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Antimicrobials

Cetylpyridinium chloride

Also listed as CPC

An antiseptic in many alcohol-free mouthwashes. Adds a small extra reduction in plaque and gum inflammation to brushing; can stain teeth.

Moderate evidenceTypical strength: 0.05-0.1% in mouthwash

What it is

Cetylpyridinium chloride is a positively charged antiseptic that disrupts bacterial membranes and clings to mouth surfaces for a few hours. It is the main active in many alcohol-free rinses, typically at 0.05-0.1%.

Because it is positively charged, the foaming agent in most toothpastes (sodium lauryl sulfate) can partly neutralise it. Using the rinse at a different time from brushing avoids this.

How strong is the evidence?

Moderate evidence

Systematic reviews find a small but significant added benefit for plaque and gingivitis when CPC rinses are used alongside brushing; a network meta-analysis ranked rinses above 0.05% CPC among the more effective. Results vary with the formula. For bad breath, a Cochrane review found only low-certainty evidence of modest improvement.

What it's used for, checked

Reduces plaque and gingivitis (with brushing)

Holds up

Small extra benefit; formulation matters.

Freshens breath

Mixed

Short-term improvement with low-certainty evidence.

Replaces brushing and flossing

False

Rinses are an add-on to mechanical cleaning.

Don't combine with

  • rinsing straight after brushing with a sodium lauryl sulfate toothpaste (may reduce effect; use at a separate time)

Who should be careful

  • Can cause brown surface staining on teeth and a temporary change in taste.
  • Do not swallow; follow the age limit on the label, as young children cannot reliably spit.
  • Bleeding gums that persist need a dental assessment, not just a rinse.

The studies

Every citation is checked against its PubMed record.

  1. The effect of cetylpyridinium chloride-containing mouth rinses as adjuncts to toothbrushing on plaque and parameters of gingival inflammation: a systematic review.
    Haps S, Slot DE, Berchier CE, Van der Weijden GA · Int J Dent Hyg · 2008 · Systematic review / meta-analysis

    Eight studies: CPC rinses used alongside brushing gave a small but significant extra reduction in plaque and gum inflammation.

  2. Efficacy of adjunctive anti-plaque chemical agents in managing gingivitis: A systematic review and network meta-analyses.
    Figuero E, Herrera D, Tobias A, et al. · J Clin Periodontol · 2019 · Network meta-analysis

    53 six-month trials. Among rinses, essential oils, chlorhexidine (0.10% or more) and cetylpyridinium chloride (above 0.05%) had the largest effects on gingivitis, with essential oils ranking highest; active toothpastes differed little from each other, with baking soda among the weakest.

  3. Interventions for managing halitosis.
    Kumbargere Nagraj S, Eachempati P, Uma E, et al. · Cochrane Database Syst Rev · 2019 · Systematic review

    44 mostly short trials: evidence for every bad-breath intervention was low to very low certainty. Brushing plus a CPC rinse modestly improved examiner odour scores (low certainty); no product could be shown to be better than another.