The Role of Antimicrobial Mouth Rinses in Infection Prevention

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free formulas. Alcohol is not an active ingredient in the rinse, but is a solubilizer or delivery vehicle for the other ingredients. Some patients are sensitive to the burning sensation of alcohol-containing mouth rinses, especially if they experience xerostomia. In addition, patients who have issues with alcohol abuse are not candidates for use of alcohol-containing mouth rinses. Long term use of CHX oral rinses has been shown to cause brownish discoloration of the teeth and some restorations, as well as some staining of the tongue and gingiva. It should be noted, however, that heavy staining on teeth has been shown to be associated with unremoved plaque, which can be decreased with improved oral hygiene. It can also cause a change in taste perception for some patients. Cetylpyridinium chloride (CPC) is also an antiseptic – a cationic quaternary ammonium compound which is used in products such as toothpaste, nasal sprays, and more recently in mouth rinses in a .45% to 10% concentration. CPC rinses are more recent additions to the antimicrobial therapeutic rinse category and have also been extensively studied for their effectiveness, which is said to be comparable to CHX rinses. In addition to the concentration of the CPC in a therapeutic rinse, it is important that the other ingredients in the rinse, such as solubilizers (sometimes alcohol), preservatives and stabilizers do not have a negative effect on the bioavailability of the CPC. Higher bioavailability is will increase the effectiveness of the rinse. CPC rinses have been shown to prevent the formation of plaque and reduce gingivitis, a precursor to periodontitis, by penetrating the cell walls of bacteria, which causes leakage and eventually death of the bacteria. Like CHX, CPC is a long-acting agent, shown to be bioactive in the mouth for up to 12 hours after using the rinse due to its ability to adhere to the teeth. CPC mouth rinses are also available in both alcohol and alcohol-free formulas. A distinct advantage of CPC mouthrinses is that they are OTC products, making them more readily available to patients. Essential Oils formulations are OTC rinses. The essential oil formulation that has been approved by the FDA as a therapeutic oral rinse is that of Listerine®, with a composition of eucalyptol, menthol, methyl salicylate, and thymol which are delivered in an alcohol base. Rinses with essential oils as their active ingredients are able to disrupt cell membranes and also inhibit the enzyme activity of cells, which makes the products bacteriostatic or bactericidal. Because alcohol is the delivery vehicle for this formulation, patients may experience burning and it is not the most appropriate choice for patients with xerostomia or who are alcohol abusers. Essential oils rinses have not been proven to have the adhesive properties of CHX and CPC products, therefore they have more limited bioavailability. Mouthrinses and Prevention of Bacteremia Antimicrobial mouth rinses used by the patient before a dental procedure can decrease the number of microorganisms introduced into the patient's bloodstream during invasive dental procedures. The scientific evidence is not clear, however, that reducing the number of microorganisms through mouth rinsing directly reduces the incidence of bacteremia. In its 1997 www.ColgateOralHealthNetwork.com Webinars | On-Demand Courses | Articles | Textbooks 4
guidelines for antibiotic prophylaxis, the American Heart Association (AHA) recommended the use of pre-procedural mouth rinses for patients at risk for bacteremia during dental procedures. In its most current guidelines, the AHA does not mention pre-procedural mouth rinsing. In addition, the American Academy of Orthopaedic Surgeons (AAOS) also states in their 2012 guidelines on Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures that the evidence is inconclusive to support the use of topical antimicrobials (mouth rinses) to prevent orthopaedic implant infections. Further study is needed to determine the effectiveness of pre-procedural mouth rinsing for reducing dental procedure-induced bacteremia and the incidence of bacteremia in patients who have underlying risks. Mouth Rinses for Environmental Infection Control The third issue related to pre-procedural mouth rinsing is that of reducing the number of bacteria in the saliva during dental procedures that involve the creation of aerosols, spatter and spray. These procedures include the use of a high and slow speed handpieces, air/water syringes and ultrasonic scalers. The most effective way to reduce the aerosol and spatter contamination is to use a dental dam. But a dental dam would interfere with hygiene procedures, such as ultrasonic scaling and polishing. And the use of dental dam for restorative procedures may take additional time and instrumentation that many practices choose not to adapt into their protocols. In this case, a pre-procedural antibacterial mouth rinse is a simple way to decrease the potential for aerosol contamination in the treatment rooms. While the Centers for Disease Control and Prevention (CDC) does not specifically recommend pre-procedural mouthrinses as an infection prevention protocol, there is evidence that using an antimicrobial mouthrinse prior to procedures can reduce the potential for is contamination of equipment and environmental surfaces. According to the CDC, the spray from dental procedures typically contains large-particle spatter or spray of water, saliva, blood, microorganisms and other debris (tooth, restorative material, calculus). The spatter has been shown to travel only short distances from the patient’s mouth, which would potentially contaminate equipment (e.g. bracket tray), operatory surfaces (counter tops or other work surfaces) and the dental team members and patients. Aerosol, on the other hand is composed of much smaller particles and can remain airborne for long periods of time and can pose an inhalation risk for dental team members. It is important to note, however, that there is no evidence of transmission of bloodborne pathogens, such as hepatitis B or C or HIV/AIDS through exposure to aerosol or spatter in dentistry. The use of pre-procedural mouthrinses is an additional safeguard that could be employed by dental practices for protection against other types of microorganisms, such as the influenza virus. But dental teams should utilize dental dams and high volume evacuation as their first line of defense against spatter and aerosolization of saliva and blood during dental procedures. It is also important to note that the use of pre-procedural mouthrinses does not preclude the need for environmental cleaning and disinfection of equipment and surfaces following treatment. Although the mouthrinse may www.ColgateOralHealthNetwork.com Webinars | On-Demand Courses | Articles | Textbooks 5
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The Role of Antimicrobial Mouth Rinses in Infection Prevention

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