Effects on gingivitis of daily rinsing with 1.5% H2O2

Effectiveness of hydrogen peroxide as auxiliary treatment for hospitalized COVID-19 patients in Brazil: preliminary results of a randomized double-blind clinical trial

OBJECTIVES

To evaluate the effectiveness of hydrogen peroxide (H2O2) in the form of mouthwash and nasal spray as an auxiliary treatment for coronavirus disease 2019 (COVID-19).

METHODS

Forty hospitalized patients who tested positive for severe acute respiratory syndrome coronavirus 2 using a reverse-transcription polymerase chain reaction test were evaluated. They were randomly divided into an experimental group (n= 20; gargling with 1.0% H2O2 and nasal wash with 0.5% H2O2) or a control group (n= 20). The solutions were used for 7 days and the patients were monitored every 2 days, for a total of 8 days. At check-ups, patients were asked about their symptoms and possible adverse effects of the solutions. The presence and severity (mild, moderate, or severe) of symptoms were recorded. Data were compared using the Student test and the Fisher exact test (α= 0.05).

RESULTS

There was no significant difference between the 2 groups in the length of hospital stay (p= 0.65). The most frequent symptom on day 0 was coughing (72.0% in the experimental group and 76.5% in the control group), which abated over time. There was no significant difference between the groups in the evaluated symptoms. Most (75.0%) of the patients in the experimental group presented a reduction in dyspnea between days 0 and 2. Few patients reported adverse effects from the use of the solutions.

CONCLUSIONS

H2O2 as a mouthwash and nasal spray is safe to use. There is insufficient evidence to demonstrate that H2O2 is effective as an auxiliary treatment for hospitalized COVID-19 patients.

A Systematic Review of the Effect of Oral Rinsing with H2O2 on Clinical and Microbiological Parameters Related to Plaque, Gingivitis, and Microbes

BACKGROUND

Hydrogen peroxide (H2O2) has been used for more than a century clinically to control plaque and gingival inflammation, with unclear supporting evidence.

AIM

The aim of the present systematic review of the literature is to assess the effect of mouth rinses with H2O2 on dental plaque, gingival inflammation, and oral microorganisms.

METHODS

Five databases (PubMed, Scopus, Embase, Cochrane Library, and Web of Science) were searched with the following focused question: what is the effect of hydrogen peroxide, in comparison to chlorhexidine or to a placebo solution, in oral microbiota control, dental plaque, and gingival inflammatory outcomes? Two independent examiners retrieved the articles and evaluated the evidence.

RESULTS

The majority of included studies were performed with 1.5% H2O2. Results related to plaque accumulation generally demonstrate a slightly better effect of H2O2 as compared to placebo mouth rinses, however with a lower performance as compared to chlorhexidine. In terms of gingival inflammation, H2O2 performs better than placebo and more clearly demonstrates an anti-inflammation effect. No studies evaluated the effect of H2O2 against viruses or fungi. In terms of bacteria, H2O2 demonstrates an antibacterial effect.

CONCLUSION

Rinsing with H2O2 has the potential to affect plaque, gingivitis, and oral bacteria, as compared to placebo. However, the antibacterial results are not comparable to the performance of chlorhexidine.

Hydrogen peroxide masks the bitterness of chlorhexidine mouthwash without affecting its antibacterial activity

Background:

Chlorhexidine (CHX) is an antiseptic mouthwash widely used as the gold standard for inhibiting plaque formation. However, the bitter taste of CHX limits patient compliance. We developed a 0.12% CHX and 1.5% hydrogen peroxide (H₂O₂) mouthwash that masked the bitter taste of CHX. This study evaluated the antibacterial activity and subject satisfaction of the developed mouthwash.

Materials and Methods:

Three mouthwashes were used as follows: (1) a commercial 0.12% CHX mouthwash, (2) a prepared 0.12% CHX mouthwash containing 1.5% H₂O₂, and (3) a prepared 0.12% CHX mouthwash. A disc diffusion assay was performed to determine the antibacterial activity of each mouthwash against Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans. To assess subject satisfaction with each mouthwash, a satisfaction questionnaire was completed immediately after rinsing with each mouthwash.

Results:

The antibacterial activities of the three mouthwashes were similar. Moreover, the questionnaire results revealed that the level of satisfaction was significantly higher for the 0.12% CHX/1.5% H₂O₂ mouthwash compared with the other mouthwashes.

Conclusion:

The 0.12% CHX/1.5% H₂O₂ mouthwash revealed a similar antibacterial activity as the CHX standard against periodontal disease pathogens. In addition, the subjects were more satisfied with the new formula compared with 0.12% CHX alone. These data suggest that the 0.12% CHX/1.5% H₂O₂ formulation is an alternative antibacterial mouthwash to avoid the unpleasant CHX side effects.

Hamster Cheek Pouch Bioassay of Dentifrices Containing Hydrogen Peroxide and Baking Soda

The objective of this study was to determine the effects of hydrogen peroxide alone and in combination with 7,12-dimethylbenza[a]anthracene (DMBA) in the oral cavity because H2o2, has been implicated as a complete carcinogen or cocarcinogen in two animal models. In the two independent studies, golden Syrian hamsters were used to evaluate the carcinogenic and cocarcinogenic potential of dentifrices containing H2o2 and NaHCO3. In the first study, the cocarcinogenic potential of a dentifrice containing 0.75% H2O2/ 5% baking soda was compared with that of a commercial dentifrice with similar ingredients except baking soda and H2O2. In the second study, the cocarcinogenic potential of a dentifrice formulated with 1.5% H, sb>2O2/7.5% baking soda was compared with a mixture of 3% H2O2/baking soda. All materials were applied to the right cheek pouches of experimental animals, and the left cheek pouches were untreated. In the first study. 0.5% DMBA was administered five times weekly for 20 weeks, and the dentifrices were applied immediately after the DMBA. Dentifrices or mineral oil alone were also applied five times weekly. In the second study. 0.5% DMBA or 0.25% DMBA were applied three times weekly for 16 weeks; dentifrices (or 3% H2O2/baking soda) were applied five times weekly for 16 weeks. The dual-phase dentifrice containing 0.75% H2O2/5% baking soda was not carcinogenic, and in combination with DMBA resulted in no observable acceleration of tumor onset, compared with DMBA alone. In fact, animals treated with 0.5% DMBA and the H2O2/baking soda dentifrice had a significantly delayed onset of tumor formation than did animals treated with DMBA alone. In the second bioassay, an increased latency period for tumor formation was observed with 0.5% DMBA and a dual-phase dentifrice containing 1.5% H2O2/7.5% baking soda, compared with 0.5% DMBA alone. With 0.25% DMBA, latency was not affected by addition of the dual-phase dentifrice. In contrast, animals receiving 0.25% DMBA and 3% H2O2/ NaHCO3 had a significantly lower rate of tumor formation and overall mass incidence. Croton oil also reduced the rate of tumor formation when applied with 0.25% DMBA. Histopathologic examination of cheek pouches revealed squamous cell carcinomas in the majority of DMBA-treated animals. Cheek pouches of DMBA-treated animals killed at interim times indicated a progression from keratotic changes and/or dyskeratosis at 6 weeks with the occurrence of carcinomas in approximately half the animals examined at 12 weeks. No significant histopathologic abnormalities were observed in animals not receiving DMB A other than slight keratosis in the oral mucosa of one or two animals per group. These results demonstrated that an oral product containing baking soda and hydrogen peroxide was not carcinogenic, and that baking soda and H2O2 did not enhance the tumorigenicity of DMB A. Furthermore, the tumor-igenic response of DMBA was reduced by coadministration of 3% H2O2 and sodium bicarbonate.

Clinical use of hydrogen peroxide in surgery and dentistry--why is there a safety issue?

The use of hydrogen peroxide (HP) is limited in dental surgery by UK interpretation of EC legislation. The product, however, has wide application in surgery, particularly in the debridement of wounds. Its use in sensitive areas such as the carotid artery and vein illustrate its value in safely cleaning wounds.

Evaluation of a new mouthwash on caseous formation

Tonsil caseous affects a significant percentage of the population. Surgeries, conservative or not, have been the only viable alternatives of treatment. However, today there is still not, up to now, an economical and non-invasive treatment that presents satisfactory results.

Aims

The objectives of this study are to evaluate the efficiency of a mouthwash, with active ingredients that associate oxygenating and antimicrobial substances, in the reduction of caseous and tongue coating formation, whose etiology is similar to caseous, and to evaluate the reduction of the volatile sulfur compounds (VSCs) concentration.

Study design

Double blind, placebo-controlled, randomized, clinical and experimental study.

Material e methods

A sample of 50 volunteers with more than one year of chronic caseous tonsillitis complaint used it. The research was carried out in 2005, in the cities of São Paulo and Campinas.

Results

For the group that used the placebo solution, there was no correlation between the variables or statistical significance in the results. For the group that used the mouthwash, the results were significant in all analyzed questions.

Conclusions

This new mouthwash proved to be a viable conservative alternative for the treatment of tonsil caseous, being also efficient in the reduction of tongue coating formation and VSCs concentration.

Salivary hydrogen peroxide produced by holding or chewing green tea in the oral cavity

Tea (Camellia sinensis) catechins have been studied for disease prevention. These compounds undergo oxidation and produce H(2)O(2). We have previously shown that holding tea solution or chewing tea leaves generates high salivary catechin levels. Herein, we examined the generation of H(2)O(2) in the oral cavity by green tea solution or leaves. Human volunteers holding green tea solution (0.1-0.6%) developed salivary H(2)O(2) with C(max) = 2.9-9.6 microM and AUC(0 --> infinity) = 8.5-285.3 microM min. Chewing 2 g green tea leaves produced higher levels of H(2)O(2) (C(max) = 31.2 microM, AUC(0 --> infinity) = 1290.9 microM min). Salivary H(2)O(2) correlated with catechin levels and with predicted levels of H(2)O(2) (C(max(expected)) = 36 microM vs C(max(determined)) = 31.2 microM). Salivary H(2)O(2) and catechin concentrations were similar to those that are biologically active in vitro. Catechin-generated H(2)O(2) may, therefore, have a role in disease prevention by green tea.

Ventilator-associated pneumonia and pressure ulcer prevention as targets for quality improvement in the ICU

The health care culture must change. Florence Nightingale wrote [8] "deep-rooted and universal is the conviction that to give a medicine is to be doing something, or rather everything and to give air, warmth, cleanliness etc. is to do nothing." Hygiene care practices and mobility activities are fundamental and independent care components in the nursing profession. When implemented using available evidence, they can significantly improve patient outcomes. It is time to claim and demonstrate the importance of consistent delivery of the fundamentals of basic nursing care. Interventional patient hygiene is an effective framework to ensure the the basics of nursing care are consistently applied to improve patient outcomes.

Mineral loss from bovine enamel by a 30% hydrogen peroxide solution

This study investigated the effect of a 30% hydrogen peroxide bleaching agent on bovine enamel in terms of mineral loss. Contents of mineral elements both in the teeth and bleaching agent were evaluated to estimate the effect of hydrogen peroxide on teeth. Finely polished non-carious bovine incisors (n = 5) were immersed in a 30% hydrogen peroxide solution for 120 h. The amounts of concentrated elements in the bleaching agent (5 mL) were measured using inductively coupled plasma-atomic emission spectrometer and ion chromatograph. The contents of mineral elements in the teeth were measured using an electron probe microanalyzer. The Ca/P ratio in the bleaching agent was approximately 1.99. The amount of Zn in the bleaching agent was below the detection limit. The total content of mineral elements of the unbleached enamel (90.75 +/- 1.58) was slightly greater than that of the bleached enamel (87.44 +/- 0.77). The Ca/P ratio of the bleached enamel was 2.06. The amount of Ca loss from the bleached enamels after 120 h was similar to the amount of Ca loss from teeth exposed to a soft drink or juice for a few minutes. Therefore, mineral loss caused by the bleaching process may not be a threatening factor to teeth.

Hydrogen peroxide tooth-whitening (bleaching) products: review of adverse effects and safety issues

Hydrogen peroxide in the form of carbamide peroxide is widely used for tooth whitening (bleaching), both in professionally- and in self-administered products. Adverse effects have become evident. Cervical root resorption is a possible consequence of internal bleaching and is more frequently observed in teeth treated with the thermo-catalytic procedure. Tooth sensitivity is experienced in 15-78% of patients undergoing external tooth bleaching. However, clinical studies addressing other adverse effects are lacking. Direct contact with hydrogen peroxide induces genotoxic effects in bacteria and cultured epithelial cells, but the effect is reduced or totally abolished in the presence of metabolising enzymes. Several carcinogenesis studies, including the hamster cheek pouch model, indicate that hydrogen peroxide (H(2)O(2)) might possibly act as a promoter. Until further clinical research is concluded to address the question of possible carcinogenicity, it is recommended that: tooth-bleaching products using concentrated H(2)O(2) should not be used without gingival protection; that H(2)O(2) containing products should be avoided in patients with damaged or diseased soft tissues. For nightguard vital bleaching, minimal amounts of low dose H(2)O(2) (including in the form of carbamide peroxide) are preferred, thereby avoiding prolonged and concentrated exposures.

Hydrogen peroxide tooth-whitening (bleaching): review of safety in relation to possible carcinogenesis

Hydrogen peroxide in the form of carbamide peroxide is widely used in professionally and self-administered products for tooth whitening. Hydrogen peroxide is a highly reactive substance that can damage oral soft and hard tissues when present in high concentrations and with exposures of prolonged duration. This review examines the issue of oral mucosal damage and possible carcinogenicity relating to the use of hydrogen peroxide in the mouth for tooth whitening, with an emphasis on safety with prolonged exposure to low concentrations of peroxide products.

Periodontal diseases in the child and adolescent

BACKGROUND

Periodontal diseases are among the most frequent diseases affecting children and adolescents. These include gingivitis, localized or generalized aggressive periodontitis (a.k.a., early onset periodontitis which includes generalized or localized prepubertal periodontitis and juvenile periodontitis) and periodontal diseases associated with systemic disorders. The best approach to managing periodontal diseases is prevention, followed by early detection and treatment.

METHODS

This paper reviews the current literature concerning the most common periodontal diseases affecting children: chronic gingivitis (or dental plaque-induced gingival diseases) and early onset periodontitis (or aggressive periodontitis), including prepubertal and juvenile periodontitis. In addition, systemic diseases that affect the periodontium and oral lesions commonly found in young children are addressed. The prevalence, diagnostic characteristics, microbiology, host-related factors, and therapeutic management of each of these disease entities are thoroughly discussed.

Safety issues relating to the use of hydrogen peroxide in dentistry

Hydrogen peroxide is used widely in professionally and self-administered products. Hydrogen peroxide is a highly reactive substance which can damage oral soft tissues and hard tissues when present in high concentrations and with exposures of prolonged duration. This report provides an overview of health issues relating to the use of hydrogen peroxide, with an emphasis on safety with prolonged exposure to low concentrations of peroxide products. There is good evidence for the safety of hydrogen peroxide when used at low concentrations on a daily basis over extended periods of time, in self-administered oral health care products such as dentifrices and mouthrinses. These low concentrations neither damage oral hard or soft tissues, nor do they pose a significant risk of adverse long-term effects. Caution should be exercised with the increasingly higher concentration peroxide products used for 'walking' or 'power' bleaching due to the possibility of chemical irritation of oral soft tissues with injudicious use. The volumes of material and application times should be controlled carefully. Thorough education of patients is particularly important with self-applied gels because of the lack of professional supervision with such products. Such education is part of the duty of care of the dentist who supplies bleaching gels for at-home use.

Irritant contact stomatitis: a review of the condition

Several different types of interactions are possible between a chemical, a mixture of chemicals, and associated extrinsic factors (i.e., mechanical irritation) in the oral mucosa. These interactions can be broadly classified as irritative or allergenic in nature. In each case, the pathology usually includes mucosal inflammation. The information compiled and reviewed in this article suggests that, given the broad definition of surface lesions/mucosal abnormalities, there may be a continuum of irritation that can be termed "irritant contact stomatitis." This may be due to the fact that the mouth is lined with highly vascular mucosa that turns over rapidly compared to the skin, and may or may not be covered by keratin. Some regions in the mouth are uniquely sensitive to irritants because they can penetrate through the tissue easily. Key factors involved in the potential development of irritation are: inherent irritation potential of the agent, amount of exposure (concentration, duration, and frequency), ability to penetrate the tissue, and inherent reactivity of the subject as well as other extrinsic factors. Irritation leading to oral mucosal alterations is a common occurrence caused by a wide variety of exposures and insults to the oral cavity. Various irritants such as foods, chemicals, friction, thermal/mechanical injury, metals, spices, and oral care products have been documented to cause irritant reactions in susceptible individuals, particularly if used under exaggerated exposure conditions. It is important to note that most irritation in the oral cavity tends to reverse quickly when the causative agent is removed. Oral irritation is a commonly occurring phenomenon. Thus, it is important that the clinician be aware of the clinical manifestations and etiology of the condition.

Hydrogen peroxide: a review of its use in dentistry

Several dentifrices that contain hydrogen peroxide are currently being marketed. The increased use of bleaching agents containing (or generating) H2O2 prompted this review of the safety of H2O2 when used in oral hygiene. Daily exposure to the low levels of H2O2 present in dentifrices is much lower than that of bleaching agents that contain or produce high levels of H2O2 for an extended period of time. Hydrogen peroxide has been used in dentistry alone or in combination with salts for over 70 years. Studies in which 3% H2O2 or less were used daily for up to 6 years showed occasional transitory irritant effects only in a small number of subjects with preexisting ulceration, or when high levels of salt solutions were concurrently administered. In contrast, bleaching agents that employ or generate high levels of H2O2 or organic peroxides can produce localized oral toxicity following sustained exposure if mishandled. Potential health concerns related to prolonged hydrogen peroxide use have been raised, based on animal studies. From a single study using the hamster cheek pouch model, 30% H2O2 was referred to as a cocarcinogen in the oral mucosa. This (and later) studies have shown that at 3% or less, no cocarcinogenic activity or adverse effects were observed in the hamster cheek pouch following lengthy exposure to H2O2. In patients, prolonged use of hydrogen peroxide decreased plaque and gingivitis indices. However, therapeutic delivery of H2O2 to prevent periodontal disease required mechanical access to subgingival pockets. Furthermore, wound healing following gingival surgery was enhanced due to the antimicrobial effects of topically administered hydrogen peroxide. For most subjects, beneficial effects were seen with H2O2 levels above 1%.

Antimicrobial mouthrinses: overview and update

The Seal of Acceptance of the American Dental Association's Council on Dental Therapeutics has been awarded to Listerine and chlorhexidine gluconate (Peridex). The mechanism of action of Listerine involves bacterial cell wall destruction, bacterial enzymatic inhibition, and extraction of bacterial lipopolysaccharides. Chlorhexidine has the property of substantivity, i.e. the ability to bind to hard and soft tissue with slow release. Antibacterial mouthrinses/dentifrices containing triclosan hold promise for the reduction of plaque and gingivitis but are not yet available in the United States. The quaternary ammonium compounds and sanguinarine compounds (Viadent) have some merit, but studies of their efficacy in plaque and gingivitis reduction are mixed. New products containing various fluorides and oxygenating agents may have potential for the future as antiplaque and antigingivitis agents.

At-home bleaching system: effect on gingival tissue

This study evaluated the effects of an at-home vital bleaching system on gingival responses over a 6-week period. Objective measures were utilized to measure and monitor gingival inflammation over this period of time. Vital bleaching was performed as follows: (1) bleaching gel in a prefabricated mouthguard and (2) an ad-mix technique--bleaching gel and toothpaste in a 1:1 ratio. In addition a control group used a placebo in a prefabricated mouthguard. The at-home vital bleaching system produced no adverse gingival tissue responses. Furthermore, the at-home vital bleaching system helped produce a therapeutic effect on inflamed gingival tissues over the course of the study.

Is home tooth bleaching gel cytotoxic?

Tooth whitening systems are widely used clinically and for home usage. The aim of this study was to determine the effects of two bleaching gels, each containing 10 percent and 15 percent carbamide peroxide, respectively, a 'bleaching gel' without carbamide peroxide, and carbamide peroxide alone on the viability of human endothelial cells in vitro in comparison with culture medium that acted as a negative control. The incubation period used was 30 minutes. A colorimetric viability assay (MTT assay) was employed. The results showed that the gel without carbamide peroxide is not cytotoxic compared to the negative control, while carbamide peroxide on its own and 10 percent and 15 percent carbamide peroxide bleaching gels were cytotoxic, but there were no significant differences (p greater than 0.05) among these latter three test groups. These data indicate that 10 percent and 15 percent carbamide peroxide bleaching gels are cytotoxic and that carbamide peroxide is the component responsible for this cytotoxic effect. This paper also discusses why this in vitro cytotoxic effect appears not to be significant in vivo.

Report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

The growth in the dental literature continues to escalate, as evidenced by the publication of at least 326 new books in 1988 and 1989 and more than 20 new journals in 1989. There still appears to be undue emphasis on quantity instead of quality of research. This proliferation in the literature poses ever increasing difficulties to this Committee in filtering out the articles that are of particular interest to the members of the Academy and identifying those that are most likely to have a major impact on dental practice and service. The subjects covered include periodontics, caries and preventive dentistry, craniomandibular disorders, occlusion, pulp biology, ceramics, and restorative dental materials.