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PubMed1991

In vitro activity of chlorhexidine against enteric rods, pseudomonads and acinetobacter from human periodontitis.

Fifty-eight periodontal isolates of the families Enterobacteriaceae and Pseudomonadaceae, and the genera Acinetobacter and Achromobacter were studied to determine their susceptibility to Peridex (0.12% chlorhexidine digluconate solution; Procter & Gamble). In an agar dilution assay, about 50% of the study strains grew in the presence of 70 micrograms/ml of chlorhexidine. Enterobacter cloacae, Klebsiella pneumoniae, Pseudomonas aeruginosa, Pseudomonas cepacia, and Serratia marcescens comprised the most resistant species. Studies are needed to determine the microbiological and clinical effects of chlorhexidine usage in patients infected with enteric rods and pseudomonads.

Acinetobacter↗
PubMed1995

Porphyromonas gingivalis outer membrane vesicles promote bacterial resistance to chlorhexidine.

Porphyromonas gingivalis has been frequently associated with some types of periodontal diseases and possesses various mechanisms favoring the pathogenic process. It has been recently observed that vesicles elaborated by P. gingivalis are able to protect bacteria from the bactericidal activity of human serum. The aim of the present investigation was to evaluate the ability of vesicles from P. gingivalis in protecting oral bacteria against chlorhexidine. Data indicate that vesicles released by P. gingivalis may bind chlorhexidine, thus allowing protection for itself and for other oral bacterial species. It has also been demonstrated that lipopolysaccharides are the major component involved in the binding of chlorhexidine by vesicles. The mechanism of resistance reported in this study indicates that bacterial interactions in the oral cavity may influence the sensitivity of microbes.

Anti-Infective Agents, Local↗
PubMed2005

Antimicrobial effects of essential oils in combination with chlorhexidine digluconate.

The aim of the present study was to compare antimicrobial effects of essential oils alone and in combination with chlorhexidine digluconate against planktonic and biofilm cultures of Streptococcus mutans and Lactobacillus plantarum. The essential oils included cinnamon, tea-tree (Melaleuca alternifola), manuka (Leptospermum scoparium), Leptospermum morrisonii, arnica, eucalyptus, grapefruit, the essential oil mouthrinse Cool Mint Listerine and two of its components, menthol and thymol. Cinnamon exhibited the greatest antimicrobial potency (1.25-2.5 mg/ml). Manuka, L. morrisonii, tea-tree oils, and thymol also showed antimicrobial potency but to a lesser extent. The combination effect of the essential oil-chlorhexidine was greater against biofilm cultures of both S. mutans and L. plantarum than against planktonic cultures. The amount of chlorhexidine required to achieve an equivalent growth inhibition against the biofilm cultures was reduced 4-10-fold in combination with cinnamon, manuka, L. morrisonii, thymol, and Listerine. We conclude that there may be a role for essential oils in the development of novel anticaries treatments.

Anti-Infective Agents, Local↗
PubMed1975

The effect of chlorhexidine irrigation of the bladder in the rat.

Rats' bladders were irrigated with aqueous solutions of chlorhexidine digluconate 1 : 5,000 or 1 : 10,000 for varying periods up to 48 hours. Histologic examination of the bladders showed severe erosive cystitis in a high percentage of cases. It is concluded that chlorhexidine cannot be recommended for prolonged irrigation of the bladder or for instillation during the intermittent catheterisation where chlorhexidine has repeated and prolonged contact with bladder mucosa.

Animals↗
PubMed1992

The mechanism of action of chlorhexidine.

Chlorhexidine did not inhibit ATPase in intact cells of Escherichia coli K12 W1317i-, even at bactericidal concentrations, and ATP hydrolysis was greatest at the highest concentration (40 mg/l), even though no net uptake of substrate occurred. Like dinitrophenol and tribrominated salicylanilide, polymyxin and chlorhexidine collapsed the membrane potential at inhibitory concentrations. Membrane disruption, and not ATPase inactivation, is considered the lethal event in chlorhexidine action.

Adenosine Triphosphate↗
PubMed1978

Use of chlorhexidine gluconate and povidone iodine mouthwashes in the treatment of acute ulcerative gingivitis.

A trial was conducted to compare the effectiveness of povidone iodine and chlorhexidine gluconate with buffered peroxyborate in the treatment of acute ulcerative gingivitis. After 20 patients had entered the trial and 11 had required additional therapy with metronidazole to control their symptoms, the study was terminated. Those patients receiving peroxyborate all showed a satisfactory improvement in clinical signs and symptoms. One patient each receiving povidone iodine or chlorhexidine reported a symptomatic improvement, although gingival ulceration was still apparent at 1 week. The remaining patients all required metronidazole therapy to control their symptoms. Povidone iodine and chlorhexidine gluconate therefore cannot be recommended for the treatment of acute ulcerative gingivitis.

Acute Disease↗
PubMed1980

Effects of a 1% chlorhexidine gel during the healing phase after inverse bevel mucogingival flap surgery.

A split-mouth double-blind trial was designed to compare the effects of chlorhexidine and placebo gels during the healing phase following mucogingival flap surgery. Fifteen patients were treated with 30 inverse bevel flap procedures, one on each side of the maxilla, with an interval of 4 weeks between each procedure. Gel was applied to the gums using a toothbrush once daily. Comparison of results revealed no significant differences in Plaque Index, Gingival Index, crevicular fluid or depth of pockets. More pain and swelling were recorded on the side treated with placebo gel, and more patients indicated that they preferred the chlorhexidine gel. The results were comparable to previous investigations using penicillin and suggest that, because of the reduced pain and swelling, chlorhexidine gel may be a suitable alternative to penicillin after periodontal flap surgery.

Chlorhexidine↗
PubMed1981

Clinical study to compare the effect of stannous fluoride and chlorhexidine mouthrinses on plaque formation.

A clinical study was conducted on four adults to compare the relative efficacy of 0.2% chlorhexidine digluconate and 0.1% stannous fluoride (SnF2). Using a crossover experimental design, subjects rinsed twice daily for 5 days with SnF2 and then, after a 2-day interim recovery period, for 5 days with chlorhexidine. Statistically significant differences (P less than 0.05) in the relative efficacy of the two agents were found. Chlorhexidine was more effective in reducing Gingival and Plaque Indices, plaque wet weight and bacterial Colony Forming Units, calculated both per subject and per group.

Chlorhexidine↗
PubMed1981

Comparison of the in vivo and in vitro antibacterial properties of antiseptic mouthrinses containing chlorhexidine, alexidine, cetyl pyridinium chloride and hexetidine. Relevance to mode of action.

A study was carried out to compare the antibacterial properties of four cationic antiseptics, three of which are available as commercial mouthrinse preparations. Minimum inhibitory concentrations for alexidine, cetyl pyridinium chloride, chlorhexidine gluconate and hexetidine against a range of standard test organisms, were determined by tube dilution. Similar values for Oxford staphylococcus were then obtained in Dubos medium to which protein as yeast, or food extract, or serum was added in doubling dilutions to 16%. Salivary bacterial counts after a single rinse with the antiseptics or water throughout the day were measured in 10 subjects together with the duration of any residual antiseptic activity in the saliva. All antiseptics were effective at low concentrations against the organisms tested but the minimum inhibitory concentration values for hexetidine were the highest. Food extract and serum markedly increased the minimum inhibitory concentration values of all antiseptics, although alexidine and hexetidine were the least affected in percentage terms. The activity of a 1% povidone iodine preparation, used for comparison, was almost completely vitiated. An immediate significant fall in salivary bacterial counts was produced by the cationic antiseptics. Return to pre-rinse levels was seen for hexetidine after 90 min, cetyl pyridinium chloride after 3 hours, alexidine after 5 hours and chlorhexidine gluconate after 7 hours. Residual salivary antibacterial activity remained to 90 min for cetyl pyridinium chloride, to 3 hours for hexetidine and alexidine and to 5 hours for chlorhexidine gluconate. The antibacterial properties measured, in particular the duration of effect in vivo, may be relevant to the anti-plaque activity of cationic antiseptics.

Bacteria↗
PubMed1982

Gingival bleeding after chlorhexidine mouthrinses.

During a clinical trial for evaluating the antiplaque effect of two flavoured chlorhexidine rinses, the observation was made that bleeding after gentle massage of the gingival margin occurred more often after chemical than after mechanical oral hygiene measures. In order to ascertain the validity of this unexpected observation, the same dental students participated in a repetition of the trial 18 months later. The results of the two trials indicate that gingival bleeding after gentle massage of the margin with the side of a periodontal probe actually occurs more frequently after rinsing twice daily with a 0.2% aqueous chlorhexidine solution for 1 week than after meticulous mechanical oral hygiene measures during an equally long time period. The average frequency of bleeding, in per cent of all examined gingival units, ranged from 1.3% after mechanical cleaning of the teeth to 5.4% after rinsing with chlorhexidine for 1 week. Neither the frequency of bleeding nor the difference between mechanical and chemical plaque control were considered to be of clinical significance. Further microbiological and histological studies are being conducted in an attempt to clarify the reason for the observed bleeding tendency.

Chlorhexidine↗
PubMed1984

Gingival bleeding after chlorhexidine rinses with or without mechanical oral hygiene.

In a previous paper a slight increase in gingival bleeding tendency was reported after the use of chlorhexidine rinses in dental students with clinically healthy gingivae. For further clarification of this finding the study was repeated using a split mouth approach. 30 dental students brushed the teeth in either the left or the right side of their mouth twice daily during a 7-day period. After each brushing, they rinsed for 1 min with 10 ml of a 0.2% chlorhexidine digluconate solution. Both the Plaque Index (P1I) scores and the bleeding tendency after massage of the gingival margin were low at the initial examination. The low P1I scores at baseline were further reduced on both sides of the jaws. On the side which was only rinsed the P1I scores were higher than on the side of combined mechanical and chemical cleaning. The gingival bleeding tendency was found to decrease on the brushed side and to increase on the side which was only rinsed. An increased bleeding tendency was most often observed in those individuals whose gingivae were the healthiest at baseline. A SEM analysis of the 2 sides of the dentition indicated that bleeding after chlorhexidine rinses may be associated with irritation from debris which, after the 7-day period of no mechanical oral hygiene measures, seemed to obliterate the gingival sulcus.

Chlorhexidine↗
PubMed1984

Effect of metronidazole on chronic periodontal disease in subjects using a topically applied chlorhexidine gel.

A double blind between subject comparison of the effect of metronidazole and placebo tablets was completed over 22 weeks in 45 subjects with chronic periodontal disease ranging in severity from moderate (PI = 2.0-3.9) to high (PI = 4.0-6.0). All subjects used a topically applied chlorhexidine gel for the first 10 weeks. Throughout the trial plaque, bleeding and calculus were assessed on the buccal, lingual, mesial and distal surfaces of teeth 16, 21, 24, 36, 41 and 44 and their supporting tissues. The pocket depths on the same 4 aspects of all teeth present were measured. The regime employed consisted of oral hygiene instruction (OHI) at the initial visit followed by scaling and further OHI at visits 1 and 2 weeks later. After the third visit 16 X 200 mg metronidazole or placebo tablets were issued with instructions to take 1 that evening and 3 per day at 5-h intervals for the next 5 days. 4 weeks later, scaling and OHI were carried out and the course of test or placebo tablets was repeated. The subjects returned for further scaling and OHI 4 weeks later and the chlorhexidine gel was withdrawn. Final assessments were made 12 weeks later. The results showed that metronidazole had no effect on plaque levels and gingival bleeding beyond the effect of OHI, scaling and chlorhexidine gel. On the other hand, significantly greater reductions in pocket depths were achieved with the use of metronidazole. A surprising and interesting finding was that these reductions were apparent only in the subjects with severe periodontal disease (PI = 4.0-6.0).

Administration, Topical↗
PubMed1984

Comparison of the effect of chlorhexidine and CuSO4 on plaque formation and development of gingivitis.

Recent studies have shown that several metal ions inhibit plaque formation and reduce the acidogenicity of dental plaque. The aim of the present study was to compare the effect on plaque and gingivitis of 2.2 mM CuSO4 with an equimolar solution of chlorhexidine in a modified experimental gingivitis model. The study was performed according to a double-blind cross-over design. Before each experimental period the GI was recorded and the participants' teeth were scaled and polished to remove all supragingival deposits. All mechanical oral hygiene was suspended during the experimental periods. The mean PII after rinsing with chlorhexidine, CuSO4 and water was 0.29, 0.79 and 1.25, respectively. The corresponding GI values were 0.57, 0.83 and 1.02. All differences were statistically significant. The results showed that CuSO4 inhibits plaque formation and development of gingivitis, but not to the same degree as chlorhexidine.

Adult↗
PubMed1984

Comparison of the immediate effects on the sub-gingival microflora of acrylic strips containing 40% chlorhexidine, metronidazole or tetracycline.

In the management of chronic periodontitis, there has been a renewed interest in the local delivery of antimicrobial drugs into periodontal pockets. This study assessed the effects of the acrylic strip delivery system containing chlorhexidine, metronidazole or tetracycline on subgingival microflora assessed by dark field microscopy. Strips containing 40% chlorhexidine, metronidazole or tetracycline were placed for 2 to 3 days into pockets greater than 6 mm which bled on probing. Plaque samples were obtained before and after treatment and counts of morphological and motile groups of organisms were made by dark field microscopy. Prior to treatment, the dark field microscopic counts were similar to those previously reported for diseased sites with motile bacteria, in particular spirochaetes, present in high numbers. Following treatment, all 3 antimicrobial drugs produced a significant increase in the proportion of cocci and significant decreases in all other types of organisms. Motile organisms, in particular, were markedly reduced and spirochaetes could not be recovered from some sites treated with metronidazole and tetracycline. Metronidazole was significantly more effective than tetracycline or chlorhexidine on spirochaetes. The results indicate that acrylic strips may be useful in the management of chronic periodontitis as an adjunct to routine mechanical methods.

Acrylic Resins↗
PubMed1986

Clinical and microbiological effects of sustained release chlorhexidine in periodontal pockets.

Previous studies have shown that a 3-day exposure of the pocket flora to the sustained release of chlorhexidine significantly reduced the relative numbers of spirochetes and motile rods in periodontal pockets to negligible amounts. By 14 days post-treatment, their numbers had returned to pre-treatment levels. The present study extended the exposure time of the pocket flora to the sustained release of chlorhexidine in an attempt to prolong the suppression of the microbial flora for a clinically significant period of time. Clinical parameters were also studied. Sustained release devices (SRD) were inserted into 13 pockets from 8 patients. Pocket depth ranged between 5 and 8 mm. The SRD's were replaced every 3 days to give a total exposure of 9 days. Plaque index (PlI), bleeding on probing and pocket depth were measured, and bacterial samples taken for dark field microscopy and anaerobic culture. There was a marked decrease in the relative proportions of spirochetes and motile rods and the total anaerobic count post-treatment. Pocket depth was reduced in all 13 pockets. These results indicate that a prolonged exposure to chlorhexidine suppresses the pocket flora to negligible amounts and reduces pocket depth for up to 11 weeks post-treatment.

Adult↗
PubMed1987

Antimicrobial properties of 2 aliphatic amines and chlorhexidine in vitro and in saliva.

The surfactants tetradecylamine, hexadecylamine and chlorhexidine have been compared with regard to their ability to inhibit microbial growth. Antibacterial activity was assessed by tube dilution methods. Tetradecylamine and chlorhexidine were similar in antibacterial activity, being effective at low concentrations against most organisms tested. Hexadecylamine also inhibited growth but at higher concentrations. Viable counts of salivary organisms were monitored in volunteers over 48 h after one rinse with the agents. The initial reduction in numbers of total viable salivary bacteria and streptococci by tetradecylamine and of streptococci by hexadecylamine had disappeared 3 h after a single mouth rinse, but the reduction in numbers of all salivary bacteria by chlorhexidine was more prolonged.

Adult↗
PubMed1988

Photographic assessment of the antiplaque properties of sanguinarine and chlorhexidine.

The purpose of this study was to assess the effect of rinsing and topical application of sanguinarine on labial surface plaque accumulation, compared with topically applied water, and compared with rinsing with chlorhexidine, while refraining from all oral hygiene measures for 5 days. Color photographs of the disclosed plaque were taken at the end of each phase of treatment and blindly traced using an Apple II micro-computer graphic tablet digitizer. The plaque score for each tooth was calculated by dividing the computer reading of the labial plaque surface area by the total labial surface area of the tooth. Topically applied sanguinarine showed better plaque reduction than mouthrinsing with sanguinarine. There was a significant reduction in plaque accumulation after rinsing with chlorhexidine compared with topically applied sanguinarine, water, and mouthrinsing with sanguinarine. The results of this study indicate that chlorhexidine is a more superior antiplaque agent than sanguinarine. The use of an Apple II micro-computer graphic tablet digitizer provided a valuable method for accurate plaque assessments.

Administration, Topical↗
PubMed1988

Quality-specific taste impairment following the application of chlorhexidine digluconate mouthrinses.

Although chlorhexidine has been widely used in the prevention and treatment of gingivitis, its effects on taste sensation have not been well studied. The purpose of the present study was to evaluate taste alterations following regular applications of 0.2% chlorhexidine mouthrinses. 24 healthy and non-smoking clinical instructors, dental assistants and dental students were divided into 3 groups after having reached a status of clinical gingival health by 4 weeks of supervised oral hygiene procedures. Following this, they were asked to abolish all mechanical oral hygiene for a period of 14 days, during which time they rinsed twice daily with different mouthrinses. Group A rinsed with a 0.2% chlorhexidine solution, group B served as control and utilized a 0.001 molar solution of quinine hydrochloride as a placebo rinse. A second control group (C) rinsed with distilled water. At days -3 and -2, as well as at days 1, 2, 13 and 14 of the experimental period, and 1 and 2 days after cessation of the rinsing, taste sensitivity was evaluated by a magnitude estimation, suprathreshold scaling procedure for the 4 taste qualities--sweet, salty, sour and bitter. 6 different concentrations of each of sucrose, sodium chloride, citric acid and quinine hydrochloride were utilized. Magnitude estimations of the perceived intensities of each series of test solutions were calculated. The analysis of co-variance revealed significant differences at the short-term and treatment-related suprathreshold scaling responses between both control groups (B, C) and the test group (A) for the sodium chloride magnitude estimation function. However, no significant inter-group differences in the magnitude estimation function were found for the remaining taste qualities.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗