Sei sulla pagina 1di 5

Al Habashneh et al.

, Dentistry 2014, 4:2


http://dx.doi.org/10.4172/2161-1122.1000191

Dentistry
Research Article

Open Access

The Effect of Listerine Mouthwash on Dental Plaque, Gingival


Inflammation and C - reactive protein (CRP)
Al Habashneh R1*, Qubain TG2, Alsalman W2 and Khader Y3

Department of Preventive Dentistry, Jordan University of Science and Technology, Jordan


Department of Preventive Dentistry, Jordan University of Science and Technology, Jordan
3
Department of Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Jordan
1
2

Abstract
Aims and Objectives: The objectives of this study were to assess the antiplaque and antigingivitis properties of
Listerine mouth rinse and to investigate its effect on serum level of C-reactive protein.
Materials and Methods: patients received Listerine or placebo (water) in a single-blind 4-week trial. Thirty
qualifying subjects aged 20-50 years completed a 2-week preparatory period during which scaling and polishing
were done twice. Subjects were then randomly grouped into: Listerine or water (control) group. Clinical periodontal
parameters including visible plaque index (VPI), sulcus bleeding index (SBI), calculus index (CI), extrinsic tooth stain
index (SI) and percentage of sites with bleeding on probing (BOP) were obtained from test group as well as matched
controls. The measurements were performed at baseline and 4 weeks thereafter. Moreover, serum C-reactive protein
levels (CRP) were assayed. Subjects then started rinsing twice daily with 20 ml of their respective mouthwash as
adjunct to their usual mechanical oral hygiene procedures. Subjects were re-examined after 4 weeks, and intergroup
differences for all clinical variables and CRP level were tested using appropriate statistical procedures.
Results: All thirty subjects were evaluated after 4 weeks. Rinsing compliance was high for both groups. There
were no statistically significant differences between the two groups at baseline for all clinical variables with the
exception of the percentage of sites with BOP which was slightly significantly higher for the Listerine group compared
with the water group (p=0.047). At the end of the experimental period, Listerine group showed statistically significant
reductions in the VPI (-24.1), SBI (-0.9) and percentage of sites with BOP (-28.7) compared with the water group
(p<0.05). However, there were no statistical significant differences in CI and SI between the two groups. Moreover,
Listerine mouth rinse did not show statistical significant reduction in the serum levels of CRP compared with the water
group (-0.4 and -0.7 respectively, p=0.743).
Conclusion: This 4-week controlled clinical trial demonstrated that Listerine mouth rinse possesses antiplaque
and antigingivitis activities. Insofar, Listerine did not result in any side effects such as calculus formation and teeth
staining. Furthermore, Listerine couldnt show any effect on the serum levels of CRP relative to baseline measures.

Keywords: Mouthwash; Dental plaque; Gingival inflammation; CRP


Introduction
Dental plaque is a host associated biofilm which exists as soft
deposits adhering to tooth surfaces or other hard surfaces in the oral
cavity, and consists of bacteria embedded in a matrix of polymers of
bacterial and salivary origin [1]. There is a causal relationship between
dental plaque and gingivitis which was established decades ago [24]. Many studies have shown that self-performed mechanical homecare methods are essential in the prevention of periodontal diseases
[5,6]. These mechanical home-care methods include tooth brushing
by manual or electric means combined with inter-dental cleaning.
Therefore mechanical home-care methods remain the best approach
for the prevention of gingivitis [7] and can also reduce the risk for the
development or recurrence of periodontitis which progresses due to the
presence of subgingival bacteria that is derived from the supragingival
dental plaque. However, the use of mechanical home-care methods
requires time, motivation and manual dexterity [8]. Also, despite the
use of these methods, bacteria are often left behind especially in hardto-reach areas such as the posterior teeth or at the marginal gingiva.
Moreover, elderly patients, those with mental or physical limitations
and those with bridge work, malpositioned teeth or orthodontic
appliances may find brushing and flossing techniques difficult [9,10].
Therefore, the use of an antimicrobial mouth rinse as an adjunct to
mechanical home-care methods has been suggested to reduce plaque
missed by tooth brushing [11-13].
To date, there are two antiseptic mouth rinses that have the potential
to inhibit plaque and gingivitis and have received the Scientific Affairs

Dentistry
ISSN: 2161-1122 Dentistry, an open access journal

Seal of Acceptance by the American Dental Association Council. They


include chlorhexidine (CHX) and Listerine [13]. CHX has been studied
in many controlled clinical trials for long periods of six months or more
and results have shown that plaque reduction has ranged from 16-45%
and that gingivitis reduction has ranged from 27-80%.(14) Moreover,
bacterial resistance to CHX was not detected [14].
Despite the usefulness of chlorhexidine mouth rinse, it has certain
disadvantages such as brown staining on teeth, tongue and restorations,
altering taste sensation for up to 4 hours after rinsing and sometimes
associated with supragingival calculus buildup [15].
On the other hand, Listerine is an essential oil containing
mouth rinse that has similar antiplaque and antigingivitis effects
as chlorhexidine but does not have the unwanted side effects of
chlorhexidine, although there have been some complaints about its

*Corresponding author: Rola Al Habashneh, Department of Preventive Dentistry,


Faculty of Dentistry, Jordan University of Science and Technology, P.O. Box (3030),
Irbid 22110, Jordan, Tel: 962-2-7278662 ext. 291; Fax: 962-2-7278-962; E-mail:
rolaperio@yahoo.com
Received December 10, 2013; Accepted January 03, 2014; Published January
05, 2014
Citation: Al Habashneh R, Qubain TG, Alsalman W, Khader Y (2014) The Effect
of Listerine Mouthwash on Dental Plaque, Gingival Inflammation and C - reactive
protein (CRP). Dentistry 4: 191. doi:10.4172/2161-1122.1000191
Copyright: 2014 Al Habashneh R, et al. This is an open-access article
distributed under the terms of the Creative Commons Attribution License, which
permits unrestricted use, distribution, and reproduction in any medium, provided
the original author and source are credited.

Volume 4 Issue 2 1000191

Citation: Al Habashneh R, Qubain TG, Alsalman W, Khader Y (2014) The Effect of Listerine Mouthwash on Dental Plaque, Gingival Inflammation and
C - reactive protein (CRP). Dentistry 4: 191. doi:10.4172/2161-1122.1000191

Page 2 of 5

taste. It consists of a mixture of three phenolic-derived essential oils:


0.064% thymol, 0.092% eucalyptol and 0.042% menthol combined with
0.060 methyl salicylate. Its mechanism of action is through alteration
of the bacterial cell wall. It has low substantivity and it is uncharged
so it favors compliance because of no dentifrice interactions. One
adverse effect reported during the use of Listerine is burning sensation
[15]. Listerine has been studied in many controlled clinical trials
which showed plaque reductions ranging from 22-36% and gingivitis
reductions ranging from 23-36% with the longest study being 9 months
[14].
Several casecontrol studies have demonstrated a correlation
between periodontitis and serum levels of C-reactive protein. It has been
seen that its levels are generally higher in the presence of periodontal
disease [16,17]. Separate studies have explored the potential effects of
periodontal treatment on circulating CRP and other surrogate markers
of the vascular response [18,19]. As reported in the meta-analysis of
Paraskevas et al. [20] moderate evidence suggests that periodontal
therapy lowers the level of CRP in patients with periodontal disease.
Recent Meta analysis and systematic review by Freitas et al. [21]
indicated that non-surgical periodontal treatment had a positive effect
with regard to reduction of the serum levels of C-reactive protein.
The aim of this controlled clinical study was to assess the effect of
4 weeks rinsing with Listerine as adjunct to mechanical home-care
methods on plaque formation, gingivitis, calculus formation, staining,
and percentage of sites with bleeding on probing and the concentration
of serum C-reactive protein (CRP).

Methods
Participants
One hundred subjects were randomly recruited from Elite dental
center in Amman, Jordan during the period of January 2012 to June
2012. The study was approved by Ethical Committee at Jordan University
of Science and Technology in Jordan. Subjects were interviewed and
examined for eligibility to be included in the study. Subjects were
included in this study if they were diagnosed with chronic gingivitis.
The American Academy of Periodontology (1999) definitions of
plaque-associated gingivitis and localized, was used in the study [22].
Plaque-associated gingivitis is defined as gingival inflammation, which
is confined to the gingivae with no clinical attachment loss or on stable,
but reduced periodontium and is only associated with dental plaque
and no other local contributing factors [22]. Participants have to be
with no history of systemic diseases that may affect the C- reactive
protein level (CRP), such as impaired glucose tolerance, diabetes
mellitus or other endocrine diseases, nephrotic syndrome, chronic
renal disease and cardiovascular disease. Only nonsmokers who have
at least 20 natural teeth and not subjected to periodontal treatment in
the 6 months prior to the study were included. Patients were excluded if
they pregnant have had any systemic alteration(s) that might interfere
with the periodontal disease course, according to the literature; wearing
fixed or removable orthodontic appliances; having used antiseptic
mouthwashes in the three months prior to the study; undergoing
treatment with antimicrobial or anti-inflammatory drugs within the
3 months prior to the study. Only 30 patients (13 male, 17 female)
accepted to participate, fit the inclusion criteria, and completed the
baseline test after signing the consent form. The power was calculated
for testing the difference in the mean changes of studied parameters
between the study and control groups at a level of significance of 0.05.
For a sample size of 15 in group 1 (Essential oil mouth rinse) and 15 in
Dentistry
ISSN: 2161-1122 Dentistry, an open access journal

group 2: (Water as a negative control), the power to detect a medium


effect size of 0.5 standard deviation (SD) units for any of the studied
parameters exceeded 60%. The power was calculated using G*Power
version 3.1.7(Franz Faul, University Kiel, Germany).

Study procedures
Screening and selection of subjects was conducted by a single dental
experienced examiner (TQ). All subjects filled the study questionnaire
that included questions concerning the socio demographic information
of the subjects, dental history and medical history. Also they underwent
screening examination to assess the overall status of their dentition.
This was followed by a two week preparatory period during which
supragingival scaling and professional mechanical tooth cleaning was
done twice a week to remove all visible calculus, plaque, and extrinsic
tooth stain. The professional mechanical tooth cleaning was done using
abrasive paste with a brush or a rubber cup. In addition, subjects were
told to continue their usual mechanical home-care methods.
After completing the preparatory period, subjects were randomly
assigned, by tossing a coin, into two groups:
Group 1: Essential oil mouthrinse (Listerine antiseptic): 15 subjects
(7 males and 8 females) mean age of 28.07 ( 4.93) years;
Group 2: Water as a negative control: 15 subjects (6 males and 9
females) with mean age of 28.4 (6.12) years.
Approximately one week after the debridement visit, subjects
returned for baseline data collection (Week 0), which were collected in
the following order: Visible Plaque Index (VPI) [23], Sulcus bleeding
index (SBI) [24], Calculus Index (CI) [25], Tooth stain index (SI)
[26], - Le and Silness gingival index (GI) [27], and Probing depths in
millimeters (PD).
Prior to the beginning of this study, measurement reliability was
determined, based on examinations performed on 20 patients. Of the
replications, 98% were consistent for VPI, 94% were consistent for SBI
and 97% were consistent for CI, SI and percentage of sites with BOP, by
making two visits one week apart.
The two week preparatory period was followed by a four weeks
experimental period during which subjects were asked to rinse twice
with 20 ml of their respective mouthwash for 30 seconds (according
to the manufacturer instructions) as adjunct to their usual mechanical
home-care methods. Patients were instructed to perform regular oral
hygiene habits, i.e. twice-daily brushing by roll-on technique for a
minimum of 2 min, using a standard tooth brush (Colgate with soft
consistency bristles) and tooth paste (Colgate dental ) provided to
them during the preparatory and experimental periods. The type of
Listerine mouth rinse bottles that were provided to subjects were of
the Advanced Listerine with Tartar Protection- Arctic Mint one.
Subjects were also provided with toothbrushes and toothpastes to use
them during the preparatory and experimental periods. Compliance
of subjects was also assessed by measuring the residual volume of the
mouth rinse in the bottles.
At the end of the baseline visit, subjects received a randomlyassigned mouthwash. Subjects were instructed to brush as usual then
rinse their mouth with the assigned mouth wash daily. At Weeks 8,
measurements were retaken on the same teeth in the same order as
Week 0. Subjects were questioned about any changes in their medical
histories and whether they had experienced any side effects. If at the end
of the study a subject presented with any one or all of these-calculus,
stain, and BOP, an exit debridement was performed. All subjects were

Volume 4 Issue 2 1000191

Citation: Al Habashneh R, Qubain TG, Alsalman W, Khader Y (2014) The Effect of Listerine Mouthwash on Dental Plaque, Gingival Inflammation and
C - reactive protein (CRP). Dentistry 4: 191. doi:10.4172/2161-1122.1000191

Page 3 of 5

dismissed after finishing the trial and requested to return to their usual
oral health care professional for continuing care.
One examiner, who was blinded to the treatment assignments
and calibrated before the study began, collected the clinical data on all
subjects. All measurements were taken on six sites per tooth (mesialbuccal, buccal, distalbuccal, distal-lingual, lingual, and mesial-lingual)
on all teeth except third molars and teeth with crown and bridge
coverage. Scores were averaged per tooth then added together and
divided by number of teeth for the subjects full mouth score.

Blood sampling and measurement of hs-CRP


Following the examination of each patient (control and test group),
5 ml venous blood sample was obtained after 10 hours of fasting, at
baseline and at follow up visit. Blood was collected in tubes with
clot activator, 3.2% sodium citrate; or EDTA. Samples taken for CRP
determination were centrifuged and stored at 20C until analyzed.
The CRP levels (mg/dL) were analyzed using a high-sensitivity ELISA.
Serum levels of CRP were measured with an immuno-turbidimetric
high-sensitivity assay (Tina-quant CRP immunoturbidimetric assay
performed on a Cobas integra analyzer; Roche Diagnostics, GmbH,
Mannheim, Germany for USA). The serum CRP content is determined
using the Roche Diagnostics/Hitachi 912 System. The Roche CRP
Listerine Group
D0

Water Group
D0

mean (SD)

mean (SD)

VPI

52.2 (11.6)

52.0 (15.3)

0.971

SBI

2.15 (0.4)

2.05 (0.41)

0.481

CI

0.0 (0.0)

0.0 (0.0)

SI

0.3 (0.8)

0.0 (0.0)

0.207

% BOP

68.3 (10.9)

61.5 (6.7)

0.047

C reactive protien

4.4 (8.04)

2.7 (3.3)

0.454

Clinical Parameters

p- value

SD= Standard Deviation, D0= Day 0


SD= Standard Deviation, D0= Day 0, D28= Day 28
Table 1: Mean values for the clinical parameters at baseline.
Clinical Parameter

assay is based on the principle of particle-enhanced immunological


agglutination, this new microparticle-based CRP assay provides
the accuracy and precision that is required to determine CRP at low
concentrations.

Statistical analysis
Paired t-test was used to test the statistical significant difference of
change in dependant variables within each group between baseline and
at the end of the experimental period (28 days). Independent t-test was
used to test for the statistical significant difference of change in clinical
parameters between Listerine and water groups. A p-value of less than
0.05 was considered statistically significant.

Results
Baseline characteristics
This study included 15 subjects (7 males and 8 females) in Listerine
group and 15 subjects (7 males and 9 females) in water group. The mean
(SD) age was 28.07 (4.93) year for subjects in Listerine group and 28.4
(6.12) year in water group with no significant difference. At baseline,
there were no significant differences in the percentage of sites with
visible plaque, Sulcus Bleeding Index, Calculus Index, Stain Index, and
serum level of C-reactive protein (Table 1). However, percentage of sites
with bleeding on probing was significantly higher in the Listerine group.

Clinical parameters (Tables 2 and 3)


There were statistically significant differences between treatment
groups (p-value=0.000) at 4 Week. Relative to baseline, the Listerine
group had 24.1% decrease in the percentage of surfaces with plaque
compared with 0.5% slight increase in the percentage of surfaces with
plaque) for the water group (p=0.000). The mean difference in the VPI
for Listerine group was -24.1% (a decrease in the percentage of surfaces
with plaque) compared with 0.5% (a slight increase in the percentage of
surfaces with plaque) for the water group (p=0.000). This difference was
statistically significant (p=0.000).

Listerine Group

VPI (%)
SBI

D0

D 28

D28-D0

mean(SD)

mean(SD)

mean (SD)

52.2(11.6)

28.1(6.2)

-24.1(9.5)

2.2(0.4)

1.3(0.2)

-0.9(0.5)

Water Group
D0

D 28

D28-D0

mean(SD)

mean(SD)

mean(SD)

0.000

52.0(15.3)

52.5(14.4)

0.5(1.7)

0.309

0.000

2.0(0.4)

2.0(0.4)

0.0(0.1)

0.975
0.164

p-value

pvalue

CI

0.0(0.0)

0.3(0.5)

0.3(0.5)

0.041

0.0(0.0)

0.1(0.4)

0.1(0.4)

SI

0.3(0.8)

1.1(2.1)

0.9(2.0)

0.121

0.0(0.0)

0.0(0.0)

0.0(0.0)

--

68.3(10.9)

39.6(9.4)

-28.7(8.7)

0.000

61.5(6.7)

63.1(7.6)

1.5(1.8)

0.005

4.4(8.0)

4.0(9.1)

-0.4(2.7)

0.574

2.7(3.3)

2.0(3.3)

-0.7(1.1)

0.039

% BOP
CRP

SD= Standard Deviation, D0= Day 0, D28= Day 28, VPI=Visible Plaque Index, SBI= Sulcus Bleeding Index, CI= Calculus Index, SI= Stain Index, %BOP= Percentage of Sites
with Bleeding on Probing, CRP= Serum Level of C-Reactive Protein
Table 2: Mean values for all clinical parameters at the start and at the end of the experimental period and their mean difference.

Clinical Parameter

Listerine Group
(D28- D0)

Water Group
(D28- D0)

mean (SD)

mean (SD)

p- value

VPI

-24.1 (9.5)

0.5 (1.7)

0.000

SBI

-0.9 (0.5)

0.0 (0.1)

0.000
0.379

CI

0.3 (0.5)

0.1 (0.4)

SI

0.9 (2.03)

0.0 (0.0)

0.110

% BOP

-28.7 (8.7)

1.5 (1.8)

0.000

CRP

-0.4 (2.7)

-0.7 (1.1)

0.743

SD= Standard Deviation, D0= Day 0, D28= Day 28, VPI=Visible Plaque Index, SBI= Sulcus Bleeding Index, CI= Calculus Index, SI= Stain Index, %BOP= Percentage of Sites
with Bleeding on Probing, CRP= Serum Level of C-Reactive Protein
Table 3: Mean values for the difference in clinical parameters between day 0 and day 28.

Dentistry
ISSN: 2161-1122 Dentistry, an open access journal

Volume 4 Issue 2 1000191

Citation: Al Habashneh R, Qubain TG, Alsalman W, Khader Y (2014) The Effect of Listerine Mouthwash on Dental Plaque, Gingival Inflammation and
C - reactive protein (CRP). Dentistry 4: 191. doi:10.4172/2161-1122.1000191

Page 4 of 5

Sulcus bleeding index reduced in Listerine group -0.9 ( 0.5),


(p=0.000) with no changes detected in water group.

VPI with the use of Listerine mouth rinse (-24.1) compared with the
water group (0.5).

As Table 2 shows that the amount of calculus increased between


baseline and after treatment for both groups but it was slightly higher
in the Listerine group 0.3 ( 0.5) compared with the water group 0.1
( 0.4). No significant differences were seen in both groups (p=0.379).

Many previous studies, such as those conducted by Axelsson and


Lindhe [5], Overholser et al. [28] and Sharma et al. [29], showed similar
results and they were designed to evaluate the effect of using a mouth
rinse solution as adjunct to regular mechanical home-care methods
during periods ranging between 6 weeks and 6 months. The results
of these studies have shown a more pronounced effect of Listerine
on gingival condition when patients rinse after disrupting the plaque
deposits mechanically. Hence, these studies have shown the limited
ability of Listerine mouthwash to penetrate the plaque biofilm [30].
Therefore, in this study the plaque deposits were disrupted by scaling
and polishing which was performed twice during the preparatory
period. Moreover, subjects continued their mechanical home-care
methods during the experimental period which also disrupts the
biofilm and aids in the penetration of Listerine mouth rinse into the
biofilm.

The stain index (SI) with Listerine group 0.9 ( 2.0) were little
higher than water group 0.0 (0.0). However, the difference was not
statistically significant (p=0.110).

Percentage of sites with bleeding on probing


At day 0, the mean values of the percentage of sites with BOP for the
Listerine group was higher (68.3) than that of the water group (61.5).
This difference was only slightly statistically significant (p=0.047)
(Table 1). However, the percentage of sites with BOP greatly decreased
in Listerine group in which the mean values for the difference in the
percentage of sites with BOP between day 0 and day 28 was shown to be
-28.7. In the water group, there was a slight increase in the percentage
of sites with BOP (1.5 ( 1.8)).

Serum level of C-reactive protein


The serum level of CRP at day 0 was higher in the Listerine group
(4.4) compared to the water group (2.7), but this difference was not
statistically significant (p=0.454) (Tables 2 and 3). At the end of the
experimental period, both groups had a slight decrease in the serum
level of CRP, however, with greater reduction in water group (Listerine
group the decrease was 0.4 while in the water group the decrease was
0.7). However, this difference was not statistically significant (p=0.743)
(Tables 2 and 3).

Discussion
This randomized, placebo-controlled, single-blind study suggests
that Listerine is effective in the treatment of gingivitis, as evidenced
by the decreases in inflammatory signs. Subjects who participated in
this study presented with varying amounts of plaque, calculus and
gingivitis. These subjects were then involved in a two-week preparatory
period, during which scaling and polishing was performed twice. The
preparatory period was important in order to obtain realistic and
objective levels of plaque and gingival health, and it was followed by
a four-week experimental period during which subjects rinsed twice
daily with 20ml of their respective mouthwash (Listerine or water).
During both the experimental and the preparatory periods, all subjects
continued to practice their regular, self-performed and non-supervised
oral hygiene and they were provided with new toothbrushes and
identical dentifrice (toothpaste).
This study demonstrated that rinsing twice daily for 4 weeks with
Listerine mouth rinse as adjunct to mechanical home-care methods
resulted in significant reductions in plaque accumulation and gingivitis
levels. However, rinsing with Listerine did not significantly affect
calculus formation nor did it cause staining of the dentition. Moreover,
this is the first study conducted to investigate the effect of twice daily
rinsing with Listerine mouth rinse for a period of 4 weeks on the serum
level of C-reactive protein (CRP). Results showed that Listerine mouth
rinse slightly decreased the serum level of CRP but this decrease was
not statistically significant.
Visible Plaque Index (VPI) measures the percentage of sites
harboring visible plaque which gives an indication about the level of
plaque accumulation. This study showed a significant decrease in the

Dentistry
ISSN: 2161-1122 Dentistry, an open access journal

Moreover, results of this study are in agreement with many longterm studies. For example Sharma et al. conducted a 6-month controlled
clinical trial comparing the antiplaque and antigingivitis effectiveness
of CHX and essential oil mouth rinses, during which subjects
continued their oral hygiene methods [29]. The study demonstrated
that essential oil and CHX mouth rinses possessed antiplaque property
[29]. Similarly, Gordon et al. performed a 9-month clinical trial (in
which subjects continued their oral hygiene methods) and showed that
Listerine significantly reduced the development of plaque at 1, 3, 6 and
9 months [31].
Sulcus Bleeding Index (SBI) is a measure of the level of gingivitis.
This study showed a significant reduction in the SBI in the Listerine
group (-0.9) compared with water group (0.0) which showed no change.
Although the guidelines of the American Dental Association on the
use of trials to measure gingivitis reduction insist on a period of at least
six months, studies of lesser duration have been conducted in spite of
the guidelines. Moreover, in most cases, the amount of plaque present
is assessed together with gingivitis [32].
Short-term studies have showed that Listerine could reduce plaque
compared with placebo but its ability to reduce gingivitis is not marked
[32]. For example, the two short-term studies conducted by Brecx et al.
showed that the gingival index scores were equal in Listerine, Meridol
and placebo groups, while in the CHX group the values were only half
those of other groups [27,28]. These two studies showed no effect of
Listerine mouth rinse on gingivitis, which may be due to the short
duration of the studies [33,34].
On the other hand, long-term studies have showed that Listerine
possessed an antigingivitis property. For example, in a 6-month
clinical trial conducted by Sharma et al. comparing the antiplaque
and antigingivitis effectiveness of CHX and Listerine mouth
rinses demonstrated that both mouth rinses possessed comparable
antigingivitis property [29]. This antigingivitis property was obvious
for CHX at both 3 and 6 months, while for Listerine it was obvious
only at 6 months [29]. Similarly, Gordon et al. showed that Listerine
mouthrinse significantly reduced the development of gingivitis at 9
months [25].
Calculus Index (CI) measures the amount of calculus accumulation
on the lingual surface of the lower anterior teeth. This study did not
show significant increase in calculus accumulation in the Listerine
group compared with water group. The 6-month controlled clinical trial

Volume 4 Issue 2 1000191

Citation: Al Habashneh R, Qubain TG, Alsalman W, Khader Y (2014) The Effect of Listerine Mouthwash on Dental Plaque, Gingival Inflammation and
C - reactive protein (CRP). Dentistry 4: 191. doi:10.4172/2161-1122.1000191

Page 5 of 5

conducted by Sharma et al. showed that at 3 months, calculus formation


was greatest in the CHX group, and it was greater in the Listerine than
in the control group [29]. However, at 6 months, calculus accumulation
was the same in both the Listerine and the control groups which was
less than the CHX group [29].
Stain Index (SI) measures the area and severity of stain at the labial
surfaces of the upper and lower teeth. Results of this study showed a
higher SI in the Listerine group (0.9) compared to water group (0.0),
but this difference was not statistically significant. Listerine has not
been reported previously as producing staining of the teeth [32]. On
the contrary, Moran et al. 1991 did find a significant difference in
severity of staining compared with placebo [35]. Moreover, Sharma et
al. showed a significantly more gingival region stain in the CHX and
Listerine groups compared to the control group, although stain was
greater in the CHX than the Listerine group [29].
This study has shown a significant reduction in the percentage of
sites with BOP in the Listerine group (-28.7) compared with water
group (1.5). The observation for the percentage of sites with BOP
paralleled the significant VPI and SBI reductions seen in the Listerine
group and it was consistent with the result of Sharma et al. [29].
The serum level of CRP decreases slightly in both groups but
this difference was not statistically significant. This study has shown
that Listerine does not affect the serum level of CRP even though it
results in a decrease in gingivitis level. This observation may be due
to the short duration of the study. Hence, longer-term studies of at
least 6-month duration should be conducted to further investigate the
effect of Listerine on the serum level of CRP. An experimental period
of 4 weeks was chosen for permitting comparison to other studies.
However, to guarantee these results and the effectiveness of this mouth
rinse, additional long-term clinical trials should be performed that
incorporate more isolates from clinical samples. Another limitation
that should be considered when interpreting the findings of this study
is the low power to detect the differences in the change of the studied
parameters between the two study groups because of the small sample
size. Within the limitations of this preliminary clinical study, it can be
conclude that Listerine mouth rinse was effective in controlling plaque
and gingivitis.
References
1. Socransky S, Haffajee A (2002) Dental biofilms: difficult therapeutic targets.
Periodontology 2000 2002: 28: 12-55.
2. Ash M, Gitlin BN, Smith NA (1964) Correlation between plaque and gingivitis.
J Periodontol 35: 425-429.
3. Le H, Theilade E, Jensen SB (1965) Experimental gingivits in man. J
Periodontol 36: 177-187.
4. Lindhe J, Rylander H (1975) Experimental gingivitis in young dogs. Scand J
Dent Res 83: 314-326.
5. Axelsson P, Lindhe J (1978) Effect of controlled oral hygiene procedures on
caries and periodontal disease in adults. J Clin Periodontol 1: 126-158.
6. Le H (2000) Oral hygiene in the prevention of caries and periodontal disease.
Int Dent J 50: 129-139.
7. Axelsson P (1993) Mechanical plaque control. Proceedings of the 1st European
Workshop on Periodontology. Quintessence Publishing Co. Ltd, London.
8. De PaolaL G, Overholser CD, Meiller TF, Minah GE, Niehaus C (1989)
Chemotherapeutic inhibition of supragingival dental plaque and gingivitis
development. J Clin Periodontal 16: 311-315.
9. Baker K (1993) Mouthrinses in the prevention and treatment of periodontal
disease. Curr Opin Periodontol 1: 89-96.
10. Ciancio SG (1988) Use of mouthrinses for professional indications J Clin
Periodontol 15: 520-523.

Dentistry
ISSN: 2161-1122 Dentistry, an open access journal

11. Mandel ID (1988) Chemotherapeutic agents for controlling plaque and


gingivitis. J Clin Periodontal 15: 488-498.
12. Barnett ML (2003) The role of therapeuticantimicrobial mouthrinses in clinical
practice. Control of supragingival plaque and gingivitis. J Am Dent Assoc 134:
699-704.
13. Moran JM (2008) Home-use oral hygiene products: mouthrinses. Periodontol
2000 48: 42-53.
14. Santos A (2003) Evidence-based control of plaque and gingivitis. J Clin
Periodontol 30: 13-16.
15. Ciancio SG (2008) Mouth rinses and their impact on oral hygiene. Lead Story.
16. Slade GD, Offenbacher S, Beck JD, Heiss G, Pankow JS (2000) Acute-phase
inflammatory response to periodontal disease in the US population. J Dent Res
79: 49-57.
17. Loos BG, Craandijk J, Hoek FJ, Wertheim- van Dillen PM, van der Velden U
(2000) Elevation of systemic markers related to cardiovascular diseases in the
peripheral blood of periodontitis patients. J Periodontol 71: 1528-1534.
18. Noack B, Genco RJ, Trevisan M, Grossi S, Zambon JJ, et al. (2001) Periodontal
infections contribute to elevated systemic C-reactive protein level. J Periodontol
72: 1221-1227.
19. DAiuto F, Parkar M, Andreou G,Suvan J,Brett PM, et al. (2004) Periodontitis
and systemic inflammation: control of the local infection is associated with a
reduction in serum inflammatory markers. J Dent Res 83: 156-160
20. Paraskevas S, Huizinga JD, Loos BG (2008) A systematic review and metaanalyses on C-reactive protein in relation to periodontitis. J Clin Periodontol
35: 277-290.
21. Freitas CP, Gomes-Filho IS, Naves RC, Nogueira Filho Gda R, Cruz SS, et al.
(2012) Influence of periodontal therapy on C-reactive protein level: a systematic
review and meta-analysis. J Appl Oral Sci 20: 1-8.
22. Armitage GC (1999) Development of a classification system for periodontal
diseases and conditions. Ann Periodontol 4: 1-6.
23. Ainamo J, Bay I (1975) Problems and proposals for recording gingivitis and
plaque. Int Dent J 25: 229-235.
24. Muhlemann HR, Son S (1971) Gingival sulcus bleeding - a leading symptom in
initial gingivitis. Helv Odontol Acta 15: 107-113.
25. Greene JC, Vermillion JK (1964) The simplified oral hygiene index. J Am Dent
Assoc 68: 7-13.
26. Lobene RR (1968) Effect of dentifrices on tooth stains with controlled brushing.
J Am Dent Assoc 77: 849-855.
27. Loe H, Silness J (1963) Periodontal disease in pregnancy part I, Prevalence
and severity. Acta Odontol Scand 21: 533-551.
28. 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 gingivitis. J Clin Periodontol 17: 575-579.
29. Sharma N, Charles CH, Lynch MC, Qaqish J, McGuire, JA, 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 study. J Am
Dent Assoc 135: 496-504.
30. Netuschil L, Weiger R, Preisler R, Brecx M (1995) Plaque bacteria counts and
vitality during chlorhexidine, meridol and Listerine mouthrinses. Eur J Oral Sci
103: 355-361.
31. Gordon JM, Lamster IB, Seiger MC (1985) Efficacy of Listerine antiseptic in
inhibiting the development of plaque and gingivitis. J Clin Periodontol 12: 697704.
32. Adams D, Addy M (1994) Mouthrinses. Adv Dent Res 2: 291-301.
33. Brecx M, Netuschil L, Reichert B, Schreil G (1990) Efficacy of Listerine, Meridol
and chlorhexidine mouthrinses on plaque, gingivitis and plaque bacteria vitality.
J Clin Periodontol 17: 292-297.
34. Brecx M, Brownstone E, MacDonald L, Gelskey S, Cheang M (1992) Efficacy of
Listerine Meridol and chlorhexldine mouth rinses as supplements to regular
tooth cleaning measures. J Clin Periodontol 19: 202-207.
35. Moran J, Pal D, Newcombe R, Addy M (1991) Comparison of a phenolic and
a 0.2% chlorhexidine mouthwash on the development of plaque and gingivitis.
Clin Prev Dent 13: 31-35.

Volume 4 Issue 2 1000191