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JOURNAL LIBRARY: PROOF BEHIND OUR PRODUCTS.

Peer reviewed and evidence-based scientific information at your fingertips

The following is a list of scientific information related to oral health including current guidelines, reduction of plaque and gingivitis, antimicrobial activity of mouthrinses accepted by the American Dental Association® (ADA), and more. So it's easy to know the latest data when recommending our products to your patients.

Plaque and gingivitis reduction

Increasing antiplaque/antigingivitis efficacy of an essential oil mouthrinse over time: an in vivo study

Christine A. Charles, RDH, BS n J.A. McGuire, MS n James Qaqish, BS n Pejmon Amini, DDS

Objective

To determine the the efficacy of an essential oils-containing (EO) antiseptic mouthrinse (in conjunction with toothbrushing) in reducing and/or controlling existing plaque or gingivitis over 6 months.

Methods

In this randomized, observer blind, parallel, controlled 6-month trial, 139 healthy adults with mild to moderate plaque and gingivitis were randomized into essential Oil (EO) or control (C) groups. All subjects received oral/written instructions, monthly monitoring, and assigned unsupervised rinses. Efficacy variables were whole-mouth mean Modified Gingival Index (MGI), Turesky modification of the Quigley Hein plaque index (PI), and bleeding index (BI) at 6, 12 and 24 weeks. Data analysis utilized an analysis of covariance (ANCOVA) model.

Results

The EO group provided greater and increasing MGI, PI, and BI reductions than did C group over all examination periods. Compared to the C group, at 6, 12, and 24 weeks, MGI reductions for the EO group were 4.7%, 9.1%, and 20.4%, and PI reductions were 7.6%, 12.6%, and 26.3%, respectively. BI scores decreased over time and were significant compared to those for the C group (P < 0.001). Additionally, the percentages of sites improved versus baseline MGI over time for EO were 14.1%, 26.4%, and 43.3%, respectively.

Conclusion

This study confirmed that an antiseptic EO rinse can provide a clinically significant benefit in reducing existing plaque and gingivitis. This study demonstrated that an EO-containing mouthrinse can provide an increasing benefit over a period of 6 months with twice daily use.

REFERENCE 1.Charles CA, McGuire JA, Qaqish J, Amini P. Increasing antiplaque/antigingivitis efficacy of an essential oil mouthrinse over time: an in vivo study. Gen Dent 2013:61(1):23-28.

Managing the complexity of a dynamic biofilm

Thomas JG, Nakaishi LA. (2006)

Although biofilms cannot be eliminated, the pathogenic nature of plaque biofilm can be diminished by maintaining a normal oral flora through oral hygiene procedures that include daily toothbrushing, flossing, and rinsing with an antimicrobial mouthrinse.

Thomas JG, Nakaishi LA. (2006)

MANAGING THE COMPLEXITY OF A DYNAMIC BIOFILM1

Background

This article provides an overview of the history of oral microbiology, a discussion of dental plaque as both microbial community and a biofilm, and a review of the measures available to control the oral microflora.

Methods

The authors reviewed the literature related to oral microbiology and associated infectious diseases. They also examined articles that detailed the structure and physiology of biofilms, including dental plaque biofilms.

Results

Biofilms cannot be eliminated. The pathogenic nature of the dental plaque biofilm can be diminished in the oral cavity by reducing the bioburden and effectively maintaining a normal oral flora via oral hygiene procedures that include daily toothbrushing, flossing, and rinsing with an antimicrobial mouthrinse. An oral hygiene regimen that includes rinsing with an antimicrobial mouthrinse is a practical approach to the prevention and management of periodontal diseases. This strategy may have wider benefits when the link between periodontal disease and certain systemic diseases is considered.

Conclusion

An effective oral hygiene regimen can help control dental plaque biofilm and associated periodontal diseases.

REFERENCE 1.Thomas JG, Nakaishi LA. Managing the complexity of a dynamic biofilm. J Am Dent Assoc. 2006;137(suppl 3):10S-15S.


The Rationale for the Daily Use of an Antimicrobial Mouthrinse

Barnett ML (2006)

In this review article, the author finds that incorporating effective antimicrobial mouthrinses into a daily oral hygiene regimen to control plaque biofilm is well-supported by scientific rationale. The two key aspects were the essential role of adequate plaque control in the prevention of periodontal diseases and findings that antimicrobial activity can have a significant impact on supra- and subgingival bacterial colonization of teeth. A review of 12 published 6-month plaque/gingivitis clinical trials
—7 of which studied LISTERINE® Antiseptic essential oil-containing mouthrinses—is included.

Barnett ML (2006)

THE RATIONALE FOR THE DAILY USE OF AN ANTIMICROBIAL MOUTHRINSE1

Objective

This article reviews the rationale for incorporating effective antimicrobial mouthrinses into a daily oral hygiene regimen along with mechanical plaque control methods.

Methods

The author reviewed studies demonstrating the essential etiologic role of a pathogenic dental plaque biofilm in the development of gingivitis, as well as studies indicating that most people fail to maintain a level of mechanical plaque control sufficient to prevent disease. In addition, he did a brief review of studies of oral microbial ecology that identified the oral mucosal tissues as a reservoir of bacteria that colonize tooth surfaces, and he summarized 6-month clinical studies of marketed antimicrobial mouthrinse ingredients and products.

Results

There is a twofold rationale for daily use of antimicrobial mouthrinses: first, given the inadequacy of mechanical plaque control by the majority of people, as a component added to oral hygiene regimens for the control and prevention of periodontal diseases; second, as a method of delivering antimicrobial agents to mucosal sites throughout the mouth that harbor pathogenic bacteria capable of recolonizing supragingival and subgingival tooth surfaces, thereby providing a complementary mechanism of plaque control. The efficacy of several mouthrinse ingredients and products is supported by published 6-month clinical trials.

Conclusion

The daily use of an effective antiplaque/antigingivitis antimicrobial mouthrinse is well-supported by a scientific rationale and can be a valuable component of oral hygiene regimens.

REFERENCE 1. Barnett ML. The rationale for the daily use of an antimicrobial mouthrinse. J Am Dent Assoc. 2006;137(suppl 3):16S-21S.


Adjunctive Benefit of an Essential Oil-Containing Mouthrinse in Reducing Plaque and Gingivitis in Patients Who Brush and Floss Regularly: A Six-Month Study

Sharma N, Charles CH, Lynch MC, et al. (2004)

This long-term study showed that even for those who brush and floss, the addition of LISTERINE® Antiseptic provides a 52% greater plaque reduction and a 21% greater gingivitis reduction versus brushing and flossing alone.

Sharma N, Charles CH, Lynch MC, et al. (2004)

ADJUNCTIVE BENEFIT OF AN ESSENTIAL OIL-CONTAINING MOUTHRINSE IN REDUCING PLAQUE AND GINGIVITIS IN PATIENTS WHO BRUSH AND FLOSS REGULARLY: A SIX-MONTH STUDY1

Objective

To determine the incremental benefit of the adjunctive use of LISTERINE® Antiseptic in reducing plaque and gingivitis in patients who brush and floss regularly.

Methods

In this randomized, controlled 6-month trial, 246 subjects with gingivitis were randomly assigned to one of three treatment groups: brushing/control mouthrinse; brushing/flossing/control (BFC) mouthrinse; or brushing/flossing/rinsing with LISTERINE® Antiseptic (BFL). All subjects were instructed to brush thoroughly twice daily and received toothbrushes and dentifrices as needed. Subjects' dental hygiene procedures were not supervised, but subjects in the BFC and BFL groups had to demonstrate proper flossing technique before participating in the study. Subjects were asked not to use oral care products other than those provided for the study. Patients were evaluated for plaque and gingivitis at baseline, 3 months, and 6 months and using the modified gingival index (MGI), Turesky plaque index (PI), and bleeding index (BI).

Results

After 6 months, patients in the brushing/flossing/LISTERINE® Antiseptic group had a 29.9% additional reduction in whole-mouth MGI scores and a 56.3% additional reduction in whole-mouth PI scores vs patients in the brushing/control rinse group (p<0.001). Patients in the brushing/flossing/LISTERINE® Antiseptic group, had a 21% additional reduction in whole-mouth MGI scores and a 51.9% additional reduction in whole-mouth PI scores vs patients in the brushing/flossing/control rinse group (p<0.001).

Conclusion

This long–term study demonstrates that the adjunctive use of an "essential oil" EO–containing mouthrinse twice daily provides a meaningful and clinically significant incremental benefit to a recommended regimen of brushing twice daily and flossing once daily.

REFERENCE 1. Sharma N, Charles CH, Lynch MC, et al. Adjunctive benefit of an essential oil-containing mouthrinse in reducing plaque and gingivitis in patients who brush and floss regularly: a six-month study. J Am Dent Assoc. 2004;135(4):496-504.


Comparative Effects of 2 Chemotherapeutic Mouthrinses on the Development of Supragingival Dental Plaque and Gingivitis

Overholser CD, Meiller TF, DePaola LG, Minah GE, Niehaus C. (1990)

The objective was to determine the efficacy and safety of LISTERINE® Antiseptic and Peridex in helping to control supragingival plaque and gingivitis when used as an adjunct to normal oral hygiene routine and regular professional care.

Overholser CD, Meiller TF, DePaola LG, Minah GE, Niehaus C. (1990)

COMPARATIVE EFFECTS OF 2 CHEMOTHERAPEUTIC MOUTHRINSES ON THE DEVELOPMENT OF SUPRAGINGIVAL DENTAL PLAQUE AND GINGIVITIS1

Objective

To determine the efficacy and safety of LISTERINE® Antiseptic and Peridex in helping to control supragingival plaque and gingivitis when used as an adjunct to normal oral hygiene routine and regular professional care.

Methods

This was a 6-month, randomized, double-blind, supervised, controlled clinical study in which 124 adult subjects received a professional dental prophylaxis and then rinsed for 30 seconds twice a day for 6 months with 20 mL of either LISTERINE® Antiseptic, Peridex, or a 5% hydroalcohol control rinse in addition to their normal oral routine. Subjects were provided with a soft nylon toothbrush and fluoride toothpaste and were asked not to use any other mouthrinses during the study. At baseline and at 3 and 6 months, subjects were evaluated for gingivitis, supragingival plaque, extrinsic tooth stain, and supragingival calculus formation.

Results

At 6 months, LISTERINE® Antiseptic produced a 36.1% inhibition of supragingival plaque development and a 35.9% inhibition of gingivitis development compared with the control group. Peridex provided a 50.3% reduction for plaque and 30.5% reduction for gingivitis compared to the control. There were no significant increases in either extrinsic tooth stain or supragingival calculus compared to baseline scores in either the LISTERINE® Antiseptic or the control group.

LISTERINE® Antiseptic Results

LISTERINE® Antiseptic Results(Inhibition vs control at 6 months)

LISTERINE® Antiseptic Results(Mean scores at 6 months)

REFERENCE 1. Overholser CD, Meiller TF, DePaola LG, Minah GE, Niehaus C. Comparative effects of 2 chemotherapeutic mouthrinses on the development of supragingival dental plaque and gingivitis. J Clin Periodontol. 1990;17(8):575-579.


Chemotherapeutic Inhibition of Supragingival Dental Plaque and Gingivitis Development

DePaola LG, Overholser CD, Meiller TF, Minah GE, Niehaus C. (1989)

At 6 months, LISTERINE® Antiseptic, as an adjunct to regular oral hygiene, significantly inhibited the development of both plaque and gingivitis by 34% compared with the control rinse. There was no increase in extrinsic tooth staining.

DePaola LG, Overholser CD, Meiller TF, Minah GE, Niehaus C. (1989)

CHEMOTHERAPEUTIC INHIBITION OF SUPRAGINGIVAL DENTAL PLAQUE AND GINGIVITIS DEVELOPMENT1

Objective

To determine the long–term efficacy of rinsing with LISTERINE® Antiseptic as a supplement to regular oral hygiene in inhibiting the buildup of plaque and gingivitis.

Methods

This was a 6-month, randomized, double-blind, supervised, controlled clinical trial in which 107 adult subjects received a dental prophylaxis and then rinsed for 30 seconds twice a day for 6 months with 20 mL of either LISTERINE® Antiseptic or a 5% hydroalcohol control rinse in addition to their usual oral routine. Soft nylon toothbrushes and fluoride dentifrices were supplied to all subjects throughout the study. Subjects were asked not to use any mouthrinses that were not provided for the study. At baseline and at 3 and 6 months, subjects received an oral soft–tissue examination and were evaluated for plaque levels, gingivitis, and extrinsic tooth stain.

Results

At 6 months, LISTERINE® Antiseptic, as an adjunct to regular oral hygiene, significantly inhibited the development of both plaque and gingivitis by 34% compared with the control rinse. There was no increase in extrinsic tooth staining.

DePaola Chart(Inhibiton vs control at 6 monts)

DePaola Chart(Mean scores at 6 months)

REFERENCE 1. DePaola LG, Overholser CD, Meiller TF, Minah GE, Niehaus C. Chemotherapeutic inhibition of supragingival dental plaque and gingivitis development. J Clin Periodontol. 1989;16(5):311-315.


Comparative Efficacy of an Antiseptic Mouthrinse and an Antiplaque/Antigingivitis Dentifrice: A Six-Month Clinical Trial

Charles CH, Sharma NC, Galustians HJ, Qaqish J, McGuire JA, Vincent JW. (2001)

This study showed that the LISTERINE® Antiseptic regimen was significantly more effective in reducing the bleeding index (p=0.033) and the plaque index (p< 0.001) than the Colgate® regimen, with no difference in reducing the gingivitis index.

Charles CH, Sharma NC, Galustians HJ, Qaqish J, McGuire JA, Vincent JW. (2001)

COMPARATIVE EFFICACY OF AN ANTISEPTIC MOUTHRINSE AND AN ANTIPLAQUE/ANTIGINGIVITIS DENTIFRICE: A SIX-MONTH CLINICAL TRIAL1

Objective

To determine the comparative efficacy of LISTERINE® Antiseptic and Colgate Total®, an antiplaque/antigingivitis dentifrice.

Methods

In this 6-month, randomized, unsupervised, controlled clinical trial, 316 subjects with mild–to–moderate gingival inflammation and plaque received a dental prophylaxis and were assigned to one of the following regimens: control (fluoride) toothpaste/LISTERINE® Antiseptic: Colgate Total®/control (inactive) rinse; or a control regimen (fluoride toothpaste/inactive rinse). Subjects were instructed not to use any other mouthrinses or dentifrices during the study. At baseline, 3 months, and 6 months, the examiner performed an intraoral exam, scoring for modified gingival index, bleeding index, and plaque index.

Results

Both active regimens demonstrated significantly greater reductions vs the control regimen in all three measured parameters (p<0.001). The LISTERINE® Antiseptic regimen was no different than the Colgate® regimen in reducing the gingivitis index but was significantly more effective in reducing the bleeding index (p=0.033) and the plaque index (p<0.001). However, the magnitude of the difference in the bleeding index was small. While the active treatment groups produced similar reductions in gingivitis, LISTERINE® Antiseptic provided greater benefit in inhibiting plaque formation when used with a fluoride dentifrice.

Charles Chart(Reductions vs control regimen at 6 months)

REFERENCE 1. Charles CH, Sharma NC, Galustians HJ, Qaqish J, McGuire JA, Vincent JW. Comparative efficacy of an antiseptic mouthrinse and an antiplaque/antigingivitis dentifrice: a six-month clinical trial. J Am Dent Assoc. 2001;132(5):670-675.


Efficacy of LISTERINE® Antiseptic in Inhibiting the Development of Plaque and Gingivitis

Gordon JM, Lamster IB, Seiger MC. (1985)

The LISTERINE® Antiseptic group had significantly lower plaque scores and gingivitis was reduced significantly (by 22.1%) compared with the vehicle control group at the conclusion of the 9-month study.

Gordon JM, Lamster IB, Seiger MC. (1985)

EFFICACY OF LISTERINE® ANTISEPTIC IN INHIBITING THE DEVELOPMENT OF PLAQUE AND GINGIVITIS1

Objective

To determine the efficacy of LISTERINE® Antiseptic in inhibiting the development of plaque and gingivitis.

Methods

This was a 9-month, randomized, double-blind, controlled clinical trial in which 85 adult subjects completed all phases of the study. Subjects received 3 complete professional dental prophylaxes at weekly intervals and an additional rubber-cup polishing at the outset of the study to maximize initial gingival health and reduce plaque to zero. Subjects rinsed with 20 ml of LISTERINE® Antiseptic, a vehicle control, or a water control for 30 seconds twice daily, in addition to their usual oral hygiene. During the first 6 months, rinsing was supervised on weekdays; rinsing was unsupervised during the final 3 months. Subjects were periodically given a non-therapeutic, low-abrasive dentifrice and soft nylon toothbrushes, and were asked not to use any mouthrinses that were not provided for the study.

Results

LISTERINE® Antiseptic group had significantly lower plaque scores than in the vehicle control group by 18.6% and 13.8%, respectively, at 6 and 9 months. Although there was virtually no change in gingivitis in the control group over the 9-month period following the multiple prophylaxes, gingivitis in the LISTERINE® Antiseptic group was reduced significantly by 22.1% compared with the vehicle control group at the conclusion of the 9-month study.

Gordon Chart

REFERENCE 1. Gordon JM, Lamster IB, Seiger MC. Efficacy of Listerine antiseptic in inhibiting the development of plaque and gingivitis. J Clin Periodontol. 1985;12(8):697-704.


Comparative Antiplaque and Antigingivitis Effectiveness of a Chlorhexidine and an Essential Oil Mouthrinse: 6-Month Clinical Trial

Charles CH, Mostler KM, Bartels LL, Mankodi SM. (2004)

The results show that, at 6 months, LISTERINE® Antiseptic and Peridex® had comparable antiplaque and antigingivitis activity. Also, importantly, subjects receiving Peridex® had significantly more extrinsic tooth stain and calculus formation than subjects receiving LISTERINE® Antiseptic.

Charles CH, Mostler KM, Bartels LL, Mankodi SM. (2004)

COMPARATIVE ANTIPLAQUE AND ANTIGINGIVITIS EFFECTIVENESS OF A CHLORHEXIDINE AND AN ESSENTIAL OIL MOUTHRINSE: 6-MONTH CLINICAL TRIAL1

Objective

To compare the antiplaque and antigingivitis effectiveness and the side-effect profiles of LISTERINE® Antiseptic and Peridex®.

Methods

One hundred eight subjects aged 20-57 years were randomized into 3 groups: LISTERINE® Antiseptic, Peridex® (0.12% chlorhexidine), or a 5% hydroalcohol negative control. Subjects were examined and scored at baseline using the Loe-Silness Gingival Index, Turesky modification of Quigley-Hein Plaque Index, Volpe-Manhold Calculus Index, and the Lobene Extrinsic Tooth Stain Index. Following a dental prophylaxis, subjects rinsed twice daily (supervised once daily on weekdays) in addition to their usual mechanical oral routine. Subjects were given soft nylon toothbrushes and fluoride toothpaste. They were asked not to use any mouthrinses that were not provided for the study. The treatment groups were reevaluated at 3 and 6 months.

Results

At 6 months, LISTERINE® Antiseptic and Peridex® had comparable antiplaque and antigingivitis activity. Importantly, subjects receiving Peridex® had significantly more extrinsic tooth stain and calculus formation than subjects receiving LISTERINE® Antiseptic. While all differences were statistically significant vs control (p<0.001), the reductions in plaque and gingivitis with LISTERINE® Antiseptic and Peridex® were not significantly different from each other.

Charles Mostler Chart(Inhibition vs control at 6 months)

REFERENCE 1. Charles CH, Mostler KM, Bartels LL, Mankodi SM. Comparative antiplaque and antigingivitis effectiveness of chlorahexadine and essential oil mouthrinse: a six-month clinical trial. J Clin Periodontol. 2004;31(10):878-884.


The Effect of LISTERINE® Antiseptic on Reduction of Existing Plaque and Gingivitis

Lamster IB, Alfano MC, Seiger MC, Gordon JM. (1983)

The LISTERINE® Antiseptic group had a 20.8% reduction in plaque scores and a 27.7% reduction in gingivitis scores compared with the vehicle control group at 6 months.

Lamster IB, Alfano MC, Seiger MC, Gordon JM. (1983)

THE EFFECT OF LISTERINE® ANTISEPTIC ON REDUCTION OF EXISTING PLAQUE AND GINGIVITIS1

Objective

To determine the efficacy of LISTERINE® Antiseptic as an adjunct to normal oral hygiene in reducing existing plaque and gingivitis over a 6-month period.

Methods

In this 6-month, randomized, double-blind, supervised, controlled clinical trial, all 129 subjects completing the trial had preexisting plaque scores >1.8 using the Turesky modification of the Quigley-Hein Index and pre-existing gingival index scores >2.0 using the noninvasive Modified Gingival Index. Subjects rinsed twice a day with 20 ml of either LISTERINE® Antiseptic or its vehicle control (26.9% hydroalcohol) in addition to their usual oral hygiene. Soft bristle toothbrushes and nonfluoridated, low-abrasive toothpaste were supplied. Use of dental floss was permitted. Subjects were asked not to use mouthrinses, other than those provided for the study, or oral hygiene devices. No dental prophylaxis was performed prior to treatment. Plaque, stain, gingivitis, and oral soft tissues were evaluated at baseline and at 1, 3, and 6 months.

Results

The LISTERINE® Antiseptic group had a 20.8% reduction in plaque scores and a 27.7% reduction in gingivitis scores compared with the vehicle control group at 6 months.

Lamster Chart1

Lamster Chart2

REFERENCE 1. Lamster IB, Alfano MC, Seiger MC, Gordon JM. The effect of Listerine Antiseptic on reduction of existing plaque and gingivitis. Clin Prev Dent. 1983;5(6):12-16.


The Effect of an Antiseptic Mouthrinse on Implant Maintenance: Plaque and Peri-implant Gingival Tissues

Ciancio SG, Lauciello F, Shibly O, Vitello M, Mather M. (1995)

The authors concluded that twice-daily rinsing with LISTERINE® Antiseptic, used as an adjunct to routine mechanical oral hygiene, is effective in reducing plaque and improving the gingival health of peri-implant tissues.

Ciancio SG, Lauciello F, Shibly O, Vitello M, Mather M. (1995)

THE EFFECT OF AN ANTISEPTIC MOUTHRINSE ON IMPLANT MAINTENANCE: PLAQUE AND PERI-IMPLANT GINGIVAL TISSUES1

Objective

To determine the effect of LISTERINE® Antiseptic on plaque at the gingival/implant interface and on peri-implant gingivitis, when used as an adjunct to mechanical oral hygiene routines.

Methods

In this 3-month, randomized, double-blind, parallel, unsupervised, controlled clinical study, 20 healthy adult patients with at least two dental implants, a modified gingival index >1.5, and a Quigley-Hein Plaque Index >1.7 were enrolled. Patients received an oral prophylaxis and were assigned to rinse unsupervised with 20 ml of either LISTERINE® Antiseptic or a 5% hydroalcohol control rinse for 30 seconds twice daily, in addition to their usual oral care routines. Patients were scored for the plaque index, gingival index, and bleeding index at baseline and at 1, 2, and 3 months.

Results

At 3 months, the LISTERINE® Antiseptic group had statistically significant reductions in plaque index, gingival index, and bleeding index compared to the control group. There were no adverse events reported. The authors concluded that twice-daily rinsing with LISTERINE® Antiseptic, used as an adjunct to routine mechanical oral hygiene, is effective in reducing plaque and improving the gingival health of peri-implant tissues.

Ciancio Chart(Reductions vs control rinse at 3 months)

REFERENCE 1. Ciancio SG, Lauciello F, Shibly O, Vitello M, Mather M. The effect of an antiseptic mouthrinse on implant maintenance: plaque and peri-implant gingival tissues. J Periodontol. 1995;66(11):962-965.


The Long-Term Effect of a Mouthrinse Containing Essential Oils on Dental Plaque and Gingivitis: A Systematic Review

Stoeken JE, Paraskevas S, van der Weijden GA. (2007)

This review of 11 different studies in which LISTERINE® Antiseptic was used as an adjunct to regular daily toothbrushing showed that it provides an additional benefit with regard to plaque and gingivitis reduction as compared to placebo or control.

Stoeken JE, Paraskevas S, van der Weijden GA. (2007)

THE LONG-TERM EFFECT OF A MOUTHRINSE CONTAINING ESSENTIAL OILS ON DENTAL PLAQUE AND GINGIVITIS: A SYSTEMATIC REVIEW1

Objective

To review the literature on the effects of a mouthrinse containing essential oils (LISTERINE® Antiseptic) on plaque and parameters of gingival inflammation.

Methods

The MEDLINE and Cochrane Central Register of Controlled Trials were searched up to and including December 2006 to identify appropriate studies. The primary outcome measure was gingivitis. Secondary parameters were plaque and, when reported, staining.

Results

Independent screening of titles and abstracts of 566 papers resulted in 11 publications that met the criteria of eligibility. In all studies, LISTERINE® Antiseptic was used as an adjunct to regular daily toothbrushing. A statistically significant reduction in overall gingivitis was noted compared to the control (weighted mean difference [WMD]: -0.32, 95% confidence interval [CI]: -0.46 to -0.19, P<0.00001; test for heterogeneity: P<0.00001, I2 = 96.7%). For interproximal sites the use of the test mouthrinse resulted in significantly more gingivitis reduction compared to control mouthrinse (WMD: -0.29, 95% CI: -0.48 to -0.11, P=0.002; test for heterogeneity: P<0.00001, I2 = 95.18%), whereas no differences were observed compared to dental floss. With respect to plaque scores, LISTERINE® Antiseptic produced significant overall reductions in plaque (WMD: -0.83, 95% CI: -1.13 to -0.53, P<0.00001; test for heterogeneity: P<0.00001, I2 = 96.1%). Separate analysis for interproximal areas revealed that LISTERINE® Antiseptic resulted in more pronounced plaque drops compared to the control mouthrinse (WMD: -1.02, 95% CI: -1.44 to -0.60, P<0.00001; test for heterogeneity: P<0.00001, I2 = 96.1%) or the use of floss (WMD: -0.75, 95% CI: -1.15 to -0.363, P<0.0002; test for heterogeneity: P<0.0002, I2 = 93.0%). Most studies agreed that LISTERINE® Antiseptic did not produce more staining than the control products.

Conclusion

When used as an adjunct to unsupervised oral hygiene, LISTERINE® Antiseptic provides an additional benefit with regard to plaque and gingivitis reduction as compared to a placebo or control.

REFERENCE 1. Stoeken JE, Paraskevas S, van der Weijden GA. The long-term effect of a mouthrinse containing essential oils on dental plaque and gingivitis: a systematic review. J Periodontol. 2007;78(7):1218-1228.


Broad-Spectrum Antimicrobial Activity of Mouthrinses

Effect of an Essential Oil-Containing Antiseptic Mouthrinse on Plaque and Salivary Streptococcus Mutans Levels

Fine DH, Furgang D, Barnett ML, et al. (2000)

LISTERINE® Antiseptic can significantly reduce the level of oral S. mutans. This provides further evidence for in situ bactericidal activity, as well as, an additional rationale for its daily use as an adjunct to mechanical oral hygiene regimens.

Fine DH, Furgang D, Barnett ML, et al. (2000)

EFFECT OF AN ESSENTIAL OIL-CONTAINING ANTISEPTIC MOUTHRINSE ON PLAQUE AND SALIVARY STREPTOCOCCUS MUTANS LEVELS1

Objective

To examine the effect of twice-daily rinsing with LISTERINE® Antiseptic on levels of recoverable S. mutans and total streptococci in supragingival interproximal plaque and in saliva.

Methods

Twenty-nine qualifying subjects were randomly assigned either to LISTERINE® Antiseptic or a sterile water control. Subjects rinsed under supervision twice daily with 20 ml for 30 seconds for 11 days and once on the 12th day, in addition to their normal oral care regimens. Subjects brushed with fluoride toothpaste and a soft toothbrush, which were provided by the investigator, throughout the study period. At baseline and on Day 12, saliva and plaque samples were collected and microbiological quantification of recoverable S. mutans and total streptococci was performed. After a 1-week washout period, the procedures were repeated with the alternate rinse.

Results

Rinsing with LISTERINE® Antiseptic resulted in significant reductions in both S. mutans and total streptococci both in interproximal plaque and in saliva. LISTERINE® Antiseptic reduced total streptococci and S. mutans by 69.9% and 75.4%, respectively, in plaque, with corresponding reductions of 50.8% and 39.2% in saliva.

Conclusion

The finding that the essential oil mouthrinse used in the study reported herein can significantly reduce the level of oral S. mutans provides further evidence for in situ bactericidal activity as well as an additional rationale for its daily use as an adjunct to mechanical oral hygiene regimens.

REFERENCE 1. Fine DH, Furgang D, Barnett ML, et al. Effect of an essential oil-containing antiseptic mouthrinse on plaque and salivary Streptococcus mutans levels. J Clin Periodontol. 2000;27(3):157-161.


In Vivo Antimicrobial Activity of an Essential Oil-Containing Mouthrinse on Interproximal Plaque Bacteria

Charles CH, Pan PC, Sturdivant L, Vincent JW. (2000)

This study suggests that the clinical effectiveness of the essential oil mouthrinse LISTERINE® Antiseptic against plaque and gingivitis may be attributable to the rapid kill and plaque permeabilizing properties of the formulation.

Charles CH, Pan PC, Sturdivant L, Vincent JW. (2000)

IN VIVO ANTIMICROBIAL ACTIVITY OF AN ESSENTIAL OIL-CONTAINING MOUTHRINSE ON INTERPROXIMAL PLAQUE BACTERIA1

Objective

To determine the in vivo interproximal bactericidal efficacy of LISTERINE® Antiseptic following toothbrushing.

Methods

This was a randomized, controlled, crossover study involving 34 generally healthy adults aged 23-64 years. Subjects rinsed for 30 seconds with 20 ml of either LISTERINE® Antiseptic or a sterile water control rinse. Five minutes later, interproximal plaque was collected using paper points, and bacterial counts were quantified using high end point dilution and spectrophotometric methods. After a 48-hour washout period, subjects repeated the procedure with the alternate rinse.

Results

LISTERINE® Antiseptic significantly reduced total plaque bacteria. There was a 43.8% reduction in recoverable plaque bacteria from interproximal spaces following rinsing with LISTERINE® Antiseptic compared to control (p<0.001). This study confirms and expands upon the study by Fine et al (2000), which documented reductions in S. mutans and total streptococci specifically.

Conclusions

These results suggest an antimicrobial mechanism for this mouthrinse in support of the clinically observed reductions in interproximal gingivitis demonstrated in several 6-month clinical trials. This study suggests that the clinical effectiveness of the essential oil mouthrinse against plaque and gingivitis may be attributable to the rapid kill and plaque permeabilizing properties of the formulation.

Charles Pan Chart

REFERENCE 1. Charles CH, Pan PC, Sturdivant L, Vincent JW. In vivo antimicrobial activity of an essential oil-containing mouthrinse on interproximal plaque bacteria. J Clin Dent. 2000;11(4):94-97.


Ability of Mouthrinses to Kill Germs for 12-hour Plaque and Gingivitis Protection

In Vivo Antimicrobial Effectiveness of an Essential Oil-Containing Mouth Rinse 12 H After a Single Use and 14 Days' Use

Fine DH, Furgang D, Sinatra K, Charles C, McGuire A, Kumar LD. (2005)

Two studies – a daytime study and an overnight study – were undertaken to measure the antimicrobial efficacy of LISTERINE® Antiseptic 12 hours after a single rinse and 12 hours after 2 weeks of twice daily rinsing. LISTERINE® Antiseptic demonstrated effectiveness in reducing supragingival plaque and gingivitis as well as in controlling intrinsic oral malodor over prolonged periods.

Fine DH, Furgang D, Sinatra K, Charles C, McGuire A, Kumar LD. (2005)

IN VIVO ANTIMICROBIAL EFFECTIVENESS OF AN ESSENTIAL OIL-CONTAINING MOUTH RINSE 12 HOURS AFTER A SINGLE USE AND 14 DAYS' USE1

Objective

Two studies – a daytime study and an overnight study – were undertaken to measure the antimicrobial efficacy of an essential oil-containing mouthrinse 12 hours after a single rinse and 12 hours after 2 weeks of twice daily rinsing.

Methods

The studies used a randomized, double-blind, unsupervised, controlled crossover design. After baseline sampling of bacteria from supragingival plaque and the dorsum of the tongue, patients brushed as usual and rinsed twice daily with either an essential oil mouthrinse containing 0.09% zinc chloride or a negative control rinse (5% hydroalcohol) for 2 weeks.* Sampling of bacteria was conducted 12 hours after the first rinse, then 12 hours after the final rinse 14 days later. After a washout period of at least 7 days, subjects repeated the procedures using the alternative rinse. There were 17 evaluable subjects in the daytime study, 15 in the overnight study. Samples were placed on selective media to assess gram-negative anaerobes, total anaerobes and volatile sulphur compound-producing microorganisms.

Results

At 12 hours after rinsing, subjects using the essential oil mouthrinse (a LISTERINE® Antiseptic formula) had significantly lower (p=0.005) mean bacterial counts than subjects using the control rinse in all comparisons. Mean reductions with LISTERINE® Antiseptic ranged from 57.3% to 95.3% for plaque samples and from 76.0% to 96.1% for tongue samples. There was a trend toward higher reductions after 14 days' use. The findings were similar in the daytime and overnight studies. LISTERINE® Antiseptic had long-lasting effects in reducing anaerobic bacteria overall as well as gram-negative anaerobes and VSC-producing bacteria both in supragingival plaque and on the tongue.

Conclusion

The significant reductions in numbers of these bacteria…"12 hours after rinsing" can play a key role in explaining the essential oil mouthrinse's effectiveness in reducing supragingival plaque and gingivitis as well as its effectiveness in controlling intrinsic oral malodor over prolonged periods.

*The tartar-control ingredient in Advanced LISTERINE® Antiseptic is 0.09% zinc chloride.

REFERENCE 1. Fine DH, Furgang D, Sinatra K, Charles C, McGuire A, Kumar LD. In vivo antimicrobial effectiveness of an essential oil-containing mouth rinse 12 h after a single use and 14 days use. J Clin Periodontol. 2005;32(4):335-340.


Determination of the In Situ Bactericidal Activity of an Essential Oil Mouthrinse Using a Vital Stain Method

Pan P, Barnett ML, Coelho J, Brogdon C, Finnegan MB. (2000)

In summary, this study has demonstrated that rinsing with LISTERINE® Antiseptic has significant bactericidal activity against supragingival plaque bacteria in situ.

Pan P, Barnett ML, Coelho J, Brogdon C, Finnegan MB. (2000)

DETERMINATION OF THE IN SITU BACTERICIDAL ACTIVITY OF AN ESSENTIAL OIL MOUTHRINSE USING A VITAL STAIN METHOD1

Objective

To determine the bactericidal effects of Listerine® Antiseptic on dental plaque bacteria in situ.

Methods

In this crossover study of 17 subjects, 1-day-old plaque was sampled at baseline from the buccal surfaces of diagonally contralateral maxillary and mandibular bicuspids and first molars. Subjects were randomly assigned to either LISTERINE® Antiseptic or a sterile saline negative control and rinsed under supervision with 20 ml for 30 seconds. Plaque was sampled 30 minutes later from the remaining contralateral posterior teeth. Following a washout period of 7 days, subjects repeated these procedures with their respective alternate rinse. Plaque samples were stained and analyzed with computerized image analysis.

Results

LISTERINE® Antiseptic displayed statistically significant bactericidal effects against bacteria within the plaque biofilm. At 30 minutes, LISTERINE® Antiseptic killed 78.7% of bacteria compared to 27.9% with the control rinse (p<0.001). These data confirm the findings of previous in vitro and in vivo studies that demonstrated the significant biocidal activity of LISTERINE® Antiseptic.

Conclusions

In summary, this study has demonstrated that rinsing with the essential oil mouthrinse has significant bactericidal activity against supragingival plaque bacteria in situ. The results of this study confirm the findings of previous in vitro and in vivo studies which demonstrated this mouthrinse formulation to have significant microbiocidal activity against oral microorganisms. They are of particular interest in the context of our current understanding of the nature of biofilms insofar as they demonstrate the ability of the mouthrinse formulation to penetrate the plaque biofilm and exert a bactericidal activity on the organisms contained therein.

REFERENCE 1. Pan P, Barnett ML, Coelho J, Brogdon C, Finnegan MB. Determination of the in situ bactericidal activity of an essential oil mouthrinse using a vital stain method. J Clin Periodontol. 2000;27(4):256-261.


Effect of Mouthrinses on Maintaining the Balance of Oral Flora

Evaluation of Microbial Shifts in Supragingival Plaque Following Long-Term Use of an Oral Antiseptic Mouthrinse

Walker C, Clark W, Wheeler T, Lamm R. (1989)

The authors conclude that long-term use of LISTERINE® Antiseptic results in a decrease in total supragingival plaque and does not produce a shift in the microbial composition of this plaque that would be detrimental to oral health.

Walker C, Clark W, Wheeler T, Lamm R. (1989)

EVALUATION OF MICROBIAL SHIFTS IN SUPRAGINGIVAL PLAQUE FOLLOWING LONG-TERM USE OF AN ORAL ANTISEPTIC MOUTHRINSE1

Objective

To determine the effect of long-term use of LISTERINE® Antiseptic mouthrinse on microbial composition of supragingival dental plaque.

Methods

A subset of 40 subjects participating in a 6-month trial completed this assessment. Subjects rinsed unsupervised with LISTERINE® Antiseptic or a 5% hydroalcohol control twice daily in addition to normal oral hygiene. Supragingival plaque was evaluated at baseline and at 3 and 6 months for bacterial composition, based on dark-field microscopy, culture on selective and non-selective media and enumeration by colony morphology.

Results

No significant differences in bacterial composition of supragingival plaque were found. Additionally, no opportunistic pathogens-such as yeast, enteric bacteria, or staphylococci-emerged. The authors concluded that long-term use of LISTERINE® Antiseptic results in a decrease in total supragingival plaque and does not produce a shift in the microbial composition of this plaque that would be detrimental to oral health.

REFERENCE 1. Walker C, Clark W, Wheeler T, Lamm R. Evaluation of microbial shifts in supragingival plaque following long-term use of an oral antiseptic mouthrinse. J Dent Res. 1989;68:412. Abstract 1845.


Effects of 6 Months Use of an Antiseptic Mouthrinse on Supragingival Dental Plaque Microflora

Minah GE, DePaola LG, Overholser CD, et al. (1989)

At 6 months, the LISTERINE® Antiseptic group revealed no alteration in the proportions of microbial species present in supragingival plaque and no resistant bacterial forms.

Minah GE, DePaola LG, Overholser CD, et al. (1989)

EFFECTS OF 6 MONTHS USE OF AN ANTISEPTIC MOUTHRINSE ON SUPRAGINGIVAL DENTAL PLAQUE MICROFLORA1

Objective

To determine whether long-term use of LISTERINE® Antiseptic led to undesirable succession of oral pathogens or the emergence of resistant microbial forms.

Methods

This was a 6-month, randomized, double-blind, supervised, controlled study of 83 subjects with pre-existing plaque and gingivitis. After a complete prophylaxis, subjects rinsed twice daily with either LISTERINE® Antiseptic or a hydroalcohol control in addition to normal oral hygiene. Subjects were asked not to use any other mouthrinses during the study. Supragingival plaque was collected before and at either 3 or 6 months after treatment. Plaque samples were analyzed by dark-field microscopy, culture on a series of nonselective and selective bacteria media, and by recognition of microbial forms by recognition of distinct colony on a nonselective medium.

Results

At 6 months, the LISTERINE® Antiseptic group revealed no alteration in the proportions of microbial species present in supragingival plaque and no emergence of resistant bacterial forms was found.

Conclusion

The microbiological evaluations of supragingival dental plaque demonstrated that long-term use of the antiseptic studied did not cause a meaningful shift in its microbial composition or emergence of presumptive oral pathogens. Additionally, it can be deduced from the results of this study that bacterial susceptibility to the antiseptic did not decrease since this would have led to a detectable microbial flora shift.

REFERENCE 1. Minah GE, DePaola LG, Overholser CD, et al. Effects of 6 months use of an antiseptic mouthrinse on supragingival dental plaque microflora. J Clin Periodontol. 1989;16(6):347-352.


Alcohol-Containing Mouthrinses Are Not Associated With Oral Cancer Risk

Use of Alcohol-Containing Rinses to Reduce Oral Microbial Burden: Safety and Efficacy

Iacopino AM. (2009)

This review article discusses the scientific flaws in experimental design and data interpretation of 3 recent publications that allege a relationship between alcohol-containing mouthrinses and oral cancer. These studies are contrasted to an FDA investigation and an evaluation of epidemiologic literature over a 25-year period – rigorously designed studies with large numbers of patients – both of which found no relationship.

Alcohol-Containing Mouthwash and Oropharyngeal Cancer: A Review of the Epidemiology

Cole P, Rodu B, Mathisen A. (2003)

The weight of evidence strongly suggests that professionals may recommend to their patients that they use the mouthwashes of their choice, including those that contain alcohol.

Cole P, Rodu B, Mathisen A. (2003)

ALCOHOL-CONTAINING MOUTHWASH AND OROPHARYNGEAL CANCER: A REVIEW OF THE EPIDEMIOLOGY1

Objective

To review epidemiological studies investigating whether the use of alcohol-containing mouthrinses (ACM) increases the risk of developing oropharyngeal cancer (OPC).

Methods

In this review, the authors examined nine English-language epidemiologic studies of OPC and ACM. They also reanalyzed data from one of the studies.

Results

Six of the nine studies reviewed were negative, showing no indication of increased risk of OPC. One of the three studies with positive results was later determined in a reanalysis of data to not support a causal relationship.

Conclusions

The weight of the evidence strongly suggests that use of ACM does not increase the risk of OPC. Practicing dentists may recommend to their patients that they use the mouthwashes of their choice, including those that contain alcohol. [Reference Style]

REFERENCE 1. Cole P, Rodu B, Mathisen A. Alcohol-containing mouthwash and oropharyngeal cancer: a review of the epidemiology. J Am Dent Assoc. 2003;134(8):1079-1087.


Oral Cancer and Mouthwash Use: Evaluation of the Epidemiologic Evidence

Elmore JG, Horwitz RI (1995)

The authors conclude that a rigorous methodologic review and analysis of the available evidence does not support a causal association between mouthwash use and risk of oral cancer.

Elmore JG, Horwitz RI (1995)

ORAL CANCER AND MOUTHWASH USE: EVALUATION OF THE EPIDEMIOLOGIC EVIDENCE1

Objective

To review the methodologies and results of seven published epidemiological studies that discuss the possible association between mouthrinse use and oral cancer.

Methods

The studies were independently reviewed, and specific criteria were applied to assess issues in the designs, analyses, and results of the studies.

Results

There was a lack of consistency across the studies. Some studies suggested a possible association between mouthrinse use and oral cancer while others suggested no association or that mouthrinse use may have a protective effect. However, according to the authors, few of the studies were of acceptable quality in terms of methodology. Smoking and alcoholic beverage consumption are two known risk factors for oral cancer. In the subset of patients who did not smoke or drink alcoholic beverages and used mouthrinse, there was no elevated risk of oral cancer. (Note: if there were a causal effect, the association with mouthrinse use would have been strongest in this group.)

Conclusion

We conclude that a rigorous methodologic review and analysis of the available evidence do not support a causal association between mouthwash use and risk of oral cancer. [Reference Style]

REFERENCE 1. Elmore JG, Horwitz RI. Oral cancer and mouthwash use: evaluation of the epidemiologic evidence. Otolaryngol Head Neck Surg. 1995;113(3):253-261.


Federal Register (May 2003 Issue)

The Federal Register, published by the Office of the Federal Register, National Archives and Records Administration, is the official daily publication for rules, proposed rules, and notices of U.S. federal agencies and organizations. Its Subcommittee concludes that the available data do not support a causal relationship between the use of alcohol–containing mouthrinses like LISTERINE® Antiseptic and oral cancer. The vote was unanimous.

Federal Register (May 2003 Issue)

The Federal Register, published by the Office of the Federal Register, National Archives and Records Administration, is the official daily publication for rules, proposed rules, and notices of U.S. federal agencies and organizations. The May 29, 2003 issue of the Federal Register includes FDA (Food and Drug Administration) Advisory Committee information indicating that the relationship between high-alcohol content mouthrinses and oropharyngeal cancer is unclear. It states that studies to date are contradictory and fail to show a consistent dose-response relationship between alcohol-containing mouthrinses and oral cancer. A dose-response relationship would be important for determining a causal relationship, according to this report. In addition, the Federal Register reports that the findings of many studies may have been confounded by the presence of risk factors such as high alcoholic-beverage consumption and tobacco use among study subjects.

Conclusion

Based on the studies reviewed, the Subcommittee concludes that the available data do not support a causal relationship between the use of alcohol–containing mouthrinses and oral cancer. The vote was unanimous. [Reference Style]

REFERENCE 1. Oral health care drug products for over-the-counter human use: antigingivitis/antiplaque drug products; establishment of a monograph; proposed rules. Part III, Department of Health and Human Services, Food and Drug Administration. Federal Register. May 29, 2003;68:32231-32287.


Alcohol-Containing Mouthrinses Are Not Associated With Dry Mouth Risk

Use of Essential Oil-Containing Mouthrinses by Xerostomic Individuals: Determination of Potential for Oral Mucosal Irritation

Fischman SL, Aguirre A, Charles CH. (2004)

This study in extremely xerostomic patients indicates that the essential oil mouthrinse LISTERINE® Antiseptic can be safely recommended to such individuals in view of its minimal potential for oral mucosal irritation.

Fischman SL, Aguirre A, Charles CH. (2004)

USE OF ESSENTIAL OIL-CONTAINING MOUTHRINSES BY XEROSTOMIC INDIVIDUALS: DETERMINATION OF POTENTIAL FOR ORAL MUCOSAL IRRITATION1

Objective

To assess the irritation and drying potential of LISTERINE® Antiseptic in patients with documented xerostomia. This study followed an "exaggerated-use" clinical model, meaning that exposures to the mouthrinse exceeded those recommended in label directions.

Methods

After receiving a baseline oral soft-tissue examination, 19 qualifying female subjects with xerostomia secondary to Sjogren's syndrome, mean age 61 years, were randomly assigned to either LISTERINE® Antiseptic or a 5% hydroalcohol (negative control) rinse. Subjects rinsed unsupervised with 20 ml for 30 seconds 3 daily (150% of the recommended daily dose) for the next 14 days and received soft-tissue examinations on Days 7 and 14. After a 1-week washout period, subjects switched to the alternate rinse, and the examination and rinsing regimens were repeated for 2 weeks.

Results

LISTERINE® Antiseptic had a low potential for irritation. At the 7-day examination, only 2 subjects had minor oral mucosal abnormalities attributable to the test rinses. Both subjects were using LISTERINE® Antiseptic. At the 14-day exam, both subjects had normalized. Assessment of salivary flow rates indicated no statistically significant differences in salivary flow between periods (prerinse/postrinse) or treatment groups.

Key Quotes

"...the exaggerated use of the essential oil mouthrinse did not result in any observed oral dryness compared to the control rinse containing a considerably lower alcohol level, or in a clinically significant difference in oral irritation, even in this xerostomic population which would be the most vulnerable to 'drying'."

"This study in extremely xerostomic patients indicates that the essential oil mouthrinse can be safely recommended to such individuals in view of its minimal potential for oral mucosal irritation."

REFERENCE 1. Fischman SL, Aguirre A, Charles CH. Use of essential oil-containing mouthrinses by xerostomic individuals: determination of potential for oral mucosal irritation. Am J Dent. 2004;17(1):23-26.


A comparison of the effects of 2 commercially available nonprescription mouthrinses on salivary flow rates and xerostomia

Kerr AR, Katz RW, Ship JA. (2007)

This crossover study of healthy subjects with normal salivary rates showed no difference in objective and subjective measures of mouth dryness between alcohol- and nonalcohol-containing mouthrinses (LISTERINE® Antiseptic compared with ACT®).

Kerr AR, Katz RW, Ship JA. (2007)

A COMPARISON OF THE EFFECTS OF 2 COMMERCIALLY AVAILABLE NONPRESCRIPTION MOUTHRINSES ON SALIVARY FLOW RATES AND XEROSTOMIA1

Objectives

To determine if two commercial mouthrinses, one alcohol-based (LISTERINE® Antiseptic) and one nonalcohol-based (ACT®), affect salivary flow and symptoms of dry mouth in nonxerostomic adults.

Methods

This observer-blinded, randomized, crossover pilot study involved 20 adults. The primary endpoints were whole salivary flow rates and the perceived mouth dryness VAS scores following 1 week of use. ANOVA was used to determine differences in these endpoints between groups, and ANCOVA was used to control for any variation in baseline flow rates and VAS scores (p<.05).

Results

There were no significant differences between groups at baseline. After 1 week of mouthrinse use, ANOVA and ANCOVA of combined data (before and after crossover) revealed no significant differences in either flow rates or VAS scores between groups (p>.05).

Conclusion

There were no differences in objective or subjective measures of mouth dryness between alcohol- and nonalcohol-containing mouthrinses after 1 week in nonxerostomic subjects.

REFERENCE 1. Kerr AR, Katz RW, Ship JA. A comparison of the effects of 2 commercially available nonprescription mouthrinses on salivary flow rates and xerostomia. Quintessence Int. 2007;38(8):e440–447.

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