A comparison of the plaque-inhibitory properties of stannous fluoride and low-concentration chlorhexidine mouthrinses

Evaluation of Salvadora persica L. and green tea anti-plaque effect: a randomized controlled crossover clinical trial

Background

In the author’s earlier in vitro investigation, a combination of 0.25 mg/ml green tea and 7.82 mg/ml Salvadora persica L. aqueous extracts was found to exhibit significant synergistic anti-bacterial and anti-adherence effects against primary plaque colonizers biofilm. A clinical trial was needed to support these preliminary in vitro results and to investigate its efficacy as a mouthwash in the control of dental plaque.

Methods

A 24 h plaque re-growth, double-blinded, randomized crossover trial was carried out. Participants (n = 14) randomly rinsed with test formulation, 0.12% chlorhexidine (control) and placebo mouthwashes for 24 h. A week before the trial, all participants received scaling, polishing and oral hygiene education. On the trial day, the participants received polishing at baseline and rinsed with 15 ml of randomly allocated mouthwash twice daily without oral hygiene measures. After 24 h, plaque index was scored and then the participants entered a 6-days washout period with regular oral hygiene measures. The same protocol was repeated for the next 2 mouthwashes.

Results

The results were expressed as mean (±SD) plaque index. The test mouthwash (0.931 ± 0.372) significantly reduced plaque accumulation when compared with placebo (1.440 ± 0.498, p < 0.0167) and chlorhexidine (1.317 ± 0.344, p < 0.0167) mouthwashes. No significant difference was found between chlorhexidine and placebo (p > 0.0167).

Conclusions

The test mouthwash has an anti-plaque effect for a 24 h period. Longer-term clinical studies are highly encouraged to investigate its anti-plaque effect for longer periods.

Trial registration

This study was registered in ClinicalTrials.gov as NCT02624336 in December 3, 2015.

Electronic supplementary material

The online version of this article (doi:10.1186/s12906-016-1487-0) contains supplementary material, which is available to authorized users.

Effect of Chlorhexidine with Fluoride Mouthrinse on Plaque Accumulation, Plaque pH - A Double Blind Parallel Randomized Clinical Trial

INTRODUCTION

Mouthwashes are important means used in chemical control of dental plaque. There is strong evidence suggestive of better effectiveness, when fluoride is added to chlorhexidine mouthwash.

AIM

To assess the anti-plaque efficacy of Chlorhexidine combined with Fluoride mouthwash and to measure its impact on plaque accumulation and on plaque pH.

MATERIALS AND METHODS

Initially 100 subjects were screened. A double blind, parallel randomized clinical trial was conducted on 30 subjects after applying inclusion and exclusion criteria. Other independent variables were matched before randomly allocating them in three groups: Group A-Chlorhexidine as positive control, Group B-Chlorhexidine + Fluoride as test group and Group C- Distilled water as negative control. Oral prophylaxis of participants was done before onset of the study. Plaque pH was assessed before and immediately after rinsing at 0, 5 and 10 minutes interval and after 7 days with digital pH electrode (pHepR pH meter, Hanna Instruments R10285) and accumulation of plaque was recorded by Turesky et al., modification of Quigley Hein Plaque Index (1970). ANOVA test was used for statistical analysis.

RESULTS

Although there was a statistically significant reduction in mean plaque scores from baseline to seven days in both Groups A and B, Group B showed better anti-plaque efficacy . Almost equal drop in plaque pH was seen for both the groups at 5 and 10 minutes.

CONCLUSION

Better anti-plaque efficacy was observed in Group B (Chlorhexidine and Fluoride combination) with minimum variation of plaque pH.

Inhibition of de novo plaque growth by a new 0.03 % chlorhexidine mouth rinse formulation applying a non-brushing model: a randomized, double blind clinical trial

OBJECTIVES

The aim of this study was to investigate the plaque inhibitory effect of a new 0.03 % chlorhexidine digluconate (CHX) and 0.05 % cetylpyridinium chloride (CPC) mouthrinse formulation and to explore patients' experience and side effects after its use.

MATERIALS AND METHODS

This short-term, randomized, double blind, parallel, clinical trial enrolled 150 periodontally healthy patients. These volunteers were randomly allocated to one of following mouthrinse groups (n = 50/group): 0.12 % CHX + 0.05 % CPC (Perio-Aid® Treatment alcohol-free), 0.03 % CHX + 0.05 % CPC new test formulation or to the placebo group. Clinical parameters (plaque, gingival, and stain indexes) and microbiological samples were taken at baseline, before supragingival cleaning, and after 4 days of undisturbed plaque growth, rinsing twice/day with one of the mouthrinses.

RESULTS

Plaque reduction was similar for the 0.12 % CHX (-0.52 ± 0.55) and 0.03 % CHX (-0.47 ± 0.49) groups. Both showed significant reductions in plaque accumulation compared to the placebo (p < 0.001). The new formulation had less of a negative impact on taste perception when compared to the 0.12 % CHX solution. The new CHX mouthrinse was also able to control bacterial loads and reduce some periodontopathogens.

CONCLUSIONS

This study indicated that the new 0.03 % CHX + 0.05 % CPC formulation exerted clinical efficacy similar to that achieved by an already-marketed 0.12 % CHX + 0.05 % CPC mouthrinse, but with slightly fewer side effects.

CLINICAL RELEVANCE

Lower CHX mouthrinse formulations could be effective in the inhibition of plaque regrowth with reduced unpleasant subjective side effects.

Comparison of the Antibacterial Properties of Three Mouthwashes Containing Chlorhexidine Against Oral Microbial Plaques: An in vitro Study

Background:

The mouth provides an environment that allows the colonization and growth of a wide variety of microorganisms, especially bacteria. One of the most effective ways to reduce oral microorganisms is using mouthwashes.

Objectives:

The aim of this study was to investigate the antibacterial effects of chlorhexidine mouthwashes (manufacture by Livar, Behsa, Boht) on common oral microorganisms.

Materials and Methods:

In this in vitro study, isolated colonies of four bacteria, including Streptococcus mutans, S. sanguinis, S. salivarius and Lactobacillus casei, were prepared for an antimicrobial mouth rinse test. The tube dilution method was used for determining the minimum inhibitory concentrations (MIC) and minimum bactericidal concentrations (MBC).

Results:

The MICs for Kin gingival, Behsa and Boht mouthwashes were 0.14, 0.48 and 1000 micrograms/mL using the tube method for S. mutans, respectively. The MBCs for the mentioned mouthwashes were 0.23, 1.9 and 2000 micrograms/mL for S. mutans, respectively. The MICs for Kin gingival, Behsa and Boht mouthwashes were 0.073, 0.48 and 250 micrograms/mL using the tube method for S. sanguinis, respectively. The MBCs for the mentioned mouthwashes were 0.14, 1.9 and 1000 micrograms/mL for S. sanguinis, respectively.

Conclusions:

The Kin Gingival chlorhexidine mouthwash has a greater effect than Behsa and Boht mouthwashes on oral microorganisms and is recommended to be used for plaque chemical inhibition.

Effect of cleansing of biofilm formed on titanium discs

OBJECTIVES

To study the combined effect of mechanical and chemical cleansing on a 4-day biofilm grown intra-orally on titanium discs with different surface characteristics.

MATERIAL AND METHODS

Twenty subjects used a splint with two metal plates in the upper jaw. Each plate was placed in the premolar-molar region and carried four titanium discs with four different surface characteristics (OsseoSpeed(™), TiOblast(™), experimental and turned surface). After 4 days of biofilm growth, the discs were cleaned mechanically and chemically with saline or chlorhexidine. Following cleansing, microbial samples were obtained and analysed by culture. The titanium discs were processed for scanning electron microscope (SEM) analysis. The experiment was repeated 3 days later using delmopinol or a mixture of essential oils during cleansing.

RESULTS

The combination of mechanical and chemical cleansing was ineffective in complete biofilm removal from all four titanium discs. The microbiological analysis did not reveal any statistically significant differences between surface types or between cleaning agents regarding logarithmic mean counts of CFU for specific bacteria, aerobes, anaerobes or the TVC. Aerobes were more numerous than anaerobes on all surface types. The SEM analysis disclosed that the remaining biofilm on moderately rough surfaces (OsseoSpeed(™), TiOblast(™) and experimental) was complex and firmly attached, while the biofilm on turned surface had a pattern of spread bacteria forming less clusters.

CONCLUSIONS

Cleansing may call for prolonged time of chemomechanical debridement and/or more effective disinfectants to suppress biofilms on dental implant surfaces.

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.

Effects of low dose chlorhexidine mouthrinses on oral bacteria and salivary microflora including those producing hydrogen sulfide

BACKGROUND/AIMS

Clinical studies have demonstrated the considerable effects of chlorhexidine on dental plaque and oral microbiota as well as improvements in indices of oral health. This investigation examined the efficacy of lower concentrations of chlorhexidine.

METHODS

Mouthrinses with 0.03%, 0.06%, 0.12% chlorhexidine and a control rinse without chlorhexidine were examined. Alamar blue, an oxidation-reduction dye with fluorescent end-points proportional to bacterial viability, was used to determine bacterial viability. Further clinical studies examined the effects of these rinses on salivary bacteria and on bacteria producing hydrogen sulfide (H(2)S) and implicated in halitosis.

RESULTS

In laboratory tests, a significant dose-dependent effect was observed with Actinomyces viscosus as a model system using the Alamar blue procedure (P < 0.05). Clinical studies examined the effects 1.5 h and 3 h post-treatment on salivary bacteria and bacteria producing H(2)S. The first study compared the control rinse with the 0.03% and 0.06% chlorhexidine rinses; a second study compared the effects of the control rinse and the 0.06% and 0.12% chlorhexidine mouthrinses. In both studies, chlorhexidine rinses demonstrated significant dose-dependent effects post-treatment on salivary bacteria vs. the control rinse (P < 0.05). Significant decreases in H(2)S-producing bacteria were noted with these chlorhexidine rinses vs. the control rinse (P < 0.05).

CONCLUSION

The results highlight the dose-dependent relationships noted in laboratory and clinical tests which have potential implications for the use of lower doses of chlorhexidine to inhibit oral bacteria, including those implicated in halitosis.

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.

The role of therapeutic antimicrobial mouthrinses in clinical practice: control of supragingival plaque and gingivitis

BACKGROUND

Although mechanical plaque control methods have the potential to maintain adequate levels of oral hygiene, clinical experience and population-based studies demonstrate that such methods are not being employed sufficiently by large numbers of the population. The need for additional help in controlling bacterial plaque provides the rationale for patients' using antimicrobial mouthrinses as adjuncts to their mechanical oral hygiene regimens.

TYPES OF STUDIES REVIEWED

The author presents an overview of the types of studies used to support the effectiveness of antiplaque and antigingivitis mouthrinses, ranging from laboratory studies to six-month clinical trials. He discusses plaque as an example of a biofilm and the implications of recent research on the nature of biofilms with respect to the nature of the evidence that can be used to demonstrate clinical effectiveness.

CONCLUSIONS

The safety and clinical effectiveness of antiplaque and antigingivitis antimicrobial mouthrinses are best determined using prospective, randomized clinical trials conducted in accordance with ADA guidelines.

CLINICAL IMPLICATIONS

The adjunctive use of antimicrobial mouthrinses can provide significant benefits to patients who cannot maintain adequate levels of plaque and gingivitis control through mechanical methods alone. Dentists should recommend products that have proven clinical activity as demonstrated using generally accepted safety and effectiveness criteria.