Chlorhexidine spray as an adjunct in the control of dental biofilm in children with special needs

The aim of this study was to evaluate the clinical effectiveness of .12% chlorhexidine applied via spray and the acceptance. A total of 26 individuals with mental health issues, aged 7–14, were included into two groups: placebo (control, n = 13) and chlorhexidine (experimental, n = 13). Both groups received two daily applications of spray during 2 months. The periodontal conditions were evaluated by the simplified oral hygiene index (OHI‐S) and gingival index (GI). The evaluation of acceptance of the application method (spray) was assessed by questionnaire. Data were analyzed with nonparametric tests, with a significance level of 5%. Regarding the OHI‐S index, only the experimental group showed significant change during the evaluations (p < 0.001). Regarding the GI, both groups showed significant changes during the evaluations. The method of application was well accepted by patients and caregivers, and .12% chlorhexidine solution applied via spray significantly reduced the rates of dental and gingival biofilm.     

Comparison of chlorhexidine delivery by mouthwash and spray on plaque accumulation

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

The use of 0.2% chlorhexidine spray as an adjunct to oral hygiene and gingival health in physically and mentally handicapped adults

Chlorhexidine has been used as an aid to or replacement for oral hygiene measures in special needs groups such as the handicapped. Previous studies have indicated that spray delivery of chlorhexidine is both effective and acceptable. This study evaluated twice daily use of a 0.2% chlorhexidine spray as an adjunct to toothbrushing in a group of physically and mentally handicapped adults attending a day training center. The study was a double-blind, placebo controlled, cross-over design involving two 31 days regimens separated by 30 days. Plaque, bleeding on probing, and pocketing were measured at the beginning and end of each regimen. There were clinically and statistically significantly lower plaque and bleeding scores at the end of the chlorhexidine compared to the placebo period. Pocketing was also significantly less after chlorhexidine, although in clinical terms the difference was small. The apparent acceptability and effectiveness of the regimen suggests that small doses of chlorhexidine delivered by sprays may be of considerable value as an aid to oral hygiene in handicapped individuals.     

The effect of mouthrinses and topical application of chlorhexidine on the development of dental plaque and gingivitis in man

Twenty-four male dental students with healthy gingivae and clean teeth ceased all oral hygiene procedures. (A) Four subjects rinsed, twice daily, with a 0.2 per cent solution of chlorhexidine gluconate; (B) eight students rinsed, once daily, with the same solution; (C) six students did not rinse and formed the control group and (D) six students received one daily application of a 2 per cent solution of chlorhexidine gluconate. The study confirmed previous observations (Löe and Rindom Schiött 1969, 1970) that two daily mouth rinses with a 0.2 per cent solution of chlorhexidine effectively prevent plaque formation. One daily rinse did not inhibit plaque formation in all areas of the dentition. One daily topical application of a 2 per cent solution of chlorhexidine gluconate prevented plaque formation completely. Upon discontinuation of the chlorhexidine treatment plaque formed at normal rates, suggesting that there is no appreciable effect beyond a 24 hour period. It is concluded that complete inhibition of plaque and prevention of gingivitis may be achieved by daily application of chlorhexidine, provided the agent is administered in such a way that it reaches all tooth surfaces.     

Antimicrobial spray for toothbrush disinfection: an in vivo evaluation.

OBJECTIVE: The aim of this study was to evaluate the efficacy of a spray containing an antimicrobial solution for toothbrush disinfection. METHODS AND MATERIALS: Three different solutions were sprayed on toothbrush bristles among 30 adults after they had brushed: (1) basic formulation (base) plus chlorhexidine; (2) base only, and (3) sterile tap water (control). Each solution was tested for 1 week. After that, the toothbrushes were collected and sonicated in Letheen Broth, diluted in 10-fold series, and plated on selective and nonselective media for detection of anaerobes, aerobes, streptococci, and gram-negative bacilli. After incubation, the colonies of those microorganisms were counted. Presence of mutans streptococci on the bristles was also confirmed. RESULTS: Spray 1 produced a significant reduction in the microbial contamination of toothbrushes for all the microorganisms, spray 2 provided some reduction of contaminants, and spray 3 demonstrated the least antimicrobial effect. CONCLUSION: The antimicrobial spray with chlorhexidine proved to be an effective and practical means for toothbrush disinfection.     

Oral hygiene in mentally handicapped children. A clinical trial using a chlorhexidine spray

A bstract — A daily 0.2 per cent chlorhexidine spray, when used as the sole oral hygiene measure in mentally handicapped children, produced a significant reduction in plaque levels and gingival inflammation.     

Microbial contamination and disinfection methods of pacifiers

Objectives

To evaluate the microbial contamination of pacifiers by Mutans Streptococci (MS) and the efficacy of different methods for their disinfection.

Methods

Twenty-eight children were assigned to a 4-stage changeover system with a 1-week interval. In each stage, children received a new pacifier and the parents were instructed to maintain their normal habits for 1 week. After this time, the pacifiers were subjected to the following 4 disinfection methods: spraying with 0.12% chlorhexidine solution, Brushtox^® or sterile tap water, and immersion in boiling tap water for 15 minutes. Microbiological culture for MS and Scanning Electron Microscopy (SEM) were performed. The results were analyzed statistically by Friedman’s non-parametric test (a=0.05).

Results

The 0.12% chlorhexidine spray was statistically similar to the boiling water (p>0.05) and more effective than the Brushtox^® spray and control (p<0.05). The analysis of SEM showed the formation of a cariogenic biofilm in all groups with positive culture.

Conclusions

Pacifiers become contaminated by MS after their use by children and should be disinfected routinely. Spraying with a 0.12% chlorhexidine solution and immersion in boiling water promoted better disinfection of the pacifiers compared with a commercial antiseptic toothbrush cleanser (Brushtox^®).     

Effects of 0.2% chlorhexidine gluconate and amoxicillin plus clavulanic acid on the prevention of alveolar osteitis following mandibular third molar extractions

OBJECTIVE: The purpose of this study was to evaluate the use of a 0.2% chlorhexidine gluconate and amoxicillin plus clavulanic acid combination as a prophylactic therapy for the prevention of alveolar osteitis after mandibular third molar extractions and to investigate adverse reactions to chlorhexidine. STUDY DESIGN: This randomized, placebo-controlled, parallel group study was conducted in a group of 177 subjects, from which 3 groups were formed. The first group (n = 62) received 0.2% chlorhexidine gluconate, the second group (n = 56) received a 0.2% chlorhexidine gluconate and amoxicillin plus clavulanic acid combination, and the third group (n = 59) received 0.09% sterile saline solution. All patients were recalled for the diagnosis of alveolar osteitis on the third and seventh postoperative days. RESULTS: When patients in the antibiotic group were compared with those in the other 2 groups, a significant reduction in alveolar osteitis was noted (P <.05). An alteration in taste, the bad taste of the solution, and staining of dentures and oral tissues were the major complaints about chlorhexidine. CONCLUSION: It would be more beneficial to use chlorhexidine solution with a beta-lactamase inhibitor-containing antibiotic to enhance its effectiveness for the prevention of alveolar osteitis.     

The clinical and microbiological effects of a novel acidified sodium chlorite mouthrinse on oral bacterial mucosal infections

Acidified sodium chlorite mouthrinses have been shown to have equivalent anti-plaque activity to those containing chlorhexidine, the current 'gold standard'. In this study, sodium chlorite mouthrinses (ASC) acidified with either malic or gluconic acids were compared to each other and with a chlorhexidine rinse and sterile water for their effect on salivary bacterial counts. Sixteen subjects participated in the study, which had a cross-over Latin square design. In a second study, a sodium chlorite/gluconic acid rinse was compared with chlorhexidine for its clinical and microbiological effects in 36 patients with oral mucosal infections. The sodium chlorite rinses acidified with malic and gluconic acids and the chlorhexidine rinse caused significant reductions in salivary bacterial counts up to 7 h after a single rinse compared with water. There were no significant differences between the three active treatments. In the mucosal infection study, there was a significant reduction in erythema in the chlorhexidine group compared with the ASC group. Patients who received the ASC rinse reported significantly less discomfort following treatment than those receiving the chlorhexidine rinse. Staphylococcus aureus counts were significantly reduced in the group who received the sodium chlorite rinse. There were no other significant differences between the treatments. ASC appears to be an effective alternative to chlorhexidine mouthrinse.     

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)     

Inhibition of experimental caries by plaque prevention

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

A comparison of three delivery methods of chlorhexidine in handicapped children. I. Effects on plaque, gingivitis, and toothstaining

In handicapped groups, the maintenance of oral hygiene can be a major problem, and chemical plaque control offers many advantages. This study compared the effectiveness of chlorhexidine gluconate, delivered as a 0.2% mouthrinse, a 0.2% spray, and a 1% gel in trays, in controlling dental plaque and gingival bleeding in a group of 49 spastic children. All three delivery methods produced an improvement in plaque and gingival bleeding scores. However, the gel was significantly more effective than either the mouthwash or the spray. There was no significant difference between delivery methods in the amount of tooth staining.     

Plaque inhibition by sustained release of chlorhexidine from removable appliances

We studied the effectiveness of a sustained-release delivery system for chlorhexidine in plaque prevention. A clinical trial in a group of eight students wearing orthodontic appliances coated by ethyl cellulose polymer containing the drug demonstrated that plaque accumulation was decreased for a period of four days. All oral procedures had been withdrawn during the clinical study. No side-effects of chlorhexidine, such as tooth staining and unpleasant taste, were observed.     

Subgingival metronidazole in dialysis tubing and subgingival chlorhexidine irrigation in the control of chronic inflammatory periodontal disease

The present investigation compared subgingival metronidazole in dialysis tubing and subgingival chlorhexidine irrigation in the control of chronic inflammatory periodontal disease. 10 patients with 4 mm or deeper periodontal pockets were divided into 2 groups. Both received baseline scaling, root planing, subcontact area cleaning and instruction in the Bass technique of tooth brushing, but not in interdental cleaning. One group with 80 pockets received 0.2% chlorhexidine subgingival irrigation for 28 days and the other with 86 pockets received 0.5% metronidazole solution incorporated in subgingivally placed dialysis tubing. The tubings were replaced with freshly filled ones at days 7, 14 and 21. Active treatment ceased at day 28. Plaque Index, Sulcus Bleeding Index, pocket depth and gingival shrinkage were recorded at days 0, 7, 14, 21, 28, 56 and 84. Subgingival 0.5% metronidazole in dialysis tubing and 0.2% chlorhexidine irrigation were found to be equally effective in reducing chronic periodontitis. Metronidazole reduced Plaque Index less but pocket depth more than chlorhexidine. Improvements were maintained significantly below baseline levels for at least 8 weeks after the end of the 4-week treatment period.     

Decreased alveolar bone resorption in rice rats treated with chlorhexidine and stannous fluoride

Rice rats were used to test the effect of topically applied chlorhexidine gluconate and stannous fluoride on the loss of periodontal bone. Eighty-eight weanlings were divided into eight groups of eleven animals each. Four groups were swabbed five times each week with either: a) 0.2 % chlorhexidine; b) 2 % chlorhexidine; c) 0.2 % chlorhexidine and 10 % stannous fluoride combined, or d) deionized water. Four other groups were swabbed only twice (once at the start and once at day 30) with either: e) 0.2 % chlorhexidine; f) 10 % SnF₂; g) 0.2 % chlorhexidine and 10 % SnF₂, or h) deionized water. After two months the animals were killed and the mandibular quadrants scored to estimate bone loss. Concentrations of 0.2 and 2 % chlorhexidine applied five times per week and 10 % SnF₂ applied only twice, significantly reduced bone loss when compared to the deionized water control. The more frequent applications had a significant beneficial effect as compared to the less frequent applications.     

Clinical and microbiological effects of chlorhexidine and arginine sustained-release varnishes in the mentally retarded

Local applications of sustained-released varnishes of chlorhexidine and arginine were used in a controlled pilot study of 34 mentally retarded patients, ages 18–45, assigned to one of these groups: chlorhexidine (C), arginine (A), or placebo (P). A professional scaling followed by four weeks of professional brushing to reach a Plaque Index (PII) and Gingival Index (GI) of 1.0 at baseline preceded eight weeks of daily varnish application to the buccaI and labial surfaces of all teeth. Clinical parameters (PII and GI) and bacterial samples from selected teeth were collected at predetermined intervals. Four and eight weeks following the baseline, the PII was significantly different among the groups, with the lowest score in the chlorhexidine group. No significant differences among the three groups were noted for the GI. The chlorhexidine and arginine groups showed significant reductions (p < 0.05 and p < 0.01, respectively) in the number of S. mutans. The arginine group showed a nonsignificant increase in the number of S. sanguis. These results suggest that the topical antimicrobial agents may have some relevance to plaque control among patients with mental retardation.     

Association of chlorhexidine and fluoride for plaque control and white spot lesion remineralization in primary dentition

Background. Plaque control and caries arrest still remain a challenge for dentists. Objective. This study was conducted to assess the effect of the combined use of chlorhexidine varnish and fluoride varnish on the visible plaque index (VPI) and white spot lesion (WS) remineralization in primary dentition. Methods. A total of 80 caries-active preschool children (3–5 years) were randomly divided into four groups. Group 1 received a chlorhexidine varnish application every week during 4 weeks. Group 2 received a fluoride varnish application every week during 4 weeks. Group 3 received alternated applications of chlorhexidine and fluoride varnish during 4 weeks. Group 4 served as control (without any type of cariostatic agent). Results. There was no statistically significant difference in the VPI and WS remineralization among the groups after 1 month. However, 3 months follow-up demonstrated that group 3 (chlorhexidine + fluoride) showed significantly better results for both VPI and WS remineralization. Conclusion. The combined application of chlorhexidine and fluoride varnishes is more effective on plaque and remineralization of incipient caries after 3 months than the same agents applied separately.     

Efficacy of chlorhexidine swabbing in oral health care for people with severe disabilities

Chlorhexidine is effective when used as an oral rinse, but many disabled people cannot use such a protocol. A double-blind cross-over study tested the efficacy of applying chlorhexidine with a sponge-swab, in a sample of 76 severely disabled adults, drawn from diverse rehabilitation settings. Two randomly assigned groups applied 10 mL 0.12% chlorhexidine gluconate (Perldex™, Procter & Gamble) or 10 mL placebo, using a "Toothette™" (Halbrand) once daily, 5 times per week for 10 weeks. All subjects received 10 mL 0.05 % NaF, applied similarly but separately from the test/placebo agent. Pre- and post-trial measures included perceived level of function and oral status, that is, DMFS, plaque, calculus, pocket depth, and tooth stain. The protocol received high levels of compliance and acceptance. Compared with placebo, swabbing with chlorhexidine resulted in consistent, and, In part, significant improvements in plaque, gingivitis, and periodontal pocket depth. Side effects of chlorhexidine, that is, tooth stain and calculus, were relatively minor. Perceived Improvements in dental health were associated with improved physical health, appearance, and mouth odor. The results Indicate that chlorhexidine swabbing is a useful oral disease preventive protocol for persons with disability.     

The effect of different treatment modalities on connective tissue attachment

This study compared the effect of four treatment modalities on connective tissue attachment. Ligature-induced periodontitis was established around the mandibular premolars of five young beagle dogs over 8 weeks. Following a 2-week period without ligatures, a reference dog was sacrificed to estimate the extent and nature of the disease. Three dogs received flap procedures in one mandibular posterior segment, and the six experimental roots were treated with citric acid (pH 1) for 3 minutes; the contralateral mandibular segments received flap procedures and the roots were treated with 4% chlorhexidine gluconate in the Hibiclens preparation for 3 minutes. One segment of the control dog received flap procedures, and the roots were treated with sterile normal saline; the contralateral segment received closed root planning. The experimental dogs were sacrificed 1, 2 and 3 months after treatment. The control dog was sacrificed 3 months postoperatively. One week before sacrifice each dog received a Procion dye injection. At sacrifice the study segments of all four treated dogs were clinically healthy, with no observable differences between the different treatment modalities. Histologically, the 1, and 3-month chlorhexidine, the 3-month saline and 3-month root planed specimens had long junctional epithelial adhesions with little connective tissue attachment. The 2-month chlorhexidine and all citric acid-treated sections showed appreciable amounts of new connective tissue attachment. Some 2-month and 3-month citric acid and 2-month chlorhexidine sections showed cementum over the apical portion of the long junctional epithelium. The frequency of occurrence and the length of cementum overlapping epithelium increased appreciably over time.(ABSTRACT TRUNCATED AT 250 WORDS)     

The effects of antimicrobial sprays and mouthrinses on supragingival plaque regrowth: a comparative study

BACKGROUND: Due to the side effects of chlorhexidine digluconate (CHX) mouthrinsing, a spray has been proposed as an alternative method of CHX delivery to the oral cavity. The aim of this study was to investigate the plaque inhibitory effects of CHX, cetylpyridinium chloride (CPC), and triclosan (TRN) delivered by sprays and mouthrinses. METHODS: The study was an observer-masked, randomized cross-over design balanced for carryover effects, involving 15 healthy volunteers in a 4-day plaque regrowth model. Products being tested (0.2% CHX, 0.12% CHX, 0.05% CPC, and 0.03% TRN) were used both as sprays and mouthrinses. A saline solution served as a negative control. On day 1, subjects received professional prophylaxis, suspended oral hygiene measures, and commenced using their allocated products. On day 5, subjects were scored for disclosed plaque. RESULTS: CHX sprays (P<0.01) were the most effective sprays in preventing plaque regrowth, without significant differences between the two concentrations tested (P>0.05). TRN spray showed a significant inhibition of plaque regrowth in comparison to the negative control (P<0.05). CPC spray did not differ from saline spray (P>0.05). A similar trend of efficacy was detected for rinses. Although the effect on plaque regrowth observed with CHX rinses was superior to that of CHX sprays (P<0.0003), the latter did not cause side effects (P>0.2). CONCLUSIONS: These findings, together with those from clinical trials, suggest that the CHX-containing sprays may represent an effective alternative to CHX rinses when mechanical oral hygiene has to be avoided in restricted areas. On the contrary, the TRN and CPC sprays showed little or no plaque inhibitory effects.