Gingivitis Management With Mouthrinses

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Mouthrinse above sink

Antimicrobial mouthrinses have been investigated as a therapy to reduce plaque and gingivitis. They are formulated to negatively impact the formation, growth, and maturation of oral biofilms. Mouthrinses are popular with patients because they are easy to use and have minimal side effects. In addition, about 20% of the oral environment is made up of tooth surfaces but plaque biofilm can occupy areas in the remaining 80% of the oral environment, including the oral mucosa and tongue. It is possible that a mouthrinse could provide an antimicrobial effect to the entire mouth.

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Essential Oils

Essential oil (EO) rinses consist of a combination of thymol, menthol, and eucalyptol with methyl salicylate. Alcohol content varies from 21.0% to 26.9%. Depending on the concentration, EO rinses can either disrupt the cell wall and precipitate cell proteins (higher concentration) or inactivate some essential enzymes (lower concentration). They also may exert antioxidant activity. Gunsolley concluded that EO rinses are among the most efficacious over-the-counter mouthrinses available in the US. Clinicians should not recommend antimicrobial mouthrinses containing alcohol to patients who are recovering or current alcoholics or to children younger than 12. Patients should be instructed to rinse with 20 ml for 30 seconds. Contraindications include a burning sensation during use with certain formulations.

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Cetylpyridinium Chloride

Cetylpyridinium Chloride (CPC) is a widely used cationic quaternary ammonium compound with a broad antimicrobial spectrum. Part of its molecule interacts with the bacterial cell membrane, which can cause cell growth inhibition and eventually cell death. It is mostly effective against Gram-positive bacteria and yeast. CPC should be used as a 20-ml rinse twice a day. Reported side effects include increased calculus formation, staining, and occasional burning sensation.

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Mouthrinses Used as Irrigators?

While clinicians have used antimicrobial rinses for in-office irrigation and in power instrumentation devices (eg, ultrasonics), the evidence does not support the benefits of a single professional episode of subgingival irrigation. In addition, studies have found that use of water, through irrigation, is just as effective as the use of an antimicrobial in the device. The reason is likely due to the quick elimination of fluids placed subgingivally due to the gingival crevicular fluid.

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Natural Options

Many consumers are seeking natural products for use in oral health care, as they are perceived as being safer than synthetic products. Only one systematic review was located that reported on natural-compound-containing mouthrinses as an adjunct to oral hygiene in the control of plaque and gingivitis. The authors concluded there is insufficient evidence to support the use of the natural-compound-containing mouthrinses and that more high-quality research is needed in this area. Some mouthrinses containing natural components, such as EO, have a long history of efficacy, showing strong antimicrobial and anti-inflammatory effects. Other mouthrinses are available that contain herbal ingredients, such as Centella asiatica, Echinacea purpurea, and Sambucus nigra, which have been investigated for the reduction of inflammation and biofilm.

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Outside-of-the-Box Approaches

Sodium hypochlorite (household bleach) has been investigated as an antimicrobial mouthrinse and irrigant. Used as a diluted solution, it has been found to reduce plaque scores and signs of gingival inflammation. However, the studies are small and the applicability to larger populations is not known. Oil pulling, originating from ancient Ayurvedic medicine, has been advocated as a method to remove harmful bacteria from the oral cavity to improve gingival health. Several oils have been used for this method, including sunflower, olive, and sesame seed oil, which is thought to react with saliva to produce a reaction similar to soap formation. The oil is swished in the mouth for up to 30 minutes before expectorating. High-level clinical evidence is needed to determine the efficacy of this approach.

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