LLUSD Biomaterials Research Center faculty research
An In-Vitro Study Comparing the Effectiveness of Alcohol and Non-Alcohol Containing Mouthrinses
Joni Ehrler Stephens, RDH, MS, EdS
February 1997
Literature
review
Purpose
Materials
and methods
Color
palate
Results and
conclusions
Most over the counter mouthrinses contain alcohol in concentrations ranging from 5-27%. Ciuffreda L, Boylan R, Scherer W, et al.:An in vitro comparison of the antimicrobial activities of four commercial mouthwashes. J Clin Dent 1994; 5(4):103-5.
Alcohol levels higher than 70% or lower than 50% lose germicidal effectiveness. Otomo-Corgel J:Over the counter and prescription mouthrinses-An update for the 1990's. Compend Cont Educ Dent 1992;13:1086-95.
Oral pain, in healthy tissue, is directly related to the alcohol concentration contained in the mouthrinse. Small levels of alcohol (<10%) do not generally produce substantial painful sensations. Bolanowski SJ, Gescheider GA, Sutton SVW: Relationship between oral pain and ethanol concentration in mouthrinses. J Periodont Res 1995;192-197.
In a study performed on individuals with healthy gingiva, using high concentrations of alcohol (>70%) produced ulceration, inflammation and epithelial sloughing of the oral mucosa. Compend Cont Educ Dent 1992
In mouthrinses, some of the uses of alcohol are thought to include: antimicrobial effects providing the soluble vehicle to distribute the active ingredient improve shelf-life of the products. Several studies have also noted prolonged exposure to alcohol-containing mouthrinses increases the onset of oral cancers.
Clinical concerns with the use of alcohol in mouthrinses:
- families with children
- head and neck radiation therapy patients
- individual experiencing xerostomia
- recovering alcoholics
Head and neck radiation patients are the most "at risk" for negative side effects caused by alcohol. Cacchillo D, Barker G, Barker B: Late effects of head and neck radiation therapy and patient/dentist compliance with recommended dental care. Special Care in Dentistry 1993; 13(4);159-162.
Head and neck radiation is known to cause xerostomia, ulcerating mucositis, as well as damaging tissues resulting in extreme sensitivity in these areas. Special Care in Dentistry 1993; 13(4);159-162.
The burning effects of alcohol multiply and intensify these symptoms, causing the patient to avoid using the recommended product, resulting in increased rampant dental caries and possible secondary infections. Special Care in Dentistry 1993; 13(4);159-162.
The concept of alcohol-free mouthrinses is relatively new. These products can
provide all of the benefits without the adverse effects of alcohol to the
consumer.
The purpose of this study is to determine and compare the effectiveness of alcohol containing and non-alcohol containing mouthrinses.
Alcohol containing mouthrinses:
- Chlorhexidine gluconate 0.12% (11.6%)
- Ethyl alcohol and essentials oils (26.9%)
- Cetylpyridinium chloride (19%)
- Hydrogen peroxide (2.6%)
Non-alcohol containing mouthrinses:
- Chlorhexidine gluconate 0.12%
- Chlorine dioxide
- Methylparaben
- Sodium laurel sulfate
Bacteria
- Streptococcus mutans
- Actinobacillus actinomycetemcomitans
- Porphyromonas gingivalis
The bacteria were prepared 24 hours before the inoculation in the appropriate nutrient broth for each bacteria. Standardization - OD = 0.11 @ 570nm
One hundred microliter (0.1mL) of each of the inoculum was spread evenly using a sterile glass rod, S. mutans onto a blood agar plate and both Aa and Pg onto Brucella plates.
Four sterile filter paper discs, 6mm in diameter were evenly spaced on the inoculated plates, using sterile cotton pliers. Twenty microliter (0.02mL) of one mouthrinse was pipetted onto all four sterile discs. This procedure was performed separately for each of the eight mouthrinses.
Blood agar plates were incubated in a 37° C walk-in incubator for 24 hours. Brucella plates were incubated in anaerobic environment in the same incubator for 48 hours.
Three consecutive trials were performed to insure accuracy and
validity.
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 Fig 1 |
 Fig 2 |
An ANOVA and a multicomparison statistical test were performed to test for differences in the effectiveness of the eight mouthrinses.
This study was performed to show overall inhibition of the microbial growth when products are used against S. mutans, Aa, and Pg. These products claim to kill numerous microorganisms; however, this study focused primarily on cariogenic and periodontal pathogens.
Two alcohol and two non-alcohol mouthrinses inhibited S. mutans with the two chlorhexidine products demonstrating the largest zones of inhibition. None of the mouthrinses were effective against Aa Three of the alcohol and three of the non-alcohol mouthrinses were effective against P. gingivalis, again with the CHX products being the most effective.
From these results, it appears that non-alcohol containing mouthrinses are as
effective in inhibiting the growth of bacteria causing periodontal disease and
caries as mouthrinses containing alcohol.