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The daily maintenance required for optimal oral health—especially in the prevention of gingivitis and periodontal diseases—can be challenging for patients. Compliance with brushing, flossing, and other mechanical plaque removal strategies may be problematic. Although mechanical plaque control methods have the potential to maintain oral hygiene, clinical experience and research demonstrate that such methods are not used sufficiently to make a difference in oral health.1,2 A therapeutic mouthrinse, however, can help patients improve their plaque control efforts and maintain optimal oral health.

Mouthrinse Solution 

Therapeutic mouthrins es can be effective in reducing the microbial load. Their ease of use and relatively low cost may also increase patient compliance. 

Important tools in the dental hygienist's oral health armamentarium, therapeutic oral rinses are widely available, both by prescription and over the counter.3 Clinicians need to be well versed in their various ingredients so they can effectively advise patients on the mouthrinse best suited for their needs. 

Some of the most common therapeutic mouthrinse agents have been clinically proven to produce significant gingival and plaque control benefits when formulated at specific therapeutic concentrations. This includes: chlorhexidine; essential oils; cetylpyridinium chloride (CPC); and delmopinol. 

The American Dental Association (ADA) supports chlorhexidine and essential oils as ingredients effective against plaque and gingivitis. Scientific evidence supports the use of mouthrinses containing essential oils and chlorhexidine to inhibit the development of plaque and gingivitis.4 Delmopinol is not an antimicrobial, but rather acts as a barrier to plaque, helping prevent biofilm from adhering to the teeth and gingiva.5 

Chlorhexidine 

Therapeutic mouthrinses containing chlorhexidine gluconate oral solution 0.12% (CHX) are used as adjunctive chemotherapeutic aids to treat gingivitis between dental visits. CHX is available by prescription only and reduces the amount of bacteria within the oral cavity. 

When used in conjunction with scaling and root planing, chlorhexidine mouthrinses have been shown to significantly improve the clinical signs of periodontal diseases.Chlorhexidine 0.12% has the ADA Seal of Acceptance and is approved by the United States Food and Drug Administration for the reduction of plaque and gingivitis.Considered the "gold standard" of antimicrobial mouthrinses, chlorhexidine offers broad-spectrum antibacterial activity and substantivity that lasts between 8 hours and 12 hours.7 Chlorhexidine does have significant side effects, including: temporary loss of taste; temporary staining of the teeth, restorations, and mucosa; dry, sore mucosa; bitter taste; and slight increase in supragingival calculus formation. 

Essential Oils 

Mouthrinses containing essential oils (thymol, menthol, eucalyptol, and methyl salicylate) are effective in reducing supragingival plaque and gingivitis.8 The anti-plaque and anti-gingivitis efficacy of essential oils has been well documented in the literature.9 Essential oil mouthrinses disrupt the bacterial production while inhibiting the adherence of biofilm. Long-term trials, including those involving flossing and rinsing, showed reductions in gingivitis from 12% to 30%, and plaque reductions from 21% to 56%, when compared to placebo.10-14 

Research shows that the adjunctive use of essential oil mouthrinses provides a clinically significant advantage among patients with gingival inflammation.11 One study showed a 21% incremental reduction in gingivitis among patients who brushed and flossed regularly when they added an essential oil-based mouthrinse to their routine.11 Additionally, rinsing with the essential oil mouthrinse provided a 15.8% reduction in interproximal gingivitis when added to the brushing and flossing routine.11 

Cetylpyridinium Chloride 

An antiseptic, CPC is a quarternary ammonium compound that kills bacteria and other microorganisms, and may help reduce plaque. CPC binds to the surface of biofilm, which helps diminish plaque buildup. A randomized, placebo-controlled study found that patients who rinsed with a CPC mouthrinse in addition to toothbrushing twice a day exhibited 15.8% less plaque accumulation compared to the control group (who brushed twice a day but used a placebo mouthrinse), as well as 33.3% less gingival bleeding.15 CPC side effects include bitter taste, temporary staining, and oral ulceration. 

Delmopinol 

A new addition to the well of mouthrinse ingredients, delmopinol is an anti-plaque, morpholinoethanol derivative and tertiary amine surfactant that produces plaque that is less adhesive. This mechanism of action allows for the formation of a barrier that prevents plaque from adhering to the teeth and gingiva.9 One study found a 33% reduction in gingival bleeding among participants who used a mouthrinse containing 0.2% delmopinol compared to the control group who used a placebo rinse over a 2-week period.16 A delmopinol mouthrinse is indicated as a precursor to chlorhexidine and as a follow-up after chlorhexidine treatment is completed.17 

Alcohol-free Options 

Some patients should be using therapeutic mouthrinses but are put off by the alcohol content of many rinses. Alcohol-free options are available that offer comparable oral health benefits. CPC-based mouthrinses are alcohol-free. Alcohol-free versions of chlorhexidine and essential oil mouthrinses are also available. These products should be recommended to patients for whom alcohol is contraindicated.18 

Conclusion 

Therapeutic mouthrinses are not substitutes for mechanical oral hygiene, but they can serve as important adjunctive aids for reducing plaque and gingivitis, as well as improving patient compliance. 


 

 

Lynn Marsh, RDH, EdD, is an assistant professor in the Department of Dental Hygiene at Farmingdale State College, Farmingdale, NY, and a member of the National Dental Hygiene Honor Society, Sigma Phi Alpha. Her teaching responsibilities include radiology laboratory, current issues in dental hygiene, pain management laboratory, and clinical instruction. She has been practicing dental hygiene for more than 19 years and recently finished a doctoral degree in educational administration. Marsh is also a member ofDimensions' Peer Review Panel. 

References 

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2. Alexander DC. Therapeutic mouthrinses: reaching beyond mechanical plaque control for reduction in dental plaque and gingivitis. Inside Dentistry. 2011;6(Special Issue).
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5. Addy M, Moran J, Newcomb RG. Meta-analyses of studies of 0.2% delmopinol mouth rinse as an adjunct to gingival health and plaque control measures. J Clin Periodontol. 2007;34:58-65.
6. Killoy, W. Assessing the effectiveness of locally delivered chlorhexidine in the treatment of periodontitis. J Am Dent Assoc. 1999;130:567-570.
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9. Stoeken JE, Paraskevas S, van der Weijden GA. The long-term effect of a mouthrinse containing essential oils on dental plaque and gingivitis: a systematic review. J Periodontol. 2007;78:1218-1228.
10. Hughes P. An adjunct to mechanical plaque removal. Dimensions of Dental Hygiene. 2006;4(4):32-34.
11. Sharma N, Charles CH, Lynch MC, et al. Adjunctive benefit of an essential oil-containing mouthrinse in reducing plaque and gingivitis in patients who brush and floss regularly: a six-month study. J Am Dent Assoc. 2004;135:496-504.
12. Bauroth K, Charles CH, Mankodi SM, Simmons K, Zhao Q, Kumar LD. The efficacy of an essential oil antiseptic mouthrinse vs. dental floss in controlling interproximal gingivitis: a comparative study. J Am Dent Assoc. 2003;134:359-365.
13. Sharma NC , Charles CH, Qaqish JG, Galustians HJ, Zhao Q, Kumar LD. Comparative effectiveness of an essential oil mouthrinse and dental floss in controlling interproximal gingivitis and plaque. Am J Dent Assoc. 2002;15:351-355.
14. Charles CH, Sharma NC, Galustians HJ, Qaqish J, McGuire JA, Vincent JW. Comparative efficacy of an antiseptic mouthrinse and an antiplaque/antigingivitis dentifrice. A six-month clinical trial. J Am Dent Assoc. 2001;132:670-675.
15. Mankodi S, Bauroth K, Witt JJ, et al. A 6-month clinical trial to study the effects of a cetylpyridinium chloride mouth rinse on gingivitis and plaque. Am J Dent. 2005;18 (Special Issue):9A-14A.
16. Collaert B, Attström R, De Bruyn H, Movert R. The effect of delmopinol rinsing on dental plaque formation and gingivitis healing. J Clin Periodontol. 1992;19:274-280.
17. Bruhn A. Biofilm barrier. Dimensions of Dental Hygiene. 2011;9(9 Suppl):19-22.
18. Borrajo J, Varela L, Castro G , Rodriguez-Nunez I, Figueroa M, Torreira M. Efficacy of chlorhexidine mouthrinses with and without alcohol: A clinical study. J Periodontol. 2002;73:317-321.
 


From Dimensions of Dental HygieneNovember 2011; 9(11): 55-57.

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