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PubMedDate not supplied

[Effect of cetylpyridinium chloride on formation and metabolism of human dental plaque].

In this work, the Cepacol (cetylpyridinium chlorid) diluted 1:2, when used for mouthwashes three time a day decreased the "in situ" formation of human dental plaque, however it didn't decreased neither the plaque fermentation, nor the IEP synthesis by the plaque. When the Cepacol was used for treating the "in vitro" dental plaque in both 1:10 and 1:20 dilutions, decreased the fermentation and the IEP synthesis of the "in vitro" plaque.

Cetylpyridinium↗
PubMed1989

[The significance of the contamination of dental care articles. The results of a field study].

Permissible conclusions both from recent available literature and our own field-study results concerning the problematic nature of microbial contamination of dental hygiene articles and the resulting possible health hazard for the consumer can be summarized as follows: Manufacturing practices as are given in the basic instructions for production sites of the cosmetic industry, render a possible degree of microbial contamination. This largely rules out the danger of infection of the consumer upon acquisition of the dental hygiene product. Secondary contamination of these products, as inevitably is the case during use of dental hygiene articles, leads to microbial colonization especially of toothbrush bristles. The extent of this colonization depends at least partially upon the utilization age of the toothbrush. Also for this reason a toothbrush should be replaced by a new one after period of three months, six months at the latest and in all cases of inflammatory changes of the mouth and throat region. The contamination of both the glass or plastic container used for rinsing the teeth after brushing or for gargling can be held within certain limits by dry storage. Only in exceptional cases do mouthwashes show a small degree of contamination. Provided they contain antimicrobial substances, no therapeutically serviceable possibilities worth mentioning follow for the reduction of oropharyngeal flora. Microbial colonization of toothpastes as a result of secondary contamination following use is observed only in exceptional cases due to their preservative content. Significant germination of stagnated residual water in waterpicks often occurs, achieving germ counts up to more than 10(7) cfu per ml. Moreover, waterpicks can represent a biotope for Pseudomonas aeruginosa, and should be used neither by patients with open wounds or mucous membrane lesions in the oropharyngeal area, nor by patients with reduced immune resistance. Manufacturers of waterpicks are urged to impede or prevent the stagnation of residual water more effectively by introducing constructive improvements. Denture and retainer cleansing agents presently on the market display a sufficient antimicrobial effect within the frame of their application, however do not meet the standards set for disinfectants. Dental hygiene products are without relevance for the epidemiology of Legionnaires' disease.

Bacteria↗
PubMed1989

Oral hygiene products may cause dental erosion.

The erosive effects of the mouthwashes Calcusan, Salisan and Veadent, and of a tablet, Salivin, meant to be sucked, were studied using enamel blocks from bovine permanent teeth. For comparison, the Hart-Sport sport drink (pH 3.1), which is known to be erosive, and carbonated mineral water Vichy (pH 5.4), which is known to have no erosive effect, were also tested. After two hours of exposure to each test product losses of tooth material were measured by recording the surface profile, using a Dectak profilometer. Changes in the enamel blocks were also studied using a stereomicroscope and a scanning electron microscope (SEM). In the profilometric study, Calcusan was found to have a marked erosive effect (77 +/- 5 microns), four times as severe as the erosive effect of the positive control Hart-Sport (19 +/- 4 microns). Veadent had a less marked effect (3 +/- 1 microns). Salisan and Salivin had no detectable erosive effects and were similar in action to the negative control, carbonated mineral water. From the SEM pictures, Calcusan resulted in an EDTA-type reaction, with dissolution of the peripheral areas of enamel prisms. It is important to recognize that the organic acids and chelating agents in various oral hygiene products may have deleterious effects on teeth.

Alkaloids↗
PubMed1989

Dental bacteremia and its relationship to bacterial endocarditis: preventive measures.

This article indicates that using local degerming agents in conjunction with traditional antibiotics prevents dental bacteremia more effectively than either procedure alone. In many patients at risk for endocarditis who practice home-care procedures than can produce bacteremia from gingival bleeding, daily antibiotic prophylaxis is impractical and contraindicated. This article discusses an effective method to control daily bacteremia with 0.2% chlorhexidine mouthwash. The article also attempts to identify patients at risk, determine the degree that they are exposed to potentially bacteremic situations, and encourage an aggressive team approach of physician and dentist to protect such patients adequately. Recommendations to prevent bacteremia are offered to supplement traditional antibiotic regimens.

Animals↗
PubMed1989

Toothpastes containing 0.3% and 0.5% triclosan. I. Effects on 4-day plaque regrowth.

Triclosan has been added to toothpaste formulations, alone or with zinc salts, to reduce plaque regrowth. The most encouraging results have been obtained with triclosan/zinc formulations particularly at the higher concentrations of one or both agents. Formulations containing 0.2% triclosan alone have shown less promise and the aim of this study was to measure plaque regrowth over 4-day periods with the use of 0.3% and 0.5% triclosan toothpastes with and without the addition of a copolymer, polyvinyl methyl ether maleic acid (PVM/MA) and to compare the findings with a conventional fluoride/anionic detergent based toothpaste and a 0.2% chlorhexidine mouthrinse. The method was a no oral hygiene randomized 6 times crossover study using the toothpaste slurry rinsing method. Plaque was recorded by a plaque index and by area. Three of the four triclosan toothpastes reduced plaque regrowth significantly compared with the placebo, with no significant differences among the triclosan toothpastes. Plaque scores were always significantly lower with the chlorhexidine mouthwash compared to all toothpastes. The results suggest that at 0.3% to 0.5% triclosan alone or with a copolymer toothpaste may be a benefit to oral hygiene, but whether this is sufficient to affect gingival health requires further clinical evaluation. Further research would also appear indicated to determine optimal levels for the copolymer concentrations in toothpastes.

Adult↗
PubMedDate not supplied

Direct plaque removal by a pre-brushing dental rinse.

A study was conducted to evaluate the ability of a dental rinse to remove dental plaque. The hypothesis was tested that plaque, as a complex soil comprising microorganisms, cell debris, salivary deposits and other ill-defined organic and inorganic components, would be susceptible to removal by a rinse with high detersive action. A rinse was prepared based on the principles applied to formulation of products for cleansing biologic surfaces, including anionic and nonionic surfactants, sodium benzoate, and auxiliary cleansing agents. Subjects randomly selected from a dental clinic population were scored for plaque area on the lingual and buccal surfaces of the Ramfjord teeth using the Turesky modification of the Quigley-Hein Index. The subjects then rinsed 30 seconds with 15 ml of product, and stainable plaque area was scored again. The rinsing reduced average plaque scores by an average of 13-20%, a very high level of significance. A placebo rinse and a conventional mouthwash removed 2.0% and 1.3% stainable plaque, respectively. The experimental rinse substantially increased the number of surfaces that were totally free of plaque.

Adult↗
PubMed1978

Partial and full mouth recording of gingivitis scores.

Sixty-six dental students, randomly assigned to one of three examiners, were scored initially for gingivitis using the Columbia gingival index (GI). After four weekly prophylaxes, gingival scores for all teeth were recorded at day 0. Following prophylaxes, all subjects were randomly assigned one of three mouthwash formulations. Gingival scores were taken on the full mouth after three weeks and again after six weeks. Pearson product moment correlation coefficients (r) were obtained for the gingivitis index from six selected teeth (partial score) with the full mouth score, usually based on 24 to 28 teeth. GI scores obtained from partial recording on the six selected teeth correlated very well with scores obtained from full mouth examinations. A special study was set up to obtain independent GI readings for the six target teeth and for the full mouth. GI scores obtained by independent examinations of the six selected teeth also correlated well with the full mouth scores, although not as well as when the partial scores were derived from the full mouth scores. Partial scores should only be compared with partial scores obtained from evaluating the same teeth and not with full mouth scores, in clinical trials or epidemiologic surveys.

Drug Evaluation↗
PubMedDate not supplied

Circulatory response to laryngoscopy and tracheal intubation with or without prior oropharyngeal viscous lidocaine.

Oropharyngeal topical anesthesia with viscous lidocaine (25 ml of 2% as a "mouthwash and gargle" 10 min before laryngoscopy) attenuated the pressor but not heart rate (HR) response during laryngoscopy and tracheal intubation. Compared with control patients, mean arterial pressure (MAP) increased less in response to tracheal intubation (23 +/- 5 torr versus 39 +/- 4 torr, p less than 0.05) and returned toward awake levels sooner in patients receiving viscous lidocaine. MAP increased more than 40 torr in response to intubation in 6/20 patients treated with viscous lidocaine, while 12/20 control patients manifested this degree of blood pressure elevation. HR increased about 20 bpm (p less than 0.05) with or without viscous lidocaine. Arterial lidocaine concentrations were less than 0.5 microgram/ml after oropharyngeal anesthesia. Prior topical anesthesia of the oropharynx with viscous lidocaine should be considered when pressor responses during tracheal intubation would be particularly likely or hazardous.

Anesthesia, Local↗
PubMed1995

Mouth care for patients receiving oral irradiation.

Oral irradiation causes acute mucositis and pain, dry mouth, loss of taste, impaired nutrition, depression and isolation. These problems can be significantly improved by skilled, research-based nursing care. The most important factors in oral care are frequent mechanical cleansing, good pain control, effective management of candida and regular, structured evaluation. An oral care regime using saline rinses may be more effective than a regime using a more astringent mouthwash. The use of an oral assessment guide and protocol ensures that all patients receive the same high-quality care. They simplify documentation and are useful audit tools and teaching aids.

Acute Disease↗
PubMedDate not supplied

Cyclosporine A, an alternative to the oral lichen planus erosive treatment.

We present a double-blind study in two groups afflicted with oral lichen planus erythematous of long evolution and resistant to other treatments. We tested on it a treatment with Cyclosporine A (CyA) which had been successfully used before by many dermatologists. In the group A we used mouthwashes with a 5 ml Cyclosporine A solution to a 10% in olive oil of 0.4 degrees of acidity for five minutes, three times a day for eight weeks. In the control group we used acetonide of triamcinolone 01% in aqueous solution. Patients in group A improved considerably in their symptomatology in a 90% against a 60% in group B. In group A we could appreciate a disappearance of the symptomatology after two weeks of treatment in 60% of patients against 30% in group B. CyA can be an alternative to the conventional treatments in the acute period of lichen planus although it can not be considered as a first option drug because of the high cost of the treatment. For long term, results are not so good and we consider that extensive studies are necessary.

Acute Disease↗
PubMed1997

Oral malodor: philosophical and practical aspects.

Although oral malodor or bad breath is an unpleasant condition experienced by most individuals, it typically results in transient discomfort. At least 50 per cent of the population suffer from chronic oral malodor, however, and approximately half of these individuals experience a severe problem that creates personal discomfort and social embarrassment. The mouth air of chronic malodor sufferers is tainted with compounds such as hydrogen sulphide, methyl mercaptan and organic acids, which produce a stream of foul air that is gravely offensive to the people in their vicinity. Sufferers often make desperate attempts to mask their oral malodor with mints and chewing gum, compulsive brushing, and repeatedly rinsing with commercial mouthwashes. While dental diseases have been strongly associated with this condition, there is considerable evidence that dentally healthy individuals can exhibit significant levels of mouth odor. Proteolytic activity by microorganisms residing on the tongue and teeth results in foul-smelling compounds, and is the most common cause of oral malodor. A specialized device called the halimeter is available to measure the volatile sulphur compounds in mouth air. Many of the manufacturers of bad breath remedies claim that their products contain antibacterial mechanisms with sufficient strength to control oral malodor over long periods of time. None, however, effectively eliminate the problem. Interest in oral malodor research and clinical treatment has increased in the last few years, and this distressing problem is finally getting the attention it deserves.

Breath Tests↗
PubMed1997

Use of environmental scanning electron microscopy to evaluate dental stain removal.

The purpose of the study was to assess the usefulness of environmental scanning electron microscopy (ESEM) to evaluate stain removal from extracted teeth. The ESEM differs from conventional SEM in that no sample preparation is needed, eliminating artifactual changes. Furthermore, the same sample can be viewed on multiple occasions, allowing "before" and "after" pictures of the same tooth. As a model stain removal device, we tested the Sonicare sonic toothbrush, which has previously been shown to remove dental stain in vivo. Twelve freshly extracted teeth with extrinsic coffee, tea or tobacco stain were obtained for the study. Nine of these had heavy stain (stain covering more than one-third buccal or lingual surface) and were used without further modification. Three teeth were treated in vitro with chlorhexidine and a mixture of coffee and tea to enhance staining. All teeth were examined by ESEM at three times: prior to brushing, after 15-30 seconds of brushing, and after 60-80 seconds of brushing. Light microscopy and 35 mm photography was also done to correlate the ultrastructural changes with those visible at low magnification. Water, mouthwash and 30% slurry of toothpaste were used as fluid vehicles during brushing, but little difference in stain removal was noted among these three fluids. Approximately half the stain was removed within 15-30 seconds, and most visible stain was removed in 60-80 seconds of brushing. Pits and crevices of tooth enamel that were smaller than the bristle diameter, and thus would be inaccessible to abrasive cleaning by direct bristle contact, were generally found to be stain-free. These findings confirm previous reports of the stain removal effectiveness of the Sonicare, and demonstrate the usefulness of ESEM for stain removal studies.

Chlorhexidine↗
PubMed1997

Bactericidal effects of mouth rinses on oral bacteria.

The bactericidal efficacy of two types of Listerine; Listerine and Cool Mint Listerine, and povidone iodine on oral microorganisms, methicillin-resistant Staphylococcus aureus (MRSA), Streptococcus pyogenes, Helicobacter pylori and Candida albicans were examined. Most of the oral bacteria were killed completely by a 10-sec exposure to Listerine or Cool Mint Listerine. H. pylori, MRSA and C. albicans were also reduced by a 30-sec exposure to the Listerine mouth rinse. Bacteria in dental plaque were decreased by exposure to Listerine, Cool Mint Listerine, and povidone iodine for 30 seconds. Mouthwashing with Listerine for 30 seconds resulted in a decrease to approximately 1/100 of the viable bacterial counts in saliva. These bactericidal effects against bacteria in saliva and dental plaque indicated that Listerine and Cool Mint Listerine antiseptic are useful in oral cavity as antiseptic mouth rinses.

Adult↗
PubMed2002

Treatment of chronic erosive oral lichen planus with low concentrations of topical tacrolimus: an open prospective study.

BACKGROUND: Chronic erosive oral lichen planus (EOLP) is a severe form of lichen of the buccal mucosa that is often resistant to systemic or topical therapies. OBJECTIVE: To evaluate the efficacy and safety of topical tacrolimus, 0.1 mg per 100 mL of water, in treating EOLP. DESIGN: Open-label, prospective, noncomparative study, with 6 months of treatment and 6 months of follow-up. SETTING: Dermatology department at a university hospital in Nice, France. PATIENTS: Ten patients with histologically proved EOLP that was refractory to treatment. Two patients were withdrawn because of noncompliance; findings in 8 were available for evaluation. INTERVENTIONS: Mouthwashes with tacrolimus, 0.1 mg per 100 mL of distilled water, 4 times daily for 6 months. MAIN OUTCOME MEASURES: Efficacy was assessed using a calculated score that combined the intensity of spontaneous and meal-triggered pain and the surface area of erosions. Safety assessment included the monitoring of adverse effects, clinical laboratory values, and blood concentrations of tacrolimus. RESULTS: Among the 8 patients evaluated, 1 had no improvement and 7 were improved. The mean score decreased from 7.00 at baseline to 5.43 (a 22.43% decrease) at 1 month, 4.14 (a 40.86% decrease) at 2 months, 3.00 (a 57.14% decrease) at 3 months, 2.43 (a 65.29% decrease) at 4 months, 2.57 (a 63.29% decrease) at 5 months, and 3.43 (a 51.00% decrease) at 6 months. A decrease of symptoms was reported by the 7 responding patients as soon as the first month of treatment. No severe adverse effects were observed. All patients had whole-blood concentrations of tacrolimus below the detection limit of the assay (1.5 ng/mL) at all intervals. At 9 months, 6 patients had had a relapse within a mean of 38.6 days. At 12 months, all patients had had a relapse and required treatment with topical corticosteroids or systemic hydroxychloroquine sulfate. CONCLUSION: Results of our study suggest a rapid and important palliating effect of low concentration of topical tacrolimus in distilled water in patients with EOLP.

Administration, Topical↗
PubMed2002

Nutrition support for bone marrow transplant patients.

BACKGROUND: Bone marrow transplantation involves the administration of toxic chemotherapy and infusion of marrow cells. After treatment, patients can develop a poor appetite, mucositis and gastrointestinal failure, leading to malnutrition. To prevent this, parenteral nutrition (PN) support is the first choice but is associated with an increased risk of infection. Enteral nutrition (EN) is an alternative, as is the addition of substrates e.g. glutamine to enteral and parenteral solutions. However, the relative effectiveness of these treatments is not clear. OBJECTIVES: To determine the efficacy of EN or PN support for patients receiving a bone marrow transplant. SEARCH STRATEGY: Trials were identified by searching the Cochrane Library (Issue 4, 2000 ), MEDLINE (1966-2000), EMBASE (1988-2000) and CINAHL (1982-2000 ). Reference lists of identified trials and conference proceedings were searched for relevant reports. Date of the most recent search: 2000. SELECTION CRITERIA: RCTs that compared one form of nutrition support with another, or control, for bone marrow transplant patients were included. DATA COLLECTION AND ANALYSIS: Thirty five reports were identified, 11 were excluded. Two reviewers extracted data from 24 studies; 16 were allocated to four interventions: oral glutamine versus placebo; PN and glutamine versus standard PN; PN versus IV hydration; PN versus EN. Eight studies were other interventions. Data were collected on participants' characteristics; adverse effects; neutropaenia; % change in body weight; graft versus host disease; and survival. Trialists were contacted for unreported data. MAIN RESULTS: Two studies (82 subjects) found that glutamine mouthwash reduced days of neutropaenia (6.82 days, 95% CI (1.67-11.98) p=0.009) compared with placebo. Three studies (103 subjects) showed that patients receiving PN with glutamine had a reduced hospital stay, 6.62 d (95% CI 3.47, 9.77, P=0.00004) compared with patients receiving standard PN. Two studies (73 subjects) indicated that patients receiving PN plus glutamine had a reduced incidence of positive blood cultures (OR 0.23, 95% CI 0.08-0.65, p=0.006) compared to those receiving standard PN. One study, (25 subjects) showed patients receiving PN had a higher incidence of line infections (odds ratio 21.23, 95% CI 4.15,108.73, P=0.0002) compared to those receiving standard IV fluids. There were no evaluable data to compare PN with EN. REVIEWER'S CONCLUSIONS: Lack of evaluable data means that the relative effectiveness of EN versus PN cannot be evaluated. Further studies and missing data from completed trials need to be retrieved. Studies comparing PN with glutamine versus standard PN suggest that patients leave hospital earlier, and experience a reduced incidence of positive blood cultures, than those receiving standard PN. Patients with gastrointestinal failure should consider PN with the addition of glutamine if enteral feeding is not possible.

Bone Marrow Transplantation↗
PubMed2002

Interventions for replacing missing teeth: maintaining and re-establishing healthy tissues around dental implants.

BACKGROUND: To maintain healthy tissues around oral implants it is important to institute an effective preventive regimen (supportive therapy) and when a pathologic condition of the tissue around implants is diagnosed, an intervention should be initiated as soon as possible. Different maintenance regimens and treatment strategies for failing implants have been suggested, however it is unclear which are the most effective. OBJECTIVES: To test the null hypothesis of no difference between different interventions for maintaining or re-establishing healthy tissues around dental implants. SEARCH STRATEGY: The Cochrane Oral Health Group Specialised Register, The Cochrane Controlled Trials Register, MEDLINE and EMBASE were searched. Hand searching included several dental journals. In addition, authors of all identified trials, fifty-five oral implant manufacturers and two extensive personal libraries (ME and AJ) were consulted. SELECTION CRITERIA: All randomised controlled trials of oral implants comparing agents or interventions for maintaining or re-establishing healthy tissues around dental implants. DATA COLLECTION AND ANALYSIS: Data were independently extracted, in duplicate, by two reviewers (ME & HW). Authors were contacted for details of randomisation and withdrawals and a quality assessment was carried out. The Cochrane Oral Health Group's statistical guidelines were followed. MAIN RESULTS: Nine RCTs were identified. Five of these trials, which reported results from a total of 127 patients, were suitable for inclusion in the review. REVIEWER'S CONCLUSIONS: There is only a little reliable evidence for which are the most effective interventions for maintaining health around peri-implant tissues. There was no evidence that the use of powered or sonic toothbrushes was superior to manual toothbrushing. There is a weak evidence that Listerine mouthwash, used twice a day for 30 seconds, as adjunct to routine oral hygiene is effective in reducing plaque formation and marginal bleeding around implants. There was no evidence that phosphoric etching gel offered any clinical advantage over mechanical debridement. These findings are based on RCTs having short follow-up periods and few subjects. There is not any reliable evidence for the most effective regimens for long-term maintenance. For the treatment of failing implants (peri-implantitis) there is not any reliable evidence for preferring one therapeutic regimen over another. More RCTs should be conducted in this area. In particular, there is a definite need for trials investigating which is the most effective approach for the treatment of peri-implantitis and for trials with longer follow-up for maintenance. Such trials should be reported according the CONSORT guidelines (http://www.consort-statement.org/).

Dental Implants↗
PubMed2003

Use of oral mucosal neutrophil counts to detect the onset and resolution of profound neutropenia following high-dose myelosuppressive chemotherapy.

Severe neutropenia following cytotoxic, anti-cancer chemotherapy is well-known to be associated with an increased risk of infections that may be life-threatening, particularly if not treated immediately. Consequently, serial measurements of neutrophil counts in peripheral blood are done routinely following the administration of high-dose myelosuppressive chemotherapy in order to monitor the onset, severity, and duration of iatrogenic neutropenia. We have studied a non-invasive method of quantifying neutrophils recoverable from the oral mucosa, a normal tissue site of neutrophil turnover, as an alternative approach for monitoring severe, chemotherapy-induced neutropenia. This method is based on the quantification of fluorochrome-stained neutrophils present in timed mouthwash specimens. Blood neutrophil (ANC) and mucosal neutrophil counts (MNC) were measured repeatedly in 23 patients who had been treated with dose-intensive chemotherapy for a variety of indications. All 23 patients developed profound neutropenia (ANC < 100/mm3), and 19 developed neutropenic fever (>101 degrees F) during the 2 weeks following treatment. Nadirs of neutropenia defined by MNC were significantly less prolonged than those defined by the ANC. Furthermore, the onset and resolution of neutropenic fever coincided more precisely with nadirs of neutropenia defined by the MNC than with those defined by the ANC. Our findings indicate that oral mucosal neutrophil counts predict the timing of clinical events associated with neutropenia (e.g., the onset and resolution of fever) with significantly greater accuracy than blood neutrophil counts.

Acridine Orange↗