Mouthwash is no substitute for dental floss, a federal judge ruled, calling a Listerine ad campaign false and misleading and a public health risk.

Judge Denny Chin said in a written ruling made public Friday that he expected to order Pfizer Inc. as early as Monday to stop claiming that its product, Listerine, is as effective as floss at reducing plaque and gingivitis between teeth.

The ruling came after McNeil-PPC Inc., a subsidiary of Johnson & Johnson, filed a lawsuit saying that false claims in the advertising campaign that began last June posed an unfair threat against its sales of dental floss.

"Dentists and hygienists have been telling their patients for decades to floss daily," Chin wrote. "They have been doing so for good reason. The benefits of flossing are real — they are not a `myth.' Pfizer's implicit message that Listerine can replace floss is false and misleading."

Pfizer in print ads had featured a Listerine bottle balanced on a scale opposite a floss container. The ad said: "Listerine antiseptic is clinically proven to be as effective as floss at reducing plaque and gingivitis between the teeth."

The campaign also featured a television commercial titled the "Big Bang." In it, the commercial announces that Listerine is as effective as floss and that clinical tests prove it, though it does add that there is no replacement for flossing.

The judge said "substantial evidence" demonstrates that flossing is important in reducing tooth decay and gum disease and that it cannot be replaced by rinsing with a mouthwash.

The judge also noted that the authors of articles on which Pfizer based its advertising campaign had emphasized that dental professionals should continue to recommend daily flossing and cautioned that they were not suggesting that mouth rinse be used instead of floss.

Chin said Pfizer based its findings on two flawed studies of people with mild to moderate gingivitis who did not use floss properly. The studies, he added, proved only that Listerine is "as effective as improperly used floss."

Gingivitis, which affects some two-thirds of the U.S. population, causes inflamed, swollen and sometimes bleeding gums. It can precede periodontitis, a less common inflammation that develops in deeper tissues and sometimes leads to tooth loss.

The judge noted that 87 percent of consumers floss either infrequently or not at all, despite frequent warnings from dentists and dental hygienists to do so.

The judge said Pfizer had received complaints about its advertising, including one from a dental professional who said he was "aghast" to hear of the company's claims and another who said the claims "can set back years of progress by the ethical dental profession in convincing patients that flossing is essential for their oral health."

Chin wrote that flossing provides benefits that Listerine does not, including the ability to remove plaque below the gumline and to dislodge pieces of food trapped between teeth.

The judge said he found it "highly troubling" that Pfizer took the position in the lawsuit that floss can be replaced by Listerine even though it had told dental professionals for two years that it was not suggesting that was the case.

Messages left with Pfizer were not immediately returned. Danielle Devine, a Johnson & Johnson spokeswoman, said the company was pleased with the ruling.

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Reference Source 102
January 10, 2005