Hibitane in oral disease in handicapped patients.
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Biguanides↗
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Hibitane in the treatment of oral candidiasis.
Denture stomatitis (chronic atrophic candidosis) is a very common complication to the wearing of complete dentures. The infection is due to a contamination of the denture by yeasts. In a number of studies the clinical effect of Hibitane when used as a denture disinfectant has been studied. It was found that Hibitane (0.2--2%) caused a significant amelioration of inflamed palatal tissues and a reduction in the number of yeast cells harbored on the palatal mucosa and the fitting surface of the dentures. However, relapse of the infection was frequent after treatment was sustained. It was concluded that Hibitane could not be recommended for routine denture disinfection, first, because it caused staining of the dentures, second, because of the relative resistance of the yeast to the action of the drug. However, it seems justified to use Hibitane prophylactically as a denture disinfectant in patients who are highly susceptible to developing disseminating or systemic candidosis. Hibitane is a valuable drug in the treatment of denture stomatitis when used as a denture disinfectant.
Biguanides↗
Comparison of the bisbiguanide antiseptics alexidine and chlorhexidine. II. Clinical and in vitro staining properties.
A blind cross-over trial was carried out to compare the tooth and tongue staining associated with the use of a 0.035% alexidine and a 0.2% chlorhexidine mouthrinse. Twenty-two volunteers were divided into two groups termed "tea drinkers" and "non-tea drinkers". All volunteers were requested to refrain from oral hygiene measures throughout two 10-day periods when they rinsed twice a day with the preparation randomly allocated for the respective period. During both periods the members of the groups excluded coffee, red wine and port from their diet. The tea drinking group consumed seven cups of tea per day. Tooth and tongue staining was recorded for extent and severity at the end of each period. The amount of stain accumulating in the two groups was similar following the use of chlorhexidine and alexidine. However, for both chlorhexidine and alexidine the extent and severity of tooth and tongue staining were significantly increased in the tea drinking group. An in vitro study of tea staining of perspex blocks exposed twice a day to 0.035% solutions of alexidine or chlorhexidine throughout a 5-day period demonstrated significantly more staining with alexidine when measured spectrophotometrically. Visually however, the differences in the specimens were minimal. Saliva treatment of the perspex did not significantly alter the staining by alexidine or chlorhexidine. The results provide further evidence for a dietary aetiology to the staining associated with cationic antiseptics. However, alexidine at the concentration used offered no advantage in reducing the side effect of staining when compared with chlorhexidine.
Biguanides↗
The effect of single morning and evening rinses of chlorhexidine on the development of tooth staining and plaque accumulation. A blind cross-over trial.
A dietary aetiology for tooth staining associated with the use of chlorhexidine has been postulated. The time related activity of chlorhexidine would therefore suggest that evening rinsing would result in less staining than morning rinsing. This study measured tooth and tongue staining and plaque accumulation in a group of 18 volunteers, rinsing once at night or once in the morning with chlorhexidine in a blind cross-over design. Beverage intake during two 10-day periods was prescribed. Significantly more tooth staining, but not tongue staining, was seen with morning rinsing. Plaque accumulation showed a trend to more plaque with morning rinsing, which was not significant. The findings would be consistent with a dietary aetiology for tooth staining. However, these results emphasise the considerable duration of activity of chlorhexidine on surfaces in the oral cavity and the theory of progressive desorption of chlorhexidine from the tooth surface is questioned.
Adult↗
Plaque control with chlorhexidine and D-301, a quaternary ammonium compound.
Eighteen female dental hygiene students took part in a double-blind, crossover clinical trial of equimolar (2.2 mmol) rinsing solutions of D-301, a quaternary ammonium compound and chlorhexidine digluconate, Rinsings were partly supervised, test periods were 7 days (5 days without oral hygiene) with a 1-week interval. Plaque formation was significantly reduced by both test solutions versus the control; on not precleaned tooth surfaces plaque formation was equally inhibited by the chlorhexidine and D-301 mouthrinses. On precleaned surfaces D-301 significantly inhibited plaque formation compared with the control rinse, but was less effective than chlorhexidine. There was no significant change in the PBI, a measure of gingival inflammation, during any of the test period. Staining of teeth and tongue was judged as equal after chlorhexidine and D-301 use. Reports of taste and gastric disturbances were minimal but more frequent during the D-301 test period.
Benzalkonium Compounds↗
Extrinsic dental stain caused by chlorhexidine and other denaturing agents.
Experiments were performed in a standardized rabbit model for examination of the potential of chlorhexidine and other denaturing agents to induce dental stain together with ferric ions. The studies supported the view that denaturation may be a major aspect of the mechanism of stain formation and that iron sulphide may be one important cause for extrinsic dental stain. Analytical microprobe analysis showed high amounts of Fe and S in the stain. The stain formation could be inhibited by SnF2, possibly by a red-ox reaction. Established stain could be removed by an oxidizing agent.
Animals↗
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↗
Efficacy of mouthrinses in inhibiting dental plaque and gingivitis in man.
The aim of the present trial was to determine the effect of different mouthwash preparations used as supplements to regular oral hygiene measures on dental plaque and gingivitis in humans. 96 volunteers were recruited for the study. Following a baseline examination, each subject was given a careful prophylaxis, following which the mouthrinse regimens were initiated. During the 6 weeks of trial, the subjects continued to exercise their regular non-supervised, self-performed plaque control measures. The 96 volunteers were assigned either to 1 or 3 different treatment groups or to a control group according to a randomized code. The members of the control group and the listerine group rinsed with 20 ml of the mouthrinse for 30 s, twice daily, while the members of the chlorhexidine groups (using either a 0.2% or a 0.1% solution) rinsed with 10 ml of the antiseptic solution for 60 s twice daily. Examinations regarding extrinsic stain and plaque were performed at baseline and after 3 and 6 weeks, while the conditions of the gingiva were examined at baseline and after 6 weeks. Extrinsic stain was evaluated using the Lobene index, plaque was assessed by the Turesky modification of Quigley-Hein index and the gingival condition was examined using the gingival index system of Loe & Silness. The results of the trial demonstrated that the 3 active mouthwash preparations used as supplements to regular tooth cleaning measures markedly improved both the oral hygiene status and the gingival conditions of the participating human volunteers, compared to the control rinse.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
The effects of a 0.2% chlorhexidine gluconate mouthrinse on plaque, toothstaining and candida in aphthous ulcer patients. A double-blind placebo-controlled cross-over study.
Despite the known effectiveness of 0.2% chlorhexidine gluconate mouthwash in preventing plaque formation, relatively few studies have assessed adjunctive benefit to normal unsupervised oral hygiene measures. Furthermore, there have been few accurate measurements of toothstaining in the presence of normal oral hygiene and little data of effects on oral candidal carriage. This study was a double-blind placebo-controlled cross-over study of a 0.2% chlorhexidine gluconate mouthwash used 3 times daily on plaque, staining and candidal carriage in a group of recurrent aphthous ulcer suffers who maintained normal oral hygiene measures. At the end of 2 6-week treatment periods, baseline plaque scores were reduced by active and placebo mouthwashes. Chlorhexidine significantly reduced plaque compared to the placebo. Staining has markedly and significantly increased during chlorhexidine rinsing. Candidal carriage was present in 22.2% of this group and there was no significant effect of chlorhexidine on the mean number of candidal colonies. The distribution of plaque and staining by tooth was plotted and observationally studied. Baseline and placebo treatment plaque distributions indicated the considerable relevance of toothbrushing behaviour for plaque distribution. The effects of toothbrushing on plaque distribution were minimised during the use of chlorhexidine. Staining associated with chlorhexidine showed a distribution again suggesting the influence of toothbrushing. In conclusion, chlorhexidine has significant adjunctive effects on plaque inhibition in the presence of normal unsupervised oral hygiene, but toothbrushing did not prevent toothstaining.
Adolescent↗
Chemotherapeutic inhibition of supragingival dental plaque and gingivitis development.
A 6-month double-blind, controlled clinical study was conducted on 107 healthy adult subjects to determine the efficacy of a mouthrinse used as a supplement to regular oral hygiene measures on supragingival dental plaque and gingivitis. 115 healthy adult patients were recruited for the study. Following screening examinations for minimal entry levels of existing gingivitis and plaque in patients with a minimum of 20 sound natural teeth, extrinsic tooth stain, gingivitis and plaque index scores were recorded. Soft tissues were evaluated. All subjects then received a complete dental prophylaxis, removing plaque, calculus and extrinsic stain. Utilizing their normal oral hygiene, subjects began a regimen of rinsing with 20 ml of the randomly assigned rinse, twice daily for 30 s for 6 months. 7 days after prophylaxis, gingivitis was again scored (baseline 2). Soft tissue, gingivitis, plaque area and extrinsic stain were evaluated again at 3 and 6 months. Results demonstrated that after 6 months, listerine produced a 34% inhibition of both plaque and of gingivitis compared to a hydroalcohol control (p less than 0.001).
Adolescent↗
Comparison of manual and power toothbrushing, with and without adjunctive oral irrigation, for controlling plaque and gingivitis.
We compared the effects of four oral hygiene methods (manual tooth-brushing, power toothbrushing, manual toothbrushing plus irrigation, and power toothbrushing plus irrigation) on plaque and periodontal disease. These methods were tested both when used alone and when used in conjunction with professional mechanical oral hygiene. 108 subjects were clinically assessed for plaque, stain, gingival inflammation, bleeding to probing, probing depth and attachment loss, and randomly assigned to one of the 4 oral hygiene groups. Subjects were carefully instructed in the use of their assigned method and asked to discontinue all other forms of oral hygiene. After 3-months, subjects returned for re-examination and full-month professional mechanical oral hygiene care. 3 months later, subjects returned for a final oral examination. All subjects kept a diary of use of their assigned method and were called every 2 weeks to monitor discomfort, provide reinforcement and answer questions. Results showed that all the oral hygiene methods were equally effective in reducing plaque and stain accumulation, gingival bleeding, bleeding to probing ratio and the % of pockets 4 mm or deeper. None of the oral hygiene methods was associated with injury to soft or hard tissues.
Adolescent↗
The use of an oxidising mouthwash to reduce staining associated with chlorhexidine. Studies in vitro and in vivo.
Discolouration of the teeth, tongue and dental restorative materials associated with the use of cationic antiseptics is still the limiting factor in long-term usage of antiplaque agents such as chlorhexidine. Oxidising agents have been used successfully to remove dental stain in animals, but products and regimens have not been evaluated in humans. These pilot studies in vitro and in vivo assessed a long-established oxidising mouthwash, based on peroxyborate, for stain removal from teeth and acrylic. The laboratory studies measured chlorhexidine tea stain removal from tooth and acrylic specimens. The oxidising agent markedly reduced staining on specimens. In a short-term clinical experiment, dental staining was forced over a 2 1/2-day period by reciprocal chlorhexidine and tea rinsing. 5 rinses with the oxidising mouthwash during the next 1 1/2 days dramatically reduced staining compared with water after rinses. Additionally, a single rinse with peroxyborate following the 5 water after rinses, again considerably reduced the residual staining. Effects on tongue staining were less impressive. Both experimental models produced findings consistent with those from the animal model. The results suggest proprietary oxidising mouthwashes could have a place in the control of dental stain associated with the use of chlorhexidine. Further studies to evaluate such products in a more conventional chlorhexidine regimen are indicated.
Adult↗
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↗
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↗
Observations and concepts of the oral health consequences of tobacco use of Finnish periodontists and dentists.
The observations of Finnish periodontists and other dentists, and their concepts of the oral health consequences of tobacco use as well as their counseling on tobacco use, were surveyed from November 1987 to January 1988. A questionnaire was mailed to all 61 Finnish periodontists and to 535 other dentists; 37 periodontists (61%) and 432 of the other dentists (80%) responded. The periodontists enquired about and advised on smoking significantly more frequently than did the other dentists; 71% of the periodontists often or always enquired about, and 62% advised their patients on smoking. 31% of all dentists had patients who were users of smokeless tobacco, and 62% of those dentists had often or always advised the users to quit. Nearly all dentists had seen some tobacco-caused effects. Periodontists reported more frequently than the other dentists that they had observed more periodontitis, impaired healing of periodontitis and more changes in the oral mucosa in smokers compared with non-smokers. The majority of those who had seen users of smokeless tobacco had noticed changes in the oral mucosa and in the color of the gingiva. The majority of all dentists believed that heavy smoking may impair the host response in the periodontium, with periodontists believing in this more strongly than other dentists.
Adult↗
A 6-month home usage trial of a 1% chlorhexidine toothpaste (1). Effects on plaque, gingivitis, calculus and toothstaining.
Research and development has been aimed towards the development of toothpastes for oral hygiene and gingival health benefits. The most effective antiplaque agent to date, chlorhexidine, is difficult to formulate into active toothpaste products. Despite some encouraging findings for experimental chlorhexidine toothpastes, there are to date no commercially available products. Based on positive findings from an experimental gingivitis study, this investigation evaluated 2 chlorhexidine toothpastes, one with fluoride, as adjuncts to oral hygiene. The study was a double-blind controlled, parallel, balanced group design, extending over 6 months. A total of 297 volunteers commenced the study after screening for a minimum acceptance level of gingivitis. At baseline, 6, 12 and 24 weeks, stain, gingival, bleeding and plaque indices were recorded, together with a calculus index at 6, 12 and 24 weeks. After a baseline prophylaxis, volunteers used the allocated product 2 x per day, with no other oral hygiene instructions given. Plaque, gingival and bleeding scores improved in all 3 groups, but to an overall significantly greater extent in the active groups. However, staining and calculus indices were significantly increased in the active compared to the control group. If the local side-effects of chlorhexidine are considered to be acceptable, these chlorhexidine toothpastes could be recommended for the same clinical applications as other chlorhexidine products. The apparent compatibility of fluoride with chlorhexidine in the one product may be pertinent to caries prevention.
Adolescent↗
Evaluation of a mouthrinse containing chlorhexidine and fluoride as an adjunct to oral hygiene.
Chlorhexidine and fluoride have valuable preventive roles in dental and oral diseases. There is also evidence that in caries prevention, together, they provide additive benefits. However, combined chlorhexidine/fluoride formulations have rarely been evaluated. The aim of this study was to determine whether a 0.12% chlorhexidine, 100 ppm F- mouthrinse provided adjunctive oral hygiene benefits compared to a minus active control rinse. The study was a randomised double-blind parallel design involving 102 subjects of whom 99 completed the 6 week experimental period. Subjects rinsed 2x per day for 1 min with 15 ml of the allocated rinse. Normal toothbrushing procedures were maintained throughout the study. At 6 weeks, plaque and gingivitis scores were significantly lower and the incremental reduction significantly larger in the active rinse group. However, as expected, toothstaining was significantly increased with the active rinse. It is apparent that this chlorhexidine/fluoride rinse could be used in those regimens recommended for other chlorhexidine formulations. The value of the formulation in caries prevention would seem worthy of further investigation.
Adolescent↗
The effect of a mouthrinse containing chlorhexidine and fluoride on plaque and gingival bleeding.
The aim of this study was to test the effect of a rinse with 0.05% sodium fluoride and 0.05% chlorhexidine on plaque and gingival inflammation compared with a placebo without these agents. In a double-blind study, 47 adults with > 20 teeth and a CPITN score > 1 but < 4 were randomised into test and control groups. After baseline assessments for plaque, bleeding and stain, teeth were professionally cleaned. Subjects were asked to rinse for 30 s with 10 ml of the respective test or placebo rinse after normal oral hygiene for 8 weeks. 39 subjects completed the study. There was no significant difference in the 2 groups at baseline with respect to either plaque or bleeding scores. After scaling and 8 weeks use of the test rinse, there were significant reductions (p < 0.001) in both plaque and bleeding. The control group showed no significant reduction in plaque scores after 8 weeks, but a significant (p < 0.05) reduction in bleeding. However, this reduction was significantly greater (p < 0.001) in the test group than in the control. The test group had a significantly greater (p < 0.05) stain score than the control at baseline. After scaling and rinsing for 8 weeks, stain scores were lower for both groups compared to baseline but reached significance (p < 0.05) only for the control group. It is concluded that, as an adjunct to normal oral hygiene, the chlorhexidine/fluoride rinse had a significant inhibitory effect on plaque and bleeding but its effect on staining is uncertain.
Adult↗