Effects on plaque and gingivitis of a chlorhexidine dental gel in the mentally retarded

The effectiveness of a 1% chlorhexidine-containing dental gel on dental plaque and gingival health was evaluated over a period of 6 months using a double-blind procedure. One hundred and seventeen mentally retarded subjects aged between 10-17 years resident in an institution were divided into two groups. One group was assigned daily brushing with the 1% chlorhexidine gel, the other group a placebo quinine sulfate-containing gel. No other form of oral hygiene was used during the experimental period. Assessment of dental plaque accumulation and gingivitis was made at 0, 1, 3, and 6 months. An assessment was also made 2 months after the gel was withdrawn from use and normal toothbrushing procedures resumed. No clinical or statistical advantage was noted in plaque or gingivitis scores in the group receiving chlorhexidine treatment during the 6-month period. This group showed a higher prevalence of tooth staining. It was concluded that periodontal severity and poor oral hygiene exceeded the plaque- and gingivitis-preventing potential of chlorhexidine.     

Use of oral irrigators as vehicle for the application of antimicrobial agents in chemical plaque control

Abstract The purpose of the present investigation was to study the topographical distribution of plaque formation using chlorhexidine digluconate (CH) as a mouthrinse and in oral irrigators during experimental gingivitis. Forty dental students (aged 22–26) with clean teeth and healthy gingivae abolished oral hygiene oral period of 3 weeks (Löe et al. 1965). During this period the participants were randomly assigned to one of five groups, Group A rinsed daily with 30 ml of a placebo and Group B with 30 ml 0.1% chlorhexidine digluconate. In Groups C and E a fractionated jet irrigator was used for the daily application of 600 ml placebo (C) or O.05% CH (E); 600 ml of 0.05% CH was also used in a monojet irrigator (Group D). At the start, after 1, 2 and 3 weeks of no oral hygiene and 1 week following reinstituted oral hygiene, plaque was assessed using the Plaque Index (Silness &. Löe 1964) and gingival health was scored according to the criteria of the Gingival Index (Löe & Silness 1963). The discoloration of the teeth was determined using a set of color photos. During the experiment all groups reached plaque levels that were significantly different from each other. The highest PII were seen in the placebo rinsing group (A) followed by placebo irrigation (C). Plaque was significantly reduced in the CH groups. However, rinsing (B) formed significantly more plaque than using the oral irrigator (D, E). Group E showed the least amount of plaque. In addition, the interproximal PII were equally low as the buccal and lingual. With CH (B, D, E), gingivitis did not develop except for some interproximals in Group B. A fractionated jet irrigator was more effective for the application of CH than rinsing.     

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.     

Electron microscopic evidence of a cellular attachment between junctional epithelium and dental calculus

Following scaling, the gingiva of rhesus monkeys was maintained in a state of clinical normalcy by single daily intra-oral swabs with 2 % chlorhexidine gluconate, supplemented by toothbrushing and interdental cleansing with toothpicks three times per week. Chance findings in 2 animals, one maintained for 3 months on this regimen, the other for only 3 weeks followed by a period of 12 days without oral hygiene, revealed that under these circumstances, the junctional epithelium is able to form an attachment to a calculus mass which contained morphologically recognizable bacterial cells. Electron microscopy revealed that this attachment was mediated through a dental cuticle, a basement lamina and hemidesmosomes. The ultrastructure of the epithelial attachment to calculus was indistinguishable from that which exists between junctional epithelium and various tooth surfaces. These results may be due to the inhibiting effect of chlorhexidine gluconate on plaque formation and possibly a concomitant lowering of the toxicity of calculus.     

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)     

Preventive action of short-term and long-term chlorhexidine rinses

The purpose of this study was to evaluate the effects of 0.12% chlorhexidine mouthrinses on the presence of plaque and gingivitis, either used as the only oral hygiene practice during a short period of time (21 days) or associated with routine daily brushing for 180 days. The experimental subjects were 40 dental students of an average age of 20.9 years. Following a thorough examination and mechanical prophylaxis. The subjects were divided into two treatment groups. Twenty subjects stopped all oral hygiene procedures for 21 days except for twice-daily rinses with 0.12% chlorhexidine or a placebo. Plaque, gingivitis scores and oral soft tissue health were recorded on days 0, 7, 14 and 21 for the short term group and on days 0, 90 and 180 of experimentation for the long term group. After 21 days of rinsing, plaque accumulation, gingivitis and bleeding on probing were significantly lower in the chlorhexidine group than in the placebo group. After three and six months of mouthrinses, the chlorhexidine group had less plaque and significantly less gingivitis than the placebo group. No significant differences in adverse oral soft tissue effects were observed between the different groups. It was concluded that a 0.12% chlorhexidine digluconate mouthrinse can provide an important adjunct to the prevention and control of gingivitis when used as the only oral hygiene practice or with regular personal hygiene procedures. The results obtained in this clinical study, using stringent parameters of evaluation with statistic analysis, corroborated the results obtained by other studies.     

Antimicrobial effect of a dental varnish, in vitro.

The effects of a polymer based antimicrobial releasing varnish Cervitec were investigated against different gram-positive and gram-negative bacterial strains as well as a yeast using the agar diffusion inhibitory test (ADT-test in vitro). As positive controls a 1% chlorhexidine gel and 1% aqueous solution of thymol and a placebo polymer varnish without active agents were employed. The test experimental varnish containing 1% chlorhexidine and 1% thymol showed antimicrobial activity against all gram-positive and gram-negative microorganisms tested including one Candida strain. The positive controls were similar in effect compared to the test varnish. No antimicrobial effect was observed with the placebo varnish without active ingredients. Toothpicks and dental floss treated with the test varnish showed an antimicrobial effect against S. mutans even after storing in room temperature up to 12 months. The results from this study support earlier laboratory studies that chlorhexidine and thymol diffuse out of the experimental varnish and that the varnish is active against various of oral pathogens. The possibility to use toothpicks or dental floss impregnated with the varnish with the aim to become chemotherapeutically active against periodontal diseases as well as against dental caries, is promising and should be tested in vivo.     

The effects of a 0.2% chlorhexidine gluconate mouthrinse on plaque, toothstaining and candida in aphthous ulcer patients

Despite the known effectiveness of 0.2% chlorhexidine gluconate mouthwash in preventing plaque formation, relatively few studies have assessed adjunctive benefit to normal unsupervised oral hygiene measures. Furthermore, there have been few accurate measurements of toothstaining in the presence of normal oral hygiene and little data of effects on oral candidal carriage. This study was a double-blind placebo-controlled cross-over study of a 0.2% chlorhexidine gluconate mouthwash used 3 times daily on plaque, staining and candidal carriage in a group of recurrent aphthous ulcer suffers who maintained normal oral hygiene measures. At the end of 2 6-week treatment periods, baseline plaque scores were reduced by active and placebo mouthwashes. Chlorhexidine significantly reduced plaque compared to the placebo. Staining has markedly and significantly increased during chlorhexidine rinsing. Candidal carriage was present in 22.2% of this group and there was no significant effect of chlorhexidine on the mean number of candidal colonies. The distribution of plaque and staining by tooth was plotted and observationally studied. Baseline and placebo treatment plaque distributions indicated the considerable relevance of toothbrushing behaviour for plaque distribution. The effects of toothbrushing on plaque distribution were minimised during the use of chlorhexidine. Staining associated with chlorhexidine showed a distribution again suggesting the influence of toothbrushing. In conclusion, chlorhexidine has significant adjunctive effects on plaque inhibition in the presence of normal unsupervised oral hygiene, but toothbrushing did not prevent toothstaining.     

The effect of various plaque control measures on gingivitis and caries in schoolchildren

The aims of the present study were (1) to analyze the separate effects on plaque, caries, and gingivitis of several measures (oral hygiene instruction, professional tooth cleaning with mechanical instruments, topical application of sodium monofluorophosphate - MFP) which have been incorporated in a prophylactic treatment program, described by AXELSSON & LINDHE1, and (2) to prevent caries and gingivitis by applying the combined treatment but replacing the professional mechanical tooth cleaning with chemical cleaning using a chlorhexidine-containing gel. 164 children, 13-14 years old, divided into four groups, participated in a 2-year trial. All participants were recalled once every 2nd week for preventive treatment provided by dental nurses. During the 1st year Group 3 and 4 received prophylactic treatment identical to that described by AXELSSON & LINDHE1. During the 2nd year the professional tooth cleaning was omitted but oral hygiene instruction was given every 2nd week. During the 1st year Groups 1 and 2 were treated with 0.5% chlorhexidine but during the 2nd year they were subjected to professional tooth cleaning with mechanical instruments. Throughout the trial Groups 1 and 3 rinsed once every 2nd week with a 2% MFP solution. The results showed that by oral hygiene instruction and frequently repeated professional tooth cleanings it was possible to substantially reduce the frequency of gingivitis and prevent caries. When this treatment was used, mouthrinsings with 2% MFP had no additional effect on caries. The substitution of the mechanical cleaning procedure with topical application of a 0.5% chlorhexidine gel failed to (1) remove supragingival plaque accumulations, (2) reduce the frequency of gingivitis, and (3) retard the rate of caries development. The data also revealed that interdental cleaning with mechanical instruments was of decisive importance in the prevention of approximal surface caries.     

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).     

The efficacy of an anti-gingivitis chewing gum

Abstract Chlorhexidine is a well-established agent used for the control of supragingival plaque but is not without disadvantages, such as tooth staining, which limits its clinical applications to short-term use. This clinical trial studied the clinical effectiveness and stain-forming potential of chlorhexidine in a chewing gum base. Subjects (151) were screened for baseline plaque and gingival indices before receiving a dental prophylaxis and randomized into 3 treatment groups: group 1 chewed 2 pieces of chlorhexidine diacetate gum for 10 min 2× a day (total daily chlorhexidine=20 mg). group 2 chewed 2 pieces of placebo gum for 10 min 2× a day and group 3 rinsed with 10 ml of 0.2% chlorhexidine gluconate mouthwash for 1 min 2× per day (total daily chlorhexidine=40 mg). Plaque, gingivitis and stain evaluations were made at 4 and 8 weeks. Plaque and bleeding scores were significantly lower at 4 and 8 weeks in the chlorhexidine gum group compared to the placebo gum group and similar at 8 weeks to the rinse group. Stain intensity at week 8 was significantly less for the chlorhexidine gum than rinse. The staining measured by extent was also Jess with the chlorhexidine gum than the rinse, but the difference was not significant at week 4. At week 8, stain extent was significantly lower in the chlorhexidine gum group than chlorhexidine rinse. In conclusion, the results of this study demonstrate that this chlorhexidine chewing gum used with normal tooth cleaning provides similar adjunctive benefits to oral hygiene and gingival health as a 0.2% chlorhexidine rinse.     

Plaque-removing effect of dental floss and toothpicks in children 12–13 years of age

The aim of the present study was to assess the cleaning effect of dental floss and toothpicks on interproximal surfaces. The plaque situation was assessed in a group of children 12-13 years of age by the Patient Hygiene Performance Index (PHPI). It was found that dental floss has a greater plaque-removing effect of the interproximal areas than toothpicks, predominantly on the mesial surfaces of the teeth.     

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.     

Optimal dosage of chlorhexidine digluconate in chemical plaque control when applied by the oral irrigator

Abstract Chlorhexidine digluconate for chemical plaque control was tested in different concentrations using a fractionated jet oral irrigator. The inhibition of plaque formation and the prevention of gingival inflammation were evaluated in a double-blind study. During a 10-day period of abstinence from any mechanical oral hygiene procedures, the pattern of plaque formation and gingivitis development under the influence of chemical plaque control was analyzed. As a positive control, one group rinsed twice daily with 30 ml of a 0.2% chlorhexidine solution while a group applying 600 ml of a placebo solution served as a negative control. Forty dental students and assistants with plaque-free dentitions and healthy gingival tissues were divided into four groups. After a 10-day period of no oral hygiene, a recovery period of 11 days with perfect oral hygiene was again instituted. This experiment was repealed three times so that a total of 10 concentrations in the irrigator, the control rinsing and the placebo control could be evaluated. Daily application of 600 ml of a 0.001%(6 mg), 0.0033% (20 mg), 0.005% (30mg), 0.01% (60 mg), 0.02% (120 mg), 0.05% (300 mg) and 0.1% (600 mg) and 400 ml of a 0.015 % (60 mg), twice 400 ml of a 0.015% (120 mg) and 400 ml of a 0.02% (SO mg) solution of chlorhexidine was tested. At the start of each experimental period (day 0), after 3, 7 and 10 days and 11 days following reassuming oral hygiene procedures, the plaque accumulations were determined using the Plaque Index System (Silness & Löe 1964) and the development of gingivitis was evaluated according to the criteria of the Gingival Index System (Löe & Silness 1963). The results suggested that one daily irrigator application of 400 ml of a 0.02 % chlorhexidine solution was the optimal and lowest concentration and dose to be used for complete inhibition of dental plaque.     

Clinical and microbiological effects of local chlorhexidine applications

AIM: To study the effects of an application of chlorhexidine varnish (40%) on dental plaque. DESIGN: Randomised controlled clinical trial. SUBJECTS: 40 patients (50% females), aged 25-34 years after undergoing any necessary restorative treatment. Exactly one half of these individuals practiced good oral hygiene, the efforts of the others were poor. METHOD: Test groups received a chlorhexidine varnish application, the control group received a placebo varnish. Initially and after 2 and 6 weeks, a modified Dentocult SM-test, bleeding on probing, and a plaque index (Quigley-Hein) were recorded. RESULTS: In contrast to the control group, improvements in plaque index and bleeding on probing scores were found in patients with poor oral hygiene. The results of the Dentocult SM-tests showed a considerable reduction of streptococcus colonisation. The test group with good oral hygiene showed only slight improvement of the examined indices after chlorhexidine application. The index parameters of all patients of the placebo groups remained unchanged over the examination time period. CONCLUSION: The application of a chlorhexidine varnish reduced the quantity of the Streptococcus mutans colonies significantly and improved clinical parameters in patients with elevated plaque accumulation.     

The effect of different methods of interdental cleaning

Three experimental studies were carried out to compare the effect of different implements recommended for interdental cleaning. In young adults, with healthy periodontal tissues, dental floss was superior to toothpicks in removing plaque from the lingual parts of the interproximal surfaces. The use of a single-tufted brush as a supplement to the toothpicks compensated for the lack of effectiveness of toothpicks alone. In wide-open interproximal areas, following periodontal destruction, the interdental brush is the most suitable implement to remove bacterial plaque.     

Alcohol-free mouthrinse solutions to reduce supragingival plaque regrowth and vitality. A controlled clinical study

BACKGROUND: The aim of this study was to evaluate the clinical and antibacterial properties of alcohol-free mouthrinses, an amine fluoride/stannous fluoride mouthrinse (ASF) and two triclosan solutions in comparison with a chlorhexidine and a placebo rinse. MATERIAL AND METHODS: In a double-blind, randomised 5-cell cross-over 4-day plaque regrowth study, 19 volunteers rinsed 2 x a day with 15 ml of each of the distributed solutions. Each test cycle was followed by a 10 days wash-out period. On day 0 of each test week, volunteers received a dental prophylaxis. Thereafter they refrained from all mechanical oral hygiene procedures for the next four days. Plaque regrowth was assessed daily by the plaque index and on day 4 by calculating the plaque area with a computer program after disclosure and photography of the front teeth. The vitality of the plaque was examined on days 1 to 4 by the vital fluorescence technique. RESULTS: 19 participants completed the study. Compared to the placebo the ASF solution showed 15.7% (p>0.5), 30.6% (p<0.001), 40.5% (p<0.001) and 44.7% (p<0.001) reductions on the consecutive days 14 in plaque index and a reduction of 61.9% in plaque area. The decrease of vitality of supragingival plaque was highly significant compared to placebo on every test day ranging between 30.9% and 36.6%. A reduction in plaque index from 19.4% (p<0.01) on day 2, 34.9% (p<0.001) on day 3 and 40.4% (p<0.001) on day 4 concommitant with a reduction in plaque area of 48.9% (p<0.001) was noted for alcohol-free chlorhexidine. Concerning the vitality chlorhexidine reduced the percentage of vital bacteria significantly on every day (16.0% to 24.9%). The reductions in mean plaque index for the 0.15% triclosan solution during the test period were 6.3%, 22.4%, 24.6% and 36% and in plaque area 41.8%. Vitality was significantly reduced at every day compared to placebo. Plaque Index reduction with the 0.02% triclosan increased from 15.3% (day 2) to 31.0% (day 4) and a reduction of 23.6% was seen in plaque area. A significant effect concerning the vitality of the plaque was only found at the first and the last day of the test cycle. CONCLUSION: Alcohol-free mouthrinse solutions were shown to be effective in reducing both plaque accumulation and plaque biofilm vitality compared to a placebo solution.     

Effects of chlorhexidine gel in a group of maintenance-care patients with poor oral hygiene

An intraindividual double-blind crossover study was designed in order to see if a 1% chlorhexidine gel used twice a day could substitute for ordinary toothpaste in group of maintenance-care patients with poor oral hygiene. Twenty patients from a student clinic participated, each with a long history of maintenance-care problems. A 4-week test period with chlorhexidine gel or placebo gel was followed by an intermediate period with ordinary toothpaste, and then by another 4-week test period. Plaque-covered surfaces (%), bleeding sites (%) and extraneous staining (color slides) were recorded at each sitting. The results demonstrated that brushing with chlorhexidine gel significantly influenced both the oral hygiene level and the gingival inflammation. The only adverse effect observed was a marked increase in the amount of brown staining, especially on the facial surfaces of the nonsmokers. In this short-term study, the staining was not considered cosmetically unacceptable by the patients. The total amount of staining was always greater in smokers than in nonsmokers.     

Six-month study of the effects of a chlorhexidine mouthrinse on gingivitis in adults

The effects of a chlorhexidine gluconate mouthrinse on plaque and gingivitis were studied among 430 adults in a six-month clinical trial. Subjects were divided in two comparable treatment groups matched for age, sex, and initial gingivitis severity. Following a thorough oral prophylaxis, they were instructed to rinse twice a day for 30 seconds with 15 ml of a 0.12% chlorhexidine gluconate mouthrinse or a placebo mouthrinse. After three and six months of mouthrinse use, the chlorhexidine group had significantly less gingivitis, gingival bleeding, and plaque accumulation compared to the placebo group. As expected, accumulation of dental calculus and extrinsic dental stain increased in the chlorbexidine group. No significant differences in adverse oral soft tissue effects were observed between the two groups.
Since use of oral antimicrobial agents has been reported to produce tooth and tongue stain, gingivitis examinations were done with and without tooth covers to eliminate the potential for examiner bias. Comparable reductions in the Gingival Index scores and gingival bleeding were obtained when the evaluations were conducted with or without the tooth covers.
It was concluded that a 0.12% chlorhexidine gluconate mouthrinse can provide an important adjunct to the prevention and control of gingivitis when used with regular personal oral hygiene procedures and professional care.     

Plaque formation and gingivitis after supervised mouthrinsing with 0.2% delmopinol hydrochloride, 0.2% chlorhexidine digluconate and placebo for 6 months

OBJECTIVES AND METHODS: A double-blind, randomized, 6-month clinical trial with parallel group design in 162 patients with gingivitis divided into three rinsing groups was conducted in order to study the efficacy and safety of a flavoured solution of delmopinol hydrochloride 2 mg ml“‘ (0.2% w/v, Decapinol Mouthwash”^®) used for supervised mouthrinsing in one rinsing group, in comparison with chlorhexidine digluconate 2 mg ml^-1 (0.2% w/v, Hibitane Dental’^{a, b}) in a second rinsing group, and placebo in the third group. The criteria of the Plaque Index (PI) were used to assess plaque formation. Bleeding on probing (BOP) to the bottom of the pocket with a standard pressure was used as the primary gingivitis assessment. The occurrence of supragingival dental calculus and extrinsic tooth staining were also assessed. In addition, patients were asked to report adverse events at each visit. RESULTS: Delmopinol and chlorhexidine exhibited lower scores of the mean PI and the BOP percentage than placebo, both at the 3-month and 6-month examinations. Furthermore, both active solutions showed a higher extent of staining of the teeth than placebo during these two observation periods. Rinsing with chlorhexidine resulted in more dental calculus than placebo after 6 months. Chlorhexidine showed lower scores for plaque formation and gingivitis development but higher scores of supragingival dental calculus (after 6 months) and tooth staining than did delmopinol. Both active solutions were reported by the patients–approximately to the same extent but more frequently than placebo–to induce taste alterations and a transient anaesthetic sensation of the oral mucosa. However, subjective staining of the teeth and tongue was reported by 16% of the delmopinol patients, but by 86% of the patients rinsing with chlorhexidine for 6 months. Furthermore, 24% of the patients in the chlorhexidine group, 9% in the delmopinol group and 4% in the placebo group wished to withdraw from treatment. CONCLUSIONS: The results from this clinical trial indicate that supervised rinsing with 0.2% delmopinol hydrochloride or with 0.2% chlorhexidine digluconate twice daily for 60 s as a supplement to normal mechanical oral hygiene procedures resulted in less plaque formation and gingivitis than rinsing with placebo. Although chlorhexidine was more effective than delmopinol regarding plaque formation and gingivitis, it was considered by the patients as less tolerable.