Antimicrobial effects of chlorhexidine, matrica drop mouthwash (chamomile extract), and normal saline on hospitalized patients with endotracheal tubes

Don't Rush with Your Brush: An In Vitro Study on Toothbrush Hygiene

Aim

To evaluate the effectiveness of audiovisual (AV) aids in creating awareness of toothbrush hygiene.

Materials and methods

This randomized trial study was conducted on 40 children aged 6-11 years. Children were given soft toothbrushes and then collected after brushing for 14 days. The toothbrushes were collected and sent to the laboratory for microbial culture evaluation. A questionnaire consisting of various questions regarding daily toothbrush hygiene practices was filled by the parents at the same time. After 14 days, brushes were collected, and the parents were shown an AV aid regarding toothbrush decontamination, parental awareness, and supervision. Those children were given new sets of toothbrushes and instructed to decontaminate them with chlorhexidine solution. After 14 days, the same questionnaire was filled out by the parents and toothbrushes were collected and immediately sent to the laboratory for microbial culture evaluation.

Results

All the sampled toothbrushes had significant (p < 0.001) bacterial growth after 14 days of use. The use of disinfectant led to a 99.98% reduction in microbial colony counts. Hence, showed a significant result. Questionnaire analysis showed a positive parental approach toward maintaining toothbrush hygiene.

Conclusion

Cleaning and disinfection of toothbrushes is crucial to stop the spread of disease since bacterial contamination cannot be 100% eliminated. AV aids can be effective tools for increasing awareness.

Clinical significance

Through this study, we want to emphasize toothbrush hygiene and create awareness for the same through AV aid because a healthy toothbrush leads to healthy oral health.

How to cite this article

Sharma S, Tandon S, Rai TS, et al. Don't Rush with Your Brush: An In Vitro Study on Toothbrush Hygiene. Int J Clin Pediatr Dent 2024;17(2):162-167.

The impact of aromatherapy-based oral care on oral conditions, salivary pH, and halitosis in older adults with dementia: Pilot study

Inadequate oral care and poor oral health in older adults are known to increase the risk of dementia. Dementia patients residing in long-term care facilities are especially vulnerable to oral diseases due to their care-resistant behavior. This study aimed to investigate the effects of a 7-day oral care program based on an aroma solution in 58 dementia patients (29 each in the experimental and control groups) admitted to a long-term care hospital in South Korea. The experimental group received oral care with a solution containing peppermint, tea tree, and lemon essential oils, and the control group with a saline solution. The effectiveness of oral care was assessed by the participants' oral condition, salivary pH, and halitosis. The experimental group showed significant improvements (P<.001) in all three outcomes, indicating that oral care with an aroma solution can improve the oral health of older dementia patients residing in long-term care facilities.

Anti-Inflammatory and Anti-Bacterial Effects of Mouthwashes in Intensive Care Units: A Systematic Review and Meta-Analysis

Mouthwashes are used as oral care for critical care patients to prevent infections. However, there are conflicting data concerning whether mouthwashes are needed as a part of daily oral care for critical care patients. This study aimed to evaluate the anti-inflammatory and anti-bacterial effects of mouthwashes for critical care patients. The PubMed, EMBASE, CENTRAL, and grey literature databases were searched by descriptors combining population (intensive care unit patients) and intervention (mouthwashes). After the screening, only randomized controlled trials (RCTs) evaluating the anti-inflammatory and anti-bacterial effects of mouthwashes in patient critical care were included. From the 1531 articles, 16 RCTs satisfied the eligibility criteria for systematic review and 10 were included in the meta-analyses. A significant difference was found in the incidence of ventilator associated pneumonia (VAP) (odds ratio [OR] 0.53, 95% confidential interval [95% CI] 0.33 to 0.86) between the mouthwash and placebo groups, while no significant difference was found in the mortality (OR 1.49, 95%CI 0.92 to 2.40); the duration of mechanical ventilation (weighted mean difference [WMD] -0.10, 95%CI -2.01 to 1.81); and the colonization of Staphylococcus aureus (OR 0.88, 95%CI 0.34 to 2.30), Escherichia coli (OR 1.19, 95%CI 0.50 to 2.82), and Pseudomonas aeruginosa (OR 1.16, 95%CI 0.27 to 4.91) between the two groups. In conclusion, mouthwashes were effective in decreasing the incidence of VAP. Thus, mouthwashes can be used as part of daily oral care for critical care patients.

In vitro antibacterial effect of Pimpinella anisum essential oil on Enterococcus faecalis, Lactobacillus casei, Actinomyces naeslundii, and Aggregatibacter actinomycetemcomitans

INTRODUCTION

Pimpinellaanisum is a medicinal plant with antimicrobial, antifungal, and anti-oxidative properties. Limited studies have assessed the antibacterial properties of Pimpinellaanisum on oral and dental pathogens.

The effect of oral care using honey as an additional topical agent on oral health status of intubated patients in the intensive care unit

BACKGROUND

Patients using endotracheal tubes are at high risk of oral health status dysfunction due to impaired natural airway defence, oral flora composition changes and protective substances of the teeth, medication causing xerostomia. Oral care has not been enough to manage oral mucosal dryness, so an additional topical agent is needed to protect oral mucosa to maintain oral health. Honey is one of the recommended topical agents.

OBJECTIVE

This study aims to identify the effect of oral care with honey as topical agents on the oral health status of patients using endotracheal tube in the Intensive Care Unit.

METHODS

This was an experimental study with a randomized pretest and posttest design. The sample was adult intubated patients, consisting of 36 patients. The data were analysed using the parametric test, and dependent and independent t-test.

RESULTS

The oral health score in the control group was found to be pre & post mean score11.94 and 13.28 (p=.004) respectively, while in the intervention group 11.89 and 8.33 (p<.001). Mean differences in both groups were 4.95 (p<.001) and the BOAS subscale differences were seen on the lips, gums & mucosa, and tongue (p<.05).

CONCLUSION

Oral care with honey as a topical agent can improve the oral health status of intubated patients on the lips, gum, mucosa, and tongue subscale. Therefore, honey as an additional topical agent can be a moisturizer to maintain the oral mucosa for intubated patients in the Intensive Care Unit. Furthermore, good mucosal health will help prevent the infection and colonization of microorganisms.

Harnessing the Antibacterial Properties of Fluoridated Chitosan Polymers against Oral Biofilms

Dental caries are a worldwide endemic chronic disease affecting people of all ages. Due to the limitations of daily used oral hygiene products, there is an unmet need for new, effective, safe, and economic oral products. We have recently demonstrated that N-(2(2,6-diaminohexanamide)-chitosan (CS3H Lys) has enhanced antibacterial properties against Streptococcus mutans, the main cariogenic bacterium, and here we investigated the effect of fluoridation of this polymer (CS3H Lys F) on its antibacterial properties and the ability to protect teeth from acid demineralization. We further formulated this polymer into mouthwash preparations and studied their cytocompatibility and physicochemical stability over 6 months. CS3H Lys F was 1.6-fold more effective than the highest tested oral NaF dose in preventing acid demineralization. CS3H Lys F has a 3- to 5-fold lower minimum inhibitory concentration value against S. mutants than the values reported for chitosan polymers and showed negligible cell toxicity. The mouthwashes were stable at both 25 and 40 °C. Further work is under way towards other CS3H Lys F oral hygiene products such as a toothpaste.

Polysaccharide-Based Micro- and Nanosized Drug Delivery Systems for Potential Application in the Pediatric Dentistry

The intensive development of micro- and nanotechnologies in recent years has offered a wide horizon of new possibilities for drug delivery in dentistry. The use of polymeric drug carriers turned out to be a very successful technique for formulating micro- and nanoparticles with controlled or targeted drug release in the oral cavity. Such innovative strategies have the potential to provide an improved therapeutic approach to prevention and treatment of various oral diseases not only for adults, but also in the pediatric dental practice. Due to their biocompatibility, biotolerance and biodegradability, naturally occurring polysaccharides like chitosan, alginate, pectin, dextran, starch, etc., are among the most preferred materials for preparation of micro- and nano-devices for drug delivery, offering simple particle-forming characteristics and easily tunable properties of the formulated structures. Their low immunogenicity and low toxicity provide an advantage over most synthetic polymers for the development of pediatric formulations. This review is focused on micro- and nanoscale polysaccharide biomaterials as dental drug carriers, with an emphasis on their potential application in pediatric dentistry.

Attention to COVID-19 Pandemic among Dental Experts of Kerala State, India: A Knowledge, Attitude, and Practice Study

Background:

Dentists are the common preys for the transmission of pandemic disease because of the airborne spread via routine dental checkups. This study which is a cross-sectional one gives the idea about awareness and alertness of dentists about COVID-19 in Kerala, India.

Materials and Methods:

The survey comprised 25 closed-ended questions. The survey was separated into two sections. The initial segment of the poll was identified with the socio-segment qualities that were researched, while the subsequent part was worried about dental practitioners' perspectives toward the management of COVID-19 and the apparent danger of defilement in dental facilities.

Results:

Coronavirus management in dental clinics differs regarding adherence to the rules. An aggregate of 750 respondents finished the form, out of which 686 (91.46%) complete reactions were incorporated. The majority of the respondents concurred on inquiries regarding the knowledge, practice, and mentality of dental specialists toward the COVID-19 pandemic.

Conclusion:

The feedback of most dental specialists with respect to the readiness and view of disease control measures against the COVID-19 pandemic was positive. Dental facilities need to adhere more to the central and state government suggestions in alertness of their facilities or by tutoring their dental specialists and staff.

Systematic review: Effectiveness of herbal oral care products on ventilator-associated pneumonia

Ventilator-associated pneumonia (VAP) resulting from bacterial infection is a prevalent medical problem in intensive care units (ICUs). The purpose of this study was to systematically review available studies on oral products employed to control and reduce VAP in patients undergoing tracheal intubation. This study was based on a systematic review of clinical trial data from science databases such as PubMed, Cochrane, Scopus, and Web of science. Articles were reviewed and selected according to defined criteria and assessed by the primary evaluation checklist. After a critical review of 3,143 search hits, only 18 relevant articles were finally selected for discussion. Our assessment revealed that chlorhexidine and some other oral herbal medications are beneficial in preventing VAP. Chlorhexidine oral dosage forms provide a remarkable role in oral health and prevention of VAP by decreasing the microbial flora in the mouth. Because of similar benefits and comparable effects, some herbal medicines can be suggested as a practical alternative to chlorhexidine.

Fear and Practice Modifications among Dentists to Combat Novel Coronavirus Disease (COVID-19) Outbreak

An outbreak of novel coronavirus disease (COVID-19) in China has influenced every aspect of life. Healthcare professionals, especially dentists, are exposed to a higher risk of getting infected due to close contact with infected patients. The current study was conducted to assess anxiety and fear of getting infected among dentists while working during the current novel coronavirus diseases (COVID-19) outbreak. In addition, dentists' knowledge about various practice modifications to combat COVID-19 has been evaluated. A cross-sectional study was conducted using an online survey from 10th to 17th March 2020. The well-constructed questionnaire was designed and registered at online website (Kwiksurveys) and validated. A total of 669 participants from 30 different countries across the world responded. After scrutiny, completed questionnaires (n = 650) were included in the study. Statistical analysis was performed using SPSS version 25. Chi-Square and Spearman correlation tests were applied to control confounders and assess the relation of dentists' response with respect to gender and educational level. More than two-thirds of the general dental practitioners (78%) from 30 countries questioned were anxious and scared by the devastating effects of COVID-19. A large number of dentists (90%) were aware of recent changes in the treatment protocols. However, execution of amended treatment protocol was recorded as 61%. The majority of the dentists (76%) were working in the hospital setting out of which 74% were from private, and 20% were from government setups. Individually we received a large number of responses from Pakistan and Saudi Arabia, but collectively more than 50% of the responses were from other parts of the world. Despite having a high standard of knowledge and practice, dental practitioners around the globe are in a state of anxiety and fear while working in their respective fields due to the COVID-19 pandemic impact on humanity. A number of dental practices have either modified their services according to the recommended guidelines to emergency treatment only or closed down practices for an uncertain period.

Oropharyngeal Bacterial Colonization after Chlorhexidine Mouthwash in Mechanically Ventilated Critically Ill Patients

WHAT WE ALREADY KNOW ABOUT THIS TOPIC

WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Oropharyngeal care with chlorhexidine to prevent ventilator-associated pneumonia is currently questioned, and exhaustive microbiologic data assessing its efficacy are lacking. The authors therefore aimed to study the effect of chlorhexidine mouthwash on oropharyngeal bacterial growth, to determine chlorhexidine susceptibility of these bacteria, and to measure chlorhexidine salivary concentration after an oropharyngeal care.

METHODS

This observational, prospective, single-center study enrolled 30 critically ill patients under mechanical ventilation for over 48 h. Oropharyngeal contamination was assessed by swabbing the gingivobuccal sulcus immediately before applying 0.12% chlorhexidine with soaked swabs, and subsequently at 15, 60, 120, 240, and 360 min after. Bacterial growth and identification were performed, and chlorhexidine minimal inhibitory concentration of recovered pathogens was determined. Saliva was collected in 10 patients, at every timepoint, with an additional timepoint after 30 min, to measure chlorhexidine concentration.

RESULTS

Two hundred fifty bacterial samples were analyzed and identified 48 pathogens including Streptococci (27.1%) and Enterobacteriaceae (20.8%). Oropharyngeal contamination before chlorhexidine mouthwash ranged from 10 to 10 colony-forming units (CFU)/ml in the 30 patients (median contamination level: 2.5·10 CFU/ml), and remained between 8·10 (lowest) and 3·10 CFU/ml (highest count) after chlorhexidine exposure. These bacterial counts did not decrease overtime after chlorhexidine mouthwash (each minute increase in time resulted in a multiplication of bacterial count by a coefficient of 1.001, P = 0.83). Viridans group streptococci isolates had the lowest chlorhexidine minimal inhibitory concentration (4 [4 to 8] mg/l); Enterobacteriaceae isolates had the highest ones (32 [16 to 32] mg/l). Chlorhexidine salivary concentration rapidly decreased, reaching 7.6 [1.8 to 31] mg/l as early as 60 min after mouthwash.

CONCLUSIONS

Chlorhexidine oropharyngeal care does not seem to reduce bacterial oropharyngeal colonization in critically ill ventilated patients. Variable chlorhexidine minimal inhibitory concentrations along with low chlorhexidine salivary concentrations after mouthwash could explain this ineffectiveness, and thus question the use of chlorhexidine for ventilator-associated pneumonia prevention.

Gingival Inflammatory Indices and Dental Stain Index after Using Aloe Vera-Green Tea Mouthwash, Matrica Mouthwash, or 0.2% Chlorhexidine Mouthwash Compared with Placebo in Patients with Gingival Inflammation

Introduction:

The purpose of this study was to evaluate and compare the effects of composition of aloe vera-green tea, matrica, and chlorhexidine on gingival inflammatory indices and dental stain index.

Materials & Methods:

In this double-blinded placebo-controlled clinical trial, anti-inflammatory, anti-plaque formation, and dental staining effects of two herbal mouthwashes, including aloe vera-green tea and matrica in comparison with chlorhexidine in 60 patients with plaque induced gingivitis referring to Isfahan University of Medical Sciences, School of Dentistry were evaluated. The indices evaluated in this study were plaque index (Silness and Loe), gingival index (Loe and Silness), bleeding on probing index (Ainamo and Bay) and dental stain index (Lobene stain index). They were evaluated on the first day of using mouthwashes and two weeks later. The obtained data were analyzed using SPSS software version 22. One-way ANOVA, Tukey post hoc, and paired t and Chi-square tests (α=0.05) were used as appropriate.

Results:

There was no significant difference between the four groups in terms of the mean values of plaque index, gingival index, BOP index, and stain index before the application of mouthwash. However, after mouthwash application, the mean values of indices were significantly different between the four groups. Aloe vera-green tea and chlorhexidine mouthwashes reduced plaque index, gingival index, and bleeding on probing index significantly and there was no significant difference between these two mouthwashes (P>0.05). The effect of matrica mouthwash on plaque index and gingival index was significantly lower than aloe vera-green tea and chlorhexidine (P<0.05). The mean reduction in BOP index was not significantly different between the aloe vera-green tea, chlorhexidine, and matrica groups. Regarding dental stain index, both herbal mouthwashes caused significantly lower dental stain in comparison with chlorhexidine (P<0.05).

Conclusion:

The results of the present study show that aloe vera-green tea mouthwash may be an effective mouthwash owing to its antiplaque and anti-inflammatory properties and may be an ideal substitute for chlorhexidine.

Clinical Trial:

The clinical trial code: IR.MUI.REC.1395.3.573

Oral Chlorhexidine Against Ventilator-Associated Pneumonia and Microbial Colonization in Intensive Care Patients

The aim of this systematic review was to determine the effect of chlorhexidine at different concentration and frequency on ventilator-associated pneumonia and microbial colonization in mechanically ventilated patients. Relevant studies in English language were identified by searching data bases between January 2010 and December 2017. Ten studies met the inclusion criteria. Chlorhexidine with 0.2% concentration was found to be more effective than the control group (placebo dental gel and normal saline) in preventing the development of ventilator-associated pneumonia in three of the eight studies. Twice-daily application was found to be effective reducing the rate of ventilator-associated pneumonia in three studies using 0.2% and 2% chlorhexidine. Microbial colonization was found to be less in 2% chlorhexidine group than herbal mouth wash 0.9% NaCl and 0.2% chlorhexidine in three studies. Chlorhexidine is an effective intervention in oral care for ventilator-associated pneumonia and microbial colonization.