Safety and Efficacy of Antimicrobial Mouthrinses in Clinical Practice

Abstract

Efficacy Overview. The use of an antimicrobial mouthrinse is an important adjunct to toothbrushing and interdental cleaning. To varying degrees, chlorhexidine gluconate (CHG), cetylpyridinium chloride (CPC), and essential oils (EO) interrupt the integrity of the bacterial cell membrane, leading to lysis and death. CHG binds to salivary mucins, tooth structure, dental plaque, and oral soft tissues and is released slowly into the mouth, where it inhibits adsorption of bacteria onto teeth. CHG is active against a wide range of gram-positive and gram-negative microorganisms. CPC binds to teeth and plaque to a lesser degree than CHG and is generally less efficacious than CHG. CHG and EO penetrate plaque biofilm and produce changes in microbial cell surface morphology that alter coaggregation, recolonization, and, thus, survival. CHG, CPC, and EO are active against a wide variety of aerobic and anaerobic bacteria. An overview of the Food and Drug Administration and American Dental Association rigorous approval processes for efficacy and safety is provided.

Safety Overview. Long-term use of CHG or EO does not adversely affect the ecology of oral microbial flora, including microbial overgrowth, opportunistic infection, or development of microbial resistance. Long-term use of CHG, CPC, or EO does not contribute to soft tissue lesions or mucosal aberrations and has no serious adverse effect on salivary flow, taste, tooth deposits, or dental restoration. There is no evidence of a causal link between alcohol-containing mouthrinses and the risk of oral and pharyngeal cancer.