Effects of fixed orthodontic treatment and two new mouth rinses on gingival health: A prospective cohort followed by a single-blind placebo-controlled randomized clinical trial

Efficacy of herbal versus chlorhexidine-based mouthwashes towards oral hygiene maintenance in patients undergoing fixed orthodontic therapy: a systematic review and meta-analysis

BACKGROUND AND OBJECTIVE

The review aims to fill the gap in literature by comparing the efficacy of herbal and chlorhexidine-based mouthwashes towards oral hygiene maintenance (OHM) in patients undergoing fixed orthodontic treatment (OT).

METHODS

Indexed databases were searched electronically to include randomized controlled trials (RCTs) for data gathering. The protocol was registered in PROSPERO (CRD42020182497). Risk of bias assessment, quality of evidence investigation, and meta-analysis were performed to evaluate reported OHM related parameters at time points before and after the use of chlorhexidine (control group) and herbal mouthwashes (intervention group). With 95% confidence intervals, mean difference (MD) or standardized mean difference (SMD) were used to estimate effect size.

RESULTS

Out of eight RCTs, results from one RCT favored chlorhexidine and the results from a second RCT favored herbal mouthwashes. Results from three RCTs showed comparable effects for the respective investigated OHM related parameters. Chlorhexidine demonstrated higher antimicrobial efficacy against Streptococcus mutans (S.mutans) in two studies, and one RCT found comparable antimicrobial efficacies. Risk of bias was low in 4 studies, and moderate and high in two studies each. Quality of evidence was very low to moderate for the respective investigated parameters. Sub-group analysis for parameters colony forming units (CFU) {SMD (0.40) [95% CI (-0.22, 1.03)], gingival index (GI) {MD (0.06) [95% CI (-0.08, 0.20)]}, plaque index (PI) {SMD 0.22 [95% CI (-0.23, 0.67)]} before the use of chlorhexidine and herbal mouthwashes remained inconclusive.

CONCLUSION

The comparison between efficacy of herbal and chlorhexidine towards OHM in patients undergoing fixed OT remains debatable.

Miswak and oral health: An evidence-based review

Poor oral health has been associated with several chronic and systemic disease. Currently, the most common method of teeth cleaning is the use of a toothbrush together with dentifrices. However, natural chewing stick such as S. persica miswak is still used in many developing countries due to their low cost and availability. The present review aims to summarize the evidences on effectiveness of miswak in promoting oral health. The search was performed using Medline via Ebscohost, Scopus and Google Scholar database to obtain relevant articles published between 2010 to May 2020 using the following set of keywords 1) Miswak OR Salvadora OR persica AND 2) dental OR caries OR plaque OR oral OR orthodontics. Isolated microbial inhibition studies were excluded from the review due to its well-established wealth of literature. Miswak was administered as ten different forms, namely mouthwash, toothpaste, chewing stick, essential oil, aqueous extract, ethanol extract, probiotic spray, dental varnish, dental cement or chewing gum. All studies reported a positive effect of miswak as an anti-plaque, anti-gingivitis, anti-cariogenic, promotion of gingival wound healing, whitening properties, orthodontic chain preservation, and biocompatibility with oral cells. Miswak in its different forms demonstrated positive effect towards oral health maintenance and management.

Self-Reported Changes in Oral Hygiene Habits among Adolescents Receiving Orthodontic Treatment

The prevalence of malocclusion and a need for orthodontic treatment is high. Orthodontic appliances increase biofilm accumulation by expanding plaque retention sites. The aim of this study was to investigate the self-reported changes in oral hygiene habits among adolescents receiving orthodontic treatment. A cross-sectional study of 291 patients aged 10–17 years (mean (M) = 12.98; standard deviation (SD) = 2.36) was conducted in the Department of Orthodontics, Lithuanian University of Medical Sciences (LSMU) Hospital (Kaunas, Lithuania) during the fall semester (October–January) of the 2017/2018 study year. An anonymous self-administered questionnaire covered background information, experience of orthodontic treatment, oral hygiene habits and the seeking of professional dental care. Statistical data analysis was performed using SPSS version 22. To establish relationships between categorical variables, Chi-squared tests (χ2) were used. A p-value ≤ 0.05 was set to indicate statistically significant difference. The univariate logistic regression analysis evaluated the probability of an event given a certain risk indicator, including odds ratio (OR) and its confidence interval (95% CI). Associations were found between the usage of auxiliary measures (OR = 1.797 (1.118–2.887), p = 0.015), tongue cleaning (OR = 1.712 (1.059–2.767), p = 0.028), mouth rinsing after meals (OR = 1.707 (1.048–2.781), p = 0.032) and experience of orthodontic treatment, respectively. More orthodontic patients underwent professional oral hygiene regularly than non-orthodontic patients (p = 0.024). More patients with fixed orthodontic appliances reported significantly changed oral hygiene habits, while more orthodontic patients with removable appliances did not change their oral hygiene habits.