Current uses of chlorhexidine for management of oral disease: a narrative review

Effects of oral hygiene management containing Cibotium Barometz J. Smith extract on peri-implant mucositis: a randomized clinical trial

BACKGROUND

The purpose of this study was to confirm the improvement of peri-implant mucositis (PIM) in patients using the toothpick method (TPM) containing a natural ingredient: Cibotium barometz J. Smith (CB).

METHODS

As a randomized, blind, controlled trial study, there were 21 participants in the CB TPM group (CBG), 20 participants in the chlorhexidine group (CG), and 19 participants in the saline group (SG). All three groups were examined both before and after TPM. We performed a paired t-test to determine the differences between the mean values of the three groups. We used ANOVA to evaluate the mean differences in clinical indicators, saliva tests, and periodontal bacteria.

RESULTS

There were no significant differences in sociodemographic characteristics and oral health status between the three groups, thus ensuring homogeneity among the participants. Occult blood in the saliva test increased for SG and CG and decreased for CBG. Compared to the before-TPM condition, leukocyte and protein levels decreased for CG and CBG after TPM (p < 0.05). As a result of checking the effect size (Cohen's d) before and after TPM according to the three groups, three species of bacteria were identified that showed a significant effect only on CBG, and two species were identified that showed a significant effect on CBG and CG (Cohen's d ≥ 0.8).

CONCLUSION

This study confirmed the efficacy of CB-applied TPM on PIM patients and demonstrated its potential as a non-surgical treatment option. Therefore, practitioners could extensively use CB-applied TPM as a mechanical tool and safe chemical and biological removal agent for post-implant management in clinical settings.

TRIAL REGISTRATION

The trial was registered in the International Clinical Trial Registry Platform (ICTRP) under the registration number KCT0008626 on 17/07/2023 and was retrospectively registered.

Caries prevention effects of nano silver fluoride sustained release orthodontic elastomerics in dental microcosm biofilms

OBJECTIVES

To evaluate the clinical applicability of nano silver fluoride sustained release orthodontic elastomerics (NSF-RE) by investigating its effects on inhibiting biofilm formation and enamel demineralization using dental microcosm biofilms.

METHODS

Two types of 23 % NSF coating solutions were prepared depending on the presence or absence of the plasticizer (polyethylene glycol [PEG] 6000: NSF-EP and NSF-E); the elastomerics were dip-coated individually with these. Biofilms were allowed to form on bovine enamel specimens with the elastomerics. Biofilm maturity (red/green ratio) was measured. After 7 days, biofilm thickness, live/dead cell ratio, and cell viability were evaluated. Microbiome taxonomic profiling was conducted on days 3 and 7. Mineral loss beneath the biofilm was quantified from fluorescence loss (ΔF) and ΔFmax values obtained. Demineralization at varying distances from the specimen center was evaluated based on the difference in ΔF between the control and experimental groups.

RESULTS

The NSF-EP (elastomerics treated with NSF coating containing PEG) had a 6.7 % significantly lower R/G ratio from day 3 and a 36.1 % thinner biofilm compared to the negative control with uncoated elastomerics. In the NSF-EP group, cell viability assessments indicated reductions in total and aciduric bacterial counts by 9.4 % and 13.0 %, respectively. NSF-EP also had the lowest relative abundance of five caries-related bacteria. Additionally, NSF-EP significantly increased ΔF and ΔFmax by 34.8 % and 38.7 %, respectively, indicating reduced mineral loss. Demineralization did not differ according to distance from the elastomerics.

CONCLUSION

NSF-RE significantly reduces biofilm formation and demineralization, offering a promising caries prevention strategy in orthodontic patients.

CLINICAL SIGNIFICANCE

By inhibiting both biofilm formation and demineralization, NSF-RE provides a dual-function approach that may effectively prevent dental caries in orthodontic patients.

Chemical composition, antibacterial, and antifungal effects of Citrus medica (citron), Pimpinella anisum (anise), and Artemisia dracunculus (tarragon) on oral pathogens: An in vitro study

Background

Dental caries are caused by acidic by-products from bacterial fermentation of dietary carbohydrates and can lead to oral complications. Oral candidiasis is another disease affecting quality of life, especially in diabetic and immunocompromised patients. Interest in using Persian medicine to manage oral diseases has been growing recently. Persian medicine texts highlight medicinal plants such as Artemisia dracunculus, Citrus medica, and Pimpinella anisum for oral health benefits. The present research explores the antimicrobial effects of these plants against microorganisms causing caries and oral candidiasis.

Materials and Methods

This is an in vitro study, aimed to evaluate the chemical composition, and antimicrobial effects of C. medica, P. anisum, and A. dracunculus on oral pathogens. Based on criteria such as accessibility, recognizability, and novelty, leaves of A. dracunculus, peels of C. medica, and seeds of P. anisum were chosen. Their chemical compositions were analyzed after procuring the plant samples and preparing their essential oils (EOs). Subsequently, the diameters of the inhibition zones and their minimum inhibitory concentration (MIC) and minimum bactericidal concentration/minimum fungicidal concentration values were measured.

Results

The major chemical components of P. anisum's EO (PAEO), A. dracunculus' EO (ADEO), and C. medica's EO (CMEO) were estragole (75.77%), anethole (89.03%), and limonene (92.31%), respectively. All pathogens were susceptible to all EOs except Streptococcus salivarius, which was resistant to CMEO and had the highest MIC. Except for this EO, all the other EOs showed inhibition zones with diameters ranging from 6 to 30 mm, ADEO being the most effective. In MICs, Lactobacillus acidophilus was the most sensitive microorganism tested with MIC. In contrast, the most resistant microorganism was S. salivarius.

Conclusion

The attained results demonstrated that the examined plants possess notable antimicrobial properties against oral pathogens.

Engineering Antibacterial, Biocompatible, Anti-Oxidant Titanium-Based Implants Using Polyphenols-Chlorhexidine Networks for Bone Regeneration

Implant-associated infections leading to osteolysis and implant loosening are an ongoing clinical challenge. Various strategies have been proposed to equip bone implants with antibacterial properties to prevent infection. However, the cytotoxicity associated with antimicrobial effects adversely impacts the osseointegration. Herein, a facile and safe strategy is proposed to endow bone implants with infection prevention, good cytocompatibility, inflammatory-responsive antimicrobial properties, thus promoting bone healing. The coating is fabricated on the implant through both covalent and non-covalent bonds of polyphenols with chlorhexidine (CHX). The covalent bonds guarantee long-term stability, while non-covalent bonds facilitate early release of CHX. Furthermore, the inclusion of polyphenols reduces the electrophilicity of CHX, inhibits reactive oxygen species generated by CHX, and minimizes interference with the mitochondrial electron transport chain, thereby reducing cellular toxicity. Consequently, the coating effectively fortified the bone implant, successfully impeding bacterial invasion within 7 days in Sprague-Dawley rats and suppressing inflammation as well as bone resorption caused by bacteria during a 60-day femoral implantation, thus facilitated osseointegration on the implant. The study investigated the cytotoxicity associated with mitochondrial interference induced by CHX and proposed a strategy to enhance its cellular compatibility, thereby providing a novel approach for fabricating biocompatible antibacterial bone implants.

Resorcinol-based Bolaamphiphilic Quaternary Ammonium Compounds

Quaternary ammonium compounds (QACs) play crucial disinfectant roles in healthcare, industry, and domestic settings. Most commercially utilized QACs like benzalkonium chloride have a common architectural theme, leading to a rise in bacterial resistance and urgent need for novel structural classes. Some potent QACs such as chlorhexidine (CHX) and octenidine (OCT) feature a bolaamphiphilic architecture, comprised of two cationic centers at the molecular periphery and a non-polar region connecting them; these compounds show promise to elude bacterial resistance mechanisms. Inspired by such structures, we synthesized a series of 43 biscationic amphiphilic compounds focused on a resorcinol core, featuring flexibility of linker lengths, alkyl tails, and relative substituent positioning, to study their structure activity relationships (SARs). Antibacterial activity evaluation against a panel of gram-positive and gram-negative strains, including ESKAPE pathogens (A. baumannii, P. aeruginosa), were encouraging, with minimum inhibitory concentrations (MICs) of 0.5-4 μM against all tested strains for select compounds. Ten prepared compounds bearing either 17 or 18 total side chain carbons demonstrated uniformly strong antibacterial activity against P. aeruginosa (MIC 4-16 μM) and 6 other strains (MIC ≤4 μM), irrespective of cationic spacing. These findings promise to further extend the application of bolaamphiphilic QACs as a novel class of disinfectants.

Antimicrobial, remineralization, and infiltration: advanced strategies for interrupting dental caries

Dental caries, driven by plaque biofilm, poses a major oral health challenge due to imbalance in mineralization and demineralization. The primary objective in caries management is to maintain biofilm homeostasis while facilitating the repair and regeneration of dental hard tissues, thus restoring both structural integrity and functionality of affected teeth. Though antimicrobial and remineralization approaches haven shown promise, their standalone utilization without concurrent bacterial control or rebalancing lacks an integrated strategy to effectively arrest caries progression. Furthermore, according to the principles of minimally invasive dentistry, treatment materials should exhibit high permeability to ensure optimal sealing of demineralized tooth surfaces. The concept of interrupting dental caries (IDC) has emerged as a holistic approach, drawing upon extensive research encompassing three pivotal techniques: antibacterial strategies, remineralization therapies, and infiltration mechanisms, all of which are indispensable components in combating the progression of dental caries. In this review, we provide a comprehensive overview of the mechanisms and applications of antibacterial, remineralization, and infiltration technologies within the context of caries management. Additionally, we summarize advanced materials that align with the IDC concept, aiming to offer valuable insights for designing next-generation materials adept at preventing or halting caries progression efficiently.

Antibacterial Activity and Randomised Controlled Trial of Chlorhexidine-Coated Floss on Gingival Bleeding

INTRODUCTION

While Chlorhexidine mouthwash is widely studied for the treatment of periodontal disease, research on chlorhexidine in the form of dental floss is limited. This study aims to evaluate the effect of chlorhexidine wax-coated dental floss on dental plaque accumulation and gingival bleeding. Additionally, antibacterial activity and cellular toxicity were also investigated in vitro.

METHODS

Various concentrations of chlorhexidine wax-coated floss (0%, 0.12%, 1%, and 2%) were prepared. The antibacterial activity against Streptococcus mutans was studied using a disc diffusion assay. Cellular toxicity was assessed in L929 cells and human gingival fibroblasts using an MTT assay. To evaluate the effects on plaque accumulation and gingival bleeding, 27 participants were randomly divided into 3 groups: 1) 0% chlorhexidine wax-coated dental floss (control), 2) 0.12% chlorhexidine wax-coated dental floss, and 3) 1% chlorhexidine wax-coated dental floss. All participants were instructed to use the provided dental floss once daily at bedtime for 14 days. Six sites per tooth were evaluated for the Quigley-Hein plaque index and bleeding index (BI) at day 0 (baseline) and day 15. All fully erupted teeth, except the third molars, were examined.

RESULTS

Chlorhexidine-coated floss exhibited antibacterial activity against S. mutans in a dose-dependent manner. In an in-vitro study, a 2% concentration of chlorhexidine in the floss was found to be highly toxic, leading to its exclusion from clinical trials. After 14 days of use, significantly lower levels of BI were observed in the groups using chlorhexidine wax-coated dental floss, compared to the control. Additionally, there was no significant difference in BI between the 0.12% and 1% chlorhexidine wax-coated dental floss groups. However, no significant difference in plaque index was found between the groups using chlorhexidine wax-coated dental floss and the control group.

CONCLUSIONS

This study demonstrated the antibacterial and anti-gingivitis properties of chlorhexidine wax-coated dental floss. Our results showed that using chlorhexidine wax-coated dental floss at a concentration as low as 0.12% could significantly reduce gingival bleeding. However, no additional benefit of chlorhexidine wax-coated dental floss on dental plaque accumulation was found.

Preventive effects of taxifolin on dental caries in vitro and in vivo

OBJECTIVES

The present study aimed to explore the inhibitory effect of taxifolin (TAX) on Streptococcus mutans (S. mutans) in vitro and evaluated the anti-caries efficacy of TAX in vivo.

DESIGN

The anti-microbial and anti-biofilm properties of TAX were examined on the S. mutans, and the results were preliminarily verified by quantitative real-time PCR. Polarized light microscopy and transverse microradiography were used to detect the effect of TAX on inhibiting enamel demineralization. The effect of TAX on the remineralization of demineralized enamel was analyzed by a microhardness tester, atomic force microscope, and transverse microradiography. The rat dental caries model was constructed to explore the anti-caries effect of TAX in vivo.

RESULTS

The minimum inhibitory concentration of TAX against S. mutans was 1 mg/mL. The 1 mg/mL TAX impeded the biofilm formation, destroyed the biofilm structure, and effectively prevented enamel demineralization caused by S. mutans. Both the 0.5 mg/mL and 1 mg/mL TAX-treated groups exhibited a higher percentage of surface microhardness recovery, along with lower surface roughness, mineral loss, and lesion depth. Additionally, 1 mg/mL TAX demonstrated the ability to inhibit the initiation and progression of caries in rats, while also proving to be biologically safe.

CONCLUSIONS

TAX had a significant inhibitory effect on S. mutans, could inhibit enamel demineralization and promote remineralization of demineralized enamel, and showed a promising anti-caries effect in vivo.

Proanthocyanidin B2 alleviates Pg.LPS-induced RAW264.7 cellular inflammation and oxidative stress via PI3K/Akt/NFkB pathway

Periodontitis is a multifactorial chronic inflammatory infectious disease associated with systemic diseases. Proanthocyanidin B2 (PB2), a polyphenol, has been investigated to exhibit antioxidant, anti-inflammatory and anti-cancer pharmacological properties. PB2 has shown good efficacy in treating hepatocellular carcinoma, type 2 diabetes mellitus, and ulcerative colitis. There are few studies on PB2 in treating periodontitis, and the molecular mechanism is unknown. This research focused on the effects of PB2 in Porphyromonas gingivalis-derived lipopolysaccharide (Pg. LPS)-stimulated RAW264.7 cells, as well as the potential mechanisms. CCK-8 assay was used to assess the cytotoxic effects of PB2. qRT-PCR assay and ELISA assay were used to evaluate the expression of inflammatory cytokines. DCFH-DA probe and other assay kits were employed to detect oxidative stress indicators. Western blot was conducted to assess important proteins of the PI3K/Akt/NFκB pathway. The results showed that PB2 downregulated the overproduction of pro-inflammatory mediators IL-1β, IL-6, and TNF-α; reduced the generation of ROS, MDA, and NO; Enhanced the activities of anti-inflammatory factor IL-10 and the total antioxidant capacity; and inhibited the activation of PI3K/Akt/NFκB pathway. In addition, the PI3K agonist 740Y-P was able to partially reverse the effects of PB2. This study indicates that PB2 exhibits significant anti-inflammatory and antioxidant effects in P. gingivalis LPS-stimulated RAW264.7 cells, primarily through the inhibition of the PI3K/Akt/NFκB signaling pathway.

Dental plaque-inspired peptide engineered to control plaque accumulation

Effective control of plaque accumulation is an important strategy for reducing the risk of both localized oral health issues and systemic diseases associated with plaque. However, existing approaches for preventing plaque accumulation exhibit some limitations, such as insufficient compatibility with the oral microbiota and tissues, as well as inconvenience in their use. Herein, inspired by dental plaque, a new class of peptides featuring excellent anti-fouling performance is successfully developed. Our peptides consist of a salivary-acquired peptide with tooth surface-selective adhesion, a zwitterionic peptide with anti-adhesion property, and four proline residues that provide structural rigidity. We conduct a series of progressive experiments, including molecular dynamics simulation and assessments of the anti-fouling performance of our peptides on hydroxyapatite slices, human tooth enamel slices, and ex vivo human teeth. The results demonstrate that our peptides possess the abilities of rapid anchoring on tooth surfaces and effective inhibiting protein and bacterial adhesion. These characteristics enable our peptide to efficiently control plaque accumulation through rinsing or spraying while preserving the balance of the oral microbiota. These findings open an appealing avenue for the development of anti-fouling agents for controlling plaque accumulation on tooth surfaces.

Color stability of frequently used aesthetic restorative materials following in vitro exposure to chlorhexidine- and octenidine-based mouthrinses

BACKGROUND

Long-term color match is one of the most important characteristics of aesthetic restorative materials as discoloration constitutes a primary reason for otherwise unnecessary replacements. The aim of the present in vitro study was to evaluate the color stability of frequent dental materials (ceramic, composite, orthodontic adhesive) induced by common antiseptic mouthrinses taking into account black tea consumption and mechanical cleaning.

METHODS

Twenty-four disc-shaped specimens (8 × 2 mm) were made of the materials Ceram.x Spectra™ ST HV, Ceram.x Spectra™ flow, Ceramill® Zolid HT+ PS and Unitek™ Transbond™ LR. Each of the following solutions was tested on six pieces per material: Chlorhexamed forte (CHX), octenident® (OCTD), octenimed® (OCTM) and artificial saliva (control). Dental samples underwent a total of 30 discoloration cycles in which they were alternatively placed into artificial saliva, black tea and respective mouthrinse or only in artificial saliva. After every 10 cycles, discs were mechanically cleaned with toothbrush and toothpaste. After 30 cycles, dental specimens were submitted to professional polishing. Color shifts were measured at different time-points using the VITA Easyshade® V spectrophotometer and displayed as total color difference ∆E (mean ± standard error). A post-hoc Tukey test (⍺ = 0.05) was applied to the mean ∆E values after 30 cycles to determine discoloration discrepancies between various mouthrinses as well as the control. Moreover, photos of individual discs were taken at all measurement times to visualize potential color changes by eye.

RESULTS

All mouthrinses showed major color shifts in the clinically visible range compared to the control on all different dental materials tested. However, CHX caused significantly more discoloration than OCTM and OCTD. Established color changes could be almost completely removed by simple brushing and even further by professional polishing to clinically acceptable levels on all tested materials.

CONCLUSIONS

Prolonged application of antiseptic mouthrinses may cause discoloration on different restorative materials. To maintain aesthetically satisfying conditions, patients should be educated about the importance of daily mechanical tooth brushing and regular professional polishing.

Comparing In Vitro Virucidal Efficacy of Commercially Available Mouthwashes Against Native High-Risk Human Papillomavirus Types 16 and 18

The rising incidence of oropharyngeal cancer caused by high-risk Human Papillomavirus (HPV) type 16 and HPV18 in the U.S and other developed countries is an important public health issue. This has been attributed to changes in sexual behavior, including the practice of oral sex, which may expose individuals to increased risk of acquiring oral HPV infection. The incidence of oral HPV infections highlights the role of the oral cavity as an important anatomical site in the acquisition and transmission of high-risk HPVs. Generally, the use of mouthwash/oral rinses have focused on targeting the oral bacteriome, and could additionally be formulated for managing the oral virome. Here, we examined virucidal properties of common over-the-counter antibacterial mouthwash products against native HPV16 and HPV18 virion in vitro, and downstream modification of virus infectivity. We tested oral rinses containing essential oils/alcohol, hydrogen peroxide, and cetylpyridinium chloride. Our results demonstrated greater than 90% efficacy against HPV16 inactivation, but comparatively with less efficacy against HPV18. Overall, hydrogen peroxide containing oral rinses demonstrated the best efficacy against both high-risk types, albeit with lower efficacy against HPV18. Prophylactic virucidal oral rinses targeted towards high-risk HPVs could be beneficial in reducing incidental oral HPV load, prevalence, and persistent infections.

A Novel Sugar-Free Probiotic Oral Rinse Influences Oral Candida albicans in Children with Down Syndrome Post Complete Oral Rehabilitation: A Pilot Randomized Clinical Trial with 6-Month Follow-Up

Down syndrome (DS), caused by trisomy 21, affects 1 in 600-1000 live births and is associated with distinctive physical features, cognitive impairment, and oral health challenges such as increased susceptibility to dental caries, periodontal disease, and elevated prevalence of oral Candida spp. Barriers to dental care necessitate comprehensive strategies to address the unique oral health needs of children with DS. The aim of the study was to evaluate the effectiveness of a sugar-free probiotic oral rinse versus 0.2% chlorhexidine digluconate in reducing oral Candida albicans (OCA) counts and improving oral health outcomes in children with DS. A double-blind randomized controlled trial (CTRI/2022/10/046847) enrolled 30 children with DS (aged 6-14 years). Baseline evaluations included OCA quantification and oral health assessments (OHI-S and PHP). Following individualized oral rehabilitation, participants were randomized to either a probiotic rinse (Group 1) or chlorhexidine rinse (Group 2) for 2 weeks. OCA and oral health parameters were assessed at baseline (T0), 2 weeks post-rehabilitation (T1), 2 weeks post-rinse (T2), and 6 months post-rinse (T3). Both groups showed significant improvements in OHI-S and PHP scores (p < 0.05). The probiotic group demonstrated significantly lower OCA counts than the chlorhexidine group at T2 and T3 (p = 0.001). Hence, the probiotic oral rinse can be considered a safe, effective method for reducing OCA and improving oral health outcomes in children with DS, advocating its inclusion in oral health management strategies for this population.

Oral care medications for the prevention and treatment of ventilator-associated pneumonia in intensive care unit

This study aims to ameliorate the management of VAP in clinical practice and deliver more precise care in the ICU. Study selection using the appropriate critical appraisal tools was undertaken by three authors. This review provides an overview of empirical antibiotics, chlorhexidine, and povidone-iodine, which are currently commonly used in critical care. It also discusses oral medications and preparations that may be used to prevent and treat ICU ventilator-associated pneumonia, including new antibiotics, hydrogen peroxide solutions, sodium bicarbonate, octenidine, and oral herbal medicines. It also discusses ongoing research and potential applications, such as the antimicrobial effects of these agents in ICU oral hygiene. Pharmaceuticals and formulations used in oral hygiene are effective or have huge application potential in the prevention and treatment of VAP, but further research is needed to standardize oral health assessment and care practices to develop evidence-based personalized oral hygiene for critically ill patients.

Anti-inflammatory and antimicrobial efficacy of coconut oil for periodontal pathogens: a triple-blind randomized clinical trial

OBJECTIVES

To evaluate the effect of coconut oil on the oral bacteriome and inflammatory response in patients with periodontitis by integrating next-generation sequencing analyses of pathogenic bacterial shifts and quantification of inflammatory markers, thereby assessing its potential as a natural adjunct to standard nonsurgical periodontal therapy.

MATERIALS AND METHODS

A triple-blind clinical trial was conducted with 30 participants diagnosed with periodontitis, randomized into 3 groups: (1) coconut oil, (2) chlorhexidine and (3) placebo. Saliva and gingival crevicular fluid (GCF) samples were collected before treatment, one month after treatment, and one month post-non-surgical periodontal therapy. Bacterial DNA was extracted, and the V3-V4 region of the 16 S rRNA gene was PCR-amplified and sequenced using Illumina MiSeq technologies. Inflammatory biomarkers, including Interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α), were quantified from GCF samples.

RESULTS

Coconut oil treatment significantly reduced pathogenic bacterial families such as Spirochaetaceae and Tannerellaceae while promoting beneficial bacteria such as Streptococcaceae. At the genus and species levels, coconut oil reduced pathogens such as Tannerella forsythia and Treponema denticola along with increase in beneficial bacteria such as Streptococcus. The subgingival microbial dysbiosis index improved significantly in both coconut oil and chlorhexidine groups. Furthermore, the coconut oil demonstrated a reduction in IL-6 and TNF-α levels, indicating decreased local inflammation.

CONCLUSIONS

Coconut oil treatment significantly modulated the oral microbiome and reduced inflammatory markers in patients with periodontitis, suggesting its potential as a natural and effective adjunct in periodontal therapy.

CLINICAL RELEVANCE

This study highlights coconut oil's potential as a natural adjunct in periodontal therapy, effectively reducing pathogenic bacteria and inflammatory markers (IL-6, TNF-α). It offers a safe alternative to chlorhexidine, promoting microbiome balance and improved periodontal health.

Green Tea: A Novel Perspective on the Traditional Plant's Potential in Managing Periodontal Diseases

Green tea (Camellia sinensis) exhibits significant potential in oral health due to its antioxidant, anti-inflammatory, and antimicrobial properties. This review explores its role in managing periodontal disease, a common condition characterized by inflammation, microbial imbalances, and tissue destruction. The primary bioactive components, particularly epigallocatechin-3-gallate (EGCG), contribute to green tea's therapeutic effects by inhibiting bacterial adhesion, modulating inflammatory pathways, and reducing oxidative stress. Clinical studies suggest green tea improves periodontal health by reducing pocket depth, inflammation, and bleeding. It can serve as an adjunct to conventional therapies, including scaling and root planing, and be incorporated into oral care products such as mouthwashes and dentifrices. Furthermore, green tea presents a natural alternative to chemical agents like chlorhexidine, potentially mitigating side effects and addressing concerns about antibiotic resistance. However, its efficacy remains moderate compared to established treatments, highlighting the need for further research to optimize its formulation and therapeutic applications. Green tea represents a sustainable and biocompatible approach to periodontal therapy, supporting its integration into preventive and therapeutic oral health strategies.

Microbiological and toxicity analyses of the synthetic polymer polyhexamethylene guanidine hydrochloride against endodontic microorganisms

Failures in endodontic treatments are common due to microbial resistance in the pulp canal. The study evaluated the in vitro activity of polyhexamethylene guanidine hydrochloride (PHMGH) against endodontic strains, as well as in vivo toxicity. Using minimum inhibitory concentration and minimum bactericidal concentration techniques, PHMGH was effective against all microorganisms, even at low concentrations. At 50.0 µg/mL, it inhibited Enterococcus faecalis; furthermore, when compared to chlorhexidine (CLX), it demonstrated values 19 times lower against Candida albicans. The polymer's activity was also determined by agar diffusion, evaluating products A (calcium hydroxide - Ca(OH)2, as a reference), B (Ca(OH)2 combined with physiological solution, reference with a vehicle), C (PHMGH 6.25%), D (PHMGH 3.125%), E (PHMGH 1.5625%), F (PHMGH 0.78125%), G (PHMGH 6.25% and Ca(OH)2), H (PHMGH 3.125% and Ca(OH)2), I (PHMGH 1.5625% and Ca(OH)2), J (PHMGH 0.78125% and Ca(OH)2), and K (positive control, CLX 0.12%). Products containing PHMGH were more effective than the references against all strains, and C, D, and G were more effective than CLX against Peptostreptococcus anaerobius, Actinomyces naeslundii, and Actinomyces viscosus. According to the fractional inhibitory concentration index, the combination of PHMGH and CLX showed indifference for Peptostreptococcus anaerobius, Actinomyces naeslundii, Actinomyces viscosus and Escherichia coli, antagonism for Candida albicans, and synergy for Enterococcus faecalis. The toxicity of PHMGH at different concentrations was tested in Caenorhabditis elegans and did not show lethality in nematodes, with the LC50 observed only at the highest concentration (100 µg/mL) after two days of exposure. It is suggested that PHMGH exhibited antimicrobial activity against endodontic strains and low toxicity, raising expectations for new preventive and therapeutic products in endodontics.

Antimicrobial efficacy and cytotoxicity of ethanolic extracts of Salvia officinalis and Juglans regia against oral pathogens

Background

Herbal extracts have gained attention for their potential benefits in promoting oral health and preventing dental caries and periodontal diseases. This study evaluated the antimicrobial effects and cytotoxicity of ethanolic extracts of Salvia officinalis and Juglans regia, both individually and in combination, against Streptococcus mutans, Lactobacillus casei, and Candida albicans, microorganisms associated with oral diseases.

Methods

In this in vitro study, the hydroalcoholic (ethanolic) extracts of J. regia and S. officinalis were prepared using the maceration method. To determine the antimicrobial effectiveness, the zone of inhibition in the disk agar diffusion, minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were assessed for each extract, separately and in combination. The extracts' cytotoxicity was investigated at their effective doses using the MTT (methyl thiazole tetrazolium) assay.

Results

Compared to the negative control, ethanolic extracts of S. officinalis and J. regia exhibited a significant inhibitory effect (P<0.001) on S. mutans and L. casei. Salvia officinalis extract exhibited antimicrobial activities, as evidenced by the MIC values of 237.5 µg/mL for S. mutans, 118.7 µg/mL for Lactobacillus casei, and 31.25 mg/mL for C. albicans. The ethanolic extract of Juglans regia exhibited MIC values of 29.6 µg/mL for S. mutans, 475 µg/mL for L. casei, and 15.62 mg/mL for C. albicans, respectively. MTT assay results showed that the extracts had no cytotoxic effects at the MIC on the L929 cell line; however, pure chlorhexidine was toxic at 0.2% concentration.

Conclusion

The study results revealed that the ethanolic extracts of S. officinalis and J. regia and their combined application showed antimicrobial activity against pathogenic microorganisms pertinent to oral health. In addition, cytotoxicity evaluations indicated that these extracts are non-toxic to the L929 cell line at effective concentrations.

Ex vivo oral biofilm model for rapid screening of antimicrobial agents including natural cranberry polyphenols

The search has been ongoing for safe and effective antimicrobial agents for control and prevention of oral biofilm associated with disease. Clinical trials for oral specific anti-bacterials are costly and often provide inconclusive results. The simple approach of ex vivo testing of these agents has not demonstrated utility, likely due to variability of effects observed even with a single donor. We show how shed oral biofilms, easily obtained from donor saliva, and tested under optimized conditions, respond reproducibly to anti-bacterial challenges measured by reductions in rRNA accumulation in susceptible taxa. Responses are in part donor specific, but many bacteria taxa were shown to be reproducibly susceptible over a group of donors. For two antibiotics, vancomycin and penicillin G tested at pharmacologic levels, a subset of Gram-positive bacteria was inhibited. A natural product with antibacterial properties, diluted Vaccinium macrocarpon (cranberry) juice, was shown to inhibit a range of oral taxa, including Alloprevotella sp__HMT_473, Granulicatella adiacens, Lachnoanaerobaculum umeaense, Lepotrichia sp__HMT_215, Peptostreptococcus stomatis, Prevotella nanceiensis, Stomatobaculum sp__HMT_097, Veillonella parvula, and kill some targets. The model discussed in this study has promise as a rapid, precise, and reproducible ex vivo method to test and identify potential clinically useful antimicrobial agents active against the oral biofilm community.

Unraveling the complexity of radiotherapy- and chemotherapy-induced oral mucositis: insights into pathogenesis and intervention strategies

Radiotherapy- or chemotherapy-induced oral mucositis (RIOM/CIOM) presents significant challenges in cancer treatment, severely impacting patients' quality of life (QoL) and therapeutic outcomes. Despite advancements, existing prevention and treatment measures have notable limitations. RIOM/CIOM involves a multifaceted interplay of inflammatory cascades orchestrated by the innate immune response. Furthermore, dysbiosis of oral and intestinal microbiota, triggered by anticancer therapy, exacerbates mucosal damage through intricate interactions with the innate immune system. This review provides an update on pivotal signaling pathways governing the initiation and progression of RIOM/CIOM. It also elucidates the intricate relationship between microbiota dysbiosis and dysregulation of oral mucosal immune homeostasis. Moreover, potential interventions targeting these pathogenic mechanisms are summarized, offering valuable insights for further exploration of RIOM/CIOM's complex pathophysiology and the development of more effective interventions.

Effect of the Darolac® (Oralis SB®) Probiotic Formulation on Oral Health: A Narrative Review

Gingivitis and periodontitis are prevalent periodontal conditions associated with dysbiosis of the oral cavity, which leads to inflammation and bleeding of gums, loss of tooth attachment, and degradation of the underlying bone structure. The standard adjunctive treatment for periodontal conditions, chlorhexidine mouthwash, is effective but is associated with several side effects. Probiotics have been explored as an alternative solution that promotes oral health by restoring homeostasis in the oral cavity. This review presents a summary of clinical trials using the Darolac® (Oralis SB®) probiotic formulation (Lactobacillus acidophilus Rosell®-52, Lactobacillus rhamnosus Rosell®-11, Bifidobacterium longum Rosell®-175 and Saccharomyces boulardii CNCM I-1079) as a mouthwash to support the maintenance of oral health or the restoration of its balance. In reviewed studies, Darolac® is compared to a placebo or other common solutions for periodontal conditions, including chlorhexidine mouthwash. Studies show that Darolac® is as effective or even superior to other available solutions, which supports its use as an effective adjuvant to oral health. The effects of Darolac® on the reduction in oral pathogens and markers of oral dysbiosis are reviewed, and the association between periodontitis, inflammation, and systemic diseases, as well as their implications and the use of probiotics in the periodontal field, are discussed.

A novel multilayer antimicrobial urinary catheter material with antimicrobial properties

Urinary catheters are commonly used in medical practice to drain and monitor urine of patients. However, urinary catheterisation is associated with the risk of developing catheter-associated urinary tract infections (CAUTIs), which can result in life-threatening sepsis that requires antibiotics for treatment. Using the layer-by-layer (LbL) technique, we assembled a multilayer catheter comprising nine quadruple layers (9QL) of alginate, chlorhexidine (CHX), alginate and poly(β-amino ester) (PBAE) built upon an amino-functionalised silicone. The prepared catheter materials were tested for pre-packaged storage conditions and sterilisation techniques. The daily release of CHX was measured at pH 7.4 and pH 5 and simulated urine at 37 °C, which was used to determine the antimicrobial affect. CHX release was detected for a minimum of 14 days in PBS (pH 7.4), pH 5 release media, and simulated urine for the samples tested against storage conditions and sterilisation techniques. Incubation of the prepared material with bacterial cultures for 24 hours restricted bacterial growth compared to incubation with the standard material. The minimum inhibition concentration of CHX for clinically isolated urinary tract infection (UTI) bacterial strains was in the range of 19.4-77.4 µM, at which the released CHX could indirectly prevent bacterial growth for up to 14 days. Based on the daily CHX release from the samples, the hydrolysis of PBAE at pH 5 was gradual, resulting in a greater number of days of preventing bacterial growth, followed by pH 7.4 and then simulated urine. To the best of our knowledge, this is the first report on the use of PBAE in association with a urinary catheter material for the release of an antimicrobial drug.

The positive effects of preoperative chlorhexidine rinse to reduce postoperative pneumonia after kidney transplantation surgery

BACKGROUND

Postoperative pneumonia is one of the most observed hospital-acquired infections and increases the postoperative mortality rate. Further, it drives the healthcare systems under a severe financial burden. Preventing postoperative pneumonia is an incredibly challenging issue for clinicians. Since immunosuppression therapy, the patients who had kidney transplants are more vulnerable to postoperative infections. There is no data in the scientific literature focusing on the effects of preoperative oral care with chlorhexidine antiseptic solutions on postoperative pneumonia in kidney transplantation surgery cases. In the present research, we studied this topic.

METHODS

A prospective, randomized clinical trial was conducted at our institution between August 2020 and August 2022. Group A: Received 0.12 % chlorhexidine oral rinse preoperatively; Group B: Not received 0.12 % chlorhexidine oral rinse preoperatively. We analyzed the differences between the two trial groups using a chi-square or t-test. The Mann-Whitney U test was used for the categorical data.

RESULTS

Nine patients (17.6 %) were diagnosed with postoperative pneumonia in Group A and fourteen (25.9 %) in Group B (p < 0.05). Hospitalization time of Group B was prolonged (p < 0.05). In multivariate analysis, significant risk factors associated with postoperative pneumonia were advanced age, diabetes mellitus, smoking, delayed graft function and not gargling with 0.12 % chlorhexidine (p < 0.05).

CONCLUSIONS

To reduce postoperative pneumonia risk in patients undergoing kidney transplantation surgery, an oral health protocol including 0.12 % chlorhexidine mouth rinse seems beneficial.

Synergistic potential of Bauhinia holophylla leaf extracts with conventional antifungals in the inhibition of Candida albicans: A new approach for the treatment of oral candidiasis

OBJECTIVE

This study investigated the combination of Bauhinia holophylla (Bong.) Steud. leaf extracts with conventional antifungal agents, highlighting the extracts' potential as adjuvants in treating oral candidiasis.

DESIGN

Ethanolic and aqueous extracts of B. holophylla leaves were analyzed using ultra-high-performance liquid chromatography with a diode array detector (UHPLC-DAD) to assess their chemical composition. Their Minimum Inhibitory Concentration (MIC) against standard strains of Candida albicans and isolates from oral mucosa was determined. Additionally, the potential synergistic effects with chlorhexidine gluconate, nystatin, and fluconazole were investigated, along with their impact on inhibiting and disrupting biofilm formation, germ tube formation of C. albicans, and cytotoxicity in human erythrocytes.

RESULTS

Protocatechuic acid, epicatechin, and rutin were identified in both extracts. They exhibited fungistatic activity with a median minimum inhibitory concentration (MIC50) of 15.62 µg/mL for the ethanolic extract (EEB) and 62.50 µg/mL for the aqueous extract (AEB) against C. albicans. In growth kinetics, both extracts reduced the viable cell count of C. albicans by 2 logs after 24 h compared to the positive control. The extracts reduced germ tube formation by 81.6 % for EEB and 86.3 % for AEB. The synergistic combination with fluconazole and nystatin resulted in a 50 % reduction in the concentration required to inhibit C. albicans growth. No hemolytic activity was detected in human erythrocytes at the tested concentrations.

CONCLUSION

Both ethanolic and aqueous extracts show promising potential as adjuvants in managing oral candidiasis. Notably, the aqueous extract is advantageous due to its non-toxic solvent, cost-effectiveness, and ease of preparation.

Association of over-the-counter mouthwash use with markers of nitric oxide metabolism, inflammation, and endothelial function-a cross-sectional study

Introduction

Regular use of mouthwash can disrupt nitrate reduction by oral bacteria and may affect systemic nitric oxide (NO) levels, which are important for inflammation and endothelial function. We aim to assess the association between over-the-counter (OTC) mouthwash use and nitrate/nitrite, markers of inflammation (IL-6, TNF-α, CRP) and endothelial function (sICAM-1, sVCAM-1) in serum and saliva, and to assess the relationship between nitrate/nitrite levels and these biomarkers, as well as how OTC mouthwash modulated this relationship. We hypothesize that nitrates/nitrites are associated with these biomarkers, and that their associations would vary with the frequency of mouthwash use.

Method

Our cross-sectional study used data and specimen from the baseline of the San Juan Overweight Adult Longitudinal Study (SOALS). Robust Gamma regression with log-link function, Spearman correlations and partial correlations adjusted for covariates were used for the analysis.

Results

Using OTC mouthwash twice a day or more was significantly associated with lower serum nitrite levels compared to less frequent use (β = -0.357, 95% CI: -0.650, -0.064), but not with other markers of inflammation and endothelial function. Mouthwash use differentially impacted the relationship between nitrate/nitrite and TNF-α, sICAM-1 and sVCAM-1. Specifically, in the participants who used mouthwash less than twice a day or no use, TNF-α (β = -0.35, 95% CI: -0.52, -0.18), and sICAM-1 (β = -0.21, 95% CI: -0.32, -0.09) were negatively associated with serum nitrite. In the participants who used mouthwash twice a day or more use, TNF-α was positively associated with serum nitrate (β = 3.36, 95% CI: 2.07, 4.65), salivary nitrite (β = 1.04, 95% CI: 0.39, 1.69) and salivary nitrate (β = 0.48, 95% CI: 0.25, 0.71); sICAM-1 was positively associated with serum nitrate (β = 1.58, 95% CI: 0.86, 2.29). In both subgroups of mouthwash users, sVCAM-1 was positively correlated with serum nitrate and salivary nitrate. In addition, sVCAM-1 was positively correlated with serum nitrite in participants who used mouthwash frequently (ρ_S = 0.18, p = 0.045).

Discussion

Regular use of OTC mouthwash was associated with systemic nitric oxide. This raises concerns about its potential effects on the levels of inflammatory and endothelial biomarkers associated with cardiometabolic diseases.

Dental applications of Punica granatum L. in the treatment of gingivitis: A review of ethnomedicinal uses, randomized clinical trials, and antibacterial potential against Porphyromonas gingivalis

ETHNOPHARMACOLOGICAL RELEVANCE

Mouthwashes based on medicinal plants have demonstrated benefits in controlling plaque and inflammation, acting positively on the oral hygiene of patients with gingivitis. In traditional medicine, Punica granatum L. has been used to treat oral diseases in countries in Europe, Asia, North America, and Africa.

AIM OF THE STUDY

The present study aimed to conduct a comprehensive review on the dental applications of Punica granatum L. for the treatment of gingivitis, including ethnomedicinal uses, analysis of randomized clinical trials, antibacterial activity against Porphyromonas gingivalis, mechanisms of action of phytochemicals isolated from this plant, and preclinical toxicity.

MATERIALS AND METHODS

The literature was retrieved from Google Scholar, PubMed®, SciELO, and ScienceDirect®, since the first report published on the topic in 2001 until March 2024.

RESULTS

Several clinical trials have demonstrated that mouthwashes containing P. granatum have equal or better efficacy than chlorhexidine in treating patients with gingivitis, confirming the indications for use of this plant by traditional communities. However, reports on the in vitro antibacterial activity of extracts from the fruits of this plant have not shown clinical relevance against the pathogen P. gingivalis. The ellagitannin punicalagin isolated from P. granatum has shown potential against several strains of Gram-positive and Gram-negative bacteria, but, to date, this compound has not yet been tested against P. gingivalis. It is likely that the mechanisms of action of flavonoids, such as quercetin, are involved in the inhibition of the activities of the RgpA, RgpB, and Kgp proteases of P. gingivalis.

CONCLUSIONS

In summary, natural products obtained from P. granatum do not present toxic side effects and can be considered as possible substitutes of commercial products recommended for the treatment of gingivitis and other oral diseases.

Development of Solid Nanosystem for Delivery of Chlorhexidine with Increased Antimicrobial Activity and Decreased Cytotoxicity: Characterization and In Vitro and In Ovo Toxicological Screening

The evaluation of chlorhexidine-carrier nanosystems based on iron oxide magnetic nanoparticles (IOMNPs), has gained significant attention in recent years due to the unique properties of the magnetic nanoparticles (NPSs). Chlorhexidine (CHX), a well-established antimicrobial agent, has been widely used in medical applications, including oral hygiene and surgical antisepsis. This study aims to report an in vitro and in ovo toxicological screening of the synthesized CHX-NPS nanosystem, of the carrier matrix (maghemite NPSs) and of the drug to be delivered (CHX solution), by employing two types of cell lines-HaCaT immortalized human keratinocytes and JB6 Cl 41-5a murine epidermal cells. After the characterization of the CHX-NPS nanosystem through infrared spectroscopy and electronic microscopy, the in vitro results showed that the CHX antimicrobial efficacy was enhanced when delivered through a nanoscale system, with improved bioavailability and reduced toxicity when this was tested as the newly CHX-NPS nanosystem. The in ovo screening exhibited that the CHX-NPS nanosystem did not cause any sign of irritation on the chorioallantoic membrane vasculature and was classified as a non-irritant substance. Despite this, future research should focus on optimizing this type of nanosystem and conducting comprehensive in vivo studies to validate its therapeutic efficacy and safety in clinical settings.

Antimicrobial effectiveness of aqueous and alcoholic herbal extracts on Streptococcus mutans: A systematic review and meta-analysis of randomized controlled trials

Objective

Debates about the efficacy of herbal products in oral care have inspired researchers to conduct a large number of trials. This systematic review and meta-analysis aimed to assess the antibacterial efficacy of aqueous and alcoholic herbal extracts against Streptococcus mutans (SM) as the main cariogenic microorganism.

Materials and Methods

Online databases PubMed, Scopus, Cochrane Library, Web of Science, and Magiran were searched for randomized controlled trials evaluating the efficacy of herbal products against SM published up to July 2023. Meta-analyses were performed for immediate and long-term effects based on random effect model.

Results

Out of 57 studies that met the selection criteria for systematic review, 26 were subjected to meta-analysis. Considering both immediate and long-term effects on salivary SM, aqueous and alcoholic herbal extracts were significantly superior in the reduction of SM over non-herbal agents (immediate: SMD = -1.16; 95%CI: -2.03, -0.29, long-term: SMD = -0.76; 95%CI: -1.35, -0.17). However, the difference was not significant in the reduction of SM of plaque (SMD = -0.30, 95%CI: -1.25, 0.65). The subgroup analyses showed no significant difference compared to chlorhexidine (p>0.05). The overall quality of evidence was considered low based on GRADE tool.

Conclusion

Current evidence suggests encouraging results for herbal extracts in reduction of SM, but not over chlorhexidine. However, there is still insufficient evidence to recommend them as the first option for oral care. High-quality randomized controlled trials are required to assert the safety and effectiveness of them for preventing dental caries.

The comparative effect of propolis and chlorhexidine mouthwash on oral nitrite-producing bacteria and blood pressure regulation

Background

Propolis mouthwash (PROP-M) has demonstrated antibacterial properties like those of chlorhexidine mouthwash (CHX-M). However, its impact on the abundance of oral nitrite-producing species (NPS) and nitrite-producing activity (NPA) remains unexplored.

Methods

Forty-five healthy individuals were randomised into 2 groups to rinse their mouth twice a day for seven days with either CHX-M (n = 21) or PROP-M (n = 24). Metagenomic sequencing (16S rRNA) was performed on saliva samples collected before and after each treatment. Additionally, salivary biomarkers and blood pressure were measured.

Results

CHX-M increased the relative abundance of NPS (p < 0.001) but significantly impaired the NPA (p < 0.001) compared to baseline and PROP-M. No significant differences in the relative abundance of NPS and NPA were observed in the PROP-M group. However, a significant increase of plasma nitrate (+7 µmol/L, p = 0.047) and a decrease in systolic BP (-2 mmHg, p = 0.022) was observed in this group compared to the baseline.

Conclusion

The results indicate that PROP-M had a smaller effect on the abundance of NPS and NPA compared to CHX-M. Additionally, PROP-M reduced blood pressure in healthy individuals, but this effect was not associated with changes in the oral microbiome.

Temporin-Derived Peptides Disrupt the Exopolysaccharide Matrix of Streptococcus mutans to Prevent Related Dental Caries

Dental caries, the most prevalent oral infectious disease, is closely associated with Streptococcus mutans. This study investigates the antimicrobial properties of the temporin-GHb peptide and its derivatives (GHbR, GHbK, and GHb3K) against S. mutans. These peptides exhibited potent anti-S. mutans activity through a membrane-disruptive mechanism, confirmed by flow cytometry and fluorescence staining assays while showing lower bactericidal effects on beneficial probiotic bacteria. Additionally, they inhibited the biofilm matrix formation by disrupting extracellular polysaccharide (EPS) synthesis, as demonstrated by zymography, qRT-PCR, and sucrose metabolism experiments. In a rat model of S. mutans-induced dental caries, treatment with these peptides significantly reduced the incidence of dental lesions. H&E staining analysis of rat oral tissues confirmed the biosafety of GHb and GHb3K. These findings suggest that temporin-derived peptides effectively target EPS, inhibiting biofilm formation and virulence, offering a promising strategy for preventing dental caries and promoting oral health. The findings suggest potential applications for peptide-based interventions to mitigate biofilm-related issues across various fields, including agriculture, food processing, and healthcare.

Mesaconate from Bacillus subtilis R0179 Supernatant Attenuates Periodontitis by Inhibiting Porphyromonas gingivalis in Mice

AIMS

This research sought to assess the efficacy of Bacillus subtilis (B. subtilis) R0179 and explore potential metabolites in mitigating experimental periodontitis in mice induced by Porphyromonas gingivalis (P. gingivalis) ATCC 33277.

METHODS

B. subtilis R0179 was administered to 8-week-old male C57BL/6J mice with periodontitis. Oral load of P. gingivalis ATCC 33277 and periodontal tissue loss were quantified. The cell-free supernatant (CFS) was separated to assess its anti-P. gingivalis effect. Proteomic and metabolomic analyses identified potential antibacterial components in the CFS, further evaluated for anti-P. gingivalis effects.

RESULTS

B. subtilis R0179 significantly reduced P. gingivalis ATCC 33277 levels and mitigated periodontal tissue loss in mice. The CFS, rather than inactivated B. subtilis R0179 cells, exhibited antibacterial activity. Proteomic and metabolomic analyses identified mesaconate and citraconate as key antibacterial agents. Disk diffusion assays confirmed the efficacy of mesaconate against P. gingivalis, while citraconate had no effect. Mesaconate showed a dose-dependent reduction in P. gingivalis ATCC 33277 population and periodontal tissue loss in mice.

CONCLUSION

These findings highlight B. subtilis R0179 and its metabolite mesaconate as promising candidates for therapeutic development against periodontitis by inhibiting P. gingivalis ATCC 33277 effectively.

Biofilm targeting with chitosan-based nanohydrogel containing Quercus infectoria G. Olivier extract against Streptococcus mutans: new formulations of a traditional natural product

BACKGROUND

Biofilm formation has a crucial role in the cariogenic virulence of Streptococcus mutans, which leads to resistance to common antibacterials. The antimicrobial resistance crisis has led to increased research about traditional natural products.

PURPOSE

Quercus infectoria extract (QI extract) and nano hydrogels containing QI extract (QI-NH) and tannic acid (TA-NH) were evaluated against this pathogen.

METHODS

QI extract was analyzed by HPLC and the physiological characteristics of nanohydrogels were assessed by SEM, FTIR, zeta potential, DLS and determination of release kinetics and encapsulation efficiency. Determination of MIC and MBC of the material and their anti-biofilm effect was done by the microtiter method and on the extracted tooth surface. The properties of extracts and nano hydrogels in the expression of genes codifying glucosyltransferases (gtfB, gtfC and gtfD) and glucan binding protein B (gbpB) were quantified. Their toxicity was tested by the MTT method against the KB cell line.

RESULTS

According to HPLC, 55.18% of QI extract contained TA. The encapsulation efficiency of QI-NH and TA-NH was equal to 60% and 80%, respectively. SEM and FTIR exhibited that QI extract and TA were successfully entrapped in the networks resulting from the chemical bonding of chitosan and TPP. The average size of QI-NH and TA-NH was 70.45 and 58.43 nm, and their zeta potential was 6.17 ± 2.58 and 0.25 ± 0.03 mv, respectively. PDI < 0.3 of nano hydrogels indicated the favorable polydispersity of nanohydrogels. MIC of QI extract, QI-NH and TA-NH were 937.5, 30 and 10 µg/ml, respectively. Also their MBIC50 was 35.1, 2.1 and 0.95 µg/ml, respectively, and the extracts and nano hydrogels restrained the biofilm maturation on enamel. The pivotal genes of S. mutans in biofilm formation were significantly less expressed by treatment with QI-NH and TA-NH than others. Based on the MTT test, QI-NH had less acute toxicity than QI extract and TA-NH. IC50 of QI-NH was calculated as 775.4 µg/ml, while it was equal to 3.12 µg/ml for chlorhexidine as a common antibacterial agent.

CONCLUSION

QI-NH, a new formulation derived from traditional anti-caries, can be a safe and efficient option to combat dental biofilm.

Effect of Different Concentrations of Chlorhexidine on Anti-Plaque in Oral Care Practice: A Systematic Review and Network Meta-Analysis

OBJECTIVES

The aim of this network meta-analysis was to compare the anti-plaque effects and adverse effects of different concentrations of chlorhexidine (CHX).

METHODS

PubMed, OVID Embase and the Cochrane Library were searched from inception to October 2023 for randomised controlled trials (RCTs) of different concentrations of CHX in healthy populations. Random-effects network meta-analyses were performed to summarise the evidence, and the Grading of Recommendations Assessment, Development and Evaluation framework was used to rate the certainty of evidence. Cohen's d standardised mean differences were calculated as the measure of effect size.

RESULTS

Thirty-eight RCTs involving 2011 participants and six concentrations of CHX (0.2%, 0.12%, 0.1%, 0.3%, 1% and 0.06%) were included. The anti-plaque effects of CHX at all concentrations were compared with placebo. Moderate to very low certainty evidence established 0.2% CHX as the most effective on anti-plaque. 0.12% and 0.1% CHX also showed significant anti-plaque effects. However, the ranking probabilities showed that the adverse effects of 0.12% and 0.1% CHX were < 0.2% CHX.

CONCLUSIONS

Compared with placebo, 0.2%, 0.12% and 0.1% CHX had significant anti-plaque effects, with moderate to very low certainty evidence that 0.2% CHX was most effective on anti-plaque. However, 0.2% CHX had larger adverse effects than 0.12% and 0.1% CHX.

TRIAL REGISTRATION

PROSPERO: Number CRD: 42022327083.

Glucocorticoid-Induced Side Effects Cause Oral Lesions in Systemic Lupus Erythematosus: A Case Report

Background

Systemic Lupus Erythematosus (SLE) is a complex autoimmune disease with various complications, making its management difficult. Glucocorticoid not only plays an essential role in the pathogenic therapy of SLE but also causes side effects such as oral lesions, especially when administered long-term or at high doses.

Purpose

This case report aims to describe the management of glucocorticoid-induced side effects that cause oral lesions in SLE patient.

Case Presentation

A 30-year-old woman complained of a sore mouth and mouth-opening difficulty ten days prior. Previously, the patient complained of swelling in the legs and stomach, joint pain, hair loss, and skin redness on exposure to sunlight. Extra-oral examination revealed multiple red-black erosions and crusts on the zygoma region bilaterally over the nasal bridge, well-demarcated with an irregular shape, while the lips bled easily with hemorrhagic crusts that developed into serosanguineous crusts. Intra-oral examination showed scrapable white plaques on the palate, leaving erythematous areas, pain, and ulcers throughout the oral mucosa. The antinuclear antibody (ANA) examination revealed reactive results, positive anti-HSV-1 IgG, and positive hyphal on KOH examination. Based on the examination results, the diagnosis was SLE with herpes virus-associated oral involvement and acute pseudomembranous candidiasis.

Case Management

Comprehensive therapy, including non-pharmacological and pharmacological therapy, was involved. All oral lesions improved within one month.

Conclusion

Various oral lesions may appear as manifestations of the disease and side effects of glucocorticoid therapy in SLE patients, thus requiring multidisciplinary monitoring and therapy from various fields.

Dual drug release profiles of salicylate-based polymers and encapsulated chlorhexidine as potential periodontitis treatments

Salicylate-based poly(anhydride-esters; SAPAEs) have demonstrated wound healing properties due to salicylic acid (SA) release during polymer degradation. Additionally, the polymers are deformable and self-adhesive due to their low Young’s modulus, lower glass transition temperature ( Tg), and inherent tackiness at body temperature. These properties make them particularly well-suited for therapeutic use in the bacteria-laden environment of the oral cavity. To enhance their therapeutic capabilities, the antiseptic chlorhexidine dihydrochloride was physically incorporated into SAPAEs for dual release of antiseptic and anti-inflammatory upon degradation. This study analyzes the thermomechanical properties of two SAPAE compositions (adipate homopolymer and 50:50 adipate:sebacate copolymer) and the release of chlorhexidine (incorporated at 10% (w/w)) from these polymers. Polymer adhesivity was monitored as a function of chlorhexidine incorporation and in vitro degradation time. Throughout in vitro degradation, the polymer systems had a low Young’s modulus and a Tg at or near body temperature. Incorporation of the antiseptic further decreased Young’s modulus and increased both the Tg and adhesivity. The release profiles were also evaluated and determined to be similar for the homopolymer and copolymer, although the homopolymer degradation occurred over a longer time period. Overall, the SAPAE systems have favorable properties for periodontal disease treatments by virtue of their controlled degradability, deformability, adhesivity, and release profiles with encapsulated antiseptic.

Efficacy of adjunctive octenidine hydrochloride as compared to chlorhexidine and placebo as adjuncts to instrumentation in stage I-II periodontitis: A double-blinded randomized controlled trial

OBJECTIVES

This randomized, controlled, double-blinded clinical trial aimed to evaluate the efficacy of octenidine hydrochloride and chlorhexidine mouthwashes as adjuncts to instrumentation in stage I-II periodontitis patients.

METHODS

Forty-five patients with mild-to-moderate periodontitis were randomly allocated to three groups: 0.1% octenidine dihydrochloride (OCT), placebo, and 0.12% chlorhexidine (CHX) mouthwashes. Patients were instructed to use the mouthwash after instrumentation for twice a day up to 3 weeks. Periodontal parameters such as probing pocket depth (PPD), clinical attachment loss (CAL), O'Leary plaque index (PI), Loe and Silness gingival index (GI), Lobene stain index (SI), and oral soft tissue changes were recorded at baseline and once every week for 3 weeks. The visual analogue scale (VAS) was also recorded as a self-administered questionnaire at the end of the study. The one-way ANOVA was used to compare VAS scores between the groups. The repeated measures ANOVA and post hoc Newman-Keuls tests were used to assess the differences in the periodontal parameters between groups at different time intervals. The Kruskal-Wallis test was used to compare the mean SI.

RESULTS

There was a significant reduction in the mean GI of the OCT and CHX groups compared to placebo (p < 0.05). OCT usage resulted in significantly less staining, according to mean SI, when compared to CHX. Furthermore, VAS scores revealed that OCT was significantly the preferred mouthwash (p < 0.01).

CONCLUSION

Adjunctive octenidine hydrochloride may be an alternative to chlorhexidine in its ability to control the periodontal parameters in patients with stage I-II periodontitis. Further larger studies are necessary to confirm these findings.

Illumina Sequencing in Conjunction with Propidium Monoazide to Identify Live Bacteria After Antiseptic Treatment in a Complex Oral Biofilm: A Study Using an Ex Vivo Supragingival Biofilm Model

Background/Objectives: The evaluation of the efficacy of antibacterial treatments in complex oral ecosystems is limited by the inability to differentiate live from dead bacteria using omic techniques. The objective of this study was therefore to assess the ability of the combination of the 16S rRNA Illumina sequencing methodology and the action of propidium monoazide (PMA) to study viable bacterial profiles in oral biofilms after exposure to an antiseptic compound. Methods: Cariogenic supragingival biofilms were developed in an ex vivo model for 96 h, using saliva from healthy volunteers. The biofilms were treated with 0.12% chlorhexidine (CHX) combined with 0.05% cetylpyridinium chloride (CPC), for 60 s, using phosphate buffered saline as a control. After exposure, each biofilm was treated or not with PMA to then extract the bacterial DNA, quantify it by Qubit, quantify the bacterial population using qPCR, and perform the metataxonomic study of the samples using Illumina 16S rRNA sequencing. Results: A significantly lower DNA concentration in the PMA-treated biofilms (p < 0.05 compared with those not exposed to PMA) was observed. The viable bacterial count obtained by qPCR differed significantly from the total bacterial count in the biofilm samples exposed to the antiseptic (p < 0.05). The viable microbiome differed significantly from the total bacterial profile of the samples treated with CHX/CPC after exposure to PMA (p < 0.05 at the α- and β-diversity levels). Conclusions: The combination of Illumina 16S rRNA sequencing and PMA helps solve the inability to evaluate the efficacy of antibacterial treatments in the bacterial profile of complex ecosystems such as oral biofilms.

Randomised-crossover clinical trial on the substantivity of a single application of a gel containing chlorhexidine and o-cymen-5-ol on the oral biofilm and saliva

BACKGROUND

No clinical trials have evaluated the antimicrobial activity and substantivity of gel formulations containing chlorhexidine (CHX) and cymenol.

OBJECTIVE

To compare the in situ antimicrobial effect and substantivity of a new 0.20% CHX + cymenol gel (test) with the current 0.20% CHX gel formulation (control) on salivary flora and dental plaque biofilm up to seven hours after a single application.

METHODS

A randomised-crossover clinical trial was conducted with 29 orally healthy volunteers participating in the development of Experiments 1 (saliva) and 2 (dental plaque biofilm). All subjects participated in both experiments and were randomly assigned to receive either the test or control gels. Samples were collected at baseline and five minutes and one, three, five, and seven hours after a single application of the products. The specimens were processed using confocal laser scanning microscopy after staining with the LIVE/DEAD® BacLight™ solution. Bacterial viability (BV) was quantified in the saliva and biofilm samples. The BV was calculated using the DenTiUS Biofilm software.

RESULTS

In Experiment 1, the mean baseline BV was significantly reduced five minutes after application in the test group (87.00% vs. 26.50%; p < 0.01). This effect was maintained throughout all sampling times and continued up to seven hours (40.40%, p < 0.01). The CHX control followed the same pattern. In Experiment 2, the mean baseline BV was also significantly lower five minutes after applying the test gel for: (1) the total thickness of biofilm (91.00% vs. 5.80%; p < 0.01); (2) the upper layer (91.29% vs. 3.94%; p < 0.01); and (3) the lower layer (86.29% vs. 3.83%; p < 0.01). The reduction of BV from baseline was observed for the full-thickness and by layers at all sampling moments and continued seven hours after application (21.30%, 24.13%, and 22.06%, respectively; p < 0.01). Again, the control group showed similar results. No significant differences between test and control gels were observed in either saliva or dental plaque biofilm at any sampling time.

CONCLUSIONS

A 0.20% CHX + cymenol gel application demonstrates potent and immediate antimicrobial activity on salivary flora and de novo biofilm. This effect is maintained seven hours after application. Similar effects are obtained with a 0.20% CHX-only gel.

Inhibitory effects of chlorhexidine-loaded calcium carbonate nanoparticles against dental implant infections

This study aimed to design sustained released biodegradable calcium carbonate nanoparticles loaded with chlorhexidine (CHX-loaded NPs) and to investigate the early osteogenic differentiation and antimicrobial effects on the important bacteria involved in infections of dental implants. The microemulsion method was used to prepare the calcium carbonate nanoparticles loaded with chlorhexidine. The prepared nanoparticles were characterized using conventional methods. The release pattern determination and the biodegradation test were performed for the prepared nanoparticles. For the early osteogenic differentiation test of the prepared nanoparticles, alkaline phosphatase (ALP) activity was detected in human dental pulp stem cells (HDPSCs). The antimicrobial effects of the nanoparticles were evaluated against Escherichia coli, Streptococcus mutans, Enterococcus faecalis, Staphylococcus aureus, and Pseudomonas aeruginosa. The sizes of free calcium carbonate nanoparticles and CHX-loaded NPs were 105 ± 1.63 and 118 ± 1.47 nm and their zeta potentials were - 27 and - 36, respectively. A 50% degradation of nanoparticles was achieved after 100 days. These nanoparticles showed a two-stage sustained release pattern in vitro. Microscopic images revealed that the morphology of free calcium carbonate nanoparticles primarily took on a spherical calcite form, while CHX-loaded NPs predominantly exhibited a cauliflower-like vaterite polymorph. The nanoparticles increased the activity of ALP in cells in two weeks significantly (p < 0.05). Antimicrobial and antibiofilm results showed an efficient effect of the prepared nanoparticle against the studied bacteria. Calcium carbonate nanoparticles are an efficient multifunctional vector for chlorhexidine and can be used as a bioactive antibacterial agent against various oral microorganisms to prevent implant infections.

Comparative Evaluation of Efficacy of Chitosan and Chlorhexidine Mouthwash in Plaque Control and Gingivitis: An Observational Study

INTRODUCTION

Mouth rinse is a highly effective chemical solution for managing plaque and gingivitis. This study evaluated and compared the efficacy of chitosan (CH)-rich mouthwash with standard chlorhexidine (CHX) mouthwash in reducing gingivitis, plaque, halitosis, and stains.

MATERIALS AND METHODS

This retrospective, observational study was conducted on the clinical case records of 60 patients who were treated with CH mouthwash (formulated and dispensed from the department) as group 1 and CHX mouthwash as group 2 for at least three months. Indices such as the plaque index (PI), gingival index (GI), stain index (SI), and halitosis index (HI) were obtained at baseline (T0) and the end of three months of mouthwash use (T1) from the case records. The data were subjected to statistical analysis.

RESULTS

Both groups effectively reduced all indices from T0 to T1; however, group 1 was more effective than group 2 in reducing gingival, plaque, and stain scores. The results were statistically significant (p<0.05) for all indices, and both groups were equally effective in reducing halitosis. Male sex showed a significant positive correlation with PI, GI, and SI, whereas female sex showed a positive correlation with PI and HI.

CONCLUSION

Based on the findings of the present study, it was concluded that the CH mouthwash was more effective in reducing plaque, gingival, and staining scores than the CHX mouthwash. Both types of mouthwash were equally effective in reducing halitosis scores.

Comparative Analysis of Turmeric and Chlorhexidine Mouthwashes as Anti-plaque and Anti-gingivitis Agents: An Observational Study

INTRODUCTION

Mouthwashes are highly efficacious chemical agents for managing plaque and gingivitis. The aim of the present study was to evaluate and compare the efficacy of turmeric (TM) and chlorhexidine (CHX) mouthwash as anti-plaque and anti-gingivitis agents.

MATERIALS AND METHODS

This retrospective, observational study was conducted on the clinical case records of 60 patients with gingival and plaque scores of ≥ 1, who were treated with TM mouthwash as group 1 and CHX mouthwash as group 2 for a period of two months. Indices such as plaque index (PI) and gingival index (GI) were noted at baseline (T0) and at the end of two months of mouthwash use (T1). The data were subjected to statistical analysis.

RESULTS

Both groups were effective in reducing all indices from T0 to T1; however, group 2 was more effective than group 1 in reducing plaque scores at T1. The results were statistically significant (p<0.05), whereas there was no significant difference in the gingival scores at T1 between both groups (p>0.05). Multivariate analysis of variance (MANOVA) revealed no significant differences between the groups in gingival and plaque scores over time. Wilks' Lambda test revealed that the treatment groups had a statistically significant impact on the overall treatment outcomes.

CONCLUSION

Although both CHX and TM mouthwashes were equally effective as anti-plaque and anti-gingivitis agents, TM mouthwash is recommended in cases where prolonged use is required, such as in orthodontic patients.

The Effectiveness of Curcumin in Treating Oral Mucositis Related to Radiation and Chemotherapy: A Systematic Review

Chemotherapy (CT) and radiation therapy (RT), while effective against cancer, often cause severe side effects, such as oral mucositis and other oral diseases. Oral mucositis, characterized by inflammation and ulceration of the oral mucosa, is one of the most painful side effects that can reduce quality of life and limit cancer treatment. Curcumin, a polyphenol from Curcuma longa, has garnered attention for its anti-inflammatory, antioxidant, and anti-carcinogenic properties, which protect the oral mucosa by reducing oxidative stress and modulating inflammation. This study reviews the therapeutic potential of curcumin in preventing and managing oral mucositis caused by CT and RT. Clinical trials show curcumin's effectiveness in reducing the incidence and severity of oral mucositis. Although curcumin supplementation appears to be a promising and cost-effective approach for mitigating oral complications in cancer patients, further clinical trials are needed to confirm its efficacy and optimize dosing strategies.

Povidone Iodine vs Chlorhexidine Gluconate for Preoperative Skin Antisepsis: A Systematic Review and Meta-analysis of Randomised Controlled Trials

BACKGROUND

Surgical site infection (SSI) remains a challenge in healthcare, contributing to prolonged hospital stays, increased healthcare costs, and adverse patient outcomes, including mortality. Effective preoperative skin disinfection interventions, such as povidone-iodine (PVI) and chlorhexidine (CHG), are widely used but their efficacy remains debated. To address this gap, this meta-analysis aims to evaluate the efficacy of PVI and CHG.

METHOD

We searched PubMed, Embase, and Cochrane databases up to June 2024 to identify studies comparing PVI versus CHG for preoperative skin antisepsis. We calculated odds ratios (ORs) for binary outcomes, with 95% confidence intervals (CIs). A random-effects model was used with statistical significance set at p < 0.05. Data were analysed using R software (version 4.4.0), and heterogeneity was assessed using I2 statistics.

FINDINGS

Sixteen randomised controlled trials (RCTs) were included, involving a total of 13,721 patients, among whom 6,836 (49.8%) received PVI. Compared to CHG, PVI was associated with a non-significant reduction in deep SSI (OR 1.00; 95% CI 0.66 - 1.50; p = 0.994), but an increased risk of overall SSI (OR 1.25; 95% CI 1.06 - 1.48; p = 0.007) and superficial SSI (OR 1.67; 95% CI 1.25 - 2.24; p < 0.001).

CONCLUSION

PVI as preoperative skin antisepsis demonstrated a non-significant reduction in deep SSI compared to CHG but was associated with an increased risk of overall and superficial SSI. Despite these findings, PVI remains an effective option, especially in resource-limited settings. Further research is needed to optimise its use and improve infection prevention strategies in clinical practice.

A Rare Case of Allergic Stomatitis Due to the Consumption of Boiled Cassava

Introduction

Allergic stomatitis is an oral inflammatory disorder characterized by a painful, burning sensation, or itchiness in the oral cavity which clinically appears as erythematous plaques, vesiculation, ulceration, and/or hyperkeratosis. The causative agents include drugs, dental materials, and food ingredients. Allergic stomatitis might develop after a person eats, touches, or inhales food allergen which then triggers the hypersensitivity reaction. The most common types of food hypersensitivity generally involve type 1 and type 4 reactions or a combination of both.

Purpose

This case report aims to discuss a case of allergic stomatitis caused by one of the staple food ingredients in Indonesia: cassava.

Case

A 26-year-old woman came with complaints of burning pain from multiple ulcers on her right inner cheek. The ulcers appeared shortly after the patient ate boiled cassava, extending to the soft palate and causing pain when swallowing food. The patient has a history of asthma.

Case Management

The patient was referred for a total IgE examination with a result of 271.41 KIU/L (normal < 150 KIU/L). She was prescribed an antiseptic mouthwash and topical corticosteroids for palliative therapy. Additionally, multivitamins were also prescribed to speed up the healing process.

Conclusion

Allergic stomatitis can be caused by food ingredients, even those considered healthy or non-allergenic. A complete anamnesis, including the patient's food history, along with supporting examinations, must be carried out to confirm the diagnosis and select appropriate therapy.

Advances in the use of chlorhexidine for periodontitis treatment in diabetic patients: A review

Periodontitis and diabetes mellitus exhibit a bidirectional relationship. This narrative review descriptively outlines the role of chlorhexidine in the periodontal treatment of diabetic patients, focusing on its antimicrobial mechanisms against microbial communities and its antiplaque effects. Although chlorhexidine is proven to be effective in combating microbial presence and improving gingivitis with substantial supporting evidence, its impact on glycemic control and insulin resistance in diabetic patients remains contentious. Additionally, the effectiveness of chlorhexidine as an adjunctive chemotherapeutic in the periodontal treatment of gestational diabetes has not yet been studied, highlighting a gap in research that necessitates further prospective studies and randomized controlled trials. Considering the interconnection between periodontal inflammation and glycemic levels, this article finally advocates for collaborative care between dental and medical professionals to manage periodontitis in diabetic patients effectively.

Investigation of Chlorhexidine and Chitosan Gel-Based Coatings for the Prevention of Intravascular Catheter-Associated Infections Following Quality by Design Approach

Intravascular catheter-associated infections pose a significant threat to the health of patients because of biofilm formation. Hence, it is imperative to exploit cost-effective approaches to improve patient compliance. With this aim, our present study reported the potential of an antimicrobial polymeric gel coating of chitosan (CS) and chlorhexidine (CHX) on the marketed urinary catheters to minimize the risk of biofilm formation. The study involved the implementation of the Quality by Design (QbD) approach by identifying the critical parameters that can affect the coating of the catheter's surface in any possible way. Later, design of experiments (DoE) analysis affirmed the lack of linearity in the model for the studied responses in a holistic manner. Moreover, in vitro studies were conducted for the evaluation of various parameters followed by the antibiofilm study. The coating exhibited promising release of CHX in the artificial urinary media together with retention of the coating on the catheter's surface. Therefore, this study aims to emphasize the importance of a systematic and quality-focused approach by contributing to the development of a safe, effective, and reliable catheter coating to enhance intravascular catheter safety.

Oral microbiota and metabolites: key players in oral health and disorder, and microbiota-based therapies

The review aimed to investigate the diversity of oral microbiota and its influencing factors, as well as the association of oral microbiota with oral health and the possible effects of dysbiosis and oral disorder. The oral cavity harbors a substantial microbial burden, which is particularly notable compared to other organs within the human body. In usual situations, the microbiota exists in a state of equilibrium; however, when this balance is disturbed, a multitude of complications arise. Dental caries, a prevalent issue in the oral cavity, is primarily caused by the colonization and activity of bacteria, particularly streptococci. Furthermore, this environment also houses other pathogenic bacteria that are associated with the onset of gingival, periapical, and periodontal diseases, as well as oral cancer. Various strategies have been employed to prevent, control, and treat these disorders. Recently, techniques utilizing microbiota, like probiotics, microbiota transplantation, and the replacement of oral pathogens, have caught the eye. This extensive examination seeks to offer a general view of the oral microbiota and their metabolites concerning oral health and disease, and also the resilience of the microbiota, and the techniques used for the prevention, control, and treatment of disorders in this specific area.

New Insights Regarding the Use of Relevant Synthetic Compounds in Dentistry

Worldwide, synthetic compounds are used for both in-office and at-home dental care. They are a valuable resource for both prophylactic and curative treatments for various dental problems, such as tooth decay, periodontal diseases, and many more. They are typically preferred due to their broad range of actions and ability to produce targeted, rapid, and long-lasting effects. Using a 0.12% chlorhexidine mouthwash is capable of reducing the plaque index from 47.69% to 2.37% and the bleeding index from 32.93% to 6.28% after just 2 weeks. Mouthwash with 0.1% OCT is also highly effective, as it significantly lowered the median plaque index and salivary bacterial counts in 152 patients in 5 days compared to a control group (p < 0.0001), while also reducing the gingival index (p < 0.001). When povidone-iodine was used as an irrigant during the surgical removal of mandibular third molars in 105 patients, it resulted in notably lower pain scores after 2 days compared to a control group (4.57 ± 0.60 vs. 5.71 ± 0.45). Sodium hypochlorite is excellent for root canal disinfection, as irrigating with 1% NaOCl completely eliminated the bacteria from canals in 65% patients. A 0.05% CPC mouthwash proved effective for perioperative patient care, significantly decreasing gingival bleeding (p < 0.001) and suppressing Streptococcus levels even one week post-surgery. Lastly, a 6% H2O2 paint-on varnish and 6% H2O2 tray formulations successfully bleached the teeth of 40 patients, maintaining a noticeably whiter appearance up to the 6-month follow-up, with significant color differences from the baseline (p < 0.005). Synthetic compounds have a large research base, which also provides a greater awareness of their mechanism of action and potential adverse effects. For a better understanding of how they work, several methods and assays are performed. These are protocolary techniques through which a compound's efficacy and toxicity are established.

Impact of different chemical denture cleansers on the properties of digitally fabricated denture base resin materials

PURPOSE

To compare the impact of three different chemical denture cleansers (CDCs) (Corega, chlorhexidine, and hydrogen peroxide) on the surface roughness, microhardness, and color stability of 3D-printed, computer-aided design and computer-aided manufacturing (CAD-CAM) milled, and heat-polymerized denture base material (DBM).

MATERIALS AND METHODS

A total of 420 disc-shaped specimens (10 ± 0.1 × 2 ±0.1 mm) were fabricated using three different construction techniques: three-dimensional (3D) printing (n = 140), CAD-CAM milling (n = 140), and heat-polymerization (n = 140). Sixty specimens (20 of each DBM) were used for baseline (pre-immersion) measurements (T1) for the tested surface properties (hardness [n = 10/material] and roughness [n = 10/material]). The remaining 360 specimens (n = 120/material) were investigated for surface roughness, microhardness, and color change after immersion for 1 year (T2) in distilled water or CDCs (n = 30/solution and n = 10/test). The data were analyzed using two-way ANOVA, one-way ANOVA followed by post-hoc Tukey's test at a significance level of less than 0.05.

RESULTS

Significant differences were observed in the effects of the tested CDCs on the surface roughness, micro-hardness, and color stability of varying DBM specimens (p < 0.05). Corega showed the highest surface roughness and color change in all DBMs while H2O2 resulted in the lowest microhardness for all DBMs. The lowest changes in all tested properties were seen with distilled water followed by chlorhexidine. A significant effect of type of cleanser, denture base material, and the interaction between the two was seen on all measured properties (p < 0.05).

CONCLUSIONS

The tested CDCs significantly affected the surface properties of all DBMs but at varying degrees. Corega produced the highest negative effect on roughness and color change while H2O2 dramatically affected the microhardness. Prolonged use of CDCs should be cautiously followed.

Antimicrobial Activity of Antibacterial Sutures in Oral Surgery: A Scoping Review

OBJECTIVE

The aim of this scoping review was to explore and synthesise the current evidence on the antimicrobial activity of antibacterial suture materials used in oral surgery.

METHODS

The review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews. A bibliographic search was carried out in the PubMed and Scopus databases to retrieve all human clinical studies that investigated the antimicrobial efficacy of antibacterial-coated sutures used in oral surgery. Included studies were screened and extracted independently by 2 examiners. Data were tabulated and qualitatively described.

RESULTS

The search initially returned 150 articles and resulted in 5 included studies after the duplicates' removal and the full-text screening. Selected studies were published from 2014 to 2019. Three studies (60%) were randomised clinical trials, whilst the remaining studies did not report information on randomisation. The antimicrobial agents for coated sutures included triclosan and chlorhexidine. In almost all the studies, antibacterial-coated sutures exhibited lower bacterial retention compared to those without coating.

CONCLUSIONS

Within limitations, the antimicrobial-coated sutures employed in oral surgery exhibited good results in terms of their microbicidal activity when compared with sutures that were not coated. Considering the high variability and confounding factors identified in the included studies, more high-quality research is needed to confirm these results. Antimicrobial-coated sutures could represent a promising and clinically valid strategy to reduce microbial colonisation in oral surgery. The reduced bacterial adherence is likely to improve the clinical success of the surgical procedures. Yet, the cost-benefit ratio of antimicrobial-coated sutures should be assessed in larger clinical trials to confirm their efficacy over conventional noncoated sutures.