Validation of the anti-bacteremic efficacy of an essential oil rinse in a Brazilian population: a cross-over study

This cross-over study was conducted to assess the germ-killing efficacy of an essential oil mouthrinse (EOM) by determining the blood levels of microorganisms associated with induced bacteremia and investigating the prevalence of this event in Brazilians with mild-to-moderate gingivitis. Thirty four (31.19%) subjects positive for bacteremia induced by chewing a ration of apple were enrolled out of 109 screened subjects (50 males and 59 females). A difference of at least 10 colony forming units between the pre- and post-insult blood samples was defined as a positive result. For the following two weeks patients underwent a toothbrush plus fluoride dentifrice normalization period, and were then scheduled for the Phase I protocol as follows. At baseline I, subjects were instructed to chew a new apple ration, had new blood samples taken before and after this oral stimulus, and were randomly assigned to an experimental essential oil (n = 17) or placebo (P) mouthrinse (n = 17) treatment for 2 weeks. These procedures were repeated at the end of Phase I and then followed by a two-week wash-out period (tooth brushing with fluoride dentifrice). Bacteremia was again induced at baseline and at the end of Phase II, when subjects were crossed-over to the other EOM or placebo groups. Bacterial count differences between baseline and 2-week post-treatment (EOM versus P) in the blood samples collected were assessed by analysis of covariance. Mean aerobic counts decreased by 45.8%, whereas mean anaerobic counts decreased by 63.3% after EOM treatment. After the P treatment, aerobic bacteria increased by 28.4% and anaerobic bacteria decreased by 18.5%. This study validated this novel methodology and showed that the germ-killing action of EOM significantly reduced bacteremia.

Validation of the anti-bacteremic efficacy of an essential oil rinse in a Brazilian population: a cross-over study.

This cross-over study was conducted to assess the germ-killing efficacy of an essential oil mouthrinse (EOM) by determining the blood levels of microorganisms associated with induced bacteremia and investigating the prevalence of this event in Brazilians with mild-to-moderate gingivitis. Thirty four (31.19%) subjects positive for bacteremia induced by chewing a ration of apple were enrolled out of 109 screened subjects (50 males and 59 females). A difference of at least 10 colony forming units between the pre- and post-insult blood samples was defined as a positive result. For the following two weeks patients underwent a toothbrush plus fluoride dentifrice normalization period, and were then scheduled for the Phase I protocol as follows. At baseline I, subjects were instructed to chew a new apple ration, had new blood samples taken before and after this oral stimulus, and were randomly assigned to an experimental essential oil (n = 17) or placebo (P) mouthrinse (n = 17) treatment for 2 weeks. These procedures were repeated at the end of Phase I and then followed by a two-week wash-out period (tooth brushing with fluoride dentifrice). Bacteremia was again induced at baseline and at the end of Phase II, when subjects were crossed-over to the other EOM or placebo groups. Bacterial count differences between baseline and 2-week post-treatment (EOM versus P) in the blood samples collected were assessed by analysis of covariance. Mean aerobic counts decreased by 45.8%, whereas mean anaerobic counts decreased by 63.3% after EOM treatment. After the P treatment, aerobic bacteria increased by 28.4% and anaerobic bacteria decreased by 18.5%. This study validated this novel methodology and showed that the germ-killing action of EOM significantly reduced bacteremia.

Comparative antiplaque and antigingivitis efficacy of three antiseptic mouthrinses: a two week randomized clinical trial.

The objective of this randomized, examiner blind, parallel group, controlled clinical trial was to compare the antiplaque and antigingivitis efficacy of an essential oil-containing mouthrinse (EO) to two mouthrinses containing 0.05% Cetylpyridinium Chloride (CPC), one with alcohol and one alcohol-free, using a two-week experimental gingivitis validated-model with a 5% hydroalcohol rinse serving as the negative control. One hundred and fifty-nine subjects, 56 males and 103 females; ranging in age from 18 to 58 years in good general health were assigned to one of the four treatment groups: EO (n = 40), 0.05% CPC with alcohol (CPCa, n = 39), 0.05% CPC alcohol-free (CPCna, n = 40), and 5% hydroalcohol negative control (n = 40). The Mean Turesky Modification of the Quigley-Hein Plaque Index (PI) and the Mean Modified Gingival Index (MGI) were the primary efficacy endpoints and were evaluated at baseline and at two weeks. Following baseline examinations, subjects received a complete dental prophylaxis and began supervised rinsing with their assigned mouthrinse twice daily for two weeks, as their sole oral hygiene measure; 151 subjects completed the trial. Two weeks after baseline the EO adjusted mean PI and MGI scores were significantly lower than those of both CPC rinses and negative control (p < 0.001). In conclusion, the EO mouthrinse demonstrated significantly greater antiplaque and antigingivitis efficacy than both CPC-containing mouthrinses and the negative control.

Comparative antiplaque and antigingivitis efficacy of three antiseptic mouthrinses: a two week randomized clinical trial

The objective of this randomized, examiner blind, parallel group, controlled clinical trial was to compare the antiplaque and antigingivitis efficacy of an essential oil-containing mouthrinse (EO) to two mouthrinses containing 0.05 percent Cetylpyridinium Chloride (CPC), one with alcohol and one alcohol-free, using a two-week experimental gingivitis validated-model with a 5 percent hydroalcohol rinse serving as the negative control. One hundred and fifty-nine subjects, 56 males and 103 females; ranging in age from 18 to 58 years in good general health were assigned to one of the four treatment groups: EO (n = 40), 0.05 percent CPC with alcohol (CPCa, n = 39), 0.05 percent CPC alcohol-free (CPCna, n = 40), and 5 percent hydroalcohol negative control (n = 40). The Mean Turesky Modification of the Quigley-Hein Plaque Index (PI) and the Mean Modified Gingival Index (MGI) were the primary efficacy endpoints and were evaluated at baseline and at two weeks. Following baseline examinations, subjects received a complete dental prophylaxis and began supervised rinsing with their assigned mouthrinse twice daily for two weeks, as their sole oral hygiene measure; 151 subjects completed the trial. Two weeks after baseline the EO adjusted mean PI and MGI scores were significantly lower than those of both CPC rinses and negative control (p < 0.001). In conclusion, the EO mouthrinse demonstrated significantly greater antiplaque and antigingivitis efficacy than both CPC-containing mouthrinses and the negative control.

Epidemiologia molecular: uma abordagem crítica em relação à pesquisa em periodontologia / Molecular epidemiology: a critical review related to periodontal research

A epidemiologia é uma ciência básica para a investigação clínica. Assim, se torna crucial para o desenvolvimento de estudos significativos sobre a história natural de uma doença, sobre a qualidade de métodos diagnósticos, avaliações de risco e a efetividade de intervenções clínicas. Uma grande evolução nos delineamentos epidemiológicos tem sido observada nos últimos anos dentro da periodontologia. E, é neste contexto de evolução que se insere a epidemiologia molecular, que, pelo monitoramento de biomarcadores, permite uma compreensão mais detalhada dos eventos biológicos envolvidos na etiopatogênese das doenças. Técnicas como PCR, PCR em tempo real e hibridização com sondas de DNA, têm sido empregadas em epidemiologia molecular elucidando questões e apresentando impacto direto sobre diferentes aspectos da periodotologia. Na verdade a epidemiologia molecular substituio panorama dominado pelas teorias mais simplistas por modelos mais complexos de doença que associam fatores do hospedeiro, ambientais e causais. É claro que a visão sobre o que representa a epidemiologia molecular pode variar amplamente. Todavia, benefícios específicos podem ser a ela atribuídos principalmente no que se refere a identificação precoce de eventos associados à história natural da doença e determinação mais precisa de indivíduos ou grupos de risco. Após análise da literatura pode-se concluir que a epidemiologia molecular parece ser uma importante ferramenta no controle dos vieses associados aos modelos de estudo tradicionais. Sua contribuição pode tornar a pesquisa epidemiológica um instrumento mais apurado e, conseqüentemente, fornecer dados imprescindíveis na formação de uma base racional consistente para as investigações clínicas.

Estudo piloto sobre a ocorrência de Streptococcus mutans e de Actinobacillus actinomycetemcomitans em restaurações de amálgama com excesso marginal / Streptococcus mutans and Actinobacillus actinomycetemcomitans in amalgam overhang restorations: a pilot study

O objetivo desse estudo piloto foi comparar a ocorrência de S. mutans e A. actinomycetemcomitans em sítios periodontais com condições clínicas similares considerando-se como variável de interesse a presença de restaurações com excesso marginal. Treze indivíduos (39,69 ± 5,25 anos de idade), do gênero feminino, com no mínimo 15 dentes presentes na cavidade bucal foram incluídos. Os indivíduos deveriam apresentar no mínimo dois dentes com bolsas periodontais entre 2 e 5 mm de profundidade e nível clínico de inserção entre 2 e 4mm, sem cáries dentárias, sendo um dente com restauração de amálgama com excesso marginal (grupo teste) e um dente homólogo hígido (dente controle), ambos com dentes adjacentes hígidos. Amostras de biofilme foram coletadas e semeadas em meio de cultura seletivo para posterior identificação de S.mutans e A.actinomycetemcomitans. A prevalência de S. mutans foi de 28,8% e de A. actinomycetemcomitans de 30,8%. Não foi observada diferença entre a ocorrência das bactérias de acordo com a presença de excesso de material restaurador. Em spatios periodontais com características clínicas similares não foram encontradas diferenças em relação à ocorrência de S.mutans e A. actinomycetemcomitans. Estudos futuros deverão ser conduzidos para melhor elucidar essa questão.

The aim of this pilot study was to compare the occurrence of S. mutans and A actinomycetemcornitans in periodontal sites with similar clinical status taking in consideration the presence of overhang restorations. Thirteen individuaIs (39.69 ± 5.25 years of age), females, with at least 15 teeth had been enclosed. Each participant presented one tooth with amalgam overhang (test teeth) and also a homologous sound tooth (control teeth), both with periodontal pockets measuring 2 - 5 mm, clinical attachment level of 2 - 4mm, without caries and showing adjacent teeth without restorations. Oral biofilm were sampled and spread onto selective culture media for identification of S.mutans and A.actinomycetemcomitans. The prevalence of S. mutans was 28.8% and of A actinomycetemcornitans was 30.8%. It was not observed differences in the occurrence of the bacteria according to presence of overhang restorations. In periodontal sites with similar clinical status it was not found differences related to S.mutans and A actinomycetemcomitans occurrence. Future studies should be conducted to elucidate this question.

A short-term clinical and microbial evaluation of periodontal therapy associated with amalgam overhang removal.

BACKGROUND: This study evaluated the effect of periodontal therapy plus amalgam overhang removal (PT+AOR) on periodontal status and the presence of Actinobacillus actinomycetemcomitans and Streptococcus mutans and compared two microbiological sampling techniques. METHODS: Molar teeth with Class II overhang restorations were selected as the test group, and homologous sound teeth were selected as the control group. Periodontal probing depth (PD), clinical attachment level (CAL), and plaque and gingival indices were measured, and restorations were evaluated using radiographs and clinical exploration at baseline (T1) and 90 days after PT+AOR (T2). Microbial samples were taken with dental floss and paper points at T1 and T2. S. mutans and A. actinomycetemcomitans were detected using culture and commercial kits. RESULTS: Mean values of plaque and gingival indices did not show statistically significant differences between test and control teeth between T1 and T2. At T2, the mean CAL decreased among test teeth, and the number of test teeth positive for A. actinomycetemcomitans showed a decrease, whereas positive samples for S. mutans increased. At T1, an association between the two sampling techniques for both bacteria was found. At T2, dental floss presented low sensitivity values for A. actinomycetemcomitans, whereas paper points showed low sensitivity for S. mutans. CONCLUSIONS: PT+AOR showed a beneficial effect on clinical parameters and a decrease of A. actinomycetemcomitans. At T1, both sampling techniques showed appropriate results. At T2, the use of paper points was a more sensitive sampling technique for isolate A. actinomycetemcomitans, whereas dental floss was found to be an alternative sampling method for isolate S. mutans.

Condição periodontal de um subgrupo populacional do município de Guarulhos, SP / Periodontal status of a population subgroup from Guarulhos, SP

Este estudo transversal determinou a condição periodontal e sua associação com fatores de risco em uma amostra de conveniência de 588 indivíduos atendidos na Universidade Guarulhos, entre 1999 e 2003. Características geográficas, demográficas e comportamentais, parâmetros bucais e periodontais foram tabulados e analisados em SPSS 11.5. Os testes t Student e Qui-quadrado determinaram a significância (p < 0,05) das variáveis contínuas e categóricas. O teste de correlação de Pearson correlacionou a ocorrência de doença (PS média > 3,0 mm) com fatores de risco (por exemplo: idade, sexo, fumo) e comportamentais. A análise de regressão linear multivariada determinou a associação entre exposição aos fatores de risco e doença. A população estudada com média de idade de 36,1 ± 14,5 anos foi composta principalmente por mulheres (72,1 por cento) e minoria fumante (13,3 por cento). Os valores médios de dentes ausentes e profundidade de sondagem (PS) foram de 5,7 ± 5,9 dentes e 2,2 ± 0,8 mm, respectivamente. A prevalência de PS > 3,0mm (valor referência) foi de 13,5 por cento; e a distribuição regional da população de acordo com este critério foi: centro, 2,0 por cento; zona oeste, 17,8 por cento; zona leste, 38,0 por cento; zona sul, 6,7 por cento ; e zona norte, 35,5 por cento. As freqüências médias dos índices de placa e sangramento a sondagem foram de 75,3 por cento e 34,1 por cento, respectivamente. A condição periodontal exibiu correlação com idade, fumo e presença de biofilme supragengival. Exceto pela última, estas variáveis também mostraram associação pela análise de regressão multivariada. A população estudada exibiu elevado grau de inflamação gengival e baixo percentual de bolsas periodontais, estando a condição periodontal associada à idade e ao hábito de fumar.

This cross-sectional study determined the periodontal status and its association with risk factors in a convenience sample of 588 subjects seen at the dental clinic of Guarulhos University from 1999 to 2003. To reach the study objectives, geographic, demographic and behavioral characteristics, as well as, oral and periodontal parameters were tabulated and analyzed using SPSS. Chi-square and Student's t tests determined significance (p < 0.05) of continuous and categorical variables. Pearson's correlation test correlated disease (PPD mean > 3mm) with risk (age, sex, smoking) and behavioral factors. Multivariate linear regression evaluated the association between risk factors and periodontal disease. The study population presented a mean age of 36.1 ± 14.5 years, and was primarily comprised women (72.1 percent), while smokers were minority (13.3 percent). The mean number of missing teeth and periodontal probing depth (PPD) were 5.7 ± 5.9 teeth and 2.2 ± 0.8 mm, respectively. The prevalence of PPD > 3.0mm was 13.5 percent and the regional distribution of the population following the same cut-off point was: center 2.0 percent, west zone 17.8 percent, east zone 38.0 percent, south zone 6.7 percent, and north zone 35.5 percent. The average indices for plaque and bleeding on probing were 75.3 percent and 34.1 percent, respectively. Periodontal status was correlated with age, smoking habits and presence of supragingival biofilm. However, the latter did not show association when entered on the multivariate analysis, in contrast with the others. The study population showed high levels of gingival inflammation and a low percentage of periodontal pockets. Periodontal status was associated with smoking habits and age.

Effect of whitening dentifrices on the superficial roughness of esthetic restorative materials.

PURPOSE: The purpose of this study was to investigate the surface roughness (Ra) of different esthetic restorative materials following simulated toothbrushing using different whitening dentifrices. MATERIALS AND METHODS: Cylinders of Esthet-X (Dentsply Caulk, Milford, DE, USA), Durafil VS (Heraeus Kulzer, Wehrheim, Germany), and Vitremer (3M ESPE, St. Paul, MN, USA) were made using molds (4 mm in diameter for 2 mm in height). The superficial roughness was evaluated using a profilometer (Ra) with a cutoff length of 0.25 mm and a speed of 0.1 mm/s. The specimens (N=13) were submitted to 7,500 brushing cycles using five different toothpastes: (1) Crest Regular (control; Procter & Gamble): silica abrasive (C); (2) Crest Extra Whitening (Procter & Gamble, Cincinnati, OH, USA): bicarbonate+calcium pyrophosphate (CE); (3) Dental Care A & H (Arm & Hammer, Camilla, GA, USA): bicarbonate (DC); (4) Rembrandt Plus Whitening (Oral B Laboratories, Belmont, CA, USA): carbamide peroxide+alumina/silica (RP); and (5) experimental: hydrogen peroxide+calcium carbonate (EX). RESULTS: The data were analyzed by analysis of variance and Tukey's test (alpha=.05) for each restorative material, and the results [difference between final and initial roughness: Ra(F)-Ra(I) in microm] were as follows: Esthet-X: EX=0.15+0.07a; RP=0.29+0.16a; CE=0.96+0.33b; C=1.03+0.29b; DC=1.48+0.37b; Durafil VS: RP=0.09+0.07a; EX=0.55+0.23abc; C=0.96+0.26bc; CE=1.03+0.33cd; DC=1.09+0.37d; and Vitremer: EX=0.10+0.08a; RP=0.26+0.19a; CE=0.94+0.27b; DC=1.13+0.46bc; C=1.50+0.32c (different letters mean differences among groups). CONCLUSION: It was verified that the dentifrices containing carbamide or hydrogen peroxide along with alumina+silica and calcium carbonate, respectively (groups 4 and 5), produced minor changes in Ra when compared with the control group and with those dentifrices containing bicarbonate (groups 2 and 3). CLINICAL significance The results of this study indicate that whitening dentifrices evaluated containing silica or calcium carbonate were less abrasive when used on the resin-based esthetic restorative materials than those that contain sodium bicarbonate.

In vitro antimicrobial activity of plant extracts and propolis in saliva samples of healthy and periodontally-involved subjects.

The aim of the present study was to determine, in vitro, the antimicrobial effect of plant extracts and propolis in saliva samples of 25 periodontally healthy subjects and 25 subjects with chronic periodontitis. One saliva sample from each subject was collected and spread on the surface of trypticase soy agar plates. Paper filter discs containing clove, sage, propolis, chlorhexidine 0.12% (positive control) and distilled water (negative control) were placed onto the plates, and incubated anaerobically for 72 hours. Significant differences in the antimicrobial effects of the different substances were tested using paired t-tests and the Spearman correlation coefficient, while differences in the effects of the extracts in periodontally healthy and diseased subjects were tested using Student's t-test. The highest means, in terms of size of microbial inhibition zones (cm) were obtained with chlorhexidine, followed by pure propolis, clove, and sage in subjects with periodontal health (1.35 +/- 0.22, 1.20 +/- 0.20, 0.94 +/- 0.14 and 0.44 +/- 0.38, respectively) or disease (1.38 +/- 0.23, 1.17 +/- 0.21, 0.94 +/- 0.07 and 0.78 +/- 0.07, respectively). There was a positive correlation between the inhibitory action of 11% propolis (w/v) and chlorhexidine (rho = 0.735, p < 0.001) in diseased subjects. The antimicrobial effects of clove and sage, particularly the latter, were less marked in comparison to propolis and chlorhexidine in both groups of subjects. In conclusion, propolis showed significant antimicrobial properties in saliva samples from periodontally healthy and diseased subjects, suggesting that this substance may be used therapeutically in the future to inhibit oral microbial growth.

Experimental peri-implant tissue breakdown around different dental implant surfaces: clinical and radiographic evaluation in dogs.

PURPOSE: Tissue reactions to 4 different implant surfaces were evaluated in regard to the development and progression of ligature-induced peri-implantitis. MATERIALS AND METHODS: In 6 male mongrel dogs, a total of 36 dental implants with different surfaces (9 titanium plasma-sprayed, 9 hydroxyapatite-coated, 9 acid-etched, and 9 commercially pure titanium) were placed 3 months after mandibular premolar extraction. After 3 months with optimal plaque control, abutment connection was performed. Forty-five days later, cotton ligatures were placed around the implants to induce peri-implantitis. At baseline and 20, 40, and 60 days after placement, the presence of plaque, peri-implant mucosal redness, bleeding on probing, probing depth, clinical attachment loss, mobility, vertical bone loss, and horizontal bone loss were assessed. RESULTS: The results did not show significant differences among the surfaces for any parameter during the study (P > .05). All surfaces were equally susceptible to ligature-induced peri-implantitis over time (P < .001). Correlation analysis revealed a statistically significant relationship between width of keratinized tissue and vertical bone loss (r2 = 0.81; P = .014) and between mobility and vertical bone loss (r2 = 0.66; P = .04), both for the titanium plasma-sprayed surface. DISCUSSION AND CONCLUSIONS: The present data suggest that all surfaces were equally susceptible to experimental peri-implantitis after a 60-day period.

Clinical and microbial evaluation of dental scaling associated with subgingival minocycline in chronic periodontitis subjects.

The aims of this double-blind randomized clinical trial were to evaluate the presence of periodontal pathogens and the clinical response of periodontal pockets treatment to scaling and root planing (SRP) associated with subgingival minocycline (SM). A total of 36 subjects, 26 to 60 years old (40.7 +/- 9.1), who had been previously diagnosed with chronic periodontitis, were included in the present study. Eighteen subjects were selected for the test group (TG), who were treated with SRP plus SM (new treatment), and 18 subjects for the control group (CG) who received SRP plus vehicle (current treatment). Two homologous sites in each subject with a probing depth (PD) > or = 6 mm were chosen. To evaluate the clinical response after treatment, PD was measured at baseline and at 90 days. Microbiological evaluation was performed to detect 7 periodontal pathogens using polymerase chain reaction at baseline, 30, and 120 days. A mean reduction in PD of 2.8 and 2.1 mm was observed in the TG and CG, respectively. At baseline, P. gingivalis was the most prevalent organism in both test (65.8%) and control (48.6%) groups. After 120 days it fell to 30.8% in TG and to 23.1% in CG. There were no statistically significant differences between the test and control groups concerning PD (p > 0.05 by Wilcoxon test) or presence of periodontal pathogens (p > 0.05 by Wilcoxon and chi-square; p > 0.01 by Signal test). The results observed showed that the new treatment was as effective as the current treatment in reducing periodontal pathogens and PD among chronic periodontitis subjects.

Clinical and microbial evaluation of dental scaling associated with subgingival minocycline in chronic periodontitis subjects

O objetivo deste estudo randomizado duplo-cego foi avaliar a presença de periodontopatógenos e o comportamento clínico de bolsas periodontais tratadas com raspagem e aplainamento radicular (RAR) associado à minociclina subgengival (MS). Foram incluídos no presente estudo 36 indivíduos de 26 a 60 anos de idade (40,7 ± 9,1), previamente diagnosticados com periodontite crônica. Dezoito indivíduos foram selecionados para o grupo teste (GT), tratado com RAR e MS (novo tratamento), e 18 indivíduos, para o grupo controle (GC), que recebeu RAR e veículo (tratamento convencional). Foram selecionados dois sítios homólogos em cada indivíduo com profundidade de sondagem (PS) > 6 mm para testar a hipótese proposta. Para avaliar o comportamento clínico após o tratamento, a mensuração da PS foi realizada inicialmente e após 90 dias. A avaliação microbiana foi realizada para detecção de 7 periodontopatógenos através de reação em cadeia da polimerase, inicialmente e após 30 e 120 dias. Observou-se redução média de 2,8 e 2,1 mm na PS nos grupos teste e controle, respectivamente. Inicialmente, P. gingivalis foi o microrganismo mais prevalente tanto no GT (65,8%) quanto no GC (48,6%). Após 120 dias, houve redução para 30,8% no GT e 23,1% no GC. Não houve diferenças estatisticamente significativas entre os grupos em relação à PS (teste Wilcoxon - p > 0,05) e presença dos periodontopatógenos (teste Wilcoxon e qui-quadrado - p > 0,05 e teste do sinal - p > 0,01). Os resultados observados demonstraram que o novo tratamento foi tão efetivo quanto o tratamento convencional na redução de periodontopatógenos e de PS em indivíduos com periodontite crônica.