The efficacy of 0.12% chlorhexidine mouthrinse compared with 0.2% on plaque accumulation and periodontal parameters: a systematic review

A systematic review and meta-analysis of perioperative oral decontamination in patients undergoing major elective surgery

Background

Oral antiseptics reduce nosocomial infections and ventilator-associated pneumonia in critically ill medical and surgical patients intubated for prolonged periods. However, the role of oral antiseptics given before and after planned surgery is not clear. The aim of this systematic review and meta-analysis is to determine the effect of oral antiseptics (chlorhexidine or povidone–iodine) when administered before and after major elective surgery.

Methods

Searches were conducted of the MEDLINE, EMBASE and Cochrane databases. The analysis was performed using the random-effects method and the risk ratio (RR) with 95 % confidence interval (CI).

Results

Of 1114 unique identified articles, perioperative chlorhexidine was administered to patients undergoing elective surgery in four studies. This identified 2265 patients undergoing elective cardiac surgery, of whom 1093 (48.3 %) received perioperative chlorhexidine. Postoperative pneumonia and nosocomial infections were observed in 5.3 and 20.2 % who received chlorhexidine compared to 10.4 and 31.3 % who received a control preparation, respectively. Oral perioperative chlorhexidine significantly reduced the risk of postoperative pneumonia (RR = 0.52; 95 % CI 0.39–0.71; p < 0.01) and overall nosocomial infections (RR = 0.65; 95 % CI 0.52–0.81; p < 0.01), with no effect on in-hospital mortality (RR = 1.01; 95 % CI 0.49–2.09; p = 0.98).

Conclusions

Perioperative oral chlorhexidine significantly decreases the incidence of nosocomial infection and postoperative pneumonia in patients undergoing elective cardiac surgery. There are no randomised controlled studies of this simple and cheap intervention in patients undergoing elective non-cardiac surgery.

Trial Registration

This systematic review was registered with the International prospective register of systematic reviews (PROSPERO). The registration number is CRD42015016063.

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.

Efficacy of two mouthwashes on 3-day supragingival plaque regrowth: a randomized crossover clinical trial

BACKGROUND

The aim of this study was to evaluate the antiplaque effects of an alcohol-free essential oil (alcohol-free EO) mouthwash and an amine fluoride/stannous fluoride with zinc lactate (SnFl-Zn) mouthwash compared to a positive control of chlorhexidine (CHX) mouthwash, using an in vivo plaque regrowth model of 3 days.

MATERIALS AND METHODS

The study was designed as a double-masked, randomized, crossover clinical trial, involving 20 volunteers to compare two different mouthwashes, using a 3-day plaque accumulation model. After receiving thorough professional prophylaxis at baseline, over the next 3 days, each volunteer refrained from all oral hygiene measures and performed two daily rinses with 20 ml of the test mouthwashes. A 0.20% CHX rinse served as a positive control. At the end of each experimental period, plaque was assessed, and the panellists completed a questionnaire. Each subject underwent a 14-day washout period, and then, there was another allocation.

RESULTS

The SnFl-Zn mouthwash has shown a better inhibitory activity on plaque regrowth compared to the alcohol-free EO mouthwash in the whole mouth (plaque index = 1.93 against 2.45, respectively), but there was less of an effect compared to the CHX group, with an overall plaque index of 1.41. The differences of 0.52 between alcohol-free EO and SnFl-Zn and between SnFl-Zn and CHX and of 0.96 between alcohol-free EO and CHX were all statistically significant (P < 0.001).

CONCLUSION

The alcohol-free EO mouthwash seemed to have less of an inhibiting effect on plaque regrowth than the amine fluoride/SnFl-Zn mouthwash and the CHX control.

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.

Effect of chlorhexidine in preventing plaque biofilm on healing abutment: a crossover controlled study

INTRODUCTION

The study aimed at evaluating the effect of chlorhexidine (CHX) in preventing plaque biofilm (PB) formation on healing abutments (HAs) in patients rehabilitated with osseointegrated implants.

MATERIALS AND METHODS

Fifty HAs were placed in 34 voluntary patients 1 week after implant surgery (test group). After 7 days, a new set of 50 HAs was placed in the same implant sites and removed 1 week after (control group). During the 2 testing periods, patients were instructed to apply: CHX mouth rinsing twice daily and no brushing (test); no CHX mouth rinsing and no brushing (control). Scanning electron microscopy and image analysis were blindly used to objectively quantify PB amount on removed HAs.

RESULTS

Median values and interquartile ranges of the percent ratio of titanium surface covered from PB were 0.9 (0.1-4.1) and 1.2 (0.1-11.6) for test and control groups, respectively (P = 0.0275).

CONCLUSIONS

CHX mouth rinsing significantly limited plaque formation on HAs, being a valid contribution to mechanical brushing in early phases of plaque control on dental implants.

The efficacy of 0.12% chlorhexidine versus 0.12% chlorhexidine plus hyaluronic acid mouthwash on healing of submerged single implant insertion areas: a short-term randomized controlled clinical trial

OBJECTIVES

The study was performed to evaluate the incidence of post-surgical adverse events at submerged implant sites as well as the antiplaque, antigingivitis and antistaining effects in the entire dentition of patients treated with two mouthwashes.

METHODS

The present randomized controlled clinical study considered 40 patients subjected to dental implant treatment. Two 0.12% chlorhexidine mouthwashes were compared for 15 days: one with 0.1% hyaluronic acid (CHX⊗HYL group) and one without it (CHX group). Surgical outcome variables, and plaque, gingival, and staining indexes were recorded.

RESULTS

Significant differences were found between the two rinses regarding the presence of oedema within 2 days after surgery (20% for the CHX⊗HYL group and 78% for the CHX group). No other significant differences were recorded between the two mouthwashes. No intergroup differences in plaque, staining and gingivitis indexes were registered. The intragroup analysis revealed that for the plaque and gingival indexes, the differences between the baseline values (before surgery) and those at 15 days were all found to be significant just for CHX⊗HYL rinse, with final values ranging from 0.18 to 0.23 for the plaque index and from 0.06 to 0.07 for the gingival index. The staining index increased for both mouthwash types with significant results (with final value of 0.19 and 0.31 for CHX⊗HYL and CHX groups, respectively).

CONCLUSIONS

In the sites of patients subjected to dental implant placement, an additional anti-oedematigenous effect in early healing seemed to be disclosed for 0.12% CHX⊗HYL mouthwash. Regarding antiplaque and antigingivitis activities, HYL seemed to be ineffective.

Can mouth washes containing chlorhexidine 0.12% be used as synonym of a water solution of chlorhexidine 0.12%?

<p>Chlorhexidine digluconate (CHX) is a gold standard drug in dentistry and is widely used as a reference in both <italic>in vitro</italic> and <italic>in vivo</italic>experiments. Due to ease of access, mouth washes containing CHX 0.12% are used as a substitute for aqueous CHX 0.12% solution in laboratory experiments. Additionally, it is well known that for product flavor purposes, volatile compounds are added to mouth washes formulations. Volatiles added to CHX 0.12% may improve wash's antibacterial ability. Volatiles add potency to the mouth wash formulation. Compared with an aqueous CHX 0.12% solution, it is proposed that CHX solutions and Periogard^® would have antimicrobial activity. Antimicrobial activity was assessed in the present study via disk diffusion assays against <italic>Streptococcus mutans</italic>, <italic>Streptococcus sanguinis</italic>and <italic>Escherichia coli</italic>. Periogard^® showed a significantly higher antibacterial activity in relation to CHX 0.12% (p<0.05) and a similar activity in relation to CHX 1% (p>0.05). Periogard^(r) volatiles were analyzed by gas-chromatography/mass spectrometry (GCMS) and the presence of antibacterial menthol, menthone, isomenthol, menthyl acetate, trans-anethol and eugenol was verified. Finally, the use of Periogard^® as a synonym of CHX 0.12% must be avoided, because its antibacterial activity is closely related to CHX 1%.</p>

The effectiveness of a pre-procedural mouthrinse in reducing bacteria on radiographic phosphor plates

Purpose

This study assessed the effectiveness of three antimicrobial mouthrinses in reducing microbial growth on photostimulable phosphor (PSP) plates.

Materials and Methods

Prior to performing a full-mouth radiographic survey (FMX), subjects were asked to rinse with one of the three test rinses (Listerine®, Decapinol®, or chlorhexidine oral rinse 0.12%) or to refrain from rinsing. Four PSP plates were sampled from each FMX through collection into sterile containers upon exiting the scanner. Flame-sterilized forceps were used to transfer the PSP plates onto blood agar plates (5% sheep blood agar). The blood agar plates were incubated at 37℃ for up to 72 h. An environmental control blood agar plate was incubated with each batch. Additionally, for control, 25 gas-sterilized PSP plates were plated onto blood agar and analyzed.

Results

The mean number of bacterial colonies per plate was the lowest in the chlorhexidine group, followed by the Decapinol, Listerine, and the no rinse negative control groups. Only the chlorhexidine and Listerine groups were significantly different (p=0.005). No growth was observed for the 25 gas-sterilized control plates or the environmental control blood agar plates.

Conclusion

The mean number of bacterial colonies was the lowest in the chlorhexidine group, followed by the Decapinol, Listerine, and the no rinse groups. Nonetheless, a statistically significant difference was found only in the case of Listerine. Additional research is needed to test whether a higher concentration (0.2%) or longer exposure period (two consecutive 30 s rinse periods) would be helpful in reducing PSP plate contamination further with chlorhexidine.

The effectiveness of different concentrations of chlorhexidine for prevention of ventilator-associated pneumonia: a meta-analysis

AIMS AND OBJECTIVES

To evaluate the effectiveness of chlorhexidine for the prevention of ventilator-associated pneumonia and explore the preferred concentration of chlorhexidine.

BACKGROUND

The implementation of effective oral care measures could reduce the incidence of ventilator-associated pneumonia, but among several randomised controlled trials, whether using chlorhexidine is effective and which concentration is more appropriate remain controversial.

DESIGN

A meta-analysis was conducted.

METHODS

We searched the Cochrane Library, PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, China Biology Medicine disc and Chinese National Knowledge Infrastructure to collect randomised controlled trials of mechanically ventilated adult patients receiving oral care with chlorhexidine to prevent ventilator-associated pneumonia. The quality of randomised controlled trials was critically appraised, data were extracted by two reviewers independently, and disagreement was resolved by consensus. Meta-analyses were conducted for the eligible randomised controlled trials by revman 5.1. Relative risks and 95% CIs were calculated with the Mantel-Haenszel model, and heterogeneity was assessed with the I(2) test.

RESULTS

Eighteen randomised controlled trials were included and a meta-analysis was used. All studies indicated chlorhexidine could significantly prevent and reduce the incidence of ventilator-associated pneumonia [RR = 0·59, 95% CI (0·50-0·69), p < 0·00001]. Nine studies showed 0·12% chlorhexidine had a significant effect [RR = 0·53, 95% CI (0·43-0·67), p < 0·00001]. Three studies proved the effect of the 2% chlorhexidine on the prevention of ventilator-associated pneumonia [RR = 0·55, 95% CI (0·37-0·81), p = 0·002].

CONCLUSION

Chlorhexidine can prevent and reduce the incidence of ventilator-associated pneumonia. Chlorhexidine of 0·12% has the best effect on the prevention of ventilator-associated pneumonia according to the meta-analysis, cost analysis, adverse reactions and drug resistance analysis.

RELEVANCE TO CLINICAL PRACTICE

Ventilator-associated pneumonia remains a leading cause of morbidity and mortality in intensive care unit, and implementing effective oral care can reduce the incidence of ventilator-associated pneumonia. Chlorhexidine of 0·12% is recommended in our study.

Efficacy of different mouthrinse formulations in reducing oral malodour: a randomized clinical trial

AIMS

The aim of this study was to assess the efficacy of mouthrinses formulations in oral malodour.

MATERIAL & METHODS

This single-centre, double-blind, randomized, parallel group clinical trial compared the efficacy of Halita™ and meridol(®) with and without zinc lactate versus negative and positive control. Volunteers with confirmed oral malodour (18/group) rinsed with one mouthrinse during 7 days (15 ml, 2x/day for 1 min.). 15 min. after a first rinse (masking effect), and after 7 days (therapeutic effect) the change in organoleptic scores and level of sulphur compounds was recorded.

RESULTS

All rinses showed a masking effect (OLS 1 to 2 values reduced), only the rinses with antimicrobial ingredients showed a therapeutic effect (OLS 1 to 1.5 value less). The addition of zinc resulted in a more pronounced masking effect. Halita™ and meridol(®) with zinc showed the best therapeutic effect.

CONCLUSION

Although the masking effect of the rinses can be attributed partially to a dilution and the effect of aromas, the therapeutic effect should be linked to the anti-microbial action of active ingredients and counter action of zinc ions on VSC. A complete resolution of the unpleasant breath by additional mechanical intervention remains to be proven.

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

OBJECTIVE

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

MATERIAL AND METHODS

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

RESULTS

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

CONCLUSION

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

Adjunctive effect of chlorhexidine antiseptics in mechanical periodontal treatment: first results of a preliminary case series

OBJECTIVES

The aim of the present case series was to evaluate the clinical and microbiological effects of a single session of mechanical and manual scaling and root planing (SRP) combined with the use of two different chlorhexidine formulations in the treatment for generalized chronic periodontitis.

METHODS

Ten patients affected by chronic periodontal disease with periodontal probing depth (PPD) ≥ 5 mm were treated with SRP plus local chlorhexidine. In each patient, similar teeth, treated with SRP with the adjunctive use of chlorhexidine digluconate and dihydrochloride or chlorhexidine gluconate, respectively, were selected and assigned to a test and a control group. In both groups, PPD, bleeding on probing (BOP) parameters, total bacterial counts (TBC) and quality of periodontal bacteria at time 0 and 6 weeks after treatment were measured.

RESULTS

PPD significantly decreased over time both in the test and in the control group; however, no significant differences between the two groups were observed. BOP and TBC were significantly lower in the test than in the control group 6 weeks after treatment. In the post-treatment revaluation, a significant decrease both in the treatment and in the control group, for each of the single periodontal pathogens, was observed.

CONCLUSION

In this study--a preliminary case series with small sample size and short follow-up--the adjunctive use of chlorhexidine (CHX) to SRP resulted in clinical and microbiological benefits in the treatment for generalized chronic periodontitis. A CHX gel formulation consisting of CHX digluconate and CHX dihydrochloride seems to lead some additional benefits over SRP plus CHX gluconate in the short term. Additional investigations are needed to evaluate the effectiveness of this antiseptic therapy.

Evaluation of chlorhexidine 0.05% with the adjunct of fluoride 0.05% in the inhibition of plaque formation: a double blind, crossover, plaque regrowth study

OBJECTIVE

The aim of this study was to evaluate the effect of mouthrinses containing 0.05% chlorhexidine + 0.05% fluoride solution on early dental plaque regrowth.

MATERIALS AND METHODS

Thirty periodontally healthy subjects were included in the study. A crossover 4-day plaque regrowth protocol was adopted. The test product was initially used in 15 patients, while a placebo was administered to the other 15 patients. Then, after a washout period, each patient used the other product. No other oral hygiene manoeuvre was allowed. Full-mouth plaque and bleeding scores (FMPS and FMBS) were evaluated at baseline and after 4 days.

RESULTS

All subjects completed the study. The mean age was 27 ± 8.4 years. Five patients were smokers with a mean daily consumption of 1 ± 2.5 cigarettes. FMPS at baseline was 8.0 ± 4.4 for control group and 7.9 ± 3.8 for test group, without significant difference. After the 4-day plaque regrowth the mean FMPS significantly increased to 31.9 ± 16.5 and 36.3 ± 16.1 for control and test group, respectively (no significant difference between the two groups).

CONCLUSIONS

The test product was safe and well tolerated by subjects. The similar outcomes of the two experimental groups suggest that the two products have an equivalent effect on early dental plaque regrowth. Studies with longer follow-up are needed to clarify whether there is a beneficial long-term effect of daily rinses with the tested solution.

Topical application of 1% chlorhexidine gel versus 0.2% mouthwash in the treatment of peri-implant mucositis. An observational study

OBJECTIVE

The aim of this study was to compare the use of two chlorhexidine-based antimicrobial agents as an adjunct to mechanical therapy for the treatment of peri-implant mucositis.

MATERIALS AND METHODS

Thirty patients with peri-implant mucositis were included in the study and randomized in two groups. In addition to mechanical therapy, group A was treated with chlorhexidine 0.2% mouthwash, while group B was treated with chlorhexidine 1% gel. Probing depth, plaque index and bleeding index were recorded at each scheduled follow-up visit: ten days, 1 month and 3 months after giving the patients the assigned formulation. Patients had to fill in a questionnaire investigating their satisfaction and ease of use of the product.

RESULTS

A total of 23 patients (13 in group A and 10 in group B) attended all the follow-up visits. Chlorhexidine 0.2% mouthwash and chlorhexidine 1% gel were equally useful in the treatment of peri-implant mucositis leading to the reduction in inflammatory parameters. Probing depth decreased over time in both groups. Patients showed preference for gel formulation even if they found it more difficult to use.

CONCLUSIONS

Adjunctive treatment with different chlorhexidine formulations was beneficial to the treatment of peri-implant mucositis. Besides, no differences could be found between 0.2% mouthwash and 1% gel.

Effect of a chlorhexidine mouthrinse on plaque, gingival inflammation and staining in gingivitis patients: a systematic review

AIM

To systematically evaluate the efficacy of chlorhexidine (CHX) mouthrinses on plaque, gingival inflammation and staining in gingivitis patients.

MATERIAL & METHODS

Medline, EMBASE and Cochrane Central Register of Controlled Trials were searched through April 2011. Randomized controlled clinical trials comparing CHX to placebo/control mouthrinses or oral hygiene (OH) ≥ 4 weeks were included.

RESULTS

Among 1355 titles, 30 publications fulfilled the selection criteria. Meta-analysis (MA) showed significant weighted mean differences (WMD) favouring CHX. This was -0.39 [95% CI: -0.70; -0.08] for the Plaque Index Silness & Löe, -0.67 [95% CI: -0.82; -0.52] for the Plaque-Index Quigley & Hein (PIQH), -0.32 [95% CI: -0.42; -0.23] for the Gingival Index (GI), -0.08 [95% CI: -0.10; -0.05] for the bleeding aspect of the GI, -0.21 [95% CI: -0.37; -0.04] for the Papillary BIeeding Index, -0.16 [95% CI: -0.26; -0.07] for Bleeding on Marginal Probing and 0.91 [95% CI: 0.12;1.70] for the Lobene Stain Index. MA of studies with a low risk of author-estimated bias showed a WMD of -0.68 [95% CI: -0.85; -0.51] for the PIQH and -0.24 [95% CI: -0.29; -0.20] for the GI in favour of CHX. Relative to control, the reduction with CHX for plaque was 33% and for gingivitis 26%. CHX rinsing groups demonstrated significantly more staining.

CONCLUSIONS

In gingivitis patients, CHX mouthrinses together with OH versus placebo- or control mouthrinse provide significant reductions in plaque and gingivitis scores, but a significant increase in staining score.

The effect of an oxygenating agent on chlorhexidine-induced extrinsic tooth staining: a systematic review

BACKGROUND

Although chlorhexidine digluconate (CHX) is currently the most effective mouthwash for reducing plaque and gingivitis, one of its side effects is extrinsic tooth staining. Interestingly, oxygenating agents may reduce this staining.

OBJECTIVE

The aim of this review was to systematically search the literature for data concerning the inhibiting effect of an oxygenating agent (OA) on CHX-induced tooth staining.

METHODS

MEDLINE-PubMed, Cochrane-CENTRAL, EMBASE and other relevant electronic databases were searched for articles that were published up to November 2011. Articles were included if they were randomized controlled trials or controlled clinical trials conducted with healthy subjects ≥ 16 years of age that compared the effects of CHX mouthrinse combined with an OA with the effects of CHX alone.

RESULTS

An independent screening of 1183 titles and abstracts resulted in 4 publications that met the inclusion criteria. The extracted data allowed meta-analyses of intermediate length studies and showed that combining an OA with CHX mouthrinses led to a significant reduction in tooth staining (mean difference: 0.27; P = 0.02) and plaque scores (mean difference: 0.10; P = 0.003) when compared with CHX alone. One of the included studies reported a side effect for one participant. The present review was limited by the availability of data, and the included studies were methodologically and clinically heterogeneous, which affected the quality and interpretation of the evidence.

CONCLUSION

There is moderate evidence that a combination of CHX and an OA reduces tooth staining without interfering with plaque growth inhibition.

Professional oral hygiene as a therapeutic option for pediatric patients with plasma cell gingivitis: preliminary results of a prospective case series

BACKGROUND

Plasma cell gingivitis (PCG) is a rare, benign inflammatory condition of unclear etiology with no definitive standard of care ever reported to our knowledge. The aim of this case series is to ascertain the clinical efficacy of professional oral hygiene and periodontal therapy in younger individuals with a histologically confirmed diagnosis of PCG.

METHODS

All patients received non-surgical periodontal therapy, including oral hygiene instructions, and thorough supragingival scaling and polishing with the removal of all deposits and staining combined with the use of antimicrobials in a 9-week cohort study. Clinical outcome variables were recorded at baseline and 4 weeks after the intervention and included, as periodontal parameters, full-mouth plaque scores (FMPS), full-mouth bleeding scores (FMBS), the clinical extension of gingival involvement, and patient-related outcomes (visual analog score of pain).

RESULTS

A total of 11 patients (six males and five females; mean age: 11 ± 0.86 years) were recruited. Four weeks after finishing the oral hygiene and periodontal therapy protocol, a statistically significant reduction was observed for FMPS (P = 0.000), FMBS (P = 0.000), reported pain (P = 0.003) and clinical gingival involvement (P = 0.003).

CONCLUSION

Standard, professional oral hygiene procedures and non-surgical periodontal therapy including antimicrobials were associated with a marked improvement of clinical and patient-related outcomes in pediatric cases of PCG.