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

Multidisciplinary Management of Oral Manifestations in Pregnant Women with Beta-Thalassemia Major: A Case Report

Introduction

Beta-thalassemia major is a blood disorder caused by impaired synthesis of hemoglobin beta chain. Oral manifestations of beta-thalassemia major in pregnancy have rarely been reported.

Objective

This study aimed to describe a case of oral manifestations in a pregnant woman with beta-thalassemia major for multidisciplinary management.

Case

A 27-year-old woman, suffering from beta thalassemia major who is undergoing therapy in the form of routine blood transfusions every month and taking anti-chelation drugs but is currently stopping this because she is pregnant, currently 16 weeks pregnant, complains complained of swollen gums, bleeding, and bad breath. Extraoral examination revealed dry, exfoliative lips. Intraoral examination revealed gingival hyperplasia with erythema, soft consistency, dark red rounded gingival margins, bleeding, true pockets and pain throughout the labial, buccal, palatal, and lingual. There was no history of systemic disease in this patient. Patient has never visited a dentist, either before or now, with complaints about her oral cavity. Hematological parameters showed abnormalities, and peripheral blood examination revealed an infection. The oral diagnoses included gingival enlargement and chronic periodontitis associated with pregnancy and β- thalassemia major.

Case Management

Dental management consisted of spooling with 3% hydrogen peroxide (H2O2) spooling, chlorine dioxide spray mouthwash, antibiotics, calculus removal, and oral hygiene instructions. Blood transfusions were administered once a month, and anti-chelation therapy was stopped during pregnancy. After three months of multidisciplinary management, the results were satisfactory.

Conclusion

Multidisciplinary, collaborative dental and medical management with non-surgical therapy of oral manifestations in pregnant women with beta-thalassemia major showed satisfactory results.

Holistic Approach of a Leukemic Child Suffering from Oral Mucositis with Coinfections: A Case Report

Oral mucositis (OM) is a life-threatening side effect of chemo-radiotherapy. OM can provide a portal of entry for many microorganisms as coinfections which potentially generate other oral lesions. This case report describes a holistic approach to obtaining the successful treatment of OM with necrotizing ulcerative stomatitis (NUS) and oral candidiasis as coinfections in pediatric acute lymphoblastic leukemia (ALL). A 2-year-8-month-old boy was referred from the Pediatrics Department at Dr. Hasan Sadikin General Hospital with the chief complaint of canker sore and eating difficulty for the past two weeks. He had undergone the twelfth cycle of the last chemotherapy using methotrexate regimen. Extraoral examination revealed anemic conjunctiva, icteric sclera, and dry lips. Well-defined irregular multiple ulcers covered by yellowish to grayish pseudomembranous were found on the upper and lower labial mucosa, right and left buccal mucosa, tongue, palate, and gingiva. Potassium hydroxide (KOH) examination showed fungi in the oral lesions smear. The established diagnosis was OM with NUS and oral candidiasis as coinfections. Debridement was done using chlorine dioxide-zinc and 0.2% chlorhexidine gluconate. We collaborated with the pediatrician who prescribed ceftazidime, meropenem, and fluconazole, and also with parents. The holistic approach is beneficial and important in improving quality of life and supporting the successful treatment of OM with coinfections.

Short- and long term antibacterial effects of a single rinse with different mouthwashes: A randomized clinical trial

Objectives

Reducing the microbial level in the aerosol created during dental procedures is essential to avoiding infections. The aim of this study was to examine the change in Streptococcus mutans (S. mutans) and the total bacterial load in human saliva in vivo after a single rinse with different mouthwashes.

Material and methods

One mL of unstimulated saliva was collected from volunteers with poor oral hygiene at baseline and 5 min after a 1-min rinsing with diluted Solumium Oral® (hyper-pure 0.0015% chlorine dioxide; ClO₂), Listerine Total Care®, Corsodyl® (0.2% chlorhexidine-digluconate; CHX), or BioGate Si*CLEAN for bacterial investigation. In a second study, volunteers rinsed with 0.003% ClO₂ or CHX for 1 min, and saliva was collected at baseline, after 5 min, and after 90 min. After plating, the total plate and S. mutans colony numbers were determined.

Results

In the first study, ClO₂ and CHX similarly reduced both total germ and S. mutans numbers, while Listerine Total Care® decreased only the S. mutans counts. BioGate Si*Clean had no effect on either the total germ or S. mutans numbers. In the second study, an increasing tendency toward bacterial regrowth was observed with CHX after 90 min compared to the 5-min value, while no change was measured after ClO₂ rinsing.

Conclusion

Hyper-pure ClO₂ rinsing may be a new promising preventive and therapeutic adjuvant in dental practice, as it is similar in effectiveness to the gold standard CHX-containing mouthwashes, especially in patients concerned with taste or tooth discoloration during oral health therapy.

Phosphorylated Cotton Cellulose as a Matrix for Generating Chlorine Dioxide

Currently, developing disinfectant materials is of utmost importance. A significant advantage of our fabric is its reusability. The disinfectants based on a natural polymer of cellulose have been barely investigated. Our work presents a modified cellulose material, and the data obtained for the first time on the chlorine dioxide generation process when treating the material with a sodium chlorite alcohol solution. A method of applying NaClO₂ onto the fabric by impregnating it with a solution sprayed by an aerosol generator is proposed. This kind of fabric is capable of withstanding multiple usages after pre-washing and rinsing. The lowest alcohols-methanol, ethanol and isopropanol-are proposed as optimal solvents. It was shown that the phosphorylated cotton cellulose fabric impregnated with this solution generates chlorine dioxide during the first 25-35 min. Neither humidity nor expedites improve the process of releasing the chlorine dioxide, but high moisture content in the air causes the complete absorption of ClO₂ by microdrops and its removal from the gas environment. A promising technique for removing the excess ClO₂ by the means of UV treatment is proposed: after 15 min of treating ClO₂ in the gas phase, it disappears entirely. These materials could be used as disinfectants in different industries, such as food and industrial manufacturing.

Daily use of chlorine dioxide effectively treats halitosis: A meta-analysis of randomised controlled trials

OBJECTIVES

We aimed to conduct a systematic review on published data in order to investigate the efficacy of mouthwash products containing chlorine dioxide in halitosis.

STUDY DESIGN

Systematic review and meta-analysis.

METHODS

Our search was conducted on 14th October 2021. We searched the following electronic databases: MEDLINE, Embase, Scopus, Web of Science, and CENTRAL. We analysed data on adults with halitosis, included only randomised controlled trials and excluded in vitro and animal studies. The interventional groups used chlorine dioxide, and the comparator groups used a placebo or other mouthwash. Our primary outcomes were changes in organoleptic test scores (OLS) and Volatile Sulfur Compound (VSC) levels from baseline to the last available follow-up.

RESULTS

We found 325 articles in databases. After the selection process, ten articles were eligible for qualitative synthesis, and 7 RCTs with 234 patients were involved in the meta-analysis. Our findings showed a significant improvement in the parameters of the chlorine dioxide group compared to the placebo group in OLS one-day data (mean difference (MD): -0.82; 95% confidence intervals (95% CIs): [-1.04 --0.6]; heterogeneity: I2 = 0%, p = 0.67); and one-week OLS data (MD: -0.24; 95% CIs: [-0.41 --0.07]; I2 = 0%, p = 0.52); and also changes in H2S one-day data (standardised mean difference (SMD): -1.81; 95% CIs: [-2.52 --1.10]); I2 = 73.4%, p = 0.02).

CONCLUSION

Our data indicate that chlorine dioxide mouthwash may be a good supportive therapy in oral halitosis without known side effects.

Effects of cleaning sports mouthguards with ethylene-vinyl acetate on oral bacteria

Background

Sports mouthguards, worn in the oral cavity to prevent sports injuries, are constantly exposed to various microorganisms that cause oral infections. Hence, the optimal cleaning methods for sports mouthguards have been thoroughly examined. In this study, we evaluated the efficiency of cleaning effects with a mouthguard cleaner (MC) on microbial biofilm formation in sports mouthguards in vitro and in vivo.

Methods

We evaluated the cleaning effects of the discs produced by ethylene-vinyl acetate (EVA) on bacterial biofilms formed by the commensal bacterium Streptococcus oralis, the cariogenic bacterium Streptococcus mutans, and the opportunistic pathogen Staphylococcus aureus in vitro. EVA discs with biofilm were subjected to sterile distilled water (CTRL) and ultrasonic washing (UW), followed by treatment with MC and sodium hypochlorite (NaClO) as positive controls. Thereafter, the viable bacterial cell counts were determined. The bacteria adhering to the sheets before and after the treatment were observed under an electron microscope. The degree of cleanliness and measurement of viable microbial cell counts for total bacteria, Streptococci and Candida, opportunistic fungi, were evaluated on the used experimental sports mouthguards with and without UW and MC treatment in vivo.

Results

The number of bacterial cells significantly decreased against all the tested biofilm bacteria upon treatment with MC, compared with CTRL and UW. Electron microscopy analysis revealed the biofilm formation by all bacteria on the EVA discs before cleaning. We observed fewer bacteria on the EVA discs treated with MC than those treated with CTRL and UW. Furthermore, the degree of cleanliness of the used experimental sports mouthguards cleaned using MC was significantly higher than that of the CTRL-treated mouthguards. Moreover, the viable microbial cell counts on the used experimental sports mouthguard were considerably lower than those on the CTRL ones.

Conclusion

The cleaning effect of MC against oral bacteria was more effective than that of UW. MC treatment might have a potential future application as a cleaning method for sports mouthguards to protect athletes from oral infection.

Inactivation methods for human coronavirus 229E on various food-contact surfaces and foods

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the cause of the COVID-19 outbreaks, is transmitted by respiratory droplets and has become a life-threatening viral pandemic worldwide. The aim of this study was to evaluate the effects of different chemical (chlorine dioxide [ClO2] and peroxyacetic acid [PAA]) and physical (ultraviolet [UV]-C irradiation) inactivation methods on various food-contact surfaces (stainless steel [SS] and polypropylene [PP]) and foods (lettuce, chicken breast, and salmon) contaminated with human coronavirus 229E (HCoV-229E). Treatments with the maximum concentration of ClO2 (500 ppm) and PAA (200 ppm) for 5 min achieved >99.9% inactivation on SS and PP. At 200 ppm ClO2 for 1 min on lettuce, chicken breast, and salmon, the HCoV-229E titers were 1.19, 3.54, and 3.97 log10 TCID50/mL, respectively. Exposure (5 min) to 80 ppm PAA achieved 1.68 log10 reduction on lettuce, and 2.03 and 1.43 log10 reductions on chicken breast and salmon, respectively, treated with 1500 ppm PAA. In the carrier tests, HCoV-229E titers on food-contact surfaces were significantly decreased (p < 0.05) with increased doses of UV-C (0-60 mJ/cm2) and not detected at the maximum UV-C dose (Detection limit: 1.0 log10 TCID50/coupon). The UV-C dose of 900 mJ/cm2 proved more effective on chicken breast (>2 log10 reduction) than on lettuce and salmon (>1 log10 reduction). However, there were no quality changes (p > 0.05) in food samples after inactivation treatments except the maximum PAA concentration (5 min) and the UV-C dose (1800 mJ/cm2).

Use of Ivermectin and Chlorine Dioxide for COVID-19 Treatment and Prophylaxis in Peru: A Narrative Review

The spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, created a rapidly unfolding health crisis, especially in the initial phases of the pandemic. In the early stages of the pandemic, various strategies were proposed for COVID-19 prophylaxis and treatment with very little scientific evidence available. Among these proposed treatments were ivermectin and chlorine dioxide, which were both used widely in Peru for both disease prevention and treatment without considering their problematic side effects. For instance, ivermectin was part of an approved therapeutic scheme based on in vitro data, although its efficacy in humans was not demonstrated. In addition, chlorine dioxide was never shown to be effective but causes threatening side effects. In this article, we discuss current information regarding chlorine dioxide and ivermectin in the context of the COVID-19 pandemic, with a focus on experiences in Peru.

Evidence on the Use of Mouthwash for the Control of Supragingival Biofilm and Its Potential Adverse Effects

Antimicrobial mouthwash improves supragingival biofilm control when used in conjunction with mechanical removal as part of an oral hygiene routine. Mouthwash is intended to suppress bacterial adhesion during biofilm formation processes and is not aimed at mature biofilms. The most common evidence-based effects of mouthwash on the subgingival biofilm include the inhibition of biofilm accumulation and its anti-gingivitis property, followed by its cariostatic activities. There has been no significant change in the strength of the evidence over the last decade. A strategy for biofilm control that relies on the elimination of bacteria may cause a variety of side effects. The exposure of mature oral biofilms to mouthwash is associated with several possible adverse reactions, such as the emergence of resistant strains, the effects of the residual structure, enhanced pathogenicity following retarded penetration, and ecological changes to the microbiota. These concerns require further elucidation. This review aims to reconfirm the intended effects of mouthwash on oral biofilm control by summarizing systematic reviews from the last decade and to discuss the limitations of mouthwash and potential adverse reactions to its use. In the future, the strategy for oral biofilm control may shift to reducing the biofilm by detaching it or modulating its quality, rather than eliminating it, to preserve the benefits of the normal resident oral microflora.

Orally Administered Probiotics Decrease Aggregatibacter actinomycetemcomitans but Not Other Periodontal Pathogenic Bacteria Counts in the Oral Cavity: A Systematic Review and Meta-Analysis

Introduction: At the initial part of the gastrointestinal tract, multiple tissues serve the normal function of food delivery. Periodontal structures are integral elements of these. When they deteriorate, it is extremely challenging to regenerate and reconstruct them. The conventional intervention for periodontal disease is scaling and root planning with the aim of reducing pathogenic bacteria. However, periodontal pathogens can rapidly recolonize treated areas. Probiotics have been proposed as novel tools for managing oral health by suppressing pathogenic bacteria through their anti-inflammatory effect, but the available data are controversial. Aim: Therefore, we performed a meta-analysis to study the effect of probiotics on periodontal pathogenic bacteria. Methods: The study was registered in PROSPERO under registration number CRD42018094903. A comprehensive literature search from four electronic databases (PubMed, Cochrane CENTRAL, Embase, and Web of Science) yielded nine eligible records for statistical analysis. Studies measuring bacterial counts in saliva and supra- and subgingival plaque were included. Bacterial counts were analyzed using standard mean difference (SMD) and by a random effects model with the DerSimonian-Laird estimation. Results: The results showed a significant decrease in the overall count of Aggregatibacter actinomycetemcomitans in the probiotic-treated group compared to the control at 4 weeks (SMD: -0.28; 95% CI: -0.56--0.01; p = 0.045) but not later. Analyzing the bacterial counts in subgroups, namely, in saliva and supra- and subgingival plaque, separately, yielded no significant difference. Probiotics had no significant effect on the overall count of Porphyromonas gingivalis at 4 weeks (SMD: -0.02; 95% CI: -0.35-0.31; p = 0.914) or later. Subgroup analysis also revealed no significant difference between treatment and control groups nor did probiotics significantly decrease the overall and subgroup bacterial counts of Prevotella intermedia, Tannerella forsythia, and Fusobacterium nucleatum. Conclusion: Our data support the beneficial effect of probiotics in reducing A. actinomycetemcomitans counts, but not of other key periodontal pathogenic bacteria in periodontal disease patients. However, due to the complex mechanism associated with periodontal disease and the limitations of the available studies, there is a further need for well-designed randomized clinical trials to assess the efficacy of probiotics.

Infection control in dentistry during COVID - 19 pandemic: what has changed?

The novel coronavirus (COVID-19) pandemic has emerged disrupting many socio-economical and healthcare aspects across the world. This virus can be transmitted by symptomatic and asymptomatic individuals through saliva and contact. Due to its airborne transmission, aerosols created by natural activities and during dental treatment of infected individuals have become a potential vehicle of transmission and threat. The objective of this review was to assess the existing infection control measures taken in dental health-care settings and suggest modifications to reduce the transmission of novel coronavirus. This is a general review publication. Literature search was made at National Library of Medicine, Pubmed using key words such as "dentistry and COVID", "dentistry and COVID and infection control". Publications related to behaviour, education, ethics, treatment and childcare were excluded. Publications describing general aspects of infection control were reviewed. Keyword "Dentistry and COVID and Infection control" generated 70 publications which were reviewed. Infection control measures in dentistry are designed to minimise cross transmission mainly of blood borne pathogens. The unique nature of COVID-19 including highly infectious and transmissibility, and the ability to survive for a long time in the environment requires special attention and modification to the existing infection control measures which are highlighted here. In conclusion, a modified infection prevention and control (IPC) regime will protect the dental practitioner, assistant and staff, patients and the community. During the pandemic, drastic measures are necessary, however, during an endemic period measures can be remodified as necessary.