ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title CHX Mouthwash is More Effective in Plaque Removal Than an Essential Oil or Listerine Mouthwash
Clinical Question In adults (ages 18-60) is an essential oil (Listerine) or CHX mouthwash more effective in plaque removal?
Clinical Bottom Line CHX mouthwashes are more effective in plaque removal than essential oil or Listerine mouthwashes, but whether the difference in efficacy is large enough to alter treatment from one wash to the other is still disputed.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 12787197Santos/2003Adults from 9 RCTsSystematic Review
Key resultsBoth CHX and EO mouthwashes are effective at reducing plaque, though CHX may have slightly higher plaque reduction percentages. Chlorhexidine mouthwashes (ranging from 0.1-0.12% CHX) had a range of 16-45% plaque reduction, while Listerine reduced plaque 22-36%. Santos concludes that both agents display efficacy over six months and are viable supplements to reduce plaque in hard to reach areas.
#2) 17138709Gunsolley/2006Adults from 14 clinical trialsSystematic Review
Key resultsStudies of essential oils was the largest group of studies supporting mouthwash efficacy, as measured in anti-gingivitis and anti-plaque parameters. A smaller subset of studies displayed the strong anti-plaque effects of a 0.12% CHX mouthwash. Gunsolley asserts that multiple agents can be used effectively to reduce plaque as part of a daily oral hygiene regiment.
#3) 21043801Van Leeuwen/2011Adults from 17 RCTsSystematic Review-meta-analysis
Key resultsA meta-analysis of studies over 4 weeks long showed a statistically significant (P=0.0009) result that CHX mouthwash provided better plaque control than EO. Van Leeuwen suggests that EO mouthwashes may be a viable alternative to chlorhexidine mouthwashes with regards to gingival inflammation but not with regard to plaque.
Evidence Search “EO or Listerine, CHX mouthwashes” Filters: “Humans” “Full Text Available” “Randomized Controlled Trial, Systematic Review or Meta-Analysis” “English”
Comments on
The Evidence
These reviews generally focused on the anti-gingivitis and the anti-plaque effects of mouthwashes, but the anti-plaque effects presented in each article can be reviewed individually. Also note, the Gunsolley JADA review was partially supported by a grant from Pfizer, Morris Plains, N.J (manufactures Listerine).
Applicability A CHX mouthwash may produce slightly better results at reducing plaque than Listerine, but an EO or Listerine mouthwash is still effective in removing plaque when compared to no intervention. If plaque control is your only concern you may prefer a CHX mouthwash, but if you want a reduction in plaque and gingivitis control Listerine may be the best choice.
Specialty/Discipline (General Dentistry) (Periodontics)
Keywords CHX mouthwash, Listerine, EO mouthwash, plaque
ID# 2508
Date of submission: 07/22/2013spacer
E-mail devincen@ohsu.edu. 
Author Caroline DeVincenzi
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Ronald Sakaguchi, DDS, MS, PhD, MBA & Eli Schwarz, DDS, MPH, PhD
Faculty mentor/Co-author e-mail sakaguch@ohsu.edu, schwarz@ohsu.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
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