Cross-sectional evaluation of periodontal inflammation and oral hygiene status between fixed appliances and Invisalign in patients affected by craniofacial anomalies.

OBJECTIVE: The objective of this cross-sectional study was to compare the difference in the oral health status and oral hygiene of orthodontic treatment with aligners (AL) and with fixed appliances (FA) in patients affected by craniofacial anomalies (CFA). MATERIALS AND METHODS: The sample consisted of 100 Caucasian patients affected by various CFA from two different hospitals. Fifty patients treated with AL were matched for sex, age and CFA with a control sample of 50 patients treated with FA. Patients' periodontal conditions were evaluated in both samples. O'Leary Plaque Control Record, bleeding on probing (BOP) and DMT/dmft Index were evaluated in both samples. RESULTS: The FA group presented an O'Leary Plaque Control Record of 60% ± 30, while AL presented an O'Leary Plaque Control Record of 40% ± 29.7 (p-value = 0.02), BOP was 22.1% ± 14 in FA and 12% ± 0.13 in AL (p-value = 0.03). The DMFT/dmft was not statistically different (p-value = 0.13). p-value was set at <0.039. CONCLUSION: The study shows that the sample with FA presented a higher O'Leary Plaque Control Record and BOP compared to the AL sample. AL might, therefore, be an interesting alternative to FA in patients with CFA, who generally have a lower level of oral hygiene.

Remineralization effect of NaF, NaF with TCP, NaF with CPP-ACP and NaF with CXP varnishes on newly erupted first permanent molars: A randomized controlled trial.

INTRODUCTION: The aim of this study was to evaluate the remineralization effect of NaF, NaF with TCP, NaF with CPP-ACP and NaF with CXP varnishes on newly erupted first permanent molars using laser fluorescence (LF) method. The study was a randomized, double-blind, controlled trial with four parallel groups. METHODS: The study was carried out in 48 high caries-risk children (DMFS >8), aged 6-7 years with newly erupted permanent first molars (initial lesion with 13 < LF value<30). A total of 140 teeth were divided randomly into four groups (n = 35): G1.Duraphat Varnish containing 5% NaF, G2. Clinpro™ White Varnish containing 5% NaF with TCP, G3.Embrace™ Varnish containing 5% NaF with CXP, G4. MI Varnish containing 5% NaF with CPP-ACP. All dental treatments of the patients were completed before the varnish application. The varnishes were applied to the targeted teeth at baseline, 1 and 3 months. Patients were called for follow-up appointments at 1, 3 and 6 months, and LF scanning was used to monitor mineralization changes. Data were analysed statistically by Wilcoxon signed-rank and Mann-Whitney U-tests. RESULTS: In total, 40 children (122 teeth) completed the trial. At the end of 6 months, the amount of reduction in LF values (indicating remineralization) are as follows: NaF with CXP(6.87 ± 4.32) < NaF with TCP(7.36 ± 7.05) < NaF(7.40 ± 7.03) < NaF with CPP-ACP(8.33 ± 4.90). All of the varnishes resulted in significant decrease in LF measurements and there was no significant difference between control (NaF alone) group and other groups. Only MI varnish had a significantly greater remineralization effect than Embrace™ Varnish (p < 0.05). CONCLUSION: As a non-invasive approach, CPP-ACP, TCP and CXP containing NaF varnishes have the potential to remineralize initial caries lesions on permanent first molars in high caries-risk children.

A randomized controlled trial to evaluate the effectiveness of a novel mouth rinse in patients with gingivitis.

BACKGROUND: This single-center, randomized controlled trial aimed to determine the effectiveness of a novel, biofilm-disrupting, mouth rinse that combines Cetylpyridinium chloride (CPC) and essential oils in preventing re-accumulation of supragingival plaque and supragingival microbiome in patients with gingivitis after dental prophylaxis. METHODS: One hundred eighteen participants were randomly assigned in a 1:1 ratio to receive twice-daily test mouth rinse (59) or carrier rinse control (59) for 12 weeks after dental prophylaxis. RESULTS: In a per-protocol analysis that included patients who completed the intervention, the treatment group (39) had significantly lower supragingival plaque scores at 6 and 12 weeks compared to the control group (41; p = 0.022). Both groups showed similar improvement in gingivitis score, but neither group had improvement in bleeding score or probing depth. Thirty-eight (29%) patients did not complete the study due to loss of follow-up (17) or early discontinuation of the assigned intervention (21). Microbiome sequencing showed that the treatment rinse significantly depleted abundant and prevalent members of the supragingival plaque microbiome consortium. CONCLUSIONS: Among patients with gingivitis, the novel mouth rinse significantly reduced re-accumulation of supragingival plaque following dental prophylaxis by depleting supragingival plaque microbiome. However, long-term adherence to the rinse may be limited by adverse effects ( ClinicalTrials.gov number, NCT03154021).

Clinical efficacy of green tea, aloe vera and chlorhexidine mouthwashes in the treatment of dental biofilm induced gingivitis: A multi-arm, double-blinded, randomized controlled clinical trial.

OBJECTIVE: This multi-arm, randomized, double-blinded, controlled clinical trial was designed to evaluate the clinical efficacy of 0.5% green tea (GT), 0.2% chlorhexidine (CHX) and aloe vera (AV) mouthwash as compared to the control (CNT) group (scaling and polishing alone with no mouthwash) in the management of dental biofilm induced gingivitis among 18-40-year-old patients. MATERIAL AND METHODS: Sixty patients with generalized dental biofilm-induced gingivitis were randomly allocated to four study groups (n = 15 each) for treatment, namely Group GT, Group CHX, Group AV and Group CNT after scaling and polishing were administered to all the patients. Plaque index (PI), gingival index (GI) and sulcular bleeding index (SBI) were recorded at baseline, 14th and 21st day. RESULTS: PI, GI and SBI at various time intervals (baseline, 14th and 21st day) showed high statistically significant differences within the group (p < 0.01). Among these, the maximum percentage change was found in the CHX group followed by GT when evaluated from baseline to 21st day. The least percentage change was found in the AV group for PI and GI while the CNT group showed the least percentage change for sulcular index when evaluated from 14th to 21st day. Inter-group results showed high statistically significant differences (p < 0.01) for PI and GI when evaluated between baseline to 14th day and baseline to 21st day. SBI also showed statistically significant differences (p < 0.05) when evaluated between baselines to 14th day and baseline to 21st day. CONCLUSION: Green tea mouthwash displayed a significant reduction in plaque index, gingival index and sulcular bleeding index. 0.5% green tea catechin has equivalent anti-plaque efficacy as 0.2% chlorhexidine gluconate and can be considered a potent alternative to prevent and treat gingival diseases.

Anti-inflammatory effect of salt water and chlorhexidine 0.12% mouthrinse after periodontal surgery: a randomized prospective clinical study.

OBJECTIVES: The purpose of this study was to compare the anti-inflammatory efficacy of sodium chloride- and a 0.12% chlorhexidine mouth rinses in patients undergoing minimal invasive periodontal surgery. MATERIALS AND METHODS: Forty-seven patients with a diagnosis of periodontitis and indication for access flap procedure were randomly selected. Group A: a sodium chloride (salt)water-based mouth rinse (test group) or group B: a 0.12% chlorhexidine mouth rinse (control group) administered after surgery. Gingival Index (GI) were evaluated in the whole mouth and in the surgical site at baseline (T1), a week later (T2), and 12 weeks (T3) after the treatment. Total MMP activity was measured in GCF using a commercial kit and plate reader. Medians of total MMP activity and GI were compared for time intervals T1 vs. T2, T1 vs. T3, and T2 vs T3 using Friedman tests and Wilcoxon signed rank tests, and were also compared between test and control using Mann-WhitneyU tests at each timepoint. RESULTS: The average GI values showed significant differences between baseline and T2 (p = 0.0005) and baseline and T3 (p = 0.003) in the test group. CONCLUSION: The sodium chloride-mouth rinse use after periodontal surgery seems to have similar anti-inflammatory properties as CHX mouth rinse and can be used regularly postoperatively after periodontal surgical procedures. CLINICAL RELEVANCE: The use of salt water mouthwash showed an anti-inflammatory effect similar to CHX 0.12% after minimal invasive periodontal surgery. Salt water mouthwash is accessible to the world population and can contribute on the healing process after periodontal surgery.

Optimization of Fungal Dextranase Production and Its Antibiofilm Activity, Encapsulation and Stability in Toothpaste.

Dextranase catalyzes the degradation of the substrate dextran, which is a component of plaque biofilm. This enzyme is involved in antiplaque accumulation, which can prevent dental caries. The activity of crude dextranase from Penicillium roquefortii TISTR 3511 was assessed, and the maximum value (7.61 unit/g) was obtained at 37 °C and pH 6. The Plackett-Burman design was used to obtain significant factors for enhancing fungal dextranase production, and three influencing factors were found: Dextran, yeast extract concentration and inoculum age. Subsequently, the significant factors were optimized with the Box-Behnken design, and the most suitable condition for dextranase activity at 30.24 unit/g was achieved with 80 g/L dextran, 30 g/L yeast extract and five day- old inoculum. The use of 0.85% alginate beads for encapsulation exhibited maximum dextranase activity at 25.18 unit/g beads, and this activity was stable in toothpaste for three months of testing. This study explored the potential production of fungal dextranase under optimal conditions and its encapsulation using alginate for the possibility of applying encapsulated dextranase as an additive in toothpaste products for preventing dental caries.

Evaluation of substantivity of hypochlorous acid as an antiplaque agent: A randomized controlled trial.

BACKGROUND: Hypochlorous acid (HOCl) is a non-antibiotic antimicrobial substance with significant effects on pathogenic oral micro-organisms. The effects of HOCl as an antiplaque agent have not been studied. OBJECTIVE: The aim of this study was to evaluate the substantivity of HOCl mouthwashes compared with chlorhexidine (CHX) rinses and a placebo. MATERIALS AND METHODS: A double-blind randomized controlled trial with 75 participants was conducted. Participants were divided into five groups using block randomization: 0.025% HOCl, 0.05% HOCl, 0.12% CHX, 0.2% CHX, and sterile water as a placebo. Participants were instructed to use each rinse solution for 30 seconds after dental prophylaxis. Samples of saliva were taken at baseline and after 30 seconds, 1, 3, 5 and 7 hours to assess substantivity, and bacterial viability was established by the fluorescence method. Visible plaque in all participants was assessed with the Turesky index at baseline and at 7 hours, and adverse events were also assessed. RESULTS: HOCl led to a 33% reduction in bacterial counts in the saliva after 30 seconds compared with a 58% reduction by CHX. HOCl has no substantivity, and bacterial counts returned to baseline after 1 hour. Placebo treatment led to the highest plaque count after 7 hours compared with the CHX and HOCl groups, although the differences were not significant. HOCl rinsing induced the highest percentages of unpleasant taste and dryness sensations. CONCLUSIONS: HOCl rinses have an initial effect on bacterial viability in saliva but have no substantivity. Other mechanisms may explain its antiplaque effect.

Development of a Sustained Antiplaque and Antimicrobial Chewing Gum of a Decapeptide.

The objective of this paper was to design a chewing gum formulation delivery system in situations where typical dental hygiene practice is not practical. Thus, an analog of decapeptide KSL (KSL-W), known to possess antimicrobial and antiplaque activity, was incorporated into a chewing gum formulation containing cetylpyridinium chloride (CPC). The effect of the excipients, xylitol, and peppermint oil on active ingredients in vitro release was also assessed. Gum formulations were prepared with different excipient parameters, including heating xylitol and gum base at 65 or 85°C, using ground and unground xylitol, and the addition of 1.5, 3, and 7% peppermint oil, to determine the effect of these changes on the in vitro release of KSL-W and CPC using a chewing machine. The antimicrobial and antiplaque activities of solutions released from chewed gum formulation as well as prepared standard solutions with different concentrations were tested against placebo. The optimal temperature to avoid crystallization of xylitol during preparation was 65°C. Grinding xylitol to 104.5 µm improved release of active ingredients as compared to commercially unground xylitol. Peppermint oil had opposite effects on release of KSL-W and CPC. Peppermint oil at 1.5% was determined to be suitable (91 and 88% of KSL-W and CPC released, respectively, after 40 min). The gum formulation illustrated good sustained release of KSL-W and CPC with antibacterial and antiplaque activities after chewing. An effective antimicrobial and antiplaque chewing gum formulation was developed. This formulation has the potential to overcome oral hygiene issues in those unable to follow normal dental protocols.

Comparing the effect of 0.06% -, 0.12% and 0.2% Chlorhexidine on plaque, bleeding and side effects in an experimental gingivitis model: a parallel group, double masked randomized clinical trial.

BACKGROUND: Chlorhexidine is the gold standard of dental plaque prevention. The aim of the present study was to compare the plaque and gingivitis inhibiting effect of commercial products containing 0.2%, 0.12% and 0.06% chlorhexidine in a modified experimental gingivitis model. METHODS: In three groups of healthy volunteers, experimental gingivitis was induced and monitored over 21 days and simultaneously treated with the commercial solutions containing 0.2%, 0.12% and 0.06% chlorhexidine. The maxillary right quadrant of each individual received mouthwash only, whereas the maxillary left quadrant was subject to both rinsing and mechanical oral hygiene. Compliance and side effects were monitored at days 7, 14, and 21. Plaque and gingivitis scores were obtained at baseline and day 21. RESULTS: The commercial mouthwash containing 0.2% chlorhexidine resulted in statistically significantly lower plaque scores than the 0.12 and 0.06% mouthwashes after 21 days use, whereas no statistically significant difference was found between the effects of the two latter. CONCLUSION: A commercially available mouthwash containing 0.2% chlorhexidine had statistically significant better effect in preventing dental plaque than the 0.12% and 0.06% solutions. TRIAL REGISTRATION: ClinicalTrials.gov NCT02911766 . Registration date: September 9th 2016.

Glycolysis and Automated Plaque Regrowth Method for Evaluation of Antimicrobial Performance.

PURPOSE: This study explored the potential of a new in vitro method in evaluating antiplaque benefits from five sets of antimicrobial systems including cetylpyridinium chloride (CPC), stannous fluoride (SnF2), Listerine essential oil mouthwashes (+/- alcohol), zinc chloride (ZnCl2), and sodium fluoride. (NaF). METHODS: Gingival dental plaque was collected and propagated using sterilized tryptic soy broth and sucrose, and then allocated into separate glycolysis and regrowth recipes for antiplaque evaluations. Glycolysis measurements (in duplicate) were recorded via pH microelectrode on plaque-treatment samples thermomixed (1200 rpm, 37 °C) for 4 h. For plaque regrowth, optical densities (in duplicate) were automatically collected on plaque-treatment samples using a microplate reader (linear shaking, 37 °C) from baseline to 4 h. RESULTS: Calculations of percent change in pH and optical density were performed and analyzed for each set of antimicrobial treatment groups. Statistical analysis (one-way ANOVA, Student-Newman-Keuls stepwise comparison tests) revealed dose responses and significant differences (p < 0.05) among treatment groups, including between negative and clinically relevant positive controls. CONCLUSIONS: This lab method produces results consistent with published clinical observations. This glycolysis and plaque growth method is sensitive to antimicrobial mechanisms of action, and may offer a convenient and clinically relevant screening tool in the evaluation of putative antimicrobial agents and formulations.

Hypochlorous Acid as a Potential Postsurgical Antimicrobial Agent in Periodontitis: A Randomized, Controlled, Non-Inferiority Trial.

BACKGROUND: Hypochlorous acid (HOCl) is an antimicrobial agent with high affinity to Gram-negative bacteria of the subgingival biofilm. It could have an equivalent or no inferiority effect to chlorhexidine (CHX) to avoid recolonization of these microorganisms after the post-surgical period. OBJECTIVE: The objective is to compare the reduction of plaque index (PI), gingival index (GI), pocket depth (PD), gain of clinical attachment level (CAL), and bacterial recolonization of periodontopathic microorganisms in subgingival biofilm at 7, 21, and 90 days after Open Flap Debridement (OFD) under two antimicrobial protocols: (A) HOCl 0.05% followed by HOCl 0.025% and (B) CHX 0.2%/CHX 0.12% used per 21 days without regular oral hygiene during the post-surgical period. MATERIAL AND METHODS: A no-inferiority randomized controlled trial was carried out. Thirty-two patients were randomly divided to receive each antiplaque protocol after OFD in patients with periodontitis. Clinical indexes and bacterial recolonization were assessed using qPCR for up to 90 days. Data were analyzed using repeated measures ANOVA, mixed effects models adjusted for treatment, time, and the Chi-squared/Fisher test. A no-inferiority analysis was also performed using the Hodges-Lehmann hypothesis test for non-inferiority. RESULTS: HOCl was not inferior to CHX in reducing PI. Both groups showed a comparable reduction of recolonization for Porphyromonas gingivalis, Tannerella forsythia, and Eubacterium nodatum. However, the HOCl protocol was non-inferior to the CHX protocol for Treponema denticola and Aggregatibacter actinomicetemcomitans. CONCLUSIONS: HOCl improved periodontal healing. HOCl showed an impact in reducing the recolonization of periodontopathic bacteria in the postoperative period.

A Cross-Sectional Study to Evaluate Dental Professionals' Knowledge of Antiplaque Mouth Rinse Agents and their Application in Periodontal Practice.

Background: Mouth rinse agents reduce inflammation and microbial burden, improving periodontal clinical parameters. Yet, improper clinical use of these compounds might have several deleterious repercussions. Given the lack of research on the knowledge and application of antiplaque mouth rinse agents, this research was conducted. Methods: The research is an electronic survey wherein responses were gathered for ten items with predetermined answers in addition to covariate data. The questions were conceived to illuminate the level of knowledge possessed by dental professionals and their utilization pattern in periodontal practice. The data gathered underwent quantitative statistical analysis. Results: Participants in the study included 100 dental professionals from various disciplines, all of whom agreed that mouth rinses are a vital adjuvant in periodontal therapy. Most acknowledged being aware of the various mouth rinse agents, but their knowledge and application of mouth rinses were largely confined to chlorhexidine gluconate, with little consideration being given to alternative antiplaque agents. Conclusion: Little knowledge exists among dental professionals regarding mouth rinse agents and their appropriate application. Dental schools, clinical advisory organizations, and other establishments could educate dental professionals on the specific guidelines for utilizing antiplaque mouth rinses in a dental context, especially as an adjunct to periodontal therapy.

Piperine-Loaded In Situ Gel: Formulation, In Vitro Characterization, and Clinical Evaluation against Periodontitis.

Periodontitis is an inflammatory disorder associated with dysbiosis and characterized by microbiologically related, host-mediated inflammation that leads to the damage of periodontal tissues including gingiva, connective tissues, and alveolar bone. The aim of this study was to develop an in situ gel consisting of piperine. Eight in situ gel formulations were designed by varying the concentration of deacylated gellan gum cross-linked with sodium tripolyphosphate, and poloxamer-407. The prepared gels were evaluated for gelation temperature, gelation time, viscosity, piperine-loading efficiency, and piperine release. Finally, the optimized formula was evaluated for anti-inflammatory effectiveness among human patients during a 14-day follow-up. The optimized in situ gel formulation exhibited a gelation temperature of 35 ± 1 °C, gelling of 36 ± 1 s, excellent syringeability, and piperine loading of 95.3 ± 2.3%. This formulation efficiently sustained in vitro drug release for up to 72 h. In vivo studies revealed an efficient sol-to-gel transformation of optimized in situ gel formulation at physiological conditions, permitting an efficient residence time of the formulation within a periodontitis pocket. Most importantly, a clinical study revealed that treatment with the optimized formulation elicited a significant reduction in the mean plaque score (p = 0.001), gingival index (p = 0.003), and pocket depth (p = 0.002), and exerted a potent anti-inflammatory potential, compared to the control group. Collectively, piperine-loaded in situ gel might represent a viable therapeutic approach for the management of gingival and periodontal diseases.

Comparative evaluation of nutmeg mouthwash and 0.2% chlorhexidine gluconate mouthwash on halitosis and plaque control: A randomized clinical trial.

Background: Myristica fragrans, commonly known as nutmeg, has been shown to have many medicinal properties including reduction of plaque and oral halitosis. In the present study, a mouthwash was prepared from nutmeg oil to compare its effectiveness with 0.2% chlorhexidine (CHX) gluconate mouthwash on halitosis and plaque control. Materials and Methods: A total of 60 participants having plaque and plaque-induced oral halitosis were enrolled and randomly divided into two groups as Group A (30) and Group B (30). Nutmeg and 0.2% CHX gluconate mouthwash were administered in Group A and Group B, respectively, for 21 days twice daily. Plaque index and organoleptic score were recorded at baseline, 14th day, and 21st day. The data were collected, tabulated in Microsoft Excel Sheet, and subjected to statistical analysis using appropriate statistical tests. Results: The percentage of change in plaque score between baseline and 14th day was 12.3% and 9.44% (P = 0.741), between baseline and 21st day 39.2% and 39.4% (P = 0.889), and between 14th and 21st day 27.7% and 29.9% (P = 0.805) for Group A and Group B, respectively, while the percentage of change in halitosis score between baseline and 14th day was 24.7% and 16.3% (P = 0.201), between baseline and 21st day 54.5% and 56.3% (P = 0.487), and between 14th and 21st day 34.9% and 40.0% (P = 0.393) for Group A and Group B, respectively. Conclusion: Nutmeg mouthwash is organic, economical, and equally effective as compared to 0.2% CHX gluconate mouthwash (Clinical Trials Registry-India/2020/10/028540).

Aloe vera mouthwashes can be a natural alternative to chemically formulated ones - A randomized-controlled trial.

Objectives: To evaluate the antiplaque and antibacterial efficacy of commercially available mouthwashes containing aloe vera (AV), hydrogen peroxide (HP), and cetylpyridinium chloride (CPC) in a 4-day plaque regrowth study. Methods: Plaque score and salivary samples were assessed (Day-0 and Day-4) in 96 participants in a randomised, double-blind prospective parallel-arm 4-day plaque regrowth study. Participants were divided into five groups who refrained from engaging in regular oral hygiene measures during the study period and used commercially available mouthwashes containing AV, HP, and CPC as test products with distilled water (DW) and chlorhexidine (CHX) mouthwash as negative and positive controls, respectively. Salivary bacterial count was expressed as colony-forming units (CFU) (culture method). Results: There was a significant difference both in plaque score (p < 0.001) and in CFU (p < 0.001) among the study mouthwashes at Day-4. The plaque score and CFU of AV were significantly higher and lower than those of CHX and DW, respectively. The plaque score of HP was significantly higher than that of AV (p = 0.016) and CPC (p < 0.001). No significant difference was observed between AV and CPC (p = 0.70). Moreover, the CFU of HP was significantly higher than that of CPC (p = 0.04). There was no statistically significant difference between the CFU of mouthwashes containing AV and HP (p = 0.912) or AV and CPC (p = 0.280). No significant difference was seen in the inhibition of plaque and salivary bacterial count between AV, HP, and CPC. Conclusion: The antiplaque and antibacterial efficacy of commercially available AV mouthwash was similar to that of CPC and significantly better than that of HP mouthwash and can be a natural alternative to chemically formulated mouthwashes.

Antibacterial Action, Substantivity and Anti-plaque Effect of Different Toothpaste Slurries - A Randomised Controlled Trial.

PURPOSE: This single-center, clinically controlled, double-blinded, randomised, crossover study aimed to evaluate and compare the antibacterial effect, substantivity and patients' acceptance of three toothpaste slurries after a single application on established biofilms observed for 24 h. MATERIALS AND METHODS: Twenty-four participants started a test cycle after refraining from oral hygiene for 48 h, with a baseline plaque sample measuring biofilm vitality (in %; VF0) using vital fluorescence (VF). They were instructed to rinse for 1 min with either an amine fluoride, stannous chloride (ASC), an herbal (SBC) or a sodium fluoride (SFL) toothpaste prepared as slurries. Every two hours up to 12 and after 24 h, plaque samples were harvested (VF2-VF24%). Plaque-covered areas (PA in %) were evaluated after 24 h using digital photographs. Patients' acceptance was determined by visual analogue scale (VAS) questionnaire. RESULTS: All participants (16 women, 8 men; 27.5 ± 7.9 years) completed all cycles. Two hours after application (VF2), all toothpastes showed a statistically significant reduction in bacterial vitality (p < 0.05), maintained up to 12 h. ASC revealed statistically significantly lower vitality values compared to SBC at VF2, VF4, VF8, VF12 and VF24, and at VF4, VF12 and VF24 compared to SFL (p < 0.05), while SBC and SFL did not differ statistically significantly at any time point. The preferred toothpastes were SFL (18/24 participants) and ASC (15/24 participants). CONCLUSIONS: All toothpastes showed statistically significant anti-plaque effects on established plaque biofilm and a substantivity up to 24 h compared to their baseline, while ASC still presented a statistically significant effect after 12 and 24 h compared to SBC and SFL.

Comparative Evaluation of Chitosan Chlorhexidine Mouthwash in Plaque Control: A Preliminary Randomized Controlled Clinical Trial.

AIMS: The purpose of the present study was to compare the effect of a new mouth wash formulation consisting of chlorhexidine and chitosan on dental plaque and its reduction to that of chlorhexidine or chitosan alone. MATERIALS AND METHODS: This study was a single-blind randomized clinical trial with a parallel group design of 3 months duration. Patients (20-40 years) who fulfilled the inclusion and exclusion criteria were assigned equally to group 1: chlorhexidine (0.2%), group 2: chitosan (0.5%) or group 3: chlorhexidine - chitosan combination group. The clinical parameters were recorded at baseline, 6weeks and at 3months. All patients received thorough oral prophylaxis and were instructed to rinse with 10ml of mouthwash twice daily for 1 minute. RESULTS: The combination of chitosan and chlorhexidine showed a statistically significant reduction (p less than0.05) in plaque indices from baseline at all time intervals when compared to that of chlorhexidine or chitosan alone. CONCLUSIONS: Our study demonstrates that by unifying the properties of chitosan and chlorhexidine may result in a superior antiplaque effect than that of chlorhexidine alone.

Evaluation of the efficacy of subgingival irrigation in patients with moderate-to-severe chronic periodontitis otherwise indicated for periodontal flap surgeries.

BACKGROUND: In certain medically and physically compromised; and terminally ill patients, periodontal surgery may not be feasible. They need special attention and assistance for their daily plaque control regimens for the management and maintenance of periodontal conditions. Subgingival irrigation home care devices with antiplaque agents may serve as useful tools in such specific patient populations. AIMS: The aim of this study was to evaluate of the efficacy of sub-gingival irrigation in patients with moderate-to-severe chronic periodontitis otherwise indicated for periodontal flap surgeries. SETTINGS AND DESIGN: Randomized comparative parallel group interventional clinical trial. MATERIALS AND METHODS: Forty adults with moderate-to-severe periodontitis, divided inot Group A and B, were subjected to the use of subgingival home irrigations using 0.06% chlorhexidine (CHX) and mouth-rinsing with 15 ml of 0.12% CHX twice daily, respectively after Phase I therapy. Clinical parameters, i.e., gingival index, oral hygiene index simplified, and bleeding on probing scores were assessed at baseline, 2 weeks, 4 weeks, and 12 weeks' postphase I therapy, whereas clinical attachment level (CAL), probing depth (PD), and stain assessment at baseline and 12 weeks following Phase I therapy. STATISTICAL ANALYSIS USED: Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, USA version 15.0 for Windows). RESULTS: A statistically significant difference was seen with the use of 0.06% CHX irrigations in PD (P = 0.004) and CAL (P = 0.002) as compared to the use of mouth rinsing with 0.12% CHX. Similar differences were observed in both intensity (P = 0.014) and area (P = 0.034) of lingual surface staining with greater staining with CHX mouth rinsing. CONCLUSION: The adjunctive use of subgingival home irrigations using 0.06% CHX has a promising potential to maintain the oral health and results in lesser staining compared to CHX mouth rinsing. The regimen may further obviate the need of periodontal surgery in medically compromised subjects.

Effects of statins on multispecies oral biofilm identify simvastatin as a drug candidate targeting Porphyromonas gingivalis.

BACKGROUND: Statins effectively reduce risk of cardiovascular-related morbidity and mortality in patients with hyperlipidemia, hypertension, or type 2 diabetes. In addition to lowering cholesterol levels, several studies have attributed statins with immunomodulatory and bactericidal properties. Therefore, the aim of this study was to investigate statins' antimicrobial activity against periodontal homeostasis bacteria. METHODS: Statin effect on bacterial growth was tested using planktonic monocultures and multibacterial biofilms. The latter consisted of five microbial species (Porphyromonas gingivalis, Fusobacterium nucleatum, Actinomyces naeslundii, Tannerella forsythia, and Streptococcus gordonii) associated with dysbiosis of the oral microbiota underlying establishment and perpetuation of periodontitis. RESULTS: All four tested statins efficiently inhibited P. gingivalis growth and significantly decreased the cumulative bacterial load in developing and established biofilms. Simvastatin was most efficient and decreased P. gingivalis counts more than 1,300-fold relative to the control. CONCLUSIONS: These findings suggest that similar effects on bacterial composition of the dental plaque may occur in vivo in patients on statins, thus, leading to a shift of the oral microbiome from a dysbiotic to a more homeostatic one. Simvastatin, being highly effective against P. gingivalis while not affecting commensal microbiota, possesses many properties qualifying it as a potential adjunctive treatment for chronic periodontitis. Further studies are needed to evaluate whether similar effects on bacterial composition of the dental plaque may occur in vivo in patients on statins, thus, leading to a shift of the oral microflora from dysbiotic to a more homeostatic one.

Comparative evaluation of antiplaque and antigingivitis effects of an herbal and chlorine dioxide mouthwashes: A clinicomicrobiological study.

AIM: The aim of the present study was to compare the efficacy of herbal mouthwash and chlorine dioxide mouthwash in reduction of plaque and gingivitis. SETTINGS AND DESIGN: In a randomized clinical trial, forty patients were randomly selected and divided equally into two groups. MATERIALS AND METHODS: After professional oral prophylaxis, the clinical parameters plaque index, gingival index, and modified sulcular bleeding index were recorded at baseline, 7th day, 14th day, and 21st day. The plaque samples were collected from gingival sulcus with an absorbent sterile paper point and were stored in a thioglycollate broth, then sent for microbiological examination. The microbial colony-forming units were assessed at baseline, 7th day, 14th day, and 21st day for Streptococcus mutans, Tannerella forsythia, and Fusobacterium nucleatum. RESULTS: There was a statistical significant reduction in both clinical and microbiological parameters were observed with use of both the mouthwashes. However, herbal mouthwash was more effective in reducing the plaque and gingivitis than chlorine dioxide mouthwash. CONCLUSION: Herbal mouthwash was statistically efficacious in controlling plaque and gingivitis with potent antimicrobial activity.