Clinical efficacy of antimicrobial mouthrinses

Objective: The goal of this report is to present the current state of the evidence evaluating the efficacy of anti-plaque, anti-gingivitis mouthrinses and to determine the clinical relevance of the evidence. Material and methods: To accomplish this goal a two stage approach was used. First a systematic review of the literature was done to find any systematic review that evaluated the efficacy of anti-plaque, anti-gingivitis mouthrinses from long term (six months) randomized placebo controlled clinical trials. Secondly, the clinical relevance was determined by comparing the percent reduction in plaque and gingivitis attributable to the anti-plaque, anti-gingivitis mouthrinses to change over time in the placebo groups attributable to adult prophylaxis and oral hygiene instructions. Results: Three systematic reviews and one meta-analysis were found that evaluated the efficacy of anti-plaque, anti-gingivitis mouthrinses. The systematic reviews concluded that there is strong evidence supporting the efficacy of chlorhexidine and essential oils as anti-plaque, anti-gingivitis mouthrinses. The evidence for cetyl pyridinium chloride (CPC) was weaker due to few clinical trials testing the same formulations of CPC. There was one meta-analysis of studies from a manufacure of Delmopinol, but it was not a systematic review of the literature. The report based on the meta-analysis concluded that Delmopinol was an effective anti-plaque, anti-gingivitis agent. Evaluation of clinical relevance by estimating percent reduction due to the active agents and changes over time in the placebo groups, demonstrated that the clinical effect of both chlorhexidine and essential oil containing mouthrinses met or exceeded reductions over time for placebo groups. Again the results for CPC were less consistent, but were similar to reductions over time in the placebo groups. Conclusions: These results suggest that the clinical benefits of anti-plaque, anti-gingivitis mouthrinses are similar to the benefits of oral prophylaxis and oral hygiene instructions at six month recall appointments. (C) 2010 Elsevier Ltd. All rights reserved.