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PubMed1978

The effect of a quaternary ammonium-containing mouthwash on formed plaque.

The effect on formed dental plaque of a commercial mouthwash containing cetylpyridinium chloride (CPC) was evaluated in forty-one adults. During this fourteen day study no oral hygiene other than the use of a mouthwash was provided. Plaque and gingival indices were scored on sixteen teeth at days 0, 7 and 14. The results of this study suggested that subjects using the CPC containing mouthwash formed less plaque than those using the placebo mouthwash. No change in the Gingival Index was observed. Of those patients using the CPC containing mouthwash, four showed a slight staining of the anterior teeth and five reported a mild burning sensation of the tongue.

Adult↗

PubMed1983

Oral cancer and mouthwash use.

The role of mouthwash and other factors was examined in relation to oral cavity cancer by means of a retrospective study. Daily use of mouthwash showed an excess risk in females but no excess risk in males. No dose response was seen in females with increased duration of use. In nonsmoking, nondrinking women as well, daily mouthwash use was associated with excess risk. Multiple logistic regression including all factors of interest showed inconsistent results for duration and frequency of mouthwash use. Due to the absence of a dose-response relationship and the possibility of confounding by tobacco and alcohol use, it was not possible to attribute causal significance to the association between daily mouthwash use and oral cancer in women.

Adult↗

PubMed1994

An in vivo comparison of antimicrobial activities of four commercial mouthwashes.

The purpose of this in vivo double-blind study was to determine and compare the antimicrobial effectiveness of four commercial over-the-counter mouthwashes and a water control. Two of the products tested contained alcohol (Listerine and Scope) and two products were alcohol-free (Rembrandt Mouth Refreshing Rincs and Clear Choice). The antimicrobial efficacy of the products was determined against aerobic, microaerophilic, and anaerobic bacteria in saliva. Thirty human subjects participated in the study. At each experimental session for a given subject, a pretest saliva sample was taken. This sample was divided and used to grow three bacteria cultures under the different incubation environments. After giving the pretest sample, the subject rinsed with one of the commercial mouthwashes or the water control for 30 seconds, then waited one hour at which time a posttest saliva sample was collected. Again, the sample was divided and used to culture the different type of bacteria. Following a 48-hour incubation period, the numbers of microbial colonies on each plate were counted and compared. The results indicated that all of the mouthwashes tested performed significantly better than the water control. Both of the non-alcohol-containing products showed efficacy in inhibiting aerobic, microaerophilic, and anaerobic bacteria. Rembrandt Mouth Refreshing Rinse and Listerine inhibited all three types of bacteria, and were not significantly different from each other in efficacy. The Rembrandt mouth wash inhibited all three types of bacteria more effectively than Clear Choice mouthwash, and inhibited two of the three types of bacteria more effectively than Scope mouthwash.

Analysis of Variance↗

PubMed1997

A clinical assessment of the effectiveness of a mouthwash based on triclosan and on Zea mays L used as supplements to brushing.

The effectiveness of a mouthwash based on triclosan in combatting plaque and gingivitis was compared with a mouthwash based on nonsaponifiable maize germ (Zea mays L). Both were used to supplement conventional mechanical oral hygiene. The study was carried out under double-blind conditions with a negative control (a placebo) and a positive control (a mouthwash based on chlorhexidine). After a period of 14 days to allow the Plaque Index and Gingival Index to standardize, the 43 subjects who formed the sample were examined weekly for 3 weeks. During the study, five subjects were excluded because they did not meet the criteria for selection for the study. Although the mouthwash based on triclosan reduced the Plaque Index by 7.3% in comparison with the placebo negative control (a less marked effect than that of chlorhexidine, which achieved an 8.43% reduction), it had scarcely any effect on the Gingival Index. The mouthwash based on Zea mays L had no beneficial action on the Plaque Index, which increased slightly, but it led to an improvement in the Gingival Index (7.17% in comparison with the placebo).

Adult↗

PubMed1996

Increased acetaldehyde production by mouthwashings from patients with oral cavity, laryngeal, or pharyngeal cancer.

Excessive ethanol consumption is associated with an increased risk of oral cavity, laryngeal, and pharyngeal cancer. Ethanol has been shown to be oxidized to acetaldehyde by microflora of the upper respiratory tract. As a highly toxic and reactive compound, acetaldehyde of microbial origin has been incriminated as a possible carcinogenic factor behind alcohol-associated malignancies of the upper respiratory tract. The aim of the present in vitro study was to compare the acetaldehyde producing capacity of mouthwashings obtained from patients with oral cavity, laryngeal, or pharyngeal cancer to that of mouthwashings from controls. The ability of mouthwashings to produce acetaldehyde from ethanol in vitro was determined by incubating them in closed vials containing various concentrations of ethanol (0-44 mM) at 37 degrees C for 1 hr. Acetaldehyde formed during the incubation was then analyzed by head space gas chromatography. Acetaldehyde production by mouthwashings increased with raising ethanol concentration in both groups. Acetaldehyde production by mouthwashings from patients with oral cavity, laryngeal, or pharyngeal cancer was significantly (p < 0.01) higher than that of the controls. Increased acetaldehyde formation from ethanol in the upper respiratory tract could thus contribute to the pathogenesis of alcohol-associated oral cavity, laryngeal, and pharyngeal cancers.

Acetaldehyde↗

PubMed1995

Evaluation of GM-CSF mouthwash for prevention of chemotherapy-induced mucositis: a randomized, double-blind, dose-ranging study.

Uncontrolled clinical trials have shown that parenteral administration of GM-CSF reduces the frequency of chemotherapy-induced mucositis. The mechanism of this effect could be related to acceleration of haematopoiesis and/or increase in functional activation of WBC. We conducted a double-blind, placebo-controlled, dose ranging study of GM-CSF (mol-gramostim) mouthwash in patients with breast cancer during the first treatment cycle of a combination chemotherapy regimen which has historically produced dose-limiting (grade > or = 3) mucositis in approximately 39% of patients. Subjects were randomized to receive either placebo mouthwash (0.1 percent albumin) or one of four concentrations of GM-CSF mouthwash (0.01, 0.1, 1.0 or 10 mcg/ml). The primary endpoint was to evaluate the relationship between dose of GM-CSF mouthwash received and probability of grade > or = 3 mucositis using a logistic model. Solutions were administered four times daily starting within 24 hours of chemotherapy initiation and continuing until the end of the cycle (day 21). Mucositis was assessed on days 1-6, 10, 15 and 21. Day 6 plasma samples were assayed for GM-CSF. Forty-five patients were evaluable for response (nine per dosing group). A 42% risk (15/36) of mucositis grade > or = 3 was evident on day 15 in patients receiving GM-CSF compared to 2 of 9 patients on the placebo arm. No evidence of dose response was found by logistic regression. Five patients had a detectable plasma concentration of GM-CSF (56-209 pg/ml). A positive correlation between GM-CSF dose and leukocyte recovery was noted (P = 0.04).

Adult↗

PubMed1984

Human oral retention of zinc from mouthwashes containing zinc salts and its relevance to dental plaque control.

Subjects using 30 mM zinc phenolsulphonate as a mouthwash retained 12 per cent of the zinc. Salivary zinc concentration was increased by using mouthwashes containing 17-35 mM zinc as the sulphate, phenolsulphonate or citrate. For 17 mM zinc sulphate or phenolsulphonate, the effect lasted 3-4 h. Zinc retained in the mouth gave visible fluorescence after rinsing with 8-hydroxyquinoline and was particularly evident on the tongue, cheek mucosa and dental plaque. The concentration of zinc in plaque was increased 13-19-fold 1 h after using 31 or 18 mM zinc phenolsulphonate. A 3-fold increase was still present 6 h later for the 31 mM mouthwash. Zinc salts inhibited acid production from [14C]-glucose in vitro by plaque at concentrations which were found in plaque in vivo after using the mouthwashes. The effect of zinc on the metabolic activity of plaque may reduce the growth rate of plaque-bacteria and so decrease plaque growth.

Acids↗

PubMed1997

Effect of use of 0.05% cetylpyridinium chloride mouthwash on normal oral flora.

OBJECTIVES: The aims of this study were to examine the effect of the use of a mouthwash containing 0.05% cetylpyridinium chloride (CPC) on (1) the composition of the normal oral microbial flora and (2) the establishment of non-oral bacterial species in the mouth. METHOD: In a double-blind study, 129 subjects used, twice daily for 6 weeks, either a randomly assigned test or placebo mouthwash. At baseline and at the completion of the study, a sample of the oral flora was obtained by asking each subject to "swish" around the mouth for 30 s, 10 ml of distilled water. The numbers of total colony forming units (CFU), facultative bacteria, streptococci, mutans streptococci, lactobacilli, staphylococci, yeasts and enterococci were enumerated after culture on eight non-selective and selective media. RESULTS: After 6 weeks use of either the test or placebo mouthwashes, there were no significant differences (analysis of variance) between the counts (CFU/ml of sample) for any of the microbial taxa. CONCLUSIONS: These data indicate that the use of a CPC-containing mouthwash does not alter the composition of the normal oral flora or result in the establishment of non-oral and potentially pathogenic bacteria in the mouth.

Analysis of Variance↗

PubMed2001

In vitro permeation studies of triamcinolone acetonide mouthwashes.

The effects of vehicle composition, contact time of mouthwash and cosolvent on permeation of triamcinolone acetonide (TA) were investigated in vitro using hamster cheek pouch mucosa and synthetic membranes. Mouthwashes containing 0.1% TA with and without the mucoadhesive carboxyvinyl polymer were formulated. Aqueous suspensions and Orabase were used as control formulations. The contact time of mouthwash was varied from 1 to 5 min. Ethanol was used as a cosolvent in various binary-water mixtures. TA was delivered to a significantly lesser extent to mucosal tissue by the mouthwash than by the aqueous suspension (P < 0.001), but to a higher extent than by the Orabase formulation (P < 0.001). No effects of contact time or the mucoadhesive polymer were observed on amount of TA accumulated in the mucosal membrane. These observations have suggested that the use of carboxyvinyl polymer and a high content of ethanol are not appropriate as vehicles for local drug delivery but are suitable for transmucosal drug carriers.

Animals↗

PubMed1994

Identification of M. tuberculosis ribosomal RNA in mouthwash samples from patients with tuberculosis.

It is often not possible to obtain satisfactory sputum samples from patients suspected of having pulmonary tuberculosis. In this study, we asked whether it was possible to identify M. tuberculosis ribosomal RNA (rRNA) in mouthwash samples, and in a prospective clinical study, whether the presence of this rRNA correlated with clinical M. tuberculosis infection. Using a combination of reverse transcriptase and polymerase chain reaction amplification, it was possible to identify M. tuberculosis rRNA in mouthwash samples. M. tuberculosis rRNA was identified in mouthwash samples from patients with active tuberculosis more commonly than in samples from control subjects (P < 0.05). The test was positive in four of ten patients with active pulmonary tuberculosis, one of eight contacts, none of eight past cases of tuberculosis, two of eight patients with other diagnosis and one of five healthy volunteers. M. tuberculosis rRNA was identified in sputum from four of eight patients and in bronchoscopy trap samples from four of five patients with active tuberculosis. However, one of ten sputum samples and two of five bronchoscopy samples from subjects with a clinical diagnosis other than active tuberculosis were positive. These results indicate that although it is technically possible to identify M. tuberculosis on the basis of the presence of rRNA in mouthwash samples, the poor sensitivity and specificity of the technique suggest that it is unlikely to be useful clinically.

Base Sequence↗

PubMed2003

Essential oil mouthwashes: a key component in oral health management.

This Supplement provides clear evidence that essential oil (EO) mouthwashes can be a beneficial, safe component of daily oral health routines. However, despite the wealth of supporting evidence, several issues are worthy of discussion. Patient compliance is a clear issue with oral home-care routines, and the emphasis is on dental professionals to communicate the importance of adherence. The reasons for each step of the oral-care routine (i.e. brushing, flossing, rinsing) should be clearly explained, and if required, additional motivation should be provided. Most mouthwashes contain denatured alcohol as a delivery vehicle, and some concern has been raised about the association of alcohol with oral cancer. However, a review by the Food and Drug Administration and American Dental Association found that the supporting evidence to date is inconsistent and contradictory. Some mouthwashes have a pH below 5.5, and some researchers believe that this can lead to tooth erosion. Studies have shown that although the pH of an EO mouthwash is below 5.5, salivary pH remains above 5.5 following rinsing and for 15 min postrinse.

Anti-Infective Agents, Local↗

PubMed1998

In vitro studies of the effect of antiseptic-containing mouthwashes on the formation and viability of Streptococcus sanguis biofilms.

The aims of this study were to evaluate the growth of Streptococcus sanguis on hydroxyapatite, bovine enamel and polytetrafluoroethylene substrata in a constant depth film fermentor, and to determine the effects of three antimicrobial-containing mouthwashes on biofilm formation and bacterial viability on hydroxyapatite and enamel. There was little difference in the final cell density (5 x 10(4) cfu mm-2) of the Strep. sanguis biofilm on the three substrata. When hydroxyapatite-grown biofilms were exposed to the mouthwashes for 1 min, the one containing triclosan (T) proved the most effective. The chlorhexidine-containing mouthwash (CX) also achieved significant kills. The T-containing mouthwash was the most effective at killing biofilms grown on enamel. Pre-treatment of hydroxyapatite with CX, cetylpyridium chloride (CPC) or T for 1 min resulted in undetectable biofilm formation after 8 h. After 8 h of growth, only biofilms grown on enamel discs pre-treated with CX showed a reduction in the number of viable organisms. In conclusion, the results of this study have shown that while growth of Strep. sanguis on hydroxyapatite and enamel were similar, the ability of antimicrobial agents to prevent the accumulation of viable bacteria depended on the nature of the substratum.

Animals↗

PubMed1998

Aqueous hydrocortisone mouthwash solution: clinical evaluation.

Patients often experience difficulties in applying topical steroids in orabase to the oral mucosa, particularly when large areas need to be covered. An aqueous hydrocortisone mouthwash solution has been developed, one that was anticipated to be more acceptable to patients. The solution contains hydrocortisone (0.3% w/v) in a 4.5% (w/v) 2-hydroxypropyl-beta-cyclodextrin solution. Hydroxypropylmethylcellulose (0.5% w/v) was used to increase the viscosity of the solution and to promote the hydrocortisonecyclodextrin complex. One hundred and two patients with aphthous ulceration, lichen planus, and other mucosal conditions used the mouthwash in an open clinical efficacy study. Most patients reported some or considerable improvement following a 2-week course of treatment with the mouthwash: 26 of 33 (78.8%) patients with aphthous ulceration were 'much better', as were 26 of 54 (48.1%) patients with lichen planus and 5 of 16 (31.3%) patients with other mucosal lesions. No serious side effects were reported. Aqueous mouthwash solutions offer a potential vehicle for topical steroid therapy of oral mucosal lesions.

2-Hydroxypropyl-beta-cyclodextrin↗

PubMedDate not supplied

The effect of the use of mouthwash on ethylglucuronide concentrations in urine.

Two studies were performed to evaluate the effect of alcohol containing mouthwash on the appearance of ethyl glucuronide (EtG) in urine. In the first study, 9 volunteers were given a 4-oz bottle of mouthwash, which contained 12% ethanol. They gargled with all 4 oz. of the mouthwash at intervals over a 15-min period. All urine samples were collected over the next 24 h. Of 39 provided urine samples, there were 20 > 50 ng/mL, 12 > 100 ng/mL, 5 > 200 ng/mL, 3 > 250 ng/mL, and 1 > 300 ng/mL. The peak concentrations were all within 12 h after the exposure. In the second study, 11 participants gargled 3 times daily for 5 days. The first morning void was collected. Sixteen of the 55 submitted samples contained EtG concentrations of greater than 50 ng/mL. All of them were less than 120 ng/mL. These studies show that incidental exposure to mouthwash containing 12% ethanol, when gargling according to the manufacturer's instructions, can result in urinary EtG values greater than 50 ng/mL. All specimens were negative for ethanol. The limits of detection and quantitation for the EtG testing were 50 ng/mL.

Ethanol↗

PubMed1996

Alcohol-containing mouthwashes and oropharyngeal cancer: a spurious association due to underascertainment of confounders?

Recently it has been suggested that the use of alcohol-containing mouthwashes may increase the risk of oropharyngeal cancer. Heavy alcohol intake and tobacco use are established causes of oropharyngeal cancer. Their use is associated with mouthwash use. In addition, alcohol and tobacco use both tend to be underreported. Here the authors show that, under the hypothesis that mouthwash does not increase the risk of oropharyngeal cancer, confounding due to underascertained exposure to alcohol and tobacco would result in a spuriously elevated odds ratio for mouthwash use. As a general principle, a null association becomes apparently positive if a confounding variable is incompletely ascertained: a spurious association may be produced even in the absence of a difference in the extent of the underascertainment of the confounder among the comparison groups.

Confounding Factors, Epidemiologic↗

PubMed1994

Allopurinol mouthwashes in the treatment of 5-fluorouracil-induced stomatitis.

This study was aimed at assessing the efficacy of allopurinol mouthwashes in the treatment of 5-fluorouracil-induced stomatitis. A randomized double-blind, placebo-controlled trial was thus designed to test its efficacy to treat oral mucositis in advanced cancer patients receiving 5-fluorouracil-containing chemotherapy. There were 44 patients randomized to receive allopurinol mouthwashes, or placebo, as soon as mucosal lesions were observed during any treatment cycle. Stomatitis was evaluated at the end of each 5-day treatment cycle. Allopurinol mouthwashes resolved stomatitis in 9 of 22 treated patients (40.9%), and diminished its intensity in 10 more patients (45.4%); stomatitis resolved completely in none of the 22 patients, and partially in 3 patients in the placebo group (p < .001 by chi 2 test). Duration of symptoms was also significantly different between the two groups (median: 4 days for the allopurinol group, 7.5 days for the control group; p < .0005 by Student's t-test). In conclusion, our results suggest that allopurinol mouthwashes can be effective to treat 5-fluorouracil-induced stomatitis.

Adult↗

PubMed1992

The effect of using a pre-brushing mouthwash (Plax) on oral hygiene in man.

The aim of this study was to investigate whether the use of a pre-brushing mouthwash (Plax) improved subjects' oral hygiene over a 2-week period. In a double-blind placebo controlled cross-over study, 33 adult subjects (mean age 35.3 years) used either Plax or a placebo mouthwash for 30 s prior to toothbrushing during a 2-week period. After a washout period of 4 weeks, the subjects used the other mouthwash in the same way. The modified plaque index of Quigley and Hein (QHI) was recorded for 16 teeth (16, 14, 13, 11, 21, 23, 24, 26, 36, 34, 33, 31, 41, 43, 44, 46) at each visit. The bleeding index (BI) was recorded at the beginning and end of the study. Results were analysed using a paired one-tailed t-test. Neither plax nor placebo mouthwashes reduced plaque scores significantly (p > 0.05) below baseline. There was no statistically significant difference between the mean BI at the beginning of the trial (0.42) and at the end (0.44). These results suggest that the routine use of Plax is not a useful adjunct to toothbrushing.

Aged↗

PubMed1996

Efficacy of a potassium nitrate mouthwash in alleviating cervical dentine sensitivity (CDS).

Potassium nitrate (KNO3) has been used previously in a dentifrice or gel to alleviate cervical dentine sensitivity (CDS). The aim of this study was to compare a 3% KNO3 Silica/NaF mouthwash with a NaF/silica mouthwash in a 6-week multi-centre double-blind study. 47 subjects (12M; 35F, mean age 36.2 (SD 11.46) years) participated in the study. Subjects were evaluated for tactile (Yeaple probe) and air sensitivity (dental air syringe) together with subjective perception of pain (0-10 scale) at 0, 2 and 6 weeks. Results for Yeaple probe (gm wt) (Wilcoxon paired rank test) between 6 weeks and baseline, were highly significant for both groups. Differences between groups at 6 weeks were statistically significant. Subjective Yeaple probe scores (paired t-tests) between 6 weeks and baseline were significant for both groups. There were no significant differences (unpaired t-tests) between groups over 6 weeks for subjective Yeaple probe scores. Subjective air scores (paired t-tests) between 6 weeks and baseline were significant for both groups. There were significant differences (unpaired t-tests) between groups in favour of the 3% KNO3/Silica/NaF group at 6 weeks. The 2 weeks and baseline results for both groups were the same as reported for 6 weeks and baseline. The results demonstrated that a 3% KNO3/Silica/NaF mouthwash compared to a Silica/NaF control significantly reduced CDS when evaluated by tactile and thermal stimuli. A 3% KNO3/silica/NaF mouthwash would, therefore appear to have therapeutic potential to alleviate CDS.

Adolescent↗