Effects of hypochlorous acid mouthwash on salivary bacteria including Staphylococcus aureus in patients with periodontal disease: a randomized controlled trial.

BACKGROUND: The effects of a low concentration of hypochlorous acid (HOCl) mouthwash on salivary bacteria remained unclear. We aimed to evaluate the antibacterial effects of 100 ppm HOCl mouthwash on salivary bacteria, including Staphylococcus aureus (S. aureus), in patients with periodontal disease (PD). METHODS: Patients with PD were randomized into mouthwash-only (MW, n = 26) and mouthwash with periodontal flosser (MWPF, n = 27) groups. Patients without PD were selected for the control group (n = 30). S. aureus culture and saliva samples (before and after the intervention) were collected for bacterial DNA extraction. A real-time polymerase chain reaction assay and serial dilutions of S. aureus culture and saliva samples were used to measure the salivary bacteria total count (SBTC) and confirm the antibacterial effects of the mouthwash using S. aureus. RESULTS: No significant difference in demographic data was observed among the three groups. Before the intervention, the baseline SBTC of the MW and MWPF groups was significantly higher than that of the control group. After the mouthwash rinses, the SBTC data significantly changed in the MW and MWPF groups only (by 62.4% and 77.4%, respectively). After the base-2 log-transformation of the SBTC data, a similar trend was observed. Linear regression revealed that baseline SBTC and the MWPF intervention significantly affected SBTC reduction percentage by volume. After incubation with 10% (v/v) of mouthwash, the survival rates of 106 and 107 colony-forming units/mL of S. aureus were 0.51% ± 0.06% and 1.42% ± 0.37%, respectively. CONCLUSIONS: These study results indicated that 100 ppm HOCl mouthwash treatment could effectively reduce SBTC in patients with PD and the abundance of S. aureus. It provides that the HOCl mouthwash can be an option for individuals to help control SBTC, especially in patients with PD. TRIAL REGISTRATION: The study protocol was approved by the Institutional Review Board of Kaohsiung Medical University Hospital (KMUHIRB-F(I)-20200042) on 20/03/2020 and retrospectively registered at ClinicalTrial.gov (NCT05372835) on 13/05/2022.

Postoperative effects on lower third molars of using mouthwashes with super-oxidized solution versus 0.2% chlorhexidine gel: A randomized double-blind trial.

BACKGROUND: The main objective of the present study is to evaluate the effects and possible benefits with regard to the postoperative period of lower third molar extractions, comparing the intraalveolar application of a bioadhesive gel of 0.2% chlorhexidine (CHX) to the use of a mouthwash with a super-oxidized solution, (SOS) Dermacyn® Wound Care (Oculus Innovative Sciences lnc., California, USA). MATERIAL AND METHODS: A randomized double-blind study was carried out in 20 patients with a split-mouth design, with a total of 40 extractions of symmetrically impacted bilateral lower third molars. Patients were divided into two groups, a control group (C = 20) and an experimental group (D = 20). Any infectious complications, wound healing, plaque accumulation in the stitches, and presence of trismus and inflammation were evaluated using the distance between different facial points, at three, eight, and fifteen days after extraction. Pain, swelling, and amount of analgesics taken were evaluated using the VAS scale throughout the 15 days following extraction. Tolerance to treatment was evaluated using a verbal scale. Results were statistically compared using the Student's t- and chi-squared tests. RESULTS: No statistically significant differences were found between the two groups with regard to infectious complications, swelling, or wound healing. Use of analgesics and self-reported pain levels were slightly lower in the experimental group than in the control group during days 6 and 7 of the study (p < 0.05). The global treatment tolerance was satisfactory and similar in both groups. CONCLUSIONS: Both CHX and SOS are effective at improving the postoperative period after extraction of lower third molars.

Topical Approaches to Improve Surgical Outcomes and Wound Healing: A Review of Efficacy and Safety.

Surgical procedures are an important piece of a dermatologist's daily practice. Therefore, the optimization of post-surgical wound healing is an area of utmost importance and interest. Although low risk, one notable barrier to proper wound healing is surgical site infection.

In an attempt to mitigate this risk and improve surgical outcomes, multiple topical products continue to be used both pre- and postprocedure. Traditionally, this includes both topical antibiotics and antiseptics. However, these products are not without consequence.

The overuse of topical antibiotics as prophylaxis for infection has contributed to increased bacterial resistance, and in fact is no longer recommended by the American Academy of Dermatology in clean post surgical wounds. Topical antiseptics, including chlorhexidine and povidone-iodine, can have a cytotoxic effect on keratinocytes and may actually impede wound healing as a result. In addition, chlorhexidine in particular can produce both otologic and ocular toxic effects when used on the face. Emerging products, such as hypochlorous acid, may be a potential alternative to the more commonly used agents, as it has effective antimicrobial actions and minimal adverse effects. Therefore, the purpose of this review is to highlight several topical products used to optimize post-surgical wound healing and discuss both their efficacy and safety.

J Drugs Dermatol. 2017;16(3):209-212.

Evaluation of an automated dental unit water system's contamination control protocol.

BACKGROUND: This study addresses the efficacy of an automated decontamination protocol using the germicide 'tetra acetyl ethylene diamine (TAED) perborate' (Farmec SpA, Italy). The germicide TAED perborate protocol is used in the Castellini Dental Units fitted with an Autosteril unit (an automated device that can cycle 0.26% TAED perborate solution and sterile water for cleaning the water system between patients and overnight). Prior to testing the Autosteril and the 0.26% TAED perborate protocol on the Logos Jr Dental Unit (Castellini SpA, Italy), TAED perborate was used on a dental unit water system simulation device. METHODS: A dental unit water system simulation device equipped with four dental unit water systems and with naturally grown and mature biofilm contamination was used in this study (three treatment units and one control). One treatment group used a simulated 5 minutes contact with TAED perborate and sterile water for irrigation; the second used a simulated 5 minutes contact with TAED perborate and 2 ppm ClO2 for irrigation; the third used a simulated 5 minutes contact with TAED perborate and municipal water for irrigation. The control group used municipal water for irrigation with no cleaning/disinfection protocols. This protocol was repeated for 30 cycles. Laser scanning confocal microscopy (LSCM) was used to study the effects on natural and mature biofilms, and R2A agar used to quantify heterotrophic plate counts in the effluent irrigant. Antimicrobial efficacy was evaluated by challenging TAED perborate with microbes and spores (M. smegmatis and B. subtilis). Deleterious effects of the germicide were evaluated on metal and nonmetal parts of dental unit water systems. Heterotrophic plate counts using R2A agar and LSCM of the lines were conducted to assess biofilm and microbial control. RESULTS: Baseline water samples showed mean contamination >5.6 log10 cfu/ml. After initial cleaning, all three groups maintained mean contamination levels of less than 1.1 (SD <0.3) log10 cfu/ml. LSCM of baseline samples was positive for live biofilm in all groups. At the end of the study, viable biofilm was only present in the control. In the microbial challenge test, all vegetative organisms were killed within 30 seconds of contact, while spores were killed within 5 minutes. Corrosion was seen in metals used in US-manufactured dental unit materials, while not observed in those used in the Castellini Logos Jr dental unit. CONCLUSION: In this study, the TAED perborate protocol was effective in biofilm control and control of dental treatment water contamination. Use of sterile water or 2 ppm ClO2 along with TAED treatment also controlled planktonic contamination effectively. CLINICAL SIGNIFICANCE: Environmental biofilms contaminate dental unit water systems over time and affect the quality of dental treatment water. Contaminants include environmental biofilms, microbes, including gram-negative rods and endotoxins in high doses that are not of acceptable quality for treating patients. There are many germicidal protocols for treating this contamination and one such is the prescribed use of TAED perborate used in conjunction with sterile water for irrigation in the autosteril device, an integral component of the Castellini dental units for between patient decontamination of dental unit water systems. This study was conducted on an automated simulation dental unit water system to test the TAED perborate protocol's efficacy on naturally grown, mature environmental biofilms, it's efficacy on microbes and spores and it's effects on materials used in dental unit water systems. This translational research addresses both microbial control and material effects of TAED perborate in studying efficacy and possible deleterious effects and simulated use in dentistry. Currently, this antimicrobial use protocol is followed worldwide in the Castellini dental units that are used in day-to-day dental patient care.

The effectiveness of the information-motivation model and domestic brushing with a hypochlorite-based formula on peri-implant mucositis: A randomized clinical study.

OBJECTIVE: Management of mucositis is essential for the long-term maintenance of dental implants. This study determined the efficacy, in terms of clinical parameters, of an adjunctive domiciliary agent paired with non-surgical periodontal therapy (NSPT) for patients with peri-implant mucositis. MATERIALS AND METHODS: Patients involved in a periodontal maintenance program were randomly distributed to the domestic use of a chlorhexidine toothpaste and mouthwash (control) or a hypochlorite-based formula brushing solution (test) after diagnosis of peri-implant mucositis. A modified approach towards NSPTwas performed after 10 days of domestic use of the assigned maintenance product in both groups. Clinical and patient-related outcomes were recorded during a 90-day follow-up period. RESULTS: Forty patients completed the three-month study (20 patients per group). Both groups showed relevant clinical and patient outcome improvements after the NSPT (T2) and between T1 and T2 (p < 0 0.01), except for PPD. For the test group, the clinical improvement was significantly greater than that for the control group at the seventh-day evaluation (T1 ) in the gingival index (0-3) and FMBS (%). Favorable outcomes were maintained during the entire follow-up period. CONCLUSION: The present study showed that the modified NSPT paired with the domestic use of nitradine-based formula helps resolve peri-implant mucositis and that nitradine might represent an alternative to chlorhexidine in these cases. CLINICAL RELEVANCE: The gold standard for nonsurgical maintenance is full-mouth disinfection. A previous decontamination of the oral cavity with chlorhexidine or nitradine domiciliary for 10 days could reduce plaque and inflammation, resulting in a painless operative session. This protocol may help reduce airborne contamination and the risk of cross-infection, and during the pandemic, the protocol is safer for clinicians. In the same clinical cases, nitradine may be more efficient than chlorhexidine, and the former has no side effects such as discolouration.

Dermacyn irrigation in reducing infection of a median sternotomy wound.

BACKGROUND: Sternal wound infection is an infrequent yet potentially devastating complication following sternotomy. Among the standard practices used as preventive measures are the use of prophylactic antibiotics and povidone-iodine as an irrigation agent. A new antiseptic agent, Dermacyn super-oxidized water (Oculus Innovative Sciences), has recently been used as a wound-irrigation agent before the closure of sternotomy wounds. METHODS: This prospective, randomized clinical trial was conducted to compare the effectiveness of Dermacyn and povidone-iodine in reducing sternotomy wound infection in patients undergoing coronary artery bypass graft surgery. Upon chest closure and after insertion of sternal wires, wounds were soaked for 15 minutes with either Dermacyn or povidone-iodine. Subcutaneous tissue and skin were then closed routinely. Patients were followed up, and any wound infection was analyzed. RESULTS: Of the 178 patients, 88 patients were in the Dermacyn group, and 90 were in the povidone-iodine group. The mean (+/-SD) age of the patients was 61.1 +/- 7.6 years. The incidence of sternotomy wound infection was 19 cases (10.7%). Five (5.7%) of these cases were from the Dermacyn group, and 14 (15.6%) were from the povidone-iodine group (P = .033). No Dermacyn-related complication was identified. CONCLUSION: We found Dermacyn to be safe and more effective as a wound-irrigation agent than povidone-iodine for preventing sternotomy wound infection.

Antimicrobial activity of hypochlorite solutions and reciprocating instrumentation associated with photodynamic therapy on root canals infected with Enterococcus faecalis - An in vitro study.

INTRODUCTION: The aim of this study is to evaluate the antimicrobial activity of hypochlorite solutions and reciprocating instrumentation associated with photodynamic therapy (PDT). METHODS: One hundred and thirty two root canals were enlarged up to #35 K-file and inoculated with E.faecalis for 14 days. The 132 samples were randomly divided into eleven groups (n = 12) and subjected to the following protocols: G1-distilled water + Reciproc R40 (control), G2-1% sodium hypochlorite (NaOCl) + Reciproc R40, G3-2.5% NaOCl + Reciproc R40; G4-1% calcium hypochlorite (Ca[OCl]2) + Reciproc R40, G5-2.5% Ca(OCl)2 + Reciproc R40; G6-PDT; G7-distilled water + Reciproc R40 + PDT, G8-1% NaOCl + Reciproc R40 + PDT, G9-2.5% NaOCl + Reciproc R40 + PDT; G10-1% Ca(OCl)2 + Reciproc R40 + PDT, G11-2.5% Ca(OCl)2 + Reciproc R40 + PDT. The percentage bacterial reduction was checked by counting the colony-forming units (CFUs) in 10 samples of each group. The remaining 2 samples of each group were submitted to scanning electronic microscopy (SEM) to illustrate the effectiveness of the proposed treatments. Data were subjected to one-way ANOVA followed by Tukey's post hoc test (α = 0.05). RESULTS: The greatest ability to promote bacterial reduction was observed in groups 8 (1% NaOCl + R40 + PDT), 9 (2.5% NaOCl + R40 + PDT), 10 (1% Ca[OCl]2 + R40 + PDT), and 11 (2.5% Ca[OCl]2 + R40 + PDT), with no significant difference between them (p < 0.05). CONCLUSIONS: The association of PDT with hypochlorite solutions and reciprocating instrumentation provides effective elimination of E.faecalis.

Comparación de la efectividad antimicrobiana entre hipoclorito de sodio 2, 5% y ácido hipocloroso 5% frente a Enterococcus faecalis: prueba in vitro / Comparison of antimicrobial effectiveness between sodium hypochlorite 2.5% and hypochlorous acid 5% against Enterococcus faecalis: an in vitro test

La terapia endodóntica tiene como uno de sus objetivos lograr la completa desinfección del sistema de conductos radiculares. Por esto, se deben seleccionar sustancias irrigantes que tengan la capacidad de eliminar todo el contenido de dicho sistema. La acción antimicrobiana es una de las características más importantes a tener en cuenta en la elección. El hipoclorito de sodio (NaOCl) tiene capacidad bactericida sobre muchos de los microorganismos de la flora endodóntica. El Enterococcus faecalis es una bacteria altamente resistente a antibacterianos que sobrevive en condiciones extremas. El ácido hipocloroso (HOCl) es una molécula derivada del NaOCl que ha demostrado tener alto poder bactericida sobre cepas patogénicas bucales. El objetivo de este trabajo fue evaluar y comparar la efectividad antimicrobiana in vitro del NaOCl 2.5% y el HOCl al 5% frente a Enterococcus faecalis. Una suspensión de Enterococcus faecalis (ATCC29212), de turbidez 0.5 en escala de McFarland, fue inoculada en varios tubos de ensayo, los cuales contenían cada antimicrobiano. Se dejaron actuar durante 1, 5 y 10 minutos para luego neutralizarlos e inclubarlos a 37º C en condiciones de capnofilia durante 48 hs. Todo el procedimiento se realizó por quintuplicado. Los resultados se midieron mediante recuento de UFC/ml. No se evidenció presencia de Enterococcus faecalis en las placas que contenían la solución de NaOCl al 2.5% como tampoco en aquellas que contenían HOCl al 5%. In vitro, el HOCl y el NaOCl en las concentraciones probadas, eliminaron completamente las cepas de Enterococcus faecalis (AU)

Hypochlorous acid and taurine-N-monochloramine in periodontal diseases.

Chronic periodontitis is a multi-factorial disease involving anaerobic bacteria and the generation of an inflammatory response, including the production of metalloproteinases, pro-inflammatory cytokines, and eicosanoids. Hypochlorous acid (HOCl) and taurine-N-monochloramine (TauCl) are the end-products of the neutrophilic polymorphonuclear leukocyte (PMN) respiratory burst. They act synergistically to modulate the inflammatory response. In the extracellular environment, HOCl and TauCl may directly neutralize interleukin 6 (IL-6) and several metalloproteinases, while HOCl increases the capacity of alpha(2)-macroglobulin to bind Tumor Necrosis Factor-alpha, IL-2, and IL-6, and facilitates the release of various growth factors. TauCl inhibits the production of inflammatory mediators, prostaglandins, and nitric oxide. HOCl activates tyrosine kinase signaling cascades, generating an increase in the production of extracellular matrix components, growth factors, and inflammatory mediators. Thus, HOCl and TauCl appear to play a crucial role in the periodontal inflammatory process. Taken together, these findings may offer opportunities for the development of novel host-modulating therapies for the treatment of periodontitis.

Antimicrobials in periodontal maintenance.

Mechanical and chemical antimicrobial intervention is the mainstay of preventive periodontal therapy. Successful periodontal maintenance care depends upon the ability of oral health care professionals to combat periodontal infections, and patient compliance with prescribed follow-up care. Since tooth brushing, flossing, and oral rinsing do not reach pathogens present in furcations and at the depths of deep periodontal pockets, adequate oral hygiene should include subgingival treatment with home irrigators or other appropriate self-care remedies in patients with these conditions. Povidone-iodine for professional use and diluted bleach for self-care are inexpensive and valuable antimicrobial agents in periodontal maintenance. The present article outlines the prudent use of antimicrobial therapy in periodontal maintenance.

Effect of smear layer deproteinizing on resin-dentine interface with self-etch adhesive.

OBJECTIVES: This study aimed to investigate deproteinizing effect of sodium-hypochlorite (NaOCl) and mild acidic hypochlorous-acid (HOCl) pretreatment on smear layer-covered dentine and to evaluate their effects on morphological characteristics of resin-dentine interface with self-etch adhesive. METHODS: Human coronal-dentine discs with standardized smear layer were pretreated with 6% NaOCl or 50ppm HOCl for 15s or 30s. Their deproteinizing effects at the treated smear layer-covered dentine surfaces were determined by the measurement of amide:phosphate ratio using ATR-FTIR analysis. In addition, using TEM, micromorphological alterations of hybridized complex and nanoleakage expression were evaluated at the interface of a self-etch adhesive (Clearfil SE Bond) to the pretreated dentine surface with or without subsequent application of a reducing agent (p-Toluenesulfinic acid salt; Accel(®)). RESULTS: Both pretreatments of NaOCl and HOCl significantly reduced the amide:phosphate ratio as compared with the no-pretreated group (p<0.05), coincident with the elimination of the hybridized smear layer on their bonded interfaces. Nanoleakage within the hybrid layer was found in the no-pretreated and NaOCl-pretreated groups, whereas the subsequent reducing agent application changed the reticular nanoleakage to spotted type. HOCl-pretreated groups showed less nanoleakage expression in a spotted pattern, regardless of reducing agent application. CONCLUSIONS: NaOCl and HOCl solutions could remove the organic component on the smear layer-covered dentine, which could eliminate the hybridized smear layer created by self-etch adhesive, leading to the reduction of nanoleakage expression within hybrid layer. CLINICAL SIGNIFICANCE: Smear layer deproteinizing could modify dentine surface, giving an appropriate substrate for bonding to self-etch adhesive system.

Exit-site care in peritoneal dialysis.

Exit-site infection (ESI), tunnel infection and associated peritonitis are major causes of morbidity and catheter loss in chronic peritoneal dialysis patients. Meticulous exit-site care is vital in preventing ESI. Avoiding trauma to the exit-site and daily cleaning of the exit-site with a dedicated antimicrobial soap is essential for the longevity of the peritoneal dialysis catheter. Antibiotics cream and disinfectant agents including povidone-iodine, chlorhexidine, electrolytic chloroxidizing solutions (Amuchina 10% - ExSept Plus, Amuchina 5% - ExSept) are useful to keep the resident micro-organisms inhibited. ESI rates in peritoneal dialysis patients treated with Amuchina 10% (ExSept Plus) and Amuchina 5% (ExSept) for the exit-site care are similar or lower compared to povidone-iodine or chlorhexidine. Electrolytic chloroxidizing (Amuchina 10% - ExSept Plus and Amuchina 5% - ExSept) solutions for exit-site care are effective for prevention and treatment of ESI.

Materials and methods for cleaning dentures.

Proper hygienic care of removable dentures is an important means of maintaining a healthy oral mucosa in denture wearers. Denture cleanliness is often poor due to improper mechanical cleansing and the relative inefficiency of most commercial products for chemical cleansing of dentures. Dentists and patients should realize that microbial plaque on dentures may be harmful to both the oral mucosa and the patient's general health. It is the responsibility of the patient to maintain oral hygiene through a daily home care routine. It is the obligation of the dentist to motivate and instruct the patient and provide the means and methods for plaque control. Future research should be directed to developing solution cleansers which can maintain plaque-free dentures with a daily soaking period of 15 to 30 minutes and not affect the color and surface luster of the denture acrylic resin.

[Etiology and prevention of recurring aphthous stomatitis]. / Atiologie und Prophylaxe der rezidivierenden Aphthen

New results concerning the etiology of recurrent aphthae are reported. According to own experiments of the authors, adenoviruses persisting in the epithelial cells of the oral mucosa may sensitize the aphthous patient. Adenovirus antigen was demonstrable in the oral mucosa cells in more than 50% of the patients and in the lymphocytes in approx. 1% of the patients. Lymphoblast transformation in the circulating lymphocytes could be demonstrated in vitro with heat-inactivated type 1 adenovirus, in 75% of the patients. This virus type has been isolated from 2 patients. Köbner's isomorphous phenomenon could be demonstrated in aphthous patients. The use of a disinfectant for mouth rinsing, the removal of foci as well as vitamin treatment are recommended for preventing recurrent aphthae.

Intraperitoneal antiseptics in experimental bacterial peritonitis.

A model of bacterial peritonitis, using mice infected with Escherichia coli, has been used to assess the protective effects of intraperitoneal treatment with antiseptics. Of the five antiseptics tested, only chlorhexidine gluconate had any protective effect, concentrations of 0.05 and 0.02 per cent reducing the mortality to 14 and 50 per cent respectively. The other antiseptics, taurolin, noxytiolin, povidone iodine and hypochlorite were all ineffective. Delayed treatment with chlorhexidine was not as effective as instillation immediately postinfection.