Plaque Inhibition: The Science and Application of ... - DentalCEToday

Continuing Education 

Course Number: 146 

Plaque Inhibition: 

The Science and Application 

of Oral Rinses 

Authored by Richard Demke, DDS 

Upon successful completion of this CE activity 2 CE credit hours may be awarded 

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Plaque Inhibition: The Science and 

Application of Oral Rinses 

Effective Date: 02/1/2012 Expiration Date: 02/1/2015 

LEARNING OBJECTIVES 

After participating in this CE activity, the individual will learn: 

• The fundamentals of plaque biofilm and the role of oral 

rinses in plaque inhibition. 

• Plaque control and treatment options currently available. 

ABOUT THE AUTHOR 

Dr. Demke received his DDS degree 

from Marquette Dental School, and BS 

degree in science from the University of 

Wisconsin. He maintained a private 

practice in central Wisconsin and created 

a company to commercialize dental 

education booklets he wrote and produced. He spent 2 

years with Siemens in the development of nuclear medicine 

devices, and 13 years at GC America as the vice president 

of research and development. He can be reached at 

richard.demke@us.sunstar.com. 

Disclosure: Dr. Demke is currently the senior director 

of technology and new product development for Sunstar 

Americas. 

INTRODUCTION 

The purpose of this article is to inform dental clinicians 

about the fundamentals of plaque biofilm, at-home 

treatment and control options currently available, the role of 

oral health rinses, and how and why mouthrinses should be 

applied in daily practice to provide more effective treatment 

and improved outcomes regarding periodontal disease. 

THE PREVALENCE OF PERIODONTAL DISEASE 

The prevalence of all forms of periodontal disease in the 

United States is approximately 75%, 1 and recent research by 

the Amer ican Academy of Periodontology and US Centers for 

Disease Control and Prevention suggests that periodontal 

disease prevalence rates may have been underestimated by 

1 


as much as 50%. 1 

Periodontal disease is a bacterial infection known to be 

caused by the effects of certain pathogenic bacteria that 

colonize the oral cavity. The early form of periodontal disease, 

gingivitis, has the potential to cause gingival inflammation and 

bleeding. Gingivitis is plaque induced and initiated by a hostinflammatory 

response to maturing plaque biofilm, which is the 

primary etiological factor for gingival inflammation. 2 If left 

untreated, the disease may progress to periodontitis, which 

may lead to tissue recession, bone loss, and tooth loss. 

Advanced stages of periodontitis have been linked to systemic 

diseases, such as cardiovascular disease and diabetes. 3-5 

Dental biofilm is a living community of bacteria comprised 

of millions of cells that possess vigorous metabolic and 

reproductive attributes. Biofilm grows as a complex, 3dimensional, 

self-protective, and sticky structure that is built 

up in layers (Figure 1). Biofilm consists of different species of 

bacteria, notably Actinobaccillus actinomycetemcomitans, 

Streptococcus mutans, Fusobacterium nucleatum, 

Treponema denticola, Porphyro monas gingivalis, and 

Tannerella forsythus. 6-8 These species of bacteria are built up 

sequentially in layers, which enable them to interact and 

cooperate with each other using various forms of 

communication. Chemical signals are the most common 

method; however, electrical signals and the exchange of 

genetic material have also been documented. The signals are 

specific, organized, and timed according to conditions in the 

oral cavity that favor colonization of subsequent bacterial 

species (Figure 2). These bacteria facilitate the arrival of other 

bacteria by providing diverse adhesion sites, called coadhesion 

and co-aggregation. 6-8 Some species are not able 

to attach to a surface on their own, but are often able to 

anchor themselves to the biofilm matrix or directly to other 

bacteria. Once a biofilm colony has formed in the mouth, it 

releases chemicals and enzymes that signal other bacteria to 

join the colony. 6 

The challenge, therefore, is to disrupt the colonization, 

proliferation, and sequential layering of biofilm in order to 

interrupt the development and progression of periodontal 

disease. 9 During the past 200 years, various means have 

been devised with varying degrees of success, which is 

largely determined by the effectiveness of the pa tient’s oral 

care regimen.

CURRENT TOOLS AND 

RESOURCES TO INHIBIT 

PLAQUE 

Perhaps the most common means 

of plaque control, or more specifically, 

biofilm disruption, has been 

the daily and proper use of a 

toothbrush. 10,11 William Addis of 

England is believed to have 

produced the first mass-produced 

toothbrush in 1780, and the first 

American to patent a toothbrush 

was H.N. Wadsworth in 1857. 12 

Toothbrushes, however, are not 

always effective in cleaning 

interproximal surfaces, as these 

areas are beyond the reach of 

most toothbrush bristles. In 

addition, gingival sulci are often not 

cleaned as well as desired due to 

the individual’s brushing technique. 

Dental floss has been proven 

highly effective in disrupting biofilm 

in interproximal areas, including 

portions of the sulcus; however, its 

effectiveness is technique sensitive and dependent on the 

patient’s skill, frequency of use, and motivation. The ADA 

statistics indicate that only 11% to 51% of people in developed 

countries claim to use dental floss or some other interdental 

cleaning device. 13-17 

Another time-tested plaque re moval implement is the 

wooden toothpick. Re cent advances in synthetic materials and 

design have provided new soft picks and nylon bristle brushes, 

which improve the ability to access tight interproximal spaces. 

These advancements also caused their name to change to 

“interdental cleaners,” which is more descriptive of their 

function. Interdental cleaners can be effective ad juncts to other 

mechanical means of bio film disruption if used correctly and 

regularly. Some interdental cleaners have rows of soft, tiny 

bristles that can break up and sweep away supraginvigal bio - 

film between teeth, around and under fixed prosthodontic and 

orthodontic appliances. Examples of interdental cleaners 

featuring small bristles are GUM Go-Betweens Proxabrush 


Plaque Inhibition: The Science and Application of Oral Rinses 

Figure 1. The attachment and progression of dental biofilm. (Used with permission from MSU Center for 

Biofilm Engineering.) 

Figure 2. Examples of later colonizing bacteria: Virulent, tissue-invasive, causative for periodontitis. 

2 

Clean ers (Sunstar Americas), and the Oral-B Interdental 

Brush System (Oral-B). 

All of the aforementioned devices are useful and 

effective on hard tissues and, to a lesser extent, gingiva. 

However, due to their designs, these devices are unsuitable 

for cleaning the sensitive oral mucosa, which can harbor 

more bacteria than teeth and gums combined. Mechanical 

methods of oral hygiene are targeted only toward tooth 

surfaces and the dentogingival margins (approximately 

10% to 20% of the total oral surface area), and do not act 

on the mucosal surfaces of the oral cavity. Therefore, the 

remaining 80% to 90% of uncleaned soft tissues can rapidly 

reseed the mechanically cleaned areas with their ample 

reserves of living bacteria; unstimulated saliva contains 50 

million to 100 million bacteria per mL. 18,19 Therefore, it is 

necessary to address these large bacterial reserves in 

order to reduce or eliminate their potential to rapidly 

repopulate the teeth and gingival surfaces.

Advent of Mouthrinse 

In 1879, Drs. Joseph Lawrence and Jordan 

Wheat Lambert developed a liquid antiseptic 

formula for use as a surgical disinfectant and 

named it after Sir Joseph Lister, an English 

physician famous for performing the first 

antiseptic surgery in 1865. In 1884, the 

Lambert Company began to manufacture and 

market LISTERINE products to the medical 

community as a multipurpose antiseptic. In 

1895, the Lambert Company extended the 

sale of LISTERINE disinfectant to the dental 

profession as a powerful oral antiseptic. By 

1914, the formula had become popular and 

was one of the first prescription products to be 

available over the counter, thereby founding 

the mouthwash category. 20 In the decades 

following, other manufacturers of oral care 

products developed cosmetic oral rinses that 

primarily freshened breath via antiseptic and 

flavoring agents, but in the 1970s a separate 

classification of mouthrinses, called therapeutic 

mouthrinses, was established. 

ROLE OF THERAPEUTIC MOUTHRINSES 

Ongoing research in oral bacteriology has resulted in 

greater understanding of the ways aerobic and anaerobic 

bacteria enter the mouth, colonize, reproduce, 

communicate, and mutate. Therapeutic mouthrinses use 

various active ingredients to support the key benefits 

offered, and are available over the counter and by 

prescription. Primary active ingredients of therapeutic 

mouthrinses include: 

1. A fixed mixture of essential oils (phenol compounds) 

2. Quaternary ammonium compounds (cetylpyridinium 

chloride [CPC]) 

3. Bisbiguanide antiseptics (chlor hexidine gluconate 

[CHX]) by prescription only in the US and Canada. 

4. Amine alcohols (delmopinol hydrochloride). 

The active ingredients in therapeutic mouthrinses may 

control oral biofilm at differing stages of colonization, which 

includes colonization of the soft tissues; however, therapeutic 

mouthrinses are most effective when used in combination with 



a 

Figure 3. (a) Placebo: tooth brushing, topical application of placebo, no toothpaste, plaque 

disclosant. (b) Including delmopinol: tooth brushing, topical application of delmopinol, 

toothpaste, plaque disclosant. (Photos courtesy of Dr. Richard Nagelberg.) 

a 

Figure 4. Periodontitis is a chronic, noncurable bacterial infection. Failure to prevent the 

progression of gingivitis (a) to periodontitis (b) condemns the patient to a lifetime of disease 

management. (Photo courtesy of Dr. Richard Nagelberg.) 

3 

b 

b 

other oral care procedures. Mouthrinses are not intended to 

replace mechanical attempts to remove/disrupt organisms and 

colonies on tooth surfaces and gums, but rather to provide an 

adjunctive means to achieve greater and more consistent 

reductions in plaque and gingival inflammation. 

Therapeutic mouthrinses provide an additional level of 

effective care adjunctive to toothbrushing, interproximal 

cleaning, and prophylaxis. In support of this, the rationale for 

daily use of antiplaque mouthrinses is twofold: (1) as a 

component added adjunctively to mechanical oral hygiene 

regimens for the control and prevention of gingivitis, and (2) as 

a method for delivering antiplaque agents to mucosal sites 

throughout the mouth that harbor pathogenic bacteria 

capable of recolonizing su pra gingival and subgingival tooth 

surfaces. 21 The properties of anti plaque agents can be 

bactericidal, bacteriostatic, or antiadhesive, which may 

prevent plaque from developing on clean tooth surfaces. 

EFFICACY AND EFFICIENCY OF ORAL HEALTH RINSES 

IN CONTROLLING PLAQUE AND GINGIVITIS 

Therapeutic mouthrinses provide a variety of choices that

approach plaque control through different strategies to 

interrupt and/or reduce the proliferation of pathogenic bacteria 

and the progression of periodontal disease. These strategies 

range from adjunctive oral health maintenance to acute 

disease intervention. There fore, the choice of mouthrinse may 

be informed and guided by the patient’s clinical needs and 

tolerance of the formulation’s active and inactive ingredients. 

1. Essential oils/phenols. The most well-known 

mouthrinse with a phenol-related fixed mixture of essential 

oils formulation is LISTERINE (John son & Johnson). It 

contains Thymol (0.064%), eucalyptol (0.092%), menthol 

(0.042%), and methyl salicylate (0.060%). This combination 

is dispersed in a denatured alcohol vehicle (between 21.6% 

to 26.9%). 



4 

The mechanism of action is complex. At high 

concentrations, there is a disruption of the cell wall and 

precipitation of cell proteins; at lower concentrations, 

essential (bacterial) enzymes are inhibited. This formulation 

can penetrate plaque biofilm and exert bactericidal activity. 

The bacterial load is reduced with concomitant decrease in 

plaque mass and pathogenicity. 22 

2. Quaternary ammonium compounds (CPC). CPC is a 

cationic (positively charged) surface-active agent that has a 

broad antimicrobial spectrum of activity that involves the 

rapid destruction of Gram-positive patho gens and yeasts. An 

example of a CPC-containing therapeutic mouthrinse is 

Crest Pro-Health Multi-Protection Rinse (Procter & Gamble). 

Crest Pro-Health contains high bio available CPC (0.07%) in 

Table 1. Indications and Contraindications for 4 Representative Products as set Forth by Their Respective Manufacturers 

Product Name LISTERINE Antiseptic Crest Pro-Health PERIDEX Chlorhexidine GUM PerioShield 

Multi-Protection Rinse Gluconate (CHX) 0.12% Oral Health Rinse 

Oral Rinse 

Active Ingredient(s) Fixed combination Quaternary ammonium CHX Amine alcohols/delmopinol 

of 4 essential oils a compounds/cetylpyridinium 0.12% hydrochloride 0.2% 

chloride 0.07% 

Primary Mode of Action Antimicrobial Antimicrobial Antimicrobial Antiadherent 

Indications Kills germs that Antigingivitis/antiplaque For use between dental visits Helps prevent and treat 

cause bad breath, rinse; fights bad breath; as part of a professional gingivitis; recommended for 

plaque, and gingivitis. alcohol free. program for the treatment patients with heavy plaque 

of gingivitis as characterized and chronic gum 

by redness and swelling inflammation. 

of the gingivae, including 

gingival bleeding upon probing. b 

Contraindications Not for patients younger Not for patients younger Should not be used by Individuals with known 

than age 6 years. than age 12 years. persons who are known to hypersensitivity to any of the 

be hypersensitive to ingredients; children under 

CHX, or other age 12 years or pregnant 

formula ingredients. women. c 

Adverse Reactions Increase in staining 

of teeth and other oral 

surfaces; increase in calculus 

formation; alteration of 

taste perception. 

a Thymol 0.064%, eucalyptol 0.092%, methyl salicylate 0.060%, menthol 0.042%, solubilized in 21.6% to 26.9% denatured alcohol. 

b CHX Oral Rinse has not been tested among patients with acute necrotizing ulcerative gingivitis. 

c Due to limited testing of this product on these populations.

an alcohol-free formulation. 

The mode of action is through the disruption of the cell 

membrane function, leakage of cytoplasmic material, and 

collapse of intracellular equilibrium. The substantivity (or 

duration of effectiveness) of CPC is reported to be between 

3 and 5 hours, at least in part due to its cationic nature. 23 

It is significant to note that not all CPC-containing 

mouthrinses provide the same degree of clinical benefit due to 

the bioavailability of CPC. The formulation of the vehicle 

ingredients can have a significant impact on the bioavailability 

of CPC. Increased bio availability is associated with higher 

probability of effectiveness, greater antiplaque activity, and 

greater reductions in gingivitis; decreased bioavailability and 

lower concentrations of CPC are associated with cosmetic 

claims alone, such as in vitro germ killing (and) fresh breath. 19 

3. Bisbiguanide antiseptics (CHX). CHX has been widely 

used in medicine and surgery for presurgical disinfection 

since the 1940s, and was first investigated for effectiveness 

in the oral cavity in 1970. 24 It is considered the “gold standard” 

therapeutic mouth rinse. Or iginally, this prescription-only 



Table 2. Comparison of Plaque and Gingivitis Scores Among 4 Representative Mouthrinse Types 

Reductions in Plaque and Gingivitis in 6-month Clinical Studies a 

Active Ingredient Maximum Maximum Maximum Bleeding Reference 

Plaque Gingivitis on Probing 

Reduction Reduction Reduction 

(%) b (%) b (%) b 

Chlorhexidine 60.9% 42.5% 77% 30, 31, 35, 39 

0.12% 

Fixed Combination 56.3% 35.9% 69.8% 11, 31-35, 37, 39 

of Essential Oils c 

Delmopinol 35% 18% 57% 29, 35, 37, 38 

Hydrochloride 

0.2% 

Cetylpyridinium 15.8% 15.4% 33.3% 36 

Chloride 

0.07% 

a Comparison between agents is inadvisable due to differences in study design and indices reported. 

b Compared with negative control at 6 months. 

c Thymol 0.064%, eucalyptol 0.092%, methyl salicylate 0.060%, menthol 0.042%, solubilized in 21.6% to 26.9% denatured alcohol. 

5 

mouth rinse (in the US and Canada) was formulated with 

alcohol (approximately 11.6%), and now alcohol-free 

formulations are available. An example of an alcoholcontaining 

CHX 0.12% mouth rinse is PERIDEX (3M ESPE), 

while an example of an alcohol-free CHX 0.12% mouthrinse 

is GUM CHX Oral Rinse USP, 0.12% (Sunstar Americas). 

The CHX molecule is a strong base, with 2 positive charges 

(dicationic) at pH levels greater than 3.5. 25 These 2 positive 

charges make CHX extremely interactive with anions and are 

the basis of its clinical effectiveness as well as its unwanted 

effects, such as tooth staining. 

The primary mode of action is thought to occur against the 

cell wall, which is negatively charged. The positively charged 

CHX molecule is rapidly attracted to the negatively charged 

cell surface, and binds via adsorption to oral surfaces, the 

pellicle, and saliva. At low concentrations, the integrity of the 

cell membrane is altered and leads to increased permeability 

and leakage of low molecular weight intracellular contents, but 

this is reversible and the cell can recover. This effect is 

considered bacteriostatic. At higher concentrations, there is

educed leakage of low molecular weight intracellular contents, 

but coagulation along with precipitation of the cytoplasm 

occurs, which is irreversible and therefore the effect is 

considered bactericidal. 26 

4. Amine alcohols (delmopinol hydro chloride). A new 

generation of anti plaque and antigingivitis agents has been 

established that inhibits or disrupts the formation of plaque 

while possessing little, if any, effect on the bacteria, thus 

avoiding disruption to the balance of bacterial flora found in 

a healthy mouth. Delmopinol hydro chloride (morpholinoethanol 

derivative) is an amine alcohol that functions as 

a surface-active agent shown to interact with pellicle 

constituents and inhibit glucan synthesis by S mutans. 27 It 

has little or no demonstrable effect on the bacteria, but it 

interferes with plaque/biofilm matrix formation. The nascent 

bio film mass, being loosely adherent, produces a reduction 

in the proportion of dextran-producing cocci. 28 The 

interference with plaque matrix formation leads to the 

plaque deposit being less sticky and less dense, which 

makes it easier to remove through mechanical means. 

An example of a delmopinol hy dro chloride oral rinse is 

GUM PerioShield Oral Health Rinse (Sunstar Americas). 

Per ioShield contains delmopinol hydro chloride (0.2%), 

which studies have shown to be effective against plaque 

and gingivitis in short-term studies on individuals with no 

oral hy giene, as well as in long-term, home-use studies. 

The short-term studies on individuals with no oral hygiene 

showed plaque inhibition close to that of CHX. 29 (Figures 

3a to 4b) (Ta bles 1 and 211,29-39 ). 

ORAL HEALTH RINSES RECOMMENDED ACCORDING 

TO PATIENT NEEDS 

The clinician’s recommendation of a therapeutic mouthrinse is 

determined by the pa tient’s clinical needs and tolerance of the 

product’s ingredients, including sensory perceptions, as this 

can directly affect patient compliance. In general, the 

choice of mouthrinse may be based upon the pa tient’s state 

of oral health. For example, for patients with acute gingivitis, 

the clinician may prescribe a CHX rinse, typically for 2 to 4 

weeks. As the pa tient responds and oral health improves, the 

clinician may recommend a nonCHX rinse, such as a mixture 

of essential oils or CPC formulation if bacterial control is still 



6 

de sired, or a delmopinol rinse to inhibit the adhesion of 

plaque and facilitate easier re moval. As a nonantimicrobial 

rinse, delmopin ol helps maintain healthy oral flora, which 

may prevent po tential overgrowths of antimicrobial-resistant 

strains. This prop erty enables long-term use of delmopinol 

following short-term treatment with CHX, as well as 

treatment without CHX for less severe gingivitis patients 

where a strong antibacterial effect may not be indicated. 

Patient Acceptance 

After ruling out allergic reactions to the ingredients of any 

mouthrinse, the goal of the clinician is to recommend a 

mouthrinse that is: (1) effective for the treatment of the 

patient’s condition, (2) tolerated by the patient for the 

recommended duration and frequency of use, and (3) has 

acceptable side effects. 

The patient’s sensory perceptions play a key role in 

acceptance; therefore, the clinician should an ticipate the 

possible rejection of a recommended product based on its 

odor, flavor, inclusion of certain ingredients, or “mouth feel” 

while being used. For example, the presence of alcohol in a 

product may or may not be a factor in patient ac ceptance. 

Since alcohol is of no therapeutic benefit, alcohol containing 

formulations may be undesirable for diabetics, nursing 

mothers, al coholics, and those who choose to avoid alcohol for 

any reason. For such pa tients, acceptance and compliance 

may be im proved by recommending alcohol-free formulations. 

In addition, tooth staining, taste alteration, stinging, and 

tongue numbing are factors that should be considered in 

regard to patient acceptance. While some patients may 

consider these effects to be incidental, easily tolerated, or 

merely temporarily bothersome, others may con sider them 

unacceptable. There fore the clinician should be prepared to 

recommend a different formulation when the patient’s 

sensory perceptions or negative experience with a pro duct 

threaten com pliance. 

SUMMARY AND CONCLUSION 

The adjunctive use of therapeutic mouthrinses provides a way 

of overcoming deficiencies in mechanical tooth cleaning. 

Through direct de struction of susceptible oral bacteria or 

through the prevention of bacterial adhesion and aggregation,

therapeutic mouthrinses are a well-accepted means of 

interrupting the accumulation and progression of oral biofilms, 

which in turn may interrupt or prevent the progression of 

gingivitis. Therefore, therapeutic mouthrinses play an 

important role in the treatment and prevention of gum disease 

and in the maintenance of oral health. 

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8 

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0.2% delmopinol hydrochloride, 0.2% chlor hexidine 

digluconate and placebo for 6 months. Oral Dis. 

1998;4:105-113. 

38. Hase JC, Attström R, Edwardsson S, et al. 6-month 

use of 0.2% delmopinol hydrochloride in comparison 

with 0.2% chlorhexidine digluconate and placebo. (I). 

Effect on plaque formation and gingivitis. J Clin 

Periodontol. 1998;25:746-753. 

39. Charles CH, Mostler KM, Bartels LL, et al. 

Comparative antiplaque and antigingivitis 

effectiveness of a chlorhexidine and an essential oil 

mouthrinse: 6-month clinical trial. J Clin Periodontol. 

2004;31:878-884.

POST EXAMINATION INFORMATION 

To receive continuing education credit for participation in 

this educational activity you must complete the program 

post examination and receive a score of 70% or better. 

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POST EXAMINATION QUESTIONS 

1. According the American Academy of Periodontology, 

the prevalence of periodontal disease in the United 

States is approximately: 

a. 25%. 

b. 40%. 

c. 50%. 

d. 75%. 



9 

2. Dental biofilm is composed of: 

a. Individual free-floating bacteria on the pellicle. 

b. One or more layers of bacteria attached to teeth and 

soft tissue. 

c. Calculus. 

d. Both a and c. 

3. Adequate tooth brushing and flossing may clean up 

to _______ of the total oral surfaces: 

a. 20%. 

b. 50%. 

c. 80%. 

d. 40%. 

4. Unstimulated saliva contains: 

a. 10 million to 50 million bacteria per liter. 

b. 25 million to 50 million bacteria per mL. 

c. 50 million to 100 million bacteria per mL. 

d. 75 million to 150 million bacteria per liter. 

5. Certain therapeutic mouthrinses can: 

a. Kill all bacteria in the oral cavity. 

b. Temporarily attenuate the growth of oral bacteria. 

c. Prevent the attachment and layering of biofilm. 

d. Both b and c. 

6. Therapeutic mouthrinses: 

a. Can replace mechanical methods of plaque removal. 

b. Are used as an adjunctive means to reduce plaque. 

c. Have no side effects when used as directed. 

d. All require a prescription. 

7. Therapeutic mouthrinses: 

a. May control the growth or layering of free-floating and 

organized biofilm. 

b. May reach all tissues in the oral cavity. 

c. Achieve more consistent reductions in plaque. 

d. All of the above. 

8. The rationale for using therapeutic mouthrinses is/are: 

a. So the patient may omit flossing when mouthrinses 

are used as directed. 

b. To augment mechanical oral hygiene regimens and 

deliver antiplaque agents. 

c. To allow for the nonsurgical treatment of periodontitis. 

d. Both b and c.

9. Therapeutic mouthrinses with a fixed mixture of 

essential oils: 

a. Are bactericidal when used as directed. 

b. Prevent layering of biofilm when used as directed. 

c. Are bacteriostatic when used as directed. 

d. May stain teeth when used as directed. 

10. Therapeutic mouthrinses with high bioavailable 

cetylpyridinium chloride: 

a. Prevent layering of biofilm when used as directed. 

b. Are bactericidal and bacteriostatic when used as 

directed. 

c. Require a prescription from a doctor. 

d. Are bacteriostatic when used as directed. 

11. Therapeutic mouthrinses with chlorhexidine 

gluconate (CHX): 

a. Is the “gold standard” therapeutic mouthrinse. 

b. Contains a strong base with 2 positive charges at pH 

levels above 3.5. 

c. Are extremely interactive with anions. 


12. Therapeutic mouthrinses with CHX: 

a. May be used indefinitely when used as directed. 

b. Prevent the attachment and layering of oral biofilm. 

c. Bind to the cell walls, which initiates its antibacterial 

mode of action. 

d. Do not require a doctor’s prescription in the United 

States. 



10 

13. Therapeutic mouthrinses with delmopinol 

hydrochloride: 

a. Prevent the attachment and layering of oral biofilm. 

b. Are bactericidal and bacteriostatic when used as 

directed. 

c. Disrupt the balance of oral flora. 

d. May not be used indefinitely when used as directed. 

14. Therapeutic mouthrinses with delmopinol 

hydrochloride: 

a. Have little or no demonstrable effect on oral bacteria. 

b. Interfere with plaque/biofilm matrix formation. 

c. Make plaque less sticky and easier to remove. 


15. When should a dental professional recommend a 

therapeutic mouthrinse? 

a. When a patient’s efforts at mechanical plaque 

removal are inadequate. 

b. Not until a patient has periodontitis. 

c. When a patient has poor plaque control and is under 

the age of 6 years. 

d. Both b and c. 

16. Therapeutic mouthrinses may work through: 

a. Inoculation of the oral cavity against microorganisms. 

b. Direct destruction of susceptible oral bacteria. 

c. Prevention of bacterial adhesion. 

d. Both b and c.

PROGRAM COMPLETION INFORMATION 

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the 16 questions correctly. 

Complete online at: dentalcetoday.com 

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Dentistry Today 

Department of Continuing Education 

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Fairfield, NJ 07004 

Fax: 973-882-3622 

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ANSWER FORM: COURSE #: 146 

Please check the correct box for each question below. 

1. ❏ a ❏ b ❏ c ❏ d 9. ❏ a ❏ b ❏ c ❏ d 

2. ❏ a ❏ b ❏ c ❏ d 10. ❏ a ❏ b ❏ c ❏ d 

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8. ❏ a ❏ b ❏ c ❏ d 16. ❏ a ❏ b ❏ c ❏ d 

PROGRAM EVAUATION FORM 

Please complete the following activity evaluation questions. 

Rating Scale: Excellent = 5 and Poor = 0 

Course objectives were achieved. 

Content was useful and benefited your 

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