Comparison of the efficacy of 40% chlorhexidine varnish and 1% chlorhexidine-fluoride gel in decreasing the level of salivary mutans streptococci

Comparative Evaluation of the Efficacy of Chlorhexidine, Fluoride and the Combined Use of Chlorhexidine and Fluoride Varnishes on Salivary Streptococcus mutans Count in Children with Mixed Dentition: An In Vivo Study

Aim

Materials and methods

Results

Conclusion

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Orthodontic Attachments and Chlorhexidine-Containing Varnish Effects on Gingival Health

Objective: To compare the severity of clinical inflammation parameters and the level of the inflammatory mediator interleukin (IL)–1β during orthodontic treatment by using brackets and bands. In addition, the effect of a chlorhexidine-containing varnish was investigated.

Materials and Methods: This prospective randomized controlled trial included 40 healthy children who required an orthodontic treatment of mild crowding. Either brackets or bands were randomly allocated to the premolars with a split-mouth design. Twenty of the children received a chlorhexidine-containing varnish during the treatment (0, 12, 24 weeks), while the remaining children served as a control group. Prior and until 24 weeks after the insertion, data were recorded regarding the pocket depth (PD), the gingival appearance (gingival index [GI]), and the plaque accumulation (plaque index [PI]). Gingival crevicular fluid was collected as well. A quantitative enzyme-linked immunoassay technique was used to detect differences in IL-1β.

Results: The PDs and the gingival index of teeth with brackets showed significantly lower values in comparison with teeth treated with bands (P = .0001). The IL-1β levels confirmed these findings. In contrast, the PI showed higher values for the teeth with brackets (P = .0001). The teeth that received a chlorhexidine-containing varnish showed significantly lower values in the follow-ups for most of the evaluated parameters (PDBand, PIBand, PIBracket, GIBand, GIBracket; P < .015).

Conclusion: The clinically observed parameters as well as the IL-1β levels reflected the higher impact of bands on gingival health. These values showed a significant decrease after application of a chlorhexidine-containing varnish. However, the PI showed higher values for the teeth with brackets.

Effect of chlorhexidine varnish application on mutans streptococci counts in orthodontic patients

INTRODUCTION

Enamel demineralization occurs frequently around orthodontic brackets. High levels of mutans streptococci (MS) increase the risk of caries. The hypotheses tested in this study were that high-frequency application of 40% chlorhexidine varnish (40%CHX) results in lower levels of MS in plaque of orthodontic patients compared with low-frequency application, and that bimonthly application of 40%CHX results in lower levels of MS in plaque compared with 1% chlorhexidine/1% thymol varnish (1%CHX).

METHODS

Eighty adolescent patients were randomly allocated to 4 treatment groups: monthly, bimonthly, and quarterly 40%CHX application, and bimonthly application of 1%CHX. Plaque samples were collected monthly and processed for MS counts. Twenty patients dropped out before the evaluation time at 1 month. Data from the remaining 60 adolescents were analyzed by using linear regression models with the plaque bacterial ratio (PBRx) as the dependent variable. The trial was ended after 5 months because of a high number of dropouts.

RESULTS

High-frequency application of 40%CHX did not provide lower mean PBRx than low-frequency application. Mean PBRx after 40%CHX application was lower than 1%CHX after 1 month (P = .002). This reduction was undiscernible 2 months after the application.

CONCLUSIONS

40%CHX application results in greater reduction of MS in plaque than 1%CHX a month after application. A follow-up study with a larger study population is warranted to test the first hypothesis.

Effect of 40% chlorhexidine varnish on mutans streptococci counts in pits and fissures of permanent first molars

OBJECTIVES

This study aimed to test the following hypotheses: (1) a carry-over effect of EC40 does not occur in a split-mouth model, (2) two consecutive applications of EC40 varnish with an interval of 3 months per year has a better inhibiting effect on mutans streptococci in pit and fissure plaque of permanent first molars of 6-7-year olds than a repeated application at each 6 months and (3) EC40 exerts an inhibiting effect on mutans streptococci for at least a 6-month duration.

METHODS

Using a split-mouth design, test molars received EC40 on fissures and pits and control molars remained without treatment. One group of test molars received EC40 at baseline, 6, 12 and 18 months and another group at baseline, 3, 12 and 15 months. Plaque samples were taken from pits and fissures of test and control molars at baseline, 6, 9, 12 and 24 months. A mixed ANOVA model was used to analyze the data.

RESULTS

The first hypothesis was accepted, the second rejected and the third accepted.

CONCLUSIONS

Twice a year EC40 application on pits and fissures of permanent first molars of 6-7-year-old children can significantly reduce mutans streptococci numbers for a 6-month period, but the reductions were small.

The effect of different formulations of chlorhexidine in reducing levels of mutans streptococci in the oral cavity: A systematic review of the literature

OBJECTIVES

The current study undertakes a systematic review of the literature in order to assess how long different formulations (solutions, gels and varnishes) of chlorhexidine (CHX) reduce the level of mutans streptococci (MS) in the oral cavity.

SOURCES

A search of the PUBMED and LILACS databases was conducted through October 2005.

STUDY SELECTION

Clinical studies evaluating the effects of CHX solutions, gels, or varnishes on MS levels were targeted (n=52).

CONCLUSIONS

The studies varied greatly in quantity of mouthwash solution used in rinsing, length of rinsing, and treatment frequency and period. CHX mouthwash solution had short-term effect on salivary MS. Most of studies evaluating CHX gel and varnish used a concentration of 1%. The 1% CHX gel showed a significant reduction through intensive treatment (3-4 daily applications over 2 days) or through daily application for 10 and 14 days. It cannot be asserted that 1% CHX varnish provides better results when applied intensively as compared to applications conducted at intervals of 1 or more months. Treatment using 1% CHX varnish displays large variations in the level and length of decreased MS levels. Despite variability in results, 40% CHX varnish has a greater effect on the period of decreased MS levels than does 1% CHX varnish. Studies did not show a statistically significant difference between the gel and the varnish. The effects of CHX treatment must be monitored, given sharp individual variability in response to this treatment.

The effect of 0.12% chlorhexidine dentifrice gel on plaque accumulation: a 3-day non-brushing model

BACKGROUND

Maintaining an adequate low level of plaque through daily tooth brushing is often not feasible. Effective chemotherapeutic agents as an adjunct to mechanical plaque control would therefore be valuable. Chlorhexidine (CHX) mouthwash has proved to be an effective inhibitor of plaque accumulation.

AIM

The purpose of the present study was to assess the effect of application of 0.12% CHX dentifrice gel on de novo plaque accumulation.

MATERIAL AND METHODS

The study was designed as a single blind, randomized three-arm parallel clinical trial. At the beginning of the test period all volunteers received a thorough professional oral prophylaxis. Subjects were randomly assigned to one of three regimens. During a 3-day non-brushing period, subjects abstained from all forms of mechanical oral hygiene. One regimen (test group) used 0.12% chlorhexidine dentifrice gel (CHX-DGel, Perio.Aid) applied in a fluoride gel tray, the benchmark control group used a regular dentifrice applied in a fluoride gel tray (RegD, Everclean HEMA). The positive control group rinsed with a 0.12% chlorhexidine mouthwash (CHX-MW, Perio.Aid). The Quigley and Hein plaque index (PI) from all subjects was assessed after 3 days of de novo plaque accumulation. Subsequently, all subjects received a questionnaire to evaluate their attitude, appreciation and perception towards the products used employing a Visual Analogue Scale scores. After the experimental period, habitual oral hygiene procedures were resumed.

RESULTS

Ninety-six systemically healthy subjects completed the study. After 3 days, the full-mouth PI for the CHX-DGel regimen was 1.87 compared with 1.93 for the RegD regimen and 1.55 for the CHX-MW regimen. The two dentifrices (CHX-DGel and RegD) were significantly less effective as the CHX-MW (P=0.0006). No significant difference between scores of the dentifrices was found.

CONCLUSION

Within the limitations of the present 3-day non-brushing study design, it can be concluded that application of 0.12% CHX dentifrice gel is not significantly different from application of regular dentifrice on plaque accumulation. Use of a 0.12% CHX mouthwash is significantly more effective. CHX-DGel appears a poor alternative for a dentifrice. It is not an effective inhibitor of plaque growth and does not possess fluoride.

Antimicrobial Effectiveness of a Highly Concentrated Chlorhexidine Varnish Treatment in Teenagers with Fixed Orthodontic Appliances

Objective: To evaluate the recolonization pattern of Mutans streptococci (ms) on densely colonized teeth with fixed orthodontic appliances after treatment with a highly concentrated (36%) chlorhexidine varnish.

Materials and Methods: Healthy subjects (n = 19) with fixed orthodontic appliances and high bacterial ms counts in saliva were recruited. In order to establish a baseline registration, plaque adjacent to brackets was sampled and cultivated on Dentocult® strips. Following professional tooth cleaning, chlorhexidine varnish was applied on all teeth for 8 minutes. The degree of recolonization with ms was assessed 2 weeks after varnish application in plaque around the brackets. For statistical analysis, the data were subjected to a repeated measures design.

Results: After 2 weeks, ms counts were reduced as compared to baseline values. However, the reduction only weakly met statistical significance (P = .049).

Conclusions: The application of a highly concentrated chlorhexidine varnish in patients with fixed orthodontic appliances does not result in a distinct reduction of ms numbers 2 weeks after treatment.

Study of the clinical usefulness of a dental drug system for selective reduction of mutans streptococci using a case series

The aim of this study was to evaluate the clinical efficacy and safety of a dental drug delivery system (3DS) for the selective reduction of mutans streptococci. Twenty patients with high levels of mutans streptococci in saliva participated. The efficacy of 0.2% chlorhexidine (CHX) delivered by 3DS in reducing the salivary levels of mutans streptococci compared with total streptococci and lactobacilli was investigated. Each subject was treated by professional mechanical tooth cleaning (PMTC) and subsequently individual trays with CHX for 5 min. Salivary bacterial samples were taken at the baseline and weeks 1-12. A significant reduction in the colony count of mutans streptococci was observed during the first 4 weeks compared with the baseline count, while no significant decrease in the count of total streptococci or lactobacilli was found during 12 weeks. In particular, the proportion of mutans streptococci in total streptococci remained low after 12 weeks. Our results indicate that the new 3DS used in combination with PMTC appears to be a promising intraoral drug delivery system which, when used with a low CHX concentration selectively, effectively reduces mutans streptococci in the oral cavity with no adverse effects.

Recolonization of mutans steptococci on teeth with orthodontic appliances after antimicrobial therapy

The aim of the present study was to compare the recolonization pattern of mutans streptococci on densely colonized teeth with and without fixed orthodontic appliances after treatment with a 40 per cent chlorhexidine (CHX) varnish (EC 40, Explore). Healthy subjects free of carious lesions requiring fixed orthodontic appliance treatment but with high bacterial mutans streptococci saliva counts were recruited (n = 10). For baseline registration, plaque from buccal sites was sampled and cultivated on Dentocult strips. Following professional tooth cleaning, CHX varnish was applied to all teeth for 8 minutes. Subsequently, orthodontic brackets and bands were inserted in either the upper or lower arch. Eight weeks after varnish application the degree of recolonization with mutans streptococci was reassessed on the buccal sites. Statistical analysis showed that recolonization with mutans streptococci was significantly higher (P < 0.05) on teeth with orthodontic appliances. The results indicate that the use of fixed orthodontic appliances creates artificial environments suitable for the proliferation of mutans streptococci after CHX varnish suppression.

Feasibility of eradication of mutans streptococci from oral cavities

OBJECTIVES

Dental caries prevention programs using chlorhexidine (CHX) have been proposed, but CHX's effect in reducing levels of mutans streptococci (S. mutans and S. sobrinus) appears to last for only a few months. The aim of this study was to attempt to eradicate mutans streptococci from the oral cavity using intensive professional mechanical tooth cleaning (PMTC) and topical application of CHX in custom-made trays.

METHODS

Seven adult dentate subjects participated in this study (mean age 53.7+/-5.6, age range 46 to 62, mean DMFT, 9.1+/-4.2). For each subject, PMTC was carried out eight times within ten days. After each PMTC, 1% CHX was applied twice to the tooth surface using custom-made trays. In addition, as home treatment, subjects were required to carry out tooth brushing three times a day, and apply 0.2% CHX in custom trays after brushing in the morning and evening. In addition, subjects rinsed with 0.2% CHX solution after lunch. Salivary levels of mutans streptococci were evaluated using Dentocult-SM at baseline and on days 9, 20, 70, 120.

RESULTS

Mutans streptococci were eradicated by day 120 from 4 of the 7 seven subjects participating in this study. Those 3 subjects still harboring mutans streptococci exhibited deep periodontal pocketing.

CONCLUSIONS

Eradication of mutans streptococci from the oral cavity is feasible using a combination of CHX application in custom-made trays and intensive PMTC.

Efficacy of differently concentrated chlorhexidine varnishes in decreasing Mutans streptococci and lactobacilli counts

The objective of the present prospective trial was to compare the efficacy of differently concentrated chlorhexidine varnishes (EC40) = 40% chlorhexidine and Cervitec = 1% chlorhexidine + 0.1% thymol) on levels of Mutans streptococci (ms), lactobacilli (lb) and plaque formation in interproximal plaque and saliva. Twenty-four volunteers with a high level of ms in saliva were randomized into two groups and treated with the experimental varnishes. Varnish applications were performed in accordance with literature. Over a period of 2 weeks Cervitec was applied three times and EC40 once or twice, depending on ms counts after first application. Four and 12 weeks after final varnish application ms in plaque and saliva were evaluated. Furthermore, lactobacilli (lb) counts in saliva and the effect on plaque formation were recorded. Both varnishes revealed a reduction of ms in interproximal plaque and saliva after 4 and 12 weeks. The highly concentrated varnish revealed a significantly stronger reduction of ms in plaque and saliva compared with the lowly-concentrated varnish. No effect could be demonstrated on lb counts and plaque formation. The results indicate that the chlorhexidine varnishes tested may reduce ms in both interproximal plaque and saliva. However, the application of the highly concentrated varnish EC40 results in a higher decrease of ms in plaque sites and saliva.

Effects of chlorhexidine on human taste perception

Chlorhexidine, a bis-cationic biguanide antiseptic, greatly reduces the perceived intensity of the salty prototype sodium chloride and may prove to be an important probe of mechanisms that underlie the human salty taste quality. Chlorhexidine, which tastes bitter, also reduces quinine hydrochloride taste intensity, but neither sweet sucrose nor sour citric acid is affected. Perceptual intensity rating and quality identification were measured for human subjects before and for 30 min following treatment with 1.34 mM chlorhexidine gluconate. In one experiment, test stimuli were the taste-quality prototypes; in a second experiment, stimuli were series of sodium, halide and sulfate salts. Experiment 1 showed a single 3-min chlorhexidine treatment resulted in reductions in taste intensity that persisted for at least 30 min. Experiment 2 showed a single 2-min chlorhexidine treatment reduced perceptual intensities of halide and sulfate salts except those with divalent cations. Chlorhexidine impaired identification of the salty quality and produced a bitter quality in nonbitter salts and impaired identification of the bitter quality of quinine, but not bitter salts. The specific effect of chlorhexidine on the bitterness of quinine suggests it may bind to the same receptor as quinine. The ability of chlorhexidine to specifically disrupt saltiness of a wide range of salts is consistent with proposed peripheral transduction mechanisms for the salty quality that involve transepithelial ion transport.

Maintaining mutans streptococci suppression with xylitol chewing gum

BACKGROUND

One strategy for treating dental caries is to suppress oral mutans streptococci, or MS, with chlorhexidine, or CHX, mouthrinse. Oral MS levels, however, tend to quickly return to baseline values without further intervention. In this clinical study, the authors evaluated the effect of xylitol chewing gum on MS regrowth.

METHODS

The authors selected 151 subjects with elevated oral MS levels (> or = 105 colony-forming units per milliliter, or CFU/mL, of paraffin-stimulated saliva). Subjects rinsed with 0.12 percent CHX gluconate mouthrinse twice daily for 14 days. The authors then randomly assigned the subjects to one of three groups. Those in the test group (n = 51) chewed a commercial xylitol gum three times daily for a minimum of five minutes each time for three months. The placebo group subjects (n = 50) used a commercial sorbitol gum, and the control group subjects (n = 50) did not chew gum. The authors estimated MS load on the dentition using paraffin-stimulated saliva samples. The authors serially diluted the samples, plated them on selective media and incubated them anaerobically; they then enumerated the colonies under a stereomicroscope.

RESULTS

MS levels were not significantly different between the three groups at baseline (mean log CFU/mL +/- standard deviation: 5.4 +/- 0.7, 5.4 +/- 0.8, 5.2 +/- 0.7, respectively) nor after CHX therapy (2.7 +/- 0.8, 3.1 +/- 1.1, 3.0 +/- 1.1, respectively). After three months of gum chewing, the test group subjects had significantly lower salivary MS levels (3.6 +/- 1.2) than did the placebo (4.7 +/- 1.2) or control (4.4 +/- 1.3) group subjects.

CONCLUSIONS

Xylitol chewing gum appears to have the ability to prolong the effect of CHX therapy on oral MS.

CLINICAL IMPLICATIONS

Maintaining long-term caries-pathogen suppression is feasible with currently available commercial products and can be expected to result in significant caries inhibition.

Prevention of bacteremia in dogs undergoing dental scaling by prior administration of oral clindamycin or chlorhexidine oral rinse

Dogs with periodontitis were used to determine the efficacy of an oral regimen of clindamycin versus chlorhexidine acetate oral rinse in reducing the total number of bacteria and the incidence of bacteremia before and after dental scaling. Aerobic and anaerobic bacteria, isolated from blood and gingival swab cultures, were identified to genus using an automated system.

Influence of maternal xylitol consumption on acquisition of mutans streptococci by infants

Xylitol is effective as a non-cariogenic sugar substitute. Habitual xylitol consumption appears to select for mutans streptococci (MS) with impaired adhesion properties, i.e., they shed easily to saliva from plaque. One hundred sixty-nine mother-child pairs participated in a two-year study exploring whether the mothers' xylitol consumption could be used to prevent mother-child transmission of mutans streptococci. All mothers showed high salivary levels of mutans streptococci during pregnancy. The mothers in the xylitol group (n = 106) were requested to chew xylitol-sweetened gum (65% w/w) at least 2 or 3 times a day, starting three months after delivery. In the two control groups, the mothers received either chlorhexidine (n = 30) or fluoride (n = 33) varnish treatments at 6, 12, and 18 months after delivery. The children did not chew gum or receive varnish treatments. MS were assessed from the mothers' saliva at half-year intervals and from the children's plaque at the one- and two-year examinations. The MS were cultured on Mitis salivarius agars containing bacitracin. The salivary MS levels of the mothers remained high and not significantly different among the three study groups throughout the study. At two years of age, 9.7% of the children in the xylitol, 28.6% in the chlorhexidine, and 48.5% in the fluoride varnish group showed a detectable level of MS. In conclusion, therefore, habitual xylitol consumption by mothers was associated with a statistically significant reduction of the probability of mother-child transmission of MS assessed at two years of age. The effect was superior to that obtained with either chlorhexidine or fluoride varnish treatments performed as single applications at six-month intervals.

Interdental caries incidence and progression in relation to mutans streptococci suppression after chlorhexidine-thymol varnish treatments in schoolchildren

The aim of this study was to evaluate interdental caries incidence and progression in relation to the effect of antibacterial varnish treatments in schoolchildren anticipated at caries risk. After a screening procedure, 110 healthy children (8-10 years) with moderate and high counts of salivary mutans streptococci (MS) were invited to join a 2-year longitudinal study. At baseline, MS were enumerated at all mesial interdental sites of the first permanent molars with a chair-side technique. The children were then treated 3 times within 2 weeks by interdental spot applications with a 1% chlorhexidine/thymol-containing varnish (Cervitec). Follow-up samples of saliva and plaque were collected 1, 3, 6, and 12 months after onset of treat. Caries prevalence, incidence and progression of the selected approximal surfaces were scored from bitewing radiographs exposed at baseline and after 2 years. Sixty-three children of the same age formed a non-varnish-treated reference group. Reduction of caries incidence and progression was dearly dependent on the outcome of the antibacterial treatment. A significantly (P< 0.01) higher progression score was found among children who exhibited a less marked suppression of interdental MS levels compared with those with high suppression and the children of the reference group. The results suggest that a suppression of MS in interdental plaque may be an important event to prevent and arrest approximal caries development in schoolchildren at risk. Monitoring the effect of antibacterial agents in a site-specific way could therefore be advocated.

Caries prevention: current strategies, new directions

Despite major advances in caries prevention, a large subset of the U.S. population still needs additional control measures. In numerous other countries, needs are escalating as caries rates continue to rise. Building on current strategies and new insights into the specific mechanisms of caries initiation, researchers are creatively using a variety of new technologies, especially in molecular biology, to fashion a new generation of preventive measures.