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Comparison effectiveness between cetylpyridinium chloride and triclosan mouthwash on plaque

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Introduction: Dental plaque is a soft deposit that accumulates on the teeth. It is a complex microbial community with as many as 400 distinct bacterial species. One of the most prevalent diseases of the oral cavity is periodontal disease which begins with gingivitis. The main cause of gingivitis is plaque accumulation. Aim of this research is to comparison effectiveness of mouthwash containing cetylpyridinium chloride and mouthwash containing triclosan on plaque. Methods: The research was experimental study, with the double blinded parallel design. A total of 30 students of SMA Pasundan 8 were chosen. Clinical examination was conducted to obtain the plaque score using the Quigley Hein Index (modified) 1970. Subjects were divided into two groups. One group was given the cetylpyridinium chloride mouthwash and the other group was given triclosan mouthwash. Data were then analysed using the ANOVA test. Results: there is no significant difference between the effectiveness of mouthwash containing cetylpyridinium chloride and mouthwash containing triclosan on plaque (P>0.05). Conclusion: the mouthwash containing cetylpyridinium chloride and mouthwash containing triclosan is effective in reducing plaque.
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189
Comparison between cetylpyridinium chloride and triclosan mouthwash on plaque (Gurtej Singh Chinger et al.)
Corresponding author: Nunung Rusminah, Department of Periodontics, Faculty of Dentistry Universitas Padjadjaran,
Indonesia. Jalan Sekeloa Selatan I, Bandung, West Java, Indonesia, 40132; Phone: +6222-2504985/2532805
Comparison eectiveness between cetylpyridinium chloride
and triclosan mouthwash on plaque
Gurtej Singh Chinger*, Dede Hadidjah*, Nunung Rusminah*
*Department of Periodontics Faculty of Dentistry Universitas Padjadjaran
ABSTRACT
Introduction: Dental plaque is a soft deposit that accumulates on the teeth. It is a complex
microbial community with as many as 400 distinct bacterial species. One of the most prevalent diseases
of the oral cavity is periodontal disease which begins with gingivitis. The main cause of gingivitis is
plaque accumulation. Aim of this research is to comparison eectiveness of mouthwash containing
cetylpyridinium chloride and mouthwash containing triclosan on plaque. Methods: The research was
experimental study, with the double blinded parallel design. A total of 30 students of SMA Pasundan 8
were chosen. Clinical examination was conducted to obtain the plaque score using the Quigley Hein
Index (modied) 1970. Subjects were divided into two groups. One group was given the cetylpyridinium
chloride mouthwash and the other group was given triclosan mouthwash. Data were then analysed using
the ANOVA test. Results: there is no signicant dierence between the eectiveness of mouthwash
containing cetylpyridinium chloride and mouthwash containing triclosan on plaque (P>0.05). Conclusion:
the mouthwash containing cetylpyridinium chloride and mouthwash containing triclosan is eective in
reducing plaque.
Keywords: Cetylpyridinium chloride, triclosan, Quigley Hein index.
INTRODUCTION
Basically, health is very essential for human
being and oral health is a part of general health.
Oral hygiene is associated with the occurrence of
gum and periodontal disease, the lower the level
of cleanliness of one’s mouth, it will be more
easy for periodontal and gum disease to occur.
Periodontal disease is a term which includes all
pathological conditions of the gingiva, cementum,
periodontal membrane and alveolar bone.
It is however used in reference to those
lesions which have an inammatory basis and
are described as gingivitis or periodontitis1,2,3
Maintaining oral hygiene is to control plaque
which is needed for prevention and treatment of
gingivitis and periodontitis. Plaque can be dened
as biolm, usually pale yellow, that develops
naturally on the teeth. There are 2 methods of
controlling plaque which can be done by chemical
and mechanical.
Mechanical plaque control is the removal
of microbial and the prevention of accumulation
on the teeth and adjacent gingival surface by
the use of tooth brush and other mechanical
hygiene aids. Plaque control using chemical way
is one of the most common way used by the
community. Chemical agents acts on the plaque
ultrastructurally and prevent the formation of
plaque. Plaque removing eorts can be done
190
Padjadjaran Journal of Dentistry. 2012;24(3):189-193.
through chemical using mouthwash. Mouthwash is
a kind of solution which is used to clean the oral
cavity. Some mouthwash comes with anti-plaque
properties which can kill the bacterial plaque.
Cetylpyridinium Chloride (CPC) is a cationic
quaternary ammonium compound in some types
of mouthwashes. It is an antiseptic that kills
bacteria and other microorganisms. Alcohol has an
extensive history of safety when used in products
as recommended, for the vast majority of the
population. However, certain individuals may not
be able to tolerate alcohol-containing mouthrinses
for a variety of reasons, so there are choices
available to be recommended to our patients.
CPC has shown to besafe. In a mouthwash, it binds
to the surface of the germs and causes them to
burst, which helps reduce their build up on the
teeth4.
Triclosan is an antibacterial agent used in
mouthwash. It is a polychloro phenoxy phenol and
an agent that is eective in reducing and controlling
bacterial growth. Triclosan (2,4,4’-trichloro-
2’hydroxydiphenyl ether) is used to increase the
ability of mouthwash to bind to the oral mucosa
and thus be available for longer periods of time.
This organic compound is a white powdered
solid with a slight aromatic and phenolic odor.
It is a chlorinated aromatic compound that has
functional groups representative of both ethers
and phenols. Phenols often show antibacterial
properties5.
Based on the above information, therefore
the writer was interested to do this research on
comparison between Cetylpyridinium Chloride
and Triclosan Mouthwash on Plaque on students
of SMA Pasundan 8, Bandung. We encouraged
all SMA Pasundan 8 school student who was
undergoing treatment in RSGM. Since there was
limited dental services around the school area, we
encouraged to boost the level of awareness of oral
hygiene to the students of SMA Pasundan 8. Aim
of this research is to comparison eectiveness of
mouthwash containing cetylpyridinium chloride
and mouthwash containing triclosan on plaque.
METHODS
The type of research was experimental,
with the double blinded parallel design. A total
of 30 students of SMA Pasundan 8 were chosen.
The criteria of the volunteers are as follows: male
or female, in good general health, free from any
medication, does not wear any orthodontic or
prosthodontic appliance, willing to be a subject
of research (informed consent).
Clinical examination was conducted to
obtain the plaque score using the Quigley Hein
Index (modied) 1970. Subjects were divided
into two groups. One group was given the
cetylpyridinium chloride mouthwash and the other
group was given triclosan mouthwash. Data were
then analysed using the ANOVA test. For this study
the plaque score is taken on the Ramfjord teeth.
RESULTS
From the table 2, it shows that all the re-
sults are signicant (Sig = 0.000) means there is
dierence in reducing plaque after using mouth-
Figure 1. Quigley-hein plaque index
Table 1. Scoring criteria for plaque index quigely hein index (modied) 1970
0No plaque
1Separate eck of plaqie (up to one mm) at the cervical margin of the tooth
2A thin continuous band of plaque wider than 1 mm but covering less than one0third of the crown of the tooth
3A band of plaque wider than one mm but covering less than one-third of the crown of the tooth
4Plaque covering at least one-third but less than two-thirds of the crown of the tooth
5Plaque covering two-thirds or more of the crown of the tooth
191
Comparison between cetylpyridinium chloride and triclosan mouthwash on plaque (Gurtej Singh Chinger et al.)
Table 2. Comparison test for the amount of plaque according to time for cetylpyridinium chloride and triclosan
Mouthwash Initial Check up – 3rd Initial Chek up- 7th 3rd Day-7th day
Mean di Sig Mean di Sign Mean Sig
Cetylpyridinium Chloride 0,059722 0.000 0,084028 0.000 0,052778 0.001
Triclosan 01.09 0.000 0,101389 0.000 0,053472 0.000
*The mean dierence is signicant at the 0.05 Level
Table 3. Comparison between cetylpyridinium chloride and triclosan mouthwash according to plaque scoring at initial check
up
Mouthwash Mean plaque
score
Std
deviation t-test Mean dierences Signicant
Cetylpyridinium Chloride 3.12 0.79 -2.16 -0.51 0.005
Triclosan 3.63 0.45
*The mean dierence is signicant at the 0.05 Level
Table 4 comparison between cetylpyridinium chloride and triclosan mouthwash according to plaque scoring at 3rd day
Mouthwash Mean plaque
score
Std
deviation t-test Mean dierences Signicant
Cetylpyridinium Chloride 2.27 0.52 -1.16 -0.27 -0.27
Triclosan 2.53 0.41
Table 5. comparison between cetylpyridinium chloride and triclosan mouthwash according to plaque scoring at 7th day
Mouthwash Mean plaque
score
Std
deviation t-test Mean dierences Signicant
Cetylpyridinium Chloride 1.51 0.31 -1.67 -0.26 0.105
Triclosan 1.77 0.52
Figures 2 graph shows the distribution of plaque
accumulation obtained for group cetylpyridinium chloride
Figures 3 graph shows the distribution plaque accumulation
obtained for triclosan
washcontaining
Cetylpyridinium Chloride and mouthwash
containing Triclosan. There is a signicant dier-
ence between the initial check up with the 3rd
day control and the 7th day controland also be-
tween the 3rd day control and the 7th day control
while using the cetylpyridinium chloride mouth-
wash and Triclosan mouthwash.
Results shows in table 5 that there is signif-
icant dierence between mouthwash which con-
tains Cetylpyridinium Chloride and Triclosan for
Initial Check up, but there is no signicant dier-
ence for 3rd day, and 7th day. (Table 3,4,5)
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Padjadjaran Journal of Dentistry. 2012;24(3):189-193.
DISCUSSION
The results of the research and statistical
calculation show that mouthwash containing
cetylpyridinium chloride and mouthwash
containing triclosan have the same eectiveness
against reducing plaque. During the 3rd day and
the 7th day control for cetylpyridium chloride and
triclosan, the result showed that the plaque has
reduced. There was a previous research done by
Karen BW to study the eects of a cetylpyridinium
chloride mouthwash on gingivitis and plaque.
The purpose of the following research was to
evaluate the eects of mouth rinse containing
0.07% high bioavailable cetylpyridinium chloride
on the development of gingivitis and plaque
versus a placebo control6. The research’s results
showed that one 124 subjects were evaluable
at Month 3 and 119 at Month 6. After 6 months,
subjects rinsing with the CPC rinse showed 15.4%
less gingival inammation, 33.3% less gingival
bleeding, and 15.8% less plaque relative to
the placebo group. All reductions were highly
statistically signicantly dierent (P< 0.01).
Results were similar at 3 months.
Besides that, for triclosan, a randomized
clinical evaluation of triclosan-containing
dentifrice and mouthwash association in the
control of plaque and gingivitis was carried out
by Villalpando KT (2010). The aim of this double-
blind study was to evaluate the clinical ecacy of
the association of triclosan-containing mouthwash
and dentifrice on biolm and gingivitis reduction.
Intragroup evaluation revealed a statistically
signicant reduction in Plaque Index for groups
that used triclosan). Intergroup analysis suggested
that only the group that used the association of
triclosan dentifrice and mouthwash (group TT)
demonstrated statistically reduced plaque index at
30 days, when compared to the control group (CC)
(P < .05). With regard to gingivitis reduction, no
dierence was observed between groups, although
the association presented a faster reduction in
bleeding levels. Only the association of triclosan
dentifrice and triclosan mouthwash statistically
reduced plaque index, when compared to the
control group. However, regarding the additional
benets to gingivitis control, more studies should
be done to conrm the results.
Another study was carried out by Wu X
(2001) on eect of a new triclosan-containing
mouthwash on oral infection. The objective was
to study the eect of a new Triclosan-containing
mouthwash--LIBO Anti-plaque mouthwash on oral
infection7. As the results, Triclosan mouthwash
was eective to decrease the plaque index (PLI)
and supragingival bleeding index (SBI). Triclosan
mouthwash has strongest anti-adhesion eect
among the three tested agents and has continuous
disinfecting eect and help control the formation
and adhesion of dental plaque.
Based on the previous research above,
it is proven that cetylpyridinium chloride and
triclosan are indeed an eective antiseptic
and antimicrobial. From the results of this
research, initial check up to 3rd day control, both
cetylpyridinium and triclosan mouthwash showed a
reduction of plaque. Futhermore, from the 3rd day
control to 7th day control, both cetylpyridinium
chloride and triclosan showed reduction of plaque
too. This research was only to see the eectiveness
of mouthwash containing cetylpyridinium chloride
and mouthwash containing triclosan towards
reducing plaque.
CONCLUSION
Mouthwash containing cetylpyridinium
chloride and mouthwash containing triclosan
is eective in reducing plaque. Both of the
mouthwash does not have clear dierence in their
eectiveness in reducing plaque.
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Comparison between cetylpyridinium chloride and triclosan mouthwash on plaque (Gurtej Singh Chinger et al.)
preventionmouthrinse.com. 2004.
6. Karen B 2005. Evaluation Cetylpyridinium
chloride mouth rinse on gingivitis and plaque;
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7. Wu X. Eect of a new triclosan-containing
mouth rinse on oral infection; Department of
Stomatology 2001;36(4):301-3.
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Article
Full-text available
The subgingival bacterial floras of naturally occurring gingivitis in adults and children were characterized and compared with the floras of other periodontal conditions previously studied. The composition of the gingivitis floras was found to be distinct from that of floras associated with health or with moderate, severe, or juvenile periodontitis. There were no major differences between the floras of naturally-occurring gingivitis and the floras of the human experimental gingivitis model. Data indicated that the flora of healthy sites within a mouth is influenced by the number of inflamed sites, which argues against independence of sites bacteriologically. Proportions of ten bacterial species increased in both gingivitis and periodontitis, as compared with health, in both adults and children. These species were found in both affected and unaffected sites of people with gingivitis. The numbers of five other cultivable species and the "large treponeme", which was not cultivated, increased in gingivitis and periodontitis of adults only. Significant differences in non-spirochetal floras between children and adults were not found, although they were in the experimental gingivitis model studied previously. Cultivable spirochetes did differ between children and adults. Children had fewer samples positive for spirochetes, and children's positive samples contained greater proportions of T. socranskii subsp. paredis. Some species that predominate in periodontitis, but which are absent from healthy gingivae, were found as a small percentage of the flora in gingivitis. This suggests that increased serum and blood in the gingival crevice encourage species that relate to periodontitis.
Article
To study the effect of a new Triclosan-containing mouthrinse--LIBO Anti-plaque mouth rinse on oral infection. 1. Before and after the use of triclosan mouthrinse: the gingival data were checked and secorded; plaque sausples were collected, cultured in selective and non-selective media, bacteria were isolated, sounted, and compased. 2. With Streptococcus mutans and P. Gingivalis as experimental bacteria, triclosan and chlorhexidine (CHX) mouthrinses anti-bacterium substance, the minimum inhibitory concentrations (MICs) of the two rinses were compared. 3. Smooth plates with the film of Streptococcus mutans C were set in different mouthrinses and water. Observing the exfoliation of bacteria film from the plates in three agents. 1. Triclosan mouthrinse was effective to decrease the plaque index (PLI) and supragingival bleeding index (SBI). 2. The bacteria count obtained after use of triclosan mouthrinse was lower than that before using it. 3. The minimum inhibitory concentrations of triclosan mouthrinse against Streptococcus mutans C was much lower than that of chlorhexidine mouthrinse. 4. In triclosan mouthrinse, the bacterial films were most easily exfoliated from the plate. Triclosan mouthrinse has strongest anti-adhesion effect among the three tested agents. Triclosan mouthrinse has continuous disinfecting effect and help control the formation and adhesion of dental plaque.
Clinical Practice of dental Hygine
  • E Wilkins
Wilkins E M. Clinical Practice of dental Hygine. 8 th edition Philadelphia: Lippincott Williams & Wilkins. 1999. p. 267-4.
  • F A Carranza
  • M G Newman
  • H H Takei
Carranza, F.A.; Newman, M.G.; Takei, H.H.2002. Clinical Periodontology. 9th
The Effective of Mouth Rinces
  • J A Douglas
Douglas JA. The Effective of Mouth Rinces. Available from:http://www.