Effect of different concentrations of commercially available mouthwashes on wound healing following periodontal surgery: a randomized controlled clinical trial

Efficacy of Chlorhexidine after Oral Surgery Procedures on Wound Healing: Systematic Review and Meta-Analysis

Our objective was to evaluate qualitatively and quantitatively, through a systematic review and meta-analysis, available evidence on the efficacy of chlorhexidine (CHX) when applied after oral surgery on wound healing and related clinical parameters. MEDLINE/PubMed, Embase, CENTRAL, Web of Science, and Scopus were searched for studies published before January 2023. The quality of the methodology used in primary-level studies was assessed using the RoB2 tool; meta-analyses were performed jointly with heterogeneity and small-study effect analyses. Thirty-three studies and 4766 cases were included. The results point out that the application of CHX was significantly more effective, compared to controls where CHX was not employed, providing better wound healing after oral surgery (RR = 0.66, 95% CI = 0.55-0.80, p < 0.001). Stratified meta-analyses confirmed the higher efficacy of 0.20% CHX gel vs. other vehicles and concentrations (p < 0.001, respectively). Likewise, the addition of chitosan to CHX significantly increased the efficacy of surgical wound healing (p < 0.001). The use of CHX has also been significantly beneficial in the prevention of alveolar osteitis after any type of dental extraction (RR = 0.46, 95% CI = 0.39-0.53, p < 0.001) and has also been effective when applied as a gel for a reduction in pain after the surgical extraction of third molars (MD = -0.97, 95% CI = -1.26 to -0.68, p < 0.001). In conclusion, this systematic review and meta-analysis demonstrate on the basis of evidence that the application of CHX exerts a beneficial effect on wound healing after oral surgical procedures, significantly decreasing the patient's risk of developing surgical complications and/or poor wound healing. This benefit was greater when CHX was used at 0.20% in gel form with the addition of chitosan.

Supra and subgingival application of antiseptics or antibiotics during periodontal therapy

Periodontal diseases (gingivitis and periodontitis) are characterized by inflammatory processes which arise as a result of disruption of the balance in the oral ecosystem. According to the current S3 level clinical practice guidelines, therapy of patients with periodontitis involves a stepwise approach that includes the control of the patient's risk factors and the debridement of supra and subgingival biofilm. This debridement can be performed with or without the use of some adjuvant therapies, including physical or chemical agents, host modulating agents, subgingivally locally delivered antimicrobials, or systemic antimicrobials. Therefore, the main aim of this article is to review in a narrative manner the existing literature regarding the adjuvant application of local agents, either subgingivally delivered antibiotics and antiseptics or supragingivally applied rinses and dentifrices, during the different steps in periodontal therapy performed in Europe.

Essential oils for healing and/or preventing infection of surgical wounds: a systematic review

OBJECTIVE

To analyze the evidence available in the literature on the use of essential oils for healing and/or preventing infection in surgical wounds.

METHOD

Systematic review according to the JBI model and PRISMA statement. The search was carried out in November/2020 and updated in December/2021, using descriptors and keywords, in the CINAHL, LILACS, CENTRAL, EMBASE, PUBMED, Scopus, and Web of Science databases. The quality of the evidence was assessed using the JBI critical appraisal tool for randomized controlled trials.

RESULTS

Five publications were included. Three studies evaluated healing and the presence of infection after episiotomy using the Redness-Edema-Ecchymosis-Discharge-Approximation (REEDA) scale; one study evaluated healing after periodontal surgery using the plaque index and Modified Gingival Index; the other four studies considered the presence of infection after episiotomy. Most studies used lavender oil, associated or not with other oils (80%). Two studies showed an improvement in healing. The infection outcome, although mentioned by 60% of studies, was not assessed as a primary outcome.

CONCLUSION

The promising efficacy of essential oils, especially lavender, was verified in the healing of surgical wounds, especially in episiotomies.

[Assessment of antimicrobial activity of bioflavonoid CITROX and chlorhexidine combination against P. gingivalis (in vitro)]

OBJECTIVE

The aim of the study - evaluation of the antiseptic properties of the combination of chlorhexidine and bioflavonoid CITROX against P. gingivalis.

MATERIAL AND METHODS

Clinical isolates of microbial cultures from the collection of the Department of Microbiology, Immunology, Virology of the Moscow State Medical University named after A.I. Evdokimov: P. gingivalis. Primary seeding of the studied material was carried out on nutrient media produced by Himedia Laboratories Pvt. Limited (India): Colombian agar with the addition of 5% defibrinated blood and a selective additive for the isolation of non-spore anaerobes. To conduct the experiment, a thermostatic rotary system - RTS-1 (Biosan, Latvia) was used, which performs a modern type of mixing due to the formation of a vortex-type diffusing effect. The interpretation of the results was carried out by changing the optical density index (the indicator in McFarland units) at a wavelength of λ = 850 nm.

RESULTS

The combination of CITROX + chlorhexidine 0.05% more effectively suppresses the growth of periodotopathogenic bacteria than chlorhexidine 0.05%, prolonging the adaptive phase (lag phase) of the growth of P.gingivalis bacteria and can be considered as an alternative to chlorhexidine without additives. Prolongation of the lag phase increases the time until the first clinical symptoms appear, as a result, the body has more time to form an immune response.

CONCLUSION

The combination of the complex of bioflavonoids CITROX and chlorhexidine bigluconate in concentrations of 0.05% and 0.2% is active against P. gingivalis and can be considered as an alternative to chlorhexidine without additives. The inclusion of CITROX in the rinse aid reduces the concentration of chlorhexidine in the rinse aid, which can lead to a decrease in the severity of undesirable effects and be considered as an alternative remedy in the treatment of periodontal diseases.

Óleos essenciais para a cicatrização e/ou prevenção de infecção de feridas cirúrgicas: revisão sistemática

RESUMO Objetivo: Analisar as evidências disponíveis na literatura sobre o uso de óleos essenciais para a cicatrização e/ou prevenção de infecção em feridas cirúrgicas. Método: Revisão sistemática segundo modelo JBI e declaração PRISMA. Busca realizada em novembro/2020 e atualizada em dezembro/2021, utilizando-se descritores e palavras-chave, nas bases CINAHL, LILACS, CENTRAL, EMBASE, PUBMED, Scopus e Web of Science. A qualidade das evidências foi avaliada usando a ferramenta JBI critical appraisal para ensaios clínicos randomizados. Resultados: Cinco publicações foram incluídas. Três estudos avaliaram a cicatrização e presença de infecção após episiotomia por meio da escala REEDA (Redness-Edema-Ecchymosis-Discharge-Approximation); um avaliou cicatrização após cirurgia periodontal por meio do índice de placa e Índice Gengival Modificado; o restante considerou a presença de infecção após episiotomia. A maioria dos estudos utilizou o óleo de lavanda, associado ou não a outros óleos (80%). Em dois estudos houve melhora da cicatrização. O desfecho infecção, embora mencionado por 60% estudos, não foi avaliado como primário. Conclusão: Verificou-se a eficácia promissora de óleos essenciais, sobretudo do de lavanda, na cicatrização de feridas cirúrgicas, especialmente em episiotomias.

A Pilot Study on the Degree of Tooth Staining Caused by Pollen Water and Chlorhexidine: In Vitro Study

Background:

Chlorhexidine oral rinse has been used as an adjuvant in the treatment of periodontal disease. However, there are drawbacks of using chlorhexidine i.e. tooth staining and other side effects, including allergy reaction. In light of the proven therapeutic properties of pollen water as well as its relatively cheap cost in the market, pollen water has a potential to be an effective alternative to chlorhexidine oral rinse. The aim of this study is to compare the degree of tooth staining influenced by water-based pollen mouthwash to the standard Chlorhexidine mouthwash using spectrophotometer.

Materials and Methods:

24 specimens from extracted intact human teeth were soaked into the three different solutions, Chlorhexidine, Pollen water (date palm pollen water suspension), and normal water. Color measurements were carried out by a spectrophotometer devise and recorded at 5 different time intervals. Color change (∆E), Chroma (C*) and Hue (H*) were analyzed and compared among the three solutions.

Results:

Overall mean ∆E was similar in all groups, significant difference between all time points was found only in pollen water. The change in C* was higher in pollen water as compared to other solutions. There was a subtle increase in H* in the Chlorhexidine samples after week 3. The H* values in pollen water were stable, but a sudden decrease was observed in week 6. The difference in H* among the three solutions was significant after 3 weeks.

Conclusion:

Within the limitation of our study, it can be concluded that Pollen water stained teeth to a lesser extent than did chlorhexidine. It might be beneficial to use Pollen water as mouthwash however, further investigation is needed regarding the efficacy of plaque control.