Salivary arginase activity after mechanical-chemical therapy / Atividade de arginase salivar após tratamento mecânico-químico

Introduction: Salivary components can be used as biomarkers for diagnosing and monitoring oral diseases. There is evidence that one potential biomarker, arginase, is associated with the inflammatory processes of periodontal disease, and its enzymatic activity is reduced according to the improvement in the clinical parameters after treatment. Objective: The present study aimed to evaluate the salivary arginase activity in gingivitis and periodontitis patients treated with full-mouth mechanical procedures combined with the adjunctive use of essential oils or chlorhexidine mouthwash, respectively. Material and method: Twenty-six gingivitis and 16 periodontitis patients received complete periodontal examinations at the baseline and 3 months after therapy, in which the periodontal probing depth, clinical attachment loss, plaque index, and gingival index measurements were taken. At these same appointments, the salivary total protein level and salivary arginase activity were also established via spectrophotometry. Result: There were improvements in all of the clinical parameters (p < 0.05) evaluated from the baseline to 3 months in both groups. In addition, the salivary arginase activity and total protein levels were reduced after the gingivitis treatment. Conclusion: Similar to the clinical results, both therapeutic protocols positively affected the salivary arginase activity; however, further studies are necessary to clarify its potential as a salivary biomarker for periodontal monitoring.

Introdução: Componentes salivares podem ser usados como biomarcadores para diagnóstico e monitoramento de doenças orais. Há evidências de que um potencial biomarcador, arginase, está associado com os processos inflamatórios da doença periodontal, e após o tratamento sua atividade enzimática é reduzida em concordância com a melhora nos parâmetros clínicos. Objetivo: O presente estudo objetivou avaliar a atividade da arginase salivar em pacientes com gengivite e periodontite tratados com procedimentos mecânicos em estágio único combinados ao uso coadjuvante de enxaguatórios com óleos essenciais ou clorexidina, respectivamente. Material e método: Vinte e seis pacientes com gengivite e 16 pacientes com periodontite receberam exame periodontal completo antes e 3 meses após a terapia, em que mensurações de profundidade de sondagem, perda de inserção clínica, índice de placa e índice gengival foram realizadas. Nestas mesmas consultas os níveis de proteína total e a atividade de arginase salivar foram estabelecidos via espectrofotometria. Resultado: Todos os parâmetros clínicos melhoraram, em ambos os grupos, do exame inicial para o de 3 meses (p < 0,05). Adicionalmente, após tratamento para gengivite houve redução da atividade de arginase salivar e do nível de proteína total. Conclusão: Semelhante aos resultados clínicos, ambos os protocolos terapêuticos afetaram positivamente a atividade da arginase salivar; entretanto, estudos futuros são necessários para clarificar seu potencial como biomarcador salivar para o monitoramento periodontal.

The effects of essential oil mouthrinses with or without alcohol on plaque and gingivitis: a randomized controlled clinical study.

BACKGROUND: The efficacy of several variants of essential oil mouthrinses has been studied extensively. This is the first study to compare the anti-plaque and anti-gingivitis efficacy of two marketed essential oil mouthrinses: one is an alcohol containing mouthrinse and the other one is an alcohol-free mouthrinse. METHODS: This examiner-blind, parallel-group study randomized subjects to three groups: 1) Mechanical Oral Hygiene (MOH) only; 2) MOH plus Alcohol-Containing essential oil Mouthrinse (ACM); 3) MOH plus Alcohol-Free essential oil Mouthrinse (AFM). Primary endpoint was whole-mouth mean Modified Gingival Index (MGI) at six months. Secondary endpoints included whole-mouth mean MGI at one and three months, and whole-mouth mean Plaque Index (PI) and whole-mouth mean Bleeding Index (BI) at one, three and six months. Safety assessments were conducted at all time points. RESULTS: A total of 370 subjects were enrolled; 348 subjects completed the study. After six months, subjects using essential oil mouthrinses with or without alcohol showed significant reduction (p < 0.001) in gingivitis (28.2% and 26.7%, respectively) and significant reduction (p < 0.001) in plaque (37.8% and 37.0%, respectively), compared to those performing MOH only. Significant reductions in MGI, PI, and BI (p < 0.001) were observed at one and three months and also at six months for mean BI. No statistically significant differences were observed for all measured indices between ACM and AFM groups at any time point. Both mouthrinses were well tolerated. CONCLUSIONS: No significant differences were observed in the efficacy of ACM and AFM to reduce plaque and gingivitis, when used in addition to MOH, over six months. TRIAL REGISTRATION: The trial was registered on clinicaltrials.gov on November 30, 2016. The registration number is NCT02980497 .

Gingival health benefits of essential-oil and cetylpyridinium chloride mouthrinses: a 6-month randomized clinical study.

PURPOSE: This randomized, single center, examiner-blind, controlled, parallel-group, 6-month clinical study compared the antiplaque/antigingivitis potential of an essential oil (EO) versus a 0.07% cetylpyridinium chloride (CPC)-containing mouthrinse. A 5% hydroalcohol solution was included as a control group. METHODS: 354 healthy volunteers (18-71 years of age) were enrolled in this clinical trial; 338 subjects completed the study. At baseline, 1-, 3-, and 6-month visits, subjects received an oral examination, gingivitis (MGI), gingival bleeding (BI) and plaque assessments (PI). Following randomization, subjects received a prophylaxis and began brushing twice daily with the provided fluoride toothpaste and rinsing twice daily with 20 mL of the assigned mouthrinse for 30 seconds. RESULTS: All rinses were well tolerated by the subjects, with the exception of extrinsic tooth stain complaints in 13 subjects in the CPC group between the 3- and 6-month exams. Statistically significant reductions in gingivitis, bleeding and plaque were observed for both EO and CPC at all post-baseline time-points when compared to the negative control. At 6 months MGI and PI were reduced by 42.6% and 42.0% for EO and by 17.1% and 13.9% respectively, for CPC vs. control. When compared to CPC, EO was statistically significantly superior at all post-baseline time-points. EO showed increasing reductions in MGI of 10.5%, 20.3% and 30.7% as well as reductions in PI of 12.7%, 23.7% and 32.6% at 1, 3 and 6 months, respectively. When analyzing the number of healthy sites (MGI scores of 0 or 1), the beneficial effect of the EO-containing mouthrinse is 45.8% greater than using a CPC-containing mouthrinse and 59.8% greater than placebo.

Early benefits with daily rinsing on gingival health improvements with an essential oil mouthrinse--post-hoc analysis of 5 clinical trials.

PURPOSE: The aim of this investigation through post-hoc analyses was to determine the ability to achieve gingival health in the short term with daily rinsing with an essential oil containing antimicrobial mouthrinse. METHODS: Conventional Analysis of Covariance (ANCOVA) on whole mouth mean plaque and gingivitis scores were originally conducted to demonstrate efficacy of adjunctive use of Cool Mint® LISTERINE® Antiseptic (EO) compared to negative control [brushing (B) or brushing/flossing (BF)] in each of 5 studies containing a 4 week evaluation. The Modified Gingival Index (MGI) was split into 2 categories: healthy (scores 0, 1) and unhealthy (≥2). Data, reflecting subjects that completed 4 weeks of treatment from 5 studies, were evaluated to determine the mean percent of healthy sites and mean percent of more inflamed "affected" areas (MGI≥3). RESULTS: At baseline, the mean percent healthy gingival sites ranged from 0.1 to 3.2%. At 4 weeks, up to 29.3% and 16.1% of sites were healthy for the EO group and negative control group, respectively. Three and 6 month data from 2 of the 5 studies resulted in up to 39.6% and 62% at 3 and 6 month mean percent healthy sites per subject for EO and up to 17.2% and 15.6% at 3 and 6 months, respectively, for negative control. Virtually plaque free sites (PI=0, 1) at 4 weeks ranged up to 34.3% and 8.1% for EO and control groups, respectively. CONCLUSION: Significantly more healthy gingival sites and virtually plaque free tooth surfaces can be achieved as early as 4 weeks with use of an essential oil antimicrobial mouthrinse. This finding continues through 6 months twice daily use as part of oral care practices compared to mechanical oral hygiene alone.

Mouthrinse recommendation for prosthodontic patients.

Different reasons can contribute to classifying dental prosthesis wearers as high-risk individuals in relation to dental biofilm accumulation. These include a past history of oral disease, age and additional retentive areas. Other common complaints include inflammation and halitosis. Moreover, prosthesis replacement and prosthetic pillar loss are generally associated with caries and periodontal disease recurrence. Therefore, the present study undertook to make a critical review of the literature, aiming at discussing the main aspects related to chemical agent prescriptions for dental prosthesis wearers. Most of the articles were selected based on relevance, methods and availability in regard to the specific subject under investigation, without considering publication year limitations. Different types of prostheses and their impact on teeth and other oral tissues were reported. It was demonstrated that there is greater biofilm buildup and increased inflammatory levels in the presence of different types of prostheses, suggesting that additional measures are required both on population-wide and individual levels in order to control these factors. Mechanical control consists of a combination of manual or electric toothbrush and toothpaste, as well as specific devices for interdental cleaning. Although many chemical agents exhibit antimicrobial benefits when used for prosthesis disinfection, only a few agents can be used safely without causing damage. Regarding the selection of antiseptics by the overall population, chlorhexidine is the most indicated in the short term and in sporadic cases. The most indicated adjuncts to overcome the deficiencies and limitations of daily mechanical biofilm control are products containing essential oils as active ingredients.

Antimicrobial mouthrinse use as an adjunct method in peri-implant biofilm control.

Great possibilities for oral rehabilitation emerged as a result of scientific consolidation, as well as a large number of dental implant applications. Along with implants appeared diseases such as mucositis and peri-implantitis, requiring management through several strategies applied at different stages. Biofilm accumulation is associated with clinical signs manifest by both tooth and implant inflammation. With this in mind, regular and complete biofilm elimination becomes essential for disease prevention and host protection. Chemical control of biofilms, as an adjuvant to mechanical oral hygiene, is fully justified by its simplicity and efficacy proven by studies based on clinical evidence. The purpose of this review was to present a consensus regarding the importance of antimicrobial mouthrinse use as an auxiliary method in chemical peri-implant biofilm control. The active ingredients of the several available mouthrinses include bis-biguanide, essential oils, phenols, quaternary ammonium compounds, oxygenating compounds, chlorine derivatives, plant extracts, fluorides, antibiotics and antimicrobial agent combinations. It was concluded that there is strong clinical evidence that at least two mouthrinses have scientifically proven efficacy against different oral biofilms, i.e., chlorhexidine digluconate and essential oils; however, 0.12% chlorhexidine digluconate presents a number of unwanted side effects and should be prescribed with caution. Chemical agents seem beneficial in controlling peri-implant inflammation, although they require further investigation. We recommend a scientifically proven antiseptic, with significant short and long term efficacy and with no unwanted side effects, for the prevention and/or treatment of peri-implant disease.

Níveis comparativos pré- e pós-tratamento de CSV, carga bacteriana total subgengival e sangramento gengival / Pre-and post-treatment comparative levels of VSC, subgingival total bacterial load and gingival bleeding

O objetivo deste ensaio clínico randomizado de 3 meses de duração foi avaliar os efeitos da combinação de procedimentos mecânicos e químicos sobre os níveis de sangramento gengival, Compostos Sulfurados Voláteis (CSV) e carga total bacteriana de pacientes com gengivite. Sessenta voluntários sistemicamente saudáveis com gengivite foram divididos em dois grupos: raspagem profissional associada ao uso diário de óleos essenciais (20ml/2x/dia) ou solução placebo (20ml/2x/dia). Todos os participantes receberam instruções de higiene bucal. Índice de sangramento gengival, carga bacteriana total subgengival (PCR em tempo real) e concentrações de CSV (dosador portátil Halimeter) foram mensurados antes e 90 dias após o tratamento gengival. Os dados foram comparados estatisticamente pelos teste t-Student e teste t-pareado (p < 0,05). Resultados: Finalizaram o estudo 27 indivíduos no grupo teste e 25 no grupo placebo. A carga bacteriana total e o IG reduziram mais evidentemente no grupo teste do que no grupo placebo. No grupo teste os valores médios de CSV reduziram de 94,62ppb (inicial) para 62,19ppb (3 meses) enquanto no grupo placebo eles se mantiveram estáveis entre as mensurações inicial (93,46ppb) e de 3 meses (95,00ppb). Conclusões: o tratamento gengival seguido de 90 dias de uso de solução de óleos essenciais acarretou melhora dos parâmetros monitorados, IG, carga total bacteriana e CSV.

The aim of this 3-month randomized clinical study was to evaluate the effects of the combination of mechanical and chemical procedures over the levels of gingival bleeding, VSC and total bacterial load in patients with gingivitis. Sixty systemically healthy individuals with gingivitis were randomized in two groups: professional debridement along with the daily use of essential oils (20ml/2x/day) or of a placebo solution (20ml/2x/day). All participants received oral hygiene instructions. Gingival Index, total bacterial load (real time PCR) and VSC concentration (portable Halimeter) were measured at baseline and at 90 days after gingival treatment. Data were statistically compared by Student-t test and paired-t test (p < 0.05). Results: Twenty-seven individuals finished the study in the test group and 25 in the placebo group. Total bacterial load and GI were greatest reduced in the test group than in the placebo group. Mean VSC values in the test group were reduced from 94,62ppb (at baseline) to 62,19ppb (3 months) while in the placebo group measures continued stable between baseline (93,46ppb) and (95,00ppb) 3-month examinations. Conclusions: Gingival treatment followed by the use of essential oils for 90 days lead to an improvement in the monitored parameters, GI, total bacterial load and VSC.

Validation of the anti-bacteremic efficacy of an essential oil rinse in a Brazilian population: a cross-over study

This cross-over study was conducted to assess the germ-killing efficacy of an essential oil mouthrinse (EOM) by determining the blood levels of microorganisms associated with induced bacteremia and investigating the prevalence of this event in Brazilians with mild-to-moderate gingivitis. Thirty four (31.19%) subjects positive for bacteremia induced by chewing a ration of apple were enrolled out of 109 screened subjects (50 males and 59 females). A difference of at least 10 colony forming units between the pre- and post-insult blood samples was defined as a positive result. For the following two weeks patients underwent a toothbrush plus fluoride dentifrice normalization period, and were then scheduled for the Phase I protocol as follows. At baseline I, subjects were instructed to chew a new apple ration, had new blood samples taken before and after this oral stimulus, and were randomly assigned to an experimental essential oil (n = 17) or placebo (P) mouthrinse (n = 17) treatment for 2 weeks. These procedures were repeated at the end of Phase I and then followed by a two-week wash-out period (tooth brushing with fluoride dentifrice). Bacteremia was again induced at baseline and at the end of Phase II, when subjects were crossed-over to the other EOM or placebo groups. Bacterial count differences between baseline and 2-week post-treatment (EOM versus P) in the blood samples collected were assessed by analysis of covariance. Mean aerobic counts decreased by 45.8%, whereas mean anaerobic counts decreased by 63.3% after EOM treatment. After the P treatment, aerobic bacteria increased by 28.4% and anaerobic bacteria decreased by 18.5%. This study validated this novel methodology and showed that the germ-killing action of EOM significantly reduced bacteremia.

Validation of the anti-bacteremic efficacy of an essential oil rinse in a Brazilian population: a cross-over study.

This cross-over study was conducted to assess the germ-killing efficacy of an essential oil mouthrinse (EOM) by determining the blood levels of microorganisms associated with induced bacteremia and investigating the prevalence of this event in Brazilians with mild-to-moderate gingivitis. Thirty four (31.19%) subjects positive for bacteremia induced by chewing a ration of apple were enrolled out of 109 screened subjects (50 males and 59 females). A difference of at least 10 colony forming units between the pre- and post-insult blood samples was defined as a positive result. For the following two weeks patients underwent a toothbrush plus fluoride dentifrice normalization period, and were then scheduled for the Phase I protocol as follows. At baseline I, subjects were instructed to chew a new apple ration, had new blood samples taken before and after this oral stimulus, and were randomly assigned to an experimental essential oil (n = 17) or placebo (P) mouthrinse (n = 17) treatment for 2 weeks. These procedures were repeated at the end of Phase I and then followed by a two-week wash-out period (tooth brushing with fluoride dentifrice). Bacteremia was again induced at baseline and at the end of Phase II, when subjects were crossed-over to the other EOM or placebo groups. Bacterial count differences between baseline and 2-week post-treatment (EOM versus P) in the blood samples collected were assessed by analysis of covariance. Mean aerobic counts decreased by 45.8%, whereas mean anaerobic counts decreased by 63.3% after EOM treatment. After the P treatment, aerobic bacteria increased by 28.4% and anaerobic bacteria decreased by 18.5%. This study validated this novel methodology and showed that the germ-killing action of EOM significantly reduced bacteremia.

Comparative antiplaque and antigingivitis efficacy of a multipurpose essential oil-containing mouthrinse and a cetylpyridinium chloride-containing mouthrinse: A 6-month randomized clinical trial.

OBJECTIVE: This 6-month, examiner-blind, single-center, randomized, parallel group clinical trial compared the antiplaque and antigingivitis effects of an essential oil-containing mouthrinse with zinc chloride and sodium fluoride (EO) to a 0.05% cetylpyridinium chloride-containing mouthrinse (CPC) also with fluoride. METHOD AND MATERIALS: Four hundred and eight gingivitis subjects were monitored for the primary outcomes of modified Gingival Index (MGI) and Plaque Index (PI) at baseline and 3 and 6 months. Subjects were randomly assigned to 6-month twice a day unsupervised use of EO, CPC, or negative control rinse in conjunction with normal brushing and flossing. RESULTS: EO was always better than CPC at 3 and 6 months considering all parameters. All benefits allowed by EO increased from 3 to 6 months. CPC was better than the negative control at 3 and 6 months with respect to whole mouth plaque, and the proportion of more severe sites (baseline scores ≥ 3) in PI and MGI. At 6 months, CPC did not differ from negative control in relation to whole mouth MGI reduction, proximal MGI reduction, and percentages of sites improved over baseline in PI and MGI. CONCLUSION: This new EO mouthrinse provided superior clinical benefits to CPC and demonstrated increasing plaque and gingivitis reductions over 6 months. Our findings support the regular long-term use of the EO mouthrinse and selection over a 0.05% CPC rinse for better efficacy.

Essential oils in one-stage full-mouth disinfection: double-blind, randomized clinical trial of long-term clinical, microbial and salivary effects.

AIM: This randomized clinical trial evaluated the effects of an essential oils-containing mouthrinse for full-mouth disinfection. MATERIAL AND METHODS: Fifty patients were assigned to receive full-mouth disinfection with either essential oils or placebo. At baseline, 2 and 6 months of treatment the primary outcomes probing depth (PD), plaque index (PlI) and modified gingival index (MGI) were monitored. Additional monitoring included bacterial presence (by polymerase chain reaction) in subgingival, saliva and tongue samples; flows, pH, total protein and alkaline phosphatase salivary levels. The following statistics were used: ANOVA, Student's t-test, chi(2) and Kruskal-Wallis (p<0.05). RESULTS: Mean PD>or=3.5 mm was reduced over time in both the placebo and the test groups, but there was no difference in PD reduction between groups at 2 and 6 months. At 2 and 6 months, PlI and MGI showed greater reductions in the test group than in the placebo group. Porphyromona gingivalis was not reduced in any site. At 6 months, Campylobacter rectus increased in both groups, while Tannerella forsythensis decreased subgingivally in the test group. S. sanguinis increased, except subgingivally, in the placebo group. Salivary pH and flows were not altered. Total protein reduced only in the test group. Alkaline phosphatase did not change in either group. CONCLUSIONS: Essential oils for full-mouth disinfection showed clinical benefits, namely reducing plaque and gingival inflammation without altering basic salivary parameters.

Efeitos antiplaca e anti-gengivite associados ao uso de um anti-séptico bucal contendo óleos essenciais no protocolo terapêutico desinfecção de boca-total em estágio único / Anti-plaque and anti-inflammatory effects associated with an essential-oils containing mouthrinse in the “one-stage full-mouth disinfection” therapeutic protocol

Objetivos: Avaliar os efeitos antiplaca e antigengivite de um anti-séptico bucal contendo óleos essenciais no protocolo“desinfecção de boca-total em estágio único”. Metodologia: Índice de placa (IP) e Índice gengival modificado(IGM) foram mensurados pelo mesmo examinador treinado e calibrado, em todos os dentes presentes, de 50 indivíduos com periodontite leve. Adicionalmente, foi obtido o nível de proteína total em amostras de saliva não estimulada. Os indivíduos foram distribuídos aleatoriamente em um dos seguintes grupos: “desinfecção de boca-total em estágio único” associada aos óleos essenciais (n = 25) ou “desinfecção de boca-total em estágio único” associada a placebo (n = 25). Após a realização dos procedimentos mecânicos os participantes realizaram bochechos duas vezes ao dia por sessenta dias consecutivos. Os parâmetros clínicos e salivares foram obtidos inicialmente (T0), aos dois (T1) e seis meses (T2). Resultados: A análise intergrupos demonstrou uma redução significativa dos parâmetros periodontais clínicos (IP e IGM) no grupo teste em relação ao placebo (ANOVA e teste t Student, p < 0,05). Além disso, o grupo teste apresentou maior redução de gengivite do que de acúmulo de placa (Mann-Whitney, p<0,05). Em acréscimo, apenas o grupo teste apresentou redução do nível total de proteína na saliva (Kruskal-Wallis, p < 0,05).Conclusões: Os efeitos anti-placa e antigengivite previamente demonstradas pelos óleos essenciais também foram observadas quando da sua aplicação no protocolo “desinfecção de boca-total em estágio único”.

Objectives: To evaluate anti-plaque and anti-gingivitis effects of an essential-oils containing mouth-rinse in the “onestagefull-mouth disinfection” protocol. Methods: The same calibrated examiner measured plaque and modified gingivalindices of all teeth in fifty subjects with mild periodontitis. In addition, total level of protein in unstimulated whole salivawas determined. The subjects were randomly allocated in either: “one-stage full-mouth disinfection” plus essential oils (n= 25) or “one-stage full-mouth disinfection” plus placebo (n= 25). After finishing the mechanical procedures subjects rinsed at home twice a day for the following sixty days. All parameters were monitored at baseline (T0), 2- (T1) and 6- months (T2). Results: The inter-group analysis showed higherreductions of PlI and MGI in the test-group compared to the placebo group (ANOVA and Student-t test, p <0,05).Moreover, test group showed higher reductions regarding gingivitis than plaque amount (Mann-Whitney, p < 0,05). Only the test group revealed a reduction of the total protein level in the saliva, while this type of periodontaltherapy did not alter the level of alkaline phosphatases (Kruskal-Wallis, p < 0,05). Conclusions: The anti-plaque andanti-inflammatory effects previously demonstrated by essential oils were observed after use in the “one stagefull-mouth disinfection”.

In vitro antimicrobial activity of plant extracts and propolis in saliva samples of healthy and periodontally-involved subjects.

The aim of the present study was to determine, in vitro, the antimicrobial effect of plant extracts and propolis in saliva samples of 25 periodontally healthy subjects and 25 subjects with chronic periodontitis. One saliva sample from each subject was collected and spread on the surface of trypticase soy agar plates. Paper filter discs containing clove, sage, propolis, chlorhexidine 0.12% (positive control) and distilled water (negative control) were placed onto the plates, and incubated anaerobically for 72 hours. Significant differences in the antimicrobial effects of the different substances were tested using paired t-tests and the Spearman correlation coefficient, while differences in the effects of the extracts in periodontally healthy and diseased subjects were tested using Student's t-test. The highest means, in terms of size of microbial inhibition zones (cm) were obtained with chlorhexidine, followed by pure propolis, clove, and sage in subjects with periodontal health (1.35 +/- 0.22, 1.20 +/- 0.20, 0.94 +/- 0.14 and 0.44 +/- 0.38, respectively) or disease (1.38 +/- 0.23, 1.17 +/- 0.21, 0.94 +/- 0.07 and 0.78 +/- 0.07, respectively). There was a positive correlation between the inhibitory action of 11% propolis (w/v) and chlorhexidine (rho = 0.735, p < 0.001) in diseased subjects. The antimicrobial effects of clove and sage, particularly the latter, were less marked in comparison to propolis and chlorhexidine in both groups of subjects. In conclusion, propolis showed significant antimicrobial properties in saliva samples from periodontally healthy and diseased subjects, suggesting that this substance may be used therapeutically in the future to inhibit oral microbial growth.