Susan Parker RDH, B.S., MEd, MBA
For long-term use, essential oil mouthwash (EO-MW) appears to be a reliable alternative for chlorhexidine mouthwash (CHX-MW) with respect to parameters of gingival inflammation.
In this relatively well-conducted systematic review, the authors were unable to analyze the treatment effects as a function of different levels of plaque, calculus, bleeding and gingivitis so, in essence, the conclusions were generic.
For patients with gingivitis, what is the effect of a standardized EO-MW compared to a CHX-MW with respect to the clinical parameters of gingival inflammation?
Two electronic databases were used to search for appropriate articles up to and including September 2010 written in English. Randomized or controlled clinical trials that evaluated the effects of EO-MW compared to CHX-MW were eligible for inclusion if they were, conducted in humans 16 years or older and in good general health. The authors compared the performance of EO-MW and CHX-MW in a meta-analysis utilizing weighted mean differences of the following clinical parameters of gingival inflammation: plaque, calculus, bleeding and gingivitis.
All but one of the 19 selected studies used for data extraction were RCTs. In a meta-analysis on long-term studies (> 4 weeks), CHX-MW provided significantly better effects regarding plaque control (WMD = 0.19; 95%CI = 0.08 to 0.30, 2 studies, N= 159 participants) However, no significant difference was found with respect to reduction of gingival inflammation (WMD = -0.03; 95%CI = -0.16 to 0.09, 1 study, N=77 participants) and staining (WMD = -0.42; 95%CI = -0.94 to 0.01, 1 study, N= 77 participants). The stated differences in calculus formation favoring EO-MW and the lack of difference in gingival bleeding were based on the authors' interpretation of the data from the individual studies rather than a meta-analysis.
"In long-term use, the standardized formulation of EO-MW appeared to be a reliable alternative to chlorhexidine mouthwash with respect to parameters of gingival inflammation."
Source of Funding:
Study was self-funded by the authors and the Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Netherlands.
Importance and Context:
Daily oral hygiene controls plaque development, which is the key to preventing gingivitis. In long-term use, essential oil mouthwashes appear to be as effective as chlorhexidine mouthwashes in reducing gingival inflammation.
Strengths and Weaknesses of the Systematic Review:
This systematic review followed acceptable guidelines. The authors considered quality assessment parameters, statistical validity, and conducted a risk of bias analysis. The authors searched two electronic databases seeking only English language articles. They performed meta-analysis using the mean and standard deviations of baseline and end-point data, which is not what is usually expected. In the end, they included only two studies in the meta-analysis from the 19finally included.
Strengths and Weaknesses of the Evidence:
Most studies were considered to have a low risk of bias as shown by a consistent Grade A as determined by the Center of Evidence-Based Medicine scale. The authors compared CHX-MW to EO-MW; however, they did not include a 'no-mouthwash' or placebo group for comparison. Due to lack of evidence the authors were unable to analyze the treatment effects as a function of different levels of plaque, calculus, bleeding and gingivitis.
Implications for Dental Practice:
The primary method of plaque control is still mechanical removal of plaque with toothbrush and interdental devices such as woodsticks (Hoenderdos et al. 2008). When long-term (>4 weeks) anti-inflammatory oral care is needed, EO-MW appears to be a reliable alternative to CHX-MW with respect to controlling gingival inflammation. There is limited evidence that EO-MW (i.e., Listerine) may be a reliable alternative to CHX-MW (i.e., Peridex) in managing different levels of gingivitis. Dentists should exercise caution when utilizing these conclusions as it is still not clear what level of gingival inflammation is needed to prevent progression from gingivitis to significant periodontitis.