Use of over-the-counter mouthwashes as an additional measure in individual oral prophylaxis on adults with plaque-induced gingivitis: a double-blind, parallel, randomized controlled trial

BACKGROUND

Plaque-induced gingivitis is a chronic inflammatory condition characterized by complete reversibility of tissue damage once the periodontal biofilm has been disorganised. The aim of this study was to evaluate the efficacy of two commercially available mouthwashes (MWs) versus a chlorhexidine (CHX) 0.12% MW in reducing gingival bleeding (GB) in adults with plaque-induced gingivitis.

METHODS

The present study was a double-blind, parallel, randomized controlled trial involving 6492 gingival sites (i.e. 39 subjects × 28 teeth × 6 sites/tooth) aged 18-75 years. During a 2-week period, subjects were randomized to receive MWs: a control CHX 0.12% MW (group C, 1818 sites); a MW test containing CHX 0.09% + Citrox®/P complex (group CX, 2628 sites); a MW test based on natural compounds (group P, 2016 sites). GB was assessed at the inclusion visit (T0) and after 2 weeks of MW use (T1). Analyses of GB were compared between groups and then restricted to subjects with bleeding sites between 10 and 30% (moderate gingivitis) or ≥ 30% (severe gingivitis) at T0. Pairwise comparisons were made between groups and logistic regression was used to identify correlates of GB (T1).

RESULTS

For total bleeding site analysis, GB reduction between T0 and T1 ranged from 23% (C), 26% (CX) and 36% (P), respectively (all p < 0.05). Multiple comparison between groups showed that group C was significantly less effective (p < 0.05) than groups CX and P. Splitting the analysis, in patients with severe gingivitis (≥ 30% bleeding sites at T0), all MWs had a positive effect on GB with a reduction at T1 of 36% (C), 33% (CX) and 42% (P), respectively. While GB reduction between T0 and T1, was significant for all groups, the comparison among groups showed no significant difference between group C and CX, whereas the improvement was significant for group P. On the other hand, in adults with moderate gingivitis (< 30% bleeding sites at T0), only CX and P had a positive effect on GB reduction at T1(9% in CX and 2% in P, respectively), although the differences between the three groups were not significant.

CONCLUSION

The daily use of MWs with natural components (groups P and CX) for 2 weeks should be considered positively as an adjunct to individual oral prophylaxis to reduce GB compared to the control MW containing CHX 0.12% (group C) in healthy adults with plaque-induced gingivitis. For subjects with severe gingivitis, it is advisable to first use natural MW (P) and then MW based on CHX 0.09% with natural components (CX), compared to MW with CHX 0.12% (C). For adults with moderate gingivitis, P and CX can be advisable, even if no definitive recommendations can be drawn.

TRIAL REGISTRATION

ACTRN12622000215729, 07/02/2022.

Prevalence, Severity of Extension, and Risk Factors of Gingivitis in a 3-Month Pregnant Population: A Multicenter Cross-Sectional Study

The scope of this study was to assess the prevalence, severity of extension, and risk factors of gingivitis among pregnant women. In this cross-sectional study, 220 nulliparous women at 3 months of pregnancy were recruited in 2022 at the first obstetrical visit in Dakar, Senegal. Demographic characteristics, lifestyle habits, prenatal clinical status, and oral clinical parameters were recorded. Multivariable logistic regression modeling was used to assess relationships between gingivitis and risk factors. Eighty-eight percent of women had gingivitis, 15% were classified as moderate and 73% as severe. A total of 66.7% (95% CI [28.8-92.1]) of the sites had bleeding on interdental brushing. The odds for gingivitis decreased significantly for women consuming more than five portions of fruits and vegetables per day (OR = 0.15; 95% CI [0.03-0.66]) and increased in women who had a professional activity (OR = 6.75; 95% CI [1.27-35.87]) and high education. Concomitantly, the percentage of dental plaque (OR = 131.6; 95% CI [10.80-1619.71] and the severity of clinical attachment loss (OR = 7.70; 95% CI [3.16-18.92]) were important risk factors. Inverse associations were observed with increasing body mass index (OR = 0.76; 95% CI [0.63-0.93]). Our results underline that gingivitis cases and bleeding were particularly high among 3-month pregnant women. Literacy and adequate oral hygiene actions to modify behaviors and to achieve meticulous biofilm disorganization could make a favorable change in the gingival health outcome. Additionally, further research is necessary to precisely determine the role of biofilm-induced gingivitis and systemic-induced gingivitis in improving gingival conditions.

Vitamin C stimulates RNA expression of human gingival fibroblasts proliferation and adhesion in cigarette smokers: An in vitro study

Background

Smoking and the severity of periodontal disease have long been associated. In Saudi Arabia, tobacco smoking is rising, contributing to the increased demand for products that counter its detrimental effects. The antioxidant properties of vitamin C (vit C) make it a powerful countermeasure to tobacco toxicity. Observation of these effects on human gingival fibroblasts (hGFs) would suggest use of vitamin C in future dental applications.

Aim

To examine the proliferation, adhesion, and expression of extracellular RNA in human gingival fibroblasts extracted from cigarette smokers when compared to never-smokers, in association with vitamin C.

Materials and Methods

Human gingival fibroblasts were extracted from Periodontal free sites of healthy adult male participants. Group 1; consisted of Heavy cigarette smokers (n = 1) while group 2 was never-smokers (n = 1). Collected cells were cultured and subcultured in supplemented growth medium. Vitamin C was then induced in the medium at the experimental sixth passage. RNA expression analysis using quantitative reverse transcriptase-polymerase chain reaction was performed to analyze the adhesion, proliferation, and extracellular matrix expression.

Results

Expression of the adhesion gene (CD44) in the smoker group was significantly downregulated than never-smoker group (p-value = 0.024). After the induction of vitamin C, the smoker samples showed a significant improvement in their gene expression levels. The extracellular genes involved in this study (COL1A1, LAMA3, and TGFB3) were significantly affected by the smoking status. In addition, the proliferation of MK167 and CCNB1 genes in smokers and never-smokers was increased.

Conclusion

Cigarette smoking affects the overall properties of human gingival fibroblasts’ adhesion, proliferation, and extra-cellular matrix formation. Furthermore, the addition of vitamin C affects these cellular properties in a positive manner.

Influence of Occupational Factors on the Job Satisfaction Among Licensed Periodontist in Kingdom of Saudi Arabia: A Cross-Sectional Study

Aim:

To evaluate the overall job satisfaction among periodontists, highlighting the significance of intrinsic and extrinsic factors and their satisfaction level with patients, facilities, and workplace when working in the Kingdom of Saudi Arabia.

Materials and Methods:

An interview-type questionnaire-based cross-sectional study was formulated and consisted of total 38 questions in 8 domains. Contact details of registered periodontists were taken and a weblink containing details of the questionnaire using the tool SurveyMonkey was sent to periodontist from the office of Saudi Dental Society. A single investigator was done to minimize bias evaluated with all the responses. Statistical Package for the Social Sciences software version 21 (SPSS Inc., Chicago, IL, USA) was used for tabulation of descriptive analysis. Standard deviation, percentages and means were calculated.

Results:

Out of the total 75 emails sent to the periodontists, 65 (86%) responses were received. 63 (96.9%) of the respondents were Saudi nationals, whereas the rest 2 (3.1%) were non‑Saudis. 40 (61.5%) respondents were males, whereas 25 (38.5%) were females. Majority of the respondents were dentists 43 (66.2%). 32.3% reported better professional growth as the main reason for choosing periodontal profession. However, a vast majority of the respondents, 56.9% stated that working as a periodontist was their first choice. 49.3% of the respondents affirmed that they were pleased with the working environment as it was conductive and professional. Approximately, 73.9% of the periodontist were of the view that they had good relations with their patients.

Conclusion:

Job satisfaction among periodontists working in the Kingdom of Saudi Arabia was adequate as majority of them displayed a positive attitude toward working environment, their profession, peers, and intrinsic and extrinsic factors related to periodontal profession.

Clinical Significance:

Job satisfaction plays a vital role in delivering standard quality health care. Dissatisfaction in job may lead to stress, anxiety, and/or depression leading to compromised health care facilities and patient satisfaction.

The use of mouthwash containing essential oils (LISTERINE®) to improve oral health: A systematic review

Background

Standard recommendations to maintain daily oral hygiene include tooth brushing and interdental cleaning. Evidence from literature indicates that using a mouthrinse as an adjunct provides benefit beyond mechanical methods. The objective of this article was to evaluate the short- and long-term effect of a mouthwash containing essential oils (LISTERINE®) in improving oral health.

Methods

PubMed (MEDLINE) and bibliographies from the relevant retrieved reviews were searched to identify clinical studies involving the use of LISTERINE mouthrinse. The primary outcome measure was short- and long-term efficacy of mouthrinse containing essential oil (LISTERINE®) in improving oral health.

Results

Based on our search, 26 studies supported the use of essential-oil-containing mouthrinse (LISTERINE®) as an adjunct to daily oral health regimen. Most studies were conducted in healthy subjects, 2 studies in orthodontic patients, 1 each in xerostomia patients and mentally disabled patients. Of these, 13 studies supported the short-term (<3 months) and 13 studies supported the long-term (3-6 months) efficacy of LISTERINE mouthrinse as an adjunct to mechanical methods.

Conclusions

This review provides strong evidence of the anti-plaque and anti-gingivitis effects of essential-oil-containing mouthrinse LISTERINE® as an adjunct to daily tooth brushing and interdental cleaning.

Effect of scaling and root planing with and without adjunct use of an essential-oil-based mouthwash on whole salivary interleukin-1β levels in patients with periodontal disease: A short-term follow-up study

OBJECTIVE

The aim of the present short-term follow-up study was to assess the effect of scaling and root planing (SRP) with and without adjunct use of an essential-oil-based mouthwash (EOBM) on whole salivary interleukin (IL)-1beta (β) levels in patients with periodontal disease.

METHODS

Ninety individuals with periodontal disease were divided into two groups. Patients in group 1 underwent SRP and were instructed to rinse with 10 mL of an EOBM twice daily for 30 days. Patients in group 2 underwent SRP and were instructed to rinse with 10 mL of water twice daily for 30 days. Whole saliva samples were collected, and IL-1β levels were measured at baseline and after 60 days of treatment. P-values < 0.05 were considered statistically significant.

RESULTS

At baseline, whole salivary IL-1β levels were comparable among patients in groups 1 (135.6 ± 13.5 μg/mL) and 2 (141.2 ± 5.4 μg/mL). After 60 days of follow-up, there is a significant decrease in whole salivary IL-1β levels among patients in group 1 (10.2 ± 6.4 μg/mL) as compared to those in group 2 (56.6 ± 10.2 μg/mL) (P < 0.01).

CONCLUSION

SRP, when performed with adjunct use of an EOBM, is more effective in reducing whole salivary IL-1β levels as compared to when SRP is performed without the use of an EOBM.

Effect of scaling and root planing with and without adjunctive use of an essential-oil-based oral rinse in the treatment of periodontal inflammation in type-2 diabetic patients

AIM

The aim was to assess the effect of scaling and root planing (SRP) with and without adjunctive use of an essential-oil (EO)-based oral rinse in the treatment of periodontal inflammation in type-2 diabetic (T2D) patients.

METHODS

Sixty T2D patients were included. In Group 1 (n = 30), SRP was performed and patients were instructed to rinse twice daily with EO-based oral rinse for 30 days. In Group 2 (n = 30), SRP was performed and participants were instructed to rinse twice daily with water for 30 days. Periodontal parameters (plaque index (PI), bleeding on probing (BOP), and probing pocket depth (PPD) ≥ 4 mm) and hemoglobin A1c (HbA1c) levels were assessed at baseline and after 90 days.

RESULTS

In both groups, periodontal parameters were similar at baseline. After 90 days of follow-up, there was a significant reduction in the severity of periodontal parameters in patients in Group 1 compared with Group 2. After 90 days of follow-up, there was also a significant reduction in HbA1c among patients in Group 1 compared with Group 2.

CONCLUSIONS

Scaling and root planing with adjunct use of an EO-based oral rinse is more effective in the treatment of periodontal inflammation in T2D patients than SRP alone. This approach also helps reduce hyperglycemia in T2D patients as compared with when SRP is performed alone.

The role of lasers in the treatment of peri-implant diseases: A review

We reviewed the indexed literature regarding the efficacy of laser therapy in the treatment of peri-implantitis (PI). Databases were searched using combinations of the following keywords: peri-implantitis, bone loss, photodynamic therapy, laser, and light-activated disinfection. Titles and abstracts of publications from these search results were screened to determine which studies fulfilled the eligibility criteria. Full texts of relevant studies were read and independently assessed against the eligibility criteria. The resulting 28 studies described the role of lasers in the treatment of PI. The erbium:yttrium–aluminum-garnet laser can be used to sterilize implant surfaces without damaging them. Likewise, the carbon dioxide laser can disinfect implant surfaces and enhance the bone-to-implant contact around previously infected sites. Photodynamic therapy exhibits high target specificity and can destroy pathogens associated with the etiology of PI. Laser therapy can significantly reduce levels of clinical markers of peri-implant tissue inflammation (i.e., bleeding upon probing and clinical attachment loss) without jeopardizing the integrity of the implant or alveolar bone. In conclusion, laser therapy as an adjunct to conventional mechanical debridement therapy can be used effectively for the treatment of PI.

Impact of scaling and root planing on clinical periodontal status and glycemic levels in prediabetic patients

OBJECTIVE

The aim was to assess the effect of scaling and root planing (SRP) on clinical periodontal parameters and glycemic levels in prediabetic patients.

METHODS

Fifty prediabetic patients with periodontal disease were included. Demographic data (age, gender, education status, duration of prediabetes, type of treatment adopted for prediabetes management, and oral hygiene maintenance protocols) were recorded using a questionnaire. Patients were randomly divided into two groups (25 patients/group). In Group 1, SRP alone was performed, in Group 2, SRP + oral doxycycline (100 mg) administration. In both groups, fasting blood glucose (FBG) levels and periodontal parameters (plaque index [PI], bleeding on probing [BOP], and probing depth [PD]) were assessed at baseline and after 6 months. Statistical analysis was performed using one-way analysis of variance.

RESULTS

Age, gender, and duration and treatment of prediabetes were comparable among patients in Groups 1 and 2. PI, BOP, and PD significantly reduced in both groups than baseline values. Reduction in periodontal parameters among Groups 1 and 2 were comparable. There was no significant reduction in FBG levels among patients in Groups 1 and 2 after 6 months of SRP.

CONCLUSION

SRP was effective in reducing periodontal inflammation in prediabetic patients. FBG levels did not show any significant difference after SRP in both groups.