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CompletedNCT02875769Updated Jun 4, 2020

Pre-procedural Mouthwash in Reducing Bacteria in Dental Aerosols

A Phase 3 interventional study of Dental prophylaxis and Mouthwash CPC+Zn+F in Chronic Periodontitis, sponsored by University of Guarulhos. Completed. Open to participants aged 18 Years to 70 Years. Per ClinicalTrials.gov, last updated 2020-06-04.

Sponsored by University of Guarulhos · Phase 3, Interventional, and Prevention

Phase
Phase 3
Study type
Interventional
Enrollment
60
Allocation
Randomized
Ages
18 Years to 70 Years
Sex
All
01

Study summary

The aim of this randomized, single blinded clinical trial was to evaluate the effect of a pre-procedural mouthwash containing cetylpyridinium chloride (CPC), zinc lactate (Zn) and sodium fluoride (F) in the reduction of viable bacteria in oral aerosol/splatter after a dental prophylaxis with ultrasonic scaler.

Read the detailed description

The propagation of oral microorganisms in the dental office during different oral procedures has been a concern. The use of certain equipment such as ultrasonic devices, highspeed dental handpieces or three-way syringes may spread aerosols and splatters containing microorganisms in the environment. These microorganisms may cause cross-infections in the dental office, jeopardizing the health of patients and dental professionals. Different procedures, materials and antimicrobial agents have been proposed to minimize microbial cross-contamination in the dental office. Chlorhexidine (CHX) is considered the gold standard substance in controlling oral biofilm growth in the oral cavity or microbial spread by oral aerosols due to its broad antibacterial spectrum and substantivity of 8 to 12 hours. However, other antiseptics have also been used as pre-procedural mouthwashes. CPC has an important antimicrobial activity and is considered a safe product for marketing. In this context, the present trend has been to combine more than one active substance in mouthwash and toothpaste formulations with the aim of increasing the efficacy of the products, or treating more than one clinical problem, such as plaque accumulation and halitosis, caries or gingival inflammation. Therefore, the aim of this randomized clinical trial (RCT) was to evaluate the effectiveness of a new mouthwash formulation containing 0.075% CPC, 0.28% zinc lactate and 0.05% sodium fluoride (CPC+Zn+F) in reducing viable bacteria present in oral aerosol/splatter. Sixty systemically healthy volunteers receiving dental prophylaxis were randomly assigned to one of the following experimental groups (15 per group): i) rinsing with 0.075% CPC, 0.28% Zn and 0.05% F (CPC+Zn+F), ii) 0.12% chlorhexidine digluconate (CHX), iii) no rinsing and iv) rinsing with water. Viable bacteria were collected from different locations in the dental office on enriched TSA plates and anaerobically incubated for 72 hours. The colonies were counted and species were then identified by Checkerboard DNA-DNA Hybridization. The total number of colony-forming units (CFUs) detected in the aerosols/splatters from volunteers who rinsed with CPC+Zn+F or CHX was statistically significantly (p\<0.05) lower than of those subjects who did not rinse or who rinsed with water. When all locations were considered together, the aerosols/splatters from the CPC+Zn+F and CHX groups showed, respectively, 70% and 77% fewer CFUs than those from the no rinsing group and 61% and 70% than those from the water group. The mean proportions of bacterial species from the orange complex were statistically significantly (p\<0.05) lower in aerosols/splatter from the CPC+Zn+F and CHX groups compared with the two negative controls. In conclusion, the results of the present investigation showed that a mouthwash containing 0.075% CPC, 0.28% Zn and 0.05% F, is effective in reducing viable bacteria in oral aerosol/splatter after a dental prophylaxis with ultrasonic scaler. This finding is highly relevant to the clinical practice, as it may greatly reduce the risk of cross-contamination in dental offices.

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Conditions studied

  • Chronic Periodontitis

Keywords

  • cetylpyridinium chloride
  • chlorhexidine
  • oral aerosol
  • oral splatter
  • mouthwash
  • microbiology
03

In context

Periodontitis

1,635 studies on the registry are indexed under Periodontitis; 327 are open to participants now.

This study's enrollment of 60 is above the median of 45 across 1,191 interventional studies indexed under Periodontitis.

Browse Periodontitis studies →

Lead sponsor

University of Guarulhos is the lead sponsor of 17 studies on the registry; 4 are open to participants now.

Counted across the registry records on this site, refreshed daily.

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Who can participate

Ages eligible
18 Years to 70 Years
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • aged between 18-70 years;
  • minimum of 20 natural teeth (excluding third molars and teeth with advanced decay indicated for extraction);
  • at least 80% of the sites with visible supragingival plaque;
  • fewer than 10% of sites with visible supragingival calculus;
  • fewer than 30% of sites with probing depth (PD) ≥ 5 mm.

Exclusion criteria

Exclusion Criteria:

  • presence of orthodontic bands;
  • partial removable dentures;
  • lesions of the soft or hard tissues of the oral cavity;
  • carious lesions requiring immediate restorative treatment;
  • history of allergy to CHX, CPC, zinc lactate or sodium fluoride;
  • participation in any other clinical study within the one-month period prior to entering into the study;
  • professional tooth cleaning procedure (oral prophylaxis) during the period of one month prior to entering the study;
  • pregnant or breast-feeding women;
  • antibiotic therapy in the previous 6 months;
  • continuous use of oral mouthwashes;
  • any systemic condition that may require prophylactic medication for dental treatment (e.g., mitral valve prolapse).
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Study design

Phase
Phase 3
Primary purpose
Prevention
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Single (Care provider)
Enrollment
60 participants (actual)

Study arms

  • Experimental
    Test: Mouthwash CPC+Zn+F

    To rinse with pre-procedural mouthwash containing 0.075% cetylpyridinium chloride, 0.28% zinc lactate and 0.05% sodium fluoride in an Alcohol-free base (for one minute and 20 ml of solution) + full mouth dental prophylaxis using ultrasonic scaler.

    Procedure: Dental prophylaxis · Drug: Mouthwash CPC+Zn+F

  • Active comparator
    Positive control: Mouthwash CHX

    To rinse with pre-procedural mouthwash containing 0.12% CHX with 10% alcohol (for one minute and 20 ml of solution) + full mouth dental prophylaxis using ultrasonic scaler.

    Procedure: Dental prophylaxis · Drug: Mouthwash CHX

  • Placebo comparator
    Negative control A: No rinsing

    No rinsing with pre-procedural mouthwash + full mouth dental prophylaxis using ultrasonic scaler.

    Procedure: Dental prophylaxis · Other: No rinsing

  • Placebo comparator
    Negative control B: Water

    To rinse with pre-procedural mouthwash containing water from a three-way syringe (for one minute and 20 ml of solution) + full mouth dental prophylaxis using ultrasonic scaler.

    Procedure: Dental prophylaxis · Other: Water

Interventions

  • ProcedureDental prophylaxis

    Full mouth dental prophylaxis (FMDP) was conducted in one appointment lasting 10 minute, using an ultrasonic scaler at a frequency of 25 kHz (Cavitron Select SPC, Dentsply professional, York, PA, USA) at less than 50% power. The FMDP performed without anesthesia and in order to eliminate supragingival plaque, calculus and stainings.

  • DrugMouthwash CPC+Zn+F

    The volunteer rinsed with pre-procedural mouthwash containing 0.075% cetylpyridinium chloride, 0.28% zinc lactate and 0.05% sodium fluoride in an Alcohol-free base for one minute, 20 ml of solution and then expectorated all remaining liquid.

    Also known as: Pre-procedural mouthwash CPC+Zn+F

  • DrugMouthwash CHX

    The volunteer rinsed with pre-procedural mouthwash containing 0.12% CHX with 10% alcohol for one minute, 20 ml of solution and then expectorated all remaining liquid.

    Also known as: Pre-procedural mouthwash

  • OtherNo rinsing

    The volunteer did not rinse with any pre-procedural mothwash.

  • OtherWater

    The volunteer rinsed with pre-procedural mouthwash containing water from a three-way syringe for one minute, 20 ml of water and then expectorated all remaining liquid.

06

What researchers measure

Primary outcomes

  1. Difference between groups (test, positive control, negative control A and negative control B) for the mean number of total colony-forming units (CFUs) in all plates.

    Time frame: During oral prophylaxis procedure.

Secondary outcomes

  1. Number of total CFUs in plates positioned on the clinician forehead.

    Time frame: During oral prophylaxis procedure.

  2. Number of total CFUs in plates positioned on the volunteer's chest.

    Time frame: During oral prophylaxis procedure.

  3. Number of total CFUs in plates positioned on the support board.

    Time frame: During oral prophylaxis procedure.

  4. Proportion of the microbial complexes.

    Time frame: During oral prophylaxis procedure.

  5. Reduction in CFUs in the CPC+Zn+F and CHX groups in comparison with the two negative control groups.

    Time frame: During oral prophylaxis procedure.

07

Study locations

No study locations are listed for this record.

08

References and documents

Publications

  • Bentley CD, Burkhart NW, Crawford JJ. Evaluating spatter and aerosol contamination during dental procedures. J Am Dent Assoc. 1994 May;125(5):579-84. doi: 10.14219/jada.archive.1994.0093. PubMed 8195499 ↗
  • Cochran MA, Miller CH, Sheldrake MA. The efficacy of the rubber dam as a barrier to the spread of microorganisms during dental treatment. J Am Dent Assoc. 1989 Jul;119(1):141-4. doi: 10.14219/jada.archive.1989.0131. PubMed 2760346 ↗
  • Erovic Ademovski S, Lingstrom P, Renvert S. The effect of different mouth rinse products on intra-oral halitosis. Int J Dent Hyg. 2016 May;14(2):117-23. doi: 10.1111/idh.12148. Epub 2015 May 31. PubMed 26031397 ↗
  • Grenier D. Quantitative analysis of bacterial aerosols in two different dental clinic environments. Appl Environ Microbiol. 1995 Aug;61(8):3165-8. doi: 10.1128/aem.61.8.3165-3168.1995. PubMed 7487047 ↗
  • Gupta G, Mitra D, Ashok KP, Gupta A, Soni S, Ahmed S, Arya A. Efficacy of preprocedural mouth rinsing in reducing aerosol contamination produced by ultrasonic scaler: a pilot study. J Periodontol. 2014 Apr;85(4):562-8. doi: 10.1902/jop.2013.120616. Epub 2013 Jul 15. PubMed 23855840 ↗
  • Harrel SK, Molinari J. Aerosols and splatter in dentistry: a brief review of the literature and infection control implications. J Am Dent Assoc. 2004 Apr;135(4):429-37. doi: 10.14219/jada.archive.2004.0207. PubMed 15127864 ↗
  • Jones CG. Chlorhexidine: is it still the gold standard? Periodontol 2000. 1997 Oct;15:55-62. doi: 10.1111/j.1600-0757.1997.tb00105.x. PubMed 9643233 ↗
  • Kanjirath PP, Coplen AE, Chapman JC, Peters MC, Inglehart MR. Effectiveness of gloves and infection control in dentistry: student and provider perspectives. J Dent Educ. 2009 May;73(5):571-80. PubMed 19433532 ↗
  • Keni NN, Aras MA, Chitre V. Chlorhexidine allergy due to topical application. Indian J Dent Res. 2012 Sep-Oct;23(5):674-6. doi: 10.4103/0970-9290.107393. PubMed 23422617 ↗
  • Kjaerheim V, Skaare A, Barkvoll P, Rolla G. Antiplaque, antibacterial, and anti-inflammatory properties of triclosan mouthrinses in combination with zinc citrate or polyvinylmethylether maleic acid (PVM-MA) copolymer. Eur J Oral Sci. 1996 Oct-Dec;104(5-6):529-34. doi: 10.1111/j.1600-0722.1996.tb00137.x. PubMed 9021321 ↗
  • Lang C, Murgia C, Leong M, Tan LW, Perozzi G, Knight D, Ruffin R, Zalewski P. Anti-inflammatory effects of zinc and alterations in zinc transporter mRNA in mouse models of allergic inflammation. Am J Physiol Lung Cell Mol Physiol. 2007 Feb;292(2):L577-84. doi: 10.1152/ajplung.00280.2006. Epub 2006 Nov 3. PubMed 17085522 ↗
  • Leggat PA, Kedjarune U. Bacterial aerosols in the dental clinic: a review. Int Dent J. 2001 Feb;51(1):39-44. doi: 10.1002/j.1875-595x.2001.tb00816.x. PubMed 11326448 ↗
  • Legnani P, Checchi L, Pelliccioni GA, D'Achille C. Atmospheric contamination during dental procedures. Quintessence Int. 1994 Jun;25(6):435-9. PubMed 7938434 ↗
  • Mendes L, Coimbra J, Pereira AL, Resende M, Pinto MG. Comparative effect of a new mouthrinse containing chlorhexidine, triclosan and zinc on volatile sulphur compounds: a randomized, crossover, double-blind study. Int J Dent Hyg. 2016 Aug;14(3):202-8. doi: 10.1111/idh.12132. Epub 2015 Feb 26. PubMed 25727335 ↗
  • Nejatidanesh F, Khosravi Z, Goroohi H, Badrian H, Savabi O. Risk of Contamination of Different Areas of Dentist's Face During Dental Practices. Int J Prev Med. 2013 May;4(5):611-5. PubMed 23930175 ↗
  • Pandit S, Cai JN, Jung JE, Lee YS, Jeon JG. Effect of brief cetylpyridinium chloride treatments during early and mature cariogenic biofilm formation. Oral Dis. 2015 Jul;21(5):565-71. doi: 10.1111/odi.12312. Epub 2015 Feb 13. PubMed 25600577 ↗
  • Rivera-Hidalgo F, Barnes JB, Harrel SK. Aerosol and splatter production by focused spray and standard ultrasonic inserts. J Periodontol. 1999 May;70(5):473-7. doi: 10.1902/jop.1999.70.5.473. PubMed 10368050 ↗
  • Slots J. Low-cost periodontal therapy. Periodontol 2000. 2012 Oct;60(1):110-37. doi: 10.1111/j.1600-0757.2011.00429.x. PubMed 22909110 ↗
  • Socransky SS, Haffajee AD, Cugini MA, Smith C, Kent RL Jr. Microbial complexes in subgingival plaque. J Clin Periodontol. 1998 Feb;25(2):134-44. doi: 10.1111/j.1600-051x.1998.tb02419.x. PubMed 9495612 ↗
  • Souza-Gugelmin MC, Lima CD, Lima SN, Mian H, Ito IY. Microbial contamination in dental unit waterlines. Braz Dent J. 2003;14(1):55-7. doi: 10.1590/s0103-64402003000100010. Epub 2003 Jul 31. PubMed 12656466 ↗
  • Thomas E. Efficacy of two commonly available mouth rinses used as preprocedural rinses in children. J Indian Soc Pedod Prev Dent. 2011 Apr-Jun;29(2):113-6. doi: 10.4103/0970-4388.84682. PubMed 21911948 ↗
  • Timmerman MF, Menso L, Steinfort J, van Winkelhoff AJ, van der Weijden GA. Atmospheric contamination during ultrasonic scaling. J Clin Periodontol. 2004 Jun;31(6):458-62. doi: 10.1111/j.1600-051X.2004.00511.x. PubMed 15142216 ↗
  • Toroglu MS, Haytac MC, Koksal F. Evaluation of aerosol contamination during debonding procedures. Angle Orthod. 2001 Aug;71(4):299-306. doi: 10.1043/0003-3219(2001)0712.0.CO;2. PubMed 11510639 ↗
  • Varoni E, Tarce M, Lodi G, Carrassi A. Chlorhexidine (CHX) in dentistry: state of the art. Minerva Stomatol. 2012 Sep;61(9):399-419. English, Italian. PubMed 22976567 ↗
  • Veena HR, Mahantesha S, Joseph PA, Patil SR, Patil SH. Dissemination of aerosol and splatter during ultrasonic scaling: a pilot study. J Infect Public Health. 2015 May-Jun;8(3):260-5. doi: 10.1016/j.jiph.2014.11.004. Epub 2015 Jan 3. PubMed 25564419 ↗
  • Yengopal V. The use of essential oil mouthwashes as preprocedural rinses for infection control. SADJ. 2004 Jul;59(6):247-8, 250. No abstract available. PubMed 15457911 ↗
  • Costa X, Laguna E, Herrera D, Serrano J, Alonso B, Sanz M. Efficacy of a new mouth rinse formulation based on 0.07% cetylpyridinium chloride in the control of plaque and gingivitis: a 6-month randomized clinical trial. J Clin Periodontol. 2013 Nov;40(11):1007-15. doi: 10.1111/jcpe.12158. Epub 2013 Sep 11. PubMed 24024983 ↗
  • Feres M, Figueiredo LC, Faveri M, Stewart B, de Vizio W. The effectiveness of a preprocedural mouthrinse containing cetylpyridinium chloride in reducing bacteria in the dental office. J Am Dent Assoc. 2010 Apr;141(4):415-22. doi: 10.14219/jada.archive.2010.0193. PubMed 20354090 ↗
  • Giertsen E. Effects of mouthrinses with triclosan, zinc ions, copolymer, and sodium lauryl sulphate combined with fluoride on acid formation by dental plaque in vivo. Caries Res. 2004 Sep-Oct;38(5):430-5. doi: 10.1159/000079623. PubMed 15316186 ↗
  • Kang JH, Jang YJ, Kim DJ, Park JW. Antimicrobial effectiveness of cetylpyridinium chloride and zinc chloride-containing mouthrinses on bacteria of halitosis and peri-implant disease. Int J Oral Maxillofac Implants. 2015 Nov-Dec;30(6):1341-7. doi: 10.11607/jomi.3824. Epub 2015 Oct 16. PubMed 26478974 ↗
  • Kaur R, Singh I, Vandana KL, Desai R. Effect of chlorhexidine, povidone iodine, and ozone on microorganisms in dental aerosols: randomized double-blind clinical trial. Indian J Dent Res. 2014 Mar-Apr;25(2):160-5. doi: 10.4103/0970-9290.135910. PubMed 24992844 ↗
  • Logothetis DD, Martinez-Welles JM. Reducing bacterial aerosol contamination with a chlorhexidine gluconate pre-rinse. J Am Dent Assoc. 1995 Dec;126(12):1634-9. doi: 10.14219/jada.archive.1995.0111. PubMed 7499664 ↗
  • Reddy S, Prasad MG, Kaul S, Satish K, Kakarala S, Bhowmik N. Efficacy of 0.2% tempered chlorhexidine as a pre-procedural mouth rinse: A clinical study. J Indian Soc Periodontol. 2012 Apr;16(2):213-7. doi: 10.4103/0972-124X.99264. PubMed 23055587 ↗
  • Shetty SK, Sharath K, Shenoy S, Sreekumar C, Shetty RN, Biju T. Compare the effcacy of two commercially available mouthrinses in reducing viable bacterial count in dental aerosol produced during ultrasonic scaling when used as a preprocedural rinse. J Contemp Dent Pract. 2013 Sep 1;14(5):848-51. doi: 10.5005/jp-journals-10024-1414. PubMed 24685786 ↗

Study documents

  • Statistical analysis plan · Mar 30, 2017

Documents are hosted by the registry — open the source record to download them.

Individual participant data

Plan to share: Yes — September 2016

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Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Jun 4, 2020, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
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Registry details

Key details

Study ID
NCT02875769
Lead sponsor
University of Guarulhos
Responsible party
Belén Retamal-Valdes (DDS, MSc, PhD Student, University of Guarulhos) — Principal investigator
First posted
Aug 23, 2016
Start date
Feb 2015
Primary completion
Mar 2015
Completion
Apr 2015
Last update
Jun 4, 2020

Study contacts

Magda Feres, Professor
study chair · Guarulhos University

Oversight

Data monitoring committee
No
View the source record on ClinicalTrials.gov ↗

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