A Comparison of the Efficacy of Non-alcoholic 0.05% Cetylpyridinium Mouthwash and Chlorhexidine Alcohol-free Mouth Rinse on Patients with Gingivitis: A Double-blind Randomized Controlled Trial
Keywords:
Cetylpyridinium, Chlorhexidine, Periodontal diseaseAbstract
Background: Oral health preservation is of major importance in patients undergoing periodontal surgery. Tooth brushing is a competency that is challenging to perform. Therefore, materials with biochemical properties that can control the tooth plaque biofilm are used. Objective: The purpose of the study was to determine the clinical outcome of alcohol-free Chlorhexidine (AFCHX) 0.12% oral rinse in comparison with 0.05% Cetylpyridinium chloride (CPC) non-alcoholic mouthwash in outpatients with periodontitis. Methods: Patients with periodontal diseases attending the Department of Periodontology, Dental School of the Islamic Azad University of Medical Sciences, Tehran, Iran received a double-blind randomized controlled trial. In this study, a total of 38 patients with gingivitis and pocket depth ≤4 mm were randomly allocated into two equal study groups and followed up within 90 days: Group A (performed mouth rising twice a day with the liquid including 10 ml of the 0.05% CPC without ethanol), Group B (performed mouth rising twice daily with 10 ml of the alcohol-free 0.012% chlorhexidine solution). Furthermore, periodontal parameters and Stain Index (SI) were obtained at baseline and for both groups one month later. ANOVA was used to analyze the data. Statistical significance was defined as p-value <0.05. Results: Full-mouth plaque index (PI) was non-significantly different in the two groups, and the decline was 35% for the CPC group and 44% for the individual AFCHX group. Moreover, reductions in BOP were statistically significant for the CHX group after the 12th week (p=0.0001). Additionally, the PD drop within 30 days was statistically significant (1.92±0.30) AFCHX group and (2.30±0.36) CPC group (p=0.002). Meanwhile, CPC and AFCHX plan of teeth were also compared, and greater rates of staining were observed in AFCHX areas of teeth at days 7 to four weeks. Conclusion: The findings indicated that the application of a therapeutic CPC mouth rinse, twice daily aids control plaque as well as gingivitis, and periodontitis surpassing traditional plaque control, although not as much as AFCHX mouthwash. Trial registration: The study was registered under Identifier No. NCT02756377 at ClinicalTrials.gov. Funding: This study was entirely sponsored by researchers and did not receive a specific grant from any funding agency.References
Potempa J, Banbula A, Travis J. Role of bacterial proteinases in matrix destruction and modulation of host
responses. Periodontol 2000, 2000: Oct 24: 153-92. doi: 10.1034/j.1600-0757.2000.2240108.x, PMid:
Bartold PM, Van Dyke TE. Periodontitis: a host-mediated disruption of microbial homeostasis. Unlearning
learned concepts. Periodontol 2000. 2013 Jun; 62(1):203-17. doi: 10.1111/j.1600-0757.2012.00450.x,
PMid: 23574467, PMCid: PMC3692012
Mandel ID. Dental plaque: nature, formation and effects. J Periodontology, 1966; 37:537-567. doi:
1902/jop.1966.37.5.357
Theilade E, Wright WH, Jensen SB, Loe H. Experimental gingivitis in man. II. A longitudinal clinical and
bacteriological investigation. J Periodontal Research, 1966; 1:1-13. doi: 10.1111/j.1600-
1966.tb01842.x, PMid: 4224181
Warren PR, Landmann H, Chater BV. Electric toothbrush use. Attitudes and experience among dental
practitioners in Germany. American J Dentistry, 1998; 11:S3-6.
Teles RP, Teles FR. Antimicrobial agents used in the control of periodontal biofilms: effective adjuncts to
mechanical plaque control? Braz Oral Res. 2009; 23 Suppl 1:39-48. doi: 10.1590/S1806-
, PMid: 19838557
Paraskevas S, Van der Weijden GA. A review of the effects of stannous fluoride on gingivitis. J Clin
Periodontol 2006; 33: 1–13. doi: 10.1111/j.1600-051X.2005.00860.x, PMid: 16367849
Barnett ML. The role of therapeutic antimicrobial mouth rinses in clinical practice. Control of
supragingival plaque and gingivitis. J Am Dent Assoc 2003; 134: 699–701.
Kumar S, Patel S, Tadakamadla J, Tibdewal H, Duraiswamy P, Kulkarni S. Effectiveness of a mouthrinse
containing active ingredients in addition to chlorhexidine and triclosan compared with chlorhexidine and
triclosan rinses on plaque, gingivitis, supragingival calculus and extrinsic staining. Int J Dent Hyg. 2013;
(1):35-40. doi: 10.1111/j.1601-5037.2012.00560.x, PMid: 22672130
Bhate D, Jain S, Kale R, Muglikar S. The comparative effects of 0.12% chlorhexidine and herbal oral rinse
on dental plaque-induced gingivitis: A randomized clinical trial. Journal of Indian Society of
Periodontology. 2015; 19(4):393-5. doi: 10.4103/0972-124X.153478, PMid: 26392686, PMCid:
PMC4555795
Leyes Borrajo JL, Garcia VL, Lopez CG, Rodriguez-Nunez I, Garcia FM, Gallas TM. Efficacy of
chlorhexidine mouthrinses with and without alcohol: a clinical study. J Periodontol. 2002; 73(3):317-21.
doi: 10.1902/jop.2002.73.3.317, PMid: 11924590
Quirynen M, Avontroodt P, Peeters W, Pauwels M, Coucke W, van Steenberghe D. Effect of different
chlorhexidine formulations in mouthrinses on de novo plaque formation. Journal of clinical periodontology.
; 28(12):1127-36. doi: 10.1034/j.1600-051X.2001.281207.x, PMid: 11737510
Feres M, Figueiredo LC, Faveri M, Stewart B, Vizio W. The effectiveness of a preprocedural mouthrinse
containing cetylpyridinium chloride in reducing bacteria in the dental office. J Am Dent Assoc. 2010;
(4):415-22. doi: 10.14219/jada.archive.2010.0193, PMid: 20354090
Gupta G, Mitra D, Ashok KP, Gupta A, Soni S, Ahmed S et al. Efficacy of preprocedural mouth rinsing in
reducing aerosol contamination produced by ultrasonic scaler: a pilot study. J Periodontol. 2014; 85(4):562-
doi: 10.1902/jop.2013.120616, PMid: 23855840
Leggat PA, Kedjarune U. Bacterial aerosols in the dental clinic: a review. Int Dent J. 2001; 51(1):39-44.
doi: 10.1002/j.1875-595X.2001.tb00816.x, PMid: 11326448
Logothetis DD, Martinez-Welles JM. Reducing bacterial aerosol contamination with a chlorhexidine
gluconate pre-rinse. J Am Dent Assoc. 1995; 126(12):1634-9. doi: 10.14219/jada.archive.1995.0111,
PMid: 7499664
Jones CG. Chlorhexidine: is it still the gold standard? Periodontol. 2000. 1997; 15(1):55-62. doi:
1111/j.1600-0757.1997.tb00105.x, PMid: 9643233
Thomas E. Efficacy of two commonly available mouth rinses used as preprocedural rinses in children. J
Indian Soc Pedod Prev Dent. 2011; 29(2):113-6. doi: 10.4103/0970-4388.84682, PMid: 21911948
Varoni E, Tarce M, Lodi G, Carrassi A. Chlorhexidine (CHX) in dentistry: state of the art. Minerva
Stomatol. 2012; 61(9):399-419.
Boneta AE, Aguilar MM, Romeu FL et al. Comparative investigation of the efficacy of
triclosan/copolymer/sodium fluoride and stannous fluoride/sodium hexametaphosphate/zinc lactate
dentifrices for the control of established supragingival plaque and gingivitis in a six-month clinical study. J
Clin Dent 2010; 21 (4): 117–123.
Costa X, Laguna E, Herrera D et al. Efficacy of a new mouth rinse formulation based on 0.07%
cetylpyridinium chloride in the control of plaque and gingivitis: a 6-month randomized clinical trial. J Clin
Periodontol 2013; 40 (11): 1007–1015. doi: 10.1111/jcpe.12158, PMid: 24024983
Fine DH. Chemical agents to prevent and regulate plaque development. Periodontol 2000 1995; 8: 87–107.
doi: 10.1111/j.1600-0757.1995.tb00047.x, PMid: 9567948
Teles RP, Teles FR. Antimicrobial agents used in the control of periodontal biofilms: the effective adjuncts
to mechanical plaque control? Braz Oral Res 2009; 23 (Suppl 1): 39–48. doi: 10.1590/S1806-
, PMid: 19838557
Haps S, Slot DE, Berchier CE et al. The effect of cetylpyridinium chloride-containing mouth rinses as
adjuncts to tooth brushing on plaque and parameters of gingival inflammation: a systematic review. Int J
Dent Hyg 2008; 6 (4): 290–303. doi: 10.1111/j.1601-5037.2008.00344.x, PMid: 19138180
Gunsolley JC. Clinical efficacy of antimicrobial mouthrinses. J Dent 2010; 38 (Suppl 1): S6–S10. doi:
1016/S0300-5712(10)70004-X
Serrano J, Escribano M, Roldán S, Martín C, Herrera D. Efficacy of adjunctive anti-plaque chemical agents
in managing gingivitis: a systematic review and meta-analysis. J Clin Periodontol 2015; 42 Suppl 16:S106-
doi: 10.1111/jcpe.12331, PMid: 25495592
Haps S, Slot DE, Berchier CE, Van der Weijden GA. The effect of cetylpyridinium chloride-containing
mouth rinses as adjuncts to toothbrushing on plaque and parameters of gingival inflammation: a systematic
review. Int J Dent Hyg 2008; 6:290-303. doi: 10.1111/j.1601-5037.2008.00344.x, PMid: 19138180
Gunsolley JC. Clinical efficacy of antimicrobial mouthrinses. J Dent 2010; 38 Suppl 1:S6-10. doi:
1016/S0300-5712(10)70004-X
Quirynen M, Soers C, Desnyder M, Dekeyser C, Pauwels M, van Steenberghe D. A 0.05% cetyl
pyridinium chloride/0.05% chlorhexidine mouth rinse during maintenance phase after initial periodontal
therapy. J Clin Periodontol. 2005 Apr; 32(4):390-400. doi: 10.1111/j.1600-051X.2005.00685.x, PMid:
Turesky S, Gilmore ND, Glickman I. Reduced plaque formation by the chloromethyl analogue of victamine
C. J Periodontol. 1970 Jan; 41(1):41–43. doi: 10.1902/jop.1970.41.1.41, PMid: 5264376
Timothy J. O'Leary. Robert B. Drake. James E. Naylor. The Plaque Control Record. Journal of
Periodontology .January 1972; 43(1): 38-40. doi: 10.1902/jop.1972.43.1.38, PMid: 4500182
Ainamo J, Bay I. Problems and proposals for recording gingivitis and plaque. Int Dent J 1975; 25:229 35.
Carter HG, Barnes GP. The Gingival Bleeding Index. J Periodontol. 1974 Nov; 45(11):801-5. doi:
1902/jop.1974.45.11.801, PMid: 4547795
Lobene RR. Effect of dentifrices on tooth stains with controlled brushing. J Am Dent Assoc. 1968; 77:849-
doi: 10.14219/jada.archive.1968.0298, PMid: 5244497
Lopez-Jornet P, Plana-Ramon E, Leston JS, Pons-Fuster A. Short term side effects of 0.2% alcohol-free
chlorhexidine mouthrinse in geriatric patients: a randomized, double blind, placebo- controlled
study.Gerodontology. 2012; 29(4):292–98. doi: 10.1111/j.1741-2358.2012.00671.x, PMid: 22486193
Jones CG. Chlorhexidine: is it still the gold standard? Periodontol 2000. 1997; 15:55–62. doi:
1111/j.1600-0757.1997.tb00105.x, PMid: 9643233
Van Strydonck DA, Slot DE, Van der Velden U, Van der Weijden F. Effect of a chlorhexidine mouthrinse
on plaque, gingival inflammation and staining in gingivitis patients: a systematic review. J Clin
Periodontol.2012; 39:1042–55. doi: 10.1111/j.1600-051X.2012.01883.x, PMid: 22957711
Sanz M, Vallcorba N, Fabregues S, Müller I, Herkströter F. The effect of a dentifrice containing
chlorhexidine and zinc on plaque, gingivitis, calculus and tooth staining. J Clin Periodontol. 1994; 21:431–
doi: 10.1111/j.1600-051X.1994.tb00741.x, PMid: 8089246
La Vecchia C: Mouthwash and oral cancer risk: An update. Oral Oncol. 2009, 45: 198-200. doi:
1016/j.oraloncology.2008.08.012, PMid: 18952488
Brownstein CN, Briggs SD, Schweitzer KL, Briner WW, Kornman KS. Irrigation with chlorhexidine to
resolve naturally occurring gingivitis. A methodologic study. J Clin Periodontol. 1990; 17:588–593. doi:
1111/j.1600-051X.1990.tb01110.x, PMid: 2212090
Corbet EF, Tam JO, Zee KY, Wong MC, Lo EC, Mombelli AW, et al. Therapeutic effects of supervised
chlorhexidine mouthrinses on untreated gingivitis. Oral Dis. 1997; 3(1):9-18. doi: 10.1111/j.1601-
1997.tb00003.x, PMid: 9456641
Zanatta FB, Antoniazzi RP, Rösing CK. The effect of 0.12% chlorhexidine gluconate rinsing on previously
plaque-free and plaque- covered surfaces: a randomized, controlled clinical trial. J Periodontol. 2007;
:2127–2134. doi: 10.1902/jop.2007.070090, PMid: 17970679
Türkoğlu O, Becerik S, Emingil G, Kütükçüler N, Baylas H, Atilla G. The effect of adjunctive
chlorhexidine mouthrinse on clinical parameters and gingival crevicular fluid cytokine levels in untreated
plaque-associated gingivitis. Inflamm Res. 2009; 58:277–283. doi: 10.1007/s00011-008-8129-z, PMid:
Becerik S, Türkoğlu O, Emingil G, Vural C, Ozdemir G, Atilla G. Antimicrobial effect of adjunctive use of
chlorhexidine mouthrinse in untreated gingivitis: a randomized, placebo-controlled study. APMIS. 2011
Jun; 119(6):364-72. doi: 10.1111/j.1600-0463.2011.02741.x, PMid: 21569094
45.Allen, D.R., Davies, R., Bradshaw, B., Ellwood, R., Simone, A. J., Robinson, R., Mukerjee, C., Petrone,
M.E. et al. Efficacy of a mouthrinse containing 0.05% cetylpyridinium chloride for the control of plaque
and gingivitis: a 6- month clinical study in adults. Compend Contin Educ Dent 1998; 19 (2 Suppl.), 20–26.
Hernandez-Cott, P.L., Boneta, A.E., Stewart, B., DeVizio, W. and Proskin, H.M. A clinical investigation of
the efficacy of a commercial mouthrinse containing 0.05% cetylpyridinium chloride in reducing dental
plaque. J Clin Dent 2009; 20, 39–44.
47.Lotufo, R., Calil, C.M., Feng, H.S., Sekiguchi, R.T., Stewart, B., DeVizio, W. and Proskin, H.M. (2009)
Clinical investigation of the efficacy of a commercial mouthrinse containing 0.05% cetylpyridinium
chloride in preventing dental plaque. J Clin Dent 2009; 20, 50–54
Silva, M.F., Santos, N.B., Stewart, B., DeVizio, W. and Proskin, H.M. A clinical investigation of the
efficacy of a commercial mouthrinse containing 0.05% cetylpyridinium chloride to control established
dental plaque and gingivitis. J Clin Dent 2009; 20, 55–61
Kiszely A. Comparison of the effects of cetylpyridinium chloride with an essential oil mouthrinse on dental
plaque and gingivitis – a six month randomized control trial. J. Clin. Periodontol. 2007; 34:658–667. doi:
1111/j.1600-051X.2007.01103.x, PMid: 17635245
Holbeche J.D., Ruljancich M.K., Reade P.C. A clinical trial of the efficacy of a cetylpyridinium chloride
mouthwash: TEMPeffect on plaque accumulation and gingival condition. Aust. Dent. J. 1975; 6:397–404.
doi: 10.1111/j.1834-7819.1975.tb04390.x, PMid: 1062978
51.Mankodi S., Bauroth K., Witt J.J., Bsoul S., He T., Gibb R., Dunavent J., Hamilton A. A six month
clinical trial to study teh TEMPeffects of a cetylpyridinium chloride mouthrinse on gingivitis and plaque.
Am. J. Dent. 2005; 18:9A–14A.
52.Roberts W.R., Addy M. Comparison of the in vivo and in vitro antibacterial properties of antiseptic
mouthrinse containing chlorhexidine, alexidine, cetylpyridinium chloride and hexitidine. Relevance to
mode of action. J. Clin. Periodontol. 1981; 8(4):295–310. doi: 10.1111/j.1600-051X.1981.tb02040.x, PMid:
Ciancio S.G. Agents for the management of plaque and gingivitis. J. Dent. Res. 1992; 71:1450–1454. doi:
1177/00220345920710071701, PMid: 1629462
Lobene R.R. Clinical studies of plaque control agents: an overview. J. Dent. Res. 1979; 58 (12):2381–2388.
doi: 10.1177/00220345790580120902, PMid: 117032
Witt J., Ramji N., Gibb R., Dunavent J., Flood J., Barnes J. Antibacterial and antiplaque effects of a novel,
alcohol free oral rinse with cetylpyridinium chloride. J. Contemp. Dent. Pract. 2005; 6:15. doi:
5005/jcdp-6-1-1, PMid: 15719071
56.Allen, D.R., Davies, R., Bradshaw, B., Ellwood, R., Simone, A. J., Robinson, R., Mukerjee, C., Petrone,
M.E. et al. (1998) Efficacy of a mouthrinse containing 0.05% cetylpyridinium chloride for the control of
plaque and gingivitis: a 6- month clinical study in adults. Compend Contin Educ Dent 19 (2 Suppl.), 20–26.
57.Stookey GK, Beiswanger B, Mau M, Isaacs RL, Witt JJ, Gibb R. A 6- month clinical study assessing the
safety and efficacy of two cetylpyridinium chloride mouthrinses. Am J Dent 2005; 18 (Sp Is A):24A-28A.
Rioboo M, García V, Serrano J et al. Clinical and microbiological efficacy of an antimicrobial mouth rinse
containing 0.05% cetylpyridinium chloride in patients with gingivitis. Int J Dent Hyg 2012; 10 (2): 98–106.
doi: 10.1111/j.1601-5037.2011.00523.x, PMid: 2183125
59..Zimmer S, Korte P, Verde P, Ohmann C, Naumova E, Jordan RA. Randomized controlled trial on teh
efficacy of new alcohol-free chlorhexidine mouthrinses after 8 weeks. Int J Dent Hyg. 2015 May;
(2):110-6. doi: 10.1111/idh.12111, PMid: 25382448
Ellingsen JE, Rolla G, Eriksen HM. Extrinsic dental stain caused by chlorhexidine and other denaturing
agents. J Clin Periodontal. 1982; 9(4):317–322. doi: 10.1111/j.1600-051X.1982.tb02098.x, PMid: 6821208
Flötra L. Different modes of chlorhexidine application and related local side effects. J Periodontal Res
Suppl. 1973; 12(3):41–44. doi: 10.1111/j.1600-0765.1973.tb02162.x, PMid: 4269597
Charles CH, Mostler KM, Bartels LL, Mankodi SM. Comparative antiplaque and antigingivitis
effectiveness of a chlorhexidine and an essential oil mouthrinse: 6-month clinical trial. Journal of clinical
periodontology. 2004; 31(10):878-84. doi: 10.1111/j.1600-051X.2004.00578.x, PMid: 15367192
Blenman TV, Morrison KL, Tsau GJ, Medina AL, Gerlach RW. Practice implications with an alcohol-free,
07% cetylpyridinium chloride mouthrinse. Am J Dent. 2005; 18 Spec No: 29A–34.
Papaioannou W, Vassilopoulos S, Vrotsos I, Margaritis V, Panis V. A comparison of a new alcohol-free
2% chlorhexidine oral rinse to an established 0.2% chlorhexidine rinse with alcohol for the control of
dental plaque accumulation. Int J Dent Hyg. 2015. doi: 10.1111/idh.12182, PMid: 26449740
Jose A, Butler A, Payne D, Maclure R, Rimmer P, Bosma ML. A randomised clinical study to evaluate the
efficacy of alcohol-free or alcohol-containing mouthrinses with chlorhexidine on gingival bleeding. British
dental journal. 2015; 219(3):125-30. doi: 10.1038/sj.bdj.2015.592, PMid: 26271869, PMCid: PMC4648057
Leyes Borrajo JL, Garcia VL, Lopez CG, Rodriguez-Nunez I, Garcia FM, Gallas TM. Efficacy of
chlorhexidine mouthrinses with and without alcohol: a clinical study. J Periodontol. 2002; 73(3):317-21.
doi: 10.1902/jop.2002.73.3.317, PMid: 11924590
Sreenivasan PK, Haraszthy VI, Zambon JJ. Antimicrobial efficacy of 0.05% cetylpyridinium chloride
mouthrinses. Lett Appl Microbiol 2013; 56 (1): 14–20. doi: 10.1111/lam.12008, PMid: 23039819
Pandit S, Cai JN, Jung JE, Lee YS, Jeon JG. Effect of brief cetylpyridinium chloride treatments during
early and mature cariogenic biofilm formation. Oral Dis. 2015; 21(5):565–71. doi: 10.1111/odi.12312,
PMid: 25600577
Latimer J, Munday JL, Buzza KM et al. Antibacterial and anti-biofilm activity of mouth rinses containing
cetylpyridinium chloride and sodium fluoride. BMC Microbiol 2015; 15: 169. doi: 10.1186/s12866-015-
-x, PMid: 26293609, PMCid: PMC4546200
Rösing CK, Cavagni J, Gaio EJ, Muniz FWMG, Ranzan N, Oballe HJR, Friedrich SA, Severo RM, Stewart
B, Zhang YP. Efficacy of two mouthwashes with cetylpyridinium chloride: a controlled randomized
clinical trial. Braz Oral Res. 2017 Jul 3; 31:e47. doi: 10.1590/1807-3107bor-2017.vol31.0047, PMid:
Downloads
Published
Issue
Section
License
Copyright (c) 2021 Knowledge Kingdom Publishing
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
