A multidisciplinary group of US and international oral health experts is developing recommendations that emphasize individualized, risk-based approaches to preventing and managing periodontal diseases, including selective use of adjunctive antiseptic mouthrinses.
The recommendations emerged from a 2-day meeting at Kenvue’s headquarters in New Jersey as part of the Principles for Oral Health initiative, led by the SEPA Foundation and sponsored by LISTERINE. The panel included specialists in periodontology, dental hygiene, research, and education from several US and international academic institutions.
A central focus of the recommendations is identifying patients who may have difficulty achieving adequate biofilm control through toothbrushing and interdental cleaning alone. Although mechanical oral hygiene remains the foundation of gingivitis management and periodontal disease prevention, the panel noted that it may be insufficient for some patients even when appropriate oral hygiene instruction is provided.
The evidence reviewed by the group supports the adjunctive use of certain antiseptic agents, particularly essential oils, chlorhexidine, and cetylpyridinium chloride, for reducing dental biofilm and gingival inflammation when combined with mechanical plaque control.
However, the panel emphasized that these agents should not be recommended routinely for all patients. Instead, their use should be based on individual clinical needs, patient characteristics, and barriers to effective mechanical biofilm control. The experts also noted that current evidence is insufficient to conclude that home use of antiseptics alone can prevent the development of periodontitis.
The recommendations come amid a substantial burden of periodontal disease in the United States. According to National Health and Nutrition Examination Survey data cited in the report, 42.2% of dentate US adults aged 30 years or older had some degree of periodontitis, including 7.8% with severe disease. Prevalence reached 59.8% among adults aged 65 years or older and 59.9% among individuals who reported having diabetes.
The group identified several patient populations and clinical circumstances in which adjunctive strategies may warrant particular consideration. Local factors that can complicate biofilm control include crowded teeth, restorations with overhanging margins, certain orthodontic appliances, anatomical features that promote plaque retention, and extensive or complex prosthodontic restorations.
General factors may include suboptimally controlled diabetes, frailty, advanced age, impaired manual dexterity, low motivation to maintain oral hygiene, and temporary limitations following surgical procedures.
“Not all patients have the same ability to achieve effective biofilm control through mechanical measures,” Gustavo Ávila-Ortiz, DDS, MS, PhD, co-leader of the project and clinical professor and director of graduate periodontics at the University of Michigan School of Dentistry, said in a press release from the SEPA Foundation. “It is therefore essential to identify the circumstances that can make daily oral hygiene more difficult and assess when an adjunctive strategy may provide an additional benefit.”
Adjunctive antiseptics also may have a role after periodontal treatment. According to the report, available evidence suggests additional reductions in gingival inflammation and biofilm when certain antiseptics are used alongside mechanical measures during periodontal maintenance, particularly among patients with local or systemic factors that make plaque control more difficult.
The recommendations also address situations in which mechanical cleaning is temporarily limited. Chlorhexidine may be considered for limited periods during certain phases of periodontal therapy as an adjunct to subgingival mechanical instrumentation in selected cases. Following some surgical procedures, mouthrinses may also help control biofilm when patients cannot adequately clean the treated area.
“The value of antiseptics does not lie in replacing toothbrushing or interdental cleaning, but in their ability to provide additional support for controlling biofilm and gingival inflammation in certain patients and clinical situations,” Ana Molina, DDS, associate professor of periodontology at Complutense University of Madrid and project co-leader, said in the release.
The panel also advised caution for children younger than 6 years and individuals who cannot adequately control swallowing because of the risk of accidental ingestion. The report states that safety has not been sufficiently studied in pregnant or breastfeeding women and recommends following local regulations and guidance from health care professionals.
Overall, the recommendations emphasize integrating adjunctive antiseptic strategies into a broader preventive approach centered on mechanical biofilm control, patient education, professional follow-up, and individualized assessment of periodontal risk.
