Principles for Oral Health highlights role of antiseptics

SEPA

Tue. 3 November 2026

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SUMMIT, N.J., US: At a two-day meeting in September, a multidisciplinary group of experts discussed the prevention and management of periodontal diseases. The meeting marked another step towards publishing the US edition of the Principles for Oral Health report. In particular, the discussions reinforced the importance of integrating individual risk assessment and appropriate adjunctive antiseptic strategies into periodontal prevention and long-term care.

“Bringing together this exceptional group of US and international experts reflects our conviction that prevention must sit at the heart of periodontal care. With more than four in ten American adults affected by periodontitis, translating rigorous science into practical, personalised guidance for the dental team has never been more important. Through Principles for Oral Health, LISTERINE and SEPA are proud to put science at the service of oral health professionals, and, ultimately, of their patients,” commented Smruti Nair, manager of medical affairs for oral care at Kenvue, the global consumer health company behind LISTERINE. Kenvue hosted the meeting at its headquarters in New Jersey.

The burden of periodontal disease in the US

The need to move towards risk-based preventive strategies is especially relevant given the high prevalence of periodontal disease in the US. According to data from the National Health and Nutrition Examination Survey (2009–2014), 42.2% of dentate US adults aged 30 or older had some degree of periodontitis, including 7.8% with severe periodontitis.¹ The same study reported an overall prevalence of 59.8% among adults aged 65 or older and 59.9% among those who reported having diabetes. Prevalence was also higher among men (50.2%) than women (34.6%) and among current smokers (62.4%) than non-smokers (34.4%).

Gingivitis management and periodontal disease prevention

Effective management of gingivitis, a reversible inflammatory condition affecting the gingiva, is an important component of primary prevention of periodontitis.^2–4 Patient-performed oral hygiene, including toothbrushing and interdental cleaning, remains the cornerstone of gingivitis management and periodontal disease prevention. However, with appropriate oral hygiene instructions and sufficient brushing time, mechanical biofilm removal may be insufficient for some patients.

Evidence for adjunctive antiseptics

The scientific evidence supports the use of certain antiseptic agents and mouthrinses as adjuncts to mechanical oral hygiene. Among the agents reviewed, essential oils, chlorhexidine and cetylpyridinium chloride have demonstrated efficacy in reducing dental biofilm and gingival inflammation when used alongside mechanical biofilm control.^{3, 5}

These products should not be routinely recommended to all patients. Instead, their use should be individualised according to clinical needs, patient characteristics and difficulties achieving adequate mechanical biofilm control. However, there is insufficient direct evidence to conclude that home use of antiseptics can prevent the onset of periodontitis.^3–5

Individualising periodontal prevention

Periodontal prevention should be tailored to each patient’s clinical profile and needs, taking into account factors that may make daily biofilm control more difficult.^{2, 6} Individualised care is particularly important for patients who have undergone periodontitis treatment and are receiving supportive periodontal care. Available evidence suggests that certain antiseptics may provide additional benefits in controlling gingival inflammation and biofilm when used alongside mechanical measures, particularly in patients with factors that make biofilm control more difficult.⁶ Such strategies form part of secondary prevention, which aims to prevent disease recurrence or progression and maintain treatment outcomes over the long term.

The meeting brought together experts in periodontology, dental hygiene, research and education from leading academic institutions, including the University of Michigan, the University of California, San Francisco, the University of Pennsylvania, Ohio State University, Texas A&M University, A.T. Still University and Complutense University of Madrid. (Image: SEPA)

Local factors include limited access for cleaning, as may occur with crowded teeth, restorations with overhanging margins or certain orthodontic appliances, as well as anatomical features that encourage biofilm retention. Patients with extensive or complex prosthodontic restorations may also require particular consideration. Systemic and patient-related factors include systemic conditions, including poorly controlled diabetes; frailty and age-related limitations; temporary or permanent limitations in manual dexterity; and low motivation to maintain oral hygiene. Recovery after certain surgical procedures may also temporarily limit a patient’s ability to perform mechanical oral hygiene.

“Not all patients have the same ability to achieve effective biofilm control through mechanical measures. 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,” said Dr Gustavo Ávila-Ortiz, co-leader of the project and clinical professor and director of graduate periodontics in the Department of Periodontics and Oral Medicine at the University of Michigan School of Dentistry.

Clinical applications and precautions

The discussions also addressed clinical situations in which mechanical biofilm control may be temporarily compromised. During certain phases of periodontal treatment, chlorhexidine mouthrinses may be considered for limited periods as an adjunct to subgingival instrumentation in selected cases.⁶ After certain surgical procedures, when patients cannot adequately clean the treated area, chlorhexidine mouthrinses may help control biofilm during healing.^{7, 8}

“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,” noted Dr Ana Molina, associate professor of periodontology at the Faculty of Dentistry at Complutense University of Madrid in Spain and co-leader of the project.

The use of antiseptic mouthrinses also requires consideration of potential risks. The experts noted that children under 7 years of age and individuals who have difficulty controlling swallowing should avoid mouthrinses because of the risk of accidental ingestion. Safety considerations during pregnancy and breastfeeding depend on the antiseptic formulation, and local regulations and advice from healthcare professionals should be followed.

Principles for Oral Health is an initiative led by the SEPA Foundation and sponsored by LISTERINE. More information can be found at principlesfororalhealth.com. The international report, which was published in 2024, can be accessed here.

Editorial note:

The list of references can be found here.