Oral Hygiene: Mouthwashes

• What are the basic ingredients found in mouthwashes?

  • Water
  • Alcohol (also non-alcoholic ones but are slightly less effective)
  • Sweeteners
  • Preservatives
  • Surfactants - SLS
  • Colourings - synthetic dyes
• What affect does mouthwash have on the mouth?

  -Contains anti-plaque agents

  -Prevents proliferation of plaque development
• Describe the features of chlorhexidine:

  • Cationic Bisbiguanide
  • Strong affinity to skin and mucous membranes - works on both gram-positive and gram-negative bacteria.
  • Low concentrations = Bacteriostatic (inhibits bacterial growth)
  • High concentration = Bactericidal (kills bacteria)
• How does chlorhexidine work?

  • Disruption of cell membrane.
  • Rapidly attracted to the negatively charged bacterial cell surface, with specific and strong adsorption to phosphate containing compounds.
• Describe the action of CHX

  -Binds to the different surfaces within the mouth (teeth and mucosa)

  -Also binds to pellicle and saliva-Attached to pellicle by one cation, leaving the other free to interact with bacteria attempting to colonise the tooth surface
• How long does CHX exhibit bactericidal activity for, after one rinse?

  5 hours
• How long does CHX exhibit bacteriostatic activity for?

  12 hours
• What concentration of CHX is available in the UK?

  0.06% - no alcohol, daily use, designed to reduce build-up of plaque

  0.2%- Intense use for specific clinical reason where mechanical plaque removal is compromised e.g after a surgery. Shouldn't use for a long period of time
• What are other active ingredients used in mouthwashes?

  1.Essential oil Phenolic (listerine) - Shown reduced numbers of anaerobic bacteria in plaque up to 12 h after rinsing

  2.Cetyl Pyridinum Chloride (aquafresh) - Increasing rinsing freq to 4 times a day = equivalent to using chlorhexidine

  3.Hydrogen peroxide - Useful for acute necrotising conditions due to effect on anaerobic bacteria.
• What is the key for effectiveness?

  Substantivity - ability to bind to pellicle, tooth surface, soft tissues
• What are the side effects of CHX?

  • Staining
  • Altered taste
  • Burning mouth
  • Parotid swelling
  • Allergy - rare
  • Oral desquamation, paraesthesia, cheilitis (inflammation of lips, perioral dermatitis
  • Enhanced supra gingival calculus formation

  
• What is the dicationic nature of chlorhexidine?

  • One charged end of the CHX molecule binding to the tooth surface
  • The other remaining available to initiate the interaction with the bacterial membrane
• Why is CHX better than other mouth washes?

  
  

  • Non-CHX have an immediate effect BUT once removed from the mouth, plaque builds up once again ( no adsorption)
  • Other agents show limited persistence by one of 2 ways:

  1. Either lost from the tooth surface faster than CHX
  2. 2. Or bound to the surface in a way which they cannot interact with a bacterium
• What is the value of adjunctive antiseptics/chemotherapeutic agents for the management of gingival inflammation?

  The basis of the management of gingival inflammation is self-performed mechanical removal of biofilm.

  Adjunctive measures, including antiseptics, Amy be considered in specific cases or as part of a personalised approach.
• What are the BSP guidelines for overall considerations when selecting a mouthwash?

  Patient preferences : including cost, tasteUnwanted effects : staining, burning sensation during use.

  Potential negative impacts on beneficial aspects of the oral micro-biome

  Potential negative impacts on blood pressure ( can slightly increase systolic blood pressure)