The effects of a 0.2% chlorhexidine gluconate mouthrinse on plaque, toothstaining and candida in aphthous ulcer patients

Despite the known effectiveness of 0.2% chlorhexidine gluconate mouthwash in preventing plaque formation, relatively few studies have assessed adjunctive benefit to normal unsupervised oral hygiene measures. Furthermore, there have been few accurate measurements of toothstaining in the presence of normal oral hygiene and little data of effects on oral candidal carriage. This study was a double-blind placebo-controlled cross-over study of a 0.2% chlorhexidine gluconate mouthwash used 3 times daily on plaque, staining and candidal carriage in a group of recurrent aphthous ulcer suffers who maintained normal oral hygiene measures. At the end of 2 6-week treatment periods, baseline plaque scores were reduced by active and placebo mouthwashes. Chlorhexidine significantly reduced plaque compared to the placebo. Staining has markedly and significantly increased during chlorhexidine rinsing. Candidal carriage was present in 22.2% of this group and there was no significant effect of chlorhexidine on the mean number of candidal colonies. The distribution of plaque and staining by tooth was plotted and observationally studied. Baseline and placebo treatment plaque distributions indicated the considerable relevance of toothbrushing behaviour for plaque distribution. The effects of toothbrushing on plaque distribution were minimised during the use of chlorhexidine. Staining associated with chlorhexidine showed a distribution again suggesting the influence of toothbrushing. In conclusion, chlorhexidine has significant adjunctive effects on plaque inhibition in the presence of normal unsupervised oral hygiene, but toothbrushing did not prevent toothstaining.     

Influence of additional active ingredients on the effectiveness of non-alcoholic chlorhexidine mouthwashes: a randomized controlled trial

BACKGROUND: Non-alcoholic chlorhexidine mouthwashes are equally effective and have fewer potential risks than hydroalcoholic solutions. Nowadays, other active ingredients are added to these mouthwashes in an attempt to improve their effectiveness and reduce side effects. Following an experimental gingivitis model, this study examined three non-alcoholic commercial mouthwashes having 0.12% chlorhexidine digluconate (CHX) in common. METHODS: Using a double masked, cross-over design, 30 subjects underwent three consecutive experimental phases with three mouthwashes: CHX, CHX + 0.05% sodium fluoride (CHXNaF), and CHX + 0.05% cetylpyridinium chloride (CHX-CPC). In each one of these 21-day phases, the subjects discontinued all oral hygiene measures and were treated exclusively with the experimental mouthwash randomly assigned (an oral rinse twice a day). Each experimental phase was preceded by a 14-day washout period. Levels of gingivitis, dental plaque, supragingival calculus, and dental staining were assessed at baseline and end (day 21) of experimental phases. RESULTS: The evolution of gingival and dental staining indices did not show statistically significant differences between the treatments. Differences were noticed in the plaque index (P = 0.0002), with CHX-NaF the treatment with the greatest increase. Differences were also observed in the supragingival calculus index (P = 0.0136), with CHX-CPC showing a smaller increase. Tongue staining was more frequent with CHX-CPC (P = 0.0141). CONCLUSION: In non-alcoholic 0.12% chlorhexidine mouthwashes, the addition of other active ingredients does not produce beneficial effects, but may even reduce the antiplaque effectiveness or increase tongue staining.     

0.2% Chlorhexidine Mouthwash With an Antidiscoloration System Versus 0.2% Chlorhexidine Mouthwash: A Prospective Clinical Comparative Study

Background: The goal of this study is to evaluate the degree of staining and clinical efficacy of a chlorhexidine mouthwash with an antidiscoloration system (ADS) versus 0.2% chlorhexidine mouthwash (traditional). Secondary objectives are to evaluate the patient “compliance” factor according to patterns assigned by the clinician and to observe the side effects of the two mouthwashes. Methods: This comparative study is carried out on a sample of 15 non‐smoking patients with chronic periodontitis at the Department of Periodontology, the International University of Catalunya, Barcelona, Spain. All patients used either 0.2% chlorhexidine mouthwash (control group = bottle B) or chlorhexidine with ADS (test group = bottle A) for 15 days. Each patient first rinsed with a randomly assigned mouthwash for 15 days followed by a 15‐day washout period. Subsequently, each patient used a second mouthwash. Before each cycle, a full dental prophylaxis was performed. The plaque, gingival, and Brecx staining indexes were used. Results: The results showed less tooth staining with the test group (P <0.01). No statistically significant differences were observed in plaque (P = 0.1496) and gingival indexes (P = 0.1688). Eighty‐eight percent of patients followed the instructions outlined in the protocol. In terms of other adverse effects, two patients reported a bad taste with both mouthwashes. Conclusions: The test group with ADS had less staining than the control group during a usage period of 15 days. However, the two mouthwashes seemed to be equally effective as antiplaque and antigingivitis agents.     

Effects of oral rinsing with triclosan and sodium lauryl sulfate on dental plaque formation: a pilot study

Mouthwashes containing 0.3% or 0.15% triclosan in combination with 1.5% sodium lauryl sulfate (SLS) produced a significant reduction in plaque formation in a test panel of 11 students who refrained from oral hygiene during the test periods, during which they rinsed twice daily with different mouthwashes. Pl.I. was evaluated after each test period. A mouthwash containing only 1.5% SLS inhibited plaque to almost the same degree. In both cases, the major effect was on the buccal/lingual surfaces, where score 2 was changed to score 0. Addition of triclosan appeared to reduce the untoward side-effects of mouthwashes containing SLS alone (i.e. desquamation and a burning sensation in the mouth).     

Comparison of chlorhexidine delivery by mouthwash and spray on plaque accumulation

The delivery of chlorhexidine by spray systems have been found useful in controlling plaque in handicapped individuals. This study using a single blind crossover design compared chlorhexidine delivery by mouthwash and spray for plaque inhibitory effects. A group of 14 volunteers participated in two 4 day, no oral hygiene regimens. During one regimen chlorhexidine was professionally sprayed onto the teeth twice a day and during the other chlorhexidine was rinsed twice a day under supervision. Plaque regrowth from a zero baseline was recorded using a plaque index and by area. Little plaque accumulated during the two periods. There was no significant difference in plaque measurements following the use of the spray or mouthwash. This study demonstrated that chlorhexidine when sprayed under optimal conditions was as effective as a mouthwash at controlling plaque despite only requiring one seventh of a dose from a rinse. The results have implications for the use and delivery of chlorhexidine for plaque control and are relevant to the proposed mode of action of this antiseptic.     

Influence of alcohol in mouthwashes containing triclosan and zinc: an experimental gingivitis study

OBJECTIVES: An experimental gingivitis model was used to analyse the influence of alcohol in mouthwashes containing 0.15% triclosan and zinc chloride on the formation of supragingival plaque, the development of gingivitis and the appearance of adverse events. MATERIAL AND METHODS: Using a double-blind crossover design, 30 subjects underwent two consecutive experimental phases with two 0.15% triclosan and zinc chloride mouthwashes, differentiated mainly by their excipient (hydroalcoholic or aqueous). In each phase, the subjects discontinued all oral hygiene measures and were treated solely with the randomly assigned experimental mouthwash for 21 days. Each experimental phase was preceded by a 14-day washout period in which, after receiving a complete oral prophylaxis, the subjects were instructed to perform thorough oral hygiene procedures. Gingivitis and plaque levels were assessed at the start and end of both the experimental phases. RESULTS: The evolution of the gingivitis and plaque indices showed no statistically significant differences between both treatments. The mean gingival index increased from 0.30 to 0.38 with the non-alcoholic mouthwash and from 0.32 to 0.42 with the hydroalcoholic mouthwash. The respective changes in plaque index were from 0.88 to 1.93 and from 0.94 to 1.92. The hydroalcoholic mouthwash produced a larger number of fresh symptoms (p=0.033), oral itching being the most reported. CONCLUSIONS: Alcohol does not influence the effectiveness of a 0.15% triclosan and zinc chloride mouthwash against gingivitis development and supragingival plaque formation. The absence of alcohol significantly decreases the incidence of adverse events produced by the mouthwash.     

Valutazione clinica di due collutori a base di clorexidina digluconato senza alcol con e senza sistema di antipigmentazione. Studio clinico controllato randomizzato

ObjectivesThe aim of this study was to evaluate the efficacy of two alcohol-free, 0.2% chlorhexidine mouthwashes, with and without antidiscoloration systems, following nonsurgical periodontal therapy.Materials and methodsThirty patients suffering from chronic generalized periodontitis were randomly divided into two groups. After completion of root scaling and planing, the patients in the test group were instructed to use the alcohol-free 0.2% chlorhexidine mouthwash containing an antidiscoloration system, while those of the control group were treated with alcohol-free 0.2% chlorhexidine mouthwash alone.ResultsThe mouthwash used in the test group caused less discoloration than the one used by controls.ConclusionsTreatment for 2 weeks with alcohol-free 0.2% chlorhexidine mouthwash containing an antidiscoloration system allows good control of mucobacterial plaque without causing tooth discoloration.     

Antiplaque and antigingivitis effectiveness of a hexetidine mouthwash

OBJECTIVE: To assess the antiplaque/antigingivitis efficacy of a hexetidine-containing mouthwash. METHODS: This examiner-blind, parallel group, controlled clinical study examined the effectiveness of a hexetidine (0.1%) mouthwash both in inhibiting the development of supragingival plaque and in reducing gingivitis. One hundred and thirty-four adult subjects completed the 2-week experimental gingivitis model study. Following baseline examinations, which included plaque index, modified gingival index and gingival bleeding index, subjects received a full dental prophylaxis. Subjects were randomly assigned to one of three mouthwashes (hexetidine 0.1%, chlorhexidine 0.12% (positive control) or a 5% hydroalcohol negative control) and commenced three times daily supervised rinsing as their sole method of oral hygiene. All indices were rescored after 2 weeks. RESULTS: Compared to the negative control group, the hexetidine group demonstrated a statistically significant inhibition and reduction of supragingival plaque and gingival inflammation with reductions of 6.3%, 33.5% and 56% for gingivitis, plaque and gingival bleeding, respectively. The results of the chlorhexidine group were used to validate the study. CONCLUSION: The study confirms the efficacy of a hexetidine rinse in reducing supragingival plaque and gingival inflammation.     

Effect of aloe vera mouthwash on dental plaque and gingivitis indices in children: A randomized controlled clinical trial

BackgroundThere is a tendency nowadays to encourage the use of natural substances in dentistry. Aloe vera is one of these substances, which has recently gained great importance in clinical research.ObjectivesTo evaluate the effectiveness of Aloe vera mouthwash in improving plaque, gingival and gingival bleeding indices in children.Materials and methodsThe study sample consisted of (17) children [age: (8) to (12) years]. The crossover design was applied, which means that the three types of mouthwashes (experimental “Aloe vera”, positive control “chlorhexidine”, and negative control “placebo”) would be used for all participants, with a washout period of (12) days. A special plaque guard was fabricated to facilitate localized plaque accumulation for (3) days. After that period, the mouthwashes were applied for (5) days. Plaque, gingival and gingival bleeding indices were studied before plaque accumulation (T0), after plaque accumulation (T1), and after applying the mouthwashes (T2). The values of plaque index (PI), gingival index (GI) and gingival bleeding index (GBI) were measured at each studied time point (T0, T1, and T2). Then, the differences between the values at the beginning of the use of each type of the mouthwashes and at the end of the period of there use were compared.ResultsThe results showed the efficacy of Aloe vera mouthwash in improving plaque, gingival and gingival bleeding indices, which was similar to chlorhexidine mouthwash effectiveness when both compared to the placebo mouthwash.ConclusionsThe use of Aloe vera mouthwash is effective in improving oral health and preventing gingivitis.     

Effect of Essential Oil and Chlorhexidine Mouthwashes on Gingival Fibroblast Survival and Migration

Background: Chemical plaque control is the most commonly recommended means of oral hygiene after periodontal surgery. Commercially available mouthwashes contain a variety of active ingredients that have bactericidal properties but may potentially be toxic to the host cells. The goal of this in vitro study is to investigate the effect of commercially available mouthwashes on the survival and migratory capacity of human fibroblasts. Methods: Human gingival and periodontal ligament (PDL) fibroblasts were treated with commercially available mouthwashes that contained either chlorhexidine (CHX) or essential oils (EO) as the active ingredient. Each mouthwash was tested over a range of concentrations for its ability to affect fibroblast survival and migration, as well as long‐term effects on cell viability. Results: Undiluted mouthwashes induced near‐complete cell death 24 hours after only a 60‐second treatment. Dilutions of 15% to 20% for both CHX and EO mouthwashes resulted in 50% cell death. When diluted to 10% to 15%, EO did not reduce cell migration, whereas similar dilutions of CHX resulted in reduced cell migration. Concentrations of 10% of both EO and CHX mouthwashes retained most of their antibacterial capacity. Treatment with EO did not result in gingival fibroblast death, whereas 5% CHX resulted in near‐complete gingival fibroblast death 7 days after exposure. Conclusions: The results of this in vitro study indicate that diluted EO displayed no detectable detrimental effects on human gingival and PDL fibroblasts, whereas diluted CHX reduced both cell migration and long‐term survival. Both solutions retained their antimicrobial activity in lower concentrations.     

Effects of two cetylpyridinium chloride-containing mouthwashes on bacterial plaque.

The purpose of this single blind clinical study was to determine the effects of two commerical mouthwashes (one containing cetylpyridinium chloride and domiphen bromide and the other containing only cetlypridinium chloride) on existing plaque accumulations. A second purpose was to determine if a residual effect could be shown 2 weeks after cessation of using these mouthwashes. A total of 120 adult subjects, who had been divided into three groups, were initially in the study. For a period of 31 days, the subjects in Group A rinsed with a commercial mouthwash containing cetylpyridinium chloride and domiphen bromide; Group B rinsed with a commercial mouthwash containing only ceytlpyridinium chloride; and Group C served as controls and rinsed with colored flavored water. All subjects continued their normal home oral hygiene practices, except that mothwashes other than as assigned were forbidden. The subjects received three identical examinations to determine their plaque scores. The examinations were conducted the day preceding initiation; the day following cessation; and 15 days after cessation of the rinsing procedures. A total of 105 subjects received the first and second examinations, and 93 subjects received all three examinations. Based upon the data obtained, the daily use of each of the cetylpyridinium chloride mouthwashes tested, appears to be partially effective in reducing existing bacterial plaque accumulations. The cetylpyridinium chloride-domophen bromide product was slightly, but not significantly, more effective than the other commercial mouthwash. Neither commerical product demonstrated a significant residual effect 2 weeks after cessation of use.     

Randomized clinical trial of the effectiveness of 3 commonly used mouthwashes to treat chemotherapy-induced mucositis

OBJECTIVE: To test the effectiveness of 3 mouthwashes used to treat chemotherapy-induced mucositis. The mouthwashes were as follows: salt and soda, chlorhexidine, and "magic" mouthwash (lidocaine, Benadryl, and Maalox).Study Design: A randomized, double-blind clinical trial was implemented in 23 outpatient and office settings. Participants were monitored from the time they developed mucositis until cessation of the signs and symptoms of mucositis, or until they finished their 12-day supply of mouthwash. All participants followed a prescribed oral hygiene program and were randomly assigned a mouthwash. Nurses used the Oral Assessment Guide for initial assessment and taught patients how to assess their own mouths, then phoned the patients every other day to gather status reports. RESULTS: In 142 of 200 patients, there was a cessation of the signs and symptoms of mucositis within 12 days. No significant differences in time for the cessation of the signs and symptoms were observed among the 3 groups. CONCLUSIONS: Given the comparable effectiveness of the mouthwashes, the least costly was salt and soda mouthwash.     

An approach to efficacy screening of mouthrinses: studies on a group of French products

Abstract. There is a large and increasing number of oral hygiene products available to the general public. As such, it is difficult to demonstrate efficacy for all in long-term home-use studies. The aim of this project was to determine whether screening studies could position the activity and efficacy of a number of antiseptic mouthrinses, available in France, by comparison with an established product. This study reports the experiments in vitro. The products under test were, 4 containing chlorhexidine (Eludril, Hibident, Parodex and Prexidine) with Hibident considered the positive control, one containing cetylpyridinium chloride (Alodont) and one containing hexetidine (Hextril). The 1st study determined the antibacterial profile of the chlorhexidine products against a panel of oral bacteria using an agar dilution method. The 2nd study recorded, by optical density, the propensity of all products to induce tea staining on clear acrylic specimens. The maximum inhibitory dilutions (MID) of the chlorhexidine products against the test organisms, once adjusted for initial concentration differences, were essentially similar. One exception was Eludril which had an increased MID against Capnocytophaga sputigena, an organism normally less sensitive to chlorhexidine. Hibident and Prexidine produced expected levels of tea staining; that produced by Parodex was lower than the expected. Staining by Eludril was little different than water controls suggesting markedly reduced availability of chlorhexidine in this product. Alodont consistent with the very low CPC content also produced little staining and would be expected to show minimal effects against plaque in vivo. Hextril produced similar staining to Hibident but, because of the different antiseptic content, it is difficult to extrapolate the data to clinical effects. For the chlorhextdine products these data in vitro are cautiously extrapolated to indicate an expected similarity in clinical activity for Hibident and Prexidine and probably Parodex. Eludril would be expected to show considerably reduced substantivity and efficacy.     

Efficacy of Listerine®, Meridol® and chlorhexidine mouthrinses as supplements to regular tooth-cleaning measures

The anti-plaque, anti-gingivitis and anti-microbial efficacies of a phenolic compound (Listerine) and 2 different amine/stannous fluoride mouthwashes (Meridol I, II) were compared when these solutions were used in addition to usual tooth cleaning. A placebo preparation was utilized as a negative control and a chlorhexidine solution as a positive control in this double-blind study. After professional tooth cleaning, 49 volunteers continued their habitual, self-performed and non-supervised oral hygiene for a period of 2 weeks, in order to have a more standard baseline. At day 0, they began to rinse twice daily with 1 of the 5 mouthwashes. After 3 weeks of rinsing, plaque indices remained the lowest in the chlorhexidine and the Meridol I groups, while subjects using Listerine or Meridol II demonstrated similar indices significantly lower than that of individuals rinsing with the placebo solution. Through this period, the gingival index scores were similar in the Meridol, Listerine and chlorhexidine groups. At day 21, the mean GI scores in the chlorhexidine group were significantly lower than the scores in the placebo group. The plaque vitality scores showed a bacterial effect in vivo of chlorhexidine and, to a lesser extent, of the Meridol solutions. No substantial evidence of an antibacterial effect in vivo was found for Listerine. This study has demonstrated that when mouthrinses are used to supplement habitual mechanical oral hygiene, chlorhexidine remains the most powerful solution. Furthermore, it was also shown that a combination of habitual self-performed and non-supervised oral hygiene with Meridol or Listerine is more beneficial for plaque control than the use of mechanical oral hygiene alone.     

Comparative staining in vitro and plaque inhibitory properties in vivo of 0.12% and 0.2% chlorhexidine mouthrinses

Abstract. The mere incorporation of an active ingredient in an oral hygiene product does not necessarily guarantee efficacy. As new formulations appear, it would seem prudent to at least screen for activity by comparison with an established product. The aim of this study was to compare a new 0.12% chlorhexidine containing rinse with a well researched 0.2% chlorhexidine rinse product. The rinses were firstly compared in vitro for dietary staining effects and in vivo for plaque inhibition. Both formulations in vitro produced progressive staining of acrylic specimens with increasing passages through a standard tea solution. The clinical investigation was a 3-treatment, randomised, double blind, crossover, 4-day plaque regrowth study, balanced for 1st and 2nd order residual effects and involving 24 volunteers. From a zero plaque baseline, volunteers suspended oral hygiene and rinsed 2×per day with the allocated rinse. The chlorhexidine doses were 18 mg and 20 mg per rinse for the 0.12% and 0.2% formulations, respectively. Plaque was scored by area and index on day 5. The results showed that the 2 chlorhexidine rinses were similar in efficacy by comparison with the control rinse. These studies in vitro and in vivo indicate that the chlorhexidine in the new preparation is available and active and the product could find use in those preventive applications suggested for other chlorhexidine formulations.     

A non‐staining chlorhexidine mouthwash? Probably not: a study in vitro

Background and aim: Tooth staining is a common side effect of chlorhexidine mouth rinses and caused by the interaction of the di‐cationic antiseptic with dietary chromogens. A product is now available, which claims an anti‐discolouration system (ADS) with one clinical study in support. This study in vitro aims to determine whether two ADS rinses do or do not bind dietary chromogens. Method and materials: Optically clear acrylic specimens were cycled through human saliva (2 min), one of the three chlorhexidine rinses (two ADS and a positive control) (2 min) or water and then soaked in tea (60 min). After each cycle the optical density (OD) of specimens were read on a UV/visible spectrophotometer. The exit point was the cycle at which OD was >2.0. Results: All three rinses exceeded OD 2 at 11 cycles and there was no significant difference in staining for the ADS rinses compared with the positive control rinse. Conclusion: Based on extensive literature for the correlation of this test in vitro with chlorhexidine anti‐plaque activity and propensity to stain in vivo these ADS rinses will have the same anti‐plaque efficacy and potential to cause stain as established chlorhexidine rinse products.     

The effect of two different dental gels and a mouthwash on plaque and gingival scores: a six-week clinical study

AIM: To evaluate the clinical efficacy of two gel formulations containing chlorhexidine gluconate and neem extract with a commercially available chlorhexidine gluconate mouthwash. METHOD: An open labelled randomised six-week clinical study with parallel group design in 48 subjects divided into four groups. Plaque accumulation and gingival condition were recorded using plaque index and gingival index. On the basis of mean baseline plaque and gingival scores, subjects were allocated to four different groups, using their assigned products twice a day, before bed and after breakfast. Plaque and gingival scores were recorded after three and six weeks. RESULTS: Mean plaque and gingival scores were reduced over the six-week trial period for experimental and control groups. Chlorhexidine gluconate gel reduced the plaque and gingival scores significantly more (p<0.05) than the chlorhexidine gluconate mouthwash. Neem extract gel also showed significant (p<0,05) reduction in plaque and gingival scores when compared with the control group. But there was no significant difference between the groups treated with chlorhexidine gel and neem extract gel. CONCLUSION: The results of this clinical study indicate that better therapeutic efficacy can be achieved using gels for treating oral infections than conventional treatments using mouthwash.     

Inhibition of experimental caries by plaque prevention

abstract – The purpose of this study was to test the hypothesis that a frequent intake of sucrose does not produce caries if the teeth are regularly treated with an antibacterial agent. Twenty-four students with clean teeth and normal gingivae were assigned to one of the following three groups: (1) eight individuals ceased all active oral hygiene measures and rinsed 9 times daily with 50% sucrose, (2) eight students refrained from all active oral hygiene procedures, rinsed 9 times daily with sucrose and twice daily with 10 ml 0.2% chlorhexidine gluconate, (3) the third group consisted of two subgroups each comprising 4 students. One subgroup ceased all oral hygiene procedures and rinsed twice daily with 0.2% chlorhexidine gluconate. The other was instructed to practice meticulous tooth brushing twice daily. The experiment lasted for 22 days. The group who rinsed with sucrose showed heavy plaque accumulation, those who rinsed with sucrose + chlorhexidine showed a drastic reduction in the formation of plaque. In the subgroup rinsing with chlorhexidine only and in that performing good oral hygiene, plaque was non-existent. The gingival state essentially paralleled the plaque formation. The sucrose group showed a definite increase in Caries Index. No significant changes occurred in the group rinsing with sucrose + chlorhexidine, with chlorhexidine only, or in the group performing good oral hygiene. It is concluded that prevention of plaque formation inhibits the development of gingivitis and dental caries, even with frequent rinses of sucrose.