The comparative tea staining potential of phenolic, chlorhexidine and anti-adhesive mouthrinses

Formulation and assessment of biological properties of garcinia indica fruit extract mouthrinse as an adjunct to oral hygiene regimen: an in vitro analysis

The prevalence of gingivitis is substantial within the general population, necessitating rigorous oral hygiene maintenance.

OBJECTIVE

This study assessed a Garcinia indica (GI) fruit extract-based mouthrinse, comparing it to a 0.1% turmeric mouthrinse and a 0.2% Chlorhexidine (CHX) mouthrinse. The evaluation encompassed substantivity, staining potential, antimicrobial efficacy and cytocompatibility.

METHODOLOGY

The study employed 182 tooth sections. For antimicrobial analysis, 64 extracted human teeth coated with a polymicrobial biofilm were divided into four groups, each receiving an experimental mouthrinse or serving as a control group with distilled water. Microbial reduction was assessed through colony forming units (CFU). Substantivity was evaluated on 54 human tooth sections using a UV spectrophotometer, while staining potential was examined on 64 tooth sections. Cytocompatibility was tested using colorimetric assay to determine non-toxic levels of 0.2% GI fruit extract, 0.1% Turmeric, and 0.2% CHX.

RESULTS

Data were analysed with one-way ANOVA (α=0.05). Cell viability was highly significant (p<0.001) in the 0.2% GI group (64.1±0.29) compared to 0.1% Turmeric (40.2±0.34) and 0.2% CHX (10.95±1.40). For antimicrobial activity, both 0.2% GI (20.18±4.81) and 0.2% CHX (28.22±5.41) exhibited no significant difference (P>0.05) at end of 12 hours. However, 0.1% Turmeric showed minimal CFU reduction (P<0.001). Substantivity results at 360 minutes indicated statistically significant higher mean release rate in 0.1%Turmeric (12.47±5.84 ) when compared to 0.2% GI (5.02±3.04) and 0.2% CHX (4.13±2.25) (p<0.001). The overall discoloration changes (∆E) were more prominent in the 0.2% CHX group (18.65±8.3) compared to 0.2% GI (7.61±2.4) and 0.1% Turmeric (7.32±4.9) (P<0.001).

CONCLUSION

This study supports 0.2% GI and 0.1% Turmeric mouth rinses as potential natural alternatives to chemical mouth rinses. These findings highlight viability of these natural supplements in oral healthcare.

Dental Bleaching with Phthalocyanine Photosensitizers: Effects on Dentin Color and Collagen Content

With the increasing demand for tooth bleaching in esthetic dentistry, its safety has been the focus of a comprehensive body of literature. In this context, the aim of the present study was to evaluate the application effects of pentalysine β-carbonylphthalocyanine zinc (ZnPc(Lys)₅)-mediated photodynamic therapy in dentin bleaching and its effects on dentin collagen. We first established a new and reproducible tooth staining model using dentin blocks stained by Orange II and then bleached with ZnPc(Lys)₅ (25 μM) and hydrogen peroxide (10% or 30%). Data were analyzed with one- and two-way ANOVA and a significance level of p < 0.05. ZnPc(Lys)₅ effectively bleached the dentin samples to an extent comparable to hydrogen peroxide at either 10% or 30% concentrations. Further studies on the dentin morphology, chemical element distribution, and protein constituents, using an electron microscope, energy dispersive spectroscopy, X-ray photoelectron spectroscopy, and SDS-PAGE, demonstrated that treatment with the photosensitizer preserved the dentin structure and, at the same time, the major organic component, collagen type I. For comparison, hydrogen peroxide (10% or 30%) treatment significantly degraded the collagen protein. This work indicated that the photosensitizer exerts potent bleaching effects on dentin staining; importantly, does not damage dentin and its collagen content; and opens up a new strategy to further explore various photosensitizers for the bleaching of both tooth enamel and dentin.

Effects of black tea tooth staining previously to 35% hydrogen peroxide bleaching

Aim: To determine if the artificial staining with black tea (BT) influences the enamel microhardness before in-office bleaching and if BT staining is necessary to evaluate the efficacy of bleaching with 35% hydrogen peroxide Methods: Enamel/dentin blocks were randomized into groups according to the staining protocol (n=5/group): (CO) control – maintained in artificial saliva solution (AS); (BT4) immersed in black tea solution for 4 h; (BT24) immersed in black tea solution for 24 h. After the staining protocols, all specimens were kept in AS for one week, followed by bleaching (three sessions of HP application for 40 min). Knoop surface microhardness (kgF/mm2) was determined at baseline (T0), after staining (T1), after 7 days of storage in AS (T2), and after bleaching (T3). The color (ΔE00) and coordinate changes (ΔL, Δa, Δb) were measured using a digital spectrophotometer at T0 and T3. Data were submitted to one-way (ΔE00, ΔL, Δa, Δb) or two-way ANOVA repeated measures (kgF/mm2) and Tukey’s test (a=5%). Results: The staining protocols (BT4 and BT24) promoted significantly lower microhardness (T1 and T2, p<0.05) than CO, whereas CO was the only group to maintain microhardness values over time. Bleaching promoted perceptible ΔE00 without a significant difference among the groups regardless of the staining protocol (p=0.122). CO and BT4 showed no differences in terms of ΔL and Δa (p>0.05), but BT4 displayed a higher Δb than CO. Conclusion: The artificial staining with BT negatively affected the enamel surface microhardness and was not essential to evaluate the efficacy of 35% hydrogen peroxide bleaching.

The Impact on Dental Staining Caused by Beverages in Combination with Chlorhexidine Digluconate

OBJECTIVES

 There are several hypotheses regarding how chlorhexidine (CHX) digluconate causes staining with the role of beverages, specifically the precipitation of anionic dietary chromogens onto adsorbed cations, the most probable cause. The aim of this study was to investigate and compare the staining potential of common beverages using an in vitro staining and brushing model to better understand the interactions between chromogens from different beverage categories and the teeth.

MATERIALS AND METHODS

 Human enamel samples were exposed to a cyclic treatment of artificial saliva and 0.2% CHX mouthwash combined with a range of beverages, with and without brushing, simulating a period equivalent to 2 weeks. Eleven beverages were tested: diet coke, diet lemonade, white wine, red wine, lager beer, black tea, coffee, black tea with milk, coffee with milk, ginger and lemon infusion, and water. Toothbrushing was performed in a brushing simulator with toothpaste and also with water. Colorimetric differences were determined by ΔE using a VITA Easyshade dental spectrophotometer. Statistical analyses were performed by one-way analysis of variance with post hoc Tukey's honestly significant difference test and Levene's test.

RESULTS

 Black tea and red wine produced highest staining, which agrees with the literature. Significant staining was also observed for a ginger and lemon infusion, coffee, coffee with milk, tea with milk, and lager beer compared with water (p < 0.05). The staining potential of diet coke in combination with brushing appeared to be connected to its low pH. Both white wine and diet lemonade produced stain comparable to the water control. After treatment with high staining beverages, scanning electron microscope evaluation confirmed the formation of a surface layer. The mechanical resistance of the stain differed depending on the beverage, black tea stain was the most resistant. The addition of milk to tea and coffee considerably modified the stain layer and the adhesion to the tooth surface.

CONCLUSION

 The data may help demonstrate that appropriate user guidance can avoid stain and in turn help improve user compliance during short-term use of this gold standard antimicrobial treatment.

Effect of Temperature on Tooth Staining by 0.12% Chlorhexidine Gluconate

Introduction: Natural color of dentin is affected by many variables, including anatomical variations, age, how much dentin is exposed, or how much enamel is covering the dentin. Chlorhexidine gluconate (CHX) has been observed to cause tooth staining, especially of exposed dentin. Risk factors for CHX staining include the amount of time for CHX utilization amongst others. Interestingly, the temperature of the rinse when used has been identified as a risk factor. However, no evidence of the effect of temperature is available in the literature. The purpose of this study was to determine the effect of temperature on dentin staining due to CHX exposure.

Methods: Two studies were done. The first a pilot study at room temperature to determine the time needed to establish staining solutions, a method to evaluate stain intensity, and establish the time needed to stain dentin samples in vitro. The second study exposed dentin samples on a twice daily basis to a 1 min soak in CHX at different temperatures, followed by a period in an unstimulated saliva mixed with black tea mixture. Temperatures tested were 4, 23, 37 and 50°C. Control samples were exposed to only black tea and saliva (no CHX) and tested at 23°C.

Results: The pilot study found that the combination of CHX and black tea causes dentin staining. From this data the sample size needed for the second experiment was calculated, requiring 12 samples per group. Sixty dentin samples were divided amongst 5 groups. The data from this study showed significant darkening of the dentin samples over 18 days. The 4 and 23°C CHX rinses resulted in significant staining compared to the control samples. The 37 and 50°C CHX rinses did not stain significantly more than the control samples.

Conclusions: Chlorhexidine has the ability to cause tooth staining in the presence of chromogens such as those in black tea. Significant darkening was observed at lower temperatures (4 and 23°C) over 18 days, therefore dental professionals may wish to advise gently warming the CHX rinse toward 37°C prior to use to reduce the risk of staining.

In Vitro Evaluation of Substantivity, Staining Potential, and Biofilm Reduction of Guava Leaf Extract Mouth Rinse in Combination with its Anti-Inflammatory Effect on Human Gingival Epithelial Keratinocytes

This study aimed to assess the biofilm reduction, staining potential, and cytotoxicity of guava extract mouth rinse compared to chlorhexidine (CHX). Substantivity, staining, and antibiofilm potential were investigated by spectrophotometry, colony-forming units, and luminosity color meter, respectively. The cell viability assay was conducted using a colorimetric assay to determine nontoxic levels of guava (0.15%) and CHX in human gingival epithelial keratinocytes (HGEK-16). Cells were treated with lipopolysaccharides (LPS, 1μg/mL) and guava to assess inflammatory gene expression levels of interleukin-β1, tumor necrosis factor-α, and Prostaglandin E2. A scratch wound healing assay investigated the effects of guava on cell migration. The teeth coated in guava mouth rinse displayed 19.4% higher substantivity compared to CHX (0.2%), and the anti-biofilm reduction was observed with both guava and CHX mouth rinses (P < 0.05). The overall discoloration changes were higher with CHX and distilled water compared to guava. Also, guava significantly enhanced HGEK-16 cell viability (P < 0.05), and IL-β1, TNFα and PGE2 expression presented a 0.6-fold decrease when exposed to guava and LPS (P < 0.05). The present study showed that guava mouth rinse fulfilled the requirement for an effective and useful oral care product with desirable substantivity and anti-biofilm action. In addition, guava reduced the inflammation response in HGEK-16 and may be a potential oral rinse for oral anti-inflammatory therapies.

Anti-plaque effect of a synergistic combination of green tea and Salvadora persica L. against primary colonizers of dental plaque

OBJECTIVE

Green tea (Gt), leafs of Camellia sinensis var. assamica, is widely consumed as healthy beverage since thousands of years in Asian countries. Chewing sticks (miswak) of Salvadora persica L. (Sp) are traditionally used as natural brush to ensure oral health in developing countries. Both Gt and Sp extracts were reported to have anti-bacterial activity against many dental plaque bacteria. However, their combination has never been tested to have anti-bacterial and anti-adherence effect against primary dental plaque colonizers, playing an initial role in the dental plaque development, which was investigated in this study.

METHODS

Two-fold serial micro-dilution method was used to measure minimal inhibitory concentration (MIC) of aqueous extracts of Gt, Sp and their combinations. Adsorption to hexadecane was used to determine the cell surface hydrophobicity (CSH) of bacterial cells. Glass beads were used to mimic the hard tissue surfaces, and were coated with saliva to develop experimental pellicles for the adhesion of the primary colonizing bacteria.

RESULTS

Gt aqueous extracts exhibited better anti-plaque effect than Sp aqueous extracts. Their combination, equivalent to 1/4 and 1/2 of MIC values of Gt and Sp extracts respectively, showed synergistic anti-plaque properties with fractional inhibitory concentration (FIC) equal to 0.75. This combination was found to significantly reduce CSH (p<0.05) and lower the adherence ability (p<0.003) towards experimental pellicles.

CONCLUSION

Combination between Gt and Sp aqueous extracts exhibited synergistic anti-plaque activity, and could be used as a useful active agent to produce oral health care products.

Can Chemical Mouthwash Agents Achieve Plaque/Gingivitis Control?

Also note that structured abstracts are not allowed per journal style: What is the effect of a mouthwash containing various active chemical ingredients on plaque control and managing gingivitis in adults based on evidence gathered from existing systematic reviews? The summarized evidence suggests that mouthwashes containing chlorhexidine(CHX) and essential oils (EO) had a large effect supported by a strong body of evidence. Also there was strong evidence for a moderate effect of cetylpyridinium chloride(CPC). Evidence suggests that a CHX mouthwash is the first choice, the most reliable alternative is EO. No difference between CHX and EO with respect to gingivitis was observed.

The comparative effects of 0.12% chlorhexidine and herbal oral rinse on dental plaque-induced gingivitis: A randomized clinical trial

Background:

Chlorhexidine (CHX) is considered as a gold standard of antimicrobial rinses. Various herbal oral rinses are available in the market. However, little is known of its effectiveness.

Aim:

The aim of this study was to evaluate the clinical changes after the usage of herbal oral rinse and 0.12% CHX.

Materials and Methods:

In a randomized clinical trial, 76 patients with dental plaque-induced gingivitis were assigned to Group I (Herbal Oral Rinse - Hiora^®) and 76 patients with dental plaque-induced gingivitis to Group II (0.12% Chlorhexidine-Peridex^®). Gingival index and Plaque index scores were recorded at baseline and 21 days after scaling.

Results:

Intragroup comparison in both groups showed that plaque index and gingival index scores were statistically significant after 21 days as compared to baseline. Intergroup comparison showed that plaque index scores and gingival index scores were statistically significant in Group II as compared to Group I.

Conclusion:

When herbal oral rinse was compared to 0.12% CHX, 0.12% CHX mouth rinse effectively reduced the clinical symptoms of plaque-induced gingivitis.

In Vitro Evaluation of the Efficacy of Different Over-the-Counter Products on Tooth Whitening

This in vitro study evaluated the whitening effect of four different over-the-counter products compared with a 10% carbamide peroxide (CP) bleaching gel. Specimens obtained from bovine incisors were stained in a tea solution and randomly divided into six groups according to the product used (n=10): CT: conventional toothpaste (negative control); CWT: Crest 3D White toothpaste; CWR: Crest 3D White mouth rinse; CWS: Crest 3D White strips; DW: Dazzling White (paint-on gel); and OP: Opalescence PF 10% CP (at-home bleaching gel, positive control). Over-the-counter products and 10% CP were used according to the manufacturer's recommendations. Color measurements were performed according to the CIELab system using spectrophotometer after staining, and after 4 and 8 weeks of the treatment procedure. The ∆E, ∆L, ∆a, and ∆b values were calculated. The data obtained were analyzed by repeated-measures ANOVA. Tukey's test for multiple comparisons was applied (p<0.05). All groups, except CWT, were effective in tooth whitening in comparison with conventional toothpaste. There was no significant difference in tooth whitening between CWT and CT (p=0.93). CWS, DW and OP groups presented significantly higher color changes than the CWR group. DW and CWS showed similar tooth whitening to OP.

Evaluation of Extraradicular Diffusion of Hydrogen Peroxide during Intracoronal Bleaching Using Different Bleaching Agents

Objectives. Extra radicular diffusion of hydrogen peroxide associated with intracoronal teeth bleaching was evaluated. Methods. 108 intact single rooted extracted mandibular first premolars teeth were selected. The teeth were instrumented with WaveOne system and obturated with gutta percha and divided into four groups (n = 27) according to the bleaching materials used. Each main group was divided into three subgroups (n = 9) according to the time of extra radicular hydrogen peroxide diffusion measurements at 1, 7, and 14 days: group 1 (35% hydrogen peroxide), group 2 (35% carbamide peroxide), group 3 (sodium perborate-30% hydrogen peroxide mixture), and group 4 (sodium perborate-water mixture). Four cemental dentinal defects were prepared just below the CEJ on each root surface. The amount of hydrogen peroxide that leached out was evaluated after 1, 7, and 14 days by spectrophotometer analysis. The results were analyzed using the ANOVA and Tukey's test. Results. Group 1 showed highest extra radicular diffusion, followed by group 3 and group 2, while group 4 showed the lowest mean extra radicular diffusion. Conclusion. Carbamide peroxide and sodium perborate-water mixture are the most suitable bleaching materials used for internal bleaching due to their low extra radicular diffusion of hydrogen peroxide.

The antiplaque effect of herbal mouthwash in comparison to chlorhexidine in human gingival disease: a randomized placebo controlled clinical trial

BACKGROUND

The aim of this study was to compare the efficacy, safety, antiplaque and antigingivitis properties of a herbal mouthwash with chlorhexidine mouthwash.

METHODS

A double-blinded randomized clinical trial was conducted among 72 undergraduate students with age group 18-24 years. They were randomly divided into three mouthwash group with 24 participants in each group. Group A (herbal), Group B (chlorhexidine) and Group C (normal saline).The Turesky et al. 1970 plaque index and Loe and Silness 1963 gingival index was recorded. Student's t-test and one-way ANOVA were used to test the significance.

RESULTS

A statistically highly significant difference was obtained between mouthwash B and C (p=0.00) and a significant difference between mouthwash A and C (p=0.004), showing that chlorhexidine was superior to herbal mouthwash and saline. However, there was a nonsignificant difference between mouthwash A and B (p=0.435) showing that herbal and chlorhexidine mouthwash was equally effective in reducing plaque and gingivitis.

CONCLUSIONS

The efficacy of herbal mouthwash was equally effective in reducing plaque and gingivitis as compared to chlorhexidine mouthwash and may be considered as a good alternative. The chlorhexidine mouthwash was reported with many side effects which limits its acceptability and long-term use, whereas the presently tested herbal mouthwash had no side effects apart from mild burning sensation.

Tooth staining potential of experimental amine fluoride/stannous fluoride mouth rinse formulations-a randomized crossover forced staining study

OBJECTIVES

It was the aim to investigate experimental mouth rinses concerning their tooth and tongue staining potential using the standardized short-term forced staining model.

MATERIALS AND METHODS

A single centre, clinically controlled, randomized, investigator-blinded study was conducted in a crossover design. In healthy dental students, three experimental AmF/SnF2 (A, B, C) mouth rinses and a phenolic/essential oil rinse (D) were compared to a water control (E). Four treatment days consisted of eight hourly rinses with mouth rinse and black tea. Mechanical oral hygiene was ceased. At the fifth day, tooth and tongue staining indices were recorded. Between treatment periods, a 10-day washout phase was performed.

RESULTS

Twenty-eight participants entered and completed the study. All mouth rinses including the water control led to tooth and tongue staining. Most tooth staining occurred after rinsing with test rinse A, followed by B, D, C and E. Statistically significant differences existed between products A and C, D, and E. Most tongue staining happened in group B, followed by A, D, C and E (not statistically significant).

CONCLUSION

Within the limitations of the model, mouth rinse C has a promising potential of causing less tooth discoloration than other AmF/SnF2 rinses. C is highly recommended to be investigated in further long-term clinical studies on its in vivo staining potential and antiplaque efficacy.

CLINICAL RELEVANCE

This forced staining study has proven that one of the experimental AmF/SnF2 rinses leads to less staining than the other experimental AmF/SnF2 rinses. These experimental results have to be confirmed by further clinical investigations.

The effects of mouth rinses on the color stability of resin-based restorative materials

OBJECTIVE

The aim of this study was to assess the color stability of three direct resin-based restorative materials: IPS Empress Direct (Ivoclar Vivadent, Schaan, Liechtenstein), Nano-filled composite (Filtek Z 350 XT, 3 M ESPE, St. Paul, MN, USA), and Nano-hybrid composite (Tetric Evo Ceram, Ivoclar Vivadent, Schaan, Liechtenstein) upon immersion into the following three mouth rinses: Antiseptol (Kahira Pharmaceuticals and Chemical Industries Co. Cairo-Egypt), Flucal (Alexandria Co. Pharmaceuticals Alexandria, Egypt), and Listerine (Johnson & Johnson, UK).

MATERIALS AND METHODS

Ninety disc-shaped, 12 mm × 1 mm specimens were divided into three groups according to the type of direct resin-based restorative material used. The specimens were randomly subdivided into three different subgroups (N = 10) in terms of immersion medium. Color change was evaluated prior to and after immersion into the mouth rinses for 24 hours by spectrophotometry (Shimadzu, UV-3101 PC Shimadzu Corporation. Kyoto, Japan).

RESULTS

Data were statistically analyzed using two-way analysis of variance (ANOVA) to assess the color stability of the restorative materials. The post hoc Scheffe's test was applied to clarify pair-wise statistical significance. Results with p-values < 0.05 were considered statistically significant. IPS Empress Direct (ΔE = 1.48) exhibited more favorable stability than the other tested composite resins, Filtek Z 350 X (ΔE = 3.05) and Tetric Evo Ceram (ΔE = 10.35). The immersion media elicited a significant effect on the color stability of the tested, resin-based restorative materials, where Flucal elicited the most significant color change, followed by Listerine and Antiseptol, which elicited the least significant color change.

CONCLUSIONS

Within the limitation of this laboratory study, the following conclusions could be drawn: (1) The composite structure, namely the resin formulation, which includes the filler size and type of photo-initiator, has a direct impact on its susceptibility to stain by external agents; (2) Mouth rinses can be considered stainable solutions; (3) The chemical formulation of individual mouth rinses can significantly control their ability to stain.

CLINICAL SIGNIFICANCE

Patient use of mouth rinses should be subject to dental supervision to control their adverse effects on the aesthetic quality of the restoration. Knowing the composition of the restorative material is important, as is its polymerization cycle and the promotion of adequate surface texture in order to select the appropriate material for each clinical application, and to use it in an effective way to promote its best properties.

Role of forensic odontologist in post mortem person identification

The natural teeth are the most durable organs in the bodies of vertebrates, and humankind's understanding of their own past and evolution relies heavily upon remnant dental evidence found as fossils. The use of features unique to the human dentition as an aid to personal identification is widely accepted within the forensic field. Comparative dental identifications play a major role in identifying the victims of violence, disaster or other mass tragedies. The comparison of ante-mortem and postmortem dental records to determine human identity has long been established. Indeed, it is still a major identification method in criminal investigations, mass disasters, grossly decomposed or traumatized bodies, and in other situations where visual identification is neither possible nor desirable. This article has comprehensively described some of the methods, and additional factors aiding in postmortem person identification.

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(®).

Essential oils compared to chlorhexidine with respect to plaque and parameters of gingival inflammation: a systematic review

BACKGROUND

The purpose of this review is to systematically evaluate the effects of an essential-oil mouthwash (EOMW) compared to a chlorhexidine mouthwash with respect to plaque and parameters of gingival inflammation.

METHODS

PubMed/MEDLINE and Cochrane CENTRAL databases were searched for studies up to and including September 2010 to identify appropriate articles. A comprehensive search was designed, and the articles were independently screened for eligibility by two reviewers. Articles that evaluated the effects of the EOMW compared to chlorhexidine mouthwash were included. Where appropriate, a meta-analysis was performed, and weighted mean differences (WMDs) were calculated.

RESULTS

A total of 390 unique articles were found, of which 19 articles met the eligibility criteria. A meta-analysis of long-term studies (duration ≥ 4 weeks) showed that the chlorhexidine mouthwash provided significantly better effects regarding plaque control than EOMW (WMD: 0.19; P = 0.0009). No significant difference with respect to reduction of gingival inflammation was found between EOMW and chlorhexidine mouthwash (WMD: 0.03; P = 0.58).

CONCLUSION

In long-term use, the standardized formulation of EOMW appeared to be a reliable alternative to chlorhexidine mouthwash with respect to parameters of gingival inflammation.

Spectrophotometric assessment of the effects of 10% carbamide peroxide on enamel translucency

Tooth shade results from the interaction between enamel color, enamel translucency and dentine color. A change in any of these parameters will change a tooths color. The objective of this study was to evaluate the changes occurring in enamel translucency during a tooth whitening process. Fourteen human tooth enamel fragments, with a mean thickness of 0.96 mm (+/- 0.3 mm), were subjected to a bleaching agent (10% carbamide peroxide) 8 hours per day for 28 days. The enamel fragment translucency was measured by a computer controlled spectrophotometer before and after the bleaching agent applications in accordance with ANSI Z80.3-1986--American National Standard for Ophthalmics--nonprescription sunglasses and fashion eyewear-requirements. The measurements were statistically compared by the Mann-Whitney non-parametric test. A decrease was observed in the translucency of all specimens and, consequently, there was a decrease in transmittance values for all samples. It was observed that the bleaching procedure significantly changes the enamel translucency, making it more opaque.

Internalized discoloration of dentin under porcelain crowns: a clinical report

This clinical report describes the situation of a patient who was concerned about the appearance of porcelain crowns that were placed on the maxillary incisors 4 years prior. The mechanicochemical gingival retraction technique combining the use of ferric sulfate and knitted retraction cord is described as a possible etiology of internalized discoloration of the dentin in this situation. The hypothesis is explained by the high acidity of gingival retraction fluids (GRFs) and the high affinity of iron for hard tooth tissues, resulting in an interaction with bacterial byproducts and precipitation of insoluble ferric sulfide in the porous demineralized dentin. A prospective clinical trial is warranted to track the effects of GRFs on tooth structure. This article describes the treatment of internalized discoloration of dentin under porcelain crowns.

A prospective controlled trial of pulsed nasal nebulizer in maximally dissected cadavers

BACKGROUND

Nasal douching is common practice in treatment of chronic sinusitis and after endoscopic sinus surgery. Current nasal delivery techniques show inconsistent sinus penetration. The aim of this study was to compare sinonasal penetration of nasal douching to an optimized nasal nebulizer in an operated cadaver model.

METHODS

Fourteen preserved cadavers were used receiving complete sphenoethmoidectomies with a Draf III, wide maxillary antrostomy, or medial maxillectomy. Seven control cadavers received nasal douching with one standardized squeeze bilaterally of a 200-mL nasal irrigation bottle and seven intervention cadavers were nebulized with 3 minutes of the PARI sinus device bilaterally. Douching solutions were stained with methylene blue. Independent observers documented sinonasal anatomy, staining intensity, and percentage area covered by dye using standardized grading protocols.

RESULTS

Combined data showed a significant increase in intensity of stain (2.06 versus 0.26, p < 0.001), percentage of stain (49.96% versus 4.19%, p < 0.001), and circumference stained (76.59% versus 12.7%, p < 0.001) with the plastic nasal irrigation squeeze bottle versus PARI device. Analysis of individual sinuses consistently showed significant increases in indices of nasal douching relative to nebulization. The PARI sinus nebulizer was noted to reach the ethmoids regularly (92% incidence), whereas the other sinuses were not reached as regularly with incidences noted at frontal (43%), maxillary (46%), and sphenoid (54%). This compares to 96% of all sinuses being stained by the squeeze bottle.

CONCLUSION

In all measured indices, the nasal douching method with the squeeze bottle was superior to the PARI sinus nebulizer in highly dissected sinonasal cadaver models.

Influence of salivary organic substances on the discoloration of esthetic dental materials-a review

The objective of this article was to review the articles on the interaction of salivary organic substances with resin-based dental materials and on the interaction of these organic substances with exogenous chemical agents, which results in discoloration. Original scientific articles or reviews on the saliva, acquired pellicle, and the interaction with pellicle and chemical agents related to dental resin-based materials were reviewed. Salivary esterases can increase or decrease the internal and external discoloration. The formation of acquired pellicle on the surface of a material varies by the properties of material, and the pellicle interacts with denaturation agents, such as tannin and chlorhexidine, to form stains and also adsorbs staining substances. Therefore, for the quality and longevity of restorations, protocols for the evaluation of the influence of organic substances on the extrinsic staining of restorative materials should be included in the evaluation of aesthetic restorative materials.

Influence of Additional Active Ingredients on the Effectiveness of Non-Alcoholic Chlorhexidine Mouthwashes: A Randomized Controlled Trial

BACKGROUND

Non-alcoholic chlorhexidine mouthwashes are equally effective and have fewer potential risks than hydroalcoholic solutions. Nowadays, other active ingredients are added to these mouthwashes in an attempt to improve their effectiveness and reduce side effects. Following an experimental gingivitis model, this study examined three non-alcoholic commercial mouthwashes having 0.12% chlorhexidine digluconate (CHX) in common.

METHODS

Using a double masked, cross-over design, 30 subjects underwent three consecutive experimental phases with three mouthwashes: CHX, CHX + 0.05% sodium fluoride (CHXNaF), and CHX + 0.05% cetylpyridinium chloride (CHX-CPC). In each one of these 21-day phases, the subjects discontinued all oral hygiene measures and were treated exclusively with the experimental mouthwash randomly assigned (an oral rinse twice a day). Each experimental phase was preceded by a 14-day washout period. Levels of gingivitis, dental plaque, supragingival calculus, and dental staining were assessed at baseline and end (day 21) of experimental phases.

RESULTS

The evolution of gingival and dental staining indices did not show statistically significant differences between the treatments. Differences were noticed in the plaque index (P = 0.0002), with CHX-NaF the treatment with the greatest increase. Differences were also observed in the supragingival calculus index (P = 0.0136), with CHX-CPC showing a smaller increase. Tongue staining was more frequent with CHX-CPC (P = 0.0141).

CONCLUSION

In non-alcoholic 0.12% chlorhexidine mouthwashes, the addition of other active ingredients does not produce beneficial effects, but may even reduce the antiplaque effectiveness or increase tongue staining.

Development and evaluation of a method in vitro to study the effectiveness of tooth bleaching

AIM

To develop and evaluate a reproducible intrinsic discolouration model in vitro, based on tea, which would allow the effectiveness of bleaching to be evaluated.

METHOD

The crown portions of extracted human third molars were sectioned bucco-lingually in half. Colour assessments were made at baseline, post staining and post whitening using a standard clinical shade guide (SG), a shade vision clinical colorimeter system (SVS) and a reflectance chromometer. Internal staining employed a standard tea solution into which groups of five specimens were placed from 1 to 6 days. All assessments demonstrated maximum staining within one day. Groups of stained specimens were exposed to 1. Water (placebo control) 2. Enamel polished 3. Enamel polished and bleached through enamel 4. Bleached through enamel 5. Bleached through dentine 6. Bleached through enamel and dentine 7. Exposed to the bleach vehicle (minus active control). Control and bleach gel treatments were for 30 min. Comparisons of treatment effects were made using unpaired t-test on groups selected a priori for analysis.

RESULTS

SG and SVS revealed that control and polish treatments had no or little effect respectively on tooth shade but all bleach treatments produced marked and statistically significant whitening effects and to a similar magnitude. Bleaching treatments returned the majority of specimens to the original shade or beyond representing a SG mean change of 13.8-15 shade guide units (SGU). Chromometer readings were consistent except that polishing alone increased tooth lightness slightly.

CONCLUSIONS

Teeth were reproducibly stained internally, to provide a model in vitro by which to evaluate bleaching. The model, could be used to study many aspects of vital tooth bleaching, but has the limitation, without in vivo or in situ data, of cautiously extrapolating the effects in vitro to outcome clinically.

Influence of tea on intrinsic colour of previously bleached enamel

Aim of the study was to evaluate the influence of tea applied at various time intervals after bleaching of enamel on intrinsic tooth colour. Ninety bovine specimens were distributed among six groups (A-F, n=15). The samples of group A-D were bleached with the 10% carbamide peroxide (CP) gel VivaStyle for 8 h, followed by storing in artificial saliva for the remaining period of the day. The specimens were removed from the saliva at different intervals (A: 0 min, B: 60 min, C: 240 min) and immersed in freshly prepared black tea for 10 min. Group D (bleaching, no tea), E (no bleaching, but tea) and F (no bleaching, no tea) served as controls. These procedures were repeated for 8 days. Colour was measured at baseline, after each day, and after final cleaning using the CIELab-system. Then Deltab (initial b-value - final reading), DeltaL, and composite colour (DeltaE) were statistically analysed. External bleaching (A-D) led to a distinct whitening effect with lower Deltab- (=reduction in yellow) and higher DeltaL-values (=increase in brightness) compared with controls. The Deltab- and DeltaL-values of the samples A-C were not significantly different from the samples which were bleached only. No significant difference was observed comparing specimens of group A-C. It is concluded that application of tea directly after bleaching with 10% CP does not significantly effect the outcome of a bleaching treatment irrespective of the time interval elapsed between the bleaching procedure and the contact of the tooth surface with tea.

Clinical effects of a new mouthrinse containing chlorhexidine, cetylpyridinium chloride and zinc-lactate on oral halitosis. A dual-center, double-blind placebo-controlled study

OBJECTIVES

The aim of this double-blind, parallel study was to test the clinical efficacy of a newly developed mouthrinse in the treatment of oral halitosis in patients without periodontitis.

MATERIAL AND METHODS

Forty volunteers, recruited in two centers, participated in this study. Patients were selected on the basis of (1) halitosis of oral origin, (2) full-mouth organoleptic score>1, using an arbitrary 0-5 scale, (3) level of volatile sulfur compounds (VSC)>170 parts per billion (ppb) and (4) Winkel tongue coating index (WTCI)>4 (0-12). Intervention included gargling with a mouthrinse containing chlorhexidine (0.05%), cetylpyridinium chloride (0.05%) and zinc-lactate (0.14%) or with a placebo mouthrinse without active ingredients. At days 0 and 14 clinical variables were assessed in order of performance: (1) organoleptic assessments, (2) levels of VSC, and (3) WTCI.

RESULTS

Treatment with the active mouthrinse resulted in a significant mean reduction in the organoleptic score from 2.8 to 1.5 (p<0.005). In the placebo group, no significant reduction in the mean organoleptic score occurred. Consequently, this resulted, after 2 weeks, in a greater change of the organoleptic scores in the test group in comparison to the placebo group (p<0.005). The mean VSC scores were reduced from 292 to 172 ppb in the test group (p<0.005), whereas no reduction was observed in the placebo group. At the 2-week examination, the mean change of the VSC scores in the test group was significantly greater than the mean change in the placebo group (p<0.005). Neither in the test nor in the placebo group a significant reduction in tongue coating was observed.

CONCLUSIONS

In conclusion, the tested mouthrinse is effective in the treatment of oral halitosis.

Associated postmortem dental findings as an aid to personal identification

The use of the unique features of the human dentition to aid in personal identification is well accepted within the forensic field. Indeed, despite advances in DNA and other identification methodologies, comparative dental identifications still play a major role in identifying the victims of violence, disaster or other misfortune. The classic comparative dental identification employs the use of postmortem and antemortem dental records (principally written notes and radiographs) to determine similarities and exclude discrepancies. In many cases the tentative identification of the individual is unknown and therefore antemortem records cannot be located. In such a situation a dental profile of the individual is developed to aid the search for the individual's identity. With such a profile a forensic odontologist can identify and report indicators for age at time of death, race (within the four major ethnic groups) and sex. In addition to these parameters the forensic dentist may be able to give more insight into the individual. This paper outlines, for the non-expert, some of the additional personal information that can be derived from the teeth of the deceased, and which may assist in their ultimate identification.

Studies on the effect of polyvinyl pyrrolidone on the activity of chlorhexidine mouthrinses: plaque and stain

BACKGROUND, AIMS

Polyvinyl pyrrolidone (PVP) was shown in vitro to reduce chlorhexidine induced, dietary staining without affecting the uptake of the antiseptic to the test substrate. The aim of these studies in vivo was to determine whether PVP affected plaque and dietary staining by a low concentration chlorhexidine rinse.

METHODS

The plaque and stain studies used a double blind, randomised 6, treatment crossover design involving healthy subjects with a high standard of oral hygiene and gingival health. The rinse formulations under test were: (A) aqueous alcohol (placebo control), (B) 0.03% chlorhexidine, (C) 0.06% chlorhexidine, (D) 0.06% chlorhexidine+1.2% PVP, (E) 0.06% chlorhexidine+5% PVP, (F) 0.06% chlorhexidine+10% PVP. In the plaque study, on day 1 of each period, subjects were rendered plaque free and then rinsed with 15 ml of the test rinse for 60 s. No further tooth cleaning was performed and subjects returned 24 h later for plaque scoring by area. In the stain study, on day 1 of each period, the tongue and teeth of each subject were rendered stain free. Subjects then rinsed under supervision for 60 s with 15 ml of the allocated rinse 8 x a day between 09:00 h and 17:00 h for 3 days. Immediately after each rinse with the test formulation, subjects rinsed for 120 s with 15 ml of warm black tea. Subjects were requested to also drink at least 5 cups of tea or coffee per day. On day 4, stain was scored by area and intensity from designated teeth and dorsum of the tongue. Washout periods were at least 7 days in both studies.

RESULTS

Plaque areas were greatest with placebo and least with 0.06% chlorhexidine. Plaque scores increased with increasing concentrations of PVP in the 0.06% chlorhexidine rinse and were significantly higher than 0.06% chlorhexidine without PVP rinse. Tooth stain areas were comparable for placebo, 0.03% and 0.06% chlorhexidine rinses, but significantly reduced with the PVP/chlorhexidine rinses compared to the 0.06% chlorhexidine rinse. Tooth stain intensity was significantly increased with 0.06% chlorhexidine rinses compared to placebo and chlorhexidine/PVP rinses. Tongue stain area and intensity were significantly reduced with 5% and 10% PVP/chlorhexidine rinses compared to 0.06% chlorhexidine rinse.

CONCLUSION

PVP, at the concentrations tested, reduced the stain propensity of a 0.06% chlorhexidine rinse but at the expense of some loss of plaque inhibition.

The effect of toothpaste on the propensity of chlorhexidine and cetyl pyridinium chloride to produce staining in vitro: a possible predictor of inactivation

BACKGROUND/AIMS

Cationic antiseptics such as chlorhexidine (CHX) and cetyl pyridinium chloride (CPC) interact with dietary chromogens to produce extrinsic stain, and this can be used as a measure of activity of products. The aim of these studies in vitro was to determine if toothpaste influenced the tea staining effects of CHX and CPC as a predictor of action in vivo.

METHOD

Clear acrylic specimens were soaked in pooled human saliva followed by sequential 2-min soaks in pairs of agents, namely 0.05% CHX, 0.05% CPC, 0.2% CHX, water (W) and toothpaste slurry (TP). The combinations were; TP/CHX, CHX/TP, TP/CPC, CPC/TP, W/CHX, CHX/W, W/CPC, CPC/W, TP/W, W/TP, W/W. These treatments were followed by a 60 min soak in tea. Optical density readings were taken at baseline and after each of 8 cycles.

RESULTS

In the separate CHX and CPC studies by comparison with W/CHX, TP/0.05% CHX had little effect on staining, but TP/0.2% CHX showed a reduction in staining of 18%. 0.05% CHX/TP reduced staining by >40%, and 0.2% CHX by >78%. TP/CPC reduced staining by >26% and CPC/TP by 80%. Water after 0.2% CHX, 0.05% CHX and CPC reduced staining by 18%, 13% and 17% respectively. Little staining was seen with TP and W combinations. The data for CHX are in agreement with a study in vivo except TP followed by CHX reduced the activity of CHX.

CONCLUSION

Toothpaste appears to adversely affect the activity of CHX and CPC particularly if used immediately after the antiseptics. The data further supports the concept of separating the use of antiseptics until sometime after the use of toothpaste, and the idea of developing mouthwash friendly toothpastes.

Antibacterial agents in the control of supragingival plaque--a review

This review considers the main agents which have been used as antibacterial agents in mouthwashes and other vehicles to inhibit the growth of supragingival plaque. The agents discussed are bisguanide antiseptics, quaternary ammonium compounds, phenolic antiseptics, hexetidine, povidone iodine, triclosan, delmopinol, salifluor, metal ions, sanguinarine, propolis and oxygenating agents. The plaque inhibitory, anti-plaque and anti-gingivitis properties of these agents are considered along with their substantivity, safety and possible clinical usefulness. Clinical trials of these agents that have been published are also reported. The possible clinical uses of antiseptic mouthwashes are finally considered along with some advice about assessing manufacturers claims. Throughout this review the terms plaque inhibitory, anti-plaque and anti-gingivitis have been used according to the clarification of terminology suggested by the European Federation of Periodontology at its second workshop. This defines a plaque inhibitory effect as one reducing plaque to levels insufficient to prevent the development of gingivitis; an anti-plaque effect as one which produces a prolonged and profound reduction in plaque sufficient to prevent the development of gingivitis; and anti-gingivitis as an anti-inflammatory effect on the gingival health not necessarily mediated through an effect on plaque.

The propensity of different brands of tea and coffee to cause staining associated with chlorhexidine

Dental staining is a well known and probably the most problematic side effect of using chlorhexidine oral products. Whatever mechanisms are involved, there is no doubt that cationic antiseptics, such as chlorhexidine, can precipitate or bind to surfaces anionic chromogens contained in foods and beverages. The aim of this study in vitro was to determine whether, under controlled conditions, different brands of tea or coffee varied in their propensity to cause staining associated with chlorhexidine. Optically clear acrylic specimens were cycled through saliva, chlorhexidine and different tea and coffee solutions. Staining was measured using a spectrophotometer. After 15 cycles, it was apparent that staining varied at the extreme, both within and between the tea and coffee groups. All coffee brands produced less staining than the tea brands. The least staining coffee and least staining tea brands were approximately 3x less chromogenic than the most staining equivalent beverage. Previous randomised controlled clinical trials have indicated that tea and coffee contribute to dental and tongue staining associated with chlorhexidine mouthrinses. Additionally, abstinence from tea and coffee significantly reduces staining. The results of this study in vitro suggest that when abstinence is difficult, tea and coffee brands of low chromogenicity may be recommended. Clearly these data in vitro require validation in vivo.

An evaluation of an antiadhesive copolymer agent on plaque inhibition by chlorhexidine

The high molecular weight copolymer M239144 has proven antiadhesive action in vitro but clinically lacked effect, even when combined with chlorhexidine. This latter result was thought to arise from inactivation of chlorhexidine by the copolymer. The aim of this study was to determine whether improved activity might arise if the copolymer and chlorhexidine were applied sequentially rather than combined. The study was a double-blind, randomised crossover design balanced for carryover using a 24-h plaque regrowth method. 2 groups of 25 subjects from a zero plaque baseline rinsed 1x with 15 ml volumes of the allocated paired rinses for 60 s. Subjects abstained from toothcleaning for 24 h and were scored for plaque by area. The paired regimens were: 1. placebo: placebo; 2. placebo: 0.03% chlorhexidine; 3. 1% co-polymer and 0.03% chlorhexidine; 4. placebo: 1% co-polymer; 5. placebo: 0.12% chlorhexidine. Plaque regrowth was greatest with regimen 1 and least with regimen 5. However, regimens 3 and 4 were not significantly different from regimen 1, whereas regimen 2 was significantly more effective than regimen 3. The results indicate that the copolymer alone is ineffective, and even delivered sequentially, inactivates chlorhexidine.

The comparative effects on plaque regrowth of phenolic chlorhexidine and anti-adhesive mouthrinses

The inhibition of bacterial attachment to the tooth surface is one possible approach to plaque control. This study evaluated in vivo the plaque inhibitory action of a novel copolymer reported to have considerable antiadhesive properties in vitro. The study was a single blind, 5-treatment, randomised Latin square crossover design, incorporating balance for carry-over effects. The rinses were the antiadhesive (1%), the antiadhesive with 0.02% chlorhexidine, a 0.2% chlorhexidine rinse product, an essential oil/phenolic rinse product and water. 15 volunteers participated and on day 1 of each study period were rendered plaque-free, ceased toothcleaning and rinsed 2 x daily, under supervision, with the allocated formulation. On day 5, plaque was scored by index and area. Washout periods were 2 1/2 days. Alone or combined with chlorhexidine, the antiadhesive agent showed no effects greater than water. The chlorhexidine rinse was significantly more effective than the essential oil/phenolic rinse which in turn was significantly more effective than the other rinses.