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Effect of mouthwash and accelerated aging on the color stability of esthetic restorative materials.

PURPOSE: To evaluate the color stability of esthetic restorative materials after immersion in mouthwashes and accelerated aging. MATERIALS AND METHODS: Compomers and resin-based composites (RBC) were measured at baseline and repeatedly after immersion in three kinds of mouthwash (Listerine, Peridex, Rembrandt Age Defying) for 24 hrs and 7 days, and after aging for 150 kJ/m2. Color was measured according to CIE L*a*b* color scale on a reflection spectrophotometer. RESULTS: After immersion for 7 days, the mouthwash groups did not produce significantly higher color changes than the distilled water group, except with some mouthwashes used with Tetric-Ceram. After immersion for 7 days and aging for 150 kJ/m2, the mouthwash groups did not produce significantly higher color changes than the distilled water group. Aging in weathering chamber produced color change (deltaE*) of 1.1-3.9, which was mainly influenced by the material. With some exceptions, the color changes from immersion of the RBCs and compomers in mouthwashes were not perceptible (deltaE*<3.3).

Analysis of Variance↗

Alcohol-containing mouthwashes and oral cancer. Critical analysis of literature.

For centuries, mouthwashes have been used in order to provide us with oral health or cosmetic benefits. Nowadays, in most countries, there is a variety of formulas available for the general public in the form of products which may require prescription or not. Alcohol is used in mouthwashes as a solvent of other ingredients and as a preservative of the preparation. For years, different formulas of mouthwashes have been used, however, the question about its alcohol content being a threat for health or not has recently appeared. The high quantity of alcohol in some mouthwashes combined with the fact that they keep in contact with the oral mucosa for much more time than alcoholic drinks, can make us think about a harmful effect from a local mechanism. Mouthrinses increase the time of the mucosa being in contact with alcohol and it has been proved that those with a high content of alcohol do cause hyperkerastosic lesions both in human beings and laboratory animals. At the moment and with the data we have, it has not been possible to establish a causal relationship between the use of alcohol-containing mouthwashes and the development of oral cancer. There is neither an evidence of the fact that alcohol increases the effects of antiplaque agents in mouthwashes.

Case-Control Studies↗

Effects of a two-phase oil-water mouthwash on halitosis.

Many oral microorganisms possess hydrophobic outer surfaces. A two-phase, oil-water mouthwash has, therefore, recently been developed to remove such oral microorganisms. The oil phase consists of olive oil and other essential oils. The aqueous phase includes cetylpyridinium chloride, which is a disinfectant that promotes the adhesion of microorganisms to oil droplets. This study determined the effects of this mouthwash on the production of volatile sulfide in vivo and in vitro. Neither rinsing with water nor brushing teeth decreased the concentration of sulfide in mouth air at 3.5 h after treatment. A reduction of only 30% of sulfide was observed when a commercial mouthwash was used. However, this study demonstrated that use of the two-phase mouthwash led to approximately 80% reduction of sulfide. Furthermore, volatile sulfide and 2-ketobutyrate productions from methionine in a saliva putrefaction system were completely inhibited by the two-phase mouthwash; and consumption of methionine was decreased by 65 percent. It is concluded that the two-phase mouthwash strongly inhibits the production of volatile sulfide.

Adolescent↗

Effect of water and mouthwashes on pH of oral monkey mucosa.

Among the many factors involved in homeostasis, maintenance of hydrogen-ion concentration is one of the most important functions of the body. Surface pH measurements of oral tissues after rinsing with water or mouthwashes are meager. This report presents results of the effect of tap water and 9 commercial mouthwashes on intraoral pH under controlled conditions. Nine rhesus monkeys, 5 females and 4 males between 3 and 8 years of age, were used in this study. During measurements they were sedated with phencyclidine hydrochloride and anesthetized with pentobarbital sodium. A Beckman pH meter with potassium chloride and silver chloride combination electrode was utilized. The pH was measured on the lingual gingva opposite the right lower first molar. Control readings were obtained, then a 30-sec pulsed-water-jet lavage with tap water with a force of 5 psi was given, and the pH was observed for 5 min. The 1 ml of mouthwash was administered on a thoroughly soaked gauze for 30 sec. This procedure was repeated 3 times on different days for each of the 9 mouthwashes used. All of the measurements showed a decrease in pH after tap-water lavage. In general, acid mouthwashes decreased the pH, while mouthwashes with alkaline pH's increased the pH of the oral tissues. The effects on pH was, however, transitory since the major change appeared within 8 min and approached equilibrium by 12 to 16 min.

Animals↗

A controlled evaluation of an allopurinol mouthwash as prophylaxis against 5-fluorouracil-induced stomatitis.

Pursuant to a promising report suggesting that an allopurinol mouthwash could have a protective effect against 5-fluorouracil (5-FU)-induced stomatitis, the authors performed a randomized, placebo-controlled, double-blind, crossover study. Seventy-seven patients, receiving their first 5-day course of chemotherapy with 5-FU +/- leucovorin, were assigned to use a mouthwash containing 20 mg of allopurinol or a placebo. The mouthwash was administered every hour for four doses commencing with each chemotherapy dose. The severity of subsequent mucositis was graded (on a 0-4 scale) by the attending physician and also by a patient-completed questionnaire. There was trend toward less mucositis in the placebo group with mean physician-judged mucositis scores of 1.3 for placebo and 1.8 for allopurinol (P = 0.07) and mean patient-judged mucositis scores of 1.5 for placebo and 1.9 for allopurinol (P = 0.15). There were no substantial differences in mucositis attributable to the two mouthwashes in the patients who crossed-over on their second cycle of chemotherapy. These data demonstrate that the tested allopurinol mouthwash regimen does not offer any protective effect against 5-FU-induced mucositis.

Allopurinol↗

Alcohol content of proprietary mouthwashes.

The use of mouthwashes with high ethanol content has been linked to excess risks of mouth cancer, as have prolonged and frequent use of mouthwashes with lower ethanol contents. Twenty two proprietary mouthwashes available without prescription in Ireland were analysed by gas chromatography and their ethanol contents (w/v) at manufacturers' recommended dilutions for use were calculated. The ethanol contents of diluted mouthwashes ranged from < 0.01-23.40% w/v. 27% had ethanol contents > 10% w/v; 9% had ethanol contents > 20% w/v. As the use of the higher ethanol content mouthwashes may be a possible risk factor for oral cancer in frequent or constant users, we believe that the attention of the statutory regulatory authorities should be drawn to this situation.

Ethanol↗

Efficacy of an antibiotic mouthwash in contaminated head and neck surgery.

Twelve head and neck cancer patients scheduled to undergo an operation contaminated by entrance into the upper aerodigestive tract were enrolled in a prospective, randomized, double-blinded study to evaluate the efficacy of a preoperative antibiotic mouthwash in reducing oral cavity quantitative bacterial counts and the incidence of postoperative wound infections. The group who received the antibiotic mouthwash had a large reduction in the bacterial counts, whereas the group who received the placebo mouthwash had an increase in the bacterial counts (p = 0.024). None of the patients who received the antibiotic mouthwash had postoperative complications; two of the five patients who received the placebo mouthwash had postoperative complications.

Colony Count, Microbial↗

Influence of fluoridated mouthwashes on corrosion resistance of orthodontics wires.

The aim of the present study was to classify the different alloys commonly used to make orthodontic wire according to their corrosion resistance in different media. The four materials analysed were titanium-based alloys: TMA, TiNb, NiTi and CuNiTi, which were tested in three fluoride mouthwashes: Elmex, Meridol and Acorea as well as in Fusayama Meyer artificial saliva. The electrochemical study showed that the alloys could be divided into two groups. In one group were the NiTi-based alloys which were subject to strong corrosion in the presence of monofluorophosphate found in Acorea solution. In the other group were TiNb, which was the most resistant to corrosion, and TMA, which corroded strongly with the stannous fluoride found in Meridol mouthwash. The results obtained in the present study will enable us to provide attending practitioners with advice concerning fluoride mouthwash to recommend, depending on the treatment phase and the alloy used. So we can advise Elmex mouthwash for patients with TMA and NiTi-based orthodontics wires but we suggest Acorea or Meridol mouthwashes for patients with TiNb orthodontics wires.

Corrosion↗

Oral cancer and mouthwash use: evaluation of the epidemiologic evidence.

BACKGROUND: An association between mouthwash use and cancer of the oropharynx has been the focus of many epidemiologic studies. PURPOSE: To critically review the methodology of studies of this association. METHODS: Studies were identified through a computerized MEDLINE search of English-language publications from 1976 to 1994. Eligible studies were independently reviewed, and specific criteria were applied to assess issues in the design, analysis, and results of the studies. Methodologic criteria were used that define a case-control study of acceptable epidemiologic quality: (1) histologic confirmation of cancer; (2) use of incident cases; (3) population-based cases; (4) equal exclusions of controls; (5) population-based controls; (6) exposure to mouthwash use before the cancer diagnosis; and (7) adjustments or restrictions for tobacco, alcohol, or both. RESULTS: Seven case-control studies were identified. The odds ratios for these studies ranged from a protective effect (0.82 for any use of mouthwash) to an elevation in risk (2.5 at the highest exposure). Two studies had significant unadjusted odds ratios for the risk of oral cancer. Of the three studies with data on women adjusted for tobacco and alcohol use, one was statistically significant, and none of the three similar studies in men was significant (although one was close). The five studies with data on female nonsmokers, nondrinkers, or both had odds ratios ranging from 1.1 to 3.16 (only one study was significant at the p = 0.05 level), and the four studies with similar data on men were not significant. Two studies met only two of the methodologic criteria, three studies met three, one met four, and one met all seven. CONCLUSIONS: Few of the available studies on mouthwash use and risk of subsequent oropharynx cancer adhere to basic methodologic principles of case-control design. Neither the data for the overall association nor the analysis in patients without other clinical risk factors support a link between mouthwash use and oral cancer.

Female↗

Mouthwash use and dentures in relation to oral epithelial dysplasia.

This case-control study investigated the potential association between oral epithelial dysplasia (OED) and both mouthwash and denture use. Incident OED cases aged 20-79 years were identified through two oral pathology laboratories. Controls were pair-matched (1:1) to cases on age (+/- 5 years), gender, appointment date and surgeon. A telephone interview was used to obtain exposure information. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were generated using conditional logistic regression. Based upon 127 case-control pairs and after adjusting for smoking, drinking, education and either denture or mouthwash use, the OR for OED and regular mouthwash use (1+ uses/week for 6+ months) was 0.8 (95% CI, 0.4-1.5) while the OR for OED and wearing a denture was 0.7 (95% CI, 0.4-1.3). There were no clear trends of increased OED risk with increased mouthwash use or years of denture wearing. Our findings suggest that neither mouthwash nor denture use are associated positively with OED risk.

Adult↗

Formation of nitrosamines during consumption of nitrate- and amine-rich foods, and the influence of the use of mouthwashes.

We studied the formation of carcinogenic nitrosamines during consumption of food rich in nitrate and amines, and its possible inhibition by use of an antibacterial mouthwash. Twelve volunteers were fed a diet containing the high-nitrate vegetables lettuce or spinach during two periods of four consecutive days, in combination with fish products containing high levels of amines as nitrosatable precursors. During the two periods, the subjects used an antibacterial mouthwash containing chlorhexidine or a control mouthwash without antibacterial activity. Twenty-four-hour urine samples were collected after consumption of the meals, and saliva samples were collected 1 h after each meal. The nitrate and nitrite contents of the urine and saliva samples were determined by spectrophotometry (for nitrite) and HPLC (for nitrate). The concentrations of volatile nitrosamines in the urine samples were determined by gas chromatography-mass spectrometry. Significant increases in mean urinary nitrate levels (from 59 to 135 mg/24 h) and in mean salivary nitrate levels (from 10 to 56 microg/ml) and salivary nitrite levels (from 2 to 11 microg/ml) were observed during the consumption of food rich in nitrate and amines, as well as a significant increase in the mean urinary excretion of total examined volatile nitrosamines (from 2 to 7 nmol/24 h) and of N-nitrosodimethylamine (from 1.2 to 2.9 nmol/24 h). Use of the antibacterial mouthwash resulted in a decrease in mean salivary nitrite levels from 16 to 3 microg/ml and a decrease in mean urinary excretion of N-nitrosomorpholine (from 7.0 to 0.3 nmol/24 h). For the whole data set, significant correlations were observed between nitrate intake in food and urinary nitrate (p = 0.01; r2 = 0.07) and between urinary nitrate and urinary N-nitrosodimethylamine (p = 0.002; r2 = 0.11). In conclusion, consumption of a diet rich in nitrate and amines increases the risk of formation of carcinogenic nitrosamines. Use of an antibacterial mouthwash containing chlorhexidine can result in inhibition of nitrosamine formation.

Adult↗

Development of patient-friendly preparations: preparation of a new allopurinol mouthwash containing polyethylene(oxide) and carrageenan.

Stomatitis is a harmful side effect induced by high and/or multiple dosing of cytotoxic drugs such as 5-fluorouracil. Allopurinol mouthwash has been used to prevent stomatitis induced by cancer chemotherapy. In the present study, the pharmaceutical utility of allopurinol mouthwash (Alkox-mw), which consists of polyethylene(oxide) (Alkox) and iota-carrageenan (INA), was investigated as a possible material for a new oral dosage preparation for improving the adhesiveness onto the oral mucosa. From the observation of the gel formation, which was studied as a function of the variety of the added Alkox and/or INA, the preferential compositions of Alkox-mw (Alkox:INA % ratio) seemed to be 1.0:(0-1.0) and (0-3.0):0.4, respectively. The adhesiveness and the spinnability of various allopurinol mouthwashes were also investigated using a creep meter. The adhesiveness of Alkox-mw increased with the increase in the amount of added Alkox. Furthermore, the adhesion force of Alkox-mw was greater than that of allopurinol mouthwash consisting of sodium carboxymethylcellulose (CMC-Na). From the in vitro assessment of mimicking the effusion of the allopurinol mouthwashes from the surface of the oral mucosa, the effusion of Alkox-mws was retarded by the added Alkox. The results obtained in the present study suggest that Alkox-mws may be useful as a new dosage form that adheres to the oral mucosa.

Adhesiveness↗

Corrosion resistance of three orthodontic brackets: a comparative study of three fluoride mouthwashes.

In the present study, three types of orthodontic brackets were investigated: cobalt-chromium (CoCr), iron-chromium-nickel (FeCrNi) and titanium (Ti) based. Their corrosion resistance was compared with that of platinum (Pt), which was chosen as the reference material because of its excellent electrochemical properties. The test solutions were Elmex, Meridol and Acorea fluoride mouthwashes. Fusayama Meyer artificial saliva was used as the reference solution. The corrosion resistance of the different brackets in the three mouthwashes was assessed electrochemically to determine the corrosion potential and corrosion current density, and polarization resistance values were then calculated. A scanning electron microscopic (SEM) study and an analysis of released metal ions confirmed the electrochemical studies. The results showed that the bracket materials could be divided into two groups: Ti and FeCrNi in one, and CoCr, which has properties close to those of Pt, in the other. Similarly, two groups of electrolytes were identified: Elmex and Acorea mouthwashes in one group, and Meridol mouthwash in the second group. The results indicate that because of the risk of corrosion Meridol mouthwash should not be prescribed for patients wearing Ti or FeCrNi-based orthodontic brackets.

Alloys↗

A study of the relationship between mouthwash use and oral and pharyngeal cancer.

As part of a larger case control study on a male veteran population at risk (drinking and smoking) for oral and pharyngeal cancer, 95 cases and 913 controls provided complete histories in a questionnaire that included data on mouthwash use. Analysis revealed no significant differences in the frequency of mouthwash users in cancer cases versus controls. In addition, no significant differences could be found between users and nonusers of mouthwash in relation to age or smoking and drinking habits. When a logistic regression analysis was performed to simultaneously remove the effects of age, or smoking and drinking habits, while controlling for all other factors, oral and pharyngeal cancer did not appear related to mouthwash use. In this study there is no evidence that mouthwash is a risk factor in the development of oral and pharyngeal cancer in males.

Adult↗

Collection of genomic DNA by the noninvasive mouthwash method for use in pharmacogenetic studies.

STUDY OBJECTIVE: To determine long-term stability, quantity, and quality of genomic DNA samples collected in buccal cells by the mouthwash method, for use in pharmacogenetic studies. DESIGN: Prospective analysis. SETTING: University pharmacogenomics center in Florida and medical centers in Puerto Rico and the United States participating in a multicenter international trial. SUBJECTS: Ten volunteers at the pharmacogenomics center and 201 participants in the ongoing multicenter clinical trial. INTERVENTION: Stability of genomic DNA was determined by measuring DNA yield from mouthwash samples obtained from six volunteers and stored at room temperature over 90 days and from 201 clinical trial samples that were stored and shipped at room temperature. Whether DNA yield was higher with three 5-ml mouthwash rinses versus one 10-ml rinse was evaluated in four volunteers. Quality of genomic DNA was assessed on 32 randomly selected samples from the six volunteers in the stability study, by determining the success rate of DNA amplification with polymerase chain reaction (PCR) testing and by genotyping. MEASUREMENTS AND MAIN RESULTS: For the stability studies, the quantity of genomic DNA decreased over time with storage at room temperature (overall p < 0.01), with the largest declines occurring at 60 and 90 days. Median DNA recovery at 30 and 90 days was 59% and 28% of that at baseline, respectively. Mean +/- standard deviation, median, and range for recovery of genomic DNA from the 201 samples were 45.2 +/- 55 microg, 25.2 microg, and 1-330 microg, respectively. Median recoveries of DNA from the one-rinse and three-rinse methods were not statistically significantly different (9.1 vs 10.5 microg). All samples were amplified successfully by PCR and genotyped, indicating quality of the DNA samples. CONCLUSION: The mouthwash method for collection of genomic DNA is a simple, inexpensive, and noninvasive method that poses less risk than venipuncture and may be used in a variety of settings. Genomic DNA in mouthwash is stable for prolonged periods at room temperature, and the quantity of DNA recovered from this method is more than sufficient for pharmacogenetic studies. Such an approach should be valuable to pharmacogenetic researchers and others who are conducting genetic research.

DNA↗

Amine fluoride/stannous fluoride and chlorhexidine mouthwashes as adjuncts to surgical periodontal therapy: a comparative study.

BACKGROUND: Postsurgical mouthwashes are routinely used in clinical studies and also in daily clinical practice. Chlorhexidine gluconate (CHX) has long been the gold standard for supra-gingival chemical plaque control regimens. Amine fluoride/stannous fluoride (AmF/SnF2) formulations have also been extensively studied and shown to have an antibacterial effect and be useful as antiplaque agents. The antibacterial effect of AmF/SnF2 and its minimal extrinsic tooth staining make it a possible alternative to CHX as an adjunct to periodontal surgical therapy. The aim of this double-blind, controlled clinical trial was to evaluate and compare the combined effect of an AmF/SnF2 or a CHX mouthwash and surgical periodontal therapy on periodontal parameters. METHODS: Thirty-two patients with at least 3 pockets > or =5 mm in the same quadrant were selected for this study, following a hygienic phase of therapy. They were randomized into 2 treatment groups: surgical flap debridement and a postsurgical CHX mouthwash or surgical flap debridement and an AmF/SnF2 postsurgical mouthwash, performed twice daily for 3 weeks. Clinical measurements were taken at baseline and 3 and 12 weeks postsurgery. RESULTS: Both treatment modalities resulted in significant improvements in probing depth and clinical attachment level. There was no significant difference between groups in any of the recorded parameters. Staining index at week 3 in the CHX group was significantly higher than in the AmF/SnF2 group (P<0.05). However these differences leveled down at 12 weeks. CONCLUSIONS: Our results support the alternative use of an AmF/SnF2 mouthwash in plaque control management of patients following flap debridement surgery.

Amines↗

[Antibacterial activity of Chinese medicine kou-kang mouthwash and its acute toxicity test].

OBJECTIVE: To study the antibacterial activity of Chinese medicine kou-Kang mouthwash and its acute toxicity, and provide the basis of experiment and therapy for infectious diseases of the oral cavity. METHODS: Minimal inhibitory concentrations (MIC) of kou-Kang mouthwash were determined by the agar dilution method, and the acute toxicity was done. RESULTS: The range of MIC kou-Kang mouthwash against 27 Gram negative bacterial were 0.03-1.0 g.ml-1. MIC50 was 0.125 g.ml-1 and MIC90 was 0.125-0.5 g.ml-1. The range of MIC kou-Kang mouthwash against 21 Gram positive bacterial was 0.008-0.5 g.ml-1. The range of MIC50 and MIC90 were 0.015-0.125 g.ml-1 and 0.015-0.5 g.ml-1, respectively. The value of MIC was 0.015 g.ml-1 against candidia albicans. The acute toxic test indicated that the maximum tolerance dose was 417.6 g.kg-1 and 210 times as much as the clinical dose a day. No death of animals or toxicity and side-effect occurred in the test. CONCLUSION: Kou-Kang mouthwash shows a potent antibacterial activity against various pathogens of the oral cavity. Its antibiotic activity against Gram positive bacteria was 2-8 times stronger than that against Gram negative bacteria. It has low toxicity and can be used in clinical application.

Animals↗

Mouthwash use and oral conditions in the risk of oral and pharyngeal cancer.

Interviews with 866 patients with cancer of the oral cavity and pharynx and 1249 controls of similar age and sex from the general population in four areas of the United States revealed increased risks associated with the regular use of mouthwash. Risks of oral cancer were elevated by 40% among male and 60% among female mouthwash users, after adjusting for tobacco and alcohol consumption. Risks among both sexes generally increased in proportion to duration and frequency of mouthwash use. The increased risks were confined to users of mouthwash high in alcohol content, consistent with the elevated risks associated with drinking alcoholic beverages. Except for a higher prevalence of leukoplakia among cases, little relationship was found with oral or dental conditions, although denture wearing was reported more often by patients with cancer of the gums. These findings, together with other studies, provide further incentive for clarifying the association between mouthwash use and oral cancer.

Adult↗