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PubMed1993

Efficacy of chlorhexidine in disinfecting dentinal tubules in vitro.

Solutions of 0.2% and 2% chlorhexidine, 0.2% and 2% sodium hypochlorite (NaOCl) and normal saline were tested for their efficacy in disinfecting dentinal tubules following root canal irrigation in vitro. Freshly extracted bovine incisor roots were prepared as cylindrical shapes, 4 mm high and 5 mm wide with a lumen 2.1 mm wide. After mechanical removal of the cementum and elimination of the smear layer on the dentine surface with EDTA and NaOCl, the root sections were autoclaved and the dentinal tubules infected with E. faecalis (NCTC 775) by incubating in yeast extract glucose broth for 1 week. The root canals were irrigated with 20 ml of an irrigant solution using a syringe. Each irrigant was used in six specimens. Dentine was removed from the canal wall by sterile burs of increasing diameter to give samples 100, 100-300 and 300-500 microns deep. The dentine samples were then cultured to determine the presence and quantity of remaining micro-organisms. The results indicated that chlorhexidine and NaOCl were equally effective antibacterial agents at similar concentrations against the test microorganism. They significantly reduced the bacterial counts in the first 100 microns of dentinal tubules, however up to 50% of dentine samples remained infected following use of both agents.

Analysis of Variance↗

PubMed1998

Accumulation of strontium and fluoride in approximal dental plaque and changes in plaque microflora after rinsing with chlorhexidine-fluoride-strontium solution.

OBJECTIVES: To find out if strontium is incorporated into plaque and enamel in vivo during a 2-week rinsing period with a chlorhexidine-fluoride-strontium solution and to determine the effects of the rinsing on the numbers of mutans streptococci and lactobacilli in plaque. SUBJECTS AND METHODS: A total of 18 adult participants rinsed their mouths twice a day for 2 weeks, first with a placebo solution and subsequently, separated by a 1-week interval without rinsing, with a chlorhexidine gluconate (0.05%)-sodium fluoride (0.04%)-strontium (100 ppm as SrCl2) rinsing solution (CXFSr) for another 2 weeks. RESULTS: After the CXFSr rinsing period the strontium and fluoride contents (microgram g-1 plaque dry weight; mean +/- sr) of approximal plaque were 32.5 +/- 4.7 and 72.8 +/- 9.0, compared with the respective contents of 8.4 +/- 1.2 and 42.0 +/- 4.8 after placebo rinsing (P = 0.0001 for both comparisons). The strontium content remained elevated for 6 weeks. The median proportion of mutans streptococci of approximal plaque of the total viable count of bacteria was 1% after placebo rinsing but decreased to 0.2% after CXFSr rinsing. The proportion of mutans streptococci remained low at 3 weeks (P = 0.018 vs placebo) but had reached the placebo level at 6 weeks. Rinsing with CXFSr solution did not reduce lactobacilli in plaque. The strontium or fluoride contents of the enamel surfaces subjected to tooth brushing did not significantly change. CONCLUSIONS: Strontium and fluoride accumulated in dental plaque during a 2-week CXFSr rinsing period and the proportion of mutans streptococci in approximal plaque was reduced at least for 3 weeks after completion of the rinsing.

Adult↗

PubMed1999

Topical corticosteroids in association with miconazole and chlorhexidine in the long-term management of atrophic-erosive oral lichen planus: a placebo-controlled and comparative study between clobetasol and fluocinonide.

OBJECTIVE: To evaluate the efficacy of a combination of topical corticosteroids with topical antimycotic drugs in the therapy of atrophic-erosive forms of oral lichen planus (OLP). PATIENTS AND METHODS: The study population consisted of 60 patients with OLP subdivided into three groups matched for sex and age. The first group (25 patients) and the second group (24 patients) received respectively 0.05% clobetasol propionate ointment or 0.05% fluocinonide ointment in an adhesive medium (4% hydroxyethyl cellulose gel) plus in each case antimycotic treatment consisting of miconazole gel and 0.12% chlorhexidine mouthwashes. The third group (11 patients), placebo group, received only hydroxyethyl cellulose gel and antimycotic treatment as above. All the treatment regimens were carried out for 6 months. Each patient was examined every 2 months during the 6-month period of active treatment and for a further 6 months of follow-up. Objective and subjective clinical progress was scored and compared between the three groups. Plasma cortisol levels were monitored in half the patients using the topical corticosteroids. RESULTS: All patients treated with clobetasol and 90% of the patients treated with fluocinonide witnessed some improvement, whereas in the placebo group only 20% of patients improved (P < 0.0001 and P = 0.00029, respectively. However, when considering complete responses, only clobetasol gave significantly better results than placebo. Clobetasol resolved 75% of the lesions whereas fluocinonide was effective in 25% of cases and placebo in none. Clobetasol achieved better results statistically than did fluocinonide (P = 0.00442) and placebo (P = 0.00049) whereas there was no statistical difference among fluocinonide and placebo (P = 0.140). Similar results were obtained for symptoms. Both drugs were shown to be effective in the treatment of erosive lesions, but clobetasol was considerably more efficacious than fluocinonide in the atrophic areas (75% vs 25% of total response, respectively) (P = 0.00442). None of the treated patients contracted oropharyngeal candidiasis. After 6 months of follow-up, 65% of the clobetasol-treated group and 55% of the fluocinonide group were stable. Estimation of plasma cortisol levels showed no significant systemic adverse effects of clobetasol or fluocinonide. CONCLUSIONS: Our results suggest that a very potent topical corticosteroid such as clobetasol may control OLP in most cases, with no significant adrenal suppression or adverse effects. Moreover, a concomitant antimycotic treatment with miconazole gel and chlorhexidine mouthwashes is a useful and safe prophylaxis against oropharyngeal candidiasis.

Administration, Topical↗

PubMed1984

Prevention and control of neonatal pyoderma with chlorhexidine.

The extent of staphylococcal colonisation and neonatal pyoderma was studied in 5 220 infants in two large Swedish hospitals in 1979-1982. A method for routine cord care with 4% chlorhexidine detergent solution was evaluated in one hospital. Nursery colonisation with Staph. aureus and streptococci decreased significantly. The method proved to be clinically efficient for prevention of pyoderma in the nursery as well as for controlling staphylococcal infection after discharge from hospital. The combined use of a quantitative sampling method and phage-typing showed that most post-discharge lesions were nursery-derived. In one of the hospitals, daily cord care with 70% ethanol failed to prevent streptococcal and staphylococcal omphalitis in the nursery whereas daily cord care with chlorhexidine reduced the incidence of omphalitis from 21 to 1%.

Chlorhexidine↗

PubMed1987

Susceptibility of small-sized oral spirochetes to eight antibiotics and chlorhexidine.

The purpose of the study was to examine the susceptibility of two different small-sized spirochete morphotypes from subgingival plaque to eight antibiotics and chlorhexidine. MIC-values were determined by a broth dilution method and related to achievable antibiotic tissue- and blood concentrations. The spirochetes were characterized as susceptible, moderate susceptible, and resistant to the different antibiotics. The MICs of tetracycline hydrochloride, doxycycline, penicillin G, and chlorhexidine were all considerably lower for spirochete strains with a 2:4:2 endoflagella system (two endoflagella from each cell-end) than for strains with a 1:2:1 endoflagella system (one endoflagellum from each cell-end). No differences were observed for the remaining antibiotics. Spirochetes containing one endoflagellum from each cell-end were found to be susceptible to metronidazole and doxycycline, susceptible to moderate susceptible to tetracycline hydrochloride, moderate susceptible to penicillin G, and resistant to the remaining antibiotics. Spirochetes containing two endoflagella from each cell-end were susceptible to doxycycline, tetracycline hydrochloride, and metronidazole. Susceptible to moderate susceptible to penicillin G. These spirochetes were resistant to the remaining agents. The significance of these observations is discussed in relation to obtainable gingival crevicular fluid concentrations and treatment of marginal periodontitis.

Anti-Bacterial Agents↗

PubMedDate not supplied

Synergistic effect of ethyl-6-O-decanoyl glucoside and chlorhexidine in contact lens disinfection.

Contact lenses with adherent Serratia marcescens and Pseudomonas aeruginosa could not be sterilised either with polyaminopropyl biguanide or with chlorhexidine (CHX) commercial solutions meant for contact lens disinfection, even after treatment lasting 12 h. Ethyl-6-O-decanoyl glucoside (EDG) with chlorhexidine enhanced the killing significantly. The same was also found to be the case for dispersed cells of P. aeruginosa on cellulose acetate filters. EDG enhances the bactericidal effect of 0.00025 CHX by a mechanism not solely due to detergent action and is a potential adjunct to CHX in clinical applications.

Chlorhexidine↗

PubMed2000

The effectiveness of 10% chlorhexidine varnish treatment on dental caries incidence in adults with dry mouth.

OBJECTIVES: This study compared a 10% chlorhexidine varnish treatment with placebo and sham treatments for preventing dental caries in adult patients with xerostomia (dry mouth). DESIGN: The study was a multicentred, randomized, parallel group, double blind, placebo-controlled clinical trial. SETTING: All examinations and procedures were performed at Tuft's University, Boston, MA, the University of British Columbia, Vancouver, BC or the University of Western Ontario, London, ON. SUBJECTS: Subjects were adults with recent or current dental caries experience, high salivary levels of cariogenic microorganisms and low salivary flow rates. RESULTS: 236 subjects completed at least one post-treatment examination. There were 697 new carious lesions diagnosed, 446 (64%) located on coronal surfaces and 251 (36%) located on root surfaces. The mean attack rate was 0.23 surfaces/100 surfaces at risk. A treatment difference observed between the Active and Placebo groups was statistically significant for root caries increment (p = .02) and total caries increment (p = .03). A treatment difference observed between the Active and Sham groups was not statistically significant for coronal, root or total caries increment. Analysis of variance of treatment group differences was performed using mutans streptococci counts, salivary flow rates, age, sex, caries prevalence, medications, time to first event and early withdrawal as co-variables. These factors did not meaningfully alter the findings. CONCLUSIONS: The difference between the 10% chlorhexidine varnish and placebo treatments is considered to be highly clinically significant for root caries increment (41% reduction) and for total caries increment (25% reduction) but only for coronal caries increment (14%).

Aged↗

PubMed2001

Effects of mouthrinses with linseed extract Salinum without/with chlorhexidine on oral conditions in patients with Sjögren's syndrome. A double-blind crossover investigation.

OBJECTIVES: To study the effect of mouthrinses with salivary replacement substances on oral conditions in patients with primary Sjögren's syndrome. DESIGN: Cross-over, double-blind study. SETTING: Facilities at the Centre for Oral Health Sciences, Malmö University and at Malmö University Hospital, Malmö, Sweden. SUBJECTS: Twenty-two patients with Sjogren's syndrome. INTERVENTION: Linseed extract Salinum alone (Sal) or with addition of chlorhexidine (Sal/Chx) was used for mouthrinsing during 3-week periods of rinsings separated by a 3-week "wash-out" period. MEASUREMENTS: Recordings of percentages of sites with dental plaque and bleeding on probing, mirror friction test and microbiological analyses. Questionnaire on oral symptoms due to reduced salivation. RESULTS: Dental plaque and bleeding on probing were reduced after Sal and after Sal/Chx. Friction was reduced after both treatments. No significant differences for counts of studied microbial groups were seen after Sal but the total anaerobically cultured microorganisms and of mutans streptococci fell after Sal/Chx (p<0.05 and p<0.001). Symptoms of oral dryness improved following Sal and Sal/Chx (p<0.05 and p<0.001 respectively). Speaking problems and burning mouth symptoms improved after use of Sal (p<0.05). CONCLUSIONS: Positive effects on symptoms in patients with Sjögren's syndrome were seen after use of Salinum without or with chlorhexidine.

Adult↗

PubMedDate not supplied

Effects of chlorhexidine spray on plaque and gingival health in institutionalized persons with mental retardation.

In this study, eight institutionalized males received a 0.12% chlorhexidine gluconate spray twice daily. A second group of eight males received a placebo spray in the same manner. The results indicated that pump-administered chlorhexidine spray can effectively reduce plaque and gingivitis in patients with mental retardation who are unable to brush their own teeth.

Adult↗

PubMedDate not supplied

Chlorhexidine and xylitol gum in caries prevention.

This paper presents the current best evidence on the respective and comparative outcomes of chlorhexidine and xylitol and extrapolates these data to individuals with special needs. It analyzes the probable mechanisms of action for both chlorhexidine and xylitol then reviews individual products and discusses the anticipated effectiveness of these products in individuals with special needs.

Anti-Infective Agents, Local↗

PubMed2002

Action of chlorhexidine digluconate against yeast and filamentous forms in an early-stage Candida albicans biofilm.

An in situ method for sensitive detection of differences in the action of chlorhexidine against subpopulations of cells in Candida albicans biofilms is described. Detection relies on monitoring the kinetics of propidium iodide (PI) penetration into the cytoplasm of individual cells during dosing with chlorhexidine. Accurate estimation of the time for delivery of the dosing concentration to the substratum was facilitated by using a flow cell system for which transport to the interfacial region was previously characterized. A model was developed to quantify rates of PI penetration based on the shape of the kinetic data curves. Yeast were seeded onto the substratum, and biofilm formation was monitored microscopically for 3 h. During this period a portion of the yeast germinated, producing filamentous forms (both hyphae and pseudohyphae). When the population was subdivided on the basis of cell morphology, rates of PI penetration into filamentous forms appeared to be substantially higher than for yeast forms. Based on the model, rates of penetration were assigned to individual cells. These data indicated that the difference in rates between the two subpopulations was statistically significant (unpaired t test, P < 0.0001). A histogram of rates and analysis of variance indicated that rates were approximately equally distributed among different filamentous forms and between apical and subapical segments of filamentous forms.

Amphotericin B↗

PubMed1981

Prolonged survival of Serratia marcescens in chlorhexidine.

During an outbreak of Serratia marcescens infections at our hospital, we discovered widespread contamination of the 2% chlorhexidine hand-washing solution by S. marcescens. Examination by electron microscopy of the sides of bottles in which this solution was stored revealed that microorganisms were embedded in a fibrous matrix. Bacteria, free in the liquid, were morphologically abnormal, showing cell wall disruption or cytoplasmic changes. Furthermore, bacteria adherent to the walls of the storage jugs and embedded in this fibrous matrix also had morphologically abnormal cytoplasm. Despite these changes, viable S. marcescens organisms were recovered from the fluid during a storage period of 27 months. The concentration of chlorhexidine required to inhibit these strains of Serratia was 1,024 microgram/ml; however, the organism could survive in concentrations of up to 20,000 micrograms/ml. Additional studies are needed to define the mechanism(s) that allows such bacteria to contaminate and survive in disinfectants.

Cell Wall↗

PubMed2006

Value of the chlorhexidine decontamination method for recovery of nontuberculous mycobacteria from sputum samples of patients with cystic fibrosis.

The chlorhexidine method was compared to the N-acetyl-l-cysteine-NaOH-oxalic acid decontamination method currently recommended for the recovery of nontuberculous mycobacteria (NTM) from patients with cystic fibrosis. Sputum samples (n = 827) treated with chlorhexidine yielded twice as many NTM-positive cultures as those treated by the reference method (54 [6.50%] versus 27 [3.25%]; P < 0.0001) despite a higher contamination rate (20% versus 14.2%; P = 0.0017).

Acetylcysteine↗

PubMed1996

Impact of chlorhexidine-silver sulfadiazine-impregnated central venous catheters on in vitro quantitation of catheter-associated bacteria.

To assess the impact of the antiseptic effects of silver sulfadiazine-chlorhexidine-impregnated central venous catheters on catheter culture systems, a series of in vitro experiments was performed. Segments of antiseptic and non-antiseptic-impregnated catheters were sonicated in thioglycolate broth and removed. After the addition of 10(3) CFU of Staphylococcus epidermidis per ml, aliquots of catheter-exposed broth were subcultured onto blood agar at 15-min intervals. Decreased mean colony counts were noted at 45 min for broth exposed to antiseptic-impregnated catheters compared with the colony counts for broth exposed to non-antiseptic-impregnated catheters (170 versus 540 CFU/ml). These effects, which were also demonstrated by the roll-plate method, were abrogated by the use of medium containing inhibitors of silver sulfadiazine and chlorhexidine. To assess the duration of the antiseptic effects, catheter segments were suspended for up to 14 days in phosphate-buffered saline, incubated with 10(6) CFU of S. epidermidis per ml, and cultured. Inhibition of bacterial growth by antiseptic-impregnated catheters disappeared after 14 days. These studies suggest that antiseptic compounds elute from catheters during broth- and solid medium-based culturing processes, making necessary the addition of inhibitors of these compounds in culture media. They further suggest that the antimicrobial effects of antiseptic-impregnated catheters wane within several days of placement.

Anti-Infective Agents, Local↗

PubMed1980

Comparison of hexachlorophane and chlorhexidine powders in prevention of neonatal infection.

The protective effect of treating the skin of newborn infants with powders containing 1% chlorhexidine or 0.33% hexachlorophane was compared. Each was equally effective in preventing colonisation and infection by Staphylococcus aureus. In contrast, the skin became profusely colonised by coagulase-negative staphylococci, irrespective of the powder used. Venous blood concentrations of chlorhexidine were low or undetectable in the few infants whose blood was analysed.

Chlorhexidine↗

PubMed2005

Inhibitory effect of sodium fluoride and chlorhexidine on the growth of oral lactobacilli.

The accumulation of microorganisms in dental plaque is related to the etiology of caries and periodontal disease, with a high prevalence worldwide. The prophylactic measures include the use of chemical agents as NaF and chlorhexidine. Lactic acid bacteria are members of the normal microbiota of the oral cavity being discussed with regard to their beneficial or detrimental effect in this environment. The present study was performed to determine the growth of some species of Lactobacillus at different concentrations of NaF and chlorhexidine. The strains were isolated from both caries-free and caries patients. Their growth parameters were evaluated by the application of the Gompertz model to the experimental data of optical density as a measurement of growth. The degree of inhibition of the growth of all of the lactobacilli studied was different, depending on each particular strain. NaF at 1 mmol x L(-1) inhibited between 5% and 46%, at 5 mmol x L(-1) between 13% and 65%, and at 20 mmol x L(-1) between 57% and 84%. CHX at higher concentrations (197 and 98 mmol x L(-1) showed a complete inhibition of some of the strains. The significance of the results was evaluated by the application of a multivariate analysis and also compared with the inhibition of pathogenic Streptococcus mutans and with lactobacilli strains from collection cultures.

Chlorhexidine↗

PubMed2000

Use of chlorhexidine-releasing nylon fibres to reduce device-related uterine infections.

Implantation of intrauterine devices (IUDs) is associated with an increased incidence of uterine infection, probably as a result of vaginal bacteria entering the uterus at the time of insertion. To reduce the incidence of IUD-related infections, the incorporation of antimicrobial agents into the tail of the device was studied. Chlorhexidine was shown to be released from within nylon hollow fibres at a rate of approximately 114 microg x day(-1) for 10 days. This rate of release was sufficient to exhibit a biocidal effect on bacteria embedded within a mucus gel in vitro. When these devices were implanted transcervically into the guinea-pig uterus they significantly reduced the extent of uterine bacterial contamination within 24 h. These findings indicate that chlorhexidine-releasing devices are potentially useful in the reduction of device-related infections.

Animals↗

PubMedDate not supplied

Effect of quarterly treatments with a chlorhexidine and a fluoride varnish on approximal caries in caries-susceptible teenagers: a 3-year clinical study.

The aim of this study was to compare the effect of two different dental varnishes on approximal caries incidence in teenagers with proven caries susceptibility during a 3-year period. Two hundred 13- to 14-year-old subjects exhibiting at least two approximal enamel caries lesions were selected to take part in the study. One hundred and eighty subjects participated after informed consent and were randomly assigned to two equally sized groups. One group was treated with a fluoride varnish (FV, Fluor Protector) containing 0.1% F every 3rd month and the participants of the other group were treated in the same mode with a chlorhexidine varnish (CV, Cervitec((R))) containing 1% chlorhexidine and 1% thymol. In total, each subject was treated 12 times during the experimental period. Approximal caries including enamel lesions (DMFS(appr)) were recorded from four bitewing radiographs exposed at the start and end of the study. The mean (+/-SD) caries prevalence at baseline was 2.2+/-3.4 in the FV group and 2.5+/-4.0 in the CV group. After 3 years, the average approximal caries incidence was 2.7+/-3.1 and 3.1+/-3.5 in the FV and CV groups, respectively. The differences at baseline and after 3 years were not statistically significant. In conclusion, treatments every 3rd month with either a fluoride- or a chlorhexidine/thymol-containing varnish showed a promising effect with low approximal caries incidence and progression in teenagers with proven caries susceptibility.

Adolescent↗