Comparing the antiplaque efficacy of 0.5% Camellia sinensis extract, 0.05% sodium fluoride, and 0.2% chlorhexidine gluconate mouthwash in children

Effects of probiotic yogurt, casein phosphopeptide-amorphous calcium phosphate, and xylitol chewing gums on the salivary count of Streptococcus mutans: A single-blinded randomized controlled clinical trial

Background

Dental caries is a preventable multifactorial disease, with Streptococcus mutans being suggested to be its primary pathogen. Our study aim was to compare the effects of three different low-cost and easy-to-use regimens with that of the gold standard (chlorhexidine [CHX] mouthwash) on the count of salivary S. mutans in dental students over 30 days.

Materials and Methods

In this single-blinded parallel randomized controlled clinical trial, a total of 120 dental students were included and randomly allocated into four intervention groups: (1) CHX mouthwash (control(, (2) probiotic yogurt, (3) casein phosphopeptide-amorphous calcium phosphate chewing gum, and (4) xylitol chewing gum. Salivary S. mutans counts were evaluated at baseline, 15 days, and 30 days after initiation of the study and compared at different times and among different groups using the repeated measures analysis of variance design analysis and least significant difference test with SPSS software version 20. The level of significance was determined to be 0.05.

Results

The microorganism count variable at baseline, first, and second follow-ups was significantly different for all groups except the probiotic yogurt group (P = 0.340). S. mutans count was significantly different when comparing the first follow-up and baseline values in the CHX and xylitol gum groups (P = 0.027, P = 0.037). When comparing the second follow-up with baseline values, a significant difference was observed in the xylitol gum group (P = 0.003).

Conclusion

Xylitol chewing gum seems to be a viable alternative to the gold standard (CHX mouthwash) in reducing the salivary count of S. mutans.

Polyphenols in Oral Health: Homeostasis Maintenance, Disease Prevention, and Therapeutic Applications

Polyphenols, a class of bioactive compounds with phenolic structures, are abundant in human diets. They have gained attention in biomedical fields due to their beneficial properties, including antioxidant, antibacterial, and anti-inflammatory activities. Therefore, polyphenols can prevent multiple chronic or infectious diseases and may help in the prevention of oral diseases. Oral health is crucial to our well-being, and maintaining a healthy oral microbiome is essential for preventing various dental and systemic diseases. However, the mechanisms by which polyphenols modulate the oral microbiota and contribute to oral health are still not fully understood, and the application of polyphenol products lies in different stages. This review provides a comprehensive overview of the advancements in understanding polyphenols' effects on oral health: dental caries, periodontal diseases, halitosis, and oral cancer. The mechanisms underlying the preventive and therapeutic effects of polyphenols derived from dietary sources are discussed, and new findings from animal models and clinical trials are included, highlighting the latest achievements. Given the great application potential of these natural compounds, novel approaches to dietary interventions and oral disease treatments may emerge. Moreover, investigating polyphenols combined with different materials presents promising opportunities for developing innovative therapeutic strategies in the treatment of oral diseases.

Prevention of Dental Biofilm Formation with Polyphenols: A Systematic Review

Polyphenols are plant secondary products with health-promoting properties against various degenerative or infectious diseases, and thus may help in the prevention of oral diseases. The aim of the present systematic review was to investigate polyphenols as a possible adjuvant in inhibiting dental biofilm formation, which is an important precondition for the most prevalent oral disease - caries and periodontitis. A literature search was conducted using the databases PubMed, CENTRAL and Scopus. Only studies with oral healthy participants and plaque level as outcome were included. Data search and extraction was conducted by two authors independently. Of the 211 initially identified studies, only six met all inclusion criteria. Meta-analysis was performed with five studies using the random effect model. Treatment with polyphenols reduced the plaque level in comparison to a negative control, but not significantly. Strong evidence of heterogeneity was observed. The diversity and complexity of polyphenols and their preparation need to be considered. There is no clear evidence that clinical use of polyphenols can prevent dental biofilm formation. Additional research with more and larger randomized controlled trials are required.

Green Alternatives as Antimicrobial Agents in Mitigating Periodontal Diseases: A Narrative Review

Periodontal diseases and dental caries are the most common infectious oral diseases impacting oral health globally. Oral cavity health is crucial for enhancing life quality since it serves as the entranceway to general health. The oral microbiome and oral infectious diseases are strongly correlated. Gram-negative anaerobic bacteria have been associated with periodontal diseases. Due to the shortcomings of several antimicrobial medications frequently applied in dentistry, the lack of resources in developing countries, the prevalence of oral inflammatory conditions, and the rise in bacterial antibiotic resistance, there is a need for reliable, efficient, and affordable alternative solutions for the prevention and treatment of periodontal diseases. Several accessible chemical agents can alter the oral microbiota, although these substances also have unfavorable symptoms such as vomiting, diarrhea, and tooth discoloration. Natural phytochemicals generated from plants that have historically been used as medicines are categorized as prospective alternatives due to the ongoing quest for substitute products. This review concentrated on phytochemicals or herbal extracts that impact periodontal diseases by decreasing the formation of dental biofilms and plaques, preventing the proliferation of oral pathogens, and inhibiting bacterial adhesion to surfaces. Investigations examining the effectiveness and safety of plant-based medicines have also been presented, including those conducted over the past decade.

Characterization of Cocoa Bean Husk Extract Particles and its Comparison as a Mouthrinse with Different Vehicles in Children aged 7-12 Years

Aim

Assessing the efficacy of cocoa bean husk extract (CBHE) particles with different vehicles as a mouthrinse in children aged 7-12 years in comparison to chlorhexidine (CHX) and sodium fluoride (NaF) mouthrinse.

Materials and methods

A total of 80 children aged 7-12 years residing at a residential school/orphanage in Bengaluru city were selected and randomly allocated into five groups-group I: 0.1% CBHE with distilled water (DW); group II: 0.1% CBHE with Ringer's lactate (RL); group III: 0.12% CHX; group IV: 0.1% CBHE with normal saline (NS); and group V: 0.05% NaF. A Simplified Oral Hygiene Index (OHI-S) was recorded, salivary pH was assessed, and unstimulated saliva samples were collected at baseline (BL) after 30 minutes of rinsing on day 7 and day 14. These saliva samples were subjected to microbiological analysis, and all the data from five groups at four different time intervals was tabulated and statistically evaluated.

Results

Nearly 0.1% CBHE with NS as vehicle showed maximum antibacterial properties among all the groups at all time intervals. The addition of RL to CBHE provided better anti-plaque efficacy than 0.1% CBHE with DW and 0.12% CHX mouthwash. All three combinations of 0.1% CBHE and 0.12% CHX mouthwash proved to be better anti-plaque agents than 0.05% NaF. Improving the preparation of CBHE mouthwash by using NS, RL, and with the addition of saccharin sodium also improved the patient's compliance.

Conclusion

Thus, preparing chocolate/CBHE mouthwash with NS or RL instead of plain DW increased the salivary pH, anti-plaque efficacy, and antibacterial property by reducing Streptococcus mutans growth.

Clinical significance

Cocoa bean husk extract (CBHE) mouthwash is a better anticariogenic and nonalcoholic mouthwash compared to CHX and NaF, which can be safely used in children as a routine oral rinse and also for those with gingivitis and high-risk of caries.

How to cite this article

Kibriya S, Srinivasan I, Setty JV, et al. Characterization of Cocoa Bean Husk Extract Particles and its Comparison as a Mouthrinse with Different Vehicles in Children aged 7-12 Years. Int J Clin Pediatr Dent 2023;16(1):54-59.

Camellia sinensis in Dentistry: Technological Prospection and Scientific Evidence

Purpose

This study aimed to evaluate reports of patents for oral care formulations, based on Camellia sinensis (C. sinensis), deposited and granted in intellectual property banks.

Methods

A survey was conducted through collection, treatment, and analysis of extracted information from patent reports selected. The documentary research was conducted in January 2021 on formulations with C. sinensis for dental applications, including since the first patent deposits until the current time. The risk of bias of clinical trials with these formulations was analyzed to verify the scientific evidence. The data extracted represent the distribution of the number of patents by banks, annual evolution of patent deposits, applicant of patents by country, distribution of patents according to International Patent Classification codes, and the types of patented products.

Results

Data and information from 20 selected patents were extracted. The United States Patent and Trademark Office (USPTO) and World Intellectual Property Organization (WIPO) were the banks with the largest number of patents for products/formulations with C. sinensis for oral care applications with 7 (35%) and 6 (30%) patent registrations, respectively. Other banks did not provide patents related to the search. Patents of compositions were the largest with 14 filings, and the remainder of formulations are represented specially by mouthwashes and toothpastes. As for clinical application, 18 patents were filed as products with antimicrobial and antibiofilm action, while 2 patents are directed to the treatment of xerostomia. In general, the aspects of the studies of clinical efficacy pointed to a low risk of bias.

Conclusion

The study pointed out a small number of products protected by patents for Camellia sinensis for oral care indication, highlighting mainly mouthwash compositions and formulations. In the methodological parameters of clinical trials carried out with the formulations, the majority pointed out a low risk of bias.

Impact of Green Tea (Camellia Sinensis) on periodontitis and caries. Systematic review and meta-analysis

Background

The oral health-promoting effects of green tea are attributed to its polyphenol components. Aim of this work was to systematically review the literature in search for clinical trials assessing green tea for managing periodontitis and caries.

Methods

Randomized clinical trials comparing the efficacy of green tea versus control groups in oral hygiene and gingival health; periodontitis; caries; periodontal pathogens number; Streptococcus mutans, Lactobacillus spp. Meta-analysis and meta-regression analysis were performed.

Literature searches were carried out using MedLine (PubMed), Scopus, and the Cochrane Library. Eighteen studies (870 subjects) were included.

Results

Green tea treatment had medium positive effect size in reducing GI (SMD: 0.50; 95%CI: −0.02/1.01); PI (SMD: 0.54; 95%CI: 0.14/0.95); GBI (SMD: 0.58; 95%CI: −0.41/1.56) and BOP (SMD: 0.52; 95%CI: −0.57/1.60) in respect to the control group. Splitting to subgroups, green tea showed a small negative effect in the chlorhexidine control groups. Green tea treatment had medium positive effect size in reducing CAL (SMD 0.58; 95%CI: −0.49/1.65) and large positive effect size in reducing PPD (SMD:1.02; 95%CI: 0.45/1.59).

Conclusion

Even if the results are encouraging, there is insufficient evidence to recommend the use of green tea formulation as first choice treatment for gingivitis, periodontitis and caries.

Camellia Sinensis Mouthwashes in Oral Care: a Systematic Review

Herbal products are increasingly growing in the oral care market. Some of the related herbal compounds in this field have considerable clinical evidence for use in mouthwashes in their background. Camellia sinensis or tea plant has attracted numerous researchers of dentistry and pharmaceutical sciences, in recent years, for its biologic and medicinal properties. The effects such as anti-septic, anti-oxidative, and anti-inflammatory activities have made this plant a suitable candidate for preparation of mouthwashes. In this systematic review, we tried to find, evaluate, and categorize the sparse evidence in medical literature about Camellia sinensis mouthwashes. We explored three scientific databases with keywords including tea, dental care, Camellia sinensis, and mouthwashes and found 69 relevant studies including 41 randomized controlled trials (RCTs), which are generally proposing anti-microbial, anti-plaque, and analgesic indications for these tea formulations. Considering the main trend in clinical evidence and favorable safety profile, Camellia sinensis products are able to act as antiseptic, anti-plaque, and anti-inflammatory agents and can be used as useful mouthwashes in the future clinical studies and practice.

Inhibitory effects of Mezoneuron benthamianum root extracts on oral cariogenic microorganisms and 2,2-diphenyl-1-picrylhydrazyl (DPPH) scavenging radical

Background

Chewing sticks are commonly used as oral hygiene tool in Africa and reactive oxygen species have been linked to the cause of degenerative diseases because of their ability to induce oxidative damage to biological molecules. Plants have been a long source of dietary antioxidants as most plants have been found to exhibit excellent antioxidant potentials. Mezoneuron benthamianum is a plant that is used locally as chewing sticks in southwest, Nigeria, but its use as a therapeutic agent in dental caries, a disease caused by bacteria especially Streptococcus mutans is poorly investigated. This study was therefore designed to investigate the anticaries activities of the crude extracts of M. benthamianum root against four clinical oral pathogens (Staphylococccus aureus, Escherichia coli, Pseudomonas aeruginosa and Streptococcus mutans) and the antioxidant activities using 2,2-diphenyl-1-picrylhydrazyl (DPPH).

Results

The results of this study showed that M. benthamianum had a consistent activity against all the bacterial organisms tested, with the ethyl acetate extract having the highest anticaries activity with minimum inhibitory concentration values of 78 and 156 μg/mL, while the hexane extract had the least anticaries activity with MIC values of 2500 μg/ml against S. mutans and E. coli respectively. The results also revealed that the ethyl acetate and aqueous methanol extract exhibited a higher antioxidant activity (IC50 = 23.70 and 21.30 μg/mL) than standard ascorbic acid (IC50 = 38.20 μg/mL).

Conclusion

This study demonstrated the anticaries and antioxidant potentials of M.benthamianum and therefore justifies the folkloric use of M. benthamianum in oral hygiene.

Polyphenols in Dental Applications

(1) Background: polyphenols are a broad class of molecules extracted from plants and have a large repertoire of biological activities. Biomimetic inspiration from the effects of tea or red wine on the surface of cups or glass lead to the emergence of versatile surface chemistry with polyphenols. Owing to their hydrogen bonding abilities, coordination chemistry with metallic cations and redox properties, polyphenols are able to interact, covalently or not, with a large repertoire of chemical moieties, and can hence be used to modify the surface chemistry of almost all classes of materials. (2) Methods: the use of polyphenols to modify the surface properties of dental materials, mostly enamel and dentin, to afford them with better adhesion to resins and improved biological properties, such as antimicrobial activity, started more than 20 years ago, but no general overview has been written to our knowledge. (3) Results: the present review is aimed to show that molecules from all the major classes of polyphenolics allow for low coast improvements of dental materials and engineering of dental tissues.

Efficacy of green tea-based mouthwashes on dental plaque and gingival inflammation: A systematic review and meta-analysis

Objectives

The purpose of this study was to conduct a systematic review and if appropriate a meta-analysis of the efficacy of daily rinsing with green tea-based mouthwashes in terms of plaque index (PI) and/or gingival index (GI) as compared to other mouthwashes in plaque-induced gingivitis patients.

Materials and Methods

MEDLINE, Cochrane Central Register of Controlled Trials, IndMed, Google Scholar, and major journals were searched for studies up to December 2016. A comprehensive search strategy was designed, and the eligible articles were independently screened for eligibility by two reviewers. Randomized controlled trials in which individuals were intervened with oral mouthwashes of interest were included. Where appropriate, a meta-analysis was performed and standardized mean differences (SMDs) for GI and PI were calculated.

Results

A total of 9 articles out of the 311 titles met the eligibility criteria. A meta-analysis was performed for five studies that compared green tea-based mouthwashes with chlorhexidine (CHX). The SMD for PI was -0.14 (95% CI: -1.70, 1.43; P = 0.86 and I² = 94%), while that for GI was 0.43 ((95% CI: -0.63, 1.49; P = 0.43, I² = 89%). Both these estimates suffered from significant heterogeneity. For both PI and GI, two studies were in favor of green tea while three studies were in favor of CHX.

Conclusions

Green tea-based mouthwashes can be considered an alternative to CHX mouthwashes in sustaining oral hygiene, especially because of the added advantages provided by such herbal preparations.

Comparison of the Streptococcus mutans and Lactobacillus colony count changes in saliva following chlorhexidine (0.12%) mouth rinse, combination mouth rinse, and green tea extract (0.5%) mouth rinse in children

BACKGROUND

Compounds present in green tea have been shown to inhibit the growth and activity of bacteria associated with oral infections. The purpose of this study was to compare the efficacy of chlorhexidine (0.12%) mouth rinse and combination (chlorhexidine and sodium fluoride) mouth rinse to that of green tea extract (0.5%) mouth rinse in reducing the salivary count of Streptococcus mutans and Lactobacillus in children.

MATERIALS AND METHODS

The sample for the study consisted of 75 school children aged 8-12 years with four or more (decay component) of decayed, missing, and filled teeth index. Children were divided randomly into three equal groups and were asked to rinse with the prescribed mouth rinse once daily for 2 weeks after breakfast under supervision. Nonstimulated whole salivary sample (2 ml) was collected at baseline and postrinsing and tested for the colony forming units of S. mutans and Lactobacillus.

RESULTS

The results of the study indicate that there was a statistically significant reduction in S. mutans and lactobacilli count in all the three study groups. The statistically significant reduction in the mean S. mutans and lactobacilli counts were more in 0.12% chlorhexidine group than in the combination mouth rinse and 0.5% green tea mouth rinse group. There was no statistically significant difference in the reduction of S. mutans and lactobacilli count between combination mouth rinse group and 0.5% green tea mouth rinse group.

CONCLUSION

Green tea mouth rinse can be a promising preventive therapy worldwide for the prevention of dental caries.

Evaluation of Salvadora persica L. and green tea anti-plaque effect: a randomized controlled crossover clinical trial

Background

In the author’s earlier in vitro investigation, a combination of 0.25 mg/ml green tea and 7.82 mg/ml Salvadora persica L. aqueous extracts was found to exhibit significant synergistic anti-bacterial and anti-adherence effects against primary plaque colonizers biofilm. A clinical trial was needed to support these preliminary in vitro results and to investigate its efficacy as a mouthwash in the control of dental plaque.

Methods

A 24 h plaque re-growth, double-blinded, randomized crossover trial was carried out. Participants (n = 14) randomly rinsed with test formulation, 0.12% chlorhexidine (control) and placebo mouthwashes for 24 h. A week before the trial, all participants received scaling, polishing and oral hygiene education. On the trial day, the participants received polishing at baseline and rinsed with 15 ml of randomly allocated mouthwash twice daily without oral hygiene measures. After 24 h, plaque index was scored and then the participants entered a 6-days washout period with regular oral hygiene measures. The same protocol was repeated for the next 2 mouthwashes.

Results

The results were expressed as mean (±SD) plaque index. The test mouthwash (0.931 ± 0.372) significantly reduced plaque accumulation when compared with placebo (1.440 ± 0.498, p < 0.0167) and chlorhexidine (1.317 ± 0.344, p < 0.0167) mouthwashes. No significant difference was found between chlorhexidine and placebo (p > 0.0167).

Conclusions

The test mouthwash has an anti-plaque effect for a 24 h period. Longer-term clinical studies are highly encouraged to investigate its anti-plaque effect for longer periods.

Trial registration

This study was registered in ClinicalTrials.gov as NCT02624336 in December 3, 2015.

Electronic supplementary material

The online version of this article (doi:10.1186/s12906-016-1487-0) contains supplementary material, which is available to authorized users.

Comparative Evaluation of Arimedadi Oil with 0.2% Chlorhexidine Gluconate in Prevention of Plaque and Gingivitis: A Randomized Clinical Trial

INTRODUCTION

Chemical plaque control measures are advocated to maintain proper oral hygiene. Ayurvedic medicines are alternatives considered with minimal side effects to treat systemic diseases and dental diseases. So the present study was conducted to assess the anti-plaque efficacy of Arimedadi (herbal) oil against 0.2% Chlorhexidine gluconate mouthwash.

AIM

To assess the anti-plaque efficacy of Arimedadi (herbal) oil against 0.2% Chlorhexidine gluconate mouthwash.

MATERIALS AND METHODS

A total of 45 patients aged 18 to 21 years, with mild to moderate gingivitis were recruited and were divided randomly into three groups with 15 subjects in each group. After baseline data, scaling and polishing was performed. Group A, as Control, Group B, Chlorhexidine gluconate mouthwash and Group C used experimental Arimedadi oil mouthwash. Instructions were given to use 10 ml mouthwash twice daily after 30 min of tooth brushing for 1 min till 21 days. Plaque Index (PI) and Gingival Index (GI) were taken to assess Plaque and Gingival health on 7(th) day, 14(th) day and at 21(st) day. The statistical analysis was done using Paired t-test and analysis of variance (ANOVA) followed by Post Hoc test.

RESULTS

There was similar improvement in gingival health among both groups compared to control group up to 21 days (p<0.001). However from 14(th) day to 21(st) day there was no difference in gingival health between Chlorhexidine and Arimedadi group (p>0.05).

CONCLUSION

Arimedadi oil is equally effective to Chlorhexidine gluconate as an adjunct to mechanical plaque control in prevention of plaque accumulation and gingivitis. Arimedadi oil could be an effective and safe alternative to 2% Chlorhexidine gluconate mouthwash due to its prophylactic and therapeutic benefits.