R. Periodontia - Setembro 2008 - Volume 18 - Número 03
PRODUTOS QUÍMICOS EM ENXAGUATÓRIOS
COMERCIALIZADOS EM CAMPINAS, BRASIL
Chemicals in commercial mouthwashes available in Campinas, Brazil
Kleber Leilsson dos Santos1, Camila Oliveira Lopes1, José Carlos Morais de Oliveira1, Raquel Soares Binotti2, Celso Henrique
de Oliveira1
RESUMO
Esse estudo teve por objetivo avaliar os diferentes componentes químicos de enxaguatórios comercializados na
cidade de Campinas/SP. Dezessete produtos foram analisados. O estudo demonstrou um total de 82 produtos químicos diferentes, relacionados em 195 citações. Os produtos químicos mais prevalentes foram anti-sépticos,
conservantes, aditivos, corantes e produtos derivados de
plantas. O presente estudo mostrou que vários componentes químicos presentes na formulação dos
enxaguatórios podem contribuir para o aparecimento de
reações adversas e sensibilização em humanos.
UNITERMOS: Enxaguatório; Mentha piperita; Saúde
Bucal; Higiene Bucal. R Periodontia 2008; 18:46-51.
1
INTRODUCTION
Mouthwashes are commonly used to keep the
mouth clean and smelling fresh, and are prescribed
by dentists and physicians for treating halitosis,
gingivitis, recurrent aphthous ulcers, and prevention
of dental caries (Marsh, 1992; Barrons, 2001; Drisko,
2001; FDI Commission, 2002). These products
became progressively available for purchase in Brazil
in recent years. However, little information is available
about the most important chemicals in these
products, as well, the differences among them.
Mouthwashes can be constituted by several
chemicals such as antiseptics, preservatives, additives,
dyes, sweeteners, and solvents. Despite being
considered safe and effective, mouthwashes can
cause many adverse effects and human sensitization
(Gar vey et al, 2007; Morken & Gjerdet, 2006;
Krautheim et al, 2004; Soo Hoo et al, 2003).
The aim of this study was to analyze the
chemicals present in mouthwashes commercially
available in Brazil, commonly used for mouth hygiene
by children and adults.
School of Medicine, São Francisco University – USF – Bragança Paulista (SP), Brazil
School of Medicine, State University of Campinas – UNICAMP – Campinas (SP), Brazil
Recebimento: 16/04/08 - Correção: 18/06/08 - Aceite: 28/07/08
46
MATERIAL AND METHODS
Seventeen different commercially available
products were purchased in stores in Campinas, São
R. Periodontia - 18(3):46-51
Table 1
LIST OF MOUTHWASHES PURCHASED IN CAMPINAS - SP, BRAZIL
Trade Name
1
2
®
Malvona
Scope
®
®
Industry
Country
Lot #
Vol. (ml)
Laboratório Primá
Brazil
1103H02
100
Procter & Gamble
US
NA
250
Kolynos do Brasil
Brazil
09
250
3
Plax
4
Anapyon®
DM Indústria Farmacêutica
Brazil
503
100
5
Malvatricin®
Laboratório Daudt Oliveira
Brazil
30304
100
Kolynos do Brasil
Brazil
12
250
6
7
Kolynos
®
®
Dental Fresh
Kley Hertz
Brazil
3010
300
8
®
Cepacol
Aventis Pharma
Brazil
302202
300
9
Listerine®
Warner-Lambert
US
02433L
250
10
Tom and Jerry®
Johnson & Johnson
Brazil
01
250
Gillette Argentina
Argentine
Y-140-2
350
Laclede
US
84175
250
Biolab Sanus Farmacêutica
Brazil
302590
240
Kolynos do Brasil
Brazil
10
250
Kolynos do Brasil
Brazil
09
250
Johnson & Johnson
Brazil
03
250
Sonae Distribuição Brasil
Brazil
07B03D
250
11
12
13
Oral-B
®
®
Biotene
Fluotrat
®
®
14
PerioGard
15
Sorriso Herbal®
16
Fluordent®
17
®
Enxaguatório Bucal Big
NA = not available
Paulo/Brazil, from September to October, 2003. All chemicals
described in mouthwash labels were listed and discussed.
The data were analyzed by descriptive statistics.
RESULTS
Table 1 presents a list of 17 mouthwashes. Their labels
showed 82 different chemicals, a total of 195 citations. The
Chemicals prevalence among the total of citations on labels
from mouthwashes are presented in Figure 1. Interestingly,
the most frequently obser ved chemicals listed were
antiseptics and/or preservatives, herbally derived compounds,
additives, and dyes [Tables 2 to 4].
A median of 12 chemicals was observed for each product.
Furthermore, the average and the standard deviation were
11.5 ± 4.5 chemicals for product (ranging from 2 to 16
chemicals). In one case, the product label listed only 2
chemicals (product #7); neither the solvent(s) nor the aroma
described in front-label as ‘Strong Peppermint’ were listed as
compounds. This fact shows that information on chemicals
listed on labels of mouthwashes may be incomplete.
Herbally derived compounds were obser ved in 12
different mouthwashes (70.6%). An average of 1.8 herbal
derived chemicals were observed per product (range of 0 to
6 and median of 1). Eleven different plants were listed. The
most prevalent was Peppermint (Mentha piperita),
representing 48.4% of herbal citations. In addition, 11
products (64.7%) had Peppermint-derived compounds in their
composition (not included the product # 7 – see the previous
paragraph).
Eucalyptus (Eucalyptus globulus) was also habitually
cited, representing 12.9% of herbal derived compounds. Less
Figure 1 - Chemicals prevalence among the total of citations on labels from mouthwashes (%)
47
R. Periodontia - 18(3):46-51
Table 2
LIST OF CHEMICALS DESCRIBED IN LABELS FROM 17 MOUTHWASHES PURCHASED IN BRAZIL
Chemicals
+
%
Acidulating / Alkalizing Agents
Chemicals
+
%
Antiseptics / Preservatives
Sodium phosphate monobasic
4
23.5
Cetylpyridinium chloride
7
41.2
Citric acid
2
11.8
Sodium benzoate
5
29.4
Lactic acid
1
5.9
Benzoic acid
3
17.6
Sodium hidroxide
1
5.9
Methylparaben
3
17.6
Propylparaben
3
17.6
Additives
Sodium fluoride
7
41.2
EDTA disodium
2
11.8
Sorbitol
6
35.3
Tyrothricin
2
11.8
Starch
1
5.9
Triclosan
2
11.8
Zinc gluconate
1
5.9
Sodium borate
1
5.9
Sodium lactate
1
5.9
Domiphen bromide
1
5.9
Lactoferrin
1
5.9
Chlorhexidine digluconate
1
5.9
Sodium methyltaurate
1
5.9
Chinosol
1
5.9
Povidone
1
5.9
Thymol
1
5.9
Sweeteners
Surfactants
Saccharin sodium
10
58.8
Poloxamers 402 or 407
4
23.5
Xylitol
2
11.8
Polysorbates 20 / 80
3
17.6
Sodium cyclamate
1
5.9
Sodium lauryl sulfate
2
11.8
Sucralose
1
5.9
Pluronic F-108 or F-127
2
11.8
Copolymer
1
5.9
Emulsifiers
Glycerin
9
52.9
Polyoxyl 40 stearate
1
5.9
Disodium phosphate
6
35.3
Surfon R-400
1
5.9
Sorbitan laurate
1
5.9
Others
Aroma
4
23.5
Enzymes
Glucose oxidase
1
5.9
Methyl salicylate
2
11.8
Lactoperoxidase
1
5.9
Tannic acid
1
5.9
Lysozyme
1
5.9
Benzocaine
1
5.9
Zinc chloride
1
5.9
Solvents
Water
15
88.2
Fenosalil
1
5.9
Ethanol
11
64.7
Hydrolized
1
5.9
Propylene glycol
1
5.9
Ethyl hydroxyethyl cellulose
1
5.9
(+) = number of products in which the chemical was listed. Dyes and herbally derived chemicals not included.
popular plants such as Erva-de-Bugre (Casearia sylvestris)
were also listed. Table 4 shows the plants listed on
mouthwash labels.
DISCUSSION
In conjunction with regular tooth cleaning, over-the48
counter mouthwashes are dental care products that can be
used to treat halitosis, gingivitis, periodontitis, recurrent
aphthous ulcers, and for dental caries prevention (Marsh,
1992; Barrons, 2001; Drisko, 2001; FDI Commission, 2002).
In intensive care units, oral decontamination with 2%
chlorhexidine solution for the prevention of ventilator-
R. Periodontia - 18(3):46-51
Table 3
Table 4
LIST OF DYES DESCRIBED IN LABELS FROM 17
PREVALENCE OF HERBALLY DERIVED COMPOUNDS DESCRIBED
MOUTHWASHES PURCHASED IN BRAZIL.
Dyes
IN LABELS FROM 17 MOUTHWASHES PURCHASED IN BRAZIL.
Present in ‘n’ Products
%
Herbal Citations
Present in
‘n’ Products
%
Blue (CI 42090)
7
41.2
Yellow (CI 19140)
5
29.4
Peppermint
(Mentha piperita)
11
64.7
Red (CI 16035)
2
11.8
Yellow (CI 15985)
1
5.9
Eucalyptus
(Eucalyptus globulus)
4
23.5
Blue
(CI not available)
1
5.9
Clove (Syzygium
aromaticum)
2
11.8
Caramel
(CI not available)
1
5.9
High Mallow
(Malva sylvestris)
2
11.8
Green (CI 42053)
1
5.9
Aloe (Aloe vera)
1
5.9
Red (CI 17200)
1
5.9
Chamomile (Matricaria
chamomilla)
1
5.9
Chinese Cinnamon
(Cinnamomum cassia)
1
5.9
Erva-de-Bugre
(Casearia sylvestris)
1
5.9
Tea Tree (Melaleuca
alternifolia)
1
5.9
Myrrh
(Commiphora spp.)
1
5.9
Salvia (Salvia officinalis)
1
5.9
CI = International Colour Index (The Merck Index, 2003)
associated pneumonia showed to be significantly effective
(Tantipong et al, 2008).
In recent years, mouthwash use has increased in Brazil.
Despite the fact that their use can generally be considered
safe, few studies have evaluated the adverse effects of
mouthrinsing (Moghadam et al, 1991; Gagari & Kabani,
1995). Adverse or allergic events after mouthwash use are
considered to be rare. However, several adverse events have
already been described after mouthwashing, such as
angioedema, anaphylaxis, skin rash, urticaria, or contact
dermatitis (Garvey et al, 2007; Morken & Gjerdet, 2006;
Krautheim et al, 2004; Moghadam et al, 1991; Gagari &
Kabani, 1995). Phenolic compound (such as eucalyptol,
menthol, and thymol) toxicity was suspected to be associated
to a case of fatal large-volume mouthwash ingestion (Soo
Hoo et al, 2003).
The present study reviewed that several chemicals
present in mouthwashes can contribute to adverse effects
and sensitization, with the most prevalent chemicals being
antiseptics, preser vatives, additives, and dyes. These
chemicals are recognized to be frequently related to human
sensitivity and irritant lesions in skin and mucous membranes
(Garvey et al, 2007; Guin, 1995).
Herbal compounds were habitually listed mouth-rinse
labels. Many studies have studied the effect of herbal
compounds in oral diseases such as gingivitis and gingival
bleeding, or as an antimicrobial agent (Walker, 1988;
Wennstrom, 1988; Kaim et al, 1998; Pistorius et al, 2003). A
double-blind, placebo controlled, parallel-study with 40
healthy adult volunteers showed that Herbal Mouth and
Gum Therapy significantly reduced gingivitis and gingival
bleeding scores compared to the control group (Scherer et
al, 1998).
Finally, it is noteworthy that products # 2, 6, 8, 15, and
16 listed the dye tartrazine (CI 19140) in their composition
as requested by the newer Government Resolution RE #572
(re-published in April, 4th 2002). This Resolution requests that
labels must inform the consumer that tartrazine can lead to
allergic reactions (Agência Nacional de Vigilância Sanitária,
2004).
CONCLUSION
The study showed that mouthwashes are quite different
in their chemical composition. Antiseptics and preservatives
were the most frequently obser ved chemicals. Herbally
derived compounds (mainly from Peppermint), additives, and
dyes are also common. Several chemicals present in
mouthwash formulas can contribute to adverse effects and
human sensitization to mouthwashes.
ABSTRACT
The aim of this study was to investigate chemicals in
commercial mouthwashes purchased in the city of Campi49
R. Periodontia - 18(3):46-51
nas/SP. Seventeen different mouthwashes were analyzed. The
study showed a total of 82 different chemicals listed on labels
with 195 citations. The most prevalent chemicals listed were
antiseptics, preservatives, additives, dyes, and herbal related
compounds. The present study showed that several
chemicals present in mouthwash formulas can contribute
to adverse effects and human sensitization to mouthwashes.
UNITERMS: Mouthwashes; Mentha piperita; Oral
health; Oral hygiene
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Endereço para correspondência:
Celso Henrique de Oliveira
Av. Orosimbo Maia, 570 - 51
CEP: 13010-918 – Campinas - SP, Brazil
Phone: + 55 (19) 3233-5319
Fax number: + 55 (19) 3236-5759
E-mail: [email protected]
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