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The alexidine mouthrinse used in this study (CP-101) is effective in reducing plaque. There was a reduction in gingivitis after 6-months use but not at a statistically significant level. An extrinsic brown stain occurred at a significant level on the teeth of participants using the active mouthrinse. Blood and urine laboratory results indicated that alexidine can be safely used over a 6-month period.
Thirty patients took part in a 4 week 'double-blind' clinical trial. Following initial oral hygiene instruction and scaling, half the patients were instructed to brush with a 1% Chlorhexidine gel in the evenings, the other half to use placebo. A standard dentifrice was used in the morning. In both groups there was a marked improvement in all parameters recorded, and although final plaque scores showed a statistically significant difference in favor of the test group, there was virtually no difference in rate or degree of resolution of gingivitis. The use of standard dentifrice was only partially successful in preventing staining.
The primary purpose of this study was to determine the amount of tooth staining produced by an alexidine mouthrinse. One hundred and eighty subjects rinsed twice daily for 1 month with either 15 ml of alexidine (0.035%) or a placebo solution. Prior to the study, the subjects were classified according to their smoking, coffee and tea drinking habits and these factors were subsequently considered in the analysis of the stain scores. Additionally, the effects on staining of a prior prophylaxis and the use of a fluoridated toothpaste during the study were determined. Upon termination of the study, subjects utilizing the active mouthrinse manifested a greater degree of staining than placebo users. The amount and intensity of the stain due to alexidine were not influenced (increased) by smoking, tea or coffee drinking habits. A prior prophylaxis did not reduce the staining propensity of alexidine users. The method of scoring developed can be used to assess the degree of tooth staining induced by antiplaque agents.
The phenomenon of surface adsorption appears fundamental to the antiplaque activity of the cationic antiseptics. Moreover, reaction with chromogenic material is relevant to the local side effect of staining. The purpose of this investigation was to determine how such local reactions affect the antibacterial activity of some of these antiseptics. The minimum inhibitory concentration (MIC) of commercial mouthrinses containing alexidine, cetyl pyridinium chloride, chlorhexidine gluconate and hexetidine against Oxford staphylococcus (NCTC 6571) and Escherichia coli (NCTC 10418) was established by tube dilution. The effect on the MIC values against O. staphylococcus of adding polymethylmethacrylate polymer or against E coli of adding a standard tea solution was then measured. The zones of inhibition around acrylic blocks soaked in the respective antiseptics, with and without postexposure washings, were measured. The effects on zone width of placing the antiseptic-soaked blocks in tea were recorded. The MIC values of alexidine, cetyl pyridinium chloride and chlorhexidine gluconate, but not hexetidine, were all increased by adding polymethylmethacrylate to cultures. Tea added to the culture increased the MIC values against E. coli for alexidine, chlorhexidine and hexetidine, but not for cetyl pyridinium chloride. Zones of inhibition around antiseptic-treated blocks were reduced by washing and, in the case of hexetidine, completely abolished. Tea-soaking further reduced the zones of inhibition for alexidine and chlorhexidine, but not cetyl pyridinium chloride.(ABSTRACT TRUNCATED AT 250 WORDS)
The Prophy-Jet was evaluated for its effectiveness in removing plaque and stain from teeth and on its effects on the marginal gingiva. Using a randomized split-mouth design, half the mouth was treated with the Prophy-Jet and the contralateral side with a rubber cup and prophylaxis paste. The results indicated that the Prophy-Jet removes tooth plaque and stain as well as the rubber cup and prophylaxis paste method, and does so in less time. It was also found that there was some immediate soft tissue trauma following both treatment modalities, with a mean Trauma Index score of 0.23 not equal to 0.16 for the rubber cup and prophylaxis paste and 0.75 not equal to 0.37 for the Prophy-Jet. Within 6 days, the trauma index scores were not significantly different. Similar results were found for marginal gingival redness and bleeding on probing. The Prophy-Jet is an excellent alternative instrument for removal of tooth stain and dental plaque.
This clinical trial compared the effect on the gingiva of the Prophy-Jet and the rubber cup and paste techniques of stain and supragingival plaque removal. Twenty-one human subjects with healthy gingiva or slight gingivitis participated. A split mouth design was used. The Prophy-Jet caused a statistically significant increase (P less than 0.05) in gingival irritation immediately posttreatment, but the differences were not deemed clinically significant. There were no statistically significant (P less than 0.05) or clinically significant differences in the effect on the gingiva between the two techniques at 7 and 21 days posttreatment. There was no lasting difference in gingival trauma between the two methods of stain and supragingival plaque removal in subjects with healthy gingiva or slight gingivitis.
Chlorhexidine is an effective antimicrobial agent. Its application can enhance periodontal therapy. The pharmacology of chlorhexidine and suggestions for its use are outlined. In addition, its potential for inducing cancer and bacterial resistance are discussed.
In handicapped groups, the maintenance of oral hygiene can be a major problem, and chemical plaque control offers many advantages. This study compared the effectiveness of chlorhexidine gluconate, delivered as a 0.2% mouthrinse, a 0.2% spray, and a 1% gel in trays, in controlling dental plaque and gingival bleeding in a group of 49 spastic children. All three delivery methods produced an improvement in plaque and gingival bleeding scores. However, the gel was significantly more effective than either the mouthwash or the spray. There was no significant difference between delivery methods in the amount of tooth staining.
As part of a study of chlorhexidine used for plaque control in handicapped children, preferences and difficulties with the three delivery methods were evaluated by questionnaire. The delivery methods were a 0.2% mouthwash, 0.2% spray, and 1% gel in trays. Responses from parents and house parents revealed the least preference for, and most difficulties with, the gel in trays. The spray was the most popular and 96% of the respondents would be prepared to use this indefinitely as a method of oral hygiene. The most effective method was the gel in trays, but results of the questionnaire suggested that the respondents would be unwilling to use it for prolonged periods. The importance of user acceptance and compliance to the long-term success of oral hygiene methods was evident.
An air-powder abrasive system was tested among 20 volunteers, who had healthy gingiva or slight gingivitis, but no periodontal pockets. Impressions of randomly selected areas (n = 103) were taken before and after airpolishing and positive replicas were prepared for scanning electron microscopy (SEM). Gingival bleeding increased statistically significantly (p less than 0.001) during the treatment. Also gingival erosive changes were increased when using airpolishing technique (p less than 0.001). The erosive changes observed by SEM and the subjective symptoms during and after the operation positively correlated to the presence of gingival inflammation (p less than 0.001). It can be concluded that also the negative aspects of the airpolishing technique should be taken into consideration, especially when operating near the gingival margin.
This study compared the clinical efficacy of three mouthrinses containing either 0.12% chlorhexidine, phenolic compounds, or sanguinarine, which were used unsupervised, in a placebo-controlled, double-blind study of 6 months' duration. The study was conducted according to ADA clinical guidelines for evaluation of antigingivitis agents and was completed by 481 adults. Following baseline exams and a prophylaxis, subjects were randomly divided into treatment groups matched for age, gender, and gingivitis severity, and were instructed to use the rinses in accordance with manufacturer's directions. Followup examinations evaluated supragingival plaque, gingivitis, and gingival bleeding. Compared to placebo at 6 months, the group rinsing with 0.12% chlorhexidine had significantly less gingivitis (31% reduction), gingival bleeding (39% reduction), and plaque (49% reduction) and was significantly better than any of the other treatment groups (P less than 0.05). Both the phenolic and sanguinarine groups showed moderate, yet significant, reductions in plaque compared to placebo (24% and 12% respectively) yet were significantly less effective than the 0.12% chlorhexidine rinse (P less than 0.05). However, neither the phenolic nor sanguinarine rinses were significantly different than placebo in their effects on gingivitis or gingival bleeding. These results support previous published results on the superiority of 0.12% chlorhexidine when used in conjunction with professional care and as an adjunct to routine oral hygiene practices.
The aim of this short-term study was to compare the effect of delmopinol HCl 0.2% and chlorhexidine digluconate 0.2% rinses on the development of dental plaque, the healing of experimental gingivitis, and the salivary microbiology. As part of a larger study protocol, 45 healthy males enrolled in an oral hygiene program to upgrade their oral health. For this portion of the study, participants had their teeth professionally cleaned on day 0. The participants then abstained from standard mechanical oral hygiene procedures, but applied a placebo solution twice daily for 2 weeks. At the end of this period the subjects received a second professional cleaning and were then assigned to 2 treatment groups: Group 1 rinsed with 10 ml of delmopinol HCl 0.2% and Group 2 rinsed with 10 ml of chlorhexidine digluconate 0.2% for 1 minute twice daily for the next 2 weeks and continued to refrain from mechanical oral hygiene procedures. At the end of the placebo and active treatment periods 1) saliva samples were taken and cultivated on a series of media; 2) the degree of gingivitis was assessed with gingival crevicular fluid (GCF) and gingivitis index (GI); and 3) the plaque index was assessed and the stainable buccal plaque extension was analyzed planimetrically. No changes in the salivary microbiological counts were detected for the subjects rinsing with delmopinol. Subjects rinsing with chlorhexidine showed significant reductions of anaerobes, aerobes, and S. mutans in saliva. The amounts of GCF and GI were reduced largely to the same extent in both treatment groups. Mean plaque extension was reduced by 52% after delmopinol and 88% after chlorhexidine rinsing.(ABSTRACT TRUNCATED AT 250 WORDS)
BACKGROUND: Reports suggest powered toothbrushing may provide some clinical benefit over manual tooth-brushing, but most studies have been of short duration with subjects trained in toothbrush use. The aim was to determine if the oscillating-rotating powered brush (PB) could safely provide clinical benefits over and above a manual brush (M) in subjects with no formal instruction or experience in powered brush use. METHODS: This 6-month, single-masked, parallel design, randomized clinical trial compared the PB with an American Dental Association (ADA)-accepted soft-bristle manual brush in a non-flossing gingivitis population (n = 157). Subjects were given written instructions but no demonstration on toothbrush use at baseline. Efficacy was assessed by changes in gingival inflammation, plaque, calculus, and stain, while changes in clinical attachment levels and recession measurements provided safety data. A prophylaxis was provided after baseline assessment. The 6-month plaque index (PI) was recorded immediately post-brushing after covert timing of the subjects, and correlation analyses were run to assess the relationship of brushing time to PI. Paired t tests, analysis of variance (ANOVA), and analysis of covariance (ANCOVA) were used to assess within and between treatment group differences for PB (n = 76) versus M groups (n = 81). RESULTS: Measures of inflammation showed a statistically significant drop for both brushes at 3 and 6 months. Mean overnight full-mouth PI scores were significantly lower at 3 months for the PB (1.57) compared to the M group (1.80), P = 0.0013. Immediate post-brushing PI at 6 months was also significantly lower for the PB (1.10) versus M (1.39) (P= 0.0025). There was an overall negative correlation for PI and brushing time (r = -0.377, P= 0.0001). Mean calculus index (CI) scores were lower for the PB at 3 (P= 0.0304) and 6 months (P = 0.0078), while no significant differences in stain were observable. Clinical attachment level and recession measurements showed no significant between-group changes from baseline for either brush on canine teeth or on teeth with recession at baseline. CONCLUSION: The oscillating-rotating toothbrush safely provides clinical benefits in plaque and calculus reduction over a manual brush even in subjects with no formal oral hygiene instruction.
BACKGROUND: A randomized clinical trial was performed to test the efficacy of a fluoridated hydrogen peroxide-based mouthrinse on gingivitis and tooth whitening in a two-phase study. The first phase (28 days) included the experimental gingivitis phase; the second phase (5 months) was the oral hygiene phase, which included rinsing. METHODS: A total of 99 subjects were included in the study and were randomly assigned to receive either placebo or test mouthrinse. Clinical measures were chosen to reflect the gingival health and tooth whiteness in an intent-to-treat study design. Statistical analyses of clinical parameters related to gingival health and tooth color were conducted, using the method of generalized estimating equations (GEE), with an exchangeable working correlation to accommodate tooth-level data. Baseline differences between the groups were adjusted. Microbial samples taken at the beginning and at the end of the study were analyzed by DNA-DNA hybridization technique, to determine whether there was any adverse shift in supragingival flora. RESULTS: Eastman bleeding index, modified gingival index, intensity of stain, and extent of stain were significantly reduced in the test group at 6 months compared to baseline (P < 0.05). In contrast, only the Eastman bleeding index was significantly reduced in the control group (P < 0.05). The reduction in the index of gingival inflammation for the test group was significantly greater than for the control group (P = 0.004). Subjects using the test rinse were also six times more likely to exhibit an improvement in tooth color after 6 months than were subjects using placebo (P = 0.002). As a result of the clinical evaluations and microbial analysis, test mouthrinse was found to be safe during a 6-month period. CONCLUSION: The results of this study indicate that the fluoridated hydrogen peroxide-based mouthrinse effectively whitens teeth and significantly reduces gingivitis.
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OBJECTIVE: To investigate the tooth whitening effects of various concentrations of carbamide peroxide (CP) gels and 6% hydrogen peroxide (HP) whitening strips used on an intrinsic, in vitro stain model in a simulated home-applied bleaching protocol. METHOD: Extracted third molars were sectioned and stained to Vita shade C4 using a standardized tea solution. Stained specimens were then bleached with 10, 15, 20, 22, and 30% CP gels applied in custom-made trays for 8-hour sessions for 14 days. A 6% HP whitening strip product was also tested in a regimen of twice-daily 30-minute treatments for 14 days. Shades were assessed at baseline and at 2, 5, 7, 10, and 14 days of treatment using a shade guide (SG) and a shade vision system (SVS), recorded as shade guide unit (SGU) changes from baseline, and CIE L*a*b* recordings using a chromometer. RESULTS: By day 14, all CP treatments resulted in at least 12 SGU improvements by SG and SVS methods: the HP treatment mean was just less than 12 SGU. With the chromometer, the CP improvements ranged from approximately 19 to 28 units and 16 units for the HP whitening strips. Observationally, by SG and SVS, CP treatments achieved the maximum improvement (12-13 SGU) at different time points: day 5 for 30% CP, day 10 for 22% CP, and day 14 for the other three treatments. SG and SVS data were virtually binary, switching from 0 to scores of 9 or above as bleaching progressed. The differences between the six treatments in the mean day to achieve a positive SG or SVS score (9 or more units) approached significance. For each of the SG, SVS, and L*a*b* scores, the dose-response correlation with CP concentration was significant at one or more assessment times. SG and SVS showed extremely strong agreement in detecting change and substantial agreement with L*a*b*. CONCLUSION: This in vitro study supports the limited data available from the very few available randomized controlled clinical trials indicating that CP and HP home-use bleaching systems can achieve considerable tooth whitening outcomes, albeit at different rates, which appear to be concentration dependent. CLINICAL SIGNIFICANCE: There is a clear significant relationship for both concentration and duration of exposure for CP bleaching agents. The final shade change is independent of the concentration of bleaching agent, with time as the dominant variable. Higher concentrations of CP that have not been investigated previously may be a treatment option for esthetic improvement of shade where time is at a premium, but caution must be exercised in view of the possible increased incidence of sensitivity.
A case of Y-shaped lower bilateral central incisors found in an 18-year-old Japanese man is reported. Each of the central incisors had an abnormally high cusp located at the labial surface. The cause of this malformation of the lower central incisors is obscure, but we suspect that it was due to hyperplasia of the labial surface of the central lobe of the incisor during tooth development.
Bleaching tetracycline-stained teeth is the most challenging form of tooth lightening. This article reports on 44 subjects who bleached their tetracycline-stained teeth for 6 months using trays with reservoirs overnight in a half-mouth designed study and 2 of 3 different concentrations of carbamide peroxide (10%, 15% or 20%). The subjects were followed for 5 years. The area evaluated was the middle third of the teeth. More than 55% of tooth lightening occurred within 1 month; after 5 years, more than 65% of the maximum tooth whitening remained for all 3 gel concentrations. Tooth whitening can be accomplished with any of the 3 concentrations used.