Efficacy of 38% silver diamine fluoride in reducing gingival inflammation and plaque accumulation in older adults living in retirement-homes: A randomized controlled pilot trial.

OBJECTIVES: Emerging from earlier case reports the potential benefits of 38 % silver diamine fluoride (SDF) in addressing pathogenic biofilms and mitigating gingival inflammation and enlargement have sparked interest. Our study aimed to evaluate the efficacy of 38 % SDF in reducing gingival inflammation and plaque accumulation in older adults living in retirement-homes. METHODS: This 7-week randomized, controlled, double-blinded pilot trial employed a parallel assignment design. The study enrolled older adults (aged ≥65) residing in retirement homes in Dallas County, ultimately comprising a cohort of 40 participants who were evenly divided into two arms. The experimental group received SDF treatment, whereas the comparator group received a placebo. Over three consecutive weeks, both groups had solutions applied to the facial surfaces of all their teeth once per week. The primary outcomes measured the change in Löe-Silness Gingival Index (GI) and Silness-Löe Plaque Index (PI) at 7 weeks following baseline treatment. Repeated measures ANOVA was utilized to assess changes over time within each group (n = 15 each). Post-hoc paired t-tests were conducted to compare changes between week 1 and each subsequent follow-up time point (weeks 3, 5, 7), supplemented with 95 % confidence intervals for change from week 1. RESULTS: In the SDF group, within-group comparisons demonstrated significant reductions (adjusted p < .05) in GI scores within 3 weeks (-.93±.37), as opposed to week 1 (1.90±.39). Between-group comparisons unveiled reductions in both mean GI (p < .05) and PI (p < .05), indicating less gingival inflammation and plaque accumulation in the SDF group at all time points, commencing at week 3. CONCLUSIONS: This study showed that 38 % SDF was effective in reducing gingival inflammation and plaque accumulation in older adults living in retirement-homes. CLINICAL SIGNIFICANCE: Oral health in older adults is a public health concern, especially for the medically compromised or those without traditional care. Our findings offer hope for enhancing oral health quality of life by introducing a cost-effective, compliance-free, noninvasive, and accessible therapeutic. TRIAL REGISTRATION: NCT03445286.(clinicaltrials.gov).

Efficacy of flossing and mouth rinsing regimens on plaque and gingivitis: a randomized clinical trial.

BACKGROUND: To investigate the effects of combinations of mechanical (brushing and flossing) and chemotherapeutic regimens which included essential oils (EO) non-alcohol and alcohol-containing mouthrinses compared to brushing only in the prevention and reduction of plaque, gingivitis, and gingival bleeding. METHODS: This was a randomized, virtually supervised, examiner blind, controlled clinical trial. Following informed consent and screening, subjects (N = 270) with gingivitis were randomly assigned to one of the following regimens: (1) Brush Only (B, n = 54); (2) Brush/Rinse (EO alcohol-containing mouthrinse) (BA, n = 54); (3) Brush/Rinse (EO non-alcohol containing mouthrinse) (BZ, n = 54); (4) Brush/Floss (BF, n = 54); (5) Brush/Floss/Rinse (EO non-alcohol containing mouthrinse) (BFZ, n = 54). Unflavored waxed dental floss (REACH unflavored waxed dental floss), and fluoridated toothpaste (Colgate Cavity Protection) were used. Examinations included oral hard and soft tissue, plaque, gingivitis, gingival bleeding, probing depth and bleeding on probing. RESULTS: After 12 weeks, both BA and BZ and the BFZ group were superior in reducing interproximal plaque (30.8%, 18.2%, 16.0%, respectively), gingivitis (39.0%, 36.9%, 36.1%, respectively), and bleeding (67.8%, 73.6%, 79.8%, respectively) compared to B. The BF group did not provide significant reductions in interproximal plaque but did reduce interproximal gingivitis (5.1%, p = 0.041) at Week 4 and bleeding at Weeks 4 and 12 (34.6%, 31.4%, p < 0.001 respectively) compared to B. The BFZ group did not significantly reduce interproximal plaque, gingivitis or bleeding compared to BZ. CONCLUSIONS: This study demonstrated that the addition of EO non-alcohol containing mouthrinse to the manual toothbrushing and flossing regimen further reduces plaque, gingivitis and bleeding showing that addition of EO mouthrinses (alcohol or non-alcohol containing) to the oral hygiene regimen provides sustained reductions in plaque to help maintain gingival health after a dental prophylaxis. Dental professional recommendation of the addition of an EO non-alcohol containing mouthrinse to daily oral hygiene routines of brushing or brushing and flossing should be considered to aid supragingival plaque control and improve gingivitis prevention. STUDY REGISTRY NUMBER: NCT05600231.

Antibacterial and clinical effectiveness of a mouthwash with a novel active system of amine + zinc lactate + fluoride: a randomized controlled trial.

OBJECTIVES: To support the daily oral hygiene of patients experiencing gum inflammation, a new mouthwash was developed containing an amine + zinc lactate + fluoride system. In vitro and clinical efficacy was assessed using traditional methods as well as using novel site-specific and subject-specific analyses of the clinical data. MATERIALS AND METHODS: This mouthwash was evaluated in a 12-h biofilm regrowth assay against a negative control mouthwash and in a 6-month plaque and gingivitis clinical study as compared to a negative control mouthwash. Analyses of healthy versus inflamed sites, visible plaque versus non-visible plaque sites, as well as subject-level evaluations bring new perspectives to the overall performance of this mouthwash and its significance from a patient outcome perspective. RESULTS: Studies demonstrated that this new mouthwash provided long-term (12-h) antibacterial activity after single application in vitro and reduced clinically all plaque and gingivitis parameters after 3 months and 6 months of use when compared to the negative control mouthwash. Examination of site-level and subject-level data determined that this mouthwash significantly increased the number of healthy sites in the oral cavity and significantly improved the gum health of subjects in the study, as compared to the negative control mouthwash. CONCLUSIONS: In vitro and clinical research has demonstrated the antibacterial and clinical benefits of this mouthwash containing an amine compound + zinc lactate + fluoride system. CLINICAL RELEVANCE: Our subject-specific and site-specific analyses provide the dental practitioner with tools that can be used to guide patients who suffer from gingivitis toward optimal product selection and use. CLINICAL TRIAL REGISTRATION: The trial was registered at ClinicalTrials.gov (reference no. NCT05821712).

Combating Cariogenic Streptococcus mutans Biofilm Formation and Disruption with Coumaric Acid on Dentin Surface.

Streptococcus mutans, the primary cause of dental caries, relies on its ability to create and sustain a biofilm (dental plaque) for survival and pathogenicity in the oral cavity. This study was focused on the antimicrobial biofilm formation control and biofilm dispersal potential of Coumaric acid (CA) against Streptococcus mutans on the dentin surface. The biofilm was analyzed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) viability assay, microtiter plate assay, production of extracellular polymeric substances (EPSs), florescence microscopy (surface coverage and biomass µm2) and three-dimensional (3D) surface plots. It was observed that CA at 0.01 mg/mL reduced bacterial growth by 5.51%, whereases at 1 mg/mL, a significant (p < 0.05) reduction (98.37%) was observed. However, at 1 mg/mL of CA, a 95.48% biofilm formation reduction was achieved, while a 73.45% biofilm dispersal (after 24 h. treatment) was achieved against the preformed biofilm. The MTT assay showed that at 1 mg/mL of CA, the viability of bacteria in the biofilm was markedly (p < 0.05) reduced to 73.44%. Moreover, polysaccharide (EPS) was reduced to 24.80 µg/mL and protein (EPS) to 41.47 µg/mL. ImageJ software (version 1.54 g) was used to process florescence images, and it was observed that the biofilm mass was reduced to 213 (µm2); the surface coverage was reduced to 0.079%. Furthermore, the 3D surface plots showed that the untreated biofilm was highly dense, with more fibril-like projections. Additionally, molecular docking predicted a possible interaction pattern of CA (ligand) with the receptor Competence Stimulating Peptide (UA159sp, PDB ID: 2I2J). Our findings suggest that CA has antibacterial and biofilm control efficacy against S. mutans associated with dental plaque under tested conditions.

Photodynamic therapy in periodontitis: A narrative review.

BACKGROUND: Periodontitis, a chronic infectious disease, is primarily caused by a dysbiotic microbiome, leading to the destruction of tooth-supporting tissues and tooth loss. Photodynamic therapy (PDT), which combines excitation light with photosensitizers (PS) and oxygen to produce antibacterial reactive oxygen species, is emerging as a promising adjuvant treatment for periodontitis. METHODS: This review focuses on studies examining the antibacterial effects of PDT against periodontal pathogens. It also explores the impact of PDT on various aspects of periodontal health, including periodontal immune cells, human gingival fibroblasts, gingival collagen, inflammatory mediators, cytokines in the periodontium, vascular oxidative stress, vascular behavior, and alveolar bone health. Clinical trials assessing the types of PSs and light sources used in PDT, as well as its effects on clinical and immune factors in gingival sulcus fluid and the bacterial composition of dental plaque, are discussed. RESULTS: The findings indicate that PDT is effective in reducing periodontal pathogens and improving markers of periodontal health. It has shown positive impacts on periodontal immune response, tissue integrity, and alveolar bone preservation. Clinical trials have demonstrated improvements in periodontal health and alterations in the microbial composition of dental plaque when PDT is used alongside conventional treatments. CONCLUSIONS: PDT offers a promising adjunctive treatment for periodontitis, with benefits in bacterial reduction, tissue healing, and immune modulation. This article highlights the potential of PDT in periodontal therapy and emphasizes the need for further research to refine its clinical application and efficacy.

Use of over-the-counter mouthwashes as an additional measure in individual oral prophylaxis on adults with plaque-induced gingivitis: a double-blind, parallel, randomized controlled trial.

BACKGROUND: Plaque-induced gingivitis is a chronic inflammatory condition characterized by complete reversibility of tissue damage once the periodontal biofilm has been disorganised. The aim of this study was to evaluate the efficacy of two commercially available mouthwashes (MWs) versus a chlorhexidine (CHX) 0.12% MW in reducing gingival bleeding (GB) in adults with plaque-induced gingivitis. METHODS: The present study was a double-blind, parallel, randomized controlled trial involving 6492 gingival sites (i.e. 39 subjects × 28 teeth × 6 sites/tooth) aged 18-75 years. During a 2-week period, subjects were randomized to receive MWs: a control CHX 0.12% MW (group C, 1818 sites); a MW test containing CHX 0.09% + Citrox®/P complex (group CX, 2628 sites); a MW test based on natural compounds (group P, 2016 sites). GB was assessed at the inclusion visit (T0) and after 2 weeks of MW use (T1). Analyses of GB were compared between groups and then restricted to subjects with bleeding sites between 10 and 30% (moderate gingivitis) or ≥ 30% (severe gingivitis) at T0. Pairwise comparisons were made between groups and logistic regression was used to identify correlates of GB (T1). RESULTS: For total bleeding site analysis, GB reduction between T0 and T1 ranged from 23% (C), 26% (CX) and 36% (P), respectively (all p < 0.05). Multiple comparison between groups showed that group C was significantly less effective (p < 0.05) than groups CX and P. Splitting the analysis, in patients with severe gingivitis (≥ 30% bleeding sites at T0), all MWs had a positive effect on GB with a reduction at T1 of 36% (C), 33% (CX) and 42% (P), respectively. While GB reduction between T0 and T1, was significant for all groups, the comparison among groups showed no significant difference between group C and CX, whereas the improvement was significant for group P. On the other hand, in adults with moderate gingivitis (< 30% bleeding sites at T0), only CX and P had a positive effect on GB reduction at T1(9% in CX and 2% in P, respectively), although the differences between the three groups were not significant. CONCLUSION: The daily use of MWs with natural components (groups P and CX) for 2 weeks should be considered positively as an adjunct to individual oral prophylaxis to reduce GB compared to the control MW containing CHX 0.12% (group C) in healthy adults with plaque-induced gingivitis. For subjects with severe gingivitis, it is advisable to first use natural MW (P) and then MW based on CHX 0.09% with natural components (CX), compared to MW with CHX 0.12% (C). For adults with moderate gingivitis, P and CX can be advisable, even if no definitive recommendations can be drawn. TRIAL REGISTRATION: ACTRN12622000215729, 07/02/2022.

Customised enriched coconut oil as panacea for oral biofilm mediated diseases - A prospective study.

Aims: To evaluate a customised enriched formulation of coconut (CEC) oil with Arimedadi Tailam (AT) and 0.2% chlorhexidine mouth rinse (CHX) for their plaque control and potential anticaries effects using the oratest in healthy volunteers. Settings and Design: Parallel, double-blinded (outcome assessor and statistician), randomised controlled institution-based pilot study. Methods and Materials: 60 adults (18-22 years) having DMFT score of 2-11, gingival and plaque index as zero, no history of antibiotics for one month or fluoride application in 2 weeks were randomly divided (computer-generated list) and allocated into 3 groups (A-CHX, B-CEC, C-AT) of 20 subjects each based on the intervention. Oratest at baseline, days 15 and 30 were recorded. Statistical Analysis Used: Due to 5 dropouts on day 30, data were analysed based on the intention-to-treat (ITT) approach. The difference in oratest scores (baseline vs. day 15 and 30) were found to be normally distributed (Shapiro-Wilk test and Levene's test). One way ANOVA followed by Tukey's post hoc test was used to determine the statistically significant difference (P < 0.05) between groups. Results: Plaque and gingival index was zero throughout the study period. Difference in oratest scores was highest with CEC oil, followed by CHX and AT though there was no statistically significant differences between groups at baseline vs day 15 (P = 0.203) and baseline vs day 30 (P = 0.085) and between oils from baseline vs day 30 (P = 0.068). Conclusions: Within the limitations of the pilot study, both oils are comparable to CHX for their antiplaque and anticaries potential. Clinically, CEC was better than AT though statistical difference was not there.

Antibacterial and anti-inflammatory effects of a novel herb-mediated nanocomposite mouthwash in plaque-induced gingivitis: A randomized controlled trial.

BACKGROUND: Gingivitis is frequently painless, rarely causes spontaneous bleeding and is manifested by minor clinical changes. Therefore, most patients are unaware of the disease or do not seek treatment, as it is asymptomatic. Several methods for removing microbial plaque have been proposed, including mechanical and chemical ones. Amla or Indian gooseberry is a medicinal herb; its secondary metabolites, such as phenolic acid, flavonoids and terpenoids, can be used to preferentially reduce metal ions and form nanoparticles (NPs). Green synthesis with the use of the amla seed extract is a unique approach for the production of graphene oxide (GO)-silver (Ag) nanocomposite mouthwash. OBJECTIVES: The aim of the present study was to prepare an amla seed-mediated GO-Ag nanocomposite mouthwash, and to assess its antibacterial and anti-inflammatory efficacy in plaque-induced gingivitis. MATERIAL AND METHODS: The present double-blind randomized controlled trial was conducted among 30 gingivitis patients. The patients were randomly allocated into 2 groups based on the intervention: group A (n = 15; nanocomposite mouthwash); and group B - control (n = 15; 0.2% chlorhexidine (CHX) mouthwash). Clinical parameters, including the plaque index (PI), the gingival index (GI), a microbiological parameter - colony forming units (CFUs), and a biochemical parameter - the C-reactive protein (CRP) level in gingival crevicular fluid (GCF), were assessed at baseline and at 15 days. RESULTS: The study results showed statistically significant differences in the mean PI and GI scores, and the CRP levels in the post-intervention period as compared to baseline in both groups. After the intervention period of 15 days, there were statistically significant differences between the 2 study groups in terms of mean PI and GI scores, and CRP levels. CONCLUSIONS: The amla seed-mediated GO-Ag nanocomposite mouthwash efficiently reduced plaque, gingival inflammation and CFUs among patients with plaque-induced gingivitis, but was not equivalent to the CHX mouthwash.

Short-term anti-plaque effect of a cymenol mouthwash analysed using the DenTiUS Deep Plaque software: a randomised clinical trial.

BACKGROUND: The effect of cymenol mouthwashes on levels of dental plaque has not been evaluated thus far. OBJECTIVE: To analyse the short-term, in situ, anti-plaque effect of a 0.1% cymenol mouthwash using the DenTiUS Deep Plaque software. METHODS: Fifty orally healthy participants were distributed randomly into two groups: 24 received a cymenol mouthwash for eight days (test group A) and 26 a placebo mouthwash for four days and a cymenol mouthwash for a further four days thereafter (test group B). They were instructed not to perform other oral hygiene measures. On days 0, 4, and 8 of the experiment, a rinsing protocol for staining the dental plaque with sodium fluorescein was performed. Three intraoral photographs were taken per subject under ultraviolet light. The 504 images were analysed using the DenTiUS Deep Plaque software, and visible and total plaque indices were calculated (ClinicalTrials ID NCT05521230). RESULTS: On day 4, the percentage area of visible plaque was significantly lower in test group A than in test group B (absolute = 35.31 ± 14.93% vs. 46.57 ± 18.92%, p = 0.023; relative = 29.80 ± 13.97% vs. 40.53 ± 18.48%, p = 0.024). In comparison with the placebo, the cymenol mouthwash was found to have reduced the growth rate of the area of visible plaque in the first four days by 26% (absolute) to 28% (relative). On day 8, the percentage areas of both the visible and total plaque were significantly lower in test group A than in test group B (visible absolute = 44.79 ± 15.77% vs. 65.12 ± 16.37%, p < 0.001; visible relative = 39.27 ± 14.33% vs. 59.24 ± 16.90%, p < 0.001; total = 65.17 ± 9.73% vs. 74.52 ± 13.55%, p = 0.007). Accounting for the growth rate with the placebo mouthwash on day 4, the above results imply that the cymenol mouthwash in the last four days of the trial reduced the growth rate of the area of visible plaque (absolute and relative) by 53% (test group A) and 29% (test group B), and of the area of total plaque by 48% (test group A) and 41% (test group B). CONCLUSIONS: The 0.1% cymenol mouthwash has a short-term anti-plaque effect in situ, strongly conditioning the rate of plaque growth, even in clinical situations with high levels of dental plaque accumulation.

Comparative Evaluation of 0.25% Lemongrass Oil Mouthwash and 0.2% Chlorhexidine Mouthwash in Fixed Orthodontic Patients Suffering from Gingivitis.

AIM: The aim of this study is to compare the antiplaque and antigingivitis efficacy of 0.25% lemongrass oil mouthwash and 0.2% chlorhexidine mouthwash in patients undergoing fixed orthodontic treatment, who are suffering from gingivitis. MATERIALS AND METHODS: A total of 60 patients undergoing fixed orthodontic treatment with mild-to-moderate gingivitis were selected for the study. The patients were randomly divided into three groups of twenty each, that is, group I: 0.25% lemongrass oil mouthwash (n = 20); group II: 0.2% chlorhexidine mouthwash (n = 20); and group III: oral prophylaxis (n = 20). Baseline gingival index (GI) and plaque index (PI) were accessed followed by oral prophylaxis was done and the PI score was set to zero for all the patients. Patients were asked to swish their mouth with their respective mouthwashes and brushing (twice daily), that is, morning and before bedtime for 21 days. The PI and GI scores were recorded for all three groups on the 14th and the 21st days. The post hoc Bonferroni test was used for multiple comparisons of mean differences among variables after the application of the analysis of variance (ANOVA) test for comparison within the groups. RESULTS: A lower PI and the GI were found in the lemongrass oil mouthwash group by the 14th and the 21st days, respectively, a statistically significant difference (p < 0.001) compared to the chlorhexidine mouthwash group. CONCLUSION: The findings of the current study suggested that 0.25% lemongrass oil mouthwash has the potential to be used as a natural or herbal alternative to chlorhexidine mouthwash. CLINICAL SIGNIFICANCE: It can be suggested that 0.25% lemongrass oil mouthwash may be a good herbal alternative to mouthwash containing 0.2% chlorhexidine gluconate.

The effect of mastic mouthwash on halitosis and oral hygiene in orthodontic patients: a randomized clinical trial.

BACKGROUND/OBJECTIVES: The aim of this trial was to investigate the effect of mastic mouthwash on halitosis using as a proxy the levels of the Volatile Sulfur Compounds (VSCs), and the effect on plaque and gingival indices in adolescents undergoing orthodontic treatment with fixed conventional labial appliances. SUBJECTS/METHODS: The study was a double-blinded, placebo-controlled, parallel-group, randomized clinical trial. Thirty patients with fixed orthodontic appliances were randomly allocated at a 1:1 ratio, to either the mastic-mouthwash or the placebo-mouthwash group. Eligibility criteria included ages between 13 and 18, active orthodontic treatment with fixed appliances, good general health, and total initial VSCs levels above 150 ppb. The primary outcome was the objective hydrogen sulfide (H2S) level, measured with the Oral ChromaTM device. The secondary outcomes were (1.) the methyl-mercaptan (CH3SH) and (2.) dimethyl sulfide [(CH3)2S] levels, measured with the same device, (3.) the subjective perception of the own malodour via questionnaires, and (4.) the oral hygiene assessed with the use of the Modified Silness and Löe Plaque Index (PI-M) and the Silness and Löe Gingival Index (GI) at baseline (T0) and after 2 weeks (T1). Stratified randomization by gender was used, and allocation was concealed with opaque numbered sealed envelopes. RESULTS: H2S level dropped from 221.00 ppb (T0) to 125.00 ppb (T1), and the difference between treatment groups was statistically significant in favour of the mastic group (coef: 72.34, 95% CI: 8.48, 136.27, P = 0.03). The levels of the other VSCs, the subjective measurements of oral malodour, and the oral hygiene indices did not differ between treatment arms. LIMITATIONS: The objective organoleptic assessment by a calibrated examiner was not performed. CONCLUSIONS/IMPLICATIONS: Mastic mouthwashes could be an alternative treatment for adolescent patients suffering from halitosis during orthodontic treatment with fixed appliances. REGISTRATION: The trial was registered at ClinicalTrials.gov (identifier: NCT05647369).

Comparative efficacy of topical povidone-iodine and chlorhexidine gel on dental plaque regrowth in toddlers: A randomized controlled trial.

OBJECTIVES: This study aimed to compare and evaluate the efficacy of topical use of povidone-iodine (PVP-I) solution and chlorhexidine (CHX) gel on dental plaque regrowth after 3 and 7 days in toddlers aged 24-36 months. MATERIALS AND METHODS: A randomized controlled trial that included 45 healthy toddlers aged 24-36 months, who were randomly assigned to three groups. The first group received a placebo (distilled water (DW)) (negative control). The second group received topical CHX gel (0.2% w/v) (positive control). The third group received topical PVP-I solution (10% w/v). Plaque accumulation was measured at the baseline (t0 ), after 3 days (t1 ) and after 7 days (t2 ) using the Turesky-modified Quigley-Hein plaque index (TMQHPI). Oral hygiene practices were prohibited during the trial period. The trial ID is ACTRN12623000567628. RESULTS: In the DW group, the mean of the TMQHPI score was 1.89 ± 0.67 at t0 and decreased to 1.45 ± 0.66 at t1 (p = .028). Similarly, in the CHX group, the mean of the TMQHPI score was 1.83 ± 1.06 at t0 and decreased to 1.02 ± 0.99 at t1 (p = .033). Regarding the PVP-I group, the mean of the TMQHPI score went from 1.84 ± 0.85 to 1.01 ± 0.61 at t1 and then increased to 1.57 ± 0.74 at t2 . Those changes were statistically significant (p = .001) and (p = .002), respectively. No statistically significant difference was noted between TMQHPI scores at t0 (p = .789). Regarding t1 and t2 , no statistically significant difference was found between the three groups (p > .05). CONCLUSION: CHX and PVP-I efficacy lasted only for 3 days, and PVP-I was not superior to CHX in terms of plaque control in toddlers. However, further studies are needed to determine the long-term efficacy of these antiplaque agents in toddlers.

Dextranase enzyme and Enterococcus faecium probiotic have anti-biofilm effects by reducing the count of bacteria in dental plaque in the oral cavity of dogs.

OBJECTIVE: Periodontal disease is a common clinical complication and has a negative impact on the quality of life and the welfare of companion dogs. Periodontal disease occurs when pathogenic bacteria are accumulated in the gingival sulcus, which favors biofilm formation. The oral health of dogs can be significantly compromised by dental plaque accumulation. Thus, this investigation demonstrates the effect of Enterococcus faecium probiotic, dextranase enzyme, and their combination on dental biofilm in the oral cavity of dogs. ANIMALS: The 30 dogs were referred to Polyclinic with no oral ulcers, severe periodontitis, and internal diseases. PROCEDURES: Dextranase enzyme, E faecium probiotic, and their combination were administered in the oral cavity of dogs. Microbiological samples were obtained from tooth surfaces and gums before and after intervention with the substances. Bacterial colonies were enumerated by using a colony counter. Also, Porphyromonas gingivalis hmuY gene expression was evaluated by reverse transcription quantitative real-time PCR analysis. RESULTS: The total colony count of the bacterial culture indicated that the dextranase enzyme, E faecium probiotic, and their combination significantly reduced the total bacteria count in the oral cavity. Moreover, in the reverse transcription quantitative real-time PCR analysis it was observed that using the combination of E faecium probiotic and dextranase enzyme decreases the hmuY gene expression of P gingivalis bacteria. CLINICAL RELEVANCE: The results clearly indicated that the dextranase enzyme and E faecium probiotic could be used as preventive agents to reduce oral biofilm in dogs. Furthermore, no side effects were observed while using these substances.

Efficacy of 0.12% Chlorhexidine and Salvadora persica-based Mouthwash in Reducing Oral Candida Carriage and Periodontal Inflammation in Cigarette Smokers and Non-smokers after Non-surgical Periodontal Therapy.

PURPOSE: The present study assessed the efficacy of 0.12% chlorhexidine (CHX) and Salvadora persica-based mouthwashes (SPM) in reducing oral Candida carriage (OCC) and periodontal inflammation in cigarette smokers and non-smokers after non-surgical periodontal treatment (NSPT). MATERIALS AND METHODS: Self-reported cigarette smokers and non-smokers with periodontal inflammation as well as non-smokers with a healthy periodontal status were included. NSPT was performed in all participants. Based on the type of mouthwash, participants were randomly divided into three groups as follows: group 1: CHX; group 2: SPM; and group 3: distilled water (ddH2O) with mint flavour (control group). Clinical attachment loss (CAL), plaque index (PI), gingival index (GI), probing depth (PD), and marginal bone loss (MBL) were measured. Clinical periodontal parameters were re-assessed at a 6-week follow-up. Oral yeast samples were collected and identified using a concentrated oral-rinse culture technique and PCR, respectively. Clinical and laboratory-based investigations were done at baseline and after six weeks. Statistical significance was set at p < 0.05. RESULTS: At baseline, PI, MBL, PD and CAL were comparable in all participants. None of the patients had periodontitis at baseline. Post-operatively, CHX and SPM were more effective in reducing PI (p < 0.01), GI (p < 0.01) and PD (p < 0.01) in non-smokers than in the control group. The OCC was statistically significantly higher among smokers compared with non-smokers at baseline. At the 6-month follow-up, CHX was more effective than SPM in reducing OCC in non-smokers (p < 0.01). At the 6-week follow-up, there was no difference in OCC among cigarette smokers regardless of the type of mouthwash prescribed postoperatively. CONCLUSION: In cigarette smokers and non-smokers, CHX and SPM are effective in reducing periodontal soft-tissue inflammation after NSPT. Post-operative use of CHX is more effective than SPM in reducing OCC.

The anti-plaque effect of high concentration sodium bicarbonate dentifrice on plaque formation and gingival inflammation, irrespective to individual polishing technique and plaque quality.

AIM: To assess the anti-plaque effect of a high concentration sodium bicarbonate dentifrice on plaque formation, and gingivitis, as compared to a control toothpaste, irrespective of individual brushing technique and plaque quality. METHODS: The experimental gingivitis model, with a split-mouth design was used to assess the anti-plaque effect of a high concentration sodium bicarbonate dentifrice on plaque formation. By producing individual fitted trays, the toothpaste was applied in the test quadrant and a control dentifrice in the contralateral. The participants used the individual fitted trays for 1 min every morning and evening, for 21 days. In this period, the participants was only allowed to brush the teeth in the opposite jaw, as usual. Twenty healthy individuals successfully completed the study. RESULTS: At 21 days, there was no statistically significant difference between test quadrant and control quadrant with regard to plaque indices, gingival index and number of bleeding sites. CONCLUSION: This study demonstrated that the high concentration sodium bicarbonate dentifrice used did not produce statistically significant anti-plaque effect compared to the control dentifrice, in terms of Plaque- and Gingival Indices, number of bleeding sites or by Quigely and Hein, the Turesky modification Plaque Index, irrespective of brushing technique and individual plaque quality. TRIAL REGISTRATION: Regional Committee for Medical Research and Ethics, South-East Norway in 2021 (REK.2021/370116). CLINICAL TRIAL REGISTRATION: NCT05441371 (First registered 09/06/2022, First posted 01/07/2022) ( http://www. CLINICALTRIALS: gov ). (Retrospectively registered).

Effect of silver diamine fluoride upon the microbial community of carious lesions: A scoping review.

OBJECTIVES: To explore the effects of silver diamine fluoride (SDF) on the microbial community of carious lesions. DATA: Original studies evaluating the effect of SDF treatment on the microbial community of human carious lesions were included. SOURCES: A systematic search of English-language publications was performed in PubMed, EMBASE, Scopus, and Web of Science. Gray literature was searched in ClinicalTrials.gov and Google Scholar. STUDY SELECTION/RESULTS: This review included seven publications reporting the effects of SDF on microbial community of dental plaque or carious dentin, including the microbial biodiversity, relative abundance of microbial taxa, and predicted functional pathways of the microbial community. The studies on microbial community of dental plaque reported that SDF did not have a significant effect on both the within-community species diversity (alpha-diversity) and inter-community microbial compositional dissimilarity (beta-diversity) of the plaque microbial communities. However, SDF changed the relative abundance of 29 bacterial species of plaque community, inhibited carbohydrate transportation and interfered with the metabolic functions of the plaque microbial community. A study on the microbial community in dentin carious lesions reported that SDF affected its beta-diversity and changed the relative abundance of 14 bacterial species. CONCLUSION: SDF showed no significant effects on the biodiversity of the plaque microbial community but changed the beta-diversity of the carious dentin microbial community. SDF could change the relative abundance of certain bacterial species in the dental plaque and the carious dentin. SDF could also affect the predicted functional pathways of the microbial community. CLINICAL SIGNIFICANCE: This review provided comprehensive evidence on the potential effect of SDF treatment on the microbial community of carious lesions.

The efficacy of mouthwashes on oral microorganisms and gingivitis in patients undergoing orthodontic treatment: a systematic review and meta-analysis.

BACKGROUND: Mouthwashes were convenient adjuncts to mechanical cleaning procedures. This review aimed to evaluate the efficacy of mouthwashes on oral microorganisms and gingivitis in orthodontic patients. METHODS: By April 16, 2022, multiple databases and grey literature were searched based on the PICOS strategy. Randomized controlled trials in orthodontic patients evaluating the efficacy of mouthwashes with at least one microbial parameter and/or plaque- and/or gingival inflammation-related index were included. Relevant data were extracted, and the risk of bias was evaluated using Cochrane's tool. Individual mean and standard deviation of the outcomes in mouthwashes and placebos/blank controls were pooled to estimate the weighted mean differences (WMDs) and 95% confidence intervals (95%CIs). Sensitivity analysis, and certainty of evidence were evaluated. RESULTS: Of 1684 articles, 32 studies satisfied the eligibility criteria, and nine were included for meta-analysis. Missing outcome data was the primary source of bias. Compared to blank controls, the short-term application of fluoride mouthwashes significantly reduced the colony counts of Mutans streptococci (MS), while the long-term application may not be effective. Compared to placebos or blank controls, Chlorhexidine mouthwashes significantly reduced the colony counts of multiple microorganisms in the short-term. Compared to placebos or blank controls, herbal mouthwashes showed the inhibitory effect of MS in the short-term, with some results lacking statistical significance. After meta-analysis, significant lower plaque- and gingival inflammation-related indexes were observed in the Chlorhexidine mouthwashes groups [Gingival Index: WMD = -0.45, 95%CI = -0.70 to -0.20 (placebos as control); WMD = -0.54, 95%CI = -0.96 to -0.13 (blank controls); Plaque Index: WMD = -0.70, 95%CI = -1.12 to -0.27 (blank controls)]. Significant lower gingival inflammation-related indexes were observed in the herbal mouthwashes groups [Gingival Index: WMD = -0.20, 95%CI = -0.32 to -0.09 (blank controls)]. CONCLUSIONS: The short-term application of fluoride mouthwashes may reduce the colony counts of cariogenic bacteria, but the long-term effect is not evident. Chlorhexidine may reduce the colony counts of multiple microorganisms in the short-term. Short-term application Chlorhexidine and herbal mouthwashes may effectively reduce plaque- and gingival inflammation-related indexes. However, the risk of bias, inconsistency, and imprecision in the included studies may reduce the certainty of the evidence.

A randomized double-blind clinical trial evaluating comparative plaque and gingival health associated with commercially available stannous fluoride-containing dentifrices as compared to a sodium fluoride control dentifrice.

BACKGROUND: Gingivitis is a non-specific inflammatory lesion in response to the accumulation of oral biofilm and is a necessary precursor to periodontitis. Enhanced oral hygiene practices, including utilization of a dentifrice that could significantly improve plaque accumulation and gingival inflammation, is desirable to prevent and treat gingivitis and potentially prevent progression to periodontitis. This clinical study aimed to investigate the effect of a new stannous fluoride-containing dentifrice with 2.6% ethylenediamine tetra acetic acid (EDTA) as an anti-tartar agent to reduce plaque index and gingival index over a 3-month study period compared to other commercially-available fluoride-containing dentifrices. METHODS: This double-blind, randomized controlled clinical study evaluated plaque, gingival inflammation, and sulcular bleeding in patients using one of five commercially available fluoride-containing dentifrices The dentifrices tested contained: 0.454% stannous fluoride and 2.6% EDTA (D1), 0.24% sodium fluoride (C), and 0.454% stannous fluoride (D2-D4). One hundred fifty subjects participated over a 3-month period. Co-primary endpoints were improvements in plaque index (PI) and modified gingival index (mGI) from baseline values. No professional cleaning was performed during the study period. RESULTS: All subjects in the study demonstrated statistically significant improvements in all measures of oral hygiene over the 3-month study period. Subjects using dentifrice 1 (D1) showed statistically significantly greater reductions in PI, mGI, and modified sulcular bleeding index (mSBI) compared with all other commercially-available dentifrices tested (p < 0.00001). CONCLUSIONS: A new dentifrice with 0.454% stannous fluoride and 2.6% EDTA demonstrated significant improvements in clinical parameters associated with gingivitis compared to other sodium and stannous fluoride containing dentifrices.

Photodynamic nano hydroxyapatite with biofilm penetration capability for dental plaque eradication and prevention of demineralization.

Dental caries represents one of the most prevalent diseases worldwide, characteristic of the growth of dental plaque and demineralization of tooth enamel. Current medications for eradication of dental plaques and prevention of demineralization suffer from several limitations to overcome, calling for novel strategies with great potency in eliminating cariogenic bacteria and dental plaque that forms, as well as in inhibiting the demineralization of enamel, into an integrated system. Considering the potency of photodynamic therapy in bacteria inactivation and the composition of enamel, we herein report that the novel photodynamic nano hydroxyapatite (nHAP), named Ce6 @QCS/nHAP, was useful for this purpose. Ce6 @QCS/nHAP, comprised of quaternary chitosan (QCS)-coated nHAP loaded with chlorin e6 (Ce6), exhibited good biocompatibility and non-compromised photodynamic activity. In vitro studies revealed that Ce6 @QCS/nHAP could effectively associate with cariogenic Streptococcus mutans (S. mutans), leading to a significant antibacterial effect through photodynamic killing and physical inactivation against the planktonic microbe. Three-dimensional fluorescence imaging suggested that Ce6 @QCS/nHAP exhibited a superior S. mutans biofilm penetration capacity to free Ce6, resulting in effective dental plaque eradiation when light irradiation was applied. The number of surviving bacteria in biofilm was at least 2.8 log units lower in the Ce6 @QCS/nHAP group compared to that in the free Ce6 group. Further, in the S. mutans biofilm-infected artificial tooth model, treatment with Ce6 @QCS/nHAP also resulted in the significant prevention of hydroxyapatite disks from demineralization, with lower percentage of fragmentation and weight loss These data suggest that our photodynamic nanosystem can effectively eradicate dental plaque while also significantly protecting artificial tooth from demineralization, opening up new possibilities in treating bacterium-associated dental caries.

Comparison of the plaque regrowth inhibition effects of oil pulling therapy with sesame oil or coconut oil using 4-day plaque regrowth study model: A randomized crossover clinical trial.

OBJECTIVES: The aim of this study was to compare the plaque-inhibiting effects of oil pulling therapy with sesame oil or coconut oil using 4-day plaque regrowth study model. METHODS: This clinical observer-masked, randomized, crossover designed study involved 24 participants. The participants received professional prophylaxis in the preparatory period and after that subjects started to use the allocated mouthrinse (coconut oil or sesame oil). On day 5, periodontal clinical parameters including plaque index (PI), gingival index (GI), stain index (SI) and bleeding on probing (BOP) were recorded. Subjects underwent a 14-day wash out period and then used the other mouthrinse for 4 days. RESULTS: Oil pulling therapy with coconut oil or sesame oil exhibited similar plaque regrowth inhibition (PI = 1.60 ± 0.28 and 1.49 ± 0.22, for oil pulling with coconut oil and sesame oil, respectively) and tooth staining (SI = 0.20 ± 0.11 and 0.21 ± 0.09, for oil pulling with coconut oil and sesame oil, respectively.) In addition, GI and BOP were similar in both groups (GI = 0.61 ± 0.19 and 0.69 ± 0.16; BOP = 0.09 ± 0.24 and 0.03 ± 0.03 for oil pulling with coconut oil and sesame oil, respectively). CONCLUSIONS: Oil pulling therapy with coconut or sesame oil showed similar results in terms of plaque regrowth inhibition and tooth staining. According to the present results, both coconut oil and sesame oil can be used for oil pulling therapy with the aim of plaque regrowth inhibition.