Antimicrobial efficacy of chitosan versus sodium hypochlorite: A systematic review and meta-analysis.

AIM: This meta-analysis aimed to compare the antibacterial efficacy of chitosan/chitosan nanoparticles (Ch/Ch-NPs) versus sodium hypochlorite/chlorhexidine (NaOCl/CHX). MATERIALS AND METHODS: A search was performed in four electronic databases until December 08, 2023. Studies with missing, unclear, and insufficient data sets were excluded. The included studies were assessed by two independent reviewers using the Joanna Briggs Institute Critical Appraisal Checklist for Quasi-Experimental Studies. The meta-analysis of standardized mean difference was performed using a random effects model. Additionally, funnel plots as well as Egger's regression intercept test were used to evaluate potential publication bias. RESULTS: A total of 426 samples were used in nine included studies. There was no difference in antibacterial efficacy between Ch/Ch-NPs-NaOCl (SMD: 0.005; 95% CI: -0.844-0.854; p = 0.990). However, the antibacterial efficacy of NaOCl was statistically more effective than Ch/Ch-NPs (SMD: 0.807; 95% CI: 0.015-1.599; p = 0.046) using the bacterial culture method, and Ch/Ch-NPs was statistically higher than NaOCl (SMD: -1.827; 95% CI: -2.720, -0.934; p < 0.000) using confocal laser scanning microscopy. CONCLUSIONS: Ch/Ch-NPs may be an alternative to NaOCl against Enterococcus faecalis. The methods used in the in vitro studies evaluating the antibacterial efficacy of irrigation solutions against E. faecalis may have had an impact on the results.

Glass ionomer cement particles pre-reacted with chlorhexidine: Physical/chemical properties and antimicrobial activity.

OBJECTIVE: Analyze the effects of the functionalization of pre-functionalized GIC particles with chlorhexidine on the physicochemical properties and antimicrobial activity. MATERIALS AND METHODS: Four groups were prepared: (1) GIC (Bioglass R - Biodinamica) - control group; (2) GIC-CHX 1%: Group containing 1% pre-reacted CHX particles; (3) GIC-CHX 2.5%: Group containing 2.5% pre-reacted CHX particles; (4) GIC-CHX 5%: Group containing 5% pre-reacted CHX particles. Hourglass-shaped specimens (10 mm × 2 mm x 1 mm) were fabricated for mechanical tests including cohesive strength (n = 12), modulus of elasticity (n = 12) and microhardness (n = 10). Discs (10 mm × 2 mm) were prepared for the analysis of Ca+2, PO4- and F- ions release (n = 3), and roughness (n = 12). To evaluate the setting time, a Gilmore needle was used according to ISO 9917-1:2016. Disk-shaped specimens (5 × 1mm) were manufactured and subjected to bacterial activity (n = 9) (Streptococcus mutans ATCC 159). RESULTS: Modulus, roughness, setting time and ions release (Ca+2, PO4-, and F-) there were no statistically significant differences among the groups (p > 0.05). The setting time did not change with the incorporation of CHX. The GIC-CHX 2.5% and GIC-CHX 5% groups exhibited superior antibacterial activity compared to the control group and GIC-CHX 1% (p < 0.001). The GIC-CHX 5% group showed the highest microhardness values (p < 0.041), cohesive strength (p < 0.009) when compared to the control group. CONCLUSION: The pre-reacted CHX in GICs was able to confer antimicrobial activity, improve cohesive strength, microhardness, and did not impair ion release, setting time, and roughness.

Investigation of the Mechanical Properties of Thermoplastic Materials Influenced by Different Chemicals.

Objective: The quality of orthodontic forces in aligners is mainly influenced by their mechanical properties. At present, there is insufficient information on how environmental factors affect the mechanical function of aligners, and studies have shown that patients do not pay enough attention to removing aligners while eating and drinking. Therefore, in this study, we investigated the effect of different chemicals on the mechanical properties of thermoplastic materials. Methods: In this study, 175 thermoplastic samples from Easy-Vac gasket (3A Medes, Korea) were prepared, and their chemical composition, tensile strength, and hardness before and after exposure to solutions of orange juice, Cola, chlorhexidine mouthwash, and distilled water were measured. One-Way analysis of variance (ANOVA), Tamhane's test, and Tukey's test were used for statistical analysis. Results: The tensile strength of the sheets increased with continuous exposure to orange juice and chlorhexidine mouthwash, and their hardness decreased with continuous exposure to carbonated beverages. There was no change in the chemical composition of the samples after exposure to different chemicals. Conclusion: Although these changes are statistically significant, they do not have a significant effect on the result of aligner performance. Therefore, the only concern is the cariogenicity of orange juice and Cola during treatment with aligners and the administration of chlorhexidine mouthwash.

Cutaneous hypersensitivity to chlorhexidine following facial fat grafting: a delayed intradermal response.

Chlorhexidine (CHD) is commonly included in surgical antiseptics and can be associated with adverse reactions ranging from contact dermatitis to anaphylaxis. A 32-year-old female presented to the OR for facial fat grafting. Surgical sites were prepped with CHD gluconate or topical iodine. Donor and recipient sites were infiltrated with local anesthetic injection prior to fat harvest and facial injection. Eleven days later, she presented with new painful, pruritic rash over donor sites where CHD had been applied prior to local anesthetic infiltration. Treatment with topical clobetasol and prednisone taper resulted in complete symptom resolution. This patient's response most likely represented a delayed type IV, T-cell mediated hypersensitivity. CHD is a known trigger of allergic reactions. Infiltration of local anesthetic may introduce skin prep into the subcutaneous tissue akin to intradermal testing. For those with delayed cutaneous reactions, steroids may provide symptomatic relief.

Antibiotic dip and irrigation solutions confer increased antimicrobial efficacy of inflatable penile prosthesis hydrophilic surfaces compared with 0.05% chlorhexidine gluconate.

BACKGROUND: Chlorhexidine gluconate (CHG) (0.05%) has recently been suggested as both a dip for the hydrophilic surface and an irrigation solution in the setting of penile prosthesis (PP) surgery. AIM: The study sought to compare the antimicrobial efficacy of 0.05% CHG with vancomycin and gentamicin (VG) antibiotics as dip and/or irrigation solutions in the setting of a hydrophilic PP surface in vitro. METHODS: Sterile PPs with a hydrophilic coating were obtained. A series of experiments were performed to evaluate the efficacy of normal saline (NS), 0.05% CHG, or VG as dip and/or irrigation solutions to reduce methicillin-sensitive Staphylococcus aureus adhesion to PP surfaces. The 8-mm discs from PPs were incubated in 105 colony-forming units/mL of methicillin-sensitive S aureus for 48 hours, plated, and counted. Disc-diffusion tests were conducted by suspending 6-mm discs for 2 minutes in NS, 0.05% CHG, or VG, then placing them coated side down onto plates streaked with the following organisms: methicillin-sensitive S aureus, S epidermidis, Enterococcus, and Escherichia coli. After 24 hours of growth, zones of inhibition were measured. OUTCOMES: We found average bacterial counts (colony-forming units/mL) and zones of inhibition (mm) following a series of treatment protocols of PP discs. RESULTS: PP discs dipped in VG reduced bacterial adhesion to the implant surface >0.05% CHG (~5.5 log vs ~1.5 log; P < .01). Discs irrigated with either 0.05% CHG or NS removed all dip solution adsorbed to the hydrophilic surface, allowing bacterial growth. VG irrigation adsorbed to the hydrophilic surface even after 0.05% CHG or NS dips, reducing bacterial adherence (~3 log). Dipping and irrigating discs with VG was most effective in reducing adherent bacteria (~5.5 log) and was the only irrigation that showed antimicrobial activity. CLINICAL TRANSLATION: VG, when used both as a prophylactic dip and as an intraoperative irrigation solution for hydrophilic penile implant surfaces, has improved efficacy to 0.05% CHG and NS. STRENGTHS AND LIMITATIONS: This is the first study to compare the use of VG, 0.05% CHG, and NS as prophylactic dips and intraoperative irrigations for hydrophilic penile implant surfaces. Limitations include the use of in vitro studies, which serve as a proxy for in vivo practices and may not be entirely accurate nor translatable clinically. CONCLUSION: We demonstrated the superior efficacy of VG as a combined dip and irrigation solution for hydrophilic penile implant surfaces compared with 0.05% CHG.

Evaluation of postoperative pain in endodontic retreatment with apical periodontitis using ozonated 2% chlorhexidine and 0.1% octenidine application: A randomized clinical trial.

Introduction: This study aimed to evaluate and compare postoperative pain (PP) in single-visit nonsurgical endodontic retreatment (SV NSER) with 2% chlorhexidine (CHX), 0.1% octenidine (OCT) with or without ozone, and 5.25% sodium hypochlorite (NaOCl). Materials and Methods: In this randomized, parallel, prospective, double-blind, clinical trial, 132 single-rooted, root-filled teeth with symptomatic apical periodontitis (AP) requiring NSER were allocated into six groups randomly (n = 22/group): 2% CHX with NaOCl (CHXH), 2% Ozonated CHX without NaOCl (OCHX), 2% Ozonated CHX with NaOCl (OCHXH), 0.1% OCT with NaOCl (OCTH), 0.1% Ozonated OCT without NaOCl (OOCT), and 0.1% Ozonated OCT with NaOCl (OOCTH). Standard NSER protocol was followed groups were irrigated with 15 ml of ozonated or nonozonated irrigant (CHX/OCT) for 3-5 min with ultrasonic agitation. PP at baseline, after 6, 12, 24, 48 h, and 7 days was recorded using the Visual Analog Scale (VAS). Logistic regression of predictor variables was compared using the Chi-square test. For group-wise and time-wise comparisons, a two-way analysis of variance followed by the post hoc Bonferroni test was carried out. Results: None of the patient-related variables in logistic regression obtained a statistically significant (P > 0.05) role in PP. The VAS score after 6 h was OCHX (4.72) > OOCT (4.42) > CHXH (4.23) > OCTH (3.95) > OCHXH (3.42) > OOCTH (3.21). OOCTH and OCHXH groups demonstrated statistically significant reductions in VAS scores at various time intervals (P < 0.05). Conclusion: SV NSER with ozonated OCT, CHX irrigation, and NaOCl resulted in lesser PP at all time intervals, i.e., 6, 12, 24, 48 h, and 7 days in patients with symptomatic AP.

Staphylococcus aureus screening and preoperative decolonisation with Mupirocin and Chlorhexidine to reduce the risk of surgical site infections in orthopaedic surgery: a pre-post study.

BACKGROUND: Nasal carriage of Staphylococcus aureus is a risk factor for surgical site infections (SSI) in orthopaedic surgery. The efficacy of decolonisation for S. aureus on reducing the risk of SSI is uncertain in this speciality. The objective was to evaluate the impact of a nasal screening strategy of S. aureus and targeted decolonisation on the risk of S. aureus SSI. METHODS: A retrospective pre-post and here-elsewhere study was conducted between January 2014 and June 2020 in 2 adult orthopaedic surgical sites (North and South) of a French university hospital. Decolonisation with Mupirocin and Chlorhexidine was conducted in S. aureus carriers starting February 2017 in the South site (intervention group). Scheduled surgical procedures for hip, knee arthroplasties, and osteosyntheses were included and monitored for one year. The rates of S. aureus SSI in the intervention group were compared to a historical control group (South site) and a North control group. The risk factors for S. aureus SSI were analysed by logistic regression. RESULTS: A total of 5,348 surgical procedures was included, 100 SSI of which 30 monomicrobial S. aureus SSI were identified. The preoperative screening result was available for 60% (1,382/2,305) of the intervention group patients. Among these screenings, 25.3% (349/1,382) were positive for S. aureus and the efficacy of the decolonisation was 91.6% (98/107). The rate of S. aureus SSI in the intervention group (0.3%, 7/2,305) was not significantly different from the historical control group (0.5%, 9/1926) but differed significantly from the North control group (1.3%, 14/1,117). After adjustment, the risk factors of S. aureus SSI occurrence were the body mass index (ORaper unit, 1.05; 95%CI, 1.0-1.1), the Charlson comorbidity index (ORaper point, 1.34; 95%CI, 1.0-1.8) and operative time (ORaper minute, 1.01; 95%CI, 1.00-1.02). Having benefited from S. aureus screening/decolonisation was a protective factor (ORa, 0.24; 95%CI, 0.08-0.73). CONCLUSIONS: Despite the low number of SSI, nasal screening and targeted decolonisation of S. aureus were associated with a reduction in S. aureus SSI.

Chlorhexidine gluconate for antisepsis in preterm neonates: A review of safety and efficacy.

Sepsis is a leading cause of death in preterm neonates. The increased susceptibility to sepsis is due to prolonged hospitalization, the need for invasive procedures, and immaturity of innate and adaptive immunity. Chlorhexidine gluconate is a popular topical disinfectant that was not recommended for use in preterm neonates until 2012. Thus, there are few studies assessing the role of chlorhexidine gluconate in antisepsis for preterm neonates. A better understanding of the safety and efficacy of chlorhexidine gluconate as an antiseptic agent for preterm neonates is the first step in establishing best practice guidelines for this population.

Low-cost antiseptic-impregnated tracheostomy tube for the prevention of ventilator-associated pneumonia caused by multidrug-resistant bacteria: In vitro and pilot study in humans.

Ventilator-associated pneumonia (VAP) is one of the most common causes of nosocomial infections. The aim of this study was to evaluate the antimicrobial and anti-biofilm activity of an in-house low-cost tracheostomy tube impregnated with chlorhexidine and violet crystal. The impregnated tracheostomy tubes demonstrated antimicrobial activity, including for multidrug-resistant bacteria. Fourteen patients were evaluated. During ventilation, VAP occurred in one patient in the coated group and in three patients in the control group (p=0.28). A reduction of biofilm cells was observed. This study provides preliminary evidence to support that the antiseptic impregnation of a tracheostomy tube provides significant antimicrobial activity.

Effect of Preventive Dental Products on Bonding Force: An in vitro Study.

Aim: Testing the effect of Fluoride, chlorhexidine, and molecular iodine applications on the mean micro-shear bond strength (SBS) of enamel in an attempt to preserve enamel integrity during the bonding process. Materials and Methods: The study was an observational case-control one in which 150 human teeth were classified into 10 groups according to the product kind and the prescribed treatment. Each group consisted of 15 teeth. Group C was the control group. Groups FP, FV, and OS utilized products that could be utilized in a professional dental setting. Group FP was treated with 1.23% NaF prophy paste, Group FV was treated with 5% NaF varnish, and Group OS was treated with Opal® Seal Fluoride releasing primer and sealant. Groups L, LF, CHX, and I were treated with mouth rinses. Group L was treated with Listerine Zero Fluoride-Free Mouthwash, Group LF with Listerine Zero 0.02% NaF Mouth Rinse, Group CHX with 0.12% chlorhexidine gluconate, and Group I with ioRinse RTU 100 ppm molecular iodine rinse. Groups TP and G utilized alternative remineralization products. Group TP was treated with Fluoro Calcium Phosphosilicate bioglass containing toothpaste, and Group G was treated with Curodont Protect remineralizing tooth gel. One-way ANOVA test was utilized to perform all statistical analysis in this study. Results: For mean micro-SBS, no significant difference (P > 0.05) between any of the experimental groups was observed when compared to the control group. There was a significant difference (P < 0.05) between Opal Seal versus Listerine Total, Opal Seal versus Peridex, Listerine versus Listerine Total, and Listerine versus Peridex. All other experimental group comparisons revealed a nonsignificant difference (P > 0.05). Conclusions: As the null hypothesis (H0) assumes that changes observed in an experiment are due to chance, hence, the outcomes of this study are coherent with (H0) since the aforementioned application methods did not significantly impact the SBS of orthodontic resin cement to enamel.

Antifungal Activity of Morinda citrifolia Methanolic Extract against Candida albicans: An In Vitro Study.

Aim: Natural medicine used as an alternative and/or complementary treatment to counteract diseases is of great importance in public health. Therefore, the purpose of the present study was to assess the in vitro antifungal activity of Morinda citrifolia methanolic extract of peel, pulp, and seed against Candida albicans. Materials and Methods: The present study was experimental in vitro and cross-sectional. Eight replicates were prepared in Sabouraud dextrose agar with five wells each, where 0.12% chlorhexidine, distilled water, and methanolic extract of seed, peel, and pulp of Morinda citrifolia fruit were placed at concentrations of 10,690, 8,270, and 6,430 mg/mL, respectively, to evaluate sensitivity according to Duraffourd's scale. In addition, the minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) were determined by dilution and agar seeding method. Statistical analysis was performed by analysis of variance (ANOVA) and Tukey's post hoc test, considering a significance level of P < 0.05. Results: The inhibition halos of Morinda citrifolia methanolic extract of seed, peel, and pulp against Candida albicans measured on average 15.94, 11.94, and 11.56 mm, respectively. The MIC of seed, peel, and pulp extract were 1366.25, 2067.5, and 1607.5 mg/mL respectively, whereas the MFC for seed, peel, and pulp extract were 2672.50, 2067.5, and 3215 mg/mL, respectively. Moreover, seed extract presented significantly higher antifungal activity than peel and pulp (P < 0.001). Conclusions: Morinda citrifolia methanolic extract of peel, pulp, and seed showed fungistatic and fungicidal effect against Candida albicans, being this very sensitive to seed extract with a MIC of 1366.25 mg/mL and a MFC of 2672.5 mg/mL, which allows recommending the development of effective pharmacological formulations for the control of candidiasis.

In Vitro Study of Tensile Strength Comparison of Selected Nonabsorbable and Absorbable Suture Materials after Immersion in 0.12% Chlorhexidine Gluconate.

Aim: To compare the tensile strength (TS) of absorbable and nonabsorbable suture materials after immersion in 0.12% chlorhexidine gluconate. Materials and Methods: Six 4-0-gauge suture materials were used, namely silk (S), polypropylene (PP), polyamide 6 (PA6), polyglactin 910 (PG910), poliglecaprone 25 (PL25), and polydioxanone (PDX). A total of 540 suture materials were divided equally (90) into six groups and tested. These materials were divided into a nonimmersed condition (10) and two thermostatically controlled immersion media (40 each), using artificial saliva for the control group (CG) and 0.12% chlorhexidine gluconate for the test group (TG). The specimens were tied to prefabricated rubber rods before immersion and removed at the testing timepoint. By using a universal testing machine (Instron 5566) with hooks attached, a hook-mounted specimen TS testing was performed on days 0, 1, 3, 7, and 14 at a 10 mm/min crosshead speed until the material was stretched to failure, and the maximum TS was recorded in Newtons (N). The continuous variables were taken as the mean and standard deviation across the six study groups to assess the significance at α = 0.05. A two-factor analysis of variance (ANOVA) was performed to assess the TSs over time in different media. A Bonferroni correction was performed when the data were statistically significant according to a two-factor ANOVA. Intragroup statistical comparisons were performed by repeated ANOVA for each study group. All data were analyzed using SPSS 26. Results: The suture material TS analysis showed that nonabsorbable suture materials maintained their TS throughout the study; silk exhibited different behaviors, decreasing in TS from baseline to day 1 and maintaining its TS until day 14. All absorbable suture materials decreased in TSs by day 14. The silk and PG910 samples in the TG performed significantly better than those in the CG. Conclusions: Prescribing 0.12% chlorhexidine gluconate as a postsurgical mouth rinse is safest when silk and PG910 are the optimal suture materials.

Clinical and microbial evaluation of mouthwash containing Achyranthes aspera and Trachyspermum ammi: A randomized controlled non-inferiority trial.

Objectives: Achyranthes aspera (Apamarga) and Trachyspermum ammi (Ajwain) have been used in many clinical conditions, and it displays valuable properties as an alternative to Chlorhexidine (CHX) in the management of gingivitis. Therefore, this study aims to assess the effect of Achyranthes aspera and Trachyspermum ammi (AA + TA) based herbal mouthwash, 0.2 % CHX, and placebo mouthwash on gingival health, plaque control and antibacterial activity against specific periodontal pathogens (Porphyromonas gingivalis and Tannerella forsythia) using quantitative real-time PCR (RT-PCR). Methods: This was a randomized controlled non-inferiority trial involving 108 children with plaque-induced gingivitis who were randomly assigned to three groups of 36 children each: Group A, AA + TA mouthwash; Group B, CHX mouthwash; and Group C, placebo mouthwash. Gingival index and plaque index were recorded at baseline, 7th and 21st day. RT-PCR was employed to determine the bacterial counts of each plaque sample at baseline and after 21 days. Results: All three groups exhibited a gradual and significant reduction in both gingival and plaque scores from baseline to days 7 and 21. However, the placebo group did not demonstrate a significant difference in scores between days 7 and 21. Furthermore, a significant reduction in bacterial counts of P. gingivalis and T. forsythia was observed in the groups receiving CHX and AA + TA mouthwash after 21 days of intervention compared to the placebo group. Conclusion: AA + TA mouthwash demonstrated non-inferiority in anti-gingivitis and anti-plaque properties compared to CHX, suggesting its potential suitability as an alternative to CHX when used in conjunction with mechanical plaque control measures.

Insights into the Cytotoxicity and Irritant Potential of Chlorhexidine Digluconate: An In Vitro and In Ovo Safety Screening.

Chlorhexidine (CHX) represents one of the most commonly used antiseptics in dentistry and other medical-pharmaceutical fields due to its broad-spectrum antimicrobial activity. However, the potential toxic events arising from its common use in practice has become a subject of increasing concern. Thus, the present study was designed to investigate the potential toxicity of CHX digluconate at concentrations covering its antibacterial properties (0.0002-0.2%) in HGF primary gingival fibroblasts, HaCaT immortalized human keratinocytes, and JB6 Cl 41-5a epidermal cells, as well as its irritant action in ovo. Our results indicate that CHX exerted a concentration- and time-dependent cytotoxicity in all cell lines, which was evidenced by the reduction in cell viability, number, and confluence, damaged cell membrane integrity, impaired cell morphology, and specific apoptotic nuclear shape. The highest cytotoxicity was caused by CHX digluconate 0.02% and 0.2%, concentrations, at which an irritant effect on the chorioallantoic membrane was also observed. The novel findings revealed in this research contribute to the overall safety profile of CHX and stand as a basis for further investigations in this regard.

Effect of Using Mouthwash Containing Cibotium barometz J. Smith on Cariogenic Bacteria and Acid-producing Ability of Saliva: A Randomised Blinded Clinical Trial.

PURPOSE: To examine the anti-caries effect of mouthwashes containing Cibotium barometz J. Smith (CB), a natural substance, and compare it with chlorhexidine and saline solution. MATERIALS AND METHODS: A randomised, blinded clinical trial was conducted on 76 study participants. The differences between the 3 gargle groups (saline gargle: SAL; chlorhexidine gargle: CHX; CB gargle group: CB) and the differences over time (baseline, after 1 week, after 2 weeks) were compared. To this end, ANOVA was performed on caries-related clinical indicators (e.g. O'Leary plaque index, caries activity, and satisfaction). RESULTS: The O'Leary index, caries activity, and saliva tests, gradually improved in group CB at one and two weeks. In the case of bacterial tests, unlike SAL and CHX, only in group CB did the decrease occur one and two weeks later. The caries-related indicators decreased significantly over time in group CB compared to SAL and CHX groups, and there was also a statistically significant difference in interaction between groups and time (p<0.05). CONCLUSIONS: The mouthwash containing CB extract showed statistically significant improvement in biofilm adhesion as well as the saliva and bacterial tests compared to SAL and CHX. However, since there were differences in the initial oral conditions of the three groups, additional long-term research is needed through crossover clinical trials to supplement these.

Antibacterial, Antibiofilm, and Tooth Color Preservation Capacity of Magnesium Oxide Nanoparticles Varnish (in vitro Study).

Purpose: Antibacterial and antibiofilm properties of magnesium oxide nanoparticles (MgONPs) mixture assessed against Streptococcus mutans (S. mutans), in addition to examining MgONPs varnish impact on the preservation of the tooth color and inhibition of methylene blue diffusion to the enamel. Methods: MgONPs mixture was prepared in deionized water (DW), absolute ethanol (E), and rosin with ethanol (RE), named varnish. The antibacterial and antibiofilm capacities of MgONPs mixtures were tested by agar well diffusion, colony-forming unit (CFU), and biofilm inhibition microtiter methods in triplicate and compared to sodium fluoride varnish (NaF) and chlorhexidine mouthwash (ChX). A spectrophotometer was used to record basic tooth color. The artificial demineralization was initiated for 96 h. Then, experimental materials were applied to the corresponding group, and 10-day pH cycles proceeded. Then, the color was recorded in the same ambient environment. The methylene blue diffusion was evaluated by staining the samples for 24 h. After that, the diffusion test was calculated by a digital camera attached to the stereomicroscope. Results: The agar well diffusion test expressed a significant inhibition zone with all MgONPs mixtures (p = 0.000), and maximum inhibition zone diameter associated with MgONPs-RE. The same finding was observed in the CFU test. Additionally, 2.5%, 5%, and 10% MgONPs-RE varnish showed strong biofilm inhibition capacity (p = 0.039) compared to NaF and ChX groups that inhibit biofilm formation moderately (p = 0.003). The study shows that the 5% MgONPs-RE varnish maintains basic tooth color with minimal methylene blue diffusion compared to NaF varnish (p = 0.00). Conclusion: Evaluating MgONPs as a mixture revealed antibacterial and antibiofilm capacity against S. mutans with a higher effect of MgONPs-RE varnish. Also, examining the topical effect of MgONPs-RE varnish on the preservation of the tooth color after pH cycle challenges and methylene blue diffusion to enamel confirmed the high performance of MgONPs-RE varnish at 5%.

In vitro comparison of zinc-based, chlorhexidine, and essential oil mouth rinses.

BACKGROUND: Chlorhexidine (CHX)-based mouth rinses are frequently prescribed following periodontal surgeries. A more recently available brand of zinc-based mouth rinses advertises one of its mouth rinses as a substitute for chlorhexidine. The purpose of this study was to evaluate, in vitro, the effects of this brand of zinc-based mouth rinses on cell survival, cell motility, and gene expression of human gingival fibroblasts (HGFs). METHODS: HGFs were exposed to essential oil (EO), CHX, and three types of one brand of zinc-based mouth rinses designed to treat breath malodor (ZnA), dry mouth (ZnB), and gingivitis (ZnC). Each mouth rinse was tested over a range of concentrations for its effects on HGF survival and motility. Gene expression of cytokines, interleukins, and growth factors were evaluated via reverse transcriptase-polymerase chain reaction (RT-PCR), as a means to assess potential influences on inflammation and wound healing. RESULTS: Cell survival was significantly decreased for CHX and ZnC at 10% dilutions (p < 0.05). For all time points, cells exposed to ZnC displayed the greatest reduction in cell motility (p < 0.05). The various mouth rinses examined differentially altered the expression of growth factor transcripts. ZnC particularly enhanced the expression of BMP-2 and FGF-2. CONCLUSION: ZnC was more cytotoxic and inhibited cell motility to a greater extent than any of the other mouth rinses. Therefore, using ZnC as an alternative to CHX could potentially have negative effects on wound healing after periodontal surgery. However, further investigation is required to confirm the clinical relevance of these in vitro findings. PLAIN LANGUAGE SUMMARY: One type of zinc-based mouth rinse designed to replace chlorhexidine (often prescribed after oral surgeries) demonstrated the greatest oral cell death and reduction in cell movement when compared to other zinc-based mouth rinses. These zinc-based mouth rinses also reduced the amounts of proteins involved in regulating inflammation, potentially reducing the destruction of bone holding the teeth in place. They also changed the amounts of several molecules involved in tissue healing. It is unknown if this will speed or slow the healing of the soft tissues of the mouth.

Colloidal chitosan-silver nanoparticles-fluoride nanocomposite as an antibacterial mouthwash against salivary Streptococcus mutans in orthodontic patients (a randomized clinical trial).

OBJECTIVES: This study aimed to synthesize and characterize colloidal chitosan-silver nanoparticles-fluoride nanocomposite (CCAgNPF) and evaluate its efficacy compared to chlorhexidine on salivary Streptococcus mutans in orthodontic patients. MATERIALS AND METHODS: AgNPs stabilized with chitosan were synthesized by chemical reduction of AgNO3. The nanoparticles were characterized with SEM, FTIR, DLS and ICP-OES. The MIC and MBC against S. mutans and IC50 concentration of CCAgNPF were obtained for antibacterial and cytotoxicity evaluations, respectively. For the clinical study, a total of 45 orthodontic patients were divided into three groups of 15 and used the following mouthwashes twice a day for 1 month: CCAgNPF, chlorhexidine 0.2% and the combination of these mouthwashes. The colony count of salivary S. mutans was evaluated before and after using the mouthwashes. The data were analyzed using One-way ANOVA and Tukey's test. RESULTS: Stabilized AgNPs were spherical with a diameter of 25.3 ± 3.3 nm. The MIC, MBC and IC50 of CCAgNPF were 4.42, 8.85 and 18.89 µg/ml. All mouthwashes reduced the salivary S. mutans of the orthodontic patients, however, no significant difference was found between the efficacy of CCAgNPF and chlorhexidine (P-value > 0.05). The best results were achieved by the combination of CCAgNPF and chlorhexidine mouthwashes (P-value < 0.05). CONCLUSION: The CCAgNPF and its combination with chlorhexidine present potent bactericidal, biocompatible and effective anti-carious mouthwashes for orthodontic patients. CLINICAL RELEVANCE: This study proved CCAgNPF as an antibacterial mouthwash with lower cytotoxicity and side effects for patients undergoing orthodontic treatments to maintain oral hygiene and reduce salivary S. mutans.

Impact of various solutions on the oral health status of critically ill patients.

Oral care is a crucial challenge of nursing care in orally intubated patients. Oropharyngeal colonization with microorganisms is probably the first step in the pathogenesis of most bacterial pulmonary infections. This study aimed to investigate the effect of different oral care solutions on the oral health status of critically ill patients. We conducted a quasi-experimental study involving a convenience sample of 60 adult orally intubated patients, distributed equally into three groups: 20 patients received 0.12% chlorhexidine gluconate (CHX) solution as an oral rinse; 20 patients received 0.1% hexetidine (HEX) solution as an oral rinse; and a control group of 20 patients received routine hospital oral care with 0.9% normal saline (NS) solution. Oropharyngeal and tracheal cultures were obtained from patients within 24-48 h of admission, before the administration of topical oral antimicrobial solutions and then repeated on day 4 and day 7 after the oral solutions. The study revealed that CHX has a more powerful effect than HEX and NS in improving the oral mucosa and decreasing colonization of both the oropharynx and trachea. On day 7, the improvements were statistically significant in the CHX group and the HEX group (P = 0.02 and P = 0.03, respectively), but not in the NS group. This research confirms the effect of CHX and HEX in lowering the risk of tracheal and oropharyngeal colonization, and recommends the use of a CHX solution as oral mouth care in critically ill patients.

The effects of chlorhexidine, povidone-iodine and vancomycin on growth and biofilms of pathogens that cause prosthetic joint infections: an in-vitro model.

BACKGROUND: Chlorhexidine gluconate (CHG) and povidone-iodine (PI) are commonly used to prevent prosthetic joint infection (PJI) during total joint replacement; however, their effective concentrations and impact on biofilms are not well defined. AIM: To determine: (1) the in-vitro minimum inhibitory concentration of CHG and PI against model PJI-causing organisms and clinical isolates; (2) their impact on biofilm formation; (3) whether there is a synergistic benefit to combining the two solutions; and (4) whether adding the antibiotic vancomycin impacts antiseptic activity. METHODS: We measured in-vitro growth and biofilm formation of Staphylococcus epidermidis, meticillin-sensitive and meticillin-resistant Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa and Candida albicans, as well as recent clinical isolates, in the presence of increasing concentrations of CHG and/or PI. Checkerboard assays were used to measure potential synergy of the solutions together and with vancomycin. FINDINGS: CHG and PI inhibited growth and biofilm formation of all model organisms tested at concentrations of 0.0004% and 0.33% or lower, respectively; highly dilute concentrations paradoxically increased biofilm formation. The solutions did not synergize with one another and acted independently of vancomycin. CONCLUSION: CHG and PI are effective at lower concentrations than typically used, establishing baselines to support further clinical trials aimed at optimizing wound disinfection. There is no synergistic advantage to using both in combination. Vancomycin is effective at inhibiting the growth of S. epidermidis and S. aureus; however, it stimulates P. aeruginosa biofilm production, suggesting in the rare case of P. aeruginosa PJI, it could exacerbate infection.