Chemical agents to prevent and regulate plaque development

Utility of intraoral scanner imaging for dental plaque detection

Purpose

Oral hygiene, maintained through plaque control, helps prevent periodontal disease and dental caries. This study was conducted to examine the accuracy of plaque detection with an intraoral scanner (IOS) compared to images captured with an optical camera.

Materials and Methods

To examine the effect of color tone, artificial tooth resin samples were stained red, blue, and green, after which images were acquired with a digital single-lens reflex (DSLR) camera and an IOS device. Stained surface ratios were then determined and compared. Additionally, the deviation rate of the IOS relative to the DSLR camera was computed for each color. In the clinical study, following plaque staining with red disclosing solution, the staining was captured by the DSLR and IOS devices, and the stained area on each image was measured.

Results

The stained surface ratios did not differ significantly between DSLR and IOS images for any color group. Additionally, the deviation rate did not vary significantly across colors. In the clinical test, the stained plaque appeared slightly lighter in color, and the delineation of the stained areas less distinct, on the IOS compared to the DSLR images. However, the stained surface ratio was significantly higher in the IOS than in the DSLR group.

Conclusion

When employing IOS with dental plaque staining, the impact of color was minimal, suggesting that the traditional red stain remains suitable for plaque detection. IOS images appeared relatively blurred and enlarged relative to the true state of the teeth, due to inferior sharpness compared to camera images.

Comparison of plaque control record measurements obtained using intraoral scanner and direct visualization

OBJECTIVE

Intraoral scanner (IOS) can acquire three-dimensional color images of teeth. Thus, the detection of areas with plaque adhesion stained by plaque-disclosing solutions using an IOS could be a potential oral hygiene evaluation method. This study aimed to verify the usefulness of obtaining O'Leary's plaque control record (PCR) measurements using an IOS in clinical practice.

METHODS

Twenty patients with >20% PCR measurements who underwent oral prophylaxis were enrolled in this study. A plaque-disclosing gel was applied to stain the areas with plaque adhesion, and the dentition was scanned using the IOS. The PCR values obtained via the direct method and those obtained using the digital image were compared for the entire dentition, maxillary total area, the labial and palatal aspects of the maxillary anterior teeth, the buccal and palatal aspects of the maxillary posterior teeth, mandibular total area, the labial and lingual aspects of the mandibular anterior teeth, and the buccal and lingual aspects of the mandibular posterior teeth.

RESULTS

The IOS group tended to have higher values than the direct observation group. The labial and palatal aspect of the maxillary anterior teeth, the labial and lingual aspects of the mandibular anterior teeth did not differ significantly between the groups.

CONCLUSION

Plaque adhesion was visualized easily and conclusively using an IOS. As the large tip size often hinders its use, it is necessary to develop a smaller IOS tip in the future.

Efficacy of a herbal mouthwash for management of periodontitis and radiation-induced mucositis - A consolidated report of two randomized controlled clinical trials

BACKGROUND

Oral diseases like periodontitis and mucositis often require home care using topical agents in the form of mouthwashes. Many herbal mouthwashes are found to be beneficial; however lack proper scientific evidence to support their use.

OBJECTIVES

Study 1 evaluated clinical efficacy of herbal mouthwash in the management of chronic periodontitis in comparison with chlorhexidine mouthwash. Study 2 aimed at assessment of herbal mouthwash in patients of radiation-induced mucosititis.

METHODS

The novel herbal mouthwash used in the present study wa prepared from extracts of five plants namely Emblica Officinalis, Terminalia chebula, Terminalia bellerica, Glycyrrhiza glabra, and Azadirachta indica. 50 periodontitis patients were randomly allocated to two groups. As per allocation, they were instructed to use either herbal mouthwash or chlorhexidine mouthwash twice daily for two weeks after nonsurgical periodontal therapy. Similarly, patients with radiation-induced mucositis were randomly given herbal mouthwash and soda saline mouthwash. Intergroup and intragroup comparisons of continuous variables were conducted using paired and unpaired t-tests. Categorical variables were compared using the chi-square test.

RESULTS

Significant reductions in gingival bleeding, plaque accumulation, and pocket depth were noticed in periodontitis patients in both groups. Patients reported acceptable taste, freshness, and satisfaction after the use of herbal mouthwash. The herbal mouthwash group noticed a significant reduction in the severity of radiation-induced mucositis and analgesic requirements. The intensity of pain, dryness of mouth, oral hygiene, and need for the use of antibiotic and antifungal during radiotherapy was not significant among the groups.

CONCLUSION

The results of this preliminary clinical trial support the use of the tested herbal formulation mouthwash as an adjunct in the treatment of periodontitis as well as radiation-induced mucositis.

CLINICAL TRIAL REGISTRATION NUMBER

For Study 1: CTRI/2019/10/021574, Study 2: CTRI/2020/04/024851.

Effects of Curcuma as an adjunct therapy on periodontal disease: A systematic review and meta-analysis

BACKGROUND

Periodontal disease (PD) is the second most prevalent buccal infectious condition in adults. Owing to its multifactorial etiology, treatment and maintenance are challenging. Scaling and root planing, associated with adequate plaque control, are considered the gold standard treatments for this disease. However, the instrumentation techniques can fail to completely eliminate calculus, particularly in higher grade and progression rated PD cases, and the continuing efficient removal of the biofilm by the patient can limit the long-term response of this treatment. Anti-infective herbal products, such as Curcuma, have been added as adjuvant therapy to prolong periodontal treatment outcomes.

OBJECTIVE

This systematic review aimed to summarize and evaluate whether Curcuma can contribute to PD treatment when applied as an adjunct to the standard scaling and root planing therapy.

DATA SOURCES

We searched databases using specific keywords and Boolean operators and systematically conducted the extraction and analysis according to the PROSPERO (CRD42019145691) database. The main eligibility criteria were randomized clinical trials in humans published in the English language.

RESULTS

Twelve studies were included in the review and 11 in the meta-analysis. Quantitative analysis of different clinical parameters was described. In comparison with the control group, Curcuma was associated with a reduction in pocket depth after 90 days of treatment (mean deviation: 0.48; 95% confidence interval: 0.89-0.08).

CONCLUSION

This systematic review and meta-analysis indicated that Curcuma is an effective product when applied as adjunct therapy for PD treatment. This improved the clinical and microbiological parameters.

Dysbiosis From a Microbial and Host Perspective Relative to Oral Health and Disease

The significance of microbiology and immunology with regard to caries and periodontal disease gained substantial clinical or research consideration in the mid 1960's. This enhanced emphasis related to several simple but elegant experiments illustrating the relevance of bacteria to oral infections. Since that point, the understanding of oral diseases has become increasingly sophisticated and many of the original hypotheses related to disease causality have either been abandoned or amplified. The COVID pandemic has reminded us of the importance of history relative to infectious diseases and in the words of Churchill "those who fail to learn from history are condemned to repeat it." This review is designed to present an overview of broad general directions of research over the last 60 years in oral microbiology and immunology, reviewing significant contributions, indicating emerging foci of interest, and proposing future directions based on technical advances and new understandings. Our goal is to review this rich history (standard microbiology and immunology) and point to potential directions in the future (omics) that can lead to a better understanding of disease. Over the years, research scientists have moved from a position of downplaying the role of bacteria in oral disease to one implicating bacteria as true pathogens that cause disease. More recently it has been proposed that bacteria form the ecological first line of defense against "foreign" invaders and also serve to train the immune system as an acquired host defensive stimulus. While early immunological research was focused on immunological exposure as a modulator of disease, the "hygiene hypothesis," and now the "old friends hypothesis" suggest that the immune response could be trained by bacteria for long-term health. Advanced "omics" technologies are currently being used to address changes that occur in the host and the microbiome in oral disease. The "omics" methodologies have shaped the detection of quantifiable biomarkers to define human physiology and pathologies. In summary, this review will emphasize the role that commensals and pathobionts play in their interaction with the immune status of the host, with a prediction that current "omic" technologies will allow researchers to better understand disease in the future.

The efficacy of convenient cleaning methods applicable for customized abutments: an in vitro study

Background

The demand for implant dentistry, which includes customized abutments, is increasing. A lot of pollutions are generated on the customized abutment surface following milling procedure. This study evaluated the surface topography and cleanliness of customized abutments after cleaning procedures, which are simply applicable in the dental clinic.

Methods

Thirty computer-aided design and computer-aided manufacturing internal connection type titanium abutments were produced, milled, and randomly divided into 3 groups: steam cleaning (control group), chlorhexidine (CHX) scrubbing (test group 1), and ultrasonic cleaning with CHX solution, acetone, and ethyl alcohol (test group 2). Each group was evaluated using microscopic and microbial analysis.

Results

Foreign bodies were observed on the abutment surfaces in control group and test group 1, but not in test group 2. Bacteria were observed on 40% of the agar plates following steam cleaning; most of the colonies consisted of Bacillus cereus and Staphylococcus warneri. Colony growth was absent following test group 1 and 2.

Conclusion

For customized abutments, cleaning with steam is ineffective. CHX scrubbing effectively eliminates only bacteria. Ultrasonic cleaning with CHX solution, acetone, and ethyl alcohol successfully removes both foreign bodies and bacteria. Thus, the ultrasonic cleaning method is conveniently applicable in the dental clinic for eliminating contamination of the customized abutment surface.

The Effects of Curcumin in the Treatment of Gingivitis: A Systematic Review of Clinical Trials

Different modalities of treatments are available for management of gingival disease but most have adverse effects. Curcumin has anti-inflammatory properties and can be used for management of various inflammatory processes. This systematic review evaluates the effects of curcumin as an adjuvant to oral hygiene on plaque index (PI), gingival index (GI), gingival bleeding index (GBI), and inflammation in patients with gingivitis. A comprehensive search was conducted using PubMed/MEDLINE, Cochrane, SCOPUS, and Google Scholar. Based on the Population, Intervention, Control, and Outcome (PICO) model, clinical trials which tested the effects of curcumin as an adjunctive product or alone in control of gingival inflammation up until 21 February 2020 with language restrictions were selected. From the 422 papers found, 14 met the eligibility criteria. In most of these studies, curcumin treatment achieved significant reductions in PI, GI, GBI, and microbial colony count and was as effective as chlorhexidine mouthwash, with no serious adverse effects. We conclude that treatment with curcumin for gingivitis is safe as a natural herbal compound and is as effective as chlorhexidine mouthwash.

Effects of Herbal Mouthwashes on Plaque and Inflammation Control for Patients with Gingivitis: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

Objective

The aim of this study was to evaluate the overall effects of herbal mouthwashes as supplements to daily oral hygiene on plaque and inflammation control compared with placebos and chlorhexidine (CHX) mouthwashes in the treatment of gingivitis.

Methods

PubMed, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and grey literature databases were searched. Only randomised controlled trials (RCTs) comparing herbal mouthwashes with placebos or CHX in the daily oral hygiene of patient with gingivitis were included to compare the effect of different mouthwashes on plaque and inflammation control.

Results

A total of 13 studies satisfied the eligibility criteria, and 11 studies were included in meta-analyses. Significant differences were observed in favour of herbal mouthwashes compared with placebos in both plaque- and inflammation-related indices (Quigley-Hein Plaque Index, QHPI: WMD = −0.61, 95% CI (−0.80, −0.42), P < 0.001; Gingival Index, GI: −0.28 (−0.51, −0.06), P=0.01; Modified Gingival Index, MGI: −0.59 (−1.08, −0.11), P=0.02; Gingival Bleeding Index, GBI: −0.06 (−0.09, −0.04), P < 0.001). No significant difference was found between herbal and CHX mouthwashes.

Conclusions

Herbal mouthwashes have potential benefits in plaque and inflammation control as supplements to the daily oral hygiene of patients with gingivitis. Although no difference was observed between herbal and CHX mouthwashes in the selected studies, further high-quality RCTs are needed for more firm support before advising patients with gingivitis about whether they can use herbal mouthwashes to substitute for CHX mouthwashes or not (PROSPERO registration number: CRD42019122841).

Effectiveness of novel herbal dentifrice in control of plaque, gingivitis, and halitosis - Randomized controlled trial

Background and aim

Plaque is a common etiological factor for common oral conditions like gingivitis, periodontitis, dental caries and halitosis. We aimed to evaluate the efficacy of a novel herbal dentifrice in control of plaque, gingivitis, and halitosis in comparison to control dentifrice.

Experimental procedure

We conducted a randomized controlled, single center, double-blinded parallel arm clinical trial. Participants were randomly distributed with commercially available herbal dentifrice or control dentifrice. Assessments of plaque, gingivitis, halitosis, unstimulated saliva pH were done at baseline and at one month by a trained and calibrated periodontist. All the participants were given new toothbrushes one week before the start of the study. They were asked to brush with the designated dentifrices for 2–4 min, twice daily for one month.

Results and conclusion

A total of 79 participants were recruited for this study, out of which 75 participants completed the follow-up. Inter-group comparisons of all the variables at baseline showed no significant differences in the mean plaque index, gingival index, halitosis and pH between test and control groups respectively. Intra-group comparisons showed a significant decrease in mean plaque, gingival and halitosis at follow-up than at baseline in both test and control groups. No significant differences between test and control groups were seen in the mean plaque index (P = 0.792), gingival index (P = 0.292), halitosis (P = 0.266), pH (P = 0.742) at follow-up after adjusting the respective baseline scores. The novel herbal dentifrice could be a suitable alternative for the control of plaque, gingivitis, and halitosis.

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Significant decrease in clinical indices at follow-up than baseline in both groups.

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Significant increase in salivary pH at follow-up than baseline in both groups.

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No significant differences were seen clinical indices between test and control.

A Novel Small Molecule, ZY354, Inhibits Dental Caries-Associated Oral Biofilms

Biofilm control is a critical approach to the better management of dental caries. Antimicrobial small molecules have shown their potential in the disruption of oral biofilm and control of dental caries. The objectives of this study were to examine the antimicrobial activity and cytotoxicity of a newly designed small-molecule compound, ZY354. ZY354 was synthesized, and its cytotoxicity was evaluated in human oral keratinocytes (HOK), human gingival epithelial cells (HGE), and macrophages (RAW) by CCK-8 assays. Minimal inhibitory concentrations (MICs), minimum bactericidal concentrations (MBCs), minimum biofilm inhibition concentrations (MBICs), and minimum biofilm reduction concentrations (MBRCs) of ZY354 against common oral streptococci (i.e., Streptococcus mutans, Streptococcus gordonii, and Streptococcus sanguinis) were determined by microdilution method. The exopolysaccharide (EPS)/bacterium ratio and the dead/live bacterium ratio in the ZY354-treated multispecies biofilms were determined by confocal laser scanning microscopy, and the microbial composition was visualized and quantified by fluorescent in situ hybridization and quantitative PCR (qPCR). The demineralizing activity of ZY354-treated biofilms was evaluated by transverse microradiography. The results showed that ZY354 exhibited low cytotoxicity in HOK, HGE, and RAW cells and exhibited potent antimicrobial activity against common oral streptococci. The EPS and the abundance of S. mutans were significantly reduced after ZY354 treatment, along with an increased dead/live microbial ratio in multispecies biofilms compared to the level with the nontreated control. The ZY354-treated multispecies biofilms exhibited reduced demineralizing activity at the biofilm/enamel interface. In conclusion, the small-molecule compound ZY354 exhibits low cytotoxicity and remarkable antimicrobial activity against oral streptococci, and it may have a great potential in anticaries clinical applications.

Comparative Evaluation of Neem Mouthwash on Plaque and Gingivitis: A Double-blind Crossover Study

AIM

The present study aimed at evaluating the impact of neem-containing mouthwash on plaque and gingivitis.

MATERIALS AND METHODS

This randomized, double-blinded, crossover clinical trial included 40 participants aged 18 to 35 years with washout period of 1 week between the crossover phases. A total of 20 participants, each randomly allocated into groups I and II, wherein in the first phase, group I was provided with 0.2% chlorhexidine gluconate and group II with 2% neem mouthwash. After the scores were recorded, 1-week time period was given to the participants to carry over the effects of the mouthwashes and then the second phase of the test was performed. The participants were instructed to use the other mouthwash through the second test phase.

RESULTS

There was a slight reduction of plaque level in the first phase as well as in the second phase. When comparison was made between the groups, no statistically significant difference was seen. Both the groups showed reduction in the gingival index (GI) scores in the first phase, and there was a statistically significant difference in both groups at baseline and after intervention (0.005 and 0.01 respectively). In the second phase, GI scores were reduced in both groups, but there was a statistically significant difference between the groups only at baseline scores (0.01).

CONCLUSION

In the present study, it has been concluded that neem mouthwash can be used as an alternative to chlorhexidine mouthwash based on the reduced scores in both the groups.

CLINICAL SIGNIFICANCE

Using neem mouthwash in maintaining oral hygiene might have a better impact in prevention as well as pervasiveness of oral diseases as it is cost-effective and easily available.

Effectiveness of Salvadora persica extracts against common oral pathogens

Objective

The purpose of this study was to evaluate the antibacterial activity of ethanol and hexane extracts of Salvadora persica against common oral pathogens.

Materials and methods

Well diffusion, Minimum Inhibition Concentration (MIC), Minimum Bactericidal Concentration (MBC), and Broth microdilution tests were used to determine the optimum antimicrobial concentrations of S. persica extracts against Streptococcus mutans (S. mutans), Streptococcus sanguis (S. sanguis), and Streptococcus salivarius (S. salivarius) over 1, 3, 6, 12, and 24 h. Chlorhexidine (CHX) 0.2% was used as a positive control.

Results

The findings showed that the microbial activity of both extracts was concentration-dependent. Ethanol extract of S. persica at 25, 50, and 100 mg/ml had more growth inhibitory effect against all isolates compared to hexane extract. In addition, ethanol extract at 8 mg/ml (MBC value) was able to eradicate the growth of all isolates. S. sanguis and S. salivarius were very sensitive to hexane extract and required 4 mg/ml (MBC value) for their eradication while S. mutans was the most resistant (MBC = 8 mg/ml).The statistical findings of CFU counts showed no significant difference (p = 1.000) in antibacterial effectiveness between the two extracts against all isolates. A significant decline overtime in CFU counts was noted, except at 12 h and 24 h where no significant difference (p = 0.793) was observed and was comparable to CHX.

Conclusion

Ethanol and hexane extracts of S. persica were found to exhibit maximum antimicrobial activity against S. mutans, S. sanguis and S. salivarius at high concentrations.

Cetylpyridinium chloride mouth rinses alleviate experimental gingivitis by inhibiting dental plaque maturation

Oral rinses containing chemotherapeutic agents, such as cetylpyridinium chloride (CPC), can alleviate plaque-induced gingival infections, but how oral microbiota respond to these treatments in human population remains poorly understood. Via a double-blinded, randomised controlled trial of 91 subjects, the impact of CPC-containing oral rinses on supragingival plaque was investigated in experimental gingivitis, where the subjects, after a 21-day period of dental prophylaxis to achieve healthy gingivae, received either CPC rinses or water for 21 days. Within-subject temporal dynamics of plaque microbiota and symptoms of gingivitis were profiled via 16S ribosomal DNA gene pyrosequencing and assessment with the Mazza gingival index. Cetylpyridinium chloride conferred gingival benefits, as progression of gingival inflammation resulting from a lack of dental hygiene was significantly slower in the mouth rinse group than in the water group due to inhibition of 17 gingivitis-enriched bacterial genera. Tracking of plaque α and β diversity revealed that CPC treatment prevents acquisition of new taxa that would otherwise accumulate but maintains the original biodiversity of healthy plaques. Furthermore, CPC rinses reduced the size, local connectivity and microbiota-wide connectivity of the bacterial correlation network, particularly for nodes representing gingivitis-enriched taxa. The findings of this study provide mechanistic insights into the impact of oral rinses on the progression and maturation of dental plaque in the natural human population.

Clinical efficacy of turmeric use in gingivitis: A comprehensive review

INTRODUCTION

Gingivitis affects an estimated 80% of the population, and is characterized as the world's most predominant inflammatory periodontal disease. Without intervention, gingivitis can advance to alveolar bone loss. Therefore, the primary goal in patients suffering with gingivitis is to control plaque buildup and soft tissue inflammation. Current guidelines consider chlorhexidine as the gold standard in the prevention and treatment of gingivitis. However, negative side effects of chlorhexidine, including oral mucosal erosion, discoloration of teeth, and bitter taste, provide an opportunity for alternative medications. Turmeric, a commonly used herb, possesses anti-inflammatory, antioxidant, antibacterial, antiviral, and antifungal properties. By virtue of these properties, multiple controlled trials have been performed to investigate the efficacy of turmeric in gingivitis.

OBJECTIVES

The aim of this comprehensive review is to summarize and evaluate the evidence on the efficacy of turmeric as compared to chlorhexidine in the prevention and treatment of gingivitis.

RESULTS

PubMed, MedLine (Web of Science), and EBSCO (academic search complete) were utilized as primary literature search tools. The following search strategy was used: ((turmeric OR curcumin OR curcuma) AND (gingivitis OR "gum inflammation")). Five reviewed studies show that both turmeric and chlorhexidine significantly decrease plaque index (PI) and gingival index (GI), and can therefore be used in the prevention and treatment of gingivitis.

CONCLUSIONS

Both chlorhexidine and turmeric can be used as an adjunct to mechanical means in preventing and treating gingivitis. However, trials longer than 21 days with a greater number of patients are necessary to further evaluate the comparison between turmeric and chlorhexidine.

Antimicrobial effects of Citrus sinensis peel extracts against dental caries bacteria: An in vitro study

Background

Ethnomedicine is gaining admiration since years but still there is abundant medicinal flora which is unrevealed through research. The study was conducted to assess the in vitro antimicrobial potential and also determine the minimum inhibitory concentration (MIC) of Citrus sinensis peel extracts with a view of searching a novel extract as a remedy for dental caries pathogens.

Material and Methods

Aqueous and ethanol (cold and hot) extracts prepared from peel of Citrus sinensis were screened for in vitro antimicrobial activity against Streptococcus mutans and Lactobacillus acidophilus, using agar well diffusion method. The lowest concentration of every extract considered as the minimal inhibitory concentration (MIC) values were determined for both test organisms. One way ANOVA with Post Hoc Bonferroni test was applied for statistical analysis. Confidence level and level of significance were set at 95% and 5% respectively.

Results

Dental caries pathogens were inhibited most by hot ethanolic extract of Citrus sinensispeel followed by cold ethanolic extract. Aqueous extracts were effective at very high concentrations. Minimum inhibitory concentration of hot and cold ethanolic extracts of Citrus sinensis peel ranged between 12-15 mg/ml against both the dental caries pathogens.

Conclusions

Citrus sinensispeels extract was found to be effective against dental caries pathogens and contain compounds with therapeutic potential. Nevertheless, clinical trials on the effect of these plants are essential before advocating large-scale therapy.

Key words:Agar well diffusion, antimicrobial activity, dental caries, Streptococcus mutans, Lactobacillus acidophilus.

Comparative evaluation of topical application of turmeric gel and 0.2% chlorhexidine gluconate gel in prevention of gingivitis

Introduction:

Turmeric commonly known as “Haldi” is a popular spice frequently used in Indian foods and curry. Turmeric holds a high place in Ayurvedic medicine as a “detoxifier of the body,” and today, science has documented several diseased conditions that can be healed by the active ingredients of turmeric. Curcumin is the most active constituent of turmeric curcuminoids obtained from the rhizome of Curcuma longa. Curcumin has been found to have antioxidant, anti-tumor, anti-inflammatory, antiviral, antibacterial, antifungal, analgesic, anti-allergic, antiseptic properties and thus has a potential against various diseases. Due to these properties it was felt that promotion of turmeric in dental practice may prove beneficial.

Materials and Methods:

The study was conducted in the Department of Periodontology, Faculty of Dental Sciences, King George's Medical University, Lucknow, India. A total of 40 subjects of both the sexes from age group 20-35 years. Simple random sampling was followed and the participants were assigned to two groups ‘A’ and ‘B’ of 20 participants each. Group A subjects were advised 0.2% chlorhexidine gluconate gel. Group B 30 subjects were advised experimental (turmeric) gel.

Statistical Analysis:

Data were summarized as mean ± SD. Pre and post outcome measures of two groups were compared by repeated measures analysis of variance (RM ANOVA) using general linear models (GLM) and the significance of mean difference within and between the groups was done by Bonferroni post hoc test after adjusting for multiple contrasts (comparisons).

Conclusions:

Based on the observations of our study, it can be concluded that chlorhexidine gluconate as well as turmeric gel can be effectively used as an adjunct to mechanical plaque control in prevention of plaque and gingivitis. chlorhexidine gluconate gel has been found to be more effective when antiplaque and anti-inflammatory properties were considered. The effect of turmeric observed may be because of its anti-inflammatory action. The antiplaque action of chlorhexidine gluconate is due to its substantivity. Substantivity of tutmeric is required to be further studied.

Efficacy of 0.25% Lemongrass Oil Mouthwash: A Three Arm Prospective Parallel Clinical Study

BACKGROUND

Chlorhexidine mouthwash has earned eponym of gold standard to treat and/or prevent periodontal diseases. However, the present study was carried out to explore an alternative herbal mouthwash.

AIM

To compare the anti-plaque and anti-gingivitis efficacy of a 0.25% lemongrass oil mouthwash to that of 0.2% chlorhexidine mouthwash.

MATERIALS AND METHODS

A double-blinded parallel designed clinical trial with 60 subjects was taken for the study. Baseline plaque index (PI) & gingival index (GI) score was recorded. Oral prophylaxis was done and the plaque score was set at zero. Then, subjects were randomly allocated into 3 groups (N=20 in each): 0.25% lemongrass oil mouthwash, 0.2% chlorhexidine mouthwash and oral prophylaxis only. Subjects were asked to swish with respective mouthwash twice daily for 21 days. Subjects were again re-evaluated on 14(th) and 21(st) day for GI and PI. Comparison of the mean difference among the variables was performed by parametric tests.

RESULTS

Lemongrass oil mouthwash group showed highest reduction in GI & PI at both 14(th) and 21(st) day, which was statistically significant (p≤0.05).

CONCLUSION

Lemongrass oil mouthwash can also be used as a good herbal alternative to chlorhexidine mouthwash, so further studies are needed.

The antiplaque efficacy of propolis-based herbal toothpaste: A crossover clinical study

BACKGROUND

In recent years, herbal products have been suggested as an economic, safe and probably effective alternative for prevention and control of various oral diseases. But still there are some products which need to be evaluated. Of lately, Propolis is one such product. To assess and compare the efficacy of herbal dentifrice containing Propolis with Miswak and Colgate total toothpastes in controlling plaque formation.

MATERIALS AND METHODS

A double blind, randomized, crossover study design was conducted among thirty healthy dental students. After oral prophylaxis all subjects were given a washout product for one week period. Subjects were then made to brush with (washout product) for 1 minute followed by 1 minute brushing with assigned test product. The baseline MGMPI plaque scores were recorded. Subjects were then refrained from oral hygiene for 24 hours, and were recalled to be re-disclosed and re-measured for plaque formation. This procedure was repeated according to crossover design after a washout period of (2 week). Statistical tests used were Krukalwallis and Wilcoxon sign rank test.

RESULTS

There was a significant difference in 24 hour score between the test products evaluated. When the change from baseline to 24 hours was analyzed, the test product Propolis resulted in a consistently and significantly (p < 0.05) lower MGMPI mean scores than the Colgate Total and Miswak toothpastes.

CONCLUSION

Propolis was found to be safe and effective in reducing plaque accumulation when compared to Miswak and Colgate total toothpaste.

Effect of two herbal mouthwashes on gingival health of school children

This study aimed at determining the effect of indigenously prepared neem and mango chewing stick mouthwashes on plaque and gingival indices. A sample of 105 children aged 12-15 years was randomized into three groups, namely neem, mango, and chlorhexidine mouthwash groups. All the children were examined at baseline and gingival and plaque indices were recorded. Baseline scores for plaque and gingivitis were fair and moderate, respectively, in all the three groups and there existed no statistically significant difference among them. Ten millilitres each of herbal and chlorhexidine mouthwashes (0.2%) were administered according to the group allocation twice daily for 21 days. Indices were reassessed at 21 days (immediately after intervention) and at 1 month, 2 months, and 3 months after discontinuing the mouthwashes. Statistically significant reduction (P < 0.001) in plaque index was found in all the three mouthwash groups at 21 days and at 1 month from discontinuing the mouthwash. Chlorhexidine additionally showed statistically significant reduction in plaque index at 2 months from discontinuing the mouthwash. Statistically significant reduction (P < 0.001) in gingival index was found in all the three mouthwash groups at 21 days (immediately after discontinuing the mouthwash) and at 1 and 2 months from discontinuing the mouthwash. To conclude, all the three mouthwashes were effective antiplaque and antigingivitis agents. Chlorhexidine and neem possess equivalent efficacy in reducing plaque, while chlorhexidine has superior antigingivitis properties.

The effect of a dentifrice containing Magnolia extract on established plaque and gingivitis in man: a six-month clinical study

AIM

The aim was to evaluate the clinical effect of a dentifrice containing 0.3% Magnolia extract on dental plaque and gingivitis.

MATERIAL AND METHODS

The trial was a 6-month double-blind, stratified, randomized and 2-armed parallel group study. Forty-six subjects in the test group brushed their teeth with a dentifrice containing 0.3% Magnolia extract and 48 subjects in the control group brushed with a placebo dentifrice. Plaque and gingivitis were assessed at baseline, 3 and 6 months.

RESULTS

There was a significantly larger gingivitis reduction in the Magnolia group than in the control group (0.26 ± 0.11 versus 0.11 ± 0.12) (P < 0.001). There was a greater increase in the total number of healthy gingival units Gingival Index (GI score 0) in the Magnolia group than in the control group (149% versus 31%) and a larger reduction in inflamed gingival units (GI score 2/3) (60% versus 30%). Furthermore, at sites with similar amounts of plaque, less clinical signs of gingival inflammation were observed in the Magnolia group than in the control group.

CONCLUSION

Six months' unsupervised use of a dentifrice containing 0.3% Magnolia extract resulted in significantly greater gingivitis reduction than a corresponding control dentifrice.

In vitro efficacy of cold atmospheric pressure plasma on S. sanguinis biofilms in comparison of two test models

Dental plaque critically affects the etiology of caries, periodontitis and periimplantitis. The mechanical removal of plaque can only be performed partially due to limited accessibility. Therefore, plaque still represents one of the major therapeutic challenges. Even though antiseptic mouth rinses reduce the extent of biofilm temporarily, plaque removal remains incomplete and continuous usage can even result in side effects. Here we tested argon plasma produced by kinpen09 as one option to inactivate microorganisms and to eliminate plaque. S. sanguinis biofilms cultivated in either the European Biofilm Reactor (EUREBI) or in 24 well plates were treated with argon plasma. In both test systems a homogeneous, good analyzable and stable biofilm was produced on the surface of titan plates within 72 h (>6,9 log10 CFU/ml). Despite the significantly more powerful biofilm production in EUREBI, the difference of 0.4 log10 CFU/ml between EUREBI and the 24 well plates was practically not relevant. For that reason both test models were equally qualified for the analysis of efficacy of cold atmospheric pressure plasma. We demonstrate a significant reduction of the biofilm compared to the control in both test models. After plasma application of 180 s the biofilm produced in EUREBI or in 24 well plates was decreased by 0.6 log10 CFU/ml or 0.5 log10 CFU/ml, respectively. In comparison to recently published studies analyzing the efficacy of kinpen09, S. sanguinis produces a hardly removable biofilm. Future investigations using reduced distances between plasma source and biofilm, various compositions of plasma and alternative plasma sources will contribute to further optimization of the efficacy against S. sanguinis biofilms.

Comparative evaluation of 0.1% turmeric mouthwash with 0.2% chlorhexidine gluconate in prevention of plaque and gingivitis: A clinical and microbiological study

BACKGROUND

The aim of our clinical trial was to assess the efficacy of 0.1% turmeric mouthwash as an anti-plaque agent and its effect on gingival inflammation and to compare it with 0.2% chlorhexidine gluconate by evaluating the effect on plaque and gingival inflammation and on microbial load.

MATERIALS AND METHODS

60 subjects, 15 years and above, with mild to moderate gingivitis were recruited. Study population was divided into two groups. Group A-30 subjects were advised chlorhexidine gluconate mouthwash. Group B-30 subjects were advised experimental (turmeric) mouthwash. Both the groups were advised to use 10 ml of mouthwash with equal dilution of water for 1 min twice a day 30 min after brushing. Parameters were recorded for plaque and gingival index at day 0, on 14 (th) day, and 21 (st) day. Subjective and objective criteria were assessed after 14(th) day and 21(st) day. The N-benzoyl-l-arginine-p- nitroanilide (BAPNA) assay was used to analyze trypsin like activity of red complex microorganisms.

RESULTS

On comparison between chlorhexidine and turmeric mouthwash, percentage reduction of the Plaque Index between 0 and 21 (st) day were 64.207 and 69.072, respectively (P=0.112), percentage reduction of Gingival Index between 0 and 21(st) day were 61.150 and 62.545 respectively (P=0.595) and percentage reduction of BAPNA values between 0 and 21(st) day were 42.256 and 48.901 respectively (P=0.142).

CONCLUSION

Chlorhexidine gluconate as well as turmeric mouthwash can be effectively used as an adjunct to mechanical plaque control in prevention of plaque and gingivitis. Both the mouthwashes have comparable anti-plaque, anti-inflammatory and anti-microbial properties.

Effect of ZnCl2 on plaque growth and biofilm vitality

OBJECTIVE

The aim of this study was to evaluate the effects of ZnCl(2) on plaque-growth and vitality pattern of dental biofilm and to determine the optimum zinc concentration for the inhibition of plaque formation.

DESIGN

Data were collected from nine volunteers for whom a special-designed acrylic appliance was prescribed after a careful dental check up. The volunteers rinsed twice daily for 2min with ZnCl(2) of 2.5, 5, 10, 20mM as treatment and double distilled water (DDW) as control in respective assigned test weeks. The plaque index (PI) was assessed after 48h of appliance wearing. The glass discs with the adhered biofilm were removed from the splints and stained with two fluorescent dyes. The biofilm thickness (BT) and bacterial vitality of the whole biofilm as well as the mean bacterial vitality (BV) of the inner, middle and outer layers of biofilm were evaluated under confocal laser scanning microscope (CLSM).

RESULTS

PI, BT and BV of biofilms treated by various concentrations of ZnCl(2) were reduced significantly when compared with the DDW group (p<0.05). PI, BT and BV of the 2.5mM ZnCl(2) group was significantly higher than groups of 5, 10, 20mM ZnCl(2) (p<0.05). The mean BV of the 3 layers (inner, middle and outer layers) showed that 2.5mM ZnCl(2) was the lowest concentration to inhibit BV in the outer layer, 5mM was the lowest concentration to extend this inhibition of BV to the middle layer, and none of the concentrations investigated in this study has shown any effect on bacteria inhibition in the inner layer.

CONCLUSION

Zinc ions exhibited possible inhibitory effects on plaque formation, and have a promising potential to be used as an antibacterial agent in future dentifrices and mouthrinses.

Testing a low molecular mass fraction of a mushroom (Lentinus edodes) extract formulated as an oral rinse in a cohort of volunteers

Although foods are considered enhancing factors for dental caries and periodontitis, laboratory researches indicate that several foods and beverages contain components endowed with antimicrobial and antiplaque activities. A low molecular mass (LMM) fraction of an aqueous mushroom extract has been found to exert these activities in in vitro experiments against potential oral pathogens. We therefore conducted a clinical trial in which we tested an LMM fraction of shiitake mushroom extract formulated in a mouthrinse in 30 young volunteers, comparing the results with those obtained in two identical cohorts, one of which received water (placebo) and the other Listerine. Plaque index, gingival index and bacterial counts in plaque samples were determined in all volunteers over the 11 days of the clinical trial. Statistically significant differences (P < 0.05) were obtained for the plaque index on day 12 in subjects treated with mushroom versus placebo, while for the gingival index significant differences were found for both mushroom versus placebo and mushroom versus Listerine. Decreases in total bacterial counts and in counts of specific oral pathogens were observed for both mushroom extract and Listerine in comparison with placebo. The data suggest that a mushroom extract may prove beneficial in controlling dental caries and/or gingivitis/periodontitis.

Comparative evaluation of turmeric and chlorhexidine gluconate mouthwash in prevention of plaque formation and gingivitis: a clinical and microbiological study

AIM

To compare the efficacy of turmeric mouthwash and chlorhexidine gluconate mouthwash in prevention of gingivitis and plaque formation.

MATERIALS AND METHODS

A total of 100 randomly selected subjects visiting the Department of Periodontology at Bharati Vidyapeeth Deemed University, Dental College and Hospital, were considered for the study. The gingival index (GI) by Loe and Silness was recorded which was followed by Turesky- Gilmore-Glickman modification of Quigley Hein plaque index (TQHPI) at 0, 14 and 21 days. Individuals who gave an informed consent, subjects in the age group of 25 to 35 years with having fair and poor gingival index scores and a score >1 for plaque index, were included in the study.

RESULTS

Results showed statistically significant reduction (p < 0.05) in mean plaque index (PI) with chlorhexidine gluconate mouthwash when compared with turmeric mouthwash. No significant difference in mean gingival index (GI) was seen when chlorhexidine mouthwash was compared with turmeric mouthwash. Significant reduction in total microbial count (p < 0.05) was observed in both the groups. No significant difference was observed in total microbial count when chlorhexidine mouthwash was compared with turmeric mouthwash.

CONCLUSION

From the above observations, it can be concluded that chlorhexidine gluconate as well as turmeric mouthwash can be effectively used as an adjunct to mechanical plaque control methods in prevention of plaque and gingivitis. Chlorhexidine gluconate has been found to be more effective when antiplaque property was considered.

CLINICAL SIGNIFICANCE

From this study, it could be stated that turmeric is definitely a good adjunct to mechanical plaque control. Further studies are required on turmeric based mouthwash to establish it as a low cost plaque control measure.

The antimicrobial effect of a triclosan/copolymer dentifrice on oral microorganisms in vivo

BACKGROUND

The authors compared the in vivo antimicrobial effects on microorganisms from dental plaque, saliva and the tongue in subjects who used a triclosan/copolymer dentifrice and a fluoride dentifrice (control).

METHODS

The authors assigned 15 subjects randomly to the control dentifrice or the triclosan/copolymer dentifrice for twice-daily use for one week. They collected samples of plaque, saliva and tongue scrapings six and 12 hours after the final brushing. They analyzed colony-forming units of Veillonella species, Fusobacteria species, total cultivable anaerobes and hydrogen sulfide (H(2)S)-producing bacteria. A one-week washout followed. The authors repeated the protocol with the second dentifrice.

RESULTS

The results showed no differences at baseline. Significant reductions (88 to 96 percent) in oral anaerobic bacteria were observed in the triclosan/copolymer group six and 12 hours after brushing compared with the control group (P = .001). Fusobacteria decreased by 77 to 92 percent and Veillonella decreased by 84 to 89 percent six and 12 hours after brushing in the triclosan/copolymer group versus the control group. The triclosan/copolymer group also demonstrated a significant decrease in H(2)S-producing bacteria six and 12 hours after brushing (74 to 85 percent) (P = .001).

CONCLUSIONS

Brushing with the triclosan/copolymer dentifrice resulted in significant reductions in microorganisms from the three sites compared with the control dentifrice.

CLINICAL IMPLICATIONS

The triclosan/copolymer dentifrice produced sustained effects on oral bacteria for 12 hours.

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.

An ex-vivo multiplexed antibacterial test on oral microflora

BACKGROUND/AIMS

Characterized clinical strains of oral bacteria are utilized to examine the antimicrobial efficacy of oral care formulations. A demonstration of antimicrobial effects of formulations on microbial samples obtained from the human mouth offers advantages, i.e. incorporates the considerable microbial diversity of this environment with bacteria harvested from naturally occurring biofilms to form the focus of this investigation.

MATERIALS AND METHODS

Samples of oral flora from each adult subject were briefly treated (2 min) with test and control formulations and plated on appropriate agar for multiplexed antimicrobial effects on functional groups of oral bacteria associated with specific conditions.

RESULTS

Ex-vivo treatments of oral samples with the triclosan/copolymer dentifrice demonstrated significant dose-dependent antimicrobial effects compared with a control formulation on anaerobic and facultative oral bacteria from a group of 16 volunteers (P < 0.05) with reproducible effects observed in three separate trials (P < 0.05). Similarly, significant dose-dependent effects were noted with chlorhexidine mouthrinses (P < 0.05). A simultaneous assessment of the effects of these formulations on several functional classes of oral bacteria associated with specific oral conditions such as dental caries and oral malodor demonstrated multiplexed antimicrobial activity (P < 0.05).

CONCLUSIONS

A rapid procedure using small volumes of human oral samples and well-known formulations demonstrates ex-vivo multiplexed antimicrobial effects on functional groups of bacteria with both dentifrices and mouthrinses. Modifications of this approach may include antibacterial effects over time with formulations at clinically relevant concentrations, effects of novel agents or samples from subjects stratified on the basis of their clinical status.

The role of Triclosan in dentifrice formulations, with particular reference to a new 0.3% Triclosan calcium carbonate-based system

AIM

To discuss the role of Triclosan in dentifrice systems and demonstrate the enhanced efficacy of Triclosan in calcium carbonate-based systems when the level of the antimicrobial agent is raised from 0.2% to 0.3%. Triclosan is the most commonly used antimicrobial agent in oral care products, being compatible with a wide range of ingredients found in toothpaste formulations, whilst having no negative sensory features (e.g. taste, staining) that are associated with some other antimicrobial/anti-plaque agents. Triclosan is a broad spectrum antimicrobial agent, with additional anti-metabolic and anti-inflammatory properties. When delivered to the mouth in oral care products, Triclosan can selectively inhibit Gram negative anaerobic bacteria implicated in gingivitis and periodontal diseases, while leaving species associated with oral health relatively unaffected. Worldwide, attempts have been made to boost delivery/activity of Triclosan, either by use of copolymers or by combination with other agents such as zinc citrate. However, Triclosan has also been shown to maintain clinical efficacy against plaque and gingivitis when present as the sole antimicrobial in toothpaste formulations.

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.

Antimicrobial effects of a new therapeutic liquid dentifrice formulation on oral bacteria including odorigenic species

The control of oral malodor is well-recognized in efforts to improve oral health. Antimicrobial formulations can mitigate oral malodor, however, procedures to assess effects on oral bacteria including those implicated in halitosis are unavailable. This investigation examined the antimicrobial effects of a new liquid triclosan/copolymer dentifrice (test) formulation that demonstrated significant inhibition of oral malodor in previous organoleptic clinical studies. Procedures compared antimicrobial effects of the test and control formulations on a range of oral micro-organisms including members implicated in halitosis, substantive antimicrobial effects of formulations with hydroxyapatite as a surrogate for human teeth and ex vivo effects on oral bacteria from human volunteers. With Actinomyces viscosus, as a model system, the test formulation demonstrated a dose-dependent effect. At these concentrations the test formulation provided significant antimicrobial effects on 13 strains of oral bacteria including those implicated in bad breath at selected posttreatment time points. Treatment of hydroxyapatite by the test dentifrice resulted in a significant and substantive antimicrobial effect vs. controls. Oral bacteria from subjects treated ex vivo with the test dentifrice resulted in significant reductions in cultivable oral bacteria and odorigenic bacteria producing hydrogen sulfide. In summary, microbiological methods adapted to study odorigenic bacteria demonstrate the significant antimicrobial effects of the test (triclosan/copolymer) dentifrice with laboratory and clinical strains of oral bacteria implicated in bad breath.

The oral environment: the challenge for antimicrobials in oral care products

For any antibacterial/ anti-plaque system from an oral care product to be effective, it must firstly be delivered and retained at relevant sites in the oral cavity and secondly, remain active within the chosen formulation to successfully target the biofilm cells within dental plaque. This must include inhibition of the growth and metabolism of relevant organisms associated with disease. This review will concentrate on understanding the environmental conditions in which such oral care products must work and summarise the activity within the oral cavity of the main antibacterial and anti-plaque agents in common oral care products, namely chlorhexidine, essential oils, metal salts and Triclosan. Routes to further enhance the activity of these products, together with the use of relatively novel formats such as confectionery products to provide added consumer oral health benefits will be considered.

A rapid procedure to ascertain the antimicrobial efficacy of oral care formulations

A rapid method examining the antimicrobial efficacy of oral care formulations with alamar blue, an oxidation-reduction dye with fluorescent end-points, is described. Significant correlations between increasing viable plate counts of the oral bacteria Actinomyces viscosus, Streptococcus sanguis, Streptococcus mutans and Actinobacillus actinomycetemcomitans and increased alamar fluorescence were noted. Metabolically active bacteria reduced alamar with the reduced dye found in the cell-free filtrate. Insignificant alamar reductions were noted in the absence of bacteria or by spent culture supernatants. The efficacy of mouthrinses with clinically proven antiplaque agents such as chlorhexidine or cetylpyridinium chloride were determined by alamar blue. In a model system with A. viscosus, triclosan dentifrices demonstrate a dose-dependent effect on bacteria. Human salivary bacteria demonstrate increasing alamar fluorescence with increasing plate counts. A clinical study examined the effects of rinsing with chlorhexidine or cetylpyridinium chloride mouthrinses in comparison with a placebo mouthrinse and water on salivary bacteria. Rinsing with chlorhexidine resulted in the least number of bacteria by alamar and plate count methods. In summary, the current study demonstrates the utility of alamar blue to examine the antimicrobial effects of oral care formulations in laboratory and clinical studies.

Effect of chitosan rinsing on reduction of dental plaque formation

The purpose of the present study was to investigate whether the use of a chitosan mouthrinse could be efficacious in reducing plaque and saliva mutans streptococci level. A randomized crossover clinical trial was performed to evaluate the effect of a rinse with 0.5% chitosan for 14 days on plaque formation and mutans streptococci counts in saliva. Twenty-four subjects were randomly assigned either the chitosan rinse or a placebo rinse in addition to their usual oral hygiene procedures. Following the baseline examination, each subject was given a prophylaxis. They were instructed to rinse with 20 ml of the mouthrinse twice daily for 30 seconds. Plaque scores were measured after a 14-day rinsing period, and mutans streptococci counts in saliva were also determined at the start and the end of the each rinsing period. The procedures were repeated with the alternate rinse after a 14-day washout period. Rinsing with 0.5% chitosan was significantly more effective in plaque reduction using the Quigley & Hein Index (chitosan: 1.44, placebo: 1.62, p < 0.001) and Plaque Severity Index (chitosan: 0.138, placebo: 0.186, p = 0.003). The mutans streptococci count in saliva was less after the chitosan rinsing (chi 2 cal = 13.51, p = 0.035) than placebo rinsing. In conclusion, the chitosan rinsing was effective in reducing plaque formation and counts of salivary mutans streptococci after a 14-day rinsing period. These results would appear to warrant further investigation into the potential value of chitosan as an effective anti-plaque agent for use in oral hygiene products.

Clinical implications of the oral manifestations of HIV infection in children

The authors hypothesized that patients infected with HIV at birth would be more vulnerable to oral diseases such as periodontal disease and caries because of their compromised immune system. As a result, they designed a 3-year, longitudinal, case-controlled study that examined HIV-infected children as compared with their normal noninfected household peers. Over 100 HIV-infected participants ages 2 to 15 years were examined at 6-month intervals; no differences were found with respect to caries or periodontal disease prevalence and incidence when the two groups were compared. Although the level of oral disease was similar in the two groups, both groups had more caries than the national norm. Thus, failure to use a control group would have led to the erroneous conclusion that children with HIV infection had a high level of caries. In addition, the authors discovered that tooth eruption was delayed in the HIV-infected group, suggesting some developmental impediment. The HIV-infected group also showed more oral lesions that included candidiasis, linear gingival erythema, and medial rhomboid glossitis. Overall, oral lesions were not valid predictors of the serious consequences of AIDS. The authors speculated, however, that examinations at intervals more frequent than every 6 months might be required to determine whether oral lesions can predict frank AIDS and lowered CD4 cell counts.

Antiplaque biocides and bacterial resistance: a review

Modern dentistry emphasizes the importance of dental plaque control to improve oral health. The use of oral care formulations with antiplaque biocides plays a crucial role in patient-directed approaches for plaque control. The antiplaque efficacies of these formulations have been extensively studied in many long-term clinical studies designed in accordance with well-accepted guidelines. The results from these studies conclusively demonstrate that long-term use of oral care formulations with well-known antiplaque biocides such as chlorhexidine and triclosan reduce supragingival plaque and gingivitis. This review summarizes microbiological results from clinical studies conducted with oral care formulations containing antiplaque biocides. Results from a number of long-term clinical studies conducted under real-life use conditions indicate no adverse alterations in the bacteria found in dental plaque or emergent microbial resistance. Additionally, microbial sampling of dental plaque subsequent to extended use of antiplaque biocides reveals no increase in resistant microflora. Large numbers of common oral bacteria isolated from patients using chlorhexidine indicate no increase in microbial resistance to chlorhexidine or to commonly used antibiotics. The effects of antiplaque biocides containing oral care formulations on dental plaque that exists naturally as a biofilm are examined. These formulations contain biocide, surfactants, polymers and other components that are effective against the biofilm. In summary, the results of studies on the real-life use of oral care formulations with antiplaque biocides show no emergence of resistant microflora or alterations of the oral microbiota, while such formulations have been found to provide the benefits of reducing plaque and gingivitis.

Effect of molecular mass and degree of deacetylation of chitosan on adsorption of Streptococcus sobrinus 6715 to saliva treated hydroxyapatite

We evaluated the influence of molecular mass and degree of deacetylation of chitosan on the adsorption of Streptococcus sobrinus 6715 to saliva-treated hydroxyapatite (S-HA) by measuring the optical density of the bacterial cell suspensions released from saliva-treated hydroxyapatite. Twenty-five chitosan samples with different molecular masses (0.8-6 kDa) and degrees of deacetylation (10-95%) were prepared for the study. We found that the inhibition of adsorption of S. sobrinus 6715 to S-HA correlated positively with the molecular mass of chitosan (R = 0.876) and that the optimal degree of deacetylation was 50-60% for maximum inhibition of bacterial binding to S-HA. We also examined the effect of chitosan on zeta potentials of the oral bacteria and their surface hydrophobicities. It was observed that chitosan reduced the magnitude of the zeta potential and surface hydrophobicities of the oral bacteria. Thus, the results demonstrated that chitosan with a molecular mass of 5-6 kDa and a degree of deacetylation of 50-60% might have the potential to act as an effective anti-plaque agent because of its polycationic properties.

Nonsurgical periodontal therapy

Regular home care by the patient in addition to professional removal of subgingival plaque is generally very effective in controlling most inflammatory periodontal diseases. When disease does recur, despite frequent recall, it can usually be attributed to lack of sufficient supragingival and subgingival plaque control or to other risk factors that influence host response, such as diabetes or smoking. Causative factors contributing to recurrent disease include deep inaccessible pockets, overhangs, poor crown margins and plaque-retentive calculus. In most cases, simply performing a thorough periodontal debridement under local anesthesia will stop disease progression and result in improvement in the clinical signs and symptoms of active disease. If however, clinical signs of disease activity persist following thorough mechanical therapy, such as increased pocket depths, loss of attachment and bleeding on probing, other pharmacotherapeutic therapies should be considered. Augmenting scaling and root planing or maintenance visits with adjunctive chemotherapeutic agents for controlling plaque and gingivitis could be as simple as placing the patient on an antimicrobial mouthrinse and/or toothpaste with agents such as fluorides, chlorhexidine or triclosan, to name a few. Since supragingival plaque reappears within hours or days after its removal, it is important that patients have access to effective alternative chemotherapeutic products that could help them achieve adequate supragingival plaque control. Recent studies, for example, have documented the positive effect of triclosan toothpaste on the long-term maintenance of both gingivitis and periodontitis patients. Daily irrigation with a powered irrigation device, with or without an antimicrobial agent, is also useful for decreasing the inflammation associated with gingivitis and periodontitis. Clinically significant changes in probing depths and attachment levels are not usually expected with irrigation alone. Recent reports, however, would indicate that, when daily irrigation with water was added to a regular oral hygiene home regimen, a significant reduction in probing depth, bleeding on probing and Gingival Index was observed. A significant reduction in cytokine levels (interleukin-1beta and prostaglandin E2, which are associated with destructive changes in inflamed tissues and bone resorption also occurs. If patient-applied antimicrobial therapy is insufficient in preventing, arresting, or reversing the disease progression, then professionally applied antimicrobial agents should be considered including sustained local drug delivery products. Other, more broadly based pharmacotherapeutic agents may be indicated for multiple failing sites. Such agents would include systemic antibiotics or host modulating drugs used in conjunction with periodontal debridement. More aggressive types of juvenile periodontitis or severe rapidly advancing adult periodontitis usually require a combination of surgical intervention in conjunction with systemic antibiotics and generally are not controlled with nonsurgical anti-infective therapy alone. It should be noted, however, that, to date, no home care products or devices currently available can completely control or eliminate the pathogenic plaques associated with periodontal diseases for extended periods of time. Daily home care and frequent recall are still paramount for long-term success. Nonsurgical therapy remains the cornerstone of periodontal treatment. Attention to detail, patient compliance and proper selection of adjunctive antimicrobial agents for sustained plaque control are important elements in achieving successful long-term results. Frequent re-evaluation and careful monitoring allows the practitioner the opportunity to intervene early in the disease state, to reverse or arrest the progression of periodontal disease with meticulous nonsurgical anti-infective therapy.

Modern supragingival plaque control

Supragingival plaque control is essential for the maintenance of oral health. Despite the many chemotherapeutic agents available as mouthrinses and toothpastes, mechanical plaque removal is still the best method to achieve effective plaque control. This is due, in part, to the lack of development of oral antimicrobials with the effectiveness and substantivity of chlorhexidine gluconate but without its adverse effects of dental staining and calculus formation. The use of the numerous mechanical (manual and electric) oral hygiene devices extant and their effectiveness, however, are dependent upon patient dexterity and compliance and concomitant active professional treatment for the monitoring of home care, oral hygiene instruction and patient motivation. This paper evaluates the current methods available to reduce plaque and gingivitis with emphasis on their effectiveness at both supragingival plaque control and disease prevention. In addition, recent studies on the newer oscillating/rotating electric plaque removers and interdental cleaning devices will be discussed as related to their efficacy and compliance.