Comparative effects of 2 mouthrinses on the development of supragingival dental plaque and gingivitis

A 6-month double-blind, controlled clinical study was completed with 124 healthy adult subjects to determine the efficacy of 2 mouthrinses, Listerine (LA) and Peridex (PX), used as supplements to regular oral hygiene measures in reducing supragingival dental plaque and gingivitis. Following screening examinations for entry levels of existing gingivitis and plaque, baseline gingival and plaque area indices, extrinsic tooth stain, supragingival calculus, bleeding and soft tissue condition were recorded. All subjects then received a complete dental prophylaxis to remove plaque, calculus and extrinsic stain. Subjects were randomly assigned to 1 of 3 groups and performed supervised rinses twice daily for 30 s in addition to their normal oral hygiene, for 6 months. All indices were again evaluated at 3 and 6 months. After 6 months, LA and PX significantly (p less than 0.001) inhibited development of plaque by 36.1% and 50.3%, respectively, and the development of gingivitis by 35.9% and 30.5%, respectively, compared to a hydroalcohol control. PX was more effective in inhibiting plaque and both mouthrinses appeared to be equally effective in inhibiting gingivitis. LA patients did not develop significant levels of stain or supragingival calculus at 6 months, compared to baseline or control. PX patients developed significant levels of extrinsic stain and supragingival calculus compared to baseline and control. Though PX was more effective than LA in the control of plaque, this study indicates that both LA and PX were effective agents in a regimen for the control of plaque and gingivitis.     

The effect of 3 mouthrinses on plaque and gingivitis development.

The aim of this study was to evaluate the effect of 3 mouthrinses, Listerine Antiseptic (thymol), Peridex (chlorhexidine), Perimed (povidone iodine and hydrogen peroxide), and a placebo (water) on the development of dental plaque and gingivitis, when used as the only oral hygiene procedure for 14 days. 71 subjects were entered into a randomized, double-blind study. At the baseline examination, papillary bleeding score (PBS), and plaque index (PI) were registered, after which subjects received supragingival prophylaxis and were assigned to 1 of 4 study cells. Subjects were asked to refrain from all oral hygiene procedures except for the supervised 14-day 2 x daily rinsing with the assigned preparation. At day 14, the same clinical parameters were again registered. Statistical analysis was performed by a one-way analysis of variance (ANOVA) to compare the 4 groups, followed by Duncan's multiple range test to determine specific group differences. At baseline, average PBS and PI scores were similar for all 4 groups. After 14 days, the average PBS for Peridex and Perimed was significantly lower than for Listerine Antiseptic and water. The frequency of interdental units with a PBS greater than 2 was significantly lower for Peridex and Perimed than for Listerine Antiseptic and water. We concluded that both Peridex and Perimed were effective in reducing plaque and gingivitis when used as a 2 x daily mouthrinse by subjects refraining from other oral hygiene procedures. In vitro, a synergistic effect was assumed when inhibition was achieved with Perimed at the same or greater dilution than was achieved with povidone-iodine alone.     

The effect of delmopinol rinsing on dental plaque formation and gingivitis healing

The aim of this study was to investigate a possible dose-response effect of delmopinol hydrochloride, on the development of plaque and on the healing of gingivitis. 64 healthy male volunteers, aged 18-40 years with healthy gingivae and clean teeth, participated. During a 2-week period, the participants refrained from all oral hygiene and rinsed 2x daily with a placebo solution. On day 14 of the study, they received professional toothcleaning, and were randomly assigned to 4 groups. For the following 2 weeks, they rinsed 2x daily for 1 min with 10 ml of 0.05% (15 subjects), 0.1% (17) or 0.2% (16) delmopinol, respectively. 16 subjects rinsed with 0.2% chlorhexidine. No oral hygiene procedures were performed during the test period. On days 0, 14 and 28, gingival bleeding index and the presence of stainable plaque were determined. Periodic identical photographs were used for planimetric determination of buccal plaque extension. No significant difference for the reduction in gingival bleeding index was found between 0.2% delmopinol and chlorhexidine rinsing. The mean plaque index showed its most significant reduction on lingual surfaces of both upper and lower jaws when rinsing with 0.2% delmopinol. Mean plaque extension was reduced by 23% for 0.05%, 39% for 0.1% and 55% for 0.2% delmopinol. A significant dose-response effect for 0.05%, 0.1% and 0.2% delmopinol was found for gingival bleeding index, plaque index and plaque extension. The results show that delmopinol favors the healing of gingivitis and reduces plaque formation.     

Efficacy of Listerine antiseptic in inhibiting the development of plaque and gingivitis

A 9-month double-blind controlled clinical study was conducted on adult subjects using either Listerine antiseptic, its vehicle control, or a water control in order to determine the efficacy of the antiseptic mouthrinse in inhibiting the development of plaque and gingivitis. Following screening examinations for minimal entry levels of plaque and gingivitis, all subjects received a complete prophylaxis. Subjects then continued their usual oral hygiene habits for a 3-week normalization period and were examined for soft tissue abnormalities and baseline measurements of plaque, gingivitis, and tooth stain. 2 additional prophylaxes were then performed, followed by a second baseline gingival examination. Zero plaque was re-established by rubber cup polishing and twice daily rinsing was begun. Soft tissue, plaque, gingivitis, and extrinsic tooth stain were evaluated after 1, 3, 6 and 9 months of rinsing with the randomly assigned mouthrinses. Results demonstrated that Listerine antiseptic significantly reduced the development of plaque at 1, 3, 6 and 9 months and the development of gingivitis at 9 months, as compared to its vehicle control or water control.     

Effect of two new chlorhexidine mouthrinses on the development of dental plaque, gingivitis, and discolouration. A randomized, investigator-blind, placebo-controlled, 3-week experimental gingivitis study

OBJECTIVE: The aim of this experimental gingivitis study was to assess the efficacy and safety of two new chlorhexidine (CHX) mouthrinses. MATERIAL AND METHODS: Ninety volunteers participated in this investigator-blind, randomized, clinical-controlled trial in parallel groups. During the treatment period, no oral hygiene measures except rinsing with non-alcoholic 0.2% CHX or 0.2% CHX/0.055% sodium fluoride mouthrinses, a positive control, or a negative control were permitted. The primary parameter was the gingival index; the secondary parameters were plaque index, discolouration index, and bleeding on probing. Clinical examinations were conducted 14 days before the start of the study, at baseline, and after 7, 14, and 21 days. The two sample t-test, anova, and ancova were used for the statistical analysis. RESULTS: No difference in efficacy was found between the two new CHX formulations and the positive control. On day 21, statistically significantly less gingival inflammation and plaque accumulation compared with placebo were observed. Besides discolouration and taste irritations, no adverse events were recorded. CONCLUSION: The two new CHX mouthrinses were able to inhibit plaque re-growth and gingivitis. Neither the omission of alcohol nor the supplementation with sodium fluoride had weakened the clinical efficacy of CHX with respect to the analysed clinical parameters.     

Clinical efficacy of listerine in inhibiting and reducing plaque and experimental gingivitis

103 adult subjects completed a supervised 2-week double-blind controlled clinical study to determine the effect of using either listerine antiseptic (LA) or its vehicle control (VC), as the only oral hygiene procedure, in inhibiting the development of and in reducing plaque and experimental gingivitis. Following baseline examinations, half-mouth prophylaxes were performed on each subject, who continued normal oral hygiene and returned 4 or 5 days later for a second baseline. Subjects then rinsed, under supervision, either 2 or 4 times daily for 2 weeks with LA or twice daily with VC, but suspended all other oral hygiene measures. Plaque and gingivitis were evaluated at baselines and after 2 weeks. Subjects using LA 2 or 4 times a day as the only oral hygiene procedure for 2 weeks demonstrated highly significant inhibition and reduction of both supragingival plaque and gingival inflammation compared to those using VC.     

Effect of localized experimental gingivitis on early supragingival plaque accumulation

Abstract Previous investigations have reported increased plaque formation in the presence of gingival inflammation as compared with gingival health. In these investigations, experimental gingivitis has been induced by total abolition of oral hygiene such that increased levels of salivary bacteria could contribute to the increased plaque formation. In the present study, experimental gingivitis was localized to 2 selected teeth whilst maintaining normal oral hygiene measures in the rest of the mouth. The aim of this study was to investigate whether the mass of plaque accumulating in a 3-day period is influenced by the inflammatory status of the adjacent gingival margins. Following scaling, prophylaxis and a period of optimal hygiene to establish gingival health, “plaque-guards” were worn during routine oral hygiene performance to prevent any cleaning on the buccal surfaces of teeth 14 and 15 from days 0 to 3. On day 3, accumulated plaque was removed from a 1.5 mm zone on the buccal surfaces of 14 and 15 adjacent to the gingival margins and weighed immediately. Subjects continued to wear their plaque-guards during oral hygiene until day 14 to induce experimental gingivitis around the experimental teeth. At day 14, all plaque was cleaned from the buccal surfaces of the experimental teeth and the mass of plaque accumulating over the next 3 days weighed on day 17. Comparison of plaque weights showed that the wet-weight of 3 day-old plaque was higher in the presence of experimental gingivitis than in the presence of gingival health (p= 0.02). This observation suggests that the inflammatory status of the marginal gingival has an important effect on early, supragingival plaque accumulation.     

一种香精油漱口水抑制菌斑和牙龈炎症作用的研究

目的评价一种香精油漱口水抑制菌斑和牙龈炎症的作用。方法将67名改良牙龈指数(MGI)≥1.5且改良菌斑指数(MPI)≥2.0的受试者纳入试验,指导其在每天早晚刷牙后含漱20ml香精油漱口水30s,持续13周之后,检查受试者的MGI、MPI和牙龈出血指数(GBI),与基线值进行比较。结果使用香精油漱口水13周之后,与基线值相比,受试者的MGI下降了26.52%,MPI下降了61%,GBI下降了30.65%,差异均有显著性(P<0.01)。结论在日常刷牙的同时,配合使用香精油漱口水能够抑制菌斑和牙龈炎症。     

Clinical and microbial evaluation of a histatin-containing mouthrinse in humans with experimental gingivitis

OBJECTIVE: P-113, a 12 amino acid histatin-based peptide, was evaluated in a mouthrinse formulation for safety, prevention of the development of experimental gingivitis, and for its effects on periodontal flora. METHOD: 159 periodontally healthy subjects abstained from oral hygiene procedures and self-administered either 0.005%, 0.01%, 0.05% P-113 or placebo mouthrinse formulations twice daily over a four week treatment period. During this time, the safety, anti-plaque, and anti-gingivitis effects of P-113 were evaluated. RESULTS: There was a significant reduction in plaque (p=0.046) and a reduction in gingivitis (p=0.086) for subjects using 0.01% P-113 mouthrinse. Significantly more subjects in the 0.01% and 0.05% treatment groups showed a small increase in plaque index of <0.25 as compared to the placebo group (p<0.05). Similar trends were noted for changes in the % of sites with bleeding on probing in the 0.01% P-113 group. There were no treatment-related adverse events, and there were no adverse shifts in supragingival microflora during the study. CONCLUSION: These data suggest that P-113 mouthrinse is safe and reduces plaque, gingivitis and gingival bleeding in the human experimental gingivitis model.     

Effect of Listerine® on dental plaque and gingivitis

abstract — The present study was performed in 10 adults in order to evaluate the effect of an antiseptic mouthrinse (Listerine®) on the rate of dental plaque formation and gingivitis development during a 2-week period when all efforts towards active mechanical oral hygiene were withdrawn. The study was performed as a crossover study and was carried out during four consecutive 2-week periods. During the first and third periods (preparatory periods) the participants were subjected to repeated professional tooth cleanings in order to establish plaque- and gingivitis-free dentitions. During the second and fourth periods (test and control periods) the participants were not allowed to brush their teeth but rinsed their mouths three times a day with Listerine or a placebo mouthwash. Plaque Index, Gingival Index, gingival fluid flow, and crevicular leukocytes were assessed on d 0, 2, 4, 7, and 14. On d 7 and 14, dental plaque was removed from the right and left jaws respectively and the wet weights determined. The chemotactic activity elaborated by the plaques was studied in Boyden chambers. During the Listerine test period, significantly lower Plaque and Gingival Index values were scored and lower amounts of plaque could be sampled in comparison to the control period.     

The effect of herbal extracts in an experimental mouthrinse on established plaque and gingivitis

Abstract. The purpose of the present study was to establish in vitro the inhibiting effect of a herbal extract mixture on a selected number of micro-organisms and to test in vivo the effect of a mouthwash containing 6.3 mg/ml herbal extract mixture on plaque and gingivitis as compared to a minus active control mouthrinse. The herbal extract was a mixture of: Juniperus communis (juniper), Urtica dioca (nettle), Achillaea millefolium (yarrow); 1:1:1. In the study, in-vitro, the effect of pure herbal extract mixture on acid production of Streptococcus mutans was tested and the minimum inhibitory concentrations (MIC) of the following micro-organisms were tested: Streptococcus mutans, Streptococcus mitis, Actynomyces viscosus, Actynomyces naeslundii, Actinobacillus actinomycetemcomitans, Prevotella intermedia, Campylobacter rectus, Fusobacterium nucleatum, Veillonella parvula. The MIC-values for A. viscosus and P. gingivalis were 100 mg/ml. The MIC-values for A. naeslundii and A. actinomycetemcomitans were considerably lower (10 mg/ml). S. mitis was the most susceptible of the tested organisms to the extract with a MIC value of 1 mg/ml. S. mutans, C. rectus, V. parvula, and F. nucleatum were not influenced by the extracts. No inhibitory effect of the 6.3 mg/ml herbal extract mixture was observed on the acid production of S. mutans. For the study in-vivo, 45 volunteers were selected on the basis of having moderate gingival inflammation. As efficacy parameters the plaque index, modified gingival index and angulated bleeding index were assessed. The subjects were randomly divided among 3 experimental groups (2× test and 1‘minus active’control). The participants were requested to rinse with 10 ml of mouthwash twice a day for a period of three months. After 6 weeks and 3 months, the same clinical indices as at baseline were recorded. The results show no difference between the two test groups and the control group. In conclusion, the results of the present study have shown that the mixture of the 3 herbal extracts, Juniperus communis, Urtica dioca and Achillaea millefolium when used in a mouthrinse has no effect on plaque growth and gingival health.     

The effect of a triclosan-containing dentifrice on established plaque and gingivitis

Abstract The aim of the present clinical trial was to study the effect on existing plaque and gingivitis of an oral hygiene regimen which utilized a dentifrice which contained triclosan. 120 subjects were recruited for the trial. They were examined for plaque and gingivitis using the criteria of (i) the Turesky modification of the Quigley & Hein plaque index and (ii) the Löe & Silness gingival index. Plaque and gingivitis were assessed in all parts of the dentition and at 6 location points around each tooth. Following a baseline examination, the subjects were stratified in 2 balanced groups based on age, plaque and gingivitis scores. The subjects were randomly assigned to the following treatment: 1 test group used a dentifrice containing triclosan/copolymer/fluoride and 1 control group used a traditional fluoride containing dentifrice. The participants were given the assigned dentifrice and a soft-bristled toothbrush for home use. They were instructed to brush their teeth in the morning and in the evening for one minute each time. They were re-examined 6 weeks, 3 and 6 months after the baseline examination. The findings from the re-examinations revealed that an oral hygiene regimen which utilized a dentifrice which contained triclosan/copolymer significantly reduced pre-existing plaque and gingivitis above what was accomplished by a traditional fluoride containing dentifrice. The improvement of the gingival conditions occurred in all parts of the dentition and at all tooth surfaces and units. In addition, the present data support the hypothesis that triclosan may induce alterations in the quality of existing plaque.     

Clinical and microbial evaluation of a histatin-containing mouthrinse in humans with experimental gingivitis: a phase-2 multi-center study

OBJECTIVE: P-113, a 12 amino acid histatin-based peptide, was evaluated in a mouthrinse formulation for safety and efficacy in a phase 2 multi-center clinical study. METHOD: 294 healthy subjects abstained from oral hygiene procedures and self-administered either 0.01% P-113, 0.03% P-113 or placebo mouthrinse formulations twice daily over a 4-week treatment period. During this time, the safety, anti-gingivitis, and anti-plaque effects of P-113 were evaluated. RESULTS: There was a significant reduction in the change from baseline to Day 22 in bleeding on probing in the 0.01% P-113 treatment group of the intent to treat population (p=0.049). Non-significant trends in the reduction of the other parameters were observed in this population (p> or =0.159). A sub-group of subjects which developed significant levels of disease within the four-week timeframe of the study was identified based on baseline gingival index scores > or =0.75. Significant findings were observed for bleeding on probing, gingival index and plaque index within this population (p<0.05). There were no treatment-related adverse events, and there were no adverse shifts in supragingival microflora during the study. Significant amounts of the peptide were retained in the oral cavity following rinsing. CONCLUSION: These data suggest that P-113 mouthrinse is safe and reduces the development of gingival bleeding, gingivitis and plaque in the human experimental gingivitis model.     

Chemotherapeutic agents for controlling plaque and gingivitis

There has been a vigorous search for many years for chemical agents that could supplement or even supplant patient-dependent mechanical plaque control and thus reduce or prevent oral disease. 5 categories of agents or approaches have been considered: (1) broad spectrum antiseptics, (2) antibiotics aimed at specific bacteria, (3) single or combinations of enzymes that could modify plaque structure or activity, (4) non-enzymatic dispersing or modifying agents and (5) agents that could affect bacterial attachment. The success of these approaches can be evaluated clinically by the use of standard scoring methods for measuring plaque and gingivitis and their safety established by soft tissue and microbiologic examination. Antiseptic agents have received the bulk of the attention over the years. At present, only 2 antiseptics, the bis-biguanide, chlorhexidine gluconate (Peridex) and a combination of phenol related essential oils (Listerine), have developed sufficient supporting data in 6-month (or longer) studies to gain the approval of the Council On Dental Therapeutics of the American Dental Association. On the basis of short-term studies, cetylpyridinium chloride, zinc and copper salts, sanguinarine and octenidine warrant continued study as does stannous fluoride at an appropriate concentration. On the basis of current research, a new generation of more specific antibacterial agents that interfere with attachment to pellicle can be developed. It is hard to predict, however, that they will affect gingivitis, at least until there is more information on what specific organisms should be targeted.     

Development of plaque and gingivitis after mouthrinsing with 0.2% delmopinol hydrochloride

A double-blind, randomized, 2-wk experimental gingivitis clinical trial with cross-over design in 14 dental students was conducted in order to study the efficacy and safety of delmopinol hydrochloride solution (2 rug/ml), used with no other oral hygiene procedures, in comparison with placebo. Plaque formation was measured by the Q uigley & H ein Plaque Index and gingivitis was assessed by bleeding on probing according to M ühlemann & S on . Rinsing with delmopinol resulted in lower plaque scores compared to placebo. The development of gingivitis was weak during the 2-wk test periods, and thus no conclusive results were obtained. As in previous studies, the most frequent adverse event when rinsing with delmopinol was a transient anaesthetic sensation in the oral mucosa. The results showed that rinsing with delmopinol hydrochloride solution (2 mg/ml) for 60 s twice daily with no other oral hygiene procedures led to less plaque formation than rinsing with placebo. This study also showed good tolerance and acceptability of mouthrinsing with delmopinol.     

Comparison of different measurements of development of plaque and gingivitis in man

Abstract— The purpose of the present study was to compare efficiency of measurements commonly used to study the development of plaque and gingivitis in short-term clinical trials. Data from a recent experiment on the effect of mutanase on accumulation of plaque and development of gingivitis were used. Efficiency was compared using 1) level of significance and 2) minimum number of individuals necessary to obtain a statistically significant result at a given level of significance and with a given power of the test. Of all the measurements used, the gingival exudate measurement was the most efficient. Among the nonparametric indices, Plaque Index was the most efficient, especially on proximal surfaces in the mandible. Reduction of the scales for the nonparametric indices from a four-point scale to a two-point (dichotomous) scale slightly reduced experimental efficiency.     

The effect of mouthrinses containing zinc and triclosan on plaque accumulation and development of gingivitis in a 3-week clinical test

Abstract. Experimental mouthrinses containing 0.4% zinc sulphate and 0.15% triclosan were compared with a chlorhexidne and a negative control mouthrinse in a 3-week clinical trial. The zinc/triclosan mouthrinses 1 and 2 differed in their ethanol and humectant contents used to deliver the triclosan. The experimental protocol employed the partial mouth gingivitis design, whereby participants wear a toothshield during toothbrushing. Gingival health at baseline was established by professional cleaning, oral hygiene instruction and effective toothbrushing 3 × per day during a pre-experimental period of 2 weeks. The mouthrinses were subsequently used 2 × daily following normal toothbrushing during 3 weeks. The pre-experimental oral hygiene phase very effectively reduced plaque levels and gingival bleeding. During the rinsing period, in the absence of mechanical removal of plaque from the protected teeth, gingival bleeding rose to above the prestudy level in the negative control group. The increments (change from baseline to 21 days) of plaque and bleeding scores for the zinc/triclosan mouthrinse 1 were significantly lower than those in the negative control group. As expected, plaque and gingivitis scores were lowest in the group that rinsed with chlorhexidine. The results extend previous observations on the efficacy of the zinc/triclosan system to maintain gingival health.     

Effect of delmopinol hydrochloride mouthrinse on plaque formation and gingivitis in "rapid" and "slow" plaque formers

Abstract The aim of the present study was to investigate differences in the plaque and gingivitis inhibiting effect of delmopinol rinsing between “rapid” and “slow” plaque formers. 23 subjects (12 “rapid” and 11 “slow” plaque formers) were selected from 71 healthy young adults. The selection was based on the plaque index on the buccal surfaces of all premolars and 1st molars after 3-days without plaque control. The 23 subjects were randomly assigned into 3 groups with different mouthrinses, i.e., 0.1% delmopinol, 0.2% delmopinol, and placebo. The study was double-blind with parallel design between the “rapid” and “slow” plaque formers and cross-over design between 2 active periods and a placebo period. Each rinsing period lasted for 5 days. During the 3 test periods, the subjects refrained from all oral hygiene and rinsed 2 × daily with either one of the 3 solutions. Gingival crevicular fluid (GCF) was collected from buccal surfaces of upper canines and premolars and bleeding on probing (BOP) recorded at 6 sites around each tooth before and after each test period. Plaque assessment, including plaque index (PI) and standardized color slides for planimetric analyses obtained from the canines and premolars, were only recorded after each test period. Results showed that the mean PI and planimetry values for both the “rapid” and “slow” plaque formers were lower than the placebo, for either the 0.1% or the 0.2% delmopinol mouthrinse. The differences between the “rapid” and “slow” plaque formers were not statistically significant. There was a small reduction in BOP in both groups for the delmopinol periods, as against a slight increase in the placebo period: the difference between the placebo group and the 2 groups of plaque formers was not statistically significant (p>0.6 for both 0.1% and 0.2% delmopinol). Results suggested that both 0.1% and 0.2% delmopinol reduce plaque formation and gingivitis to a similar extent in subjects with extreme rates of plaque formation.     

Effects of 6 months use of an antiseptic mouthrinse on supragingival dental plaque microflora

This study was undertaken to determine whether long-term use (6-months) of an antiseptic mouthrinse (Listerine Antiseptic, Warner Lambert Co., Morris Plains, NJ, USA) led to an undesirable succession of oral pathogens or the emergence of resistant microbial forms. Supragingival plaque was collected from 83 subjects before treatment and after either 3 or 6 months use of either the active antiseptic or a 5% hydroalcohol control. Subjects rinsed with their assigned mouthrinse twice daily under supervision. The plaque samples were analyzed for microbial content by darkfield microscopy, culture on a series of nonselective and selective bacterial media, and by recognition of microbial forms by recognition of distinct colony on a nonselective medium. Statistical analysis of the results revealed no significant microbial shifts including no significant increases in presumptive oral pathogens, spirochetes, black-pigmented Bacteroides, Streptococcus mutans, or Candida albicans. Additionally, no detectable rise in either staphylococci or enteric bacteria, potential opportunistic pathogens, was observed.