Effects of fixed orthodontic treatment with and without chlorhexidine mouthwash on vitality of oral mucosal cells reflected by cell nuclear indexes: A preliminary 3-phase before-after clinical trial.

INTRODUCTION: Effects of mouthwashes on the vitality of oral mucosal cells have not been determined in orthodontic patients. We aimed to assess, for the first time, the effects of fixed orthodontic treatment with and without chlorhexidine (CHX) mouthwash on the oral mucosal cell vitality. MATERIALS AND METHODS: All patients meeting the eligibility criteria were consecutively included until the desired sample size was reached. Oral buccal mucosal cell samples were taken immediately before orthodontic treatment. For each patient, 20 metal brackets and 4 bands were installed on the teeth. Cell samples were recollected after one month of treatment. Then, the patients used an ethanol-free 0.12% CHX mouthwash two times a week for one month. Sampling was repeated at the end of the second month. Papanicolaou staining was used for micronucleus screening of the indexes: micronucleus (MIC), karyorrhexis (KR), karyolysis (KL), and broken eggs (BE). The repair index (RI) was calculated as RI=KR+KL/BE+MIC. Comparisons of nuclear changes over 3 intervals were done using the Friedman and Dunn-Bonferroni tests (α=0.05, ß<0.05). RESULTS: This prospective before-after clinical trial was performed on 408 observations of 34 patients (14 males, 20 females, mean age: 16.68±3.75 years) at 3 intervals (×4 parameters each). The means of MIC, KR, KL, BE, and RI were respectively 1.312±1.219, 0.241±0.564, 0.426±0.657, 0.115±0.224, and 0.476±0.360 before treatment. They were 1.348±1.171, 0.215±0.236, 0.406±0.369, 0.124±0.187, and 0.511±0.310 at the first interval and 1.909±1.263, 0.368±0.174, 0.615±0.269, 0.253±0.150, and 0.529±0.195 at the second interval. Friedman showed significant time-dependent changes for all variables (P<0.0005) except RI. Dunn-Bonferroni showed that except MIC (P=0.017), KR/KL/BE changed insignificantly after orthodontic treatment (P≥0.974). MIC/KR/KL/BE increased significantly after the addition of CHX (P<0.0005). CONCLUSION: CHX mouthwash, together with orthodontic treatment, has a strong deteriorating effect on nuclear indexes associated with the vitality of buccal mucosal cells. Nuclear changes caused by orthodontic treatment alone might be negligible.

Evaluation of NLRP3 and IL-18 Levels after Periodontal Therapy.

The progression of periodontitis depends on interactions between the periodontal pathogens and the host immune cytokines, including interleukin (IL)-1ß and IL-18. Production of IL-1ß is regulated by NOD-like receptors family pyrin domain containing 3 (NLRP3). This study aimed to evaluate the effect of periodontal treatment on the concentrations of IL-18 and NLRP3 in patients with chronic periodontitis. In this experimental study, 18 patients with chronic periodontitis and a mean age of 46.2±8.95 years, were included. The gingival crevicular fluid (GCF) was collected at the beginning of the study, 4 weeks after non-surgical (phase I), and 4 weeks after surgical periodontal treatment. The levels of NLRP3 and IL-18 were measured; using an enzyme-linked immunosorbent assay. Pearson correlation test was used to analyze the concentration of NLRP3 and IL-18 before and after the treatments with CAL and PD. There was a significant association between the level of NLRP3 and the mean values of PD and CAL before treatment. After each treatment phase, a significant decrease was observed in the NLRP3 level. There was no significant relationship between IL-18 and clinical parameters before and after periodontal treatments. Given the possible association between the level of NLRP3 and clinical parameters, we suggest it as a possible indicator of inflammation in chronic periodontitis and an index for evaluating the treatment outcome.