L. Virginia Powell DMD, GPR
Cetylpyridinium (CPC)-containing mouthwashes, when used as an adjunct to toothbrushing, provide a small but significant benefit in the reduction of plaque and gingivitis.
Gingival health improved when CPC-containing rinses were added to daily oral hygiene practice, but, the review authors were unable to characterize the magnitude of the benefit
Do adults who supplement their toothbrushing regimen with CPC-containing mouth rinses have less dental plaque and gingival inflammation than those who only toothbrush?
Two reviewers searched two databases through January 2008. They also conducted hand searches of relevant bibliographies. The search included studies published before January 2008. The authors established consensus protocol and selection criteria a priori. Inclusion criteria were clinical trials of adults aged 18 years or older, CPC-mouthwash usage for a minimum of four weeks, and measures of plaque, bleeding and gingivitis. They conducted meta-analyses of data at baseline and at endpoint, and calculated a weighted mean difference (WMD) between CPC and the control comparison. They did not compare the magnitude of intervention effect because essential data were not reported from the underlying studies
The authors identified 3,250 titles, from which they selected eight clinical trials for review (867 subjects). The studies varied in evaluation period (four weeks to six months), as did the CPC-concentration of rinses (0.05 percent to 0.1 percent). The majority of the studies reported statistically significant improvements in plaque, bleeding, and gingival index scores for the study groups using CPC-containing rinses. The meta-analysis confirmed this trend for plaque (>/= four weeks of duration: WMD = 0.35, 95 percent confidence interval [CI], -0.47, -0.24; >/=six weeks of duration: WMD = 0.42, 95 percent CI, -0.53, -0.31) and gingivitis (>/=four weeks: WMD = 0.15, 95 percent CI, -0.23, -0.07). The description of adverse effects included tooth staining, white plaque on the tongue, unpleasant taste, and mouth burning.
The authors concluded that CPC-containing mouthwashes (e.g., Cepacol, Crest Prohealth), when used as an adjunct to toothbrushing, provide a small but significant benefit by reducing of plaque and gingivitis.
Source of Funding:
Importance and Context:
Some individuals are unable to achieve optimal gingival health with routine brushing and flossing for a variety of reasons. Those who lack dexterity with mechanical methods can enhance the oral hygiene regimen with an effective over-the-counter rinse.
Strengths and Weaknesses of the Systematic Review:
The authors conducted a detailed search using accepted methods. Their inclusion criteria were clearly stated and relevant to the research question. They listed the excluded studies and the reasons for exclusion. They described the relevant information from the included studies in a clear format and considered study quality. They analyzed the data appropriately and addressed heterogeneity. Authors did not report the review of any unpublished studies which may be of significance in that several of the published studies were funded by industry, so publication bias may be a factor.
Strengths and Weaknesses of the Evidence:
The authors included eight clinical trials for analysis; seven were randomized and five were double-blinded. Although they reported significant heterogeneity among the studies, they noted all studies trended a significant treatment effect. The majority of the underlying studies did not report the magnitude of treatment effect; therefore, the authors were unable to estimate the overall treatment effect. Without this estimate, the clinical relevance of the treatment effect cannot be fully determined. However. the weighted mean difference between the test and control treatment at endpoint was significant in favor of CPC for plaque scores and gingivitis in studies greater or equal to four weeks' duration.
Implications for Dental Practice:
Patients who are unable to achieve adequate plaque removal with routine brushing may benefit by the addition of a CPC-containing mouth rinse to their oral care regimen.