The role of antiseptic mouthrinses for effective oral disease prevention

A consensus was reached amongst a panel of key opinion leaders from Australia and New Zealand regarding the use of antiseptic mouthrinses for improved oral health. This consensus was presented during the recent Australian Society of Periodontology conference in Sydney.

The panel recommended that an antiseptic mouthrinse should be used as a daily adjunct to mechanical cleaning.

"Dental plaque is a biofilm of complex microbial communities within microbial ecosystems of the oral cavity," said Associate Professor Christopher Sissons, Wellington School of Medicine and Health Sciences, New Zealand. "Plaque, bacteria on the tongue and other areas of the mouth, the patient's mouth environment and patient behaviour interact to create a steady-state level of pathogenicity. The aim is to help patients maintain a healthy equilibrium."

"Dental plaque is the primary causative factor in the development of dental caries and periodontal diseases. Therefore, the use of a mouthwash with a proven antiplaque and antigingivitis capability would be a useful adjunct to mechanical disruption in the primary prevention of these diseases," said Professor Saso Ivanovski from Griffith University.

Dental products combining both fluoride and antimicrobial activity may be beneficial as reducing plaque could help the action of fluoride.

Daily, self-performed oral hygiene mechanical methods have been regarded as the first-line defense for control of supragingival plaque. However, the efficacy of this mechanical cleaning largely depends on technique and dexterity. On average, patients spend only 46 seconds brushing their teeth,¹ while only 2-10% of the population floss regularly and effectively.²

"The efficacy of mechanical cleaning depends upon technique, motivation and perseverance. Unfortunately, most patients do not know the proper techniques in the use of interdental cleaning (e.g. flossing) and brushing to effectively control plaque. Not so surprising is that most patients report finding the mechanical techniques tedious and time consuming," said Terri Slough from the Dental Hygienists' Association of Australia Inc.

Dental health professionals can play a major role in improving the effectiveness of and compliance to home self-care by improving self-confidence and recommending a simple and effective homecare routine. A 2007 review suggested that a "...chemotherapeutic approach could be beneficial when used as an adjunct to daily, self-performed oral hygiene cleaning".³

Professor Laurie Walsh from the University of Queensland agreed, "Antiseptic oral mouthrinses are a useful general strategy to control gingivitis, since it can provide adjunctive benefits at sites where mechanical plaque control is challenging."

"Oral health problems are multifactorial," stated Professor Schwarz, University of Sydney, "In Australia and New Zealand, many factors contribute to a decline in dental health. Among them is an ageing population which requires ongoing maintenance and treatment, the inequality in access to regular dental care and of course the current shortage in the dental workforce."

The panel of experts agreed that there is a lack of awareness of preventive measures among the general population.

The following consensus was agreed on:

1. Most people are unable to maintain effective levels of plaque control with mechanical means alone, especially interdentally;
2. There is scientific rationale for the use of antiplaque and antigingivitis agents for the control of biofilms throughout the whole mouth; and
3. Primary prevention of gingivitis should encompass the daily use of an antiseptic mouthrinse as an adjunct to mechanical cleaning.

Members of ANZ Scientific Oral Health Advisory Panel (ANZSOHAP) included Albert Tan (Princess Margaret Hospital, Perth); Chris Sissons (Wellington School of Medicine and Health Sciences); Eli Schwarz (University of Sydney); Eric Reynolds (University of Melbourne); Laurie Walsh (University of Queensland); Saso Ivanovski (Griffith University, Queensland); and Terri Slough (Dental Hygienists' Association of Australia Inc).

References

1. Beals D et al. Am J Dent 2000; 13: 5A-14A.
2. Bader H. Dent Today 1998: 17: 78-81.
3. Stoeken JE et al. J Periodontol 2007:78: 1218-1228.