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PubMed1997

Evaluation of the antibacterial activities of calcium hydroxide, chlorhexidine, and camphorated paramonochlorophenol as intracanal medicament. A clinical and laboratory study.

The antibacterial activities of camphorated paramonochlorophenol, chlorhexidine, and calcium hydroxide were compared using a clinical and laboratory evaluation. In the clinical experiment, root canals that yielded positive cultures a week after complete chemomechanical preparation and camphorated paramonochlorophenol dressing were medicated with one of the three substances tested. Postmedication samples were taken from the canal 1 week later. In the laboratory experiment, the agar diffusion test was used to evaluate the inhibitory activity of the medicaments against bacteria commonly found in endodontic infections. The results of the clinical evaluation showed that all medicaments were effective in reducing or eliminating the endodontic microbiota, as demonstrated by the incidence of negative cultures. There was no statistically significant difference among the medicaments tested. In the laboratory evaluation, camphorated paramonochlorophenol showed the largest zones of bacterial inhibition against all bacterial strains tested.

Anti-Infective Agents, Local↗

PubMed1999

Antifungal effects of sodium hypochlorite and chlorhexidine in root canals.

The purpose of this study was to evaluate the antifungal properties of 0.12% chlorhexidine, 1% NaOCl, and 5% NaOCl. Root sections were enlarged and the smear layer was removed in half of the specimens. The specimens were fixed in the wells of tissue culture plates. Each root canal was dispensed with an inoculum of Candida albicans. After 10 days, the root sections were treated with 3 ml of either disinfectant solution for 1 min, 5 min, 30 min, and 1 h. Then, root sections were incubated in test tubes having Sabouraud's Dextrose Broth at 37 degrees C for 24 h. In the presence of the smear layer, antifungal activity was observed only in 1-h treatment groups for all solutions. However, in the absence of the smear layer, 5% NaOCl alone started to show antifungal activity after 30 min. The antimicrobial effectiveness of irrigating solutions should be re-evaluated, particularly in patients predisposed to oral candidiasis.

Anti-Infective Agents, Local↗

PubMed1983

Nosocomial infections by chlorhexidine solution contaminated with Pseudomonas pickettii (Biovar VA-I).

Over a period of 10 days, six patients in a cardiac intensive care unit developed Pseudomonas pickettii (biovar VA-I) septicaemia after installation of a venous catheter. The organism was also recovered from all the vials of the aqueous solution of 0.05 per cent chlorhexidine ('Hibitane') prepared with contaminated bidistilled water. There were no further cases of infection when the use of this water was prohibited.

Adult↗

PubMed2001

Integration of Raman microscopy, differential interference contrast microscopy, and attenuated total reflection Fourier transform infrared spectroscopy to investigate chlorhexidine spatial and temporal distribution in Candida albicans biofilms.

Two spectroscopic techniques, attenuated total reflection Fourier transform infrared spectroscopy (ATR-FTIR) and Raman microscopy (RM), were used to characterize transport of chlorhexidine digluconate (CHG) in Candida albicans (CA) biofilms. Different (volumetric) regions of the biofilm are sampled by these two vibrational spectroscopies making them complementary techniques. Simple mathematical models were developed to analyze ATR-FTIR and RM data to obtain an effective diffusion coefficient describing transport through CA biofilms. CA biofilms were composed primarily of yeast and hyphal forms, with some pseudohyphae. Upper regions of biofilms that had become confluent, (i.e., biofilms that completely covered the germanium (Ge) substratum) were composed primarily of a tangled mass of hyphae with openings between germtubes about 10 to 50 microm across. Quantitative analysis of ATR-FTIR kinetic data curves indicated that the effective diffusion coefficient for transport of CHG through confluent biofilms about 200-microm thick was reduced 0.1 to 0.3 times compared to the diffusion coefficient for CHG in water. Effective diffusion coefficients obtained from analysis of RM data were consistently higher than those indicated by ATR-FTIR data suggesting that transport is more hindered in regions near the base of the biofilm than in the outer layers. Analysis of both ATR-FTIR and RM data obtained from thicker films indicated that adsorption of CHG to biofilm components was responsible for a substantial portion of the transport limitation imposed by the biofilm. Comparison of ATR-FTIR and RM data for both types of biofilms indicated that sites of CHG adsorption were more concentrated in the interfacial region than in the bulk biofilm. Comparison of results for ATR-FTIR and RM measurements suggests that these relatively thick CA biofilms can be modeled, for purposes of predicting transport, approximately as a homogeneous thin planar sheet. Thus, these biofilms offer a relatively tractable model system for initial investigations of the relation between antimicrobial transport and kinetics of antimicrobial action.

Anti-Bacterial Agents↗

PubMed1997

Evaluation of chlorhexidine and silver-sulfadiazine impregnated central venous catheters for the prevention of bloodstream infection in leukaemic patients: a randomized controlled trial.

It has been suggested that central venous catheters impregnated with antiseptics such as chlohexidine and silver-sulfadiazine reduce the risk of catheter-related bacteraemia in intensive care patients. Patients suffering from haematologic malignancy treated by chemotherapy through a central venous catheter are at even greater risk of catheter-related bacteraemia. A prospective double-blind randomized controlled trial was performed in order to investigate the effectiveness of chlorhexidine and silver-sulfadiazine impregnated catheters (CH-SS) in these patients. A total of 680 catheters (13,826 catheter days) were inserted, of which 338 were antiseptic impregnated. Bloodstream infection was observed in 105 cases with an overall risk of 7.6 per 1000 catheter days. Thirty-two infections (30.5%) were catheter-related, corresponding to a risk of 2.3 per 1000 catheter days. There was no statistically significant different between the overall rates of bloodstream infection for impregnated and non-impregnated catheters (14.5 vs. 16.3%). The incidence of catheter-related infection was also similar in both groups (5 vs. 4.4%) and there was no difference in the time of the onset of bacteraemia in the two groups. It is concluded that the use of CH-SS catheters in patients with haematologic malignancy reduces neither the overall risk of bloodstream infection, nor the catheter-related infection rate, nor the delay for the occurrence of infection.

Adult↗

PubMed1997

Chlorhexidine gluconate (CHG) activity against clinical isolates of vancomycin-resistant Enterococcus faecium (VREF) and the effects of moisturizing agents on CHG residue accumulation on the skin.

The effectiveness of skin decontamination by chlorhexidine gluconate (CHG) in the presence of commonly-used skin moisturizing lotions was evaluated using vancomycin-resistant Enterococcus faecium (VREF) as a representative nosocomial pathogen. Anti-bacterial efficacy was determined in vitro using pigskin preparations inoculated with five VREF clinical isolates to evaluate Calgon Vestal 2 and 4% (by weight) CHG solutions in comparison with Hibiclens Antiseptic Antimicrobial Cleaner (4% CHG solution). Control inocula were determined for each experiment from recovery of VREF harvested directly from the surface of each control piece of skin. These CHG formulations were evaluated in the presence and absence of Calgon Vestal 'Lotion Soft Skin Conditioner' (LSSC) to determine potential interactions of CHG with LSSC, and also with ¿Vaseline Intensive Care' lotion as a CHG-deactivating agent. The 2% Calgon Vestal CHG alone reduced VREF 10(2)-10(3)-fold, as well as 10(3)-10(4)-fold when LSSC was present, and was as efficacious as either 4% CHG solution when these were tested in the presence of LSSC. Four percent Calgon Vestal CHG produced reductions of 10(3)-10(5)-fold with or without LSSC present. Conversely, ¿Hibiclens' showed similar reductions in the presence of LSSC to that for the Calgon Vestal 4% CHG, but only a 10(1)-10(3)-fold reduction without LSSC. ¿Vaseline Intensive Care' lotion completely inactivated the VREF-killing effects for all of the CHG formulations tested, while LSSC and ¿Vaseline Intensive Care' lotion both showed minimal activity alone against these VREF isolates. These results indicate that the Calgon Vestal 2% CHG solution is as effective against VREF, even in the presence of LSSC, as either the 4% Calgon Vestal or Hibiclens 4% CHG formulations; the use of this lower concentration of CHG may be associated with less irritation, particularly with concomitant use of LSSC.

Animals↗

PubMed1999

Comparison of the antibacterial efficacy of 4% chlorhexidine gluconate and 1% triclosan handwash products in an acute clinical ward.

The antibacterial efficacy of 4% chlorhexidine gluconate (CHG) and 1% triclosan as handwash antiseptics is well established. Few published studies have identified hand bacteria found in glove juice samples, and most studies have used nonclinical study subjects. We report a longitudinal comparative study to determine the effect of 4% CHG and 1% triclosan on the composition of the hand bacterial flora of clinical staff in a specialist surgical unit. Prehandwash and posthandwash samples were collected on 3 separate occasions throughout each day by using the glove juice method and a supervised handwashing technique. Total bacterial counts were determined as well as counts for specific pathogens including methicillin-resistant Staphylococcus aureus and coliforms. Both 4% CHG and 1% triclosan were found to effectively reduce the total hand bacterial count preduty (P =.0001). Four percent CHG also was consistently more effective at reducing the total count than was 1% triclosan. However, 1% triclosan eliminated methicillin-resistant S aureus, whereas 4% CHG failed to do so (P =.0001). Gram-negative bacteria were more likely to be eliminated after the use of 4% CHG compared with 1% triclosan. This study is the first to report the effects of 1% triclosan on the bacterial flora present on the hands of clinical staff and demonstrates the ability of 1% triclosan to eliminate methicillin-resistant S aureus.

Anti-Infective Agents, Local↗

PubMed1998

The effect of monitored chlorhexidine gel treatment on mutans streptococci in margins of restorations.

OBJECTIVES: The objective of this study was to compare the effect of a monitored chlorhexidine (CHX) gel treatment with a conventional two-day CHX treatment in subjects with well-restored dentitions and high numbers of salivary mutans streptococci (MS). METHODS: In the test group (n = 8), the effect of the CHX gel applications was monitored in margins of restorations and in saliva during a period of 12 weeks. Strip Mutans was used for monitoring and whenever a sample revealed growth of MS, the subject received a 3 x 5 min 1% CHX gel treatment at the clinic. Nine subjects (control group) were only given the baseline (conventional) treatment with CHX gel 3 x 5 min on two consecutive days. RESULTS: The monitored treatment in the test group resulted in a more pronounced reduction of MS both in margins of restorations and in saliva than the conventional treatment. The difference between the level of MS in the margins in the two groups was, however, only significant at the 20-week examination. There was a large individual variation in the effect of the CHX treatment, and three to nine extra CHX gel applications were needed in the test group to keep MS below a detectable level during the 12 weeks. CONCLUSIONS: Our findings illustrate the difficulties to obtain a long-lasting reduction of MS in subjects with a large number of restorations and a high number of MS by antimicrobial treatment only. The results indicate the necessity to combine antimicrobial treatment with, for example, sucrose restriction, in order to keep MS at a low level for a longer period of time.

Adult↗

PubMed1986

Postoperative complications after surgical removal of mandibular third molars. Effects of penicillin V and chlorhexidine.

A random material of 112 patients, was investigated after surgical removal of impacted lower third molars. 2 experimental groups and 1 control group were studied. Prophylactic medication with penicillin V combined with preoperative rinsing using 0.2% chlorhexidine gluconate (Hibitane) was found to reduce postoperative symptoms, when compared with preoperative rinsing alone. In both cases, patients were compared with the control group.

Adolescent↗

PubMed2003

Reduction of oral acetaldehyde levels using a controlled-release chlorhexidine chip as a prevention strategy against upper digestive tract cancer.

Increasing evidence indicates a strong relationship exists between harmful habits like smoking and alcohol drinking and upper digestive tract cancer. In addition, smokers and alcohol drinkers also exhibit high salivary levels of carcinogenic acetaldehyde, the first metabolite of alcohol. This compound has been indicated as a major cancer causing factor in the upper digestive tract, especially among alcohol drinkers. Interestingly, acetaldehyde is produced from alcohol present in the epithelia by mucosal alcohol dehydrogenases (ADH) in the upper digestive tract. However, much higher levels derive from the bacterial oxidation of alcohol by the oral microflora. In this respect, the reduction of oral microbes can become a fundamental factor in diminishing the risk of cancer. In this article, we hypothesize that the antimicrobial agent chlorhexidine, formulated as controlled-release chip, and fixed by a dental device, (i.e., a modified orthodontic bracket), may be the most rational strategy for reducing acetaldehyde production by microflora.

Acetaldehyde↗

PubMed2000

Chitosan films and hydrogels of chlorhexidine gluconate for oral mucosal delivery.

Topical delivery of antimicrobial agents is the most widely accepted approach aimed at prolonging active drug concentrations in the oral cavity. As most antifungals do not posses inherent ability to bind to the oral mucosa, this is best achieved through improved formulations. Chitosan, a partially deacetylated chitin, which is a biologically safe biopolymer, prolongs the adhesion time of oral gels and drug release from them. Chitosan also inhibits the adhesion of Candida albicans to human buccal cells and has antifungal activity. The antifungal agent, chlorhexidine gluconate (Chx), also reduces C. albicans adhesion to oral mucosal cells. The aim of this study was to design a formulation containing chitosan for local delivery of Chx to the oral cavity. Gels (at 1 or 2% concentration) or film forms of chitosan were prepared containing 0.1 or 0.2% Chx and their in vitro release properties were studied. The antifungal activity of chitosan itself as well as the various formulations containing Chx was also examined. Release of Chx from gels was maintained for 3 h. A prolonged release was observed with film formulations. No lag-time was observed in release of Chx from either gels or films. The highest antifungal activity was obtained with 2% chitosan gel containing 0.1% Chx.

Absorption↗

PubMed1996

New stability-indicating high performance liquid chromatography assay and proposed hydrolytic pathways of chlorhexidine.

Chlorhexidine (CHD) is an antiseptic agent widely used in mouth rinses and ophthalmic solutions. Its assay in these solutions has been commonly performed with high performance liquid chromatography (HPLC). Published HPLC assays were unable to detect the many possible hydrolysis products of CHD, with the exception of p-chloroaniline. This raises concerns regarding the stability-indicating capabilities of the HPLC assays. In addition, the reliability of these assays was affected by the irreversible absorption of CHD on silica-based reversed phase (RP) columns. Special attention must be paid to the mobile phase or sample matrices in order to obtain reliable assay results. This paper presents a polymer-based RP-HPLC method that is stability-indicating. The method detected six UV-absorbing hydrolysis products of CHD. The identities of the products, which were elucidated by UV and mass spectral analyses, are consistent with the proposed hydrolytic pathways of CHD. Quantitation problems observed with silica-based RP-HPLC assays do not arise with the new method. Preliminary data indicate that the new HPLC method can be developed into a reliable, stability-indicating assay for CHD in ophthalmic solutions.

Anti-Infective Agents, Local↗

PubMedDate not supplied

Antibacterial effect of chlorhexidine on bacteria adsorbed onto experimental dental plaque.

The most common method used to examine the antibacterial effect of antiplaque agents is the minimal inhibitory concentration (MIC) method, which is tested on bacteria in suspensions. Examining the antibacterial effect on bacteria adsorbed onto dental surfaces models is not as popular, although it is clear that such models reflect the conditions in the oral cavity far more accurately than the conventional MIC method. The antibacterial effect of chlorhexidine (CHX) on bacteria adsorbed onto experimental dental plaque model was investigated. Hydroxyapatite beads were coated with human saliva. Next, cell-free fructosyltransferase (FTF) and glucosyltransferase (GTF) were adsorbed onto the beads, and sucrose was added to allow the synthesis of polysaccharide by the surface-bound enzymes. Following adsorption of Streptococcus sobrinus to the experimental dental plaque (EDP), the EDP was exposed to CHX at concentrations between 0.008 to 0.0002% at pH values of 5.5, 6.5, and 7.5. After 150 min incubation, growth of the adsorbed bacteria was measured by their incorporation of 3H-uridine or 3H-thymidine. Comparison of bacterial growth on the EDP with that in suspension showed that the surface-bound bacteria were less sensitive to CHX than were the bacteria in suspension. At all tested CHX concentrations, the antibacterial effect was independent of pH. In addition, under our experimental conditions, the use of 3H-uridine as an indicator of bacterial viability proved to be more sensitive than 3H-thymidine. The antibacterial effect of an agent in a model closely mimicking the tooth surface should generate results that are more relevant to the in vivo conditions than are conventional methods, thus bearing significant information concerning clinical applications of CHX.

Adult↗

PubMedDate not supplied

Mechanisms underlying chlorhexidine-induced cytotoxicity.

Chlorhexidine (CLX) is the most widely used antiseptic for wound and skin disinfection. Despite its potent bactericidal action, skin irritation is observed when it is used topically. This study aimed to evaluate the mechanisms underlying CLX-induced toxicity on human dermal fibroblasts with special emphasis on factors that may mediate or counteract its undesirable effects. Cells were exposed to CLX concentrations of 0.00005-0.025% for 3, 6, 8 or 24 h in the absence or presence of different concentrations of foetal calf serum (FCS) (2, 5 and 10%). Depletion of cell ATP occurred, in a time- and concentration-dependent manner, in all experimental conditions at [CLX] >0.001%. At 24 h of CLX exposure time, the decrease in intracellular ATP was produced from a 10-times lower CLX concentration (0.0001%). Concentrations > or =0.02% produced total loss of ATP. However, cell survival was maintained after CLX treatment for 3 and 8 h and CLX concentrations > or =0.005% were required to produce total cell death. CLX exerted an inhibitory concentration-dependent effect on DNA synthesis from concentrations as low as 0.0001%. Only FCS at 10% appeared to have a cytoprotective action against CLX-induced cytotoxicity.

Adenosine Triphosphate↗

PubMed1997

Clinical effects of chlorhexidine mouthwashes on patients undergoing orthodontic treatment.

This study compared the short-term clinical effect of 0.12% chlorhexidine gluconate and placebo mouthrinses in 30 adolescents (ages 11 to 15) undergoing orthodontic treatment. Subjects were randomized into experimental (CHX) and control (C) groups. Baseline values were recorded 10 days after prophylaxis and included Plaque index (PI), Gingival index (GI), Rentention Index (RI), Discoloration index (DI), and probing depths (PD). Both groups (CHX and C) received soft toothbrushes with instructions to brush twice daily, as well as the CHX and placebo mouthrinses, respectively, with oral and written instructions for rinsing twice daily with 15 ml for 30 seconds. Reevaluations were performed 1, 2, and 3 months after baseline, except for the DI and PD, which were only assessed at 3 months. The Student's t test and the paired t test were used to analyze the data at the P < 0.05 level of significance. No differences between groups were seen at baseline for any of the parameters. At 30 days, there was a significant difference for the RI between CHX (0.15 +/- 0.16; mean +/- SD) and C (0.05 +/- 0.06) at the mesial buccal, and for CHX (0.07 +/- 0.10) and C (0.02 +/- 0.05) at the midbuccal. The 60-day evaluation showed similar results. At 90 days, lower PI were observed in the CHX group at the distal buccal (0.38 +/- 0.19), midbuccal (0.22 +/- 0.17), and mesial buccal (0.47 +/- 0.22) sites as compared with the C group (0.97 +/- 0.38, 0.83 +/- 0.40, and 0.95 +/- 0.43, respectively). A similar trend was noted with the GI, as the lower values were related to the CHX group. The changes of the PI and GI, at 30, 60, and 90 days, as analyzed by the paired t test, were statistically significant in the case of the experimental group, as the changes in the means were a reflection of significantly lower scores observed in the experimental group. After 3 months, the DI showed higher scores in the experimental group as compared with the control, but they were not statistically significant. Deeper PD were detected in the C group at 90 days, and they were statistically significant, except for the midlingual site. The RI did not show significant differences at 90 days, but higher values were recorded in the CHX group. The data indicate that the use of the CHX, in addition to regular oral hygiene habits, was effective in reducing plaque and gingivitis in adolescents undergoing orthodontic treatment.

Adolescent↗

PubMed2000

Outer membrane changes in Pseudomonas stutzeri resistant to chlorhexidine diacetate and cetylpyridinium chloride.

Changes in outer membrane proteins (OMP) and lipopolysaccharide (LPS) in cells of strains of Pseudomonas stutzeri sensitive and resistant to chlorhexidine diacetate (CHA) or cetylpyridinium chloride (CPC) have been examined. Four of five CHA-resistant strains had alterations in OMP profiles, including the expression of two additional protein bands. All the CPC-resistant strains had altered OMP profiles but the changes varied from strain to strain. Loss of the fastest-migrating bands was observed in the LPS from CHX-resistant strains. In strain JM 302R with high-level CHX resistance (minimal inhibitory concentration 100 mg/l as opposed to 2.5 mg/l in the parent-strain, JM 302), all the fast-migrating bands were lost and the strain showed 'cross-resistance' to polymyxin, gentamicin and ethylenediamine tetraacetic acid. It is however, possible that the altered LPS patterns reflect a response to alterations in other components rather than being directly associated per se with the enhanced resistance.

Anti-Infective Agents, Local↗

PubMed2003

Efficacy of chlorhexidine- and calcium hydroxide-containing medicaments against Enterococcus faecalis in vitro.

OBJECTIVE: We sought to assess the efficacy of chlorhexidine (CHX) and calcium hydroxide, Ca(OH)(2), against Enterococcus faecalis in vitro. STUDY DESIGN: The effect of CHX (0.2% and 2% in gel or solution) and Ca(OH)(2) (alone or with 0.2% CHX gel) was evaluated by using the agar diffusion test and an in vitro human root inoculation method, to measure zone of inhibition or bacterial growth with optical density analysis, respectively. For optical density analysis, samples from infected root canals were collected after 7 days of medication and were cultured for 24 hours in brain-heart infusion to detect viable bacteria. RESULTS: In the agar diffusion test, CHX was effective against E faecalis in a concentration-dependent fashion, but Ca(OH)(2) alone had no effect. In the root canal inoculation test, CHX was significantly more effective against E faecalis than Ca(OH)(2) was (P < .05), but there were no significant differences between the modes of medication or concentrations of CHX. CONCLUSIONS: CHX is effective against E faecalis in vitro. Further in vivo studies are needed to confirm the value of CHX in clinical treatment.

Anti-Infective Agents, Local↗

PubMed2004

In vitro evaluation of the antimicrobial activity of chlorhexidine and sodium hypochlorite.

The aim of this study was to investigate in vitro the antimicrobial activity of 0.2%, 1%, and 2% chlorhexidine gluconate (CHX gel and CHX liquid), against endodontic pathogens and compare the results with the ones achieved by 0.5%, 1%, 2.5%, 4%, and 5.25% sodium hypochlorite (NaOCl). A broth dilution test was performed, and the timing for irrigants to kill microbial cells was recorded and statistically analyzed. Both 2.0% gel and liquid formulations eliminated Staphylococcus aureus and Candida albicans in 15 seconds, whereas the gel formulation killed Enterococcus faecalis in 1 minute. All tested irrigants eliminated Porphyromonas endodontalis, Porphyromonas gingivalis, and Prevotella intermedia in 15 seconds. The timing required for 1.0% and 2.0% CHX liquid to eliminate all microorganisms was the same required for 5.25% NaOCl. The antimicrobial action is related to type, concentration, and presentation form of the irrigants as well as the microbial susceptibility.

Anti-Infective Agents, Local↗