The effect of a mouthrinse containing chlorhexidine and fluoride on plaque and gingival bleeding

Abstract The aim of this study was to test the effect of a rinse with 0.05% sodium fluoride and 0.05% chlorhexidine on plaque and gingival inflammation compared with a placebo without these agents. In a double-blind study, 47 adults with >20 teeth and a CPITN score >1 but <4 were randomised into test and control groups. After baseline assessments for plaque, bleeding and stain, teeth were professionally cleaned. Subjects were asked to rinse for 30 s with 10 ml of the respective test or placebo rinse after normal oral hygiene for 8 weeks. 39 subjects completed the study. There was no significant difference in the 2 groups at baseline with respect to cither plaque or bleeding scores. After scaling and 8 weeks use of the test rinse, there were significant reductions (p <0.001) in both plaque and bleeding. The control group showed no significant reduction in plaque scores after 8 weeks, but a significant (p <0.05) reduction in bleeding. However, this reduction was significantly greater (p <0.001) in the test group than in the control. The test group had a significantly greater (p <0.05) stain score than the control at baseline. After scaling and rinsing for 8 weeks, stain scores were lower for both groups compared to baseline but reached significance (p <0.05) only for the control group. It is concluded that, as an adjunct to normal oral hygiene, the chlorhexidine/fluoride rinse had a significant inhibitory effect on plaque and bleeding but its effect on staining is uncertain.     

Effects of 0.2% chlorhexidine spray applied once or twice daily on plaque accumulation and gingival inflammation in a geriatric population

BACKGROUND/AIMS: Chlorhexidine (CHX) spray has proven to be an easily applicable method for the chemical control of plaque in elderly and handicapped patients. A randomized double-blind cross-over placebo-controlled trial was undertaken to compare the effects of 0.2% CHX spray applied once or twice daily on the plaque and gingival indexes in 13 institutionalized elderly patients. METHOD: The study subjects were randomly assigned to one of two groups. During the first 30-day period, one group received 0.2% chlorhexidine spray twice daily and the other received 0.2% CHX spray once daily plus placebo spray once daily. A washout period of 42 days then followed, after which the groups were interchanged and the process was repeated for another 30-day period. Plaque index and gingival index were determined at the beginning and end of each period. The patients continued with their usual oral hygiene practices throughout the study. RESULTS: A significant reduction in plaque and gingival indexes was produced in both the groups. There were no significant differences in index scores between the groups. CONCLUSIONS: The results of the present study suggest that a single-daily application of 0.2% CHX spray is equally as effective in reducing plaque accumulation and gingival inflammation in institutionalized elderly patients as are two-daily applications of the same spray.     

Effect of a polyhexamethylene biguanide mouthrinse on bacterial counts and plaque

OBJECTIVES: For various clinical applications, polyhexamethylene biguanide (PHMB) has been used for many years as an antiseptic in medicine. Little is known, however, of its antibacterial activity in the oral cavity and its ability to inhibit plaque formation. In this study, a 0.04% PHMB mouthrinse (A) was compared with a negative control placebo rinse (10% ethanol, flavour) (B) and 2 positive control chlorhexidine rinses, one of which was a 0.12% aqueous solution (C) and the other a commercially available mouthrinse (Skinsept mucosa) diluted to a chlorhexidine concentration of 0.12% (D). MATERIAL AND METHODS: The study was a double-blind, randomised 4-replicate 4 x 4 Latin square cross-over design. Plaque regrowth was assessed with the Turesky et al. modification of the Quigley and Hein plaque index. The in vivo antibacterial effect was assessed by taking bacterial counts from the tooth surface (smears from the lingual surface of 16) and mucosa (smears from the buccal mucosa) 4 h after the 1st rinse with the preparations on day 1 and prior to the clinical examination on day 5. 16 volunteers participated, and on day 1 of each study period were rendered plaque-free, ceased toothcleaning, and rinsed 2x daily with the allocated mouthrinse. On day 5, plaque was scored and smears were collected according to the protocol. Washout periods were 9 days. Data were analysed using ANOVA with Tukey HSD adjustment for multiple comparisons (significance level alpha=0.05). RESULTS: Mouthrinses A, C, and D were significantly more effective in inhibiting plaque than the placebo (B). Mouthrinse C was significantly better than mouthrinses A and D, while mouthrinses D and A were equally effective in inhibiting plaque. Bacterial count reductions on the tooth surface with mouthrinse C were significantly greater compared to mouthrinse A and the placebo (B). The reduction of bacterial counts on the mucosa with C was significantly greater than with A and B after 4 h and significantly greater than with A, B and D after 5 days. Mouthrinse A reduced bacteria on the mucosa significantly more effectively than the placebo (B) after 4 h and 5 days, while mouthrinse D was more effective than the placebo (B) after 4 h. CONCLUSION: The results indicate that a 0.04% PHMB mouthwash inhibits plaque regrowth and reduces oral bacterial counts, and may be used in preventive applications in the oral cavity.     

The influence of gingival inflammation on de novo plaque formation

Abstract The aim of the present clinical trial was to examine the influence of gingival inflammation on de novo plaque formation. In addition, the effect of a varying number of salivary bacteria on early plaque formation was evaluated. 10 subjects were recruited for the trial which was designed to establish 2 different starting points for de novo plaque formation. 1 in a healthy dentition and 1 in a gingivitis dentition. On Day 0 and at regular intervals during a 5-week period, the panelists were examined with respect to gingivitis, plaque and number of salivary bacteria. The findings from the study demonstrated that the condition of the marginal gingiva plays an important role in the early stages of plaque formation. Thus, in both phases of the study, it was observed that at sites with initially healthy gingival units, less plaque formed (PII=0.93 and 0.82) than at sites with G1 > 0 (PII= 1.24 and 1.28) at the 2 different starting points. The number of salivary bacteria seemed to be less important than the state of the gingiva for the amount of plaque that formed during a 4-day period of no active mechanical tooth cleaning.     

6-month use of 0.2% delmopinol hydrochloride in comparison with 0.2% chlorhexidine digluconate and placebo (II). Effect on plaque and salivary microflora

Abstract. This double-blind, randomised, 6-month clinical trial with parallel group design in 68 subjects with gingivitis was conducted to study the effects on the oral flora of delmopinol hydrochloride 2 mg/ml (0.2% w/v, Decapinol Mouthwash), when used for partly supervised mouthrinsing in comparison with placebo and chlorhexidine digluconate 2 mg/ml (0.2% w/v, Hibitane Dental, ICI Pharmaceuticals, UK). Apart from estimating the total cultivable microbial dental plaque flora and salivary flora, analyses were focused on bacterial groups associated with gingivitis/periodontitis and dental caries. Furthermore, the presence of staphylococci, Gram-negative enteric bacteria and yeasts in saliva were evaluated. The minimal inhibitory concentration (MIC) was determined for isolates belonging to the predominating micro-organisms in samples of both dental plaque and saliva. In relation to the findings in the placebo group, the use of delmopinol during the rinsing period did not produce an undesirable shift in the bacterial populations considered to be related to dental caries or periodontal diseases. These groups remained virtually unchanged during the study. In relation to the observations in the placebo group, slight reductions in the total cultivable plaque and salivary flora were observed during the study and no change was found in the ratio total anaerobically/aerobically cultivable microbial flora. Furthermore, no increased growth in staphylococci, enteric bacteria or yeasts was observed in the saliva samples. The pattern of changes taking place in the composition of the plaque and salivary microbial flora in samples from the participants rinsing with chlorhexidine were in most aspects similar to that observed in the delmopinol group. In the delmopinol group, no microbiologically significant changes were observed over time in the MIC-values for the isolates, neither in the plaque nor in the saliva samples, which indicates that no adaptation to delmopinol had taken place during the rinsing period. Similar observations were made for the plaque isolates in samples from the participants in the chlorhexidine group. On the other hand, when Gram-positive and catalase-negative cocci from the saliva samples of the latter group were tested against chlorhexidine, 4–6 times higher MIC-values were obtained at 3 and 6 months both when compared to baseline and in comparison with the other two rinsing groups (p<0.01 or p<0.05). Neither delmopinol nor chlorhexidine showed any residual effect on the studied microbial groups in the plaque and the saliva samples 3 months after the end of treatment. In conclusion, delmopinol was accompanied by a composition of the plaque and salivary flora associated with healthy conditions in the oral cavity.     

The effect of herbal,essential oil and chlorhexidine mouthrinse on de novo plaque formation

To cite this article:
Int J Dent Hygiene DOI: 10.1111/j.1601‐5037.2012.00556.x
Singh A, Daing A, Dixit J. The effect of herbal, essential oil and chlorhexidine mouthrinse on de novo plaque formation. Abstract: Background: Brushing and flossing are the most widely accepted procedures, the ‘gold standard’, for controlling bacterial plaque, but these mechanical methods have limitations. Based on results derived from several clinical trials, essential oil (EO) mouthrinse (Listerine^®) and a chlorhexidine mouthrinse have been accepted by ADA to be used as an adjunct to routine mechanical oral hygiene measures however, both of them are associated with side effects, therefore, the present study was undertaken to evaluate the antiplaque efficacy of a new herbal formulation as compared to an EO and chlorhexidine rinse. Materials and method: The study was a single blind parallel randomized controlled trial involving four groups. 48 volunteers refrained from all oral hygiene measures for 4 days, but rinsed instead twice daily with 10 ml of a herbal (HM), EO, chlorhexidine (CHX) or a placebo (PL) solution. Plaque index and plaque area (PA) was assessed on Day 4. Results: The HM and EO showed a significant inhibition of plaque regrowth compared to PL (P < 0.001), but the lowest values of PI and PA were obtained with CHX. Statistically significant difference in plaque parameters was observed when CHX was compared to HM and EO, and HM to EO rinse. Conclusion: The new herbal mouthrinse had a promising plaque inhibitory potential but it not as efficacious as chlorhexidine in preventing plaque regrowth.     

A comparison of delmopinol and chlorhexidine on plaque regrowth over a 4-day period and salivary bacterial counts

Delmopinol has been considered as a potential agent for the chemical control of plaque. The aims of these studies were to measure the effects of a 0.2% delmopinol hydrochloride mouthrinse on (1) plaque reformation and (2) salivary bacterial counts. Comparisons were made with a 0.2% chlorhexidine rinse and a placebo rinse. A group of 12 male volunteers took part in the plaque study which was of a double blind, randomised, 3 cell, cross-over design. From a zero plaque baseline subjects rinsed, 2x a day, under supervision, for 1 min with 10-ml volumes of the allocated rinse. After 4 days, during which no other form of oral hygiene was performed, plaque was scored by area and index. Plaque results were significantly lower with chlorhexidine and delmopinol compared with control, and with chlorhexidine compared to delmopinol. Side-effects with delmopinol were transient tingling and numbness of the tongue in some subjects. A 2nd group of 12 male volunteers received single, 1-min rinses of the 3 formulations. Salivary bacterial counts were determined immediately before and up to 420 min after rinsing. Compared to the control rinse, chlorhexidine significantly reduced bacterial counts of 420 min. Delmopinol produced a small reduction in bacterial counts which was only significantly different from control at one time point. Delmopinol deserves further evaluation as a chemical plaque inhibitor, particularly when used as an adjunct to normal toothcleaning.     

The effect of 1% chlorhexidine gel and 0.12% dentifrice gel on plaque accumulation: a 3-day non-brushing model

To cite this article:
Int J Dent Hygiene  8 , 2010; 294–300
DOI: 10.1111/j.1601‐5037.2010.00487.x
Slot DE, Rosema NAM, Hennequin‐Hoenderdos NL, Versteeg PA, van der Velden U, van der Weijden GA. The effect of 1% chlorhexidine gel and 0.12% dentifrice gel on plaque accumulation: a 3‐day non‐brushing model. Abstract: Aim: The purpose of the study was to compare the effects of four treatments on ‘de novo’ plaque accumulation. Treatments included tray application of 1% chlorhexidine gel (CHX‐Gel), 0.12% chlorhexidine dentifrice‐gel (CHX‐DFG), a regular dentifrice (RDF) tray application, or 0.2% chlorhexidine mouthwash (CHX‐MW) in a 3‐day non‐brushing model. Material and methods: The study was designed as a single blind, randomized parallel clinical trial. After professional prophylaxis, subjects abstained from all other forms of oral hygiene during a 3‐day non‐brushing period. Subjects were randomly assigned to one of the four test groups (CHX‐Gel, CHX‐DFG, RDF applied in a fluoride gel tray or rinsing with a CHX‐MW). After 3 days, the Quigley & Hein plaque index (PI) and Bleeding on Marginal Probing (BOMP) index was assessed. Subsequently, all subjects received a questionnaire to evaluate their attitude, appreciation and perception towards the products used employing a Visual Analogue Scale. Results: After 3 days, the full‐mouth PI means were 0.88 for the CHX‐gel regimen, 0.79 for CHX‐MW, 1.16 for CHX‐DFG and 1.31 for the RDF regimen. The two dentifrices (CHX‐DFG and RDF) were significantly less effective than the CHX‐Gel or the CHX‐MW. Conclusion: Within the limitations of the present 3‐day non‐brushing study design, it can be concluded that the effect of a 1% CHX‐Gel application tray is significantly greater than that of 0.12% CHX‐DFG or RDF in inhibiting plaque accumulation. The 1% CHX‐Gel applied via a tray and 0.2% CHX‐MW rinse were comparably effective.     

The effect of a polyhexamethylene biguanide mouthrinse compared to an essential oil rinse and a chlorhexidine rinse on bacterial counts and 4-day plaque regrowth

OBJECTIVES: For various clinical applications, polyhexamethylene biguanide hydrochloride (PHMB) has been used for many years as an antiseptic in medicine. Recently, a 0.04% PHMB mouthwash was shown to inhibit plaque regrowth and to reduce oral bacterial counts. In this study, a 0.12% PHMB mouthrinse (A) was compared with a negative control placebo rinse (10% ethanol, flavour) (B), a positive control 0.12% chlorhexidine rinse (C), and a commercially available mouthrinse containing essential oils (Listerine) (D). MATERIALS AND METHODS: The study was a double-blind, randomised 4-replicate 4 x 4 Latin square cross-over design in which plaque regrowth was measured. The in vivo antibacterial effect was assessed by taking bacterial counts from the tooth surface and mucosa 4 h after the first rinse with the preparations on day 1 and prior to the clinical examination on day 5. 16 volunteers participated and, on day 1 of each study period, were rendered plaque-free, ceased toothcleaning, and rinsed 2x daily with the allocated mouthrinse. On day 5, plaque was scored and smears were collected according to the protocol. Washout periods were 9 days. Data were analysed using ANOVA with Bonferroni HSD adjustment for multiple comparisons (significance level alpha=0.05). RESULTS: The 0.12% PHMB mouthrinse (A) was significantly more effective in inhibiting plaque than the placebo (B) but no significant differences could be observed between A and 0.12% chlorhexidine (C), or between A and Listerine (D). Bacterial count reductions on the tooth surface with PHMB (A) were significantly greater compared to the placebo (B) after 4 h and significantly greater compared to B and D after 5 days. Chlorhexidine (C) was more effective than A after 5 days. On the mucosa, chlorhexidine (C) was significantly more effective in reducing bacterial counts than the other 3 treatments at both time points investigated. PHMB (A) was significantly more effective in reducing bacterial counts than the placebo (B) after 4 h and after 5 days, and than D after 4 h. CONCLUSION: Consistent with a previous study, a PHMB mouthrinse was shown to inhibit plaque recolonisation and to reduce oral bacterial counts, indicating that PHMB may find applications in the prevention of plaque-associated diseases.     

The influence of a hydrogen peroxide and glycerol containing mouthrinse on plaque accumulation: a 3-day non-brushing model

Abstract: Aim: To evaluate the inhibition of plaque growth by an experimental mouthrinse (BioXyl^®) based on hydrogen peroxide/glycerol. Design: It was a double‐blind, randomized study involving 40 volunteers in good general health. At the start of the trial, all participants received a dental prophylaxis to remove all plaque deposits. During the next 3 days subjects refrained from any mechanical oral hygiene procedure, except for the allocated mouthrinse being either the hydrogen peroxide (H₂O₂; 0.013% H₂O₂/0.004% glycerol) or the placebo without H₂O₂. At the third day of appointment, plaque levels were assessed at six sites per tooth. Results: The test group had a mean overall plaque score of 2.66 and the placebo group of 2.70. The difference in plaque scores between the two groups was not statistically significant. Conclusions: The results of this pilot study showed that there was no statistically significant difference between the H₂O₂/glycerol group and the placebo group with respect to plaque inhibition within this study design.     

The effect of xylitol and chlorhexidine acetate/xylitol chewing gums on plaque accumulation and gingival inflammation

Chewing gums may be suitable vehicles for the delivery of xylitol (X) and chlorhexidine acetate (CHX), both of which can aid oral health. The aim of this study was to determine the clinical effectiveness of chewing gums containing X or a combination of X and CHX in a double-blind, randomised, cross over, 5-day clinical trial, with a 9-day washout period in a group of participants over 40 years old. After professional tooth cleaning, 8 subjects (mean age 51.3+/-10.4 years) used in a random order 2 pieces of ACHX (a liquorice flavoured CHX/X) gum, 2 pieces of BCHX (a chocolate mint flavoured CHX/X), 2 pieces of X (a liquorice flavoured X gum) and 1 piece of ACHX. Gums were chewed 2x daily for 15 min and volunteers refrained from all other oral hygiene procedures. Data were analysed using Friedman nonparametric analysis of variance. Plaque indices for chewing 2 pieces of ACHX gum (0.78+/-0.15) and BCHX gum (0.52+/-0.15) were significantly lower (p<0.0006) than for X gum (1.57+/-0.08). The gingival index was significantly greater (p<0.05) for X containing gum than for the other chewing regimes. The subjects' attitudes to the gums were also assessed by structured questionnaires which showed that all gums were easy to chew, did not adhere to dentures, teeth or restorations and that the subjects preferred to chew 2 pellets rather than 1.     

The effect of a polyhexamethylene biguanide mouthrinse compared with a triclosan rinse and a chlorhexidine rinse on bacterial counts and 4-day plaque re-growth

OBJECTIVES: For various clinical applications, polyhexamethylene biguanide hydrochloride (PHMB) has been used for many years as an antiseptic in medicine. Recently, a 0.04% and a 0.12% PHMB mouthwash were shown to inhibit plaque re-growth and to reduce oral bacterial counts. In this study, a 0.2% PHMB mouthrinse (A) was compared with a positive control 0.12% aqueous chlorhexidine solution (B), a commercially available 0.3% triclosan/2.0% polyvinyl methyl ether maleic acid copolymer mouthrinse (Colgate Total Plax) (C), and a negative control placebo rinse (10% ethanol, flavour) (D). MATERIALS AND METHODS: The controlled clinical study was a double blind, randomized, four replicate cross - over design. Plaque re-growth was assessed with the Turesky et al. (1970) modification of the Quigley & Hein (1962) plaque index. The antibacterial effect was assessed by taking bacterial counts on the tooth surface (smears from the buccal surface of 16/26) and mucosa (smears from the buccal mucosa in opposite of area 16/26) after the professional prophylaxis and after the first rinse with the preparations on day 1 and prior to the clinical examination on day 5. Sixteen volunteers participated and, on day 1 of each study period were rendered plaque-free, ceased toothcleaning, and rinsed twice daily with the allocated mouthrinse. On day 5, plaque was scored and smears were collected according to the protocol. A 10-day wash-out period was carried out between each rinse evaluation. Data were analysed using ancova with Bonferroni HSD adjustment for multiple comparisons (colony forming units per sample) with a significance level alpha=0.05. RESULTS: The 0.2% PHMB mouthrinse (A) was significantly better at inhibiting plaque than the placebo (D), but significant less effective than the 0.12% aqueous chlorhexidine solution (B). There is no significant difference between A and the 0.3% triclosan/2.0% copolymer mouthrinse (C). Bacterial count reductions (tooth surface and mucosa) with PHMB (A) were significantly greater compared with the placebo (D) and triclosan (C), but significantly lower compared with chlorhexidine (B) (tooth surface) and equally effective compared with chlorhexidine (B) (mucosa). CONCLUSION: Consistent with previous studies, a PHMB mouthrinse was shown to inhibit plaque re-growth and to reduce oral bacterial counts, indicating that PHMB could be an alternative to established mouthrinses in preventive applications.     

The effect of chlorhexidine acetate/xylitol chewing gum on the plaque and gingival indices of elderly occupants in residential homes

AIM: A randomised, controlled, double-blind, clinical trial was conducted to investigate the effect of a chlorhexidine acetate/xylitol gum (ACHX) on the plaque and gingival indices of 111 elderly occupants in residential homes. A gum containing xylitol alone (X) and a no gum (N) group was included. Participants' opinions about chewing gum were also investigated. METHODS: Subjects chewed 2 pellets, for 15 min, 2x daily for 12 months. RESULTS: In the ACHX group, the plaque and gingival indices significantly decreased (p<0.001) over the 12 months. In the X group, only the plaque score significantly decreased (p<0.05) and in the N control group, both indices remained high and did not change significantly. The acceptance of both chewing gums was high but more participants in the ACHX group felt that the gum kept their mouth healthy (p<0.05). The effect of the ACHX gum on plaque and gingival indices was significantly greater than for the X gum. CONCLUSION: The long-term use of a chlorhexidine acetate/xylitol chewing gum may therefore support oral hygiene routines for an elderly dependent population.     

Effects of 0.05% sodium hypochlorite oral rinse on supragingival biofilm and gingival inflammation

Objectives: This study aimed to evaluate the clinical effects of 0.05% sodium hypochlorite mouth rinse on supragingival biofilm and gingival inflammation. Methods: The study was performed as a controlled, randomised, investigator‐blinded, parallel group trial in 40 prison inmates. Following a preparatory period to obtain a plaque‐ and gingivitis‐free dentition, tooth‐brushing was substituted for 21 days by supervised twice daily rinsing with either 15 ml of fresh solution 0.05% sodium hypochlorite or 15 ml of distilled water. Clinical outcomes were assessed using the Quigley–Hein Plaque Index (QHPI), the Löe and Silness Gingival Index (L&SGI) and bleeding on probing. Adverse events were evaluated by questionnaire, visual examination and clinical photographs. Results: At day 21, the average QHPI score had increased to 3.82 in the water rinse group and 1.98 in the sodium hypochlorite rinse group. The average L&SGI score had increased to 2.1 in the water rinse group and 1.0 in the sodium hypochlorite rinse group, and the average percentage of sites that bled on probing had increased to 93.1% in the water rinse group and 56.7% in the sodium hypochlorite rinse group. Differences were statistically significant (P = 0.001). A brown extrinsic tooth stain along the gingival margin appeared in 100% of participants in the sodium hypochlorite rinse group and in 35.0% of participants in the water rinse group (P < 0.05). Conclusions: An oral rinse with 0.05% sodium hypochlorite resulted in significant reductions in supragingival biofilm accumulation and gingival inflammation. Dilute sodium hypochlorite may represent an efficacious, safe and affordable antimicrobial agent in the prevention and treatment of periodontal disease.     

The achievement and maintenance of inter-examiner consistency in the assessment of plaque and gingivitis during a multicentre study based in general dental practices

Abstract This study set out lo demonstrate that it was possible to train general dental pracitioners (gdps) to achieve and maintain high levels of inter-examiner consistency in the use of simple periodontal indices over a 12-month period. The gdps were trained by one trainer in the use of the plaque index (PlI) and a modified version of the gingival index (mGI) which assessed gingival bleeding only. All the gdps underwent intensive training and employed a technique, when assessing inter-examiner consistency in the use of the PlI, such that the 1st examiner did not disturb in situ plaque from 50% of the circumference of a tooth. The problem of variation due to repeat probing, when assessing inter-examiner consistency for mGI, was overcome by one examiner lightly probing gingival margins and both examiners scoring the results. The problems relating to the multicentre nature of the study included: distance between the centres, the need for strict adherence to the study protocol, consistency in the use of forms arid instruments, in the application of periodontal indices, and of inclusion and exclusion criteria. Techniques for overcoming these problems included: the planning and application of a coherent study design, which employed simple indices, a detailed protocol, the recruitment of very well-motivated gdps of similar age and experience as examiners, the recruitment of an experienced trainer who trained the gdps thoroughly and monitored their performance throughout the study, and repeat visits to the practices involved to explain the nature of the study to all their staff members. Initially, the gdps achieved inter-examiner K scores of 0.78–0.85 (mean 0.81) for PlI and of 0.73–0.94 (mean 0.87) for mGI when assessing 168 sites for each variable. During the following 12 months, individual κ scores, assessed every 3 months at 42 sites, ranged from 0.51–0.90 for P1I and from 0.73–1.00 for mGL Mean κ for PlI scores achieved by the five gdps fell during the study from 0.81 to 0.76, whereas that for mGI rose from 0.87 to 0.92. It is concluded that it is possible lo train gdps to achieve high levels of inter-examiner consistency in the use of P1I and mGI and for these high levels to be maintained during a 12-month multicentre study.     

The effect of a plaque control programme on the incidence and severity of cyclosporin-induced gingival changes

The efficacy of plaque control as a means of preventing cyclosporin-induced gingival overgrowth was assessed in 27 adult renal transplant patients. After baseline examination, patients were randomly allocated to receive intensive oral hygiene instructions, scaling and root planing (OH group) or no treatment (no treatment group). Gingival condition was assessed 6 months after baseline and changes in gingival form were related to various periodontal and pharmacokinetic measures. In both treatment groups, there was a significant increase (P less than 0.05) in gingival hyperplasia scores at 6 months. In the OH group, plaque scores were significantly lower (P less than 0.05) at 6 months, whereas in the no treatment group, a significant increase in plaque scores, gingival inflammation and probing depths was observed at 6 months. Dosages of cyclosporin, whole blood concentrations of cyclosporin, baseline gingival index, hyperplasia scores, and 6-month plaque index were not important determinants for the increase in gingival over-growth in both treatment groups. It is concluded that attention to plaque control and the removal of local irritants is of some benefit for the gingival health of cyclosporin-treated adult renal transplant patients, but these measures alone did not prevent gingival overgrowth. Pharmacokinetic variables of cyclosporin and various periodontal measures were not good predictors of cyclosporin-induced gingival changes.