Antibacterial toothpastes and mouthwashes

• These preparations are widely available from supermarkets and pharmacies.
• Antibacterial agents include cetylpyridinium chloride, chlorhexidine, hexetidine, hydrogen peroxide, and triclosan.
• Given the lack of good evidence to support these products, the choice of preparation will depend on individual preference and product tolerability.
• Of the mouthwashes, chlorhexidine gluconate 0.2% mouthwash is most commonly prescribed in primary care. However, some people may find it difficult to use chlorhexidine in the long term because [Porter and Scully, 2006]:
• Chlorhexidine-based products (dental gel, mouthwash, and spray) can cause discolouration of the tongue and teeth (this is reversible on discontinuation of treatment) [ABPI Medicines Compendium, 2007; ABPI Medicines Compendium, 2009a; ABPI Medicines Compendium, 2009b].
• Tooth staining can be minimized by reducing consumption of tea, coffee, or red wine and by brushing teeth before using the chlorhexidine product.
• Staining of dentures can be reduced by cleaning with a conventional denture cleanser.
• Chlorhexidine products can cause transient taste disturbance and a burning sensation of the tongue (particularly if used too frequently).
• These effects may occur initially and usually diminish with continued use [ABPI Medicines Compendium, 2007; ABPI Medicines Compendium, 2009a; ABPI Medicines Compendium, 2009b].
• Some experts do not recommend the use of mouthwashes with a high alcohol content as this can cause a drying effect on the mouth [Morita and Wang, 2001]. Alcohol-free mouthwashes are available.