Clinical effects on chronic periodontitis of a simplified system of oral hygiene including subgingival pulsated jet irrigation with chlorhexidine

The aim of this study was to investigate the effects of a simplified system of oral hygiene, comprising Bass brushing, scaling, root planing and subgingival irrigation using a pulsated monojet oral irrigator, in patients with chronic periodontitis. After initial assessment, patients received scaling, root planing and instruction in Bass brushing and in use of a pulsated jet oral irrigator (Water Pik + Imax attachment) to irrigate subgingivally. 11 patients with 262 approximal periodontal pockets used 0.02% chlorhexidine (CH), or a placebo as the irrigating solution once daily for 28 days. Plaque index (PlI), sulcus bleeding index (SBI), and probing pocket depth (PPD) were assessed on days 0, 28, 56 and 84. Within procedure comparisons for all groups showed that the regime was highly effective in reducing PlI, SBI and PPD, improvements being maintained at least until day 84. Between procedure comparisons showed that benefits were improved only marginally by the use of 0.02% CH as the irrigation fluid. The patients found the procedure pleasant and neither injuries nor staining were noted during the study. It was concluded that this simplified oral hygiene system was effective in reducing periodontal inflammation and pocket depth, although no significant added benefit with 0.02% CH was apparent. The technique may be useful in patients who cannot achieve high levels of routine mechanical oral hygiene, particularly interdentially. The effects of using higher concentrations of chlorhexidine should be investigated.     

Use of oral irrigators as vehicle for the application of antimicrobial agents in chemical plaque control

Abstract The purpose of the present investigation was to study the topographical distribution of plaque formation using chlorhexidine digluconate (CH) as a mouthrinse and in oral irrigators during experimental gingivitis. Forty dental students (aged 22–26) with clean teeth and healthy gingivae abolished oral hygiene oral period of 3 weeks (Löe et al. 1965). During this period the participants were randomly assigned to one of five groups, Group A rinsed daily with 30 ml of a placebo and Group B with 30 ml 0.1% chlorhexidine digluconate. In Groups C and E a fractionated jet irrigator was used for the daily application of 600 ml placebo (C) or O.05% CH (E); 600 ml of 0.05% CH was also used in a monojet irrigator (Group D). At the start, after 1, 2 and 3 weeks of no oral hygiene and 1 week following reinstituted oral hygiene, plaque was assessed using the Plaque Index (Silness &. Löe 1964) and gingival health was scored according to the criteria of the Gingival Index (Löe & Silness 1963). The discoloration of the teeth was determined using a set of color photos. During the experiment all groups reached plaque levels that were significantly different from each other. The highest PII were seen in the placebo rinsing group (A) followed by placebo irrigation (C). Plaque was significantly reduced in the CH groups. However, rinsing (B) formed significantly more plaque than using the oral irrigator (D, E). Group E showed the least amount of plaque. In addition, the interproximal PII were equally low as the buccal and lingual. With CH (B, D, E), gingivitis did not develop except for some interproximals in Group B. A fractionated jet irrigator was more effective for the application of CH than rinsing.     

Clinical effectiveness of subgingival irrigation with a pulsated jet irrigator versus syringe.

Previous studies have shown clinical and microbiological improvement with subgingival irrigation particularly after scaling and root planing. In this study we monitored the effects of saline irrigation on non-treated periodontal pockets. Ten subjects with severe periodontal disease and symmetrical lesions on multirooted teeth were selected. They had not received periodontal treatment or antibiotics for the previous 6 months. Patients were given simplified oral hygiene instructions. Neither scaling nor root planing was provided during the study. Two teeth were randomly selected per quadrant for subgingival irrigation with saline solution. One side was treated with a syringe and the other side with a pulsated jet irrigator with a modified tip, professionally administered. Clinical parameters (pocket depth, plaque index, gingival index, crevicular fluid, bleeding index, attachment level, and subgingival microflora) were evaluated on days 0, 15, 30, 60, and 90. Both subgingival irrigation products induced changes (reductions) in these indices during the study. Significant differences (P less than 0.001) with the oral irrigator were found for the following parameters: microscopy, pocket depth, crevicular fluid, and plaque index. In this study, professionally administered saline irrigation with a pulsated jet irrigator was more effective than syringe treatment with the same solution. Neither treatment resulted in a detectable gain in probing attachment level. Since gain in attachment level is achievable by other techniques, neither of these subgingival irrigation procedures alone can be considered adequate for periodontal therapy.     

Irrigation with chlorhexidine to resolve naturally occurring gingivitis A methodologic study

This study compared oral irrigation and rinsing with chlorhexidine (CHX) and placebo in the treatment of naturally occurring chronic gingivitis. 44 subjects with at least 6 interproximal sites which bled on probing were randomly distributed on a double-blind basis into 4 treatment groups, placebo-rinse, CHX-rinse (0.12%), placebo-irrigation and CHX-irrigation (0.06%). A half-mouth was scaled 2 weeks prior to therapy in all groups. Rinses were performed 2 times daily and irrigation was performed once a day by means of an oral irrigator with the tip directed at a right angle to the tooth. Subjects continued with routine oral hygiene without instruction. The active treatment period was 2 months. Parameters were recorded at baseline and at 60 days. At the conclusion, marginal plaque was cultured for predominant microbial types. CHX-rinse (0.12%) and CHX-irrigation (0.06%) significantly reduced (p less than 0.05) plaque. Gingival bleeding decreased by 26% in both scaled and unscaled sites following CHX (0.12%) rinses and by 40% at both types of sites following CHX (0.06%) irrigation. Bleeding was reduced with CHX-irrigation greater (p less than 0.05) than with the placebo-irrigation. The mean log of colony-forming units of Actinomyces species was significantly lower (p less than 0.05) in the CHX (0.12%) rinse and CHX (0.06%) irrigator groups than in the placebo groups. These data therefore indicate that delivery of CHX (0.06%) by an oral irrigator is an effective means of treating naturally occurring gingivitis.     

Combined systemic and local antimicrobial therapy of periodontal disease in Papillon-Lefèvre syndrome. A report of 4 cases

4 patients, 2 pairs of siblings, suffering from Papillon-Lefèvre syndrome were treated for periodontal disease. Following extraction of hopeless teeth, the children received scaling and adjunctive systemic antibiotics (metronidazole and amoxicillin for 7 to 10 days). In addition, they performed supragingival pulsated jet irrigation with 0.06% chlorhexidine digluconate 1 x daily. In 2 siblings, A. actinomycetemcomitans was suppressed subgingivally below detectable levels, pocket probing depths were reduced to 4 mm or less, and plaque and bleeding indices were low. No further disease progression was seen over a 3-year-period. Another female patient also showed clinical improvement and suppression of subgingival A. actinomycetemcomitans and B. forsythus up to the 9-month-follow-up, while her sister showed further attachment loss over the course of 4 years. The present case reports indicated that in some patients suffering from Papillon-Lefèvre syndrome periodontal disease may be arrested by means of (i) oral hygiene instruction, (ii) extraction of severely diseased teeth, (iii) scaling, (iv) systemic antibiotics and (v) long-term antimicrobial irrigation.     

Optimal dosage of chlorhexidine digluconate in chemical plaque control when applied by the oral irrigator

Abstract Chlorhexidine digluconate for chemical plaque control was tested in different concentrations using a fractionated jet oral irrigator. The inhibition of plaque formation and the prevention of gingival inflammation were evaluated in a double-blind study. During a 10-day period of abstinence from any mechanical oral hygiene procedures, the pattern of plaque formation and gingivitis development under the influence of chemical plaque control was analyzed. As a positive control, one group rinsed twice daily with 30 ml of a 0.2% chlorhexidine solution while a group applying 600 ml of a placebo solution served as a negative control. Forty dental students and assistants with plaque-free dentitions and healthy gingival tissues were divided into four groups. After a 10-day period of no oral hygiene, a recovery period of 11 days with perfect oral hygiene was again instituted. This experiment was repealed three times so that a total of 10 concentrations in the irrigator, the control rinsing and the placebo control could be evaluated. Daily application of 600 ml of a 0.001%(6 mg), 0.0033% (20 mg), 0.005% (30mg), 0.01% (60 mg), 0.02% (120 mg), 0.05% (300 mg) and 0.1% (600 mg) and 400 ml of a 0.015 % (60 mg), twice 400 ml of a 0.015% (120 mg) and 400 ml of a 0.02% (SO mg) solution of chlorhexidine was tested. At the start of each experimental period (day 0), after 3, 7 and 10 days and 11 days following reassuming oral hygiene procedures, the plaque accumulations were determined using the Plaque Index System (Silness & Löe 1964) and the development of gingivitis was evaluated according to the criteria of the Gingival Index System (Löe & Silness 1963). The results suggested that one daily irrigator application of 400 ml of a 0.02 % chlorhexidine solution was the optimal and lowest concentration and dose to be used for complete inhibition of dental plaque.     

Effect of chlorhexidine (0.12%) rinses on periodontal tissue healing after tooth extraction

Abstract. The aim of the present study was to evaluate the effects of a 1 -month period of chlorhexidine (CHX) rinses on the periodontal conditions of teeth adjacent to extraction sockets. 40 patients signed consent forms for this double blind trial and were randomly assigned to either the test group rinsing 2 × daily with 15 ml of a 0.12% CHX solution (Peridex®) starting 2 days after tooth extraction or the control group rinsing with a placebo solution for 30 days. Clinical periodontal parameters were obtained from test sites located adjacent to as well as matched controls distant to the extraction sites. The measurements were performed at baseline before the extraction and 1, 2, 3 and 6 months thereafter. During the observation period, the patients were exposed to initial periodontal therapy. The test sites of the group rinsing with CHX demonstrated significantly reduced ( p < 0.05) plaque indices, gingival indices and lower %s of sites bleeding on probing one month following the extraction. The test sites of the control group rinsing with the placebo demonstrated a tendency for loss of clinical attachment between 1 and 2 months after the tooth extraction. The mean pocket probing depth (PPD) at test sites of the CHX rinsing group was smaller than in the placebo rinsing group at the one month examination. Also, the mean PPD of the test sites in the CHX group was significantly smaller than at the control sites at 1 month. This difference was not observed in the control group rinsing with placebo. Due to the effect of initial periodontal therapy, the differences in the clinical parameters were no longer statistically significant at six months. It is concluded that the administration of 0.12% CHX rinses following tooth extraction results in a significant improvement of the periodontal conditions adjacent to extraction sockets and hence, should be recommended routinely.     

The effects of a simplified oral hygiene regime plus supragingival irrigation with chlorhexidine or metronidazole on chronic inflammatory periodontal disease

This study compared a simplified oral hygiene regime (scaling, root planing and Bass brushing) with this same regime plus 0.02% chlorhexidine (CH), 0.05% metronidazole (MD) and inactive control (PL) solutions delivered supragingivally by a pulsating water jet irrigator. 22 patients were distributed randomly into 3 groups, 0.02% chlorhexidine (CH), 0.05% metronidazole (MD), and inactive control (PL). Approximal surfaces with associated pockets greater than or equal to 4 mm were monitored at day 0, for plaque index (PII), gingival index (GI), sulcus bleeding index (SBI), baseline measurement for gingival shrinkage and probable pocket depth. All monitored surfaces were then immediately scaled and root planed. All patients received identical oral hygiene instruction (Bass brushing), with a sodium fluoride toothpaste and a multituft toothbrush, and were shown how to use the oral irrigator. Proficiency in use of the oral irrigator was checked again at day 7. No interdental cleaning was taught. The active treatment period was 28 days. Patients were seen at days 7, 28, 56 and 84, and all parameters were recorded at each visit, but no further oral hygiene instruction was given. Within procedure comparisons of the findings at days 28 (end of active treatment) 56 and 84 with those at day 0, showed statistically highly significant improvements in all parameters for all groups. Regarding between procedure comparisons, CH was better in reducing PII at all times except at day 84, and on several occasions in reducing GI and SBI. Irrigated groups were always better than nonirrigated groups. Although the differences were statistically highly significant, clinically the differences between groups were relatively small, except for CH effect on PII.(ABSTRACT TRUNCATED AT 250 WORDS)     

Plaque formation and gingivitis after supervised mouthrinsing with 0.2% delmopinol hydrochloride, 0.2% chlorhexidine digluconate and placebo for 6 months

OBJECTIVES AND METHODS: A double-blind, randomized, 6-month clinical trial with parallel group design in 162 patients with gingivitis divided into three rinsing groups was conducted in order to study the efficacy and safety of a flavoured solution of delmopinol hydrochloride 2 mg ml“‘ (0.2% w/v, Decapinol Mouthwash”^®) used for supervised mouthrinsing in one rinsing group, in comparison with chlorhexidine digluconate 2 mg ml^-1 (0.2% w/v, Hibitane Dental’^{a, b}) in a second rinsing group, and placebo in the third group. The criteria of the Plaque Index (PI) were used to assess plaque formation. Bleeding on probing (BOP) to the bottom of the pocket with a standard pressure was used as the primary gingivitis assessment. The occurrence of supragingival dental calculus and extrinsic tooth staining were also assessed. In addition, patients were asked to report adverse events at each visit. RESULTS: Delmopinol and chlorhexidine exhibited lower scores of the mean PI and the BOP percentage than placebo, both at the 3-month and 6-month examinations. Furthermore, both active solutions showed a higher extent of staining of the teeth than placebo during these two observation periods. Rinsing with chlorhexidine resulted in more dental calculus than placebo after 6 months. Chlorhexidine showed lower scores for plaque formation and gingivitis development but higher scores of supragingival dental calculus (after 6 months) and tooth staining than did delmopinol. Both active solutions were reported by the patients–approximately to the same extent but more frequently than placebo–to induce taste alterations and a transient anaesthetic sensation of the oral mucosa. However, subjective staining of the teeth and tongue was reported by 16% of the delmopinol patients, but by 86% of the patients rinsing with chlorhexidine for 6 months. Furthermore, 24% of the patients in the chlorhexidine group, 9% in the delmopinol group and 4% in the placebo group wished to withdraw from treatment. CONCLUSIONS: The results from this clinical trial indicate that supervised rinsing with 0.2% delmopinol hydrochloride or with 0.2% chlorhexidine digluconate twice daily for 60 s as a supplement to normal mechanical oral hygiene procedures resulted in less plaque formation and gingivitis than rinsing with placebo. Although chlorhexidine was more effective than delmopinol regarding plaque formation and gingivitis, it was considered by the patients as less tolerable.     

Pulsated jet subgingival irrigation with 0.1% chlorhexidine, simplified oral hygiene and chronic periodontitis

This study investigated the efficacy of a 0.1% chlorhexidine preparation as an aid to a basic oral hygiene programme comprising only baseline root and crown debridement, instruction in bass brushing without emphasis on interdental cleaning, and pulsated mono-jet subgingival irrigation. Baseline data for plaque index, papilla bleeding index and probeable pocket depth were similar in both test and control groups. Mean values for all 3 parameters were clearly lower in the chlorhexidine group, both at the end of the period of active treatment and up to 2 months thereafter. These differences were statistically significant for P1I at day 28, PBI at day 56 and PPD at days 56 and 84, but not at day 168. Proportionately more sites generally showed improvement in the chlorhexidine group at all times. It was concluded that 0.1% chlorhexidine significantly enhances the effects of the practical oral hygiene regime described.     

Clinical and microbiological effects of subgingival and gingival marginal irrigation with chlorhexidine gluconate

Recent interest in the local delivery of antimicrobial and anti-inflammatory agents has stimulated interest in the efficacy of various treatment regimens. Chlorhexidine gluconate (CHX) delivered daily by home-applied marginal irrigation as a 0.04% solution in combination with a single professional irrigation of 0.12% CHX was tested over a 3-month period. Sixty periodontal maintenance patients each having at least 2 pockets greater than or equal to 4 mm probing depth, and bleeding on probing were assigned to either Group 1: one professional subgingival 0.12% CHX (Peridex) irrigation (Perio Pik) followed by adjunctive daily home marginal 0.04% CHX irrigation (Pik Pocket); Group 2: one professional subgingival 0.12% CHX irrigation followed by adjunctive daily home marginal water irrigation; Group 3: one professional subgingival water irrigation followed by adjunctive daily home marginal water irrigation; or Group 4: control. At baseline and 3 month visits, subgingival plaque samples were taken from 2 sites per patient. Cultural microbiological analysis was performed using non-selective and selective media. Plaque Index, Gingival Index, pocket probing depths, and gingival recession were assessed. Scaling and root planing (supportive periodontal treatment) was provided for each patient followed by subgingival irrigation as outlined above. At 3 months the Gingival Index and pocket probing depths were both significantly reduced (P less than .05) in all irrigation groups compared to baseline. There were no significant changes in clinical parameters in the control group from baseline to 3 months. In Group 1 the GI was significantly reduced (P less than .05) compared to Group 4 at 3 months.(ABSTRACT TRUNCATED AT 250 WORDS)     

Plaque formation and gingivitis after mouthrinsing with 0.2% delmopinol hydrochloride, 0.2% chlorhexidine digluconate and placebo for 4 weeks, following an initial professional tooth cleaning

A double-blind, randomised. 4-week clinical trial with parallel group design in 57 patients with gingivitis was conducted for studying the antibacterial efficacy and safety of a delmopinol HCl aqueous solution 2 mg/ml (0.2% w-'v). which was used for unsupervised mouth-rinsing and compared with placebo and chlorhexidine digluconate 2 mg/ml (0.2% w/v, Hibitane Dental. 1CI Pharmaceuticals, UK). The plaque index and plaque wet weight were used to measure plaque formation, and gingival fluid flow and bleeding on probing to measure gingivitis. According to the reduction from baseline, chlorhexidine showed a significantly better effect on plaque formation than the placebo after 4 weeks treatment for both plaque measurements. Delmopinol exhibited significantly lower plaque index scores than placebo. The difference between chlorhexidine and delmopinol was not statistically significant for any of the plaque measurements. For gingivitis, no statistically significant differences were obtained between the effects of delmopinol. chlorhexidine and placebo. A transient anaesthetic sensation in the oral mucosa was experienced more clearly by the patients in the delmopinol group than by those using chlorhexidine or placebo rinses. Rinsing with chlorhexidine resulted in more staining of the teeth and tongue than did delmopinol and placebo. The placebo solution lasted better than the 2 active solutions. The results showed that rinsing with either delmopinol HC1 aqueous solution 2 mg/ ml or chlorhexidine digluconate 2 mg/ml 2× daily for 60 s as a supplement to normal oral hygiene, following an initial professional tooth cleaning, leads to a lower plaque formation than rinsing with placebo. In order to obtain conclusive results beyond the initial etTect of the professional tooth cleaning and the placebo effect and lo achieve enough power in the statistical analysis of gingivitis reduction, trials of longer duration and with a larger number of patients are required. This study showed good tolerance and acceptability of mouth-rinsing with the detmopinol HC1 aqueous solution 2 mg/ml.     

The effect of irrigation with chlorhexidine or saline on plaque vitality

Abstract 24 adult patients suffering from Adult periodontitis were assigned to 4 groups: the 1st rinsed for 1 min with 0.2% chlorhexidine gluconate (CHX); the 2nd group were irrigated for 15 s with 0.2% CHX in a pulsed oral irrigator; the 3rd group rinsed for 1 min with saline and the 4th group were irrigated for 15 s with saline. Plaque vitality was measured after the 4 experimental procedures, using the method described by Netuschil et al. and scored using the method described by Rundegren et al. The results showed that a single rinse or irrigation with 0.2% CHX solution decreased the % of viable micro-organisms, but the vitality of the bacteria remained unchanged in saline groups. Statistical analysis indicated that irrigation with CHX was more effective at reducing plaque vitality than rinsing with CHX.     

6-month use of 0.2% delmopinol hydrochloride in comparison with 0.2% chlorhexidine digluconate and placebo

Abstract. A double-blind, randomized, 6-mónth clinical trial with parallel group design in 149 patients with gingivitis was conducted to study the efficacy and safety of delmopinol hydrochloride 2 mg/ml (0.2% w/v. Decapinol Mouthwash) used for partly supervised mouthrinsing in comparison with chlorhexidine digluconate 2 mg/ml (0.2% w/v. Hibitane Dental®, ICI Pharmaceuticals. UK) and placebo as an addition to normal oral hygiene. Assessments of efficacy were performed using the plaque index and bleeding on probing (BOP). Delmopinol showed 22% lower plaque index scores than placebo after 3 months ( p <0.01) and 13% lower scores after 6 months. The corresponding figures for chlorhexidine were 38% ( p <0.001) and 38% ( p <0.001) after 3 and 6 months, respectively. Bleeding on probing was reduced for delmopinol in comparison with placebo by 11% after 3 months and by 18% ( p <0.05) after 6 months. For chlorhexidine the corresponding figures were 18% ( p <0.01) and 22% ( p <0.01) after 3 and 6 months, respectively. While chlorhexidine showed greater plaque reduction than delmopinol ( p <0.01 at 6 months), no statistically significant difference was reached between these two solutions regarding BOP Both active solutions showed an increased amount of dental calculus in comparison with placebo. A transient anaesthetic sensation in the oral mucosa and taste affection were commonly reported adverse events in both the delmopinol and the chlorhexidine groups. The number of patients withdrawn from treatment due to adverse events or lack of cooperation was 7 in the chlorhexidine group. 4 in the placebo group and 1 in the delmopinol group. The results showed that rinsing with either 0.2% delmopinol hydrochloride or 0.2% chlorhexidine digluconate twice daily for 60 sees for 6 months results in less plaque formation and gingivitis than rinsing with placebo. Mouthrinsing with the 0.2% delmopinol hydrochloride solution was well accepted in this study.     

The effects of a simplified mechanical oral hygiene regime plus supragingival irrigation with chlorhexidine or metronidazole on subgingival plaque

23 patients with pockets greater than or equal to 4 mm and evidence of bone loss on radiographs received thorough scaling and root planing followed by instruction in Bass brushing. They refrained from routine interdental cleaning for the first 28 days. A pulsating jet irrigator was used once daily supragingivally with 0.02% chlorhexidine (CH) 0.05% metronidazole (MD) or 0.01% quinine sulphate inactive control (PL), on a randomized double blind basis. Molar sites were not irrigated and served as control sites; they were only mechanically cleaned. For each patient, subgingival plaque samples were obtained from 2 test and 1 control sites at baseline (day 0), and on days 7, 28, 56 and 84. Plaque samples were monitored by darkfield microscopy on the basis of morphological characteristics of 4 types of bacteria: cocci, motile cells, spirochaetes and "others" (nonmotile rods, filaments and fusiforms). The simplified oral hygiene regime of scaling, root planing and Bass toothbrushing combined with interdental supragingival pulsating jet irrigation with CH, MD or PL appeared superior to a system of simplified oral hygiene alone, particularly during the first 4 weeks. However, at most time-points, the benefits were not statistically significant except for metronidazole. By day 84, the end of the experimental period, all groups approximated baseline levels. The results indicate that supragingival pulsated jet irrigation has limited effects on the composition of subgingival plaque. More marked changes occur when the irrigation fluid contains a chemical agent such as metronidazole known to be effective against important subgingival organisms, but probably not to such an extent as to change the composition of the flora from one associated with diseased sites to one associated with healthy sites.     

Effects of 0.2% chlorhexidine spray applied once or twice daily on plaque accumulation and gingival inflammation in a geriatric population

BACKGROUND/AIMS: Chlorhexidine (CHX) spray has proven to be an easily applicable method for the chemical control of plaque in elderly and handicapped patients. A randomized double-blind cross-over placebo-controlled trial was undertaken to compare the effects of 0.2% CHX spray applied once or twice daily on the plaque and gingival indexes in 13 institutionalized elderly patients. METHOD: The study subjects were randomly assigned to one of two groups. During the first 30-day period, one group received 0.2% chlorhexidine spray twice daily and the other received 0.2% CHX spray once daily plus placebo spray once daily. A washout period of 42 days then followed, after which the groups were interchanged and the process was repeated for another 30-day period. Plaque index and gingival index were determined at the beginning and end of each period. The patients continued with their usual oral hygiene practices throughout the study. RESULTS: A significant reduction in plaque and gingival indexes was produced in both the groups. There were no significant differences in index scores between the groups. CONCLUSIONS: The results of the present study suggest that a single-daily application of 0.2% CHX spray is equally as effective in reducing plaque accumulation and gingival inflammation in institutionalized elderly patients as are two-daily applications of the same spray.     

Adjunctive supragingival irrigation with acetylsalicyclic acid in periodontal supportive therapy

Abstract To assess the clinical efficacy of adjunctive supragingival irrigation with buffered 0.3% acetylsalicylic acid (ASA), 60 patients with periodontitis receiving supportive periodontal therapy were randomly assigned to 1 of 3 home regimens: (1)1 × daily adjunctive supragingival irrigation with 300 ml water immediately followed by 200 ml of buffered 0.3% ASA; (2) 1 × daily adjunctive supragingival irrigation with 500 ml water; or (3) normal oral hygiene alone. Clinical parameters were assessed at baseline and 6 months. Irrigator use was measured by timers built into the irrigator units. Results at 6 months showed that both supragingival irrigation with buffered 0.3% ASA and supragingival irrigation with water significantly reduced gingival index scores (median 0.1 and 0.35, respectively) and pocket probing depths (both median 0.26 mm) compared to the control group. In addition, irrigation with water resulted in a significant reduction in bleeding on probing (median 0.13), whereas irrigation with buffered 0.3% ASA had no significant effect on bleeding on probing compared to the control group. The clinical efficacy of irrigation with either ASA or water was found to be positively correlated to initial disease severity and irrigator use. Thus, frequent supragingival irrigation with either 0.3% ASA or water in addition to regular oral hygiene appears to be a beneficial adjunct to periodontal supportive therapy in patients with moderate to severe signs of periodontitis. However, the use of buffered 0.3% ASA as an irrigant does not seem to enhance the clinical efficacy of supragingival irrigation on periodontal health.     

Efficacy of chlorhexidine mouthrinses with and without alcohol: a clinical study

BACKGROUND: Plaque control is the main method for preventing periodontal diseases. Chlorhexidine digluconate mouthrinse is widely recognized as helping to maintain plaque control. Most of these mouthrinses contain alcohol, making them impractical for many patients, including those with oral mucosal hypersensitivity. Mouthrinses without alcohol might cause fewer side effects, but also be less efficient. In this study, we evaluated the efficacy of a 0.12% chlorhexidine mouthrinse without alcohol against one with 11% ethanol and a placebo. METHODS: This a double-blind, parallel group study with 96 patients who tested 3 mouthrinses containing 1) chlorhexidine digluconate 0.12% sodium fluoride 0.05%, and ethanol 11% (group 1; CHX-A); 2) the same solution without alcohol (group 2; CHX-NA); and a placebo (group 3; P). Plaque and bleeding indexes were recorded in all patients prior to treatment and at 14 and 28 days. RESULTS: There were significant differences in plaque, gingivitis, and papilla bleeding indexes in both chlorhexidine rinses compared to placebo, but no differences between the 2 CHX products. CONCLUSIONS: In this study, the alcohol-free rinse was as effective as one containing alcohol in controlling plaque and reducing gingival inflammation. Therefore, it would seem that its use can be recommended in all patients, but especially in patients for whom the use of alcohol is contraindicated.     

Rinsing with delmopinol 0.2% and chlorhexidine 0.2%: short-term effect on salivary microbiology, plaque, and gingivitis.

The aim of this short-term study was to compare the effect of delmopinol HCl 0.2% and chlorhexidine digluconate 0.2% rinses on the development of dental plaque, the healing of experimental gingivitis, and the salivary microbiology. As part of a larger study protocol, 45 healthy males enrolled in an oral hygiene program to upgrade their oral health. For this portion of the study, participants had their teeth professionally cleaned on day 0. The participants then abstained from standard mechanical oral hygiene procedures, but applied a placebo solution twice daily for 2 weeks. At the end of this period the subjects received a second professional cleaning and were then assigned to 2 treatment groups: Group 1 rinsed with 10 ml of delmopinol HCl 0.2% and Group 2 rinsed with 10 ml of chlorhexidine digluconate 0.2% for 1 minute twice daily for the next 2 weeks and continued to refrain from mechanical oral hygiene procedures. At the end of the placebo and active treatment periods 1) saliva samples were taken and cultivated on a series of media; 2) the degree of gingivitis was assessed with gingival crevicular fluid (GCF) and gingivitis index (GI); and 3) the plaque index was assessed and the stainable buccal plaque extension was analyzed planimetrically. No changes in the salivary microbiological counts were detected for the subjects rinsing with delmopinol. Subjects rinsing with chlorhexidine showed significant reductions of anaerobes, aerobes, and S. mutans in saliva. The amounts of GCF and GI were reduced largely to the same extent in both treatment groups. Mean plaque extension was reduced by 52% after delmopinol and 88% after chlorhexidine rinsing.(ABSTRACT TRUNCATED AT 250 WORDS)     

Plaque-inhibiting effect of bioadhesive mucosal tablets containing chlorhexidine in a 4-day plaque regrowth model

BACKGROUND AND AIM: Compliance in the use of daily oral antiseptics can probably be enhanced by prescribing easily-applied bioadhesive tablets which slowly release chlorhexidine (CHX). This could also be of use in patients with difficulties in rinsing or performing mechanical plaque control. The aim of the present study was to evaluate the capacity of bioadhesive tablets containing either 30 mg or 40 mg of CHX to inhibit de novo plaque formation. METHOD: In this single, examiner-blinded, crossover study, 22 volunteers between 21 and 25 years of age refrained from oral hygiene for 4 days. Bioadhesive mucosal tablets containing 30 mg or 40 mg of CHX were applied in the canine region. Rinses with a 0.2% CHX solution and placebo tablets served as controls. Plaque regrowth was evaluated with the Quigley-Hein Index modification of Turesky and by an automatic image analysis system (AIA) using slides of stained plaque. Rinsing and application of the tablets were done under supervision twice daily. RESULTS: According to the plaque index, plaque regrowth was significantly inhibited by CHX rinses ( P<0.001) and by tablets with 40 mg of CHX ( P<0.02) for all teeth and surfaces. Placebo tablets and 30-mg CHX tablets had no plaque-inhibiting effect. For taste, the subjects preferred the placebo and the 30-mg tablets more than the rinses and 40-mg tablets. In 3/22 of the subjects, superficial mucosal lesions were found at the side of application of the 40-mg tablets. Using the AIA system for evaluation of plaque regrowth, similar results for plaque inhibition were found. CONCLUSION: It can be concluded that bioadhesive mucosal tablets containing 40 mg of CHX can inhibit plaque regrowth as well as 0.2% CHX rinses. However, unpleasant taste and superficial mucosal lesions are local side effects to be considered.