Effects of 0.2% chlorhexidine spray applied once or twice daily on plaque accumulation and gingival inflammation in a geriatric population

Effect of Different Concentrations of Chlorhexidine on Anti-Plaque in Oral Care Practice: A Systematic Review and Network Meta-Analysis

OBJECTIVES

The aim of this network meta-analysis was to compare the anti-plaque effects and adverse effects of different concentrations of chlorhexidine (CHX).

METHODS

PubMed, OVID Embase and the Cochrane Library were searched from inception to October 2023 for randomised controlled trials (RCTs) of different concentrations of CHX in healthy populations. Random-effects network meta-analyses were performed to summarise the evidence, and the Grading of Recommendations Assessment, Development and Evaluation framework was used to rate the certainty of evidence. Cohen's d standardised mean differences were calculated as the measure of effect size.

RESULTS

Thirty-eight RCTs involving 2011 participants and six concentrations of CHX (0.2%, 0.12%, 0.1%, 0.3%, 1% and 0.06%) were included. The anti-plaque effects of CHX at all concentrations were compared with placebo. Moderate to very low certainty evidence established 0.2% CHX as the most effective on anti-plaque. 0.12% and 0.1% CHX also showed significant anti-plaque effects. However, the ranking probabilities showed that the adverse effects of 0.12% and 0.1% CHX were < 0.2% CHX.

CONCLUSIONS

Compared with placebo, 0.2%, 0.12% and 0.1% CHX had significant anti-plaque effects, with moderate to very low certainty evidence that 0.2% CHX was most effective on anti-plaque. However, 0.2% CHX had larger adverse effects than 0.12% and 0.1% CHX.

TRIAL REGISTRATION

PROSPERO: Number CRD: 42022327083.

Effect of oral health interventions for dependent older people-A systematic review

BACKGROUND

There is an increasing proportion of older people in the population worldwide, with a large group being dependent on the care of others. Dependent older people are more vulnerable to oral diseases, which can heavily impact their quality of life (OHRQoL) and general health.

OBJECTIVE

The purpose of this systematic review was to comprehensively assess interventions to improve oral health or guarantee access and adherence to dental treatment of dependent older people.

METHODS

We searched MEDLINE, EMBASE, CENTRAL and clinical trial registries. Two reviewers performed the selection, data extraction, risk of bias evaluation using the Cochrane Risk of Bias tool and assessment of certainty of the evidence. When possible, we conducted a meta-analysis to calculate effect estimates and their 95%CIs. Primary outcomes were OHRQoL, oral/dental health, and use of the oral care system.

RESULTS

We included a total of 30 randomised clinical trials assessing educational and non-educational interventions for community-dwelling older people (n = 2) and those residing in long-term care facilities (n = 28). Most studies assessed oral hygiene and showed that interventions may result in a reduction in dental plaque in the short term (with low certainty of evidence), but there is limited evidence for long-term effectiveness. Only one study assessed OHRQoL, and none evaluated changes in the use of the oral health care system.

CONCLUSION

Our findings do not provide strong conclusions in favour of any specific intervention, mainly due to study quality and imprecision. There is limited information about the long-term effect of interventions, and further research is needed, especially targeting community-dwelling older people.

PROSPERO ID

CRD42021231721.

Dental plaque control strategies for the elderly population: A scoping review

OBJECTIVE

To review the scientific literature and identify dental plaque control strategies focussed on elderly people that improve plaque indices.

DESIGN

Scoping review (Joanna Briggs protocol).

DATA SOURCES

Individual search strategies developed for six databases. The selection of the manuscripts in two phases: title and abstract review, and complete review.

ELIGIBILITY CRITERIA

Studies on interventions for plaque control in elderly people (60y+). Epidemiological studies and those focussed on caregivers, health professionals and periodontal maintenance therapies were excluded.

RESULTS

The initial search yielded 2803 studies, 26 were included. The results were classified into: exclusively chemical (10), educational (9), exclusively mechanical (6), and combined mechanical and chemical (1). The studies reported different types of interventions: sugarless chewing gum, chlorhexidine (CHX) in different preparations and concentrations, mouthwash based on essential oils, stannous/sodium fluoride dentifrice and lactoferrin/lactoperoxidase tablets. Additionally, conventional and alternative toothbrushes and professional brushing were tested. Educational interventions included oral hygiene guidance, verbal information, and demonstrations of dental and denture cleaning procedures, and lifestyle changes. Many studies have reported strategies that improve dental plaque indices but without statistical significance when compared to control groups. Promising results were found with the use of CHX, sugarless chewing gum, professional brushing and educational strategies with demonstration, but the results were not long-lasting.

CONCLUSION

The literature reports that mechanical, chemical and educational strategies have some efficacy in dental plaque control in the elderly population. The results should be viewed with caution, considering the type of intervention (isolated or combined) and the maintenance of the results obtained.

A randomised clinical trial on the effect of oral antimicrobial sprays in institutionalised elders

OBJECTIVE

To compare the effectiveness of chlorine dioxide, chlorhexidine and placebo sprays in improving oral hygiene among institutionalised elders.

BACKGROUND

Available evidence suggests that oral sprays may be an effective alternative delivery method for plaque control; however, few studies have evaluated antimicrobial agents other than chlorhexidine.

MATERIALS AND METHODS

A total of 228 elders across 11 nursing homes in Hong Kong were recruited into the clinical trial. Participants were randomly allocated into one of the following groups: 0.1% pH-balanced chlorine dioxide spray, 0.2% chlorhexidine spray or sterile water spray (placebo control), once daily. Dental plaque, gingival bleeding and other clinical oral health outcomes were assessed at baseline, 3 and 6 months. Participant acceptability of the interventions was assessed at the end of the clinical trial.

RESULTS

Review assessments were conducted for 135 elders at 6 months. Significantly greater reductions in plaque index scores were observed with the chlorhexidine spray (0.4) and chlorine dioxide spray (0.3) than the placebo spray (0.1). While significant reductions in gingival bleeding scores were observed within the chlorhexidine (7.4), chlorine dioxide (7.5) and placebo (5.3) sprays after 6 months, change scores were not significantly different between groups. Significantly greater increases in the levels of staining were observed in the chlorhexidine spray group (-0.1) than the chlorine dioxide (0.0) and placebo spray (0.0) groups.

CONCLUSION

Antimicrobial sprays were shown to be effective among institutionalised elders. Chlorine dioxide spray showed equivalent effects on dental plaque and gingival bleeding relative to the chlorhexidine spray over a 6-month period.

Effect of polyhexanide as antiseptic mouth rinse against oral pathogens in an in vitro biofilm model

OBJECTIVE

The aim of this study was to evaluate the anti-biofilm effect of polyhexanide mouth rinses against oral pathogens in vitro.

MATERIAL AND METHODS

Biofilms of Candida albicans, Streptococcus mutans, Actinomyces naeslundii, Aggregatibacter actinomycetemcomitans, methicillin-resistant Staphylococcus aureus and Fusobacterium nucleatum were grown on 10 mm diameter hydroxyapatite discs for 5 days. Biofilms were exposed to test substances for 30 s (ProntOral, polyhexanide 0.15%, chlorhexidine 0.2%). Another test set simulating blood contamination in the oral cavity was performed by submerging the discs in defibrinated sheep blood prior to antimicrobial exposure. Biofilm mass was determined via crystal violet staining. The proliferation potency of the cells after antimicrobial exposure was evaluated by plating serially diluted suspensions from extracted biofilms on agar plates and determining the number of colony-forming units (CFU/ml). Mann-Whitney-U, Kruskal-Wallis and Dunn's test were used for statistical analyses.

RESULTS

Regardless of blood contamination ProntOral led to a significant reduction of biofilm mass in all strains. Chlorhexidine and polyhexanide reduced biofilm mass in five out of six strains and in only four strains after blood contamination. All agents significantly reduced CFU/ml from S. mutans, A. actinomycetemcomitans and F. nucleatum biofilms. C. albicans and S. aureus biofilms were only affected by ProntOral and polyhexanide. None of the antiseptics significantly reduced the CFU/ml for A. naeslundii biofilms. After blood contamination ProntOral and polyhexanide significantly reduced CFU/ml in all strains, whereas CHX tended to increase the CFU/ml.

CONCLUSIONS

Polyhexanide mouth rinses seem to be suitable disinfectants against oral pathogens without their anti-biofilm potential being impaired by blood.

First insights into chlorhexidine retention in the oral cavity after application of different regimens

Objectives

This in situ study aimed to determine and compare the chlorhexidine (CHX) retention in the oral cavity after the application of different CHX pharmaceutical regimens.

Methods

Five volunteers used different CHX treatment regimens including mouth rinses, dental spray and toothpaste gel. After the application of the different CHX regimens, 2-μl samples were taken from saliva and buccal mucosa pellicle as well as the dental pellicle samples formed on standardized enamel surfaces. Sample collection was conducted at six time points within 12 h. Retention of CHX was measured using matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry.

Results

CHX retention values in the oral mucosa pellicle were significantly higher than those in saliva. CHX remained in the mucosal pellicle at microgrammes per millilitre levels for 12 h after mouth rinsing, 10 h after spray application and 2 h after using the toothpaste. CHX was detected in the dental pellicle for at least 12 h after application of mouth rinsing and spray. Retention of CHX after mouth rinsing or spray application was significantly higher than the retention after using toothpaste.

Conclusions

Oral mucosa was the favourable site for CHX retention. Higher mouth rinse concentration and longer rinsing time produced a slight increase in CHX retention. CHX spray provided considerable retention values, whereas toothpaste gel delivered the lowest retention after application. MALDI-TOF was a sensitive method with excellent limits of quantification for CHX detection.

Interventions to improve oral health of older people: A scoping review

OBJECTIVES

A range of interventions have been tested to improve oral health of older people. We performed a scoping review to map interventions' aims, outcome measures and findings, and to locate them on different levels of care.

DATA

We systematically screened for (1) controlled studies on (2) people over 65 years of age, (3) comparing at least two interventions to improve oral health. Interventions were summarized according to their aims and the employed intervention type, mapped on their level of action, and classified as primary/secondary/tertiary prevention.

SOURCES

Studies retrieved via MEDLINE, EMBASE, CINAHL.

STUDY SELECTION

Eighty-one studies (published 1997-2019, conducted mainly in high-income countries) were included. Sample sizes varied (n = 24-1987). Follow-up was 0.25-60 months. Most studies (64/81) found a statistically significant benefit of the intervention. A total of 13 different aims were identified, and a range of intervention types employed (e.g. educational interventions, professional oral healthcare, restorative treatment, fluoride application and, generally, dentifrices, mouthwashes, chewing gums/food supplements). Most studies were located on the carer/patient level (56/81 studies) or the system/policy-maker level (44/81). The majority of studies aimed for primary prevention (64/81).

CONCLUSIONS

Oral health improvement interventions are widely studied. However, study aims, methods and outcome measures are highly heterogeneous, which limits the ability for robust conclusions. Current research focusses on primary prevention on the level of patients/carers or system/policy-maker level. Future studies may want to consider interventions on dentists' level focussing on secondary prevention. These studies should rely on a core set of comprehensive, standardized set of outcome measures.

CLINICAL SIGNIFICANCE

While specific interventions seem efficacious to improve older people's oral health, the current body of evidence is neither comprehensive (significant gaps exists in relevant levels of the care process) nor comparable enough to draw robust conclusions.

The effect of antiseptic oral sprays on dental plaque and gingival inflammation: A systematic review and meta-analysis

OBJECTIVES

To review the effectiveness of antiseptic oral sprays on oral health.

METHODS AND MATERIALS

Three electronic databases (PubMed, Cochrane Library and Web of Science) were systematically searched to identify relevant studies. Only randomized controlled trials (RCTs) comparing the effect of oral sprays to placebo/control spray or mouthrinse on dental plaque and gingival inflammation were included.

RESULTS

Among a total of 996 papers, 20 effective studies fulfilled the selection criteria, and 8 studies were suitable for inclusion in meta-analyses. A meta-analysis of three studies using a 0.2% chlorhexidine (CHX) spray intervention, without prophylaxis at baseline, showed reductions in Plaque Index (PI) (Silness and Löe) and Gingival Index (GI) (Silness and Löe) scores of 0.74 (95% CI: -1.03 to -0.45) and 0.22 (95% CI: -0.38 to -0.06), respectively. Five studies provided a prophylaxis for subjects before study initiation. Three of these five studies used 0.2% CHX spray. A meta-analysis demonstrated an increase of 0.18 (95% CI: -0.01 to 0.37) in PI (Silness and Löe) scores. Two RCTs compared 0.12% and 0.2% CHX spray, and a meta-analysis showed increases of 1.71 (95% CI: 1.27 to 2.14) and 1.58 (95% CI: 1.23 to 1.93), respectively, in PI (Quigley and Hein) scores. Of the RCTs not amenable to meta-analysis, eight studies reported significant improvements in PI and GI scores.

CONCLUSIONS

Available evidence suggests that oral sprays are an acceptable delivery method for antiseptic agents. Further high-quality studies are warranted to determine the effectiveness of alternative chemotherapeutic agents delivered via oral sprays on oral health.

The effect of chlorhexidine in reducing oral colonisation in geriatric patients: a randomised controlled trial

INTRODUCTION

Inadequate oral care has been implicated in the development of aspiration pneumonia in frail geriatric patients and is a major cause of mortality, due to the colonisation of microbes in vulnerable patients. This type of pneumonia has been associated with an increase in respiratory pathogens in the oral cavity. The aim of this study was to evaluate the effects of chlorhexidine compared to routine oral care in edentulous geriatric inpatients.

METHODS

A double-blind, parallel-group randomised controlled trial was carried out. The intervention group received oral care with chlorhexidine 0.2%, while the control group received routine oral care with thymol. Nurses provided oral care with assigned solutions of 20 mL once daily over seven days. Oral cavity assessment using the Brief Oral Health Status Examination form was performed before each oral care procedure. Data on medication received and the subsequent development of aspiration pneumonia was recorded. An oral swab was performed on Day 7 to obtain specimens to test for colonisation.

RESULTS

The final sample consisted of 35 (control) and 43 (intervention) patients. Chlorhexidine was effective in reducing oral colonisation compared to routine oral care with thymol (p < 0.001). The risk of oral bacterial colonisation was nearly three times higher in the thymol group compared to the chlorhexidine group.

CONCLUSION

The use of chlorhexidine 0.2% significantly reduced oral colonisation and is recommended as an easier and more cost-effective alternative for oral hygiene.

Results from a preliminary review of scientific evidence for appropriateness of preparations, dosage forms and other product design elements for older adult patients

The aging population and the growing multimorbidity of the major patient population as well as the advanced (pharmaco)therapeutic treatment options are increasing the complexity of independent drug therapy management and administration. The increased complexity may have an impact on drug adherence (including any need for patients initiated coping strategies), and consequently on the safety and efficacy of the medicine. To overcome adherence issues caused by the design of the medicine, it is crucial that developers consider the age appropriateness of the medicine (route of administration, dosage form, excipients in the composition, frequency of dosing) in meeting patients' needs to manage their therapy without the support of a care giver. In order to understand the scientific evidence on such age appropriately designed medicines for use by older adults, a literature search was performed in the Medline database (all languages included). The search produced 34 publications that met the inclusion and exclusion criteria for the patient population of 65 years an older. An in-depth analysis of the included publications with respect to the methodological quality (study design, data collection, endpoints chosen) and results showed that none of these publications had adequately investigated the age appropriateness of the medicine for use by older adults. The authors consider that the knowledge gap in this area requires attention of all stakeholders in the healthcare community.

Chlorhexidine spray as an adjunct in the control of dental biofilm in children with special needs

The aim of this study was to evaluate the clinical effectiveness of .12% chlorhexidine applied via spray and the acceptance. A total of 26 individuals with mental health issues, aged 7-14, were included into two groups: placebo (control, n = 13) and chlorhexidine (experimental, n = 13). Both groups received two daily applications of spray during 2 months. The periodontal conditions were evaluated by the simplified oral hygiene index (OHI-S) and gingival index (GI). The evaluation of acceptance of the application method (spray) was assessed by questionnaire. Data were analyzed with nonparametric tests, with a significance level of 5%. Regarding the OHI-S index, only the experimental group showed significant change during the evaluations (p < 0.001). Regarding the GI, both groups showed significant changes during the evaluations. The method of application was well accepted by patients and caregivers, and .12% chlorhexidine solution applied via spray significantly reduced the rates of dental and gingival biofilm.

Short-term side effects of 0.2% alcohol-free chlorhexidine mouthrinse in geriatric patients: a randomized, double-blind, placebo-controlled study

OBJECTIVE

To determine the effects of a 0.2% alcohol-free chlorhexidine mouthwash applied twice a day during 30 days in patients over 65 years of age.

MATERIALS AND METHODS

A randomized, double-blind, placebo-controlled study was made of 70 denture wearers over 65 years of age. The study subjects were randomly assigned to one of the two groups (chlorhexidine or placebo). The patients were instructed to complete a first whitening phase with a duration of 1 week, followed by a 30-day treatment period. The following data were collected: Silness and Löe plaque index, gingival index, the number of colony-forming units of Candida albicans at the start and end of treatment and the possible adverse effects of chlorhexidine.

RESULTS

Significant differences were observed in the evolution of the Silness and Löe plaque index and gingival index in the two groups, as well as in the number of colony-forming units of C. albicans between the start and end of treatment.

CONCLUSIONS

These results suggest that the clinical benefits of antiplaque, antigingivitis mouthrinses in both study groups.

Public health issues in geriatric dentistry in the United States

The aging United States population living in the new millennium has dental needs that are very different and more complex than those experienced by previous older adult cohorts during the twentieth century. The type of dental care to be provided for older Americans goes way beyond emergency care, extractions and denture care. Dental caries is still clearly a public health problem for subgroups of older Americans, such as those of lower socioeconomic status, with dementia, who are homebound and who are institutionalized. These are also the subgroups experiencing greater barriers to accessing dental care. Stakeholders, including dental professionals and the dental benefits industry, need to work together to develop innovative dental financing programs that will increase older Americans access to dental care.

Inhibition of “De Novo” Plaque Formation With 0.12% Chlorhexidine Spray Compared to 0.2% Spray and 0.2% Chlorhexidine Mouthwash

BACKGROUND

Chlorhexidine (CHX) is widely accepted as the most effective product in the control of supragingival plaque. It is available in different delivery devices. The aim of this study was to test whether 0.12% CHX spray was as effective as 0.2% CHX spray and 0.2% CHX mouthwash in a 3-day "de novo" plaque formation model.

METHODS

Ninety volunteers were enrolled into a single-blind, randomized, three-group parallel study. They received a thorough dental prophylaxis prior to the test period. Subjects were divided randomly into three equal groups. They were requested to refrain from all forms of mechanical oral hygiene and instructed to use only their assigned product during the 3-day experimental period. After 3 days, the plaque growth was assessed using the Quigley and Hein plaque index (Q&H PI) at six sites per tooth.

RESULTS

After 3 days, the CHX mouthwash group had a mean Q&H PI of 1.17 compared to 1.41 for the 0.2% CHX spray and 1.49 for the 0.12% CHX spray. The difference between the mouthwash and the two sprays was statistically significant, whereas the two sprays did not differ significantly from each other.

CONCLUSIONS

Within the limitations of this 3-day "de novo" plaque formation study, the two sprays were not as effective as the mouthwash in plaque inhibition. No significant difference was found between the two sprays. To achieve the same effectiveness as a mouthwash, a higher dose (number of puffs) of CHX spray may be necessary.

The effect of 0.12% chlorhexidine dentifrice gel on plaque accumulation: a 3-day non-brushing model

BACKGROUND

Maintaining an adequate low level of plaque through daily tooth brushing is often not feasible. Effective chemotherapeutic agents as an adjunct to mechanical plaque control would therefore be valuable. Chlorhexidine (CHX) mouthwash has proved to be an effective inhibitor of plaque accumulation.

AIM

The purpose of the present study was to assess the effect of application of 0.12% CHX dentifrice gel on de novo plaque accumulation.

MATERIAL AND METHODS

The study was designed as a single blind, randomized three-arm parallel clinical trial. At the beginning of the test period all volunteers received a thorough professional oral prophylaxis. Subjects were randomly assigned to one of three regimens. During a 3-day non-brushing period, subjects abstained from all forms of mechanical oral hygiene. One regimen (test group) used 0.12% chlorhexidine dentifrice gel (CHX-DGel, Perio.Aid) applied in a fluoride gel tray, the benchmark control group used a regular dentifrice applied in a fluoride gel tray (RegD, Everclean HEMA). The positive control group rinsed with a 0.12% chlorhexidine mouthwash (CHX-MW, Perio.Aid). The Quigley and Hein plaque index (PI) from all subjects was assessed after 3 days of de novo plaque accumulation. Subsequently, all subjects received a questionnaire to evaluate their attitude, appreciation and perception towards the products used employing a Visual Analogue Scale scores. After the experimental period, habitual oral hygiene procedures were resumed.

RESULTS

Ninety-six systemically healthy subjects completed the study. After 3 days, the full-mouth PI for the CHX-DGel regimen was 1.87 compared with 1.93 for the RegD regimen and 1.55 for the CHX-MW regimen. The two dentifrices (CHX-DGel and RegD) were significantly less effective as the CHX-MW (P=0.0006). No significant difference between scores of the dentifrices was found.

CONCLUSION

Within the limitations of the present 3-day non-brushing study design, it can be concluded that application of 0.12% CHX dentifrice gel is not significantly different from application of regular dentifrice on plaque accumulation. Use of a 0.12% CHX mouthwash is significantly more effective. CHX-DGel appears a poor alternative for a dentifrice. It is not an effective inhibitor of plaque growth and does not possess fluoride.

Anti-gingivitis effect of a dentifrice containing bioactive glass (NovaMin) particulate

BACKGROUND

The objective of this pilot clinical trial was to evaluate the anti-gingivitis and anti-plaque effects of a dentifrice containing bioactive glass (NovaMin) compared with a placebo control dentifrice in a 6 weeks clinical study.

METHODS

The study design was a randomized, double-blinded, controlled clinical trial. One hundred volunteers took part in the study and were matched for plaque index (PLI), gingival bleeding index (GBI), age and gender. The protocol was reviewed and approved by the Ethical Committee of the University. The subjects received a supragingival prophylaxis to remove all plaque, calculus and extrinsic stain. Following the baseline examination, subjects were instructed to brush with their assigned dentifrice and toothbrush. The PLI and GBI were determined for the baseline and 6 weeks. The data were analysed using a repeated-measures anova conducted on the two dependent measures to compare the effect between the test and control group.

RESULTS

Ninety-five subjects finished the study. The results showed that the PLI (baseline=1.54, 6 weeks=1.29) and GBI (baseline=1.14, 6 weeks=0.47) were significantly reduced, respectively, over the 6 weeks period in the test group (p<0.001 for each measure). There was a 58.8% reduction in gingival bleeding and a 16.4% reduction in plaque growth. There was no difference of the PLI (baseline=1.60, 6 weeks=1.57) and GBI (baseline=1.18, 6-week=1.02) over the 6 week period in the control group.

CONCLUSION

This study demonstrated that a dentifrice containing NovaMin significantly improves oral health as measured by a reduction in gingival bleeding and reduction in supragingival plaque compared with a negative dentifrice over the 6 weeks study period.

Efficacy of chlorhexidine-thymol varnish (CervitecR) against plaque accumulation and gingival inflammation in a geriatric population

OBJECTIVES

To determine whether the 3-monthly application of chlorhexidine (CHX)-thymol varnish is an effective method of controlling plaque and gingivitis in a group of institutionalised elderly as a complement to their usual oral hygiene practices.

DESIGN

A 6-month double-blind clinical trial.

SETTING

Two residential homes in Almería (Spain).

PARTICIPANTS

Fifty-six dentate subjects aged above 64 years who completed the 6-month study.

INTERVENTION

The study subjects were randomly assigned to one of two groups (Cervitec or placebo). Varnishes were applied twice in the first week of the study and were applied again a month later and every 3 months until the end of the study. The patients continued with their usual oral hygiene practices throughout the study.

MEASUREMENT

Plaque index and gingival index scores were determined at baseline and after 1, 3 and 6 months.

RESULTS

Treatment with Cervitec varnish had a statistically significant effect overtime on the gingival index score (p = 0.029), but not on the plaque index score (p = 0.651). The groups did not significantly differ in reductions in plaque or gingival index scores between baseline and 1, 3 or 6 months.

CONCLUSION

According to these results, Cervitec, a CHX-thymol varnish, does not appear to reduce plaque and gingivitis by a 3-monthly application in the institutionalised elderly with poor oral hygiene. Wider studies are required to investigate different varnishing protocols in geriatric populations.

The Effects of Antimicrobial Sprays and Mouthrinses on Supragingival Plaque Regrowth: A Comparative Study

BACKGROUND

Due to the side effects of chlorhexidine digluconate (CHX) mouthrinsing, a spray has been proposed as an alternative method of CHX delivery to the oral cavity. The aim of this study was to investigate the plaque inhibitory effects of CHX, cetylpyridinium chloride (CPC), and triclosan (TRN) delivered by sprays and mouthrinses.

METHODS

The study was an observer-masked, randomized cross-over design balanced for carryover effects, involving 15 healthy volunteers in a 4-day plaque regrowth model. Products being tested (0.2% CHX, 0.12% CHX, 0.05% CPC, and 0.03% TRN) were used both as sprays and mouthrinses. A saline solution served as a negative control. On day 1, subjects received professional prophylaxis, suspended oral hygiene measures, and commenced using their allocated products. On day 5, subjects were scored for disclosed plaque.

RESULTS

CHX sprays (P<0.01) were the most effective sprays in preventing plaque regrowth, without significant differences between the two concentrations tested (P>0.05). TRN spray showed a significant inhibition of plaque regrowth in comparison to the negative control (P<0.05). CPC spray did not differ from saline spray (P>0.05). A similar trend of efficacy was detected for rinses. Although the effect on plaque regrowth observed with CHX rinses was superior to that of CHX sprays (P<0.0003), the latter did not cause side effects (P>0.2).

CONCLUSIONS

These findings, together with those from clinical trials, suggest that the CHX-containing sprays may represent an effective alternative to CHX rinses when mechanical oral hygiene has to be avoided in restricted areas. On the contrary, the TRN and CPC sprays showed little or no plaque inhibitory effects.

The Effects of Three Oral Sprays on Plaque and Gingival Inflammation

BACKGROUND

The aim of this clinical trial was to compare the effects of three oral sprays containing chlorhexidine (CHX), benzydamine hydrochloride (B-HCl), and CHX plus B-HCl (CHX/B-HCl) on plaque and gingivitis.

METHODS

Fifty-one periodontally healthy volunteers, randomly divided into three spray groups, refrained from all mechanical oral hygiene measures for 7 days and, instead, used one of the randomly assigned sprays twice daily. The plaque index (PI), gingival index (GI), and gingival bleeding time index (GBTI) were assessed at days 0 and 7. Side effects were also evaluated.

RESULTS

In all groups, PI, GI, and GBTI showed significant increases from the baseline to day 7. There were no significant side effects for B-HCl spray and CHX spray at day 7, but, for CHX/B-HCl, burning sensation significantly increased from the baseline. For all parameters, there were significant differences between B-HCl and CHX/B-HCl and between B-HCl and CHX, but no significant differences were observed between CHX/B-HCl and CHX. In addition, a significant difference was found between CHX/B-HCl and CHX with regard to burning sensation.

CONCLUSIONS

These results indicate that both CHX and CHX/B-HCl sprays have equal clinical effectiveness, but only B-HCl spray has less anti-plaque and anti-gingivitis effects. Furthermore, CHX/B-HCl spray causes more side effects.

The effects of a chlorhexidine mouthrinse on culturable microorganisms of the tongue and saliva

A randomized and cross-over design clinical study with normal adult volunteers examined the effects of a 0.12% chlorhexidine (CHX) mouthrinse and a control rinse on a range of microflora including those implicated in halitosis on the tongue and saliva. Saliva and tongue scrapings were collected from 13 subjects prior to treatments with additional samples collected at 3 h post-treatment cultured on media to enumerate anaerobic, Gram-positive and Gram-negative bacteria, odorigenic bacteria producing hydrogen sulphide (H2S) and oral bacteria with proteolytic activity. In comparison to the control, rinsing with CHX demonstrated statistically significant reductions that ranged from 81-90% for tongue microflora with a 89-95% decrease noted on salivary flora (p<0.05). The effects of CHX on anaerobic, Gram-positive and Gram-negative bacteria are in accord with those noted on odorigenic bacteria producing H2S or proteolytic activity. These results help to explain previous clinical results on the malodor efficacy of CHX and highlight microbiological approaches for bacteria implicated in malodor.