Therapeutic effects of supervised chlorhexidine mouthrinses on untreated gingivitis

Evaluation of the Anti-microbial Efficacy of a Novel Endodontic Irrigant Against Enterococcus faecalis: An In Vitro Study

INTRODUCTION

Enterococcus faecalis is a constant microbiome that plays an inevitable role in the etiology of peri radicular lesions after endodontic treatment, chronic and, apical periodontitis and, recently, in periimplantitis. The effective biomechanical preparation and the use of potent irrigating solutions will permit bacterial neutralization and toxin inactivation, leading to the success of endodontic treatment. This study aimed to evaluate the "anti-microbial" efficacy of simvastatin (SMV) against E. faecalis as an endodontic irrigant.

MATERIALS AND METHODS

In this invitro experimental study, the antimicrobial efficacy of SMV was evaluated against E. faecalis using the agar diffusion method. The samples were divided randomly into the following groups. GROUP 1: SMV solution 1 μM/L concentration, GROUP 2: SMV solution 5 μM/L concentration, GROUP 3: SMV solution 10 μM/L concentration, GROUP 4: 2% chlorhexidine gluconate (CHX) solution (positive control), and GROUP 5: normal saline (negative control). Linear measurement was done by measuring the zones of inhibition around the medicaments in the cavities in millimeters. Results were tabulated.

RESULTS

The results of the study have shown the zone of inhibition of Group 4 (2% CHX solution) is 19 mm, which demonstrated the best outcome. When comparing the test samples, Group 3 (SMV solution 10 M/L concentration) has the best zone of inhibition, measuring 14 mm, followed by Group 2 (SMV solution 5 M/L concentration), which is 9 mm.

CONCLUSION

The results of this in vitro study have proven that SMV's anti-microbial activity, albeit less potent than CHX in this in vitro investigation, has demonstrated that it can be utilized as an efficient endodontic irrigant.

Comparative Evaluation of Efficacy of Herbal and Chlorhexidine Mouthwash on Gingival Health

INTRODUCTION

Chlorhexidine (CHX) is a chemical mouthwash that has been considered the gold standard, but has its drawbacks. When used for a longer duration, it produces taste alteration and staining on the tooth surfaces. Nowadays, herbal extracts from plants have been widely used as they possess anti-inflammatory, antimicrobial and analgesic actions.

MATERIAL AND METHODS

A group of 45 healthy subjects in the age group of 19-35 years were selected and randomly divided into three groups, Group A - Himalaya complete care mouthwash, Group B - CHX mouthwash, Group C - Distilled water as a control group. Gingival index and plaque index, OHI-s index, and Ainamo and Bay index for bleeding were recorded. Subjects received complete supragingival scaling at baseline and were instructed to use 10 ml of mouthwashes twice a day in their group. Variables were again recorded on the seventh and 14th day after the use of mouthwashes, and data obtained was subjected to statistical analysis. Posthoc and ANOVA tests were used for statistical analysis.

RESULTS

It was found that both CHX and herbal mouthwash proved to be more effective than placebo in maintaining gingival health. There was no significant difference between the test group on gingival health.

CONCLUSION

Herbal mouthwash is an effective alternative to CHX mouthwash, in the light of the reported side effects of CHX mouthwash.

Photodynamic optimization by combination of xanthene dyes on different forms of Streptococcus mutans: An in vitro study

OBJECTIVE

The photokilling rate in antimicrobial photodynamic therapy (a-PDT) is highly related to interaction of reactive oxygen species (ROS) produced, ability of photosensitizers (PS) in incorporating into microorgansims and light devices/microorganism type. Since xanthene dyes (Rose Bengal and Erythrosine) are present in the dental practice as PS, have high quantum yield of singlet oxygen and are efficiently incorporated into bacterial cells, the additive bactericidal ability of a combination of xanthene dyes was tested on planktonic cultures and biofilms of Streptococcus mutans when irradiated by a hand-held LED photopolymerizer unit.

METHODS

Planktonic cultures of S. mutans (UA 159 ATCC 700610) were grown in BHI broth with 1 % sucrose. This culture was exposed to a concentrations of Rose Bengal (RB) and Erythrosine (ER) at 1.5, 3.5 μM, in combination (RB + ER + L+) / alone (RB + L+/ ER + L+) and irradiated with a blue LED high light intensity (L). Accordingly, concentrations of dyes and time irradiation were increased in 10 times and applied on 120 h - biofilms of S. mutans and compared with a 0.12 % Chlorhexidine solution (0.12 % - CHX). For statistical analysis, parametrical procedures were applied (n = 6; ANOVA test and Tukey post hoc test; α = 0.05) and data transformed into log ₁₀.

RESULTS

Substantial antimicrobial reduction was verified in planktonic cultures (∼ 7 log reduction) and biofilm (∼ 1 log reduction) for combined a-PDT group (RB + ER + L+) presenting a significant statistical difference to control group (p < 0.05) with similar effect to CHX group (p > 0.05).

CONCLUSION

Different forms of S. mutans can be effectively controlled by photodynamic therapy and optimized when in combination of xanthene dyes.

Effectiveness of herbal oral care products in reducing dental plaque & gingivitis - a systematic review and meta-analysis

Background

Despite the large number of trials conducted using herbal oral care products for the reduction of dental plaque or gingivitis, results are conflicting and inconclusive.

Objective

To assess the effectiveness of herbal oral care products compared to conventional products in reducing dental plaque and gingivitis adults.

Methods

We searched the following databases for Randomised controlled trials (RCTs): MEDLINE Ovid, EMBASE Ovid etc. which yielded 493 trails. Of which 24 RCTs comparing herbal toothpaste or mouth rinse with over the counter toothpaste or mouth rinse in adults aged 18 to 65 years were included. Two authors extracted information and assessed the methodological quality of the included studies using Risk of Bias. Meta-analyses using the random-effects model were conducted for four outcomes for tooth paste and mouth rinse respectively. Mean difference (MD) or standardized mean difference (SMD) were used to estimate the effect, with 95% confidence intervals.

Results

A total of 1597 adults participated in 24 RCT studies. These were classified as herbal toothpaste (HTP) (15 trials, 899 participants) and herbal mouth rinse (HMR) (9 trials, 698 participants) compared with non-herbal toothpaste (NHTP) or non-herbal mouth rinse (NHMR). We found that HTP was superior over NHTP (SMD 1.95, 95% CI (0.97–2.93)) in plaque reduction. The long-term use of NHMR was superior in reduction of dental plaque over HMR (SMD -2.61, 95% (CI 4.42–0.80)). From subgroup analysis it showed that HTP was not superior over fluoride toothpaste (SMD 0.99, 95% CI (0.14–2.13)) in reducing dental plaque. However, HTP was favoured over non-fluoride toothpaste (SMD 4.64, 95% CI (2.23–7.05)).

Conclusion

For short-term reduction in dental plaque, current evidence suggests that HTP is as effective as compared to NHTP; however, evidence is from low quality studies.

Topical application of glycyrrhetinic acid in the gingival sulcus inhibits attachment loss in lipopolysaccharide-induced experimental periodontitis in rats

BACKGROUND AND OBJECTIVE

Attachment loss of the junctional epithelium and alveolar bone destruction are signs of periodontitis, which is mainly caused by an inflammatory response to dental plaque. Glycyrrhetinic acid (GA), a component of the licorice herb, has been shown to have important anti-inflammatory activities; however, there are no previous reports on the ability of its inhibitory effects to prevent periodontal diseases. Hence, in this study, using our experimental periodontitis model, we attempted to evaluate whether GA had an effect on the prevention of attachment loss and alveolar bone loss.

MATERIAL AND METHODS

Rats were intraperitoneally immunized with Escherichia coli lipopolysaccharide (LPS). The LPS group (n = 5) received 3 topical applications of 50 μg/μL of LPS followed by one application of the vehicle (propylene glycol:ethyl alcohol:phosphate-buffered saline [PBS] = 8:1:1) into the gingival sulcus. This protocol was repeated twice per day for 10 days. The low (n = 5) and high (n = 5) groups received topical application of LPS and 0.03% or 0.3% GA, respectively. The control group received topical application of PBS and vehicle. The rats were killed on the 10th day. Attachment loss, alveolar bone level and inflammatory cell infiltration were investigated histometrically. The formation of immune complexes and infiltration of LPS were evaluated immunohistologically.

RESULTS

Attachment loss, formation of immune complexes and infiltration of inflammatory cells were increased in the LPS group compared with the control group, and were completely inhibited in the low and high groups compared with the LPS group. The LPS group showed greater alveolar bone destruction compared with the control group and GA-treated groups. In addition, invasion of LPS was detected in the LPS group, was absent in the control group and was weaker in the GA-treated groups than in the LPS group.

CONCLUSION

In the present study, we showed that GA inhibits periodontal destruction in the rat experimental periodontitis model.

Chlorhexidine mouthrinse as an adjunctive treatment for gingival health

BACKGROUND

Dental plaque associated gingivitis is a reversible inflammatory condition caused by accumulation and persistence of microbial biofilms (dental plaque) on the teeth. It is characterised by redness and swelling of the gingivae (gums) and a tendency for the gingivae to bleed easily. In susceptible individuals, gingivitis may lead to periodontitis and loss of the soft tissue and bony support for the tooth. It is thought that chlorhexidine mouthrinse may reduce the build-up of plaque thereby reducing gingivitis.

OBJECTIVES

To assess the effectiveness of chlorhexidine mouthrinse used as an adjunct to mechanical oral hygiene procedures for the control of gingivitis and plaque compared to mechanical oral hygiene procedures alone or mechanical oral hygiene procedures plus placebo/control mouthrinse. Mechanical oral hygiene procedures were toothbrushing with/without the use of dental floss or interdental cleaning aids and could include professional tooth cleaning/periodontal treatment.To determine whether the effect of chlorhexidine mouthrinse is influenced by chlorhexidine concentration, or frequency of rinsing (once/day versus twice/day).To report and describe any adverse effects associated with chlorhexidine mouthrinse use from included trials.

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 28 September 2016); the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 8) in the Cochrane Library (searched 28 September 2016); MEDLINE Ovid (1946 to 28 September 2016); Embase Ovid (1980 to 28 September 2016); and CINAHL EBSCO (Cumulative Index to Nursing and Allied Health Literature; 1937 to 28 September 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.

SELECTION CRITERIA

We included randomised controlled trials assessing the effects of chlorhexidine mouthrinse used as an adjunct to mechanical oral hygiene procedures for at least 4 weeks on gingivitis in children and adults. Mechanical oral hygiene procedures were toothbrushing with/without use of dental floss or interdental cleaning aids and could include professional tooth cleaning/periodontal treatment. We included trials where participants had gingivitis or periodontitis, where participants were healthy and where some or all participants had medical conditions or special care needs.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened the search results extracted data and assessed the risk of bias of the included studies. We attempted to contact study authors for missing data or clarification where feasible. For continuous outcomes, we used means and standard deviations to obtain the mean difference (MD) and 95% confidence interval (CI). We combined MDs where studies used the same scale and standardised mean differences (SMDs) where studies used different scales. For dichotomous outcomes, we reported risk ratios (RR) and 95% CIs. Due to anticipated heterogeneity we used random-effects models for all meta-analyses.

MAIN RESULTS

We included 51 studies that analysed a total of 5345 participants. One study was assessed as being at unclear risk of bias, with the remaining 50 being at high risk of bias, however, this did not affect the quality assessments for gingivitis and plaque as we believe that further research is very unlikely to change our confidence in the estimate of effect. Gingivitis After 4 to 6 weeks of use, chlorhexidine mouthrinse reduced gingivitis (Gingival Index (GI) 0 to 3 scale) by 0.21 (95% CI 0.11 to 0.31) compared to placebo, control or no mouthrinse (10 trials, 805 participants with mild gingival inflammation (mean score 1 on the GI scale) analysed, high-quality evidence). A similar effect size was found for reducing gingivitis at 6 months. There were insufficient data to determine the reduction in gingivitis associated with chlorhexidine mouthrinse use in individuals with mean GI scores of 1.1 to 3 (moderate or severe levels of gingival inflammation). Plaque Plaque was measured by different indices and the SMD at 4 to 6 weeks was 1.45 (95% CI 1.00 to 1.90) standard deviations lower in the chlorhexidine group (12 trials, 950 participants analysed, high-quality evidence), indicating a large reduction in plaque. A similar large reduction was found for chlorhexidine mouthrinse use at 6 months. Extrinsic tooth staining There was a large increase in extrinsic tooth staining in participants using chlorhexidine mouthrinse at 4 to 6 weeks. The SMD was 1.07 (95% CI 0.80 to 1.34) standard deviations higher (eight trials, 415 participants analysed, moderate-quality evidence) in the chlorhexidine mouthrinse group. There was also a large increase in extrinsic tooth staining in participants using chlorhexidine mouthrinse at 7 to 12 weeks and 6 months. Calculus Results for the effect of chlorhexidine mouthrinse on calculus formation were inconclusive. Effect of concentration and frequency of rinsing There were insufficient data to determine whether there was a difference in effect for either chlorhexidine concentration or frequency of rinsing. Other adverse effects The adverse effects most commonly reported in the included studies were taste disturbance/alteration (reported in 11 studies), effects on the oral mucosa including soreness, irritation, mild desquamation and mucosal ulceration/erosions (reported in 13 studies) and a general burning sensation or a burning tongue or both (reported in nine studies).

AUTHORS' CONCLUSIONS

There is high-quality evidence from studies that reported the Löe and Silness Gingival Index of a reduction in gingivitis in individuals with mild gingival inflammation on average (mean score of 1 on the 0 to 3 GI scale) that was not considered to be clinically relevant. There is high-quality evidence of a large reduction in dental plaque with chlorhexidine mouthrinse used as an adjunct to mechanical oral hygiene procedures for 4 to 6 weeks and 6 months. There is no evidence that one concentration of chlorhexidine rinse is more effective than another. There is insufficient evidence to determine the reduction in gingivitis associated with chlorhexidine mouthrinse use in individuals with mean GI scores of 1.1 to 3 indicating moderate or severe levels of gingival inflammation. Rinsing with chlorhexidine mouthrinse for 4 weeks or longer causes extrinsic tooth staining. In addition, other adverse effects such as calculus build up, transient taste disturbance and effects on the oral mucosa were reported in the included studies.

The effect of adjunctive chlorhexidine mouthrinse on GCF MMP-8 and TIMP-1 levels in gingivitis: a randomized placebo-controlled study

Background

The aim of the present study was to evaluate the effect of adjunctive chlorhexidine (CHX) mouthrinse on gingival crevicular fluid (GCF) MMP-8 and TIMP-1 levels in plaque-associated gingivitis.

Methods

A total of 50 gingivitis patients were included in the present study. In addition to daily plaque control, CHX group rinsed with CHX, while placebo group rinsed with placebo mouthrinse for 4 weeks. GCF samples were collected, and clinical parameters including plaque index, papillary bleeding index, calculus index and pocket depth were recorded at baseline and 4 weeks. GCF MMP-8 and TIMP-1 levels were determined by immunofluorometric assay (IFMA) and enzyme-linked immunosorbent assay (ELISA), respectively.

Results

In both groups, GCF MMP-8 levels of anterior and posterior sites at four weeks were not different from baseline (p > 0.05). There were no significant differences in GCF MMP-8 levels between the study groups at four weeks (p > 0.05). GCF TIMP-1 levels of anterior and posterior sites at four weeks were higher compared to baseline in both groups (p < 0.05). There was no significant difference in GCF TIMP level between the study groups at four weeks (p > 0.05).

Conclusions

CHX usage had no significant effects on the GCF MMP-8 and TIMP-1 levels in plaque-associate gingivitis. However, daily plaque control resulted in the increase of GCF TIMP-1 levels regardless of CHX usage.

Staining and calculus formation after 0.12% chlorhexidine rinses in plaque-free and plaque covered surfaces: a randomized trial

Objectives

Studies concerning side effects of chlorhexidine as related to the presence of plaque are scarce. The purpose of this study was to compare the side effects of 0.12% chlorhexidine gluconate (CHX) on previously plaque-free (control group) and plaque-covered surfaces (test group).

Methods

This study had a single-blind, randomized, split-mouth, 21 days-experimental gingivitis design, including 20 individuals who abandoned all mechanical plaque control methods during 25 days. After 4 days of plaque accumulation, the individuals had 2 randomized quadrants cleaned, remaining 2 quadrants with plaque-covered dental surfaces. On the fourth day, the individuals started with 0.12% CHX rinsing lasting for 21 days. Stain index intensity and extent as well as calculus formation were evaluated during the experimental period.

Results

Intergroup comparisons showed statistically higher (p<0.05) stain intensity and extent index as well as calculus formation over the study in test surfaces as compared to control surfaces. Thus, 26.19% of test surfaces presented calculus, whereas calculus was observed in 4.52% in control surfaces.

Conclusion

The presence of plaque increased 0.12% CHX side effects. These results strengthen the necessity of biofilm disruption prior to the start of CHX mouthrinses in order to reduce side effects.

Effects of chlorhexidine on a tongue-flora microcosm and VSC production using an in vitro biofilm perfusion model

An in vitro perfusion biofilm model, derived from tongue-scrape microflora removed from one individual, was employed to study sulfide biogenesis and the effects of repeated exposure to chlorhexidine (CHX). Volatile sulfur compounds (VSC) were measured using a carbon veil electrode within the biofilm and a halimeter for liquid and gas phase levels, respectively. The microflora of the perfusate and the biofilm were assessed by microbiological techniques and polymerase chain reaction (PCR) to estimate diversity. Biofilms treated with a 1 mL pulse of 0.1% CHX twice a day for three days showed (1) a large reduction in viable count (>90% kill), (2) a (slow) reduction in the VSC production rate, consistent with the reduction in microbes rather than direct inhibitory effects on the biotransformation steps, and (3) a preferential reduction of strict anaerobes. Treated biofilms allowed to recover over 3-5 days showed a nominal amount of regrowth in some experiments, although population numbers were still well below those found in untreated controls. The microbiological composition of biofilms treated but allowed to recover was markedly different from the controls, with proportionally fewer strict anaerobes. Thus, CHX treatment caused detectable ecological shifts with consequent long-term effects on the response of the biofilm in terms of VSC generation, consistent with clinical observations. The model appears highly suited for testing the efficacy of putative anti-malodour or antimicrobial agents.

The Impact of a Low-Frequency Chlorhexidine Rinsing Schedule on the Subgingival Microbiota (the TEETH clinical trial)

BACKGROUND

Information on the efficacy of chlorhexidine (CHX) rinsing on the subgingival microbiota is limited. This study tested if intermittent CHX rinsing over 5 years had an impact on the subgingival microbiota.

METHODS

Subgingival plaque samples were analyzed by the checkerboard DNA-DNA hybridization method in a double-blind randomized CHX rinse study.

RESULTS

A total of 210 subjects were included. The mean age of the subjects was 71.7 (+/- 4.1) years, and 56.2% were women. Evidence of alveolar bone loss was found in 39% of subjects. Bacterial loads were not correlated significantly with probing depth. At year 5, subjects in the CHX rinse group with no evidence of bone loss presented with lower total bacterial counts than control subjects with no bone loss. The levels of the following bacteria were significantly lower in the CHX group: Lactobacillus acidophilus (P <0.05), Eikenella corrodens (P <0.05), Fusobacterium nucleatum sp. nucleatum (P <0.01), Treponema denticola (P <0.05), Leptotrichia buccalis (P <0.05), and Eubacterium saburreum (P <0.05). No differences in bacterial loads were found between CHX and control rinse subjects with alveolar bone loss.

CONCLUSIONS

Older subjects with or without periodontitis carry a large variety of bacteria associated with periodontitis. Intermittent rinsing with CHX may provide a preventive benefit in reducing levels of bacteria but only in subjects without alveolar bone loss.

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

AIM

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Viruses in periodontal disease - a review

The purpose of this review was to evaluate the evidence supporting the hypothesis that viral infection plays a role in the development of periodontitis. An involvement in periodontal diseases has been suspected specifically for human immunodeficiency virus (HIV) and herpes viruses. An association has been demonstrated between HIV infection and some distinct forms of periodontal infection, i.e. necrotizing lesions. Furthermore, reports of increased prevalence and severity of chronic periodontitis in HIV-positive subjects suggests that HIV infection predispose to chronic periodontitis. Several studies, most of them from the same research group, have demonstrated an association of herpesviruses with periodontal disease. Viral DNA have been detected in gingival tissue, gingival cervicular fluid (GCF) and subgingival plaque from periodontaly diseased sites. In addition markers of herpesviral activation have been demonstrated in the GCF from periodontal lesions. Active human cytomegalovirus (HCMV) replication in periodontal sites may suggest that HCMV re-activation triggers periodontal disease activity. Concerns regarding sampling, methods and interpretation cast doubts on the role of viruses as causes of periodontal disease.

Characterization of Actinobacillus actinomycetemcomitans isolated from young Chinese aggressive periodontitis patients

OBJECTIVE

This study characterized Actinobacillus actinomycetemcomitans isolates from young Chinese aggressive periodontitis patients.

METHODS

Subgingival plaque samples (two/subject) were collected from diseased subjects < 25 years old (n = 9, mean age 21.1 +/- 1.6 years) and age-matched periodontitis-free controls (n = 47, mean age 22.0 +/- 1.1 years). Selective and anaerobic culture were used. The serotype, leukotoxin gene (ltx) operon promoter and the cytolethal distending toxin (cdt) genes complex of the A. actinomycetemcomitans isolates were investigated. Effects of the isolates on non-keratinizing periodontal ligament epithelial cells monolayer were studied.

RESULTS

Diseased subjects had significantly higher full-mouth bleeding score (p = 0.002) and total viable counts from plaque samples (7.2 x 10(6) vs. 2.1 x 10(5) CFU/paperpoint, p < 0.005). A. actinomycetemcomitans was isolated from 67%/56% or 6%/4% of diseased or controls subject/sites, respectively (p < 0.001). The proportion of A. actinomycetemcomitans isolatable from aggressive periodontitis or periodontitis-free associated subgingival plaque was low (0.7% vs. 0.1%, p < 0.02). The serotype of the isolates was characterized. All isolates possessed 652-like ltx gene promoter and all but one serotype c isolate from a diseased patient had intact cdtABC genes. That particular strain appeared to confer the least cellular damages on periodontal ligament epithelial monolayer compared to others.

CONCLUSION

This preliminary study confirmed the notion of increased prevalence and quantity of A. actinomycetemcomitans associated with aggressive periodontitis in young patients. The overall ltx promoter and cdt characteristics of the A. actinomycetemcomitans isolates, however, were similar among the diseased and control groups. A strain lacking the cdtABC gene appeared to be less damaging to a periodontal ligament epithelial cell model. Further studies therefore are warranted to clarify the pathogenic role and potentials of A. actinomycetemcomitans in aggressive periodontitis.

The effect of two different dental gels and a mouthwash on plaque and gingival scores: a six-week clinical study

AIM

To evaluate the clinical efficacy of two gel formulations containing chlorhexidine gluconate and neem extract with a commercially available chlorhexidine gluconate mouthwash.

METHOD

An open labelled randomised six-week clinical study with parallel group design in 48 subjects divided into four groups. Plaque accumulation and gingival condition were recorded using plaque index and gingival index. On the basis of mean baseline plaque and gingival scores, subjects were allocated to four different groups, using their assigned products twice a day, before bed and after breakfast. Plaque and gingival scores were recorded after three and six weeks.

RESULTS

Mean plaque and gingival scores were reduced over the six-week trial period for experimental and control groups. Chlorhexidine gluconate gel reduced the plaque and gingival scores significantly more (p<0.05) than the chlorhexidine gluconate mouthwash. Neem extract gel also showed significant (p<0,05) reduction in plaque and gingival scores when compared with the control group. But there was no significant difference between the groups treated with chlorhexidine gel and neem extract gel.

CONCLUSION

The results of this clinical study indicate that better therapeutic efficacy can be achieved using gels for treating oral infections than conventional treatments using mouthwash.

Attachment of Periodontal Ligament Cells to Chlorhexidine-Loaded Guided Tissue Regeneration Membranes

BACKGROUND

Early exposure of a guided tissue regeneration (GTR) membrane in the oral cavity results in bacterial contamination, which may lead to failure or incomplete regeneration. Incorporation of antimicrobial agents in GTR membranes may be valuable to control membrane-associated infection during GTR therapy. The purpose of this study was to evaluate whether the incorporation of chlorhexidine into various GTR membranes improves the attachment of periodontal ligament cells in the presence of Actinobacillus actinomycetemcomitans.

METHODS

The possible effects of chlorhexidine on the viability of primary human periodontal ligament (PDL) cells were determined using 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyltetrazolium bromide (MTT), which measures cellular metabolic activity. An expanded polytetrafluoroethylene (ePTFE) membrane, glycolide fiber membrane, and collagen membrane were loaded with chlorhexidine and characterized. Attachment of PDL cells to the chlorhexidine-loaded membranes with or without A. actinomycetemcomitans was examined using scanning electron microscopy (SEM) analysis.

RESULTS

Relative cellular viability of PDL cells was reduced to approximately 50% when 15 microg/ml (0.0015%) of chlorhexidine was used. Chlorhexidine released from the coated GTR membranes inhibited the growth of A. actinomycetemcomitans. At the concentration used in this study, chlorhexidine incorporated into the GTR membranes did not interfere with the attachment of PDL cells. The inhibitory effects of A. actinomycetemcomitans on cellular attachment were reduced using chlorhexidine-loaded membranes, including ePTFE, glycolide fiber, and collagen membranes.

CONCLUSIONS

These results suggest that incorporation of chlorhexidine into GTR membranes is beneficial in reducing bacterial effects on cellular attachment. The future application of chlorhexidine-loaded membranes during GTR therapy may be of value.

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

BACKGROUND/AIMS

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Effectiveness of 0.12% Chlorhexidine Gluconate Oral Rinse in Reducing Prevalence of Nosocomial Pneumonia in Patients Undergoing Heart Surgery

• Background Decreasing the levels of bacteria in the oropharynx should reduce the prevalence of nosocomial pneumonia.

• Objectives To test the effectiveness of 0.12% chlorhexidine gluconate oral rinse in decreasing microbial colonization of the respiratory tract and nosocomial pneumonia in patients undergoing open heart surgery.

• Methods A prospective, randomized, case-controlled clinical trial design was used. Peridex (0.12% chlorhexidine gluconate) was the experimental drug, and Listerine (phenolic mixture) was the control drug. A total of 561 patients undergoing aortocoronary bypass or valve surgery requiring cardiopulmonary bypass were randomized to an experimental (n = 270) or a control (n = 291) group. Nosocomial pneumonia was diagnosed by using the criteria established by the Centers for Disease Control and Prevention.

• Results The overall rate of nosocomial pneumonia was reduced by 52% (4/270 vs 9/291; P = .21) in the Peridex-treated patients. Among patients intubated for more than 24 hours who had cultures that showed microbial growth (all pneumonias occurred in this group), the pneumonia rate was reduced by 58% (4/19 vs 9/18; P = .06) in patients treated with Peridex. In patients at highest risk for pneumonia (intubated &gt;24 hours, with cultures showing the most growth), the rate was 71% lower in the Peridex group than in the Listerine group (2/10 vs 7/10; P = .02).

• Conclusions Although rates of nosocomial pneumonia were lower in patients treated with Peridex than in patients treated with Listerine, the difference was significant only in those patients intubated more than 24 hours who had the highest degree of bacterial colonization.

Efficacy of chlorhexidine mouthrinses with and without alcohol: a clinical study

BACKGROUND

Plaque control is the main method for preventing periodontal diseases. Chlorhexidine digluconate mouthrinse is widely recognized as helping to maintain plaque control. Most of these mouthrinses contain alcohol, making them impractical for many patients, including those with oral mucosal hypersensitivity. Mouthrinses without alcohol might cause fewer side effects, but also be less efficient. In this study, we evaluated the efficacy of a 0.12% chlorhexidine mouthrinse without alcohol against one with 11% ethanol and a placebo.

METHODS

This a double-blind, parallel group study with 96 patients who tested 3 mouthrinses containing 1) chlorhexidine digluconate 0.12% sodium fluoride 0.05%, and ethanol 11% (group 1; CHX-A); 2) the same solution without alcohol (group 2; CHX-NA); and a placebo (group 3; P). Plaque and bleeding indexes were recorded in all patients prior to treatment and at 14 and 28 days.

RESULTS

There were significant differences in plaque, gingivitis, and papilla bleeding indexes in both chlorhexidine rinses compared to placebo, but no differences between the 2 CHX products.

CONCLUSIONS

In this study, the alcohol-free rinse was as effective as one containing alcohol in controlling plaque and reducing gingival inflammation. Therefore, it would seem that its use can be recommended in all patients, but especially in patients for whom the use of alcohol is contraindicated.

The effect of chlorhexidine acetate/xylitol chewing gum on the plaque and gingival indices of elderly occupants in residential homes

AIM

A randomised, controlled, double-blind, clinical trial was conducted to investigate the effect of a chlorhexidine acetate/xylitol gum (ACHX) on the plaque and gingival indices of 111 elderly occupants in residential homes. A gum containing xylitol alone (X) and a no gum (N) group was included. Participants' opinions about chewing gum were also investigated.

METHODS

Subjects chewed 2 pellets, for 15 min, 2x daily for 12 months.

RESULTS

In the ACHX group, the plaque and gingival indices significantly decreased (p<0.001) over the 12 months. In the X group, only the plaque score significantly decreased (p<0.05) and in the N control group, both indices remained high and did not change significantly. The acceptance of both chewing gums was high but more participants in the ACHX group felt that the gum kept their mouth healthy (p<0.05). The effect of the ACHX gum on plaque and gingival indices was significantly greater than for the X gum.

CONCLUSION

The long-term use of a chlorhexidine acetate/xylitol chewing gum may therefore support oral hygiene routines for an elderly dependent population.