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Comparative evaluation of the efficacy of cetylpyridinium chloride and essential oil mouthwashes in reducing plaque and gingivitis: a systematic review and meta-analysis

Evidence-Based Dentistry volume 26, page 156 (2025)Cite this article

Subjects

Abstract

Background

Despite being the gold standard for chemical plaque treatment, chlorhexidine digluconate (CHX) mouthwash has adverse effects that make it necessary to use alternatives. Essential oil (EO) and cetylpyridinium chloride (CPC) mouthwashes effectively reduce plaque and gingivitis. Hence, the aim of this review is to assess and compare the available data on the efficacy of CPC and EO mouthwashes in reducing plaque and gingivitis.

Methods

Scopus, PubMed, Cochrane, Science Direct, EBSCOhost, Lilacs, Science Direct, Web of Science, and Google Scholar were searched from the earliest available year (1990) till January 10, 2025. PICO Strategy: P: Individuals with plaque and gingivitis; I: CPC mouthwash; C: EO mouthwash; O: Reduction in plaque and gingivitis. The review only comprised randomised controlled trials. The risk of bias assessment and quality of evidence were assessed using the RoB-2 Tool and GRADE Tool respectively.

Results

After meeting the eligibility requirements, seven full-text publications were assessed for qualitative synthesis and six articles for quantitative synthesis. Overall, there was no significant difference in the reduction of plaque and gingivitis between CPC and EO mouthwashes. At two weeks, however, EO demonstrated a greater reduction in gingivitis (SMD: 4.67 [4.08, 5.26]; p < 0.00001; I² = 0%). Both mouthwashes were equally effective at reducing plaque and gingivitis at one, three, and six months.

Conclusion

While CPC mouthwash matched EO mouthwash’s long-term efficacy, EO mouthwash demonstrated superior short-term anti-gingivitis effects. Both were equally successful in reducing plaque. Depending on the needs of the patient, either can be utilized because of their distinct mechanism of action. Additional research should be done to reduce bias and enhance the methodology.

PROSPERO Registration No

CRD42025638243

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Fig. 1: PRISMA Flowchart.
Fig. 2: Risk of bias assessment using the RoB-2 tool.
Fig. 3: Meta-analysis.
Fig. 4: Subgroup analysis for anti-gingivitis efficacy.
Fig. 5

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Data availability

The data supporting this systematic review’s findings are available from the corresponding author upon reasonable request. The datasets generated and analyzed during the current study are not publicly available due to privacy restrictions but are available from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. Department of Public Health Dentistry, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, 411018, India

    Subhashree Mohapatra

  2. Department of Oral and Maxillofacial Pathology and Oral Microbiology, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, 411018, India

    Rahul Mohandas

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SM: concept, design, and definition of intellectual content, literature search, data acquisition, data analysis, manuscript preparation. RM: data acquisition, manuscript editing and manuscript review.

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Correspondence to Rahul Mohandas.

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Mohapatra, S., Mohandas, R. Comparative evaluation of the efficacy of cetylpyridinium chloride and essential oil mouthwashes in reducing plaque and gingivitis: a systematic review and meta-analysis. Evid Based Dent 26, 156 (2025). https://doi.org/10.1038/s41432-025-01163-2

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