Dose response of chlorhexidine against plaque and comparison with triclosan

Cytotoxic effects of different mouthwash solutions on primary human articular chondrocytes and normal human articular cartilage - an in vitro study

OBJECTIVES

To compare the cytotoxicity of octenidine dihydrochloride and chlorhexidine gluconate at different concentrations on primary human articular chondrocytes and cartilage.

MATERIALS AND METHODS

Primary cultures of human normal adult articular chondrocytes were exposed to octenidine dihydrochloride (0.001562%, 0.003125%, 0.00625%, 0.0125%, 0.025%, 0.05%, and 0.1%), chlorhexidine gluconate (0.003125%, 0.00625%, 0.0125%, 0.025%, 0.05%, 0.1%, and 0.2%), and control (Dulbecco's modified Eagle medium or phosphate-buffered saline) for 30 s. Normal human articular cartilage explants were exposed to octenidine dihydrochloride (0.1% versus control) and chlorhexidine gluconate (0.1% versus control) for 30 s. The viability of human articular chondrocytes was measured by Trypan blue staining, Cell Proliferation Reagent WST-1, and Live/Dead staining. The proliferation of human chondrocytes was measured using the Cell Proliferation Reagent WST-1. The viability of human articular cartilage explants was measured by using Live/Dead staining.

RESULTS

Octenidine dihydrochloride and chlorhexidine gluconate exposure decreased cell viability and proliferation in a dose-dependent manner in primary human articular chondrocytes. Octenidine dihydrochloride and chlorhexidine gluconate exposure decreased cell viability in human articular cartilage explant cultures.

CONCLUSION

The degree of toxicity varied between octenidine dihydrochloride and chlorhexidine gluconate, with chlorhexidine gluconate being less toxic than octenidine dihydrochloride at the same concentration. Additionally, both octenidine dihydrochloride and chlorhexidine gluconate evaluation had cytotoxic effects on human articular cartilage. Therefore, dosing for the antimicrobial mouthwash ingredients administration would ideally be determined to remain below IC50.

CLINICAL RELEVANCE

These data support the in vitro safety of antimicrobial mouthwashes on primary adult human articular chondrocytes.

Influence of Chlorhexidine and Cetylpyridine on Periodontal Status and Indicators of Oxidative Stress in Patients with Type 1 Diabetes

Objective: One of the treatment goals in type 1 diabetes and periodontitis is to address chronic inflammation to prevent the development of neurovascular complications. The aim of this study was to assess the local anti-inflammatory effects of chlorhexidine digluconate and cetylpyridine chloride on periodontal status and indicators of oxidative stress in saliva in patients with type 1 diabetes. Materials and Methods: A total of 42 subjects aged 27 (interquartile range, IQR 22–35) years, with type 1 diabetes for a duration of 12 (IQR 9–18) years, and glycated hemoglobin 8.05 (IQR 7.1–9.4)% were included. Patients were examined twice—initially, and after 14 days of using toothpaste with chlorhexidine and cetylpyridine. Clinical examination of gingival tissues was performed. Certain oxidative stress markers (TP, TEAC, TBARS, AOPP) were measured in the saliva samples. Results: There were significant changes in clinical indicators of periodontal status before and after the application of the toothpaste (API before 0.35 (0.24–0.65) vs. API after 0.265 (0.18–0.39), p = 0.03; SBI before 0.07 (0.04–0.15) vs. SBI after 0.035 (0-0.06), p = 0.002; GI before 0.88 (0.46–1) vs. GI after 0.67 (0.25–1), p = 0.0008). The concentration of saliva TBARS decreased (p = 0.00005) and TEAC increased (p = 0.09). Conclusion: Proper oral hygiene supported by antibacterial chemicals may improve the periodontal status and reduce inflammation.

Differences in chlorhexidine mouthrinses formulations influence the quantitative and qualitative changes in in-vitro oral biofilms

OBJECTIVE

Chlorhexidine mouthrinses are marketed in different formulations. This study aimed at investigating qualitative and quantitative changes in in-vitro multispecies oral biofilms, induced by different chlorhexidine-containing mouthrinses.

BACKGROUND DATA

Earlier studies comparing chlorhexidine mouthrinses are either clinical studies or in-vitro studies assessing the antimicrobial efficacy of the mouthrinses. However, no clear investigations are available regarding ecological impact of different chlorhexidine formulations on in-vitro multispecies oral biofilms after rinsing with different chlorhexidine formulations.

METHODS

Nine commercially available chlorhexidine mouthrinses were selected. Multispecies oral communities (14 species) were grown for 48 h in a Biostat-B Twin bioreactor. After that, they were used to develop biofilms on the surface of hydroxyapatite disks in 24-well pates for 48 h. Biofilms were then rinsed once or multiple times with the corresponding mouthrinse. Biofilms were collected before starting the rinsing experiment and every 24 h for 3 days and vitality quantitative PCR was performed. The experiment was repeated 3 independent times on 3 different days and the results were analyzed using a linear mixed model.

RESULTS

The mouthrinses provoked different effects in terms of change in total viable bacterial load (VBL), ecology, and community structure of the multispecies biofilms. There was no relation between chlorhexidine concentrations, presence, or absence of cetylpyridinium chloride and/or alcohol, and the observed effects. Some tested chlorhexidine mouthrinses (MC, HG, HH, and HI) strongly lowered the total VBL (≈10⁰⁷ Geq/ml), but disrupted biofilm symbiosis (≥40% of the biofilms communities are pathobionts). On the other hand, other tested chlorhexidine mouthrinses (MD, ME, and HF) had limited impact on total VBL (≥10¹⁰ Geq/ml), but improved the biofilm ecology and community structure (≤10% of the biofilms communities are pathobionts).

CONCLUSION

Not all chlorhexidine mouthrinses have the same effect on oral biofilms. Their effect seems to be strongly product dependent and vary according to their compositions and formulations.

Mouthwash with Active Oxygen (blue®m) Reduces Postoperative Inflammation and Pain

The aim of this case series was to evaluate the effects of blue®m mouthwash on oral surgical wounds. Eleven patients underwent bilateral preprosthetic surgery and were instructed to apply the product only to the right side of the surgery. In this way, the right side corresponds to the test side and the left side (place without applying any type of solution) to the control side. After seven days of using the product (3 times a day), the following parameters were evaluated by means of a visual analogue scale: pain, changes in taste, and acceptance by the patient. Then, the level of tissue inflammation was assessed, by the number of pixels, using ImageJ® software. The main results show that the blue®m mouthwash was widely accepted by patients, reducing their pain. The number of inflammation pixels was lower on the test side (p < 0.05), indicating improved healing. It is suggested that blue®m mouthwash positively influences tissue healing reducing pain and the postsurgical inflammatory process; however, randomized clinical trials should be done to prove this clinical observation.

[Prevention of complications in patients with cleft lip and palate combined with teeth crowding receiving long-term orthodontic treatment]

This study aim was to improve the effectiveness of treatment of patients with cleft lip and palate in combination with crowding of teeth receiving long-term orthodontic treatment. The study involved 30 patients divided in 3 groups in which chlorhexidine-containing medication was included in the individual prevention and treatment program. The effectiveness of using 0.2% CG gel was assessed after 6 months to control the development of inflammatory phenomena in periodontal tissues during long-term orthodontic treatment. The obtained clinical and laboratory data indicate the normalization of the cytokine profile and oral hygiene indices as a result of using a CG-containing preparation for effective control of the biofilm etiological factor.

Effect of non-surgical periodontal therapy on insulin resistance and insulin sensitivity among individuals with borderline diabetes: A randomized controlled trial

OBJECTIVE

To investigate the effect of non-surgical periodontal therapy on insulin resistance and sensitivity among individuals with borderline diabetes not receiving medications.

METHODS

A crossover, randomized controlled trial was conducted among participants with borderline diabetes diagnosed by a 75-g oral glucose tolerance test. Participants were randomly assigned to either an early or later intervention group. The early intervention group underwent non-surgical periodontal therapy of scaling and root planing during the first 6 months, followed by a 6-month non-intervention period. The order was reversed in the later intervention group. Primary outcomes included: fasting or post-load serum glucose and insulin, body mass index (BMI), HOMA-IR, HOMA-β, and Matsuda Index.

RESULTS

Seventy-four participants were randomized, and 71 participants completed the trial. There were no significant differences between groups in glucose and insulin concentrations during the intervention and non-intervention periods. When analyzed within groups by median-split of bleeding on probing (BOP) levels before intervention, the lower BOP group showed improved changes in BMI, HOMA-IR, HOMA-β, and Matsuda Index (P < 0.05). Further, we observed a positive correlation between baseline BOP and change in BMI (P = 0.06). Change in BMI was positively correlated with changes in HbA_1c, HOMA-IR, and HOMA-β (P < 0.05), and inversely correlated with change in Matsuda Index (P = 0.001).

CONCLUSIONS

Periodontal therapy had no significant effect on markers related to insulin and glucose metabolism among individuals with borderline diabetes. However, participants with a lower BOP (%) showed significant improvements in BMI, fasting serum insulin, HOMA-IR, HOMA-β and Matsuda Index.

CLINICAL SIGNIFICANCE

Among individuals diagnosed with borderline diabetes, those who had <37% of a lower BOP (%) showed potential improvements in BMI, fasting serum insulin, HOMA-IR, HOMA-β and Matsuda Index following non-surgical periodontal therapy.

Dose-response effect of chlorhexidine on a multispecies oral biofilm formed on pure titanium and on a titanium-zirconium alloy

This study aimed to test the dose-response effect of chlorhexidine on multispecies biofilms formed on commercially pure titanium (cpTi) and titanium-zirconium (TiZr) alloy. Biofilms were formed on cpTi and TiZr discs and treated two times per day with five different chlorhexidine concentrations (0.12, 0.20, 0.50, 1, 2%). The biofilms were collected for microbiological, biochemical and microscopic analyses. The significance of differences among groups was evaluated by linear regression, ANOVA, Bonferroni and Tukey tests. The mean number of colony-forming units decreased as the chlorhexidine concentration increased for both cpTi and TiZr (p < 0.05). The maximum effect was observed with the 0.5% concentration. Confocal microscopy images suggested an increase in the number of dead bacterial cells with increased chlorhexidine concentration. The biofilm pH increased after chlorhexidine exposure (p < 0.05). Chlorhexidine showed an antimicrobial dose-response effect in controlling biofilm on cpTi and TiZr. 0.5% chlorhexidine can be used to achieve the maximum antimicrobial effect on both materials.

Comparison of Antimicrobial Efficacy of (between) 0.2% Chlorhexidine and Herbal Mouthwash on Salivary Streptococcus mutans: A Randomized Controlled Pilot Study

Background:

The chemomechanical plaque control measures are helpful in controlling dental plaque and thus caries, especially in pediatric age group.

Aim:

This study aims to compare effectiveness of herbal mouthrinse containing Terminalia chebula to that of 0.2% chlorhexidine against children's salivary mutans streptococci levels.

Settings and Design:

A double-blind, randomized, controlled study design will be framed for conducting this study.

Methods:

A total of 45 participants were randomly categorized in Group 1, Group 2, or Group 3 (control group, experimental group, or negative control). Baseline unstimulated saliva was collected. All the participants were instructed regarding the use of mouthrinse for 2 weeks. After 2 weeks, again unstimulated saliva was collected. After collection, saliva samples were sent for microbiological analysis.

Statistical Analysis:

The mean colony-forming units (CFU/ml) were determined. Paired t-test, ANOVA test, and post hoc test were applied for statistical analysis.

Results:

Statistically significant difference in CFU count has been observed in 0.2% chlorhexidine and Oratreat groups at 15 days as compared to baseline (P < 0.001). At 15 days, reduction in CFU count has seen more in Oratreat group as compared to 0.2% chlorhexidine group, and the difference is statistically significant (P < 0.001).

Conclusion:

0.2% chlorhexidine and Oratreat mouthwash reduce the salivary Streptococcus mutans count. Oratreat herbal mouthwash has proved to be better as compared to 0.2% chlorhexidine mouthwash.

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.

Effectiveness of stevia as a mouthrinse among 12-15-year-old schoolchildren in Nellore district, Andhra Pradesh - A randomized controlled trial

Aim

The aim of this study is to determine the effectiveness of stevia as a daily mouthrinse among 12-15 year-old schoolchildren in Nellore District, Andhra Pradesh.

Materials and Methods

A randomized, controlled triple blind trial was carried out among 108 children in B. V. S Municipallity Girls High school in Nellore. Children were randomly allocated into four groups comprising 27 in each group. Four mouthrinses composed of 0.2% chlorhexidine gluconate; 0.05% sodium fluoride, 10.6% stevioside and placebo were provided to the study participants. Plaque index, gingival index, and International Caries Detection and Assessment System (ICDAS) II, respectively, were used for assessing oral condition. The mouthrinsing was carried out for 6 months.

Results

Group C showed maximum reduction of 8% and 10% on plaque and gingival scores, respectively, followed by Group A and Group B. However, Group D participants showed 1.5% and 1.8% increase in plaque and gingival scores, respectively. Analysis of ICDAS scores at 6 months indicated that values recorded were same as baseline for all the three groups except that for Group D, there was an increase in the prevalence of cavitated lesion D_2-6from 5.6% to 5.8%.

Conclusion

Stevia demonstrated very potent antiplaque and antigingivitis properties as compared to other mouthrinses at the end of 6 months trial.

Plaque Removal and Gingival Health after Use of a Novel Dental Gel: A Clinical Study

Background

Goal of this in vivo prospective, randomized, controlled, double-blinded, cross over study was to compare the level of plaque control and gingivitis after use of a novel dental gel (test) vs. A Triclosan/copolymer dentifrice (control).

Methods

After coronal polishing, 22 subjects with moderate gingivitis were randomly assigned to brush twice daily with test or control dentifrice for the first study Arm. Plaque, gingival and sulcus bleeding indices were recorded at baseline, week 2 and week 4. Professional coronal polishing was repeated, and then subjects brushed with the second dentifrice for 4 weeks. Clinical indices were again recorded at Baseline, week 2 and week 4. The effects of each dentifrice on clinical indices were compared using Student’s t-test.

Results

Brushing with the test gel produced significantly greater levels of plaque reduction versus the Triclosan/copolymer control dentifrice at each time point. 45% less plaque was measured after 4 weeks of test agent use than after control agent use (p<0.000000005). A significant reduction in gingival inflammation from test vs control agent over w\4 weeks was also observed (p=0.000342).

Conclusions

An activated edathamil dental gel formulation provides effective plaque control and reduced gingival inflammation compared to a Triclosan/Co-polymer dental gel. Practical Implications: A novel dental gel formulation that does not contain abrasives, detergents or antimicrobials may provide effective plaque control and support gingival health.

Mechanisms of Stain Formation on Teeth, in Particular Associated with Metal Ions and Antiseptics

Much has been written on the subject of extrinsic tooth discoloration, but, except when the pigment is intentionally applied, the etiologies and mechanisms are poorly understood. Extrinsic stains have been classified as non-metallic or metallic. The pigment usually lies not on or in the dental tissues, but in surface deposits, particularly the acquired pellicle layer and at sites receiving limited cleaning. Whether pigments absorb, adsorb, or chemically interact with dental surfaces is unclear. Some stains merely seem to reflect the color of the apparent source, whereas others have been ascribed to a secondary chemical alteration of a substance at the tooth or pellicle surface. Theories of chromogenic bacteria and formation of metal sulfides are frequently propounded but without clear supportive evidence. Staining by cationic antiseptics and, to a lesser extent, metal salts has attracted research interest. Chlorhexidine and other cationic antiseptics, it is hypothesized, may catalyze browning reactions or facilitate metal sulfide formation in pellicle. Controlled clinical studies have repeatedly shown that dental and mucosal staining associated with the use of chlorhexidine and some metal salts is dependent upon volunteers' imbibing reasonable quantities of chromogenic beverages, such as tea. However, it must be appreciated that cationic antiseptics and polyvalent metals can precipitate chromogenic material from a large range of dietary compounds. The control of dental staining, at least that associated with chlorhexidine, can be achieved both in vitro and in vivo by the use of oxidizing agents which appear to remove the stain physically from the surfaces.

Anti-biofilm and bactericidal effects of magnolia bark-derived magnolol and honokiol on Streptococcus mutans

Dental caries affects people of all ages and is a worldwide health concern. Streptococcus mutans is a major cariogenic bacterium because of its ability to form biofilm and induce an acidic environment. In this study, the antibacterial activities of magnolol and honokiol, the main constituents of the bark of magnolia plants, toward planktonic cell and biofilm of S. mutans were examined and compared with those of chlorhexidine. The minimal inhibitory concentrations of magnolol, honokiol and chlorhexidine for S. mutans were 10, 10 and 0.25 µg/mL, respectively. In addition, each agent showed bactericidal activity against S. mutans planktonic cells and inhibited biofilm formation in a dose- and time-dependent manner. Magnolol (50 µg/mL) had greater bactericidal activity against S. mutans biofilm than honokiol (50 µg/mL) and chlorhexidine (500 µg/mL) at 5 min after exposure, while all showed scant activity against biofilm at 30 s. Furthermore; chlorhexidine (0.5-500 µg/mL) exhibited high cellular toxicity for the gingival epithelial cell line Ca9-22 at 1 hr, whereas magnolol (50 µg/mL) and honokiol (50 µg/mL) did not. Thus; it was found that magnolol has antimicrobial activities against planktonic and biofilm cells of S. mutans. Magnolol may be a candidate for prevention and management of dental caries.

Effects of two different post-surgical protocols including either 0.05 % chlorhexidine herbal extract or 0.1 % chlorhexidine on post-surgical plaque control, early wound healing and patient acceptance following standard periodontal surgery and implant placement

OBJECTIVES

The aim of this study was to compare early wound healing, tooth staining and patient acceptance with two different post-surgical maintenance protocols.

MATERIALS AND METHODS

Forty patients scheduled for flap surgery to treat periodontal pockets or accommodate dental implants were randomly assigned to receive the following two different post-surgical maintenance protocols: (a) 2 weeks rinsing with a 0.05 % chlorhexidine digluconate (CHX)/herbal extract combination (test) or (b) a 0.1 % CHX solution (control). Early wound healing was evaluated clinically and immunologically. Tooth staining and patient acceptance were assessed by means of visual analogue scale (VAS).

RESULTS

Both groups presented with comparable wound healing profiles. No statistically significant differences were observed between the two protocols regarding early wound healing and plaque index (p > 0.05). However, in the control group, statistically significantly more patients felt discomfort due to tooth staining (p = 0.0467). Compared with patients from the test group, patients in the control group reported statistically significant more irritation of taste at week 1 (p = 0.0359) and at week 2 (p = 0.0042).

CONCLUSIONS

The present findings indicate that the two CHX protocols resulted in comparable healing and inhibition of plaque formation. Tooth staining and subjective discomfort related to irritation of taste were more frequent in the control group.

CLINICAL RELEVANCE

A post-operative protocol including 0.05 % CHX/herbal extract may have the potential to improve patient compliance during post-operative maintenance.

Cytotoxic effects of octenidine mouth rinse on human fibroblasts and epithelial cells - an in vitro study

OBJECTIVES

This study compared the cytotoxicity of a new octenidine mouth rinse (MR) against gingival fibroblasts and epithelial cells with different established MRs.

METHODS

The following MRs were used: Octenidol (OCT), Chlorhexidine 0.2% (CHX), Listerine (LIS), Meridol (MER), Betaisodona (BET); and control (medium only). Human primary gingiva fibroblasts and human primary nasal epithelial cells were cultivated in cell-specific media (2 × 10(5) cells/ml) and treated with MR for 1, 5, and 15 min. Each test was performed 12 times. Metabolism activity was measured using a cytotoxicity assay. A cellometer analyzed cell viability, cell number, and cell diameter. The data were analyzed by two-way analysis of variance with subsequent Dunnett's test and additional t-tests.

RESULTS

The cytotoxic effects of all MRs on fibroblasts and epithelial cells compared to the control depended on the contact time (p < 0.001). OCT and BET showed less influence on cell metabolism in fibroblasts than other MRs. OCT also demonstrated comparable but not significant results in epithelial cells (p > 0.005). Cell numbers of both cell types at all contact times revealed that OCT showed a less negative effect (p > 0.005), especially for epithelial cells compared to CHX after 15 min (p < 0.005). OCT and BET showed the best results for viability in fibroblasts (p > 0.005), but MER showed less influence than OCT in epithelial cells (p < 0.005).

CONCLUSIONS

OCT is a potential alternative to CHX regarding cytotoxicity because of its lower cell-toxic effect against fibroblasts and epithelial cells.

Chlorhexidine salt-loaded polyurethane orthodontic chains: in vitro release and antibacterial activity studies

The widespread use of indwelling medical devices has enormously increased the interest in materials incorporating antibiotics and antimicrobial agents as a means to prevent dangerous device-related infections. Recently, chlorhexidine-loaded polyurethane has been proposed as a material suitable for the production of devices which are able to resist microbial contamination. The aim of the present study was to characterize the in vitro release of chlorhexidine from new polymeric orthodontic chains realized with polyurethane loaded with two different chlorhexidine salts: chlorhexidine diacetate or chlorhexidine digluconate. The orthodontic chains constituted of three layers: a middle polyurethane layer loaded with chlorhexidine salt inserted between two layers of unloaded polymer. In vitro release of chlorhexidine diacetate and digluconate from orthodontic chains loaded with 10% or 20% (w/w) chlorhexidine salt was sustained for 42 days and followed Fickian diffusion. The drug diffusion through the polyurethane was found to be dependent not only on chlorhexidine loading, but also on the type of chlorhexidine salt. The antibacterial activity of 0.2% (w/w) chlorhexidine diacetate-loaded orthodontic chain was successfully tested towards clinically isolated biofilm forming ica-positive Staphylococcus epidermidis via agar diffusion test. In conclusion, the chlorhexidine salt-loaded chains could provide an innovative approach in the prevention of oral infections related to the use of orthodontic devices.

Effect of a chlorhexidine mouthrinse on plaque, gingival inflammation and staining in gingivitis patients: a systematic review

AIM

To systematically evaluate the efficacy of chlorhexidine (CHX) mouthrinses on plaque, gingival inflammation and staining in gingivitis patients.

MATERIAL & METHODS

Medline, EMBASE and Cochrane Central Register of Controlled Trials were searched through April 2011. Randomized controlled clinical trials comparing CHX to placebo/control mouthrinses or oral hygiene (OH) ≥ 4 weeks were included.

RESULTS

Among 1355 titles, 30 publications fulfilled the selection criteria. Meta-analysis (MA) showed significant weighted mean differences (WMD) favouring CHX. This was -0.39 [95% CI: -0.70; -0.08] for the Plaque Index Silness & Löe, -0.67 [95% CI: -0.82; -0.52] for the Plaque-Index Quigley & Hein (PIQH), -0.32 [95% CI: -0.42; -0.23] for the Gingival Index (GI), -0.08 [95% CI: -0.10; -0.05] for the bleeding aspect of the GI, -0.21 [95% CI: -0.37; -0.04] for the Papillary BIeeding Index, -0.16 [95% CI: -0.26; -0.07] for Bleeding on Marginal Probing and 0.91 [95% CI: 0.12;1.70] for the Lobene Stain Index. MA of studies with a low risk of author-estimated bias showed a WMD of -0.68 [95% CI: -0.85; -0.51] for the PIQH and -0.24 [95% CI: -0.29; -0.20] for the GI in favour of CHX. Relative to control, the reduction with CHX for plaque was 33% and for gingivitis 26%. CHX rinsing groups demonstrated significantly more staining.

CONCLUSIONS

In gingivitis patients, CHX mouthrinses together with OH versus placebo- or control mouthrinse provide significant reductions in plaque and gingivitis scores, but a significant increase in staining score.

Effectiveness of a mouthrinse containing active ingredients in addition to chlorhexidine and triclosan compared with chlorhexidine and triclosan rinses on plaque, gingivitis, supragingival calculus and extrinsic staining

OBJECTIVES

To assess the effectiveness of three different mouthrinses--chlorhexidine, triclosan + sodium fluoride and chlorhexidine + triclosan + sodium fluoride + zinc chloride--on plaque, calculus, gingivitis and stains and to evaluate the occurrence of adverse effects with these three treatments.

METHODS

Forty-eight healthy subjects participated in a double-blind, randomized, parallel experiment and were randomly allocated to any one of the three experimental mouthrinses: group A (0.2% chlorhexidine (CHX) gluconate), group B (0.03% triclosan + 0.025% sodium fluoride (NaF) + 12% ethyl alcohol) or group C (0.2% CHX + 0.3% triclosan + 0.3% NaF + 0.09% Zn chloride (ZnCl(2)). All the subjects were assessed for gingivitis, plaque, supragingival calculus and extrinsic stains at baseline and at the end of the 21-day experimental period.

RESULTS

There was a significant difference (P = 0.046) in the effectiveness for the prevention of gingivitis and plaque, with subjects of group A and group C presenting least and highest gingival and plaque scores, respectively. Significant differences (P = 0.03) were observed for the accumulation of supragingival calculus where the deposition of calculus in group A was nearly double that of the group B, and group B was most effective in the prevention of supragingival calculus. Highest deposition of extrinsic stains was in the group A followed by group C and group B. There was no significant difference between the three treatments for adverse events' occurrence.

CONCLUSIONS

CHX mouthrinse was most effective in controlling plaque and gingivitis but caused greatest deposition of extrinsic stains. Supragingival calculus deposition was least in triclosan + NaF group followed by CHX + triclosan + NaF + ZnCl(2) and CHX. More than half of the subjects reported adverse events during the experimental phase.

Antimicrobial penetration and efficacy in an in vitro oral biofilm model

The penetration and overall efficacy of six mouthrinse actives was evaluated by using an in vitro flow cell oral biofilm model. The technique involved preloading biofilm cells with a green fluorescent dye that leaked out as the cells were permeabilized by a treatment. The loss of green color, and of biomass, was observed by time-lapse microscopy during 60 min of treatment under continuous flow conditions. The six actives analyzed were ethanol, sodium lauryl sulfate, triclosan, chlorhexidine digluconate (CHX), cetylpyridinium chloride, and nisin. Each of these agents effected loss of green fluorescence throughout biofilm cell clusters, with faster action at the edge of a cell cluster and slower action in the cluster center. The time to reach half of the initial fluorescent intensity at the center of a cell cluster, which can be viewed as a combined penetration and biological action time, ranged from 0.6 to 19 min for the various agents. These times are much longer than the predicted penetration time based on diffusion alone, suggesting that anti-biofilm action was controlled more by the biological action time than by the penetration time of the active. None of the agents tested caused any removal of the biofilm. The extent of fluorescence loss after 1 h of exposure to an active ranged from 87 to 99.5%, with CHX being the most effective. The extent of fluorescence loss in vitro, but not penetration and action time, correlated well with the relative efficacy data from published clinical trials.

Halitosis, oral health and quality of life during treatment with Invisalign(®) and the effect of a low-dose chlorhexidine solution

AIM

This study examined how halitosis, oral dryness and general oral health were impacted during treatment with the Invisalign(®) system. Furthermore, the effect of a lowdose chlorhexidine solution (CHX) was evaluated.

PATIENTS AND METHODS

Thirtyone patients with good periodontal health participated in this crossover study and were divided into two groups (group 1: CHX/no CHX, group 2: no CHX/CHX). The following parameters were recorded during the first 8 months of Invisalign(®) treatment: stimulated saliva flow rate, organoleptic index, tongue coating index, measurement of the oral volatile sulfur compound level (ppb), modified gingival and plaque index and bleeding on probing index. Professional oral cleaning was performed at the beginning of each period lasting 3 months. The patients received a questionnaire at the first, third, fourth, sixth and eighth control visits.

RESULTS

The very low volatile sulfur compound level was significantly decreased by CHX (0.06%) during the first examination period (p = 0.02), i.e. for the first group of patients only. Neither halitosis, nor oral dryness, nor high plaque or gingival index measurements were observed. Oral health-related quality of life was hardly influenced by wearing aligners and oral hygiene habits were very good.

CONCLUSIONS

This study provides evidence that Invisalign(®) treatment is characterized by only minimal impairment of overall oral health and the associated quality of life. Consequently, it appears unnecessary to recommend the general adjunctive use of a low-dose chlorhexidine mouthwash during treatment with Invisalign(®).

Comparing the effects of chlorhexidine and persica on alveolar bone healing following tooth extraction in rats, a randomised controlled trial

Chlorhexidine is broadly prescribed by clinicians for treating extraction socket wounds; however, studies have reported adverse effects for chlorhexidine. Persica, a herbal antibacterial agent, could be an alternative for chlorhexidine. The aim of this randomised controlled trial was to investigate the effects of persica and chlorhexidine on alveolar bone healing following tooth extraction in rats. Eighteen Wistar rats were randomly allocated to three study groups: 0.2% chlorhexidine, 10% persica and controls (tap water). The rats were mouth-rinsed for 14 days. On day 8, the mandibular right first molars of all the rats were extracted. On day 21, the rats were euthanized and histological slides of their extraction sockets were prepared. The amount of new bone formation and the number of inflammatory cells in the extraction socket for each rat were recorded. Data were analysed using linear regression and Mann-Whitney tests. There was no significant difference between the control group and the intervention groups in terms of new bone formation and inflammatory cell count. The mean new bone formation was significantly higher in the persica group than in the chlorhexidine group. There was a significant association between new bone formation and inflammatory cell count in the entire sample. In conclusion, there were no significant differences between rinsing with tap water and rinsing with 0.2% chlorhexidine and 10% persica in enhancing extraction socket wound healing in rats. Extraction socket wound healing in rats was better enhanced with 10% persica than 0.2% chlorhexidine.

[Mouthwash solutions containing microencapsulated natural extracts: Clinical results on dental plaque and gingivitis]

INTRODUCTION

New mouthwash solutions containing microencapsulated natural extracts have been developed. Besides antiseptic activity, these solutions have antioxidant and immunoregulatory properties on oral tissues. The objective of this preliminary clinical study was to assess the efficiency of a mouthwash containing microencapsulated natural extracts (GingiNat, LoB5 Foundation, Paris, France) on gingivitis.

PATIENTS AND METHODS

Twenty volunteers (37 + or - 2 years) with significant gingivitis (bleeding when tooth-brushing) used a 6% GingiNat mouthwash solution, two to three times per day (according to oral hygiene habits) for 21 days in addition to their usual oral care. Each volunteer was examined at day 0, 4, 7 and 21. The Löe and Silness Plaque Index, the Russel Periodontal Index, a breath index (halitosis), and oral tissue tolerance were assessed. Finally, each volunteer filled in a daily follow-up form and answered a questionnaire on tolerance and acceptability.

RESULTS

A significant decrease of the dental plaque index was observed on day 4, 7, and 21, in respectively 29, 48 and 71% of volunteers. This decrease reached 18% on day 4 (p=0.014), 32% on day 7 (p=0.002), and 47% on day 21 (p<0.001). A significant decrease of the periodental index was observed on day 4, 7 and 21, in respectively 52, 81 and 95% of volunteers. This decrease reached 30% (p=0.001) on day 4, 49% (p<0.001) on day 7, and 78% (p<0.001) on day 21. A significant improvement of the breath index was noted on day 4, 7, and 21, in respectively 43, 52 and 48% of volunteers. This improvement reached 29% (p=0.004) on day 4, 35% (p=0.001) on day 7, and 32% (p=0.002) on day 21. The mouthwash was well tolerated. The patients liked its effectiveness and organoleptic properties. All patients expressed the wish to continue using this solution.

DISCUSSION

The GingiNat mouthwash solution at 6% had a significant efficiency on plaque, gingivitis, and halitosis after 21 days of use. This makes it a good complementary treatment for gingivitis. Tolerance and acceptability were good despite the long and repeated use. Further studies are needed to have a detailed analysis of its efficiency in the long run and on patients presenting with various forms of periodontitis.

Efficacy of a low-concentration chlorhexidine mouth rinse in non-compliant periodontitis patients attending a supportive periodontal care programme: a randomized clinical trial

OBJECTIVE

To assess the clinical and microbiological efficacy of a 0.05% chlorhexidine and 0.05% cetyl-pyridinium chloride mouth rinse in supportive periodontal care (SPC) in patients with inadequate plaque control.

MATERIAL AND METHODS

The study was a randomized, double-blinded, placebo-controlled clinical trial in patients with moderate to severe chronic periodontitis under SPC with an inadequate plaque control (Turesky index >1). After supragingival prophylaxis and oral hygiene reinforcement, participants rinsed twice a day for 3 months with the test or placebo solutions, in addition to conventional hygiene. Primary clinical outcome variables included plaque and gingival indices. As secondary outcomes, periodontal and microbiological variables were studied. ancova and chi(2) tests were used to compare the variables.

RESULTS

Forty-seven patients (22 placebo and 25 test group) participated. After 3 months, plaque levels increased in the placebo group, while diminished in the test group (p<0.001). Similar effects were found for bleeding on probing. The other clinical parameters did not show significant differences. Microbiological variables demonstrated inter-group significant reductions in subgingival counts of Fusobacterium nucleatum and Prevotella intermedia and a decrease of the total bacterial counts in saliva.

CONCLUSIONS

The tested mouth rinse demonstrated efficacy in reducing plaque and gingivitis, as well as in decreasing the microbial load in saliva and gingival sulcus.

Antiseptic effect of a novel alcohol-free mouthwash: A convenient prophylactic alternative for high-risk patients

We developed an efficacious and non-irritant mouthwash that is alcohol-free and that has a low concentration of chlorhexidine, in order to be used for preventing oral cavity infections in immunocompromised and cancer patients. The novel mouthwash solution was tested for its antimicrobial efficacy against both free floating (planktonic) and the biofilm forms of Candida albicans. The solution was also tested against Klebsiella pneumoniae, Pseudomonas aeruginosa, and methicillin-resistant Staphylococcus aureus (MRSA), using a modification of a previously published method. The activity of the novel mouthwash was also compared with that of three commercially available mouthwashes. The experimental mouthwash showed efficacy against C. albicans, both in free-floating form and in biofilm. With higher concentration of chlorhexidine, the solution was also efficacious in inhibiting the growth of K. pneumoniae, P. aeruginosa, and MRSA. The antiseptic activity of the alcohol-free mouthwash against other bacterial organisms and C. albicans was comparable to other commercially available alcohol-based mouthwash solutions. A novel alcohol-free mouthwash solution, that has low concentration of chlorhexidine, showed antiseptic effect against planktonic and biofilm forms of C. albicans and against K. pneumoniae, P. aeruginosa, and MRSA.

The Peritoneal Explant Test for Evaluating Tissue Tolerance to Mouthrinses

The tissue cultures of explants of neonatal rat peritoneum have been demonstrated to be a sensitive test for tissue compatibility with wound antiseptics. The present study investigated the suitability of this method to assess the relative toxicity of mouthrinses to tissue. Mouthrinses containing 0.1% chlorhexidine (Chlorhexamed Fluid 0.1%) (A), 0.3% triclosan (Colgate) (B), essential oil in ethanolic solution (Listerine) (C), and amine/stannous fluoride (Meridol) (D) were tested at use concentration and in dilutions of 10, 1, and 0.1% with exposure times of 1, 10, and 30 min, respectively. The mouthrinses (test) and Ringer's solutions (control) were applied to opened rat peritoneum. After thorough irrigation with Ringer's solution, a piece of peritoneum was removed and 1 x 1 mm explants were cut. The explants were cultivated with a bovine serum culture medium in 24-well plates at 37 degrees C in a CO2 incubator (95% air, 5% CO2). After 10 days, the tissue proliferation for the explants was assessed by a stereo microscope at 10x magnification after ethanol fixing and hemalaun staining. With 24 grafts per test, the proliferation rate was calculated relative to a control, which was run for each mouthrinse and concentration/time combination. Data were analyzed using ANOVA (SPSS 11.0) and post-hoc paired t test. Statistical significance of all correlations was tested by setting the significance level at p < 0.05. At most concentrations, D caused significantly less tissue damage than A or B. There was no difference between C and A or C and B at 100%. However, the toxicity of C was significantly less than A or B at 10, 1, and 0.1%. C and D behaved similarly except for the 10% (30 min) and the 1% (10 min) solutions in which C was significantly less toxic. We concluded that the rat peritoneum explant test was demonstrated to be a sensitive test to assess the relative toxicity of mouthrinses to tissue.

An efficacy and safety analysis of a chlorhexidine chewing gum in young orthodontic patients

AIM

The objective of the present study was to investigate the impact of a chlorhexidine (CHX) chewing gum in teenage orthodontic patients on plaque levels, gingival bleeding tendency and tooth staining.

MATERIALS AND METHODS

A randomized-controlled, double-blind, parallel study was conducted on 31 teenagers in fixed orthodontic therapy. Subjects of the CHX gum group were asked to continue their oral hygiene procedures in conjunction with chewing two pieces of a 5 mg CHX-containing chewing gum for 10 min. twice a day for 3 months. Subjects of the placebo gum group received the same instructions; however, using a CHX-free chewing gum. Plaque levels, gingival bleeding on probing and tooth staining were monitored at baseline and subsequently after 1-3 months.

RESULTS

Plaque levels significantly decreased from baseline at lingual/palatal sites in the placebo gum group. In the CHX gum group, a similar, yet non-significant trend was observed. At buccal sites, plaque levels remained unaffected in both groups. Gingival bleeding tendency significantly decreased in both groups, predominantly at lingual/palatal sites. There were no significant between-group differences in any of the efficacy parameters at any time point. However, the increase in staining was nearly five times higher in the CHX gum group.

CONCLUSIONS

There seems to be no indication for a CHX chewing gum in teenage orthodontic patients when used as an adjunct to normal oral hygiene practices.

An in vitro antimicrobial comparison of miswak extract with commercially available non-alcohol mouthrinses

The aim of this study was to assess the antimicrobial activity of eight commercially available mouthrinses and 50% miswak extract against seven microorganisms. Corsodyl, Alprox, Oral-B advantage, Florosept, Sensodyne, Aquafresh Mint, Betadine and Emoform mouthrinses were used while 50% aqueous extract of miswak (Salvadora persica) was used against Streptococcus faecalis, Streptococcus pyogenis, Streptococcus mutans, Candida albicans, Staphylococcus aureus and Staphylococcus epidermidis. The ditch plate method was used to test the antimicrobial activity. Inhibition zones of microorganisms around ditches were measured in millimetres. Range, mean and standard deviations were used for comparison of antimicrobial activity. Mouthrinses containing chlorhexidine was with maximum antibacterial activity, while cetylpyridinium chloride mouthrinses were with moderate and miswak extract was with low antibacterial activity. Further research is needed for the substantivity of these mouthrinses and further in vivo/in vitro studies are needed using Biofilm model to substantiate present findings. Dental professionals must exercise caution and provide guidance in assisting their patients in making informed choices regarding their use of mouthrinses for clinical efficacy.

The effect of a polyhexamethylene biguanide mouthrinse compared with a triclosan rinse and a chlorhexidine rinse on bacterial counts and 4-day plaque re-growth

OBJECTIVES

For various clinical applications, polyhexamethylene biguanide hydrochloride (PHMB) has been used for many years as an antiseptic in medicine. Recently, a 0.04% and a 0.12% PHMB mouthwash were shown to inhibit plaque re-growth and to reduce oral bacterial counts. In this study, a 0.2% PHMB mouthrinse (A) was compared with a positive control 0.12% aqueous chlorhexidine solution (B), a commercially available 0.3% triclosan/2.0% polyvinyl methyl ether maleic acid copolymer mouthrinse (Colgate Total Plax) (C), and a negative control placebo rinse (10% ethanol, flavour) (D).

MATERIALS AND METHODS

The controlled clinical study was a double blind, randomized, four replicate cross - over design. Plaque re-growth was assessed with the Turesky et al. (1970) modification of the Quigley & Hein (1962) plaque index. The antibacterial effect was assessed by taking bacterial counts on the tooth surface (smears from the buccal surface of 16/26) and mucosa (smears from the buccal mucosa in opposite of area 16/26) after the professional prophylaxis and after the first rinse with the preparations on day 1 and prior to the clinical examination on day 5. Sixteen volunteers participated and, on day 1 of each study period were rendered plaque-free, ceased toothcleaning, and rinsed twice daily with the allocated mouthrinse. On day 5, plaque was scored and smears were collected according to the protocol. A 10-day wash-out period was carried out between each rinse evaluation. Data were analysed using ancova with Bonferroni HSD adjustment for multiple comparisons (colony forming units per sample) with a significance level alpha=0.05.

RESULTS

The 0.2% PHMB mouthrinse (A) was significantly better at inhibiting plaque than the placebo (D), but significant less effective than the 0.12% aqueous chlorhexidine solution (B). There is no significant difference between A and the 0.3% triclosan/2.0% copolymer mouthrinse (C). Bacterial count reductions (tooth surface and mucosa) with PHMB (A) were significantly greater compared with the placebo (D) and triclosan (C), but significantly lower compared with chlorhexidine (B) (tooth surface) and equally effective compared with chlorhexidine (B) (mucosa).

CONCLUSION

Consistent with previous studies, a PHMB mouthrinse was shown to inhibit plaque re-growth and to reduce oral bacterial counts, indicating that PHMB could be an alternative to established mouthrinses in preventive applications.

The Impact of Periodontal Therapy and the Adjunctive Effect of Antiseptics on Breath Odor-Related Outcome Variables: A Double-Blind Randomized Study

BACKGROUND

Bad breath is often caused by periodontitis and/or tongue coating. This study followed the impact of initial periodontal therapy on several halitosis-related outcome variables over a 6-month period. Organoleptic ratings are often uncomfortable for the patient and have several disadvantages. They are, for instance, influenced by external parameters (e.g., food intake and cosmetics) and need to be calibrated among researchers worldwide. A second aim was to evaluate the reliability of saliva incubation as an in vitro indirect test for breath recording.

METHODS

In this double-blind, randomized, medium-term, parallel study 45 moderate periodontitis patients without obvious tongue coating were enrolled. Besides a one-stage, full-mouth disinfection and oral hygiene improvement (including daily tongue scraping), patients were instructed to rinse daily for 6 months with one of the following products (randomly allocated): chlorhexidine (CHX) 0.2% + alcohol, CHX 0.05% + cetyl pyridinium chloride (CPC) 0.05% without alcohol (a new formulation), or a placebo solution. At baseline and 3 and 6 months, a series of parameters were recorded including: concentration of volatile sulfide compounds (VSC), tongue coating, and an estimation of the microbial load (at anterior and posterior parts of the tongue, saliva, dental plaque). The intraoral VSC ratings were compared to in vitro VSC recordings and organoleptic evaluations of the headspace air from 1 and 2 hours incubated saliva (0.5 ml, 37 degrees C, anaerobic chamber).

RESULTS

Even though the initial VSC values were not high (+/-90 ppb with only 18 patients revealing more than 100 ppb), significant (P <0.05) reductions could be achieved in the CHX and CHX + CPC group, and to a lower extent in the placebo group (P = 0.10). Tongue scraping resulted in a significant reduction (P < or =0.05) of the tongue coating up to month 6 in the placebo and CHX + CPC group, but not in the CHX group (confusion due to staining). The CHX and CHX + CPC group showed, in comparison to baseline, significant (P <0.001) reductions in the number of anaerobic species in the supragingival plaque, in the saliva, and on the anterior part of the tongue. For the posterior part of the tongue the microbial changes remained < or =0.3 log values (P >0.05). For the placebo group, the microbial changes never reached a level of significance (< or =0.3 log values). A strong correlation was found between the intraoral VSC ratings and the 1-hour (r = 0.48, P <0.0001; r = 0.54, P = 0.0003 for baseline data only) and 2-hour (r = 0.43, P <0.0001) VSC production of incubated saliva. The latter also correlated very strongly (r = 0.71) with the number of anaerobic species in the saliva. The VSC values and organoleptic ratings of the incubated saliva also correlated strongly with each other (r = 0.64 for 1-hour and 0.73 for 2-hour incubation).

CONCLUSIONS

The results of this study indicate that in patients with moderate periodontitis, initial periodontal therapy including tongue scraping did not have a significant effect on the microbial load of the tongue and had only a weak impact on the VSC level, except when combined with a mouthrinse. Saliva incubation can be used as an indirect way to score breath odor. It offers simplicity, objectivity, and is less invasive.

Plaque inhibition of two commercially available chlorhexidine mouthrinses

BACKGROUND

Chlorhexidine (CHX) 0.2% solution is still "the leading oral antiseptic" for controlling gingivitis. Side effects, however, limit the acceptability to users and the long-term employment of a 0.2% CHX antiseptic in preventive dentistry. This stimulated the development of new formulations. The aim of the present study was to assess the effect on plaque inhibition and taste perception of two commercially available mouthrinses (0.12% CHX non-alcohol base with 0.05% cetyl pyridinium chloride (Cpc) versus 0.2% CHX alcohol base).

METHODS

The study was designed as a single-blind, randomized two group parallel experiment, to compare two different commercially available mouthrinses, during a 3-day plaque accumulation model. Forty healthy volunteers were enrolled in the study and received a thorough dental prophylaxis at the beginning of the test period. Over a 72-h experimental non-brushing period, during which subjects abstained from all forms of mechanical oral hygiene, one group (test) used a 15 ml alcohol free 0.12% CHX (=18 mg) mouthrinse on a Cpc base (Perioaid), CHX plus sign in circleCpc), twice daily for 30 s. The other group (control) used a 10 ml 0.2% CHX (=20 mg) mouthrinse on an 11.8% ethanol alcohol base (Corsodyl), CHX plus sign in circleAlc), twice daily for 60 s. After 72 h of plaque formation, the amount of plaque was evaluated. By the use of visual analogue scale, the subjects were asked for their appreciation of the taste of the mouthrinse they had used.

RESULTS

The mean plaque index for the CHX plus sign in circleCpc group was 0.97 and for the CHX plus sign in circleAlc group 0.78. After 72 h of non-brushing, there was no significant difference in plaque accumulation between the two groups. The answers to the questions (taste perception and after-taste) showed a statistically significant difference between the two groups. The mean visual analogue scale (VAS) scores for taste appreciation on a scale from very bad to very good taste (0-10) were 5.92 for the CHX plus sign in circleCpc group and 4.10 for the CHX plus sign in circleAlc group (p=0.02). The mean visual analogue scale (VAS) scores for the after-taste on a scale from very short to very long (0-10) were 7.24 for the CHX plus sign in circleCpc group and 5.38 for the CHX plus sign in circleAlc group.

CONCLUSIONS

Within the limitations of the present study design, it can be concluded that rinsing with a 0.12% CHX mouthrinse on a non-alcohol base with 0.05% Cpc (Perio-Aid) is not significantly different from rinsing with a 0.2% CHX mouthrinse on an alcohol base (Corsodyl). It appears that the subjects appreciated the taste of the non-alcohol CHX solution better but the after-taste of the rinse remained longer in the mouth.

A 0.05% cetyl pyridinium chloride/0.05% chlorhexidine mouth rinse during maintenance phase after initial periodontal therapy

BACKGROUND

Chlorhexidine (CHX) mouth rinse/spray can still be considered the gold standard in the chemical prevention of plaque formation and development of gingivitis. The product unfortunately has some side effects, such as extrinsic tooth staining, poor taste, taste disturbance, sensitivity changes in tongue, pain and irritation because of the alcohol content. These side effects led to the search of new formulations.

METHODS

In this double-blind, randomized, long-term, parallel study, 48 moderate periodontitis patients rinsed for 6 months (starting immediately after a "one-stage, full-mouth" disinfection) with one of the following products: CHX 0.2%+alcohol (Corsodyl), CHX 0.05%+ cetyl pyridinium chloride (CPC) 0.05% and no alcohol (Perio-Aid Maintenance, a new formulation), or the placebo of the latter. After 1, 3 and 6 months a series of clinical and microbiological parameters were recorded for the supra- and subgingival area as well as for saliva.

RESULTS

Although there was a significant treatment impact (mechanical debridement) in all groups, both CHX solutions further decreased both plaque and gingivitis indices (p<0.001 and p<0.05, respectively), when compared with placebo. This was also reflected by additional reductions in the number of CFU/ml of aerobic and especially anaerobic species and by a suppression of Streptococcus mutans (versus an overgrowth for the placebo), in all niches. Differences between both CHX solutions were never encountered. The subjective ratings were slightly in favour of the new CHX-CPC formulation when compared with the other CHX-alcohol formulation, especially for taste of the product (p<0.05), but less impressive for the staining of teeth and tongue.

CONCLUSIONS

The results of this study demonstrated the potential of a new CHX 0.05%+CPC 0.05% non-alcoholic formulation as an effective antiplaque agent for long-term use with reduced subjective side effects.

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

BACKGROUND/AIMS

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

METHODS

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

RESULTS

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

CONCLUSION

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

A randomized clinical trial on the short-term clinical and microbiological effects of the adjunctive use of a 0.05% chlorhexidine mouth rinse for patients in supportive periodontal care

OBJECTIVE

To evaluate the clinical and microbiological activity of a new mouth rinse formulation, used as an adjunct to oral hygiene, for patients in supportive periodontal care.

PATIENTS AND METHODS

This was a randomized, placebo-controlled clinical trial with two groups: test group, rinsing twice per day with the test product (with 0.05% chlorhexidine and 0.05% cetylpyridinium chloride); and control group, rinsing with a placebo. Treated chronic periodontitis patients were included, and two visits were rendered, baseline, and after 15 days. Clinical outcome variables included plaque and gingival indices, and probing pocket depth. Subgingival samples were processed by culturing. Patient-based variables and adverse effects were also assessed. Outcome variables were compared by t-test, chi2, and Mann-Whitney test.

RESULTS

The results belonged to 33 patients. Plaque and gingival indices, and the log of bacterial total counts were reduced in the test group (p < or = 0.01), but differences between groups were only statistically significant (p < 0.05) for plaque and bacterial counts. A significant reduction in the proportions of flora (p < 0.05) and frequency of detection (p = 0.01) of Porphyromonas gingivalis was observed in the test group.

CONCLUSIONS

The newly formulated mouth rinse demonstrated short-term plaque-inhibitory activity. This was associated with a reduction in the total load of anaerobic subgingival microflora.

Inhibition of orally produced volatile sulfur compounds by zinc, chlorhexidine or cetylpyridinium chloride--effect of concentration

Zinc ions, chlorhexidine (CHX) and cetylpyridinium chloride (CPC) are all known to inhibit production of volatile sulfur compounds (VSCs). The objective was to examine the anti-VSC dose-response effects of each of the above agents. Oral malodor was induced in 13 test subjects using the cysteine challenge method. The oral VSC response to rinses with 6 mm l-cysteine (pH 7.2) before and 1, 2 and 3 h after rinsing with zinc ions (Zn2+: 0.1, 0.3 and 1.0%), CHX and CPC (0.025 and 0.2%) was measured. Mouth air was analysed for VSC by gas chromatography (GC) according to current methodology. Zinc had a marked dose- and time-dependent anti-VSC effect. Zinc at 1% concentration had a somewhat unpleasant taste, whereas the lowest concentration was found acceptable. Chlorhexidine maintained a moderate anti-VSC effect over time. At 3 h, 0.2% CHX was the most effective agent but tasted relatively unpleasant. Cetylpyridinium at a concentration of 0.2% was only marginally more effective than 0.025% CHX over the 3 h, while 0.025% CPC had no better anti-VSC effect than water at both 2 h and 3 h. It was concluded that the three test agents demonstrated different anti-VSC kinetics. Although Zn had the best anti-VSC effect at 1 h, 0.2% CHX was at least as effective as 1% Zn at 3 h, most likely as a result of its unique substantivity.

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

BACKGROUND/AIMS

Chlorhexidine (CHX) spray has proven to be an easily applicable method for the chemical control of plaque in elderly and handicapped patients. A randomized double-blind cross-over placebo-controlled trial was undertaken to compare the effects of 0.2% CHX spray applied once or twice daily on the plaque and gingival indexes in 13 institutionalized elderly patients.

METHOD

The study subjects were randomly assigned to one of two groups. During the first 30-day period, one group received 0.2% chlorhexidine spray twice daily and the other received 0.2% CHX spray once daily plus placebo spray once daily. A washout period of 42 days then followed, after which the groups were interchanged and the process was repeated for another 30-day period. Plaque index and gingival index were determined at the beginning and end of each period. The patients continued with their usual oral hygiene practices throughout the study.

RESULTS

A significant reduction in plaque and gingival indexes was produced in both the groups. There were no significant differences in index scores between the groups.

CONCLUSIONS

The results of the present study suggest that a single-daily application of 0.2% CHX spray is equally as effective in reducing plaque accumulation and gingival inflammation in institutionalized elderly patients as are two-daily applications of the same spray.

The effects of a new mouthrinse containing chlorhexidine, cetylpyridinium chloride and zinc lactate on the microflora of oral halitosis patients: a dual-centre, double-blind placebo-controlled study

AIM

This study evaluated the microbial effects of a newly formulated mouthwash (Halita) on oral halitosis patients.

METHODS

Forty subjects were included in this dual-centre, double-blind, placebo-controlled parallel study. Inclusion and exclusion criteria were used to select patients. At baseline and at 2 weeks post-treatment, full-mouth organoleptic odor scores, level of volatile sulphur compounds (VSC) and the Winkel Tongue Coating Index were recorded. Standardized samples of tongue coating, saliva and subgingival plaque were microbiologically investigated. Participants were randomly assigned to the test or placebo groups.

RESULTS

High prevalences were observed for Fusobacterium nucleatum, Prevotella intermedia and Porphyromonas gingivalis in tongue coating, saliva and subgingival plaque samples. A significant positive correlation between baseline total counts of P. gingivalis in saliva samples and organoleptic and VSC scores was found. Two weeks post-treatment there was a reduction in total anaerobic counts in all samples in the test group. A significant positive correlation was observed between the reduction in total counts in saliva samples and the reduction in organoleptic scores in the test group. Significant reductions in total counts and proportions of F. nucleatum and total counts of P. intermedia in tongue coating samples were observed in the test group.

CONCLUSIONS

The test mouthwash demonstrated efficacy in reducing the microbiological parameters in three oral niches in moderate to severe halitosis patients without periodontitis, and this was correlated with the improvements in organoleptic and VSC scores but not with the tongue coating scores.

Comparison of 2 commercially available chlorhexidine mouthrinses

BACKGROUND

It has been shown that lowering the concentration of chlorhexidine (CHX) in mouthrinses from 0.2% to 0.12% does not adversely affect inhibition of plaque accumulation. The aim of this study was to evaluate the inhibition of plaque growth by 2 commercially available mouthrinses used according to the manufacturers' instructions, one with a 30-second and one with a 60-second rinsing time.

METHODS

The clinical investigation was a single-blind, randomized study involving 80 volunteers (40 female, 40 male; mean age 25.7 years). At the start of the trial, all participants received a dental prophylaxis to remove all plaque deposits. Subjects refrained from all mechanical oral hygiene procedures, but rinsed twice a day with the allocated CHX mouthrinse over a period of 72 hours. The chlorhexidine preparations compared were a 0.12% concentration used at a 15 ml dose for a rinsing time of 30 seconds and a 0.2% concentration used at a dose of 10 ml for 60 seconds. After 72 hours, the plaque index (PI) from all volunteers was recorded at 6 sites per tooth. All participants received a questionnaire to evaluate their perception of the mouthrinses.

RESULTS

After 72 hours, the 15 ml/30 second/0.12% CHX group had a mean whole mouth PI of 1.65 (SD 0.31) compared with a mean PI of 1.60 (SD 0.40) for the 10 ml/60 second/0.2% CHX group. The difference in plaque scores between the groups was not statistically significant. Results from the questionnaire showed no significant difference between the groups for taste perception, duration of taste, alteration in taste, or perceived plaque reduction; however, the panelists preferred the shorter rinsing time of 30 seconds and, for this parameter, the difference was statistically significant (P = 0.048).

CONCLUSIONS

The results of this short-term study showed that there was no statistically significant difference between both commercially available CHX mouthrinses with respect to plaque inhibition, although both differed in concentration and rinsing time. The subject preference phase of the study indicated that the shorter rinsing time of 30 seconds was favored.

A method to compare four mouthrinses: time to gingivitis level as the primary outcome variable

BACKGROUND AND AIM

The experimental gingivitis model is a well-established method in comparing the chemical antiplaque activity of agents and products. The aim of the present study was to use time in order to achieve an exit level of bleeding on probing (BOP) as the primary outcome variable.

METHODS

The study was a single blind, randomised four treatment parallel group design employing 76 healthy volunteers. The cohort was accepted into the study proper if they achieved a level of </= 25% BOP after a 5-week pre-study oral hygiene phase. At baseline, 1, 2, 3, 4, 5 weeks BOP, modified gingival index (MGI) and plaque index scores were obtained from each subject. After baseline, oral hygiene was suspended and subjects rinsed twice daily with one of the test rinses, namely: 1 0.05% cetylpyridinium chloride 2 Control fluoride 3 0.2% chlorhexidine 4 0.3% triclosan Subjects were removed from the study when they achieved >/= 50% BOP. Using the baseline and exit BOP, MGI and plaque, a deterioration rate for each parameter was derived and used as the unit of analysis.

RESULTS

There were highly significant treatment differences for all three parameters. Paired analyses revealed chlorhexidine was highly significantly more effective than the other rinses for all three parameters. CPC and triclosan were not different from the control for BOP, but CPC was significantly different from the control for MGI and plaque, and triclosan was different from the control for plaque. There were no differences between the CPC and triclosan rinses.

CONCLUSIONS

The method achieved the expected result of differentiating between the chlorhexidine and the other rinses. Some modification of the method, primarily to group sizes, should improve specificity. The method has the considerable volunteer appeal of early exit, particularly when allocated to control or low activity treatments for plaque.

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

BACKGROUND

Plaque inhibition by chlorhexidine (CHX) rinses is dose related with a relatively flat dose-response curve above 5-6 mg twice daily. Low dose regimens could therefore reduce local side effects but maintain reasonable efficacy.

AIMS

To compare the plaque inhibitory properties of two low-dose CHX rinse products with more conventional levels delivered from proprietary rinses. A secondary outcome was a comparison with a stannous fluoride/amine fluoride (SFAF) rinse product.

METHODS

The study was a five-treatments, negative controlled, randomised, single blind crossover design balanced for residual effects, involving 20 healthy subjects in a 24-h plaque re-growth model. On day 1 of each study period, subjects were rendered plaque free, suspended tooth cleaning and followed the appropriate rinse regimen. On day 2, subjects were scored for plaque by index and area. The rinse codes and rinsing regimens were: (A) 15 mg CHX 2 x daily for 30 s (0.1% CHX), (B) 9 mg CHX 2 x daily for 60 s (0.06% CHX), (C) 10 ml SFAF rinse 1 x daily for 30 s, (D) 15 ml placebo 2 x daily for 60 s, and (E) 6 mg CHX 2 x daily for 30 s (0.06% CHX).

RESULTS

Average mouth plaque indices and areas were highly significantly different between rinsing regimens. All test rinses were significantly more effective than the placebo rinse. There was a mean dose-response pattern for the CHX rinses, but there were no statistically significant differences between any of the test rinses.

CONCLUSIONS

Lower doses of chlorhexidine in rinses can be used to exert plaque inhibition comparable with products used at higher doses and equivalent to benchmark products such as the SFAF rinse. However, the availability of chlorhexidine from formulations has to be considered as in part explaining the results.

Effect of an amine-fluoride-triclosan mouthrinse on plaque regrowth and biofilm vitality

BACKGROUND

The purpose of this double-blind, prospective, latin-square crossover randomised study was to examine the efficacy of a mouthrinse solution containing a combination of triclosan, amine fluoride and sodium fluoride on supragingival plaque regrowth compared to a placebo and a chlorhexidine solution.

METHODS

12 volunteers refrained after professional oral prophylaxis from all mechanical hygiene measures for the following 96 h and rinsed instead cross-over in a randomised order with either chlorhexidine digluconate (0.2%, positive control), a verum solution (0.5% amine fluoride, 0.028% sodium fluoride, 0.03% triclosan) or a placebo solution. The plaque index was assessed after 24 and 96 h (PI 1, PI 2) and the plaque area (PA) photographed and calculated after 96 h of undisturbed plaque regrowth. Moreover plaque samples were taken after 24 and 96 h and examined with the vital fluorescence technique to assess the vitality of the biofilm microbiota (VF 1, VF 2).

RESULTS

The amine-fluoride-triclosan solution reduced the clinical parameters (PI and PA) as well as the vitality of the plaque flora (VF) significantly when compared to the placebo solution. The verum reached a 36.5% (p<0.05) and a 39.8% reduction (p<0.0001) in PI 1 and PI 2, respectively, concomittant with a reduction of 23.8% and 32.2% (p<0.001) in VF 1 and VF 2 and of 46.9% (p<0.0001) in PA at day 4. This was less than the reductions found with the positive control, i.e., the 0.2% chlorhexidine solution (54.2% and 71.1% reduction in PI 1 and PI 2, 40.0% and 53.4% in VF 1 and VF 2 and 71.5% in PA). However, significant differences between both active solutions were only established for PI 2 and PA.

CONCLUSION

During 4-day plaque regrowth the amine-fluoride-triclosan product displayed a significant antibacterial and plaque-reducing action in comparison to the control.

Anti-plaque effect of tempered 0.2% chlorhexidine rinse: an in vivo study

OBJECTIVES

The aim of this in vivo study was to compare the anti-plaque effect of warm and cold chlorhexidine gluconate irrigation on matured human plaque.

METHODS

In a split-mouth design, the antibacterial effect of 47 degrees C "warm" 0.2% chlorhexidine solution was compared with that of 18 degrees C "cold" rinse at the same concentration on newly-formed supragingival plaque that had been left undisturbed for 72 h. Before and 1 h after a 1-min rinse procedure, plaque was sampled from 10 test persons and vitality determined using vital fluorescence technique.

RESULTS

Cold and warm 0.2% chlorhexidine solution reduced plaque vitality significantly from 99.63% to 77.81% (p=0.014) and from 98.98% to 51.77% (p<0.001), respectively. Rinsing with warm chlorhexidine solution reduced plaque vitality to a significantly greater degree (p=0.003) than did cold chlorhexidine.

CONCLUSION

In this study, warm 0.2% chlorhexidine rinse showed a significantly more intensive anti-plaque effect than cold chlorhexidine solution at the same concentration.