A randomized clinical trial on the short-term clinical and microbiological effects of the adjunctive use of a 0.05% chlorhexidine mouth rinse for patients in supportive periodontal care

OBJECTIVE: To evaluate the clinical and microbiological activity of a new mouth rinse formulation, used as an adjunct to oral hygiene, for patients in supportive periodontal care. PATIENTS AND METHODS: This was a randomized, placebo-controlled clinical trial with two groups: test group, rinsing twice per day with the test product (with 0.05% chlorhexidine and 0.05% cetylpyridinium chloride); and control group, rinsing with a placebo. Treated chronic periodontitis patients were included, and two visits were rendered, baseline, and after 15 days. Clinical outcome variables included plaque and gingival indices, and probing pocket depth. Subgingival samples were processed by culturing. Patient-based variables and adverse effects were also assessed. Outcome variables were compared by t-test, chi2, and Mann-Whitney test. RESULTS: The results belonged to 33 patients. Plaque and gingival indices, and the log of bacterial total counts were reduced in the test group (p < or = 0.01), but differences between groups were only statistically significant (p < 0.05) for plaque and bacterial counts. A significant reduction in the proportions of flora (p < 0.05) and frequency of detection (p = 0.01) of Porphyromonas gingivalis was observed in the test group. CONCLUSIONS: The newly formulated mouth rinse demonstrated short-term plaque-inhibitory activity. This was associated with a reduction in the total load of anaerobic subgingival microflora.     

Comparative antiplaque and antigingivitis effectiveness of a chlorhexidine and an essential oil mouthrinse: 6-month clinical trial

OBJECTIVES: The objective of this study was to compare the antiplaque and antigingivitis effectiveness and the side-effect profiles of an essential oil-containing mouthrinse and a chlorhexidine-containing mouthrinse. MATERIAL AND METHODS: One hundred and eight qualifying subjects, aged 20-57 years, were randomized into three groups: essential oil mouthrinse (ListerineAntiseptic); 0.12% chlorhexidine mouthrinse (Peridex); or 5% hydroalcohol negative control. At baseline, subjects received a complete oral soft tissue examination and scoring of the Loe-Silness gingival index (GI), Quigley-Hein plaque index (PI), Volpe-Manhold calculus index (CI), and Lobene extrinsic tooth stain index (SI). Following a complete dental prophylaxis, subjects started rinsing twice daily with their respective mouthrinse as an adjunct to their usual mechanical oral hygiene procedures. One of the rinses on each weekday was supervised. Subjects were reexamined at 3 and 6 months. The treatment groups were compared with respect to baseline demographic and clinical variables. The primary efficacy variables were GI and PI. Intergroup differences for all clinical variables were tested at 3 and 6 months using appropriate statistical procedures. RESULTS: All of the 108 randomized subjects were evaluable at 3 months, and 107 subjects were evaluable at 6 months. There were no statistically significant differences among the three groups at baseline, with the exception that the control group PI was significantly lower than that of the essential oil group (p<0.05) and the chlorhexidine group (p<0.001), and the essential oil mouthrinse group had a significantly greater number of subjects than the control group with body region SI scores > or =1.0 (p=0.021). At 6 months, the essential oil and chlorhexidine mouthrinses produced statistically significant (p<0.001) GI reductions of 14.0% and 18.2%, respectively, and statistically significant (p<0.001) PI reductions of 18.8% and 21.6%, respectively, compared with the control and were not statistically significantly different from each other with respect to plaque and gingivitis reduction. The chlorhexidine mouthrinse group had significantly more calculus and extrinsic tooth stain than either the essential oil mouthrinse group or the control group. CONCLUSION: This 6-month controlled clinical study demonstrated that the essential oil mouthrinse and the chlorhexidine mouthrinse had comparable antiplaque and antigingivitis activity. Insofar as side effects associated with the chlorhexidine mouthrinse may limit patient compliance, it is suggested that each product can have a distinct role in the management of patients with periodontal diseases.     

A 0.05% cetyl pyridinium chloride/0.05% chlorhexidine mouth rinse during maintenance phase after initial periodontal therapy

BACKGROUND: Chlorhexidine (CHX) mouth rinse/spray can still be considered the gold standard in the chemical prevention of plaque formation and development of gingivitis. The product unfortunately has some side effects, such as extrinsic tooth staining, poor taste, taste disturbance, sensitivity changes in tongue, pain and irritation because of the alcohol content. These side effects led to the search of new formulations. METHODS: In this double-blind, randomized, long-term, parallel study, 48 moderate periodontitis patients rinsed for 6 months (starting immediately after a "one-stage, full-mouth" disinfection) with one of the following products: CHX 0.2%+alcohol (Corsodyl), CHX 0.05%+ cetyl pyridinium chloride (CPC) 0.05% and no alcohol (Perio-Aid Maintenance, a new formulation), or the placebo of the latter. After 1, 3 and 6 months a series of clinical and microbiological parameters were recorded for the supra- and subgingival area as well as for saliva. RESULTS: Although there was a significant treatment impact (mechanical debridement) in all groups, both CHX solutions further decreased both plaque and gingivitis indices (p<0.001 and p<0.05, respectively), when compared with placebo. This was also reflected by additional reductions in the number of CFU/ml of aerobic and especially anaerobic species and by a suppression of Streptococcus mutans (versus an overgrowth for the placebo), in all niches. Differences between both CHX solutions were never encountered. The subjective ratings were slightly in favour of the new CHX-CPC formulation when compared with the other CHX-alcohol formulation, especially for taste of the product (p<0.05), but less impressive for the staining of teeth and tongue. CONCLUSIONS: The results of this study demonstrated the potential of a new CHX 0.05%+CPC 0.05% non-alcoholic formulation as an effective antiplaque agent for long-term use with reduced subjective side effects.     

Comparison of the effects of cetylpyridinium chloride with an essential oil mouth rinse on dental plaque and gingivitis - a six-month randomized controlled clinical trial

Objective: To compare the effects of an experimental mouth rinse containing 0.07% cetylpyridinium chloride (CPC) (Crest Pro‐Health^®) with those provided by a commercially available mouth rinse containing essential oils (EOs) (Listerine^®) on dental plaque accumulation and prevention of gingivitis in an unsupervised 6‐month randomized clinical trial. Material and Methods: This double‐blind, 6‐month, parallel group, positively controlled study involved 151 subjects balanced and randomly assigned to either positive control (EO) or experimental (CPC) mouth rinse treatment groups. At baseline, subjects received a dental prophylaxis procedure and began unsupervised rinsing twice a day with 20 ml of their assigned mouthwash for 30 s after brushing their teeth for 1 min. Subjects were assessed for gingivitis and gingival bleeding by the Gingival index (GI) of Löe & Silness (1963) and plaque by the Silness & Löe (1964) Plaque index at baseline and after 3 and 6 months of rinsing. At 3 and 6 months, oral soft tissue health was assessed. Microbiological samples were also taken for community profiling by the DNA checkerboard method. Results: Results show that after 3 and 6 months of rinsing, there were no significant differences (p=0.05) between the experimental (CPC) and the positive control mouth rinse treatment groups for overall gingivitis status, gingival bleeding, and plaque accumulation. At 6 months, the covariant (baseline) adjusted mean GI and bleeding sites percentages for the CPC and the EO rinses were 0.52 and 0.53 and 8.7 and 9.3, respectively. Both mouth rinses were well tolerated by the subjects. Microbiological community profiles were similar for the two treatment groups. Statistically, a significant greater reduction in bleeding sites was observed for the CPC rinse versus the EO rinse. Conclusion: The essential findings of this study indicated that there was no statistically significant difference in the anti‐plaque and anti‐gingivitis benefits between the experimental CPC mouth rinse and the positive control EO mouth rinse over a 6‐month period.     

Oral mutans streptococci levels following use of a xylitol mouth rinse: a double‐blind,randomized, controlled clinical trial

Xylitol‐sweetened chewing gum has cariostatic properties, but is not suitable for all patients. This study evaluated the effect of xylitol rinse on mutans streptococci (MS) levels in the mouth. One hundred and five subjects with high salivary MS levels were randomly assigned to one of three groups. Subjects in the positive control group (N = 35) chewed two xylitol gum pellets for at least 5 minutes three times daily (xylitol dose: 4.3g/day). The experimental group (N = 36) rinsed with 20 mL of an aqueous solution of xylitol twice daily for 60 seconds (dose: 4.4g/day). The negative control group (N = 34) used neither product. No attempt was made to change the subjects’ diet. Mean MS levels at baseline were 5.6 (0.1) in positive control, 5.4 (0.1) in experimental, and 5.5 (0.1) in negative control groups. After 3 months, MS levels were 4.4 (0.2), 4.4 (0.2), and 4.9 (0.2), respectively. Differences between groups were not significant by ANOVA (p = .2); however, MS levels tended to be lower in the experimental and positive control groups. Xylitol rinse and chewing gum caused a similar but statistically insignificant reduction in MS levels in the mouth.     

A method to study sustained antimicrobial activity of rinse and dentifrice components on biofilm viability in vivo

AIM: To develop an improved method for quantitative assessment of antimicrobial efficacy and substantivity of mouth rinses and dentifrices on in vivo treated plaque. MATERIAL AND METHODS: Nine- and 72-h-old plaques were formed in volunteers carrying out standardized hygiene using NaF-containing dentifrice. Plaques were collected before (baseline) in vivo treatment with dentifrices or chlorhexidine mouth rinse, immediately post-treatment and after 1 or 6 h, dispersed in demineralized water and stained with live/dead stain after which bacteria were enumerated. Dispersed baseline plaques were treated with dentifrices or chlorhexidine to determine antimicrobial efficacy against planktonic bacteria. RESULTS: Baseline plaques revealed 56-41% viable organisms in 9- and 72-h-old plaques, respectively. Treatment of planktonic (dispersed baseline plaque) bacteria resulted in 1-4% viable organisms. Chlorhexidine mouth rinse and dentifrices produced strong immediate antimicrobial effects, but after 1 or 6 h, the proportion of viable organisms in 9-h-old plaques rebounded significantly with only chlorhexidine mouth rinse retaining significant efficacy. Seventy-two-hour-old plaques were less susceptible to antimicrobials, although dentifrices appeared more effective after 6 h than initially, whereas efficacy of chlorhexidine rinse continued to drop with time post-treatment. CONCLUSIONS: The proposed method holds promise for assessment of both immediate and retained antimicrobial actions of oral treatments against dental plaque in vivo.     

Clinical trial in mentally retarded of chlorhexidine dental gel: bacteriology

A dental gel containing 1 % chlorhexidine was applied daily to the teeth of mentally retarded patients for a period of 6 months. Although possible antimicrobial effects were noted, the gel had no practical value in reducing the numbers of different plaque bacteria. It is suggested that the lack of effect may be due to changes in susceptibility of the oral flora surviving in the mouth, allowing subsequent recolonization of the teeth.     

他克莫司含漱液治疗糜烂型口腔扁平苔藓的随机单盲对照研究

目的：评价他克莫司含漱液治疗糜烂型口腔扁平苔藓(OLP)的临床疗效。方法：采用随机单盲对照开放设计,将62例糜烂型OLP患者分为治疗组和对照组,治疗组采用他克莫司含漱液,对照组采用地塞米松含漱液,同时记录2组VAS和REU分值,使用SPSS17.0软件包对数据进行统计学分析,在用药4周和12周时分别评定疗效。结果：用药后4周和12周,2组VAS和REU分值均低于基线水平(P<0.01),2组疗效差异无显著性(χ²=0.295、0.413,P>0.01)。用药后4周,治疗组REU分值低于对照组,差异显著(P<0.01)。结论：他克莫司含漱液治疗糜烂型OLP安全可靠且起效快,可在临床推广使用。