Investigating the effectiveness of atorvastatin mouthwash on denture stomatitis: A randomized, double-blind controlled trial

STATEMENT OF PROBLEM

Denture stomatitis (DS) is a common oral disorder in patients with complete maxillary dentures. Typical treatments such as nystatin or azoles lead to drug resistance after a long period. Several studies have shown the antifungal activity of statins against Candida albicans; however, studies on the antifungal effect of atorvastatin against DS are lacking.

PURPOSE

The purpose of this randomized, double-blind controlled trial was to assess the effectiveness of atorvastatin mouthwash against DS.

MATERIAL AND METHODS

Twenty-two participants diagnosed with DS were randomly allocated into 2 groups: 11 in the intervention group (atorvastatin mouthwash) and 11 in the control group (nystatin). Participants were asked to use the mouthwash 3 times a day for 2 weeks. The length and width of the lesions were measured, and the number of colonies were counted on days 1 and 14. Data were analyzed with the Spearman correlation coefficient and the Mann-Whitney, Kruskal Wallis, and Wilcoxon tests (α=.05).

RESULTS

The number of colonies before and after using a mouthwash was significantly different in the control and intervention groups (P=.005 and P=.003, respectively). The number of colonies in the 2 groups were statistically similar on the first day (P=.809). However, a significant difference was observed between the groups on day 14 (P=.024). The number of colonies in the atorvastatin group decreased more than nystatin, indicating that atorvastatin was more effective. A significant difference among the groups was found in terms of Candida species detected after the intervention (P=.032).

CONCLUSIONS

Atorvastatin was effective in reducing Candida species in participants with DS and can be used as an antifungal agent in treating DS.

Evaluation of antimicrobial and cytotoxic effects of Echinacea and Arctium extracts and Zataria essential oil

Dental caries and oral infections have become a widespread issue in the modern world. This study aimed to investigate the antibacterial, antifungal, and cytotoxicity characteristics of the extracts of Echinacea purpura, Arctium lappa, and the essential oil of Zataria multiflora as a potential herbal mouthwash. The essential oil of Z. multiflora leaves and the extracts of E. purpurea and A. lappa roots were prepared. The characterization was carried out by GC-MS and also, total phenol and flavonoid were assed for all three samples. The antimicrobial and anti-biofilm effects were evaluated against Streptococcus mutans, Streptococcus mitis, Streptococcus salivarius, Lactobacillus acidophilus, Escherichia coli, Staphylococcus aureus, and Candida albicans. The cytotoxic effect of the samples was evaluated on HEK 293 and HDFa cells by MTT test. Thymol and carvacrol contents in EO of Z. multiflora were measured at 31% and 42.2%, respectively. A. lappa had the lowest total phenolic and flavonoid value among the samples. On the other hand, the total phenolic content of Z. multiflora and the total flavonoid content of E. purpurea were the highest. The MIC values of Zataria, Arctium, and Echinacea against S. mutans were 0.011% v/v, 187.5 mg/ml, and 93.75 mg/ml, while MBC were 0.011% v/v, 375 mg/ml, and 187.5 mg/ml, respectively. The formulation showed bactericidal activity against S. mutans in the concentration of 5.86 mg/ml for Echinacea and Burdock extracts and 0.08 µl/ml for EO of Zataria. The formulation significantly affected microbial biofilm formation and induced biofilm degradation. The cell viability percentages were higher than 50% during 24 and 48 h. The formulation had a significant antimicrobial effect on cariogenic bacteria and C. albicans, with the lowest cytotoxic effects. Therefore, this formulation can be an appropriate candidate for mouthwash.