Efficacy of cetylpridium chloride mouthwash compared to povidone iodine on oral flora for perioperative patient care: A randomized controlled feasibility study

Objectives: Perioperative oral management (POM) reduces the risk of postoperative pneumonia. Povidone iodine (PVP-I) is used in the self-care aspect of POM in Japan; however, its bactericidal capability may be reduced by dilution or saliva. Thus, we conducted a randomized parallel controlled feasibility study to evaluate the effects of 0.05% cetylpyridinium chloride (CPC) mouthwash compared to PVP-I gargle on the oral flora as perioperative self-care, in addition to brushing. Methods: A total of 100 patients scheduled for surgery, except in the head and neck region, under general anesthesia were randomly assigned into the CPC (n = 51) or PVP-I (n = 49) groups. Patients underwent clinical assessment and professional oral care (POC) before surgery, then brushed and used CPC or PVP-I products. Buccal mucosa, tongue coating, and saliva samples were collected six times in perioperative period. All samples were analyzed using 16 S rRNA gene sequencing and quantitative polymerase chain reaction. Results: Clinical indicators and samples from 83 participants (42 and 41 in the CPC and PVP-I groups, respectively) were analyzed. Reduced dental plaque adhesion and gingival bleeding and improved total bacterial counts were observed in both groups one week after surgery. In the CPC group, Streptococcus was suppressed until one week after surgery compared with that in the PVP-I group. Conclusions: Our study supports the feasibility of a full-scale randomized controlled trial to determine the effects of CPC mouthwash and PVP-I gargle on the oral flora. A CPC mouthwash may maintain the antibiotic effect longer than a PVP-I gargle.