experimental phase was preceded by a 14-day washout period. Levels of gingivitis, dental plaque, supragingival calculus, and dental staining were assessed at baseline and end (day 21) of experimental phases.

RESULTS

The evolution of gingival and dental staining indices did not show statistically significant differences between the treatments. Differences were noticed in the plaque index (P = 0.0002), with CHX-NaF the treatment with the greatest increase. Differences were also observed in the supragingival calculus index (P = 0.0136), with CHX-CPC showing a smaller increase. Tongue staining was more frequent with CHX-CPC (P = 0.0141).

CONCLUSION

In non-alcoholic 0.12% chlorhexidine mouthwashes, the addition of other active ingredients does not produce beneficial effects, but may even reduce the antiplaque effectiveness or increase tongue staining.

Efficacy of a 0.15% benzydamine hydrochloride and 0.05% cetylpyridinium chloride mouth rinse on 4-day de novo plaque formation

OBJECTIVE

To evaluate the effect of a mouth-rinse formulation combining benzydamine hydrochloride and cetylpyridinium chloride (BNZ+CPC) in preventing de novo plaque formation, in comparison with CPC and placebo mouth rinses.

PATIENTS AND METHODS

This was a controlled, observer-blind, cross-over study. In this model of plaque re-growth, subjects received a session of oral prophylaxis and were directed to withdraw oral hygiene measures for the next 4 days, using only the mouth rinse assigned. The outcome parameters were the plaque index (PlI) and gingival index (GI). In addition, microbiological evaluation of the subgingival microflora, by means of culture, was performed, as well as patient-based variables. Data analysis was carried out using anova for Latin-square design.

RESULTS

The analysis of variance showed a significant statistical difference between the BNZ+CPC association and placebo (p<0.0001). No differences between CPC and placebo were detected considering multiple comparisons between treatments. The 90% confidence interval of the differences between BNZ+CPC and CPC showed no equivalence between treatments, being the PlI lower in the BNZ+CPC group. No significant difference between groups in GI was observed. Mean anaerobic colony-forming units (CFU) demonstrated a significant increase between visits in all groups (p<0.001) and differences among groups were not significant. Subjects treated with BNZ+CPC frequently reported "tingling mouth" and "numbness mouth".

CONCLUSION

Within the limitations of the study model, the BNZ+CPC combination showed a statistically significant plaque-inhibitory capacity, as compared with the placebo mouth rinse, and an additive effect as compared with CPC. No relevant clinical or microbiological adverse effects were detected.

A 6-month clinical trial to study the effects of a cetylpyridinium chloride mouthrinse on gingivitis and plaque

PURPOSE

To evaluate the effects of a novel mouthrinse containing 0.07% high bioavailable cetylpyridinium chloride (Crest Pro-Health Rinse) on the development of gingivitis and plaque versus a placebo control over a period of 6 months.

METHODS

This was a randomized, 6-month, placebo-controlled, parallel groups, double blind, single center clinical trial. One hundred thirty-nine generally healthy adults with mild-to-moderate gingivitis were enrolled in the study. Subjects were given Modified Gingival Index (MGI), Gingival Bleeding Index (GBI) and Modified Quigley-Hein Plaque Index (MQH) examinations followed by a dental prophylaxis. Subjects were then randomly assigned to either the cetylpyridinium chloride (CPC) rinse or placebo rinse and instructed to begin rinsing twice a day with 20 ml of their assigned mouthrinse for 30 seconds after brushing their teeth. Subjects were assessed for MGI, GBI and MQH scores after 3 and 6 months of product use. Oral hard and soft tissue examinations were also performed at all visits.

RESULTS

124 subjects were evaluable at Month 3 and 119 at Month 6. After 6 months, subjects rinsing with the CPC rinse showed 15.4% less gingival inflammation, 33.3% less gingival bleeding, and 15.8% less plaque relative to the placebo group. All reductions were highly statistically significantly different (P< 0.01). Results were similar at 3 months. Both treatments were well-tolerated.

CLINICAL SIGNIFICANCE

This study demonstrates that the Crest Pro-Health 0.07% CPC mouthrinse provided significant antiplaque and antigingivitis benefits when used twice daily for 6 months as an adjunct to toothbrushing.

Practice implications with an alcohol-free, 0.07% cetylpyridinium chloride mouthrinse

PURPOSE

Behavioral research was conducted to ascertain the relevance of an alcohol-free, 0.07% cetylpyridinium chloride (CPC) therapeutic mouthrinse to contemporary dental practice over a 6-month usage period.

METHODS

A randomized, single-blind study was conducted to assess practice-relevant compliance, acceptability and side effects associated with two mouthrinses. The target population was healthy adult mouthrinse users with a history of routine dental prophylaxis and maintenance care. Subjects were randomly assigned to a therapeutic mouthrinse with 0.07% CPC (Crest Pro-Health Rinse) or a cosmetic rinse control (Scope). Other oral hygiene was not standardized. Subjects completed a questionnaire and were examined by dental hygienists at baseline, and again after 3 and 6 months rinsing. At study completion, a dental prophylaxis was administered.

RESULTS

Compliance was generally favorable, with 273 subjects (89%) completing the 6-month rinsing study. Rinsing time generally stayed the same or increased relative to baseline. Groups differed among the subset who historically used an essential oils rinse (N=137), where those assigned to the alcohol-free therapeutic rinse exhibited significantly (P= 0.02) longer rinsing times compared to subjects using the alcohol-containing cosmetic rinse. Subject evaluations were generally positive with respect to both rinses. Side effects were minimal, with no between-group differences in hygienist-rated calculus or stain accumulation, or prophylaxis time.

CLINICAL SIGNIFICANCE

In a 6-month study, a high bioavailable 0.07% CPC therapeutic mouthrinse showed generally high compliance and favorable user acceptability, with similar side effects to those seen with a cosmetic mouthrinse. These findings suggest that the 0.07% CPC mouthrinse may be readily incorporated within the contemporary recall dental practice.