Are herbal mouthwash efficacious over chlorhexidine on the dental plaque?

Gum Arabic as a potential candidate in quorum quenching and treatment of periodontal diseases

Periodontal diseases are chronic inflammatory conditions influenced by bacterial biofilm formation and host immune responses, affecting millions worldwide. Traditional treatments like mechanical debridement and systemic antibiotics often face limitations, including biofilm resilience and antibiotic resistance. Gum Arabic (GA), a natural exudate from Acacia trees, presents a promising alternative with its anti-biofilm and anti-inflammatory properties. This review highlights the role of GA in periodontal therapy, particularly its ability to interfere with quorum sensing (QS) pathways, specifically the AI-2 signaling system used by key periodontal pathogens such as Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, and Fusobacterium nucleatum. By disrupting QS, GA inhibits biofilm formation, reduces bacterial virulence, and promotes a balanced oral microbiome. GA's prebiotic properties also encourage the growth of beneficial bacteria, enhancing the host's immune response while preserving the systemic microbiome. Clinical studies demonstrate GA's effectiveness as an adjunct in periodontal therapy, with significant reductions in plaque accumulation, gingival inflammation, and bleeding. This highlights GA's potential as a natural therapeutic agent, offering an effective, antibiotic-sparing option in managing periodontal disease. However, further research is warranted to fully establish GA's role in comprehensive periodontal care and its long-term benefits.

Comparison of the postoperative anti-inflammatory efficacy of chlorhexidine, saline rinses and herbal mouthwashes after mechanical debridement in patients with peri-implant mucositis: A randomized controlled trial

AIM

The null hypothesis is that there is no difference in the post-operative anti-inflammatory efficacy of chlorhexidine (CHX), 2% saline rinses (SR) and a herbal mouthwash (MW) after non-surgical mechanical debridement (MD) for treatment of peri-implant mucositis (PiM). The aim was to compare the post-operative anti-inflammatory efficacy of CHX, 2% SR and a herbal oral rinse after non-surgical MD of PiM.

MATERIALS AND METHODS

The present randomized controlled trial had a single-blinded parallel arm design. Patients diagnosed with PiM were enrolled. Demographic information was recorded. All patients underwent MD and were randomly divided into 4 groups: CHX-group: 0.12% non-alcoholic CHX; Sodium chloride (NaCl) group: 2% NaCl rinses; Herbal MW group: Herbal-based MW and H₂ O group: distilled water with peppermint flavour. After MD, all the participants were advised to rinse twice daily (every 12 hrs) for 2 weeks with their respective MWs. In all groups, peri-implant modified plaque index (mPI), modified gingival index (mGI) and probing depth (PD) were measured at baseline and at 12 weeks of follow-up. Sample size was estimated using data from a pilot investigation; and group-comparisons were performed. Statistical significance was confirmed when P-values were below 0.01.

RESULTS

Sixty individuals (15 patients/group) were included. At baseline, mPI, mGI and PD were comparable in all groups. At baseline, there was no significant difference in peri-implant mPI, mGI and PD in all groups. At 12-weeks' follow-up, there was a statistically significant reduction in peri-implant mPI (p < 0.01), mGI (p < 0.01) and PD (p < 0.01) in CHX, NaCl and herbal MW groups compared with H₂ O group. There was no significant relation between implant location, duration for which, implants were functional, gender and peri-implant clinical parameters in all groups.

CONCLUSION

After non-surgical MD, post-operative use of CHX and herbal and NaCl MWs is useful for the management of PiM in the short-term.

Anti-plaque efficacy of Hi-Ora mouthrinse and 0.12% chlorhexidine gluconate in patients with chronic gingivitis: A case-control study

Background

Chlorhexidine (CHX) gluconate has remained the gold standard chemical plaque control agent till date, though, being associated with several disadvantages including its tendency to stain teeth and leading to irritation of soft tissues. To overcome these inherent disadvantages, there has been a surge of studies in the recent past to evaluate the efficacy of herbal mouthrinses as against CHX.

Objective

The present study was planned to compare the anti-plaque efficacy of Hi-Ora mouthrinse as against 0.12% CHX in patients with chronic gingivitis.

Materials and Methods

The present study was designed as a case-control study including 90 patients with chronic gingivitis who were divided into 3 groups including Group A in which 0.12% CHX was prescribed, Group B in which patients were prescribed Hi-Ora and Group C in which normal saline was prescribed after oral prophylaxis while the mean Gingival Index (GI) and Plaque Index (PI) scores were recorded on the 5^th postprocedural day.

Results

The mean GI score in CHX group was found to be 0.70 ± 0.25 as against 0.66 ± 0.16 in Hi-Ora and 1.59 ± 0.55 in normal saline groups. Similarly, the mean PI score in CHX group was found to be 0.80 ± 0.31 as against 0.77 ± 0.30 in Hi-Ora and 1.86 ± 0.61 in normal saline groups.

Conclusions

The results of the present study suggested Hi-Ora to be more effective than 0.12% CHX in reducing the mean GI and PI scores among all the 3 groups.

Effect of piper extract mouthwash as postprocedural rinse on levels of Porphyromonas gingivalis in periodontitis patients

Background:

Dental biofilm plays a crucial role in periodontal disease development. Mouth rinse is used to enhance oral hygiene after scaling and root planning (SRP). The aim of the study was to evaluate the clinical and microbiological effectiveness of a piper extract mouthwash against Chlorhexidine (CHX) in periodontitis patients.

Materials and Methods:

Sixty patients with Stage II periodontitis participated in this study and were randomly divided into two groups (Group I – Stage II Grade A periodontitis patients were provided with prepared piper extract mouthwash and Group II – Stage II Grade A periodontitis patients were provided with 0.2% CHX). Plaque index, gingival index, sulcus bleeding index, probing pocket depth, and clinical attachment level were recorded at baseline and 30 days after SRP. Subgingival plaque samples were taken for microbial examination (colony-forming unit), quantification of Porphyromonas gingivalis using the real-time polymerase chain reaction at baseline, and 30 days after SRP.

Results:

Intragroup comparison for the clinical parameters showed statistically significant reduction in both the groups (P < 0.0001). Intergroup comparison for clinical parameters, there was no statistical significance seen after 30 days. Intragroup comparison for microbial analysis showed significant reduction in both the groups after 30 days (P < 0.0001). On intergroup comparison for microbial analysis, both the groups showed reduction after 30 days without significance.

Conclusion:

Piper extract mouthwash (Group I) showed similar antimicrobial activity against P. gingivalis when compared to 0.2% CHX mouthwash (Group II) that could be used as a substitute to CHX.

Characteristics of an alternative antibacterial biomaterial for mouthwash in the absence of alcohol

Background/purpose

The purpose of this study was to investigate whether poly-gamma-glutamic acid (γ-PGA), a naturally derived biomaterial, was suitable as an alternative antibacterial mouthwash in the absence of alcohol.

Materials and methods

Three bacterial strains, Escherichia coli, Staphylococcus aureus, and Pseudomonas aeruginosa, were used for testing the antibacterial activity of mouthwashes. In addition, cell viability, cytotoxicity, and genotoxicity experiments were conducted for testing the toxicity of mouthwashes.

Results

We demonstrated that 10000 ppm of γ-PGA without alcohol could efficiently inhibit 99% of bacterial growth. In addition, γ-PGA did not cause any cytotoxicity or genotoxicity.

Conclusion

10000 ppm of γ-PGA in an alcohol-free mouthwash is an alternative biomaterial for mouthwashes.

Efficacy of chlorhexidine rinses after periodontal or implant surgery: a systematic review

BACKGROUND

Biofilm management and infection control are essential after periodontal and implant surgery. In this context, chlorhexidine (CHX) mouth-rinses are frequently recommended post-surgically. Despite its common use and many studies in this field, a systematic evaluation of the benefits after periodontal or implant surgery is-surprisingly-still missing.

OBJECTIVES

To evaluate the benefits of chlorhexidine rinsing after periodontal or implant surgery in terms of plaque and inflammation reduction potential. Furthermore, to screen whether the concentration changes or additives in CHX solutions reduce side effects associated with its use.

MATERIALS AND METHODS

A systematic literature search was performed for clinical trials, which compared CHX rinsing after periodontal or implant surgery with rinsing using placebo, non-staining formulations, or solutions with reduced concentrations of the active compound. Four databases (Medline, PubMed, Embase, Cochrane) were searched up to June 2018. Two reviewers independently identified and screened the literature.

RESULTS

From 691 titles identified, only eleven publications met the inclusion criteria and were finally included. Mainly early publications assessed the benefits of CHX over placebo rinsing, whereas more recent publications focused more on the evaluation of new formulations with regard to effectiveness and side effects. The use of CHX after surgery showed in general significant reduction in plaque (means of 29-86% after 1 week) and bleeding (up to 73%) as compared to placebo. No consensus, however, was found regarding the most beneficial CHX formulation avoiding side effects.

CONCLUSION

Chlorhexidine rinsing helps to reduce biofilm formation and gingival inflammation after surgery. However, no additional reduction of periodontal probing depth over any given placebo or control solution could be found irrespective of whether CHX was used or not. The use of additives such as antidiscoloration systems (ADS) or herbal extracts may reduce side effects while retaining efficacy.

CLINICAL RELEVANCE

Within the limitations of this review, it can be concluded that CHX may represent a valuable chemo-preventive tool immediately after surgery, during the time period in which oral hygiene capacity is compromised. To reduce the side effects of CHX and maintain comparable clinical effects, rinsing with less concentrated formulations (e.g., 0.12%) showed the most promising results so far.

Assessment of Effectiveness of Barleria prionitis on Oral Health

AIM

To evaluate the efficacy of Barleria prionitis extract mouthwash in comparison with gold standard chlorhexidine (CHX) mouthwash on the oral health.

MATERIALS AND METHODS

A total of 30 subjects were randomly divided into two groups, B. prionitis group and the CHX gluconate mouthwash group. The data were collected at the baseline and 3 days. The plaque was disclosed using erythrosine disclosing agent and their scores were recorded using the Quigley and Hein plaque index modified by Turesky-Gilmore-Glickman. Statistical analysis was performed to compare the effect of the two drug regime.

RESULTS

Our result showed that the CHX and the B. prionitis were statistically equally effective against dental plaque. Although the action of CHX was more pronounced.

CONCLUSIONS

This study has confirmed antimicrobial potential of the plant B. prionitis, thus supporting its folklore application as preventive remedy against oral microbial diseases.

SUMMARY

Within the limitation of this trial, herbal mouthwash has been shown to demonstrate similar effects on plaque as compared to the standard drug CHX. Further long term research needs to be done to check the efficacy and effectiveness of herbal products over standard drug regime.

Knowledge regarding prescription of drugs among dental students: A descriptive study

Introduction:

The act of indicating one or more drugs to be taken by the patient, its dosage, and the interval of the treatment is known as prescribing. It is a dynamic and individualized clinical process. Cultural, social, economic and promotional factors can influence the pattern of prescription. Thus the present study was conducted to evaluate the drug prescription knowledge in third year and final year dental students at Teerthanker Mahaveer Dental College and Research Centre, Moradabad, Uttar Pradesh, India.

Methodology:

A questionnaire consisting of 10 open-ended questions was used in a study which was conducted among 170 male and female, third year and final year dental students of Teerthanker Mahaveer Dental College and Research Centre. Tables and graphs were used to represent data.

Results:

Pain was found to be the most important reason for prescribing medication. Diclofenac was found to be the most commonly prescribed NSAID. While amoxicillin was found to be the most widely prescribed antibiotic. Lack of knowledge about drug posology was the basic reason for error done by students. Maximum number of students gets their information for prescribing drugs from their professors. Maximum number of students was unacquainted about the WHO Guide to Good Prescribing.

Conclusion:

The knowledge of prescribing drugs is of utmost need for good dental practice and hence, it is essential to expand the knowledge related to pharmacological therapy and to know about the proper therapeutic guidelines. With the help of WHO Guide to Good Prescribing, and some educational programs students will develop better prescribing skills.

Dental caries and their treatment needs in 3-5 year old preschool children in a rural district of India

Background:

Dental problems in the preschool children are neglected by their parents as the deciduous teeth are going to shed off, and hence considered to be of no importance and more of economic burden if attended to them.

Aims:

This study was to determine the caries prevalence in preschool children (3-5-year-old) of rural Moradabad district, to analyze the specific pattern of dental caries experience in this population and to assess the treatment needs among them.

Material and Methods:

Children within the age group of 3-5 years attending Anganwadi centers of rural Moradabad district were included in the study. Caries diagnosis was based on decayed, extracted, filled surface (defs) and the treatment needs were recorded using World Health Organization (WHO) oral health assessment form 1997.

Results:

Out of 1,500 children examined, 48.7% males and 52.6% females did not require any treatment. The mean decayed, extracted, filled teeth (deft) value was found to be significantly high in 5-year-old participants when compared to 3-year-old participants (P < 0.01). Majority of the children required one surface filling followed by two surface fillings, caries arresting sealant care, extraction, crown bridge element, pulp care, and space maintainer.

Conclusion:

The most common pattern was pit and fissure, then maxillary anterior pattern, posterior proximal pattern, and posterior buccal lingual smooth surface pattern. The mean deft value was higher in males as compared to females. There is a greater need for oral health education among parents and teachers.