The Role of Antimicrobial Mouth Rinses in Infection Prevention

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decrease the number of microorganisms, it does not reduce the spatter, unless high-volume suction or dental dam is used. Since hygiene procedures are the least likely to have high volume evacuation utilized, and the use of dental dam is not appropriate, pre-procedural mouthrinses make the most sense for use prior to hygiene procedures. Not only can the mouthrinse reduce microorganisms, but it provides an excellent opportunity for the hygienist to introduce the concept of utilizing an antimicrobial mouthrinse as part of routing oral health care for the patients. The hygienist has an opportunity to educate the patients about the benefits of antimicrobial rinses in controlling plaque formation and treating periodontal disease. The education process can also include information about the most appropriate antimicrobial rinse for each patient, such as alcohol-free formulas, and the long lasting effects of CPC and CHX mouthrinses. Having the patient utilize the antimicrobial mouthrinse prior to a procedure is a strong endorsement of the belief in the therapeutic value of using the rinse and opens the door for additional dialogue with the patient about their oral health and the need to control oral microorganisms that can cause disease. It also provides the opportunity for the hygienist to differentiate between cosmetic and therapeutic mouthrinses, the research that supports the use of therapeutic mouthrinses and the benefits to the patient. Implementation of a Pre-Procedural Mouthrinse Protocol: If a practice implements a pre-procedural mouthrinse protocol, the first step is to decide if the protocol will apply to all procedures or just to hygiene procedures. Although the data indicates that the most benefit is gained when no dental dam or high volume evacuation is utilized, the patient and the team can certainly benefit from the rinse being used for all hygiene, restorative and surgical procedures. Again, this makes a positive statement to patients regarding the benefit of antimicrobial mouthrinses. The next step is evaluating products and determining which product or products are most appropriate to use. As mentioned earlier, the three types of products that are classified by the FDA and therapeutic, antimicrobial rinses are those that contain CPP, CHX and Essential Oils. If a practice wishes to select a product that will work will all types of patients, including those with xerostomia and who have alcohol abuse issues, than an alcohol-free product is the most appropriate. There are alcohol-free formulations of most FDA approved antimicrobial mouthrinses. Table 3 lists commonly recommended or prescribed products with alcohol-free formulas. Another consideration is the potential for staining of the teeth which is a common occurrence with CHX and CPC rinses, although CPC rinses have been shown to cause less severe staining. If a patient has anterior composite restorations, especially older restorations, there may be some staining that occurs when the rinse is utilized. For a hygiene procedure, however, the stain will be easily removed if the teeth are polished. Other considerations may be the flavor, cost and availability. CPC and essential oil mouthrinses are available as OTC products, whereas CHX rinses are prescription-only. If the hygienist or other dental team member wants to reinforce the use of the antimicrobial rinse for the patient on a daily basis at home, this may be a consideration for some patients and possibly for the www.ColgateOralHealthNetwork.com Webinars | On-Demand Courses | Articles | Textbooks 6
practice, since the OTC products may be less expensive to utilize in the office than prescription products. Once the type and brand of mouthrinse has been selected, the team should develop a protocol for introducing the mouth rinsing procedure into the practice. The team should decide whether to utilize the mouthrinse for all operative and hygiene procedures or only for hygiene procedures. The patients should be informed and educated about the benefits of utilizing the mouth rinse and given information about the product used. This information is readily available from the product manufacturer. It may also be beneficial to provide samples if it is an OTC rinse, or to have prescription-only products available to dispense to patients. OTC products could be sold in the practice as well, which can make it convenient for patients and potentially increase their compliance with using the rinses at home. If a practice chooses not to dispense prescription-only rinses, it is recommended to have prescribing information readily available in the practice management software or pre-printed prescriptions to give to the patients. The pre-procedural rinse is administered to the patient soon after they are seated and the appropriate explanations are given. The patient is given a disposable cup with the appropriate amount of rinse, instructed to swish for the time recommended on the product, and can then spit it out in the sink in the operatory or it can be evacuated with the suction. Conclusions: The therapeutic value of antimicrobial mouthrinses has been well documented by current research for the control of plaque formation and in treating gingivitis and periodontitis. While there is no compelling evidence that suggests that utilizing pre-procedural mouthrinses is effective in controlling the introduction of microorganisms into the bloodstream during dental procedures and potentially preventing bacteremia, there is also no compelling evidence that suggests that this practice is harmful to patients, if the appropriate rinse is used. The evidence is also not conclusive that the use of a pre-procedural mouthrinse can prevent the transmission of an infectious disease by decreasing the number of microorganisms in the spatter and aerosol produced during dental procedures. But decreasing the number if microorganisms that can potentially contaminate equipment and surfaces in a treatment room through spatter, and in the aerosol produced, can help provide a safer environment for both the patients and the dental team members. The true value of using a pre-procedural antimicrobial mouthrinse may be in the example that it provides for patients and the reinforcement that they may receive about the usefulness of these rinses in their every-day home care. If the dental team believes in the therapeutic value of the rinses they can, by their example, reinforce this concept with their patients on a regular basis. www.ColgateOralHealthNetwork.com Webinars | On-Demand Courses | Articles | Textbooks 7
Page 1 and 2: Mary Govoni, CDA, RDA, RDH, MBA The
Page 3 and 4: certain safety and efficacy require
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Page 11: Author Bio Mary Govoni brings over

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