Plaque inhibition of two commercially available chlorhexidine mouthrinses

BACKGROUND: Chlorhexidine (CHX) 0.2% solution is still "the leading oral antiseptic" for controlling gingivitis. Side effects, however, limit the acceptability to users and the long-term employment of a 0.2% CHX antiseptic in preventive dentistry. This stimulated the development of new formulations. The aim of the present study was to assess the effect on plaque inhibition and taste perception of two commercially available mouthrinses (0.12% CHX non-alcohol base with 0.05% cetyl pyridinium chloride (Cpc) versus 0.2% CHX alcohol base). METHODS: The study was designed as a single-blind, randomized two group parallel experiment, to compare two different commercially available mouthrinses, during a 3-day plaque accumulation model. Forty healthy volunteers were enrolled in the study and received a thorough dental prophylaxis at the beginning of the test period. Over a 72-h experimental non-brushing period, during which subjects abstained from all forms of mechanical oral hygiene, one group (test) used a 15 ml alcohol free 0.12% CHX (=18 mg) mouthrinse on a Cpc base (Perioaid), CHX plus sign in circleCpc), twice daily for 30 s. The other group (control) used a 10 ml 0.2% CHX (=20 mg) mouthrinse on an 11.8% ethanol alcohol base (Corsodyl), CHX plus sign in circleAlc), twice daily for 60 s. After 72 h of plaque formation, the amount of plaque was evaluated. By the use of visual analogue scale, the subjects were asked for their appreciation of the taste of the mouthrinse they had used. RESULTS: The mean plaque index for the CHX plus sign in circleCpc group was 0.97 and for the CHX plus sign in circleAlc group 0.78. After 72 h of non-brushing, there was no significant difference in plaque accumulation between the two groups. The answers to the questions (taste perception and after-taste) showed a statistically significant difference between the two groups. The mean visual analogue scale (VAS) scores for taste appreciation on a scale from very bad to very good taste (0-10) were 5.92 for the CHX plus sign in circleCpc group and 4.10 for the CHX plus sign in circleAlc group (p=0.02). The mean visual analogue scale (VAS) scores for the after-taste on a scale from very short to very long (0-10) were 7.24 for the CHX plus sign in circleCpc group and 5.38 for the CHX plus sign in circleAlc group. CONCLUSIONS: Within the limitations of the present study design, it can be concluded that rinsing with a 0.12% CHX mouthrinse on a non-alcohol base with 0.05% Cpc (Perio-Aid) is not significantly different from rinsing with a 0.2% CHX mouthrinse on an alcohol base (Corsodyl). It appears that the subjects appreciated the taste of the non-alcohol CHX solution better but the after-taste of the rinse remained longer in the mouth.     

A comparison of the plaque-inhibitory properties of stannous fluoride and low-concentration chlorhexidine mouthrinses

BACKGROUND: Plaque inhibition by chlorhexidine (CHX) rinses is dose related with a relatively flat dose-response curve above 5-6 mg twice daily. Low dose regimens could therefore reduce local side effects but maintain reasonable efficacy. AIMS: To compare the plaque inhibitory properties of two low-dose CHX rinse products with more conventional levels delivered from proprietary rinses. A secondary outcome was a comparison with a stannous fluoride/amine fluoride (SFAF) rinse product. METHODS: The study was a five-treatments, negative controlled, randomised, single blind crossover design balanced for residual effects, involving 20 healthy subjects in a 24-h plaque re-growth model. On day 1 of each study period, subjects were rendered plaque free, suspended tooth cleaning and followed the appropriate rinse regimen. On day 2, subjects were scored for plaque by index and area. The rinse codes and rinsing regimens were: (A) 15 mg CHX 2 x daily for 30 s (0.1% CHX), (B) 9 mg CHX 2 x daily for 60 s (0.06% CHX), (C) 10 ml SFAF rinse 1 x daily for 30 s, (D) 15 ml placebo 2 x daily for 60 s, and (E) 6 mg CHX 2 x daily for 30 s (0.06% CHX). RESULTS: Average mouth plaque indices and areas were highly significantly different between rinsing regimens. All test rinses were significantly more effective than the placebo rinse. There was a mean dose-response pattern for the CHX rinses, but there were no statistically significant differences between any of the test rinses. CONCLUSIONS: Lower doses of chlorhexidine in rinses can be used to exert plaque inhibition comparable with products used at higher doses and equivalent to benchmark products such as the SFAF rinse. However, the availability of chlorhexidine from formulations has to be considered as in part explaining the results.     

Enamel demineralization by mouthrinses containing different concentrations of sucrose

Intra-oral enamel demineralization tests, involving rinsing with sucrose solutions (5, 1, 0.5, or 0.3%) at varying frequencies during a 1.5-hour period, showed that demineralization was a function of the total sugar dose (frequency of rinsing times concentration). Two rinses with a 5% solution caused demineralization, nine rinses were needed in the case of a 0.5% solution, and none occurred after nine rinses with a 0.3% solution. Remineralization was also observed and apparently occurred after exhaustion of the sucrose supply.     

Effects of mouthrinses containing essential oils and alcohol-free chlorhexidine on human plaque acidogenicity

The aim of this in vivo study was to evaluate the effect of two antimicrobial mouthrinses on dental plaque acidogenicity after a sucrose challenge. Twenty subjects, with a mean age of 59 years, participated in a double-blind intraindividual randomized study. Three mouthrinses were used in 16-day rinsing periods in addition to their regular mechanical oral hygiene: a solution with essential oils (EO), solution with alcohol-free chlorhexidine (CHX) and water (negative control). The three test periods were separated by 3-month washout periods. Changes in plaque acidogenicity were evaluated after a sucrose challenge at day 0 (baseline) and at day 17 of each mouthrinse period using the microtouch method. Both CHX and EO resulted at day 17 in statistically significant less attenuated pH falls compared to the water rinse. The CHX mouthrinse resulted in the least pronounced pH values compared with EO (ns) during the whole 30-min period. When calculated as area under the curve (AUC), significantly lower values (AUC_6.2 ) were found for CHX and EO at day 17 compared to day 0. A significant difference for AUC_6.2 between CHX and water was found at day 17. No statistically significant differences were found for any of the comparisons with AUC_5.7. The results from this study indicate that both the essential oils and the alcohol-free chlorhexidine reduced plaque acidogenicity after a sucrose challenge. Large interindividual variations were observed.     

A comparison of natural product, triclosan and chlorhexidine mouthrinses on 4-day plaque regrowth

There is a continuing search for ingredients to enhance the chemical plaque inhibitory action of oral hygiene products. Sanguinarine, other natural extracts and triclosan have already been used in products. The aim of this study was to evaluate a number of triclosan and natural product rinses for effects on plaque regrowth. In particular, the influence of other rinse components were assessed, notably sodium lauryl sulphate (SLS) and zinc. The study was a randomised, blind, 9-cell cross-over design to measure the effects of each rinse on 4-day plaque regrowth from a zero baseline. 15 volunteers rinsed 2x daily with each product and plaque was recorded by area and score. The 0.2% chlorhexidine rinse (positive control) was significantly more effective, and the saline rinse (negative control) significantly less effective, than other rinses. Sanguinarine alone was little different from saline and the addition of zinc made a modest improvement in activity. The 3 triclosan/SLS rinses were more effective than the sanguinarine rinses but similar to their minus triclosan control rinse. A natural product/SLS experimental rinse was second to chlorhexidine and, in many analyses, significantly better than all other rinses, but caused some oral erosions. The results indicate that the plaque inhibitory properties of basic ingredients such as SLS may be difficult to enhance or surpass. However, the possible range of recipes, particularly using natural ingredients, provides scope for research and development in the field of oral hygiene products.     

Effects of supervised chlorhexidine mouthrinses in children

The study tested the effects of supervised chlorhexidine digluconate (CH) mouthrinses on plaque and gingivitis in school children. 158 children (aged 10–12 years) participated in the study. They were divided into four groups matched according to age, sex. DMFS, and GI. Following a sealing and prophylaxis procedure. Group A was assigned to daily mouthrinses 6 times per week using a .2 % solution of CH. Group B used the same solution only twice per week, and Group C was assigned to daily rinsing using a .1 % solution of CH. Group D served as control and rinsed daily with a placebo solution. All the rinsings were supervised and timed for 30 seconds. No attempt was made to influence the oral hygiene habits of the children. Prior to the initial prophylaxis and after 6 months of supervised rinsing, plaque was scored using the Plaque Index (PII), and gingivitis was assessed using the Gingival Index (GI). Calculus was scored according to the Calculus Surface Index (CSI), and stain was also graded. DMFS indices were assessed using clinical and radiographic examinations. At the end of the study plaque was significantly reduced in all CH groups when compared with the controls, and calculus increased significantly in all CH groups. In Group A the GI dropped from .88 to .15 and in Group C from .80 to .24. In Group B the GI dropped from .79 to .38. In the control group a slight reduction from GI = .93 to GI = .75 was noted. The study has shown that gingivitis can be controlled successfully on a longitudinal basis using .1 % or .2 % mouthrinses of CH as an adjunct to daily toothbrushing.     

Comparison of 2 commercially available chlorhexidine mouthrinses

BACKGROUND: It has been shown that lowering the concentration of chlorhexidine (CHX) in mouthrinses from 0.2% to 0.12% does not adversely affect inhibition of plaque accumulation. The aim of this study was to evaluate the inhibition of plaque growth by 2 commercially available mouthrinses used according to the manufacturers' instructions, one with a 30-second and one with a 60-second rinsing time. METHODS: The clinical investigation was a single-blind, randomized study involving 80 volunteers (40 female, 40 male; mean age 25.7 years). At the start of the trial, all participants received a dental prophylaxis to remove all plaque deposits. Subjects refrained from all mechanical oral hygiene procedures, but rinsed twice a day with the allocated CHX mouthrinse over a period of 72 hours. The chlorhexidine preparations compared were a 0.12% concentration used at a 15 ml dose for a rinsing time of 30 seconds and a 0.2% concentration used at a dose of 10 ml for 60 seconds. After 72 hours, the plaque index (PI) from all volunteers was recorded at 6 sites per tooth. All participants received a questionnaire to evaluate their perception of the mouthrinses. RESULTS: After 72 hours, the 15 ml/30 second/0.12% CHX group had a mean whole mouth PI of 1.65 (SD 0.31) compared with a mean PI of 1.60 (SD 0.40) for the 10 ml/60 second/0.2% CHX group. The difference in plaque scores between the groups was not statistically significant. Results from the questionnaire showed no significant difference between the groups for taste perception, duration of taste, alteration in taste, or perceived plaque reduction; however, the panelists preferred the shorter rinsing time of 30 seconds and, for this parameter, the difference was statistically significant (P = 0.048). CONCLUSIONS: The results of this short-term study showed that there was no statistically significant difference between both commercially available CHX mouthrinses with respect to plaque inhibition, although both differed in concentration and rinsing time. The subject preference phase of the study indicated that the shorter rinsing time of 30 seconds was favored.     

Clinical comparison of the anticalculus effect of two mouthrinses

A three-month, double-blind clinical study was conducted to compare the effects of supragingival calculus deposits of a mouthrinse containing soluble pyrophosphate and a copolymer of methoxyethylene and maleic acid, as compared to a mouthrinse containing only soluble pyrophosphate and a placebo mouthrinse. Male and female adult subjects were stratified into three balanced groups according to baseline calculus scores obtained from a pre-test period. They received an oral prophylaxis and were assigned to the use of one of the three test mouthrinses. All subjects used a commercially available dentifrice containing 0.76% sodium monofluorophosphate in a silica base. The results from the three-month calculus examination indicated that the soluble pyrophosphate/copolymer mouthrinse reduced supragingival deposits by 31.70% (P less than 0.03), as compared to the placebo mouthrinse. The mouthrinse containing only soluble pyrophosphate did not provide a statistically significant reduction in calculus deposits, as compared to the placebo mouthrinse.     

Effect of essential oils containing and alcohol-free chlorhexidine mouthrinses on cariogenic micro-organisms in human saliva

Abstract

Objective. The aim of this study was to evaluate the effect on mutans streptococci and lactobacilli in saliva of mouthrinsing with essential oils and an alcohol-free chlorhexidine. Materials and method. Twenty healthy volunteers (mean age 59 years) participated in the double-blind randomized cross-over study. Three mouthrinses were used in 16 days rinsing periods in addition to their regular mechanical oral hygiene: a solution with essential oils (EO; Listerine), a solution with alcohol-free chlorhexidine (CHX; Paroex) and water (negative control). The mouthrinse periods were separated by 3-month washout periods. At days 0 (baseline) and 17 (end) of each mouthrinse period, paraffin stimulated whole saliva was collected in order to analyse CFU/ml saliva of mutans streptococci and lactobacilli. Results. Only the CHX rinse showed a significant difference for CFU mutans streptococci between baseline and end (p = 0.004). The CFU mutans streptococci at the end of the rinse periods showed statistically significant differences between CHX vs EO (p = 0.039) and CHX vs water (p = 0.022). The difference in CFU lactobacilli between baseline and end was significant for CHX (p = 0.031), but not for the other rinses. No statistically significant differences for lactobacilli were found at the end of the rinse periods between the mouthrinses. Conclusion. A significant reduction in amount of cariogenic bacteria in saliva was observed after 16 days of alcohol-free chlorhexidine mouthrinse but not after the essential oils rinse. The high number of participant's not changing to a bacterial class with a reduced number of micro-organisms showed that both rinses had little clinical significance as a caries preventing treatment method, which can decrease the number of CFU cariogenic micro-organisms.     

Comparative analysis of the effect of two chlorhexidine mouthrinses on plaque accumulation and gingival bleeding

The aim of the present study was to evaluate the effect of two chlorhexidine rinsing solutions (0.12% and 0.2%) on plaque and gingival bleeding. Ten dental students participated in this double-blind, cross-over study, rinsing twice a day, for one minute, with each one of the tested solutions for fourteen days. A wash-out period of one week between treatments was observed. In order to assess gingival bleeding, the van der Weijden et al.(1) (1994) index was used. The plaque indexes used were those of Quigley, Hein(2) (1962) and Silness, L?e(3) (1964). In the pre-experimental period, subjects received oral hygiene instructions and dental prophylaxis. The results revealed no significant differences between both concentrations in relation to plaque and gingival bleeding. Mean values (+/- standard deviation) of the Quigley & Hein index were 0.25 +/- 0.16 for the 0.12% solution and 0.23 +/- 0.26 for the 0.2% solution (p = 0.4838). Mean values (+/- standard deviation) of the Silness-L?e index were 0.12 +/- 0.10 for the 0.12% solution and 0.11 +/- 0.11 for the 0.2% solution (p = 0.7592). The bleeding index mean values at the end of the study were not different for both concentrations with mean values (+/- standard deviation) of 14.93% +/- 6.68% and 13.95 +/- 9.24% for the 0.12% and 0.2% solutions, respectively. Although an increase in gingival bleeding was observed, both concentrations were able to control dental plaque.     

Therapeutic effects of supervised chlorhexidine mouthrinses on untreated gingivitis

AIM: The aim of the present study was to test the presumptive therapeutic effect of chlorhexidine digluconate in a population with untreated gingivitis and presence of abundant calculus. SETTING AND STUDY DESIGN: Sixty subjects (? mean age of 23.4) were recruited from a knitting factory in the Province of Guangdong, People's Republic of China. By applying a double-blind clinical trial design the participants were divided into two groups (Test and Control) and matched according to their mean GI scores. The Test group (n= 20) was assigned to two daily mouth-rinses for 6 days per week using 0.12% chlorhexidine digluconate (Peridex®). The Control group (n= 40) rinsed twice daily with a placebo solution. All the rinsings were supervised and timed for 45 S. No attempt was made to influence the oral hygiene habits of the participantS. Prior to and after 3 months of the supervised rinsing, plaque was scored using the Plaque Index system (PIl), and gingivitis was assessed using the criteria of the Gingival Index system (GI).Calculus was scored according to the Calculus Surface Severity Index system (CSSI), and stain was also graded by the Discoloration Index system (DI). RESULTS: After 3 months, the Test group (n= 13) showed significant reduction in mean PIl, GI and percentage of gingivial bleeding (GB%), while significant increases in mean DI were observed. The improvement in gingival health was observed at all regions with marked reduction in mean GI (from GI = 1.40 to 1.08) and GB% reduction by 24–52%. The proportion of GI = 2 was also reduced significantly from 50-36%. The Control group (n= 23) also showed a decrease in mean PIl but significant increases in the mean GI and GB%. Intergroup comparison showed statistically significant differences between mean GI, percentage of gingival bleeding (GB%) and mean DI for the test and control groups after 3 months of supervised rinsing. However, there were no significant intergroup differences for mean PIl. CONCLUSION: In conclusion, there was a significant effect of chlorhexidine on gingivitis, although the effect may be too limited to assure prognostic benefits in the prevention of future disease progression.     

A clinical comparison of antibacterial mouthrinses: effects of chlorhexidine, phenolics, and sanguinarine on dental plaque and gingivitis

This study compared the clinical efficacy of three mouthrinses containing either 0.12% chlorhexidine, phenolic compounds, or sanguinarine, which were used unsupervised, in a placebo-controlled, double-blind study of 6 months' duration. The study was conducted according to ADA clinical guidelines for evaluation of antigingivitis agents and was completed by 481 adults. Following baseline exams and a prophylaxis, subjects were randomly divided into treatment groups matched for age, gender, and gingivitis severity, and were instructed to use the rinses in accordance with manufacturer's directions. Followup examinations evaluated supragingival plaque, gingivitis, and gingival bleeding. Compared to placebo at 6 months, the group rinsing with 0.12% chlorhexidine had significantly less gingivitis (31% reduction), gingival bleeding (39% reduction), and plaque (49% reduction) and was significantly better than any of the other treatment groups (P less than 0.05). Both the phenolic and sanguinarine groups showed moderate, yet significant, reductions in plaque compared to placebo (24% and 12% respectively) yet were significantly less effective than the 0.12% chlorhexidine rinse (P less than 0.05). However, neither the phenolic nor sanguinarine rinses were significantly different than placebo in their effects on gingivitis or gingival bleeding. These results support previous published results on the superiority of 0.12% chlorhexidine when used in conjunction with professional care and as an adjunct to routine oral hygiene practices.     

Efficacy of chlorhexidine and sanguinarine mouthrinses on selected salivary microflora

The antibacterial effects of chlorhexidine and sanguinarine on selected salivary microflora were evaluated in 15 healthy young adults. The experiment was performed in a cross-over manner enabling both mouthrinses and the saline control to be tested on all 15 subjects for periods of one week separated by three week intervals. The total bacterial count and selected bacterial genera were followed in saliva samples taken just before the first rinse, and on three occasions after the last rinse. Statistically significant reductions in the salivary levels of S. mutans and S. salivarius were obtained with chlorhexidine but not with sanguinarine, and rinsing twice a day with sanguinarine, according to the manufacturer's instructions, did not significantly reduce the total bacterial count. Additional well controlled, longer-term studies are required before any firm conclusions can be drawn regarding the effect of sanguinarine on salivary microorganisms.     

Effect of chlorhexidine mouthrinses on concentration of IgA in expectorates

Abstract – Secretary IgA is usually found in high concentrations in the mucin layer of the oral mucosa. Chlorhexidine (CH) has been shown to precipitate mucin and may thus, reduce the amount of IgA available in the oral cavity. Two human experiments were performed using single radial immunodiffusion (SRID) for quantitation of IgA in expectorates after mouth rinses. CH rnouthrinses eluted significantly more IgA from the oral cavity than did water. However, regular CH rinses for I week did not seem to reduce significantly the amount of IgA that could be extracted by water or CH. The present study did not support the suggestion that CH mouthrirases may reduce the IgA dependent defence mechanisms in the oral cavity.     

Effect of chlorhexidine mouthrinses on concentration of IgA in expectorates

Secretory IgA is usually found in high concentrations in the mucin layer of the oral mucosa. Chlorhexidine (CH) has been shown to precipitate mucin and may thus reduce the amount of IgA available in the oral cavity. Two human experiments were performed using single radial immunodiffusion (SRID) for quantitation of IgA in expectorates after mouthrinses. CH mouthrinses eluted significantly more IgA from the oral cavity than did water. However, regular CH rinses for 1 week did not seem to reduce significantly the amount of IgA the could be extracted by water of CH. The present study did not support the suggestion that CH mouthrinses may reduce the IgA dependent defence mechanisms in the oral cavity.     

The effect of chlorhexidine mouthrinses on the human oral flora

The purpose of the present study was to examine the effect of chlorhexidine mouthrinses on the oral flora. Four students rinsed, twice daily, with 10 ml of a 0.2 per cent solution of chlorhexidine gluconate, and four students served as controls on a no oral hygiene programme. The number of bacteria in saliva was estimated by a cultural technique and impression preparations were used for the study of the bacteria on the gingiva and tooth surface. The controls showed a 300 per cent increase in bacterial counts during the experiment. In the chlorhexidine group the number of bacteria per ml saliva was reduced by 85 per cent, after 24 hours, reaching a 95 per cent reduction on day 5. An 85–90 per cent reduction was maintained throughout the experimental period. Impression preparations of the gingival area in the controls showed a heavier accummulation of bacteria than in the chlorhexidine group. In addition an increasing bacterial colonization of the tooth surfaces occurred in the controls throughout the experiment, but was never observed in the chlorhexidine group. Although the number of bacteria in saliva was markedly reduced, large numbers still persisted. It, therefore, appears unlikely that the inhibition of plaque formation is primarily the result of a reduction of the salivary flora.     

Quality-specific taste impairment following the application of chlorhexidine digluconate mouthrinses

Although chlorhexidine has been widely used in the prevention and treatment of gingivitis, its effects on taste sensation have not been well studied. The purpose of the present study was to evaluate taste alterations following regular applications of 0.2% chlorhexidine mouthrinses. 24 healthy and non-smoking clinical instructors, dental assistants and dental students were divided into 3 groups after having reached a status of clinical gingival health by 4 weeks of supervised oral hygiene procedures. Following this, they were asked to abolish all mechanical oral hygiene for a period of 14 days, during which time they rinsed twice daily with different mouthrinses. Group A rinsed with a 0.2% chlorhexidine solution, group B served as control and utilized a 0.001 molar solution of quinine hydrochloride as a placebo rinse. A second control group (C) rinsed with distilled water. At days -3 and -2, as well as at days 1, 2, 13 and 14 of the experimental period, and 1 and 2 days after cessation of the rinsing, taste sensitivity was evaluated by a magnitude estimation, suprathreshold scaling procedure for the 4 taste qualities--sweet, salty, sour and bitter. 6 different concentrations of each of sucrose, sodium chloride, citric acid and quinine hydrochloride were utilized. Magnitude estimations of the perceived intensities of each series of test solutions were calculated. The analysis of co-variance revealed significant differences at the short-term and treatment-related suprathreshold scaling responses between both control groups (B, C) and the test group (A) for the sodium chloride magnitude estimation function. However, no significant inter-group differences in the magnitude estimation function were found for the remaining taste qualities.(ABSTRACT TRUNCATED AT 250 WORDS)