Clinical and microbiological efficacy of chlorine dioxide in the management of chronic atrophic candidiasis: an open study

Strategies for Preventing and Treating Oral Mucosal Infections Associated with Removable Dentures: A Scoping Review

Oral infections occur due to contact between biofilm rich in Candida albicans formed on the inner surface of complete dentures and the mucosa. This study investigated historical advances in the prevention and treatment of oral mucosal infection and identified gaps in the literature. Bibliographic research was conducted, looking at PubMed, Embase, Web of Science, and Scopus, where 935 articles were found. After removing duplicates and excluding articles by reading the title and abstract, 131 articles were selected for full reading and 104 articles were included. Another 38 articles were added from the gray literature. This review followed the PRISMA-ScR guidelines. The historical period described ranges from 1969 to 2023, in which, during the 21st century, in vitro and in vivo studies became more common and, from 2010 to 2023, the number of randomized controlled trials increased. Among the various approaches tested are the incorporation of antimicrobial products into prosthetic materials, the improvement of oral and denture hygiene protocols, the development of synthetic and natural products for the chemical control of microorganisms, and intervention with local or systemic antimicrobial agents. Studies report good results with brushing combined with sodium hypochlorite, and new disinfectant solutions and products incorporated into prosthetic materials are promising.

CLEANING OF REMOVABLE DENTAL PROSTHESES - A SYSTEMATIC REVIEW

Objectives The aim of this systematic review was to provide an overview of the scientific evidence available from prospective clinical studies regarding denture hygiene interventions. Therefore, investigations addressing the efficacy of removing microorganisms and biofilms formed on the surface of removable dental prostheses (RDPs) and denture base materials in situ and their impact on the properties of denture base materials, such as color stability, surface roughness, and dimensional stability, were included. Methods A systematic literature search was conducted from June 1975-May 2020 and included articles published in English that have been indexed in the digital archives of PubMed and Cochrane (including PubMed, Embase, ICTRP, CT.gov). A complementary manual search of the initially retrieved studies was conducted. Inclusion criteria comprised prospective clinical trials with a minimum of ten participants investigating (1) approaches and methods to remove biofilms formed on the surface of RDPs and denture base materials in situ and/or (2) the influence of these biofilms on denture base materials. A total of forty-four studies were included in this systematic review, which was registered in the PROSPERO database (CRD42020189649). Results and Conclusions Data gathered from the systematic review indicate that the combined use of chemical and mechanical denture hygiene interventions is significantly more effective than single cleaning approaches. Only limited evidence is available from clinical studies regarding the effect of denture hygiene interventions on the properties of denture base materials.

Effects of Chlorine Dioxide on Oral Hygiene - A Systematic Review and Meta-analysis

Background

Effective and selective oral rinses are required in the daily medical and dental practice. Currently mouthwashes used have substantial side effects.

Objectives

Our aim was to evaluate the efficacy of chlorine dioxide-containing mouthwashes in comparison with other previously established mouth rinses in healthy adults using oral hygiene indices.

Methods

This work was registered in PROSPERO (CRD42018099059) and carried out using multiple databases and reported according to the PRISMA statement. The search terms used were “chlorine dioxide” AND “oral”, and only randomised controlled trials (RCTs) were included. The primary outcome was the alteration of the plaque index (PI), while the secondary outcomes were the gingival index (GI) and bacterial counts. For the risk of bias assessment, the Cochrane Risk of Bias Tool was used. Statistical analysis for data heterogeneity was performed by Q-value and I²-tests.

Results

364 articles were found in the databases. After the selection process, only five RCTs were eligible for meta-analysis. Data heterogeneity was low. There were no statistical differences in effectiveness between chlorine dioxide and other effective mouth rinses in PI (0.720±0.119 vs 0.745±0.131; 95%; confidence intervals (CIs): 0.487-0.952 vs 0.489-1.001, respectively) and GI (0.712±0.130 vs 0.745±0.131; 95% CIs: 0.457–0.967 vs 0.489–1.001, respectively) and also in bacterial counts.

Conclusion

Chlorine dioxide reduces both plaque and gingival indices and bacterial counts in the oral cavity similar to other routinely used oral rinses, however, the evidence supporting this outcome is very limited. Therefore, further large scale RCTs are needed to decrease the risk of bias.

Acidified sodium chlorite solution: A potential prophylaxis to mitigate impact of multiple exposures to COVID-19 in frontline health-care providers

Limited availability of personal protective equipment is endangering first-line health-care providers treating patients with presumed or confirmed COVID-19 infections. This editorial has multiple objectives in regard to this reality: First, to raise awareness of the need for safe and effective prophylaxis to protect health-care providers with insufficient personal protective equipment from repeated exposures to COVID-19. Second, to summarize the scientific evidence in support of solutions of acidified sodium chlorite (ASC) and its daughter compounds, chlorous acid and chlorine dioxide, as potential targets for said prophylactic use. Third, to propose a regimented protocol using commercially available solutions of ASC having sufficient concentrations of chlorine dioxide for virucidal activity to support safe and effective prophylactic use. And fourth, to raise awareness of and compare other potential prophylactic options currently under investigation.

Effect of Aloe vera, chlorine dioxide, and chlorhexidine mouth rinses on plaque and gingivitis: A randomized controlled trial

OBJECTIVE

To evaluate the effect of Aloe vera, chlorine dioxide, and chlorhexidine mouth rinses on plaque and gingivitis in orthodontic treatment.

MATERIALS AND METHODS

A randomized single-center, single-blind, parallel group, controlled trial was conducted among 90 subjects undergoing fixed orthodontic treatment. The subjects were randomly divided into one of the three study groups (Aloe vera, chlorhexidine, chlorine dioxide). Plaque and gingivitis were assessed using modified Silness and Loe Plaque Index and Gingival Index at baseline and at follow-up after 15 days. Paired t-test and ANOVA with post hoc Dunnett test were used. A p-value of <0.05 was considered statistically significant.

RESULTS

A total of 85 participants completed the study; among them, 40 were male and 45 were female. There was significant reduction in mean plaque and gingival scores in all the 3 groups at follow-up when compared to baseline. A significantly higher reduction (plaque and gingival scores) was found in chlorhexidine when compared with the Aloe vera group. However, no significant difference was seen between chlorhexidine and chlorine dioxide with respect to mean reduction in plaque and gingival scores.

CONCLUSION

Chlorine dioxide can be a suitable and economical alternative for chlorhexidine. Further long-term studies are recommended for evaluating their effectiveness.

Comparing the efficacy of hyper-pure chlorine-dioxide with other oral antiseptics on oral pathogen microorganisms and biofilm in vitro

This study examines the antibacterial properties of sodium hypochlorite (NaOCl), chlorhexidine gluconate (CHX), Listerine®, and high purity chlorine dioxide (Solumium, ClO2) on selected common oral pathogen microorganisms and on dental biofilm in vitro. Antimicrobial activity of oral antiseptics was compared to the gold standard phenol. We investigated Streptococcus mutans, Lactobacillus acidophilus, Enterococcus faecalis, Veillonella alcalescens, Eikenella corrodens, Actinobacillus actinomycetemcomitans and Candida albicans as some important representatives of the oral pathogens. Furthermore, we collected dental plaque from the upper first molars of healthy young students. Massive biofilm was formed in vitro and its reduction was measured after treating it with mouthrinses: CHX, Listerine® or hyper pure ClO2. Their biofilm disrupting effect was measured after dissolving the crystal violet stain from biofilm by photometer. The results have showed that hyper pure ClO2 solution is more effective than other currently used disinfectants in case of aerobic bacteria and Candida yeast. In case of anaerobes its efficiency is similar to CHX solution. The biofilm dissolving effect of hyper pure ClO2 is significantly stronger compared to CHX and Listerine® after 5 min treatment. In conclusion, hyper pure ClO2 has a potent disinfectant efficacy on oral pathogenic microorganisms and a powerful biofilm dissolving effect compared to the current antiseptics, therefore high purity ClO2 may be a new promising preventive and therapeutic adjuvant in home oral care and in dental or oral surgery practice.

Chemometric analysis of the consumption of oral rinse chlorite (ClO2-) by human salivary biomolecules

OBJECTIVES

Oral rinse formulations containing chlorite anion (ClO(2)(-)) as an active agent exert a range of valuable oral healthcare activities. However, salivary biomolecules which chemically react with this oxidant can, at least in principle, serve as potentially significant barriers to these therapeutic properties in the oral environment. Therefore, in this investigation, we have explored the extent of ClO(2)(-) consumption by biomolecules which scavenge this agent in human salivary supernatants (HSSs) in vitro.

MATERIALS AND METHODS

HSS samples were equilibrated with oral rinse formulations containing this active agent (30 s at 35 °C in order to mimic oral rinsing episodes). Differential spectrophotometric and ion-pair reversed-phase high-performance liquid chromatographic analyses were employed to determine residual ClO(2)(-) in these admixtures.

RESULTS

Bioanalytical data acquired revealed the rapid consumption of ClO(2)(-) by biomolecular electron donors and/or antioxidants present in HSS samples. Mean ± 95 % confidence interval (CI) consumption levels of 7.14 ± 0.69 and 5.34 ± 0.69 % of the total ClO(2)(-) available were found for oral rinse products containing 0.10 and 0.40 % (w/v) ClO(2)(-), respectively. A mixed model analysis-of-variance performed on experimental data acquired demonstrated highly-significant differences between oral rinse ClO(2)(-) contents (p < 0.0001), trial participants (p < 0.001) and sampling days-within-participants (p < 0.001), and also revealed non-additive ClO(2)(-)-scavenging responses of participants' HSSs to increases in the oral rinse content of this oxidant (p < 0.0001). A slower, second phase of the reaction process (t (1/2) = 1.7-2.8 h) involved the oxidative consumption of salivary urate.

CONCLUSIONS

These data clearly demonstrate that for recommended 30 s oral rinsing episodes performed at physiological temperature, <10 % of the total oral rinse ClO(2)(-) available is chemically and/or reductively consumed by HSS biomolecules for both oral rinse formulations investigated.

CLINICAL RELEVANCE

These observations are of much clinical significance in view of the retention of these products' active agent, i.e. <10 % of ClO(2)(-) is consumed by HSS biomolecules within recommended 30 s oral rinsing episodes, and hence, the bulk of this oxyhalogen oxidant (>90 %) may effectively exert its essential microbicidal, anti-periodontal and oral malodour-neutralising actions.

The bactericidal effects of an acidified sodium chlorite-containing oral moisturizing gel: a pilot study

The aim of this study was to examine the bactericidal effects and bactericidal time of an acidified sodium chlorite compound gel (ASC-Gel) on bacteria isolated from the peri-implant sulci of 10 patients who received implants 3-27 years previously, and the depth of each peri-implant sulcus was 5 mm or less. Porphyromonas gingivalis (ATCC33277) was used as the control bacterium. Five ASC-Gel preparations were created by adding 3.3%, 5.0%, 7.0%, 9.0%, and 11.0% citric acid (CA) (condition a, b, c, d, and e, respectively) into an oral moisturizing gel containing sodium chlorite. The concentrations of chlorine dioxide (ClO2) generated in ASC-Gel under conditions (a) to (e) were 12.1, 14.1, 17.2, 21.2, and 39.3 ppm, respectively. We examined the bactericidal effects of the 5 ASC-Gel preparations at volumes of 0.5, 1.0, and 2.0 mL, and measured the bactericidal time when 2.0 mL of ASC-Gel was used under condition (e). The bactericidal effects of ASC-Gel became significantly greater with increased concentrations of CA and ClO2 and with increased usage (0.5-2.0 mL) of the gel. All bacteria were killed by using 2.0 mL of ASC-Gel under condition (e). ASC-Gel also needed between 45 and 90 minutes to kill all microbes under condition (e). Within the limits of the present investigation, these results suggest that ASC-Gel is useful as a chemical disinfectant against bacteria in the peri-implant sulcus. Further studies are also required to protect teeth, the surface of hydroxyapatite-coated implants, and the surrounding soft tissues from effects of chemical dissolution such as acid erosion due to the low pH of ASC-Gel.

In vivo efficacy of alkaline peroxide tablets and mouthwashes on Candida albicans in patients with denture stomatitis

Objective

Effective cleaning of dentures is important for the maintenance of good oral hygiene for denture stomatitis patients. The in vivo efficacy of three different brands of alkaline peroxide tablets (Polident, Efferdent, and Fittydent) and two mouthwashes (CloSYS II and Corsodyl) to eliminate Candida albicans on dentures was evaluated in this in vivo study.

Material and methods

Ninety denture wearers with clinical evidence of denture stomatitis were randomly divided into 5 test groups and 1 control group. Each group was further divided into three subgroups in which the dentures were subjected to 15-, 30-, and 60-min disinfection procedures. The dentures of each test group were treated with one of the cleaners, while those of the control group were treated with distilled water. Swab samples from the palatal surfaces (2 cm x 2 cm template delimited area) of the upper dentures were obtained before and after 15, 30, and 60 min periods of cleaner use and examined mycologically.

Results

The reduction in the number of colony-forming units (CFU) of C. albicans before, and after 15, 30, and 60 min of use of CloSYS II and Corsodyl was significantly greater than that of the control group (p<0.05). Moreover, there was no statistically significant difference (p>0.05) among Polident, Efferdent and the control group in any of the treatment periods. Dentures treated with Fittydent appeared to have a significantly greater reduction in the number of Candida spp. only after 60 min of treatment.

Conclusions

The results of this study showed that the use of mouthwashes significantly reduced the number of microorganisms on dentures.

Environmental monitoring and bactericidal efficacy of chlorine dioxide gas in a dental office

We monitored the quantity of airborne microorganisms at 11 points (points A to K) in a dental office on a routine day of use, and tested the bactericidal efficacy of chlorine dioxide (ClO₂) gas in the dental operatory after consulting hours. Fallen airborne microorganisms were collected under air-conditioning (AC) in the dental office, and under four conditions in the operatory. Specimens of the microbes were cultivated on nutrient and Sabouraud agar media (NAM and SAM). Many colonies were observed at the entrance hall and on the cabinet in a disinfection room in the NAM and SAM tests, respectively, while no colony was observed at the foot position of the operating table and treatment bed, and above the head position of the operating room in the NAM and SAM tests, respectively. In the bactericidal efficacy test using ClO₂ gas, the dental operatory could be kept clean by the use of 4 mg/L-ClO₂ gas in addition to the use of an AC with a plasma filter and the HEPA filter.

Effects of a mouthwash with chlorine dioxide on oral malodor and salivary bacteria: a randomized placebo-controlled 7-day trial

Background

Previous research has shown the oxidizing properties and microbiological efficacies of chlorine dioxide (ClO₂). Its clinical efficacies on oral malodor have been evaluated and reported only in short duration trials, moreover, no clinical studies have investigated its microbiological efficacies on periodontal and malodorous bacteria. Thus, the aim of this study was to assess the inhibitory effects of a mouthwash containing ClO₂ used for 7 days on morning oral malodor and on salivary periodontal and malodorous bacteria.

Methods/Design

A randomized, double blind, crossover, placebo-controlled trial was conducted among 15 healthy male volunteers, who were divided into 2 groups. Subjects were instructed to rinse with the experimental mouthwash containing ClO₂ or the placebo mouthwash, without ClO₂, twice per day for 7 days. After a one week washout period, each group then used the opposite mouthwash for 7 days. At baseline and after 7 days, oral malodor was evaluated with Organoleptic measurement (OM), and analyzed the concentrations of hydrogen sulfide (H₂S), methyl mercaptan (CH₃SH) and dimethyl sulfide ((CH₃)₂S), the main VSCs of human oral malodor, were assessed by gas chromatography (GC). Clinical outcome variables included plaque and gingival indices, and tongue coating index. The samples of saliva were microbiologically investigated. Quantitative and qualitative analyses were performed using the polymerase chain reaction-Invader method.

Results and Discussion

The baseline oral condition in healthy subjects in the 2 groups did not differ significantly. After rinsing with the mouthwash containing ClO₂ for 7 days, morning bad breath decreased as measured by the OM and reduced the concentrations of H₂S, CH₃SH and (CH₃)₂S measured by GC, were found. Moreover ClO₂ mouthwash used over a 7-day period appeared effective in reducing plaque, tongue coating accumulation and the counts of Fusobacterium nucleatum in saliva. Future research is needed to examine long-term effects, as well as effects on periodontal diseases and plaque accumulation in a well-defined sample of halitosis patients and broader population samples.

Trial registration

ClinicalTrials.gov NCT00748943

A randomized double blind crossover placebo-controlled clinical trial to assess the effects of a mouthwash containing chlorine dioxide on oral malodor

Background

Previous research has shown the oxidizing properties and microbiological efficacies of chlorine dioxide (ClO₂), however, its clinical efficacies on oral malodor have been evaluated only with organoleptic measurements (OM) or sulphide monitors. No clinical studies have investigated the inhibitory effects of ClO₂ on volatile sulfur compounds (VSCs) using gas chromatography (GC). The aim of this study was to assess the inhibitory effects of a mouthwash containing ClO₂ on morning oral malodor using OM and GC.

Methods

A randomized, double blind, crossover, placebo-controlled clinical trial was conducted among 15 healthy male volunteers, who were divided into 2 groups. In the first test phase, the group 1 subjects (N = 8) were instructed to rinse with the experimental mouthwash containing ClO₂, and those in group 2 (N = 7) to rinse with the placebo mouthwash without ClO₂. In the second test, phase after a one week washout period, each group used the opposite mouthwash.

Oral malodor was evaluated before rinsing, right after rinsing and every 30 minutes up to 4 hours with OM, and concentrations of hydrogen sulfide (H₂S), methyl mercaptan (CH₃SH) and dimethyl sulfide ((CH₃)₂S), the main VSCs of human oral malodor, were evaluated with GC.

Results

The baseline oral condition in the subjects in the 2 groups did not differ significantly. The mouthwash containing ClO₂ improved morning bad breath according to OM and reduced concentrations of H₂S, CH₃SH and (CH₃)₂S according to GC up to 4 hours after rinsing. OM scores with ClO₂ were significantly lower than those without ClO₂ at all examination times. Significant reductions in the concentrations of the three kinds of VSCs measured by GC were also evident at all examination times. The concentrations of the three gases with ClO₂ were significantly lower than those without ClO₂ at most examination times.

Conclusion

In this explorative study, ClO₂ mouthwash was effective at reducing morning malodor for 4 hours when used by healthy subjects.

Trial registration

ClinicalTrials.gov NCT00655772