International Summit Addresses Recommendations for Oral Antiseptics

During an online press conference from the SEPA (Spanish Society of Periodontology) Foundation’s headquarters in Madrid, Spain, on Friday, April 5, an international summit of experts presented practical recommendations and indications for the use of antiseptics, highlighting the solid scientific evidence currently available. The latest scientific and clinical evidence, systematic reviews of studies, and reference guides for dental professionals all support the efficacy and value of antiseptics as a complement to daily oral hygiene, and their use is considered a part of the prevention and treatment of periodontal diseases, the panelists stated.

Prioritizing the prevention and treatment of periodontal diseases and promoting periodontal health is key to improving overall health outcomes, preserving natural teeth, reducing healthcare costs, enhancing quality of life, and promoting public health. These benefits and findings were highlighted at the summit held at the Casa de las Encías in Madrid. Members of the media, including Dental Products Report, were invited to attend the summit via Zoom. The event combined current knowledge and analyzed the scientific literature and prevailing international guidelines to clarify the role of certain mouthwashes in oral hygiene, gingivitis treatment, and periodontitis prevention.

"Periodontal diseases are prevalent worldwide, affecting hundreds of millions of people," meeting coordinator, Dr. Paula Matesanz, vice president of SEPA, says. She acknowledges that "focusing on prevention and promoting periodontal treatment among the general public allows us to reduce the burden of this disease, improve equality in oral health, and promote overall public health. And to achieve this ambitious objective, there are effective and safe resources that are still currently underutilized."

In February, Dental Products Report reported that The SEPA Foundation and Listerine® had united under the banner of “Principles for Oral Health,” a bold global initiative aimed at advancing periodontal health and ensuring that oral healthcare professionals worldwide have access to essential tools for primary, secondary, and tertiary prevention of periodontitis. SEPA is a global nonprofit scientific organization with over 65 years of experience that serves as a cornerstone in international periodontology, boasting strong ties to prestigious societies and federations worldwide.

Oral antiseptics, generally antimicrobial mouthwashes or rinses including Listerine products, can play a key role in preventing periodontal diseases and their recurrence, given their ability to reduce dental biofilm formation. Depending on their active ingredients, as revealed by an analysis of the scientific literature, these products can help reduce bacterial load, complement daily oral hygiene practices, reduce plaque and inflammation rates, or even be incorporated as additional resources in periodontal maintenance programs, the researchers state. These benefits can help preserve periodontal health and support the long-term success of periodontal treatment.

Backed by these findings, the panelists discussed the need to make clinical practice guidelines, developed by the European Federation of Periodontology (EFP) and adapted by SEPA for use in Spain, accessible to oral health professionals, physicians, pharmacists, patients, and the general population. With a focus on engaging, empowering and educating, the group agreed that it’s important for dental professionals to be aware of this research and to then be able to educate their patients. "So that scientific knowledge is more accessible and capable of improving health," Dr Matesanz adds.

One takeaway from the meeting of experts is the need for dental professionals to have practical, simple, and easy-to-follow recommendations on the use of oral antiseptics. SEPA did state, however, that these mouthwashes do not replace tooth brushing, but can be a valuable adjunct to support periodontal health.

The Clinical Practice Guidelines for the treatment of periodontitis in stages I–III and the conclusions of the XI Periodontology Workshop of the European Federation of Periodontology provide recommendations and indications for the use of these resources. However, the panelists add that these recommendations may sometimes be complex for the oral health team, and this in turn may limit their use. This, even though, scientific information supporting the impact of certain mouthwashes and toothpastes with antiseptic formulations has been available for decades and is part of dental education.

Dr. David Herrera, trustee of the SEPA Foundation and co-director of the Etiology and Therapeutics of Periodontal Diseases Research Group (ETEP) at the Complutense University of Madrid (UCM), points out, "scientific information is often mixed with less reliable sources, inducing confusion among oral health professionals."

The Clinical Practice Guidelines for the Treatment of Periodontitis in Stages I–III, developed by the European Federation of Periodontology, is one of the main sources of information and guidance on the prevention and management of periodontitis, and is in use in many countries. But, as detailed by Dr. Iain Chapple, professor of periodontology and head of research at the Institute of Clinical Sciences of the University of Birmingham in the United Kingdom, several factors have prevented the use of oral antiseptics from getting the strong recommendations many believe they should.

The evidence from systematic reviews on the adjunctive use of oral antiseptics was strong, but due to cost implications, environmental factors, and the presence of alcohol in many mouthwashes, the consensus was to reduce the recommendation from strongly favorable to an“open” recommendation, an aspect that this meeting of experts has sought to clarify and overcome through a soon-to-be-released report that is expected to be widely disseminated and implemented globally, according to Dr Chapple.

Some antimicrobial mouthwashes have been shown to be effective in controlling dental biofilm and gingival inflammation in many studies, including numerous randomized clinical trials, according to a press release from SEPA. But it is important to understand their impact on the primary prevention of periodontal diseases (preventing their appearance) and on secondary prevention (reducing the risk of recurrence after treatment of periodontitis), the experts add.

The summit attendees state the need to focus attention on the prevention of periodontitis and, therefore, adequately treat gingivitis. "It is time for a paradigm shift: we must control gingivitis and not wait until periodontitis develops," Dr Chapple adds.

While dental professionals realize that proper tooth brushing is essential for good oral health, some situations may make this difficult—and this is where mouthwash can have a positive impact. The primary procedure for managing gingivitis and periodontitis is mechanical plaque removal, but this may not always successfully remove 100% of the biofilm. "Sometimes it is not realistic for high-risk individuals to remove enough plaque daily to remain periodontally healthy," Dr Chapple says.

To further this point, Dr. Filippo Graziani, professor of periodontology at the University of Pisa (Italy) and honorary professor at University College London (United Kingdom), says a lack of technique and even motivation in tooth brushing can limit its results, so he recommends the complementary use of mouthwash. According to Graziani, "mouthwash is easier to use than brushing and can reach even the most difficult-to-access areas."

Over the past 5 years, the EFP has endorsed systematic reviews (Serrano et al., 2015; Figuero et al., 2020) showing that while mechanical plaque control by patients remains fundamental to successful periodontal treatment, antiseptic agents, including certain mouthwashes, may be more effective than toothpaste in plaque removal and reducing gingival inflammation. Recently, Graziani's research group published the results of a large randomized clinical trial, revealing that the primary factor in resolving gingivitis is a high level of plaque control and the use of appropriate devices. Hence, according to him, "mouthwashes are not only effective for their antiplaque properties but also for their ability to modulate inflammation."

The summit is a result of the collaboration between Kenvue and SEPA. Listerine is a brand of Johnson & Johnson Consumer Inc., a subsidiary of Kenvue.

"Bringing together this illustrious group of global experts to analyze the scientific literature, guidelines, and share their extensive clinical and research experiences is of vital importance to address the existing challenges in periodontal care," Soha Dattani, director and head of scientific engagement, Listerine Oral Care, EMEA, states in a press release. She adds the Principles for Oral Health initiative represents an important step to educate and train oral health professionals so that they receive optimal support to help their patients on their journey towards periodontal health.