Alcohol-free mouthrinse solutions to reduce supragingival plaque regrowth and vitality. A controlled clinical study

Efficacy of Experimental Mouth Rinses on Caries-Related Biofilms in vitro

This study assessed the efficacy of tin and Polyethylenglycol (PEG-3) tallow aminopropylamine in different concentrations on Streptococcus mutans (S. mutans) biofilms to establish a new screening process for different antimicrobial agents and to gain more information on the antibacterial effects of these agents on cariogenic biofilms. Isothermal microcalorimetry (IMC) was used to determine differences in two growth parameters: lag time and growth rate; additionally, reduction in active biofilms was calculated. Experimental mouth rinses with 400 and 800 ppm tin derived from stannous fluoride (SnF₂) revealed results (43.4 and 49.9% active biofilm reduction, respectively) similar to meridol mouth rinse (400 ppm tin combined with 1,567 ppm PEG-3 tallow aminopropylamine; 55.3% active biofilm reduction) (p > 0.05), while no growth of S. mutans biofilms was detected during 72 h for samples treated with an experimental rinse containing 1,600 ppm tin (100% active biofilm reduction). Only the highest concentration (12,536 ppm) of rinses containing PEG-3 tallow aminopropylamine derived from amine fluoride (AmF) revealed comparable results to meridol (57.5% reduction in active biofilm). Lower concentrations of PEG-3 tallow aminopropylamine showed reductions of 16.9% for 3,134 ppm and 33.5% for 6,268 ppm. Maximum growth rate was significantly lower for all the samples containing SnF₂ than for the samples containing control biofilms (p < 0.05); no differences were found between the control and all the PEG-3 tallow aminopropylamine (p > 0.05). The growth parameters showed high reproducibility rates within the treated groups of biofilms and for the controls; thus, the screening method provided reliable results.

Long-Term Use of Oral Hygiene Products Containing Stannous and Fluoride Ions: Effect on Viable Salivary Bacteria

The aim of this randomized, controlled clinical trial was to isolate and identify viable microorganisms in the saliva of study participants that continuously used a stannous and fluoride ion (F/Sn)-containing toothpaste and mouth rinse over a period of three years in comparison to a control group that used stannous ion free preparations (noF/Sn) over the same time period. Each group (F/Sn and noF/Sn) included 16 participants that used the respective oral hygiene products over a 36-month period. Stimulated saliva samples were collected at baseline (T0) and after 36 months (T1) from all participants for microbiological examination. The microbial composition of the samples was analyzed using culture technique, matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry, and 16S rDNA Polymerase Chain Reaction (PCR). There were only minor differences between both groups when comparing the absolute values of viable microbiota and bacterial composition. The treatment with F/Sn led to a slight decrease in disease-associated and a slight increase in health-associated bacteria. It was shown that the use of stannous ions had no negative effects on physiological oral microbiota even after prolonged use. In fact, a stabilizing effect of the oral hygiene products containing stannous ions on the health-associated oral microbiota could be expected.

Efficacy of gaseous ozone in smoking and non-smoking gingivitis patients

BACKGROUND

The gingivitis treatment protocols aim to stop the progression of inflammation and prevent the affliction of deeper periodontal tissues. Current research focuses on novel methods that can be applied with handheld and ultrasonic devices to increase the effectiveness of non-surgical periodontal treatment. Ozone has been shown to have a strong antimicrobial effect against bacteria that play a role in the etiology of gingival/periodontal diseases. Research evaluating the effects of ozone gas on the treatment of gingival tissues is limited.

AIM

We investigated the effects of ozone application during the scaling procedure on clinical parameters of gingivitis in smokers and non-smokers and to investigate the efficacy of ozone gas in periodontal treatment.

METHODS

A total of 40 subjects, 27 males/13 females-20 smokers/20 non-smokers-with plaque-induced gingivitis, were selected. The patients underwent a single session of full-mouth supragingival and subgingival scaling. Gaseous ozone application was performed on a randomly selected maxillary quadrant. The other maxillary quadrant was designated as the control group receiving only initial periodontal treatment. Clinical parameters, such as PI, GI, GBTI, and PPD, were measured before and 1 week after treatment.

RESULTS

Our study shows that ozone therapy significantly improves clinical parameters in smokers and non-smokers when applied in addition to periodontal therapy.

CONCLUSIONS

Additional studies comparing the effect of ozone therapy on smokers and non-smokers to the effects of oral mouthwashes may provide valuable contributions to the field.

Evaluation of a Nystatin-Containing Mouth Rinse for Terminally Ill Patients in Palliative Care

Purpose

To evaluate the antifungal effect of a nystatin mouth rinse to control oral candidiasis of elderly patients in palliative care.

Materials and Methods

52 cancer patients (mean age: 83 years) hospitalized in a long term care facility for chronically ill geriatric patients. Mouth rinsing with 15 ml nystatin solution (4,000 Ul/ml) was carried out for one minute, six times daily, over two weeks. Yeasts were collected and seeded on CHROMagar. Growth was read qualitatively and quantitatively after two days’ incubation at 37°C.

Results

Clinical signs of oral candidiasis were observed in 31% of cases. High yeast scores were observed in 58% of the residents. There was an association between signs of oral candidiasis and high yeast scores (p<0.001). Treatment for two weeks caused no clinical changes nor reduced yeast scores.

Conclusions

No clinical or antifungal effect from the nystatin suspension suggests that the concentration of nystatin in the mouth rinse was too low. A more effective procedure should be employed for antifungal treatment of terminally ill patients. Appropriate antimicrobial solutions with lubricating activity should be developed and applied to prevent oral diseases.

Efficacy of chlorhexidine rinses after periodontal or implant surgery: a systematic review

BACKGROUND

Biofilm management and infection control are essential after periodontal and implant surgery. In this context, chlorhexidine (CHX) mouth-rinses are frequently recommended post-surgically. Despite its common use and many studies in this field, a systematic evaluation of the benefits after periodontal or implant surgery is-surprisingly-still missing.

OBJECTIVES

To evaluate the benefits of chlorhexidine rinsing after periodontal or implant surgery in terms of plaque and inflammation reduction potential. Furthermore, to screen whether the concentration changes or additives in CHX solutions reduce side effects associated with its use.

MATERIALS AND METHODS

A systematic literature search was performed for clinical trials, which compared CHX rinsing after periodontal or implant surgery with rinsing using placebo, non-staining formulations, or solutions with reduced concentrations of the active compound. Four databases (Medline, PubMed, Embase, Cochrane) were searched up to June 2018. Two reviewers independently identified and screened the literature.

RESULTS

From 691 titles identified, only eleven publications met the inclusion criteria and were finally included. Mainly early publications assessed the benefits of CHX over placebo rinsing, whereas more recent publications focused more on the evaluation of new formulations with regard to effectiveness and side effects. The use of CHX after surgery showed in general significant reduction in plaque (means of 29-86% after 1 week) and bleeding (up to 73%) as compared to placebo. No consensus, however, was found regarding the most beneficial CHX formulation avoiding side effects.

CONCLUSION

Chlorhexidine rinsing helps to reduce biofilm formation and gingival inflammation after surgery. However, no additional reduction of periodontal probing depth over any given placebo or control solution could be found irrespective of whether CHX was used or not. The use of additives such as antidiscoloration systems (ADS) or herbal extracts may reduce side effects while retaining efficacy.

CLINICAL RELEVANCE

Within the limitations of this review, it can be concluded that CHX may represent a valuable chemo-preventive tool immediately after surgery, during the time period in which oral hygiene capacity is compromised. To reduce the side effects of CHX and maintain comparable clinical effects, rinsing with less concentrated formulations (e.g., 0.12%) showed the most promising results so far.

Determining the Antibacterial Activity of Chlorhexidine Mouthwashes with and without Alcohol against Common Oral Pathogens

Aims and Objectives

Mouthwashes with antibacterial activity inhibit the growth of bacteria in the mouth and teeth. Chlorhexidine is one of the most widely used mouthwashes that inhibits dental plaque and prevents tooth surface decay. Recently, concerns have been raised that alcohol-containing mouthwashes may have carcinogenic properties and may be harmful to children and pregnant and lactating women. The aim of this study was to determine the antibacterial effects of chlorhexidine mouthwashes with and without alcohol on common oral bacteria.

Material and Methods

In this in vitro study, bacterial species were purchased from a research center and were cultured separately in proprietary environments in test tubes. Thereafter, mouthwashes with alcohol, without alcohol, and with salt water (saline) were added to test tubes containing the bacteria grown. The samples were then analyzed using a spectrophotometer to determine viability, growth rate, and bacteria waste. Finally, the data were analyzed using SPSS version 17 through analysis of variance (ANOVA) and Tukey statistical tests.

Results

The obtained results showed that the saline group had the highest antibacterial activity and that the average antibacterial activity of the alcohol and alcohol-free groups did not differ significantly (P > 0.05). Post hoc test results showed that the antibacterial activity of the saline group was significantly different statistically from that of the other two groups.

Conclusion

On the basis of the results, it can be concluded that both alcohol-free chlorhexidine and alcohol-containing chlorhexidine are effective in removing oral microbes. Moreover, by using alcohol-free chlorhexidine, the harmful effects of alcohol can be prevented.

Impact of different concentrations of an octenidine dihydrochloride mouthwash on salivary bacterial counts: a randomized, placebo-controlled cross-over trial

OBJECTIVES

This bi-centric, placebo-controlled, randomized, evaluator-blinded, incomplete cross-over clinical phase II trial was initialized to identify the most appropriate concentration of octenidine dihydrochloride (OCT) in mouth rinses.

MATERIALS AND METHODS

Rinses of 0.10, 0.15, and 0.20% OCT were compared to a saline placebo rinse regarding the reduction of salivary bacterial counts (SBCs) in 90 gingivitis patients over 4 days. Changes in plaque (PI) and gingival index (GI), taste perception, and safety issues were evaluated.

RESULTS

At baseline, the first OCT (0.10, 0.15, 0.20%) rinse resulted in a decrease of SBC (reduction by 3.63-5.44 log₁₀ colony forming units [CFU]) compared to placebo (p < 0.001). Differences between OCT concentrations were not verified. After 4 days, the last OCT rinse again resulted in a significant SBC decrease (3.69-4.22 log₁₀ CFU) compared to placebo (p < 0.001). Overall, SBC reduction between baseline and day 4 was significantly higher in OCT 0.15 and 0.20% groups compared to OCT 0.10% and placebo. Mean GI/PIs were significantly lower in OCT groups than in the placebo group (p < 0.001). Differences in GI/PI between OCT groups were not verified. Adverse effects increased with increasing OCT concentrations.

CONCLUSIONS

Considering antibacterial efficacy, frequency of adverse events, and user acceptance, 0.10% OCT was identified as the preferred concentration to be used in future clinical trials.

CLINICAL RELEVANCE

Due to its low toxicity and pronounced antibacterial properties, octenidine dihydrochloride (OCT) is a promising candidate for the use in antiseptic mouth rinses. OCT concentrations of 0.10% are recommended for future clinical trials evaluating the plaque-reducing properties of OCT mouth rinses. ( www.clinicaltrials.gov , NCT022138552).

Chlorhexidine with or without alcohol against biofilm formation: efficacy, adverse events and taste preference

In recent years, different chlorhexidine formulations have been tested, including an alcohol-free alternative, but the effect of this solution on early biofilm formation is not clear. A crossover, randomized, double-blind clinical trial was conducted to evaluate the effect of two chlorhexidine solutions against supra- and subgingival biofilm formation (NCT#02656251). Thirty-five participants were randomized and asked to rinse twice daily with 15 ml of an alcohol-containing 0.12% chlorhexidine solution, an alcohol-free 0.12% chlorhexidine solution, or placebo. The study was conducted in three experimental periods of 4 days each, with a 10-day washout between the periods. All the experimental periods followed the same protocol, except that the solutions were switched. Biofilm distribution was evaluated every 24 hours by the Plaque-Free Zone Index, during 96 hours. Adverse events were self-reported and sensory evaluation was performed using a hedonic scale. Compared to the placebo, the chlorhexidine solutions resulted in a significantly higher number of surfaces free of plaque over 96 hours (p < 0.01), and were able to prevent subgingival biofilm formation (p < 0.01). The alcohol-free chlorhexidine solution was associated with a lower incidence of adverse events, compared with alcohol-containing chlorhexidine (p < 0.05); it also received better sensory evaluation and acceptance by trial participants, compared with the alcohol-containing chlorhexidine (p = 0.007), and had a similar inhibitory effect on the formation of supra- and subgingival biofilms.

Cytotoxic effects of octenidine mouth rinse on human fibroblasts and epithelial cells - an in vitro study

OBJECTIVES

This study compared the cytotoxicity of a new octenidine mouth rinse (MR) against gingival fibroblasts and epithelial cells with different established MRs.

METHODS

The following MRs were used: Octenidol (OCT), Chlorhexidine 0.2% (CHX), Listerine (LIS), Meridol (MER), Betaisodona (BET); and control (medium only). Human primary gingiva fibroblasts and human primary nasal epithelial cells were cultivated in cell-specific media (2 × 10(5) cells/ml) and treated with MR for 1, 5, and 15 min. Each test was performed 12 times. Metabolism activity was measured using a cytotoxicity assay. A cellometer analyzed cell viability, cell number, and cell diameter. The data were analyzed by two-way analysis of variance with subsequent Dunnett's test and additional t-tests.

RESULTS

The cytotoxic effects of all MRs on fibroblasts and epithelial cells compared to the control depended on the contact time (p < 0.001). OCT and BET showed less influence on cell metabolism in fibroblasts than other MRs. OCT also demonstrated comparable but not significant results in epithelial cells (p > 0.005). Cell numbers of both cell types at all contact times revealed that OCT showed a less negative effect (p > 0.005), especially for epithelial cells compared to CHX after 15 min (p < 0.005). OCT and BET showed the best results for viability in fibroblasts (p > 0.005), but MER showed less influence than OCT in epithelial cells (p < 0.005).

CONCLUSIONS

OCT is a potential alternative to CHX regarding cytotoxicity because of its lower cell-toxic effect against fibroblasts and epithelial cells.

Effect of an oxygenating agent on oral bacteria in vitro and on dental plaque composition in healthy young adults

Oral bacteria live in symbiosis with the host. Therefore, when mouthwashes are indicated, selective inhibition of taxa contributing to disease is preferred instead of broad-spectrum antimicrobials. The potential selectivity of an oxygenating mouthwash, Ardox-X® (AX), has not been assessed. The aim of this study was to determine the antimicrobial potential of AX and the effects of a twice-daily oral rinse on dental plaque composition.

Material and methods:In vitro, 16 oral bacterial strains were tested using agar diffusion susceptibility, minimum inhibitory and minimum bactericidal concentration tests. A pilot clinical study was performed with 25 healthy volunteers. Clinical assessments and microbiological sampling of supragingival plaque were performed at 1 month before the experiment (Pre-exp), at the start of the experiment (Baseline) and after the one-week experimental period (Post-exp). During the experiment individuals used AX mouthwash twice daily in absence of other oral hygiene measures. The microbiological composition of plaque was assessed by 16S rRNA gene amplicon sequencing.

Results: AX showed high inter-species variation in microbial growth inhibition. The tested Prevotella strains and Fusobacterium nucleatum showed the highest sensitivity, while streptococci and Lactobacillus acidophilus were most resistant to AX. Plaque scores at Pre-exp and Baseline visits did not differ significantly (p = 0.193), nor did the microbial composition of plaque. During a period of 7-days non-brushing but twice daily rinsing plaque scores increased from 2.21 (0.31) at Baseline to 2.43 (0.39) Post-exp. A significant microbial shift in composition was observed: genus Streptococcus and Veillonella increased while Corynebacterium, Haemophilus, Leptotrichia, Cardiobacterium and Capnocytophaga decreased (p ≤ 0.001).

Conclusion: AX has the potential for selective inhibition of oral bacteria. The shift in oral microbiome after 1 week of rinsing deserves further research.

Confusion over live/dead stainings for the detection of vital microorganisms in oral biofilms--which stain is suitable?

BACKGROUND

There is confusion over the definition of the term "viability state(s)" of microorganisms. "Viability staining" or "vital staining techniques" are used to distinguish live from dead bacteria. These stainings, first established on planctonic bacteria, may have serious shortcomings when applied to multispecies biofilms. Results of staining techniques should be compared with appropriate microbiological data.

DISCUSSION

Many terms describe "vitality states" of microorganisms, however, several of them are misleading. Authors define "viable" as "capable to grow". Accordingly, staining methods are substitutes, since no staining can prove viability.The reliability of a commercial "viability" staining assay (Molecular Probes) is discussed based on the corresponding product information sheet: (I) Staining principle; (II) Concentrations of bacteria; (III) Calculation of live/dead proportions in vitro. Results of the "viability" kit are dependent on the stains' concentration and on their relation to the number of bacteria in the test. Generally this staining system is not suitable for multispecies biofilms, thus incorrect statements have been published by users of this technique.To compare the results of the staining with bacterial parameters appropriate techniques should be selected. The assessment of Colony Forming Units is insufficient, rather the calculation of Plating Efficiency is necessary. Vital fluorescence staining with Fluorescein Diacetate and Ethidium Bromide seems to be the best proven and suitable method in biofilm research.Regarding the mutagenicity of staining components users should be aware that not only Ethidium Bromide might be harmful, but also a variety of other substances of which the toxicity and mutagenicity is not reported.

SUMMARY

- The nomenclature regarding "viability" and "vitality" should be used carefully.- The manual of the commercial "viability" kit itself points out that the kit is not suitable for natural multispecies biofilm research, as supported by an array of literature.- Results obtained with various stains are influenced by the relationship between bacterial counts and the amount of stain used in the test. Corresponding vitality data are prone to artificial shifting.- As microbiological parameter the Plating Efficiency should be used for comparison.- Ethidium Bromide is mutagenic. Researchers should be aware that alternative staining compounds may also be or even are mutagenic.

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.

The effect of various topical peri-implantitis antiseptics on Staphylococcus epidermidis, Candida albicans, and Streptococcus sanguinis

OBJECTIVE

Although peri-implantitis has presented an ever increasing problem in modern dentistry, satisfying therapeutic strategies or scientifically based treatment recommendations are still not available. The main object of the present study was to evaluate the antibacterial efficacy of six different topical antiseptics on three test microorganisms attached to titanium implant specimens.

MATERIAL AND METHODS

For biofilm formation, plane titan specimens were incubated either in Candida albicans, Streptococcus sanguinis, or Staphylococcus epidermidis for 2h. The specimens were then treated with different topical antiseptics for 60s (sodium hypochlorite 1.0%, hydrogen peroxide 3.0%, chlorhexidine gluconate 0.2%, citric acid 40.0%, Plax, or Listerine) and with sterile saline as control. Remaining vital fungi were quantified by means of a bioluminometric assay and the bacterial load and the viability of adhering S. epidermidis and S. sanguinis by live or dead cell labelling in combination with fluorescence microscopy.

RESULTS

Sodium hypochlorite was effective against all three species, whereas hydrogen peroxide was solely effective against C. albicans. CHX and Listerine showed antimicrobial activity against S. sanguinis and C. albicans and citric acid and Plax against both tested bacteria.

CONCLUSIONS

None of the tested antimicrobial agents, except for sodium hypochlorite, showed a significant in vitro effect on all three test microbes. Considering the possible toxicity of sodium hypochlorite, none of the tested - and so far widely used - antiseptics showed any broad-spectrum antimicrobial effect and could therefore not be recommended for the topical disinfection and detoxification of infected implant surfaces.

Clinical Evidence of the Efficacy of a Mouthwash Containing Propolis for the Control of Plaque and Gingivitis: A Phase II Study

The aim of this study was to evidence the clinical efficacy of an alcohol-free mouthwash containing 5.0% (W/V) Brazilian green propolis (MGP 5%) for the control of plaque and gingivitis. Twenty five subjects, men and women aging between 18 and 60 years old (35 ± 9), were included in a clinical trials phase II study who had a minimum of 20 sound natural teeth, a mean plaque index of at least 1.5 (PI), and a mean gingival index of at least 1.0 (GI). They were instructed to rinse with 10 mL of mouthwash test for 1 minute, immediately after brushing in the morning and at night. After 45 and 90 days using mouthwash, the results showed a significant reduction in plaque and in gingival index when compared to samples obtained in baseline. These reductions were at 24% and 40%, respectively (P < .5). There were no important side effects in soft and hard tissues of the mouth. In this study, the MGP 5% showed evidence of its efficacy in reducing PI and GI. However, it is necessary to perform a clinical trial, double-blind, randomized to validate such effectiveness.

Effect of a 5000 ppm fluoride toothpaste and a 250 ppm fluoride mouth rinse on the demineralisation of dentin surfaces

Background

The purpose of this study was to test the null hypothesis that there is no difference between the effect of (1) a 5000 ppm fluoride toothpaste, and (2) a 250 ppm fluoride mouth rinse on demineralized human dentin surfaces, against the alternative hypothesis of a difference.

Findings

Dentin specimens were obtained from the cervical regions of 45 extracted human third molars. Half the surface of each specimen was sealed with a self-etching adhesive system and served as the reference surface. The dentin specimens were randomly assigned to one of the three groups, 5000 ppm fluoride toothpaste (Duraphat), 250 ppm fluoride mouth rinse (Meridol) and distilled water (negative control).

An intraoral appliance was made for one volunteer. In each test cycle, 15 specimens were inserted in the appliance and worn for 24 hours a day, over a period of three weeks.

Once daily, the appliance was immersed in the agent being tested; either toothpaste slurry, mouth rinse or distilled water for 60 seconds.

Demineralization was assessed in terms of lesion depth (μm) and mineral loss (vol. % × μm) by transversal microradiography. Data analysis was accomplished using Kolmogorov-Smirnov test and ANOVA (SPSS 12.0).

Statistically significant differences for mineral loss and lesion depth were found between the toothpaste and the mouth rinse as well as between the toothpaste and the control group, but not between the mouth rinse and the control group.

Conclusion

Within the limitations of this study, the results suggest that treatment of demineralised dentin with a toothpaste containing 5000 ppm fluoride may considerably reduce mineral loss and lesion depth on exposed dentin.

Effect of mouthrinses on Aggregatibacter actinomycetemcomitans biofilms in a hydrodynamic model

The aim of the study was to evaluate the effects of Listerine, Meridol, and Perioaid on the viability and total number of bacteria in established biofilms using an in vitro model under hydrodynamic conditions. Biofilms of Aggregatibacter actinomycetemcomitans were placed in a modified Robbins device and rinsed twice daily during 4 days. Bacteria were quantified by culture and quantitative polymerase chain reaction. Visualization of the samples was performed by scanning electron and confocal laser scanning microscopy, combined with a fluorescent vital staining. All three mouthrinses caused a significant reduction in the number of cultivable A. actinomycetemcomitans in a biofilm. Perioaid was significantly the most powerful in killing the biofilm-protected bacteria and also in counteracting the development of thick dense microbial communities. The total amount of bacteria was not significantly affected by Listerine and Meridol.

The effects of an essential oil and an amine fluoride/stannous fluoride mouthrinse on supragingival plaque regrowth

BACKGROUND

The side effects of chlorhexidine (CHX) have stimulated the search for alternative antiplaque agents such as amine fluoride/stannous fluoride (ASF) and essential oils (EO). The aim of the study was to investigate the plaque-inhibiting effects of two commercially available mouthrinses containing ASF and EO, respectively.

METHODS

The study was an observer-masked, randomized, 5 x 5 Latin square cross-over design, balanced for carryover effects, involving 15 volunteers in a 4-day plaque regrowth model. A 0.12% CHX rinse and a saline solution served as positive and negative controls, respectively. On day 1, subjects received professional prophylaxis, suspended oral hygiene measures, and commenced rinsing with their allocated rinses. On day 5, subjects were scored for disclosed plaque. The ASF rinse was tested at two dosages: 10 and 20 ml (ASF-10 and ASF-20, respectively).

RESULTS

The ASF and EO rinses showed a significant inhibition of plaque regrowth compared to saline (P <0.0001), but the lowest plaque indices were obtained with the CHX product (P <0.01). There were no significant differences among products containing ASF-10, ASF-20, and EO (P >0.05). There was no correlation between the occurrence of side effects and the use of a particular rinse product (P >0.2).

CONCLUSIONS

ASF and EO mouthrinses exerted effective and similar plaque inhibition. The two dosages tested for ASF did not differ in plaque reduction. These findings, together with those from long-term trials, suggest that ASF and EO rinses may represent effective alternatives to CHX rinse as adjuncts to oral hygiene.

Substantivity of amine fluoride/stannous fluoride following different modes of application: a randomized, investigator-blind, placebo-controlled trial

OBJECTIVE

Amine fluoride/stannous fluoride (ASF) is proven to be effective against plaque and gingivitis. The purpose of this clinical controlled study was to investigate the influence of different application modes on the substantivity of this formulation.

MATERIAL AND METHODS

Seventeen healthy volunteers received a professional dental prophylaxis. Undisturbed plaque growth was permitted for the next 48 h. In a crossover design, participants received ASF as a single mouthrinse, toothpaste, slurries with high (HA) or low (LA) air content, or a placebo. Vitality of plaque bacteria was investigated before and at 1, 2, 3, 4, 6, and 8h after application of ASF. ANOVA was applied on a 0.05 significance level.

RESULTS

Highest reduction of plaque vitality resulted after toothpaste application, followed by mouthrinse, LA, and HA slurry. No changes occurred in the placebo group. Compared to baseline and placebo, statistically significant changes were detected up to 4h in all ASF groups. Toothpaste exerted antibacterial efficacy up to 8h. Vitality reduction was higher in the LA group than in the HA group.

CONCLUSIONS

The concentration of ASF in formulations influences the time course of the antibacterial effect. Contact of ASF formulations with air might reduce their efficacy.

Effect of N-chlorotaurine mouth rinses on plaque regrowth and plaque vitality

The purpose of this 4-day plaque regrowth study was to assess the effect of N-chlorotaurine (NCT) mouth rinses on plaque inhibition and plaque vitality. Eighty volunteers participated in this investigator-blind, randomized, clinical controlled study in parallel groups. No oral hygiene was permitted except rinsing with a 2% or 3% NCT mouth rinse, a positive or a negative control. Primary parameters were the plaque index (Silness and Löe, Acta Odontol Scand, 22:121-135, 1964) and plaque vitality (Netuschil et al., J Clin Periodontol, 16:484-488, 1989) after the final rinse. In addition, another plaque index (Turesky et al., J Periodontol, 41:41-43, 1970), plaque area, and bleeding on probing were recorded. All parameters were taken at baseline and day 5. U test was applied on a 5% error level. No differences in plaque inhibition were found between the two NCT formulations and the negative control. However, a statistically significant reduction of plaque vitality compared to the negative and positive control was observed. Discoloration of the tongue and unpleasant taste were recorded in participants in the NCT groups. NCT mouth rinses did not inhibit plaque regrowth, but they did reduce the vitality of plaque bacteria. Methods of prolonging the substantivity of the NCT mouth rinses should be investigated to enhance the antibacterial properties of these formulations.

Efficacy of two alcohol-free cetylpyridinium chloride mouthwashes - a randomized double-blind crossover study

AIM

(1) To determine the plaque inhibition properties of two formulations of alcohol-free mouthwash [0.1% w/w cetylpyridinium chloride (CPC) (B) and 0.05% w/w CPC (A)] versus a placebo mouthwash (C). (2) To compare the plaque-inhibiting activity between these two new CPC mouthwashes.

MATERIAL AND METHODS

A double-blind, crossover study with three 1-week periods was used. Subjects were randomly assigned to one of the following groups. Group 1 (n=10) received the mouthwashes A, C and B in the periods 1, 2 and 3, respectively, group 2 (n=11) received the mouthwashes in the order B, A, C, while group 3 (n=11) received the mouthwashes in the order C, B, A. Mean plaque areas and Quigley & Hein plaque index scores were analysed using anova (analysis of variance). Measurements were made at the start of each period (baseline) and at 16, 24 and 40 h.

RESULTS

Mean plaque scores were similar across the groups at baseline. At all time points thereafter, volunteers using mouthwash A or B had significantly lower plaque areas and plaque index scores than those using mouthwash C (p<0.05), but there were no significant differences between the test formulations. At 16 h, the reduction in plaque area relative to mouthwash C was 22% for mouthwash A and 18% for mouthwash B; at 24 h, 11% for mouthwash A and 15% for mouthwash B; and at 40 h, 15% for mouthwash A and 16% for mouthwash B.

CONCLUSIONS

The use of both CPC mouthwashes resulted in less plaque accumulation compared with the control. There was no statistically significant difference in plaque accumulation between the two CPC mouthwashes.

Effect of two new chlorhexidine mouthrinses on the development of dental plaque, gingivitis, and discolouration. A randomized, investigator-blind, placebo-controlled, 3-week experimental gingivitis study

OBJECTIVE

The aim of this experimental gingivitis study was to assess the efficacy and safety of two new chlorhexidine (CHX) mouthrinses.

MATERIAL AND METHODS

Ninety volunteers participated in this investigator-blind, randomized, clinical-controlled trial in parallel groups. During the treatment period, no oral hygiene measures except rinsing with non-alcoholic 0.2% CHX or 0.2% CHX/0.055% sodium fluoride mouthrinses, a positive control, or a negative control were permitted. The primary parameter was the gingival index; the secondary parameters were plaque index, discolouration index, and bleeding on probing. Clinical examinations were conducted 14 days before the start of the study, at baseline, and after 7, 14, and 21 days. The two sample t-test, anova, and ancova were used for the statistical analysis.

RESULTS

No difference in efficacy was found between the two new CHX formulations and the positive control. On day 21, statistically significantly less gingival inflammation and plaque accumulation compared with placebo were observed. Besides discolouration and taste irritations, no adverse events were recorded.

CONCLUSION

The two new CHX mouthrinses were able to inhibit plaque re-growth and gingivitis. Neither the omission of alcohol nor the supplementation with sodium fluoride had weakened the clinical efficacy of CHX with respect to the analysed clinical parameters.

How to select the right mouthrinses in periodontal prevention and therapy. Part II. Clinical use and recommendations

Based on scientific proof, only few mouthrinse solutions can be recommended. However, it is impossible to construct an extended table that would provide precise recommendations or advices for mouthrinse utilisation related to any possible discomfort or diseases. Only reliable information on the drugs available against periodontal disease can be offered to the therapist. By evaluation of her or his individual experiences, she or he has to judge all the armamentarium she or he possesses to react in the best possible way in each specific situation.

Differences in efficacy of two commercial 0.2% chlorhexidine mouthrinse solutions: a 4-day plaque re-growth study

BACKGROUND

The purpose of this clinical cross-over study was to examine the antibacterial and plaque-inhibiting properties of two chlorhexidine solutions compared with a negative control.

MATERIAL AND METHODS

Twenty-one volunteers refrained from all oral hygiene measures, but rinsed instead twice daily with 10 ml of a conventional chlorhexidine solution (0.2%; CHX), a chlorhexidine solution with anti-discolouration system (ADS) (0.2%, alcohol-free chlorhexidine solution (CSP)) or a placebo solution (Pla). Plaque index (PI), plaque area (PA) and bacterial vitality were assessed after 24 h (PI1, vital flora (VF)1) and 96 h (PI2; VF2, PA). After a 10-day wash-out period, a new test cycle was started.

RESULTS

Results for Pla were 0.94, 1.59, 27.4 (PI1, PI2, PA) and 79% and 72% (VF1 and VF2). CSP significantly reduced the parameter PI1, PI2 and PA to 0.67 (p=0.012), 1.0 and 15.7 (p<0.001). VF1 and VF2 (63% and 53%) were not significantly affected. The corresponding figures of CHX were 0.42, 0.43, 6.77, 33 and 16%, which were all significantly lower (all p<0.001). On comparing the two chlorhexidine solutions, CHX showed significantly higher reductions of all parameters.

CONCLUSION

The results suggest that the 0.2% alcohol-containing solution showed superiority in inhibiting plaque re-growth and reducing bacterial vitality compared with the solution with ADS.

Short-term side effects of 0.2% alcohol-free chlorhexidine mouthrinse used as an adjunct to non-surgical periodontal treatment: a double-blind clinical study

BACKGROUND

The aims of this clinical study were to evaluate the short-term subjective (by means of questionnaire) and objective (by means of clinical examination) side effects of 0.2% chlorhexidine (CHX) mouthrinse without alcohol used as an adjunct to non-surgical periodontal treatment and to elucidate the relationship between the subjective and objective evaluations.

METHODS

This was a randomized, double-blind, placebo-controlled clinical trial with two groups: 1) the test group, rinsing with the test product (0.2% CHX without alcohol) twice per day for 1 week, and 2) the control (placebo) group, rinsing with a placebo solution twice per day for 1 week. Following the start of rinsing, patients were subjectively and objectively evaluated for the presence and severity of side effects (pain, burning sensation, pruritus, dryness of mouth, taste disturbance, mucosal irritations, and discoloration of tooth and tongue surfaces) at days 1, 3, and 7 of the rinsing period. The presence of subjective and objective side effects of the groups was compared via use of chi2 and Fisher exact tests. Analysis of the subjective and objective side effects within the evaluation periods was done by McNemar test. Spearman correlation analysis was used to assess the relationships between the subjective and objective side effects.

RESULTS

None of the patients in either group complained of dryness of the mouth. The most commonly reported side effect was the change in color of the labial and buccal mucosa, particularly of the gingiva, after day 3 of rinsing. There were significant (r=0.308 to 0.835; P<0.05) correlations between the discolorations of tongue and tooth surfaces reported by the patients and clinically detected at all evaluation periods. There was a significant and positive relationship between the subjective side effects and the soft tissue irritations when the duration of rinsing increased.

CONCLUSION

Within the limits of this clinical evaluation, rinsing with 0.2% alcohol-free CHX for 1 week caused more irritation to oral mucosa, greater burning sensation, and increased altered taste perception compared to the placebo rinse.

How to select the right mouthrinses in periodontal prevention and therapy. Part I. Test systems and clinical investigations

The use of mouthrinses is increasing, especially as adjuncts to the daily mechanical oral hygiene. Different test systems may and can be used to test their antibacterial and clinical effects: bacteriology in vitro, substantivity in vivo, 4-day plaque re-growth, experimental gingivitis and long-term use. The plaque re-growth investigations of a few days are not only of limited use but may also be dangerous because often too extensive conclusions have been drawn from their design. The 'gold standard' test is the experimental gingivitis model to reveal the antiplaque as well as the antigingivitis effects of any mouthrinse preparation during 3 weeks. The last kind of investigations are of several months' duration, where the substances are used as supplements to mechanical oral hygiene measures.

Influence of alcohol in mouthwashes containing triclosan and zinc: an experimental gingivitis study

OBJECTIVES

An experimental gingivitis model was used to analyse the influence of alcohol in mouthwashes containing 0.15% triclosan and zinc chloride on the formation of supragingival plaque, the development of gingivitis and the appearance of adverse events.

MATERIAL AND METHODS

Using a double-blind crossover design, 30 subjects underwent two consecutive experimental phases with two 0.15% triclosan and zinc chloride mouthwashes, differentiated mainly by their excipient (hydroalcoholic or aqueous). In each phase, the subjects discontinued all oral hygiene measures and were treated solely with the randomly assigned experimental mouthwash for 21 days. Each experimental phase was preceded by a 14-day washout period in which, after receiving a complete oral prophylaxis, the subjects were instructed to perform thorough oral hygiene procedures. Gingivitis and plaque levels were assessed at the start and end of both the experimental phases.

RESULTS

The evolution of the gingivitis and plaque indices showed no statistically significant differences between both treatments. The mean gingival index increased from 0.30 to 0.38 with the non-alcoholic mouthwash and from 0.32 to 0.42 with the hydroalcoholic mouthwash. The respective changes in plaque index were from 0.88 to 1.93 and from 0.94 to 1.92. The hydroalcoholic mouthwash produced a larger number of fresh symptoms (p=0.033), oral itching being the most reported.

CONCLUSIONS

Alcohol does not influence the effectiveness of a 0.15% triclosan and zinc chloride mouthwash against gingivitis development and supragingival plaque formation. The absence of alcohol significantly decreases the incidence of adverse events produced by the mouthwash.

The effect of a polyhexamethylene biguanide mouthrinse compared with a triclosan rinse and a chlorhexidine rinse on bacterial counts and 4-day plaque re-growth

OBJECTIVES

For various clinical applications, polyhexamethylene biguanide hydrochloride (PHMB) has been used for many years as an antiseptic in medicine. Recently, a 0.04% and a 0.12% PHMB mouthwash were shown to inhibit plaque re-growth and to reduce oral bacterial counts. In this study, a 0.2% PHMB mouthrinse (A) was compared with a positive control 0.12% aqueous chlorhexidine solution (B), a commercially available 0.3% triclosan/2.0% polyvinyl methyl ether maleic acid copolymer mouthrinse (Colgate Total Plax) (C), and a negative control placebo rinse (10% ethanol, flavour) (D).

MATERIALS AND METHODS

The controlled clinical study was a double blind, randomized, four replicate cross - over design. Plaque re-growth was assessed with the Turesky et al. (1970) modification of the Quigley & Hein (1962) plaque index. The antibacterial effect was assessed by taking bacterial counts on the tooth surface (smears from the buccal surface of 16/26) and mucosa (smears from the buccal mucosa in opposite of area 16/26) after the professional prophylaxis and after the first rinse with the preparations on day 1 and prior to the clinical examination on day 5. Sixteen volunteers participated and, on day 1 of each study period were rendered plaque-free, ceased toothcleaning, and rinsed twice daily with the allocated mouthrinse. On day 5, plaque was scored and smears were collected according to the protocol. A 10-day wash-out period was carried out between each rinse evaluation. Data were analysed using ancova with Bonferroni HSD adjustment for multiple comparisons (colony forming units per sample) with a significance level alpha=0.05.

RESULTS

The 0.2% PHMB mouthrinse (A) was significantly better at inhibiting plaque than the placebo (D), but significant less effective than the 0.12% aqueous chlorhexidine solution (B). There is no significant difference between A and the 0.3% triclosan/2.0% copolymer mouthrinse (C). Bacterial count reductions (tooth surface and mucosa) with PHMB (A) were significantly greater compared with the placebo (D) and triclosan (C), but significantly lower compared with chlorhexidine (B) (tooth surface) and equally effective compared with chlorhexidine (B) (mucosa).

CONCLUSION

Consistent with previous studies, a PHMB mouthrinse was shown to inhibit plaque re-growth and to reduce oral bacterial counts, indicating that PHMB could be an alternative to established mouthrinses in preventive applications.

Plaque inhibition of two commercially available chlorhexidine mouthrinses

BACKGROUND

Chlorhexidine (CHX) 0.2% solution is still "the leading oral antiseptic" for controlling gingivitis. Side effects, however, limit the acceptability to users and the long-term employment of a 0.2% CHX antiseptic in preventive dentistry. This stimulated the development of new formulations. The aim of the present study was to assess the effect on plaque inhibition and taste perception of two commercially available mouthrinses (0.12% CHX non-alcohol base with 0.05% cetyl pyridinium chloride (Cpc) versus 0.2% CHX alcohol base).

METHODS

The study was designed as a single-blind, randomized two group parallel experiment, to compare two different commercially available mouthrinses, during a 3-day plaque accumulation model. Forty healthy volunteers were enrolled in the study and received a thorough dental prophylaxis at the beginning of the test period. Over a 72-h experimental non-brushing period, during which subjects abstained from all forms of mechanical oral hygiene, one group (test) used a 15 ml alcohol free 0.12% CHX (=18 mg) mouthrinse on a Cpc base (Perioaid), CHX plus sign in circleCpc), twice daily for 30 s. The other group (control) used a 10 ml 0.2% CHX (=20 mg) mouthrinse on an 11.8% ethanol alcohol base (Corsodyl), CHX plus sign in circleAlc), twice daily for 60 s. After 72 h of plaque formation, the amount of plaque was evaluated. By the use of visual analogue scale, the subjects were asked for their appreciation of the taste of the mouthrinse they had used.

RESULTS

The mean plaque index for the CHX plus sign in circleCpc group was 0.97 and for the CHX plus sign in circleAlc group 0.78. After 72 h of non-brushing, there was no significant difference in plaque accumulation between the two groups. The answers to the questions (taste perception and after-taste) showed a statistically significant difference between the two groups. The mean visual analogue scale (VAS) scores for taste appreciation on a scale from very bad to very good taste (0-10) were 5.92 for the CHX plus sign in circleCpc group and 4.10 for the CHX plus sign in circleAlc group (p=0.02). The mean visual analogue scale (VAS) scores for the after-taste on a scale from very short to very long (0-10) were 7.24 for the CHX plus sign in circleCpc group and 5.38 for the CHX plus sign in circleAlc group.

CONCLUSIONS

Within the limitations of the present study design, it can be concluded that rinsing with a 0.12% CHX mouthrinse on a non-alcohol base with 0.05% Cpc (Perio-Aid) is not significantly different from rinsing with a 0.2% CHX mouthrinse on an alcohol base (Corsodyl). It appears that the subjects appreciated the taste of the non-alcohol CHX solution better but the after-taste of the rinse remained longer in the mouth.

Amine Fluoride/Stannous Fluoride and Chlorhexidine Mouthwashes as Adjuncts to Single-Stage Dental Implants: A Comparative Study

BACKGROUND

The growing popularity of non-submerged dental implants in recent years requires a greater emphasis on microbial plaque control. Chlorhexidine (CHX), the most commonly used mouthwash in implant surgery, is sometimes associated with tooth staining and alteration in taste perception. Amine fluoride/stannous fluoride (AmF/SnF2) mouthwash has been shown to have anti-infective properties; however, it has not been tested as an adjunct anti-infective means in non-submerged dental implants. The purpose of this trial was to compare AmF/SnF2 and CHX mouthwashes as adjuncts to single-stage dental implants.

METHODS

Thirty-three patients aged 34 to 79 (mean 54.30 +/- 8.69 SD) requiring dental implants were accepted into the study. Following comprehensive periodontal therapy patients received one to three non-submerged dental implants (maxilla: 17; mandible: 45; anterior: 3, posterior: 59). After surgery patients were given analgesics and antibiotics as well as 2,400 ml of coded mouthwash bottles previously randomized between the two above mentioned formulations. Clinical and radiographic parameters were recorded at baseline and 3 and 12 months post-surgery.

RESULTS

Twelve-month survival rates were 100% and 92.9% for the AmF/SnF2 and CHX groups, respectively. Compliance was slightly higher in the AmF/SnF2 group (84.35% +/- 3.39% versus 78.15% +/- 4.59% SE) but statistically similar. There was no statistically significant difference between the AmF/SnF2 and CHX groups in staining index at 3 months (1.519 +/- 0.22 versus 1.457 +/- 0.24 SE) and patient subjective evaluation of the mouthwashes. Radiographic bone loss was 0.79 +/- 0.23 and 1 +/- 0.13 SE at 3 months and 1.06 +/- 0.13 and 1.27 +/- 0.25 at 12 months for the CHX and AmF/SnF2 groups, respectively; the difference was statistically insignificant (P = 0.388 and 0.504, respectively).

CONCLUSION

Both CHX and AmF/SnF2 mouthwashes can be used post-surgically after one-stage implant surgery.

Effect of two antimicrobial agents on early in situ biofilm formation

OBJECTIVES

The aim of this observer-blind, controlled, three-cell cross-over study was to evaluate the influence of an amine fluoride/stannous fluoride (Meridol, 250 ppm; ASF) and a chlorhexidine mouthrinse (CHX; Chlorhexamed forte, 0.2%) compared with water on in situ biofilm growth.

MATERIAL AND METHODS

After a professional toothcleaning seven volunteers had to wear a special acrylic appliance, in which six specimens each were inserted to allow the build-up of intra-oral biofilms. The volunteers had to rinse twice daily for 1 min. with 10 ml of the allocated mouthrinse. After 48 h of wearing, the specimens with the adhering biofilms were removed from the splints and stained with two fluorescent dyes, which selectively stain vital bacteria green and dead bacteria red. Under the confocal laser scanning microscope biofilm thickness (BT) was evaluated. To examine bacterial vitality (BV%) the biofilms were scanned (1 microm sections) and digital images were made. An image analysis program was used to calculate the mean BV as well as the BV of the single sections. After a wash-out period of 14 days a new test cycle was started.

RESULTS

The use of CHX and ASF resulted in a BT of 8.4+/-4.4 mum and 15.7+/-9.9 compared with 76.7+/-29.4 mum using water. The mean vitality (in %) was reduced from 66.1+/-20.4 to 23.3+/-11.6 and 23.9+/-12.4 using CHX and ASF, respectively. Both active solutions reduced BT and BV significantly compared with water (p<0.001). Differences between the two active solutions were not significant (p>0.05).

CONCLUSION

Both mouthrinses showed antibacterial and plaque-reducing properties against the in situ biofilm. The study design enables the examination of an undisturbed oral biofilm and for the first time shows the influence of antibacterial components applied under clinical conditions regarding biofilm formation.

Amine fluoride/stannous fluoride and incidence of root caries in periodontal maintenance patients. A 2-year evaluation

AIM

The purpose of the present study was to evaluate in a group of periodontal maintenance patients, the effect of using a dentifrice and mouthrinse containing amine fluoride (AmF) and stannous fluoride (SnF2) as compared with a dentifrice and mouthrinse both containing sodium fluoride (NaF) with regard to their root caries experience.

MATERIAL

In total, 80 patients who had been treated for moderate-to-severe periodontitis agreed to participate in this study. Subjects received supportive periodontal therapy at regular intervals of 3-4 months for at least a period of 1 year. The patients were randomly divided into two groups: (1) the test group used an AmF/SnF2 dentifrice and mouthrinse and (2) the control group used an NaF-containing dentifrice and mouthrinse. Root caries was recorded at four sites per tooth at baseline and 24 months.

RESULTS

An increase in number of the exposed root surfaces was noted for both groups during the experimental period (p<0.05). The mean number of active caries lesions at baseline was 2.1 and 1.8 for the test group and control group, respectively. At 24 months, the corresponding values were 1.8 for the test and 2.2 for the control group. An increase of the mean number of restored surfaces was noted for the AmF/SnF2 group (from 7.3 to 13.4) and the control group (from 7.9 to 14.7) during the course of the study. This increase was found to be statistically significant for both groups in comparison with the baseline values (p< or =0.01). No statistically significant differences were noted between groups. Further analysis of the restored surfaces revealed that the major increase in number of the restorations was associated with restorations involving three to four root surfaces in the same tooth. Molars and premolars were the teeth receiving most new restorations.

CONCLUSION

The present study did not detect a difference in terms of root caries development between the two groups. Root caries development is a common finding associated with surfaces developing recession in patients once treated for periodontal problems.

Effect of amine fluoride/stannous fluoride toothpaste and mouthrinse on dental plaque accumulation and gingival health

OBJECTIVE

The aim was to investigate the influence of amine fluoride (AmF)/stannous fluoride (SnF2) containing toothpaste and mouthrinse on plaque accumulation and gingival health of young adults after 4 weeks use.

SUBJECT AND METHODS

Forty-two young adults (mean age: 28.33 +/- 7.19 years) were examined for the Plaque Index (PI; Silness and Löe, 1964) and Gingival Index (GI; Löe and Silness, 1963) scores, and divided randomly into two groups. Both groups used AmF/SnF2 containing toothpaste twice a day for 3 min toothbrushing, and one group after toothbrushing rinsed with AmF/SnF2 containing mouthrinse for 30 s. After 4 weeks the probands were re-examined.

RESULTS

Statistically significant decrease in dental plaque (PI) and gingival (GI) index values were found at the end of the study. The reduction of PI and GI values was significant in all groups but it was higher in the combined (toothpaste + mouthrinsing) group, than using toothpaste only.

CONCLUSION

The regular combined use of AmF/SnF2 toothpaste and mouthrinse was more effective in the reduction of plaque accumulation and maintenance of gingival health than the toothpaste alone.

Inhibitory effects of cacao bean husk extract on plaque formation in vitro and in vivo

Cacao bean husk extract (CBH) has been shown to possess antibacterial and antiglucosyltransferase activities through its unsaturated fatty acids and epicatechin polymers, respectively. In the present study, the antiplaque activities of CBH were examined in vitro and in vivo. The extract inhibited the adherence of Streptococcus mutans MT8148 to saliva-coated hydroxyapatite and reduced the accumulation of artificial dental plaque by S. mutans MT8148 on orthodontic wire. The number of mutans streptococci in dental plaque was also significantly reduced when human dental plaque was exposed to CBH from 21 children at 37 degrees C for 1 h. For the in vivo study, 28 volunteers aged 19-29 yr old rinsed their mouth with CBH, before and after each intake of food and before sleeping at night for 4 d without using other oral hygiene procedures. Plaque depositions and the numbers of mutans streptococci were reduced in the subjects, compared with rinsing with 1% ethanol alone. These results indicate that CBH possesses significant antiplaque activity in vitro and in vivo.

Mouthrinses with alcohol: cytotoxic effects on human gingival fibroblasts in vitro

BACKGROUND

Mouthrinses are widely utilized in daily oral and dental hygiene to control plaque. However, most commercially available mouthrinses contain alcohol as an excipient. Most studies have focused on the clinical side effects related to the alcoholic fraction of mouthrinses, overlooking alcohol metabolism in the mouth. Due to this oral enzymatic process, the well-recognized toxic compound acetaldehyde is emitted in the mouth. Since gingival fibroblasts play a key role in oral connective tissue health maintenance, we investigated the effects of different doses of acetaldehyde on human gingival fibroblasts (HGFs) in order to better define the effects of alcohol-containing mouthrinses on oral tissue.

METHODS

Cultured HGFs were exposed to different concentrations of acetaldehyde (10(-4) M to 10(-2) M). The cell adhesion rate was measured after a 3-hour incubation period, and cell viability over a 5-day period. In order to assess the reversibility of the damage produced by acetaldehyde, treatment was interrupted at critical doses (10(-3) M and 3 x 10(-3) M), and cell viability was evaluated on the third and fifth day of incubation. The HGF cytoskeleton was studied by immunocytochemical technique, and internal cell structures were observed with transmission electron microscopy to evaluate the morphological changes due to acetaldehyde.

RESULTS

The results showed that acetaldehyde produced a dose- and time-dependent inhibition on cell adhesion and viability, together with disruption of cytoskeletal structures and cytoplasmic organelles. Nevertheless, these quantitative and qualitative damages were reversible when the treatment was interrupted.

CONCLUSIONS

Although more knowledge is necessary, our results suggest that these deleterious effects may also occur in vivo. Pending further investigations, clinicians should be alerted to the potentially adverse effect of alcohol-containing mouthrinses and, to promote oral health, patients should be warned about improper use of these products.

Differences in antimicrobial activity of four commercial 0.12% chlorhexidine mouthrinse formulations: an in vitro contact test and salivary bacterial counts study

AIM

To evaluate the in vitro and in vivo antimicrobial activity of four commercial 0.12% chlorhexidine mouthrinses.

MATERIAL AND METHODS

The in vitro antimicrobial activity test consisted in a modified contact test where 20 selected bacterial species were tested during 1 min with each test product. After the contact, the inoculum was cultured, and the results were expressed in terms of survival/resistance and the percentage of survival as compared to a saline control. The in vivo test consisted of a double-blind, randomized, crossover salivary bacterial counts study. 10 volunteers rinsed during 1 min with each tested product. Saliva samples were obtained before rinsing, and after 5 min, and 1, 3, 5 and 7 h. These samples were cultured both aerobically and anaerobically. Percentages of survival, in regard to baseline, were calculated for each time point. Comparisons among products were tested using anova and selected paired t-test.

RESULTS

The in vitro contact test showed no survival in any tested species with CHX+CPC, while three species (Lactobacillus casei, Streptococcus mitis and Peptostreptococcus micros) were resistant to the other three products. CHX and CHX+NaF demonstrated additional resistant species (three and four species, respectively). The in vivo salivary bacterial counts test showed higher reductions of CHX+CPC and CHX+ALC in aerobic and anaerobic bacteria, lasting for 5 h. Significant differences were detected at multiple time points, when these two products were compared both with the control and the other tested products.

CONCLUSION

Important differences in activity, among 0.12% CHX products, were detected by both in vitro and in vivo tests. The formulation with alcohol was more active than those without alcohol, excepting the formulation with CHX+CPC, in which the reformulation and addition of CPC not only compensate but rather increase the antimicrobial activity.

Current products and practice section: religious, cultural, and ethical dilemmas in orthodontics

There are potential religious, cultural and ethical dilemmas facing patients who are undergoing orthodontic treatment. Opinions were collected from religious and cultural leaders, as well as from non-religious groups who take an ethical standpoint on certain medical or dental treatment. Factors relating to ingredients in orthodontic products, timing of orthodontic appointments, and the effects of religious fasting are all discussed. It is important to recognize all patients' opinions and beliefs when planning and undertaking orthodontic treatment.

Efficacy of an amine fluoride-triclosan mouthrinse as compared to the individual active ingredients

BACKGROUND

The purpose of the clinical study was to examine the antibacterial and plaque-reducing properties of mouthrinses containing triclosan (TRI), amine fluoride (AmF), and the combination of both (AFT) on 4-day plaque regrowth. A placebo solution (PLA) and a 0.2% chlorhexidine solution (CHX) served as negative and positive controls, respectively.

MATERIALS AND METHODS

After a professional tooth cleaning (day 0), 15 volunteers refrained from all mechanical oral hygiene measures for the next 96 h and rinsed instead twice daily for 1 min with 10 ml of one of the five randomly assigned solutions. Plaque index (PlI), which was assessed after 24 and 96 h (PlI1, PlI2), and plaque area of the front teeth (PA), which was planimetrically recorded from disclosed teeth after 96 h, served as clinical parameters. After 24 and 96 h a plaque sample was taken and analyzed microbiologically to evaluate biofilm vitality (VF1, VF2). The subsequent test cycles were conducted after a washout period of 10 days each.

RESULTS

No severe adverse events or allergy were seen during the study. CHX influenced all parameters at all time points in comparison to PLA. AFT and AmF showed very similar values (in all parameters), but AmF did not reach the level of significance regarding VF1, nor did AFT with VF2 and PlI1. The TRI solution only reduced PlI2 and PA significantly, but had no influence on biofilm vitality when compared to PLA.

CONCLUSION

A synergism between AmF and TRI was not observed. The results suggest that the plaque-reducing and antibacterial effects of the AFT solution are mainly based on the effects of the amine fluoride moiety.

Substantivity of toothpaste slurries and their effect on reestablishment of the dental biofilm

OBJECTIVES

Toothpastes are good vehicles for antibacterial substances to exert a prolonged effect. This effect depends on the substantivity and ability to interfere with plaque metabolism and/or vitality. It was the purpose of this clinical, randomized 2 x 4 cell crossover study to evaluate and to compare the antibacterial effects of two toothpastes (Colgate Total(R), COL and Parodontax(R), PAR) applied as slurries on established plaque over 24 h (Part I) and their effect on 4-day plaque regrowth (Part II). Chlorhexamed(R) (0.1%; CHX) and water served as positive and negative controls.

MATERIAL AND METHODS

After professional toothcleaning eight students were asked to refrain from all mechanical hygiene measures for the next 72 h. After 48 h plaque was sampled and vitality of the plaque flora examined (baseline, VF0%). The subjects then rinsed for 1 min with 15 mL of one of the test or control solutions. Every second hour up to 14 h and 24 h after rinsing, plaque sampling and staining was performed to assess plaque vitality (VF2-24, Part I). In Part II, the classical 4-day plaque regrowth design was used with two rinses (1 min) a day as the only oral hygiene measure. Vitality values were assessed on day 1 and day 4 (VF1, VF2). At day 4, teeth were stained to assess the whole mouth plaque index (PlI) and to evaluate the percentage of plaque area (PA) of the anterior teeth.

RESULTS

Compared to placebo, all active rinses reduced plaque vitality significantly over a period of 24 h (Part I). PAR, COL and CHX revealed reductions of 18-31%, 28-50% and 19-50%, respectively. In Part II, similar reductions of all parameters were found for all active rinses (PAR 12-30%, COL 34-51%, CHX 40-64%).

CONCLUSIONS

Colgate Total has shown a significant action on plaque regrowth and a high substantivity during 24 h, while Parodontax revealed a more moderate but still significant effect.

Effect of an amine-fluoride-triclosan mouthrinse on plaque regrowth and biofilm vitality

BACKGROUND

The purpose of this double-blind, prospective, latin-square crossover randomised study was to examine the efficacy of a mouthrinse solution containing a combination of triclosan, amine fluoride and sodium fluoride on supragingival plaque regrowth compared to a placebo and a chlorhexidine solution.

METHODS

12 volunteers refrained after professional oral prophylaxis from all mechanical hygiene measures for the following 96 h and rinsed instead cross-over in a randomised order with either chlorhexidine digluconate (0.2%, positive control), a verum solution (0.5% amine fluoride, 0.028% sodium fluoride, 0.03% triclosan) or a placebo solution. The plaque index was assessed after 24 and 96 h (PI 1, PI 2) and the plaque area (PA) photographed and calculated after 96 h of undisturbed plaque regrowth. Moreover plaque samples were taken after 24 and 96 h and examined with the vital fluorescence technique to assess the vitality of the biofilm microbiota (VF 1, VF 2).

RESULTS

The amine-fluoride-triclosan solution reduced the clinical parameters (PI and PA) as well as the vitality of the plaque flora (VF) significantly when compared to the placebo solution. The verum reached a 36.5% (p<0.05) and a 39.8% reduction (p<0.0001) in PI 1 and PI 2, respectively, concomittant with a reduction of 23.8% and 32.2% (p<0.001) in VF 1 and VF 2 and of 46.9% (p<0.0001) in PA at day 4. This was less than the reductions found with the positive control, i.e., the 0.2% chlorhexidine solution (54.2% and 71.1% reduction in PI 1 and PI 2, 40.0% and 53.4% in VF 1 and VF 2 and 71.5% in PA). However, significant differences between both active solutions were only established for PI 2 and PA.

CONCLUSION

During 4-day plaque regrowth the amine-fluoride-triclosan product displayed a significant antibacterial and plaque-reducing action in comparison to the control.

The effect of dental restorative materials on dental biofilm

To investigate the arrangement of biofilms formed in vivo, volunteers wore splints with slabs of six different dental materials inserted to collect smooth surface plaque. After 5 d of undisturbed plaque accumulation, the specimens were vital stained and analyzed by the confocal laser scanning microscopy (CLSM) to evaluate the percentage of vital biofilm microflora (VF percentage). Further parameters were the area of the specimens covered by plaque (surface coating; SC, %) and the height of the biofilms (BH, pm). The metals amalgam and gold, the compomer, as well as the glass-ionomer cement harboured an almost entirely dead biofilm (VF <8%). Resin composite led to vitality values between 4 and 21%, while a very thin biofilm on ceramic revealed the highest vitality values (34-86%). SC varied from 6% on glass-ionomer cement to 100% on amalgam. BH reached its highest value on amalgam and gold of 17 and 11 microm, respectively, while heights of between 1 and 6 microm were found on the ceramic, resin composite, compomer and the glass-ionomer cement. Within their limits, the present findings indicate that amalgam, gold, compomer and glass-ionomer cement exert an influence against the adhering biofilm. No general relationship could be established between the different parameters VF percentage, SC percentage and BH (microm).

Effect of an enamel matrix protein derivative (Emdogain) on ex vivo dental plaque vitality

BACKGROUND

A common clinical observation following surgical periodontal therapy with an enamel matrix derivative (Emdogain) is the improved healing of the soft tissues and the limited inflammation of the operated areas. These clinical observations are empirical and difficult to explain. One of the factors influencing the early wound healing might be a potential antimicrobial effect of Emdogain.

AIM

To investigate the effect of Emdogain on the vitality of ex vivo supragingival dental plaque and to compare this effect to that of a standard 0.2% chlorhexidine solution.

MATERIALS AND METHODS

24 patients suffering from adult periodontitis were included in the study. At the beginning of the experiment, all participants were given a professional tooth cleaning. For the following 4 days, they had to refrain from any kind of oral hygiene measures. At day 5, from each of the volunteers, a voluminous plaque biofilm sample was taken with a sterile curette from the vestibular surfaces of the 1st lower molars and divided into 5 equal parts. Each part was mounted with 5 microl of the following solutions: (1) NaCl, (2) enamel matrix derivative dissolved in water (EMD), (3) enamel matrix derivative dissolved in the vehicle (Emdogain), (4) vehicle (propylene glycol alginate, PGA), (5) 0.2% chlorhexidine digluconate (CHX). After a reaction time of 2 min the test solutions were sucked off, and subsequently the biofilm was stained with a fluorescence dye. The vitality of the plaque flora after the treatments was evaluated under the fluorescence microscope (VF%).

RESULTS

Plaque samples treated with NaCl showed a mean vitality of 76.8+/-8%. The EMD, Emdogain, PGA and CHX showed VF values of 54.4+/-9.2, 21.4+/-10.6%, 19.6+/-11.6% and 32.3+/-11.8%, respectively. Emdogain, PGA and CHX showed statistically highly significant reductions (p<0.0001) in terms of bacteria vitality when compared to water (negative control) and EMD. Both Emdogain and PGA were found to be statistically significantly different compared to CHX (p<0.001) (positive control).

CONCLUSION

The results of this study indicate that Emdogain might have an antibacterial effect on the vitality of the ex vivo supragingival dental plaque flora.