Role of Dentifrices With Essential Oil Formulations in Periodontal Healing

Role of Chlorhexidine and Herbal Oral Rinses in Managing Periodontitis

OBJECTIVE

The aim of this research was to assess the effect of 0.12% chlorhexidine (CHX) and a Salvadora persica-based mouthwash on whole salivary tumour necrosis factor-alpha (TNF-α) levels and periodontal inflammation in patients with type 2 diabetes mellitus (T2DM).

METHODS

Patients with and without medically diagnosed T2DM were included. Patients' medical records were evaluated to confirm the diagnosis of T2DM. All patients underwent nonsurgical periodontal therapy (NSPT). Patients were divided into 2 subgroups. In the test and control group, patients were advised to rinse with an S persica-based mouthwash and a non-alcoholic 0.12% CHX after NSPT twice daily for 2 weeks, respectively. Demographic data were collected. Full-mouth plaque index (PI), gingival index (GI), probing depth (PD), and clinical attachment loss (AL) were measured, and whole salivary TNF-α levels were gauged at baseline and at 3-month follow-up. Haemoglobin A1c (HbA1c) levels were measured in all patients at baseline and at 3-month follow-up. Sample size estimation was done, and group comparison was performed. Level of significance was set at P < .01.

RESULTS

Twenty-one nondiabetic individuals and 21 patients with T2DM were included. At baseline, there was no significant difference in clinical and radiographic periodontal parameters amongst in patients with and without T2DM. At 3-month follow-up, HbA1c, TNF-α, PI, PD, and clinical AL were comparable with their respective baseline values in the test and control groups amongst patients with T2DM. In nondiabetic individuals, there was a significant reduction in PI (P < .01), GI (P < .01), and PD (P < .01), and TNF-α (P < .01) at 3-month follow-up in the test and control groups compared with their respective baseline scores.

CONCLUSIONS

In the short term, NSPT with 0.12% CHX or S persica-based mouthwashes is more effective in reducing periodontal inflammation and whole salivary TNF-α levels in nondiabetic individuals than in patients with T2DM with periodontal inflammation.

Comparison of the postoperative anti-inflammatory efficacy of chlorhexidine, saline rinses and herbal mouthwashes after mechanical debridement in patients with peri-implant mucositis: A randomized controlled trial

AIM

The null hypothesis is that there is no difference in the post-operative anti-inflammatory efficacy of chlorhexidine (CHX), 2% saline rinses (SR) and a herbal mouthwash (MW) after non-surgical mechanical debridement (MD) for treatment of peri-implant mucositis (PiM). The aim was to compare the post-operative anti-inflammatory efficacy of CHX, 2% SR and a herbal oral rinse after non-surgical MD of PiM.

MATERIALS AND METHODS

The present randomized controlled trial had a single-blinded parallel arm design. Patients diagnosed with PiM were enrolled. Demographic information was recorded. All patients underwent MD and were randomly divided into 4 groups: CHX-group: 0.12% non-alcoholic CHX; Sodium chloride (NaCl) group: 2% NaCl rinses; Herbal MW group: Herbal-based MW and H₂ O group: distilled water with peppermint flavour. After MD, all the participants were advised to rinse twice daily (every 12 hrs) for 2 weeks with their respective MWs. In all groups, peri-implant modified plaque index (mPI), modified gingival index (mGI) and probing depth (PD) were measured at baseline and at 12 weeks of follow-up. Sample size was estimated using data from a pilot investigation; and group-comparisons were performed. Statistical significance was confirmed when P-values were below 0.01.

RESULTS

Sixty individuals (15 patients/group) were included. At baseline, mPI, mGI and PD were comparable in all groups. At baseline, there was no significant difference in peri-implant mPI, mGI and PD in all groups. At 12-weeks' follow-up, there was a statistically significant reduction in peri-implant mPI (p < 0.01), mGI (p < 0.01) and PD (p < 0.01) in CHX, NaCl and herbal MW groups compared with H₂ O group. There was no significant relation between implant location, duration for which, implants were functional, gender and peri-implant clinical parameters in all groups.

CONCLUSION

After non-surgical MD, post-operative use of CHX and herbal and NaCl MWs is useful for the management of PiM in the short-term.

Postoperative anti-inflammatory efficacy of 2% saline rinses and a herbal- mouthwash after non-surgical periodontal therapy for the management of periodontal inflammation in young adults with chlorhexidine allergy: A randomized controlled trial

AIM

The present randomized controlled trial assessed the postoperative anti-inflammatory efficacy of 2% saline rinses (SR) and a herbal- mouthwash (HMW) after non-surgical periodontal therapy (NSPT) for the management of periodontal inflammation in patients with chlorhexidine (CHX) allergy.

MATERIALS AND METHODS

Patients with periodontal inflammation with and without self-reported CHX-allergy were included. All patients underwent non-surgical periodontal therapy (NSPT). Patients were randomly divided into three groups. In the SR and HMW groups, 2% SR, and a HMW, respectively were prescribed. In Group-3 (CHX-group), patients without CHX allergy were included and were prescribed 0.12% CHX. In all groups, plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment loss (AL) and marginal bone loss were measured at baseline. Clinical periodontal parameters were re-assessed at 6-weeks' follow-up. P<0.01 were considered statistically significant.

RESULTS

Thirteen, 12 and 12 patients were included in the SR, HMW and CHX groups, respectively. At baseline clinical and radiographic periodontal parameters were comparable in all groups. In all groups, PI (P<0.01), GI (P<0.01) and PD (P<0.01) were significantly higher at baseline compared with their respective values at 6-weeks of follow-up. There was no significant difference in clinical AL at all time intervals in all groups. There was no significant correlation between periodontal parameters and age, gender and daily toothbrushing/flossing in all groups.

CONCLUSION

In young adults with self-reported CHX-allergy, herbal-mouthwashes and/or 2% SR are suitable postoperative prescriptions after NSPT.

Efficacy of Essential Oil Mouthwashes With and Without Alcohol on the Plaque Formation: A Randomized, Crossover, Double-Blinded, Clinical Trial

BACKGROUND

Essential oil (EO) mouthwash has been considered as one of the effective chemical agents as an adjunct to mechanical plaque control, without adverse effects compared with chlorhexidine (pigmentation, changes of taste, and formation of supragingival calculus), which limits its continuous use. New EO alcohol-based has emerged with questions regarding contraindications for its daily use.

OBJECTIVE

To compare the efficacy of EO mouthwashes with and without alcohol on the early supragingival and subgingival plaque formation using a plaque-free zone score system.

METHODS

This study was a crossover, randomized, double-blind clinical trial. Eleven participants, totaling 396 sites of evaluation, remained 4 days with no mechanical oral hygiene control and only used EO mouthwash with (control) and without alcohol (test) during this period. The presence of the plaque-free zone was recorded every 24 hours. Friedman and Wilcoxon tests were used with a 5% significance level.

RESULTS

The control group showed a more significant number of buccal surfaces free of plaque at 48, 72, and 96 hours compared with the test group. Both groups presented satisfactory efficacy up to 72 hours with a significant difference in favor of the control group. The presence of subgingival plaque on both the proximal and free surfaces was significantly higher in the test group.

CONCLUSION

EO with alcohol presented better results in retarding the early supragingival and subgingival plaque formation compared with EO without alcohol.

General Toxicity and Antifungal Activity of a New Dental Gel with Essential Oil from Abies Sibirica L

Background

The aim of this study was to analyze the antifungal activity and the general toxicity of a new dental gel containing essential oil from the tree Abies sibirica L., which grows in the Republic of Kazakhstan.

Material/Methods

The essential oil from Abies sibirica L. was obtained by microwave heating method using the STARTE Microwave Extraction System. Adjutants used to prepare the oil were carbomer 974P, glycerin, polysorbate 80, xylitol, triethanolamine, and purified water, all allowed for medical usage. The antifungal activity of the essential oil was assessed by monitoring the optical density of Candida albicans in a microplate reader. The safety was determined by analyzing the acute and subacute toxicity.

Results

The essential oil obtained by the microwave heating method revealed a higher antifungal activity in comparison with the essential oil obtained by the steam distillation method. No obvious changes were detected in guinea pigs following cutaneous application of the gel. Enteral administration of the essential oil caused minimal functional and histological changes in mice after 4 weeks. The new harmless dental gel containing pine oil from Abies sibirica L. was provided for the purposes of this particular clinical research.

Conclusions

The high antifungal activity of the gel is the basis for more in-depth studies on its safety and pharmacological activity.

Effect of oil pulling in promoting oro dental hygiene: A systematic review of randomized clinical trials

AIM

To critically appraise and evaluate the evidence from randomized clinical trials (RCTs) examining the effectiveness of oil pulling on oro dental hygiene.

METHODS

We conducted electronic searches in Medline, Embase, Amed, The Cochrane Library and Cinahl databases from inception to February 2015, and assessed reporting quality using the Cochrane risk of bias criteria. We included RCTs that compared oil pulling using conventional cooking oils with a control intervention. Our primary outcomes were measures of oro dental hygiene using validated scales.

RESULTS

Electronic searches yielded 26 eligible studies, of which five RCTs comprising a total of 160 participants were included. The studies varied in reporting quality, lasted between 10 and 45 days, and compared oil pulling with chlorhexidine, placebo or routine dental hygiene practice. Three studies reported no significant differences in post intervention plaque index scores between oil pulling and control groups (Chlorhexidine mouthwash +/- Placebo): p=0.28, 0.94, and 0.38, respectively. Two studies reported no significant difference in post-intervention modified gingival index score between oil pulling and Chlorhexidine mouthwash groups (p=0.32 and 0.64).

CONCLUSION

The limited evidence to date from clinical trials suggests that oil pulling may have beneficial effects on oro dental hygiene as seen for the short period of time investigated. Given that this is a potentially cost-effective intervention, this practice might be of particular benefit. Future clinical trials should be more rigorous and better reported.

Smart Dressings Based on Nanostructured Fibers Containing Natural Origin Antimicrobial, Anti-Inflammatory, and Regenerative Compounds

A fast and effective wound healing process would substantially decrease medical costs, wound care supplies, and hospitalization significantly improving the patients' quality of life. The search for effective therapeutic approaches seems to be imperative in order to avoid the aggravation of chronic wounds. In spite of all the efforts that have been made during the recent years towards the development of artificial wound dressings, none of the currently available options combine all the requirements necessary for quick and optimal cutaneous regeneration. Therefore, technological advances in the area of temporary and permanent smart dressings for wound care are required. The development of nanoscience and nanotechnology can improve the materials and designs used in topical wound care in order to efficiently release antimicrobial, anti-inflammatory and regenerative compounds speeding up the endogenous healing process. Nanostructured dressings can overcome the limitations of the current coverings and, separately, natural origin components can also overcome the drawbacks of current antibiotics and antiseptics (mainly cytotoxicity, antibiotic resistance, and allergies). The combination of natural origin components with demonstrated antibiotic, regenerative, or anti-inflammatory properties together with nanostructured materials is a promising approach to fulfil all the requirements needed for the next generation of bioactive wound dressings. Microbially compromised wounds have been treated with different essential oils, honey, cationic peptides, aloe vera, plant extracts, and other natural origin occurring antimicrobial, anti-inflammatory, and regenerative components but the available evidence is limited and insufficient to be able to draw reliable conclusions and to extrapolate those findings to the clinical practice. The evidence and some promising preliminary results indicate that future comparative studies are justified but instead of talking about the beneficial or inert effects of those natural origin occurring materials, the scientific community leads towards the identification of the main active components involved and their mechanism of action during the corresponding healing, antimicrobial, or regenerative processes and in carrying out systematic and comparative controlled tests. Once those natural origin components have been identified and their efficacy validated through solid clinical trials, their combination within nanostructured dressings can open up new avenues in the fabrication of bioactive dressings with outstanding characteristics for wound care. The motivation of this work is to analyze the state of the art in the use of different essential oils, honey, cationic peptides, aloe vera, plant extracts, and other natural origin occurring materials as antimicrobial, anti-inflammatory and regenerative components with the aim of clarifying their potential clinical use in bioactive dressings. We conclude that, for those natural occurring materials, more clinical trials are needed to reach a sufficient level of evidence as therapeutic agents for wound healing management.