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PubMed2002

Review of the treatment strategies for oral malodour.

Breath malodour, a significant social and/or psychological handicap, may be caused by several intra- and extraoral factors. Malodour of intraoral origin is the result of microbial putrefaction, during which volatile sulphur compounds (VSC) and other volatile compounds are produced. The treatment of oral malodour can therefore be focused on the reduction of the intraoral bacterial load and/or the conversion of VSC to nonvolatile substrates. This article outlines the efficacy and mechanisms of different antimalodour approaches. Most approaches were found to be inefficient and/or short lasting. The most successful treatment involves mechanical debridement (including toothbrushing, flossing, and tongue cleaning), possibly combined with the use of an antimicrobial mouthrinse.

Anti-Infective Agents, Local↗
PubMed2002

Monitoring of buccal epithelial cells by alkaline comet assay (single cell gel electrophoresis technique) in cytogenetic evaluation of chlorhexidine.

During the last few years, there has been increasing interest in buccal epithelial cells for cytogenetic evaluation of different materials. In the present study, the use of these cells and peripheral lymphocytes for cytogenetic evaluation of chlorhexidine digluconate (CHX) with comet assay (single cell gel electrophoresis, or SCGE) is reported. This technique detects DNA strand breaks in individual cells in alkaline conditions. Thirteen volunteers were requested to rinse their mouths with 0.12% CHX solution for 18 days. Buccal epithelial cells and peripheral blood lymphocytes were obtained from all participants at baseline and the end of the experimental period. One hundred cells per subject were analysed for the DNA damage. A statistical increase was observed in the damaged buccal and blood cells after the CHX application. The mean grade of damage in buccal cells was statistically different from that in blood cells. Due to minimal absorption of chlorhexidine into the tissues and low concentrations of free chlorhexidine in the oral cavity, the DNA damage produced by chlorhexidine in lymphocytes was lower than in buccal epithelial cells. As chlorhexidine does not accumulate in the body, the frequencies of DNA damage could be transient. Detected DNA damage after CHX use might be the indication of an earlier effect, before DNA repair begins, and could be reversible.

Adult↗
PubMed2002

Plaque-inhibiting effect of bioadhesive mucosal tablets containing chlorhexidine in a 4-day plaque regrowth model.

BACKGROUND AND AIM: Compliance in the use of daily oral antiseptics can probably be enhanced by prescribing easily-applied bioadhesive tablets which slowly release chlorhexidine (CHX). This could also be of use in patients with difficulties in rinsing or performing mechanical plaque control. The aim of the present study was to evaluate the capacity of bioadhesive tablets containing either 30 mg or 40 mg of CHX to inhibit de novo plaque formation. METHOD: In this single, examiner-blinded, crossover study, 22 volunteers between 21 and 25 years of age refrained from oral hygiene for 4 days. Bioadhesive mucosal tablets containing 30 mg or 40 mg of CHX were applied in the canine region. Rinses with a 0.2% CHX solution and placebo tablets served as controls. Plaque regrowth was evaluated with the Quigley-Hein Index modification of Turesky and by an automatic image analysis system (AIA) using slides of stained plaque. Rinsing and application of the tablets were done under supervision twice daily. RESULTS: According to the plaque index, plaque regrowth was significantly inhibited by CHX rinses ( P<0.001) and by tablets with 40 mg of CHX ( P<0.02) for all teeth and surfaces. Placebo tablets and 30-mg CHX tablets had no plaque-inhibiting effect. For taste, the subjects preferred the placebo and the 30-mg tablets more than the rinses and 40-mg tablets. In 3/22 of the subjects, superficial mucosal lesions were found at the side of application of the 40-mg tablets. Using the AIA system for evaluation of plaque regrowth, similar results for plaque inhibition were found. CONCLUSION: It can be concluded that bioadhesive mucosal tablets containing 40 mg of CHX can inhibit plaque regrowth as well as 0.2% CHX rinses. However, unpleasant taste and superficial mucosal lesions are local side effects to be considered.

Adhesiveness↗
PubMed2003

Biofilms and the tongue: therapeutical approaches for the control of halitosis.

Due to its location and functions, the tongue is one of the most important anatomic structures in the oral cavity. However, knowledge in regards to its role and implications in oral health and disease is scarce. Moreover, although the dorsum of the tongue seems to harbour one of the most complex microbiological niches in human ecology, the knowledge of the role of tongue flora in health and disease is also very limited. Similarly, the nature of the tongue coating and the factors that influence its development and composition are almost unknown. The interest in the study of the tongue niche has increased in recent years due to its association with oral halitosis and to its role as a suitable reservoir for periodontal pathogens. The structure of the tongue favours a unique and complex bacterial biofilm, in which periodontal pathogens are frequently found. However, little is known about how to control this bacterial niche, and factors affecting tongue coating composition and aspect are not fully understood. Studies available on the influence of mechanical or antimicrobial approaches against tongue biofilm are very limited. Mechanical treatments showed a transient reduction in halitosis-related variables but were limited in time. Different antimicrobials agents have been evaluated: chlorhexidine, chlorine dioxide, metal ions, triclosan, formulations containing essential oils, and hydrogen peroxide. However, most studies were designed as short-term models. Some of these studies demonstrated that the reduction in halitosis-related variables was associated with significant changes in the tongue microflora.

Anti-Infective Agents, Local↗
PubMed2003

The rational use of oral care products in the elderly.

This review examines the evidence of the effectiveness of oral care products in preventing and controlling dental caries and periodontal disease in the ageing population. The strength of evidence is indicated using the following hierarchy: Type 1 (systematic reviews), Type 2 (randomised controlled trials), Type 3 (observational studies) and Type 4 (traditional reviews). Most of the evidence to support the effectiveness of fluoride products is extrapolated from studies involving children and adolescents. The few studies that have been performed in older adults suggest that fluoride toothpaste and, in the case of high caries risk individuals, the adjunctive use of other fluoride delivery systems, may be effective in preventing coronal and root caries. Some dentifrices containing triclosan have been shown to improve plaque control and gingival health and one, which contains triclosan/copolymer, reduces the progression of periodontitis in adults and high-risk individuals. Powered toothbrushes with an oscillation-rotation action are more effective in reducing plaque and improving gingival health than manual toothbrushes.

Aged↗
PubMed2004

Does professional preventive care benefit from additional subgingival irrigation?

The effect of an oral irrigator (Water Pik, Intersante) with a subgingival tip (Pik Pocket Subgingival Tip, Intersante) in the reduction of gingivitis was investigated in a single-blind three-group study involving 45 volunteers (age 46.2+/-10.2). All volunteers (inclusion criteria: gingivitis or a superficial periodontitis) were examined and underwent professional tooth cleaning at the first appointment. They were then randomly distributed in three groups: one group used the irrigator with the subgingival tip once daily with just tap water, in addition to their regular oral hygiene; another group also used an herbal-based mouth rinse (Parodontax, GlaxoSmithkline) in the water of the irrigator; a third group did not use an irrigator or any irrigant and therefore served as control. All groups received professional oral care education at each appointment. The investigation period was 3 months. At baseline and after 4, 8, and 12 weeks, the plaque index (PI, scores 0-5), gingival index (GI, scores 0-3), bleeding index (BI scores 0-5), and sulcus fluid flow rate (SFFR, Periotron 6000) at the Ramfjord teeth were scored. At baseline and after 3 months, the probing depth (millimeters) was measured at six surfaces of all teeth. A significant reduction in BI, PI, GI, probing depth, and SFFR was observed within 3 months. With all volunteers, however, there was no statistically significant difference ( p>/=0.05, Wilcoxon-test, SAS 6.04) between the three groups at any time. The additional use of the Water Pik irrigator with the Pik Pocket subgingival irrigation device with or without an herbal mouth rinse showed no clinical benefit over professional education in oral hygiene alone.

Dental Calculus↗
PubMed2001

Clinical controlled study on plaque and gingivitis reduction under long-term use of low-dose chlorhexidine solutions in a population exhibiting good oral hygiene.

The aim of this randomized, parallel-group, placebo-controlled, blind clinical study was to examine the dental plaque and the gingivitis inhibitory effects of two low-dose 0.06% chlorhexidine (CHX) preparations in comparison to a commercially available 0.1% CHX solution, an amine fluoride/stannous fluoride (ASF) solution and a water control as an adjunct to the daily mechanical oral-hygiene measures. After prophylaxis, 81 medical students performed their tooth cleaning and were asked to rinse for 30 s, according to the instructions given by the manufacturers with the assigned amount of the following solutions: once daily 10 ml ASF 250 ppm or twice daily each 10 ml CHX 0.06% with fluoride, 10 ml CHX 0.06% without fluoride, 15 ml CHX 0.1% or 100 ml tap water. The plaque index (PlI), the gingival index (GI) and the discoloration index (DI) were taken at day -14 and months (M) 0, 1, 2, 3 and 6. In this study group with good oral hygiene, all test products led to a reduction of the PlI scores when used as supplements to the usual mechanical hygiene measures. At M3 subjects using both the 0.1% as well as the 0.06% CHX showed significantly less plaque accumulation than those using ASF. In the GI a significant difference between the control and 0.1 % CHX was found at M3 and at M6. If a further decrease in the GI is wanted, a minimum concentration of 0.1% CHX for long-term use in association with habitual cleaning is needed, which, however, should be limited to special patients. If maintaining clinical health is the goal, the other solutions are a good alternative to 0.1% CHX because they exhibit less staining.

Adolescent↗
PubMed2001

Effect of antimicrobial mouthrinses on the in vitro adhesion of Candida albicans to human buccal epithelial cells.

Adhesion to epithelial cells is a critical step in successful oral colonization and infection by Candida albicans. Therefore, three mouthrinse products, containing chlorhexidine 0.2% (CHX), cetylpyridinium chloride 0.05% (CPC) or triclosan 0.045% (TRN), were compared for their effects on the in vitro adhesion of C. albicans to human buccal epithelial cells (BEC). Candidal adhesion appeared to be significantly reduced by oral rinsing with the CHX-containing mouthrinse (P<0.0001). In vivo exposure of BEC to the CPC mouthrinse also inhibited adhesion of C. albicans (P<0.0001). Both CHX and CPC products suppressed adhesion to the same extent (P>0.01). On the other hand, the TRN mouthrinse did not significantly affect epithelial adhesion of C. albicans (P>0.01). These findings suggest that mouthrinses containing CHX or CPC could be of value in the control of candidal colonization and infection. Clinical trials are warranted on the effectiveness of these products in reducing oral Candida carriage.

Adult↗
PubMed2007

Combined effect of staining substances on the discoloration of esthetic Class V dental restorative materials.

The purpose of this study was to determine the combined effect of an organic substance (mucin as a substitute for salivary organic substances), chlorhexidine, and an iron compound/tea solution on the changes in the color of esthetic Class V dental restorative materials. Color of a glass ionomer, resin-modified glass ionomer, compomer and flowable resin composite of A2 shade, respectively, was determined according to the CIELAB color scale relative to the standard illuminant D65. Color was measured at baseline, and after sequential immersion in the following substances: Step-1, mucin in PBS (MCP) for 48 h; Step-2, chlorhexidine (CHX) for 24 h; Step-3, iron compound (IRN) or tea solution (TEA) up to 7 days; and Step-4, ultrasonic cleaning for 1 h. Color change (DeltaE(ab )*) was calculated by the equation: DeltaE(ab)* = [(DeltaL*)(2) + (Deltaa*)(2) + (Deltab*)(2)](1/2), of which DeltaL(*) indicates changes in value, Deltaa(*) indicates changes in red-green parameter and Deltab(*) indicates changes in yellow-blue parameter. DeltaE(ab)* values after immersion in MCP and CHX were compared, and DeltaE(ab)* values after immersion in IRN or TEA, and subsequent ultrasonic cleaning were compared with respect to the restorative material and immersion substance. DeltaE(ab)* and changes in the color parameters (DeltaL(*), DeltaC(ab)* and DeltaH(ab)*) were analyzed by repeated measures, analysis of variance and a post-hoc test at the 0.05 level of significance. Color changes after immersion in MCP were acceptable (DeltaE(ab)* < 3.3), and those after immersion in CHX were generally acceptable. The range of DeltaE(ab)* values after immersion in IRN was 3.1-19.6, and that after ultrasonic cleaning was 2.4-9.6. The range of DeltaE(ab)* values after immersion in TEA was 10.7-21.1, and that after ultrasonic cleaning was 11.9-14.5. Color changes of four Class V restorative materials after combined treatment with mucin, chlorhexidine and an iron compound/tea solution were not acceptable. Colors did not recover to their original values after ultrasonic cleaning. Modifications on the surface of a restoration should be considered to reduce stain accumulation.

Acrylic Resins↗
PubMed1975

Orthodontic positioner used for home fluoride treatments.

It has been well documented that the more time the enamel surface is exposed to fluoride, the higher will be the caries protection. An extremely good method of greatly increasing caries resistance is by daily or weekly home fluoride treatments. This procedure is usually limited to special cases of rampant caries, patients with hemophilia, and handicapped patients in whom caries control is vital. It is not used more widely because of the added costs of impressions, tray fabrication, and professional. If the patient already has a vehicle for applying fluoride, such as a positioner or mouth guard, it is a simple matter to prescribe or dispense fluoride gel to be used when these appliances are being worn. This is expecially true for orthodontic postioners. When bands are removed, a slight space usually exists interproximally. This space greatly facilitates fluoride contact with the proximal surfaces. Fluoride will tend to recalcify decalcified areas of enamel in addition to providing added caries protection for the patient. If positioners are not used after band removal, home fluoride trays or rinses can also be effective. Since many orthodontic patients wear a positioner when bands are removed, the orthodontist can provide his patients with the benefits of topical fluoride by prescribing fluoride gel and explaining how to use it along with his positioner.

Dental Caries↗
PubMed1982

Some considerations regarding the degradational interactions between mouth rinses and silver-soldered joints.

For immersion tests with mouth rinses of Lavoris, Green Mint, and Cepacol, silver solders and silver-soldered stainless steel joints exhibited corrosive degradational reactions. Exposures to Lavoris resulted in the severest surface attack as followed by optical microscopy, scanning electron microscopy, and energy-dispersive x-ray microanalysis. This was confirmed by measurements of electrochemical potential and polarization. The cyclic voltammograms in Lavoris indicated a highly active corrosion potential of -0.94 v. sce, while potentials in Mint and Cepacol were only about -0.25 v. This activity is attributed to the presence of zinc chloride as the active agent in Lavoris, as well as the high zinc content (up to about 20 percent) and even higher zinc concentrations contained in copper-zinc microstructural phases of the silver solders and the ease for dezincification corrosive attack. Large increases in current above about -0.2 v. are observed with all rinse solutions as well as a prepared saliva substitute solution. The importance of toxicologic considerations of the agents released from silver solders and the interactions of corrosion with stress as factors in causing delayed failures of soldered joints are discussed. The presently available commercial solders without cadmium and zinc contents, but with higher fusion temperatures and decreased flow characteristics, are recommended for dental applications to increase the resistance to corrosion.

Chemical Phenomena↗
PubMed1986

Comparative friction of orthodontic wires under dry and wet conditions.

Kinetic coefficients of friction for stainless steel, beta-titanium, nickel-titanium, and cobalt-chromium arch wires were measured on a smooth stainless steel or Teflon surface. A universal materials testing instrument was used to pull 0.017 X 0.025-inch rectangular arch wires through a pneumatically controlled binding surface. Classical friction relationships were evaluated by varying applied normal force--similar to ligature tie force--via this pneumatic control. Coefficients of friction were determined under dry and wet (artificial saliva) conditions. Frictional force values, and thus coefficients of friction, were found to increase with increasing normal force for all materials. Beta-titanium and stainless steel wires sliding against stainless steel, and stainless steel wire on Teflon consistently exhibited the lowest dry friction values. Artificial saliva increased friction for stainless steel, beta-titanium, and nickel-titanium wires sliding against stainless steel. Artificial saliva did not increase friction for cobalt chromium, stainless steel sliding against stainless steel, or stainless steel wire on Teflon compared to the dry condition. Stainless steel and beta-titanium wires sliding against stainless steel and stainless steel wire on Teflon showed the lowest friction values for the wet condition.

Chromium Alloys↗