Effect of different chlorhexidine formulations in mouthrinses on de novo plaque formation

Effects of Hypochlorous Acid and Hydrogen Peroxide Treatment on Bacterial Disinfection Treatments in Implantoplasty Procedures

One of the main problems in oral implantology today is peri-implantitis, which affects almost 20% of dental implants placed in patients. One of the most commonly used techniques to eliminate bacterial biofilm is the implantoplasty, that consists of the mechanical modification of the implant surface topography followed by treatments with chemical reagents for decontamination. In this study, the main aim is to evaluate the use of two different chemical treatments based on hypochlorous acid (HClO) and hydrogen peroxide (H₂O₂). For this purpose, 75 titanium grade 3 discs were treated with implantoplasty according to established protocols. Twenty-five discs were used as controls, 25 were treated with concentrated HClO and 25 were treated with concentrated HClO followed by treatment with 6% H₂O₂. The roughness of the discs was determined using the interferometric process. Cytotoxicity with SaOs-2 osteoblastic cells was quantified at 24 and 72 h, whereas bacteria proliferation using S. gordonii and S. oralis bacteria was quantified at 5 s and 1 min of treatment. The results showed an increase in the roughness values, the control discs had an Ra of 0.33 μm and those treated with HClO and H₂O₂ reached 0.68 μm. Cytotoxicity was present at 72 h, together with a significant proliferation of bacteria. These biological and microbiological results can be attributed to the roughness produced by the chemical agents that triggered bacterial adsorption while inhibiting osteoblast adhesion. The results indicate that even if this treatment can decontaminate the titanium surface after implantation, the produced topography will generate an environment that will not favor long-term performance.

Daily use of chlorine dioxide effectively treats halitosis: A meta-analysis of randomised controlled trials

OBJECTIVES

We aimed to conduct a systematic review on published data in order to investigate the efficacy of mouthwash products containing chlorine dioxide in halitosis.

STUDY DESIGN

Systematic review and meta-analysis.

METHODS

Our search was conducted on 14th October 2021. We searched the following electronic databases: MEDLINE, Embase, Scopus, Web of Science, and CENTRAL. We analysed data on adults with halitosis, included only randomised controlled trials and excluded in vitro and animal studies. The interventional groups used chlorine dioxide, and the comparator groups used a placebo or other mouthwash. Our primary outcomes were changes in organoleptic test scores (OLS) and Volatile Sulfur Compound (VSC) levels from baseline to the last available follow-up.

RESULTS

We found 325 articles in databases. After the selection process, ten articles were eligible for qualitative synthesis, and 7 RCTs with 234 patients were involved in the meta-analysis. Our findings showed a significant improvement in the parameters of the chlorine dioxide group compared to the placebo group in OLS one-day data (mean difference (MD): -0.82; 95% confidence intervals (95% CIs): [-1.04 --0.6]; heterogeneity: I2 = 0%, p = 0.67); and one-week OLS data (MD: -0.24; 95% CIs: [-0.41 --0.07]; I2 = 0%, p = 0.52); and also changes in H2S one-day data (standardised mean difference (SMD): -1.81; 95% CIs: [-2.52 --1.10]); I2 = 73.4%, p = 0.02).

CONCLUSION

Our data indicate that chlorine dioxide mouthwash may be a good supportive therapy in oral halitosis without known side effects.

Differences in chlorhexidine mouthrinses formulations influence the quantitative and qualitative changes in in-vitro oral biofilms

OBJECTIVE

Chlorhexidine mouthrinses are marketed in different formulations. This study aimed at investigating qualitative and quantitative changes in in-vitro multispecies oral biofilms, induced by different chlorhexidine-containing mouthrinses.

BACKGROUND DATA

Earlier studies comparing chlorhexidine mouthrinses are either clinical studies or in-vitro studies assessing the antimicrobial efficacy of the mouthrinses. However, no clear investigations are available regarding ecological impact of different chlorhexidine formulations on in-vitro multispecies oral biofilms after rinsing with different chlorhexidine formulations.

METHODS

Nine commercially available chlorhexidine mouthrinses were selected. Multispecies oral communities (14 species) were grown for 48 h in a Biostat-B Twin bioreactor. After that, they were used to develop biofilms on the surface of hydroxyapatite disks in 24-well pates for 48 h. Biofilms were then rinsed once or multiple times with the corresponding mouthrinse. Biofilms were collected before starting the rinsing experiment and every 24 h for 3 days and vitality quantitative PCR was performed. The experiment was repeated 3 independent times on 3 different days and the results were analyzed using a linear mixed model.

RESULTS

The mouthrinses provoked different effects in terms of change in total viable bacterial load (VBL), ecology, and community structure of the multispecies biofilms. There was no relation between chlorhexidine concentrations, presence, or absence of cetylpyridinium chloride and/or alcohol, and the observed effects. Some tested chlorhexidine mouthrinses (MC, HG, HH, and HI) strongly lowered the total VBL (≈10⁰⁷ Geq/ml), but disrupted biofilm symbiosis (≥40% of the biofilms communities are pathobionts). On the other hand, other tested chlorhexidine mouthrinses (MD, ME, and HF) had limited impact on total VBL (≥10¹⁰ Geq/ml), but improved the biofilm ecology and community structure (≤10% of the biofilms communities are pathobionts).

CONCLUSION

Not all chlorhexidine mouthrinses have the same effect on oral biofilms. Their effect seems to be strongly product dependent and vary according to their compositions and formulations.

Management of Peri-Implantitis Lesions without the Use of Systemic Antibiotics: A Systematic Review

BACKGROUND

This systematic review aims to assess the current evidence on the efficacy of surgical and non-surgical debridement techniques in the treatment of peri-implantitis lesions without the use of any antimicrobials.

METHOD

Five electronic databases (MEDLINE, Pubmed, Scopus, CINAHL and Cochrane) were used, alongside hand searches, to find relevant articles. Full-text articles that were randomised controlled trials, published in the English language from 2011 onwards without pre-operative, peri-operative and post-operative antibiotic usage were included. The study was conducted according to the latest Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-P protocols, the latest Cochrane Risk of Bias tool and each investigated intervention was evaluated using the grading of recommendation, assessment, development and evaluation (GRADE) system.

RESULTS

The search yielded 2718 results. After initial screening, 38 full-text articles were assessed for eligibility. From these, 11 studies satisfied all inclusion criteria. These 11 articles described six non-surgical and five surgical debridement therapies. Most articles were classified as having either a high risk of bias or presenting with some concerns. Small sample sizes, in combination with this risk of bias, meant that all interventions were adjudged to be of either low or very low quality of evidence.

CONCLUSION

While all investigated modalities displayed some sort of efficacy, this review suggests that a surgical approach may be best suited to treating peri-implantitis lesions in the absence of antibiotic therapy. Despite this weak indication, further research is required in this field.

Antimicrobial effects of mustard oil-containing plants against oral pathogens: an in vitro study

Background

The present study examines the antimicrobial activity of nasturtium herb (Tropaeoli maji herba) and horseradish root (Armoraciae rusticanae radix) against clinically important oral bacterial pathogens involved in periodontitis, gingivitis, pulpitis, implantitis and other infectious diseases.

Methods

A total of 15 oral pathogens, including members of the genera Campylobacter, Fusobacterium, Prevotella, Parvimonas, Porphyromonas, Tanerella, Veillonella, and HACEK organisms, were exposed to [1] a combination of herbal nasturtium and horseradish using a standardized gas test and [2] a mixture of synthetic Isothiocyantes (ITCs) using an agardilution test. Headspace gas chromatography mass spectrometry was employed to quantify the amount of allyl-, benzyl-, and 2- phenyl- ethyl-ITC.

Results

With exception of Veillonella parvula, all tested species were highly susceptible to herbal nasturtium and horseradish in the gas test with minimal inhibitory concentrations (MICs) between 50/20 mg and 200/80 mg and to synthetic ITCs in the agardilution with MICs between 0.0025 and 0.08 mg ITC/mL, respectively. Minimal bactericidal concentrations extended from 0.005 mg ITC/mL to 0.34 mg ITC/mL.

Conclusions

ITCs may be considered an interesting alternative to antibiotics for prevention and treatment of oropharyngeal infections, periodontitis and related diseases. Furthermore, the suitability of ITCs for endocarditis prophylaxis in dental procedures might be worth further investigation.

Adverse events associated with home use of mouthrinses: a systematic review

Background

Poor oral hygiene is strongly associated with oral and systemic diseases. Alongside mechanical tooth cleaning, the adjunctive use of mouthrinses has been widely advocated. Although research on the efficacy of various mouthrinse formulations is very active, there are a lack of conclusive data regarding their adverse effects.

Methods

We undertook a systematic review in accordance wih PRISMA guidelines of electronic databases of clinical trials of any duration with daily home use of mouthwashes, presenting clinical and subjective side effects (PROSPERO registration: CRD42016054037).

Results

After evaluating 614 titles and abstracts, 154 studies were selected for full-text analysis; 85 final papers were included. Based on the active ingredient in the test product, nine categories were created: cetyl pyridinium chloride, essential oils, chlorhexidine, triclosan, natural products, diclofenac, fluorides, delmopinol, and miscellaneous active substances. Most of the studies were of short duration (less than 6 months) with a defective 'methods' description; the reporting of adverse events often being overlooked. Both local morphological (oral mucosa and dental-crown staining, mucosal lesions) and functional (taste modifications, abnormal oral sensation) alterations were reported. Tooth staining was the most commonly listed adverse event, but it was quantitatively assessed only in a very small number of papers; most studies relied on patient reports. Staining was time associated; the longer the study, the higher its reported incidence and severity.

Conclusions

The reduced report of side effects may partly be due to a lack of an objective measure and lack of general guidelines that demand studies report their adverse events. The most frequently reported adverse effect was teeth staining. As in most studies, the effect was associated with trial duration; clinical trials should be of sufficient duration. New investigations meeting the suggested criteria of a minimal duration of 6 months should be planned.

Characteristics of an alternative antibacterial biomaterial for mouthwash in the absence of alcohol

Background/purpose

The purpose of this study was to investigate whether poly-gamma-glutamic acid (γ-PGA), a naturally derived biomaterial, was suitable as an alternative antibacterial mouthwash in the absence of alcohol.

Materials and methods

Three bacterial strains, Escherichia coli, Staphylococcus aureus, and Pseudomonas aeruginosa, were used for testing the antibacterial activity of mouthwashes. In addition, cell viability, cytotoxicity, and genotoxicity experiments were conducted for testing the toxicity of mouthwashes.

Results

We demonstrated that 10000 ppm of γ-PGA without alcohol could efficiently inhibit 99% of bacterial growth. In addition, γ-PGA did not cause any cytotoxicity or genotoxicity.

Conclusion

10000 ppm of γ-PGA in an alcohol-free mouthwash is an alternative biomaterial for mouthwashes.

Therapeutic efficacy of chlorhexidine-based mouthwashes and its adverse events: Performance-related evaluation of mouthwashes added with Anti-Discoloration System and cetylpyridinium chloride

OBJECTIVES

To compare 3 mouthwashes: 0.20% chlorhexidine (CHX) with Anti-Discoloration System (ADS), 0.20% CHX and 0.12% CHX with 0.05% cetylpyridinium chloride (CPC), in terms of reduction of plaque and gingival bleeding and side effects.

METHODS

Mild gingivitis patients were randomly divided into three Groups: they underwent professional oral hygiene and received instructions: oral rinse with 10 mL for 1', twice a day, 30' after tooth brushing, for 14 days. Primary outcomes were plaque and gingival bleeding, assessed with Plaque Control Record and Gingival Bleeding Index. Feedback questionnaire and spectrophotometer evaluated secondary outcomes: adverse events. Timing of the study was T0 (baseline), T1 (professional oral hygiene) and T2 (14th day after mouthwash use).

RESULTS

Sixty-six patients were recruited, two patients dropped out, and 64 patients completed the study. PCR T1-T2 mean variation was 30.67 (SD = 15.22; 95% CI 23.55 to 37.80; P = 0.000), 19.93 (SD = 11.03; 95% CI 14.90 to 24.95; P = 0.000) and 16.24 (SD = 15.35; 95% CI 9.60 to 22.88; P = 0.000) respectively in Groups 0.2% CHX + ADS, 0.2% CHX and 0.12% CHX + CPC. GBI mean variation (T0-T2) was -9.82 (SD = 9.27; 95% CI -5.48 to 14.16; P = 0.000), -19.31 (SD = 11.33; 95% CI -14.15 to -24.47; P = 0.000) and -21.13 (SD = 12.56; 95% CI -15.70 to -26.56; P = 0.000) respectively in Groups 0.2% CHX + ADS, 0.2% CHX and 0.12% CHX + CPC. Statistical significance was found in lower efficacy of 0.2% CHX + ADS Group. Patients tolerated 0.12% CHX + CPC mouthwash better in bleeding perception (95.5%; P = 0.046), burning sensation (13.6%; P = 0.006), and mouthwash taste (100%; P = 0.000). Results on staining were no statistically significant (P = 0.106).

CONCLUSIONS

Addition of CPC allows reduction of CHX percentage in mouthwash formulation while keeping equal efficacy and less side effects. ADS addition decreases CHX efficacy in reducing plaque and bleeding, while resulting more tolerated than CHX.

Cytotoxicity and antimicrobial action of selected phytochemicals against planktonic and sessile Streptococcus mutans

Background

Dental caries remains the most prevalent and costly oral infectious disease worldwide, encouraging the search for new and more effective antimicrobials. Therefore, the aim of this work was to study the antimicrobial action of selected phytochemicals (eugenol, citronellol, sabinene hydrate, trans-cinnamaldehyde, terpineol and cinnamic acid) against Streptococcus mutans in planktonic and biofilm states as well as the cytotoxicity of these compounds.

Methods

The antibacterial activity of the selected compounds was evaluated by the determination of the minimal bactericidal concentration. The resazurin assay was used to assess the metabolic activity of sessile S. mutans. The cytotoxicity was determined using a fibroblast cell line.

Results

Among the tested phytochemicals, citronellol, cinnamic acid and trans-cinnamaldehyde were the most effective against both planktonic and sessile S. mutans, an effect apparently related to their hydrophobic character. Additionally, these three compounds did not compromise fibroblasts cell viability.

Discussion

Citronellol, cinnamic acid and trans-cinnamaldehyde demonstrated significant antimicrobial activity and low cytotoxicity proposing their potential as a novel group of therapeutic compounds to control oral infectious diseases. Moreover, their effects are particularly relevant when benchmarked against eugenol, a phytochemical commonly used for prosthodontic applications in dentistry.

Will a chlorhexidine-fluoride mouthwash reduce plaque and gingivitis?

FOCUS QUESTION

What is the efficacy of a chlorhexidine (CHX) mouthwash (MW) containing sodium fluoride (NaF) compared to a CHX - MW alone on the parameters of plaque, gingivitis and discoloration?

MATERIAL AND METHODS

MEDLINE-PubMed, Cochrane-CENTRAL, and EMBASE were searched for papers from inception to December 2017. The inclusion criteria were (randomized) controlled clinical trials conducted in human subjects with good general health and without removable prosthesis. Papers evaluating the effect of a MW containing CHX + NaF compared to a CHX alone were included. From the eligible studies, data were extracted, a descriptive analysis was performed and a meta-analysis when feasible.

RESULTS

Independent screening of 412 unique papers resulted in 9 eligible publications presenting 10 clinical trials comparing the effect of CHX + NaF to CHX - MW and provided 13 comparisons. Five evaluated the MW as an adjunct to brushing and 8 were non-brushing comparisons of which 4 used an experimental gingivitis model. No significant difference was observed for plaque score reduction in the brushing studies the end scores (diffM; -0.04, P = .36; 95%CI: [-0.13, 0.05]) nor the differences (diffM; 0.11, P = .33; 95%CI: [-0.12, 0.24]). In the descriptive analysis, none of the experiments demonstrated a statistical significant difference regarding Gingival Index (GI), Bleeding Score and Discoloration Scores. For the GI, a meta-analysis of the difference of Means was not significant when included experimental gingivitis model studies end scores (0.01, P = .78; 95%CI: [-0.08, 0.11]) and the difference (0.01, P = .81; 9 5%CI: [-0.08, 0.10]) either for the end scores of brushing studies (diffM; -0.01, P = .82; 95%CI: [-0.10, 0.08]).

CONCLUSION

From this study, it can be concluded that NaF and CHX may be present in the same MW without reducing CHX efficacy with respect to plaque and gingivitis scores. Moreover, no difference in the development of tooth discoloration was observed.

The clinical evaluation of Vi-one chlorhexidine mouthwash on plaque-induced gingivitis: A double-blind randomized clinical trial

Background

Chlorhexidine (CHX) is the most effective antiseptic mouthwash to date. Essential oil such as thymol, have inhibitory and biocidal effects a range of bacteria.

Objective

To determine the effect of mouthwash containing CHX and thymol on plaque induced gingivitis.

Methods

This double-blind randomized clinical trial study was performed on 60 patients with plaque induced gingivitis who were randomly divided into two groups: Group I (CHX/thymol mouthwash-Vi-one) and Group II (CHX mouthwash-Behsa). Patients in each group underwent scaling and root planning and polishing, then were educated about BASS-Method brushing, and were recommended Oral-B toothbrushes and Pooneh toothpaste. The two groups were asked to rinse their mouths for 60 seconds twice a day, once in the morning and once at night, after brushing their teeth. Plaque index, gingival index, bleeding index and stain index were evaluated at baseline and 14 days later in Ramfjord teeth. Data analysis was conducted using SPSS version 21. Independent-samples t-test and paired-samples t-test were used for data analysis.

Results

The results showed that plaque index and gingival index significantly reduced in two groups (p<0.001). However, group I was significantly more efficient than group II (p<0.001, p=0.021 respectively). Similar results were observed in terms of bleeding index with the difference that the two groups did not differ significantly from each other (p=0.879). Both groups significantly increased the stain index. No remarkable difference was also observed between the two groups (p=0.754).

Conclusion

Based on the results of this study, we can conclude that the CHX/thymol mouthwash can be offered to patients with dental plaque-induced gingivitis, because it appears to be more effective in controlling dental plaque and gingivitis.

Trial registration

The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the Irct ID: IRCT201602231760N45.

Funding

This study was part of a thesis and research project (Grant No: 9440921) supported and funded by Babol University of Medical Sciences. The authors received no financial support from Behsa pharmaceutical company (Behsa mouthwash manufacturer) or Rojin cosmetic laboratory (Vi-one mouthwash manufacturer) for this study.

Comparing the effect of 0.06% -, 0.12% and 0.2% Chlorhexidine on plaque, bleeding and side effects in an experimental gingivitis model: a parallel group, double masked randomized clinical trial

BACKGROUND

Chlorhexidine is the gold standard of dental plaque prevention. The aim of the present study was to compare the plaque and gingivitis inhibiting effect of commercial products containing 0.2%, 0.12% and 0.06% chlorhexidine in a modified experimental gingivitis model.

METHODS

In three groups of healthy volunteers, experimental gingivitis was induced and monitored over 21 days and simultaneously treated with the commercial solutions containing 0.2%, 0.12% and 0.06% chlorhexidine. The maxillary right quadrant of each individual received mouthwash only, whereas the maxillary left quadrant was subject to both rinsing and mechanical oral hygiene. Compliance and side effects were monitored at days 7, 14, and 21. Plaque and gingivitis scores were obtained at baseline and day 21.

RESULTS

The commercial mouthwash containing 0.2% chlorhexidine resulted in statistically significantly lower plaque scores than the 0.12 and 0.06% mouthwashes after 21 days use, whereas no statistically significant difference was found between the effects of the two latter.

CONCLUSION

A commercially available mouthwash containing 0.2% chlorhexidine had statistically significant better effect in preventing dental plaque than the 0.12% and 0.06% solutions.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02911766 . Registration date: September 9th 2016.

Chlorhexidine with or without alcohol against biofilm formation: efficacy, adverse events and taste preference

In recent years, different chlorhexidine formulations have been tested, including an alcohol-free alternative, but the effect of this solution on early biofilm formation is not clear. A crossover, randomized, double-blind clinical trial was conducted to evaluate the effect of two chlorhexidine solutions against supra- and subgingival biofilm formation (NCT#02656251). Thirty-five participants were randomized and asked to rinse twice daily with 15 ml of an alcohol-containing 0.12% chlorhexidine solution, an alcohol-free 0.12% chlorhexidine solution, or placebo. The study was conducted in three experimental periods of 4 days each, with a 10-day washout between the periods. All the experimental periods followed the same protocol, except that the solutions were switched. Biofilm distribution was evaluated every 24 hours by the Plaque-Free Zone Index, during 96 hours. Adverse events were self-reported and sensory evaluation was performed using a hedonic scale. Compared to the placebo, the chlorhexidine solutions resulted in a significantly higher number of surfaces free of plaque over 96 hours (p < 0.01), and were able to prevent subgingival biofilm formation (p < 0.01). The alcohol-free chlorhexidine solution was associated with a lower incidence of adverse events, compared with alcohol-containing chlorhexidine (p < 0.05); it also received better sensory evaluation and acceptance by trial participants, compared with the alcohol-containing chlorhexidine (p = 0.007), and had a similar inhibitory effect on the formation of supra- and subgingival biofilms.

Evaluation of new chlorhexidine- and cetylpyridinium chloride-based mouthrinse formulations adjunctive to scaling and root planing: pilot study

OBJECTIVE

To compare the effect of two newly formulated chlorhexidine (CHX) and cetylpyridinium chloride (CPC) mouthrinses after scaling and root planing (SRP) in terms of clinical, microbiological, patient-based variables and adverse events, with a positive control with the same active components, already marketed and tested.

METHODS

A pilot, randomized clinical trial, double-blind, parallel design with 1-month follow-up was conducted. Chronic periodontitis patients requiring non-surgical periodontal therapy were enrolled and randomly assigned to: (i) SRP and test-1 (new reformulation: 0.12% CHX and 0.05% CPC); (ii) SRP and test-2 (new formulation: 0.03% CHX and 0.05% CPC); or (iii) SRP and positive control (commercial product: 0.12% CHX and 0.05% CPC). All variables were evaluated at baseline and 1 month after SRP. Quantitative variables were compared by means of anova or Kruskal-Wallis test and qualitative variables by chi-square or McNemar tests.

RESULTS

Thirty patients (10 per group) were included. After 1 month, there were significant differences among groups in plaque levels (P = 0.016) as test-1 showed less sites with plaque than test-2 (31.15% [standard error-SE 2.21%] versus 49.39% [SE 4.60%), respectively). No significant differences were found for global patient perception of the product or in adverse effects. Test groups showed better results in levels and proportions (P = 0.022) of Capnocytophaga spp.

CONCLUSIONS

Within the limitations of this pilot study, it can be concluded that the newly formulated 0.12% CHX and 0.05% CPC mouthrinse showed larger plaque level reductions, without showing more adverse effects, when compared to the other two mouthrinses, after SRP.

Adjunctive use of essential oils following scaling and root planing -a randomized clinical trial

BACKGROUND

Hitherto no study has been published on the effect of the adjunctive administration of essential oils following scaling and root planing (SRP). This study describes the effect of a mouthrinse consisting of essential oils (Cymbopogon flexuosus, Thymus zygis and Rosmarinus officinalis) following SRP by clinical and microbiological variables in patients with generalized moderate chronic periodontitis.

METHODS

Forty-six patients (aged 40-65 years) with moderate chronic periodontitis were randomized in a double-blind study and rinsed their oral cavity following SRP with an essential oil mouthrinse (n  =  23) or placebo (n  =  23) for 14 days. Probing depth (PD), attachment level (AL), bleeding on probing (BOP) and modified sulcus bleeding index (SBI) were recorded at baseline and after 3 and 6 months. Subgingival plaque was taken for assessment of major bacteria associated with periodontitis.

RESULTS

AL, PD, BOP and SBI were significantly improved in both groups after three (p   <   0.001) and 6 months (p   ≤   0.015). AL improved significantly better in the test than in the control group after 3 and 6 months (p < 0.001), so did PD after three months in the tendency (p  =  0.1). BOP improved better in the test group after 3 months (p  =  0.065). Numbers of Treponema denticola (p  =  0.044) and Fusobacterium nucleatum (p  =  0.029) decreased more in the test than in the control group after 3 months, those of Tannerella forsythia after 6 months (p  =  0.039). Prevotella micra (p  <  0.001, p  =  0.035) and Campylobacter rectus (p  =  0.002 , p  =  0.012) decreased significantly in both groups after 3 months.

CONCLUSIONS

The adjunctive use of a mouthrinse containing essential oils following SRP has a positive effect on clinical variables and on bacterial levels in the subgingival biofilm.

TRIAL REGISTRATION

332-12-24092012, DRKS 00009387, German Clinical Trials Register, Freiburg i. Br., 16.09.2015.

The Clinical Effectiveness of Post-Brushing Rinsing in Reducing Plaque and Gingivitis: A Systematic Review

INTRODUCTION

Dental plaque is the major etiological factor associated with the development of gingivitis. Hence, maintenance of oral hygiene is very essential.

AIM

To systematically review the literature on the effects of a post toothbrushing rinsing on plaque and parameters of gingival inflammation.

MATERIALS AND METHODS

A literature review was performed in PubMed Central and Cochrane library, embase, google scholar were searched up to February 2015 to identify appropriate studies. The primary outcome measure was plaque and gingival inflammation reduction.

RESULTS

Out of the total 56 titles appeared, 08articles fulfilled the criteria and were selected for the review. One article which was hand searched and one article which was through e-mail was included. A statistically significant reduction in overall plaque and gingivitis was noted when different mouth rinses were compared to the control (p<0.05). It was seen that chlorhexidine is the best antiplaque and antigingivitis agent but due to its side effects after continuous use, was not indicated for long term use. Probiotic was superior to chlorhexidine in terms of reduction of gingival inflammation.

CONCLUSION

There are relatively few studies evaluating the association between post toothbrushing rinsing and gingivitis. A clear effect was observed, indicating that different mouthrinses (chlorhexidine, probiotic, herbal, essential oil mouthrinse) when used as an adjunct to mechanical means of oral hygiene, provides an additional benefit with regard to plaque and gingivitis reduction as compared to a placebo or control.

Inhibition of de novo plaque growth by a new 0.03 % chlorhexidine mouth rinse formulation applying a non-brushing model: a randomized, double blind clinical trial

OBJECTIVES

The aim of this study was to investigate the plaque inhibitory effect of a new 0.03 % chlorhexidine digluconate (CHX) and 0.05 % cetylpyridinium chloride (CPC) mouthrinse formulation and to explore patients' experience and side effects after its use.

MATERIALS AND METHODS

This short-term, randomized, double blind, parallel, clinical trial enrolled 150 periodontally healthy patients. These volunteers were randomly allocated to one of following mouthrinse groups (n = 50/group): 0.12 % CHX + 0.05 % CPC (Perio-Aid® Treatment alcohol-free), 0.03 % CHX + 0.05 % CPC new test formulation or to the placebo group. Clinical parameters (plaque, gingival, and stain indexes) and microbiological samples were taken at baseline, before supragingival cleaning, and after 4 days of undisturbed plaque growth, rinsing twice/day with one of the mouthrinses.

RESULTS

Plaque reduction was similar for the 0.12 % CHX (-0.52 ± 0.55) and 0.03 % CHX (-0.47 ± 0.49) groups. Both showed significant reductions in plaque accumulation compared to the placebo (p < 0.001). The new formulation had less of a negative impact on taste perception when compared to the 0.12 % CHX solution. The new CHX mouthrinse was also able to control bacterial loads and reduce some periodontopathogens.

CONCLUSIONS

This study indicated that the new 0.03 % CHX + 0.05 % CPC formulation exerted clinical efficacy similar to that achieved by an already-marketed 0.12 % CHX + 0.05 % CPC mouthrinse, but with slightly fewer side effects.

CLINICAL RELEVANCE

Lower CHX mouthrinse formulations could be effective in the inhibition of plaque regrowth with reduced unpleasant subjective side effects.

Effect of Aloe vera, chlorine dioxide, and chlorhexidine mouth rinses on plaque and gingivitis: A randomized controlled trial

OBJECTIVE

To evaluate the effect of Aloe vera, chlorine dioxide, and chlorhexidine mouth rinses on plaque and gingivitis in orthodontic treatment.

MATERIALS AND METHODS

A randomized single-center, single-blind, parallel group, controlled trial was conducted among 90 subjects undergoing fixed orthodontic treatment. The subjects were randomly divided into one of the three study groups (Aloe vera, chlorhexidine, chlorine dioxide). Plaque and gingivitis were assessed using modified Silness and Loe Plaque Index and Gingival Index at baseline and at follow-up after 15 days. Paired t-test and ANOVA with post hoc Dunnett test were used. A p-value of <0.05 was considered statistically significant.

RESULTS

A total of 85 participants completed the study; among them, 40 were male and 45 were female. There was significant reduction in mean plaque and gingival scores in all the 3 groups at follow-up when compared to baseline. A significantly higher reduction (plaque and gingival scores) was found in chlorhexidine when compared with the Aloe vera group. However, no significant difference was seen between chlorhexidine and chlorine dioxide with respect to mean reduction in plaque and gingival scores.

CONCLUSION

Chlorine dioxide can be a suitable and economical alternative for chlorhexidine. Further long-term studies are recommended for evaluating their effectiveness.

A combination of cis-2-decenoic acid and chlorhexidine removes dental plaque

OBJECTIVES

To investigate the ability of cis-2-decenoic acid (C2DA) to induce dispersion in single-species biofilms formed by Streptococcus mutans and Candida albicans, as well as to remove their bacterial-fungal dual-species biofilms when combined with low concentrations of chlorhexidine (CHX).

METHODS

For biofilm dispersal bioassays, single-species biofilms of S. mutans and C. albicans were grown on the inside surface of petri dishes, using a semi-batch culture method in which the medium was replaced every 24h for 5 days. Biofilms were then treated with very low concentrations of C2DA (100 and 310 nM) for 1h to release cells into the bulk liquid and to evaluate dispersed cell number by measuring the optical density (OD). To assess the ability of C2DA combined CHX treatments to remove tested microorganisms' dual-species biofilms, they were grown on saliva-coated hydroxyapatite (sHA) discs for 48 h and then were treated with three different concentrations of CHX (0.08%, 0.06% and 0.04%) alone or in combination with indicated concentrations of C2DA for 1 min twice daily for 3 subsequent days. Biofilms were then either subjected to the field emission scanning electron microscopy (FESEM) analysis or harvested and colony forming units (CFUs) were counted after plating on agar.

RESULTS

Treatment of pre-established biofilms with 310 nM C2DA caused an approximately two-fold increase in the number of planktonic cells in both cultures. A combination of 310 nM C2DA and 0.04% CHX resulted in significant removal (p-value <0.05) of dual-species biofilms from sHA discs surface.

CONCLUSIONS

Anti-biofilm characteristic of C2DA boosts the action of CHX even at low concentrations.

Effect of 0.12% chlorhexidine in reducing microorganisms found in aerosol used for dental prophylaxis of patients submitted to fixed orthodontic treatment

Objective

This study aimed at assessing, in vivo, whether the prior use of 0.12% chlorhexidine as mouthwash would decrease air contamination caused by aerosolized sodium bicarbonate during dental prophylaxis. The study was conducted with 23 patients aged between 10 and 40 years old who were randomly selected and undergoing fixed orthodontic treatment.

Methods

The study was divided into two phases (T₁ and T₂) with a 30-day interval in between. In both phases, dental prophylaxis was performed with aerosolized sodium bicarbonate jetted to the upper and lower arches for 4 minutes. In T₁, 10 minutes before the prophylaxis procedure, the participants used distilled water as mouthwash for one minute; whereas in T₂, mouthwash was performed with 0.12% chlorhexidine. Microbial samples were collected in BHI agar plates for microbiological analysis. Two dishes were positioned on the clinician (10 cm from the mouth) and a third one at 15 cm from the patient's mouth. The samples were incubated for 48 hours at 37°C. Results were expressed in colony-forming units (CFU).

Results

Statistical analysis carried out by means of Student's t test, as well as Wilconxon and Kruskal-Wallis tests revealed that the prior use of 0.12% chlorhexidine as mouthwash significantly reduced CFU in the three positions studied (P < 0.001).

Conclusion

The prior use of 0.12% chlorhexidine as mouthwash significantly reduced contamination caused by aerosolized sodium bicarbonate during dental prophylaxis in the orthodontic clinic.

The comparative effect of propolis in two different vehicles; mouthwash and chewing-gum on plaque accumulation and gingival inflammation

Objective:

In general, chemical plaque agents have been used in mouthwashes, gels, and dentifrices. In some situations, application of mouthwashes and dentifrices can be difficult. Therefore, different approaches for oral health-care have been needed. The aim of this study was to evaluate the effect of propolis chewing-gum compared to propolis-containing mouthwash on gingival inflammation and plaque accumulation on patients that refrained from daily oral hygiene procedures for 5 days.

Materials and Methods:

10 college students with systemically healthy and very good oral hygiene and gingival health were included in this randomized, single-blind, crossover 5-day plaque regrowth with a 3-day washout period clinical study. After plaque scores were reduced to zero, participants were asked to refrain from oral hygiene procedures and allocated to either propolis mouthwash or chewing-gum group. Chewing-gum was performed after meals 3 times a day for 20 min mouthwash group was instructed to rinse mouthwash 2 times a day for 1 min. On day 5, the clinical periodontal measurements containing plaque and gingival indexes were taken from the participants.

Results:

The both plaque and gingival indexes of propolis mouthwash group were significantly lower than that of the propolis chewing-gum group (P = 0.005).

Conclusion:

It was demonstrated that the propolis mouthwash was more effective than the propolis chewing gum on the plaque inhibition and the gingival inflammation.

Novel therapeutic approach for the treatment of periodontitis by curcumin

AIMS AND OBJECTIVES

The aim of the present study was to evaluate the clinical and microbiological efficacy of locally delivered 1% curcumin gel as an adjunct to scaling and root planing in the treatment of chronic periodontitis.

MATERIALS AND METHODS

The study group consisted of 25 patients, belonging to both sex, aged between 21-45 years. All patients diagnosed as chronic periodontitis with periodontal pockets of depth >5mm bilaterally were randomly selected. A split mouth design was followed and the patients received a complete prophylaxis including scaling and root planing. Examination of plaque index, bleeding index, probing pocket depth and clinical attachment level were measured for each patient. The test group received 1% curcumin gel along with scaling and root planing whereas the control group received scaling and root planing alone followed by microbiological samples taken at baseline, 1, 3 and 6 months interval.

RESULTS

The 1% curcumin gel appeared to provide significant improvements in clinical parameters. Microbiological counts of Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum and capnocytophaga showed significant reduction in periopathogens at the test sites after six months when compared with that of control sites.

CONCLUSION

Locally delivered 1% curcumin gel was more effective in inhibiting the growth of oral bacteria when used as an adjunct to SRP in the treatment of chronic periodontitis.

Does human saliva decrease the antimicrobial activity of chlorhexidine against oral bacteria?

Background

Several studies have shown the antibacterial effectiveness of 0.2% chlorhexidine (CHX) in both in vitro and in vivo studies. In this way, CHX comes directly in contact with saliva. This in vitro study aimed at investigating the possible neutralizing effect of saliva on CHX.

Methods

Saliva samples (12 ml) were collected from twenty healthy volunteers. The aerobic and anaerobic bacterial counts in saliva were determined on Colombia blood agar (CBA) and yeast cysteine agar (HCB), respectively. Saliva from each subject was divided among 4 experimental groups (3 ml/group). Samples were centrifuged at 4000 g for 10 min. The centrifuged salivary bacteria were incubated with the following solutions: 0.2% CHX in saliva, CHX in saliva with 7% ethanol, CHX in 0.9% NaCl, CHX in 0.9% NaCl with 7% ethanol. After exposure for 1 min or 3 min to these CHX solutions, the CHX was neutralized and the bacteria were cultivated, after which the number of colony forming units (aerobic and anaerobic) was determined.

Results

CHX reduced the CFU in all groups significantly (p = 0.0001). Therefore, CHX had a similar effect on both aerobic and anaerobic microorganisms. Significantly more bacteria survived the effect of CHX when kept in salivary solution. This effect from saliva could be compensated by the addition of ethanol. In the absence of saliva there was no significant difference observed in the effectiveness of CHX with respect to ethanol. Prolonging the exposure time to 3 min enhanced the effectiveness of CHX.

Conclusions

The effect of saliva on the antimicrobial activity of CHX was weak albeit statistically significant. However, addition of 7% ethanol compensates this effect. The impact of saliva on the reduction of the antimicrobial efficacy of mouthrinses such as CHX needs to be taken into consideration with regard to improving their antibacterial properties.

The effects of three different mouth rinses in a 4-day supragingival plaque regrowth study

OBJECTIVE

This study compares the effects of three different mouth rinses with respect to reducing Streptococcus mutans (S. mutans) colony counts on the teeth and tongue surfaces.

MATERIALS AND METHODS

In this study, comparison tests using the alcohol-free 0.1% chlorhexidine mouth rinse, alcohol-containing essential oil mouth rinse, and alcohol-free essential oil-containing mouth rinse were conducted. Patients were instructed to avoid mechanical cleaning with either a toothbrush or toothpick for 4 days. The first samples were collected from teeth surfaces and the dorsum of the tongue after a professional cleaning, and the second samples were collected after a 4-day plaque re-growth period. The supragingival plaque from the buccal surfaces of teeth #11, 14, 31, 34 as well as samples from the dorsum of the tongue, were assessed using the Dentocult(®) strips.

RESULTS

The Listerine(®) and Ondrohexidine(®) groups did not show any statistically significant differences between the values of the two samples (P = 0.734, P = 0.307). The MC(®) group and the control group showed significantly higher results than the first sample values. The effectiveness of the mouth rinses on S. mutans colony counts from the teeth surfaces were higher in the Listerine(®), Ondrohexidine(®), and Mouthwash Concentrate(®) groups. The difference between the first and second samples of the S. mutans colony counts from the tongue surface was found to be statistically significant, and S. mutans colony counts were higher than the first sample (P = 0.015).

CONCLUSION

Alcohol and essential oil-containing Listerine(®) mouth rinse, alcohol-free Ondrohexidine(®), alcohol-free essential oil-containing MC(®) mouth rinse had the same effect on S. mutans counts, higher than the 1% alcohol solution on teeth surface. They had the ability to maintain the S. mutans counts at the same level for 4 days in patients who did not perform any mechanical oral hygiene regimen.

Comparative evaluation of the antiplaque effectiveness of green tea catechin mouthwash with chlorhexidine gluconate

AIM

The aim of this study is to compare the antiplaque efficacy of green tea catechin mouthwash with chlorhexidine gluconate mouthwash.

MATERIALS AND METHODS

A single blinded cross-over study was conducted among 30 participants in the age group of 18-25 years. The mouthwash samples for the study were previously labeled assigning the letters: A (0.25% of green tea catechin mouthwash) and B (0.12% of chlorhexidine mouthwash). The study subjects were randomly divided into two groups of 15 each and the study was divided into two phases. In phase I, the mouthwash A was given to one group and other group was given mouthwash B. After a 15 day washout period, in phase II, both groups were given other mouthwash. At the end of each phase of 1 week, plaque score was recorded by using Turesky modification of the Quigley-Hein plaque index.

RESULTS

The plaque scores were compared and the difference between the green tea catechin and chlorhexidine mouthwash was determined by t-test. The difference between plaque scores were not statistically significant (P > 0.05). The results showed that both the groups that is green tea catechin mouthwash (0.25%) and chlorhexidine mouthwash (0.12%) have comparable results in plaque reduction.

CONCLUSION

This study supports the effectiveness of green tea catechin mouthwash as an antiplaque agent. It should be explored as a cost-effective, long-term antiplaque rinse with prophylactic benefits.

The effects of natural compounds-containing mouthrinses on patients with fixed orthodontic appliance treatment: clinical and microbiological outcomes

AIM

To investigate the effects of two natural compounds-containing mouthrinses (NCCMs) (a fructus mume (FM) extract-containing mouthrinse and an essential oil (EO)-containing mouthrinse) on gingival health and microbial profiles in young orthodontic patients.

DESIGN

This 6-month randomized, single-blinded, parallel-controlled clinical trial consists of 90 patients with fixed appliance treatment. The subjects were allocated to (1) negative control group: oral hygiene instruction (OHI) alone; (2) test group 1: OHI plus EO mouthrinse; and (3) test group 2: OHI plus FM mouthrinse. Clinical examinations included plaque index (PI), bleeding index (BI) and modified gingival index (MGI). Salivary microbial quantifications included total aerobic and anaerobic bacteria, Streptococci and Lactobacilli counts. Clinical and microbiological examinations were conducted at baseline, 3rd and 6th months (T1, T2, and T3).

RESULTS

BI was significantly reduced in both the FM mouthrinse and EO mouthrinse groups compared with the negative control group at T3 (P < 0.05). There were no significant intergroup differences in salivary bacteria counts in all groups (P > 0.05).

CONCLUSION

Both NCCMs effectively reduced gingival bleeding without causing significant alterations of microbial profile in young orthodontic patients.

Investigating the biological properties of carbohydrate derived fulvic acid (CHD-FA) as a potential novel therapy for the management of oral biofilm infections

Background

A number of oral diseases, including periodontitis, derive from microbial biofilms and are associated with increased antimicrobial resistance. Despite the widespread use of mouthwashes being used as adjunctive measures to control these biofilms, their prolonged use is not recommended due to various side effects. Therefore, alternative broad-spectrum antimicrobials that minimise these effects are highly sought after. Carbohydrate derived fulvic acid (CHD-FA) is an organic acid which has previously demonstrated to be microbiocidal against Candida albicans biofilms, therefore, the aims of this study were to evaluate the antibacterial activity of CHD-FA against orally derived biofilms and to investigate adjunctive biological effects.

Methods

Minimum inhibitory concentrations were evaluated for CHD-FA and chlorhexidine (CHX) against a range of oral bacteria using standardised microdilution testing for planktonic and sessile. Scanning electron microscopy was also employed to visualise changes in oral biofilms after antimicrobial treatment. Cytotoxicity of these compounds was assessed against oral epithelial cells, and the effect of CHD-FA on host inflammatory markers was assessed by measuring mRNA and protein expression.

Results

CHD-FA was highly active against all of the oral bacteria tested, including Porphyromonas gingivalis, with a sessile minimum inhibitory concentration of 0.5%. This concentration was shown to kill multi-species biofilms by approximately 90%, levels comparable to that of chlorhexidine (CHX). In a mammalian cell culture model, pretreatment of epithelial cells with buffered CHD-FA was shown to significantly down-regulate key inflammatory mediators, including interleukin-8 (IL-8), after stimulation with a multi-species biofilm.

Conclusions

Overall, CHD-FA was shown to possess broad-spectrum antibacterial activity, with a supplementary function of being able to down-regulate inflammation. These properties offer an attractive spectrum of function from a naturally derived compound, which could be used as an alternative topical treatment strategy for oral biofilm diseases. Further studies in vitro and in vivo are required to determine the precise mechanism by which CHD-FA modulates the host immune response.

Antibacterial activity of selected commercial products for mouth washing and disinfection, assessed in accordance with PN-EN 1040

Background

Currently, there is a wide range of products for mouth washing on the Polish market. They have different qualitative and quantitative compositions, and they differ particularly in the concentration of active substances. In antisepsis and disinfection, the significant reduction in number of cells of microorganisms in a particular environment is very crucial. The chemical agents should provide a significant decrease in number of microorganisms in a relatively short time. The purpose of this study was to examine the bactericidal activity of selected herbal products used for treatment of inflammation, and disinfection and washing of the mouth, having antibacterial activity as declared by the manufacturers.

Material/Methods

The study included 28 products for mouth washing and disinfection available in Poland. Bactericidal activity was studied using a quantitative suspension test according to the standard PN-EN 1040.

Results

Only 1 of 4 tested herbal products, registered as medicinal products, showed satisfactory antibacterial activity when they were used according to the manufacturer’s recommendations. A total of 13 preparations (48%) complied with the standard requirements against all tested strains. Up to 19% of products showed no bactericidal activity against bacterial strains, and up to 33% were only effective against certain microorganisms.

Conclusions

The informational literature accompanying most antiseptics should be corrected by the manufacturers, providing information about antimicrobial activity consistent with the requirements of applicable standards. The information on the packaging or in the leaflets for antiseptic products should be corrected by the manufacturers to include accurate information on antimicrobial activity.

Efficacy of Subgingival Application of Xanthan-based Chlorhexidine Gel Adjunctive to Full-mouth Root Planing Assessed by Real-time PCR: A Microbiologic and Clinical Study

BACKGROUND AND AIMS

The aim of this clinical investigation was to compare clinical and microbiological effectiveness of adjunctive CHX gel in the treatment of periodontitis.

MATERIALS AND METHODS

Twenty-four subjects with localized or generalized moderate-to-severe chronic periodontitis underwent scaling and root planing. One tooth in each quadrant with a probing depth of >4 mm was chosen for combined gel and SRP, with contralateral tooth as control (SRP treated site). Clinical assessment was carried out at baseline and 1 and 3 months later; microbial assessment was performed by real-time PCR. Periodontal probing depth (PPD) was considered as primary outcome.

RESULTS

Twenty patients completed the study. Baseline PPDs were 4.90±0.78 and 5.05±0.79 in the SRP and gel groups, respectively (P>0.05), which decreased to 3.67±0.59 and 3.7±0.83 one month after treatment and 3.25±0.65 and 3.38±0.79 three months after treatment. Although values decreased significantly in both groups after one and three months (P=0.001 in the SRP and P=0.001 in the gel group), the inter-group difference was not significant neither at one-month (P=0.47) nor at three-month (P=0.77) intervals. The only clinical parameters exhibiting statistically significant inter-group differences was BOP in both one-month (P=0.004) and three-month (P=0.0001) intervals. All the other clinical measurements showed significant decreases after one and three months in both sites but without inter-group differences.

CONCLUSION

Subgingival application of xanthan chlorhexidine gel combined with scaling and root planing reduced bleed-ing of periodontal pockets. Clinical trials to evaluate effectiveness of this gel in aggressive and severe periodontitis modified by systemic factors are suggested.

A preliminary comparison of the effect of 0.3% versus 0.2% chlorhexidine mouth rinse on de novo plaque formation: a monocentre randomized double-blind crossover trial

OBJECTIVE

Chlorhexidine (CHX) is considered the gold standard against gram-negative microorganisms. Little has been written about the simultaneous influence that both time and concentration could have on antiplaque formation effectiveness of CHX. The aim of this study is to compare the clinical and microbiological effectiveness of two different CHX concentrations and time applications in a 4-day plaque regrowth study model.

MATERIAL AND METHODS

Twenty volunteers were enrolled in a randomized double-blind crossover study comparing the effectiveness of CHX 0.3% and CHX 0.2% mouth rinses applied for 15 and 30 s, respectively. Plaque index (PII), total bacterial counts and the detection of specific periopathogens were measured at the 5th day of each mouth rinse application. Taste acceptance was evaluated using a questionnaire.

RESULTS

Chlorhexidine 0.3% resulted in a statistically greater reductions (10%) in PIl and periopathogens compared to CHX 0.2%. Furthermore, patients reported comparable taste acceptance in both groups.

CONCLUSION

Chlorhexidine is an effective oral antiseptic. The CHX 0.3% mouth rinse formulation used for 15 s resulted in superior clinical and microbiological outcomes compared to the CHX 0.2% formulation, used for 30 s.

Effectiveness of a mouthrinse containing active ingredients in addition to chlorhexidine and triclosan compared with chlorhexidine and triclosan rinses on plaque, gingivitis, supragingival calculus and extrinsic staining

OBJECTIVES

To assess the effectiveness of three different mouthrinses--chlorhexidine, triclosan + sodium fluoride and chlorhexidine + triclosan + sodium fluoride + zinc chloride--on plaque, calculus, gingivitis and stains and to evaluate the occurrence of adverse effects with these three treatments.

METHODS

Forty-eight healthy subjects participated in a double-blind, randomized, parallel experiment and were randomly allocated to any one of the three experimental mouthrinses: group A (0.2% chlorhexidine (CHX) gluconate), group B (0.03% triclosan + 0.025% sodium fluoride (NaF) + 12% ethyl alcohol) or group C (0.2% CHX + 0.3% triclosan + 0.3% NaF + 0.09% Zn chloride (ZnCl(2)). All the subjects were assessed for gingivitis, plaque, supragingival calculus and extrinsic stains at baseline and at the end of the 21-day experimental period.

RESULTS

There was a significant difference (P = 0.046) in the effectiveness for the prevention of gingivitis and plaque, with subjects of group A and group C presenting least and highest gingival and plaque scores, respectively. Significant differences (P = 0.03) were observed for the accumulation of supragingival calculus where the deposition of calculus in group A was nearly double that of the group B, and group B was most effective in the prevention of supragingival calculus. Highest deposition of extrinsic stains was in the group A followed by group C and group B. There was no significant difference between the three treatments for adverse events' occurrence.

CONCLUSIONS

CHX mouthrinse was most effective in controlling plaque and gingivitis but caused greatest deposition of extrinsic stains. Supragingival calculus deposition was least in triclosan + NaF group followed by CHX + triclosan + NaF + ZnCl(2) and CHX. More than half of the subjects reported adverse events during the experimental phase.

The effect of mouthrinses on oral malodor: a systematic review

OBJECTIVE

The objective of this study is to systematically review the literature regarding the impact of mouthrinses on oral malodor and present evidence for the treatment effects of mouthrinses on oral malodor.

MATERIAL AND METHODS

PubMed-MEDLINE, the Cochrane-CENTRAL and EMBASE were searched through February 10, 2012 to identify appropriate studies. Volatile sulphur compound measurements, organoleptic measurements and tongue coating were selected as outcome variables. SEARCH RESULTS: The independent screenings of 333 unique titles and paper abstracts revealed 12 publications (12 experiments) that met the eligibility criteria. Means and standard deviations were extracted. The results were separated into short-term (<3 weeks) and longer-term (≥3 weeks) studies.

CONCLUSION

In this review, nearly all mouthwashes with active ingredients had beneficial effects in reducing oral malodor in both short- and longer-term studies. The most compelling evidence was provided for chlorhexidine mouthwashes, and those that contained a combination of cetyl pyridinum chloride and zinc provided the best evidence profile on oral malodor. Little data with respect to tongue coating were available, and none of the studies showed a beneficial effect for this parameter.

Chlorhexidine decreases the risk of ventilator-associated pneumonia in intensive care unit patients: a randomized clinical trial

BACKGROUND AND OBJECTIVE

The aim was to evaluate whether oral swabbing with 0.2% chlorhexidine gluconate (CHX) decreases the risk of ventilator-associated pneumonia (VAP) in intensive care unit (ICU) patients.

MATERIAL AND METHODS

Sixty-one dentate patients scheduled for invasive mechanical ventilation for at least 48 h were included in this randomized, double-blind, controlled study. As these patients were variably incapacitated, oral care was provided by swabbing the oral mucosa four times/d with CHX in the CHX group (29 patients) and with saline in the control group (32 patients). Clinical periodontal measurements were recorded, and lower-respiratory-tract specimens were obtained for microbiological analysis on admission and when VAP was suspected. Pathogens were identified by quantifying colonies using standard culture techniques.

RESULTS

Ventilator-associated pneumonia developed in 34/61 patients (55.7%) within 6.8 d. The VAP development rate was significantly higher in the control group than in the CHX group (68.8% vs. 41.4%, respectively; p = 0.03) with an odds ratio of 3.12 (95% confidence interval = 1.09-8.91). Acinetobacter baumannii was the most common pathogen (64.7%) of all species identified. There were no significant differences between the two groups in clinical periodontal measurements, VAP development time, pathogens detected or mortality rate.

CONCLUSION

The finding of the present study, that oral care with CHX swabbing reduces the risk of VAP development in mechanically ventilated patients, strongly supports its use in ICUs and indeed the importance of adequate oral hygiene in preventing medical complications.

Gingival tissue transcriptomes in experimental gingivitis

AIMS

We investigated the sequential gene expression in the gingiva during the induction and resolution of experimental gingivitis.

MATERIAL AND METHODS

Twenty periodontally and systemically healthy non-smoking volunteers participated in a 3-week experimental gingivitis protocol, followed by debridement and 2-week regular plaque control. We recorded clinical indices and harvested gingival tissue samples from four interproximal palatal sites in half of the participants at baseline, Day 7, Day 14 and Day 21 (the "induction phase"), and at Day 21, Day 25, Day 30 and Day 35 in the other half (the "resolution phase"). RNA was extracted, amplified, reversed transcribed, amplified, labelled and hybridized using Affymetrix Human Genome U133Plus2.0 microarrays. Paired t-tests compared gene expression changes between consecutive time points. Gene ontology analyses summarized the expression patterns into biologically relevant categories.

RESULTS

The median gingival index was 0 at baseline, 2 at Day 21 and 1 at Day 35. Differential gene regulation peaked during the third week of induction and the first 4 days of resolution. Leucocyte transmigration, cell adhesion and antigen processing/presentation were the top differentially regulated pathways.

CONCLUSIONS

Transcriptomic studies enhance our understanding of the pathobiology of the reversible inflammatory gingival lesion and provide a detailed account of the dynamic tissue responses during the induction and resolution of experimental gingivitis.

Efficacy of a low-concentration chlorhexidine mouth rinse in non-compliant periodontitis patients attending a supportive periodontal care programme: a randomized clinical trial

OBJECTIVE

To assess the clinical and microbiological efficacy of a 0.05% chlorhexidine and 0.05% cetyl-pyridinium chloride mouth rinse in supportive periodontal care (SPC) in patients with inadequate plaque control.

MATERIAL AND METHODS

The study was a randomized, double-blinded, placebo-controlled clinical trial in patients with moderate to severe chronic periodontitis under SPC with an inadequate plaque control (Turesky index >1). After supragingival prophylaxis and oral hygiene reinforcement, participants rinsed twice a day for 3 months with the test or placebo solutions, in addition to conventional hygiene. Primary clinical outcome variables included plaque and gingival indices. As secondary outcomes, periodontal and microbiological variables were studied. ancova and chi(2) tests were used to compare the variables.

RESULTS

Forty-seven patients (22 placebo and 25 test group) participated. After 3 months, plaque levels increased in the placebo group, while diminished in the test group (p<0.001). Similar effects were found for bleeding on probing. The other clinical parameters did not show significant differences. Microbiological variables demonstrated inter-group significant reductions in subgingival counts of Fusobacterium nucleatum and Prevotella intermedia and a decrease of the total bacterial counts in saliva.

CONCLUSIONS

The tested mouth rinse demonstrated efficacy in reducing plaque and gingivitis, as well as in decreasing the microbial load in saliva and gingival sulcus.

[The effect of two different oral antiseptics on dental plaque formation (de novo biofilm) and on gingival inflammation]

INTRODUCTION

Since the discovery that periodontal diseases are caused by microbial plaque the interest of many scientists has been focused on oral antiseptics. There are very few mouthrinses with oral antiseptic effect originally designed in our country. One of these is Ozosept solution.

OBJECTIVE

This study evaluated the effect of Ozosept solution (phenol compound) on the oral hygiene and gingival inflammation, in comparison with Hibidex DAP solution (chlorhexidine digluconate).

METHODS

Two groups, each of 21 persons, which did not significantly differ concerning Silness-Löe plaque index (PI) and Löe-Sillnes gingival index (GI), used one of the studied oral antiseptic for a 15-day period. Oral hygiene was maintained by subjects' habitual home methods, and no technique of professionally advised brushing was performed during the experimental period.

RESULTS

At the end of the study, PI and GI scores were lowered to a statistically high significance in both groups of participants in comparison to the indexes at the beginning of the study. At the end of the study, PI and GI scores did not significantly differ between the two analyzed groups. No side effects, which were recorded in the Hibidex DAP group (tooth and filling staining 9.5% and 4.74% respectively, transitory tongue numbness 28.6% and reduced taste sensation 14.3%), were registered in the group of subjects using Ozosept solution.

CONCLUSION

It is concluded that Ozosept solution is effective in the control of dental plaque--biofilm accumulation and gingival inflammation, and produces no side effects related to chlorhexidine digluconate usage.

Maximum inhibitory dilution of mouthwashes containing chlorhexidine and polyhexamethylene biguanide against salivary Staphylococcus aureus

Objective:

The aim of the present study was to determine the in vitro maximum inhibitory dilution (MID) of two chlorhexidine-based oral mouthwashes (CHX): Noplak®, Periogard®, and one polyhexamethylene biguanide-based mouthwash (PHMB): Sanifill Premium® against 28 field Staphylococcus aureus strains using the agar dilution method.

Materials and Methods:

For each product, decimal dilutions ranging from 1/10 to 1/655,360 were prepared in distilled water and added to Mueller Hinton Agar culture medium. After homogenization, the culture medium was poured onto Petri dishes. Strains were inoculated using a Steers multipoint inoculator and dishes were incubated at 37°C for 24hours. For reading, MID was considered as the maximum dilution of the mouthwash still capable of inhibiting microbial growth.

Results:

Sanifill Premium® inhibited the growth of all strains at 1/40 dilution and of 1 strain at 1/80 dilution. Noplak® inhibited the growth of 23 strains at 1/640 dilution and of all 28 strains at 1/320 dilution. Periogard® showed inhibited growth of 7 strains at 1/640 dilution and of all 28 strains at 1/320 dilution. Data were submitted to Kruskal-Wallis statistical test, showing significant differences between the mouthwashes evaluated (p<0.05). No significant difference was found between Noplak® and Periogard® (p>0.05). Sanifill Premium® was the least effective (p<0.05).

Conclusion:

It was concluded that CHX-based mouthwashes present better antimicrobial activity against S. Aureus than the PHMB-based mouthwash.