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Is octenidine hydrochloride available and/or recommended as an oral rinse agent?

Mouthwash bottle isolated on a white backgroundThis question was submtted by general dentist: Since Octenidine Hydrochloride seems better than Chlorhexidine, is it available and/or recommended as an oral rinse agent?  Under what name can it be purchased?

Drs. Archie McNicol and Suham Alexander provided this quick initial response.

 

Antiseptic mouth rinses are used clinically to improve dental health and/or to prevent infections arising from oral pathogens. Antimicrobial mouth rinses target predominantly Streptococcus mutans. 

Octenidine hydrochloride (Octenisept) belongs to a class of chemicals called bispyridinamines and was initially developed for use as a topical antimicrobial agent. It is capable of forming complexes and adhering to whole cells and chemical cell components and exerts high antimicrobial properties through non-cytotoxic complexes at the site of action. Octenidine hydrochloride is a broad spectrum antibiotic, effective against both Gram negative and Gram positive organisms, as well as certain fungi, including Candida albicans.

Early studies in vitro were consistent with octenidine hydrochloride having favourable bacteriocidal anti-plaque activity over chlorhexidine.    

In clinical trials, Octenidine has proven effective in preventing plaque formation in humans over a 7-day period and in inhibiting plaque and gingivitis development when used as the sole means of oral hygiene for 21 days. Other studies have proven its efficacy in reducing S. mutans to levels which are statistically significant when used as a 0.1% mouth rinse solution. Finally, Octenidine was superior to both chlorhexidine and polyvinylpyrrolidone-iodine -I complex in reducing total viable oral bacteria, Lactobacillus species, and S. mutans in orthodontically-treated patients with fixed appliances. Octenidine is likely more effective with respect to antibacterial activity when compared to chlorhexidine due to its continuous release in the oral cavity.

Although effective at significantly reducing plaque, gingivitis and bleeding sites, 0.1% Octenidine also led to significantly higher stain formation. Further, this staining took a longer time to resolve than a placebo group. Limiting factors in the use of 0.1% Octenidine in clinical studies have included an aftertaste and an objectionable extrinsic dental pain.

Regardless, Octenidine has been proposed as a potent alternative to chlorhexidine-based oral mouth wash preparations. It is available in Canada as a topical preparation as Octenisept.

References

  1. Beiswanger BB, Mallatt ME, Mau MS, Jackson RD, Hennon DK. (1990) The Clinical Effects of a Mouthrinse Containing 0.1% Octenidine. J Dent Res. 69:454-457.
  2. Dogan AA, Cetin ES, Hüssein E, Adiloglu AK. (2009) Angle Orthod.79:766-772.
  3. Kocak MM, Ozcan S, Kocak S, Topuz O, Erten H. (2009) Comparison of the Efficacy of Three Different Mouthrinse Solutions in Decreasing the Level of Streptococcus Mutans in Saliva. European Journal of Dentistry. January (3): 57-61.
  4. Patters MR et al. (1983) Inhibition of plaque formation in humans by octenidine mouthrinse. J. Peridontal Res 18: 212-19.
  5. Patters et al. (1986) Effects of octenidine mouthrinse on plaque formation and gingivitis in humans. J Peridontal Res 21: 154-62.
  6. Rohrer N, Widmer AF, Waltimo T, Kulik EM, Weiger R, Filipuzzi-Jenny E, Walter C. (2010) Infect Control Hosp Epidemiol. 31:733-739.
  7. Rupf S, Balkenhola M, Sahrhagea TO, Bauma A, Chromikb JN,  Ruppertb K, Wissenbachc DK,. Maurerc HH, Hanniga M.  (2012) Biofilm inhibition by an experimental dental resin composite containing octenidine dihydrochloridehi JOhbn. Dental Materials 28: 974-984.
  8. Sedlock DM, Bailey DM. (1986)  Microbicidal activity of octenidine hydrochloride, a new alkanediylbis [pyridine] germicidal agent. Antimicrobial Agents and Chemotherapy 28: 786-790.
  9. Slee AM, O’Connor JR. (1983)  In Vitro antiplaque activity of octenidine dihydrochloride (WIN 41464-2) against preformed plaques of selected oral plaque-forming microorganisms. Antimicrobial Agents and Chemotherapy 23: 379-38.

 

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