New evidence reaffirms the role of mouthwash in gum health
Johnson & Johnson Ltd., the makers of Listerine, are committed to supporting dental professionals in their efforts to help patients achieve and maintain gum health.
Also committed to supporting evidence-based practice, Johnson & Johnson Ltd. were pleased to see that an updated evidence base reaffirms the role of an antibacterial mouthwash in specific circumstances as an adjunct to mechanical cleaning (Figuero E et al, 2019)
The current situation
Severe periodontitis is the 6th most prevalent health condition globally, affecting 11% of the population (Marcenes W et al, 2013). In the UK, according to the Adult Dental Health Survey (2009), 83% of dentate adults showed some evidence of periodontal disease.
That is bleeding, calculus, periodontal pocketing of 4mm or more, and in the case of adults aged 55 or over, loss of periodontal attachment of 4mm or more anywhere in their mouth. (Adult Dental Health Survey 2009).
With gingivitis and periodontitis a continuum of the same inflammatory disease (Kinane DF, Attström R, 2005) it has been established that mechanical cleaning – brushing and interdental cleaning – is considered the first line in the management of plaque and, hence, the prevention of periodontal disease (Sharma N et al, 2004).
However, while mechanical cleaning dislodges the plaque bacteria that contribute to periodontal disease,5 data suggests that, for a number of reasons, this is not enough for the majority of patients to maintain good levels of oral health (Boyle et al, 2014).
Updated evidence base
Figuero and colleagues (2019) conducted a systematic review and meta-analysis exploring the adjunctive use of 11 different mouth rinse formulations.
They concluded that adjunctive antiseptics in mouthwash provide statistically significant reductions in plaque compared to controls at six months.
They also came to the conclusion that, ‘… despite the high variability in the number of studies comparing each active agent and the different risks of bias, CHX [chlorhexidine] and EOs [essential oils], in mouthrinses appeared to be the most effective active agents for plaque … control.’
In addition, the Figuero and colleagues’ (2019) outcomes add to the pre-existing evidence base presented by Araujo and colleagues (2015), which was the first meta-analysis to demonstrate the clinically significant, site-specific benefit of adjunctive essential oil mouthwash in people within a 6-month period (that is, between dental visits).7
The analysis revealed that 36.9% of subjects using mechanical methods with essential oil-containing mouthwash experienced at least 50% plaque-free sites after 6 months, compared to just 5.5% of patients using mechanical methods alone (Araujo M W B et al, 2015).
Bridging the gap
Johnson & Johnson Ltd. have two products in its Listerine range that to help support patients’ gum health – Listerine Total Care and Advance Defence Gum Treatment.
It has been demonstrated that when used as an adjunct to mechanical cleaning, Listerine Total Care, an essential oil mouthwash, manages plaque levels, to help prevent gingivitis.
Listerine Total Care may therefore support the efforts of a patient requiring early intervention, by virtue of its essential oil formulation consisting of eucalyptol, thymol, menthol and methyl salicylate, all of which are proven to:
- Penetrate the plaque biofilm (Pan et al, 2000)
- Manage the bacterial load of the mouth (Minah et al, 1989)
- Additionally, reduce maturation of remaining biofilm colonies (Johnson & Johnson).
Listerine Advanced Defence Gum Treatment is a twice-daily mouthwash clinically proven to treat gingivitis as an adjunct to mechanical cleaning.11
It is formulated with unique LAE (Ethyl Lauroyl Arginate) technology that forms a physical coating on the pellicle to prevent bacteria attaching, and so interrupts biofilm formation. As a result, when used after brushing, it helps to treat gingivitis as demonstrated by the reduction of bleeding by 50.9% (p<0.001) in just 4 weeks (Gallob JT et al, 2015).
With Listerine Advanced Defence Gum Treatment clinically proven to interrupt the plaque colonisation process (Gallob JT et al, 2015), this may offer a viable option in terms of supporting patients’ gum health.
Through our range of mouthwashes, Johnson and Johnson Ltd. help dental teams work in partnership with patients, with specific products designed to improve home care routine outcomes significantly, which help to support the prevention or management of periodontal disease when used in conjunction with mechanical cleaning.
For more information visit www.listerineprofessional.co.uk
Figuero E et al (2019)Efficacy of adjunctive therapies in patients with gingival inflammation. A
systematic review and meta-analysis. https://doi.org/10.1111/jcpe.13244.
Marcenes W et al (2013) Global burden of oral conditions in 1990-2010: a systematic analysis. Journal of Dental Research 2013; 92(7): 592-597
Adult Dental Health Survey (2009) The Health and Social Care Information Centre 2011
Kinane DF, Attström R (2005) Advances in the pathogenesis of periodontitis. Group B consensus report of the fifth European Workshop in Periodontology. J Clin Periodontol 2005; 32(Suppl. 6): 130-1
Sharma N et al (2004) Adjunctive benefit of essential oil-containing mouthrinse in reducing plaque and gingivitis in patients who brush and floss regularly: a six-month study. J Am Dent Assoc 135: 496-504
Boyle et al (2014) Mouthwash use and the prevention of plaque, gingivitis and caries. Head & Neck Oral Diseases 20(1): 1-76
Araujo M W B et al (2015) Meta-analysis of the effect of an essential oil-containing mouthrinse on gingivitis and plaque. JADA 146: 610-622
Pan et al (2000) Determination of the in situ bactericidal activity of an essential oil mouthrinse using a vital stain method. J Clin Periodontol 27: 256-261
Minah et al (1989) Effects of 6 months use of an antiseptic mouthrinse on supragingival dental plaque microflora. J Clin Periodontol. 16: 347-352
Johnson & Johnson. Data on file (2)
Gallob JT et al (2015) A randomized trial of ethyl lauroyl arginate-containing mouthrinse in the control of gingivitis. J Clin Periodontol 42: 740-747