Cetylpyridinium Chloride (CPC)
CPC is a well-known, broad-spectrum antimicrobial agent used in over-the-counter rinses to promote gingival health. It acts by penetrating the cell membrane, causing cell components to leak, which eventually leads to cell death.16 This action can be described to patients using the analogy of puncturing a water balloon. Recently, over-the-counter therapeutic CPC rinses have been introduced in alcohol-free formulations (Crest® PRO-HEALTH™ Mouthwash, Procter & Gamble).17
CPC is recognized to be effective against plaque and gingivitis when formulated at concentrations of 0.045% to 0.1% with at least 72% to 77% chemically available cetylpyridinium chloride.7 CPC’s efficacy can be affected by other ingredients in the product formulation thus necessitating specific criteria to be established for its concentration and bioavailability.18 Studies have reported formulations with high bioavailable CPC are associated with greater biological activity, consequently indicating an increased probability for clinical efficacy.19 Rinses with lower CPC concentrations or with less chemically available CPC are long standing marketed products identified as cosmetic products used for the temporary control of halitosis.
Numerous 6-month clinical studies have shown statistically significant reductions in plaque and gingivitis for therapeutic CPC rinses relative to negative controls.10,20,21 Reductions ranged from 15% to 24% for gingivitis, 27% to 67% for bleeding, and 16% to 28% for plaque. Other extended use research has shown parity benefits to a positive control rinse.22,23
CPC’s safety has been well-documented.24,10,20-23 A small percent of patients may experience temporary taste alteration and/or transient staining as documented with any effective antimicrobial rinse.17 These side effects are usually observed more frequently from the use of prescription rinses (e.g., chlorhexidine) and occur less often in the over-the-counter formulations. With the 0.07% CPC rinse, (Crest® PRO-HEALTH™ Mouthwash) user acceptability was favorable along with a high patient compliance. This CPC therapeutic mouthrinse has further demonstrated excellent bioavailability success with bacterialcidal activity and antibacterial retention.25