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.     

In vivo substantivity of 0.12% and 0.2% chlorhexidine mouthrinses on salivary bacteria

The in vivo antimicrobial activity of 0.12% and 0.2% chlorhexidine (CHX) on the salivary flora up to 7 h after its application, using epifluorescence microscopy with the SYTO 9/propidium iodide dual staining, was evaluated. Fifteen volunteers performed a single mouthrinse with sterile water (SM-water), a single mouthrinse with 0.12% CHX (0.12% SM-CHX) and a single and double mouthrinse with 0.2% CHX (0.2% SM-CHX and 0.2% DM-CHX). Samples of saliva were taken at 30 s, and 1, 3, 5, and 7 h after each application. In comparison with SM-water, 0.2% CHX (SM and DM) showed a significant antibacterial effect up to 7 h after the mouthrinse, whereas this effect only persisted up to 5 h after the 0.12% SM-CHX mouthrinse. On comparing the two concentrations of CHX, significantly higher percentages of bacterial vitality were observed in all the saliva samples after the use of 0.12% CHX than after 0.2% CHX. On comparison of the 0.2% SM-CHX and 0.2% DM-CHX, significantly higher percentages of live bacteria were observed in the saliva samples taken at 1, 3, 5, and 7 h after the single mouthrinse compared with the double mouthrinse. The 0.2% CHX mouthrinse had the greatest antimicrobial activity on the salivary flora up to 7 h after its application, with a progressive recovery in bacterial vitality. The differences observed with respect to the 0.12% CHX mouthrinse demonstrate the influence of the concentration on its immediate antimicrobial activity and substantivity.     

A randomized clinical trial on the clinical and microbiological efficacy of a xanthan gel with chlorhexidine for subgingival use

Background

The main indication of the adjunctive use of local antimicrobials lies around situations in which the outcome of non-surgical mechanical treatment results in a limited number of residual pockets. The purpose of this investigation was to evaluate the clinical and microbiological effects of the subgingival application of a xanthan-based 1.5% chlorhexidine (CHX) gel (Xan–CHX), adjunctive to scaling and root planing (SRP) in localized periodontitis.

Methods

Periodontitis patients with four to ten residual (after conventional SRP) or relapsing (during supportive periodontal treatment) pockets were recruited and randomized to receive SRP plus the subgingival application of (Xan–CHX) or SRP plus a placebo gel. Supragingival plaque, bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level were evaluated with a computerized probe at baseline, and after 1, 3, and 6 months. Subgingival samples were also collected for the microbiological analysis. Statistical analysis used ANOVA and chi-square tests.

Results

Overall, the clinical results were better in the test group, with significant changes in BOP (between baseline and 3 months) and with a significant increase in the proportion of shallow pockets (1–3 mm) at 6 months. These results did not result in significant intergroup differences. The microbiological impact was limited in both treatment groups.

Conclusion

The adjunctive use of Xan–CHX may improve, although to a limited extent, the clinical outcomes (BOP and PPD), in chronic periodontitis patients with “residual” or “relapsing” pockets, but no significant differences were detected between groups. No side effects, neither clinical nor microbiological, were detected after the use of the test product.

Clinical relevance

Adjunctive use of slow-released chlorhexidine might be considered in the management of periodontal disease and gingival inflammation to reduce the need for periodontal surgery.     

In vivo evaluation of a moisture-activated orthodontic adhesive: a comparative clinical trial

Authors – Karamouzos A, Mavropoulos A, Athanasiou AE, Kolokithas G. Objectives – To evaluate and compare the clinical performance of a water‐activated, ethyl‐cyanoacrylate adhesive to a conventional composite resin. The null hypothesis tested was that there was no difference in bracket survival distribution, over a period of orthodontic treatment, for brackets bonded with either bonding agent. Design – Single center randomized controlled clinical study. Setting and Sample Population – Twenty‐five consecutive patients (15 females and 10 males) were selected and treated with fixed appliances in a university postgraduate orthodontic clinic. All teeth, but the molars, were bonded with twin stainless steel brackets (n=429) using a split‐mouth technique and random allocation of the two adhesives. Outcome Measure – Bond failure rates during a period of 9 months were estimated for each adhesive system and the corresponding bracket survival curves were plotted using the Kaplan–Meier product‐limit estimate. Bracket survival distributions with respect to adhesive material, tooth location, investigator, and bond failure interface were then compared by means of a log‐rank test. Bond failure interface was determined using the Adhesive Remnant Index (ARI). Results – The water‐activated bonding material recorded a significantly higher bond failure (22.4%) than the composite resin (5.1%). There were also statistically significant differences in bracket survival distributions between the two adhesives (log‐rank test: p < 0.001). Premolars exhibited higher bond failure rates than incisors and canines (p < 0001). The predominant mode of failure was within the bonding material. Conclusion – Further investigations focused on the improvement of the physical and mechanical properties of the water‐activated bonding system are needed to make it a reliable alternative adhesive for the direct bonding of orthodontic brackets.     

Clinical evaluation of benzydamine, chlorhexidine, and placebo mouthwashes in the management of recurrent aphthous stomatitis

Eighteen patients with minor recurrent aphthous stomatitis were given alcoholic benzydamine hydrochloride, aqueous chlorhexidine, or a benzydamine-free placebo mouthwash in random order. Each patient used each preparation for a 3-month period. Ulcer diaries were marked at the same time each week during the 9-month test period. Records were made of the number, size, sites, and pain severity of any ulcers present. Statistical analysis of the results showed no significant differences between any of the treatments tested. Stinging of the oral mucosa was the only consistent side effects noted by nine patients using benzydamine, nine patients using placebo, and three patients using chlorhexidine. Eight patients stated a personal preference for benzydamine because of the transient local anesthetic effect of benzydamine, which gave pain relief.     

Stability change of chemically modified sandblasted/acid-etched titanium palatal implants. A randomized-controlled clinical trial

Aim: The aim of this randomized-controlled clinical study was to examine stability changes of palatal implants with chemically modified sandblasted/acid-etched (modSLA) titanium surface compared with a standard SLA surface, during the early stages of bone healing.
Materials and methods: Forty adult volunteers were recruited and randomly assigned to the test group (modSLA surface) and to the control group (SLA surface). The test and control implants had the same microscopic and macroscopic topography, but differed in surface chemistry. To document implant stability changes resonance frequency analysis (RFA) was performed at implant insertion, at 7, 14, 21, 28, 35, 42, 49, 56, 70 and 84 days thereafter. RFA values were expressed as an implant stability quotient (ISQ).
Results: Immediately after implant installation, the ISQ values for both surfaces tested were not significantly different and yielded mean values of 73.8±5 for the control and 72.7±3.9 for the test surface. In the first 2 weeks after implant installation, both groups showed only small changes and thereafter a decreasing trend in the mean ISQ levels. In the test group, after 28 days a tendency towards increasing ISQ values was observed and 42 days after surgery the ISQ values corresponded to those after implant insertion. For the SLA-control group, the trend changed after 35 days and yielded ISQ values corresponding to the baseline after 63 days. After 12 weeks of observation, the test surface yielded significantly higher stability values of 77.8±1.9 compared with the control implants of 74.5±3.9, respectively.
Conclusion: The results support the potential for chemical modification of the SLA surface to positively influence the biologic process of osseointegration and to decrease the healing time.     

Randomized clinical trial on the efficacy of 2 over-the-counter whitening systems.

OBJECTIVE: The purpose of this clinical trial was to evaluate the efficacy of 2 over-the-counter whitening systems: a liquid whitening gel (5.9% hydrogen peroxide, twice a day for 15 minutes), and a sodium chlorite-based whitening gel applied in a tray system (10 minutes twice a day). METHOD AND MATERIALS: Sixty volunteers (minimum shade A3 on 1 maxillary tooth) were selected to participate in this single-blind (examiner-blinded), single-center, 2-group trial. The subjects were randomly divided into 2 groups (n = 30 each) and instructed to bleach their teeth for 2 weeks. Efficacy was measured using the Vita Classical shade guide and a spectrophotometer at baseline, as well as after 2 weeks and 6 months. RESULTS: For the subjectively measured tooth shades, improvement for maxillary canines was 2.03 +/- 3.67 tooth shades in group 1 and 1.08 +/- 2.19 tooth shades in group 2 after 2 weeks; the maxillary incisors revealed a tooth shade improvement of 0.83 +/- 1.71 tabs in group 1 and 0.73 +/- 2.22 tabs in group 2 (P < .05, except maxillary incisors in group 2; t test). Objectively measured tooth shade scores revealed a change of 0 +/- 0.25 tooth shade tabs (P > .05). CONCLUSIONS: The bleaching gel containing hydrogen peroxide achieved a slight improvement, and the sodium chlorite-based bleaching gel achieved only a small tooth color improvement. Moreover, subjectively and objectively measured tooth shades revealed considerably different results in the clinical situation.     

A clinical trial to assess the efficacy of sanguinarine-zinc mouthrinse (Veadent) compared with chlorhexidine mouthrinse (Corsodyl)

Abstract. A single-blind crossover study was used to compare the ability of a 0.2% chlorhexidine mouthrinse (Corsodyl) with a sanguinarine-zinc mouthrinse (Veadent) to inhibit plaque and gingivitis. 14 volunteers starting with plaque-free mouths and optimal gingival health, rinsed with the preparations over two 19-day periods whilst refraining from all other oral hygiene procedures. At days 8, 15 and 19 of the trial, Corsodyl was significantly more effective at inhibiting both plaque and gingivitis. The Findings of this study would suggest that the Veadent mouthrinse would at most only have a limited rôle as an inhibitor of plaque and gingivitis.     

In vivo antimicrobial activity of 2% chlorhexidine used as a root canal irrigating solution.

The aim of the present study was to evaluate the in vivo antimicrobial activity of 2% chlorhexidine gluconate (FCFRP-USP) used as a root canal irrigating solution in teeth with pulp necrosis and radiographically visible chronic periapical reactions. Culture techniques and measurement of the inhibition zone were used. Twenty-two root canals of incisors and molars of 12 patients were used. After accessing the canal, the first root canal sample was collected with two sterile paper points that were transferred to a tube containing reduced transport fluid. The root canal was instrumented using chlorhexidine solution. A small sterile cotton pellet was placed at the root canal entrance, and the cavity was sealed with zinc oxide-eugenol cement. The canals were maintained empty for 48 h. Three sterile paper points were then introduced to absorb the root canal fluid (second sample). One paper point was placed on an agar plate inoculated with Micrococcus luteus ATCC 9341 and incubated for 24 h at 37 degrees C, and the other two were submitted to microbiological evaluation. Present in 10 cases at baseline, mutans streptococci was reduced by 100% at the second assessment. Treatment showed an efficiency of 77.78% for anaerobic microorganisms at the second assessment. These data suggest that chlorhexidine prevents microbial activity in vivo with residual effects in the root canal system up to 48 h.     

In vivo antifungal efficacy of salivary histidine-rich polypeptides: preliminary findings in a denture stomatitis model system.

Six denture stomatitis patients, all found to have Candida albicans on their maxillary denture and palatal tissue surfaces, volunteered in this preliminary study to test the in vivo efficacy of human salivary antifungal histidine-rich polypeptides (HRPs) in treating their oral disease. The patients were equally divided among the Newton types classification and, as expected, the severity of the inflammation was greatest in the Newton type III patients and least in the Newton type I patients. Patients received sterile solutions of either HRP-3 or HRP-4, which they used both as a mouthrinse and as a denture soak for a period of 1 week. Agar replicas of the tissue-fitting surface of the maxillary dentures revealed HRP reduction and/or elimination of C. albicans from the denture; in one Newton type II individual, this finding directly correlated with a site-specific reduction in palatal inflammation. In the Newton type II and type III individuals alike, there was a significant generalized decrease in inflammation suggesting the therapeutic efficacy of the HRPs. Killing of this yeast species by the HRPs, as determined by scanning electron microscopy (SEM), was probably responsible for the observed clinical benefits noted in this investigation. In the SEM, HRP-treated blastospores appeared severely deflated, as if they had been emptied of significant quantities of intracellular material.     

Cervical restoration and the amount of soft tissue coverage achieved by coronally advanced flap: A 2-year follow-up randomized-controlled clinical trial

Background: The aim of this study was to evaluate the 2-year follow-up success of the treatment of gingival recession associated with non-carious cervical lesions by a coronally advanced flap (CAF) alone or in combination with a resin-modified glass ionomer restoration (CAF+R).
Material and Methods: Sixteen patients with bilateral Miller Class I buccal gingival recessions, associated with non-carious cervical lesions, were selected. The defects received either CAF or CAF+R. Bleeding on probing (BOP), probing depth (PD), relative gingival recession (RGR), clinical attachment level (CAL) and cervical lesion height (CLH) coverage were measured at the baseline and 6, 12 and 24 months after the treatment.
Results: Both groups showed statistically significant gains in CAL and soft tissue coverage. The differences between groups were not statistically significant in BOP, PD, RGR and CAL, after 2 years. The percentages of CLH covered were 51.57 ± 17.2% for CAF+R and 53.87 ± 12.6% for CAF ( p >0.05). The estimated root coverage was 80.37 ± 25.44% for CAF+R and 83.46 ± 20.79% for CAF ( p >0.05).
Conclusion: Within the limits of the present study, it can be concluded that both procedures provide acceptable soft tissue coverage after 2 years, with no significant differences between the two approaches.     

In vitro evaluation of antimicrobial property of silver nanoparticles and chlorhexidine against five different oral pathogenic bacteria

Introduction

Numerous antimicrobial agents are used to eliminate oral biofilm. However due to emergence of multi drug resistant microorganisms, the quest to find out biologically safe and naturally available antimicrobial agents continues.

Comparative antibacterial effects of chlorhexidine and stannous fluoride-amine fluoride containing dental gels against salivary mutans streptococci.

Forty-five young adults were divided into three groups of equal size and given a professional toothcleaning (3 times during 1 wk) with dental gels containing either chlorhexidine (CHX, 1%), or a SnF2-amine fluoride (AmF) combination (F- content 1.20%). The control group received toothcleaning with a placebo gel. The study was done double blind. The number of salivary mutans streptococci was monitored for 11 wk after the gel treatment using both mitis-salivarius-bacitracin agar plates and the chairside method based on the adhesion of mutans streptococci on plastic strips (Dentocult-SM Strip mutans). Professional toothcleaning with a CHX gel was clearly most effective (P less than 0.001) but the baseline levels of streptococci returned in 11 wk. SnF2-AmF gel also reduced significantly (P less than 0.001) mutans streptococci but recolonization occurred already in 7 wk. Placebo gel, i.e. professional toothcleaning as such, did not show any statistically significant effect on the numbers of salivary mutans streptococci. None of the treatments affected the levels of lactobacilli or the total aerobic flora in saliva samples. Professional toothcleaning with a CHX gel, or with a SnF2-AmF gel, can be regarded as an alternative to the commonly used, but more patience demanding, application of gel in mouth trays at home for individuals with high caries activity.     

A clinical trial of the anticaries efficacy of casein derivatives complexed with calcium phosphate in patients with salivary gland dysfunction

OBJECTIVE: The purpose of this study was to compare the caries preventive efficacy of a mouthrinse solution containing casein derivatives coupled with calcium phosphate (CD-CP) with that of a 0.05% sodium fluoride mouthrinse among individuals with dry mouth. STUDY DESIGN: A randomized control trial design was used. Participants included individuals who had had radiotherapy for head and neck cancer (n = 82) and others with Sj?gren's syndrome (n = 56). Baseline data collection was followed by reexamination 12 months later. Posterior bite-wing radiographs were taken on both occasions. RESULTS: A total of 124 participants, 61 (49.2%) in the sodium fluoride group and 63 (50.8%) in the CD-CP group, completed the 12-month examination. The baseline characteristics of the 2 groups did not differ. Coronal caries incidence was higher in the sodium fluoride group than in the CD-CP group (34.4% and 27%, respectively), but the difference was not statistically significant. Similarly, the small difference in coronal caries increment between the 2 groups was not statistically significant (0.4 and 0.3 surfaces, respectively). There was insufficient root surface caries experience between the 2 groups observed for differences to be examined. Proportionately more of the CD-CP group lost 1 or more teeth, and the mean number of tooth loss was higher. The participants with the highest incidence and increment were those with Sj?gren's syndrome in the CD-CP group. Some of that difference was accounted for by differences in baseline caries status. CONCLUSION: It appears that CD-CP preparations hold promise as caries preventive agents for individuals with dry mouth, although confirmation of this study's findings in other settings is warranted before a definitive conclusion can be reached.