Dental plaque formation is started by the deposition of a thin biofilm onto the tooth surface. In a healthy individual, when 1-2 layers of bacteria are present on the tooth surface, the individual’s immune mechanism can carry on with these microorganisms, and the subject can thus show a healthy gingiva. Therefore, disturbing dental plaque formation is of high priority. One approach in plaque control thus is to combine the use of antimicrobial agents with the mechanical methods.1 The rationale for the use of antiplaque agents as adjuncts to mechanical cleaning is based on two reasons. Firstly, dental plaque is the major etiological factor in gingivitis and various studies suggest that mechanical tooth cleaning methods are inadequate.2
The American Dental Association Council on Dental Therapeutics (CDT-1986) developed guidelines for the design of clinical trials. These guidelines require that clinical trials: be crossover or parallel-designed, study subjects should represent typical product users, active agent should be compared with a placebo or active control, dental plaque and gingivitis scoring be conducted at baseline, six months and an intermediate interval.3
The antiplaque agents (action through plaque effects) can be subdivided for possible modes of action against plaque: prevent bacterial attachment (antiadhesive); inhibit bacterial division (antimicrobial agents); remove plaque (“chemical tooth brush”); and alter plaque ecology. Of all, antimicrobial agents have had the most success, with little or no achievements in the other areas.4
To date, a wide variety of antimicrobial agents have been studied in respect to the control of supragingival plaque. These agents can be divided into bisguanides, quaternary ammonium compounds, phenolic antiseptics, oxygenating agents, metal ions, other antiseptics and natural products.5 The cationic bis-biguanide chlorhexidine is the gold standard antimicrobial agent.6 Several studies have proven the efficacy of chlorhexidine digluconate mouth rinse in reducing gingivitis and dental plaque accumulation.7,8 Triclosan, a broad-spectrum, lipid-soluble agent, is widely used in toothpastes and mouth rinses to reduce plaque formation and to improve gingival health.8,9, It, has both anti-bacterial and anti-inflammatory properties.10
The efficacy of 0.05% sodium fluoride mouth rinse in caries control is well established.11 However, there is little evidence to suggest its effectiveness on dental plaque and gingivitis. One potentially useful combination of chlorhexidine in any oral hygiene product would be fluoride.12 The results of a 2-year clinical trial involving the use of combined chlorhexidine (0.05%) and sodium fluoride (0.044%) mouthrinse showed significant reduction in gingival bleeding as well as the least DMFS increment.13 In studies conducted for 8 weeks and 6 weeks, combined chlorhexidine and sodium fluoride mouth rinse demonstrated a significant inhibitory effect on plaque and gingival...