Influence of teeth, plaque and dentures on the retention of chlorhexidine in the human oral cavity

Abstract The retention of chlorhexidine in the oral cavity after rinsing with 10 ml 0.2 % [¹⁴C]-chlorhexidine-digluconate for 1 min was found to be 3.8 mg (S.D. = 1.4 mg) in a group of 12 edentulous patients. By comparison, the mean oral retention in 10 dental students with cleaned and polished teeth was 4.6 mg (S.D. = 0.7 mg). Measurement of the retention in 6 subjects before and after extensive tooth extractions showed no major influence of the teeth on the chlorhexidine retention. Plaque accumulation for 6 d increased the mean Plaque Index from 0 to 0.82 (S.D.=0.35). The corresponding mean oral retention increased significantly from 4.6 mg (S.D.=0.7 mg) to 5.6 mg (S.D.=1.1 mg). Chlorhexidine was readily bound to acrylic resin dentures. A mean binding of 4.2 mg (S.D.=2.0) after 16 min immersion in 110 ml 0.2% chlorhexidine solution was found. The [¹⁴C] activity of the saliva showed a sharp fall during the first few hours after insertion of the dentures, followed by a slow release, with activity still present after 24 h.     

Systemic effects of oral use of chlorhexidine gel in multihandicapped epileptic children

Abstract— The purpose of this double-blind study was to evaluate the effect on medical parameters after the daily use of chlorhexidine gel on multihandicapped epileptic children over a 2-month period. Although certain abnormalities in hematologic and biochemical blood tests were recorded both prior to and after treatment, the prevalence of abnormalities was similar in the chlorhexidine and control groups, even though the patients in the study constituted a high risk group.     

Application of chlorhexidine by oral irrigation systems

abstract — Low concentrations of chlorhexidine (0.006%) were found to inhibit plaque formation when 750 ml was applied twice daily by oral irrigation systems. The procedure took 1–2 min and may be a convenient method of maintaining oral hygiene in patients in whom normal mechanical cleansing is difficult.     

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 evaluation of the use of toothpaste containing 1% chlorhexidine and the influence of motivation on oral hygiene in patients with motor deficiency

Patients with motor deficiency have variable difficulties with mechanical plaque control, and as a consequence, the incidence of dental caries and periodontal disease can be higher in these patients. The objective of this study was to evaluate the clinical and microbiological efficacy of a toothpaste containing 1% chlorhexidine, which was used by patients with motor deficiency for 14 days. The reduction in plaque and gingival index and the impact on salivary microorganisms was evaluated. We conclude that the motivation of caregivers to carry out oral hygiene for patients with mental and motor deficiency is of great importance and is effective in reducing the formation of plaque as long as it is continuously reinforced. The use of chlorhexidine‐containing toothpaste significantly reduced the plaque index and microorganism count between days 0 and 14. A reduction was also observed in the group that used a dentifrice without the chlorhexidine, but this difference was not significant.     

Effect of chlorhexidine mouthrinse and periodontal treatment upon bacteremia produced by oral hygiene procedures

ABSTRACT – Toothbrushing for 2¹/₂ min and the use of toothpicks for 2¹/2 min produced bacteremia with streptococci in seven out of 13 patirnts with destructive periodontitis and in dontitis group and the "gingivitis" group was not significant, but there scemed to be more frequent bacteremia in the periodontal group. No correlation could be established between plaque-index, gingival-index and positive bacteremia. Barteremia seemed to be due primarily to pockets and interdental ulcerations. The use of chlorhexidine as a mouthriuse for 7 d did not reduce the bacteremia caused by the oral hygiene procedures in either of the two groups. After periodontal treatment no bacteremia was detected in the periodontitis group, whereas no reduction was obtained in the gingivitis group.     

Clinical trial in mentally retarded of chlorhexidine dental gel: bacteriology

A dental gel containing 1 % chlorhexidine was applied daily to the teeth of mentally retarded patients for a period of 6 months. Although possible antimicrobial effects were noted, the gel had no practical value in reducing the numbers of different plaque bacteria. It is suggested that the lack of effect may be due to changes in susceptibility of the oral flora surviving in the mouth, allowing subsequent recolonization of the teeth.     

A randomized clinical trial of chlorhexidine in the maintenance of oral candidiasis-free period in HIV infection

Objective: To determine if chlorhexidine can be used as an intervention to prolong the time to relapse of oral candidiasis. Subjects and methods: A double‐blinded randomized clinical trial was performed in 75 HIV/AIDS subjects with oral candidiasis. Clotrimazole troche was prescribed, and the subjects were re‐examined every 2 weeks until the lesions were completely eradicated. The subjects were then randomly divided into two groups; 0.12% chlorhexidine (n = 37, aged 22–52 years, mean 34 years) and 0.9% normal saline (n = 38, aged 22–55 years, mean 38 years). They were re‐examined every 2 weeks until the next episode was observed. Results: The time to recurrence of oral candidiasis between the chlorhexidine and the saline group was not statistically significant (P > 0.05). The following variables were significantly associated with the time of recurrence; frequency of antifungal therapy (P = 0.011), total lymphocyte (P = 0.017), alcohol consumption (P = 0.043), and candidiasis on gingiva (P = 0.048). The subjects with lower lymphocyte showed shorter oral candidiasis‐free periods (P = 0.034). Conclusions: Chlorhexidine showed a small but not statistically significant effect in maintenance of oral candidiasis‐free period. This lack of significance may be due to the small sample size. Further study should be performed to better assess the size of the effect, or to confirm our findings.     

Effect of toothbrushing with chlorhexidine gel on salivary microflora, oral hygiene, and caries

abstract – The effect of daily toothbrushing with 0.5 % chlorhexidine-containing gel for 12 months was evaluated in a double-blind study in 37 dental students. The active gel did not markedly influence plaque formation, gingival conditions, or caries as compared with placebo gel treatment. Salivary bacterial counts were performed on subgroups of six subjects using chlorhexidine gel and on six using placebo gel. No differences in the effect of treatment on the microorganisms studied in the two subgroups could be detected except for S. sanguis . The percentage of this species decreased in the placebo group and increased in the chlorhexidine group. The difference became significant after 2 weeks. A tendency to a greater reduction of S. mutans noted in the chlorhexidine group was most marked in individuals who had high initial counts of this species. The proportion of S. sanguis , which could grow on chlorhexidine-containing mitis salivarius medium, increased and after 12 months of chlorhexidine treatment averaged 34 % of cultivable S. sanguis compared with 0.002 % prior to treatment. The number of less sensitive S. sanguis decreased in the 12 months following termination of treatment. There was no observed tendency for the selection or proliferation of other streptococci, gram-negative rods, yeasts, or staphylococci.     

Adjunctive effect of chlorhexidine in ultrasonic instrumentation of aggressive periodontitis patients: a pilot study

Aim: The aim of the present pilot randomized clinical trial was to evaluate the effects of ultrasonic mechanical instrumentation (UMI) associated with the professional use of chlorhexidine (CHX) formulations compared with UMI alone during periodontal supportive therapy in patients with generalized aggressive periodontis (G‐AgP). Material and Methods: Nine patients (test group) received a single session of UMI associated with subgingival irrigation under cavitation with CHX 0.02%. A 0.2% CHX solution was used for professional tongue brushing and mouthrinsing. Ten patients (control group) received a similar session of UMI associated with subgingival irrigation and professional tongue brushing and mouthrinsing with a control formulation. Clinical and microbiological parameters were assessed pre‐treatment at 3, 6 and 12 weeks post‐treatment. Results: UMI either with or without additional CHX use determined a significant reduction of supragingival plaque and gingival inflammation as well as a significant reduction of subgingival bacterial pathogens. The additional use of CHX did not result in any additional clinical and microbiological benefit with respect to mere UMI. Conclusions: The adjunctive professional use of CHX formulations to UMI seems to produce no additional effects over UMI alone during supportive therapy in G‐AgP patients.     

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.     

Clinical effects on chronic periodontitis of a simplified system of oral hygiene including subgingival pulsated jet irrigation with chlorhexidine

The aim of this study was to investigate the effects of a simplified system of oral hygiene, comprising Bass brushing, scaling, root planing and subgingival irrigation using a pulsated monojet oral irrigator, in patients with chronic periodontitis. After initial assessment, patients received scaling, root planing and instruction in Bass brushing and in use of a pulsated jet oral irrigator (Water Pik + Imax attachment) to irrigate subgingivally. 11 patients with 262 approximal periodontal pockets used 0.02% chlorhexidine (CH), or a placebo as the irrigating solution once daily for 28 days. Plaque index (PlI), sulcus bleeding index (SBI), and probing pocket depth (PPD) were assessed on days 0, 28, 56 and 84. Within procedure comparisons for all groups showed that the regime was highly effective in reducing PlI, SBI and PPD, improvements being maintained at least until day 84. Between procedure comparisons showed that benefits were improved only marginally by the use of 0.02% CH as the irrigation fluid. The patients found the procedure pleasant and neither injuries nor staining were noted during the study. It was concluded that this simplified oral hygiene system was effective in reducing periodontal inflammation and pocket depth, although no significant added benefit with 0.02% CH was apparent. The technique may be useful in patients who cannot achieve high levels of routine mechanical oral hygiene, particularly interdentially. The effects of using higher concentrations of chlorhexidine should be investigated.     

Evaluation of a simplified diagnostic aid (Oricult-N) for detection of oral candidoses

The validity of a simplified diagnostic aid, Oricult-N, for detection of oral candidoses was compared with smears stained according to the periodic acid-SchilFs method. Samples were taken from 80 locations in 36 patients with lesions suspected for candidal infection. There was a statistically significant correlation between the two methods (P < 0.001).     

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.     

The use of 0.2% chlorhexidine in the absence of a structured mechanical regimen of oral hygiene following the non-surgical treatment of periodontitis

Abstract. The aim of the present study was to evaluate a 0.2% chlorhexidine mouthrinse following the non-surgical treatment of advanced human periodontitis in the absence of a structured mechanical oral hygiene regimen. 10 patients and a total of 1483 sites were used. Recordings for plaque, bleeding, pocket depth and attachment levels were made at baseline and at 3, 6, 9, and 12 months. Debridement was performed under local anaesthesia. No instruction or reinforcement in mechanical ocal hygiene procedures was given at any time. However, at each visit the patients were instructed in the 2× daily use of 0.2% chlorhexidine mouthwash. The plaque indices, scored as % of sites with removable deposits, showed negligible improvement from baseline scores of 80%-100% for all categories of initial probing depth. Mean bleeding score was reduced to 10–20% irrespective of initial probing pocket depth, site location or tooth surface location. Sites ≥7 mm at baseline demonstrated a reduction in mean probing pocket depth of 3.9 mm and a gain in mean probing attachment level of 2.5 mm. Moderately deep sites (4–6.5 mm) demonstrated a reduction in mean probing pocket depth of 2 mm and a gain in mean probing attachment level of 0.8 mm. Shallow sites (≤3.5 mm) demonstrated a reduction in mean probing pocket depth of 0.5 mm and a loss in mean probing attachment level of 0.2 mm. Site-specific attachment level analysis demonstrated that over 80% of losing sites were shallow with low bleeding frequency, indicating that the loss of attachment may have occurred for reasons other than inflammatory periodontal disease. The results indicate that chlorhexidine can be used as an adjunct to inadequate mechanical oral hygiene over an observation period of 1 year.     

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.