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PubMed1986

The effects of a simplified oral hygiene regime plus supragingival irrigation with chlorhexidine or metronidazole on chronic inflammatory periodontal disease.

This study compared a simplified oral hygiene regime (scaling, root planing and Bass brushing) with this same regime plus 0.02% chlorhexidine (CH), 0.05% metronidazole (MD) and inactive control (PL) solutions delivered supragingivally by a pulsating water jet irrigator. 22 patients were distributed randomly into 3 groups, 0.02% chlorhexidine (CH), 0.05% metronidazole (MD), and inactive control (PL). Approximal surfaces with associated pockets greater than or equal to 4 mm were monitored at day 0, for plaque index (PII), gingival index (GI), sulcus bleeding index (SBI), baseline measurement for gingival shrinkage and probable pocket depth. All monitored surfaces were then immediately scaled and root planed. All patients received identical oral hygiene instruction (Bass brushing), with a sodium fluoride toothpaste and a multituft toothbrush, and were shown how to use the oral irrigator. Proficiency in use of the oral irrigator was checked again at day 7. No interdental cleaning was taught. The active treatment period was 28 days. Patients were seen at days 7, 28, 56 and 84, and all parameters were recorded at each visit, but no further oral hygiene instruction was given. Within procedure comparisons of the findings at days 28 (end of active treatment) 56 and 84 with those at day 0, showed statistically highly significant improvements in all parameters for all groups. Regarding between procedure comparisons, CH was better in reducing PII at all times except at day 84, and on several occasions in reducing GI and SBI. Irrigated groups were always better than nonirrigated groups. Although the differences were statistically highly significant, clinically the differences between groups were relatively small, except for CH effect on PII.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Microbiological and clinical effects of chlorhexidine digluconate and hydrogen peroxide mouthrinses on developing plaque and gingivitis.

While the ability of chlorhexidine (CHX) to prevent plaque formation and inhibit the development of gingivitis has been well documented in the literature, the therapeutic value of hydrogen peroxide (H2O2) in preventing gingivitis is in dispute. The purpose of this study was to compare the clinical and microbiological effects of an established therapeutic agent, such as chlorhexidine with that of H2O2 in the experimental gingivitis model. Following a period of stringent oral hygiene, 32 subjects were allocated to 1 of 3 treatment groups which were balanced on the basis of their pre-experimental gingivitis scores. The subjects then refrained from any oral hygiene for 21 days. During this period, they rinsed twice a day with either a placebo, 0.12% CHX, or a 1% H2O2 mouthrinse. After 21 days, supragingival and marginal plaque was collected from each subject and assayed for total cultivable microbiota, total facultative anaerobes, facultative Streptococci, Actinomyces, Fusobacterium, Veillonella and Capnocytophaga. At the end of the experimental period, the group rinsing with 0.12% CHX showed 95% reduction in gingivitis incidence, 100% reduction in bleeding sites, and 80% reduction in plaque scores compared to the group rinsing with placebo. Conversely, the group using 1% H2O2 showed a marginal reduction in gingivitis incidence of 15% and a 28% reduction in bleeding sites compared to the placebo group, but no significant reduction in plaque scores. The microbiological results showed that 0.12% CHX was an excellent broad-spectrum antimicrobial agent which significantly reduced the number of both facultative and obligate anaerobes in plaque.(ABSTRACT TRUNCATED AT 250 WORDS)

Bacteria↗
PubMed1989

Direct measurement of the bactericidal effect of chlorhexidine on human dental plaque.

The purpose of the present study was to determine by means of a fluorescence test the ratio between vital and dead bacteria in dental plaque before and after 0.1% chlorhexidine rinses. Plaque was stained by fluoresceindiacetate (FDA), which gave a green color to the living micro-organisms, and by ethidiumbromide (EB), which introduced a red color into the nucleic acids of the dead bacteria. 1-, 2- and 3-day-old undisturbed plaque harbored 80 to 85% living micro-organisms. 1 h after chlorhexidine use, this % was reduced to a plateau of 19 to 34% of vital bacteria present in the sampled plaque. Between 6 and 8 h later, this % rose towards its original value. This study has shown that FDA/EB staining provides a method for direct measurement of bacteria vitality in dental plaque and, as such, can be of great value for testing the efficacy of various antiplaque agents.

Adult↗
PubMed1990

The effects of 0.5% chlorhexidine and 0.2% triclosan containing toothpastes on salivary bacterial counts.

A number of antimicrobial compounds could be incorporated into toothpastes to enhance plaque inhibitory effects. However, the number of possible formulations is immense and makes clinical testing in plaque and gingivitis studies difficult. In this study, the effects on salivary bacterial counts of a number of chlorhexidine and triclosan toothpastes was evaluated as a predictor of persistence of antimicrobial action in the mouth. The study was a supervised, randomised 15-way crossover study employing 10 healthy human volunteers. All toothpastes were brushed for 1 min and comparison made with a 0.2% chlorhexidine rinse. The latter produced a large drop in salivary bacterial counts to the end of the 7-h study period. The toothpastes decreased salivary bacterial counts and all but two had notably more effect than a water brushing. No toothpaste showed a significant persistence of antimicrobial effect beyond 5 h. In the light of available plaque inhibition data for the toothpastes, persistence of antimicrobial activity beyond 5 h will be necessary for a clinical effect on plaque and gingival health. The method appears to be a simple and rapid screening technique for products formulated to enhance plaque inhibition mediated through an antimicrobial action.

Adult↗
PubMed1991

Comparison of the antimicrobial effect of the application of chlorhexidine gel, amine fluoride gel and stannous fluoride gel in debrided periodontal pockets.

The clinical and microbiological effect of locally-applied chlorhexidine gel 2%, amine fluoride gel 1.25%, stannous fluoride gel 4% or placebo gel in 40 periodontal pockets of 10 patients were studied. The gels were applied 3 x within 10 min. after mechanical debridement of the pockets. The treatment effect on the subgingival microflora was evaluated by microscopic and culture studies of the subgingival plaque samples. In addition, supragingival plaque, bleeding after probing and probing pocket depth were scored. Examination were carried out before and during a period of 36 weeks after treatment. At the start, the cultured microflora consisted mainly of anaerobic Gram-positive bacteria. Following treatment, the clinical parameters were significantly reduced. Concomitantly, the %s of spirochetes, motile rods and non-motile rods decreased significantly. A significant decrease was also found in the total anaerobic count, whereas the facultative counts remained at the same level found before treatment. This suggested that the treatment resulted in a mainly facultative subgingival microflora. The % Gram-negative rods showed a significant reduction after treatment, but returned to base line at week 12. Statistical analysis of the bacteriological and clinical examinations failed to demonstrate any significant differences between the 4 treatment groups. Thus, in comparison to the placebo gel, subgingival application of chlorhexidine gel 2%, amine fluoride gel 1.25% or stannous fluoride gel 4% did not augment the effect of mechanical debridement on bacteriological and clinical parameters during the experimental period of 36 weeks. However the indicated treatments resulted in a facultative subgingival microflora which is compatible with the host.

Adult↗
PubMed1991

The effect of some chlorhexidine-containing mouthrinses on salivary bacterial counts.

A number of chlorhexidine mouthwashes are available commercially which differ in formulation and regimen of use. As a comparative measure of antimicrobial persistence, this study evaluated the effect of 4 chlorhexidine mouthwash formulations on salivary bacterial counts after a single rinse. The study was a randomised single-examiner blind 5-way crossover investigation employing a panel of 10 young healthy human volunteers. The 0.12% and 0.2% commercial formulations when rinsed according to the respective manufacturers instructions produced similar large and prolonged reductions in salivary bacterial counts during the 7-h period. A 0.1% formulation also commercially available produced minimal effects on salivary bacterial counts and was little different to the saline rinse. A reformulated 0.1% rinse, not commercially available at the time of the study, produced significant salivary bacterial count reductions over the 7-h period albeit to a lesser degree of magnitude than to the 0.2% and 0.12% rinses. The results were consistent with comparative plaque inhibitory studies of the formulations and suggest that the method is a quick and simple way of screening products for antimicrobial and antiplaque potential.

Adult↗
PubMed1992

The effect of a combination of chlorhexidine diacetate, sodium fluoride and xylitol on plaque wet weight and periodontal index scores in military academy cadets refraining from mechanical tooth cleaning for 7-day experimental periods.

45 subjects participated in a double-blind cross-over mouthwash study where a new tablet-form combination of chlorhexidine, fluoride and xylitol (XYLIHEX) was studied together with solutions of chlorhexidine (CHX) and sodium fluoride (NaF). The preparation XYLIHEX was developed as a dental chemotherapeutic that could easily be added to the soldiers' kit to be used under circumstances where practising normal oral hygiene habits is restricted. For comparative purposes, XYLIHEX was prediluted in this study to make a solution. Before starting, professional prophylaxis was given to the subjects to bring their gingivitis index scores as close to 0 as possible. The subjects refrained from mechanical tooth cleaning for three 7-day test periods. Plaque wet weight and periodontal index scores were recorded before and after the test periods. The results showed that the preparations XYLIHEX and CHX did not statistically differ from each other in reducing plaque wet weight values and the recorded periodontal index scores. Both these preparations were statistically highly significantly more effective antiplaque agents than NaF, as expected.

Adult↗
PubMed1992

Use of toothpicks for chlorhexidine staining.

The purpose of this study was to determine if the extrinsic dental staining associated with the use of chlorhexidine gluconate (CHX) mouthrinse could be prevented or controlled by the patient with the use of toothpicks. 25 subjects received a prophylaxis to establish a stain-free baseline and were then randomly assigned a control and experimental side of the mouth. The rinsing regimen was 1/2 oz of 0.12% CHX mouthrinse 2x a day for 3 months. Subjects self-examined daily for the appearance of stain. Where stain was visible, a toothpick was used to 'rub it away' on the distolabial, labial and mesiolabial surfaces of the experimental side only. The rubbing action was similar to the use of an eraser to remove a pencil mark from paper. The amount and intensity of stain was photographed and graded by a blinded examiner after 2 weeks, 1, 2 and 3 months. Subjects kept calendars to encourage and document compliance. When analyzed across time, teeth and surfaces, there was a statistically significant difference in stain between the control and experimental sides for stain amount, intensity, and for a composite of amount/intensity. Clinical differences were slight. The study indicates that the use of a simple toothpicking technique can affect chlorhexidine stain.

Analysis of Variance↗
PubMed1992

A comparison of natural product, triclosan and chlorhexidine mouthrinses on 4-day plaque regrowth.

There is a continuing search for ingredients to enhance the chemical plaque inhibitory action of oral hygiene products. Sanguinarine, other natural extracts and triclosan have already been used in products. The aim of this study was to evaluate a number of triclosan and natural product rinses for effects on plaque regrowth. In particular, the influence of other rinse components were assessed, notably sodium lauryl sulphate (SLS) and zinc. The study was a randomised, blind, 9-cell cross-over design to measure the effects of each rinse on 4-day plaque regrowth from a zero baseline. 15 volunteers rinsed 2x daily with each product and plaque was recorded by area and score. The 0.2% chlorhexidine rinse (positive control) was significantly more effective, and the saline rinse (negative control) significantly less effective, than other rinses. Sanguinarine alone was little different from saline and the addition of zinc made a modest improvement in activity. The 3 triclosan/SLS rinses were more effective than the sanguinarine rinses but similar to their minus triclosan control rinse. A natural product/SLS experimental rinse was second to chlorhexidine and, in many analyses, significantly better than all other rinses, but caused some oral erosions. The results indicate that the plaque inhibitory properties of basic ingredients such as SLS may be difficult to enhance or surpass. However, the possible range of recipes, particularly using natural ingredients, provides scope for research and development in the field of oral hygiene products.

Adult↗
PubMed1993

A 6-month home usage trial of a 1% chlorhexidine toothpaste (II). Effects on the oral microflora.

The effects of 1% chlorhexidine and 1% chlorhexidine/fluoride dentifrices on supragingival plaque flora were investigated in a 6-month home-usage study. 146 subjects were studied from whom plaque around 6 teeth was collected at baseline, 6 weeks and 24 weeks. Total anaerobic counts were reduced at 6 and 24 weeks in both active groups compared to control. No differences were seen in any other bacterial parameters. There was a significant decrease in the susceptibility to chlorhexidine of bacteria recovered from the subjects on the active treatments compared to control but, since the magnitude of effect was less than one dilution, this was not thought to be of any clinical significance.

Adolescent↗
PubMed1998

An in vivo study of the chlorhexidine release profile of the PerioChip in the gingival crevicular fluid, plasma and urine.

The release profile of chlorhexidine from the PerioChip (Chip), a biodegradable local delivery system that contains 2.5 mg of chlorhexidine gluconate (CHX) in a cross-linked hydrolyzed gelatin matrix, into the gingival crevice, was evaluated in an in vivo, open label, single-center, 10-day pharmacokinetic study conducted on 19 volunteers with chronic adult periodontitis. Each volunteer had a single chip inserted into each of 4 selected pockets, with probing pocket depths of between 5-8 mm, at time 0. Gingival crevicular fluid (GCF) samples were collected using filter paper strips prior to Chip placement and at 2 h, 4 h, 24 h and 2, 3, 4, 5, 6, 8, and 9 days post-Chip placement. The GCF volume was measured using a calibrated Periotron 6000. Blood samples were collected at times 0, 1, 4, 8, 12 h and 5 days post-dosing. Urine was collected as a total 24-h specimen immediately post-dosing and 2 single samples at time 0, prior to dosing, and 5 days. The CHX was eluted from the paper strips and the CHX levels in GCF, blood and urine quantified using HPLC. The results indicate an initial peak concentration of CHX in the GCF at 2 h post-Chip insertion (2007 microg/ml) with slightly lower concentrations of between 1300-1900 microg/ml being maintained over the next 96 h. The CHX concentration then progressively decreased until study conclusion with significant CHX concentrations (mean=57 microg/ml) still being detectable at study termination. CHX was not detectable in any of the plasma or urine samples at any time point during the study. These results indicate that the PerioChip can maintain clinically effective levels of CHX in the GCF of periodontal pockets for over 1 week with no detectable systemic absorption.

Adult↗
PubMed2005

A chlorhexidine varnish implemented treatment strategy for chronic periodontitis: short-term clinical observations.

OBJECTIVES: The aim of this study was to investigate the clinical outcome of a subgingivally applied chlorhexidine varnish when used as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis. MATERIAL AND METHODS: A randomized controlled, single blind, parallel trial was conducted on the basis of 16 volunteers suffering from chronic periodontitis. The control group received oral hygiene instructions and was scaled and root planed in two sessions. The test group received the same instructions and treatment, however, all pockets were additionally disinfected using a chlorhexidine varnish. The gingival index, plaque index, bleeding on probing, probing pocket depth (PPD) and clinical attachment level (CAL) were recorded at baseline and subsequently after 1 and 3 months. RESULTS: Both treatment strategies showed significant reductions in PPD and CAL at both follow-up visits by comparison with baseline levels (p<0.001). Yet, at study termination, combination therapy resulted in additional pocket reductions between 0.73 and 1.23 mm (p<0.02), and clinical attachment gains between 0.63 and 1.09 mm (p<0.02). CONCLUSIONS: These findings suggest that a varnish-implemented strategy may improve the clinical outcome for the treatment of chronic periodontitis in comparison with SRP alone.

Adult↗
PubMed1976

Effect of a fluoride-containing chlorhexidine gel on bacteria in human plaque.

The effect on the plaque flora of a fluoride-containing chlorhexidine gel in mouthpieces was studied in seven subjects. Use of the gel during a 3-month period resulted in a change in the pattern of sensitivity to cholorhexidine in the plaque flora as displayed by determination of the minimal inhibitory amount (MIA) of the drug in agar diffusion assays. Three months after the use of gel was discontinued, the MIA value for plaque bacteria had returned to its original level. The relative proportions of S. mutans and S. sanguis in plaque changed during the chlorhexidine period. Thus S. mutans could not be detected in plaque samples after 3-month use of the gel, and the frequency of S. sanguis was altered.

Adult↗
PubMed1976

Intraoral spread of the antimicrobial effect of a chlorhexidine gel.

The aim of the study was to determine the range of the antimicrobial effect of Hibitane Dental Gel (ICI, Macclesfield, England), containing 1% chlorhexidine, when used as a dentifrice while brushing. A standard toothpaste with no claim for antibacterial activity (Pepsodent) was used as a control. Twenty-four dental students brushed their teeth during two 4-day periods using the closed mouth technique, i.e. they kept their teeth tightly clenched and brushed only the facial tooth surfaces twice daily. Before and after each test period the lingual and linguomesial surfaces of the mandibular teeth were scored for clearly visible plaque. The facially applied chlorhexidine gel had no more effect on plaque growth lingually than the standard toothpaste which was used as control. The lack of effect of the gel was suggested to be due to an insufficient spread and penetration capacity of its antimicrobial component.

Biguanides↗
PubMed1980

Effect of mouthrinses with SnF2, LaCl3, NaF and chlorhexidine on the amount of lipoteichoic acid formed in plaque.

The in vivo effect of some cations on the amount of lipoteichoic acid (LTA) formed in plaque was investigated in two studies. In the first part five students followed six mouthrinsing programs, each of which lasted 4 d. Rinsing was performed for 1 min every second hour with a test solution (0.05% stannous fluoride (SNF2); 0.05% chlorhexidine gluconate; 0.3% lanthanum chloride (LaCl3) and 0.05% sodium fluoride (NaF), followed 5 min later with a rinse of a 15% sucrose solution. Sucrose alone and xylitol rinses were used as controls. The second part involved a group of 10 students rinsing for 1 week four times daily with a sucrose solution, and for another week four times daily with the same source sucrose solution and in addition, three times daily with a 0.05% SnF2 solution. The individual plaque samples were collected after each rinse program, made into a suspension and then divided for protein analysis, carbohydrate analysis and estimation of LTA by phenol extraction and indirect hemagglutination against a specific antiserum. The total amount of plaque formed and the LTA content were reduced in sucrose plaque by the chlorhexidine and SnF2 rinse programs, or when xylitol replaced sucrose as the main sugar source. There was no significant effect with LaCl3 or NaF. The rinse produced changes in the clinical appearance of the plaque.

Carbohydrates↗
PubMed1981

Effect of the antibacterial agents octenidine and chlorhexidine on the plaque flora in primates.

The effect of the antibacterial substance octenidine on plaque formation and on oral microflora in eight monkeys fed a sucrose diet was studied. Plaque was obtained from buccal tooth surfaces of premolars and first molars in two quadrants using a swab and a dental carver and examined using culture and fluorescent antibody procedures. A significant reduction in plaque score was observed on the buccal tooth surfaces after daily topical application of 1% solutions of octenidine and chlorhexidine for 7 d; octenidine was more effective than chlorhexidine. Placebo treatment with water was without significant effect. Octenidine and chlorahexidine affected the plaque flora in a similar manner; the proportion of S sanguis increased in relation to baseline levels while the population of Actinomyces, especially the group A. viscous and A. naeslundii, was markedly reduced. S. sanguis showed an inverse relationship to members of actinomyces in response to the action of the antimicrobial agents. Both plaque sampling methods revealed similar changes in bacterial composition as a result of treatment. The data show that octenidine is an effective inhibitor of dental plaque and its antimicrobial and antiplaque properties make it worthy of further studies.

Animals↗
PubMed1985

Salivary Streptococcus mutans count and gingivitis in children after rinsing with a chlorhexidine-fluoride solution with and without strontium.

Thirty schoolchildren, 9-12 yr old with high DMF score, rinsed their mouths twice a day for 3 days with a chlorhexidine-fluoride (CXF) solution or a chlorhexidine-fluoride-strontium (CXFSr) solution. Streptococcus mutans counts (CFU) were made from saliva incubated on MSB agar and the gingival bleeding was recorded both before and after the rinsing period. S. mutans count decreased significantly immediately after the rinsing with each of the solutions (from 650 X 10(3) to 170 X 10(3) CFU/ml by CXF and from 500 to 170 X 10(3) CFU/ml by CXFSr). Within about 18 days after the rinsing with each solution the salivary S. mutans counts returned to the original level. Gingival Bleeding Index (GBI) was significantly reduced by half through the CXF rinsing while the slight reduction by CXFSr was nonsignificant. Both of these changes were temporary. The results suggest that short rinsing periods with the CXF solution may be more advisable than daily rinses as a contribution to the maintenance of oral health in subjects or groups in need of such a prophylaxis. The weaker effect found with the CXFSr solution suggests that the cariostatic effect recently found in rats with the same solution may be due to other mechanisms than reduction of the oral S. mutans count.

Child↗
PubMed1987

Effects of chlorhexidine, NaF and SnF2 on glucan formation by salivary and culture supernatant GTF adsorbed to hydroxyapatite.

Chlorhexidine, NaF and SnF2 were tested for inhibitory activity against glucosyltransferase (GTF) which had been adsorbed to hydroxyapatite. The sources of GTF were culture supernatants of S. mutans grown in BHI or stimulated whole saliva supernatants. Chlorhexidine inhibited GTF activity from culture supernatants as well as from saliva. NaF and SnF2 had moderate effects.

Adsorption↗