Effects of Antimicrobial Mouthwashes on Oral Health and Blood Pressure: A Preliminary Parallel Randomized Controlled Trial.

OBJECTIVE

Although antimicrobial mouthwashes vary in efficacy and safety for managing biofilm-induced gingivitis, concerns remain regarding their potential to reduce nitric oxide bioavailability and increase hypertension risk. Therefore, we investigated whether octenidine is more effective and causes fewer adverse events than chlorhexidine, and whether antimicrobial mouthwash use increases hypertension risk.

METHODS

In this parallel randomized controlled trial, 90 participants were randomly allocated (1:1:1) to rinse with 10 mL of 2% saline (Group I), 0.2% chlorhexidine (Group II), or 0.1% octenidine (Group III) for 21 days. Co-primary outcomes (clinical parameters and blood pressure) and secondary outcomes (salivary bacterial count, adverse events, and pulse pressure) were assessed over 42 days.

RESULTS

At day 22, antimicrobial mouthwashes significantly reduced clinical (29%-52%) and microbial (> 92%) measures (p < 0.001), whereas saline produced minimal changes (p > 0.05). Salivary nitrate levels showed the opposite trend. Groups II and III showed comparable efficacy, but octenidine was associated with fewer adverse events. Although systolic blood pressure increased slightly in all groups, the changes were clinically insignificant. Elevated pulse pressure in antimicrobial groups returned to baseline by Day 42.

CONCLUSIONS

Octenidine (0.1%) was safer and comparably effective to chlorhexidine. Short-term antimicrobial mouthwash had no clinically significant effect on blood pressure.

TRIAL REGISTRATION: CTRI/2024/08/072091 (India), date: 07/08/2024. URL: https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=MTEwOTY5&Enc.