Cetylpyridinium chloride (CPC)

CPC is a broad spectrum antiseptic that enhances CHX’s antibacterial effect.

  • Broad spectrum antibiotic, fights gram+ and gram- bacteria, viruses and fungi, similarly to chlorhexidine in vitro; more effective against gram+ bacteria.
  • Good adsorption in oral pH conditions.
  •  Substantivity in the oral cavity of 3-5 hours.
  •  Active against plaque and against the release of proinflammatory toxins by bacteria, therefore preventing the onset of gingivitis.
  • Classified by the FDA as a safe and effective antimicrobial agent for controlling plaque-induced gingivitis, when formulated in a concentration range of between 0.045% and 0.1%.

Structure

The Cetylpyridinium chloride (CPC) molecule is a quaternary ammonium compound and monocationic surfactant that is soluble in alcohol and in aqueous solutions; it can act as a detergent and an antiseptic, it is non-corrosive and non-oxidising and has a neutral pH.

Mechanism of action

The polar and nonpolar regions of the molecule cause CPC to behave as a cationic surfactant with a net positive charge. CPC molecules bind to the negatively charged surface of the bacterial cell membrane. The nonpolar region of the molecule, which has similar traits to membrane phospholipids, penetrates the cell membrane of the bacteria, therefore altering it and generating an imbalance in the osmotic regulation, resulting in loss of cytoplasmic material and ultimately cell death.

Its anti-gingivitis activity is also due to the neutralisation of proinflammatory bacterial toxins. CPC works by integrating these lipopolysaccharides to thereby alter their structure and neutralise them.

Substantivity

CPC has a substantivity of between 3-5 hours 1,2,3.

Properties

  • Ability to inhibit oral biofilm growth.
  • Ability to reduce gingivitis4,5
  • Plaque control 6
  • Reduces plaque build-up7,8
  • Plaque inhibiting effect9

Indications

  • Prevention of gingivitis and peri-implant mucositis10
  • Patients prone to gingival inflammation11 and bleeding
  • Prevention in patients at risk for caries
  • Patients with poor plaque control
  • Orthodontic patients 12

Instructions for use

In periodontal treatments: rinse 3 times per day with 15 ml for 30 seconds after brushing.

Contraindications and interactions

Do not use in case of allergy to CPC.

Side effects

CPC has a lower incidence of side effects than CHX. The following side effects have seldomly been reported: tooth and tongue staining, gum irritation and aphthous ulcers. These side effects are not common and are reversible with discontinuation of use. Stains that appear can be removed with an abrasive paste and/or prophylaxis.

References:

  1. Roberts WR, Addy M. Comparison of the in vivo and in vitro antibacterial properties of antiseptic mouthrinses containing chlorhexidine, alexidine, cetyl pyridinium chloride and hexetidine. Relevance to mode of action. J Clin Periodontol. 1981 Aug;8(4):295–310.
  2. Jenkins S, Addy M, Wade W, Newcombe RG. The magnitude and duration of the effects of some mouthrinse products on salivary bacterial counts. J Clin Periodontol. 1994 Jul;21 (6):397-401.
  3. Elworthy A, Greenman J, Doherty FM, Newcombe RG, Addy M. The substantivity of a number of oral hygiene products determined by the duration of effects on salivary bacteria. J Periodontol. 1996 Jun;67(6):572-6.
  4. Lobene RR, Kashket S, Soparker, PM, Shioss J, Sabine ZM. The effect of cetylpyridinium chloride on human plaque bacteria and gingivitis. J Dent Res 1977;56: B195 (abstr 575). 97.
  5. Rosa M, Sturzenberger OP. Clinical reduction of gingivitis through the use of a mouthwash containing two quaternary ammonium compounds. J Periodontol. 1976 Sept; 47(9):535–7.
  6. Rioboo M., García V. Serrano J., Herrera D., Sanz M. Eficacia clínica y microbiológica de un dentífrico y un colutorio antimicrobiano con cloruro de Cetilpiridinio al 0,05% para uso en pacientes con gingivitis: ensayo clínico aleatorizado. Comunicación Oral de Investigación, Sepa Las Palmas 2009.
  7. Holbeche JD, Ruljancich MK, Reade PC. A clinical trial of the efficacy of a cetylpyridinium chloride-based mouthwash 1. Effect on plaque accumulation and gingival condition. Aust Dent J. 1975 Dec;20(6):397–404.
  8. Llewelyn J. A double-blind crossover trial on the effect of cetylpyridinium chloride 0.05 per cent (Merocet) on plaque accumulation. Br Dent J. 1980 Feb 19;148(4):103-4.
  9. García V, Rioboo M, Serrano JJ, González I, Herrera H, Sanz M. Plaque Inhibitory Effect of a 0.05% Cetyl-Pyridinium 46. Chloride Mouth-rinse. Journal of dental research 2008 ; 87C abstract 311, clinical Oral Investigations 2009.
  10. García V, Rioboo M, Serrano JJ, González I, Herrera H, Sanz M. Plaque Inhibitory Effect of a 0.05% Cetyl-Pyridinium 47. Chloride Mouthrinse; IADR Londres- September 2008.
  11. Herrera D, Santos S, Ferrús J, Barbieri G, Trombelli L, Sanz M. 2005. Efficacy of a 0.15% benzydamine hydrochloride 48. and 0.05% cetylpyridinium chloride mouth rinse on 4-day de novo plaque formation. J Clin Periodontol. 32:595–603.
  12. Herrera D, Pérez L, Escudero N, Alonso B, Serrano J, Martin C, Sanz M. Evaluation of cetylpyridinium clorhide. 49. Formulations in orthodontic patients: Periodontal outcomes. Journal of dental research 2009; abstract. & Comunicación oral Sepa Las Palmas 2009.
  13. Sheen S, Owens J, Addy M: The effect of toothpaste on the propensity of clorhexidine and cetylpiridinium chloride to 50. produce staining in vitro: a possible predictor of inactivation. J.Clin Periodontol 2001; 28:46–51.
  14. Rawlison A, Pollingtons, Walsh TF, Lamb DJ, Marlow, Haywood J, Wright P, et at. Efficacy of two alcohol-free 51. cetylpyridinium chloride mouthwashes-a randomized double-blind crossover study” J.Clin Periodontol 2008; 35:230–235.