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PubMed1999

Local delivery of chlorhexidine using a tooth-bonded delivery system.

Films containing 20% w/w chlorhexidine base (particle size 63-125 microm) in poly(epsilon-caprolactone), MW 35,000-45,000, were prepared by solvent evaporation and sections attached to the mesio-lingual and mesio-buccal surfaces of the lower first molar in healthy volunteers. Saliva (<1.5 microl) was collected on Periopaper and chlorhexidine concentrations measured by HPLC were typically higher in the area immediately adjacent to the tooth-bonded film sections and lower at more distant sites. Analysis of variance of chlorhexidine concentrations, adjacent to the film sections, showed concentrations were significantly different on the buccal and lingual sides of the tooth and depended on the time of sampling (n=5, P<0.05).

Administration, Oral↗
PubMed1985

The disinfection of respiratory syncytial virus by isopropanol and a chlorhexidine-detergent handwash.

Two of the products commonly used to disinfect the hands of nursing staff are 70% isopropanol and aqueous chlorhexidine-detergent solutions. These have been shown to rapidly destroy respiratory syncytial virus, and are therefore suitable for use where contagious spread of this virus is suspected. The virucidal component of the chlorhexidine-detergent preparation has been shown to be primarily the detergent base and not the chlorhexidine.

1-Propanol↗
PubMed1998

Effect of 6-monthly applications of chlorhexidine varnish on incidence of occlusal caries in permanent molars: a 3-year study.

OBJECTIVES: The aim of this study was to assess the effect of a chlorhexidine varnish on occlusal caries incidence when applied 6-monthly into the fissures of erupting and freshly erupted permanent molars. METHODS: In a double-blind clinical trial, 332 children aged 5/6 and 11/12 years attending a Child Dental Health Centre were randomly assigned to a control and an experimental group. Criteria for inclusion in the study were that all first permanent molars in 5-6-year-olds and all second permanent molars in 11-12-year-olds either had recently erupted, or were in a stage of eruption, or would erupt within half a year. At baseline, counts of dmfs/DMFS and mutans streptococci in saliva were recorded. During a maximum of 3 years, every 6 months the occlusal surfaces of molars in the experimental group received a 40% chlorhexidine varnish application, whereas those in the control group received a placebo varnish application. RESULTS: Data of 316 children were analysed and ANOVA showed no significant occlusal caries reduction in this sample of Dutch 5/6- and 11/12-year-old children. After stratification into low and high caries risk groups, a statistically significant caries-reducing effect on occlusal caries in permanent molars was found in the group of children with > or = 10(6) mutans streptococci per ml saliva (P < 0.05). CONCLUSION: Six-monthly application of chlorhexidine varnish has no caries-reducing effect on occlusal caries in recently erupted permanent molars in a population with low caries prevalence.

Analysis of Variance↗
PubMed2000

The effect of liquid crystalline structure on chlorhexidine diacetate release.

The aim of this study was to examine different liquid crystalline preparations containing chlorhexidine diacetate and to find connection between their structure and the kinetic of drug release. Nonionic surfactant, Synperonic A7 (PEG(7)-C(13-15)) was selected for the preparation of the examined liquid crystalline systems. Mixtures of different ratios of Synperonic A7 and water were produced. By increasing the water content of the systems, lamellar and hexagonal liquid crystal structures were observed. For the analysis of the prepared liquid crystalline systems polarising microscopy, rheology study, differential scanning calorimetry and dynamic swelling tests were carried out. The chlorhexidine diacetate release was examined by Franz-type vertical diffusion cell apparatus. The chlorhexidine diacetate release from hexagonal liquid crystalline preparations was characterised by zero-order release kinetics, while the drug release from lamellar liquid crystalline systems was described by anomalous (non-Fickian) transport. The results indicate that the drug release kinetic is strongly dependent on the liquid crystalline structure.

Anti-Infective Agents, Local↗
PubMed1999

Flow-injection extraction-spectrophotometric method for the determination of chlorhexidine in pharmaceutical preparations.

The spectrophotometric determination of trace amounts of chlorhexidine was carried out by liquid-liquid extraction using bromophenol blue with a flow system. The determination of chlorhexidine in the range of 1 x 10(-4) to 1 x 10(-5) M was possible with a sampling frequency of 40 samples per hour. The method was satisfactorily applied to the determination of chlorhexidine in pharmaceutical preparations.

Anti-Infective Agents, Local↗
PubMed2003

The effect of chlorhexidine as an endodontic disinfectant.

OBJECTIVE: The purpose of this study was to establish whether addition of a 2% chlorhexidine rinse to a conventional treatment protocol enhances the rate of the successful disinfection of the root canal system in vivo. STUDY DESIGN: Twenty-four teeth with infected necrotic pulps and resorbing apical periodontitis were treated with a conventional technique in which 1% NaOCl as irrigant was used. Half of the cases received an additional rinse with 2% chlorhexidine. Prereduced thioglycollate medium was used to take cultures that were incubated for 4 weeks. RESULTS: Cultivable bacteria were retrieved at the conclusion of the first visit in 1 out of 12 chlorhexidine cases whereas in the control group 7 out of 12 cases showed growth. This difference was significant (P < .05). CONCLUSION: The findings are clinically important.

Adolescent↗
PubMed1985

Influence of chlorhexidine in ethanol and in isopropanol on the bacterial colonization of the umbilicus of newborns.

The effect of daily treatment with 0.5% chlorhexidine in 70% ethanol and in 70% isopropanol, respectively, on navel colonization and on rates of infection in newborns has been studied in 438 infants in two maternity wards during a 3-month period. In spite of isopropanol being reported as a more efficient skin disinfectant than ethanol in several experimental models, no significant differences were seen in the frequency of navel colonization or in infection rates between the two treatment groups. The colonization rate with S. aureus was lower in this than in an earlier investigation on navel disinfection with chlorhexidine in ethanol performed in the same wards. This may reflect a progressive effectiveness of the treatment due to fewer S. aureus sources in the nursery. For practical reasons we continue to recommend daily navel disinfection with 0.5% chlorhexidine in 70% ethanol on healthy newborns in hospital nurseries.

1-Propanol↗
PubMed1987

Comparative evaluation of the immediate and sustained antibacterial action of two regimens, based on triclosan- and chlorhexidine-containing handwash preparations, on volunteers.

The degerming effect of a 3 min handwash with 2% triclosan, or 4% chlorhexidine, in detergent and enhanced efficacy of either antiseptic in isopropyl alcohol, was evaluated in volunteers. Handwashing with either antiseptic preparation reduced the normal flora by a factor of 10; alcohol rubbing by approximately a factor of 1000. Both regimens eliminated Micrococcus roseus, artificially inoculated before every procedure. The sustained action of the same detergent preparations was further studied in gloved and ungloved hands by the Vinson's 'finger imprint test'. In the gloved hand both antiseptics inhibited Staphylococcus epidermidis for 4 h. In the ungloved hand however, triclosan remained active longer than chlorhexidine. Whilst the activity of chlorhexidine was short-lived against a clinical isolate of S. aureus, particularly in the ungloved hand, the sustained effect of triclosan against the same strain persisted for 4 h on either hand.

Bacteria↗
PubMed1990

In vitro skin permeation and bioassay of chlorhexidine phosphanilate, a new antimicrobial agent.

An in vitro technique was developed to study the permeation and antimicrobial activity of graded concentrations of a new antibacterial agent, chlorhexidine phosphanilate (CHP), in cream formulations using Franz diffusion cells. Formulations containing from 0.2 to 2% CHP were quantitatively applied to intact excised skin and to skin from which the stratum corneum and partial epidermis had been enzymatically removed. Receptor fluids from diffusion cells were sampled over time and assayed by HPLC methods for chlorhexidine and phosphanilic acid; 24- and 48-hr samples of the diffusate from studies with damaged skin were also bioassayed using clinical isolates of appropriate microbial species. Through intact skin almost no permeation of CHP was observed over 48 hr. The failure of CHP to penetrate intact human skin suggests that normal stratum corneum is the rate-limiting barrier to penetration by this antimicrobial agent. In damaged skin lacking stratum corneum barrier, the release of CHP from the formulation becomes the rate-determining step. Coincident with penetrating damaged skin, CHP dissociates, and the molar ratio of the chlorhexidine and phosphanilate moities in the diffusate changes to favor phosphanilic acid. The extent of changes in the permeation rates of both moieties of CHP was directly related to the CHP concentration in cream. Both CHP moieties were found to reach equilibrium in the dermis within 24 hr after application. It was also observed that CHP creams down to 0.2% concentration yielded diffusates with activity exceeding the minimum inhibitory concentration of all test microorganisms within 24 hr.

Anti-Infective Agents, Local↗
PubMed2002

A comparison of the plaque-inhibitory properties of stannous fluoride and low-concentration chlorhexidine mouthrinses.

BACKGROUND: Plaque inhibition by chlorhexidine (CHX) rinses is dose related with a relatively flat dose-response curve above 5-6 mg twice daily. Low dose regimens could therefore reduce local side effects but maintain reasonable efficacy. AIMS: To compare the plaque inhibitory properties of two low-dose CHX rinse products with more conventional levels delivered from proprietary rinses. A secondary outcome was a comparison with a stannous fluoride/amine fluoride (SFAF) rinse product. METHODS: The study was a five-treatments, negative controlled, randomised, single blind crossover design balanced for residual effects, involving 20 healthy subjects in a 24-h plaque re-growth model. On day 1 of each study period, subjects were rendered plaque free, suspended tooth cleaning and followed the appropriate rinse regimen. On day 2, subjects were scored for plaque by index and area. The rinse codes and rinsing regimens were: (A) 15 mg CHX 2 x daily for 30 s (0.1% CHX), (B) 9 mg CHX 2 x daily for 60 s (0.06% CHX), (C) 10 ml SFAF rinse 1 x daily for 30 s, (D) 15 ml placebo 2 x daily for 60 s, and (E) 6 mg CHX 2 x daily for 30 s (0.06% CHX). RESULTS: Average mouth plaque indices and areas were highly significantly different between rinsing regimens. All test rinses were significantly more effective than the placebo rinse. There was a mean dose-response pattern for the CHX rinses, but there were no statistically significant differences between any of the test rinses. CONCLUSIONS: Lower doses of chlorhexidine in rinses can be used to exert plaque inhibition comparable with products used at higher doses and equivalent to benchmark products such as the SFAF rinse. However, the availability of chlorhexidine from formulations has to be considered as in part explaining the results.

Adult↗
PubMed2003

Efficacy of a 0.5% chlorhexidine gel on the control of gingivitis in Brazilian mentally handicapped patients.

OBJECTIVE: To evaluate the effectiveness of a 0.5% chlorhexidine gel on the reduction of interdental gingival bleeding. MATERIAL AND METHODS: Forty-three mentally handicapped subjects, living in an institution (Casas André Luiz, Brazil), were enrolled in a double-blind randomised clinical trial. The subjects were randomly divided into two groups: test (chlorhexidine gel) and control (placebo gel). The gel was applied with trays, twice a day, over a period of 8 weeks. The interdental bleeding index (IBI) was recorded before and after the period in which the gel was used. RESULTS: Statistical analysis showed that baseline IBI scores were similar (p=0.82) for test and control groups (55.6% and 54.5%, respectively). After 8 weeks, a statistically significant (p<0.001) decrease in IBI means took place in the test group (33.2%). The control group presented a small increase (60.6%) in IBI scores. The difference between groups was significant at the end of the study (p<0.001). CONCLUSION: The results indicated that the use of a 0.5% chlorhexidine gel was effective in reducing interdental gingival bleeding in special patients.

Adolescent↗
PubMed2002

Effectiveness of chlorhexidine-thymol varnish for caries reduction in permanent first molars of 6-7-year-old children: 24-month clinical trial.

OBJECTIVES: To determine the effect of chlorhexidine varnish on the prevention of caries in permanent first molars. METHODS: Two groups of 6-7-year-old school children were followed up in a clinical trial, a group of 86 children whose teeth were treated with a chlorhexidine-thymol varnish (Cervitec) and a control group of 95 children. The varnish was reapplied every 3 months and the caries increments were compared at 24 months. RESULTS: The DFS (decayed and filled surfaces in permanent first molars) increment in the control group (mean = 1.85; SD = 2.27) was higher than in the test group (mean = 0.95; SD = 1.38), resulting in a 48.6% caries reduction. This difference was statistically significant (P = 0.032). CONCLUSIONS: Chlorhexidine-thymol varnish is effective in preventing caries in permanent first molars.

Anti-Infective Agents, Local↗
PubMed2003

Caries incidence in permanent first molars after discontinuation of a school-based chlorhexidine-thymol varnish program.

OBJECTIVES: To determine whether the cessation for 3 years of a 24-month program of chlorhexidine-thymol varnish applications would affect caries incidence in the first permanent molars of a population of schoolchildren of middle and lower-middle socioeconomic level. METHODS: Two groups of 6-7-year-old schoolchildren, randomized by school-class, were followed up in a clinical trial. One group received applications of chlorhexidine-thymol varnish every 3 months and the other group acted as controls. The program ended after 24 months and its effects were evaluated. Three years later, 55.5% of the schoolchildren were re-examined and the caries increments were documented. RESULTS: At the end of the 24-month program, the treated children had significantly fewer decayed and filled surfaces in permanent molars (lower DFS index) versus the controls. At 3 years after the discontinuation of the program, this difference had disappeared; there were no differences in the incidence of decayed, missing and filled surfaces (DMFS) index in permanent molars between the treated children and the controls. CONCLUSION: The cessation for 3 years of a 3-month program of chlorhexidine-thymol varnish applications resulted in a nonsignificant increase in the prevalence of dental caries in the permanent first molar.

Anti-Infective Agents, Local↗
PubMed1983

Simple additives to increase the activity of chlorhexidine digluconate against urinary pathogens.

The concentration of chlorhexidine digluconate required to kill Gram-negative bacteria which cause urinary tract infection associated with urethral catheterisation also damages the bladder mucosa. Increased bactericidal activity was obtained by the addition of a chelating agent (EDTA) and a buffer (Tris) enabling a low concentration of chlorhexidine (0.01 per cent) to be effective against Escherichia coli NCTC 86, Pseudomonas aeruginosa NCTC 7650 Proteus mirabilis NCTC 8309 and Streptococcus faecalis NCTC 8213. The type of fluid in which the bacteria were suspended affected the time required to achieve 99.9 per cent killing. The 0.01 per cent chlorhexidine solution with added EDTA and Tris did not cause severe erosive damage to the bladder mucosa of rats. The potential of this solution for use as a skin antiseptic prior to catheterisation and as a bladder instillation after catheterisation is discussed.

Adult↗
PubMed2002

Antibacterial and physical properties of resin modified glass-ionomers combined with chlorhexidine.

The purpose of this study was to determine the effect on mechanical properties and antimicrobial activity of the addition of chlorhexidine (CHX) to a resin modified glass-ionomer (Photac-fil, ESPE, Norristown, PA, USA). Chlorhexidine diacetate was combined with a resin modified glass-ionomer material at a concentration of 5%. The samples were tested for hardness, tensile strength and erosion at 24 h and 6-week intervals and for elution of CHX and antimicrobial activity weekly for 6 weeks. At 24 h there was no significant difference in hardness between the two groups, but at 6 weeks the resin modified glass-ionomer group was significantly harder than the CHX groups (P < 0.05). The diametral tensile strength test indicated no difference between the control and CHX groups at 24 h or at 6 weeks. The jet erosion test demonstrated significantly less erosion with the CHX group at 24 h but at 6 weeks the CHX group showed significantly more erosion than the control group. The chemical assay data demonstrated a peak elution of CHX at week 1 with residual amounts at weeks 2 and 3. The microbial data demonstrated that the CHX group had a significant reduction in Streptococcus mutans numbers for weeks 1-3, but after week 4 there was no difference between the glass-ionomer with and without CHX. The addition of CHX to resin modified glass-ionomer altered hardness and erosion of the resin-modified glass-ionomer, but because there are no material specifications, it is difficult to determine clinical implications. Chlorhexidine did significantly improve the antimicrobial effect of the glass-ionomer which was consistent with the chemical assay data. The results indicated that the addition of CHX to resin modified glass-ionomer material (Photac-fil) did not seriously degrade the physical properties during the time period tested and that the addition of CHX resulted in a greater reduction in S. mutans when compared with glass-ionomer alone.

Analysis of Variance↗
PubMed2003

In vitro effects of a chlorhexidine controlled delivery system.

The aim of this work was study the effect of the chlorhexidine : hydroxypropyl-beta-cyclodextrin (CLX : HP-beta-CD) inclusion compound (IC) on in vitro slabs of bovine dentine. The substantivity, antimicrobial activity, and morphological effect of this inclusion compound were evaluated. Cyclodextrin improves the physical-chemical and pharmacological properties of drugs. Fragments of bovine dentine were immersed into either IC serial solutions at 0.24%, 0.12%, 0.06%, 0.03%, 0.015%, and 0.008% or controls water and free chlorhexidine. The desorption kinetics showed that CLX : HP-beta-CD compound release CLX for 6 days in a rate flow near to zero-order profile in comparison to plain CLX. Antimicrobial activity tests showed that CLX : HP-beta-CD inhibited A. actinomycetemcomitans and S. mutans significantly. The morphological effect studied by scanning electron microscopy (SEM) showed that CLX : HP-beta-CD did not cause morphological changes to the slab's surface. It is concluded that the chlorhexidine : hydroxypropyl-beta-CD inclusion compound creates an effective controlled release system with biological activity and that it may act as a good prevention and control agent of caries and periodontal disease in vivo.

Animals↗
PubMed2000

Evaluation of chlorhexidine and povidone iodine activity against methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus faecalis using a surface test.

Most published studies of the activity of biocides against methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) have been based on suspension tests. This study was undertaken to provide information on the effect of chlorhexidine and povidone iodine on bacteria dried on to surfaces, a situation in which biocide activity is known to be reduced. The inactivation of MRSA (10 strains), methicillin-sensitive Staphylococcus aureus (MSSA, 10 strains), VRE (nine strains) and vancomycin-sensitive Enterococcus faecalis (VSE, 10 strains) by 0.5% aqueous chlorhexidine gluconate or 10% povidone iodine was evaluated by applying the European surface test method. Povidone iodine was equally active against resistant and sensitive strains of both species with microbicidal effects (ME), i.e. the log(10)concentration of micro-organisms compared with controls treated with distilled water, after 1.5 min of 3.14 and 3.49 for VRE and VSE respectively, and 3.47 and 3.78 for MRSA and MSSA. Chlorhexidine was equally active against VRE and VSE (ME 3.37 vs. 3. 56 after 7 min, respectively), but was significantly less active against MRSA as opposed to MSSA (ME 3.07 vs. 3.83 after 10 min, P= 0. 017).

Anti-Infective Agents, Local↗
PubMed1998

Delmopinol hydrochloride- and chlorhexidine digluconate-induced precipitation of salivary proteins of different molecular weights.

Gel electrophoresis was used to analyze precipitates formed of delmopinol hydrochloride or chlorhexidine digluconate mixed with unstimulated whole saliva samples from five test subjects. Final concentrations of delmopinol (6.4 mM) or chlorhexidine (6.4 mM, 2.2 mM) mixed with whole saliva were incubated for 10 min at 37 degrees C. The precipitates were pelleted by centrifugation and resuspended to a similar protein density. The protein patterns in the pellets were analyzed by sodium dodecyl sulfate polyacrylamide gel electrophoresis, using 12.3% gels. The amount of pellet protein was determined by densitometry in four molecular weight ranges (10-21.5, 21.5-26, 26-45, and 45-300). The results indicated that high molecular weight (45-300) proteins dominated in the precipitate and that 2.2 mM chlorlhexidine precipitated more salivary protein than 6.4 mM. At equimolar concentration (6.4 mM) delmopinol precipitated more high molecular weight salivary proteins than chlorhexidine.

Adult↗