Comparison: Peridex® DioxiRinse® Listerine®

Comparison: Peridex® DioxiRinse® Listerine®

Peridex chlorhexidine	DioxiRinse active chlorine dioxide, ClO₂	Listerine essential oils
Not safe to swallow, may cause stomach upset or nausea, eye injury 4, 7, 14	Safe for incidental ingestion. ClO₂ used in water purification. Many studies illustrate safety 42, 55, 56	Alcohol content may cause toxicity, critical for children 84, 85, 86
Highly unpleasant taste causes patient non-compliance 1, 4, 11, 12	Fresh, effervescent mint taste 57	Unpleasant taste. May cause non-compliance 70, 82, 83
Will not kill spores, small effect on fungi. Ineffective on Pseudomonas 27 Proteus, Serratia, Mycobacteria 8, 9, 10	Kills all bacteria, spores, viruses and yeast, in one minute, in vitro. Includes MRSA, C. difficile 38, 39, 40, 44, 64	Little evidence of an anti- bacterial effect in vivo or in vitro 65, 66, 68, 69, 75, 77, 79
Stains teeth, dentures, and dorsal area of tongue 1, 7, 11, 13	Will not stain teeth, dentures. Whitens teeth, removes biofilm 34, 36, 41	Does not stain or whiten teeth, not an oxidant
Prolonged use can cause calculus formation. Conflicting reports as to plaque reduction 1, 3, 12, 13, 17	No restrictions for use. Further reduces plaque when combined with SRP 29, 47, 52	Prolonged use may produce mucosal lesions. Little or no odor or plaque reduction 73, 74, 75, 76, 80, 87
Can damage mucous membranes and inhibit healing. Allergic reaction may cause mouth sores, white patches 10, 11, 14	Heals sores and irritations caused by dental procedures and braces 31, 43, 51, 53, 59	May cause gum or gingival pain 65, 70, 84, 86
Eating, brushing or drinking diminishes efficacy 7, 16, 21, 22	Odor removal and disinfection is immediate. Used daily any time 33, 37	Repeated use may cause oral burning sensation 70, 83,89
Prevents wound healing, although often applied on wounds 10, 15, 23	Cures oral yeast infection, 32, 48, 49 Pseudomonas wounds, abrasions	Some reports on impairing wound healing 71, 86
Can decrease taste sensation, and alter taste 4, 12, 13	No effect on taste. Used routinely as a mouthwash 57	Highly unpleasant mouthwash taste 65, 83
Good for mouth odor control, cannot be used routinely. Kills bacteria but does not oxidize VSCs 11, 12	Fastest neutralizer of odor and odor causing bacteria, oxidizes VSC and VSC proteins 33, 38, 42, 47	Masks, not neutralizes odor 73, 84, 88
Reports of anaphylaxis, renal, liver damage. Overdose has caused slurred speech in children 19, 20, 23, 26, 28	No adverse effects reported 32, 54, 56, 59	Few adverse effects, but no studies proving efficacy presented 65, 83
Alcohol content 11.7% 12	Alcohol content ½%	Alcohol content 27% “54 proof” Useful for dissolving oils 81,89
Recommended for gingivitis, but only with SRP (FDA). May mask and worsen periodontitis 2, 5, 6, 13, 15	Clinical evidence for alleviating gingivitis and periodontitis 46, 47, 50, 57	No improvement in plaque or gingivitis-despite marketing claims 67, 68, 76, 80, 85, 87
Incompatible with soaps, carbonate, chloride. Neutralized by hard water 21, 22	Incompatible with strong reducing agents which will neutralize ClO₂	No reported incompatibilities
Not indicated for mucositis, stomatitis due to membrane irritation 14, 15, 24, 25	Successfully treats mucositis, stomatitis, glossitis 32, 62	Does not alleviate mucositis stomatitis, alcohol drying effect 84, 86

References Available

^®Peridex - Reg. trademark of 3m Co, ^®DioxiRinse - Reg. trademark of Frontier Pharmaceutical, Inc., ^®Listerine - Reg. trademark of Johnson & Johnson Co.

References to Mouthwash Comparison Chart

available on request

Peridex

1 Charles, CH, Mostler KM, Bartels LL, Mankodi SM, J.Clin. Periodontology, 2204 Oct; 31(10): 878-84, “The chlorhexidine mouthrinse group had significantly more calculus and extrinsic tooth stain than either the essential oil mouthrinse group or the control group… side effects associated with chlorhexidine mouthrinse may limit patient compliance.”

2 FDA Warning Letter to Zila Pharmaceuticals, Inc. 4/18/’08. “FDA is not aware of evidence that Peridex can heal gingivitis and prevent other forms of periodontal disease.” “A company brochure for the rinse, which is approved to treat gingivitis, also made unproven claims about how well Peridex worked and made false statements about competitors’ products.” “These claims as to the effectiveness of Peridex in the oral cavity are misleading because they are not supported by substantial evidence.” “ Peridex is only indicated as part of a professional program for the treatment of gingivitis.” “The effect of Peridex Oral Rinse on periodontitis has not been determined.”… There is no evidence that Peridex has such effects with regard to overall health or serious medical conditions, including heart disease, stroke, uncontrolled diabetes, low protein births, and respiratory disease.” “The violations discussed in this letter do not necessarily constitute an exhaustive list.”

3 Yates R. Moran J, Addy M, Mullan PJ, Wade WG, Newcombe R, J.Clin. Periodontology ‘97: 24: 603-609. “The Comparative Effect of Acidified Sodium Chlorite and Chlorhexidine Rinses on Plaque Regrowth and Salivary Bacterial Counts, “for 2 acidified sodium chlorite rinses, plaque scores were lower than for chlorhexidine rinse.”

4 Drugs.com. Review of side effects of Peridex, Unpleasant taste, dry mouth, staining of teeth, white patches or sores, decreased taste sensation, swelling salivary glands, mouth ulcers. Keep medication out of eyes ears and mouth. Can cause allergic reactions, especially in genital area.

5 Mayo Clinic.com., Chlorhexidine drug information, Apr. ‘00 “Use of chlorhexidine may make other gum problems, such as periodontitis, worse.”

6 America’s Dental Bookstore, Peridex, “Peridex has been shown to be effective in treating gingivitis, but it has never been shown to have any effect on the more serious gum disease, periodontitis, in which the supporting structures of the teeth are affected.”

7 MedicineNet.com. Peridex side effects. “Staining of teeth, mouth irritation, mouth sores, stomach upset, nausea, allergic reactions, e.g. rash, itching, swelling. Do not rinse mouth, brush teeth or eat immediately after using this drug.”

8 Thomas L, Journal of Hospital Infection, Volume 46, Issue 4, pp.297-303, Antiseptic resistance occurs in pseudomonas with a step-wise exposure to Peridex.

9 HARI, “Disease Prevention Through Proper Sanitation and Disinfection in an Indoor Psittacine Breeding Facility,” “Pseudomonas grows well in standing water and chlorhexidine is ineffective against it.”

10 Salami AA, Imosemi IO, Owoeye OO, Int. J. Morph., 24(4);673-676, ‘06. “A Comparison of the Effect of Chlorhexedine, Tap Water and Normal Saline on Healing Wounds” “Chlorhexidine causes damage to new tissues and should not come in contact with meninges and mucous membranes as this can cause permanent damage. Its antimicrobial efficacy is not total, as certain microbes are known to grow in the solution; of note in this regard is Pseudomas aeruginosa and Proteus mirabilis. “The presence of microbes in the wound which were probably brought by the antimicrobial agent, further contributed to the delayed healing seen in the antiseptic treated cases and also worsened the general state of the animals.” “…these agents should not be used on clean healing wounds.”

11 Rosenberg, M, Scientific American, Apr. ‘02, “The Science of Bad Breath” “-- effective against halitosis. Unfortunately, it can also discolor teeth, impair taste and generate oral ulcerations. These effects, though reversible, preclude the use of chlorhexidine for more than a few days.”

12 Dr. Dan Peterson, “Family Gentle Dental Care.” “Chlorhexidine may cause staining of teeth, increase in calculus formation, lingering taste causing possible change in taste perception. Contains 11.6% alcohol.”

13 DailyMed (http://dailymed,nlm,nih,gov/dailymed/droginfo.cfm?id=6210). “The effect of Peridex on periodontitis has not been determined. An increase in supragingival calculus was noted, staining of oral surfaces, alteration in taste perception, minor irritation and superficial desquamation of oral mucosa.”

14 RxMed.com. Pharmaceutical Information-Peridex. “Oral irritation and local allergy-type symptoms….” “Among postmarketing reports, the most frequently reported oral mucosal symptoms associated with chlorhexidine are stomatitis, gingivitis, glossitis, ulcer.”

15 Medscape, Monograph Chlorhexidine Gluconate ., “Although chlorhexidine gluconate topical oral solution has been used as an adjunct for the treatment of acute necrotizing ulcerative gingivitis, safety and efficacy of the oral solution for this use has not been established.” “Safety and efficacy of subgingival chlorhexidine gluconate in acutely abscessed periodontal pockets has not been established to date and such use is not recommended.”

“There are no studies to date evaluating the comparative safety and efficacy of the various anti-infectives for

subgingival administration that are commercially available in the US.”

16 VastRX.com/druginfo/peridex. “Do not swallow Peridex. If Peridex is accidentally swallowed, stomach upset or nausea may occur.” “Do not rinse mouth, brush teeth or eat immediately after using Peridex.” “Mouth sores may occur.”

17 SoftDental.com/Houston. “Chlorhexidine oral rinse will not prevent plaque or tartar from forming on your teeth…Do not eat or drink for several hours after using the oral rinse as this may decrease the effect of the medicine.”

18 Chemocare.com. Mouth sores from chemotherapy. Avoid mouthwash containing alcohol.

19 Archives of Dermatology Vol. 125 No. 1, Jan. ‘89 Okano O, Nomura S, Hata N, et.al. “Anaphylactic symptoms due to chlorhexidine gluconate.” “Six patients who developed urticaria, dyspnea, and anaphylactic shock due to topical application of chlorhexidine gluconate solution are described. Chlorhexidine gluconate was confirmed as the causative agent of type I hypersensitivity by intradermal, scratch, and epicutaneous tests; chlorhexidine may not be suitable for application to mucous membranes.”

20 Krautheim AB, Jermann TH, Bircher AJ. “Chlorhexidine anaphylaxis: case report and review of the literature.” Allergy Unit, Department of Dermatology, University Hospital, Petersgraben 4, 4031 Basel, Switzerland. “The potential risk of anaphylactic reactions due to the application of chlorhexidine is well known, especially that application to mucous membranes can cause anaphylactic reactions and was therefore discouraged.”

21 Sageproducts.com. What the Experts Say: Chlorhexidine Gluconate Skin Preps: Benefits and Compatibility. “The activity of chlorhexidine gluconate is not significantly affected by blood or other organic material. However, its acitivty is pH-dependent (5.5-7.0) and is reduced in the presence of nonionic surfactants, inorganic anions (e.g., phosphate, nitrate, chloride,)

22 Magarinos MC, Reynaldo MB, Flores MB, Infanti AY, Castelo SM. Rev. Argent Microbiol, ‘01 Oct-Dec; 33 (4); 241-6. “Results show that hard water was one of the factors that most highly affected the bacterial activity of chlorhexidine.”

23 Aalto-Korte, Kristina; Makinen-Kiljunen, Soili. Contact Dermititis, Vol. 55; No. 3, Sept. ‘06, pp173-177. “Symptoms of Immediate Chlorhexidine Hypersensitivity in Patients with a Positive Prick Test” “There are numerous reports of anaphylaxis from chlorhexidine in surgical operations and other medical procedures, usually due to its application to wounds or mucous membranes.”

24 Univ. of Florida Shands Cancer Center (ufscc.ufl.edu) “Prevention and Management of Radiation Side Effects” “Topical antiseptics, chlorhexidine or benzydamine, have been used for the prevention of mucositis, but recent research indicates that these are not effective. In a Mayo Clinic study involving 52 patients with head and neck cancers who received radiation therapy, chlorhexidine was found to be more toxic, and no more effective than placebo in the prevention of mucositis. The patients treated with chlorhexidine seemed to have more problems with inflammation, resulting in mucositis.”

25 Pitten F. Journal of Hospital Infection Vol. 53, Issue 4, pp283-291 “Do cancer patients with chemotherapy-induced leucopenia benefit from an antiseptic chlorhexidine-based or rinse? A double-blind, block-randomized, controlled study…..the risk of mucositis and clinical sequellae seems to be enhanced, although the counts of micro-organism on the oral mucous membranes are significantly reduced.”

26 British Medical Journal ‘97; 315:785 (27 Sept.) “The Committee on Safety of Medicines received 182 reported reactions to products containing chlorhexidine from 1965 to 1996 (personal communication). Most of these were cutaneous or mucosal eruptions. The committee has received only one previous report of acute circulatory failure. In Japan between 1967 and 1989 there were 15 reported cases of anaphylactic shock related to chlorhexidine, of which 13 cases followed application of the drug to mucous membranes. In 1984 the Japanese ministry of welfare recommended that the use of chlorhexidine on mucous membranes be prohibited.”

27 J. Am Dent Assoc Vol 134, No 7, pp.906-907, “Antiseptic antimicrobial handwashes.” Hibiclens Antiseptic Antimicrobial Cleanser—G.G. America, Alsip Ill.60803 “Studies have shown that chlorhexidine is minimally active against HIV, and herpes simplex virus; is somewhat effective against fungi.”

28 Lake APJ, The Internet Journal of Anesthesiology ‘07. Volume 13, Number 2. “Anaphylactic reactions associated with general anaesthesia though rare can be life threatening and caused by administered agents not directly connected to the anaesthetic. In this case a reaction, which was not immediately recognized as such, was most likely due to chlorhexidine.”

28a Hogan, JS, Smith KL, Todhunter DA, Schoenberger PS, “Animal Sciences Research and Reviews, Special Circular 156, Efficacy of a Barrier Teat Dip Containing 0.55% Chlorhexidine for Prevention of Bovine Mastitis.” “Cows dipped with the barrier in the current trial had a 52.1% increase in Pseudomonas spp. IMI. and a 49.9% in Serratia spp.IMI compared with incidence for cows dipped with the 1% iodophor. Both Seratia spp. and Pseudomonas spp. have been reported to contaminate chlorhexidine gluconate solutions.”

28b Ingenta Connect.com Rikimaru T, Kondo M, Kondo S, Oizumi K, “Efficacy of Common Antiseptics against Mycobacteria” “The results of different antiseptics on mycobacteria were examined. At concentrations of 0.05%, povidone-iodine killed 99% or more of all strains within 15 seconds, while 0.05% chlorhexidine gluconate showed no bacterial activity against mycobacteria.”

DioxiRinse

29 Yates R. Moran J, Addy M, Mullan PJ, Wade WG, Newcombe R.J. Clin. Periodontology ,’97: 24: 603-609. The Comparative Effect of Acidified Sodium Chlorite and Chlorhexidine Rinses on Plaque Regrowth and Salivary Bacterial Counts, “for 2 acidified sodium chlorite rinses plaque scores were lower than for chlorhexidine rinse. Antimicrobial action of acidified Sodium Chlorite Mouth Rinses persisted and equal to that of chlorhexidine.”

30 Jay Youngerman, ENT Specialist, Letter, July 12, ‘02. “We have been very successful in using DioxiRinse in the treatment of Stomatitis, Glossitis, Gingivitis. We have also had success in the treatment of post radiation and chemotherapy oral lesions.”

31 Jay Youngerman, ENT Specialist, Letter Nov. 6, ‘02. “I have used DioxiRinse on patients who have extensive gum disease that seems to be causing problems with lymphadenopathy and with gum pain and bleeding. In general, I am very pleased with your products.”

32 Mohammad, AR, Giannini, PJ., Preshaw, PM, Alliger, H, International Dental Journal (2004);154-158. “Clinical and Microbiological Efficacy of Chlorine Dioxide in the management of Chronic Atrophic Candidiasis: an open study.” “Within the limitations of this pilot study, the results provide evidence for the safety and clinical and microbiological effectiveness of the topical antiseptic chlorine dioxide (0.8%) in the management of chronic atrophic candidiasis.”

33 Nachnani, Sushma,”Effect of DioxiRinse Mouthwash on Oral Malodor.” “Rinsing with DioxiRinse the night before reduced oral malodor 50%, the next day, by halimeter readings.”

34 Simpson GD, Miller RF, Laxton GD, Unichem International Inc. Houston Texas, Corrosion 93, Paper # 472, A Focus on Chlorine Dioxide: The Ideal Biocide “Chlorine Dioxide, by effectively killing and stripping off any biofilm, bacteria are much slower to re-establish than when biofilm is left intact.”

35 Paol TD, Atti M, Faulkner J, J. of Clinical Periodontology, 1997;24:626-631“Chlorine Dioxide is preferred for its simultaneous disinfecting-cleaning and descaling activity.”

36 Eric Montgomery, Patent #5,944,528 Aug. ‘99. “Chlorine Dioxide causes a visible change in the whiteness of teeth.”

37 Israel Kleinberg, Stony Brook Univ. School of Dental Medicine, Oral Biology Dept., 1996. Rinsing with Ciderm removed all mouth odor for 4 hours while applying Cysteine rinse every hour. Graph

38 Westbury Diagnostics, Inc. Farmingdale, NY Aug. 7, ‘99. Microbial Challenge of Two Mouthwash Formulations, 10 logs of S aureus were killed in one minute by DioxiRinse Mouthwash.

39 Kern E, National Institute of Allergy and Infectious Diseases, Univ. of Alabama, March 5, 2002. Direct Inactivation Assay, “DioxiRinse mouthwash deactivated 7 logs of Vaccinia and Cowpox virus in one minute.”

40 Collaborative Microbiology Labs, Stony Brook, NY September 9, ‘96. InVitro Efficacy Testing of DioxiRinse Mouthwash vs. Mouth Organisms, “DioxiRinse kills K Pnemoniae faster than Chlorhexidine.”

41 Walker JT Mackerness CW, Mallon D, Makin T, J. Ind. Microbiol. ‘95 Oct; 15(4): 384-90 “Control of Legionella pneumophilia in a hospital water system by chlorine dioxide, no pneumophilia were recovered. Biofilm was dramatically reduced after disinfection.”

42 Aieta EM, Berg BD, J AWWA, Research and Technology Jun. 1986 A Review of Chlorine Dioxide in Drinking Water Treatment, “Chlorine Dioxide is an excellent disinfectant against cysts, and ClO2 is better than or equal to chlorine. Results indicate that Chlorine Dioxide is superior to Chlorine in the inactivation of viruses.”

43 Abdel Mohammad, DDS MS MPH FACD Ohio State University, College of Dentistry, February 22, ‘01Study: The use of Chlorine Dioxide on immediate dentures and geriatric patients. “When the chlorine dioxide antiseptic system is used after the denture is inserted, it will enhance the wound healing process.”

44 Sarin PS, New England J. of Med., Nov.28, ‘85, Inactivation of human T-Cell Lymphotropic Retrovirus, “Chlorine Dioxide at high dilutions inactivates HTLV-111 (AIDS virus).”

45 Farr FW, Walton C, Dept of Medicine, West Virginia University, Morgantown, VA Infect Control Hosp Epidemiol 1993, Sept; 14(9): 527-9. Inactivation of human immuno-deficiency virus by a medical waste process using chlorine dioxide. “Treatment of HIV-1 with chlorine dioxide in the presence of 25% blood caused a 6.25 log 10 reduction in infectivity.”

46 Shipp, A, DVM, FAWD Dip. AVDC, Beverly Hills California, April ‘95. Letter: Studies on chronic gingivitis.“In one case, an 8-year old Doberman with chronic stomatitis and contact lesions on the buccal and labial mucosa, Ciderm gel was applied daily to the lesions. Within 5 days the lesions were substantially reduced and the dog free of pain. In the past I have not seen such rapid reduction in stomatitis lesions.”

47 Joseph LM, PhD, RDH. “Efficacy Evaluation of ClO2 Containing Toothpaste on Plaque and Gingivitis.” “DioxiBrite showed statistically significant better removal of plaque than Colgate’s Total.”

48 Kenyon AJ, Hamilton, SG, Douglas DM. American Journal of Veterinary Research, Vol. 47, No.1, pp.96-101. “Controlled Wound Repair in Guinea Pigs, Using Antimicrobials that Alter Fibroplasia.” “Alcide treated wounds epithelialized as rapidly as did control wounds, and had minimal scar formation.”

49 Kenyon AJ, Hamilton SG, Douglas DM. American Journal of Veterinary Research, Vol. 47, No. 5, pp.1101-1104. “Comparison of Antipseudomonad Activity of Chlorine Dioxide.” “In this model, the chlorine dioxide-containing gel was more active than were preparations of providine-iodine, chlorhexidine, or silver sulfadiazine.”

50 Mohammad AR, Alliger H. “Chlorine Dioxide for the Treatment of Periodontitis in an Institutionalized Geriatric Population.” “With only two applications of ClO2 as an adjunct to SRP (scaling and root planning), greater benefits were obtained for elderly patients compared to SRP alone while ClO2 treatment alone was effective in markedly reducing bleeding on probing.”

51 Green LH. “Healing and Disinfectant Properties of the DioxiCare System” A comparative evaluation of six gel formations. “In a comparison of 6 different DioxiCare formulas vs. Neosporin and Saline (0.9%), DioxiDerm Gel and Rough Hands Gel appeared to produce the greatest amount of wound healing when the criteria of wound closure and the elimination erythema were considered.”

52 Goultschin J, Green J, Machtel E, Israel J. of Dental Sciences Vol.12 1989. “Use of a Meta-stabilized Chlorous Acid/Chlorine Dioxide Formulation as a Mouthrinse for Plaque.” “The advantage of a commercially available antiseptic mouthrinse that reduces plaque mass, as a supplement to mechanical oral hygiene measures was shown.”

53 Zane HZ, DD, August 1996. Letter; results after 40 patients. “Periodontal results showed a marked decrease in inflammation and bleeding.”

54 Abdel-Rahman MS, Gerges SE, Alliger H. Journal of Applied Toxicology, Vol.2 No. 3, ‘82, “Toxicity of Alcide” “The present data revealed no Alcide toxicity at the recommended concentration to be used for treatment of acne and herpes.”

55 Department of Health & Human Services. Federal Register Vol. 60. No. 42, March 3, ‘95. “The Food and Drug Administration is amending the food additive regulations to provide for the safe use of chlorine dioxide to control the microbial population in poultry process water.”

56 Lubbers JR, Chauan S, Bianchine R. Environmental Health Perspectives Vol. 46, pp57-62, ‘82,“Controlled Clinical Evaluations of Chlorine Dioxide, Chlorite and Chlorate in Man” “the relative safety of oral ingestion of chlorine dioxide and its metabolites, chlorite and chlorate, was demonstrated.”

57 Gianinni, Peter, J., DDS, MS Asst. Professor of Oral Biology, University of Nebraska Medical Center. “Gingivitis and periodontitis is an ongoing problem in our country. DioxiRinse Mouthwash is one of the few possibilities for arresting this chronic problem by using on a daily basis. The speed of kill with chlorine dioxide combined with the possibility of oxidizing cytokines is an intriguing combination. The mouthwash, further, is not hampered by bad taste which sometimes limits compliance with other rinses.”

58 Frank Feng, DDS.“I’d like to complement you on your fine mouthwash. We have been using it now for almost three years. Although I have no particular desire to get into sales, the surprisingly good results our patients have experienced, especially with bad gums, encourages me to do so. More than a handful of patients avoided seeing a Periodontist after conscientious use of DioxiRinse. The pleasant taste seems to help these patients maintain a good regimen. I’m surprised that chlorine dioxide “has not taken over the world.”

59 Milton Dines,DDS. “I have applied your Cl0₂solution to a number of periodontal abscesses in the active stage. In the three instances there was improvement in the status of the abscesses without noticeable adverse side effects.”

60 Martin Dinnes,DVM. “Dental fistula in a white tiger. An epthelialated fistulous, infected tract responded in three days and closed completely following extraction of the offending tooth and three treatments with Citronex liquid. Tusk fracture in an elephant with abcessation and osteomyelitis of the adjacent alveolar bone. The daily use of citronex liquid and gel caused the infection to heal and a remission of the osteomyelitis. I feel that the animal might have lost his tusk were it not for availability and utilization of citronex.”

61 Silberman, MS, DVM “One unique case was an oral lesion in a black rhinoceros. This is a recurring lesion that has been almost impossible to handle medically. When treated with chlorine dioxide topically for a few days, the lesion was resolved.”

62 Rosemary Fish, DVM “We have used your chlorine dioxide both as a mouth flush and as a gel application in our snakes with stomatitis. This compound caused no noticeable irritation in snakes receiving daily treatment, and two animals which were treated recovered completely with no other therapy.

63 Ronald Feldman, MD “ One patient used the solution to gargle with a severe sore throat with terrible pain. She had excellent relief of pain with half an hour.”64

64 Westbury Diagnostics.“Disinfectant Test of DioxiGuard Spray and DX-7 Gel, Two Chlorine Dioxide Antimicrobials.” Testing S. aureus, (MRSA), A. baumannii ,L. monocytogenes “Treatment with the disinfectants killed all of the microorganisms on the glass coverslips at both time frame, 15 or 30 seconds. The disinfecting ability of the two chlorine dioxide products was remarkable.”

64a ATS Labs, “Time Kill Test for Antimicrobial Agents.” In one minute DX-7 hand gel reduced 100,000 spores,

difficile to 70 spores.

Listerine

65 Dr. Dan Peterson, Family Gentle Dental Care, “Journal of the American Dental Association indicated that mouthwashes containing more than 25% alcohol could increase the risk of oral and pharyngeal cancers by about 50%.” “While further testing is needed, initial studies have shown that most over-the-counter antiplaque rinses and antiseptics aren’t much more effective against plaque and periodontal disease than rinsing with water.”

66 Helmbold J, Cell Biology Lab C, Abstract . www.franklincollege.edu. “The Antibacterial Effects of Mouthwashes on B.cereus and S. epidermis” April 17, ‘04, “both water and Listerine had no antibacterial effect on either bacterium.”

67 Netuschil L, Eur.J.Oral Sci. Vol. 103 Issue 6, pp 355-361, Dec. ‘95. “Plaque bacteria counts and vitality during use of chlorhexidine, meridol, and Listerine ,” “Results in the Listerine group did not differ from those in the control group.”

68 Brecx M, Netuschil L, Reichert B, Schreil G, J. Clin. Periodontology, ‘90 May: 17 (5): 292-297, “In contrast, the data gave no evidence of an antibacterial effect in vivo of Listerine.”

69 Query, Lauren, Abstract: The Effectiveness of Mouthwashes Against the bacteria Bacillus subtilis & Staphylococcus epidermis, Apr. 23, ‘02, “Listerine was proven to be the least effective mouthwash by inhibiting zero growth of the bacteria, which was the same for water.”

70 Al Ismael, DW Lewis, JL Dingle, Prevention of Periodontal Disease, The Canadian Guide to Clinical Preventive Health Care,’94, Chapter 37, p424.“Side effects of Listerine are poor taste and a burning sensation in the mouth.”

71 Bernstein ML, Oral Surg. Oral Med. Path, ‘78 Dec; 46(6): 781-5. “Oral mucosal white lesions associated with excessive use of Listerine mouthwash.” “Two patients were observed to have asymptomatic, diffuse, filmy white lesions involving large portions of the oral mucosa.”

73 Quirynen M, Hong Zhao, Daniel van Steenberghe Clinical Oral Investigations, Springer Berlin/Heidelberg Vol. 6, Number 1, March ‘02, pp 1436-3771,“This article outlines the efficacy of mechanisms of different antimalodour approaches. Most approaches were found to be inefficient and/or short lasting.”

74 Kellaway JS,Wyatt NN, Adlis S, Schoenwater WF, Allergy and Asthma Proceedings, Vol. 22, Number 6, November-December 2001, pp367-371. “Therefore, Listerine was not more effective than water in removing Flutisacone Propionate from the oropharyngheal mucosa.

75 Konopka T, Kozlowski Z, Karolewska E, “Clinical Evaluation of Listerine in Full-Mouth Disinfection,” “When subgingival rinsing using Listerine or saline solution was used on the opposite sides of the same dental arch no statistically significant differences were detected in the average values of clinical parameters.”

76 The New York Times, October 9, 1988, “U.S. Challenges Claims on Toothpaste and Mouthwash Labels.” “The Food and Drug Administration has asked six toothpaste and mouthwash manufacturers to remove from labels assertions that the products prevent gum disease and plaque buildup. The letters noted that the agency had not received information from the companies supporting the claim that their products are safe and effective in dealing with plaque and gum disease.” (Listerine was among the products cited).

77 JREF Forum, Feb.‘07, Examples of commercial products with misleading if not outright false advertising. “Listerine kills germs that cause bad breath does not mean Listerine stops bad breath. The germ killing effect of Listerine is so minimal it doesn’t even meet the FDA standard to be listed as an antiseptic. See for yourself at the FDA’s web site.”

78 FTC Lawsuit. “In Warner-Lambert v. FTC, (1977) the agency finally prevailed after a twenty year struggle against the manufacturers of Listerine Mouthwash. Unlike with Gerber, the claims made for Listerine were directly asserted, not implied. A long running series of ad campaigns claimed Listerine is an effective cold remedy, despite there being no proof this is true. The FTC not only stopped Warner-Lambert from making further false claims, they forced the company to compensate for the misleading effects of earlier ads through corrective advertising designed to disabuse consumers of the established belief that Listerine is beneficial to cold sufferers.”

79 Food and Drug Administration, (eNotAlone Google excerpt), “There is no evidence that mouthwashes can affect subgingival plaque or periodontitis.” “In 1987 the ADA awarded its second Seal of Acceptance to a mouthwash for use in the reduction of plaque and gingivitis. FDA, however, has not yet approved Listerine for this use. In fact, FDA has sent letters to the makers of Listerine and several other over-the-counter- products making anti-plaque claims stating that in its opinion the products are being marketed in violation of the Federal Food, Drug, and Cosmetic Act and are at risk of regulatory action.” “The basis for these letters is that no ingredient for use in an OTC drug product has yet been recognized as safe and effective for the prevention or reduction of plaque or gingivitis in FDA’s ongoing evaluation of OTC drug products.”

80 McKenzie WT, Forgas L, Vernino AR, J. Periodontol. 1992 Mar; 63(3): 187-93. “Comparison of a 0.12% chlorhexidine mouthrinse and an essential oil mouthrinse in institutionalized, mentally handicapped adults: one-year results.” “Both mouthrinses produced a significant improvement in the Gingival index (GI) after one month. Despite the improvement, the GI was still indicative of disease. No improvement in the Plaque index (PI) occurred in the essential oil group.”

81 Breathalyzer Wikipedia. 2008 “Listerine, for example, contains 27% alcohol.”

82 Department of Health & Human Services, June, ‘01. “Preliminary consumer feedback regarding the APF Listerine prototype indicated that the incorporation of the acidulated phosphate system into Listerine raised substantial issues of objectionable taste.”

83 Ciancio SG, Agents for the Management of Plaque and Gingivitis, Department of Periodontology, Center for Clinical Dental Studies, State Univ. of NY at Buffalo. “Adverse effects include a burning sensation and dislike of taste in some patients.”

84 Springen, Karen, Newsweek, Apr. 24, 2008, “Critics of alcohol-containing products say that alcohol dried the mouth, which could potentially worsen breath. It is a carrier for essential oils that are the active ingredients in Listerine.” “Alcohol draws moisture out of the tissues, and also slows salivary flow,” says Laura Brinker a spokeswoman for Proctor & Gamble. says the ADA’s Richard Price,. “After they bathe, people put on deodorant-just as they use mouthwash after they brush their teeth. The mouthwash is not as important as physically removing the bacteria. You don’t need a mouthwash says Richard Price.” “A dry mouth leads to an overgrowth of bacteria,” says Dr. Susan Karabin, president of the American Academy of Periodontology. “Children’s livers aren’t fully developed, so alcohol exposure can be toxic and even put them in a coma.” “It’s dangerous to leave the stuff lying around, says Northwestern’s Dr. Hurst.” Dr. Susan Karadin says, “Rinsing with hydrogen peroxide also promotes fungal growth.”

85 iVillage.com Total Health “Cosmetic mouthwashes have a limited effect on dental health. Although manufacturers tout over-the-counter mouthwashes as an effective way to promote oral health, dental experts generally do not believe that they offer significant benefits over simple flossing and brushing with a toothpaste containing fluoride. The effects are temporary. Mouthwashes are generally not recommended for use in children 12 and younger. There is the risk that children may swallow mouthwash instead of spitting it out. This can lead to alcohol poisoning, requiring medical attention.”

86 Flemingson EA, Ambalavanan N, et.al. Indian Journal of Dental Research Vol. 19, Issue 1, pp.29-35.”It was seen that Listerine was more cytotoxic than Chlorhexidine and Povidone-Iodine. The results obtained in this study demonstrate the detrimental effect of these three mouthwashes (Chlorhexidine, Listerine, Povidone-Iodine) on gingival fibroblast proliferation, which could interfere with wound healing.”

87 Wikipedia Listerine ‘08 “The efficacy of the treatment is due mainly to Listerine’s liquid properties. By the same token, however, this treatment is ineffective at physically removing plaque buildup.”

88 NYTimes.com The Media Business, Jul. 1993, Ref. 88. “Yet Listerine is predicated on its sometimes harsh taste, serving as a signal that it is powerful enough to freshen breath and kill germs—‘the taste people hate twice a day,’, ads proclaimed.”

89.McCullough, MJ, CS Farah, Australian Dental Journal 2008:53: 302-305 “The Role of Alcohol in Oral Carcinogenesis with Particular Reference to Alcohol-Containing Mouthwashes.”