Comparison of the effectiveness of Morus alba and chlorhexidine gels as an adjunct to scaling and root planing on stage II periodontitis - A randomized controlled clinical trial.

OBJECTIVES: The present study aimed to assess and compare the effect of Morus alba and chlorhexidine gel as an adjunct to scaling and root planing (SRP) in treating stage II periodontitis. METHODS: A single-blind, randomized controlled trial was conducted on 180 patients with stage II periodontitis who received full-mouth SRP. They were randomly assigned to receive chlorhexidine digluconate (CHX) gel, Morus alba (MA) and placebo gel for Groups A, B and C, respectively, at the baseline, 15 days and 30 days. Plaque index (PI), Gingival index (GI), periodontal pocket depth (PPD) and quantitative analysis (culture) of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Tannerella forsythia were assessed at baseline and 45 days. Analysis of variance was used to compare the significant difference in PI, GI, PPD and microbiological parameters between the three groups after the intervention, followed by post hoc Mann-Whitney U and Tukey's HSD test for clinical and microbiological parameters, respectively. RESULTS: Intergroup comparison of the PI, GI and microbiological parameters between the MA and CHX groups at the end of 45 days did not show a statistically significant difference (p > 0.05), whereas a statistically significant difference was observed for PPD between MA and CHX groups with the mean difference of 0.18 mm (p = 0.002). CONCLUSION: Morus alba gel was found to be effective in decreasing PPD. However, there was no difference between Morus alba and chlorhexidine gel as an adjunct to SRP in treating stage II periodontitis.

Antimicrobial Efficacy of Essential Oils and Their Combination Against Microorganisms Associated With Postradiation Therapy in Patients With Head and Neck Cancer: An In Vitro Study.

Background Head and neck cancer ranks as the sixth most common cancer globally. Reduced saliva production brought on by postradiation therapy upsets the delicate balance between bacterial load and a weakened immune system. Oral hygiene is commonly neglected in patients who have undergone radiotherapy and they often develop dry mouth, mucositis due to radiation therapy, etc., as side effects. Despite being a part of the current standard, chlorhexidine carries numerous disadvantages such as taste alteration, teeth staining, and dry mouth. An extensive review of the literature demonstrates the antibacterial properties of essential oils (EOs) derived from plant materials, which may be able to prevent the development of such opportunistic microorganisms in the oral cavity. Methodology The cinnamon bark EO and Cajeput EO were procured and checked for their solubility. The final ratio at which the oils were found to be soluble was the 1:1 (w/v) ratio. The minimum inhibitory concentration (MIC) of cinnamon bark oil (Cinnamomum verum) and Cajeput oil (Melaleuca leucadendron) against Staphylococcus aureus, Enterococcus faecalis, and Candida albicans was determined by serial dilution method using Resazurin dye, and the minimum bactericidal concentration (MBC) was done by a spread plating method. The polyherbal mouthwash was subjected to cytotoxicity assay against human gingival fibroblasts. All the experiments were performed in triplicates. Results The overall results showed that cinnamon bark EO had the strongest efficacy against S. aureus (0.33 ± 0.14 mg/mL) and E. faecalis (0.41 ± 0.14 mg/mL), but not against C. albicans (2.85 ± 2.11 mg/mL). Cajeput EO showed the least efficacy against all the groups; whereas the combination of EOs proved to be the most efficacious and showed good antimicrobial activity against these most commonly encountered microorganisms in head and neck cancer postradiotherapy. Conclusions Cinnamon and Cajeput EOs in combination proved to be effective in this in vitro study against the most common microorganisms encountered in patients with head and neck cancer postradiotherapy and are comparable to 0.2% chlorhexidine.

Exploring Parental Knowledge and Indigenous Practices for Infant Teething in Indian Population: A Cross-sectional Study.

To assess the parental knowledge and practices regarding infant teething and attitude towards infant oral health among parents of infants aged 6 months to 3-years. MATERIALS AND METHODS: A cross-sectional study was conducted among 400 parents who met the inclusion criteria. A self-designed, validated questionnaire comprising 13 questions was used. Questionnaire comprised of sociodemographic details, knowledge and experience of teething symptoms, practices used to relieve it and overall attitude towards infant oral health. Descriptive statistics and Chi-square test was applied. RESULTS: Parents attributed fever (87%), diarrhea (65%), gum irritation (71%) and desire to bite (78%) as common teething symptoms. Ninety-eight percent of the participants did not know that delayed tooth eruption could be an indicator for systemic disease. In case of first born child, parental knowledge was poor as compared to 2nd or 3rd born child (p = 0.023). Parents had a positive attitude regarding consulting a physician for teething problems and visiting a dentist for issues related to infant oral health. Tlismi necklaces (67%) and homeopathic tablets (25.8%) were two unique remedies identified in this population. Parents also reported over-the-counter use of systemic analgesics (58.2%). Emergence of upper teeth before lower teeth was considered as a bad omen by few parents. CONCLUSION: Parents wrongly attributed several systemic illnesses as teething symptoms. Though parents had a positive attitude towards infant oral care, it was not inculcated into practice. CLINICAL SIGNIFICANCE: Parents should be advised against self-medication and to report systemic illness in children to pediatricians and pediatric dentists for correct diagnosis and appropriate treatment. This study also highlights the need for educating parents about infant teething and oral care practices related to primary dentition for eruption of healthy permanent dentition. HOW TO CITE THIS ARTICLE: More SG, Sankeshwari R, Ankola AV. Exploring Parental Knowledge and Indigenous Practices for Infant Teething in Indian Population: A Cross-sectional Study. Int J Clin Pediatr Dent 2019;12(6):479-483.

Evaluation of Physical Parameters of Novel Licorice Varnish Versus Fluoride and Combination Varnish: An In-Vitro Study.

OBJECTIVES: The aim of this study was to evaluate the physical properties of locally prepared Licorice varnish (LV), commercially available Fluoride varnish (FV) and a Combination of both Varnishes (CV). MATERIAL AND METHODS: LV was prepared using authenticated licorice roots. Commercially available FV (Bifluorid 12) was used as a positive control and CV was prepared in six different concentrations of both varnishes. Conventional antibacterial activity assessment, employing disc diffusion and broth dilution methods, was inconclusive. Therefore a novel assessment method was used, whereby the varnish was directly added to a mixture of Brain Heart Infusion broth with Streptococcus mutans and incubated. Physical parameters such as pH, rate of evaporation, viscosity, film forming ability, and cost incurred for preparation were assessed and compared. RESULTS: FV, LV and CV (except the combination of LV 80% + FV 20%) showed antibacterial activity against Streptococcus mutans. All three varnishes formed films on the tooth surface as confirmed by Scanning Electron Microscopy. Mean pH was in the range of 4-4.5, viscosity 48-52 centipoise (cP), rate of evaporation was 150-160 seconds. They were comparable to each other in the physical parameters tested, except for the shelf life of LV. CONCLUSION: All three varnishes showed antibacterial activity against Streptococcus mutans which was established using an innovative method of antibacterial activity assessment. LV was most economical of all but had a shorter shelf life. The results of this study need to be evaluated through an in vivo study.

In vitro antibacterial activity of ethanolic extract of Morus alba leaf against periodontal pathogens.

CONTEXT: Antibiotic resistance is a major problem with inadvertent usage. Thus, there is a need to search for new antimicrobial agents of herbal origin to combat antibiotic resistance. One such plant is Morus alba which has a long history of medicinal use in traditional Chinese medicine. AIM: To compare the antibacterial activity of ethanolic extract of M. alba leaves with chlorhexidine gluconate against Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Tannerella forsythia. SETTINGS AND DESIGN: Experimental in vitro study. METHODOLOGY: Crude extract from the leaves of M. alba were prepared by Soxhlet extraction method by using ethanol as a solvent. Minimum inhibitory concentration (MIC) of the extract was assessed against A. actinomycetemcomitans, P. gingivalis and T. forsythia, and compared with that of chlorhexidine gluconate by broth dilution method. RESULTS: P. gingivalis was the most sensitive organism against the M. alba extract with an MIC value of 1.95 mg/ml; while T. forsythia and P. gingivalis both were most sensitive organisms against chlorhexidine gluconate with MIC values of 0.00781 mg/ml. CONCLUSION: M. alba possess good antibacterial activity against A. actinomycetemcomitans, P. gingivalis and T. forsythia and thus would be beneficial for the prevention and treatment of periodontal disease. However, chlorhexidine gluconate was found to be more effective when compared to M. alba.

Perception of health care providers toward geriatric oral health in Belgaum district: A cross-sectional study.

OBJECTIVES: To access knowledge and practices related to the oral health of geriatrics among the health care providers practicing in urban and rural areas. BACKGROUND: Older adults have identified a number of barriers that contribute to lack of dental service use. However, barriers that clinicians encounter in providing dental treatment to older adults are not as clear-cut. MATERIALS AND METHODS: 236 health professionals (of allopathy, ayurveda, and homeopathy) from urban and rural areas were assessed by means of structured questionnaire related to oral health practices and beliefs. RESULTS: Doctors practicing in urban areas assessed dental care needs more frequently (P = 0.038) and performed greater practices related to oral health of geriatrics (P = 0.043) than the doctors practicing in primary health care (PHC) centers (rural) (P = 0.038). CONCLUSION: Owing to the relative lack of knowledge among rural practitioners, there is a need to integrate primary health care with oral care in rural areas.

Effect of two herbal mouthwashes on gingival health of school children.

This study aimed at determining the effect of indigenously prepared neem and mango chewing stick mouthwashes on plaque and gingival indices. A sample of 105 children aged 12-15 years was randomized into three groups, namely neem, mango, and chlorhexidine mouthwash groups. All the children were examined at baseline and gingival and plaque indices were recorded. Baseline scores for plaque and gingivitis were fair and moderate, respectively, in all the three groups and there existed no statistically significant difference among them. Ten millilitres each of herbal and chlorhexidine mouthwashes (0.2%) were administered according to the group allocation twice daily for 21 days. Indices were reassessed at 21 days (immediately after intervention) and at 1 month, 2 months, and 3 months after discontinuing the mouthwashes. Statistically significant reduction (P < 0.001) in plaque index was found in all the three mouthwash groups at 21 days and at 1 month from discontinuing the mouthwash. Chlorhexidine additionally showed statistically significant reduction in plaque index at 2 months from discontinuing the mouthwash. Statistically significant reduction (P < 0.001) in gingival index was found in all the three mouthwash groups at 21 days (immediately after discontinuing the mouthwash) and at 1 and 2 months from discontinuing the mouthwash. To conclude, all the three mouthwashes were effective antiplaque and antigingivitis agents. Chlorhexidine and neem possess equivalent efficacy in reducing plaque, while chlorhexidine has superior antigingivitis properties.

An in vitro study to determine the effect of Terminalia chebula extract and its formulation on Streptococcus mutans.

AIM: Many weapons are available in the arsenal of a dental professional to combat dental caries, which is almost ubiquitously present. From a public health perspective, most of these weapons are far from being an ideal drug. Hence, there is a demand for better and effective antibacterial agents. This factor stimulated the process of the present study. The aim of the study was to determine the effect of ethanol extract of Terminalia chebula on Streptococcus mutans. MATERIALS AND METHODS: Dried ripe fruits of Terminalia chebula were procured and powdered. Physical tests were done to estimate purity of the fruit powder. Hydroethanolic and aqueous extracts were prepared according to standard procedures. Minimum inhibitory concentration of the extracts was determined by tube dilution method and confirmed by agar dilution method. The effect of the hydroethanolic extract on sucrose induced adhesion, glucan-induced aggregation and on glycolysis of Streptococcus mutans was also assessed. Preservative, gelling agent and sweetener were added in suitable quantities to the ethanol extract, and mouthrinse was formulated. Minimum inhibitory concentration of the formulation was also determined. RESULTS: Yield was better in case of aqueous extract. The Minimum inhibitory concentration of hydroethanolic extract was determined to be 2.5%. Minimum inhibitory concentration of the aqueous extract was determined to be 10%. Hydroethanolic extract of Terminalia chebula (2.5%) inhibited sucrose induced adherence and aggregation of Streptococcus mutans in vitro. CONCLUSION: The mouthrinse formulated from ethanol extract of Terminalia chebula demonstrated substantial antibacterial activity and could be used as an effective anticaries agent. CLINICAL SIGNIFICANCE: Terminalia chebula mouthrinse can be effectively used in clinical practice as an anticaries mouthrinse with additional benefit being that it is safe and economical.

Effectiveness of herbal and fluoridated toothpaste on plaque and gingival scores among residents of a working women's hostel - a randomised controlled trial.

PURPOSE: To determine the effectiveness of herbal and fluoridated toothpastes on plaque and gingival scores among 18- to 25-year-old female participants residing in a working women's hostel. MATERIALS AND METHODS: Sixty participants residing in a working women's hostel in Belgaum city, aged between 18 and 25 years, comprised the study population. The 60 participants were randomly allocated to the experimental and control groups. The experimental group was asked to use a herbal toothpaste (Himalaya Herbal Healthcare) and the control group a fluoridated toothpaste (Colgate Dental Cream) twice a day for 6 weeks. The plaque and gingival indices were recorded according to Silness and Löe (1964) and Löe and Silness (1963), respectively, at baseline, 3 weeks and 6 weeks of usage of the toothpastes. RESULTS: Baseline plaque and gingival scores were 1.53 ± 0.9 and 1.22 ± 0.13 for the control group and 1.30 ± 0.15 and 1.19 ± 0.12 for the experimental group, respectively. At 6 weeks, plaque and gingival scores were 0.86 ± 0.18 and 0.80 ± 0.2 for the control group and 0.99 ± 0.14 and 0.9 ± 0.21 for the experimental group, respectively. Statistically significant differences were obtained before and after the intervention in both groups (P < 0.001). CONCLUSION: The herbal toothpaste was as effective as the conventionally formulated dentifrice in controlling plaque and gingivitis.

The efficacy of Terminalia chebula rinse on Streptococcus mutans count in saliva and its effect on salivary pH.

PURPOSE: The aim of the present study was to assess the effectiveness of Terminalia chebula aqueous extract rinse on salivary pH and Streptococcus mutans. Mouthrinses have been in use from time immemorial as a supplement for routine oral hygiene practice. Although a large number of mouthrinses are currently available, many of them possess certain drawbacks, which has necessitated the search for alternate agents. MATERIALS AND METHODS: Ten per cent of T. chebula extract was prepared. A purposive sample of 30 subjects was selected and randomly divided into extract and control groups. Baseline salivary sample was collected. The freshly prepared extract rinse and control were given to the respective groups. Distilled water was used as a negative control. Salivary samples were collected at 5 and 60 min after rinsing and were subjected to pH and microbiological analyses. An acceptability questionnaire was given to all of the participants. Statistical analysis was done using paired and unpaired t tests. RESULTS: There was a significant reduction in the S. mutans count at 5 and 60 min after rinsing the extract. Salivary pH remained alkaline for a period of 1 h after rinsing the extract. Results of the acceptability questionnaire indicated that the mouthrinse was acceptable to 80% of the subjects. CONCLUSIONS: The results of the present study indicate that T. chebula may prove to be an effective anticaries mouthwash owing to its ability to increase salivary pH and inhibit S. mutans. This may also be a valuable public health intervention as it is economical and has multiple health benefits.

Antimicrobial efficacy of various disinfecting solutions in reducing the contamination of the toothbrush -- a comparative study.

BACKGROUND: Contaminated toothbrushes may play a role in the transmission of local or systemic diseases. As modern dentistry emphasises prevention and infection control, toothbrushes should be correctly stored, disinfected and changed at regular intervals. PURPOSE: The aim of this study was to test the efficacy of 3% neem, 2% triclosan, 0.2% chlorhexidine gluconate and 1% sodium hypochlorite as toothbrush disinfectants against Streptococcus mutans. MATERIALS AND METHODS: This was a double-blind, linear crossover, within-group comparative experimental trial conducted among 40 children aged 12 to 15 years. The study was divided into five phases: (1) distilled water (control); (2) 3% neem; (3) 2% triclosan; (4) 0.2% chlorhexidine gluconate; and (5) 1% sodium hypochlorite. The toothbrushes were collected after 5 days of brushing and were soaked for 12 h in antimicrobial solutions of separate phases, after which the toothbrushes were submitted for microbial analysis to check for the presence of S. mutans. RESULTS: The mean colony-forming units (CFUs) of S. mutans at phase 1 when compared with baseline was not significant (P = 0.17). The other phases had a significant drop in mean CFUs of S. mutans from baseline (P < 0.001). The percentage reduction of mean CFUs of S. mutans from baseline was the highest in phase 2 (86%). CONCLUSION: It can be concluded that all the solutions are effective in toothbrush decontamination, but 3% neem has greater efficacy than other solutions.