Home-use oral hygiene products: mouthrinses

Efficacy of a mouthwash containing ε-poly-L-lysine, funme peptides and domiphen in reducing halitosis and supragingival plaque: a randomized clinical trial

OBJECTIVE

To evaluate the antibacterial effectiveness of a combination of ε-poly-L-lysine (ε-PL), funme peptide (FP) as well as domiphen against oral pathogens, and assess the efficacy of a BOP® mouthwash supplemented with this combination in reducing halitosis and supragingival plaque in a clinical trial.

MATERIALS AND METHODS

The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of the compound against Fusobacterium nucleatum, Porphyromonas gingivalis, Streptococcus mutans, and Aggregatibacter actinomycetemcomitans were determined by the gradient dilution method. Subsequently, the CCK-8 assay was used to detect the toxicity of mouthwash on human gingival fibroblastst, and the effectiveness in reducing halitosis and supragingival plaque of the mouthwash supplemented with the combination was analyzed by a randomized, double-blind, parallel-controlled clinical trial.

RESULTS

The combination exhibited significant inhibitory effects on tested oral pathogens with the MIC < 1.56% (v/v) and the MBC < 3.13% (v/v), and the mouthwash containing this combination did not inhibit the viability of human gingival fibroblasts at the test concentrations. The clinical trial showed that the test group displayed notably lower volatile sulfur compounds (VSCs) at 0, 10, 24 h, and 7 d post-mouthwash (P < 0.05), compared with the baseline. After 7 days, the VSC levels of the and control groups were reduced by 50.27% and 32.12%, respectively, and notably cutting severe halitosis by 57.03% in the test group. Additionally, the Plaque Index (PLI) of the test and control group decreased by 54.55% and 8.38%, respectively, and there was a significant difference in PLI between the two groups after 7 days (P < 0.01).

CONCLUSIONS

The combination of ε-PL, FP and domiphen demonstrated potent inhibitory and bactericidal effects against the tested oral pathogens, and the newly formulated mouthwash added with the combination exhibited anti-dental plaque and anti-halitosis properties in a clinical trial and was safe.

TRIAL REGISTRATION

The randomized controlled clinical trial was registered on Chinese Clinical Trial Registry (No. ChiCTR2300073816, Date: 21/07/2023).

Molecular Iodine Mouthrinse Antimicrobial Activity Against Periodontopathic Bacteria

AIM

This study compared two molecular iodine mouthrinses for their in vitro bactericidal effects against subgingival biofilm bacteria from severe periodontitis patients.

MATERIALS AND METHODS

In a subgingival biofilm eradication assay, dilution aliquots of subgingival microbial specimens from 32 adults with severe periodontitis were mixed in vitro with either a mouthrinse containing 100 parts per million (ppm) molecular iodine (Iorinse®) or one containing 150 ppm molecular iodine (iClean®), followed by mouthrinse neutralization after 60 seconds with 3% sodium thiosulfate. The mixtures, along with unexposed subgingival biofilm aliquots, were inoculated onto enriched Brucella blood agar and incubated anaerobically for 7 days to quantitate total viable bacterial counts and selected red/orange complex periodontal pathogens (Porphyromonas gingivalis, Tannerella forsythia, Prevotella intermedia/nigrescens, Parvimonas micra, Campylobacter rectus, and Fusobacterium nucleatum).

RESULTS

Both molecular iodine mouthrinses significantly reduced total viable bacterial counts in the subgingival biofilm samples, with iClean® providing significantly greater in vitro suppression than Iorinse®. Both molecular iodine mouthrinses also significantly reduced total red/orange complex periodontal pathogens, with significantly greater suppression also exhibited by iClean®.

CONCLUSION

The molecular iodine mouthrinses exerted marked bactericidal activity in vitro against human subgingival biofilm microbial species, including red/orange complex periodontal pathogens associated with severe periodontitis, with iClean® providing significantly better antimicrobial activity than Iorinse®.

CLINICAL SIGNIFICANCE

These findings suggest potential value of molecular iodine mouthrinses in the treatment and prevention of periodontal diseases.

The Effects of Selected Mouthwashes on the Surface Microhardness of a Single-shade Universal Resin Composite: In Vitro Study

Aim:

To investigate the effects of selected alcohol-free mouthwashes with different formulations (zinc-hydroxyapatite, hydrogen peroxide, and sodium fluoride) on the surface microhardness of a single-shade universal resin composite.

Materials and Methods:

Forty disc-shaped specimens (8 × 2 mm) from the universal resin composite (Omnichroma®), and a nano-hybrid composite (Tetric® N-Ceram) were prepared. After polymerization, baseline surface microhardness values were recorded using Vickers microhardness tester. The samples from each material were randomly assigned to 4 groups ( n = 10) and immersed in 20 ml of the mouthwashes: Biorepair®, Listerine®, Colgate® Optic White, and distilled water (control). The samples were kept in the immersion solutions for 24 hours, and post-immersion microhardness values were recorded. Data were analyzed with one-way ANOVA and paired sample t-tests at p < .05.

Results:

Significant reduction in microhardness was observed in all resin composite groups after immersion in the mouthwashes compared to baseline values ( p < .0001). The highest microhardness reduction in Omnichroma® group was observed after immersion in Colgate® Optic White; and Tetric® N-Ceram group after immersion in Listerine® mouthwash. For both materials, the least reduction in microhardness was observed after immersion in Biorepair®. Microhardness values for Omnichroma were significantly higher than Tetric® N-Ceram ( p < .0001). However, Omnichroma exhibited a significantly greater reduction in microhardness after immersion in the tested mouthwashes.

Conclusion:

In vitro simulated use of the investigated mouthwashes negatively affected the surface microhardness of both tested resin composites. The observed effects were both mouthwash and material dependent.

The Effectiveness of Vegetable Starfruit Juice (Averrhoa bilimbi) and Rosella Tea (Hibiscus sabdariffa L) Against the Inhibition of Dental Plaque Formation

BACKGROUND: Dental disease is a significant public health problem. Various efforts have been made to maintain oral health by utilizing natural ingredients from plants. One of the natural ingredients often used among the community is Vegetable Starfruit Juice (Averrhoa bilimbi) and Rosella Tea. AIM: The purpose of this study was to analyze the effectiveness of Starfruit and rosella tea (Hibiscus sabdariffa L) on the Inhibition of Dental Plaque Formation. METHODS: Design this research is an experimental study with a post-test design only. The research was conducted in Gampong Batoh, Lueng Bata District, Banda Aceh City, from June 26 to October 04, 2021. The study population was the community of Gampong Batoh, Banda Aceh City. The sample in this study used a purposive sampling technique. The sample in this study met the criteria and was willing to assist in implementing the research by signing the informed consent. The number of research samples was 40 people. RESULTS: The results showed a significant difference in the effectiveness of Starfruit juice and rosella tea on the inhibition of plaque formation based on time duration (p < 0.05). The group that rinsed with rosella tea solution had more effective inhibition than the group that rinsed with vegetable Starfruit juice solution (p < 0.05). Vegetable Starfruit (A. bilimbi) and Rosella Tea contain bioactive compounds such as alkaloids, flavonoids, saponins, and tannins that can act as antibacterial agents in inhibiting the growth of Staphylococcus aureus. CONCLUSION: Vegetable Starfruit Juice (A. bilimbi) and Rosella Tea (H. sabdariffa L) effectively inhibit the formation of dental plaque.

Topical treatment of periodontitis using an iongel

Almost 50 % of the U.S. population suffers from oral infections such as periodontitis. Current treatment options for periodontitis include mechanical cleaning procedures, which are performed often under local anesthesia and are time-consuming. Alternate option includes systemic antibiotics which increase the risk of antimicrobial resistance and are not recommended for prolonged usage. Topical treatments of gingiva-based antimicrobial agents have shown limited efficacy due to poor penetration of the therapeutic into deep gingiva where the infection resides. Herein, we report an Iongel of a Deep Eutectic Antimicrobial (IDEA), which simultaneously exhibits deep tissue penetration and antimicrobial activity against P. gingivalis. In vivo studies confirmed that IDEA successfully penetrated into the gingiva and the gingival sulcus, where the pathogens primarily exist, within a short time. In vitro studies confirmed that the dose delivered was adequate to inactivate P. gingivalis biofilm. In vivo studies in a periodontal rat model confirmed that a topical treatment of IDEA eliminated pathogenic bacteria, and the disease progression was significantly suppressed. Safety studies confirmed excellent tolerance to IDEA. Altogether, IDEA offers a promising topical agent against periodontitis.

Recent Development of Active Ingredients in Mouthwashes and Toothpastes for Periodontal Diseases

Periodontal diseases like gingivitis and periodontitis are primarily caused by dental plaque. Several antiplaque and anti-microbial agents have been successfully incorporated into toothpastes and mouthwashes to control plaque biofilms and to prevent and treat gingivitis and periodontitis. The aim of this article was to review recent developments in the antiplaque, anti-gingivitis, and anti-periodontitis properties of some common compounds in toothpastes and mouthwashes by evaluating basic and clinical studies, especially the ones published in the past five years. The common active ingredients in toothpastes and mouthwashes included in this review are chlorhexidine, cetylpyridinium chloride, sodium fluoride, stannous fluoride, stannous chloride, zinc oxide, zinc chloride, and two herbs—licorice and curcumin. We believe this comprehensive review will provide useful up-to-date information for dental care professionals and the general public regarding the major oral care products on the market that are in daily use.

Evaluation of the efficacy of subgingival irrigation in patients with moderate-to-severe chronic periodontitis otherwise indicated for periodontal flap surgeries

Background:

In certain medically and physically compromised; and terminally ill patients, periodontal surgery may not be feasible. They need special attention and assistance for their daily plaque control regimens for the management and maintenance of periodontal conditions. Subgingival irrigation home care devices with antiplaque agents may serve as useful tools in such specific patient populations.

Aims:

The aim of this study was to evaluate of the efficacy of sub-gingival irrigation in patients with moderate-to-severe chronic periodontitis otherwise indicated for periodontal flap surgeries.

Settings and Design:

Randomized comparative parallel group interventional clinical trial.

Materials and Methods:

Forty adults with moderate-to-severe periodontitis, divided inot Group A and B, were subjected to the use of subgingival home irrigations using 0.06% chlorhexidine (CHX) and mouth-rinsing with 15 ml of 0.12% CHX twice daily, respectively after Phase I therapy. Clinical parameters, i.e., gingival index, oral hygiene index simplified, and bleeding on probing scores were assessed at baseline, 2 weeks, 4 weeks, and 12 weeks’ postphase I therapy, whereas clinical attachment level (CAL), probing depth (PD), and stain assessment at baseline and 12 weeks following Phase I therapy.

Statistical Analysis Used:

Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, USA version 15.0 for Windows).

Results:

A statistically significant difference was seen with the use of 0.06% CHX irrigations in PD (P = 0.004) and CAL (P = 0.002) as compared to the use of mouth rinsing with 0.12% CHX. Similar differences were observed in both intensity (P = 0.014) and area (P = 0.034) of lingual surface staining with greater staining with CHX mouth rinsing.

Conclusion:

The adjunctive use of subgingival home irrigations using 0.06% CHX has a promising potential to maintain the oral health and results in lesser staining compared to CHX mouth rinsing. The regimen may further obviate the need of periodontal surgery in medically compromised subjects.

Over-the-counter bleaching agents can help with tooth whitening maintenance

OBJECTIVE

This study evaluated the influence of over-the-counter agents on the maintenance of color and microhardness of the enamel after home bleaching protocol.

MATERIALS AND METHODS

Specimens of bovine teeth (6 × 6 × 2 mm) were prepared, and color (Easyshade, VITA) and microhardness (HMV-2, Shimadzu) readings were performed. All the specimens were bleached using 22% carbamide peroxide (22%CP), except for the control group, and then separated into seven groups (n = 10) according to the interaction of toothpaste (whitening, conventional, and whitening with peroxide) and mouth rinse (whitening and conventional). The study simulated 1 year of toothbrushing (Pepsodent, MAVTEC) and mouth rinse by immersion. After that, final color and microhardness measurements were performed. Data were analyzed by one-way ANOVA, Tukey's test (P < .05).

RESULTS

The group submitted to 22%CP + whitening toothpaste + whitening mouth rinse showed higher color maintenance (P < .05) than the control group. The perception of whitening of teeth (ΔWI_D ) was higher than the color change (ΔE₀₀ ). There was a decrease in microhardness after treatment with 22%CP + conventional toothpaste + whitening mouth rinse.

CONCLUSIONS

Over-the-counter products can help with the maintenance of tooth whitening after bleaching with carbamide peroxide; however, special attention should be given since the association of products can also reduce the microhardness of the dental enamel.

CLINICAL SIGNIFICANCE

The association between whitening toothpastes and mouth rinses might be beneficial for maintaining color during 1 year after bleaching treatment.

Effectiveness of herbal oral care products in reducing dental plaque & gingivitis - a systematic review and meta-analysis

Background

Despite the large number of trials conducted using herbal oral care products for the reduction of dental plaque or gingivitis, results are conflicting and inconclusive.

Objective

To assess the effectiveness of herbal oral care products compared to conventional products in reducing dental plaque and gingivitis adults.

Methods

We searched the following databases for Randomised controlled trials (RCTs): MEDLINE Ovid, EMBASE Ovid etc. which yielded 493 trails. Of which 24 RCTs comparing herbal toothpaste or mouth rinse with over the counter toothpaste or mouth rinse in adults aged 18 to 65 years were included. Two authors extracted information and assessed the methodological quality of the included studies using Risk of Bias. Meta-analyses using the random-effects model were conducted for four outcomes for tooth paste and mouth rinse respectively. Mean difference (MD) or standardized mean difference (SMD) were used to estimate the effect, with 95% confidence intervals.

Results

A total of 1597 adults participated in 24 RCT studies. These were classified as herbal toothpaste (HTP) (15 trials, 899 participants) and herbal mouth rinse (HMR) (9 trials, 698 participants) compared with non-herbal toothpaste (NHTP) or non-herbal mouth rinse (NHMR). We found that HTP was superior over NHTP (SMD 1.95, 95% CI (0.97–2.93)) in plaque reduction. The long-term use of NHMR was superior in reduction of dental plaque over HMR (SMD -2.61, 95% (CI 4.42–0.80)). From subgroup analysis it showed that HTP was not superior over fluoride toothpaste (SMD 0.99, 95% CI (0.14–2.13)) in reducing dental plaque. However, HTP was favoured over non-fluoride toothpaste (SMD 4.64, 95% CI (2.23–7.05)).

Conclusion

For short-term reduction in dental plaque, current evidence suggests that HTP is as effective as compared to NHTP; however, evidence is from low quality studies.

Effectiveness of Different Commercial Chlorhexidine-Based Mouthwashes After Periodontal and Implant Surgery: A Systematic Review

OBJECTIVES

The aim of the present study was to review the effectiveness, side effects, and patient acceptance of different concentrations and formulation of chlorhexidine-based mouthwashes used after periodontal and implant surgery.

MATERIALS AND METHODS

The PRISMA guideline was adopted in the search strategy using electronic databases PubMed and MEDLINE to identify randomized and case-control prospective studies on humans written in English language and published up to September 2017.

RESULTS

A total of 10 articles were selected for a total of 344 patients. Because of the significant heterogeneity of the outcome measures, meta-analysis was not performed, and the data were summarized in a table. A positive relationship between the use of chlorhexidine and reduction of plaque was found, demonstrating the effectiveness of the substance in terms of antisepsis and decrease of inflammation after periodontal and implant surgery.

CONCLUSION

Chlorhexidine is recognized as the primary agent for plaque control and the gold standard in preventing infection, although the presence of largely known side effects would affect patient compliance. Future research should be directed at finding chlorhexidine formulation with negligible adverse effects, without compromising or even increasing its effectiveness as the antiseptics and antiplaque agent.

Evaluation of Antibacterial Effect of Propolis and its Application in Mouthwash Production

Objectives:

Our purpose was to determine the antibacterial properties of propolis and to evaluate its use as an antibacterial mouthwash with minimal complications.

Materials and Methods:

In this experimental laboratory study, an alcoholic propolis extract was prepared. The minimum inhibitory concentration (MIC) was calculated for four bacterial species including Staphylococcus aureus (S. aureus), Streptococcus mutans (S. mutans), Lactobacillus acidophilus (L. acidophilus), and Enterococcus faecalis (E. faecalis) using agar dilution. According to the MIC, a propolis antibacterial mouthwash was produced and compared to water, chlorhexidine (CHX), and Listerine using laboratory rats for clinical examination. Salivary specimens of rats were collected at 12 hours, 1 week, and 2 weeks after using the mouthwash and examined by real-time polymerase chain reaction (RT-PCR). Data were analyzed using one-way analysis of variance (ANOVA) and repeated measures ANOVA (α=0.05).

Results:

The results of agar dilution by the number of colony-forming units showed the lowest MIC for S. aureus and the highest for L. acidophilus. Our RT-PCR findings indicated that water alone had no effect on the level of oral bacteria. Propolis mouthwash showed a significant difference with CHX and Listerine (P<0.05) in terms of the number of S. mutans, E. faecalis, and L. acidophilus colonies, while CHX and Listerine were less efficient. There was no significant difference between CHX and propolis (P=0.110) regarding S. aureus colonies, but Listerine had a lower efficacy than either (P<0.05).

Conclusion:

According to the results, propolis mouthwash was more efficient against the studied oral bacteria compared to CHX and Listerine.

Whether Chinese Medicine Have Effect on Halitosis: A Systematic Review and Meta-Analysis

OBJECT

Halitosis has great adverse impact on personal and social life. There is no strong evidence for the effect of Chinese medicine (CM) and combined Chinese and western medicine (CWM) on halitosis. The aim of the present study is to evaluate the effective rate of CM and CWM on halitosis.

MATERIALS AND METHODS

Literature search in English and Chinese was conducted in PubMed, Embase, CNKI, CBM, and Wanfang database. Study selection and data collection were conducted. Risks of bias were assessed by the Cochrane tool. Synthesis of results was done by RevMan 5.3. p<0.05 was considered significant difference. Subgroup analysis by classification of halitosis and sensitivity analysis were also conducted.

RESULTS

Seventeen studies were included. The follow-up length ranged from five days to eight weeks. CM had significantly better effect than WM on intraoral halitosis (I2 =24%; RR=1.21 (95% CI, 1.04, 1.40), P=0.01) and extraoral halitosis (I2 =0; RR=1.39 (95% CI, 1.19, 1.63), P<0.0001). CWM had significantly better effect than WM on intraoral halitosis (I2 =0; RR=1.25 (95% CI, 1.16, 1.35), P<0.00001) and extraoral halitosis (I2 =0; RR=1.19 (95% CI, 1.08, 1.31), P=0.0004). Subgroup analysis and sensitivity analysis showed insignificant results.

CONCLUSION

With the limitation of our study, both CM and CWM have significantly better effect on halitosis than WM. More effort should be made to explore long-term effect of CM and CWM on halitosis. This study was registered with the PROSPERO (ID: CRD42018107229).

Effect of mouthwashes on the discolouration of restorative materials commonly used in paediatric dentistry

AIM

This was to investigate the effects of Klorhex, Tantum Verde, Kloroben, and Listerine on the discolouration of composite resin, compomer, giomer, and resin-modified glass ionomer.

METHODS

Fifty disc-shaped specimens from each restorative material (n = 50) were prepared; initial colour values were measured with a spectrophotometer. Forty specimens from each group were placed in the four different types of mouthwashes (n = 10), while the remaining 10 specimens were immersed in distilled water for 2 min, twice a day for a period of 3 weeks. Colour change (ΔE*) values were obtained and the results were evaluated statistically.

RESULTS

The ΔE* of composite resin in Klorhex (0.84 ± 0.37) was significantly lower than that of the other mouthwash groups. Moreover, composite resin showed the least colour change when compared with the other materials in all four mouthwashes. Resin-modified glass ionomer values were significantly higher in Tantum Verde (6.36 ± 2.82) when compared with the other mouthwashes (p < 0.05). Clinically appreciable discolourations were observed in the resin-modified glass ionomer specimens placed in Tantum Verde and Listerine.

CONCLUSIONS

Nano-filling composite resins are the most successful aesthetic restorative materials, whereas the commonly used resin-modified glass ionomers exhibit more aesthetically divergent results following the use of mouthwashes.

Topical application of glycyrrhetinic acid in the gingival sulcus inhibits attachment loss in lipopolysaccharide-induced experimental periodontitis in rats

BACKGROUND AND OBJECTIVE

Attachment loss of the junctional epithelium and alveolar bone destruction are signs of periodontitis, which is mainly caused by an inflammatory response to dental plaque. Glycyrrhetinic acid (GA), a component of the licorice herb, has been shown to have important anti-inflammatory activities; however, there are no previous reports on the ability of its inhibitory effects to prevent periodontal diseases. Hence, in this study, using our experimental periodontitis model, we attempted to evaluate whether GA had an effect on the prevention of attachment loss and alveolar bone loss.

MATERIAL AND METHODS

Rats were intraperitoneally immunized with Escherichia coli lipopolysaccharide (LPS). The LPS group (n = 5) received 3 topical applications of 50 μg/μL of LPS followed by one application of the vehicle (propylene glycol:ethyl alcohol:phosphate-buffered saline [PBS] = 8:1:1) into the gingival sulcus. This protocol was repeated twice per day for 10 days. The low (n = 5) and high (n = 5) groups received topical application of LPS and 0.03% or 0.3% GA, respectively. The control group received topical application of PBS and vehicle. The rats were killed on the 10th day. Attachment loss, alveolar bone level and inflammatory cell infiltration were investigated histometrically. The formation of immune complexes and infiltration of LPS were evaluated immunohistologically.

RESULTS

Attachment loss, formation of immune complexes and infiltration of inflammatory cells were increased in the LPS group compared with the control group, and were completely inhibited in the low and high groups compared with the LPS group. The LPS group showed greater alveolar bone destruction compared with the control group and GA-treated groups. In addition, invasion of LPS was detected in the LPS group, was absent in the control group and was weaker in the GA-treated groups than in the LPS group.

CONCLUSION

In the present study, we showed that GA inhibits periodontal destruction in the rat experimental periodontitis model.

Chlorhexidine mouthrinse as an adjunctive treatment for gingival health

BACKGROUND

Dental plaque associated gingivitis is a reversible inflammatory condition caused by accumulation and persistence of microbial biofilms (dental plaque) on the teeth. It is characterised by redness and swelling of the gingivae (gums) and a tendency for the gingivae to bleed easily. In susceptible individuals, gingivitis may lead to periodontitis and loss of the soft tissue and bony support for the tooth. It is thought that chlorhexidine mouthrinse may reduce the build-up of plaque thereby reducing gingivitis.

OBJECTIVES

To assess the effectiveness of chlorhexidine mouthrinse used as an adjunct to mechanical oral hygiene procedures for the control of gingivitis and plaque compared to mechanical oral hygiene procedures alone or mechanical oral hygiene procedures plus placebo/control mouthrinse. Mechanical oral hygiene procedures were toothbrushing with/without the use of dental floss or interdental cleaning aids and could include professional tooth cleaning/periodontal treatment.To determine whether the effect of chlorhexidine mouthrinse is influenced by chlorhexidine concentration, or frequency of rinsing (once/day versus twice/day).To report and describe any adverse effects associated with chlorhexidine mouthrinse use from included trials.

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 28 September 2016); the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 8) in the Cochrane Library (searched 28 September 2016); MEDLINE Ovid (1946 to 28 September 2016); Embase Ovid (1980 to 28 September 2016); and CINAHL EBSCO (Cumulative Index to Nursing and Allied Health Literature; 1937 to 28 September 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.

SELECTION CRITERIA

We included randomised controlled trials assessing the effects of chlorhexidine mouthrinse used as an adjunct to mechanical oral hygiene procedures for at least 4 weeks on gingivitis in children and adults. Mechanical oral hygiene procedures were toothbrushing with/without use of dental floss or interdental cleaning aids and could include professional tooth cleaning/periodontal treatment. We included trials where participants had gingivitis or periodontitis, where participants were healthy and where some or all participants had medical conditions or special care needs.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened the search results extracted data and assessed the risk of bias of the included studies. We attempted to contact study authors for missing data or clarification where feasible. For continuous outcomes, we used means and standard deviations to obtain the mean difference (MD) and 95% confidence interval (CI). We combined MDs where studies used the same scale and standardised mean differences (SMDs) where studies used different scales. For dichotomous outcomes, we reported risk ratios (RR) and 95% CIs. Due to anticipated heterogeneity we used random-effects models for all meta-analyses.

MAIN RESULTS

We included 51 studies that analysed a total of 5345 participants. One study was assessed as being at unclear risk of bias, with the remaining 50 being at high risk of bias, however, this did not affect the quality assessments for gingivitis and plaque as we believe that further research is very unlikely to change our confidence in the estimate of effect. Gingivitis After 4 to 6 weeks of use, chlorhexidine mouthrinse reduced gingivitis (Gingival Index (GI) 0 to 3 scale) by 0.21 (95% CI 0.11 to 0.31) compared to placebo, control or no mouthrinse (10 trials, 805 participants with mild gingival inflammation (mean score 1 on the GI scale) analysed, high-quality evidence). A similar effect size was found for reducing gingivitis at 6 months. There were insufficient data to determine the reduction in gingivitis associated with chlorhexidine mouthrinse use in individuals with mean GI scores of 1.1 to 3 (moderate or severe levels of gingival inflammation). Plaque Plaque was measured by different indices and the SMD at 4 to 6 weeks was 1.45 (95% CI 1.00 to 1.90) standard deviations lower in the chlorhexidine group (12 trials, 950 participants analysed, high-quality evidence), indicating a large reduction in plaque. A similar large reduction was found for chlorhexidine mouthrinse use at 6 months. Extrinsic tooth staining There was a large increase in extrinsic tooth staining in participants using chlorhexidine mouthrinse at 4 to 6 weeks. The SMD was 1.07 (95% CI 0.80 to 1.34) standard deviations higher (eight trials, 415 participants analysed, moderate-quality evidence) in the chlorhexidine mouthrinse group. There was also a large increase in extrinsic tooth staining in participants using chlorhexidine mouthrinse at 7 to 12 weeks and 6 months. Calculus Results for the effect of chlorhexidine mouthrinse on calculus formation were inconclusive. Effect of concentration and frequency of rinsing There were insufficient data to determine whether there was a difference in effect for either chlorhexidine concentration or frequency of rinsing. Other adverse effects The adverse effects most commonly reported in the included studies were taste disturbance/alteration (reported in 11 studies), effects on the oral mucosa including soreness, irritation, mild desquamation and mucosal ulceration/erosions (reported in 13 studies) and a general burning sensation or a burning tongue or both (reported in nine studies).

AUTHORS' CONCLUSIONS

There is high-quality evidence from studies that reported the Löe and Silness Gingival Index of a reduction in gingivitis in individuals with mild gingival inflammation on average (mean score of 1 on the 0 to 3 GI scale) that was not considered to be clinically relevant. There is high-quality evidence of a large reduction in dental plaque with chlorhexidine mouthrinse used as an adjunct to mechanical oral hygiene procedures for 4 to 6 weeks and 6 months. There is no evidence that one concentration of chlorhexidine rinse is more effective than another. There is insufficient evidence to determine the reduction in gingivitis associated with chlorhexidine mouthrinse use in individuals with mean GI scores of 1.1 to 3 indicating moderate or severe levels of gingival inflammation. Rinsing with chlorhexidine mouthrinse for 4 weeks or longer causes extrinsic tooth staining. In addition, other adverse effects such as calculus build up, transient taste disturbance and effects on the oral mucosa were reported in the included studies.

Acute Ataxia in Children: A Review of the Differential Diagnosis and Evaluation in the Emergency Department

Acute ataxia in a pediatric patient poses a diagnostic dilemma for any physician. While the most common etiologies are benign, occasional individuals require urgent intervention. Children with stroke, toxic ingestion, infection, and neuro-inflammatory disorders frequently exhibit ataxia as an essential-if not the only-presenting feature. The available retrospective research utilize inconsistent definitions of acute ataxia, precluding the ability to pool data from these studies. No prospective data exist that report on patients presenting to the emergency department with ataxia. This review examines the reported causes of ataxia and attempts to group them into distinct categories: post-infectious and inflammatory central and peripheral phenomena, toxic ingestion, neurovascular, infectious and miscellaneous. From there, we synthesize the existing literature to understand which aspects of the history, physical exam, and ancillary testing might aid in narrowing the differential diagnosis. MRI is superior to CT in detecting inflammatory or vascular insults in the posterior fossa, though CT may be necessary in emergent situations. Lumbar puncture may be deferred until after admission in most instances, with suspicion for meningitis being the major exception. There is insufficient evidence to guide laboratory evaluation of serum, testing should be ordered based on clinical judgement-recommended studies include metabolic profiles and screening labs for metabolic disorders (lactate and ammonia). All patients should be reflexively screened for toxic ingestions.

Effectiveness of Azadirachta indica (neem) mouthrinse in plaque and gingivitis control: a systematic review

OBJECTIVES

The aim of this systematic review was to evaluate the effectiveness of Azadirachta indica (neem)-based herbal mouthrinse in improving plaque control and gingival health.

METHODS

Literature search was accomplished using electronic databases (PubMed, Cochrane Central Register of Controlled Trials and EMBASE) and manual searching, up to February 2015, for randomized controlled trials (RCTs) presenting clinical data for efficacy of neem mouthrinses when used alone or as an adjunct to mechanical oral hygiene as compared to chlorhexidine mouthrinses for controlling plaque and gingival inflammation in patients with gingivitis.

RESULTS

Of the total 206 articles searched, three randomized controlled trials evaluating neem-based herbal mouthrinses were included. Due to marked heterogeneity observed in study characteristics, meta-analysis was not performed. These studies reported that neem mouthrinse was as effective as chlorhexidine mouthrinse when used as an adjunct to toothbrushing in reducing plaque and gingival inflammation in gingivitis patients. However, the quality of reporting and evidence along with methods of studies was generally flawed with unclear risk of bias.

CONCLUSION

Despite the promising results shown in existing randomized controlled trials, the evidence concerning the clinical use of neem mouthrinses is lacking and needs further reinforcement with high-quality randomized controlled trials based on the reporting guidelines of herbal CONSORT statement.

Can Chemical Mouthwash Agents Achieve Plaque/Gingivitis Control?

Also note that structured abstracts are not allowed per journal style: What is the effect of a mouthwash containing various active chemical ingredients on plaque control and managing gingivitis in adults based on evidence gathered from existing systematic reviews? The summarized evidence suggests that mouthwashes containing chlorhexidine(CHX) and essential oils (EO) had a large effect supported by a strong body of evidence. Also there was strong evidence for a moderate effect of cetylpyridinium chloride(CPC). Evidence suggests that a CHX mouthwash is the first choice, the most reliable alternative is EO. No difference between CHX and EO with respect to gingivitis was observed.

Comparative efficacy of oil pulling and chlorhexidine on oral malodor: a randomized controlled trial

BACKGROUND

Oral malodor affects a large section of population. Traditional Indian folk remedy, oil pulling not only reduces it but can also bring down the cost of treatment.

AIMS

To compare the efficacy of oil pulling and chlorhexidine in reducing oral malodor and microbes.

MATERIALS AND METHODS

Three week randomized controlled trial was conducted among 60 students of three hostels of Maharani College of science and arts and commerce and Smt V.H.D.College of Home Science. The hostels were randomized into two intervention groups namely chlorhexidine group, sesame oil and one control (placebo) group. Twenty girls were selected from each hostel based on inclusion and exclusion criteria. Informed consent was obtained. The parameters recorded at the baseline (day 0) and post intervention on day 22 were plaque index (PI), gingival index (GI), objective (ORG1) and subjective (ORG2) organoleptic scores and anaerobic bacterial colony (ABC) count. Intra and inter group comparisons were made using Kruskal Wallis test, Wilcoxan sign rank test, ANOVA and student t-test.

RESULTS

There was significant reduction (p<0.05) in the mean scores of all the parameters within sesame oil and chlorhexidine group. Among the groups significant difference was observed in objective and subjective organoleptic scores. Post hoc test showed significant difference (p<0.000) in mean organoleptic scores of sesame oil and placebo and chlorhexidine and placebo group. No significant difference (p<0.05) was observed between sesame oil and chlorhexidine group.

CONCLUSION

Oil pulling with sesame oil is equally efficacious as chlorhexidine in reducing oral malodor and microbes causing it. It should be promoted as a preventive home care therapy.

Effect of Toothbrushing-mouthrinse-cycling on Surface Roughness and Topography of Nanofilled, Microfilled, and Microhybrid Resin Composites

The purpose of this study was to evaluate the influence of toothbrushing-mouthrinse-cycling (TMC) on the surface roughness and topography of three resin composites with different filler particle systems (Z350, nanofilled [Nf]; Durafill, microfilled [Mf], and Empress Direct, microhybrid [Mh]). Twenty specimens of each resin composite (8.0 mm diameter and 2 mm height) were randomly divided into four groups (n=5) according to the mouthrinses: alcohol-free (Plax – P) and alcohol-containing (Listerine – L and Plax Fresh Mint – PM) and artificial saliva (control – AS). The specimens were submitted to TMC for nine weeks. A surface roughness tester and a three-dimensional profilometer were used to measure the roughness (Ra) and the topography (Sa) before and after TMC. The data were analyzed by multifactor analysis of variance and Tukey post hoc test (α=0.05). In all media, Mh presented greater roughness than Mf (p&lt;0.05). The highest value of roughness was presented by Mh immersed in L (p&lt;0.05). The lowest values of roughness were presented by Mf (p&lt;0.05). The three resin composites presented the highest roughness after immersion in mouthrinses containing alcohol (PM and L) (p&lt;0.05). For the three resin composites, the increase in roughness was noticeable after the fifth week. Topographic analysis showed that the smoothest surfaces were present after immersion in AS.

The effects of mouth rinses on the color stability of resin-based restorative materials

OBJECTIVE

The aim of this study was to assess the color stability of three direct resin-based restorative materials: IPS Empress Direct (Ivoclar Vivadent, Schaan, Liechtenstein), Nano-filled composite (Filtek Z 350 XT, 3 M ESPE, St. Paul, MN, USA), and Nano-hybrid composite (Tetric Evo Ceram, Ivoclar Vivadent, Schaan, Liechtenstein) upon immersion into the following three mouth rinses: Antiseptol (Kahira Pharmaceuticals and Chemical Industries Co. Cairo-Egypt), Flucal (Alexandria Co. Pharmaceuticals Alexandria, Egypt), and Listerine (Johnson & Johnson, UK).

MATERIALS AND METHODS

Ninety disc-shaped, 12 mm × 1 mm specimens were divided into three groups according to the type of direct resin-based restorative material used. The specimens were randomly subdivided into three different subgroups (N = 10) in terms of immersion medium. Color change was evaluated prior to and after immersion into the mouth rinses for 24 hours by spectrophotometry (Shimadzu, UV-3101 PC Shimadzu Corporation. Kyoto, Japan).

RESULTS

Data were statistically analyzed using two-way analysis of variance (ANOVA) to assess the color stability of the restorative materials. The post hoc Scheffe's test was applied to clarify pair-wise statistical significance. Results with p-values < 0.05 were considered statistically significant. IPS Empress Direct (ΔE = 1.48) exhibited more favorable stability than the other tested composite resins, Filtek Z 350 X (ΔE = 3.05) and Tetric Evo Ceram (ΔE = 10.35). The immersion media elicited a significant effect on the color stability of the tested, resin-based restorative materials, where Flucal elicited the most significant color change, followed by Listerine and Antiseptol, which elicited the least significant color change.

CONCLUSIONS

Within the limitation of this laboratory study, the following conclusions could be drawn: (1) The composite structure, namely the resin formulation, which includes the filler size and type of photo-initiator, has a direct impact on its susceptibility to stain by external agents; (2) Mouth rinses can be considered stainable solutions; (3) The chemical formulation of individual mouth rinses can significantly control their ability to stain.

CLINICAL SIGNIFICANCE

Patient use of mouth rinses should be subject to dental supervision to control their adverse effects on the aesthetic quality of the restoration. Knowing the composition of the restorative material is important, as is its polymerization cycle and the promotion of adequate surface texture in order to select the appropriate material for each clinical application, and to use it in an effective way to promote its best properties.

Low-cost periodontal therapy

Periodontitis is a complex infectious disease that affects low-income individuals disproportionately. Periodontitis is associated with specific bacterial species and herpesviruses, and successful prevention and treatment of the disease is contingent upon effective control of these pathogens. This article presents an efficacious, highly safe, minimally invasive, practical and low-cost periodontal therapy that involves professional and patient-administered mechanical therapy and antimicrobial agents. The major components are scaling for calculus removal, periodontal pocket irrigation with potent antiseptics, and treatment with systemic antibiotics for advanced disease. Povidone-iodine and sodium hypochlorite have all the characteristics for becoming the first-choice antiseptics in the management of periodontal diseases. Both agents show excellent antibacterial and antiviral properties, are readily available throughout the world, have been safely used in periodontal therapy for decades, offer significant benefits for individuals with very limited financial resources, and are well accepted by most dental professionals and patients. Four per cent chlorhexidine applied with a toothbrush to the most posterior part to the tongue dorsum can markedly reduce or eliminate halitosis in most individuals. Systemic antibiotics are used to treat periodontopathic bacteria that are not readily reached by topical therapy, such as pathogens within gingival tissue, within furcation defects, at the base of periodontal pockets, and on the tongue, tonsils and buccal mucosae. Valuable antibiotic therapies are amoxicillin-metronidazole (250 mg of amoxicillin and 250 mg of metronidazole, three times daily for 8 days) for young and middle-aged patients, and ciprofloxacin-metronidazole (500 mg of each, twice daily for 8 days) for elderly patients and for patients in developing countries who frequently harbor enteric rods subgingivally. Scaling to remove dental calculus and the prudent use of inexpensive antimicrobial agents can significantly retard or arrest progressive periodontitis in the great majority of patients.

Supragingival plaque removal with and without dentifrice: a randomized controlled clinical trial

The aim of this study was to compare the efficacy of dental plaque removal by brushing with and without conventional dentifrice. Twenty-four students aged 17 to 28 years participated in this randomized controlled clinical trial. Quadrants 1-3 or 2-4 were randomly allocated to the test group (brushing without dentifrice) or control group (brushing with dentifrice). After 72 h of cessation of oral hygiene, Quigley & Hein (Turesky) plaque index was assessed before and after brushing by a calibrated and blind examiner. Overtime and intergroup comparisons were performed by Student's paired sample t-test at 5% significance level. The results showed that both groups after toothbrushing presented statistically significant reductions in plaque, with no differences between them (from 3.06 ± 0.54 to 1.27 ± 0.26 versus from 3.07 ± 0.52 to 1.31 ± 0.23). A separate analysis of the buccal and lingual aspects also showed no significant differences between groups. It may be concluded that the use of a conventional dentifrice during toothbrushing does not seem to enhance plaque removal capacity.

Clinical and microbiological efficacy of an antimicrobial mouth rinse containing 0.05% cetylpyridinium chloride in patients with gingivitis

OBJECTIVES

the aim of this study was to evaluate the effects of the use of a mouth rinse and dentifrice with cetylpyridinium chloride (CPC) in patients with gingivitis.

METHODS

the study was designed as a 1-month, double-blind, parallel, randomized clinical trial comparing a negative control regimen (minus active ingredients dentifrice and mouth rinse) with the test products (dentifrice and mouth rinse with 0.05% CPC) in terms of plaque and gingival indexes (PI, GI), patient-based and microbiological outcome variables. The comparisons in relation to the main outcome variables (PI and GI) were made by means of the t-test, either unpaired or paired for the intergroup and intragroup comparisons, respectively.

RESULTS

no differences were detected at baseline. Both groups showed statistically significant decreases in GI (0.17-0.19), without intergroup differences. The PI demonstrated a significant decrease of -0.12 in the test group and minor changes in the negative control group (increase of +0.01). Differences between groups showed a tendency towards statistical significance. A limited impact was observed for microbiological variables in both groups.

CONCLUSION

the results of this study show limited benefits of the evaluated formulations as adjuncts to unsupervised oral hygiene in reducing plaque accumulation, and no effect on gingivitis.

Clinical Evidence of the Efficacy of a Mouthwash Containing Propolis for the Control of Plaque and Gingivitis: A Phase II Study

The aim of this study was to evidence the clinical efficacy of an alcohol-free mouthwash containing 5.0% (W/V) Brazilian green propolis (MGP 5%) for the control of plaque and gingivitis. Twenty five subjects, men and women aging between 18 and 60 years old (35 ± 9), were included in a clinical trials phase II study who had a minimum of 20 sound natural teeth, a mean plaque index of at least 1.5 (PI), and a mean gingival index of at least 1.0 (GI). They were instructed to rinse with 10 mL of mouthwash test for 1 minute, immediately after brushing in the morning and at night. After 45 and 90 days using mouthwash, the results showed a significant reduction in plaque and in gingival index when compared to samples obtained in baseline. These reductions were at 24% and 40%, respectively (P < .5). There were no important side effects in soft and hard tissues of the mouth. In this study, the MGP 5% showed evidence of its efficacy in reducing PI and GI. However, it is necessary to perform a clinical trial, double-blind, randomized to validate such effectiveness.

Mouthwash use in general population: results from adult dental health survey in grampian, Scotland

OBJECTIVES

The purpose of this study was to determine the pattern of mouthwash use and to investigate the associated factors in general population.

MATERIAL AND METHODS

An Adult Dental Health Survey was conducted on 3,022 residents of Grampian region of Scotland (adjusted participation rate 58.2%). Participants received a questionnaire consisting of questions on oral health and behavioural factors.

RESULTS

The majority of participants (38.1%) have never used mouthwash, 17.5% used mouthwash less than once a month, 19.4% used mouthwash once every few days and 25.1% used mouthwash daily. Prevalence of use decreased with age (P < 0.001). Woman were more likely to use mouthwash than men (P = 0.004). Mouthwash use decreased with decrease in the level of deprivation (P < 0.001). Never-smokers were less likely to use mouthwash (40.3%) compared to smokers (53.1%) or those who stopped smoking (46.5%) (P < 0.001). Mouthwash was used by smaller proportion of people drinking alcohol on daily basis (36.6%), than by abstainers (42.2%) (P = 0.012). There was a positive relationship between flossing or brushing pattern and mouthwash use (P < 0.001). There was statistically significant relationship between mouthwash use and reasons for the last dental visit (P = 0.009). When compared to healthy individuals, mouthwash was used by higher proportion of people reporting that they had gum disease (P = 0.001), ulcers (P = 0.001), oral infections or swelling (P = 0.002) or other problems (P = 0.025).

CONCLUSIONS

Mouthwash use in general population is associated with socio-demographic, health and behavioural factors.