A comparison of three delivery methods of chlorhexidine in handicapped children. II. Parent and house-parent preferences

First insights into chlorhexidine retention in the oral cavity after application of different regimens

Objectives

This in situ study aimed to determine and compare the chlorhexidine (CHX) retention in the oral cavity after the application of different CHX pharmaceutical regimens.

Methods

Five volunteers used different CHX treatment regimens including mouth rinses, dental spray and toothpaste gel. After the application of the different CHX regimens, 2-μl samples were taken from saliva and buccal mucosa pellicle as well as the dental pellicle samples formed on standardized enamel surfaces. Sample collection was conducted at six time points within 12 h. Retention of CHX was measured using matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry.

Results

CHX retention values in the oral mucosa pellicle were significantly higher than those in saliva. CHX remained in the mucosal pellicle at microgrammes per millilitre levels for 12 h after mouth rinsing, 10 h after spray application and 2 h after using the toothpaste. CHX was detected in the dental pellicle for at least 12 h after application of mouth rinsing and spray. Retention of CHX after mouth rinsing or spray application was significantly higher than the retention after using toothpaste.

Conclusions

Oral mucosa was the favourable site for CHX retention. Higher mouth rinse concentration and longer rinsing time produced a slight increase in CHX retention. CHX spray provided considerable retention values, whereas toothpaste gel delivered the lowest retention after application. MALDI-TOF was a sensitive method with excellent limits of quantification for CHX detection.

Effect on plaque control in children patients with Down syndrome using Digital Brush with or without chlorhexidine: a randomized clinical trial

OBJECTIVES

The aim of this study was to evaluate efficacy in children affected by Down syndrome of "Digital Brush" in terms of Plaque Index reduction added to the daily oral hygiene procedures.

METHODS

A total of 56 patients with Down syndrome were recruited and randomly assigned in two groups: both control and test groups underwent standard hygiene procedures of tooth brushing twice a day followed by the intervention of Digital Brush, TNT gauze impregnated with chlorhexidine 0.12%, for the test group and by sterile gauze soaked in water for the control group. Initial plaque index was measured for all patients (T0), subsequently were instructed to use either Digital Brush or gauze soaked with water for 2 weeks. At last, patients were reevaluated (T1) and the plaque index measured.

RESULTS

Plaque index improvement from T0 to T1 in control group was 11.7%, while in test group was 24.1%. The mean differences between test and control group was statistically significant (p < 0.001).

CONCLUSIONS

This study demonstrates how the Digital Brush, added to the daily oral hygiene procedures, obtains significant improvements in supragingival plaque control in children with Down syndrome.

Chlorhexidine spray as an adjunct in the control of dental biofilm in children with special needs

The aim of this study was to evaluate the clinical effectiveness of .12% chlorhexidine applied via spray and the acceptance. A total of 26 individuals with mental health issues, aged 7-14, were included into two groups: placebo (control, n = 13) and chlorhexidine (experimental, n = 13). Both groups received two daily applications of spray during 2 months. The periodontal conditions were evaluated by the simplified oral hygiene index (OHI-S) and gingival index (GI). The evaluation of acceptance of the application method (spray) was assessed by questionnaire. Data were analyzed with nonparametric tests, with a significance level of 5%. Regarding the OHI-S index, only the experimental group showed significant change during the evaluations (p < 0.001). Regarding the GI, both groups showed significant changes during the evaluations. The method of application was well accepted by patients and caregivers, and .12% chlorhexidine solution applied via spray significantly reduced the rates of dental and gingival biofilm.

The effect of 1% chlorhexidine gel and 0.12% dentifrice gel on plaque accumulation: a 3-day non-brushing model

AIM

The purpose of the study was to compare the effects of four treatments on 'de novo' plaque accumulation. Treatments included tray application of 1% chlorhexidine gel (CHX-Gel), 0.12% chlorhexidine dentifrice-gel (CHX-DFG), a regular dentifrice (RDF) tray application, or 0.2% chlorhexidine mouthwash (CHX-MW) in a 3-day non-brushing model.

MATERIAL AND METHODS

The study was designed as a single blind, randomized parallel clinical trial. After professional prophylaxis, subjects abstained from all other forms of oral hygiene during a 3-day non-brushing period. Subjects were randomly assigned to one of the four test groups (CHX-Gel, CHX-DFG, RDF applied in a fluoride gel tray or rinsing with a CHX-MW). After 3 days, the Quigley & Hein plaque index (PI) and Bleeding on Marginal Probing (BOMP) index was assessed. Subsequently, all subjects received a questionnaire to evaluate their attitude, appreciation and perception towards the products used employing a Visual Analogue Scale.

RESULTS

After 3 days, the full-mouth PI means were 0.88 for the CHX-gel regimen, 0.79 for CHX-MW, 1.16 for CHX-DFG and 1.31 for the RDF regimen. The two dentifrices (CHX-DFG and RDF) were significantly less effective than the CHX-Gel or the CHX-MW.

CONCLUSION

Within the limitations of the present 3-day non-brushing study design, it can be concluded that the effect of a 1% CHX-Gel application tray is significantly greater than that of 0.12% CHX-DFG or RDF in inhibiting plaque accumulation. The 1% CHX-Gel applied via a tray and 0.2% CHX-MW rinse were comparably effective.

Inhibition of “De Novo” Plaque Formation With 0.12% Chlorhexidine Spray Compared to 0.2% Spray and 0.2% Chlorhexidine Mouthwash

BACKGROUND

Chlorhexidine (CHX) is widely accepted as the most effective product in the control of supragingival plaque. It is available in different delivery devices. The aim of this study was to test whether 0.12% CHX spray was as effective as 0.2% CHX spray and 0.2% CHX mouthwash in a 3-day "de novo" plaque formation model.

METHODS

Ninety volunteers were enrolled into a single-blind, randomized, three-group parallel study. They received a thorough dental prophylaxis prior to the test period. Subjects were divided randomly into three equal groups. They were requested to refrain from all forms of mechanical oral hygiene and instructed to use only their assigned product during the 3-day experimental period. After 3 days, the plaque growth was assessed using the Quigley and Hein plaque index (Q&H PI) at six sites per tooth.

RESULTS

After 3 days, the CHX mouthwash group had a mean Q&H PI of 1.17 compared to 1.41 for the 0.2% CHX spray and 1.49 for the 0.12% CHX spray. The difference between the mouthwash and the two sprays was statistically significant, whereas the two sprays did not differ significantly from each other.

CONCLUSIONS

Within the limitations of this 3-day "de novo" plaque formation study, the two sprays were not as effective as the mouthwash in plaque inhibition. No significant difference was found between the two sprays. To achieve the same effectiveness as a mouthwash, a higher dose (number of puffs) of CHX spray may be necessary.

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.

The Effects of Antimicrobial Sprays and Mouthrinses on Supragingival Plaque Regrowth: A Comparative Study

BACKGROUND

Due to the side effects of chlorhexidine digluconate (CHX) mouthrinsing, a spray has been proposed as an alternative method of CHX delivery to the oral cavity. The aim of this study was to investigate the plaque inhibitory effects of CHX, cetylpyridinium chloride (CPC), and triclosan (TRN) delivered by sprays and mouthrinses.

METHODS

The study was an observer-masked, randomized cross-over design balanced for carryover effects, involving 15 healthy volunteers in a 4-day plaque regrowth model. Products being tested (0.2% CHX, 0.12% CHX, 0.05% CPC, and 0.03% TRN) were used both as sprays and mouthrinses. A saline solution served as a negative control. On day 1, subjects received professional prophylaxis, suspended oral hygiene measures, and commenced using their allocated products. On day 5, subjects were scored for disclosed plaque.

RESULTS

CHX sprays (P<0.01) were the most effective sprays in preventing plaque regrowth, without significant differences between the two concentrations tested (P>0.05). TRN spray showed a significant inhibition of plaque regrowth in comparison to the negative control (P<0.05). CPC spray did not differ from saline spray (P>0.05). A similar trend of efficacy was detected for rinses. Although the effect on plaque regrowth observed with CHX rinses was superior to that of CHX sprays (P<0.0003), the latter did not cause side effects (P>0.2).

CONCLUSIONS

These findings, together with those from clinical trials, suggest that the CHX-containing sprays may represent an effective alternative to CHX rinses when mechanical oral hygiene has to be avoided in restricted areas. On the contrary, the TRN and CPC sprays showed little or no plaque inhibitory effects.

The Effects of Three Oral Sprays on Plaque and Gingival Inflammation

BACKGROUND

The aim of this clinical trial was to compare the effects of three oral sprays containing chlorhexidine (CHX), benzydamine hydrochloride (B-HCl), and CHX plus B-HCl (CHX/B-HCl) on plaque and gingivitis.

METHODS

Fifty-one periodontally healthy volunteers, randomly divided into three spray groups, refrained from all mechanical oral hygiene measures for 7 days and, instead, used one of the randomly assigned sprays twice daily. The plaque index (PI), gingival index (GI), and gingival bleeding time index (GBTI) were assessed at days 0 and 7. Side effects were also evaluated.

RESULTS

In all groups, PI, GI, and GBTI showed significant increases from the baseline to day 7. There were no significant side effects for B-HCl spray and CHX spray at day 7, but, for CHX/B-HCl, burning sensation significantly increased from the baseline. For all parameters, there were significant differences between B-HCl and CHX/B-HCl and between B-HCl and CHX, but no significant differences were observed between CHX/B-HCl and CHX. In addition, a significant difference was found between CHX/B-HCl and CHX with regard to burning sensation.

CONCLUSIONS

These results indicate that both CHX and CHX/B-HCl sprays have equal clinical effectiveness, but only B-HCl spray has less anti-plaque and anti-gingivitis effects. Furthermore, CHX/B-HCl spray causes more side effects.

Effects of 0.2% chlorhexidine spray applied once or twice daily on plaque accumulation and gingival inflammation in a geriatric population

BACKGROUND/AIMS

Chlorhexidine (CHX) spray has proven to be an easily applicable method for the chemical control of plaque in elderly and handicapped patients. A randomized double-blind cross-over placebo-controlled trial was undertaken to compare the effects of 0.2% CHX spray applied once or twice daily on the plaque and gingival indexes in 13 institutionalized elderly patients.

METHOD

The study subjects were randomly assigned to one of two groups. During the first 30-day period, one group received 0.2% chlorhexidine spray twice daily and the other received 0.2% CHX spray once daily plus placebo spray once daily. A washout period of 42 days then followed, after which the groups were interchanged and the process was repeated for another 30-day period. Plaque index and gingival index were determined at the beginning and end of each period. The patients continued with their usual oral hygiene practices throughout the study.

RESULTS

A significant reduction in plaque and gingival indexes was produced in both the groups. There were no significant differences in index scores between the groups.

CONCLUSIONS

The results of the present study suggest that a single-daily application of 0.2% CHX spray is equally as effective in reducing plaque accumulation and gingival inflammation in institutionalized elderly patients as are two-daily applications of the same spray.

The effect of chlorhexidine acetate/xylitol chewing gum on the plaque and gingival indices of elderly occupants in residential homes

AIM

A randomised, controlled, double-blind, clinical trial was conducted to investigate the effect of a chlorhexidine acetate/xylitol gum (ACHX) on the plaque and gingival indices of 111 elderly occupants in residential homes. A gum containing xylitol alone (X) and a no gum (N) group was included. Participants' opinions about chewing gum were also investigated.

METHODS

Subjects chewed 2 pellets, for 15 min, 2x daily for 12 months.

RESULTS

In the ACHX group, the plaque and gingival indices significantly decreased (p<0.001) over the 12 months. In the X group, only the plaque score significantly decreased (p<0.05) and in the N control group, both indices remained high and did not change significantly. The acceptance of both chewing gums was high but more participants in the ACHX group felt that the gum kept their mouth healthy (p<0.05). The effect of the ACHX gum on plaque and gingival indices was significantly greater than for the X gum.

CONCLUSION

The long-term use of a chlorhexidine acetate/xylitol chewing gum may therefore support oral hygiene routines for an elderly dependent population.

Administration of chlorhexidine to persons with mental retardation residing in an institution: patient acceptance and staff compliance

Chlorhexidine is beneficial in maintaining the oral health of persons diagnosed with mental retardation. Proper daily oral administration, however, depends upon the compliance of caregivers as well as patient acceptance. If caregivers are noncompliant or if patients are overly resistant to daily applications of chlorhexidine, its proven benefits will not be realized. This study evaluated two methods of chlorhexidine administration for patient acceptance and direct-care staff compliance among 44 institutionalized individuals diagnosed with mental retardation.

Chlorhexidine swabbing applications under various conditions of use in preventive oral care for persons with disabilities

A sample of 44 adults with severe disabilities completed a randomized single-blind cross-over study testing chlorhexidine swabbing under various conditions: with/without prior dental prophylaxis, reduced frequency of application (2 vs. 5 times per week), and prolonged use (42 weeks). All subjects received therapeutic doses of 10 mL 0.12% chlorhexidine gluconate (Peridex, Procter & Gamble) and 10 mL 0.05% NaF applied with a Toothette (Sage Products). Clinical effectiveness of chlorhexidine swabbing compared with placebo was previously reported. In the present study, while initial benefits were observed to be independent of dental prophylaxis, significant reductions in periodontal scores were sustained by a combination of dental prophylaxis and swabbing protocol, at reduced frequency of application and over prolonged time. High levels of acceptance and compliance by subjects/caregivers were maintained. Subjects/caregivers reported improvements in dental health as well as in attitude, quality of life, and smile. Chlorhexidine swabbing at maintenance frequency, combined with periodic dental prophylaxis, may offer an effective and pragmatic long-term preventive regimen for persons with disabilities.

Development and in vitro evaluation of an intra-oral controlled-release delivery system for chlorhexidine

Copolymers of hydroxyethyl methacrylate (HEMA) and methyl methacrylate (MMA) were prepared and used to fabricate a membrane-controlled reservoir-type controlled-release delivery system for chlorhexidine that should be suitable for intra-oral use. The reservoir of the system was prepared by softening an 80:20 mixture of chlorhexidine diacetate and 50:50 HEMA:MMA copolymer with methyl ethyl ketone (MEK), and pressing standard amounts of the resulting dough-like mixture into silicone rubber molds. A membrane was applied to the reservoirs by rotating them through a solution of 30:70 HEMA:MMA copolymer in MEK. The finished oval-shaped controlled-release pellets were approximately 4.7 mm wide, 3.3 mm high, and 7.4 mm long, and contained 45.0 +/- 3.7 mg of chlorhexidine diacetate. The mean in vitro release rate of chlorhexidine diacetate from the pellets into 37 degrees C water was 608 +/- 55 micrograms/24 h for days 2 through 11, and 389 +/- 50 micrograms/24 h for days 15 to 30 of the test period. The chlorhexidine released on day 30 was biologically active, as determined by a serial dilution assay against Streptococcus mutans. The extended release of biologically active chlorhexidine at a controlled rate from this system suggests that it is worthy of further evaluation for the intra-oral therapy of chlorhexidine-treatable oral infections in non-compliant and physically or mentally compromised individuals.

The use of 0.2% chlorhexidine spray as an adjunct to oral hygiene and gingival health in physically and mentally handicapped adults

Chlorhexidine has been used as an aid to or replacement for oral hygiene measures in special needs groups such as the handicapped. Previous studies have indicated that spray delivery of chlorhexidine is both effective and acceptable. This study evaluated twice daily use of a 0.2% chlorhexidine spray as an adjunct to toothbrushing in a group of physically and mentally handicapped adults attending a day training center. The study was a double-blind, placebo controlled, cross-over design involving two 31 days regimens separated by 30 days. Plaque, bleeding on probing, and pocketing were measured at the beginning and end of each regimen. There were clinically and statistically significantly lower plaque and bleeding scores at the end of the chlorhexidine compared to the placebo period. Pocketing was also significantly less after chlorhexidine, although in clinical terms the difference was small. The apparent acceptability and effectiveness of the regimen suggests that small doses of chlorhexidine delivered by sprays may be of considerable value as an aid to oral hygiene in handicapped individuals.

Comparison of chlorhexidine delivery by mouthwash and spray on plaque accumulation

The delivery of chlorhexidine by spray systems have been found useful in controlling plaque in handicapped individuals. This study using a single blind crossover design compared chlorhexidine delivery by mouthwash and spray for plaque inhibitory effects. A group of 14 volunteers participated in two 4 day, no oral hygiene regimens. During one regimen chlorhexidine was professionally sprayed onto the teeth twice a day and during the other chlorhexidine was rinsed twice a day under supervision. Plaque regrowth from a zero baseline was recorded using a plaque index and by area. Little plaque accumulated during the two periods. There was no significant difference in plaque measurements following the use of the spray or mouthwash. This study demonstrated that chlorhexidine when sprayed under optimal conditions was as effective as a mouthwash at controlling plaque despite only requiring one seventh of a dose from a rinse. The results have implications for the use and delivery of chlorhexidine for plaque control and are relevant to the proposed mode of action of this antiseptic.