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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.

Adult

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

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

Adolescent

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.

Administration, Topical

Susceptibility of various microorganisms to chlorhexidine.

The susceptibility to chlorhexidine of bacteria in aerobic, facultatively anaerobic and anaerobic isolates from clinical specimens of wounds, urine, saliva, and dental plaque was studied. Agar diffusion tests using 50 microng chlorhexidine discs and agar dilution tests were performed and the MIC values correlated with inhibition zone diameters. Anaerobic plaque strains were isolated and tested by the agar dilution method in an anaerobic glove box. Regression lines obtained for five agar media demonstrated a good correlation between zone diameters and MIC values. There was a broad range of susceptibility to chlorhexidine among both Gram-positive and Gram-negative strains. Low MIC values were noted for staphylococci, S. mutans, S. salivarius and E. coli, while strains of Proteus, Pseudomonas and Klebsiella were less susceptible. S. sanguis showed intermediate susceptibility with both low and high MIC values. Among the anaerobic isolates tested, the strains most susceptible to chlorhexidine were Propionibacterium and Selenomonas, While the least susceptible strains were Gram-negative cocci resembling Veillonella.

Bacteria

Effect of chlorhexidine on the relative proportions of Streptococcus mutans and Streptococcus sanguis in hamster plaque.

The effect of chlorhexidine on the proportions of Streptococcus mutans and Streptococcus sanguis in plaque was studied in hamsters fed a diet containing 28% sucrose. In animals given chlorhexidine in their drinking water for 10 d a decrease in the population of S. mutans and an increase of S. sanguis occurred in the plaque. Following the removal of chlorhexidine the population of S. mutans increased again in the presence of sucrose and the number of S. sanguis returned to initial values. When animals were given a sucrose-free diet the low proportion of S. mutans observed following the short-term chlorhexidine period persisted. These data indicate that there is an inverse relationship between the number of S. sanguis and S. mutans in plaque and that the sensitivity in vivo of S. mutans to chlorheximide can be used to suppress the population of S. mutans with a concomitant rise in the proportion of S. sanguis.

Animals

Effect of chlorhexidine on acidogenicity of dental plaque in vivo.

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

Adult

The effect of chlorhexidine and some other detergents on the activity of dextransucrase from Streptococcus mutans.

The inhibitory effect of chlorhexidine and other bis-biguanides on the formation of dental plaque is not fully understood. The present paper describes the effect of chlorhexidine and some selected detergents on the activity of dextransucrase (EC 2.4.1.5.), an enzyme involved in the formation of important components of dental plaque. All detergents examined exerted an inhibitory effect on dextransucrase activity, to some degree dependent on the presence of charged groups and their characters. The high concentrations of chlorhexidine necessary to inhibit dextransucrase activity seem to exclude the possibility that chlorhexidine exerts its plaque inhibiting effect by means of an effect on dextransucrase.

Biguanides

Chlorhexidine gel and Steradent employed in cleaning dentures.

It was the purpose of the study to test the efficacy of brushing with a 1% chlorhexidine gel or a commercial solution cleanser (Steradent) in preventing formation of plaque on the fitting surface of new dentures. The study group consisted of 74 denture wearers with denture stomatitis who were assigned randomly to one of four treatment groups, testing either the chlorhexidine gel, a placebo gel, Steradent, or a placebo solution. The experiment was started immediately after denture treatment was completed. The experimental period was 1 month. The amount of denture plaque, the clinical condition of the palatal mucosa, and the concentration of yeasts in mucosal and denture smears were recorded while the patients used their original dentures and after the experimental period. Plaque had formed on all new dentures but to a smaller extent in the groups testing the chlorhexidine gel or the placebo gel. The study does not provide any obvious evidence of a chemical effect of chlorhexidine gel or Steradent as a means to prevent formation of microbial plaque on the mucosal surface of maxillary complete dentures.

Biguanides

Microbiological evaluation of the efficacy of chlorhexidine in a sustained-release device for dentine sterilization.

The aim of this in-vitro study was to evaluate the effect of chlorhexidine in solution and in a sustained-release device as an intracanal medication. Hollow cylindrical dentine specimens prepared from bovine incisors were incubated with Streptococcus faecalis for a period of 3 weeks. The intracanal medicaments tested were 0.2% chlorhexidine gluconate solution (CH), chlorhexidine in a sustained-release device (1.2 mg) (SBD), camphorated paramonochlorophenol (CMCP), and a control (no medication). Each medicament was introduced into the lumen of one dentine specimen and incubated for 5 min, 24 h, 48 h or 7 days at 37 degrees C. The bacteriological samples were taken by shaving the dentine inside the lumen with dental burs ranging in size from ISO 023-033. The dentine powder was collected in test-tubes containing growth medium and incubated for 24 h. The optical density of the medium was recorded by means of a spectrophotometer at a wavelength of 540 nm. There was a statistically significant difference between the control group and all the medicaments tested.

Animals

The effect of chlorhexidine irrigation of the bladder in the rat.

Rats' bladders were irrigated with aqueous solutions of chlorhexidine digluconate 1 : 5,000 or 1 : 10,000 for varying periods up to 48 hours. Histologic examination of the bladders showed severe erosive cystitis in a high percentage of cases. It is concluded that chlorhexidine cannot be recommended for prolonged irrigation of the bladder or for instillation during the intermittent catheterisation where chlorhexidine has repeated and prolonged contact with bladder mucosa.

Animals

The mechanism of action of chlorhexidine.

Chlorhexidine did not inhibit ATPase in intact cells of Escherichia coli K12 W1317i-, even at bactericidal concentrations, and ATP hydrolysis was greatest at the highest concentration (40 mg/l), even though no net uptake of substrate occurred. Like dinitrophenol and tribrominated salicylanilide, polymyxin and chlorhexidine collapsed the membrane potential at inhibitory concentrations. Membrane disruption, and not ATPase inactivation, is considered the lethal event in chlorhexidine action.

Adenosine Triphosphate

Use of chlorhexidine gluconate and povidone iodine mouthwashes in the treatment of acute ulcerative gingivitis.

A trial was conducted to compare the effectiveness of povidone iodine and chlorhexidine gluconate with buffered peroxyborate in the treatment of acute ulcerative gingivitis. After 20 patients had entered the trial and 11 had required additional therapy with metronidazole to control their symptoms, the study was terminated. Those patients receiving peroxyborate all showed a satisfactory improvement in clinical signs and symptoms. One patient each receiving povidone iodine or chlorhexidine reported a symptomatic improvement, although gingival ulceration was still apparent at 1 week. The remaining patients all required metronidazole therapy to control their symptoms. Povidone iodine and chlorhexidine gluconate therefore cannot be recommended for the treatment of acute ulcerative gingivitis.

Acute Disease

Oral use of chlorhexidine gluconate toothpaste in epileptic children.

The purpose of this clinical study was to evaluate the effect of a 3-min daily toothbrushing with 1% chlorhexidine gluconate toothpaste on dental plaque, gingivitis and gingival hyperplasia in 30 mentally retarded epileptic children treated with phenytoin. A double-blind cross-over technique was used. Brushing once daily for 2 months with 1% chlorhexidine gluconate toothpaste resulted in significantly lower Pl I and G I values. Gingival hyperplasia was not significantly reduced by the use of the chlorhexidine toothpaste.

Administration, Oral

Absorption of chlorhexidine from the intact skin of newborn infants.

34 newborn infants who had been bathed in a standard manner with Hibiscrub were studied to find out whether it was absorbed percutaneously. Low levels of chlorhexidine were found in the blood of all 10 babies sampled by heel prick, and 5 of 24 from whom venous blood was taken. The detection of chlorhexidine varied greatly with the method and timing of sampling, and no correlation was found between gestational or postnatal age and chlorhexidine levels.

Age Factors

The irritancy of chlorhexidine gluconate in the genital tract of the mare.

Uterine irrigation was carried out in eight Welsh pony mares using 50 ml of chlorhexidine gluconate solution diluted to give active ingredient concentrations of 0.25 per cent to 2 per cent. Treatment was repeated up to twice in mares showing no adverse effects and irritancy of treatment judged on clinical symptoms and uterine biopsy. Results indicated the inadvisability of using a higher concentration than 0.25 per cent. Three daily applications of a diluted surgical scub solution containing 2 per cent chlorhexidine gluconate to the penis of an arab stallion failed to produce symptoms or irritation. An in vitro minimum inhibitory concentration test performed with the contagious equine metritis organism confirmed its high sensitivity to both chlorhexidine gluconate preparations.

Animals

Prolongation of antibacterial activity of chlorhexidine adsorbed to teeth. Effect of sulfates.

The results suggest that the effectiveness of sulfates in prolonging the antibacterial activity of teeth treated with chlorhexidine gluconate is related to the acidity and concentration of the sulfate solutions. The acidity may contribute to the effectiveness by modifying the tooth surface for enhanced reaction with sulfate ions. It is suggested that during the priming process bonded crystals of calcium sulfate develop which become transformed by treatment with chlorhexidine gluconate to relatively insoluble chlorhexidine sulfate.

Acid Etching, Dental

Cytopathologic effects of chlorhexidine on human cells.

Exposure of human cells in culture to chlorhexidine at concentrations equal to or greater than 0.004% resulted in impaired cellular function and/or cell death. Release of membrane bound 51Cr, inhibition of protein synthesis as measured by incorporation of 3H-leucine into protein-like material, and staining by trypan blue were seen as sequellae to exposure to 0.006% chlorhexidine for 3 hours. Lower doses were capable of inhibiting protein synthesis and releasing 51Cr, but did not result in staining of cells by trypan blue. Exposure of cells to 0.2% chlorhexidine for 30 seconds produced maximal suppression of protein synthesis and release of 51Cr.

Amino Acids

The effect of chlorhexidine gluconate on the formation of experimental granulation tissue.

The aim of the study was to investigate the effect of chlorhexidine gluconate on the connective tissue formation. Granulation tissue was produced with a method in which sponges were inserted beneath the back skin of rats. Dry sterilized sponges were impregnated either with 0.45% NaCl solution (control) or or 0.2% chlorhexidine solution [test]. The sponges were removed after 3, 5, 7, 10, 14, 19 and 23 days. The content of hydroxyproline, hexosamines, DNA and RNA was estimated from the sponges. The acid glycosaminoglycans were further purified and analyzed. The results of the study indicate that chlorhexidine had a clear delaying effect on the formation of granulation tissue.

Animals