CHX Rinse

GUM CHX Rinse

Sunstar Americas

Microbial plaque is widely recognized as the primary etiologic agent in the cause of gingivitis and periodontitis.

Mechanical means of plaque control (flossing and brushing) alone have limitations. The addition of various chemical agents, such as mouth rinses, has been shown to increase the efficacy of plaque removal. Most commercial mouth rinses contain alcohol in varying concentrations, which can cause potentially deleterious side effects.¹ Guha and colleagues² proposed that the daily use of alcohol-containing mouth rinses may be an independent cause of oral cancer. Additionally, alcohol-containing mouth rinses have been linked to xerostomia, tissue irritation and ulceration, as well as causing the surface softening of dental resins.³

The development of nonalcohol mouth rinses has been the subject of investigation for 30 years. Several research groups have attempted to demonstrate that nonalcohol mouth rinses can be as effective at reducing plaque and inflammation as those that contain alcohol.

I will review 2 of those studies here. To read about other similar studies, please click here.

Alcohol vs No Alcohol Rinses

In 1998, Eldridge and colleagues4 investigated the effectiveness of an alcohol-free 0.12% chlorhexidine (CHX) rinse compared to a commercially available CHX mouth rinse containing alcohol, an essential oils mouth rinse with alcohol, and a placebo. In vitro and in vivo testing were done, using Streptococcus mutans as the lab test agent and a group of 32 individuals for the clinical test. Base line Plaque Indices (PI) were measured, the gingiva was evaluated with the Silnes and Loe Gingival Index (GI), and the bleeding on probing (BPI) was measured using the Loe and Silnes index. All mechanical hygiene methods were withheld during the 21-day study, and the subjects were instructed to rinse with ½ ounce of the assigned mouth rinse for 1 minute, twice daily. All measurements were made at baseline and day 21.

The mean PI score decreased for both CHX groups, while the PI for the essential oils rinse increased. There was statistically no difference between the CHX groups. S mutans counts dropped to 0 after 21 days for the alcohol-free CHX group, as did the alcohol-containing CHX group, except for 1 subject. The essential oils group had a variable count, with 36.4% exhibiting a 0 bacterial count. Statistically, all of the test groups, except for the placebo, were effective in reducing plaque and plaque vitality.

CPC Nonalcohol Rinses

Witt and colleagues5 investigated in vivo and in vitro effects of a cetylpyridinium chloride (CPC) nonalcohol mouthrinse as an antiplaque agent. Their study involved a double blind, 3- period, cross-over methodology over 4 days, with a 10-day washout cycle between each test sequence. The CPC nonalcohol rinse was tested against a commercial essential oils mouth rinse and a placebo. The lingual surfaces of the teeth were brushed while the buccal surfaces were not; rinsing was done twice a day. The in vitro study measured the killing power of the test rinses when a standard selection of 10 oral organisms were exposed for 30 seconds to the various rinses.

The results of the study showed a greater then 99% kill ratio for both the CPC rinse and the essential oils rinse. The in vivo study demonstrated similar PI reduction for both the CPC and essential oils rinses, which was statistically significant (P < .0001). The authors stated that the benefits of the nonalcohol CPC rinse were “at least as good as” the essential oils rinse, without the side effects of alcohol.

Conclusions

Based on these studies, alcohol-free mouth rinses were as effective as those with alcohol in reducing plaque accumulation and vitality. Clinicians can be relatively confident in the use of alcohol-free mouth rinses, especially for patients who cannot tolerate the alcohol side effects.

References

1. Overholser CD, Meiller TF, DePaola LG, et al. Comparative effects of two chemotherapeutic mouthrinses on development of supragingival dental plaque and gingivitis. J Clin Periodontol. 1990;17:575-579.

2. Guha N, Boffetta P, Fiho VW, et al. Oral health and risk of sqamous cell carcinoma of the head and neck and esophagus: Results of two multicentric case-control studies. Am J Epidemiol. 2007;166:1159-1173.

3. Penugond B, Settembrini L, Scherer W, et al. Alcohol containing mouthwashes: effects on composite hardness. J Clin Dent. 1994;5:60-62.

4. Eldridge KR, Finnie SF, Stephens JA, et al. Efficacy of an alcohol-free chlorhexidine mouth rinse as an antimicrobial agent. J Prosth Dent. 1998;6:685-690.

5. Witt J, Ramji N, Gibb R, et al. Antibacterial and antiplaque effects of a novel, alcohol-free oral rinse with cetylpyridinium chloride. J Coont Dent Pract. 2005;1:1-10.