Cetylpyridinium Chloride in Mouthwash

What is Cetylpyridinium Chloride (CPC)?

Cetylpyridinium chloride is also known as CPC or cetyl chloride. 

The chemical compound is used as an active ingredient in various:

  • Over-the-counter toothpaste
  • Oral rinses
  • Other oral hygiene products

CPC is also used as a cosmetic preservative and antimicrobial spray for:

  • Fruit
  • Poultry
  • Seafood
  • Red meats

Cetyl chloride is known to help prevent gum disease and remove dental plaque. It works by penetrating the cell membrane. This causes cell components to leak. 

What Does Cetylpyridinium Chloride Do in Mouthwash?

Cetylpyridinium chloride is a compound that works against the oral bacteria within dental plaque. This makes it a beneficial antimicrobial ingredient in mouthwash.10

CPC-containing oral rinses may decrease the dental plaque’s chance to mature around the teeth. CPC can also help prevent the growth of oral bacteria that causes gum disease. 

This reduces the chance of developing gingivitis. Gingivitis leads to gum inflammation and bleeding in the oral cavity.

Using CPC-containing oral rinses ultimately helps patients improve their overall oral health.

What are the Benefits of CPC Mouth Rinses?

Oral mouthwashes contain many different components to produce specific benefits for the teeth and mouth. For example, sodium fluoride is often added to oral hygiene mouthwashes to prevent tooth decay. Peroxide may be added for whitening treatment.

Patients' wants and needs vary. This is why so many mouthwashes exist today. However, mouthwashes usually fall into one of two categories: cosmetic and therapeutic formulations. 

Cosmetic mouthwashes offer benefits like whitening or breath freshening. 

Therapeutic mouthwashes contain active ingredients like cetylpyridinium chloride to prevent dental issues like:

  • Gum disease
  • Tooth decay
  • Gingivitis

Antimicrobial agents like cetylpyridinium chloride may help reduce plaque and gingivitis in the oral cavity. CPC can also improve bad breath. Because of these oral health treatment benefits, cetylpyridinium chloride mouth rinses are considered therapeutic mouthwashes.

Well-documented studies have proven clinical efficacy in significantly reducing plaque and gingival inflammation for CPC mouthrinses compared to those who do not use it. 

Reductions range from:11

  • 15 to 24 percent for gingivitis
  • 27 to 67 percent for bleeding
  • 16 to 28 percent for dental plaque.

Other research has proven equal benefits in patients.12

Cetylpyridinium chloride is also found in many alcohol-free mouthwashes. This appeals to some people because alcohol-free CPC mouthwashes may not produce a burning sensation during use.

Alcohol-free CPC mouthwashes also do not cause a bitter taste in the mouth.

What are the Risks of CPC Mouth Rinses? 

Cetylpyridinium chloride is usually safe to use in oral health products. It is also typically safe to use as an antimicrobial spray on food. 

Frequent use of mouthwashes containing cetylpyridinium chloride can lead to minor brown staining on the:

  • Teeth
  • Dental restorations
  • The tongue

The gums are also susceptible to burning.

Staining resulting from CPC use is more likely to occur from prescription mouthwashes. For example, chlorhexidine. The staining effects appear often in over-the-counter mouthwash treatments.

Cetylpyridinium chloride mouthwashes have also been misattributed as a cause of oral cancer in the past. However, research has not shown it to link to any cancers.13

CPC is only toxic in significant doses, one gram or more of pure CPC. It is far more beneficial than harmful. None of the side effects and symptoms of CPC are particularly hazardous, but they should be considered.

What Mouthwash Products Contain Cetylpyridinium Chloride?

Recently, over-the-counter CPC mouthrinses have been introduced in alcohol-free formulations. For example, the Crest® PRO-HEALTH™ Mouthwash by Procter & Gamble. Colgate Zero for Healthy Gums Alcohol Free Mouthwash also contains CPC and reports beneficial uses for patients. 

This oral health treatment is a 0.07 percent concentration CPC rinse. Research shows that this mouthwash is highly rated with high patient compliance.11 

How Should You Choose a Mouthwash?

Consider asking your dentist about treatment using oral rinses in your dental hygiene routine. You may decide to use a mouthwash to control oral cavity bacteria or for cosmetic benefits. 

No matter what type of mouthwash your dentist recommends, following their directions and the prescription label is essential.

Not all oral hygiene mouthwashes are the same. There are many different mouthwash formulations for various oral issues. This is why it is essential to educate yourself on a formula’s ingredients and intended use before using it as a treatment.

Using an oral mouthwash does not replace the need for daily flossing and twice-daily brushing. 

You should always speak with a dental professional before trying any new oral care products for treatment. This ensures you use the best one for your needs.

Resources

Jafer, Mohammed & Patil, Shankargouda & Hosmani, Jagadish & Bhandi, Shilpa & Chalisserry, Elna & Anil, Sukumaran. (2016). Chemical Plaque Control Strategies in the Prevention of Biofilm-associated Oral Diseases. The journal of contemporary dental practice. 17. 337-343

White, DJ. “An alcohol-free therapeutic mouthrinse with cetylpyridinium chloride (CPC)--the latest advance in preventive care: Crest Pro-Health Rinse.” American journal of dentistry vol. 18 Spec No (2005): 3A-8A.

Rahman, Betul et al. “Comparative antiplaque and antigingivitis effectiveness of tea tree oil mouthwash and a cetylpyridinium chloride mouthwash: A randomized controlled crossover study.” Contemporary clinical dentistry vol. 5,4 (2014): 466-70

Walker WB. The Oral Cavity and Associated Structures. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990. Chapter 129

Lynch, M.C., Cortelli, S.C., McGuire, J.A. et al. The effects of essential oil mouthrinses with or without alcohol on plaque and gingivitis: a randomized controlled clinical study. BMC Oral Health 18, 6 (2018)

Arweiler, Nicole B, and Lutz Netuschil. “The Oral Microbiota.” Advances in experimental medicine and biology vol. 902 (2016): 45-60

Silva, Milton Fernando de A et al. “A clinical investigation of the efficacy of a commercial mouthrinse containing 0.05% cetylpyridinium chloride to control established dental plaque and gingivitis.” The Journal of clinical dentistry (J Clin Dent) vol. 20,2 (2009): 55-61.

Sreenivasan, PK, Haraszthy Vi, et al. “Antimicrobial efficacy of 0·05% cetylpyridinium chloride mouthrinses.” Letters in applied microbiology vol. 56,1 (2013): 14-20

Haps, S., Slot, DE., Berchier, C. E., & Van der Weijden, G. A. (2008). The effect of cetylpyridinium chloride-containing mouth rinses as adjuncts to toothbrushing on plaque and parameters of gingival inflammation: a systematic review. International journal of dental hygiene, 6(4), 290–303

Teng, Fei et al. “Cetylpyridinium chloride mouth rinses alleviate experimental gingivitis by inhibiting dental plaque maturation.” International journal of oral science vol. 8,3 182-90. 29 Sep. 2016, doi:10.1038/ijos.2016.18

Therapeutic Mouthrinsing: An Effective Component to Oral Hygiene Cetylpyridinium Chloride (CPC), Dental Care

Witt, Jon J et al. “Comparative clinical trial of two antigingivitis mouthrinses.” American journal of dentistry vol. 18 Spec No (2005): 15A-17A.

Flournoy, Blake. "Cetylpyridinium Chloride Side Effects" sciencing.com

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