The effect of cetylpyridinium chloride mouthrinse as adjunct to toothbrushing compared to placebo on interproximal plaque and gingival inflammation-a systematic review with meta-analyses

Objectives The present study aimed to systematically review the literature about the interproximal anti-plaque and anti-gingivitis efficacy of cetylpyrydinium chloride (CPC) mouthrinse compared to placebo solution. Materials and methods Three databases (PUBMED, SCOPUS, and EMBASE) were searched for randomized clinical trials that compared the interproximal anti-plaque and anti-gingivitis effect of CPC and placebo mouthrinses as an adjunct to toothbrushing, after a minimum of 6 weeks. Individuals with any periodontal diagnosis were considered. Two meta-analyses were performed for the Turesky modification of the Quigley-Hein plaque index and the Loe and Silness gingival index. For both analyses, the mean differences (MD) between baseline and 6-weeks were calculated using a random-effect model. Results Eight studies were included. All included studies showed significant improvement in at least one of the parameters, favoring the CPC mouthrinse when compared to placebo. The meta-analysis demonstrated that groups that used CPC displayed a significantly greater reduction in the plaque index score (MD; 95% confidence interval [95%CI]: - 0.70; - 0.83 to - 0.57) and in the gingival index (MD; 95%CI: - 0.38; - 0.47 to - 0.28) when compared to placebo. However, high heterogeneity was observed in both analyses (I-2 = 89% and I-2 = 98%, respectively). Conclusions When considering interproximal surfaces, CPC is efficacious both in plaque and gingival inflammatory parameters, demonstrating the potential to compensate for the limitations of interproximal plaque control.