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PubMed1991

Short-term bactericidal activity of chlorhexidine gel, stannous fluoride gel and amine fluoride gel tested in periodontal pockets.

The short-term bactericidal effect of 2% chlorhexidine gel, 4% stannous fluoride gel or amine fluoride gel containing 1.25% fluoride on the subgingival microflora was determined in 40 periodontal pockets of 10 patients. The antimicrobial gels or placebo gel were applied in 5-9 mm deep periodontal pockets 3 times within 10 min. Before and 30 min after the applications, samples were taken of the subgingival microflora for determination of the total number of bacteria as well as the number of black pigmented Bacteroides. Reductions of the total number of bacteria were found in all test groups. The reductions found in the pockets treated with chlorhexidine gel or stannous fluoride gel were significantly greater than the reduction found in the pockets treated with a placebo gel. A significant reduction of black-pigmented Bacteroides was found after treatment with chlorhexidine gel or amine fluoride gel. It is concluded that 2% chlorhexidine gel or 4% stannous fluoride gel has a more than 99% reduction effect on the microflora of periodontal pockets within 30 min after application.

Adult↗
PubMed1992

Effect of 4 days of mouth rinsing with delmopinol or chlorhexidine on the vitality of plaque bacteria.

Delmopinol is a new surface active anti-plaque agent that has demonstrated a low antimicrobial effect in vitro. By use of a vitality staining technique, the antimicrobial effect on bacteria in plaque samples was tested after rinsing with delmopinol or chlorhexidine. 6 healthy male subjects volunteered to rinse for 4 days using a double-blind cross-over study design with a wash-out period between the rinsing regimens. No oral hygiene measures were allowed during the test periods and each test period started with a professional tooth cleaning procedure 2 days before the start of rinsing to allow for plaque formation. Rinsing was performed with 0.2% delmopinol hydrochloride or 0.2% chlorhexidine digluconate 2 x a day. Small samples of plaque were collected from the buccal surfaces of premolars and 1st molars before the first rinse on day 1 and then before and 1, 2, 4, 7, and 24 h after the last rinse on the 4th day. The plaque samples were immediately stained with propidium iodide and fluorescein diacetate to visualize dead and vital microorganisms respectively. The vitality of the microflora was evaluated using a fluorescence microscope. The baseline vitality values were 91% for chlorhexidine and 86% for delmopinol. At day 4, the plaque vitality for chlorhexidine was approximately 40% up to 4 h and 50% at 7 h and 60% at 24 h after the last rinse. Corresponding values for plaque vitality after delmopinol rinsing were between 70 and 80% on all sampling occasions.(ABSTRACT TRUNCATED AT 250 WORDS)

Bacteria↗
PubMed1992

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↗
PubMed1993

Antimicrobial properties of human dentin impregnated with tetracycline HCl or chlorhexidine. An in vitro study.

Substantivity of tetracycline HCl and chlorhexidine digluconate to human root dentin was assessed in vitro. 51 extracted single-rooted teeth, their crowns removed, were assigned to 1 of 4 treatments in groups of 12. A control groups included 3 roots. Each group was divided into 3 subgroups to allow evaluation of drug exposure for 1, 3 or 5 min. The roots were immersed in tetracycline HCl (10 or 50 mg/ml) or chlorhexidine digluconate (0.12 or 0.2%) solutions following root planning. Control roots were immersed in sterile saline (0.9%). Following drug immersion, the roots were transferred to tubes containing 2 ml tris buffered saline. The tubes were incubated at room temperature for 22 days. Desorption media were replaced at 24-h intervals. Removed media were examined for antimicrobial activity using a microtiter assay in which bacterial growth was evaluated by optical density readings. Roots immersed in tetracycline HCl 50 mg/ml released antimicrobial activity to successive desorption media for 14 days. Tetracycline HCl 10 mg/ml activity lasted 4 days. Roots subjected to chlorhexidine digluconate released antimicrobial activity for 24 h only. Within each treatment, there were no differences between the 3 exposure intervals of 1, 3 or 5 min. Our findings suggest usage of the periodontally exposed instrumented root as a depot for sustained release of tetracycline HCl, but not chlorhexidine digluconate, to the subgingival environment. The substantiveness of tetracycline HCl seems related to drug concentration rather than the exposure interval. Clinical trials are needed to confirm the clinical significance of these in vitro observations.

Adsorption↗
PubMed1994

The effect of a dentifrice containing chlorhexidine and zinc on plaque, gingivitis, calculus and tooth staining.

In this 6 months randomized, stratified double-blind parallel study, plaque, gingivitis, calculus formation and tooth staining were assessed in 208 participants. The participants either used a 0.12% chlorhexidine rinse and a gum care dentifrice (positive control) or a placebo rinse and the gum care dentifrice (control) or the placebo rinse and an experimental dentifrice containing 0.4% chlorhexidine and 0.34% Zn2+ (experimental group). After 6 months product use, all groups had less plaque, less gingivitis and all developed calculus and tooth staining. For the positive control group and for the experimental group, significant reductions in plaque and gingivitis (gingival index and number of bleeding sites) were seen compared with the control group. Significantly more calculus developed in the positive control group, while the experimental group was not different from the control group. Finally, tooth staining was significantly higher for the groups using chlorhexidine containing products compared with the control group. The experimental dentifrice users however did develop significantly less staining compared with the positive control. It is concluded that the experimental dentifrice will contribute to a significant improvement in oral hygiene with less staining compared with using a 0.12% chlorhexidine rinse.

Adolescent↗
PubMed1994

The antibacterial and anti-staining properties of the novel anti-adherent agent M239, 144 alone and in combination with chlorhexidine.

The anti-adherent agent M239,144 has been shown to reduce the adhesion of S. sanguis strains to saliva-coated hydroxyapatite by 27-94%. The purpose of this study was to determine any antibacterial properties of M239,144 which might inhibit replication of the organisms which do adhere and to determine whether M239,144 interferes with the antibacterial properties of the antiseptic agent chlorhexidine. Maximum inhibitory dilutions (MIDs) were calculated using both broth and agar methods. 0.1% M239,144 displayed no antibacterial activity against S. oralis NCTC 7864 or S. sanguis NCTC 7863 using the broth dilution method and had no antibacterial activity against a range of plaque-forming organisms using the agar dilution method. The anti-bacterial activity of chlorhexidine against four of five oral plaque-forming species was reduced by 0.1% M239,144. The effect of a novel anti-adherent agent, MK239,144, on chlorhexidine staining was assessed in an in vitro model. 1% M239,144 completely prevented chlorhexidine staining at concentrations from 0.0002% to 0.2%. M239,144/chlorhexidine formulations show potential for a non-staining anti-plaque mouthwash.

Anti-Bacterial Agents↗
PubMed1995

The comparative effects on plaque regrowth of phenolic chlorhexidine and anti-adhesive mouthrinses.

The inhibition of bacterial attachment to the tooth surface is one possible approach to plaque control. This study evaluated in vivo the plaque inhibitory action of a novel copolymer reported to have considerable antiadhesive properties in vitro. The study was a single blind, 5-treatment, randomised Latin square crossover design, incorporating balance for carry-over effects. The rinses were the antiadhesive (1%), the antiadhesive with 0.02% chlorhexidine, a 0.2% chlorhexidine rinse product, an essential oil/phenolic rinse product and water. 15 volunteers participated and on day 1 of each study period were rendered plaque-free, ceased toothcleaning and rinsed 2 x daily, under supervision, with the allocated formulation. On day 5, plaque was scored by index and area. Washout periods were 2 1/2 days. Alone or combined with chlorhexidine, the antiadhesive agent showed no effects greater than water. The chlorhexidine rinse was significantly more effective than the essential oil/phenolic rinse which in turn was significantly more effective than the other rinses.

Anti-Infective Agents, Local↗
PubMed2005

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

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

Adult↗
PubMed2006

Topical minocycline microspheres versus topical chlorhexidine gel as an adjunct to mechanical debridement of incipient peri-implant infections: a randomized clinical trial.

AIM: This randomized clinical trial presents a 12-month follow-up of the clinical and microbiological results after application of minocycline microspheres as an adjunct to mechanical treatment of incipient peri-implant infections compared with an adjunctive treatment using 1% chlorhexidine gel application. MATERIAL AND METHODS: Thirty-two subjects with probing depth > or =4 mm, combined with bleeding and/or exudate on probing and presence of putative pathogenic bacteria were given oral hygiene instructions and mechanical treatment of infected areas adjacent to implants. The subjects were then randomly assigned adjunctive subgingival antimicrobial treatment using either chlorhexidine gel or minocycline microspheres. Sixteen patients in the minocycline group and 14 in the chlorhexidine group completed the study. Follow-up examinations were carried out after 10 days, 1, 2, 3, 6, 9 and 12 months. RESULTS: The adjunctive use of minocycline microspheres resulted in improvements of probing depths and bleeding scores, whereas the adjunctive use of chlorhexidine only resulted in limited reduction of bleeding scores. For the deepest sites of the treated implants in the minocycline group, the mean probing depth was reduced from 5.0 to 4.4 mm at 12 months. This study could not show any significant difference in the levels of bacterial species or groups at any time point between the two antimicrobial agents tested. The present findings encourage further studies on adjunctive use of minocycline microspheres in the treatment of peri-implant lesions. CONCLUSIONS: The use of a local antibiotic as an adjunct to mechanical treatment of incipient peri-implantitis lesions demonstrated improvements in probing depths that were sustained over 12 months.

Adult↗
PubMed1975

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↗
PubMed1977

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↗
PubMed1977

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↗
PubMed1979

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↗
PubMed1979

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↗
PubMed1980

Effects of chlorhexidine and iodine on in vitro plaques of Streptococcus mutans and Streptococcus sanguis.

Both chlorhexidine and iodine showed greater antimicrobial effect on in vitro grown S. mutans plaque than on plaque composed of S. sanguis. One treatment with iodine for 8 min inhibited the acid production of S. Mutans plaque whereas S. sanguis plaque required 20 min to be similarly affected. In contrast one treatment with chlorhexidine for up to 20 min did not completely inhibit the acid production of plaque of either microorganism. Repeated short term exposures increased the bactericidal effect of chlorhexidine but not that of iodine. The difference in antimicrobial effect between chlorhexidine and that of iodine on S. mutans and S. sanguis should be investigated in persons heavily infected by S. mutans.

Acids↗
PubMed1982

Transient reduction of Streptococcus mutans interdentally by chlorhexidine gel.

Chlorhexidine gel was applied interproximally with the intent to reduce Streptococcus mutans at these sites. Bacterial samples were obtained using toothpicks, which were inserted in each interproximal space and then immediately pressed against agar plates, selective for S. mutans. Duplicate bacterial samples of non-treated subjects showed that this method gave reproducible results. Using a split mouth technique, 10 subjects were exposed to short term chlorhexidine exposures of varied intensity. At the baseline sampling about 90% of the sites showed growth of S. mutans. One week after the chlorhexidine applications about 55% were infected. After 40 d S. mutans were back to about baseline levels except for the most intensively treated interproximals, which showed 75% infected sites. Thus, at many sites the reduction of S. mutans was only transient. Four subjects with more than 1 million S. mutans per ml saliva participated in a study where salivary and interproximal levels of S. mutans were compared after a rinsing period with chlorhexidine lasting for 2 weeks. The effect of the rinses varied individually, but it was noted that several interproximal spaces could be infected even if the saliva numbers did not reach detectable levels of S. mutans.

Chlorhexidine↗
PubMed1982

Iron staining of the acquired enamel pellicle after exposure to tannic acid or chlorhexidine: preliminary report.

Extrinsic discoloration of teeth following a large consumption of tannin-containing beverages or a prolonged use of chlorhexidine mouthrinses is a well known observation. Tannins as well as chlorhexidine are denaturing agents. Based on preliminary studies revealing the presence of iron in chlorhexidine discolored pellicle material, the ability of iron to stain the integument after pretreatment with the two denaturants was studied in a human model. The denaturing effect of an acidic environment was also included. Enamel slabs fixed to acrylic appliances were carried in the oral cavity and alternately exposed to the test solutions in different sequences in vitro. Pretreatment with chlorhexidine or tannic acid led to marked discoloration upon iron application during 5-d tests, whereas the compounds individually had no such effect. A large content of the metal was found in the stained material. Stannous fluoride appeared to reduce the formation of the pigments, and strong oxidation completely bleached the established color. Possible mechanisms underlying the phenomena observed are discussed.

Chlorhexidine↗
PubMed1982

Comparison between plaque inhibiting effect of chlorhexidine and aqueous solutions of copper- and silver-ions.

Rinsing experiments with chlorhexidine, copper and silver solutions were performed in a group of volunteers. The plaque was measured after rinsing with the test solutions for 4 d and no mechanical oral hygiene allowed. Chlorhexidine and copper, both 1.1 mM solutions, gave reduced plaque scores, chlorhexidine being slightly more effective than copper, but the difference was not statistically significant. A 1.1 mM solution of silver nitrate also showed a plaque inhibiting effect, statistically significant from the placebo, but the effect was also significantly less than when chlorhexidine or copper were used. Copper ions may be of clinical interest because this is an essential metal in human nutrition with low toxicity.

Chewing Gum↗