Vitamin D levels and risk for periodontal disease: A systematic review.

OBJECTIVE: To evaluate the existing evidence supporting or refuting the following questions: (i) Do patients with lower vitamin D levels have higher risk for periodontal disease? (ii) Are periodontal treatment outcomes improved by the adjuvant supplementation of vitamin D or by elevated serum vitamin D levels? MATERIAL AND METHODS: MEDLINE, SCOPUS, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched up to September 2017. Studies were included if they had measured serum vitamin D levels or vitamin D intake and any periodontal parameter. RESULTS: Overall, 27 studies were included (13 cross-sectional studies, 6 case-control studies, 5 cohort studies, 2 randomized clinical trials and 1 case series study). Sixty-five percent of the cross-sectional studies reported significant associations between low vitamin D levels and poor periodontal parameters. None of the observational longitudinal studies found that periodontal disease progression could be attributed to lower vitamin D levels. No interventional studies that evaluated the use of vitamin D supplementation as a solely adjuvant to periodontal treatment was found. No meta-analysis was performed due to high variability across studies. CONCLUSION: The data to support or refute the association between vitamin D levels and periodontal disease are inconclusive at the moment. More rigorously designed longitudinal studies with standardized definitions of periodontal disease and vitamin D are necessary.

Antimicrobial potential and gustatory perception of chlorhexidine gluconate mouthwashes with or without alcohol after a single rinse - a randomized controlled crossover clinical trial.

OBJECTIVE: The aim of this double-blind randomized clinical trial was to assess whether the presence of alcohol in chlorhexidine gluconate mouthwashes influences their antimicrobial potential against salivary bacteria in young adults. Additionally, the taste perception was assessed. MATERIALS AND METHODS: In a randomized crossover design, 20 participants (17 women and three men; aged 18-38 years old) rinsed with the 0.12% chlorhexidine gluconate with (CHX+) or without alcohol (CHX-) for 1 min. Sterile flavoured-mint physiological saline was used as control solution. All participants rinsed with the assigned products only once with a period of at least 7 days of washout in between. For antimicrobial potential assay, stimulated saliva samples were collected from participants and had their total viable bacteria determined before and after each rinse. For taste perception assay, a visual analogue scale (VAS) was used to evaluate the taste perception after each rinse. Friedman followed by Wilcoxon tests and Bonferroni correction were performed. A P-value <0.017 was considered as statistically significant. RESULTS: The median per cent reduction in groups CHX+ and CHX- was 16.07 and 12.87, respectively. No statistically significant difference was found between these groups (P = 0.09). Regarding the gustatory perception, the VAS median values in groups CHX+ and CHX- were 3.50 and 5.50. No statistically significant difference was found in this outcome (P = 0.052). CONCLUSIONS: The presence of the alcohol on the formulation of gluconate chlorhexidine mouthwashes does not seem to interfere with their antimicrobial potential and with their taste perception.

Efficacy of dental floss impregnated with chlorhexidine on reduction of supragingival biofilm: a randomized controlled trial.

BACKGROUND: The use of a toothbrush has a limited ability to control the dental biofilm in interproximal areas. Therefore, specialized devices, such as dental floss, may be useful for these specific areas. OBJECTIVE: This study aimed to investigate the efficacy of dental floss impregnated with 5% chlorhexidine gluconate on the reduction of the supragingival biofilm. METHODS: This research was parallel, single-blind, controlled and randomized, and contained a sample of thirty dental students from the Faculty of Pharmacy, Dentistry and Nursing of the Federal University of Ceará, Brazil, who were divided equally into three groups. The negative control group (NC) did not utilize any kind of interproximal cleaning; the positive control group (PC) used waxed floss without impregnation twice a day; and the test group (T) used the same dental floss, which was impregnated with 5% chlorhexidine gluconate, twice a day. For all groups, this study lasted for 15 days. The presence of a biofilm was evaluated on four surfaces (mesiobuccal, distobuccal, mesiolingual and distolingual) by the Quigley-Hein Index, resulting in four scores for each tooth. RESULTS: Group T had the lowest plaque scores, showing a significant difference compared to group NC (P < 0.001) and group PC (P < 0.001). Group PC also displayed a significant difference compared to NC (P < 0.001). CONCLUSION: It was concluded that the use of dental floss impregnated with 5% chlorhexidine gluconate resulted in additional reductions in the supragingival biofilm relative to the results achieved with conventional waxed floss on the anterior teeth of a well-motivated and well-instructed population.