Clinical Effects of Chlorhexidine 0.2% and Cetylpyridinium 0.05% Combination in Comparison with Chlorhexidine, Cetylpyridinium and Persica in Reducing Oral Bacteria in Healthy Individuals
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Abstract
Background: Preparation of a new product with the goal of reducing chlorhexidine’s side effects without decreasing (and even increasing) its effectiveness is a desirable goal for researchers in the field of oral hygiene. The aim of this study was to evaluate the efficacy of Chlorhexidine 0.2% and Cetylpyridinium 0.05% combination in reducing oral bacteria in comparison with Chlorhexidine 0.2%, Cetylpyridinium 0.05% and Persica mouthwashes.
Methods: 100 healthy volunteers aged between 18 and 30 years were randomly assigned to 5 groups. The first group received Chlorhexidine 0.2%, the second group received Cetylpyridinium 0.05%, the third received Persica, the fourth received Chlorhexidine 0.2% plus Cetylpyridinium 0.05%, and the fifth group received Chlorhexidine 0.05% plus Cetylpyridinium 0.05%. Samples were obtained at baseline and thirty minutes after oral rinsing with the mouthwashes. The number of colony-forming units (CFU/mL) before and after mouthwash administration was compared for each sample.
Results: The preparation with the most bacterial count reduction was found to be Chlorhexidine 0.2% and Cetylpyridinium 0.05% combination. However, the difference between efficacy of Chlorhexidine 0.2% plus Cetylpyridinium 0.05% and Chlorhexidine 0.05% plus Cetylpyridinium 0.05% was found not to be statistically significant.
Conclusions: A new mouthwash preparation including chlorhexidine 0.05% and cetylpyridinium 0.05 % combination is the most desirable due to the increased efficacy and fewer side effects.
Page RC, Schröder HE. Pathogenesis of inflammatory periodontal disease. A summary of current work. Lab Invest 1976;34(3):235–49.
2. Lösche WJ, Grossman NS. Periodontal disease as a specific, albeit chronic infection diagnosis and treatment. Clin Microbiol Rev 2001;14:727-52.
3. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018;392(10159):1789-1858
4. D'Aiuto F, Parkar M, Andreou G, et al. Periodontitis and systemic inflammation: control of the local infection is associated with a reduction in serum inflammatory markers. J Dent Res 2004;83(2):156–60.
5. Paraskevas S, Huizinga JD, Loos BG. A systematic review and meta-analyses on C- reactive protein in relation to periodontitis. J Clin Periodontol 2008;35(4):277-90.
6. Pussinen PJ, Alfthan G, Tuomilehto J, Asikainen S, Jousilahti P. High serum antibody levels to Porphyromonas gingivalis predict myocardial infarction. European Journal of Cardiovascular Prevention & Rehabilitation. 2004;11:408–11.
7. Pussinen PJ, Alfthan G, Jousilahti P, Paju S, Tuomilehto J. Systemic exposure to Porphyromonas gingivalis predicts incident stroke. Atherosclerosis 2007;193:222–28.
8. Scannapieco FA, Bush RB, Paju S. Associations between periodontal disease and risk for atherosclerosis, cardiovascular disease, and stroke. A Systematic Review. Annals of Periodontology 2003;8:38–53.
9. Humphrey LL, Fu R, Buckley DI, Freeman M, Helfand M. Periodontal Disease and Coronary Heart Disease Incidence: A Systematic Review and Meta-analysis. Journal of General Internal Medicine 2008;23:2079–86.
10. Rosema NA, Timmerman MF, Versteeg PA, et al. Comparison of the use of different modes of mechanical oral hygiene in prevention of plaque and gingivitis. J Periodontal 2008;79(8):1386-94.
11. Van der Weijden GA, Hioe KP. A systemic review of the effectiveness of self-performed mechanical plaque removal in adults with gingivitis using a manual toothbrush. J Clin Periodontol 2005;32(Suppl 6):214-28.
12. Sturzenburger OP, Leonard GJ. The effect of a mouthwash as adjunct in tooth cleaning. J Periodontol 1969;40(5):299-301.
13. Marsh PD. Microbiological aspects of the chemical control of plaque and gingivitis. J Dent Res 2002;71(7):1431-8.
14. Barnett ML. The role of therapeutic antimicrobial mouthrinses in clinical practice. J Am Dent Assoc 2003;134(6):699-704.
15. Barnett ML. The rationale for the daily use of an antimicrobial mouthrinse. J Am Dent Assoc 2006;137 Suppl:16S-21S.
16. Baehni PC, Takeuchi Y. Anti-plaque agents in the prevention of biofilm-associated oral diseases. Oral Dis 2003:9(Suppl 1):23-9.
17. Williams MI. The antimicrobial and antiplaque effectiveness of mouthwashes containing cetylpyridinium chloride with and without alcohol in improving gingival health. J Clin Dent 2011;22(6):179-82.
18. Khalessi AM, Pack AR, Thomson WM, Tompkins GR. An in vivo study of the plaque control efficacy of Persica: a commercially available herbal mouthwash containing extracts of Salvadora persica. Int Dent J 2004;54(5):279-83.
19. Bascones A, Morante S, Mateos L, Mata M, Poblet J. Influence of additional active ingredients on the effectiveness of non-alcoholic chlorhexidine mouthwashes: a randomized controlled trial. J Periodontol 2005;76(9):1469-75.
20. Schäffer LM, Szewczyk G, Nesta J, et al. In vitro antibacterial efficacy of cetylpyridinium chloride-containing mouthwashes. J Clin Dent 2011;22(6):183-6.
21. Sheie A. Modes of action of currently known chemical anti-plaque agents other than chlorhexidine. J Dent Res 1989;68:1609-16.
22. Haps S, Slot DE, Berchier CE, Van der Weijden GA. The effects of cetylpyridinium chloride-containing mouth rinses as adjuncts to toothbrushing on plaque and parameters of gingivial inflammation: a systematic review. Int J Dent Hyg 2008;6(4):290-303.
23. Allen DR, Davies R, Bradshaw B, 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):20-6.
24. Rawlinson A, Pollington S, Walsh TF, et al. Efficacy of two alcohol-free cetylpyridinium chloride mouthwashes- a randomized double-blind cross over study. J Clin Dent 2011;22(6):200-3.
25. Gunsolley JC. A meta-analysis of six-month studies of antiplaque and antigingivitis agents. J Am Dent Assoc 2006;137(12):1649-57.
26. He S, Wei Y, Fan X, Hu D, Screenivasan PK. A clinical study to assess the 12-hour antimicrobial effects of cetylpyridinium chloride mouthwashes on supragingivial plaque bacteria. J Clin Dent 2011;22(6):195-9.
27. Moeintaghavi A, Arab H, Khajekaramodini M, Hosseini R, Danesteh H, Niknami H. In vitro antimicrobial comparison of chlorhexidine, persica mouthwash and miswak extract. J Contemp Dent Pract 2012;13(2):147-52.
28. Halawany HS. A review on miswak (Salvadora persica) and its effect on various aspects of oral health. Saudi Dent J 2012;24(2):63-9.
29. Al-Lafi T, Abadneh H. The effect of the extract of the Miswak (chewing sticks) used Jordan and the Middle East on oral bacteria. Int Dent J 1995;45(3):218-22.
30. Renton-Harper P, Addy M, Moran J, Doherty FM, Newcombe RG. A comparison of chlorhexidine, cetylpyridinium, triclosan, and C31G mouthrinse products for plaque inhibition. J Periodontol 1996;67(5):486-9.
31. Elworthy A, Greenman J, Doherty FM, Newcobe RG, Addy M. The substantivity of a number of oral hygiene products determined by the duration of effects on salivary bacteria. J Periodontol 1996;67(6):572-6.
32. Leyes Borajo JL, Garcia VL, Lopez CG, Rodriquez-Nunez I, Garcia FM, Gallas TM. Efficacy of chlorhexidine mouthrinses with and without alcohol: a clinical study. J Periodontol 2002;73(3):317-21.
33. Ernst CP, Prockl K, Willershausen B. The effectiveness and side effects of 0.1% and 0.2% chlorhexidine mouthrinses: A clinical study. Quintessence Int 1998;29(7):443-8.
34. Berchier CE, Slot DE, Van der Weijden GA. The efficacy of 0.12% chlorhexidine mouthrinse compared with 0.2% on plaque accumulation and periodontal parameters: a systemic review. J Clin Periodontol 2010;37(9):829-39.
35. Addy M, Mahdavi SA, Lyon T. Dietary staining in vitro by mouthrinses as a comparative measure of antiseptic activity and predictor of sating in vivo. J Dent 1995;23(2):95-9.
36. Haydari M, Bardakci AG, Koldsland OC, Aass AM, Sandvik L, Preus HR. Comparing the effect of 0.06% -, 0.12% and 0.2% Chlorhexidine on plaque, bleeding and side effects in an experimental gingivitis model: a parallel group, double masked randomized clinical trial. BMC Oral Health 2017; 17(1):118.
37. Pulcini A, Bollaín J, Sanz-Sánchez I, et al. Clinical effects of the adjunctive use of a 0.03% chlorhexidine and 0.05% cetylpyridinium chloride mouth rinse in the management of peri-implant diseases: A randomized clinical trial. J Clin Periodontol 2019;46 (3):342-53.
38. Lobene RR. Clinical studies of plaque control agents: an overview. J Dent Res 1979;58(12):2381-8.
39. Finne DH, Furgang D, Barnett ML. Comparative antimicrobial activities of antiseptic mouthrinses against isogenic planktonic and biofilm forms of Actinobacillus actinomycetmcomitans. J Clin Periodontol 2001;28(7):697-700.
40. Pan PC, Harper S, Ricci-Nittel D, Lux R, Shi W. In vitro evidence for the efficacy of antimicrobial mouthrinses. J Dent 2010;38(Suppl 1):S16-20.
41. DePaola LG, Spolarich AE. Safety and efficacy of antimicrobial mouthrinses in clinical practice. J Dent Hyg 2007;81(5):1-16.
42. Gilbert P, Moore LE. Cationic antiseptics: diversity of action under a common epithet. J Appl Microbiol 2005;99(4):703-15.
43. 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. J Cli Periodontol 2001;28(12):1127-36.
44. Gründemann LJ, Timmerman MF, Ijzerman Y,et al. Stain, plaque and gingivitis reduction by combining chlorhexidine and peroxyborate. J Clin Periodontol 2000;27(1):9–15.
45. Franco Neto CA, Fatturi Parolo CC, Rösing CK, Maltz M. Comparative analysis of the effect of two chlorhexidine mouthrinses on plaque accumulation and gingival bleeding. Braz Oral Res 2008;22(2):139-44.
46. Najafi MH, Taheri M, Mokhtari MR, et al. Comparative study of 0.2% and 0.12% digluconate chlorhexidine mouth rinses on the level of dental staining and gingival indices. Dent Res J (Isfahan) 2012;9(3):305-8.
47. Mozaffari B, Mansori SH, Rajabalian S, Alimardani A, Mohamadi M. In vitro study between antibacterial and cytotoxic effects of chlorhexidine and persica mouthrinses. Journal of Dental School 2005;23(3):494-509.
48. García-Gargallo M, Zurlohe M, Montero E, et al. Evaluation of new chlorhexidine- and cetylpyridinium chloride-based mouthrinse formulations adjunctive to scaling and root planing: pilot study. Int J Dent Hyg 2017;15(4):269-79.
2. Lösche WJ, Grossman NS. Periodontal disease as a specific, albeit chronic infection diagnosis and treatment. Clin Microbiol Rev 2001;14:727-52.
3. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018;392(10159):1789-1858
4. D'Aiuto F, Parkar M, Andreou G, et al. Periodontitis and systemic inflammation: control of the local infection is associated with a reduction in serum inflammatory markers. J Dent Res 2004;83(2):156–60.
5. Paraskevas S, Huizinga JD, Loos BG. A systematic review and meta-analyses on C- reactive protein in relation to periodontitis. J Clin Periodontol 2008;35(4):277-90.
6. Pussinen PJ, Alfthan G, Tuomilehto J, Asikainen S, Jousilahti P. High serum antibody levels to Porphyromonas gingivalis predict myocardial infarction. European Journal of Cardiovascular Prevention & Rehabilitation. 2004;11:408–11.
7. Pussinen PJ, Alfthan G, Jousilahti P, Paju S, Tuomilehto J. Systemic exposure to Porphyromonas gingivalis predicts incident stroke. Atherosclerosis 2007;193:222–28.
8. Scannapieco FA, Bush RB, Paju S. Associations between periodontal disease and risk for atherosclerosis, cardiovascular disease, and stroke. A Systematic Review. Annals of Periodontology 2003;8:38–53.
9. Humphrey LL, Fu R, Buckley DI, Freeman M, Helfand M. Periodontal Disease and Coronary Heart Disease Incidence: A Systematic Review and Meta-analysis. Journal of General Internal Medicine 2008;23:2079–86.
10. Rosema NA, Timmerman MF, Versteeg PA, et al. Comparison of the use of different modes of mechanical oral hygiene in prevention of plaque and gingivitis. J Periodontal 2008;79(8):1386-94.
11. Van der Weijden GA, Hioe KP. A systemic review of the effectiveness of self-performed mechanical plaque removal in adults with gingivitis using a manual toothbrush. J Clin Periodontol 2005;32(Suppl 6):214-28.
12. Sturzenburger OP, Leonard GJ. The effect of a mouthwash as adjunct in tooth cleaning. J Periodontol 1969;40(5):299-301.
13. Marsh PD. Microbiological aspects of the chemical control of plaque and gingivitis. J Dent Res 2002;71(7):1431-8.
14. Barnett ML. The role of therapeutic antimicrobial mouthrinses in clinical practice. J Am Dent Assoc 2003;134(6):699-704.
15. Barnett ML. The rationale for the daily use of an antimicrobial mouthrinse. J Am Dent Assoc 2006;137 Suppl:16S-21S.
16. Baehni PC, Takeuchi Y. Anti-plaque agents in the prevention of biofilm-associated oral diseases. Oral Dis 2003:9(Suppl 1):23-9.
17. Williams MI. The antimicrobial and antiplaque effectiveness of mouthwashes containing cetylpyridinium chloride with and without alcohol in improving gingival health. J Clin Dent 2011;22(6):179-82.
18. Khalessi AM, Pack AR, Thomson WM, Tompkins GR. An in vivo study of the plaque control efficacy of Persica: a commercially available herbal mouthwash containing extracts of Salvadora persica. Int Dent J 2004;54(5):279-83.
19. Bascones A, Morante S, Mateos L, Mata M, Poblet J. Influence of additional active ingredients on the effectiveness of non-alcoholic chlorhexidine mouthwashes: a randomized controlled trial. J Periodontol 2005;76(9):1469-75.
20. Schäffer LM, Szewczyk G, Nesta J, et al. In vitro antibacterial efficacy of cetylpyridinium chloride-containing mouthwashes. J Clin Dent 2011;22(6):183-6.
21. Sheie A. Modes of action of currently known chemical anti-plaque agents other than chlorhexidine. J Dent Res 1989;68:1609-16.
22. Haps S, Slot DE, Berchier CE, Van der Weijden GA. The effects of cetylpyridinium chloride-containing mouth rinses as adjuncts to toothbrushing on plaque and parameters of gingivial inflammation: a systematic review. Int J Dent Hyg 2008;6(4):290-303.
23. Allen DR, Davies R, Bradshaw B, 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):20-6.
24. Rawlinson A, Pollington S, Walsh TF, et al. Efficacy of two alcohol-free cetylpyridinium chloride mouthwashes- a randomized double-blind cross over study. J Clin Dent 2011;22(6):200-3.
25. Gunsolley JC. A meta-analysis of six-month studies of antiplaque and antigingivitis agents. J Am Dent Assoc 2006;137(12):1649-57.
26. He S, Wei Y, Fan X, Hu D, Screenivasan PK. A clinical study to assess the 12-hour antimicrobial effects of cetylpyridinium chloride mouthwashes on supragingivial plaque bacteria. J Clin Dent 2011;22(6):195-9.
27. Moeintaghavi A, Arab H, Khajekaramodini M, Hosseini R, Danesteh H, Niknami H. In vitro antimicrobial comparison of chlorhexidine, persica mouthwash and miswak extract. J Contemp Dent Pract 2012;13(2):147-52.
28. Halawany HS. A review on miswak (Salvadora persica) and its effect on various aspects of oral health. Saudi Dent J 2012;24(2):63-9.
29. Al-Lafi T, Abadneh H. The effect of the extract of the Miswak (chewing sticks) used Jordan and the Middle East on oral bacteria. Int Dent J 1995;45(3):218-22.
30. Renton-Harper P, Addy M, Moran J, Doherty FM, Newcombe RG. A comparison of chlorhexidine, cetylpyridinium, triclosan, and C31G mouthrinse products for plaque inhibition. J Periodontol 1996;67(5):486-9.
31. Elworthy A, Greenman J, Doherty FM, Newcobe RG, Addy M. The substantivity of a number of oral hygiene products determined by the duration of effects on salivary bacteria. J Periodontol 1996;67(6):572-6.
32. Leyes Borajo JL, Garcia VL, Lopez CG, Rodriquez-Nunez I, Garcia FM, Gallas TM. Efficacy of chlorhexidine mouthrinses with and without alcohol: a clinical study. J Periodontol 2002;73(3):317-21.
33. Ernst CP, Prockl K, Willershausen B. The effectiveness and side effects of 0.1% and 0.2% chlorhexidine mouthrinses: A clinical study. Quintessence Int 1998;29(7):443-8.
34. Berchier CE, Slot DE, Van der Weijden GA. The efficacy of 0.12% chlorhexidine mouthrinse compared with 0.2% on plaque accumulation and periodontal parameters: a systemic review. J Clin Periodontol 2010;37(9):829-39.
35. Addy M, Mahdavi SA, Lyon T. Dietary staining in vitro by mouthrinses as a comparative measure of antiseptic activity and predictor of sating in vivo. J Dent 1995;23(2):95-9.
36. Haydari M, Bardakci AG, Koldsland OC, Aass AM, Sandvik L, Preus HR. Comparing the effect of 0.06% -, 0.12% and 0.2% Chlorhexidine on plaque, bleeding and side effects in an experimental gingivitis model: a parallel group, double masked randomized clinical trial. BMC Oral Health 2017; 17(1):118.
37. Pulcini A, Bollaín J, Sanz-Sánchez I, et al. Clinical effects of the adjunctive use of a 0.03% chlorhexidine and 0.05% cetylpyridinium chloride mouth rinse in the management of peri-implant diseases: A randomized clinical trial. J Clin Periodontol 2019;46 (3):342-53.
38. Lobene RR. Clinical studies of plaque control agents: an overview. J Dent Res 1979;58(12):2381-8.
39. Finne DH, Furgang D, Barnett ML. Comparative antimicrobial activities of antiseptic mouthrinses against isogenic planktonic and biofilm forms of Actinobacillus actinomycetmcomitans. J Clin Periodontol 2001;28(7):697-700.
40. Pan PC, Harper S, Ricci-Nittel D, Lux R, Shi W. In vitro evidence for the efficacy of antimicrobial mouthrinses. J Dent 2010;38(Suppl 1):S16-20.
41. DePaola LG, Spolarich AE. Safety and efficacy of antimicrobial mouthrinses in clinical practice. J Dent Hyg 2007;81(5):1-16.
42. Gilbert P, Moore LE. Cationic antiseptics: diversity of action under a common epithet. J Appl Microbiol 2005;99(4):703-15.
43. 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. J Cli Periodontol 2001;28(12):1127-36.
44. Gründemann LJ, Timmerman MF, Ijzerman Y,et al. Stain, plaque and gingivitis reduction by combining chlorhexidine and peroxyborate. J Clin Periodontol 2000;27(1):9–15.
45. Franco Neto CA, Fatturi Parolo CC, Rösing CK, Maltz M. Comparative analysis of the effect of two chlorhexidine mouthrinses on plaque accumulation and gingival bleeding. Braz Oral Res 2008;22(2):139-44.
46. Najafi MH, Taheri M, Mokhtari MR, et al. Comparative study of 0.2% and 0.12% digluconate chlorhexidine mouth rinses on the level of dental staining and gingival indices. Dent Res J (Isfahan) 2012;9(3):305-8.
47. Mozaffari B, Mansori SH, Rajabalian S, Alimardani A, Mohamadi M. In vitro study between antibacterial and cytotoxic effects of chlorhexidine and persica mouthrinses. Journal of Dental School 2005;23(3):494-509.
48. García-Gargallo M, Zurlohe M, Montero E, et al. Evaluation of new chlorhexidine- and cetylpyridinium chloride-based mouthrinse formulations adjunctive to scaling and root planing: pilot study. Int J Dent Hyg 2017;15(4):269-79.
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| Issue | Vol 8, No 3 (Summer 2020) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jpc.v8i3.4545 | |
| Keywords | ||
| Chlorhexidine Cetylpyridinium Persica Gingivitis Periodontitis Oral Bacteria | ||
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How to Cite
1.
Yarahmadi N, Hashemian F, Hosseini Doust R. Clinical Effects of Chlorhexidine 0.2% and Cetylpyridinium 0.05% Combination in Comparison with Chlorhexidine, Cetylpyridinium and Persica in Reducing Oral Bacteria in Healthy Individuals. J Pharm Care. 2020;8(3):116-122.
