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New sustained release dosage form of chlorhexidine for dental use: use for plaque control in partial denture wearers.

The aim of this work was to test the effectiveness of a local sustained release application of chlorhexidine in prevention of plaque formation in a group of five partial denture wearers when oral hygiene procedures were withdrawn. The clinical study demonstrates that coating of the partial dentures with ethyl cellulose polymer containing the drug, prevents accumulation of plaque during a period of 12 days. No typical side effects of chlorhexidine such as tooth staining and unpleasant taste were observed during the study.

Aged↗

The effect of sustained release application of chlorhexidine on salivary levels of Streptococcus mutans in partial denture wearers.

The effect of a slow-releasing dosage (SRD) coating of chlorhexidine on the salivary levels of Streptococcus mutans and on plaque index scores in patients with removable partial dentures (RPD) was tested. The SRD proved to be effective in maintaining a low level of S. mutans counts after mechanical cleaning, as compared to a baseline established during the control period. Plaque index scores were lower following the treatment and correlated with the microbiological results. Our findings indicate that a single application of sustained-release chlorhexidine to removable partial dentures effectively maintains S. mutans levels as well as reducing the plaque score for a minimum period of 1 week.

Chlorhexidine↗

A method for the estimation of traces of chlorhexidine in water.

A simple method of estimating traces of chlorhexidine in water using bromothymol blue is described. The procedure involves the extraction of the chlorhexidine/bromothymol blue complex into carbon tetrachloride from a buffered neutral solution and measurement of the absorbances of the extracts in a spectrophotometer. The extracted complex has good colour stability, and the method is accurate, reproducible, and very sensitive, with concentrations of chlorhexidine down to 0.05 micrograms ml-1 measurable.

Bromthymol Blue↗

Effect of chlorhexidine and toothbrushing on the presence of bacteria on gingival and buccal epithelial cells.

Swabs of buccal and gingival epithelial cells from healthy young adult donors were washed in physiological saline solution, smeared on glass slides and stained with acridine orange. The presence of bacteria attached onto epithelial cells was examined under a fluorescence microscope. Four hours after a chlorhexidine rinse, the number of cells with > 50 attached bacteria had almost completely vanished. The degree of bacterial colonization seemed to re-establish at a level exceeding the baseline. One week after chlorhexidine treatment the degree of colonization was still over the control level. Toothbrushing with a conventional toothpaste reduced immediately the number of cells with > 50 bacteria. The colonization had re-established to the pre-washing levels at the buccal sites at 1 h and at the gingival sites at 4 h after toothbrushing. A method for the evaluating of the antimicrobial power of oral hygiene products is presented.

Adult↗

Effect of chlorhexidine 0.5% on the hand bacterial flora.

The effects of cleaning the dorsal hand with chlorhexidine 0.5% in spirit was evaluated by bacteriological study in 45 adult patients. In the absence of cleaning it was found that the prevalent microorganisms were Staphylococcus epidermidis, Staphylococcus aureus, Streptococcus viridans and Enterobacteriaceae. Cleaning the hand with chlorhexidine 0.5% eliminated all bacteria except S. epidermidis and S. aureus. In both instances, the culture results showed that the microorganisms were present in very low growth density.

Adult↗

Uptake of 14C-chlorhexidine gluconate by Saccharomyces cerevisiae, Candida albicans and Candida glabrata.

Uptake of radiolabelled chlorhexidine gluconate (14C-CHG) to Saccharomyces cerevisiae, Candida albicans and C. glabrata was very rapid and near maximal within 30 s. The organism, S. cerevisiae, most sensitive to the lethal action of chlorhexidine, took up significantly more biocide than the other organisms. Cells from cultures of different ages took up different amounts of 14C-CHG.

Anti-Infective Agents, Local↗

X-ray microanalysis of chlorhexidine-treated cells of Saccharomyces cerevisiae.

The use of energy dispersive analysis of X-rays (EDAX) to identify and quantify the presence of chlorhexidine diacetate (CHA) within Saccharomyces cerevisiae cells was examined. Chlorine was used as the elemental marker tag. Saccharomyces cerevisiae cells exposed to 1000 micrograms ml-1 CHA took up increasing amounts of CHA over a time period of 30 s to 30 min. Electron probe micro-analysis was employed to examine the specific accumulation of CHA across the treated cells. These results showed that CHA was distributed evenly between the cell wall, cytoplasm and vacuoles of cells pre-treated with this concentration of CHA for 30 min. The EDAX system therefore provides a useful tool for examining the qualitative and quantitative effects of chlorhexidine on yeast cells, although quantitative data must be interpreted with caution.

Chlorhexidine↗

Effects of four preparations of 0.05% chlorhexidine diacetate on wound healing in dogs.

Four chlorhexidine diacetate (CHD) antiseptic wound lavage preparations were evaluated in vivo to determine their effects on second intention wound healing in the dog in vitro to determine their relative antibacterial activity against Staphylococcus intermedius. Chlorhexidine was diluted to 0.05% in sterile water, 0.9% sodium chloride, lactated Ringers solution (LRS), and LRS that was allowed to form a precipitate with CHD. Control solutions included sterile water and LRS. There were no significant differences in wound contraction or epithelialization. All 0.05% CHD preparations provided 100% bacterial kill.

Animals↗

Chlorhexidine gluconate versus chloroxylenol for preoperative skin preparation in dogs.

The efficacy of 3% chloroxylenol (PCMX) or 4% chlorhexidine gluconate (CG) for preoperative skin preparation was assessed in 100 dogs undergoing clean or clean-contaminated surgical procedures. Replication Organism Detection and Counting (RODAC) plates were used to quantify skin bacteria colony forming units (CFU) at the operative site before and after skin preparation and immediately postoperatively. Reduction of CFU after skin preparation and immediately postoperatively was significant for each agent. However, CFU levels were significantly lower in the CG group than in the PCMX group after surgical preparation, regardless of initial CFU numbers. No significant difference in CFU counts was observed between antiseptic groups postoperatively. Within-group comparisons showed PCMX to be significantly less efficacious when the prescrub CFU number was greater than 1,000. Bacterial reduction was similar in the CG group regardless of prescrub CFU levels. The number of negative cultures after skin preparation was significantly greater with CG than with PCMX. Chlorhexidine gluconate also had fewer cultures with heavy bacterial growth (> 5 CFUs) after surgical preparation. There was no significant difference between antiseptics in the number of negative cultures or cultures with more than 5 CFUs immediately after surgery. The number of skin reactions and postoperative wound infections that occurred with each technique were similar. Three percent PCMX, as used in this study, was less effective than 4% CG in its immediate antimicrobial activity, however, this difference was not associated with an increased wound infection rate.

Animals↗

Validation and assessment of a blood-donor arm disinfectant containing chlorhexidine and alcohol.

BACKGROUND: To minimize the bacterial contamination rate in blood collected from donors, a study was designed to evaluate the suitability of a single-use chlorhexidine-alcohol antiseptic for donor arm preparation at all blood collection venues in Australia. STUDY DESIGN AND METHODS: A prospective study of bacterial load on the skin was performed on 616 blood donors' arms before and after disinfection using a direct swabbing and plating technique. Disinfection was achieved with a swab containing 1 percent chlorhexidine gluconate with 75 percent alcohol, which was applied to the skin in a prescribed method. Feedback from blood donors and staff was obtained using questionnaires. RESULTS: After disinfection, 99 percent of donor arms had bacterial counts of 5 cfu per plate or less, and 99.5 percent had counts of 10 cfu per plate or less, respectively. The mean colony count for all donors after disinfection was 0.39, and the percentage reduction was 99 compared to predisinfection. Sixteen donors (3%) noted transient skin irritation. The majority of staff (64%) preferred not to use the new disinfectant due to the difficulty opening the packaging and an excessive amount of antiseptic solution per pack. CONCLUSION: The bacteriologic study showed that the disinfectant satisfied the requirements of the Australian Red Cross Blood Service for use to prepare blood-donor arms before venesection. An improvement to the packaging was required before it could be acceptable to all staff.

Adult↗

Reduction of conjunctival bacterial flora by povidone-iodine, ofloxacin and chlorhexidine in an outpatient setting.

PURPOSE: To compare the reduction of conjunctival bacterial flora by povidone-iodine 4%, ofloxacin 0.3%, and chlorhexidine 0.05% for endophthalmitis prophylaxis before corneal suture removal in an outpatient setting. METHODS: In each group of 25 consecutive subjects who presented for outpatient ophthalmic evaluation, one eye was treated with either povidone-iodine 4% (PI), ofloxacin 0.3% (Oflox) or chlorhexidine 0.05% (Chex). The other eye served as a control. Three minutes after treatment, cultures were taken from the inferior conjunctival sac in both eyes. Following incubation at 35 degrees for 48 hours, the numbers of colonies were counted and compared. The difference in the numbers of colonies in each pair of treated and control eyes was assessed for each drug and compared. RESULTS: The reduction in colony-forming units was highly significant for each of the three drugs tested (Wilcoxon signed-ranks test; p < 0.0001). There was no significant difference between percent reduction by the three drugs (Kruskal-Wallis test; p = 0.68). Sterile cultures following preparation by PI, Oflox and Chex were obtained in 52%, 68% and 52%, respectively. CONCLUSIONS: The regimens tested were similarly effective in reducing conjunctival commensals. They may all be considered as options for a quick prophylaxis against infection following suture removal in an outpatient setting.

Anti-Infective Agents, Local↗

Effect of chlorhexidine on gingival wound healing in the dog. A histometric study.

Wound healing after gingivectomy was studied in five 1-year-old dogs (Beagles). During a preparatory period of 4 months, the teeth of the dogs were brushed twice a day using a toothbrush and dentifrice. At the end of this period, all gingival units appeared healthy. All mechanical tooth cleaning procedures were then terminated. Following a period a 2 weeks without oral hygiene, six gingival units, taken bilaterally from the maxillary first molar and posterior premolar areas, were subjected to standardized gingivectomies. Subsequently, the biopsied areas of the left half of the jaws were treated twice a day with a 0.2% aqueous solution of chlorhexidine digluconate for 42 days, while corresponding areas of the right jaws were given saline treatment. Tissue specimens were obtained after healing periods of 42, 28, 14, 7, 4 and 2 days. They were then immediately placed in a Karnovsky fixative, and afterwards decalcified in EDTA. The rate of tissue regeneration and degree of inflammatory cell infiltration were evaluated with histometric methods. It was found that while gingival wounds treated with saline regenerated with extensive inflammatory reactions, corresponding chlorhexidine-treated wounds healed with only minor signs of inflammation.

Animals↗

The effect of a chlorhexidine-containing gel on oral cleanliness and gingival health in young adults.

Students at a vocational school participated in a double-blind, cross-over study to test the effect of brushing with a 1% chlorhexidine-containing gel once a day. In the control period, a placebo gel was used. Each treatment period lasted for 4 weeks. This was subsequently followed by 4 weeks of ordinary toothbrushing. Any toothbrushing additional to the therapeutic brushing was performed with a standard commercial dentifrice without abrasives. In addition to the treatment groups, containing a total of 24 subjects, another group of 12 subjects received standardized oral hygiene instruction. Oral hygiene and gingival condition were assessed in all groups throughout the study. The chlorhexidine-containing gel seemed to have no effect on gingivitis and only a slight inhibitory effect on plaque formation. Furthermore, an increase in the degree and frequency of staining of the tooth surfaces related to the use of active gel were observed.

Adolescent↗

The effect of partial dentures and chlorhexidine gluconate gel on plaque accumulation in the absence of oral hygiene.

A study was made of the effect of wearing partial dentures upon plaque accumulation in a group of 24 partial denture wearers, when oral hygiene procedures were withdrawn. The modifying effect of a 1% chlorhexidine gluconate gel on this plaque accumulation was measured. Plaque accumulation was measured at the end of four different denture-wearing regimens each 3 days in length. The wearing of a partial denture either day only or day and night, significantly increased plaque accumulation over not wearing a denture. There was no significant difference between plaque accumulation with day wear and day and night wear. The increase in plaque accumulation with day and night wear resulted from an equal and significant increase in both buccal and lingual plaque accumulation. Chlorhexidine gluconate in the form of a gel significantly reduced plaque accumulation during daytime wear. These results tend to confirm that plaque control is a major factor in determining the long-term effects of partial dentures upon the periodontal structures and emphasize the importance of oral hygiene in partial denture wearers.

Adult↗

Studies of a periodontal tissue lesion in the rat, untreated or treated with chlorhexidine digluconate.

The studies currently reported formed part of an enquiry whose overall objective was to identify a suitable animal model upon which initial screening of compounds and formulations with prophylactic and/or therapeutic potential in periodontitis could be carried out. An earlier study (Rovin et al. 1966) reported that periodontal inflammation could be produced in the conventional laboratory rat by application of a ligature to the molar teeth. The present paper describes the pathological and histo-pathological changes in the periodontium following application of ligatures to the molar teeth of young rats, and the tissue responses observed after topical application of chlorhexidine digluconate. Plaque formed rapidly and an acute periodontitis was induced; application of increasing concentrations of chlorhexidine digluconate gave a progressive diminution in the severity of the lesions. The major bacterial components of the plaque were actinomycetes and streptococci.

Actinomycetales↗

Comparison of plaque accumulation after topical application and mouth rinsing with chlorhexidine gluconate.

This study measured plaque accumulation on anterior teeth after topical or mouth rinse application of 0.2% chlorhexidine gluconate. Compared with water plaque scores were highly significantly reduced. There was no significant difference in plaque scores between topical application or mouth rinsing. The importance of locally adsorbed chlorhexidine is emphasised and the relevance of an oral reservoir effect questioned.

Administration, Topical↗

Plaque growth-inhibiting effects of an abrasive fluoride-chlorhexidine toothpaste and a fluoride toothpaste containing oxidative enzymes.

The aim of this 4 times cross-over double-blind clinical trial was to test the plaque-inhibiting effect of 2 fluoride-containing toothpastes. One toothpaste contained 0.8% chlorhexidine together with amine fluoride (0.1% F degrees) and a suitable abrasive agent. The other contained 1.7 U/g glucose oxidase and 8.0 U/g amyloglucosidase, added to an amine fluoride (0.1% F degrees) toothpaste. 1% Hibitane dental gel was used as a positive and a conventional fluoride toothpaste (Vademecum MFP Fluor) as a negative control. 9 dental students, in a randomized sequence, applied the 4 dentifrices twice daily from Monday afternoon to Friday morning with cap splints, designed to cover the teeth and about 2 mm of gingiva. No other oral hygiene measures were allowed during the 4 test periods. On Fridays, the teeth were cleaned professionally and good oral hygiene was maintained during the week-ends. At the beginning and at the end of each test period, per student plaque thickness was recorded using the plaque index, the visible plaque index, and plaque fresh weight as parameters, and the area of plaque as related to the area of the tooth surface was recorded planimetrically and according to the PLQ index. The best plaque growth-inhibiting effect was recorded for the positive control (CHX) with the test chlorhexidine toothpaste (TX) as next best. The enzyme-containing toothpaste (TE) did not differ significantly from the negative control (C). All the significant differences in anti-plaque effect between the 4 toothpastes were obtained by recordings of plaque thickness and none on the basis of area of plaque.

Chlorhexidine↗

Clinical effects on chronic periodontitis of a simplified system of oral hygiene including subgingival pulsated jet irrigation with chlorhexidine.

The aim of this study was to investigate the effects of a simplified system of oral hygiene, comprising Bass brushing, scaling, root planing and subgingival irrigation using a pulsated monojet oral irrigator, in patients with chronic periodontitis. After initial assessment, patients received scaling, root planing and instruction in Bass brushing and in use of a pulsated jet oral irrigator (Water Pik + Imax attachment) to irrigate subgingivally. 11 patients with 262 approximal periodontal pockets used 0.02% chlorhexidine (CH), or a placebo as the irrigating solution once daily for 28 days. Plaque index (PlI), sulcus bleeding index (SBI), and probing pocket depth (PPD) were assessed on days 0, 28, 56 and 84. Within procedure comparisons for all groups showed that the regime was highly effective in reducing PlI, SBI and PPD, improvements being maintained at least until day 84. Between procedure comparisons showed that benefits were improved only marginally by the use of 0.02% CH as the irrigation fluid. The patients found the procedure pleasant and neither injuries nor staining were noted during the study. It was concluded that this simplified oral hygiene system was effective in reducing periodontal inflammation and pocket depth, although no significant added benefit with 0.02% CH was apparent. The technique may be useful in patients who cannot achieve high levels of routine mechanical oral hygiene, particularly interdentially. The effects of using higher concentrations of chlorhexidine should be investigated.

Adult↗