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PubMed1993

In vivo effects of fluoride, chlorhexidine and zinc ions on acid formation by dental plaque and salivary mutans streptococcus counts in patients with irradiation-induced xerostomia.

Irradiation therapy including major salivary glands may result in xerostomia and enhanced susceptibility to dental caries. The present aim was to assess the ability of mouthrinses with F-, Zn2+, and chlorhexidine (CH), in various combinations, to reduce acidogenic potential of dental plaque and salivary mutans streptococcus counts (SMSC) in 7 patients with xerostomia secondary to irradiation. The patients rinsed twice daily for 3 weeks with the following test solutions: (1) 12 mmol/l NaF (F; control), (2) NaF + 20 mmol/l ZnCl2 (F-Zn), and (3) NaF + 1.1 mmol/l CH (F-CH). Resting periods (F) of varying lengths were incorporated. Acid formation by dental plaque was monitored as plaque pH response to a sucrose mouthrinse, at the end of each test period, 4 h after mouthrinsing with test solution. Plaque pH was measured repeatedly at 2-8 sites in each patient before, and up to 60 min after the sucrose mouthrinse using touch microelectrodes. SMSC were determined using Dentocult SM-Strip mutans. Compared with F, F-CH significantly (P < or = 0.02) reduced acid formation by plaque and SMSC, whereas F-Zn did not affect acid formation or SMSC significantly. Pilot experiments in 4 patients showed mouthrinses with NaF + 0.55 mmol/l CH + 10 mmol/l Zn2+ to be ineffective, whereas NaF + 2.2 mmol/l CH was highly effective, but no better than F-CH. Twice daily mouthrinses with 12 mmol/l NaF in combination with 1.1 mmol/l CH may be an effective regimen to prevent post-irradiation caries.

Adult↗

PubMed2006

Effect of chlorhexidine application on shear bond strength of brackets bonded with a resin-modified glass ionomer.

INTRODUCTION: The purpose of study was to assess the effect of chlorhexidine application on the shear bond strength and bond failure site of a resin-modified glass ionomer (Fuji Ortho LC, GC Europe, Leuven, Belgium). METHODS: Forty-five bovine permanent mandibular incisors were randomly divided into 3 groups of 15. Group 1 had no chlorhexidine treatment and served as the control; groups 2 and 3 had chlorhexidine application immediately before and 1 week before bonding, respectively. Stainless steel brackets (DB, Leone, Sesto Fiorentino, Italy) were bonded with the resin-modified glass ionomer. After bonding, all samples were stored in distilled water for 24 hours and subsequently tested in a shear mode on a testing machine. Analysis of variance (ANOVA) and the Scheffé test were applied to determine significant differences in the shear bond strength values, and the chi-square test was used to determine significant differences in the adhesive remnant index scores among the groups. Significance for all statistical tests was predetermined at P < .05. RESULTS: Group 1 (no chlorhexidine application) showed significantly higher shear bond strength values than group 2 (chlorhexidine applied immediately before bonding). No significant differences were found between groups 1 and 3 (chlorhexidine applied 1 week before bonding). Moreover, significant differences in debond locations were found among the 3 groups. CONCLUSIONS: Chlorhexidine application immediately before bonding significantly lowered the bond strength values of Fuji Ortho LC but did not affect its bond strength when applied 1 week before bonding.

Acrylic Resins↗

PubMed2005

Prevention of upper respiratory tract infections by gargling: a randomized trial.

BACKGROUND: Gargling to wash the throat is commonly performed in Japan, and people believe that such hygienic routine, especially with gargle medicine, prevents upper respiratory tract infections (URTIs). Its effectiveness, however, has not been established by clinical trials. DESIGN: Randomized controlled trial carried out in 2002-2003 winter season and analyzed in 2003 and 2004. PARTICIPANTS: Healthy volunteers (387) aged 18 to 65 years. INTERVENTION: Participants were randomly assigned to water gargling, povidone-iodine gargling, and usual care (control). Subjects in the two gargling groups were requested to gargle with water or diluted povidone-iodine at least three times a day. Participants were followed for 60 days. MAIN OUTCOME MEASURES: The primary outcome measure was first URTI incidence. Severity of URTI symptoms among incident cases was also evaluated. Both outcomes were assessed with a self-administered symptom record. Analyses were performed on an intention-to-treat basis. RESULTS: A total of 130 participants contracted URTIs. The incidence rate of first URTI was 0.26 episodes/30 person-days among control subjects. The rate decreased to 0.17 episodes/30 person-days in the water gargling group, and 0.24 episodes/30 person-days in the povidone-iodine gargling group. Respective incidence rate ratios against controls were 0.64 (95% confidence interval [CI]=0.41-0.99) and 0.89 (95% CI=0.60-1.33). A Cox regression (proportional hazard model) revealed the efficacy of water gargling (hazard ratio=0.60, 95% CI=0.39-0.95). Even when a URTI occurred, water gargling tended to attenuate bronchial symptoms (p=0.055). CONCLUSIONS: Simple water gargling was effective to prevent URTIs among healthy people. This virtually cost-free modality would appreciably benefit the general population.

Adolescent↗

PubMed2004

Quantitative analysis of the impact of the organic matrix on the fluoride effect on erosion progression in human dentine using longitudinal microradiography.

After an initial demineralisation, an intensive fluoridation is capable of inhibiting the erosive mineral loss in dentine completely, which might be related to the presence of the exposed organic dentine matrix. Aim of the present study was, therefore, to evaluate whether fluoride is also effective when the organic material is removed. The study was a cyclic de- and remineralisation model over 5 days in vitro. Samples from human coronal dentine were demineralised with citric acid (pH 2.3; 6 x 10 min per day) and intermittently stored in a remineralisation solution. Groups (n = 25 each) were defined as follows: Group 1: erosion only, no fluoridation; Group 2: erosion, alternately fluoridation with toothpaste (NaF; 0.15% F-; 3 x 5 min per day), mouthrinse (Olaflur/SnF2; 0.025 F-; 3 x 5 min per day) and gel (Olaflur/NaF; 1.25% F-; at Days 1 and 3 instead of one toothpaste application); Group 3: erosion and fluoridation as Group 2, organic material was continuously removed with collagenase (from Clostridium Histolyticum type VII, 100 U/ml) added to the remineralisation solution. Mineral content was monitored daily using longitudinal microradiogaphy. After fluoridation in the presence of collagenase, a linear increase in mineral loss (73.3 +/- 17.6 microm at Day 5) was observed, which significantly (P < or = 0.001) exceeded that of the control group (45.9 +/- 14.3 microm at Day 5). After fluoridation in the absence of collagenase, mineral loss ceased after the 2nd day (12.2 +/- 10.2 microm at Day 5) and was significantly lower compared to Groups 1 and 3 (P < or = 0.001). The results indicate that the dentine matrix is essential for the effectiveness of fluoride in dental erosion.

Cariostatic Agents↗

PubMed2006

Combined effects of NaF and SLS on acid- and polysaccharide-formation of biofilm and planktonic cells.

Bacteria grow preferentially attached to surfaces embedded in an exopolysaccharide matrix to form biofilms. In this mode of growth, bacteria often show reduced susceptibility to antimicrobials. The aim of this study was to investigate whether the combination of NaF and the detergent sodium lauryl sulphate (SLS) could result in additive effects on acid formation by planktonic and biofilm cells, as well as on extracellular polysaccharide formation. An additive inhibitory effect on Streptococcus mutans acid formation was observed, both in planktonic and biofilm cells. In dental biofilms, SLS alone and in combination with NaF reduced acid formation. Extracellular polysaccharide formation by S. mutans and saliva was reduced by SLS alone and in combination with NaF. In dentifrices and mouthrinse solutions, NaF and SLS are often present in combination. It remains to be determined whether an additive effect on acid formation may also occur in dental biofilms under different concentrations from those used in the present study, and whether the effects may be selective for certain bacterial species.

Adolescent↗

PubMed2004

Treatment of severe peri-implant bone loss using autogenous bone and a bioabsorbable polymer that delivered doxycycline (Atridox).

With an increase of the number of implants being inserted, it is inevitable that the number of cases of peri-implantitis with loss of bone will rise. We report a case in which an autogenous cancellous bone graft was placed into the peri-implant bone defect and given protection with a bioabsorbable polymer barrier (Atridox) that released doxycycline slowly.

Absorbable Implants↗

PubMed2004

Prevention of oral mucositis in paediatric patients treated with chemotherapy; a randomised crossover trial comparing two protocols of oral care.

This study compared the efficacy of two protocols for oral care using either chlorhexidine or benzydamine as oral rinses to alleviate mucositis in children undergoing chemotherapy. Eligible participants were randomised to receive either protocol for 3 weeks in a two-period crossover design. The occurrence of ulcerative lesions and severity of mucositis were measured at baseline and twice weekly, using the modified Oral Assessment Guide (OAG). Data were continuously analysed by plotting them directly on predefined sequential charts. According to this sequential analysis, the study could be terminated at the 34th within subject comparison, with a statistically significant reduction in ulcerative lesions (P<0.05) and severity of mucositis (P<0.05) in children on the chlorhexidine protocol. These findings suggest that chlorhexidine together with oral care might be helpful in alleviating mucositis when given prophylactically to children on chemotherapy, but the therapeutic benefit needs to be confirmed in a larger trial.

Adolescent↗

PubMed2004

A survey of current practice with regard to oral care for children being treated for cancer.

The aim of the study was to establish current UK oral care practice for children with cancer. A telephone survey of all 22 United Kingdom Children's Cancer Study Group (UKCCSG) centres was undertaken. Nineteen (86%) of the centres reported using guidelines/protocols for mouth care. The use of routine preventive oral care therapies showed the greatest variation between centres. Four centres (18%) did not use any prophylactic oral care therapy other than basic oral hygiene, whereas seven (32%) routinely used a combination of three or more agents. Chlorhexidine was the most frequently administered prophylactic therapy (17/22 centres, 77%), followed by nystatin (11/22 centres, 50%). There was little variation in advice given to parents/patients on basic oral hygiene. Regarding dental check-ups, 9/22 centres (41%) recommended children to attend a hospital-linked dental clinic. Only at 8/22 centres (36%) did children undergo a dental check-up before commencing cancer treatment. The survey identified significant variation in preventive oral care therapies and dental check-ups at the UKCCSG centres. Attention needs to be given to establishing evidence based, effective strategies.

Cancer Care Facilities↗

PubMed2004

Children's acceptance and tolerance of chlorhexidine and benzydamine oral rinses in the treatment of chemotherapy-induced oropharyngeal mucositis.

Oral care is of great importance in the prevention of chemotherapy-induced oropharyngeal mucositis. Although considerable attention has been given in improving oral care practices, patients' acceptance and tolerance of oral rinses is a continuing problem in oral care. A randomized crossover design was used to determine the relative acceptability and tolerability of chlorhexidine and benzydamine oral rinse agents in children receiving chemotherapy. At the end of the study, each subject was asked to compare these two agents in relation to stinging and taste, as well as his/her perception in reducing mucositis. Thirty-four children aged 6-17 years completed two courses of chemotherapy during which they alternately practiced oral care using chlorhexidine then benzydamine or benzydamine then chlorhexidine. All of the children tolerated the agents well and continued with rinsing throughout the study. Only a few children had to resort to diluting the agents with normal saline or water. Fifty-nine percent of children reported that the stinging associated with benzydamine was more accepted than chlorhexidine. The taste of both these agents was accepted by 50% of children. Approximately 60% of children reported that chlorhexidine was more helpful than benzydamine in reducing mucositis. About 47% and 50% of them preferred chlorhexidine and benzydamine in their subsequent chemotherapy, respectively. In conclusion, chlorhexidine and benzydamine are acceptable and well-tolerated by children over the age 6 years old.

Adolescent↗

PubMedDate not supplied

Duration of action of a single, early oral application of chlorhexidine on oral microbial flora in mechanically ventilated patients: a pilot study.

OBJECTIVE: The purpose of this study was to describe the effect of an early post-intubation oral application of chlorhexidine gluconate on oral microbial flora and ventilator-associated pneumonia. METHODS: Thirty-four intubated patients were randomly assigned to chlorhexidine gluconate by spray or swab or to control group. Oral cultures were done at study admission, 12, 24, 48, and 72 hours, whereas the Clinical Pulmonary Infection Score (CPIS) was documented at study admission, 48, and 72 hours. RESULTS: Reductions in oral culture scores (less growth) were only found in the treatment groups (swab and spray); no reduction was found in the control group. There was a trend for fewer positive cultures in the combined treatment groups. The mean CPIS for the control group increased to a level indicating pneumonia (4.7 to 6.6), whereas the CPIS for the treatment group increased only slightly (5.17 to 5.57). CONCLUSIONS: Trends in the data suggest that use of chlorhexidine gluconate in the early post-intubation period may mitigate or delay the development of ventilator-associated pneumonia.

Adult↗

PubMed2006

Effect of xylitol:sorbitol on fluoride enamel demineralization reduction in situ.

OBJECTIVES: To evaluate if sugar alcohols would reduce enamel demineralization enhancing the fluoride (F) effect. METHODS: A crossover in situ study was conducted in four phases, during which 10 volunteers were submitted to one of the treatments: (I) Distilled and deionized water, as a negative control; (II) F (226 microg F/ml as NaF; concentration used in commercial mouthrinse); (III) X:S (xylitol:sorbitol 1:3; final concentration 1.6M; 28% of sugar alcohols) and (IV) F+X:S (same final concentration that groups II and III). The volunteers wore palatal appliances containing four bovine enamel blocks of known surface microhardness (SMH), covered with a 'test plaque' of mutans streptococci, which were immersed during 1 min in one of the allocated treatment solutions simultaneously that the volunteers rinsed their mouths with the same solution. After the rinsing the appliances were put in the mouth and after 20 min a cariogenic challenge was made with 20% sucrose solution during 1 min. After further 45 min the 'test plaque' was collected for F analysis, enamel SMH was again determined and the percentage of change in relation to baseline was calculated; F uptake in enamel was also determined. RESULTS: With respect to all the analyses made, the group F+X:S did not differ from the F treatment (p>0.05) and the groups treated with F and F+X:S differed from the negative control (p<0.05). CONCLUSIONS: The results suggest that xylitol:sorbitol may not enhance the effect of fluoride present in mouth rinse on the reduction of enamel demineralization.

Adult↗

PubMed2006

Electric pulp tester conductance through various interface media.

A conducting media is necessary when using an electric pulp tester (EPT). The objective of this study was to observe differences in conductance through various media. We hypothesized that variations in current conductance through different media exist. The pulp chamber of a freshly extracted premolar was exposed, and the cathode of a voltmeter was inserted into the pulpal tissue. The anode was coupled to the EPT handpiece. The measurement taken during dry (no interface media) EPT tip-to-tooth contact was 0 V, which served as negative control. EPT tip directly touching the cathode measured 3.9V and served as positive control. A number of media readily available in the dental office were tested. Data was analyzed using single factor ANOVA. Listerine (3.3) conducted the most voltage (p<0.5). Of nonliquids, K-Y Brand UltraGel and Crest Baking Soda & Peroxide Whitening Tartar Control toothpaste recorded significantly (p<0.05) higher voltage readings (1.4 V).

Bicuspid↗

PubMed2005

Microbial analysis of the autogenous bone collected by bone filter during oral surgery: a clinical study.

PURPOSE: The purposes of the study presented are to identify the microbial content of the collected bone debris and to determine the antibacterial efficiency of chlorhexidine mouth rinse in reducing the microbial content of the collected bone debris. PATIENTS AND METHODS: Twenty-five patients who had asymptomatic fully impacted mandibular third molars bilaterally underwent surgical removal for prophylactic and orthodontic considerations. Immediately before surgery all patients rinsed with 10 mL of their assigned solution (chlorhexidine or sterile saline) for 2 minutes. Before surgical removal of the teeth, bone debris was collected with a stringent aspiration protocol from the ramus by bone filter. The microbial content of the bone debris was assessed and the bacterial levels between the 2 groups were compared statistically. RESULTS: All samples from both groups (chlorhexidine or sterile saline) yielded viable microorganisms. There was no significant difference between the mean/median colony-forming units (CFU)/g values of both group samples, for aerobes (Streptococcus salivarius) and anaerobes (Bacteroides, Peptococcus, Peptostreptococcus, and Veillonella species). With regard to total microorganisms, the mean CFU/g derived from the chlorhexidine group samples were 1.5 x 10(8) CFU/g per bone sample compared with 1.5 x 10(9) CFU/g for the sterile saline control group (P < .05). CONCLUSION: Although chlorhexidine rinsing immediately before surgery reduced the levels of total microorganisms when compared with stringent aspiration protocol alone, it has not been found effective on aerobic Streptococcus salivarius and, importantly, on anaerobes. The reduced bacterial levels may still carry high infectious risk and may lead to failure in autogenous grafting procedures in oral surgery.

Adolescent↗

PubMed2006

Stability of amphotericin B and nystatin in antifungal mouthrinses containing sodium hydrogen carbonate.

Amphotericin B and nystatin are two polyene antibiotics that are potent antifungal agents. These drugs are active against most pathogenic fungi like Aspergillus and Candida. Mouthrinses containing these drugs are used for preventive and curative treatment of fungal infections like oral candidiasis, which can cause multiple diseases in cancer patients. Because there were no marketed antifungal mouthrinses available, their preparations were performed at the hospital and town pharmacies. To date, there are no data available on the stability of both these drugs in the form of mouthrinses. Therefore, each mouthrinse had to be prepared extemporaneously. The aim of this study was to investigate the stability of amphotericin B (Fungizone) and nystatin (Mycostatine) in the form of mouthrinses containing 1.4% sodium hydrogen carbonate. The stability of these solutions was tested at different temperatures (4-37 degrees C) with or without electric- or sunlight exposure and in two types of containers (glass and polypropylene) over a 15-day period. The admixtures were also monitored for colour change and pH. Amphotericin B and nystatin were quantified by high-performance liquid chromatography. At 4 degrees C, amphotericin B and nystatin were stable for 15 days in polypropylene. When stored in polypropylene at room temperature, with or without light protection, amphotericin B and nystatin were stable for 3 and 4 days, respectively.

Amphotericin B↗

PubMed2004

The effects of a chlorhexidine mouthrinse on culturable microorganisms of the tongue and saliva.

A randomized and cross-over design clinical study with normal adult volunteers examined the effects of a 0.12% chlorhexidine (CHX) mouthrinse and a control rinse on a range of microflora including those implicated in halitosis on the tongue and saliva. Saliva and tongue scrapings were collected from 13 subjects prior to treatments with additional samples collected at 3 h post-treatment cultured on media to enumerate anaerobic, Gram-positive and Gram-negative bacteria, odorigenic bacteria producing hydrogen sulphide (H2S) and oral bacteria with proteolytic activity. In comparison to the control, rinsing with CHX demonstrated statistically significant reductions that ranged from 81-90% for tongue microflora with a 89-95% decrease noted on salivary flora (p<0.05). The effects of CHX on anaerobic, Gram-positive and Gram-negative bacteria are in accord with those noted on odorigenic bacteria producing H2S or proteolytic activity. These results help to explain previous clinical results on the malodor efficacy of CHX and highlight microbiological approaches for bacteria implicated in malodor.

Adult↗

PubMed2005

Immunohistochemical assessment of Viadent-associated leukoplakia.

Studies show an association between sanguinarine, the active ingredient in Viadent oral health care products, and oral premalignant lesions. The study was undertaken to quantitatively compare the staining profiles of sanguinarine-associated leukoplakia to normal and dysplastic specimens. Archived oral mucosal specimens were stained for tumor markers p16, p53, cyclin D1, Ki-67, and Bcl-x and analyzed through Simple PCI image analysis software. Quantitative analyses showed trends towards intermediate staining in Viadent-related specimens (Ki-67: normal: 18.12+/-2.15, Viadent: 16.12+/-2.16, dysplasia: 14.53+/-2.04, p>0.05; cyclin D1: normal: 15.65+/-3.68, Viadent: 12.52+/-3.57, dysplasia: 1.94+/-3.93, p<0.05; p16: normal: 55.04+/-4.16, Viadent: 49.74+/-4.16, dysplasia: 45.03+/-4.45; p>0.05; p53:normal: 2.65+/-1.37, Viadent: 4.64+/-1.52, dysplasia: 8.71+/-1.37; p<0.05 Kruskal Wallace, Tukey/Kramer). Our Viadent profiles, intermediate between normal and dysplasia, support a preneoplastic nature of this process.

Alkaloids↗

PubMed2006

Clinical evaluation of the intraoral fluoride releasing system in radiation-induced xerostomic subjects. Part 1: Fluorides.

Radiation-induced xerostomia results in significant changes in the oral cavity particularly oral microbial changes, which include a marked increase in the number of cariogenic organisms, notably Streptococcus mutans and lactobacillus species. This loss of the capacity to secrete saliva creates or promotes the rapid onset and progression of rampant dental caries. In this 2-part series, the benefit of fluoride in reducing caries activity is presented. Part 1 discusses the historical and currently available fluoride preparations and Part 2 presents data of a recently completed trial investigating the benefit of an intraoral sodium fluoride releasing system.

Anti-Bacterial Agents↗

PubMed2006

Quantitative mapping of chlorhexidine in natural river biofilms.

Soft X-ray scanning transmission X-ray microscopy has been applied to map chlorhexidine, a ubiquitous antimicrobial agent, relative to major biochemical components (proteins, lipids, polysaccharides, Ca2+, K+, CO3(2-)) in natural river biofilms. For the first time, bio-accumulation of chlorhexidine in diatoms has been observed unambiguously. The quantitative results show that chlorhexidine bioaccumulated extensively in lipid-rich regions of diatoms and bacteria. Confocal laser scanning microscopy was used to document changes in the biofilm community. The bioaccumulation provides a significant entry point for chlorhexidine into the aquatic food chain. It results in modification of the biofilm community and it impacts the photosynthetic and protozoan species in particular. X-ray microscopy mapping at high spatial resolution is shown to be a powerful tool for studies of antimicrobial agents in the environment.

Anti-Infective Agents, Local↗