Over-the-counter products in tooth bleaching: A scoping review.

OBJECTIVE: To map and summarize the current scientific evidence concerning the active ingredients, effectiveness, and adverse effects of over-the-counter (OTC) bleaching products. DATA AND SOURCE: This study was conducted according to the PRISMA-ScR guidelines for scoping reviews and registered on the Open Science Framework platform. STUDY SELECTION: Database searches were conducted in PubMed/MEDLINE, Embase, and Scopus up to January 2024. All in vitro, in situ, and clinical studies evaluating the effectiveness and adverse effects of OTC bleaching products were included. A descriptive analysis of the included studies was performed. RESULTS: A total of 88 studies were included. Most of them were in vitro studies (n = 49), followed by randomized clinical trials (n = 28). The main OTC bleaching products identified were whitening or stain-removing toothpastes (n = 42), followed by whitening strips (n = 39). Most clinical studies indicate that whitening strips are effective in improving tooth color and providing whitening benefits. In contrast, the bleaching effectiveness of toothpastes, mouth rinses and whitening trays was mainly supported by in vitro studies. The main adverse effects associated with OTC bleaching agents were tooth sensitivity and gingival irritation. CONCLUSION: A wide variety of OTC bleaching products is available for consumer self-administered use. Clinical studies have mainly confirmed the bleaching effectiveness of whitening strips, while the validation for toothpastes, mouth rinses and whitening trays has mainly relied on in vitro studies. Nevertheless, the use of OTC bleaching products may result in adverse effects, including tooth sensitivity, gingival irritation, and enamel surface changes. CLINICAL SIGNIFICANCE: Some over-the-counter bleaching products may have whitening properties supported by clinical studies, particularly those containing hydrogen or carbamide peroxide. Nonetheless, clinicians must be aware of the potential risks associated with excessive self-administration of these products, which may result in adverse effects.

Randomized placebo-controlled phase II trial of high-dose melatonin mucoadhesive oral gel for the prevention and treatment of oral mucositis in patients with head and neck cancer undergoing radiation therapy concurrent with systemic treatment.

PURPOSE: The objective of this trial was to evaluate the safety and efficacy of melatonin oral gel mouthwashes in the prevention and treatment of oral mucositis (OM) in patients treated with concurrent radiation and systemic treatment for head and neck cancer. METHODS: Randomized, phase II, double-blind, placebo-controlled trial (1:1 ratio) of 3% melatonin oral gel mouthwashes vs. placebo, during IMRT (total dose ≥ 66 Gy) plus concurrent Q3W cisplatin or cetuximab. Primary endpoint: grade 3-4 OM or Severe Oral Mucositis (SOM) incidence by RTOG, NCI, and a composite RTOG-NCI scales. Secondary endpoints: SOM duration and grade 2-4 OM or Ulcerative Oral Mucositis (UOM) incidence and duration. RESULTS: Eighty-four patients were included in the study. Concurrent systemic treatments were cisplatin (n = 54; 64%) or cetuximab (n = 30; 36%). Compared with the placebo arm, RTOG-defined SOM incidence was numerically lower in the 3% melatonin oral gel arm (53 vs. 64%, P = 0.36). In patients treated with cisplatin, assessed by the RTOG-NCI composite scale, both SOM incidence (44 vs. 78%; P = 0.02) and median SOM duration (0 vs. 22 days; P = 0.022) were significantly reduced in the melatonin arm. Median UOM duration assessed by the RTOG-NCI scale was also significantly shorter in the melatonin arm (49 vs. 73 days; P = 0.014). Rate of adverse events and overall response rate were similar between the two arms. CONCLUSIONS: Treatment with melatonin oral gel showed a consistent trend to lower incidence and shorter SOM duration and shorter duration of UOM. These results warrant further investigation in phase III clinical trial.

Over-the-counter mouthwash use, nitric oxide and hypertension risk.

Purpose: Mouthwash is used by a large population. Short-term clinical trials have shown that antibacterial mouthwash deplete oral nitrate-reducing bacteria, and decrease systemic nitric oxide bioavailability. Our previous publication from the San Juan Overweight Adults Longitudinal Study (SOALS) was the first to show frequent over-the-counter mouthwash use was independently associated with increased risk of prediabetes/diabetes. This manuscript evaluates whether over-the-counter mouthwash was associated with increased risk of hypertension.Materials and methods: SOALS recruited 40-65 year old overweight/obese individuals; baseline evaluations started in 2011 and the 3-year follow-up exam was completed by 2016. From the 1028 participants (76%) who completed follow-up, we excluded people with reported physician diagnosis of hypertension or systolic or diastolic BP at or above the hypertension cut-offs (n = 481), missing smoking (n = 1), missing physical activity (n = 1) and missing alcohol intake (n = 5) at baseline; 540 participants were included. The primary exposure was mouthwash use twice daily or more. The primary outcome for this manuscript is self-reported physician-diagnosed hypertension over the follow-up. We used Poisson regression controlling for age, sex, smoking, physical activity, waist circumference, alcohol intake, systolic blood pressure, pre-diabetes/diabetes status and cardiac medication use. We additionally evaluated other mouthwash use categorizations.Results: Twelve percent (66/540) developed hypertension over follow-up. People who used mouthwash twice/day or more had higher incidence of hypertension compared to less frequent users (Incidence Rate Ratio = 1.85; 95% Confidence Interval: 1.17, 2.94), and compared to non-users (IRR = 2.17; 95% CI: 1.27, 3.71). Several additional potential confounders evaluated did not impact these associations. Associations persisted among never smokers. Additional outcomes including BP assessed at a single study visit did not show associations.Conclusion: In this study, frequent regular use of over-the-counter mouthwash was associated with increased risk of hypertension, independent of major risk factors for hypertension and several other potential confounders.

Oral hygiene in intensive care unit patients with photodynamic therapy: study protocol for randomised controlled trial.

BACKGROUND: In intensive care units (ICUs), nosocomial infections are prevalent conditions and they have been related to high mortality indexes. Some studies have suggested that inefficient oral hygiene and ventilator-associated pneumonia (VAP) are related. Nowadays, in the Brazilian public health system there is no well-defined protocol for oral hygiene in an ICU. Due to the drawbacks of the use of antibiotics, photodynamic therapy (PDT) has emerged as an interesting technique in order to reduce antimicrobial-resistant pathogens. Methylene blue (MB) is the most common chemical agent for PDT in Brazil. However, new formulations for improved effectiveness are still lacking. The objective of this study is to evaluate the use of an MB mouthwash as an effective oral-hygiene procedure in an ICU and to show that oral hygiene using PDT with MB mouthwash may reduce VAP frequency to rates similar to, or higher than, chlorhexidine. METHODS: Phase 1 will evaluate the most effective cleaning procedure, while phase 2 will correlate oral hygiene to VAP incidence. At the start of phase 1, the ICU patients will be randomly allocated into three different groups (10 patients/group): the efficacy of chlorhexidine, classical MB-PDT, and mouthwash MB-PDT will all be measured for the quantification of viable bacteria, both pre- and post-treatment, by a Reverse Transcription Polymerase Chain Reaction (RT-PCR). In phase 2, the most effective procedure found in phase 1 and a mechanical cleaning with filtered water will be carried out daily, once a day, over 5 days, with a total of 52 ICU patients randomly allocated into the two groups. The clinical records will be evaluated in order to find any pneumonic diagnoses. DISCUSSION: Since a variety of bacterial species are related to VAP, a universal primer for bacteria will be used in order to quantify the total bacteria count in the participants' samples. In order to quantify only the living bacteria before DNA extraction, the samples will be treated with propidium monoazide. This will infiltrate the dead bacteria and will intercalate the DNA bases, avoiding their DNA amplification. This will be the first trial to evaluate MB-PDT in a mouthwash formula that can increase the effectiveness due to the control of MB aggregation. The results of this study will be able to generate an easy and low-cost protocol to be used in an ICU for the Brazilian public health system. TRIAL REGISTRATION: This protocol was approved by the Research Ethics Committee of the Conjunto Hospitalar do Mandaqui (1.317.834, CAAE: 49273515.9.3001.5551) and it was registered in Registro Brasileiro de Ensaios Clínicos (ReBEC number: RBR-94bvrc;). First received: 12 July 2015; 1st version 6 June 2016. Data will be published in a peer-reviewed journal.

Na antissepsia peri-bucal pré-operatória de exodontias deve-se utilizar clorexidina ou pvp-i? / Should chlorhexidine or pvp-i be used in preoperative peri-oral antisepsis of extractions?

A odontologia contemporânea tem se preocupado de grande maneira com o aumento de transmissão de doenças infecto-contagiosas e contaminação cruzada no sítio cirúrgico. Este estudo objetivou avaliar a eficácia da antissepsia em efeito imediato de dois antissépticos na redução bacteriana da região peri-bucal, previamente aos procedimentos cirúrgicos em exodontia. A pesquisa foi realizada nas clínicas odontológicas do Centro de Ensino Superior dos Campos Gerais (CESCAGE), localizado na cidade de Ponta Grossa-PR. Para realização do experimento foram coletadas amostras de 38 pacientes. Em cada paciente foram colhidas 3 amostras, divididas essas em 3 grupos: Grupo A: Material Controle, Grupo B: Digluconato de Clorexidina a 2% e Grupo C: PVP-I (polivinilpirrolidona-iodo). Em 12 pacientes foram enriquecidas as placas com o caldo de BHI (Infusão Cérebro Coração). Nos demais 26 pacientes as amostras foram coletadas sem o uso do caldo de BHI. Nos resultados com a utilização do caldo de BHI, as amostras sofreram alterações, pois esse enriqueceu as colônias de bactérias, promovendo o seu crescimento desproporcional e exacerbado e inativando o efeito dos antissépticos, não tendo um resultado confiável. Em relação aos 26 pacientes sem uso do caldo de BHI, compreende-se que o digluconato de clorexidina a 2% das 26 amostras coletadas, em 2 mostrou-se não eficaz, em 13 razoável e em 11 eficaz. Já no Grupo PVP-I, 11 mostraram- -se não eficazes, sendo 10 amostras razoáveis e 5 eficazes. Portanto, pode-se concluir que a clorexidina apresentou resultados melhores, mostrando-se excelente, com maior redução da carga microbiana do que o PVP-I (AU).

The contemporary dentistry has been really concerned with the increased transmission of infectious diseases and cross contamination at the surgical site. This study aimed to evaluate the efficacy of antisepsis into immediate effect of two antiseptics in bacterial reduction of peri-oral region prior to surgical procedures for extraction. The research was conducted in dental clinics of the Centro de Ensino Superior dos Campos Gerais (CESCAGE), located in the city of Ponta Grossa-PR. To perform the experiment samples of 38 patients were collected. Three samples of each patient were collected and they were divided into 3 groups: Group A: Control Material, Group B: Chlorhexidine Digluconate 2% and Group C: PVP-I (polyvinylpyrrolidone-iodine). In 12 patients plates were enriched with BHI broth (Brain Heart Infusion). In the remaining 26 patients samples were collected without the use of BHI broth. In the results with the use of BHI broth, samples have suffered alterations, as this enriched bacteria colonies promoting their disproportionate overgrowth and inactivating the effect of antiseptics, not having a reliable result. In relation to 26 patients without the use of BHI broth, it is understood that the chlorhexidine digluconate 2% of the 26 samples collected showed in two of them to be not effective, in 13 reasonable and in 11 effective. In the PVP-I Group, 11 proved to be not effective, 10 samples reasonable and 5 effective. Therefore, it can be concluded that chlorhexidine presented best results, showing to be excellent, with greater reduction of microbial load than PVP-I (AU).

Mouthwashes with hydrogen peroxide are carcinogenic, but are freely indicated on the Internet: warn your patients!

It all began in Ancient Egypt where people used to bleach their teeth with antiseptic mouthwashes made of urea from human urine. Teeth harmony is promoted by expression of feelings, communication, a real window of the brain and its content! Tooth bleaching products are medicines, not cosmetics! Mouth washing with hydrogen peroxide is an illogical and dangerous procedure! Hydrogen peroxide must be used in one's mouth only when employed by a dentist who has been properly instructed to protect the mucosa, preventing it from receiving these products. How and for how long these products are going to be used require caution in order to avoid or decrease any adverse effects on the tissues. Many websites instruct people on how to purchase and prepare hydrogen peroxide so that it is used as an antiseptic mouthwash and tooth bleaching agent. Some websites even refer to dentists as "exploiters", accusing them of not instructing patients properly. In this article, we aim at providing evidence and information upon which dentists and assistants may base their thinking as well as their opinion and procedures regarding "the indiscriminate and free use of hydrogen peroxide in the mouth, on teeth and oral mucosa". Those websites, blogs and social network profiles trespass the limits of public trust and should be immediately sued by the government for committing a crime against public health.

Avaliação comparativa ?in vivo? da eficácia do óleo de melaleuca, clorexidina e listerine sobre streptococcus mutans e microrganismos totais na saliva / ?In Vivo? Comparative Evaluation of the Efficacy of Melaleuca Oil, Chlorhexidine and Listerine against Streptococcus mutans and Total Microorganisms in Saliva

Objetivo: Comparar a eficácia dos enxaguatórios bucais: clorexidina 0,12%, Listerine e óleo de Melaleuca Alternifolia 0,5% e 2% sobre os níveis salivares de Streptococcus mutans e microrganismos totais. Métodos: O estudo foi um ensaio clínico, controlado, duplo cego e emparelhado. Para tanto foram selecionados 26 voluntários com idade entre 21 - 35 anos. Foi coletada de cada participante, no baseline, a quantidade de 1 mL de saliva não estimulada, 1 e 15 min após os bochechos com as seguintes soluções: água destilada estéril, digluconato de clorexidina 0,12%, Listerine (©Johnson & Johnson do Brasil), Melaleuca Alternifolia (Sigma-Aldrich St Louis, MO, USA) nas concentrações de 0,5% e 2%. Os participantes fizeram uso de todos os enxaguatórios bucais pesquisados, com intervalo de 15 dias entre cada solução. Imediatamente após o bochecho, foi coletada a saliva e realizadas as diluições seriadas, seguidas de plaqueamento em meio de cultura Agar sangue para o crescimento de microrganismos totais e SB-20 (Agar Sacarose Bacitracina) para S. mutans, mantidos por 48h a 37°C em microaerofilia. Após o período de incubação, as colônias foram contadas e transformadas em unidades formadoras de colônias (UFC/mL). Resultados: A clorexidina mostrou ação antimicrobiana na redução dos microrganismos totais e S. mutans, enquanto a ação do óleo Melaleuca Alternifolia 0.5% foi semelhante à água destilada. O listerine e o óleoMelaleuca Alternifolia 2% apresentaram redução microbiana, respectivamente, de 11% e 9% para microrganismos totais, entretanto para S. mutans o listerine reduziu os níveis em 20% e o óleo Melaleuca Alternifolia 2% em 11%. Conclusão: O bochecho único com clorexidina 0,12% é eficaz na redução de níveis de microrganismos totais e S. mutans presentes na saliva. Ao comparar a clorexidina com o listerine e óleo Melaleuca Alternifolia 0,5% e 2% nas mesmas condições a eficácia da ação destas soluções é diminuída.

Objective: To compare the efficacy of the mouthwashes 0.12% chlorhexidine, Listerine, and 0.5% and 2% Melaleuca Alternifolia oil against the salivary levels of Streptococcus mutans and total microorganisms.Methods: This study was double-blind controlled and paired clinical assay. Twenty-six volunteers aged 21 to 35 years old were enrolled. At baseline, 1 mL of unstimulated saliva was collected from each subject, 1 and 15 min after mouthrinsing with the following solutions: sterile distilled water, 0.12% chlorhexidine digluconate, Listerine (©Johnson & Johnson do Brasil), 0.5% and 2% concentrations of Melaleuca Alternifolia (Sigma-Aldrich). The volunteers used all the evaluated mouthrinses with a 15-day interval between the solutions. Immediately after rinsing, saliva was collected and serial dilutions were performed, followed by plating in blood agar culture medium for growth of total microorganisms and SB-20 (Sucrose-Bacitracin agar) for growth of S. mutans, and incubation at 37 °C for 48 h in microaerophilia. After incubation, the number of colonies was counted and expressed as colony forming units (UFC/mL).Results: Chlorhexidine showed antimicrobial action by reducing total microorganisms and S. mutans, while the action of 0.5% Melaleuca Alternifolia was similar to that of distilled water. Listerine and 2%Melaleuca Alternifolia oil reduced total microbial counts by 11% and 9% respectively, and S. mutans by 20% and 11%.Conclusion: A single rinse with 0.12% chlorhexidine is effective in reducing the levels of total microorganisms and S. mutans present in saliva. Under the same testing conditions, Listerine and 0.5% and 2%Melaleuca Alternifolia oil presented lower efficacy than chlorhexidine.

Mouthwashes with hydrogen peroxide are carcinogenic, but are freely indicated on the internet: warn your patients!

It all began in Ancient Egypt where people used to bleach their teeth with antiseptic mouthwashes made of urea from human urine. Teeth harmony is promoted by expression of feelings, communication, a real window of the brain and its content! Tooth bleaching products are medicines, not cosmetics! Mouth washing with hydrogen peroxide is an illogical and dangerous procedure! Hydrogen peroxide must be used in one's mouth only when employed by a dentist who has been properly instructed to protect the mucosa, preventing it from receiving these products. How and for how long these products are going to be used require caution in order to avoid or decrease any adverse effects on the tissues. Many websites instruct people on how to purchase and prepare hydrogen peroxide so that it is used as an antiseptic mouthwash and tooth bleaching agent. Some websites even refer to dentists as "exploiters", accusing them of not instructing patients properly. In this article, we aim at providing evidence and information upon which dentists and assistants may base their thinking as well as their opinion and procedures regarding "the indiscriminate and free use of hydrogen peroxide in the mouth, on teeth and oral mucosa". Those websites, blogs and social network profiles trespass the limits of public trust and should be immediately sued by the government for committing a crime against public health.

Tudo começou no Egito antigo, onde procurava-se clarear os dentes com bochechos antissépticos com ureia da urina humana. Os dentes se harmonizam com expressões de sentimentos, na comunicação, como uma verdadeira vitrine do cérebro e seus conteúdos! Clareadores dentários são medicamentos, e não cosméticos! Bochecho com água oxigenada representa um procedimento improcedente e perigoso! O uso do peróxido de hidrogênio ou água oxigenada na boca deve ser feito diretamente pelo profissional da Odontologia, treinado para proteger as mucosas contra o contato desses produtos. O tempo e a forma de uso requerem cuidados, para se proteger ou diminuir os efeitos indesejáveis sobre os tecidos. Vários websites "ensinam" como adquirir e preparar água oxigenada para fazer bochechos antissépticos e clarear os dentes. Alguns websites se referem ao profissional da Odontologia como um "explorador", por não ensinar isso ao paciente. No presente artigo, procuraremos informar e dar fundamentos para que os profissionais da Odontologia e auxiliares possam embasar suas reflexões, opiniões e condutas relacionadas ao tema "uso indiscriminado e livre de peróxido de hidrogênio na boca sobre os dentes e mucosa bucal". Esses websites, blogs e perfis em redes sociais abusam da fé pública e deveriam ser acionados judicialmente, imediatamente, pelas autoridades públicas, pelo crime contra a saúde das pessoas.

Efeito antibacteriano de antissépticos bucais sobre bactérias facultativas / Antibacterial effect of oral antiseptics on facultative bacteria

Avaliar o efeito antibacteriano de antissépticos bucais sobre bactérias facultativas por meio de testes de difusão em ágar e teste por exposição direta. Metodologia: Cepas de S. mutans (ATCC 25175), E. faecalis (ATCC 29212) e P. aeruginosa (ATCC 27853) foram inoculadas em 7 mL de brain heart infusion (BHI) e incubadas a 37°C por 24 horas. Para o teste de difusão em ágar, 15 placas de Petri com 20 mL de brain heart infusion agar (BHIA) foram inoculadas com 0,1 mL das suspensões microbianas, com auxílio de swabs esterilizados, de modo a se obter um crescimento confluente e uma placa de Petri não foi inoculada. Trinta e seis discos de papel com 9 mm de diâmetro foram imersos nas soluções experimentais de cloreto de cetilpiridínio 0,07%, cloreto de cetilpiridínio 0,075%, gluconato de clorexidina 0,12% e cloreto de benzalcônio 0,13% durante 1 minuto. A seguir, três discos de papel contendo uma das soluções irrigantes foram colocados sobre a superfície do BHIA. As placas foram mantidas por 1 hora em temperatura ambiente e incubadas a 37°C por 48 horas. Os diâmetros dos halos de inibição microbiana foram medidos valendo-se de duas medidas de forma perpendicular entre si, sendo obtida a média de seus comprimentos. Para o teste de exposição direta, 216 cones de papel absorventes esterilizados nº 50 foram imersos na suspensão de micro-organismos por 5 minutos, e a seguir foram colocados em placas de Petri e cobertos com 10 mL de uma das soluções testes. Em intervalos de 1, 5, 10 e 30 minutos, 3 cones de papel absorventes foram retirados do contato com as substâncias, transportados individualmente e imersos em 7 mL de Letheen Broth, e incubados a 37°C por 48 horas. O crescimento microbiano foi avaliado pela turbidade do meio de cultura. Um inóculo de 0,1 mL obtido do Letheen Broth foi transferido para 7 mL de BHI, e incubado nas mesmas condições descritas. O crescimento microbiano foi novamente avaliado pela turbidade do meio de cultura...

Purpose: To evaluate the antibacterial effect of four oral antiseptics (two solutions of cetylpyridinium chloride, chlorhexidine gluconate and benzalkonium chloride) on facultative bacteria using two methods. Methods: Strains were inoculated in 7 mL of brain heart infusion (BHI) and incubated at 37°C for 24 hours. For the agar diffusion test, 15 Petri plates with 20 mL of brain heart infusion agar (BHIA) were inoculated with 0.1 mL of microbial suspensions using sterile swabs to produce confluent growth; one Petri plate was not inoculated. Thirty-six 9-mm paper discs were immersed in the experimental solutions (0.07% cetylpyridinium chloride, 0.075% cetylpyridinium chloride, 0.12% chlorhexidine gluconate, and 0.13% benzalkonium chloride) for 1 minute. Subsequently, three paper discs containing irrigant solutions were placed on the BHIA in each plate. The plates were kept at room temperature for 1 hour and incubated at 37°C for 48 hours. Two measurements of the inhibition zones were made on the paper discs containing the solutions, and mean values were calculated. For the direct exposure test, 216 #50 sterilized paper points were immersed in the microorganism suspensions for 5 minutes, placed onto Petri plates and covered with 10 mL of irrigant solution. At one, five, 10 and 30 minutes, three paper points were removed from the contact substances, transported individually, immersed in 7 mL Letheen broth and incubated at 37°C for 48 hours. Bacterial growth was evaluated by turbidity. An inoculum of 0.1 mL Letheen broth was transferred to 7 mL BHI, and incubated as described above. Bacterial growth was evaluated according to turbidity. Results: Inhibition zones were greater than 10 mm for all substances and all microorganisms under study. The antibacterial...

Staining and calculus formation after 0.12% chlorhexidine rinses in plaque-free and plaque covered surfaces: a randomized trial.

OBJECTIVES: Studies concerning side effects of chlorhexidine as related to the presence of plaque are scarce. The purpose of this study was to compare the side effects of 0.12% chlorhexidine gluconate (CHX) on previously plaque-free (control group) and plaque-covered surfaces (test group). METHODS: This study had a single-blind, randomized, split-mouth, 21 days-experimental gingivitis design, including 20 individuals who abandoned all mechanical plaque control methods during 25 days. After 4 days of plaque accumulation, the individuals had 2 randomized quadrants cleaned, remaining 2 quadrants with plaque-covered dental surfaces. On the fourth day, the individuals started with 0.12% CHX rinsing lasting for 21 days. Stain index intensity and extent as well as calculus formation were evaluated during the experimental period. RESULTS: Intergroup comparisons showed statistically higher (p<0.05) stain intensity and extent index as well as calculus formation over the study in test surfaces as compared to control surfaces. Thus, 26.19% of test surfaces presented calculus, whereas calculus was observed in 4.52% in control surfaces. CONCLUSIONS: The presence of plaque increased 0.12% CHX side effects. These results strengthen the necessity of biofilm disruption prior to the start of CHX mouthrinses in order to reduce side effects.

Staining and calculus formation after 0.12 percent chlorhexidine rinses in plaque-free and plaque covered surfaces: a randomized trial

OBJECTIVES: Studies concerning side effects of chlorhexidine as related to the presence of plaque are scarce. The purpose of this study was to compare the side effects of 0.12 percent chlorhexidine gluconate (CHX) on previously plaque-free (control group) and plaque-covered surfaces (test group). METHODS: This study had a single-blind, randomized, split-mouth, 21 days-experimental gingivitis design, including 20 individuals who abandoned all mechanical plaque control methods during 25 days. After 4 days of plaque accumulation, the individuals had 2 randomized quadrants cleaned, remaining 2 quadrants with plaque-covered dental surfaces. On the fourth day, the individuals started with 0.12 percent CHX rinsing lasting for 21 days. Stain index intensity and extent as well as calculus formation were evaluated during the experimental period. RESULTS: Intergroup comparisons showed statistically higher (p<0.05) stain intensity and extent index as well as calculus formation over the study in test surfaces as compared to control surfaces. Thus, 26.19 percent of test surfaces presented calculus, whereas calculus was observed in 4.52 percent in control surfaces. CONCLUSIONS: The presence of plaque increased 0.12 percent CHX side effects. These results strengthen the necessity of biofilm disruption prior to the start of CHX mouthrinses in order to reduce side effects.

Estudio clínico comparativo entre colutorio de p-clorofenol y peróxido de hidrógeno con colutorio de clorhexidina al 0.12 por ciento en el crecimiento de placa microbiana y gingivitis / Mouthwash comparative study between p-chlorophenol and hydrogen peroxide with Chlorhexidine Mouthwash 0.12 percent in the growth of microbial plaque and gingivitis

Se formuló un colutorio a base de p-clorofenol alcanforado y peróxido de hidrógeno, y considerando que no se disponían de antecedentes de eficacia y seguridad del colutorio, se realizó un ensayo clínico para medirlas utilizando un modelo de formación de placa microbiana y gingivitis en un período de cuatro días, como control positivo se uso un colutorio de clorhexidina al 0.12 por ciento. Participaron 26 sujetos en un estudio doble ciego cruzado y con distribución aleatoria. El colutorio en base a p-clorofenol alcanforado y peróxido de hidrógeno y el de clorhexidina tuvieron un similar efecto en el control de la formación de placa y antigingivitis. No hubo diferencias entre los acontecimientos adversos observados para el colutorio y el control. Por consiguiente, el colutorio en estudio podría ser una alternativa para el control químico de la placa microbiana y gingivitis en el tratamiento de la enfermedad periodontal.

A camphorated p-chlorophenol and hydrogen peroxide-based mouthwash was prepared, and a clinical trial to measure the efficiency and safety records of the mouthwash -considering the lack of them- was carried out using a formation model of microbial plaque and gingivitis over a 4-day period, with a 0.12 percent chlorhexidine mouthwash as positive control. Twenty-six individuals participated in the randomized double-blind crossover study. The camphorated p-chlorophenol and hydrogen peroxide-based and chlorhexidine mouthwash had a similar effect in controlling the formation of plaque and antigingivitis. There was no difference between the adverse events observed for the mouthwash and the control. Therefore, the mouthwash in study might be an alternative to the chemical control of microbial plaque and gingivitis in the periodontal desease treatment.

Citotoxicidade e genotoxicidade do Listerine® em culturas de Escherichia coli e plamídios / Citotoxicity and genotoxicity of Listerine® on Escherichia coli cultures and plasmids

A utilização de testes de biocompatibilidade de materiais odontológicos é necessária para avaliar a segurança dos mesmos. Listerine® é um enxaguatório comercial usado para a prevenção e tratamento da gengivite. O objetivo do estudo foi avaliar os efeitos citotóxico e genotóxico do Listerine® em culturas de Escherichia coli e plasmídios. Na avaliação da citotoxicidade, culturas de E. coli AB1157 e BW9091 foram incubadas com Listerine® (10, 50 e 100%) e o crescimento acompanhado pela densidade óptica (DO) em 600nm por 7 horas(h). Para avaliar a sobrevivência, culturas de E. coli AB1157, em fase exponencial, foram centrifugadas, ressuspensas em solução salina (NaCl 0,9%) e incubadas (1h, 37ºC) com Listerine ® (10, 50, 100%, 1h, 37 ºC). Alíquotas foram semeadas em placas de Petri contendo meio nutritivo nos tempos 0, 30 e 60 minutos e armazenadas em estufa bacteriológica (18h, 37 ºC). As unidades formadoras de colônias contadas e as frações de sobrevivência (FS) calculadas. Como controles, culturas tratadas salina ou etanol (21,6%). Para genotoxicidade, plasmídios pBSK foram incubados com Listerine® (10, 50 e 100%) e com etanol (2,16%, 10,8% e 21,6%), associados ou não ao SnCl2(200µg/mL, 30 minutos, temperatura ambiente), realizada eletroforese em gel de agarose (0,8%, 8V/cm), observados por transiluminação UV e obtido o percentual da forma superespiralada (%SE). Os resultados indicam que o enxaguatório Listerine® foi capaz de inibir o crescimento bacteriano de culturas de E. coli na maior concentração utilizada. O enxaguatório, na maior concentração, diminuiu a sobrevivência das culturas bacterianas testadas. Listerine® não modificou o perfil eletroforético do plasmídios, indicando ausência de efeito genotóxico e também foi capaz de proteger os plamídios da ação do SnCl2. Além disso, o etanol, na mesma concentração presente no Listerine®, não alterou o perfil eletroforético dos plasmídios, sendo capaz de protegê-lo da ação do SnCl2. ...

The uses of biocompatibility tests to evaluate dentistry materials are necessary to assess safety. Listerine® is a commercial mouthwash used to prevent and treat gingivitis. The aim of this study was to evaluate the citotoxic and genotoxic effects of Listerine® on Escherichia coli cultures and bacterial plasmids. To citotoxicity tests, E.coli cultures AB1157 and BW9091 was incubated with Listerine® (10, 50 and 100%) and de growth observed by optic density at 600nm for 7 hours. To cellular survival tests, E.coli AB1157 cultures, in exponential phase, was centrifuged, ressuspended in saline solution (NaCl 0.9%) and incubated (1h, 37 ºC) with Listerine® (10, 50 and 100%). Aliquots were spread on Petri dishes with nutritive medium at 0, 30 and 60 minutes and incubated (18h, 37 ºC). The colony-forming units were counted and survival fractional (SF), calculated. As controls, cultures treated with saline and ethanol (21.6%). In genotoxicity assays, plasmids pBSK were incubated with Listerine® (10, 50 and 100%) and ethanol (2.16%, 10.8% and 21.6%) in presence or absence of SnCl2 (200µg/mL, 30 minutes, room temperature), electrophoresis agarose gel (0.8%, 8V/cm) was performed and plasmid forms were observed. Data indicated that Listerine® is capable to inhibit bacterial growth of E. coli cultures at the highest concentrations used. The mouthwash, at the higher concentration used, decreased the survival of bacterial cultures tested. Listerine® didn’t modify the electrophoretic profile of plasmids indicating no genotoxic effect but this mouthwash could protect plasmids from action of SnCl2. In addition, ethanol, at concentration present in Listerine®, didn’t alter the electrophoretic profile of plasmids but was capable of protect plasmid from action of SnCl2. The results indicated that Listerine® could present citotoxic effect on E. coli cultures, absence of genotoxic potential on plasmids but it could protect, similar to ethanol, plasmids from genotoxic effect of SnCl2.

Reviewed evidence about the safety of the daily use of alcohol-based mouthrinses.

Current scientific knowledge provides clear evidence that alcohol-based mouthwashes can be beneficial in a daily oral health routine, including dental hygiene and plaque control. Several issues are worth discussing, in spite of the wealth of supporting evidence. Despite some undesirable effects to some people, like burning sensation, and some contraindications, like the use by infants, alcohol addicts and patients with mucosal injuries, there is no reason to avoid the use of alcohol-containing mouthwashes as long as they are used following proper guidance by dental professionals and the manufacturers' instructions. The alleged correlation between oral cancer and alcohol-based mouthrinses presents so little, weak, inconsistent and even contradictory evidence in the literature that any kind of risk warning to patients would be uncalled for. Antimicrobial mouthrinses are safe and effective in reducing plaque and gingivitis, and should be part of a comprehensive oral health care regimen that includes brushing, flossing and rinsing to prevent or minimize periodontal disease.

Reviewed evidence about the safety of the daily use of alcohol-based mouthrinses

Current scientific knowledge provides clear evidence that alcohol-based mouthwashes can be beneficial in a daily oral health routine, including dental hygiene and plaque control. Several issues are worth discussing, in spite of the wealth of supporting evidence. Despite some undesirable effects to some people, like burning sensation, and some contraindications, like the use by infants, alcohol addicts and patients with mucosal injuries, there is no reason to avoid the use of alcohol-containing mouthwashes as long as they are used following proper guidance by dental professionals and the manufacturers' instructions. The alleged correlation between oral cancer and alcohol-based mouthrinses presents so little, weak, inconsistent and even contradictory evidence in the literature that any kind of risk warning to patients would be uncalled for. Antimicrobial mouthrinses are safe and effective in reducing plaque and gingivitis, and should be part of a comprehensive oral health care regimen that includes brushing, flossing and rinsing to prevent or minimize periodontal disease.

Effect of preservatives on reactivity of fluoride with dental enamel

Objectives: Evaluate the effect of preservatives, usually present in mouthrinse formulations, on fluoride reactivity with enamel. Methods: Ninety-six bovine enamel slabs (4 x 4 x 2 mm), 48 sound and 48 with caries-like lesions, were longitudinally sectioned through the center. Half of each slab was kept as control and the other one subjected during 10 min to 0.05% NaF solutions containing or not 0.2% methylparaben, 0.02% propylparaben or 0.35% benzoate. Two consecutive layers of enamel were removed from all slabs, by acid etching and fluoride acid extracted was determined with specific electrode. Results: Fluoride concentration in the half treated was subtracted from that found in the control and expressed as μg F/cm2 of enamel surface. Fluoride reactivity with sound enamel was not affected by the preservatives (P > 0.05), but methylparaben increased the reactivity of 0.05% NaF solution with carious one (P < 0.05). Conclusion: The results suggest that methylparaben may improve fluoride reactivity with enamel, presenting caries-like lesions, but further studies are necessary to evaluate the mechanism.

Objetivos: Avaliar o efeito de conservantes, usualmente presentes em enxagüatórios bucais, na reatividade do fluoreto com o esmalte dental. Métodos: Noventa e seis blocos de esmalte bonivo (4 x 4 x 2 mm), 48 hígidos e 48 com lesão artificial de cárie, foram seccionados longitudinalmente ao meio. Uma metade de cada bloco foi mantida como controle e a outra reagiu, durante 10 min, com solução de NaF 0,05% contendo ou não metilparabeno 0,2%, propilparabeno 0,02% ou benzoato 0,35%. Duas camadas consecutivas de esmalte foram removidas de todos os blocos por ataque ácido e o fluoreto presente nesse extrato ácido foi determinado com eletrodo específico. Resultados: A concentração de fluoreto da metade tratada foi subtraída daquela presente nos controles e expressa em μg F/cm2 da superfície de esmalte. A reatividade do fluoreto com esmalte hígido não foi afetada pelos conservantes (p>0,05), mas o metilparabeno aumentou a reatividade da solução de NaF 0,05% com o esmalte cariado (p<0,05). Conclusão: Os resultados sugerem que o metilparabeno pode aumentar a reatividade do fluoreto com o esmalte com lesão de cárie, masestudos adicionais são necessários para avaliar esse mecanismo.

Dentifrícios fluoretados convencional, infantil e com baixas concentrações de flúor: riscos e benefícios para fluorose e cárie dentária / Toothpastes for adults, children and with low fluoride: risks and benefits for dental fluorosis and dental caries

Ultimamente, muito tem se discutido a respeito dos dentifrícios com baixas concentrações de flúor para crianças pré-escolares. O objetivo deste trabalho é fazer uma revisão de literatura sobre os dentifrícios fluoretados, abordando os riscos e benefícios das formulações com várias concentrações de flúor, em termos de prevenção contra cárie e riscos para o desenvolvimento de fluorose dentária em crianças de até 6 anos. Os dentifrícios mais comuns presentes no mercado brasileiro apresentam-se em concentrações de 1500 e 1100 ppmF, sendo eficazes no controle da cárie dentária. Os dentifrícios com baixas concentrações de flúor (550 ppmF) precisam ser melhor avaliados, sendo necessários mais estudos a longo prazo para avaliar estas formulações. É fundamental esclarecer os pais que além dos benefícios contra a cárie, a ingestão excessiva de dentifrícios fluoretados, por crianças de 0 a 6 anos, pode causar manchas nos dentes, sendo necessária a redução da quantidade usada durante a escovação