Clinical evaluation of the effect of a hydrogen peroxide mouth rinse, sodium bicarbonate dentifrice, and mouth moisturizer on oral health.

The objective of this 60-day single-blind, parallel trial, using 150 subjects, was to evaluate the effect of a 20% sodium bicarbonate dentifrice, a 1.5% hydrogen peroxide solution and a mouth moisturizer on oral tissues and microflora. Subjects were randomly assigned to one of five groups. The treatments were: 1) Sage dentifrice (sodium bicarbonate). Toothette Plus containing baking soda saturated with the hydrogen peroxide solution and use of a mouth moisturizer, 2) Crest dentifrice, Toothette Plus containing baking soda saturated with the hydrogen peroxide solution and use of a mouth moisturizer, 3) Crest dentifrice, Toothette Plus containing baking soda with a control solution and no mouth moisturizer, 4) Crest dentifrice, Toothette (without baking soda), saturated with a control solution and no mouth moisturizer, and 5) Crest dentifrice, Toothette saturated with 1.5% flavored H2O2 and no mouth moisturizer. From a subgroup of 35 patients (seven from each group) buccal smears for exfoliative cytology were taken as were supragingival microbiological samples from the mesial aspect of first molars (pooled). Buccal smears were evaluated for signs of histopathological changes. Microbiological samples from supra- and subgingival plaque for P. gingivalis, P. intermedia, A. actinomycetemcomitans. A viscosus, F. nucleatum, F. sanguis and C. albicans were evaluated. Clinical parameters measured were a stain index (SI), the modified gingival index (MGI), and a plaque index (PI). There were no adverse changes in the oral microflora and no anaplastic or other pathological changes in any subjects. Clinical parameters showed a statistically significant reduction in the MGI ranging from 26.7-29.9% with no significant differences among the groups (p > 0.05). The PI showed small reductions in all groups except group 2, but the differences were not statistically significant from each other or baseline (p > 0.05). The SI revealed slight increases in all groups and no differences among the groups. It can be concluded that use of Sage dentifrice, Toothette Plus saturated with Perox-A-Mint and Sage Mouth Moisturizer are safe to oral tissues. Using these components did not result in clinically noticeable stain formation, promote plaque formation, or produce any significant adverse changes in the oral microflora.

Duration and Intensity of Anesthetic Effect Produced by Canker Sore Medications.

Canker sore medications are often recommended to patients for relief of pain associated with aphthous ulcers or other minor irritations of the mouth. The anesthetic effect of these medications is achieved by incorporation of local anesthetics, such as benzocaine, into the products' formulations. To determine the duration and intensity of the anesthetic effect of benzocaine-containing products, three topical oral health care medications, Red Cross Canker Sore Medication, Maximum Strength Anbesol and Orajel Mouth Aid, were compared. In this double blind cross-over study, each product was tested on 21 subjects with normal mucosa and gingiva. All three products produced anesthetic effects. Red Cross Canker Sore Medication was shown to have the longest duration and greatest intensity.

The effect of an antiseptic mouthrinse on implant maintenance: plaque and peri-implant gingival tissues.

The purpose of this controlled double-blind, parallel, randomized clinical study was to determine the effect of antiseptic mouthrinse on parameters important to dental implant maintenance. Plaque, peri-implant gingivitis, gingival bleeding, probing depth, and attachment level were assessed over a 3-month test period. Twenty healthy adult patients each of whom had at least two dental implants, a modified gingival index > 1.5, and a modified Quigley-Hein plaque index score > 1.7 were enrolled into the study. After a thorough oral prophylaxis, patients were randomly assigned to either the antiseptic mouthrinse or a 5% hydroalcohol placebo mouthrinse group and instructed to rinse twice daily for 30 seconds with 20 ml of their assigned mouthrinse as an adjunct to their usual oral hygiene procedures. The baseline examination included plaque index, gingival index, bleeding index, probing depth measurement, and attachment level measurements. The plaque and gingival indices were rescored at 1, 2, and 3 months. Probing depths, attachment levels, and bleeding index were determined again at 3 months only. At the end of 3 months, the antiseptic mouthrinse group had statistically significant reductions in plaque index, gingival index, and bleeding index compared to the placebo group. There were no significant differences between groups in probing depth or attachment level. The results of this clinical study indicate that twice daily use of an antiseptic mouthrinse may provide benefits in the maintenance of dental implants.

An alternative to dental floss in a personal dental hygiene program.

The concept of gingival massage on maintaining the health of the gingiva may be of value as an adjunct in the periodontal maintenance phase of treatment. This study compared dental floss to a test product, a massage device, in a randomized population of 20 male and female subjects. Clinical measurements were taken at baseline, week 3, and week 6. Patients were instructed to brush twice daily using their normal hygiene methods and to use the assigned product once daily. Plaque index (PI), bleeding index (BI) and pocket probing depths did improve in both the control and the test groups, but the differences did not favor either group over the other. The gingival index (GI) did, however, significantly decrease in the massage group, suggesting that this product may not only be an alternative to dental floss, but may provide added benefits from gingival massaging.

Agents for the management of plaque and gingivitis.

Numerous chemical agents have been evaluated for the supplementation of patient-dependent mechanical plaque control and thus the reduction or prevention of oral diseases. Agents discussed in this paper are those most frequently evaluated in recent studies and include chlorhexidine, essential oils, triclosan, sanguinarine, fluorides, oxygenating agents, quaternary ammonium agents, prebrushing rinses, enzymes, and antibiotics. Of the agents discussed, the greatest effect on the reduction of plaque and gingivitis can be expected from chlorhexidine, essential oils, and triclosan-containing products. These chemical agents vary in dosage form and include mouthrinses, gels, and dentifrices. Some may also be of value as irrigants. Adverse effects vary according to the chemical agent and include poor taste, burning sensation of oral tissue, staining of teeth and soft tissues, excess supragingival calculus, oral lesions in young patients, and allergic reactions. When a product is selected for a patient, consideration should be given to necessity, efficacy, adverse effects, and cost-effectiveness.

The impact of chemotherapeutic agents on treatment planning.

In this article the impact of chemotherapeutic agents on planning therapy for patients with plaque associated problems are reviewed. For special patients such as those receiving systemic medications which cause xerostomia or gingival hyperplasia, topical antimicrobials are of value for utilizing chemotherapeutic agents to teach patients a "clean mouth endpoint". Once achieved, patients can use this as a goal to obtain without the use of an agent. Two mouthrinses have been clearly shown to be effective in reducing plaque and gingivitis; one contains chlorhexidine and the other essential oils. A third agent, sanguinarine, found in both a dentifrice and mouthrinse, appears to be effective when used as combined therapy and further studies of combined usage are warranted.

The effect of an antimicrobial mouthrinse on early healing of gingival flap surgery wounds.

A randomized double-blind crossover design study using 25 patients requiring bilateral gingival flap surgery was completed. The effect of rinsing postsurgically three times daily with an antimicrobial mouthrinse or physiological saline on dental plaque formation, gingival inflammation, bleeding, wound healing, and patient comfort was evaluated at 7, 14 and 28 days. The antimicrobial rinse was statistically significantly 28.9% more effective than saline at seven days for reducing plaque. It was also significantly more effective for improving wound healing at day 7 as measured by edema (p less than 0.04). There were no significant differences in gingival index scores or bleeding at any time period. Use of an antimicrobial mouthrinse may be an effective aid in early healing of gingival flap surgery wounds.

Efficacy of epinephrine concentration in local anesthesia during periodontal surgery.

Blood loss in periodontal flap surgery using lidocaine 2% with either 1:50,000 or 1:100,000 epinephrine was compared. Ten patients from the graduate periodontal clinic were selected for the study. After the initial therapy which included oral hygiene instruction, scaling and root planning and occlusal adjustment, 20 surgical procedures were performed. In any one patient if 1:50,000 epinephrine was used on the posterior sextant of an arch, then 1:100,000 epinephrine was used on the contralateral side, with similar volumes being injected by the same method. Blood loss was determined by the cyanmethemoglobin comparison technique. Procedures using lidocaine 2% with 1:100,000 epinephrine generally had more than twice as much blood loss as those using lidocaine 2% with 1:50,000 epinephrine.