Color variations in PMMA acrylic resins after thermocycling and mouthwash simulation / Variações de cor em resinas acrílicas de PMMA após termociclagem e simulação de enxaguatório bucal

Estabilidade de cor é um requisito estético fundamental das resinas acrílicas provisórias, em especial quando esses materiais são submetidos a longos períodos na cavidade oral. Embora resinas acrílicas temporárias novas e aprimoradas estejam disponíveis, os efeitos da variação térmica e de soluções antissépticas na estabilidade de cor de resinas acrílicas provisórias ainda não foram completamente elucidados. Portanto, este estudo avaliou a coloração de resinas autopolimerizáveis polimetilmetacrilato (PMMA) e bis-acrilo submetidas à termociclagem e imersão em clorexidina. Amostras padronizadas (n=10) foram preparadas de duas resinas acrílicas temporárias a base de PMMA (Alike® e Duralay®). Foram realizadas três avaliações de cor (T1 ­ 24h após o preparo da amostra, T2 ­ após termociclagem e T3 ­ após termociclagem e imersão em clorexidina) por meio de espectrofotômetro eletrônico de seleção de sombra (Vita Easy Shade). Os dados obtidos foram analisados por ANOVA e teste t (α=0,05). As resinas de PMMA Alike e Duralay apresentaram alteração de cor após a termociclagem e também após a imersão em clorexidina.

Color stability is a fundamental aesthetic requirement for temporary acrylic resins, especially when these materials are subjected to long periods in the oral cavity. Although new and improved temporary acrylic resins are available, the effects of thermal variation and antiseptic solutions on the color stability of temporary acrylic resins have not yet been fully elucidated. Therefore, this study evaluated the color of self-polymerizing resins polymethyl methacrylate (PMMA) and bis-acryl subjected to thermocycling and immersion in chlorhexidine. Standardized samples (n=10) were prepared from two PMMA-based temporary acrylic resins (Alike® and Duralay®). Three color evaluations were carried out (T1 ­ 24h after sample preparation, T2 ­ after thermocycling and T3 ­ after thermocycling and immersion in chlorhexidine) using an electronic shade selection spectrophotometer (Vita Easy Shade). The data obtained were analyzed by ANOVA and t test (α=0.05). PMMA Alike and Duralay resins showed color changes after thermocycling and also after immersion in chlorhexidine.

Antibacterial Activity and Randomised Controlled Trial of Chlorhexidine-Coated Floss on Gingival Bleeding.

INTRODUCTION: While Chlorhexidine mouthwash is widely studied for the treatment of periodontal disease, research on chlorhexidine in the form of dental floss is limited. This study aims to evaluate the effect of chlorhexidine wax-coated dental floss on dental plaque accumulation and gingival bleeding. Additionally, antibacterial activity and cellular toxicity were also investigated in vitro. METHODS: Various concentrations of chlorhexidine wax-coated floss (0%, 0.12%, 1%, and 2%) were prepared. The antibacterial activity against Streptococcus mutans was studied using a disc diffusion assay. Cellular toxicity was assessed in L929 cells and human gingival fibroblasts using an MTT assay. To evaluate the effects on plaque accumulation and gingival bleeding, 27 participants were randomly divided into 3 groups: 1) 0% chlorhexidine wax-coated dental floss (control), 2) 0.12% chlorhexidine wax-coated dental floss, and 3) 1% chlorhexidine wax-coated dental floss. All participants were instructed to use the provided dental floss once daily at bedtime for 14 days. Six sites per tooth were evaluated for the Quigley-Hein plaque index and bleeding index (BI) at day 0 (baseline) and day 15. All fully erupted teeth, except the third molars, were examined. RESULTS: Chlorhexidine-coated floss exhibited antibacterial activity against S. mutans in a dose-dependent manner. In an in-vitro study, a 2% concentration of chlorhexidine in the floss was found to be highly toxic, leading to its exclusion from clinical trials. After 14 days of use, significantly lower levels of BI were observed in the groups using chlorhexidine wax-coated dental floss, compared to the control. Additionally, there was no significant difference in BI between the 0.12% and 1% chlorhexidine wax-coated dental floss groups. However, no significant difference in plaque index was found between the groups using chlorhexidine wax-coated dental floss and the control group. CONCLUSIONS: This study demonstrated the antibacterial and anti-gingivitis properties of chlorhexidine wax-coated dental floss. Our results showed that using chlorhexidine wax-coated dental floss at a concentration as low as 0.12% could significantly reduce gingival bleeding. However, no additional benefit of chlorhexidine wax-coated dental floss on dental plaque accumulation was found.

A Comparative Evaluation of the Effect of Different Endodontic Irrigating Solutions on Microhardness of Root Canal Dentin: An in vitro Study.

Statement of the Problem: During endodontic therapy, irrigation solutions applied in the root canal may affect the physicochemical properties of the dentinal wall, thereby changing its microhardness. This may adversely affect the sealing ability and adhesion of dental materials. Therefore, many studies have focused on the search for an ideal root canal irrigant that has a minimal effect on dentinal microhardness. Purpose: This in vitro study was conducted to determine the changes in dentin microhardness after root canal irrigation with different endodontic irrigants. Materials and Method: Ninety-five freshly extracted maxillary central incisor teeth with straight single canals were selected. These teeth were sectioned transversely at the level of the cementoenamel junction. The working length of each tooth was determined, and canal space was prepared by the HyFlex CM rotary file system. During instrumentation, normal saline was used for irrigation. Then, teeth were split longitudinally into two segments. According to the irrigating solution employed, samples were divided into five groups (n=19): normal saline (Group A), 3% sodium hypochlorite (Group B), 2% chlorhexidine (Group C), 5% calcium hypochlorite (Group D), and 0.2% nanochitosan (Group E).3 mL of the corresponding irrigating solution was administered for total15 minutes in each prepared sample. The Vickers micro-hardness tester was then used to assess micro-hardness. The data was analyzed using one-way analysis of variance (ANOVA). Results: All tested irrigating solutions decreased the dentinal microhardness. Samples irrigated with 5% calcium hypochlorite demonstrated dentinal microhardness of 42.43±1.62, which is the lowest among all the tested groups, followed by nano chitosan, sodium hypochlorite, and chlorhexidine. Samples treated with control group (saline) demonstrated the maximum microhardness of dentin in the present study. Conclusion: Within the limitations of this research, it can be concluded that the tested novel irrigating solutions, 5% calcium hypochlorite and 0.2% nanochitosan, were more detrimental to radicular dentin microhardness when compared with conventional endodontic irrigants.

Comparison of Dracocephalum Moldavica Essential Oil with Chlorhexidine on Cariogenic Bacteria.

Statement of the Problem: Dental caries and periodontal disease are the most common oral problems. Chemical antibacterial agents often have side effects; thus, researchers have long been in search for organic and herbal products to prevent dental caries and periodontal disease. Purpose: The present study has aimed to assess the effects of Dracocephalum moldavica essential oil on Streptococcus mutans, Streptococcus salivarius, Streptococcus sobrinus, and Lactobacillus acidophilus compared to Chlorhexidine (CHX). Materials and Method: In this in vitro study, the plants were collected from Zanjan Province, Iran. Analysis of the essential oil was carried out by gas chromatography/mass chromatography. Micro-broth dilution and disc diffusion methods were used for assessment of the antimicrobial activity, and minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were evaluated. Results: The mean diameter of the growth inhibition zones in the well plate method for Dracocephalum moldavica showed that it had greater antimicrobial activity against Lactobacillus acidophilus than others (p Value= 0.01). Furthermore, Dracocephalum moldavica had higher antimicrobial activity than CHX. The results of MIC and MBC showed that Dracocephalum moldavica had lower antibacterial activity than CHX. Conclusion: Dracocephalum moldavica essential oil demonstrated antibacterial properties against cariogenic bacteria. Given that other favorable properties of these essential oils are confirmed, they may be suitable for use as antibacterial agents in the formulation of oral healthcare products.

The Efficacy of Populus euphratica and Myrtus communis Herbal Mouthwash on Gingivitis in Pediatric Patients Diagnosed Clinically and with Photometric CIELab Analysis: An In Vivo Randomized Double-blind Clinical Study.

Background: Children are more prone to develop gingivitis as a result of deficient oral hygiene, morphological variance, and a diet that encourages the growth of pathogenic oral bacteria. Aim: The purpose of this randomized, double-blind clinical study is to compare the therapeutic effect of an herbal mouthwash made of decoction and ethanolic extract of Populus euphratica and Myrtus communis to that of chlorhexidine (CHX) mouthrinse. Materials and methods: In this study, 60 patients aged between 8 and 10 years were divided into four groups, each with 15 patients. The first group was treated with a mouthwash made of ethanolic herbal extract, the second group was treated with a mouthwash made of herbal decoction, the third group was treated with CHX mouthwash (0.12%) (positive control), and the fourth group was treated with a placebo made with colored distilled water (negative control). Clinical parameters gingival index (GI) and plaque index (PI) were evaluated at the start, 1, and 2 weeks from ensuing the treatment. Preoperative and postoperative photographs of the maxillary anterior sextant were recorded to evaluate CIELab coordinates to monitor color changes. Statistical analysis: One-way analysis of variance (ANOVA) with Tukey's honest significant difference (HSD) post hoc tests were used for data assessment. Results: Significant reductions in GI and PI were found among the tested groups (p < 0.05). A significant reduction in a* value was observed, while L* value showed a significant increase between baseline and posttreatment (p < 0.05). Conclusion: Herbal-based mouthwash of Populus euphratica and Myrtus communis, whether prepared by boiling or ethanolic extraction, reduced gingival inflammation significantly and has a lot of potential for treating and preventing periodontal disease in young children. Digital photography is a reliable supplementary approach for diagnosing and monitoring gingival inflammation in pediatric patients. How to cite this article: Mohamed-Ali SF, Jasim AA, Mahmood MAK, et al. The Efficacy of Populus euphratica and Myrtus communis Herbal Mouthwash on Gingivitis in Pediatric Patients Diagnosed Clinically and with Photometric CIELab Analysis: An In Vivo Randomized Double-blind Clinical Study. Int J Clin Pediatr Dent 2024;17(8):918-924.

Pre-procedural Topical Antisepsis in the Neonate: A Systematic Review Evaluating Risk Factors for Skin Injury.

BACKGROUND: Pre-procedural antisepsis is a critical component of hospital-acquired infection prevention in the neonatal intensive care unit (NICU). However, broadly utilized topical antiseptic agents pose an elevated risk of disruption to neonatal skin integrity, and evidence-based guidelines are lacking. This systematic review of the literature sought to assess and characterize the predisposing risk factors for and types of neonatal skin injury from topical antiseptic agents. METHODS: A systematic search of Medline Ovid, Embase, Web of Science, CINAHL, and Cochrane Library was conducted, including academic literature providing data on neonatal skin injuries related to topical antisepsis in the NICU. RESULTS: A total of 19 articles (99 patients) met the inclusion criteria. Of the available data, most reported skin injuries were described in extremely preterm (98.1%) and very low birth weight (98.4%) infants. The majority of reported adverse cutaneous events were attributed to chlorhexidine preparations (74.8%), followed by octenidine (18.2%), povidone-iodine (6.1%), and isopropyl alcohol (2.0%). Erythema (40.1%), skin breakdown (23.4%), and chemical burns (17.5%) were the skin reactions reported most frequently, followed by skin irritation (8.3%), and skin necrosis (2.8%). CONCLUSIONS: Our findings indicate that both extremely preterm and very low birth weight infants are particularly susceptible to skin toxicities from pre-procedural antiseptic preparations. These data underscore the need for future research to support the development of guidelines which minimize iatrogenic cutaneous injuries in the neonatal population, specifically for the care of infants under 2 months of age, for whom current recommendations are lacking due to a paucity of data.

Tissue response in a rat model of denture stomatitis treated with tissue conditioner containing antifungal complexed with ß-cyclodextrin.

Introduction. Tissue conditioners modified with antifungals are a potential alternative to denture stomatitis (DS) treatment.Gap Statement. Information on tissue response to this treatment before its clinical application is lacking.Aim. This study aimed to evaluate the tissue response of a tissue conditioner modified with antifungals in a rat model of DS.Methodology. After DS induction for 4 days under antibiotic therapy, Wistar rats had their intraoral devices (IODs) relined with the tissue conditioner Softone without (Soft) or with the MICs against Candida albicans of nystatin (Nys) or chlorhexidine (Chx) complexed or not with ß-cyclodextrin (Nys:ßCD and Chx:ßCD). Three controls were included: healthy rats [negative control (Nc)], rats using a sterile IOD [sterile device (Sd)] and rats with DS that did not receive treatment (DS). After 4 days of treatment, the palatal mucosa under the IODs underwent histological processing for morphohistopathological and histometric analyses, morphology of collagen fibres (birefringence), immunohistochemistry for the expression of cell proliferation (proliferating cell nuclear antigen) and cytokine (IL-1ß).Results. The Nc and Sd groups were similar (P>0.05), displaying epithelial and connective tissues without any discernible changes in the parameters assessed. The DS and Soft groups exhibited pronounced epithelial alterations, cell proliferation and expression of the cytokine IL-1ß. In groups treated with drug incorporation (Nys, Chx, Nys:ßCD and Chx:ßCD), all samples demonstrated a reduction in tissue inflammation or complete tissue recovery, with an epithelium compatible with health. For the immunohistochemical parameters, the Chx, Nys:ßCD and Chx:ßCD groups were comparable with Nc (P>0.05).Conclusion. The proposed treatment could be promising for DS, as it led to the tissue recovery of the palatal mucosa. Nevertheless, much lower concentrations of complexed antifungals were required to achieve a similar or higher degree of tissue response compared with uncomplexed drugs in a modified tissue conditioner formulation.

Characterization of Chlorhexidine Resistance Among Clinical Isolates of Coagulase-Negative Staphylococcus Species in a Tertiary Care Center, Chennai.

Background Coagulase-negative Staphylococci (CoNS) are potential pathogens and are often associated with healthcare-associated infections (HAIs). Chlorhexidine (CHX) is the most widely used antiseptic to reduce colonization and infection by all Staphylococci, including CoNS. Resistance to CHX among CoNS has been observed over the past few years, consequent to its widespread use. Phenotypic tolerance or reduced susceptibility to CHX is conferred by plasmid-mediated qac group of genes, mainly qacA/B and smr, which cause activation of efflux pumps over the bacterial cell wall. This study aims to characterize the phenotypic and genotypic resistance exhibited by CoNS species against CHX. Methods After ethical approval, 148 consecutive, non-repetitive isolates of clinically significant CoNS species of hospitalized patients, isolated from blood samples and exudative specimens, were included in the study. Speciation was performed by conventional biochemical identification and automated methods. Antimicrobial susceptibility testing was performed by disc diffusion technique and for vancomycin by minimum inhibitory concentration (MIC) determination, as per Clinical Laboratory Standards Institute (CLSI) M-100 2023 guidelines. Methicillin resistance was detected using a cefoxitin disc. MIC for CHX was performed by agar dilution method; reduced susceptibility was considered when MIC to CHX ≥4 µg/mL. The simplex polymerase chain reaction (PCR) was carried out with suitable controls to detect qacA/B and smr. Statistical analysis was conducted to determine the association of qacA/B and smr genes with MIC of CHX in the study isolates. Results Fifteen different species of CoNS were obtained from clinical samples. A high percentage of resistance was observed against various classes of antibiotics. Methicillin resistance was observed in 69.6% (103/148) of isolates. Of 148 CoNS, 52.7% (78/148) of isolates exhibited reduced susceptibility to CHX with an MIC ≥4 µg/mL. These isolates exhibited a higher percentage of methicillin resistance (75.6%, 59/78). By PCR, 34.5% (51/148) of isolates carried either or both genes. Gene qacA/B was solely detected in 27.02% (40/148) of isolates, of which 14 were CHX-tolerant and the remaining 26 were CHX-susceptible. Gene smr was solely detected in 4.1% (6/148) of isolates comprising three isolates each in CHX-tolerant and susceptible categories. There were 3.4% (5/148) of isolates that harbored both genes, of which only one isolate was CHX-susceptible, while the other four were CHX-tolerant. A proportion of isolates that were phenotypically tolerant to CHX did not carry either or both genes. A significant statistical association was found between reduced susceptibility to CHX and the presence of antiseptic resistance genes in the study isolates (p-value=0.033942). Conclusion To our knowledge, this is the first study from South India to investigate CHX resistance among CoNS using phenotypic and genotypic methods. The rise of antiseptic resistance among CoNS is an emerging threat to current infection control practices. The presence of qacA/B and smr genes, especially in CHX susceptible isolates, is concerning since these resistance genes are located on transferable plasmids, and the isolates can develop resistance eventually upon exposure to CHX.

Optimizing Desmostachya bipinnata-Derived Platinum Nanoparticles for Enhanced Antibacterial and Biofilm Reduction.

This study presents the green synthesis and comprehensive characterization of platinum nanoparticles (PtNPs) using Desmostachya bipinnata (Db) extract, incorporated into two innovative mouthwash formulations (MW1 and MW2). UV-Vis spectroscopy confirmed the successful synthesis of PtNPs, with distinct absorption peaks between 250-600 nm. Fourier-transform infrared (FTIR) spectroscopy identified hydroxyl and carbonyl functional groups, critical for the bioreduction and stabilization of PtNPs. High-resolution transmission electron microscopy (HR-TEM) revealed uniformly dispersed, spherical nanoparticles with a size range of 10-20 nm, while dynamic light scattering (DLS) confirmed a hydrodynamic diameter of 10-30 nm and a low polydispersity index (PDI) of 0.238, indicating excellent stability. Both formulations exhibited robust antimicrobial, antibiofilm, and anti-plaque properties, with MW2 showing superior efficacy, particularly against Staphylococcus aureus and Escherichia coli, as well as a notable 70% reduction in biofilm formation and a 60% plaque reduction within two hours of treatment. The study underscores the potential of Desmostachya bipinnata-derived PtNPs as a promising alternative to conventional mouthwash, offering enhanced antimicrobial efficacy, biofilm disruption, and plaque prevention, alongside excellent stability and biocompatibility for oral healthcare applications.

Comparative Assessment of Antimicrobial Activity of Propolis and Chlorhexidine on Salivary Isolates of Candida albicans and Streptococcus mutans in Children with Severe Early Childhood Caries: An In Vitro Study.

Background: Streptococcus mutans and Candida albicans are the chief microbes associated with severe early childhood caries (S-ECC). Diverse antimicrobial agents are widely used to prevent ECC, and a quest for newer natural products has been on the rise in the recent past. Aim: To estimate the antimicrobial activity of propolis with chlorhexidine on salivary specimens from children with S-ECC in vitro. Materials and methods: A total of 60 children with S-ECC were designated. Salivary samples of 30 children (group I) were inoculated onto mitis salivarius agar (MSA) to isolate S. mutans. Another 30 samples (group II) were inoculated on sabouraud's dextrose agar and subcultured on HiCrome Candida differential agar to isolate C. albicans. Sensitivity testing for 0.2% chlorhexidine and 10% propolis extract was done using the agar well diffusion technique using Mueller-Hinton agar medium. The antimicrobial effect was evaluated by calculating the diameter of the zone of inhibition surrounding the well. Results: All saliva samples collected from groups I and II showed growth of S. mutans and C. albicans, respectively. All cultured microbes were sensitive to 0.2% chlorhexidine and 10% propolis extract. The mean inhibition zone for S. mutans with chlorhexidine was 14.57 ± 0.63 mm, and with propolis, 11.93 ± 0.52 mm. The mean zone of inhibition for C. albicans with chlorhexidine was 12.83 ± 0.59 mm, and with propolis, 9.50 ± 0.73 mm. Chlorhexidine consistently showed statistically significantly larger zones of inhibition and hence appeared to be a more potent antimicrobial agent than propolis extract for both S. mutans and C. albicans. However, propolis has irrefutable action against both S. mutans and C. albicans. Conclusion: Propolis may be an acceptable substitute for chlorhexidine for long-term use as it has demonstrated antimicrobial activity and fewer side effects. Hence, this Association of Physicians of India herbal drug can be incorporated into mouthwashes and toothpaste to reduce microbial counts. How to cite this article: Kodgi V, Shetty P, Thimmaiah C, et al. Comparative Assessment of Antimicrobial Activity of Propolis and Chlorhexidine on Salivary Isolates of Candida albicans and Streptococcus mutans in Children with Severe Early Childhood Caries: An In Vitro Study. Int J Clin Pediatr Dent 2024;17(5):591-595.

Qualitative and Quantitative Evaluation of the Effects of Different Chelating Agents on the Calcium Content of Root Canal Dentin Using Atomic Absorption Spectrophotometer: An In Vitro Study.

Aims and background: Evaluation of the effects of different chelating agents on the calcium loss of root canal dentin. Materials and methods: Around 65 single-rooted teeth were collected and decoronated. The working length was determined, and biomechanical preparation was done in a crown-down fashion using the HyFlex Control Memory rotary nickel-titanium (Ni-Ti) system until apical preparation of 30.04. Canals were irrigated with chelating agents and sodium hypochlorite between each file insertion. Based on the type of chelating agents used, the samples were randomly divided into five groups (n = 13)-group I, liquid ethylenediaminetetraacetic acid (EDTA); group II, EDTA and chlorhexidine (CHX); group III, etidronic acid; group IV, SmearClear; and group V (control), distilled water. The total volume of the solution used was collected, and calcium ion release was quantified using an atomic absorption spectrophotometer. The qualitative analysis was done by observing the acetylene (C2H2)/air flame. Images were obtained for each sample, compared, and analyzed. Results: With respect to the control group, groups IV and I show a statistically significant difference compared to groups II and III (p < 0.05). Qualitatively, the highest intensity was observed in group IV and the least intensity in group III. Conclusion: SmearClear showed significantly higher decalcifying capability compared to EDTA, EDTA and CHX, and etidronic acid. Hence, its combined use with an organic solvent can be recommended for efficient smear layer removal. Clinical significance: Minimally invasive endodontic treatment is aimed at preserving the strength of the treated tooth without compromising cleaning effectiveness. Therefore, comparing the efficacy of different chelating agents will be promising with respect to maximum calcium loss both qualitatively and quantitatively. How to cite this article: Singhal P, Raisingani D, Prasad AB, et al. Qualitative and Quantitative Evaluation of the Effects of Different Chelating Agents on the Calcium Content of Root Canal Dentin Using Atomic Absorption Spectrophotometer: An In Vitro Study. Int J Clin Pediatr Dent 2024;17(6):647-652.

Effect of treatment frequency on the efficacy of superhydrophobic antimicrobial photodynamic therapy of periodontitis in a wistar rat model.

Superhydrophobic antimicrobial photodynamic therapy (SH-aPDT) is advantageous wherein airborne singlet oxygen (1O2) is delivered from a device tip to kill a biofilm with no photosensitizer exposure and no bacterial selectivity (Gram + or Gram -). For effective treatment of periodontitis, the frequency of treatment as well as the optical light fluence required is not known. Thus, we sought to determine whether single or repeated SH-aPDT treatments would work best in vivo using two fluence values: 60 and 125 J/cm2. We assessed the efficacy of three protocols: single treatment; interval treatments (days 0, 2, and 7); and consecutive treatments (days 0, 1, and 2). After 30 days of evaluation, we found that, SH-aPDT in 3 consecutive treatments significantly decreased Porphyromonas gingivalis levels compared to single and interval SH-aPDT treatments, as well as SRP-chlorhexidine (CHX) controls (p < 0.05). Notably, clinical parameters also improved (p < 0.05), and histological and stereometric analyses revealed that consecutive SH-aPDT treatments were the most effective for promoting healing and reducing inflammation. Our study shows what works best for SH-aPDT, while also demonstrating SH-aPDT advantages to treatment of periodontitis including no bacterial selectivity (Gram + or Gram -) and preventing the development of bacterial resistance.

A Comparative Clinical Evaluation of Subgingivally Delivered 0.5% Azithromycin Gel and 1% Chlorhexidine Gel as an Adjunct to Scaling and Root Planing in the Treatment of Chronic Periodontitis.

Background: Chronic periodontitis is a prevalent inflammatory condition affecting the supporting structures of teeth. Adjunctive therapies to scaling and root planing (SRP) play a crucial role in enhancing treatment outcomes. This study aimed to compare the clinical effectiveness of subgingivally delivered 0.5% azithromycin gel and 1% chlorhexidine gel as adjuncts to SRP in the management of chronic periodontitis. Materials and Methods: A comparative clinical evaluation was conducted involving 60 participants diagnosed with chronic periodontitis. They were randomly assigned to two groups: Group A received subgingival application of 0.5% azithromycin gel after SRP, whereas Group B received 1% chlorhexidine gel in a similar manner. Clinical parameters including probing pocket depth (PPD), clinical attachment level (CAL), and gingival index (GI) were recorded at baseline and 3-month follow-up. Results: Both groups demonstrated significant improvements in clinical parameters after treatment. However, Group A exhibited a greater reduction in PPD (mean decrease of 2.5 mm) compared with Group B (mean decrease of 1.8 mm). Similarly, Group A showed a higher gain in CAL (mean gain of 2.3 mm) compared with Group B (mean gain of 1.5 mm). In addition, a significant reduction in GI was observed in both groups, with Group A showing slightly better outcomes. Conclusion: Subgingivally delivered 0.5% azithromycin gel demonstrated superior clinical efficacy as an adjunct to SRP in the treatment of chronic periodontitis compared with 1% chlorhexidine gel. The findings suggest that azithromycin gel may serve as a promising therapeutic option in managing periodontal disease.

The Impact of Chlorhexidine as an Endodontic Irrigant/Medicament on Post-Obturation Pain in Patients Following Endodontic Therapy: A Preliminary Bayesian Meta-Analysis.

To assess the overall impact of chlorhexidine, when used as an endodontic irrigant/medicament, on post-obturation pain following endodontic treatment by the application of Bayes methods of meta-analysis. This study aimed to combine recently documented evidence using rigorous and specific search criteria. The available data were analyzed using Bayesian methods, which have the advantage of accounting for uncertainties in estimates. This is in contrast to commonly used frequentist meta-analysis methods, which are not able to model uncertainties as effectively, particularly when there is heterogeneity present. A preliminary search was conducted in the Pubmed, Cochrane, and Scielo databases using appropriate keywords. The search aimed to identify human randomized clinical studies that evaluated post-operative endodontic pain and involved the use of chlorhexidine as an endodontic irrigant or medicament. The preliminary Bayesian meta-analysis produced a more accurate estimate compared to a frequentist random effect meta-analysis model, with a narrower credible interval. The frequentist model demonstrated a detrimental impact of chlorhexidine on post-obturation pain, while the Bayesian model indicated a somewhat favorable effect of chlorhexidine on post-obturation pain. Based on the scope of this investigation, it can be inferred that a Bayesian random effects meta-analysis model demonstrated a somewhat favorable impact of chlorhexidine on post-endodontic pain, which carries significant therapeutic significance.

Comparative Evaluation of Feracrylum and Chlorhexidine in Nonsurgical Periodontal Therapy in Chronic Periodontitis: A Clinicomicrobiological Study.

Background: One common inflammatory illness that affects periodontal tissues is chronic periodontitis. By lowering inflammation and getting rid of periodontal bacteria, nonsurgical periodontal management is essential for treating chronic periodontitis. The objective of this study was to evaluate the effectiveness of chlorhexidine and feracrylum in nonsurgical periodontal management for persistent periodontitis. Techniques: As part of their periodontal therapy, 50 patients with a diagnosis of chronic periodontitis were randomized into two groups: first got chlorhexidine, while other Feracrylum received feracrylum. Microbiological analysis and clinical parameters were measured at baseline and 3 months later. Results: Clinical metrics showed a considerable improvement in both groups. Comparing feracrylum to chlorhexidine, the former showed stronger antibacterial action against periodontal infections. Conclusion: For nonsurgical periodontal management of chronic periodontitis, feracrylum shows similar effectiveness to chlorhexidine. Furthermore, feracrylum has better antibacterial activity against pathogens of the periodontal tissues, indicating that it might be used as a substitute antimicrobial agent in periodontal management.

Exploring Efficacy and Safety: Comparative Evaluation of Different Irrigation Solutions in Root Canal Therapy at a Tertiary Care Setting.

Background: In order to completely remove bacteria and debris from the root canal system, root canal treatment (RCT) calls for efficient irrigation methods. There is still a lack of research on the relative safety and efficacy of various irrigation systems in tertiary care settings. Methods: Patients receiving RCT at a tertiary care endodontic clinic were included in a prospective comparison research of 150 subjects. One of four irrigation solutions-sodium hypochlorite, chlorhexidine, ethylenediaminetetraacetic acid (EDTA), or a combination of the three-was given to patients at random. Following surgery, microbial decrease and patient-reported pain levels were evaluated. Results: The analysis showed that there were significant differences (P < 0.05) in microbial decrease between the irrigation solution groups. EDTA, sodium hypochlorite, and chlorhexidine were the next three groups with the biggest mean log decrease in microbial counts, after the combination group. Nonetheless, there were no appreciable variations in the groups' patient-reported pain levels (P > 0.05). Conclusion: Our results imply that microbial reduction in RCT is highly influenced by the irrigation solution selection. Without having an impact on the pain sensations reported by the patients, the combination of irrigation solutions showed higher efficacy in microbial control. These findings highlight how crucial it is to choose an irrigation solution carefully in order to maximize endodontic outcomes in tertiary care settings.

The ability of different diffusing enhancers to deliver chlorhexidine into dentinal tubules: An in vitro evaluation.

Background/purpose: Root canal irrigants are difficult to diffuse deep into the dentinal tubules for root canal disinfection. The purpose of this study was to assess the ability of different diffusing enhancers to deliver chlorhexidine (CHX) into dentinal tubules. Materials and methods: The diffusing property of five diffusing enhancers (acetone, DMSO, Triton X-100, JFC-E and azone) into dentinal tubules was firstly assessed using the Rhodamine B. The ability of the diffusing enhancers to deliver CHX into dentinal tubules was then evaluated both qualitatively and quantitatively. A deep dentinal tubule Enterococcus faecalis infection model was further established to test the bactericidal effect of CHX delivered by different diffusing enhancers. Finally, the in vitro cytotoxicity of these diffusing enhancers was tested using the CCK-8 method. Results: Azone, Triton X-100 and JFC-E exhibited the largest maximum diffusing depths at all root canal parts (P < 0.05). Azone group also showed the highest percentage of diffusing depths for all root canal parts, followed by Triton X-100 (P < 0.05). The percentage of dead bacteria in dentinal tubules close to cementum layer was significantly higher in the CHX + azone group than in the other groups (P < 0.05), followed by CHX + Triton X-100 and CHX + JFC-E groups. The concentration of CHX diffusing onto the exterior surface of root was significantly higher in CHX + azone group than in the other groups (P < 0.05). All the diffusing enhancers showed relatively low cytotoxicity. Conclusion: Azone showed the highest diffusing ability with low cytotoxicity and might be employed as a carrier agent for either intracanal irrigants or medications to achieve more thorough root canal disinfection.

Comparative anti-plaque and anti-gingivitis efficiency of Triphala versus chlorhexidine mouthwashes in children: a systematic review and meta-analysis.

The aim of this systematic review is to comparatively evaluate the Triphala and chlorhexidine mouthwashes efficacies in decreasing plaque formation and gingivitis in children. With a priori-set inclusion and exclusion criteria's and relevant MeSH terms, the PubMed, Cochrane and Ovid SP were scrutinized from the year 1980 to April 2023 for prospective articles. Outcomes evaluated were plaque formation and gingivitis through Plaque index and Gingival index. Five studies were finally included and were analyzed qualitatively and quantitatively. Meta-analysis, was performed using a random effects model. Plaque index (PI) and Gingival Index (GI). There was no significant difference between reduction in the gingivitis and plaque accumulation between Triphala and chlorhexidine mouthwash groups in children (p value 0.83, 0.96).

Synergistic effect of essential oils and chlorhexidine against planktonic and biofilm-forming cells of Malassezia pachydermatis.

Malassezia (M.) pachydermatis, is often associated with secondary infection of the skin and external auditory canal in dogs and cats. The treatment of Malassezia infections is based on the local application of antifungals often combined with antiseptics. Due to increased resistance of yeast to commonly used antimycotics, especially in biofilm-forming cells, the use of natural substances, e.g. plant essential oils, appears as a new promised option. In this study, the efficacy of selected plant essential oils (EO) - oregano, rosemary, bergamot, clove, cinnamon, and thyme - in combination with chlorhexidine on both planktonic and biofilm-forming cells of M. pachydermatis, was investigated. The checkerboard test was used to determine the effect of chlorhexidine combined with individual EOs. According to the FICI (fractional inhibitory concentration index) in planktonic cells, most combinations showed additive effect, except for thyme and rosemary EO, where a synergistic effect was found (33.3 % and 16.7 % respectively). In the biofilm-forming cells, a synergistic effect was noted in chlorhexidine combined with bergamot EO, recorded in 6 isolates (33.3 %), and with thyme and oregano EO, detected in 3 isolates (16.7 %). A significant decrease (p ˂ 0.05) was found in FIC (fractional inhibitory concentration) compared to MIC (minimum inhibitory concentration), for both planktonic and biofilm-forming cells. Based on the obtained results, we can conclude that the combination of chlorhexidine with EOs achieved better efficiency than when using each agent alone and made it possible to reduce the concentration of both, and a sufficient antifungal and antibiofilm effect was achieved in M. pachydermatis strains.