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PubMed1989

Studies on the effect of toothpaste rinses on plaque regrowth. (I). Influence of surfactants on chlorhexidine efficacy.

A number of compounds have been added to toothpastes to inhibit plaque regrowth. The inclusion of cationic antiseptics, such as chlorhexidine, poses formulation difficulties because of interactions with other ingredients particularly anionic detergents. More recently, Triclosan/zinc citrate formulations have been shown effective plaque inhibitors. The aim of this study was to compare a commercially available 0.2% Triclosan/0.5% zinc citrate toothpaste with a number of experimental 0.5% chlorhexidine/detergent toothpastes for effects on plaque regrowth over 4 days. Subjects rendered plaque free at each baseline rinsed twice a day with toothpaste slurries and disclosed plaque was scored at the end of each period. All toothpastes significantly reduced plaque by comparison with a control toothpaste, but were significantly less effective than a 0.2% chlorhexidine rinse. Some significant differences in favour of one chlorhexidine toothpaste were noted but these were small in magnitude. Whether the plaque inhibition obtained with Triclosan/zinc citrate toothpaste was greater than would be expected from other commercially available preparations cannot be determined from this study and is the subject of a further investigation.

Adult↗
PubMed1989

Histological and clinical parameters of human gingiva following 3 weeks of chemical (chlorhexidine) or mechanical plaque control.

The aim of the present study was to compare stereologically the histopathologic variations following 3 weeks of chemical (chlorhexidine) or mechanical plaque control. 18 students and dental hygienists volunteered for this investigation. After prophylaxis, they performed optimal oral hygiene to reach mean plaque and gingival indices approaching 0. Six of them then performed mechanical plaque control of 3 weeks (control), while the other 12 rinsed 3 times daily with a 0.12% chlorhexidine solution (test). At days 0 and 21, the plaque index (PlI), the gingival index (Gl) and the gingival exudate flow rate (GEFR) were assessed and biopsies were obtained from buccal sites. Point-counting procedures were performed at 2 different levels of magnification on light microscopic sections to estimate the volume fractions of epithelium, infiltrated and non-infiltrated connective tissue, and collagen. The relative numbers of fibroblasts, polymorphonuclear neutrophils, lymphocytes, plasma cells, macrophages and mast cells were estimated by counting the number of nuclear profiles of these cells in a specific connective tissue area adjacent to the apical termination of the junctional epithelium. After 21 days, the PlIs of the test subjects were significantly higher than the PlIs of the controls, but their Gl were similar. At the end of the experimental period, the various volume fractions and %s of cell profiles remained stable with the exception of an increase in the %s of lymphocytes in the test group. This study has shown that, clinically as well as histologically, the daily use of chlorhexidine for a 3-week period is equally efficient as optimal mechanical tooth cleaning in maintaining a healthy gingiva in the buccal sites investigated.

Chlorhexidine↗
PubMed1990

The effect of triclosan, stannous fluoride and chlorhexidine products on: (I) Plaque regrowth over a 4-day period.

A number of substances have been incorporated into toothpastes or gels to inhibit plaque regrowth. The aim of this study was to evaluate triclosan and stannous fluoride products for plaque inhibitory properties by comparison with a chlorhexidine or saline rinse and a control product which was a conventional commercially available toothpaste. In a blind 8 cell cross-over study, 15 volunteers rinsed 2 x a day for 4 days with slurries of the products or the saline and chlorhexidine solutions. No other form of oral hygiene was performed and plaque regrowth from a zero baseline was recorded by plaque score and plaque area. Plaque regrowth was significantly less with the chlorhexidine rinse and significantly greater with the saline rinse compared to the toothpaste and gel products. No significant differences were found between the test and control products. The results again demonstrate that commercially available toothpastes have plaque inhibitory effects which so far appear difficult to improve upon by the addition of specific ingredients, in this case stannous fluoride or triclosan. Commercially available products of known activity would appear useful benchmarks for comparison of experimental formulations.

Adult↗
PubMed1990

The effect of triclosan, stannous fluoride and chlorhexidine products on: (II) Salivary bacterial counts.

A previous study demonstrated that triclosan and stannous fluoride containing oral hygiene products reduced plaque regrowth compared to saline but were not more effective than a conventional commercial fluoride/anionic detergent toothpaste. To further understand these results, this study measured the persistance of antimicrobial activity of the same products by recording the duration of salivary bacterial count reductions following a single exposure to each product. Comparison was also made with a chlorhexidine rinse as the positive control. From a panel of 16 volunteers, in an 8-cell randomised cross-over designed study, salivary bacterial counts were recorded at baseline and to 420 min. All test and control products were significantly more effective than saline and significantly less effective than chlorhexidine at suppressing bacterial counts. Unlike chlorhexidine, evidence of bacterial recovery was apparent after the 30-min sampling time. There were essentially no significant differences between the test and control products, although the stannous fluoride toothpaste performed marginally better than other products. The findings are consistent with the plaque regrowth results previously obtained and again demonstrate to date that it is difficult to surpass the antimicrobial and plaque inhibitory properties of conventional commercially available toothpastes by the addition of antimicrobial agents such as triclosan and metal salts.

Adult↗
PubMed1992

Clinical effects of pulsed oral irrigation with 0.2% chlorhexidine digluconate in patients with adult periodontitis.

The aim of this study was to investigate the effects of using 0.2% Chlorhexidine digluconate in an pulsated jet irrigator by patients as part of their daily dental home-care measures. After initial assessment, 16 patients diagnosed as having adult periodontitis received scaling and polishing together with advice on the subgingival use of a pulsated jet oral irrigator with which they were supplied. 8 patients having 293 active sites with probing depths equal to or in excess of 4 mm used 0.2% chlorhexidine digluconate (CHX) in the oral irrigator, 2 x daily for 56 days. The other group of 8 patients with 253 active sites over 4 mm used a placebo as the irrigating solution. A modified dichotomous plaque index (MPI), gingival bleeding index (GBI) and probing pocket depths (PPD) were assessed on days 0, 28 and 56. Within-group comparisons showed that the CHX regime reduced MPI, GBI and PPD significantly but that the placebo group (PG) only achieved a significant reduction in the PPD. Between-group comparisons showed that the use of 0.2% CHX as an irrigant was significantly more effective than the placebo solution at reducing all the clinical parameters studied. The patients found the oral irrigator easy and pleasant to use, although all the CHX group developed staining to a varying extent. This double blind study demonstrated that 0.2% CHX used 2 x daily in an oral irrigator was effective at reducing plaque deposition, periodontal inflammation and probing pocket depths. The effects of using lower concentrations of chlorhexidine digluconate in this regime need to be investigated.

Adult↗
PubMed1993

Evaluation of a mouthrinse containing chlorhexidine and fluoride as an adjunct to oral hygiene.

Chlorhexidine and fluoride have valuable preventive roles in dental and oral diseases. There is also evidence that in caries prevention, together, they provide additive benefits. However, combined chlorhexidine/fluoride formulations have rarely been evaluated. The aim of this study was to determine whether a 0.12% chlorhexidine, 100 ppm F- mouthrinse provided adjunctive oral hygiene benefits compared to a minus active control rinse. The study was a randomised double-blind parallel design involving 102 subjects of whom 99 completed the 6 week experimental period. Subjects rinsed 2x per day for 1 min with 15 ml of the allocated rinse. Normal toothbrushing procedures were maintained throughout the study. At 6 weeks, plaque and gingivitis scores were significantly lower and the incremental reduction significantly larger in the active rinse group. However, as expected, toothstaining was significantly increased with the active rinse. It is apparent that this chlorhexidine/fluoride rinse could be used in those regimens recommended for other chlorhexidine formulations. The value of the formulation in caries prevention would seem worthy of further investigation.

Adolescent↗
PubMed1993

The effects of a chlorhexidine toothpaste on the development of plaque, gingivitis and tooth staining.

Chlorhexidine has found many uses in clinical dentistry as an antiplaque agent. To date, effective chlorhexidine-containing toothpastes have not been made available. This study was the first phase in the evaluation of a 1% chlorhexidine toothpaste, formulated to ensure a high availability of the contained antiseptic. The study was a 19-day, randomised double-blind placebo-controlled, crossover experiment al gingivitis clinical trial employing 14 healthy human volunteers. From a zero plaque and low gingivitis baseline, the development of plaque, gingivitis and dental staining was measured on days 12 and 19 of the 2 study periods. The toothpaste was used 2x a day as a slurry rinse with no other form of oral hygiene. The washout period was 21 days. The development of plaque and gingivitis was statistically and clinically highly significantly reduced during the use of the active compared to the placebo product. Conversely, dental staining was statistically and clinically significantly increased. The product deserves further evaluation for potential clinical use.

Adult↗
PubMed1995

The effect of oxidising mouthrinses compared with chlorhexidine on salivary bacterial counts and plaque regrowth.

For various clinical indications, oxidising agents have been used in dentistry for many years. Little is known, however, of their antibacterial activity and their ability to inhibit plaque formation. In this study, 2 mouthrinses containing peroxyborate (Bocasan) and peroxycarbonate (Kavosan) were compared alongside a negative control saline rinse and a positive control chlorhexidine rinse (Corsodyl) for their ability to inhibit plaque reformation. Employing a randomised four replicate 4 x 4 latin square cross over design and, whilst omitting all other oral hygiene, plaque was measured by area and index after rinsing for 4 days. In a second study, in vivo antibacterial effects of the rinses were assessed by measuring salivary bacterial counts following single rinses with the preparations at various time intervals over 7 h. Plaque inhibition by chlorhexidine was significantly greater than the other rinses. All rinses were significantly better than the saline rinse at inhibiting plaque. For plaque area, the peroxycarbonate rinse was significantly better than the peroxyborate rinse at inhibiting plaque. Salivary bacterial count reductions were significantly greater compared to saline with chlorhexidine at all time intervals up to 7 h. Whilst both peroxyborate and peroxycarbonate rinses produced greater reductions in bacterial counts than saline up to 3 h, at no time interval were the differences significant. The findings of these studies would suggest oxidising mouthrinses may inhibit plaque formation not by a direct antibacterial effect, but by some other mechanism. The magnitude of plaque reductions obtained with the peroxyborate and more so peroxycarbonate rinses would suggest a need for further study of these preparations when used as adjuncts to normal toothbrushing.

Analysis of Variance↗
PubMed1995

The use of plaque area and plaque index to measure the effect of fluoride and chlorhexidine toothpastes on 24-h plaque regrowth.

Short-term methodologies have been developed to screen chemical agents for plaque inhibitory effects. Most measure inhibition of plaque regrowth over several days. A method was described to study agents over 16-24 h periods, although some difficulties with the index used were reported. The aim of this study was to determine whether more conventional plaque scoring methods could be used. These 2 crossover studies measured plaque regrowth over 24 h in 20 subjects and in response to single brushings with either a chlorhexidine and minus active toothpaste or to a fluoride toothpaste product and water. Significantly less plaque had reformed after brushing with the chlorhexidine toothpaste compared with its control and with the fluoride toothpaste compared with water. 18 subjects participated in both studies and using their data for an interstudy comparison, less plaque developed with the chlorhexidine compared with the fluoride toothpaste. These studies had the advantage that longer-term trials already demonstrated the same differences. This permits one to conclude with some certainty that the 24-h plaque regrowth study design, using conventional measures of plaque accumulation, could be a useful and rapid method of screening potential plaque inhibitory agents and formulations.

Anti-Infective Agents, Local↗
PubMed1995

The effect of a commercially available triclosan-containing toothpaste compared to a sodium-fluoride-containing toothpaste and a chlorhexidine rinse on 4-day plaque regrowth.

Many compounds could be added to toothpaste to assist plaque inhibition, but ionic interactions can cause formulation difficulties. Moreover, the actual chemical action of a plaque inhibitory agent added to a toothpaste is difficult to assess when the product is used in the conventional manner, i.e., in addition to toothbrushing. The non-ionic antimicrobial triclosan has been incorporated in toothpastes and shown to have variable plaque inhibitory activity both alone and in conjunction with certain polymers or metal ions. Little is known of the efficacy of triclosan toothpastes compared to conventional fluoride toothpastes. The aim of this study was to compare a commercially available toothpaste containing 0.3% triclosan/co-polymer with a sodium fluoride toothpaste for chemical plaque inhibitory effects over a 4-day period. The study was designed to stratify the relative efficacy plaque inhibitory action of the products, comparisons were made with a positive control, chlorhexidine rinse and a negative control, saline. The study design was a randomised single blind crossover design balanced for first-order carryover. A total of 18 healthy, dentate volunteers participated in the study. On day 1 of each period the volunteers suspended toothcleaning and rinsed 2 x daily with the allocated mouthrinse or toothpaste slurry. On day 5, the plaque on the teeth was disclosed and scored by index and area. Increasing plaque scores were in the order chlorhexidine, triclosan toothpaste, fluoride toothpaste, and saline. Chlorhexidine was significantly more effective than all the other agents tested, and both toothpaste preparations were significantly better than the saline rinse. There was no significant difference between the two toothpaste rinses. Consistent with other studies the triclosan toothpaste offers only moderate plaque inhibitory properties when compared to a conventional toothpaste.

Adolescent↗
PubMed1998

The use of 0.2% chlorhexidine in the absence of a structured mechanical regimen of oral hygiene following the non-surgical treatment of periodontitis.

The aim of the present study was to evaluate a 0.2% chlorhexidine mouthrinse following the non-surgical treatment of advanced human periodontitis in the absence of a structured mechanical oral hygiene regimen. 10 patients and a total of 1483 sites were used. Recordings for plaque, bleeding, pocket depth and attachment levels were made at baseline and at 3, 6, 9, and 12 months. Debridement was performed under local anaesthesia. No instruction or reinforcement in mechanical oral hygiene procedures was given at any time. However, at each visit the patients were instructed in the 2x daily use of 0.2% chlorhexidine mouthwash. The plaque indices, scored as % of sites with removable deposits, showed negligible improvement from baseline scores of 80%-100% for all categories of initial probing depth. Mean bleeding score was reduced to 10-20% irrespective of initial probing pocket depth, site location or tooth surface location. Sites > or = 7 mm at baseline demonstrated a reduction in mean probing pocket depth of 3.9 mm and a gain in mean probing attachment level of 2.5 mm. Moderately deep sites (4-6.5 mm) demonstrated a reduction in mean probing pocket depth of 2 mm and a gain in mean probing attachment level of 0.8 mm. Shallow sites (< or = 3.5 mm) demonstrated a reduction in mean probing pocket depth of 0.5 mm and a loss in mean probing attachment level of 0.2 mm. Site-specific attachment level analysis demonstrated that over 80% of losing sites were shallow with low bleeding frequency, indicating that the loss of attachment may have occurred for reasons other than inflammatory periodontal disease. The results indicate that chlorhexidine can be used as an adjunct to inadequate mechanical oral hygiene over an observation period of 1 year.

Adult↗
PubMed2004

In vitro studies on controlled-release cellulose acetate films for local delivery of chlorhexidine, indomethacin, and meloxicam.

BACKGROUND: Delivery of medications into periodontal pockets to suppress or eradicate the pathogenic microbiota or modulate the inflammatory response, thereby limiting periodontal tissue destruction, has attracted significant interest with the purpose of effective periodontal treatment. However, no study has previously attempted to develop a controlled-release formulation of anti-inflammatory agents to be used in the field of periodontology. The aim of the present study was to examine the in vitro release profile of chlorhexidine gluconate, indomethacin, and meloxicam from cellulose acetate films. METHODS: Cellulose acetate films containing chlorhexidine gluconate, indomethacin, and meloxicam were prepared and cut in a form to fit to the periodontal pocket anatomy. The release of active agents was studied in 10 ml artificial saliva at 37 degrees C. Apparatus Vibrax was used at 150 r.p.m. Determinations were carried out spectrophotometrically and the release profiles were plotted as a function of time. RESULTS: The formulations showed two different release patterns for a total observation period of approximately 120 h. When the formulations of the three active agents were compared, the release patterns of meloxicam and chlorhexidine gluconate were found to be similar, while the indomethacin-containing formulation exhibited the fastest release rate. CONCLUSIONS: As a conclusion, cellulose acetate may be a suitable inert material for obtaining a prolonged local release of various anti-inflammatory agents like meloxicam. Further in vitro and in vivo studies are required before starting clinical applications of these controlled-release formulations of anti-inflammatory agents.

Anti-Infective Agents, Local↗
PubMed2005

Three different rinsing times and inhibition of plaque accumulation with chlorhexidine.

AIM: This study assessed the plaque inhibiting effect of a 0.2% chlorhexidine (CHX) solution (Corsodyl) with three different rinsing times following a 72 h non-brushing period. MATERIAL AND METHODS: The clinical investigation was a single-blind, randomised study involving 90 volunteer students (40 male and 50 female, mean age 23.2 years). Subjects were randomly allocated to one of three groups for which the protocol only differed with respect to the duration of rinsing. At the start of the trial, all participants received a dental prophylaxis to remove all plaque deposits. Subjects refrained from all mechanical oral hygiene procedures, but rinsed two times per day for the allocated duration with CHX mouth rinse over a period of 72 h. The chlorhexidine preparation was of 0.2% concentration used at a dose of 10 ml for either 15, 30 or 60 s. After 72 h, the Quigley & Hein plaque index (PI) from all volunteers was recorded at six sites per tooth. All participants received a questionnaire to evaluate their perception of rinsing duration. RESULTS: After 72 h, the mean whole-mouth PI was 1.33, 1.18 and 1.24, respectively, for the 15, 30 and 60 s rinsing group. The difference in plaque scores between the three groups was not statistically significant. Results from the questionnaire showed a significant difference between the groups for their perception of rinsing duration. CONCLUSIONS: No significant difference was observed in the level of plaque after 72 h of non-brushing whether the subjects rinsed for 15, 30 or 60 s with 0.2% chlorhexidine.

Adolescent↗
PubMed1982

Contact dermatitis to chlorhexidine.

In a 3-year period, 551 patients were patch tested with chlorhexidine gluconate 1% in water. 14 patients showed a strong and obviously relevant reaction. A severe dermatitis developed during treatment with a chlorhexidine preparation in 10 patients with venous or traumatic ulcers of the leg, and in 4 patients with skin infection on the face and/or scalp. So far the sensitizing potential of chlorhexidine has probably been underestimated.

Aged↗
PubMed1985

Contact sensitivity to chlorhexidine?

In a joint study, 2061 patients (1346 women and 715 men) were patch tested with chlorhexidine gluconate 1% in water, included in a standard test series. 48 patients (2.3%) showed a positive reaction. These were relatively more common in men (3.2%) than in women (1.9%). Positive reactions were most common in patients with leg eczema (6.8%) or leg ulcer (10.9%). Of the 48 patients who were patch test positive, 14 (2 with leg ulcer) were retested with chlorhexidine gluconate 0.01 and 1%. Only one with a leg ulcer was positive. These findings indicate that false positive reactions, known as "the excited skin syndrome", may arise from testing eczema patients in a standard series. The sensitizing potential of chlorhexidine may be very low, but the potential in patients with an eczema or ulcer of the leg has to be further evaluated.

Adult↗
PubMed1994

The effect of exposure to chlorhexidine gluconate in vitro and in vivo on in vitro adhesion of Candida albicans to buccal epithelial cells from diabetic and non-diabetic subjects.

The effect of 0.2% chlorhexidine gluconate on in vitro adhesion of Candida albicans to buccal epithelial cells (BEC) was studied in 12 healthy subjects and 12 patients with diabetes mellitus. Exposure of BEC for one minute with 0.2% chlorhexidine gluconate in vitro, or by rinsing the mouth in vivo, resulted in a significant reduction in candidal adhesion to BEC in both diabetic and non-diabetic subjects and between both groups. In addition to the known fungicidal effect of chlorhexidine, it also reduces Candida albicans adhesion to oral mucosal cells, a factor of importance in the establishment of candidal infection.

Adult↗
PubMed1978

Oral use of chlorhexidine gluconate toothpaste in epileptic children.

The purpose of this clinical study was to evaluate the effect of a 3-min daily toothbrushing with 1% chlorhexidine gluconate toothpaste on dental plaque, gingivitis and gingival hyperplasia in 30 mentally retarded epileptic children treated with phenytoin. A double-blind cross-over technique was used. Brushing once daily for 2 months with 1% chlorhexidine gluconate toothpaste resulted in significantly lower Pl I and G I values. Gingival hyperplasia was not significantly reduced by the use of the chlorhexidine toothpaste.

Administration, Oral↗
PubMed1980

Caries increment and gingival status during 2 years' use of chlorhexidine- and fluoride-containing dentifrices.

A total of 91 schoolchildren, 13 years of age, were distributed into three groups. Three test dentifrices were used containing 0.1% NaF, 0.1% NaF and 2% chlorhexidine, and 2% chlorhexidine, respectively. The caries increment and gingival conditions over a period of 2 years were recorded. The caries data of the groups were compared and related to two reference groups in order to estimate a possible influence upon the study results by a change in caries incidence general to the area and age groups in question. There was less caries in the group using the dentifrice containing fluoride and chlorhexidine than in the two other test groups. The differences in caries increment between the groups were not statistically significant. The gingival health seemed to improve in all groups, but there were no statistically significant differences between the groups. The caries data from the reference groups indicated that the general trend towards reduced caries incidence was different from that of the study group.

Adolescent↗