Effectiveness of probiotic lozenges and Chlorhexidine mouthwash on plaque index,salivary pH,and Streptococcus mutans count among school children in Makkah,Saudi Arabia

PurposeTo compare the effect of the probiotic lozenges and chlorhexidine (CHX) mouthwash on plaque index (PI) , salivary pH and Streptococcus mutans (S. mutans) 3 count among groups of Saudi children.MethodsA total of 54 participants aged 8-12 years were randomly allocated into three groups, 18 children in each group. Children in the probiotic group consumed one probiotic lozenge (Biogaia prodentis) daily, while children in the CHX group were instructed to use CHX mouthwash twice daily. The control group was only instructed to follow regular oral hygiene measures. Saliva samples were taken at baseline, 15th and 30th days. PI scores, salivary pH values and S. mutans count were evaluated. Data were statistically analyzed using the ANOVA and the Tukey post-hoc test.ResultsProbiotic lozenges and CHX mouthwash significantly reduced PI and S. mutans count and increased the salivary pH values. However, there were no statistical differences between the effect of probiotic lozenges and CHX mouthwash on PI (p-value= 800) and pH values (p-value= 0.927) on the 30th day. Conversely a significant difference was reported among their effects on S. mutans count (p-value=0.014) on the 30th day. Greater acceptance and compliance of children to probiotic lozenges were reported.ConclusionsProbiotic lozenges could be an alternative to CHX mouthwash and encouraged to be included with the daily oral hygiene measures.     

Systemic toxicity following ingestion of the chlorhexidine gluconate solution: a case report

The purpose of this article is to discuss possible adverse effects and emergency treatments following the ingestion of chlorhexidine (CHX). In this case a dental student (age 25, male) accidentally swallowed one shot of 20% CHX solution, which is equal to 100 shots of the standard 0.2% CHX mouthwash. Clinical emergency treatment included: washing the oral cavity with 30 g of toothpaste, drinking 100 ml of 5% (w/v) alginate syrup and ingestion of 5 g of cork. The following adverse effects were experienced: headache, euphoria, giddiness, blurred vision (duration = 12 h), stomachache, gastric lavage with demulcents (duration = 24 h) and complete loss of taste sensation (duration = 8 h), which recurred during the next 48 h. No change in plasma aminotransferase level was seen. We used basic chemical information about the incompatibilities of CHX for clinical management of unintentional ingestion. It is known that CHX is a cation, and, therefore, first aid in case of intoxication with CHX involves using anionic materials.     

Treatment for oral lesions in pediatric patients with Stevens‐Johnson's syndrome: A case report and literature review

Stevens‐Johnson syndrome (SJS) is a disorder forming one of the several severe cutaneous adverse reactions, a group that includes, as well, erythema multiforme, toxic epidermal necrolysis (TEN), and SJS/TEN overlap. These adverse reactions are characterized by their severe involvement of the skin and the oral, gastrointestinal, genital, and conjunctival mucosa. The purposes of the study described herein were to perform a literature review of studies describing the clinical presentations and management of SJS patients with oral manifestations and to present a case report of a patient treated with dapsone gel. The research question for the literature review was the following: For patients with SJS, does adjunctive topical antibiotic treatment provide a better resolution for oral lesions than supportive care does? An online search of studies published from 2000 to 2019 was performed using the following databases: PubMed, BBO, LILACS, the Cochrane Library, and Ovid MEDLINE. Eight case reports were identified that met the inclusion criteria. Most of the articles included information about palliative treatments, such as supragingival cleaning and debridement, and the use of palliative oral rinses and gels, such as ‘magic’ mouthwash, chlorhexidine 0.12%, and lidocaine 2% gel. The case reported added an innovative treatment consisting of dapsone gel 5%.     

Triphala,a New Herbal Mouthwash for the Treatment of Gingivitis: A Randomized Controlled Clinical Trial

Background: An antiplaque agent with minimal side effects that can be used as an effective adjunct to mechanical plaque control is needed. The current study is designed to evaluate efficacy of triphala (TRP) mouthwash in reduction of plaque and gingivitis. Methods: Ninety individuals with chronic generalized gingivitis were randomly assigned to three groups: 1) group I, placebo mouthwash; 2) group II, TRP mouthwash; and 3) group III, chlorhexidine (CHX) mouthwash. All individuals were instructed to rinse with their respective mouthwash twice daily. 1) Plaque index (PI); 2) gingival index (GI); 3) oral hygiene index‐simplified (OHI‐S); and 4) microbiologic colony counts were recorded at baseline and at 7, 30, and 60 days. Results: All three groups showed gradual reduction in PI, GI, and OHI‐S levels from baseline to 7, 30, and 60 days. There was also significant reduction in microbial counts in all groups at all time intervals except in group I. A significant difference was noticed with respect to reduction in PI, GI, OHI‐S, and microbiologic counts in group I compared with groups II and III. However, no significant differences were found between groups II and III for any parameters at any time intervals. Conclusions: TRP mouthwash was found to decrease inflammatory parameters from baseline to follow‐up intervals. Because improvement in gingivitis was comparable with that of CHX mouthwash, TRP mouthwash can be considered a potential therapeutic agent in the treatment of gingivitis.     

The effect of different formulations of chlorhexidine in reducing levels of mutans streptococci in the oral cavity: A systematic review of the literature

OBJECTIVES: The current study undertakes a systematic review of the literature in order to assess how long different formulations (solutions, gels and varnishes) of chlorhexidine (CHX) reduce the level of mutans streptococci (MS) in the oral cavity. SOURCES: A search of the PUBMED and LILACS databases was conducted through October 2005. STUDY SELECTION: Clinical studies evaluating the effects of CHX solutions, gels, or varnishes on MS levels were targeted (n=52). CONCLUSIONS: The studies varied greatly in quantity of mouthwash solution used in rinsing, length of rinsing, and treatment frequency and period. CHX mouthwash solution had short-term effect on salivary MS. Most of studies evaluating CHX gel and varnish used a concentration of 1%. The 1% CHX gel showed a significant reduction through intensive treatment (3-4 daily applications over 2 days) or through daily application for 10 and 14 days. It cannot be asserted that 1% CHX varnish provides better results when applied intensively as compared to applications conducted at intervals of 1 or more months. Treatment using 1% CHX varnish displays large variations in the level and length of decreased MS levels. Despite variability in results, 40% CHX varnish has a greater effect on the period of decreased MS levels than does 1% CHX varnish. Studies did not show a statistically significant difference between the gel and the varnish. The effects of CHX treatment must be monitored, given sharp individual variability in response to this treatment.     

The effect of 0.12% chlorhexidine dentifrice gel on plaque accumulation: a 3-day non-brushing model

Abstract: Background: Maintaining an adequate low level of plaque through daily tooth brushing is often not feasible. Effective chemotherapeutic agents as an adjunct to mechanical plaque control would therefore be valuable. Chlorhexidine (CHX) mouthwash has proved to be an effective inhibitor of plaque accumulation. Aim: The purpose of the present study was to assess the effect of application of 0.12% CHX dentifrice gel on de novo plaque accumulation. Material and methods: The study was designed as a single blind, randomized three‐arm parallel clinical trial. At the beginning of the test period all volunteers received a thorough professional oral prophylaxis. Subjects were randomly assigned to one of three regimens. During a 3‐day non‐brushing period, subjects abstained from all forms of mechanical oral hygiene. One regimen (test group) used 0.12% chlorhexidine dentifrice gel (CHX‐DGel, Perio·Aid®) applied in a fluoride gel tray, the benchmark control group used a regular dentifrice applied in a fluoride gel tray (RegD, Everclean® HEMA). The positive control group rinsed with a 0.12% chlorhexidine mouthwash (CHX‐MW, Perio·Aid®). The Quigley and Hein plaque index (PI) from all subjects was assessed after 3 days of de novo plaque accumulation. Subsequently, all subjects received a questionnaire to evaluate their attitude, appreciation and perception towards the products used employing a Visual Analogue Scale scores. After the experimental period, habitual oral hygiene procedures were resumed. Results: Ninety‐six systemically healthy subjects completed the study. After 3 days, the full‐mouth PI for the CHX‐DGel regimen was 1.87 compared with 1.93 for the RegD regimen and 1.55 for the CHX‐MW regimen. The two dentifrices (CHX‐DGel and RegD) were significantly less effective as the CHX‐MW (P = 0.0006). No significant difference between scores of the dentifrices was found. Conclusion: Within the limitations of the present 3‐day non‐brushing study design, it can be concluded that application of 0.12% CHX dentifrice gel is not significantly different from application of regular dentifrice on plaque accumulation. Use of a 0.12% CHX mouthwash is significantly more effective. CHX‐DGel appears a poor alternative for a dentifrice. It is not an effective inhibitor of plaque growth and does not possess fluoride.     

Amine fluoride/stannous fluoride and chlorhexidine mouthwashes as adjuncts to surgical periodontal therapy: a comparative study

BACKGROUND: Postsurgical mouthwashes are routinely used in clinical studies and also in daily clinical practice. Chlorhexidine gluconate (CHX) has long been the gold standard for supra-gingival chemical plaque control regimens. Amine fluoride/stannous fluoride (AmF/SnF2) formulations have also been extensively studied and shown to have an antibacterial effect and be useful as antiplaque agents. The antibacterial effect of AmF/SnF2 and its minimal extrinsic tooth staining make it a possible alternative to CHX as an adjunct to periodontal surgical therapy. The aim of this double-blind, controlled clinical trial was to evaluate and compare the combined effect of an AmF/SnF2 or a CHX mouthwash and surgical periodontal therapy on periodontal parameters. METHODS: Thirty-two patients with at least 3 pockets > or =5 mm in the same quadrant were selected for this study, following a hygienic phase of therapy. They were randomized into 2 treatment groups: surgical flap debridement and a postsurgical CHX mouthwash or surgical flap debridement and an AmF/SnF2 postsurgical mouthwash, performed twice daily for 3 weeks. Clinical measurements were taken at baseline and 3 and 12 weeks postsurgery. RESULTS: Both treatment modalities resulted in significant improvements in probing depth and clinical attachment level. There was no significant difference between groups in any of the recorded parameters. Staining index at week 3 in the CHX group was significantly higher than in the AmF/SnF2 group (P<0.05). However these differences leveled down at 12 weeks. CONCLUSIONS: Our results support the alternative use of an AmF/SnF2 mouthwash in plaque control management of patients following flap debridement surgery.     

Metal ion release from silver soldering and laser welding caused by different types of mouthwash

Objective:To compare metal ion release from samples welded with silver soldering and laser welding when immersed into mouthwashes with different ingredients.Materials and Methods:A total of 72 samples were prepared: 36 laser welded and 36 silver soldered. Four samples were chosen from each subgroup to study the morphologic changes on their surfaces via scanning electron microscopy (SEM). Each group was further divided into four groups where the samples were submerged into mouthwash containing sodium fluoride (NaF), mouthwash containing sodium fluoride + alcohol (NaF + alcohol), mouthwash containing chlorhexidine (CHX), or artificial saliva (AS) for 24 hours and removed thereafter. Subsequently, the metal ion release from the samples was measured with inductively coupled plasma mass spectrometry (ICP-MS). The metal ion release among the solutions and the welding methods were compared. The Kruskal-Wallis and analysis of variance (ANOVA) tests were used for the group comparisons, and post hoc Dunn multiple comparison test was utilized for the two group comparisons.Results:The level of metal ion release from samples of silver soldering was higher than from samples of laser welding. Furthermore, greater amounts of nickel, chrome, and iron were released from silver soldering. With regard to the mouthwash solutions, the lowest amounts of metal ions were released in CHX, and the highest amounts of metal ions were released in NaF + alcohol. SEM images were in accord with these findings.Conclusions:The laser welding should be preferred over silver soldering. CHX can be recommended for patients who have welded appliances for orthodontic reasons.     

Evaluation of the effect of probiotics in the treatment of peri-implant mucositis: a triple-blind randomized clinical trial

Objectives

To determine if the treatment of mucositis with mechanical debridement, 0.12% chlorhexidine, and a further application of Lactobacillus reuteri (L. reuteri) will result in an improvement of the clinical and microbiological parameters in comparison to the treatment with mechanical debridement and 0.12% chlorhexidine alone.

Material and methods

Fifty dental implants with mucositis in 50 patients were randomly assigned to one of the following groups: mechanical debridement, 0.12% chlorhexidine mouthwash, and the subsequent administration of a probiotic agent (test group) or mechanical debridement and 0.12% chlorhexidine mouthwash (control group). Data were analyzed to determine clinical and microbiological changes during treatment and after a follow-up period of 3 months.

Results

After the administration of 0.12% chlorhexidine, all clinical parameters improved in the test and the control group, observing a significant decrease in Full Mouth Plaque Index (FMPI), full mouth bleeding on probing (FMBOP), Plaque Index (PI), and bleeding on probing (BOP) at the implant. However, following the administration of probiotics or placebo, the clinical variables, except for probing pocket depth, slightly and progressively increased up to 3 months of follow-up, but without reaching baseline levels. From a microbiological point of view, no major alterations of the subgingival microflora were recorded at different time points between groups during the study.

Conclusions

Treatment with mechanical debridement, oral hygiene reinforcement, and administration of 0.12% chlorhexidine was effective in reducing mucositis, but it did not always result in complete resolution of inflammation. The administration of probiotics did not seem to provide an additional clinical or microbiological benefit.

Clinical relevance

The use of probiotics does not seem to provide an additional benefit in the treatment of peri-implant mucositis.

     

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.     

Essential oils compared to chlorhexidine with respect to plaque and parameters of gingival inflammation: a systematic review

Background: The purpose of this review is to systematically evaluate the effects of an essential‐oil mouthwash (EOMW) compared to a chlorhexidine mouthwash with respect to plaque and parameters of gingival inflammation. Methods: PubMed/MEDLINE and Cochrane CENTRAL databases were searched for studies up to and including September 2010 to identify appropriate articles. A comprehensive search was designed, and the articles were independently screened for eligibility by two reviewers. Articles that evaluated the effects of the EOMW compared to chlorhexidine mouthwash were included. Where appropriate, a meta‐analysis was performed, and weighted mean differences (WMDs) were calculated. Results: A total of 390 unique articles were found, of which 19 articles met the eligibility criteria. A meta‐analysis of long‐term studies (duration ≥4 weeks) showed that the chlorhexidine mouthwash provided significantly better effects regarding plaque control than EOMW (WMD: 0.19; P = 0.0009). No significant difference with respect to reduction of gingival inflammation was found between EOMW and chlorhexidine mouthwash (WMD: 0.03; P = 0.58). Conclusion: In long‐term use, the standardized formulation of EOMW appeared to be a reliable alternative to chlorhexidine mouthwash with respect to parameters of gingival inflammation.     

Chlorhexidine spray versus chlorhexidine mouthwash in the control of dental plaque after periodontal surgery

BACKGROUND/AIMS: This clinical trial aimed at comparing 2 different means of delivering chlorhexidine digluconate (CHX) in the oral hygiene phase during the 2 weeks following periodontal surgery. METHOD: 40 patients were randomly divided into 2 groups: A (using CHX mouthwash) and B (using CHX spray). Professional oral hygiene was carried out immediately before surgical operation. For 7 days after surgery, group A used CHX mouthwash and group B CHX spray on the teeth involved in the surgical procedure, while mechanical oral hygiene was maintained only on the teeth not involved surgically. After suture removal, on the 7th day, patients were allowed to perform mechanical oral hygiene also on surgical sites. Plaque index (PI) and stain index (SI) were evaluated on the 7th and 14th days after the operation. RESULTS: In both groups, PI increased similarly with respect to the baseline in surgically involved teeth, being 0.25+/-0.41 (SD) and 0.15+/-0.26, respectively, in A and B, on day 7, and 0.14+/-0.23 (A) and 0.10+/-0.22 (B), on day 14. There was no significant difference between A and B on either day 7 or 14. On the contrary, SI increased significantly in respect to the baseline over the 14 days in group A at both involved and not involved sites, while it did not differ from the baseline in group B. CONCLUSIONS: The present results indicate that the efficacy of CHX spray in the post-surgical control of dental plaque is not different from that of CHX mouthwash. Tooth staining, on the contrary, was significantly lower in the group using CHX spray. The observed effects might be related to the way of delivering CHX and to the total dose administered, about 80% lower in group B in respect to A. Further studies are needed to validate the preliminary findings of the present study.     

The effect of 1% chlorhexidine gel and 0.12% dentifrice gel on plaque accumulation: a 3-day non-brushing model

To cite this article:
Int J Dent Hygiene  8 , 2010; 294–300
DOI: 10.1111/j.1601‐5037.2010.00487.x
Slot DE, Rosema NAM, Hennequin‐Hoenderdos NL, Versteeg PA, van der Velden U, van der Weijden GA. The effect of 1% chlorhexidine gel and 0.12% dentifrice gel on plaque accumulation: a 3‐day non‐brushing model. Abstract: Aim: The purpose of the study was to compare the effects of four treatments on ‘de novo’ plaque accumulation. Treatments included tray application of 1% chlorhexidine gel (CHX‐Gel), 0.12% chlorhexidine dentifrice‐gel (CHX‐DFG), a regular dentifrice (RDF) tray application, or 0.2% chlorhexidine mouthwash (CHX‐MW) in a 3‐day non‐brushing model. Material and methods: The study was designed as a single blind, randomized parallel clinical trial. After professional prophylaxis, subjects abstained from all other forms of oral hygiene during a 3‐day non‐brushing period. Subjects were randomly assigned to one of the four test groups (CHX‐Gel, CHX‐DFG, RDF applied in a fluoride gel tray or rinsing with a CHX‐MW). After 3 days, the Quigley & Hein plaque index (PI) and Bleeding on Marginal Probing (BOMP) index was assessed. Subsequently, all subjects received a questionnaire to evaluate their attitude, appreciation and perception towards the products used employing a Visual Analogue Scale. Results: After 3 days, the full‐mouth PI means were 0.88 for the CHX‐gel regimen, 0.79 for CHX‐MW, 1.16 for CHX‐DFG and 1.31 for the RDF regimen. The two dentifrices (CHX‐DFG and RDF) were significantly less effective than the CHX‐Gel or the CHX‐MW. Conclusion: Within the limitations of the present 3‐day non‐brushing study design, it can be concluded that the effect of a 1% CHX‐Gel application tray is significantly greater than that of 0.12% CHX‐DFG or RDF in inhibiting plaque accumulation. The 1% CHX‐Gel applied via a tray and 0.2% CHX‐MW rinse were comparably effective.     

Adjunctive use of chlorhexidine in oral candidoses: a review

Oral candidosis is by far the commonest human fungal infection and manifests in a variety of clinical guises. The main reason for its high incidence appears to be the multiplicity of predisposing factors, which facilitate the conversion of oral commensal Candida to a parasitic existence. Despite the availability of a number of effective antimycotics for the treatment of oral candidoses, failure of therapy is not uncommon owing to the unique environment of the oral cavity where the flushing effect of saliva and the cleansing action of the oral musculature tend to reduce the drug concentration to sub-therapeutic levels. For these and other reasons chlorhexidine is widely prescribed in dentistry both as an antiseptic mouthwash and a denture disinfectant in order to supplement other antifungals. Chlorhexidine has a broad spectrum of antimicrobial activity including Candida albicans and other common non-albicans yeast species. In this review we outline the utility of chlorhexidine as an adjunct to conventional antimycotic therapy in the management of oral Candida infections.     

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.     

Platelet-rich plasma: clinical applications in dentistry

BACKGROUND: Platelet-rich plasma, or PRP, has become a valuable adjunct in wound healing in dentistry. Postsurgically, blood clots initiate the healing and regeneration of hard and soft tissues. Clinicians and scientists are investigating the use of PRP in dentistry as a way to enhance the body's natural wound-healing mechanisms. TYPES OF ARTICLES REVIEWED: The authors reviewed scientific articles that discuss the basic knowledge of wound healing mechanisms and that directly studied the growth factors shown to be concentrated in PRP. They also reviewed articles written by clinicians and researchers in dentistry fields, including oral and maxillofacial surgery and periodontics to determine applications of PRP in the field of dentistry. RESULTS: All of the reviewed articles expressed promise in PRP use and in the growth factors expressed by the platelets concentrated in PRP-namely platelet-derived growth factor, or PDGF, and transforming growth factor-beta, or TGF-beta--as an adjunct to postsurgical wound healing. Both PDGF and TGF-beta have been shown in vivo to accelerate wound healing through different mechanisms. The development of an autologous PRP has been shown to be relatively easy, to be effective as a surgical adjunct, to retain high levels of the desired growth factors after preparation and to be clinically effective in accelerating postsurgical healing in both periodontal and oral surgery applications. CLINICAL IMPLICATIONS: PRP has proven to be effective at improving surgical results in a variety of procedures in the field of oral and maxillofacial surgery. PRP also shows promise in periodontal regenerative therapy and should continue to be studied by scientists and clinicians alike.     

Overdose, adverse effects, and safety of oral medications

Overdose of oral medications can be a major concern. This article reviews the clinical presentations, toxic dosages, adverse effects, and the recommended treatments for the most commonly used oral medications in dentistry. Clinicians need to be aware of the toxicities and adverse effects of the most commonly used oral medications, and recognize the signs and symptoms as early as possible for expedient treatment and referral.     

Antifungal activity of lawsone methyl ether in comparison with chlorhexidine

J Oral Pathol Med (2011) 40 : 90–96 Objective: The aim of this study was to determine the antifungal activity of lawsone methyl ether mouthwash (LME) in comparison with chlorhexidine mouthwash (CHX) in vitro and in vivo. Materials and methods: For in vitro study, each mouthwash preparation was added into the inoculum of Candida. The turbidity was recorded after incubation at 37°C for 48 h. Candidal culture was performed and the number of colony of Candida albicans was recorded. For in vivo study, a crossover clinical trial was conducted in 22 HIV‐infected subjects and 32 denture wearers. Clinical examination was performed and oral rinse technique was carried out immediately before and 0, 1, 2 h after using each mouthwash. Allergy and subjective assessment of the mouthwashes were recorded. Statistical analysis was performed using one‐way ANOVA and linear mixed effect modeling. Results: In vitro, antifungal activity of 0.25% LME was significantly greater than that of 0.12% CHX (P < 0.05) and comparable with that of 0.2% CHX. In vivo, antifungal activity up to 2 hours of 0.025% LME mouthwash was evidenced in both groups of subjects, although significantly lower than that of 0.12% CHX. No allergic reaction was reported. LME mouthwash was graded to have less bitter taste than that of CHX. Subjects’ satisfaction on taste and smell of LME mouthwash was significantly greater than that of CHX (P < 0.05). Conclusions: Lawsone methyl ether mouthwash possesses potent antifungal activity both in vitro and in vivo. However, concentration of the mouthwash needs to be adjusted in addition to further clinical trials on long‐term use.     

The impact of chlorhexidine gluconate on the relative cell surface hydrophobicity of oral Candida albicans

OBJECTIVES: Adherence of Candida albicans has been implicated as the first step in the pathogenesis of oral candidosis, and its relative cell surface hydrophobicity (CSH) a contributory physical force. Chlorhexidine gluconate is by far the commonest antiseptic mouthwash prescribed in dentistry. The intra-oral concentrations of the retained chlorhexidine mouthwash fluctuate considerably due to the dilution effect of saliva and the cleansing action of the oral musculature. Hence the objective of the present study was to investigate the effect of brief exposure to sub-therapeutic concentrations of chlorhexidine gluconate on the relative CSH of C. albicans. DESIGN: The CSH of the isolates was assessed by a biphasic aqueous-hydrocarbon assay. RESULTS: A statistically significant reduction in CSH was observed following the exposure of Candida isolates to 0.005 and 0.0025% chlorhexidine gluconate. CONCLUSIONS: These results elucidate additional mechanisms by which chlorhexidine gluconate suppress candidal pathogenicity despite a brief period of transient exposure within the oral environment.