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The use of mouthwash containing essential oils (LISTERINE ® ) to improve oral health: Statement of the Saudi Dental Society

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The use of mouthwash containing essential oils (LISTERINE ® ) to improve oral health: Statement of the Saudi Dental Society

Abstract

Background Standard recommendations to maintain daily oral hygiene include tooth brushing and interdental cleaning. Evidence from literature indicates that using a mouthrinse as an adjunct provides benefit beyond mechanical methods. The objective of this article was to evaluate the short- and long-term effect of a mouthwash containing essential oils (LISTERINE®) in improving oral health. Methods PubMed (MEDLINE) and bibliographies from the relevant retrieved reviews were searched to identify clinical studies involving the use of LISTERINE mouthrinse. The primary outcome measure was short- and long-term efficacy of mouthrinse containing essential oil (LISTERINE®) in improving oral health. Results Based on our search, 26 studies supported the use of essential-oil-containing mouthrinse (LISTERINE®) as an adjunct to daily oral health regimen. Most studies were conducted in healthy subjects, 2 studies in orthodontic patients, 1 each in xerostomia patients and mentally disabled patients. Of these, 13 studies supported the short-term (<3 months) and 13 studies supported the long-term (3–6 months) efficacy of LISTERINE mouthrinse as an adjunct to mechanical methods. Conclusions This review provides strong evidence of the anti-plaque and anti-gingivitis effects of essential-oil-containing mouthrinse LISTERINE® as an adjunct to daily tooth brushing and interdental cleaning.
REVIEW ARTICLE
The use of mouthwash containing essential oils
(LISTERINEÒ) to improve oral health: A
systematic review
Fahad Ali Alshehri
Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
Available online 19 December 2017
KEYWORDS
Listerine;
Mouthwash;
Mouthrinse;
Essential oils;
Short-term efficacy;
Long-term efficacy;
Review
Abstract Background: Standard recommendations to maintain daily oral hygiene include tooth
brushing and interdental cleaning. Evidence from literature indicates that using a mouthrinse as
an adjunct provides benefit beyond mechanical methods. The objective of this article was to eval-
uate the short- and long-term effect of a mouthwash containing essential oils (LISTERINEÒ)in
improving oral health.
Methods: PubMed (MEDLINE) and bibliographies from the relevant retrieved reviews were
searched to identify clinical studies involving the use of LISTERINE mouthrinse. The primary out-
come measure was short- and long-term efficacy of mouthrinse containing essential oil (LISTER-
INEÒ) in improving oral health.
Results: Based on our search, 26 studies supported the use of essential-oil-containing mouthrinse
(LISTERINEÒ) as an adjunct to daily oral health regimen. Most studies were conducted in healthy
subjects, 2 studies in orthodontic patients, 1 each in xerostomia patients and mentally disabled
patients. Of these, 13 studies supported the short-term (<3 months) and 13 studies supported
the long-term (3–6 months) efficacy of LISTERINE mouthrinse as an adjunct to mechanical meth-
ods.
Conclusions: This review provides strong evidence of the anti-plaque and anti-gingivitis effects of
essential-oil-containing mouthrinse LISTERINEÒas an adjunct to daily tooth brushing and inter-
dental cleaning.
Ó2017 Production and hosting by Elsevier B.V. on behalf of King Saud University. This is an open access
article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
E-mail address: Fahalshehri@ksu.edu.sa
Peer review under responsibility of King Saud University.
Production and hosting by Elsevier
Saudi Dental Journal (2018) 30, 2–6
King Saud University
Saudi Dental Journal
www.ksu.edu.sa
www.sciencedirect.com
https://doi.org/10.1016/j.sdentj.2017.12.004
1013-9052 Ó2017 Production and hosting by Elsevier B.V. on behalf of King Saud University.
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Contents
1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
2. Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
3. Results and discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
3.1. Short-term (<3 months) efficacy of mouthrinse containing EO – LISTERINEÒ......................... 3
3.1.1. Comparative studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
3.1.2. Microbiological effect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
3.1.3. Viral contamination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
3.1.4. Irritation potential . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
3.2. Long-term (3–6 months) effectiveness of EO-containing mouthwash LISTERINEÒ...................... 4
3.2.1. Comparative studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
3.2.2. Studies in orthodontic patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
4. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Funding sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
1. Introduction
Dental plaque is the main factor for initiation and progression
of oral diseases (Sbordone, 2003). Therefore, plaque removal is
mandatory to prevent accumulation of plaque on the teeth and
adjacent gingival surface. Standard recommendations to main-
tain daily oral hygiene include tooth brushing and interdental
cleaning (Choo and Delac, 2001; Claydon, 2008). Tooth brush-
ing with a dentifrice containing anti-plaque agents and inter-
dental cleaning with toothpicks and dental floss has been
proven to control plaque and gingivitis. A proximal brush is
recommended in order to access open interdental spaces
(Choo and Delac, 2001). Studies indicate that regular profes-
sional plaque control by a hygienist can offer maintenance of
a healthy periodontium (Axelsson et al., 2004). In addition,
mouthrinses can prevent plaque growth and improve oral
health by inhibiting the proliferation rate of bacteria in plaque
or by preventing attachment of bacteria to dental surfaces
(Netuschil et al., 1995). Over the past 100 years, phenolic com-
pounds (e.g. LISTERINEÒ) have been acknowledged to be
germicidal and effective in reducing plaque and gingivitis.
Recently, several studies have shown the combined
effectiveness of essential oil (EO) containing mouthrinse-
LISTERINEÒin achieving healthy gingival tissue and reduc-
ing plaque (Claffey, 1985). These studies were conducted to
assess the efficacy and safety of LISTERINEÒin comparison
with other mouthrinses. However, it is important to highlight
long-term (3–6 months) versus short-term (<3 months) effec-
tiveness of LISTERINEÒtowards achieving gingival health.
Thus, the available literature was systematically assessed to
address the use of mouthwash containing EO (LISTERINEÒ)
to improve oral health.
2. Methods
We performed an electronic search of PubMed (MEDLINE)
based on the following search query: (‘‘LISTERINE[Supple
mentary Concept] OR LISTERINE[tiab]) AND (essential
oil[tiab] OR essential oils[tiab]). The results of PubMed/MED-
LINE search were as follows:
PubMed query Items
found
Search (essential oil[tiab]) OR essential oils[tiab] 11,943
Search (LISTERINE[tiab]) OR LISTERINE
[Supplementary Concept]
369
Search (((essential oil[tiab]) OR essential oils[tiab]))
AND ((LISTERINE[tiab]) OR LISTERINE
[Supplementary Concept])
100
Additionally, a manual search was performed by screening the
bibliographies from the relevant retrieved reviews as well as
included publications. All chosen clinical studies were designed
to meet the commonly accepted professional and regulatory
standards set by the American Dental Association (ADA)
and the US Food and Drug Administration (FDA). These trial
results presented detailed data including baseline characteris-
tics, intervention protocols, and outcomes.
3. Results and discussion
In the retrieved literature, it is well documented that brushing
and flossing are the ‘gold standard’ procedures for controlling
bacterial plaque. However, based on results derived from sev-
eral clinical trials, the ADA has recommended a mouthrinse
containing EO (LISTERINEÒ) as an adjunct to routine
mechanical oral hygiene measures. We grouped the studies
into short-term and long-term efficacy.
3.1. Short-term (<3 months) efficacy of mouthrinse containing
EO – LISTERINEÒ
Several clinical studies have demonstrated that EO-containing
mouthrinse – LISTERINEÒcan combat harmful bacteria and
improve oral health (Vlachojannis et al., 2015). A study to
quantify the additional benefit provided by an EO-containing
mouthrinse in reducing plaque and gingivitis in patients who
brush and floss regularly confirmed that adjunctive use of an
EO-containing mouthrinse provides a clinically significant
The use of mouthwash containing essential oils (LISTERINEÒ) to improve oral health 3
and meaningful additional benefit in reducing plaque and gin-
givitis (Sharma et al., 2004).
3.1.1. Comparative studies
3.1.1.1. Chlorhexidine (CHX). In a short, randomized, cross-
over clinical trial, alcohol-based EO mouthrinse and alcohol-
free EO mouthrinse was compared with a positive control
(0.2% CHX) and a negative control (saline), using an in vivo
plaque regrowth model for 3 days. At the end of the trial,
alcohol-free and alcohol-based EO mouthrinses showed better
inhibitory effect on plaque regrowth versus controls
(Marchetti et al., 2017). A post hoc analysis of 5 clinical trials
that evaluated the ability to achieve gingival health with daily
rinsing with Cool MintÒLISTERINEÒAntiseptic EO com-
pared with only brushing/flossing plaque control. Results
showed that healthier gingival sites and plaque-free tooth
surfaces were achieved as early as 4 weeks with use of an
EO-containing antimicrobial mouthrinse (Charles et al., 2014).
3.1.1.2. Cetylpyridinium chloride (CPC). A study that com-
pared the safety, and anti-plaque and anti-gingivitis efficacy
of a high bioavailable, alcohol-free 0.07% CPC rinse with a
positive control rinse containing EO and 21.6% ethyl alcohol
suggested that twice daily rinsing with 0.07% CPC rinse may
provide anti-plaque and anti-gingivitis efficacy similar to that
with the alcohol-based EO mouthrinse (Witt et al., 2005).
However, another two-week comparative clinical trial showed
that EO-containing mouthrinse provided superior anti-
gingivitis as well as anti-plaque efficacy compared to a
0.075% CPC mouthrinse rinse (Parikh-Das et al., 2013). In
addition, another study that compared mouthrinse containing
EO and 0.075% CPC showed that the EO-containing mou-
thrinse has superior anti-plaque/anti-gingivitis effectiveness
compared to the 0.075% CPC-containing mouthrinse without
mechanical oral hygiene influence (Charles et al., 2011).
3.1.1.3. Amine fluoride/stannous fluoride (ASF). A study com-
pared the plaque-inhibiting effects of two commercially avail-
able mouthrinses containing EO and ASF on supragingival
plaque regrowth. Results showed that ASF and EO rinses
may represent effective alternatives to CHX rinse as adjuncts
to oral hygiene (Pizzo and La Cara, 2008).
3.1.1.4. Azithromycin. A study to investigate the effects of irri-
gation with an EO-containing antiseptic and oral azithromycin
(AZM) on bacteremia caused by scaling and root planing
showed significant reduction of subgingival bacterial counts
in both the EO and AZM groups (P < .01) (Morozumi
et al., 2010).
3.1.2. Microbiological effect
The antimicrobial effectiveness of mouthrinses against pre-
dominant oral bacteria in vitro, is determined by the mini-
mum inhibitory concentration (MIC). The inhibitory effects
of the three test agents was assessed against 40 oral bacteria
at concentrations of 1, 2, 4, 8, 16, 32, 64, 128, 256 and 512
mg/ml. The data suggest that the herbal mouthrinse contain-
ing EO may provide oral health benefits by inhibiting the
growth of periodontal and cariogenic pathogens (Haffajee
et al., 2008).
A study evaluated the clinical and microbiological effects of
an EO-containing mouthrinse in 20 chronic periodontitis sub-
jects. The EO group revealed significant reduction in the occur-
rence of P. gingivalis in saliva compared to the baseline, and
45 days; this difference was stable at 180 days. The
EO-containing mouthrinse also demonstrated beneficial effects
on clinical parameters. However, microbiological findings were
less consistent (Cortelli et al., 2009).
3.1.3. Viral contamination
A clinical study was undertaken to evaluate the effect of an
EO-containing oral antiseptic (LISTERINEÒ) on the reduc-
tion of viral titer in saliva during active viral infection. LIS-
TERINEÒshowed reduction of viral contamination in oral
fluids for at least 30 min after the oral rinse (Meiller et al.,
2005).
3.1.4. Irritation potential
A study was conducted to assess the irritation potential of an
EO-containing mouthrinse (LISTERINEÒAntiseptic) in a
population with objectively documented xerostomia (hyposali-
vation) using an exaggerated-exposure clinical model. The oral
irritation potential of the EO mouthrinse was minimal, and
oral mucosal abnormalities attributable to the test rinses were
seen in only two subjects, both at the 7-day examination. These
subjects were both using the EO mouthrinse. The abnormali-
ties consisted of an asymptomatic ‘‘whitish sloughwhich
was readily wiped off leaving a normal appearing, non-
erythematous mucosa. In both subjects, the oral mucosa
appeared normal at the 14-day examination (Fischman et al.,
2004).
3.2. Long-term (3–6 months) effectiveness of EO-containing
mouthwash – LISTERINEÒ
Several clinical studies have demonstrated the long-term effi-
cacy of EO-containing mouthrinse – LISTERINEÒ.
3.2.1. Comparative studies
A meta-analysis of studies from PubMed-MEDLINE,
Cochrane-CENTRAL and EMBASE databases on the effects
of an EO mouthwash versus alcohol vehicle solution on pla-
que, gingival inflammation parameters and extrinsic tooth
staining showed that EO mouthwash appears to provide a sig-
nificant oral health benefit during the 6 months of use (Van
Leeuwen et al., 2014). In a clinical trial to determine the oral
health benefits of recommending twice-daily brushing and rins-
ing with an EO-containing mouthrinse in 766 healthy subjects
with mild to moderate levels of gingivitis, 85% of subjects
judged the EO mouthrinse as efficacious. The oral health ben-
efits of brushing and rinsing twice daily with an EO mou-
thrinse were well-perceived by patients and professionals
alike and measurable by dentists at a 3-month recall visit
(Pilloni et al., 2010).
3.2.1.1. Cetylpyridinium chloride (CPC). A 6-month clinical
study compared the potential of EO versus a 0.07% CPC-
containing mouthrinse in 354 healthy patients. Results showed
a significant reduction in gingivitis and plaque for both EO
and CPC mouthrinses (Cortelli et al., 2014). In another trial,
4 F.A. Alshehri
subjects received control, 0.05% CPC, or a fixed combination
of EO. The EO group showed lower mean scores for modified
gingival index and plaque index than CPC (32.4% and 56.2%
reductions, respectively) in reducing plaque and gingivitis
(Sharma et al., 2010). A third study compared the effects of
an experimental mouthrinse containing 0.07% CPC (Crest
Pro-HealthÒ) with a mouthrinse containing EO (LISTER-
INEÒ) on dental plaque accumulation and prevention of gin-
givitis in 151 subjects for 6 months. Results indicated that
there was no statistically significant difference (p = .05) in
the anti-plaque and anti-gingivitis benefits between the two
groups over a 6-month period (Albert-Kiszely et al., 2007).
3.2.1.2. Dental floss. A study compared the use of dental floss
with that of an EO-containing mouthrinse in 326 subjects.
Results showed that in conjunction with professional care (pro-
phylaxis) and tooth brushing over 6 months, rinsing twice daily
with an EO-containing mouthrinse was at least as good as floss-
ing daily in reducing interproximal plaque and gingivitis
(Bauroth et al., 2003). Another study compared the effective-
ness of rinsing with an EO-containing antimicrobial mouthrinse
with that of dental floss in reducing interproximal gingivitis and
plaque in 301 subjects. Results showed that EO-containing
mouthrinse was ‘‘at least as good asdental floss for the control
of interproximal gingivitis (Sharma et al., 2002).
3.2.1.3. Stannous fluoride dentifrice. A study compared the effi-
cacy of a stabilized stannous fluoride dentifrice (Crest Plus
Gum Care), baking soda and peroxide (NaF) dentifrice (Men-
tadent), and EO mouthrinse (LISTERINEÒ) to a conventional
NaF dentifrice (Crest) for the control of plaque, gingivitis and
gingival bleeding over 6 months. The results showed the stabi-
lized stannous fluoride dentifrice produced statistically signifi-
cant 17.5% reductions in gingivitis and 27.5% reductions
in gingival bleeding relative to the NaF dentifrice. The combi-
nation of NaF dentifrice and EO mouthrinse produced statisti-
cally significant reductions of 7.4% in gingivitis and 10.8%
in plaque as compared with the NaF dentifrice. The stabilized
stannous fluoride dentifrice produced statistically significant
reductions in both gingivitis (10.8%) and gingival bleeding
(23.0%) relative to the combination of NaF dentifrice and
EO mouthrinse. The baking soda and peroxide (NaF) denti-
frice did not provide reductions in gingivitis, plaque or gingi-
val bleeding as compared with the conventional NaF
dentifrice. Tis shows the efficacy and superior activity of a com-
bination of NaF dentifrice and EO mouthrinse for the preven-
tion of gingivitis (Beiswanger et al., 1997).
3.2.1.4. Chlorhexidine (CHX). A study that compared the effi-
cacy of a 0.12% CHX mouthrinse and an EO mouthrinse on
plaque accumulation and gingivitis in mentally disabled adults
over a 1-year period showed no further significant improve-
ment in the gingival index after the 1st month. A statistically
significant improvement in the plaque index occurred in the
CHX group at month 1, but returned to baseline 2 levels over
the 12 months. No improvement in the plaque index occurred
in the EO group. The probing depths remained the same over
the 12 months. In addition, undesired effects such as tooth
staining has been reported with the use of CHX (McKenzie
et al., 1992).
A study was conducted to determine whether antimicrobial
mouthrinses with different formulations could affect the com-
position of the subgingival microbiota and clinical parameters
of adjacent tissues in 116 periodontal maintenance subjects.
Results emphasized that CHX (p < .001) and herbal
(p < .05) rinses significantly reduced plaque. In addition, the
observed microbial changes were accompanied by improve-
ments in clinical parameters in the periodontal maintenance
subjects (Haffajee et al., 2009).
Another study compared antimicrobial effects of EO, either
alone or in combination with CHX digluconate, against plank-
tonic and biofilm cultures of Streptococcus mutans and Lacto-
bacillus plantarum. The EO agent included cinnamon, tea-tree
oil (Melaleuca alternifola), manuka (Leptospermum scopar-
ium), Leptospermum morrisonii, arnica, eucalyptus, grapefruit,
the EO mouthrinse Cool MintÒLISTERINEÒand two of its
components, menthol and thymol. Cinnamon exhibited the
greatest antimicrobial potency (1.25–2.5 mg/ml). Manuka,L.
morrisonii, tea-tree oils, and thymol also showed antimicrobial
potency but to a lesser extent. The combination effect of the
EO-CHX group was greater against biofilm cultures of both
S. mutans and L. plantarum than against planktonic cultures.
The amount of CHX required to achieve an equivalent growth
inhibition against the biofilm cultures was reduced 4–10 folds
in combination with cinnamon, manuka, L. morrisonii, thy-
mol, and LISTERINEÒ. They concluded that there may be
a role for EO in the development of novel anti-caries treat-
ments (Filoche et al., 2005).
3.2.2. Studies in orthodontic patients
A study that assessed the effectiveness of chemical and
mechanical control of dental biofilm in 30 orthodontic patients
showed that the use of EO-containing mouthwash LISTER-
INEÒ, together with mechanical oral hygiene, orientation,
and motivation, proved to be adequate for the maintenance
of oral health in orthodontic patients (Alves et al., 2010).
In a study that tested the use of LISTERINEÒmouthrinse
in maintaining proper oral health for orthodontic patients,
LISTERINEÒmouthrinse was shown to reduce the amount
of plaque and gingivitis. The authors concluded that adding
LISTERINEÒto the standard oral hygiene regimen may be
beneficial for orthodontic patients in maintaining proper oral
health, thus reducing the likelihood of developing white spot
lesions and gingivitis (Tufekci et al., 2008).
4. Conclusions
Gingivitis is a common oral condition resulting from gingival
inflammation due to accumulation of bacterial plaque, espe-
cially in the interdental area. Conventional mechanical meth-
ods (i.e. tooth brushing and flossing/interdental cleaning)
may result in an incomplete removal of interdental plaque.
The published evidence from short- and long-term clinical tri-
als support the benefit of adding an EO-containing mouthwash
LISTERINEÒto the daily oral regimen to maintain personal
oral hygiene.
Acknowledgements
The author thanks Dr. Hamdan Alghamdi, Department of
Periodontics and Community Dentistry, College of Dentistry,
King Saud University, for his support in writing this review.
The use of mouthwash containing essential oils (LISTERINEÒ) to improve oral health 5
Funding sources
This research did not receive any specific grant from funding
agencies in the public, commercial, or not-for-profit sectors.
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6 F.A. Alshehri
... Normally, the combination of mouthwashes (Yousefimanesh et al., 2015) and mechanical oral hygiene such as brushing and flossing is applied to prevent various oral disorders such as infection, inflammation, relieve pain and decrease halitosis. In general, mouthwashes contain antiseptics that are used in the treatment of such infections (Alshehri, 2018;Parashar, 2015). Nonetheless, many strategies focus on the biological activities of alternative natural products due to the increased microbial resistance of common antibiotics (Jain & Jain, 2016). ...
... Normally, the combination of mouthwashes (Yousefimanesh et al., 2015) and mechanical oral hygiene such as brushing and flossing is applied to prevent various oral disorders such as infection, inflammation, relieve pain and decrease halitosis. In general, mouthwashes contain antiseptics that are used in the treatment of such infections (Alshehri, 2018;Parashar, 2015). Nonetheless, many strategies focus on the biological activities of alternative natural products due to the increased microbial resistance of common antibiotics (Jain & Jain, 2016). ...
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The aim of this present study was to evalute Elettaria cardamomum (L.) Maton., Lavandula angustifolia Mill. and Salvia fruticosa Mill. essential oils in mouthwashes formulated with different combinations such as 0.1/0.25/0.1; 0.2/0.25/0.1; 0.3/0.1/0.1 in 10 mL (v/v), and their in vitro antibacterial activity performance. The characterization of the main essential oil components was performed by GC-FID and GC/MS analyses. The antimicrobial evaluation was performed by using the disc diffusion method against human pathogenic Staphylococcus aureus ATCC 6538, Escherichia coli NRLL B-3008, Bacillus cereus ATCC 14579, and Salmonella typhii (clinical isolate), respectively. In the present study, among the tested bacteria S. typhii was the most sensitive, while B. cereus and E. coli were the most resistant pathogens in the applied mouthwash formulations. The essential oil combination containg mouthwash formulations can be used as a functional naturals based cosmetics.
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Plants produce a variety of high-value chemicals (e.g., secondary metabolites) which have a plethora of biological activities, which may be utilised in many facets of industry (e.g., agrisciences, cosmetics, drugs, neutraceuticals, household products, etc.). Exposure to various different environments, as well as their treatment (e.g., exposure to chemicals), can influence the chemical makeup of these plants and, in turn, which chemicals will be prevalent within them. Essential oils (EOs) usually have complex compositions (>300 organic compounds, e.g., alkaloids, flavonoids, phenolic acids, saponins and terpenes) and are obtained from botanically defined plant raw materials by dry/steam distillation or a suitable mechanical process (without heating). In certain cases, an antioxidant may be added to the EO (EOs are produced by more than 17,500 species of plants, but only ca. 250 EOs are commercially available). The interesting bioactivity of the chemicals produced by plants renders them high in value, motivating investment in their production, extraction and analysis. Traditional methods for effectively extracting plant-derived biomolecules include cold pressing and hydro/steam distillation; newer methods include solvent/Soxhlet extractions and sustainable processes that reduce waste, decrease processing times and deliver competitive yields, examples of which include microwave-assisted extraction (MAE), ultrasound-assisted extraction (UAE), subcritical water extraction (SWE) and supercritical CO2 extraction (scCO2). Once extracted, analytical techniques such as chromatography and mass spectrometry may be used to analyse the contents of the high-value extracts within a given feedstock. The bioactive components, which can be used in a variety of formulations and products (e.g., displaying anti-aging, antibacterial, anticancer, anti-depressive, antifungal, anti-inflammatory, antioxidant, antiparasitic, antiviral and anti-stress properties), are biorenewable high-value chemicals.
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Coronavirus disease 19 (COVID-19) has taken the world by storm, affecting all age groups alike and presenting a plethora of signs and symptoms. Showcasing a high mortality rate, cytokine storm is identified as one of the most common culprits for death in affected individuals. In patients undergoing severe complications in the form of intubations and intensive care unit (ICU) admissions, increased cytokine levels have again been identified as a significant factor, indicating their substantial role in disease outcomes. Periodontitis, which is identified as a silent pandemic, is the most common oral disease that is found in individuals. The increased accumulations of plaques and calculus are the main causative agents, stimulating inflammatory cells in the periodontal tissue, leading to cytokine release. Individuals with the removable or fixed dental prosthesis are at increased risk of contracting fungal infections, which are also identified as increasing the cytokine levels and worsening an individual’s condition contracted with COVID-19. This review focuses on oral hygiene measures and scientifically proven aids that can be used by patients at home for reducing oral cytokine levels and the risk of COVID-19 related complications, thereby sensitizing them at a time when elective dental procedures are discouraged and patients are devoid of professional dental intervention. Mechanical removal of plaques and calculus cannot be substituted with auxiliary aids, but it is important that adjunct practices be adopted for efficient hygiene. Toothbrush hygiene should also be practiced to prevent disease progression and transmission. Adherence to these recommendations is not only required for healthy or infected individuals but also for viral infection recovered patients to avoid the possible risk of developing the black fungus infection.
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Introduction Patients undergoing orthodontic therapy face greater difficulties in maintaining good oral hygiene. To improve mechanical plaque removal, a common strategy is to incorporate a chemotherapeutic agent. Thus, the effects of adding essential oil mouthwash to a standard oral hygiene regimen to maintain oral health were evaluated. Material and Method Two groups were created with 25 patients each. Gingival index and orthodontic plaque index were calculated as initial reading. Gingival index and orthodontic plaque index were calculated again after 6 months. Result In the control group, the mean score of gingival index and orthodontic plaque index were significantly increased from baseline reading (T1) to after 6 months reading (T2). In the experimental group, increase in the mean score of gingival index and orthodontic plaque index was not statistically significant. Conclusion When an essential oil mouthwash is added to the daily oral hygiene regimen (conventional manual toothbrushing + brushing with monotufted brush), it maintained the gingival health and amount of plaque accumulation in orthodontic patients over a period of 6 months.
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Respiratory infection is one of the leading causes of death in the world. The outbreaks of influenza and the Middle East respiratory syndrome have added to the miseries of human beings. Interventions such as the use of masks, social distancing, hand washing, and the use of personal protective equipment by health care professionals have minimized the transmission of pathogens from infected to healthy individuals. Another intervention is gargling which is most commonly performed by the Japanese to avoid respiratory infections. PubMed was used to search articles on gargling in respiratory infections published in the last three decades. Gargling is effective in upper respiratory infections (URTIs). URTI precedes lower respiratory tract infection; early intervention could prevent complications. The gargling agents in this review are classified as synthetic and natural gargling agents. The mouthwashes or gargling agents reviewed in this article have proven efficacy in reducing either bacterial or viral (or both) respiratory infections. The mouthwashes available over the counter may also have side effects. The use of mouthwash should be based on the potential benefit of oral and systemic conditions.
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Thirteen commercial essential oils were assessed for their possible inclusion in a mouthwash formulation based on their inhibitory effect against potentially pathogenic anaerobic oral bacterial isolates from subgingival plaque, and their cytotoxicity towards gingival cells. The essential oils, originating from species belonging to seven major aromatic plant families, were chosen to provide the necessary diversity in chemical composition that was analyzed in detail by GC and GC-MS. Multivariate statistical analysis, performed using the in vitro microbiological/toxicological assays and compositional data, revealed that the major components of the essential oils were probably not the main carriers of the activities observed. A formulation of "designer" mouthwashes is proposed based on the selective action of certain essential oils towards specific bacterial isolates (e.g. Citrus bergamia vs. Parvimonas micra ), and non-toxicity to gingival cells at antimicrobially active concentrations.
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Background To evaluate the antiplaque effects of an alcohol-free mouthrinse containing essential oils?Listerine Zero (LZ)?and an alcohol-based essential oils mouthrinse (EO+) compared with a positive control of 0.20% chlorhexidine mouthrinse (CHX) and a negative control of a placebo solution (saline), using an in vivo plaque regrowth model of three days. Methods The study was designed as a double-masked, randomized, crossover clinical trial, involving 21 volunteers to compare four different mouthrinses, using a three-day plaque regrowth model. After receiving thorough professional prophylaxis at baseline, over the next three days each volunteer refrained from all oral hygiene measures and performed two daily rinses with 15 mL of the test mouthrinses. EO+ was compared with LZ. CHX rinse served as a positive control and a placebo solution as a negative control. At the end of each experimental period, the Plaque Index (PI) was assessed and a panelist completed through a visual analogue scale (VAS) questionnaire evaluating the organoleptic properties of each product. Each participant underwent a 14-day washout period and then there was another allocation. ResultsLZ showed the same inhibitory activity on plaque regrowth compared with EO+ in the whole mouth (PI = 1.72 versus 1.65, respectively), but there was less of an effect compared to the CHX (overall PI of 1.07) and a more efficient activity than the saline solution negative control (PI = 2.31). The difference of 0.07 between LZ and EO+ was not statistically significant. ConclusionsLZ seems to have the same inhibiting effect on plaque regrowth as EO+ and a less inhibiting effect than the CHX control. Both LZ and EO+, as well as the CHX control, show a better inhibiting effect on plaque regrowth than the placebo solution. Trial registrationClinicalTrials.gov, NCT02894593. Registered on 4 September 2016.
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Purpose: This randomized, single center, examiner-blind, controlled, parallel-group, 6-month clinical study compared the antiplaque/antigingivitis potential of an essential oil (EO) versus a 0.07% cetylpyridinium chloride (CPC)-containing mouthrinse. A 5% hydroalcohol solution was included as a control group. Methods: 354 healthy volunteers (18-71 years of age) were enrolled in this clinical trial; 338 subjects completed the study. At baseline, 1-, 3-, and 6-month visits, subjects received an oral examination, gingivitis (MGI), gingival bleeding (BI) and plaque assessments (PI). Following randomization, subjects received a prophylaxis and began brushing twice daily with the provided fluoride toothpaste and rinsing twice daily with 20 mL of the assigned mouthrinse for 30 seconds. Results: All rinses were well tolerated by the subjects, with the exception of extrinsic tooth stain complaints in 13 subjects in the CPC group between the 3- and 6-month exams. Statistically significant reductions in gingivitis, bleeding and plaque were observed for both EO and CPC at all post-baseline time-points when compared to the negative control. At 6 months MGI and PI were reduced by 42.6% and 42.0% for EO and by 17.1% and 13.9% respectively, for CPC vs. control. When compared to CPC, EO was statistically significantly superior at all post-baseline time-points. EO showed increasing reductions in MGI of 10.5%, 20.3% and 30.7% as well as reductions in PI of 12.7%, 23.7% and 32.6% at 1, 3 and 6 months, respectively. When analyzing the number of healthy sites (MGI scores of 0 or 1), the beneficial effect of the EO-containing mouthrinse is 45.8% greater than using a CPC-containing mouthrinse and 59.8% greater than placebo.
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To determine whether the oral health benefits of recommending twice daily brushing and rinsing with an essential oil mouthrinse (EOM) are perceived and measurable by dentists and also perceived by their patients at a 3-month recall visit. This is a monadic, open label, uncontrolled study involving 766 generally healthy Italian subjects aged 19-66 years, with mild to moderate levels of gingivitis, no pockets of more than 4 mm, and at least 20 scorable teeth. Eight dentists scored subjects for plaque and gingivitis at baseline and at 90 days using simplified 4-point plaque and gingivitis indices. All subjects brushed twice daily, immediately followed by rinsing for 30 sec with 20 ml of an essential oil mouthrinse (Listerine(®)). 735 subjects completed the study (95.9%). Average score reductions were 51.9% and 45.7% for plaque and gingivitis, respectively. About 62% and 70% were judged by the dentists as improved for plaque control and gingival health. 85% of subjects judged the EOM as efficacious. The oral health benefits of brushing and rinsing twice daily with an essential oil mouthrinse are perceived by patients and professionals alike and measurable by dentists at a 3-month recall visit.
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Two antimicrobial agents, a fixed combination of essential oils (EOs) and 0.07% cetylpyridinium chloride (CPC) are found in commercially available mouthrinses, Listerine® Antiseptic and Crest® Pro HealthTM, respectively. Both mouthrinses have been shown to control dental plaque and gingivitis in short and longer term studies. The aim of this study was to determine the comparative effectiveness of these two mouthrinses using a 2-week experimental gingivitis model. Qualified subjects were randomly assigned to one of three mouthrinse groups: a fixed combination of EOs, 0.07% CPC, or negative control (C) rinse. Following baseline clinical assessments and a dental prophylaxis, subjects began a two-week period in which they rinsed twice daily with their assigned rinse and abstained from any mechanical oral hygiene procedures or other oral care products. Subjects were reassessed at the end of the two-week period. One hundred and forty-seven subjects were randomized and 142 completed this study. After two weeks use, the EOs rinse was superior (p < 0.011) to the CPC rinse in inhibiting the development of gingivitis, plaque, and bleeding, with 9.4% and 6.6% reductions compared to CPC for gingivitis and plaque, respectively. Both rinses were superior to the negative control rinse (p < 0.001). This study demonstrates that the essential oil-containing mouthrinse has superior antiplaque/antigingivitis effectiveness compared to the 0.07% CPC-containing mouthrinse without mechanical oral hygiene influence.
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Transient bacteremia frequently occur secondary to several periodontal procedures. The purpose of the present study is to investigate the effects of irrigation with an essential oil-containing antiseptic (EO) and oral administration of azithromycin (AZM) on bacteremia caused by scaling and root planing (SRP). Thirty patients with chronic periodontitis were randomly assigned to three groups (control, EO, and AZM). The EO group received quadrant subgingival irrigation with EO, and mouthrinsing was continued at home for 1 week. Oral administration of AZM was started 3 days before SRP in the AZM group. No adjunctive treatment was performed before SRP in the control group. Peripheral blood and subgingival plaque were collected at baseline and after 1 week. The second blood sample was taken 6 minutes after the initiation of quadrant SRP. The blood samples were cultured and analyzed for bacteremia. Quantitative analysis of periodontopathic bacteria in the sulcus was performed using the polymerase chain reaction Invader method. Bacteremia incidence rates were 90%, 70%, and 20% for the control, EO, and AZM groups, respectively. Significant reduction of the incidence of bacteremia was shown in the AZM group only (P <0.01). Subgingival bacterial counts significantly decreased in both the EO and AZM groups (P <0.01). Quadrant SRP frequently induced bacteremia. Although AZM was effective in reducing bacteremia incidence, EO showed less effectiveness.
Article
Listerine® is one of the most popular mouthwashes worldwide and claims to combat harmful bacteria. In the past century, its recipe was changed from an essential oil mouthwash to a five-component mixture (thymol, menthol, eucalyptol, and methyl salicylate dissolved in 27% ethanol). The aim of this study was to get preliminary information about the antimicrobial activities of individual Listerine® components and their mixtures. We tested the bacterial strains Streptococcus mutans, Enterococcus faecalis, and Eikenella corrodens and the yeast Candida albicans. The established minimum inhibitory concentration (MIC) assay and the minimum bactericidal/fungicidal concentration (MBC/MFC) assay were applied. None of the combinations of two phenols at the concentrations contained within Listerine® were associated with either an additive or synergistic effect. Thymol had lower MIC and MBC/MFC values than the other Listerine® components and Listerine® against E. corrodens and C. albicans. The mixtures consisting of eucalyptol, methyl salicylate, and thymol were the most effective against S. mutans and E. faecalis and more effective than Listerine®. Our results demonstrate that the phenols and their concentrations as contained within Listerine® could be further optimized in terms of selecting those which increase their general effectiveness, at concentrations that do not induce harm. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.
Article
Purpose: The aim of this investigation through post-hoc analyses was to determine the ability to achieve gingival health in the short term with daily rinsing with an essential oil containing antimicrobial mouthrinse. Methods: Conventional Analysis of Covariance (ANCOVA) on whole mouth mean plaque and gingivitis scores were originally conducted to demonstrate efficacy of adjunctive use of Cool Mint® LISTERINE® Antiseptic (EO) compared to negative control [brushing (B) or brushing/flossing (BF)] in each of 5 studies containing a 4 week evaluation. The Modified Gingival Index (MGI) was split into 2 categories: healthy (scores 0, 1) and unhealthy (≥2). Data, reflecting subjects that completed 4 weeks of treatment from 5 studies, were evaluated to determine the mean percent of healthy sites and mean percent of more inflamed "affected" areas (MGI≥3). Results: At baseline, the mean percent healthy gingival sites ranged from 0.1 to 3.2%. At 4 weeks, up to 29.3% and 16.1% of sites were healthy for the EO group and negative control group, respectively. Three and 6 month data from 2 of the 5 studies resulted in up to 39.6% and 62% at 3 and 6 month mean percent healthy sites per subject for EO and up to 17.2% and 15.6% at 3 and 6 months, respectively, for negative control. Virtually plaque free sites (PI=0, 1) at 4 weeks ranged up to 34.3% and 8.1% for EO and control groups, respectively. Conclusion: Significantly more healthy gingival sites and virtually plaque free tooth surfaces can be achieved as early as 4 weeks with use of an essential oil antimicrobial mouthrinse. This finding continues through 6 months twice daily use as part of oral care practices compared to mechanical oral hygiene alone.
Article
Objective The purpose of this review was to systematically evaluate the effects of an alcohol vehicle solution (V-Sol) compared with an essential-oils mouthwash (EOMW) and if available with a water-based control (WC) on plaque, gingival inflammation parameters and extrinsic tooth staining.Materials and Methods The PubMed-MEDLINE, Cochrane-CENTRAL and EMBASE databases were searched. Where appropriate, a meta-analysis was performed, and difference of means (DIFFM) as calculated.ResultsIn total, 971 unique papers were found of which five met the eligibility criteria. The DIFFM of the meta-analysis of four 6-month studies showed that the EOMW provided significantly better plaque control (DIFFM = 0.39, P < 0.00001) and gingival inflammation reduction as measured by the Löe and Silness Index (DIFFM = 0.36, P = 0.00001) as compared to the V-Sol. Regarding extrinsic tooth staining, a small but significant difference (DIFFM = −0.08, P = 0.03) was observed.Conclusion Limited data, but with a low risk of bias, were available to assess the potential benefit of the alcohol-containing V-Sol. ‘High’- and ‘moderate’-quality data were available for the analysis of plaque and gingivitis, respectively. Within these limitations, EOMW appears to provide a significant oral health benefit during the 6 months of use. The data retrieved for this review suggest that the essential oils produce an effect on plaque and gingivitis that extends beyond the V-Sol. Furthermore, the V-Sol proved to be no different from a WC.
Article
The objective of this randomized, examiner-blind, parallel, controlled clinical study was to compare the antiplaque/antigingivitis efficacy of an essential oil-containing mouthrinse (EO) to a new 0.075% cetylpyridinium chloride mouthrinse (CPC) using a two-week experimental gingivitis model with a 5% hydroalcohol rinse serving as the negative control. After signing informed consents and completing baseline examinations, 185 subjects were randomized into three groups. Subjects began supervised/recorded rinsing with 20 ml of their assigned rinse for 30 seconds twice daily for two weeks, with no mechanical oral hygiene permitted. Baseline and two-week assessments were conducted as follows: Turesky Modification of the Quigley-Hein Plaque Index (PI), Modified Gingival Index (MGI), and the Gingival Bleeding Index (BI). Analysis of efficacy variables (i.e., mean PI, mean MGI, mean BI, and proportion of bleeding sites derived from the BI) was performed using a one-way analysis of covariance (ANCOVA). Among the 182 subjects who completed the study, the EO rinse showed statistically significant reductions compared to the negative control within the range previously reported in this model; PI = 36.5% (p < 0.001) and MGI = 17.5% (p < 0.001). A 43.2% reduction in proportion of bleeding sites (p < 0.001) was demonstrated. Mean PI, MGI, and proportion of bleeding sites at two weeks were statistically significantly lower for the EO rinse compared to the CPC rinse (p < 0.001), showing 27.7%, 11.9%, and 30.0% reductions, respectively. An EO rinse provided superior antigingivitis/antiplaque efficacy compared to a 0.075% CPC rinse in this short-term clinical trial, and demonstrated efficacy within the range shown in previous studies using this model.
Article
To evaluate the antiplaque/antigingivitis effectiveness of an essential oils containing mouthrinse as compared to a 0.05% cetylpyridinium chloride mouthrinse. Generally healthy subjects with mild to moderate levels of plaque and gingivitis participated in a 6-month, examiner-blind, single centre, randomised, parallel-group controlled clinical trial. They were randomised into three mouthrinse groups--control (C), 0.05% cetylpyridinium chloride (CPC), or a fixed combination of essential oils (EO). Subjects received a dental prophylaxis at baseline and rinsed twice daily in addition to their usual oral hygiene for six months. Plaque Index and Modified Gingival Index were determined at 3 and 6 months. At 6 months, the EO group exhibited statistically significantly lower mean scores for MGI and PI than CPC (32.4% and 56.2% reductions, respectively). Compared to control, EO provided statistically significantly lower mean MGI and PI scores (36.3% and 69.7 %, respectively). The CPC group showed statistically significantly lower mean MGI and PI scores than the C group (5.8% and 30.7%, respectively). This study demonstrated the superiority of an EO rinse compared to a 0.05% CPC rinse in reducing plaque and gingivitis and confirmed that the daily use of an EO containing mouthrinse can provide a clinically significant benefit in reducing plaque and gingivitis.