Dentaltown September 2019 - 84

Mouthwashes for gingivitis

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84

SEPTEMBER 2019 // dentaltown.com

Mouthwashes have been shown to reach
just 1.5mm subgingivally,5 which limits
their efficacy for treatment of periodontitis,
but they are still valuable for treatment of
gingivitis.
Ingredients used in mouthwashes for
treating gingivitis include:
Chlorhexidine gluconate. A 0.12%
concentration reduces gingivitis by causing
lysis of bacteria. It is effective against a wide
spectrum of bacteria, including Porphyromonas gingivalis. It is substantive: About 30%
is retained in the mouth after rinsing and is
slowly released in the oral tissues, extending
its action for 8-12 hours.6 There are several
brands of chlorhexidine rinse, including
Peridex, Periogard and GUM Paroex, which
is alcohol-free. Chlorhexidine is also used
postsurgery, and has also proved valuable as
a preprocedural rinse to reduce bacteria in
aerosols produced during dental treatment.7
Essential oils. Mouthwashes containing
essential oils have demonstrated significant
efficacy. 8 Essential oils in combination
disrupt bacterial cell walls, impair enzymatic
function of bacteria, and may also have
antioxidant properties.9 Mouthwashes with
essential oils include Listerine, which contains
thymol, menthol and eucalyptol with methyl
salicylate; and Tooth and Gums Tonic,
which contains deionized water, vegetable
glycerine, extracts of echinacea angustofolia,
echinacea purpurea, gotu kola, essential
oils of peppermint, red thyme, cinnamon
bark, eucalyptus globulus and lavender, and
plant saponins.
Hydrogen peroxide. Hydrogen peroxide
is an oral debriding agent and oral wound
cleanser. Effective against anaerobic bacteria,
it helps to cleanse and promote healing of
minor mouth irritations. Peroxyl by Colgate
contains 1.5% hydrogen peroxide.

Chlorine dioxide. Chlorine dioxide is
antibacterial, and also eliminates the volatile
sulfur compounds that cause bad breath.
Closys and OraCare are two examples of
mouthwashes with chlorine dioxide.
Cetylpyridinium chloride. CPC is a cationic quaternary ammonium compound with
a broad antimicrobial spectrum. It causes
growth inhibition, and eventually death, of
bacterial cells. It is mostly effective against
gram-positive bacteria and yeast. When used
as an adjunct to mechanical oral hygiene,
CPC rinses provide a small but significant
additional benefit on reducing both biofilm
accumulation and gingival inflammation.10
Crest Pro Health contains 0.07% CPC;
Colgate Total Advanced Pro-Shield and
Colgate Hydris also contain CPC.

The new generation of
mouthwashes for gingivitis
Until recent years, most mouthwashes for
gingivitis have been mainly antimicrobial, but
a new generation of mouthwashes offer other
modes of action, including anti-inflammatory
and antioxidant. These include:
Hyaluronic acid. Hyaluronic acid, found
naturally in healthy gingival tissue, has
been shown to have anti-inflammatory,
bacteriostatic and antioxidant properties.11
It also promotes healing by stimulating
fibroblast activity. Gengigel by Oral Science
is one example of such a rinse.
Antioxidant rinses, such as AO ProRinse
by PerioScience, are formulated with the
antioxidants curcumin (turmeric), phloretin,
ferulic acid and silymarin. Antioxidants have
been shown to work together synergistically.
Five reviewed studies show that curcumin
significantly decreased plaque index and
gingival index, and can therefore be used in
the prevention and treatment of gingivitis.12
Phloretin, derived mainly from apples,
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Dentaltown September 2019

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