CetylPyridinium
Place in Therapy
The majority of treatment options for halitosis can be divided into two focuses, mechanical and chemical. The mechanical interventions include brushing, tongue scraping, flossing, etc. with the aim of reducing the number of bacteria that produce volatile sulphur compounds (VSC) and residual food in the mouth among others. These mechanical interventions have been demonstrated to be very limited in most cases and any benefit in controlling halitosis short-lived. The chemical interventions, which often are mouthrinses with various odor-masking agents, appear to be more effective in halitosis treatment. There are wide ranges of mouthrinses on the market for treatment of halitosis. However, the success of any of these products rests on their ability to reduce VSC levels.
Cetylpyridinium chloride (CPC) is an antibacterial agent. From the various primary literature and Cochrane review analyzed above, cetylpyridinium alone shows some modest benefits in halitosis treatment, however; when combined with other odor-controlling agents it has been demonstrated to be significantly effective in reducing VSC and consequently halitosis. The use of cetylpyridinium alone has shown modest plaque activity and vague effect for gingivitis. Nevertheless, CPC as a cation is still believed to have antiseptic effects in the oral cavity. What is clear about CPC is its lack of substantivity, that is, its capacity to continue its therapeutic activity for a prolonged period of time. This is emphasized by its antimicrobial activity in the mouth that lasts only about 3 hours. This compares poorly with an antimicrobial agent like chlorhexidine that lasts for about 12 hours. A frequent use of CPC by patients could improve halitosis however this would likely lead to issues with compliance. Very few patients would like to use a mouthrinse 4 to 5 times a day when the average use of mouthrinses is twice daily. Other studies have demonstrated CPC to have the least impact on VSC levels on the morning breath compared to other products. This could perhaps be attributed to CPC's short time for therapeutic activity. Therefore, a patient can choose to use mouthrinses with cetylpyridinium alone as the antimicrobial agent but may need to use it more frequently throughout the day for consistent control of their bad breath. Alternatively, they can use mouthrinses that have a combination of CPC with other odor-controlling agents which have been shown to be more effective in controlling bad breath.
References:
1. Outhouse TL, Al-Alawi R, Fedorwicz Z, Keenan JV. Tongue scrapping for treating halitosis. Cochrane Database of Systematic Reviews 2006 Issue 2.
2. Antiseptic (cetyplpyridinium chloride) mouthwash. http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=3bbd4a08-062f-40a3-a25b-f23490ee57f6 Accessed July 7, 2013
3. Moran J, Addy M. The effects of a cetylpyridinium chloride prebrushing rinse as an adjunct to oral hygiene and gingival health. J Periodontol. 1991;62:562-4.
4. Carvalho MD, Tabchoury CM, Cury JA, Toledo S, NogueiraFilho GR. Impact of mouthrinses on morning bad breath in healthy subjects. J Clin Peridontol. 2004;31:85-90.
5. Young A, Jonski G, Rölla G. Inhibition of orally produced volatile sulfur compounds by zinc, chlorhexidine or cetylpyridinium chloride – effect of concentration. Eur J Oral Sci. 2003;111:400-4.
6. Mouth Products: Mouthwashes. Products for Minor Ailments.1st Edition. Canadian Pharmacists Association, Ottawa, ON. 2013
7. Lexicomp. Cetylpyridinum chloride. Accessed July 7, 2013.
Cetylpyridinium chloride (CPC) is an antibacterial agent. From the various primary literature and Cochrane review analyzed above, cetylpyridinium alone shows some modest benefits in halitosis treatment, however; when combined with other odor-controlling agents it has been demonstrated to be significantly effective in reducing VSC and consequently halitosis. The use of cetylpyridinium alone has shown modest plaque activity and vague effect for gingivitis. Nevertheless, CPC as a cation is still believed to have antiseptic effects in the oral cavity. What is clear about CPC is its lack of substantivity, that is, its capacity to continue its therapeutic activity for a prolonged period of time. This is emphasized by its antimicrobial activity in the mouth that lasts only about 3 hours. This compares poorly with an antimicrobial agent like chlorhexidine that lasts for about 12 hours. A frequent use of CPC by patients could improve halitosis however this would likely lead to issues with compliance. Very few patients would like to use a mouthrinse 4 to 5 times a day when the average use of mouthrinses is twice daily. Other studies have demonstrated CPC to have the least impact on VSC levels on the morning breath compared to other products. This could perhaps be attributed to CPC's short time for therapeutic activity. Therefore, a patient can choose to use mouthrinses with cetylpyridinium alone as the antimicrobial agent but may need to use it more frequently throughout the day for consistent control of their bad breath. Alternatively, they can use mouthrinses that have a combination of CPC with other odor-controlling agents which have been shown to be more effective in controlling bad breath.
References:
1. Outhouse TL, Al-Alawi R, Fedorwicz Z, Keenan JV. Tongue scrapping for treating halitosis. Cochrane Database of Systematic Reviews 2006 Issue 2.
2. Antiseptic (cetyplpyridinium chloride) mouthwash. http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=3bbd4a08-062f-40a3-a25b-f23490ee57f6 Accessed July 7, 2013
3. Moran J, Addy M. The effects of a cetylpyridinium chloride prebrushing rinse as an adjunct to oral hygiene and gingival health. J Periodontol. 1991;62:562-4.
4. Carvalho MD, Tabchoury CM, Cury JA, Toledo S, NogueiraFilho GR. Impact of mouthrinses on morning bad breath in healthy subjects. J Clin Peridontol. 2004;31:85-90.
5. Young A, Jonski G, Rölla G. Inhibition of orally produced volatile sulfur compounds by zinc, chlorhexidine or cetylpyridinium chloride – effect of concentration. Eur J Oral Sci. 2003;111:400-4.
6. Mouth Products: Mouthwashes. Products for Minor Ailments.1st Edition. Canadian Pharmacists Association, Ottawa, ON. 2013
7. Lexicomp. Cetylpyridinum chloride. Accessed July 7, 2013.