A meta-analysis of six-month studies of antiplaque and antigingivitis agents.

J Am Dent Assoc. 2006 Dec;137(12):1649-57

Authors: Gunsolley JC

BACKGROUND AND METHODS: The author conducted a systematic review of the literature to evaluate the efficacy of antigingivitis and antiplaque products in six-month trials. He searched electronic databases for six-month randomized clinical studies that evaluated both antiplaque and antigingivitis properties of dentifrices or mouthrinses. In addition, the author solicited unpublished studies from manufacturers. RESULTS: Seventeen studies support the antiplaque, antigingivitis effects of dentifrices containing 0.30 percent triclosan, 2.0 percent Gantrez copolymer. There was no evidence of efficacy for triclosan products containing either soluble pyrophosphate or zinc citrate. Dentifrices with stannous fluoride had statistically significant, but marginally clinically significant, evidence of an antiplaque effect; however, there was both a statistically and clinically significant antigingivitis effect. The largest body of studies (21 studies) supported the efficacy of mouthrinses with essential oils. A smaller body of studies (seven) supported a strong antiplaque, antigingivitis effect of mouthrinses with 0.12 percent chlorhexidine. Results for mouthrinses with cetylpyridinium chloride varied and depended on the product's formula. CONCLUSIONS: The studies in this systematic review provide strong evidence of the antiplaque, antigingivitis effects of multiple agents. These results support the use of these agents as part of a typical oral hygiene regimen.

PMID: 17138709 [PubMed - indexed for MEDLINE]

Antibacterial and antiplaque effects of a novel, alcohol-free oral rinse with cetylpyridinium chloride.

J Contemp Dent Pract. 2005 Feb 15;6(1):1-9

Authors: Witt J, Ramji N, Gibb R, Dunavent J, Flood J, Barnes J

Antimicrobial agents are commonly incorporated into hygiene products for the treatment and prevention of plaque and gingivitis. Recently, a new alcohol-free rinse containing 0.07% cetylpyridinium chloride (CPC) in a high bioavailable matrix (Crest Pro-Health Rinse) was introduced to provide antiplaque and antigingivitis benefits. This paper reviews results from an in vitro pre-clinical study and an in vivo clinical study evaluating the antibacterial and antiplaque benefits of this CPC rinse technology. In the in vitro experiment, a no-alcohol 0.065% high bioavailable CPC prototype rinse was evaluated for its hostility against a broad range of microorganisms commonly associated with plaque and gingivitis. The rinse demonstrated greater than 99% germ kill for all organisms tested individually as well as in whole saliva. The benefit of this antibacterial action on plaque inhibition was assessed in a clinical trial. A double-blinded, 3-period, 6-sequence crossover study was conducted evaluating the antiplaque effect of the novel 0.07% high bioavailable, alcohol-free CPC rinse versus a positive control (Listerine Cool Mint containing essential oils) and a negative control (placebo CPC rinse). A modification of the Addy 4-day plaque model was used for this evaluation. Plaque was measured at baseline (Day 1) of each treatment period and at Day 4 using the Turesky modification of Quigley-Hein index. During the treatment period, subjects brushed only their lingual surfaces twice daily for up to 60 seconds. Following brushing, subjects used 20 mls of the mouthrinse product for 30 seconds in the morning and evening. Fifty-five subjects completed the study. For non-brushed sites, both the essential oils and CPC rinse exhibited a 25% reduction in plaque vs. placebo after four days of product usage, which was statistically significant (p < 0.0001). Both treatments also exhibited a statistically significant benefit versus placebo (p<0.0001) for brushed sites (>38% plaque reduction). These data support the antibacterial action of the high bioavailable, alcohol-free CPC rinse and demonstrate antiplaque effects for Crest Pro-Health Rinse that are "at least as good as" the leading essential oils antiseptic, making it well-suited for a broad range of patients, particularly those who are sensitive to products containing alcohol.

PMID: 15719071 [PubMed - indexed for MEDLINE]

Effects of cetylpyridinium chloride resistance and treatment on fluconazole activity versus Candida albicans.

Antimicrob Agents Chemother. 2005 Feb;49(2):843-5

Authors: Edlind MP, Smith WL, Edlind TD

Mouthwash antiseptic cetylpyridinium chloride (CPC) has potent activity against Candida albicans; however, two of five azole-resistant strains showed reduced CPC susceptibility. To further examine the potential for cross-resistance, CPC-resistant mutants were selected in vitro and their fluconazole susceptibility was tested. MICs were unchanged, and trailing growth generally decreased. With CPC-fluconazole combinations, both antagonism and synergism were observed, which can be explained, in part, by CDR1-CDR2 multidrug transporter upregulation.

PMID: 15673785 [PubMed - indexed for MEDLINE]

[Analysis for clinical effect of a rinse containing cetylpyridinium chloride in treatment of gingivitis and periodontitis]

Shanghai Kou Qiang Yi Xue. 2003 Dec;12(6):414-8

Authors: Hu CZ, Jin HL, Liang JP, Chu M, Guo JZ, Lu Z, Sheng QP, Cai ZW

OBJECTIVE: To investigate the clinical effect of a 0.1% cetylpyridinium chloride(CPC) rinse on the treatment of gingivitis and periodontitis. METHODS: A multicenter, randomized, parallel group trial was conducted. The eligible patients were divided randomly into two groups. Subjects were assessed at the beginning and the end of a two-week period during which they rinsed with 0.1% CPC or complex hibitane in addition to their usual oral hygiene procedures. The variation of PLI, SBI, GI, PD, pain, halitosis and adverse effects were observed before and after investigation. RESULTS: After 14 days of treatment, in the CPC group, the decreasing rate of PLI was 63.0%, the effective rate for gingivitis and periodontitis were 83.3%, 36.7% respectively, while those periodontal indices of control group were 49.5%, 50% and 16.7%. After statistical analysis, the CPC group had significantly higher effective rates on gingivitis than the hibitane group (P < 0.01), at the same time, the effective rate was significantly different between two groups on periodontitis (P < 0.05). CONCLUSION: The use of 0.1% CPC rinse is effective in treating periodontal diseases.

PMID: 14966578 [PubMed - indexed for MEDLINE]

PVC matrix membrane sensor for potentiometric determination of cetylpyridinium chloride.

Anal Sci. 2001 Sep;17(9):1043-7

Authors: Mostafa GA

A novel cetylpyridinium chloride-selective membrane sensor consisting of cetylpyridinium-ferric thiocyanate ion pairs dispersed in a PVC matrix placticized with dioctylphthalate is described. The electrode shows a stable, near-Nernstian response for 1 x 10(-3)-1 x 10(-6) mol l-1 cetylpyridinium chloride (CPC) at 25 degrees C over the pH range 1-6 with a cationic slope of 57.5 +/- 0.4. The lower detection limit is 8 x 10(-7) mol l-1 and the response time is 30-60 s. Selectivity coefficients for CPC relative to a number of interfering substances were investigated. There is negligible interference from many cations, anions and pharmaceutical excipients; however, cetyltrimethylammonim bromide (CTMAB) interfered significantly. The determination of 0.5-350 micrograms/ml of CPC in aqueous solutions shows an average recovery of 98.5% and a mean relative standard deviation of 1.6% at 56.0 micrograms/ml. The direct determination of CPC in Ezafluor mouthwash gave results that compare favorably with those obtained by the British Pharmacopoeia method. Precipitation titrations involving CPC as titrant are monitored with a CP sensor. The CP electrode has been utilized as an end point indicator electrode for the determination of anionic surfactants in some commercial detergents.

PMID: 11708056 [PubMed - indexed for MEDLINE]

A chemical treatment regimen to reduce bacterial contamination in dental waterlines.

J Am Dent Assoc. 1997 May;128(5):617-23

Authors: Eleazer PD, Schuster GS, Weathers DR

This article describes a pilot study in which the authors used aerobic bacterial cultures to compare the effects of 1:10 mouthwash, 1:20 mouthwash and 2 percent ethanol in reservoir systems with seven conventional water systems. The long-term, low-concentration antiseptic reduced bacteria to within acceptable limits.

PMID: 9150645 [PubMed - indexed for MEDLINE]

Incorporation of bacterial inhibitor into resin composite.

J Dent Res. 1994 Aug;73(8):1437-43

Authors: Imazato S, Torii M, Tsuchitani Y, McCabe JF, Russell RR

Attempts to produce resin composite with antibacterial properties by incorporation of an antibacterial agent such as chlorhexidine have been reported, but problems can arise due to release of the inhibitory agent from the composite. Such problems may include toxic effects, influence on mechanical properties, and loss of effectiveness. A new monomer, methacryloyloxydodecylpyridinium bromide (MDPB), was synthesized by combining an antibacterial agent and methacryloyl group. The monomer was incorporated into resin composite to develop a non-releasing antibacterial composite. The ability of composite incorporating MDPB to inhibit growth and plaque accumulation by Streptococcus mutans in vitro was assayed, elution of antibacterial components from the material was investigated, and the influence of incorporation of MDPB on the mechanical properties of composite was studied. Uncured MDPB revealed antibacterial activity against S. mutans and six other species of oral streptococci, with the minimum inhibitory concentration for S. mutans being comparable with that of triclosan. After composite incorporating MDPB was cured, no elution of the antibacterial components was observed from the material, even after 90 days' immersion in water or other solvents. Growth of S. mutans on agar under specimens of MDPB-containing composite was inhibited compared with controls. In a bacterial accumulation study, S. mutans accumulated to a lesser degree on the surface of composite incorporating MDPB (p < 0.05) than on control. Incorporation of MDPB had no significant influence on the mechanical properties of the composite.

PMID: 8083440 [PubMed - indexed for MEDLINE]

Effect of Cetylpyridinium Chloride on Microbial Adhesion to Hexadecane and Polystyrene.

Appl Environ Microbiol. 1990 Jun;56(6):1678-1682

Authors: Goldberg S, Konis Y, Rosenberg M

Microbial adhesion at the oil-water interface is a subject of both basic interest (e.g., as a technique for the measurement of hydrophobicity) and applied interest (e.g., for use in two-phase oil-water mouthwashes for the desorption of oral microorganisms). In general, surfactants inhibit microbial adhesion to oils and other hydrophobic surfaces. In the present study, we demonstrated that the cationic surfactant cetylpyridinium chloride (CPC) significantly enhanced microbial adhesion to hexadecane and various oils, as well as to the solid hydrophobic surface polystyrene. CPC increased adhesion to hexadecane of Escherichia coli, Candida albicans and Acinetobacter calcoaceticus MR-481 and of expectorated oral bacteria from near 0% to over 90%. The CPC concentration required for optimal enhancement of adhesion was a function of the initial cell density. This phenomenon was inhibited by high salt concentrations and, in the case of E. coli, by a low pH. CPC-pretreated cells were able to bind to hexadecane, but CPC-pretreated hexadecane was unable to bind untreated cells. Another cationic, surface-active antimicrobial agent, chlorhexidine gluconate, was similarly able to promote microbial adhesion to hexadecane. The results suggest that (i) CPC enhances microbial adhesion to hexadecane by binding via electrostatic interactions at the cell surface, thus diminishing surface charge and increasing cell surface hydrophobicity, and (ii) this phenomenon may have applications in oral formulations and in the use of hydrocarbon droplets as a support for cell immobilization.

PMID: 16348211 [PubMed - as supplied by publisher]

Evaluation of teat dips with excised teats.

J Dairy Sci. 1984 Sep;67(9):2062-5

Authors: Watts JL, Boddie RL, Pankey JW, Nickerson SC

Thirty-eight teat dip formulations were evaluated for germicidal activity against Staphylococcus aureus and Streptococcus agalactiae with an excised teat model. Twenty-six of 27 iodophor products provided log reductions greater than 3 against Staphylococcus aureus, but only 13 against Streptococcus agalactiae. Log reductions obtained with two .2% quaternary ammonium and .5% cetylpyridium chloride products were greater than 4 against both organisms. A 1% benzyl alcohol formulation provided log reductions of 3.86 and 4.30 against Staphylococcus aureus and Streptococcus agalactiae. Germicidal activities of six novel formulations containing sodium chlorite were determined. Two products were effective against Staphylococcus aureus and Streptococcus agalactiae with log reductions greater than 4. One product provided a log reduction of 3; three products were ineffective.

PMID: 6386907 [PubMed - indexed for MEDLINE]

An incisor plaque model in rats.

J Dent Res. 1984 Jan;63(1):32-6

Authors: Schemehorn BR, McDonald JL, Stookey GK, Park KK

An in vivo model for studying plaque accumulation in rats has been described. This model investigates plaque formation on the mandibular incisors in animals which have been found to be rapid plaque-formers during a pre-test period. The accessibility of these tooth surfaces permits the removal of plaque prior to initiation of tests, the use of test groups balanced on the basis of plaque-forming potential, and interim assessments of plaque formation throughout the test period. In addition, baseline plaque scores of near zero can be attained, thereby permitting investigations of the impact of experimental measures on plaque formation. Moreover, the model permits intermittent plaque assessments throughout the test period. This model was found to have adequate sensitivity to distinguish effects between antimicrobial agents known to differ in their clinical activity and to detect differences between varying concentrations of the same agent.

PMID: 6582077 [PubMed - indexed for MEDLINE]

The effect of zinc chloride on the development of gingivitis in beagle dogs treated with cetylpyridinium chloride.

J Dent Res. 1982 Oct;61(10):1217-20

Authors: Ritchey TW, Lamster IB, Mann PH, Alfano MC

PMID: 6956606 [PubMed - indexed for MEDLINE]

Evaluation of an oligomer or an oligomer plus cetyl pyridinium chloride against plaque, stain, calculus, and gingivitis.

J Dent Res. 1981 Aug;60(8):1432-9

Authors: Gaffar A, Niles HP, Davis CB

A low molecular weight oligomer of sulfoacrylic acid (ND-2) was effective in inhibiting hydroxyapatite formation in vitro at 33 ppm from a saturated solution of calcium and phosphate. The oligomer did not damage or etch human dental enamel in vitro at pH 5.0 and 7.5. It significantly reduced calculus formation when applied topically in beagles at a concentration of 1% in a rinse. In a second study using 30 beagle dogs, the rinses containing 0.1% CPC and 0.1% CPC + 2% ND-2 significantly reduced (alpha less than 0.05) plaque and gingivitis for 12 wk when compared to a placebo rinse. One-tenth percent CPC rinse induced more discoloration of teeth than the placebo, while the rinse containing 0.1% CPC + 2% ND-2 had significantly less discoloration than CPC rinse or the placebo rinse in beagles. Thus the oligomer was effective in reducing CPC-induced discoloration in beagles.

PMID: 6942007 [PubMed - indexed for MEDLINE]

A simple ultrasound method to characterize in vitro plaque inhibition activity.

J Dent Res. 1979 Feb;58(2):665-9

Authors: Lim JK, Yong CL, Gerencser VF

A method employing ultrasound vibration for evaluating in vitro plaque derived from Streptococcus mutans was developed. It successfully detected small changes in the cohesive/adhesive characteristics of deposits briefly exposed to several antibacterials and "antiadherents". Increased structural fragility and diminished plaque growth were generally associated with the antibacterials.

PMID: 283099 [PubMed - indexed for MEDLINE]

Antimicrobial agents and dental caries in the rat.

J Dent Res. 1978 Feb;57(2):349-54

Authors: McDonald JL, Stookey GK

Two rat plaque-caries studies indicated that a 0.2% chlorhexidine solution topically applied to rat teeth was effective in reducing dental plaque. This reduction in plaque was accompanied by marked reductions in smooth surface caries, but not in sulcal lesions.

PMID: 277534 [PubMed - indexed for MEDLINE]