Chlorhexidine: is it still the gold standard?

Amine fluoride/stannous fluoride and chlorhexidine mouthwashes as adjuncts to surgical periodontal therapy: a comparative study

BACKGROUND

Postsurgical mouthwashes are routinely used in clinical studies and also in daily clinical practice. Chlorhexidine gluconate (CHX) has long been the gold standard for supra-gingival chemical plaque control regimens. Amine fluoride/stannous fluoride (AmF/SnF2) formulations have also been extensively studied and shown to have an antibacterial effect and be useful as antiplaque agents. The antibacterial effect of AmF/SnF2 and its minimal extrinsic tooth staining make it a possible alternative to CHX as an adjunct to periodontal surgical therapy. The aim of this double-blind, controlled clinical trial was to evaluate and compare the combined effect of an AmF/SnF2 or a CHX mouthwash and surgical periodontal therapy on periodontal parameters.

METHODS

Thirty-two patients with at least 3 pockets > or =5 mm in the same quadrant were selected for this study, following a hygienic phase of therapy. They were randomized into 2 treatment groups: surgical flap debridement and a postsurgical CHX mouthwash or surgical flap debridement and an AmF/SnF2 postsurgical mouthwash, performed twice daily for 3 weeks. Clinical measurements were taken at baseline and 3 and 12 weeks postsurgery.

RESULTS

Both treatment modalities resulted in significant improvements in probing depth and clinical attachment level. There was no significant difference between groups in any of the recorded parameters. Staining index at week 3 in the CHX group was significantly higher than in the AmF/SnF2 group (P<0.05). However these differences leveled down at 12 weeks.

CONCLUSIONS

Our results support the alternative use of an AmF/SnF2 mouthwash in plaque control management of patients following flap debridement surgery.

Attitudes of carers and the elderly occupants of residential homes to antimicrobial chewing gum as an aid to oral health

OBJECTIVE

The aim of this study was to investigate the attitudes of elderly residents to using an antimicrobial chewing gum as an aid to oral health, and the opinion of their carers on such a procedure.

DESIGN

A cross-sectional, multi-centre survey using a structured interview/questionnaire conducted with elderly residents and their carers.

SETTING

In January 1998, 9 residential/nursing homes were chosen at random from all the homes in West Hertfordshire, 207 residents were asked to chew two pieces of gum twice daily for 7 days.

SUBJECTS

The participants, 148 women and 59 men, were aged between 53-100 years (mean age 82.23 +/- 9.62 years). 47 carers, all female, were involved in distributing and collecting the gum.

RESULTS

122 residents (58.9%) were edentulous and 85 (41%) of the participants were partially dentate. Of those with teeth 23 (27%) had 21 teeth or more. 73 (35.2%) residents found that chewing the gum was difficult with 37 (17.9%) of this group being unable to chew (P < 0.0001 for those residents with no teeth/dentures or dentures unopposed by teeth or other dentures). 32 (18.6%) subjects disliked the flavour of the gum. Of the 170 residents who chewed the gum 99 (57.2%) found it reduced oral dryness and 78 (45.1%) reported it made their mouth feel healthy. 34 (53.6%) of the dentate and 47 (40.9%) of the edentate residents wished to keep using the gum (P < 0.05). 35 (74.5%) of the carers found it easy to distribute the gum and 29 (61.7%) thought that chewing gum was an acceptable method of maintaining oral health for residents.

CONCLUSION

The antimicrobial gum investigated in this study was acceptable to many elderly occupants and their carers, significantly improving perceived oral health and oral dryness of residents.

Chlorhexidine-induced changes to human gingival fibroblast collagen and non-collagen protein production

BACKGROUND

Chlorhexidine (CHX) has been used extensively as an adjunctive therapy in the treatment of periodontal disease. It is well known that chlorhexidine is toxic to bacteria, but recent evidence has suggested that chlorhexidine may also have deleterious effects on gingival fibroblast proliferation as well as collagen and non-collagen protein production in cell culture. The purpose of this study was to examine the effects of chlorhexidine on gingival fibroblast proliferation as well as collagen and non-collagen protein production in cell culture.

METHODS

Human gingival fibroblasts were incubated in MEM containing chlorhexidine concentrations ranging from 1 microM to 1300 microM at 37 degrees C for 1, 5, or 15 minutes. Control cells received an equal volume of MEM without chlorhexidine for similar times at 37 degrees C. Following incubation, the media were removed, cells washed twice with MEM supplemented with 10% FBS, and fibroblasts in treatment and control groups were allowed to recover in the same media for 24 hours.

RESULTS

In all strains, cellular proliferation was dependent on the concentration of solubilized chlorhexidine in cell culture but independent of the duration of chlorhexidine exposure. The average inhibitory concentration necessary to reduce cellular proliferation by 50% (ID50) was 222.1 microM. In regard to collagen and non-collagen protein production, fibroblasts exposed to chlorhexidine concentrations (1 microM) well below the ID50 had a 65% reduction in collagen production and a 57% reduction in noncollagen protein production.

CONCLUSIONS

These results suggest that chlorhexidine will induce a dose dependent reduction in cellular proliferation and that concentrations of chlorhexidine that have little effect on cellular proliferation can significantly reduce both collagen and noncollagen protein production of human gingival fibroblasts in vitro. Hence, the introduction of commercially available concentrations (0.12%) or diluted commercial concentrations (as low as 0.00009%) of chlorhexidine to surgical sites for short periods of time prior to wound closure can conceivably have serious toxic effects on gingival fibroblasts and may negatively affect wound healing.