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I recall just a few years ago, there was a common misconception that fluoride interferes with the antibacterial activity of cetylpyridinium chloride (CPC) - in fact, I've often seen instructions on antibacterial CPC rinses specifying that you should thoroughly rinse the toothpaste (which they probably assume contains fluoride) out of your mouth before using them.

Over the last few years, I've also seen a rise in alcohol-free fluoride rinses with some amount of CPC, marketed as anticavity with the "ADA Accepted" seal of approval.

However, I found this article recently: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4546200/ - a study that tested a rinse containing both common OTC mouthwash-standard concentrations of sodium fluoride and CPC - compared against fluoride-only, CPC-only, and placebo mouthwashes. In short: the study found that CPC doesn't significantly interfere with fluoride's anticavity properties, and fluoride doesn't interfere with CPC's antibacterial activity.

Additionally, fluoride and CPC both have different ways of making cariogenic bacteria miserable - for example, CPC breaks bacterial cell membranes (https://www.dentistrytoday.com/articles-hygiene/7104-its-80-20-with-biofilm-update-on-oral-rinses), while fluoride inhibits important bacterial enzymes and reduces acid tolerance in bacteria that would otherwise thrive in a low pH (https://www.ncbi.nlm.nih.gov/pubmed/7497353).

Despite all this information readily available in academic journal articles, I have yet to see a combined fluoride/CPC rinse labeled as both anticavity and antibacterial. For some unknown reason, the cetylpyridinium chloride is labeled as an "inactive ingredient". 2 examples: ACT Alcohol-Free Anticavity rinse, cinnamon flavor (https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f2952ca5-c1c3-42fc-82a4-08662286be44) and a similar rinse by Crest (https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=52232bad-90ce-4f59-8b26-ca4c674df836)

Several years ago I recall a Listerine fluoride anticavity rinse that also contained the regular antibacterial Listerine formulation (22% alcohol and antibacterial essential oils), yet the essential oils were listed as inactive.

Why the confusion and misinformation? If a product is both anticavity and antibacterial, it should be listed properly.

user1258361
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    I'm voting to close this question as off-topic because this seems like more of a rant than a question (or perhaps a marketing or legal question, since you've answered the medical science question in your OP). I'd suggest rephrasing, either to self answer, or to ask a specific medical science question (not just 'amirite?'). – De Novo Feb 20 '19 at 22:27
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    In case you missed the question, I'm specifically looking for answers on why mouthwash that is obviously both anticavity and antibacterial isn't labeled as antibacterial. I don't see any hint of a "rant" or "amirite". It's entirely possible that these aren't really antibacterial in their existing formulations, although that would seem to contradict the research I found. – user1258361 Feb 20 '19 at 22:32
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    From my perspective, "are the existing formulations antibacterial?" is an on topic question here, and your question could benefit from an edit to make this the clear question. As it is worded, I interpret your question as: "Medical science concludes X. Why is there so much confusion about that in marketing material for a consumer product?", which seems to be a reasonable statement followed by a good (possibly rhetorical) question, but not on topic here. This is just my own perspective, so I voted to close and let you and the community know why. – De Novo Feb 21 '19 at 04:21
  • It isn't just a matter of "marketing". It's a matter of truth and facts, which people deserve to know. If it's antibacterial, the labeling should be consistent with its functionality. It seems unusual, to say the least. I can't think of any other OTC medicine in the U.S. where effects are allowed to be hidden like this or the labeling is allowed to be so blatantly inconsistent with part of a product's functionality as determined by scientific study. – user1258361 Feb 21 '19 at 05:42
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    Many OTC drugs are marketed and labeled for consumer use in a limited manner. Aspirin, for example, is labeled as an anti-inflammatory and pain reliever. Even the 81 mg tablet is not labeled as an antiplatelet, despite that being its primary use. I do agree with your point, though, which I think you make in your question -- the labeling is incomplete. "People deserve to know the facts" just doesn't seem like a question though. – De Novo Feb 21 '19 at 05:48

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In business school (MBA) we were taught to consumer test all permutations of a possible "pitch." We would come up with permutations of the same label with different words and phrases on each. Then we would set up tables in public places and get feedback.

Basically, these large public companies have huge marketing departments. They tested the heck out of various combinations of words. What you see on the shelf is the label that had the best response from consumers with regard to ultimately buying the product.

My personal thoughts would be that anti-bacterial is a second order function that the average consumer would not understand. You are assuming that "bacteria causes cavities" is common knowledge. It isn't. The consumer understands "cavity." Cavities are talked about from when we are very young; even in cartoons.

Heart Tropix
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