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PubMedDate not supplied

Effects of dental treatment and single application of a 40% chlorhexidine varnish on mutans Streptococci in young children under intravenous anaesthesia.

Clinical studies suggest that application of a highly concentrated chlorhexidine varnish results in a decrease in the number of mutans streptococci and thereby a decrease in the caries risks. The aim of this study was to determine the effect of dental treatment on the levels of mutans streptococci (MS) and lactobacilli (LB) and the additional effect of a single application of 40% chlorhexidine varnish (EC40) on the level of MS. Twenty-three children under the age of 5 years scheduled for full dental treatment were selected. Of these 23 children (mean dmf-s 27.1, SD 19.3), 11 children had nursing bottle caries. The mean sugar exposure was 6.4. Subjects were randomly distributed into two groups of approximately equal size. One group received an EC40 application after dental treatment, while the other group received only full dental treatment, both with intravenous anaesthesia with propofol as a single drug. An unstimulated saliva sample and a plaque sample were taken prior to dental treatment. The saliva and plaque sampling of the subjects was repeated after 6 weeks. MS and LB were isolated and counted. The number of children harbouring more than 10(6) MS in a pooled plaque sample decreased significantly from 8 to 2 children 6 weeks after dental treatment. No additional effect of EC40 was found. The number of salivary MS did not change significantly between the groups or before and after treatment. The figures for LB remained at a high level of more than 10(4)/ml saliva before (21 children) and 6 weeks after treatment (17 children). The results of this study indicate that dental treatment results in a significant suppression of plaque MS, while a single application of EC40 showed no significant additional suppression after 6 weeks.

Anesthesia, Dental↗
PubMedDate not supplied

A randomised controlled trial of the caries-preventive efficacy of a chlorhexidine-containing varnish in high-caries-risk adolescents.

A professionally applied two-stage chlorhexidine varnish, Chlorzoin((R)), was developed to achieve sustained release and minimise the problems of staining and bad taste associated with chlorhexidine mouthrinses. The primary aim of this randomised controlled clinical trial was to assess the efficacy of Chlorzoin in reducing the caries increment in high-caries-risk adolescents. Secondary aims included investigating the effect of compliance upon caries increment, the effect of Chlorzoin upon salivary mutans streptococci levels and assessing the benefit of individual dental health advice by dental auxiliaries in a community setting. 1,240 children, initially aged 11-13 years, assessed to be at high caries risk were recruited into the trial. The trial design involved four arms: an observational group, a control group, an active (Chlorzoin) varnish group and a placebo varnish group. All subjects were examined annually by a calibrated examiner who was blind to the group allocation. Three-year caries increments were calculated using clinical, clinical and fibre-optic transillumination, and clinical and bitewing data sets. The results indicated that the use of Chlorzoin had an initial effect on mutans streptococci levels but that no long-term reduction in caries increment or mutans streptococci infection could be detected. One reason for this lack of efficacy may have been the regimen of reduced frequency of varnish applications after the initial period. Children who followed the protocol and, therefore, were seen regularly by dental auxiliaries had a lower caries increment than those who did not. This finding was independent of varnish allocation. In summary, under this regimen, Chlorzoin has been found to be effective in decreasing salivary mutans streptococci but ineffective as a caries-preventive agent in high-risk Scottish children when applied pragmatically in a community setting.

Adolescent↗
PubMedDate not supplied

Lack of effect of chlorhexidine varnish on Streptococcus mutans transmission and caries in mothers and children.

In a randomized clinical trial, we evaluated the effect of a 10% chlorhexidine varnish (Chlorzoin) on the mother-child transmission of Streptococcus mutans and on subsequent caries experience. Chlorhexidine (n = 38) or a placebo varnish (n = 37) was applied to the dentitions of 75 mothers at a time when their first babies were about 6 months old (approximate time of first tooth emergence). Three more applications at weekly intervals and subsequent applications at 6-month intervals followed the initial application. The mother-child pairs were followed up until the child's fourth birthday. Maternal salivary S. mutans levels in the treatment group remained significantly lower (p < 0.05) compared to the control group up to 12 months after the initial application. However, this intervention did not significantly alter the S. mutans colonization in children or the caries increment in either the mother or the child.

Adolescent↗
PubMedDate not supplied

Effect of a varnish containing chlorhexidine and thymol (Cervitec) on approximal caries in 13- to 16-year-old schoolchildren in a low caries area.

BACKGROUND: Previous studies on the effect of the chlorhexidine and thymol-containing varnish (Cervitec((R))) have consistently shown a reduction in STREPTOCOCCUS MUTANS, while the data on the caries-inhibiting effect are conflicting. AIM: To measure the effect of a chlorhexidine- and thymol-containing varnish (Cervitec) on approximal caries in a low caries population. MATERIAL: Eighty-five schoolchildren, 13 years of age, entered the study after being selected on the basis of bitewing radiographs. Children with at least one approximal lesion were included after informed consent. METHODS: The study was carried out as a double-blind, randomized controlled trial according to a split-mouth design using Cervitec on one side and a placebo varnish on the other side. All approximal surfaces between molars and premolars were treated every 3rd month. After 2 years new bitewing radiographs were taken. A total of 73 children completed the 2-year study. RESULTS: Neither the difference in number of new lesions between the Cervitec-treated and the placebo-treated side (d: -0.21; 95% CI: -0.57; 0.16) nor the mean difference in number of already existing lesions that progressed (d: -0.01; 95% CI: -0.33; 0.30) were statistically significant (paired t test; p > 0.05). CONCLUSION: The results of our study do not indicate an effect of Cervitec on initiation or progression of approximal caries in a population with a low DMFS.

Adolescent↗
PubMedDate not supplied

The effect of a single application of 40% chlorhexidine varnish on the numbers of salivary mutans streptococci and acidogenicity of dental plaque.

The relationship between the numbers of salivary mutans streptococci and the acid production in dental plaque after a single application of the 40% chlorhexidine varnish EC40 has been studied. Thirteen healthy subjects were treated with EC40 varnish. Saliva samples were taken before and up to 12 weeks after treatment to count mutans streptococci and lactobacilli. At the same time points plaque samples were taken before and after sucrose challenge and analyzed for protein and organic acid. Suppression of salivary mutans streptococci was observed together with a reduced production of lactic acid in sucrose-challenged dental plaque in 9 subjects while inhibition of acid production without significant suppression of mutans streptococci was observed in the other 4 participants. The duration of the effects differed among the individuals but never exceeded 6 weeks. We conclude that a prolonged suppression of mutans streptococci and acid production was not achieved by a single treatment with EC40 varnish in all subjects. Moreover, reduced acidogenicity of dental plaque after chlorhexidine treatment was not necessarily predicted by suppression of mutans streptococci in saliva.

Adult↗
PubMedDate not supplied

Influence of oral detergents and chlorhexidine on soft-layer electrokinetic parameters of the acquired enamel pellicle.

Electron microscopy has described the salivary pellicle as an 'uneven, knotted structure'. This study describes a novel soft-layer model of salivary pellicles, based on measured electrophoretic mobilities and the influence of dentifrices and a chlorhexidine mouthwash on the parameters of the model. The enamel surface was found to possess a high number of fixed, negative charges (zN = -62 mM) and to be electrophoretically hard (1/lambda = 0.6 nm), i.e. impenetrable to fluid flow. Adsorption of a salivary pellicle resulted in a fourfold reduction in the surface fixed charge density (zN = -15 mM) along with an increase in electrophoretic softness (1/lambda = 2.3 nm). Exposure of pellicles to various dentifrices containing sodium fluoride as an active component and sodium lauryl sulfate as a detergent had little effect on the surface fixed charge densities (varying between -15 and -30 mM, depending on the dentifrice involved) and electrophoretic softnesses (varying between 2.3 and 3.4 nm). Exposure of pellicles to a dentifrice containing sodium fluoride and hexametaphosphate as an additional detergent yielded soft (8.0 nm) pellicles, penetrable to fluid flow, with few fixed, negative charges (1 mM). This is opposite to the effects of chlorhexidine, which created an electrophoretically hard pellicle (1.7 nm). This soft-layer electrokinetic model quantitatively shows that the degree to which pellicles are penetrable to fluid flow differs upon exposure to dentifrices, with relevance for plaque formation, de- and remineralization and staining processes.

Adsorption↗
PubMedDate not supplied

Suppression of caries-related microorganisms in dentine lesions after short-term chlorhexidine or antibiotic treatment.

This study investigated the efficiency of a chlorhexidine varnish and an antibiotic paste in suppressing the cultivable microflora of deep dentine cavities in a stepwise excavation procedure. Subsequent to enamel preparation and removal of the central biomass, infected dentine was sampled from the cavity floor. Ten cavities each were either covered with the 1% chlorhexidine- and 1% thymol-containing varnish Cervitec (CE), the demeclocycline hydrocortisone-containing ointment Ledermix (LE) or received no treatment as control (CO). A compomer composite was used as intermediate restorative. Cavities were reassessed after 6 weeks and again dentine samples were microbiologically investigated for total viable counts, mutans streptococci and lactobacilli. After 6 weeks a significant reduction of the total viable counts was observed in the LE group (p = 0.011) compared to the control, whereas no differences were found in the CE group (p > 0.05). Mutans streptococci were rarely recovered at baseline and after 6 weeks. Compared to the CO group counts of lactobacilli were significantly reduced in the CE and LE groups (p < 0.05). Lactobacillus species were frequently recovered at baseline and after 6 weeks of observation. Lactobacillus rhamnosus was the predominant species in all samples investigated. Application of CE or LE resulted in reduced counts of lactobacilli after a period of 6 weeks. Although none of the materials completely eliminated the viable microorganisms, the use of LE was more effective than CE in reducing the total anaerobic microorganisms associated with carious dentine.

Actinomyces↗
PubMed1992

Effect of slow-release chlorhexidine mouthguards on the levels of selected salivary bacteria.

This study evaluated the effect of an alternate delivery system for chlorhexidine on salivary levels of mutans streptococci (MS) and other selected oral bacteria. On the basis of salivary MS levels > or = 10(4) CFU/ml, 22 subjects were enrolled. All caries lesions were restored prior to treatment. Two pretreatment paraffin-stimulated saliva samples were obtained for culturing at least 1 week apart. Complete-arch vacuum-adapted mouthguards were individually fabricated and coated internally with a 3% w/v chlorhexidine varnish. Mouthguards were worn for an average of 7 h/night for 7 nights. Saliva samples were obtained immediately after treatment and 1 and 3 months later. There was no significant change in levels of any of the monitored bacteria between the two pretreatment samples. A significant and specific reduction in salivary MS levels was observed in the three after-treatment samples as compared with baseline values (p < 0.001, p < 0.001, p < 0.05, respectively). The levels of Actinomyces viscosus were also measured, and there was a significant reduction immediately after treatment (p < 0.05), a return to baseline values at 1 month, and a significant increase above baseline values at 3 months, (p < 0.001). There was no significant change in saliva volume, in total numbers of facultatively anaerobic bacteria, or in levels of lactobacilli or Streptococcus sanguis. This treatment system is capable of significant and specific suppression of MS levels for up to 3 months without retreatment.

Actinomyces viscosus↗
PubMed1992

Effects of chlorhexidine-fluoride gel treatments in mothers on the establishment of mutans streptococci in primary teeth and the development of dental caries in children.

In a longitudinal 3-year study, 151 children were followed for the colonization of the primary dentition by mutans streptococci (MS) and for the development of dental caries. At the age of 1 year, the child-mother pairs were divided into three groups on the basis of the levels of MS in maternal saliva. In the experimental group, the mothers had MS levels higher than 10(5) CFU/ml, and they were given chlorhexidine (1%)-sodium fluoride (0.2%) gel treatments twice a year for 3 years. Two control groups were formed. In control group 1, the mothers also had high levels of MS, but no gel was given. In control group 2, the mothers had low (< 10(5) CFU/ml) baseline levels of salivary MS, and no chlorhexidine-fluoride gel was used. In the total study population, 16, 42, and 54% of the children were colonized by MS by the age of 2, 3, and 4 years, respectively. Most children harbored only Streptococcus mutans, but 2 had both S. mutans and Streptococcus sobrinus, and 2 had only S. sobrinus. Twenty-eight percent of the MS-positive children developed caries by the age of 4 years, whereas 4 out of 27 children with dental caries did not have any detectable MS in their plaque samples. Both the colonization by MS and the caries incidence were highest in control group 1 and lower in the experimental group and in control group 2. These observations suggest that the reduction of maternal salivary MS at the time of tooth emergence may delay, or perhaps even prevent, the colonization of MS in the children's primary dentition with a concomitant decline in caries incidence, even in a population with an already low prevalence of dental caries.

Child, Preschool↗
PubMed1992

Caries incidence, mutans streptococci and lactobacilli in irradiated patients during a 12-month preventive programme using chlorhexidine and fluoride.

Radiotherapy (RT) near salivary glands results in changes in the oral flora in favour of cariogenic organisms and an increased susceptibility to caries. The aim of this study was to assess the effect of a 12-month preventive programme on caries incidence and on the levels of mutans streptococci (ms) and lactobacilli in tongue loop samples taken from patients before, during and after RT. The regime consisted of 2 x daily rinsing with 10 ml 0.2% chlorhexidine, diluted 1:1 with water, for 1 week before RT, during RT and for 4 weeks after RT. This was then substituted with a 0.05% NaF rinse daily. A saliva substitute containing 2 ppm F was used as required. Scaling was carried out before RT and dietary advice and oral hygiene instruction given. Appropriate radiographs were taken at baseline and after 6 and 12 months. Tongue loop samples for microbiology were taken in the middle and end of RT and subsequently at 6, 8, 12, 24, 40 and 52 weeks. Whenever levels of ms exceeded 2 x 10(5) cfu/ml sample, 1% chlorhexidine gel in custom-made applicator trays was applied by the subject for 5 min daily for 14 days. In 25 subjects completing the programme, there was a total of 3 new caries lesions after 12 months. Thirteen pre-existing enamel lesions were arrested. There were significant reductions (p < 0.005) in ms levels from baseline values during RT and 4 weeks after RT. There were no significant increases in ms levels throughout the study.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1997

Effect of different chlorhexidine varnish regimens on mutans streptococci levels in interdental plaque and saliva.

The aim of the present study was to evaluate and compare the effects of an intensive and a monthly mode of antibacterial varnish application on the levels of mutans streptococci (MS) in interdental plaque and whole saliva. Eighty-eight healthy schoolchildren (11-13 years) with high scores of salivary MS were selected by a screening procedure and randomised into two groups, MS were enumerated at all mesial interdental sites of the first permanent molars with the aid of a modified chair-side technique, disclosing a total of 161 sites with moderate or high colonisation levels. The subjects were treated with a 1% chlorhexidine-thymol-containing varnish (Cervitec) either in an intensive mode (IM) with 3 applications within a 2-week period or in a monthly mode (MM) during a 3-month period. The varnish was applied with a miniball burnisher after the teeth had been cleaned interdentally with dental floss and dried with air. Follow-up samples of saliva and plaque from the interdental areas were collected after 1, 3 and 6 months. Both groups exhibited a statistically significant (p > 0.05) reduction of interdental MS after 1 month when compared with baseline. An eliminated MS growth appeared more frequently following the IM compared with the MM. After 3 months, a significant reduction compared with baseline was still found in the IM group but not in the MM group. No reduction was found in either group after 6 months. MS levels in saliva were mainly unaffected at the follow-up samplings, with the exception of a slight reduction in the IM group after 1 month. In conclusion, the results suggest that an intensive mode of chlorhexidine-thymol varnish application is more effective against interdental MS than the monthly mode of application. Bacterial growth should be monitored in a site-specific way, since interdental reductions were not adequately reflected in whole saliva samples.

Administration, Topical↗
PubMed1993

Local chemolysis of obstructive uric acid stone with 0.1 M THAM and 0.02% chlorhexidine.

We used a modified chemolytic solution by combining 0.1 M THAM (tris[hydroxymethyl] aminomethane) with 0.02% chlorhexidine to treat 10 obstructive uric acid stone patients. A total of 23 local chemolysis sessions were performed. Five patients received 13 sessions (average: 2.6) as an adjuvant chemolysis after extracorporeal shock wave lithotripsy 5 patients received 10 sessions (average: 2) as a primary treatment. The average time of local chemolysis was 2.3 days, ranging from 1 to 4 days. In the 23 local chemolysis sessions, only one patient developed two episodes of fever (8.7%), which were managed successfully by conservative treatment. The mean values of effective renal plasma flow of treated kidney was increased from 108.2 to 155.6 ml/min (p < 0.05). The stone-free rate assessed by IVP and ultrasonography at 3 months follow-up was 80%. Our results indicate that the combined use of 0.1 M THAM and 0.02% chlorhexidine is an effective and safe method to treat obstructive uric acid stones.

Aged↗
PubMed1982

Effects of chlorhexidine and four antimicrobial compounds on plaque, gingivitis, and staining in beagle dogs.

Solutions containing 0.2% of a bis-biguanide, chlorhexidine (positive control), and four bis-amidinourea antimicrobial agents were tested in beagle dogs in a 12-week study. The five agents significantly reduced clinical plaque and gingivitis scores, and gingival fluid volumes in treated dogs, compared with water. All compounds reduced the stain area scores compared to water controls. Stain intensity scores were higher for chlorhexidine than for the four new antimicrobial agents and the water controls. There were no overt behavioral changes. Histological examination of oral tissues revealed no irritation.

Adamantane↗
PubMed1985

Plaque inhibition by sustained release of chlorhexidine from removable appliances.

We studied the effectiveness of a sustained-release delivery system for chlorhexidine in plaque prevention. A clinical trial in a group of eight students wearing orthodontic appliances coated by ethyl cellulose polymer containing the drug demonstrated that plaque accumulation was decreased for a period of four days. All oral procedures had been withdrawn during the clinical study. No side-effects of chlorhexidine, such as tooth staining and unpleasant taste, were observed.

Adult↗
PubMed1992

Inhibition of plaque formation and gingivitis in beagle dogs by topical use of a degradable controlled-release system containing chlorhexidine.

The in vivo efficacy of a newly-developed dental application of a film-forming, chlorhexidine-containing system was examined in beagle dogs. A self-disintegrating film-forming solution was applied three times weekly to the dentitions of 7 out of 13 dogs, which were fed a soft-food diet. Plaque accumulation (Plaque Index) and gingival inflammation (Gingival Index) were recorded at one, two, four, six, and eight weeks. The local delivery of low-dose chlorhexidine to dogs significantly inhibited gingivitis and plaque formation. It is concluded that the dental application of a film-forming system may be a preferable method of periodontal disease prophylaxis, and may enhance supragingival plaque control in areas of isolated periodontal problems associated with obvious local predisposing factors.

Animals↗
PubMed1994

Potential efficacy of chlorhexidine against mutans streptococci and human dental caries.

Chemotherapeutic agents have been considered as having potential for the prevention of dental caries. Several substances have been evaluated as possible candidates, but no antimicrobial agent, with the exception of fluoride, has received as much experimental attention as the bisbiguanide chlorhexidine. This substance represents, so far, the most effective and best-documented agent. To be effective against caries, therapeutic dosages of the antimicrobial agent have to be given for a sufficient but finite time period to sites with established cariogenic plaque. In studies where this principle has been used, the aim has been to eliminate or strongly suppress the population of mutans streptococci. Of various antimicrobial agents and methods tested, the most persistent reduction of mutants streptococci has been achieved by chlorhexidine varnishes, followed by gels and mouthwashes. The best clinical effect resulting in a considerable caries reduction has been obtained when persons highly colonized with mutans streptococci have been treated with gels and when the results of the antimicrobial measures have been verified by microbiological examination.

Administration, Topical↗
PubMedDate not supplied

Anaphylaxis to an urethral lubricant: chlorhexidine as the "hidden" allergen.

We report on a severe allergic reaction during urethral catheterisation, initially erroneously attributed to natural rubber latex (NRL). However, the negative investigations for latex, the uneventful further applications of NRL, the positive skin test and basophil activation test for chlorhexidine strongly support diagnosis of chlorhexidine anaphylaxis. This case illustrates that it is not widely appreciated that "innocent" products such as urethral lubricants may elicit serious life-threatening reactions. Careful inspection of the medical records is once again re-emphasised to be mandatory in order to avert subsequent anaphylaxis.

Aged↗