Sodium fluoride and chlorhexidine effect in the inhibition of mutans streptococci in children with dental caries: a randomized, double-blind clinical trial

Effects of Oil Pulling and Chlorhexidine Mouth Rinse on the Force Decay of Orthodontic Elastomeric Chains: A Comparative In Vitro Study

BACKGROUND AND OBJECTIVES

Oil pulling is a traditional Indian folk remedy for maintaining oral hygiene among orthodontic patients. This study aimed to assess the effects of oil pulling and compare them with those of chlorhexidine (CHX) and distilled water on the force decay of elastomeric chains.

METHODS

Twenty-one samples were tested in three groups. Each of these groups contained seven samples per group. The samples evaluated contained distilled water, 0.2% CHX, and sesame oil. The samples were dipped in various mouth rinses, and force degradation was measured using a dynamometer (dynamic universal testing machine, Instron 8801, Instron, Norwood, MA) during days 0, 1, 7, 14, 21, and 28. The significance level was considered at 1%.

RESULTS

Force degradation was observed more in distilled water, followed by sesame oil, and less in CHX at the end of 28 days. Significant differences in values (p < 0.01) were found among the three groups in all the timelines in the study except on days 14 and 21.

CONCLUSION

Chlorhexidine showed the least amount of force decay, followed by oil pulling and distilled water. However, if oil pulling is practiced daily as a household remedy along with regular oral hygiene practices, it can save time and money and enhance general health.

The Evolving Microbiome of Dental Caries

Dental caries is a significant oral and public health problem worldwide, especially in low-income populations. The risk of dental caries increases with frequent intake of dietary carbohydrates, including sugars, leading to increased acidity and disruption of the symbiotic diverse and complex microbial community of health. Excess acid production leads to a dysbiotic shift in the bacterial biofilm composition, demineralization of tooth structure, and cavities. Highly acidic and acid-tolerant species associated with caries include Streptococcus mutans, Lactobacillus, Actinomyces, Bifidobacterium, and Scardovia species. The differences in microbiotas depend on tooth site, extent of carious lesions, and rate of disease progression. Metagenomics and metatranscriptomics not only reveal the structure and genetic potential of the caries-associated microbiome, but, more importantly, capture the genetic makeup of the metabolically active microbiome in lesion sites. Due to its multifactorial nature, caries has been difficult to prevent. The use of topical fluoride has had a significant impact on reducing caries in clinical settings, but the approach is costly; the results are less sustainable for high-caries-risk individuals, especially children. Developing treatment regimens that specifically target S. mutans and other acidogenic bacteria, such as using nanoparticles, show promise in altering the cariogenic microbiome, thereby combatting the disease.

Comparative Evaluation of Three Probiotics for Streptococcus mutans Prevention in Plaque Around Orthodontic Braces

BACKGROUND AND AIM

Orthodontic brackets can be a significant factor in enamel demineralization due to their complex structure, which makes brushing the teeth difficult and promotes the accumulation of food particles and dental plaque. The fact that metal braces have the highest surface tension and are more likely to cause enamel demineralization, which can result in the development of white spot lesions and enamel caries, is of critical significance to doctors, dentists, and patients. Probiotics have a beneficial effect in preventing and treating oral infectious diseases like tooth decay, gingival disorders, and bad breath. Research has shown that taking probiotics lowers the amount of Streptococcus mutans in the body. There has not been much research done to examine the results of administering a probiotic medication locally. This study was conducted to examine the effectiveness of three separate probiotics in the prevention of S. mutans accumulation in plaque surrounding orthodontic braces.

MATERIALS AND METHODS

A randomized controlled trial was conducted. The volunteers for each group were chosen using a straightforward random method. The sample size was 160 empirically determined subjects. They were divided as follows: study group 1 received probiotic lozenges (n=40). Study group 2 received probiotic sachets (n=40). Study group 3 received probiotic beverages (n=40). Group 4 was the control group, those who did not get probiotics (n=40). The samples were then plated onto culture media to test for Streptococcus mutans. S. mutans colonies were counted using a computerized colony counter.

RESULTS

The mean values of colony forming units (CFU/mL) of S. mutans at baseline in the control group were 354±23.6, while they were 232±41.7 at the end of the observation duration. The difference was non-relevant statistically (p=0.793). The mean values of CFU/mL of S. mutans at baseline in the group taking probiotic lozenges were 358.7±39.93, while they were 57±10.12 at the end of the observation duration. The difference was relevant statistically (p=0.021). The mean values of CFU/mL of S. mutans at baseline in the group taking probiotic sachets were 321.36±41.67, while they were 215.5±22.66 at the end of the observation duration. The difference was relevant statistically (p=0.043). The mean values of CFU/mL of S. mutans at baseline in the group taking the probiotic drink were 335.76±40.12, while they were 75.1±28.74 at the end of the observation duration. The difference was relevant statistically (p=0.032).

CONCLUSION

There was a significant decline in the number of colonies of S. mutans in all three forms of probiotics; however, the decline was greatest in the study participants taking probiotic lozenges.

The Safety of Fluoride Compounds and Their Effect on the Human Body-A Narrative Review

Fluoride is one of the elements commonly present in the human environment. Due to its characteristics, it is very widely used in medicine, dentistry, industry or agriculture. On the other hand, its universality possesses a real threat to the human body in the form of acute and chronic poisoning. The aim of this paper is to characterize the properties of fluoride and its effects on the human body, as well as the sources of its occurrence. Particular emphasis is placed on the safety of its use and optimal dosage intake, which prevents accumulation and reduces its potential side effects. The positive effect of proper fluoride supply is widely described. In order to avoid overdose, it is best to consult a specialist to properly select the dosage.

Chemical vs. natural toothpaste: which formulas for which properties? A scoping review

Introduction

The proliferation of the oral care industry has made it more challenging for shoppers to zero in on the best possible toothpaste for their preventative requirements. It also makes the toothpaste’s various components safer.

Objective

The researchers set out to evaluate the state of information about the biological properties and cytotoxicity of adult toothpaste so that they might make some informed recommendations.

Methods

A scoping review of research published between 2015 and 2020 according to PRISMA guidelines was performed.

Results

In vitro clinical trials account for 44% of the papers, in vivo clinical trials for 25%, systematic reviews for 19%, and metaanalyses for 12%. They have active chemical components that have been shown to be antimicrobial, anti-inflammatory, or desensitizing. Herbal toothpaste has these characteristics and is very secure to use. Toothpaste with sodium lauryl sulfate has been found to be harmful.

Conclusions

Scientists have investigated the biological effects of a wide range of chemically active compounds and plant extracts. Herbal toothpaste, it has been discovered, is both efficient and secure. Companies making toothpaste should be required to clearly label the product’s qualities, active ingredients, and potentially harmful ingredients on the packaging.

Comparative Evaluation of Efficacy of Green Tea Mouth Rinse and Green Tea Gel on the Salivary Streptococcus mutans and Lactobacillus Colony Count in 12-18-year-old Teenagers: A Randomized Clinical Trial

Aims:

Green tea is an antibacterial agent with no significant side effect. This feature makes green tea safe for children to use. The purpose of this study was to compare the effectiveness of green tea gel and mouth rinse on salivary level of Streptococcus mutans and Lactobacillus of teenagers aged 12–18 years.

Subjects and Methods:

In this randomized controlled clinical trial study, 30 children aged 12–18 years were included in the study according to the inclusion criteria and were randomly divided into two groups. Participants in mouth rinse group were asked to rinse their mouth with 0.5% green tea mouthwash twice a day for 2 weeks. In the gel group, participants were requested to brush their teeth with 0.5% green tea gel twice a day for 2 weeks. After 4 weeks of washout period, mouthwash group applied the gel and the gel group rinsed the mouthwash for 2 weeks and with the same instruction as mentioned. Colony count of S. mutans and Lactobacillus was determined before and after intervention and data were analyzed using t-test.

Results:

According to the independent t-test, there was no significant difference in the salivary levels of S. mutans before and after intervention regarding age and gender (P = 0.33). Results from paired t-test showed significant decrease in the mean count of S. mutans and Lactobacillus colonies in both groups before and after intervention (P < 0.001).

Conclusions:

Green tea gel and mouthwash contribute to a significant reduction of salivary levels of S. mutans and Lactobacillus colonies, with a greater effect of mouthwash than the green tea gel, which was not statistically significant.

Comparing the Effectiveness of Probiotic, Green Tea, and Chlorhexidine- and Fluoride-containing Dentifrices on Oral Microbial Flora: A Double-blind, Randomized Clinical Trial

Introduction:

Oral cavity harbors wide variety of microorganisms; these are considered crucial for the dental caries initiation and progression. Plaque-induced caries is a local disease; therefore, dentifrices are the most ideal vehicle for the daily delivery of antibacterial agents. In recent years, alternatives to fluorides such as green tea, probiotic, and chlorhexidine (CHX) toothpastes have been proposed to possess antiplaque and anticariogenic properties.

Aim:

To compare the effectiveness of probiotic, green tea, and CHX- and fluoride-containing dentifrices on oral microbial flora.

Materials and Methods:

A double-blinded, parallel group, randomized controlled clinical trial was conducted among healthy adults. Fifty-two individuals were randomly allocated to four groups (n = 13): Group I – green tea dentifrice, Group II – fluoridated dentifrice, Group III – CHX dentifrice, and Group IV – probiotic dentifrice. Plaque and saliva samples were evaluated for Streptococcus mutans and Lactobacillus at baseline and 15^th and 30^th days of follow-up. Paired t-test and one-way ANOVA were used to compare the mean differences of plaque and salivary S. mutans counts at two and three time periods. Wilcoxon signed-rank and Kruskal–Wallis tests were used to compare the mean Lactobacillus count in plaque and saliva samples at two and three time periods, respectively.

Results:

The mean S. mutans and Lactobacillus counts in plaque and saliva samples were significantly reduced by all the treatment groups at the 30^th day of follow-up. However, Group III showed the highest reduction and was found to be statistically significant (P < 0.05).

Conclusion:

All the four groups exhibited antimicrobial activity by bringing about a significant reduction in the mean S. mutans and Lactobacillus colony counts at the 30^th day of follow-up. Among all the preventive modalities, Group III (CHX dentifrice) showed better results compared to other groups.

Comparison Between Antibacterial Effect of Chlorhexidine 0.2% and Different Concentrations of Cyperus rotundus Extract: An In vitro Study

Aims and Objectives:

Modern methods of caries prevention concentrated on natural ingredients usage such as probiotics and polyphenols that are safer for young children with Streptococcus mutans inhibitory properties. The purpose of this study was to compare antibacterial effects of different concentration of Cyperus rotundus extract and chlorhexidine (CHX) 0.2% mouthwash on S. mutans and Lactobacillus acidophilus.

Materials and Methods:

In this in vitro study, the antibacterial effectiveness of the C. rotundus extract and CHX was compared with minimum inhibitory concentration (MIC) test in tube, minimum bactericidal concentration (MBC) test in solid medium, and disc diffusion for measurement of inhibition zone. Data were analyzed using one-way ANOVA, one sample t-test, and independent sample t-test statistical methods by SPSS. 24 software (SPSS Inc., Chicago, USA).

Results:

MIC and MBC values of the C. rotundus extract were obtained 225 and 450 mg/ml, respectively, for S. mutans and 108 and 225 mg/ml for L. acidophilus, which are more than CHX (0.5, 1 res.). The inhibition zone increased in a dose-dependent manner but lower than CHX.

Conclusion:

The C. rotundus extract had antibacterial effects (bactericide and bacteriostatic) on S. mutans and L. acidophillus. Although this effect was lower than CHX. With regard to adverse effect of CHX, this extract can be a potential antibacterial agent.

Cytotoxicity and Antimicrobial Activity of Oral Rinses In Vitro

While oral rinses used for cosmetic purposes only do not necessarily have to be antiseptic, antimicrobial activity is required for medical indications, including oral and periodontal surgery. So the question arises—is the antimicrobial activity of oral rinses associated with any destructive changes in cell viability in vitro? To answer this question, we examined twelve oral rinses with respect to their antimicrobial and cytotoxic activity. Antimicrobial activity was screened against five bacterial strains using disc diffusion. Cytotoxicity was determined by mitochondrial reductase activity with primary gingival fibroblasts, L929 cells, and HSC-2 epithelial cells. Phase contrast microscopy and trypan blue staining were then performed to reveal cell morphology. Cells remained vital after exposure to oral rinses that were only used for cosmetic purposes. Moderate cytotoxic effects were observed for oral rinses containing 0.05% chlorhexidine, ethanol, or pegylated hydrogenated castor oil and sodium dodecyl sulfate. Other oral rinses containing 0.2% chlorhexidine and cocamidopropyl betaine exhibited strong cytotoxic and antimicrobial activity. Strong cytotoxic but moderate antimicrobial activity was observed in oral rinses containing cetylpyridinium chloride. The in vitro data show that oral rinses are heterogeneous with respect to their cytotoxic and antimicrobial effects. Based on their respective properties, oral rinses can be selected either to reduce the microbial load or for cosmetic purposes.

Antimicrobial activity of ozone and NaF-chlorhexidine on early childhood caries

An early childhood carie (ECC) is an extremely destructive form of tooth decay. The aim of this study was to investigate the action of ozone (O3), and the association of sodium fluoride (NaF) with chlorhexidine (CHX) on bacteria related to ECC. Overnight culture of the bacteria was performed. On exponential phase the suspension was adjusted (101-108 CFU/mL). A drop (10μL) of each concentration of bacteria was applied on sheep blood agar plates and treated with O3 (2, 20, 200, and 2,000 ppm); after 18 hours, recovery analysis of CFU verified the reduction of bacterial activity. For NaF-CHX, sterile 96-well plates were prepared and divided into groups: G1 (150 µL TSB); G2 (20 µL of bacteria + 25 µL CHX + 25 µL NaF); and G3 (150 µL TSB + 20 µL of bacteria + 50 µL water). The plates were verified by analysis of the optical density (0, 12, 14, 16, and 18 hours). The data from O3 test were submitted to ANOVA and Tukey's test (p < 0.05). For the data from NaF-CHX, the ANOVA 2-way and Bonferroni's test (p < 0.05) were used. The number of CFU/mL showed death > 3log10 (99.9%) for all bacteria (ozone ≥ 20ppm), while the combination of NaF-CHX was more effective (p < 0.001) compared to each substance tested alone and the control group. The antimicrobial agents tested were able to inhibit all bacteria tested; O3 seemed to be a good alternative for controlling progression of carious lesions, while the association of NaF-CHX showed to be a good antimicrobial with easy and inexpensive application.

Evaluation of a hydrophobic gel adhering to the gingiva in comparison with a standard water-soluble 1% chlorhexidine gel after scaling and root planing in patients with moderate chronic periodontitis. A randomized clinical trial

OBJECTIVES

To evaluate the clinical, microbiological and enzymatic activity of a hydrophobic chlorhexidine-based gingiva-adhering gel containing herbal ingredients, compared with a commercially available 1% chlorhexidine water-soluble gel, during non-surgical therapy of moderate chronic periodontitis.

METHODS

A total of 34 subjects participated in this 6-month blinded randomized parallel controlled trial (ISRCTN35210084). After scaling and root planing (SRP), test group received the gel, by rubbing on the gingiva, once every second day, for 14 days. The control group received the control gel twice daily. Clinical parameters considered were the approximal plaque index, simplified oral hygiene index, modified gingival index, bleeding on probing, probing depth and clinical attachment level (primary outcome), assessed at baseline, 3 and 6 months, together with the frequency of detection of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis (P.g.), Prevotella intermedia, Treponema denticola (T.d.), Tannerella forsythia (T.f.), and activity of neutrophil elastase and myeloperoxidase (secondary outcomes).

RESULTS

At 3 and 6 months, all clinical parameters improved significantly, without significant intergroup differences, except OHI-S, which improved at 3 months (P < 0.05). Microbiological data resulted in no significant intergroup differences at baseline and 6 months. At 3 months, significant differences for P.g., T.f. and T.d. were noted. A significant reduction of neutrophil elastase after 3 and 6 months was observed (P < 0.005), without significant intergroup differences. For myeloperoxidase, significant reductions were noted in both groups (P < 0.005 and P < 0.05), but no significant intergroup differences. The tested product seemed to have an increased efficacy, due to longer persistence on the gingiva, with reduced application frequency.

CONCLUSIONS

Both products had a relatively similar influence on the clinical, microbiological and enzymatic outcomes at 3 and 6 months after SRP.

The efficacy of three formulations of Lippia sidoides Cham. essential oil in the reduction of salivary Streptococcus mutans in children with caries: a randomized, double-blind, controlled study

Essential oils of many plants have been previously tested in the treatment of oral diseases and other infections. This study was a randomized, double-blind, in parallel with an active control study, which aimed to evaluate the efficacy of three formulations of the Lippia sidoides Cham. essential oil (LSO) in the reduction of salivary Streptococcus mutans in children with caries. 81 volunteers, aged 6-12 years, both genders, with caries, were recruited to participate in this study, and randomly assigned to either one of five different groups. Each group received topical treatment with either 1.4% LSO toothpaste, 1.4% LSO gel, 0.8% LSO mouthwash, 1% chlorhexidine gel, or 0.12% chlorhexidine mouthwash. A 5-ml volume of each gel was placed inside disposable trays, and applied for 1 min, every 24h, for 5 consecutive days. The mouthwash groups used 5-ml volume of a mouthwash inside disposable syringes. In the toothpaste group, children brushed their teeth for 1 min, once a day for 5 days. Saliva was collected before and after treatment. MS colonies were counted, isolated and confirmed through biochemical tests. Differences in MS levels measured in different days within the same treatment group was only verified with LSO toothpaste, chlorhexidine gel and chlorhexidine mouthwash. Comparison between groups of LSO mouthwash, toothpaste and gel showed that the toothpaste group expressed significantly lower MS levels than the mouthwash and gel groups at day-30. Chlorhexidine significantly reduced MS levels after 5 days of treatment, but these levels returned to baseline in other periods of the study. LSO toothpaste reduced MS levels after 5 days of treatment, and MS levels remained low and did not return to baseline during subsequent analysis. Hence, LSO toothpaste demonstrated the most long-lasting MS reduction in saliva, whereas other LSO formulations did not effectively reduce MS levels in children with dental caries.

Does chlorhexidine in different formulations interfere with the force of orthodontic elastics?

OBJECTIVE

To evaluate the effects of different concentrations of chlorhexidine on the decline in force of orthodontic elastics.

MATERIALS AND METHODS

In a laboratory study, five groups of samples were tested, with one control group represented by distilled water (group 1) and four experimental groups: 0.12% manipulated chlorhexidine (group 2), 0.2% manipulated chlorhexidine (group 3), 0.12% chlorhexidine gluconate-based oral solution (0.12% Periogard; group 4), and 0.2% Cleanform mouthwash (formula and action; group 5). The test groups were submersed in artificial saliva at 37°C. Templates were used and submerged in the chlorhexidine solutions for 30 seconds twice a day. Force was measured with a digital dynamometer at six different time intervals: 0, 1, 7, 14, 21, and 28 days.

RESULTS

No statistical differences were found among the groups in the initial period, at 24 hours, and at 7 days (P > .05). There were statistical differences between groups 2 and 5 at 14 days of the experiment and between group 1 and the others at 28 days. In the initial period, the force was statistically higher than it was at any of the other periods of the experiment (P < .05).

CONCLUSION

In the present study, chlorhexidine showed no significant influence on the force degradation of the chain elastics tested.

Dose-response evaluation of a novel essential oil against Mutans streptococci in vivo

Research has demonstrated the need for identifying a novel antimicrobial agent for topical use in the pediatric dental population. The essential oil of Lippia sidoides Cham. (LSO) has been described as having favorable biological properties, and a broad in vitro and in vivo antimicrobial spectrum against bacteria and yeast infections. Our aim was to determine a dose and formulation of LSO, acceptable for clinical testing in a pediatric population with dental caries. Thirty-seven 6-12-year old children were selected to participate in this study, and randomly allocated to receive different concentrations of either a gel (0.8%, 1%, 1.2% and 1.4%) or a mouth rinse (0.6%, 0.8%, 1% and 1.2%) formulation. The highest percentage MS reduction was observed with 0.8% mouth rinse and 1.4% gel. The efficacy of these concentrations was compared with a Thy-Car mixture formulated as a mouth rinse and gel treatments in 11 children. Saliva was collected after a single application of the antimicrobial treatment to establish effectiveness against MS. Both rinse (p<0.001) and gel (p=0.02) formulations produced significant MS reduction. Mouth rinse concentrations above 0.8% were associated with a transient intra-oral burning sensation. In conclusion, mouth rinse and gel LSO formulations demonstrated effectiveness against MS and good acceptance among children. We suggest future randomized clinical trials to test its effectiveness against early childhood caries.