The role of therapeutic antimicrobial mouthrinses in clinical practice - Control of supragingival plaque and gingivitis

Background. Although mechanical plaque control methods have the potential to maintain adequate levels of oral hygiene, clinical experience and population-based studies demonstrate that such methods are not being employed sufficiently by large numbers of the population. The need for additional help in controlling bacterial plaque provides the rationale for patients' using antimicrobial mouthrinses as adjuncts to their mechanical oral hygiene regimens. Types of Studies Reviewed. The author presents an overview of the types of studies used to support the effectivenes of antiplaque and antigingivitis mouthrinses, ranging from laboratory studies to six-month clinical trials. He discusses plaque as an example of a biofilm and the implications of recent research on the nature of biofilms with respect to the nature of the evidence that can be used to demonstrate clinical effectiveness. Conclusions. The safety and clinical effectiveness of antiplaque and antigingivitis antimicrobial mouthrinses are best determined using prospective, randomized clinical trials conducted in accordance with ADA guidelines. Clinical Implications. The adjunctive use of antimicrobial mouthrinses can provide significant benefits to patients who cannot maintain adequate levels of plaque and gingivitis control through mechanical methods alone. Dentists should recommend products that have proven clinical activity as demonstrated using generally accepted safety and effectiveness criteria.