Clinical study to compare the effect of stannous fluoride and chlorhexidine mouthrinses on plaque formation

Abstract A clinical study was conducted on four adults to compare the relative efficacy of 0.2% chlorhexidine digluconate and 0.1 % stannous fluoride (SnF₂). Using a crossover experimental design, subjects rinsed twice daily for 5 days with SnF₂ and then, after a 2-day interim recovery period, for 5 days with chlorhexidine. Statistically significant differences (P < 0.05) in the relative efficacy of the two agents were found. Chlorhexidine was more effective in reducing Gingival and Plaque Indices, plaque wet weight and bacterial Colony Forming Units, calculated both per subject and per group.     

Effect of SnF2, administered as mouthrinses or topically applied, on Streptococcus mutans, Streptococcus sanguis and lactobacilli in dental plaque and saliva

Abstract – Mouthrinsing with SnF₂ reduced the Streptococcus mutans population in plaque and saliva and the proportion of Streptococcus sanguis in plaque. The effect was of short duration: 2 weeks after treatment the values of S. mutans in plaque and saliva were even higher than the pretreatment values. Topical SnF₂ applications reduced the S. mutans population in plaque and saliva but did not reduce the proportion of S. sanguis in plaque. The eflect was more prolonged: 4 weeks after treatment the S. mutans population in interproximal plaque remained significantly reduced and the salivary levels of the organism had not fully returned to pretreatment levels. Both SnF₂ treatments significantly increased the salivary levels of lactobacilli. The values of laclobacilli in saliva remained signilicantly increased 4 weeks after the SnF₂ mouthrinsing but had almost returned to pretreatment levels within 2 weeks after the topical SnF₂ applications. The findings suggest that the cariogenic potential of dental plaque is differently affected depending on whether a drug is administered as a mouthrinse or is applied topically.     

Effect of chlorhexidine on acidogenicity of dental plaque in vivo

Abstract— In order to evaluate the effect of chlorhexidine on the acidogenicity of dental plaque, pH changes in plaque were measured in situ after sucrose applications. The results showed that a 0.2% chlorhexidine mouthrinse inhibited acid production for a period of 24 h, whereas a 0.05% chlorhexidine rinse showed an inhibitory effect for 4 h. It is suggested that the mechanism involved may be related to the retention of chlorhexidine in the mouth and in plaque providing a bacteriostatic milieu which may be of importance in the observed long-term effect.     

Effect of different chlorhexidine formulations in mouthrinses on de novo plaque formation

BACKGROUND: Chlorhexidine (CHX) 0.2% solution, still the golden standard as mouthrinse for the prevention of plaque formation and development of gingivitis, has some limited side-effects such as extrinsic tooth staining, poor taste, taste disturbance, sensitivity changes in tongue, pain, and the content of alcohol. These side effects led to the search of new formulations. METHODS: In this double-blind, randomised, cross-over study, 16 young dental students with a healthy periodontium, abolished all means of mechanical plaque control during 4 experimental periods of 11 days (separated from each other by a washout period of 3 weeks). During each experimental period, they rinsed 2x daily with one of the following mouthrinses in a randomised order: CHX 0.2% + alcohol (Corsodyl), CHX 0.12% + alcohol (Perio.Aid), CHX 0.12% + sodium fluoride 0.05% (Cariax Gingival) and CHX 0.12% + CPC 0.05% (Perio.Aid, new formulation). After 7 and 11 days of undisturbed plaque formation, clinical parameters were recorded, questionnaires completed and plaque samples (supragingivally and saliva) collected. RESULTS: The CHX 0.12% + alcohol and the CHX 0.12% + CPC 0.05% formulations were as efficient as the CHX 0.2% mouthrinse in retarding de novo plaque formation (proven by clinical observations as well as by anaerobic and aerobic culture data), and always superior (p<0.001) to the CHX 0.12% + sodium fluoride 0.05% solution. The subjective ratings were in favour of the new CHX formulation when compared with the other CHX formulations, especially for taste (p<0.05). CONCLUSIONS: The results of this study demonstrated the potential of a new CHX 0.12% + CPC 0.05% non-alcoholic formulation as an effective anti-plaque and anti-inflammatory agent with reduced unpleasant subjective side-effects.     

Evaluation of stannous fluoride and chlorhexidine sprays on plaque and gingivitis in handicapped children

The objective of this study was to evaluate the effect of twice-daily oral sprays of 2 ml chlorhexidine (0.2%) and 2 ml stannous fluoride (0.2%) as the sole oral hygiene measure on plaque and gingivitis in handicapped children. 52 institutionalized mentally handicapped individuals (aged 10-26 years) were divided into 4 groups to participate in a 9-week, double-blind, randomized clinically controlled trial, which included a cross-over. For the first 3 weeks, groups 3 and 2 had their mouths sprayed with chlorhexidine and stannous fluoride, respectively. Following a 3-week wash-out interval, groups 1 and 4 were sprayed with chlorhexidine and stannous fluoride, respectively. The alternate groups received a placebo, water. Plaque (PI) and gingival indices (GI) were recorded. Subgingival plaque samples were collected and counts of spirochaetes, motile rods and cocci were taken using darkfield microscopy. By the 9th week of trial, the PI and GI were reduced by 48% and 52% for the stannous fluoride group. In the chlorhexidine group, reductions of 75% (PI) and 78% (GI) were achieved. Pair-wise comparisons of placebo, stannous fluoride and chlorhexidine using the U-test of Mann-Whitney revealed significant (p less than 0.05) differences for both PI and GI scores in the placebo/stannous fluoride and placebo/chlorhexidine pair by the 9th week of the trial. In the stannous fluoride/chlorhexidine pair, only the PI was significantly reduced for those on chlorhexidine. Coccoid cells were more dominant at sites with low PI and GI scores (stannous fluoride and chlorhexidine groups), while spirochaetes and motile rods were more frequent at sites with high PI and GI scores (placebo group).     

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.     

The comparative effects on plaque regrowth of phenolic chlorhexidine and anti-adhesive mouthrinses

Abstract The inhibition of bacterial attachment to the tooth surface is one possible approach to plaque control. This study evaluated in vivo the plaque inhibitory action of a novel copolymer reported to have considerable antiadhesive properties in vitro. The study was a single blind. 5-treatment. randomised Latin square crossover design, incorporating balance for carry-over effects. The rinses were the antiadhesive (1%), the antiadhesive with 0.02% chlorhexidine, a 0.2% chlorhexidine rinse product, an essential oil/phenolic rinse product and water. 15 volunteers participated and on day 1 of each study period were rendered plaque-free, ceased toothcleaning and rinsed 2x daily. under supervision, with the allocated formulation. On day 5, plaque was scored by index and area. Washout periods were 21/2 days. Alone or combined with chlorhexidine, the antiadhesive agent showed no effects greater than water. The chlorhexidine rinse was significantly more effective than the essential oil/phenolic rinse which in turn was significantly more effective than the other rinses.     

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.     

Comparison of the effect of chlorhexidine and CuSO4 on plaque formation and development of gingivitis

Recent studies have shown that several metal ions inhibit plaque formation and reduce the acidogenicity of dental plaque. The aim of the present study was to compare the effect on plaque and gingivitis of 2.2 mM CuSO4 with an equimolar solution of chlorhexidine in a modified experimental gingivitis model. The study was performed according to a double-blind cross-over design. Before each experimental period the GI was recorded and the participants' teeth were scaled and polished to remove all supragingival deposits. All mechanical oral hygiene was suspended during the experimental periods. The mean PII after rinsing with chlorhexidine, CuSO4 and water was 0.29, 0.79 and 1.25, respectively. The corresponding GI values were 0.57, 0.83 and 1.02. All differences were statistically significant. The results showed that CuSO4 inhibits plaque formation and development of gingivitis, but not to the same degree as chlorhexidine.     

Comparative study of plaque and gingivitis prevention by AmF/SnF2 and NaF A clinical and microbiological 9-month study

Abstract This comparative clinical 9-month study was designed to examine the efficacy of amine/stannous fluoride (AmF/SnF₂) (Meridol®) and sodium fluoride (NaF I. 150 probands with chronic gingivitis or early signs of periodontitis were divided into? randomised groups. Group 1 was given a NaF toothpaste and an NaF mouthrinse. group 2 AmF/SnF; toothpaste and moulhrinse, and group 3 AmF'SnF; toothpaste and NaF mouthrinse. The probands were examined at intervals (0. 1. 3 and 9 months) under conditions of a clinical double-blind study. The parameters recorded were the plaque index (PII). the approxinal plaque index (API), the gingival index (GI) and the mod. sulcus bleeding index (SBI). The probing depths IPD) were also measured. The composition of the supragingival plaque was evaluated by dark-field microscopy, A highly significant reduction in all clinical parameters was recorded in all 3 groups in the course of the study. The most pronounced reduction in PH. API. SB1 and PD was recorded in group 2. In the group comparison, however, no significant differences were recorded. Microbiological examination revealed a highly significant increase in cocci and a decrease in rods in all 3 groups. There was also a significant reduction in spirochetes. filaments and fusiforms in groups 2 and 3. In group 1, there was a significant fall only in fusiforms and small spirochetes, Overall, no significant difference in clinical parameters was recorded in the group comparison. However, the use of AmF/SnF₂ toothpaste and mouihrinse (group 21 and. to a lesser degree, the combined use of AmF/SnFi toothpaste and NaF mouthrinse display a favorable microbiological effect. The results from the present double-blind study reveal a reduction in gingival inflammation and supragingival plaque accumulation with a positive change in plaque flora in all groups. The reduction in potentially gingivopathogenic bacteria was slightly higher in the amine/stannous fluoride group.     

Efficacy of Listerine®, Meridol® and chlorhexidine mouthrinses on plaque, gingivitis and plaque bacteria vitality

The experimental gingivitis model was used to compare the anti-plaque, anti-gingivitis and anti-microbial efficacies of a phenolic compound (Listerine) and an amine/stannous fluoride mouthwash (Meridol), using a placebo preparation as negative control and a chlorhexidine solution as positive control in a double-blind study. After professional toothcleaning, 36 volunteers performed optimal oral hygiene for a period of 2 weeks. They then ceased all oral hygiene procedures for 21 days during which they rinsed twice daily with 1 of the 4 mouthrinses. After 3 weeks of rinsing, plaque indices remained the lowest in the chlorhexidine group, while subjects using Listerine or Meridol harbored similar indices significantly lower than that of individuals rinsing with the placebo solution. Up to that time, the gingival index scores were equal in all groups except for the chlorhexidine group in which the values only amounted to half of these encountered in the other groups. The plaque vitality scores showed a bactericidal effect in vivo of chlorhexidine during the entire time of experimental gingivitis. In contrast, the data gave no evidence of an antibacterial effect in vivo of Listerine. The efficacy of Meridol to kill micro-organisms was similar to chlorhexidine during the early stages of plaque accumulation and, with time, became insignificant. This study has demonstrated that chlorhexidine was superior to Listerine and Meridol in its ability to maintain low plaque scores and gingival health during this 3-week period of no mechanical oral hygiene. Moreover, it was also shown that Meridol was as effective as Listerine in reducing plaque accumulation and, in contrast to Listerine, possessed a remarkable but transient antibacterial effect in vivo.     

Comparison of effect of SnF2 and NaF mouthrinses on caries incidence, salivary S. mutans and gingivitis in high caries prevalent adults

Abstract – The effect of SnF₂ and NaF mouthrinses were compared in subjects initially selected because of their high caries prevalence and high levels of salivary S. mutans. Subjects rinsed twice a day with either SnF₂ or NaF (200 ppm F⁻). Subjects in both groups continued to be caries active during the course of the study. However, at the first year examination subjects rinsing with SnF₂ had less S. mutans/ml saliva, a lower caries incidence and less gingivitis. After 2 yr the S. mutans levels in the SnF₂ rinsing group remained significantly less. Both caries incidence and gingivitis were lower in the SnF₂ group after 2 yr but the difference was not significant.     

Effect of a fluoride-containing chlorhexidine gel on bacteria in human plaque

abstract — The effect on the plaque flora of a fluoride-containing chlorhexidine gel in mouthpieces was studied in seven subjects. Use of the gel during a 3-month period resulted in a change in the pattern of sensitivity to chlorhexidine in the plaque flora as displayed by determination of the minimal inhibitory amount (MIA) of the drug in agar diffusion assays. Three months after the use of gel was discontinued, the MIA value for plaque bacteria had returned to its original level. The relative proportions of S. mutans and S. sanguis in plaque changed during the chlorhexidine period. Thus S. mutans could not be detected in plaque samples after 3-month use of the gel, and the frequency of S. sanguis was altered.     

Effect of chlorhexidine rinses on the morphology of early dental plaque formed on plastic film

Abstract The effect of chlorhexidine on early plaque formation was studied in vivo in order to assess potential structural and quantitative changes. 3 subjects with healthy gingiva were used. Plastic films were applied to the buccal surfaces of the maxillary right first premolars and plaque was allowed to form for either 4 or 24 h. A single 1-min rinse with 0.2% chlorhexidine digluconate was used for the 4-h experiments, 1 min after film placement, whereas, for the 24-h experiments, an additional 1 min rinse was used at 12 h. In total, 62 films were obtained, half treated and half controls. These were processed for light and transmission electron microscopy, using standardized techniques for area sampling and cell counting. All plastic films were covered by a surface coating of a cellular material in or on which bacteria, epithelial cells and leukocytes were observed. In the controls, an important increase in bacterial count was seen between 4 and 24 h, whereas the increase with chlorhexidine was slight. There were fewer bacteria in the chlorhexidine as compared to the water specimens, for both time periods. Many microorganisms in the chlorhexidine. Samples appeared to be undergoing degeneration with coagulated cytoplasm and disrupted cell walls.     

Effect of chlorhexidine on dental plaque and gingivitis in mentally retarded children

ABSTRACT The purpose of the investigation was to determine the effect of chlorhexidine mouthrinses as a supplement to toothbrushing in the plaque control of mentally retarded children. Fifty-four mentally subnormal children 7–14 years of age took part in the investigation. During the first period, half of the children rinsed their mouths with 0.2 % chlorhexidine gluconate solution twice a day. The rest of the children used a placebo mouth-rinse. After an 8-week interval a “cross-over” experiment was carried out during which a 0.1 % chlorhexidine solution was used. Plaque and gingival indices were scored at the beginning of each period, after 3 weeks, and at the termination after 6 weeks. The results revealed that mouthrinses with 0.1 % as well as 0.2 % chlorhexidine gluconate reduced plaque and gingivitis in mentally retarded children. The results were statistically significant (P < 0.05) for both concentrations. Furthermore, the investigation confirmed the occurrence of certain side effects such as discoloration of teeth and tongues.     

Accumulation of strontium and fluoride in approximal dental plaque and changes in plaque microflora after rinsing with chlorhexidine-fluoride-strontium solution

OBJECTIVES: To find out if strontium is incorporated into plaque and enamel in vivo during a 2-week rinsing period with a chlorhexidine-fluoride-strontium solution and to determine the effects of the rinsing on the numbers of mutans streptococci and lactobacilli in plaque. SUBJECTS AND METHODS: A total of 18 adult participants rinsed their mouths twice a day for 2 weeks, first with a placebo solution and subsequently, separated by a I-week interval without rinsing, with a chlorhexidine gluconate (0.05%)-sodium fluoride (0.04%)-strontium (100 ppm as SrCI₂) rinsing solution (CXFSr) for another 2 weeks.
RESULTS: After the CXFSr rinsing period the strontium and fluoride contents (μg g^-plaque dry weight; mean ± s₁) of approximal plaque were 32.5 ± 4.7 and 72.8 ± 9.0, compared with the respective contents of 8.4 ± 1.2 and 42.0 ± 4.8 after placebo rinsing (P = 0.0001 for both comparisons). The strontium content remained elevated for 6 weeks. The median proportion of mutans streptococci of approximal plaque of the total viable count of bacteria was 1% after placebo rinsing but decreased to 0.2% after CXFSr rinsing. The proportion of mutans streptococci remained low at 3 weeks (P = 0.018 vs placebo) but had reached the placebo level at 6 weeks. Rinsing with CXFSr solution did not reduce lactobacilli in plaque. The strontium or fluoride contents of the enamel surfaces subjected to tooth brushing did not significantly change.
CONCLUSIONS: Strontium and fluoride accumulated in dental plaque during a 2-week CXFSr rinsing period and the proportion of mutans streptococci in approximal plaque was reduced at least for 3 weeks after completion of the rinsing.     

The effect of triclosan, stannous fluoride and chlorhexidine products on: (I) Plaque regrowth over a 4-day period

A number of substances have been incorporated into toothpastes or gels to inhibit plaque regrowth. The aim of this study was to evaluate triclosan and stannous fluoride products for plaque inhibitory properties by comparison with a chlorhexidine or saline rinse and a control product which was a conventional commercially available toothpaste. In a blind 8 cell cross-over study, 15 volunteers rinsed 2 x a day for 4 days with slurries of the products or the saline and chlorhexidine solutions. No other form of oral hygiene was performed and plaque regrowth from a zero baseline was recorded by plaque score and plaque area. Plaque regrowth was significantly less with the chlorhexidine rinse and significantly greater with the saline rinse compared to the toothpaste and gel products. No significant differences were found between the test and control products. The results again demonstrate that commercially available toothpastes have plaque inhibitory effects which so far appear difficult to improve upon by the addition of specific ingredients, in this case stannous fluoride or triclosan. Commercially available products of known activity would appear useful benchmarks for comparison of experimental formulations.     

Effect of chlorhexidine gel treatment on Streptococcus mutans population in human saliva and dental plaque

Abstract – The effect of topical application of a 1% chlorhexidine gel on the population of S.mutains in dental plaque and saliva was studied in five subjects highly infected with the organism. After treatment for 5 min daily for 14 d, S. mutans was not detected in three of the subjects and counts of 700 colony-forming units or less per ml of saliva were found in the other subjects. Reappearanceof S. mutans was slow and did not reach pretreatment level until 14 weeks or more after therapy. The proportion of S. saguis in plaque increased temporatrily after chlorhexidine treatment, whereas the population of lactobacilli was unaffected. These observations indicate that short-term use of chlorhexidine is of value in controlling oral infection of bumans by S. mutans.     

Comparison of 2 chlorhexidine mouthwashes on plaque regrowth in vivo and dietary staining in vitro

Abstract Until recently, the few available chlorhexidine mouthrinse products have been 0.2% formulations. However, concentrations of 0.12% chlorhexidine appear as effective as 0.2%, if the volume of the rinse is increased to 15 ml. Since the mere incorporation of chlorhexidine in a formulation does not guarentee availability of the antiseptic, it would seem reasonable to evaluate or compare all products. This is particularly the case when other ingredients, such as fluoride are added. The 1st study compared the effect of a 0.12% chlorhexidine rinse with a 0.12% chlorhexidine/0.022% sodium fluoride rinse for effects on plaque re-growth. The study was a 7-day, blind, randomised, 2-cell cross-over design with a baseline control run in period, in which 18 subjects participated. Both chlorhexidine products significantly reduced plaque compared to control but the chlorhexidine fluoride rinse was less effective than the chlorhexidine only rinse. The 2nd study assessed the propensity of the chlorhexidine rinses to induce dietary staining in vitro. For the chlorhexidine fluoride rinse, this was less than the other 0.12% rinse and a commonly used 0.2% product. The data in vivo and in vitro suggest reduced chlorhexidine availability from the chlorhexidine fluoride product which appears to cause some loss of efficacy.     

Effect of the antibacterial agents octenidine and chlorhexidine on the plaque flora in primates

Abstract— The effect of the antibacterial substance octenidine on plaque formation and on oral microflora in eight monkeys fed a sucrose diet was studied. Plaque was obtained from buccal tooth surfaces of premolars and first molars in two quadrants using a swab and a dental carver and examined using culture and fluorescent antibody procedures. A significant reduction in plaque score was observed on the buccal tooth surfaces after daily topical application of 1% solutions of octenidine and chlorhexidine for 7 d; octenidine was more effective man chlorhexidine. Placebo treatment with water was without significant effect. Octenidine and chlorhexidine affected the plaque flora in a similar manner; the proportion of S. sanguis increased in relation to baseline levels while the population of Actinomyces, especially the group A. viscosus and A. naeslundii, was markedly reduced. S. sanguis showed an inverse relationship to members of Actinomyces in response to the action of the antimicrobial agents. Both plaque sampling methods revealed similar changes in bacterial composition as a result of treatment. The data show that octenidine is an effective inhibitor of dental plaque and its antimicrobial and antiplaque properties make it worthy of further studies.