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1.
Cochrane Database Syst Rev ; 12: CD008367, 2020 12 24.
Artigo em Inglês | MEDLINE | ID: mdl-33368159

RESUMO

BACKGROUND: Ventilator-associated pneumonia (VAP) is defined as pneumonia developing in people who have received mechanical ventilation for at least 48 hours. VAP is a potentially serious complication in these patients who are already critically ill. Oral hygiene care (OHC), using either a mouthrinse, gel, swab, toothbrush, or combination, together with suction of secretions, may reduce the risk of VAP in these patients. OBJECTIVES: To assess the effects of oral hygiene care (OHC) on incidence of ventilator-associated pneumonia in critically ill patients receiving mechanical ventilation in hospital intensive care units (ICUs). SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 25 February 2020), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2020, Issue 1), MEDLINE Ovid (1946 to 25 February 2020), Embase Ovid (1980 to 25 February 2020), LILACS BIREME Virtual Health Library (1982 to 25 February 2020) and CINAHL EBSCO (1937 to 25 February 2020). We also searched the VIP Database (January 2012 to 8 March 2020). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: We included randomised controlled trials (RCTs) evaluating the effects of OHC (mouthrinse, gel, swab, toothbrush or combination) in critically ill patients receiving mechanical ventilation for at least 48 hours. DATA COLLECTION AND ANALYSIS: At least two review authors independently assessed search results, extracted data and assessed risk of bias in included studies. We contacted study authors for additional information. We reported risk ratio (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes, using the random-effects model of meta-analysis when data from four or more trials were combined. MAIN RESULTS: We included 40 RCTs (5675 participants), which were conducted in various countries including China, USA, Brazil and Iran. We categorised these RCTs into five main comparisons: chlorhexidine (CHX) mouthrinse or gel versus placebo/usual care; CHX mouthrinse versus other oral care agents; toothbrushing (± antiseptics) versus no toothbrushing (± antiseptics); powered versus manual toothbrushing; and comparisons of other oral care agents used in OHC (other oral care agents versus placebo/usual care, or head-to-head comparisons between other oral care agents). We assessed the overall risk of bias as high in 31 trials and low in two, with the rest being unclear. Moderate-certainty evidence from 13 RCTs (1206 participants, 92% adults) shows that CHX mouthrinse or gel, as part of OHC, probably reduces the incidence of VAP compared to placebo or usual care from 26% to about 18% (RR 0.67, 95% confidence intervals (CI) 0.47 to 0.97; P = 0.03; I2 = 66%). This is equivalent to a number needed to treat for an additional beneficial outcome (NNTB) of 12 (95% CI 7 to 128), i.e. providing OHC including CHX for 12 ventilated patients in intensive care would prevent one patient developing VAP. There was no evidence of a difference between interventions for the outcomes of mortality (RR 1.03, 95% CI 0.80 to 1.33; P = 0.86, I2 = 0%; 9 RCTs, 944 participants; moderate-certainty evidence), duration of mechanical ventilation (MD -1.10 days, 95% CI -3.20 to 1.00 days; P = 0.30, I2 = 74%; 4 RCTs, 594 participants; very low-certainty evidence) or duration of intensive care unit (ICU) stay (MD -0.89 days, 95% CI -3.59 to 1.82 days; P = 0.52, I2 = 69%; 5 RCTs, 627 participants; low-certainty evidence). Most studies did not mention adverse effects. One study reported adverse effects, which were mild, with similar frequency in CHX and control groups and one study reported there were no adverse effects. Toothbrushing (± antiseptics) may reduce the incidence of VAP (RR 0.61, 95% CI 0.41 to 0.91; P = 0.01, I2 = 40%; 5 RCTs, 910 participants; low-certainty evidence) compared to OHC without toothbrushing (± antiseptics). There is also some evidence that toothbrushing may reduce the duration of ICU stay (MD -1.89 days, 95% CI -3.52 to -0.27 days; P = 0.02, I2 = 0%; 3 RCTs, 749 participants), but this is very low certainty. Low-certainty evidence did not show a reduction in mortality (RR 0.84, 95% CI 0.67 to 1.05; P = 0.12, I2 = 0%; 5 RCTs, 910 participants) or duration of mechanical ventilation (MD -0.43, 95% CI -1.17 to 0.30; P = 0.25, I2 = 46%; 4 RCTs, 810 participants). AUTHORS' CONCLUSIONS: Chlorhexidine mouthwash or gel, as part of OHC, probably reduces the incidence of developing ventilator-associated pneumonia (VAP) in critically ill patients from 26% to about 18%, when compared to placebo or usual care. We did not find a difference in mortality, duration of mechanical ventilation or duration of stay in the intensive care unit, although the evidence was low certainty. OHC including both antiseptics and toothbrushing may be more effective than OHC with antiseptics alone to reduce the incidence of VAP and the length of ICU stay, but, again, the evidence is low certainty. There is insufficient evidence to determine whether any of the interventions evaluated in the studies are associated with adverse effects.


Assuntos
Estado Terminal , Higiene Bucal/métodos , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Respiração Artificial/efeitos adversos , Adulto , Criança , Clorexidina/uso terapêutico , Humanos , Incidência , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação , Antissépticos Bucais/uso terapêutico , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Pneumonia Associada à Ventilação Mecânica/mortalidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Respiração Artificial/estatística & dados numéricos , Escovação Dentária/instrumentação , Escovação Dentária/métodos
2.
Rev. Odontol. Araçatuba (Impr.) ; 41(3): 22-28, set./dez. 2020. tab
Artigo em Português | LILACS, BBO - Odontologia | ID: biblio-1121727

RESUMO

Objetivo: verificar a eficácia das técnicas de higiene oral, solução de clorexidina com gaze e espátula e da escovação dentária com solução de clorexidina no controle microbiológico oral de pacientes internados em UTI. Metodologia: as bases de dados utilizadas foram PUB MED, MEDLINE, SCIELO e LILACS em março a julho de 2019. Foram incluídos artigos na língua inglesa e portuguesa, disponíveis em livre acesso com o texto completo, com período de publicação entre 2009 a 2019 e que abordassem sobre os métodos de higiene oral na UTI e relacionasse a enfermidades encontradas nesse ambiente. Resultados: foram encontrados 32 artigos, 8 se enquadravam nos critérios de inclusão. Os artigos de revisão evidenciaram a importância da higiene oral em pacientes com ventilação mecânica e relatam o uso da clorexidina como método eficaz na prevenção de PAV. Já nos estudos clínicos randomizados, mostram não haver diferença estatisticamente significativa entre o uso da escova dental e a solução de clorexidina 0,12%. Conclusão: ambos os métodos são eficientes na higienização oral de pacientes internados e que não há diferença significativa nos estudos quando comparam a escova de dentes com o uso da clorexidina com gaze para a higiene oral na UTI. Mas quando se fala em prevenção de PAV, a clorexidina 0,12% é o mais citado(AU)


Objective: to verify the effectiveness of oral hygiene techniques, chlorhexidine solution with gauze and spatula and toothbrushing with chlorhexidine solution in the oral microbiological control of patients admitted to the ICU. Methodology: the databases used were PUB MED, MEDLINE, SCIELO and LILACS in March to July 2019. Articles in English and Portuguese were included, freely available with the full text, with a period of publication between 2009 and 2019 and to address oral hygiene methods in the ICU and relate to diseases found in that environment. Results: 32 articles were found, 8 fit the inclusion criteria. The review articles highlighted the importance of oral hygiene in patients with mechanical ventilation and report the use of chlorhexidine as an effective method in preventing VAP. In randomized clinical studies, however, they show no statistically significant difference between the use of the toothbrush and the 0.12% chlorhexidine solution. Conclusion: both methods are efficient in oral hygiene of hospitalized patients and that there is no significant difference in the studies when comparing the toothbrush with the use of chlorhexidine with gauze for oral hygiene in the ICU. But when talking about VAP prevention, 0.12% chlorhexidine is the most cited(AU)


Assuntos
Higiene Bucal , Pacientes Internados , Unidades de Terapia Intensiva , Escovação Dentária , Clorexidina
3.
Rev. Odontol. Araçatuba (Impr.) ; 41(3): 40-47, set./dez. 2020. ilus, graf
Artigo em Português | LILACS, BBO - Odontologia | ID: biblio-1121745

RESUMO

Este trabalho consiste em uma pesquisa realizada sobre a utilização de líquidos irrigantes por cirurgiões dentistas na cidade de Itabuna-BA. Para isto, delimitou-se a seguinte problemática: quais são as escolhas dos líquidos irrigantes nos tratamentos endodônticos com o intuito de promover uma total desinfecção dos canais radiculares? E como objetivo geral, elucidar sobre as escolhas dos cirurgiões dentistas localizados na cidade de Itabuna-Bahia em relação as substâncias utilizadas como coadjuvantes no tratamento endodôntico durante a etapa de irrigação. A pesquisa teve uma abordagem qualitativa e foi utilizado o instrumento questionário com cem dentistas da cidade selecionada. Este questionário consistia em oito perguntas, dentre elas qual irrigante utilizado e a porcentagem do mesmo. Com relação aos resultados, pode-se afirmar que no tratamento endodôntico, o hipoclorito de sódio continua sendo a solução irrigante de escolha entre os profissionais, diferentes concentrações de soluções de hipoclorito de sódio são empregadas durante o preparo biomecânico, por endodontistas e clínicas gerais que praticam a endodontia, não existindo uma unanimidade quanto a escolha, nenhum acordo existe em relação a sua concentração ideal(AU)


This work consists of a research carried out on the use of irrigating liquids by dental surgeons in the city of Itabuna-BA. For this, the following problem was defined: what are the choices of irrigating liquids in endodontic treatments in order to promote a total disinfection of the root canals? And as a general objective, elucidate about the choices of dentists located in the city of Itabuna-Bahia in relation to the substances used as adjuvants in endodontic treatment during the irrigation stage. The research had a qualitative approach and the questionnaire was used with 100 dentists in the selected city. This questionnaire consisted of eight questions, including which irrigant was used and the percentage of it. Regarding the results, it can be said that in endodontic treatment, sodium hypochlorite remains the irrigating solution of choice among professionals, different concentrations of sodium hypochlorite solutions are used during biomechanical preparation by endodontists and general practitioners who practice endodontics, there is no unanimity as to the choice, no agreement exists regarding their ideal concentration(AU)


Assuntos
Irrigantes do Canal Radicular , Preparo de Canal Radicular , Hipoclorito de Sódio , Clorexidina , Ácido Edético , Malicum Acidum
4.
Braz Dent J ; 31(5): 493-498, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33146332

RESUMO

This clinical study reports on the antibacterial effects and outcome of endodontic treatment using either a single-file or a multifile system, associated with calcium hydroxide interappointment medication. The root canals of single-rooted teeth with apical periodontitis were treated by using either Reciproc or BioRaCe instrument systems, 2.5% NaOCl irrigation, and calcium hydroxide medication. Bacteriological samples taken before preparation and immediately before obturation were evaluated for total bacterial counts by quantitative real-time polymerase chain reaction (qPCR). Patients were followed up and the treatment outcome was assessed by clinical and radiographic criteria. Decreasing lesions were classified as success in a lenient criterion or failure in a rigid one. Bacteria were detected in all initial samples (47 cases) and were significantly reduced after treatment in both groups (p<0.001). In the Reciproc and BioRaCe groups, 7/25 (28%) and 11/22 (50%) root canals yielded negative qPCR results before obturation, respectively (p>0.05). Quantitative bacterial reduction was similar between groups (p>0.05). The success rate in the BioRaCe group was 95.5% and 77% in the loose and rigid criterion, respectively. In the Reciproc group, corresponding figures were 88% and 76%. Differences in outcome were not significant (p>0.05). No diseased case showed negative qPCR results for bacteria. A difference of >1 Log10 counts was observed between healed and diseased cases. Root canal treatments of teeth with apical periodontitis using a single-file or a multifile system for preparation, associated with NaOCl irrigation and calcium hydroxide interappointment medication, showed similar antibacterial effectiveness and success rate.


Assuntos
Cavidade Pulpar , Periodontite Periapical , Hidróxido de Cálcio , Clorexidina , Desinfecção , Humanos , Periodontite Periapical/tratamento farmacológico , Irrigantes do Canal Radicular , Preparo de Canal Radicular , Hipoclorito de Sódio
5.
Niger J Clin Pract ; 23(11): 1507-1513, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33221773

RESUMO

Objective: This study aims to investigate the effects of different antiseptic mouthwash on microbiota around the mini-screw applied to patients undergoing fixed orthodontic treatment. Materials and Methods: From patients who have been undergoing fixed orthodontic treatment and who have mini-screws in their mouth, a total of 38 patients were selected for the study consisting of 4 groups, each of which has 15 mini-screws. The patients were selected from the following groups: no use of mouthwash (Group 1), use of 0.12% chlorhexidine gluconate-containing mouthwash (Group 2), use of essential oils-containing mouthwash (Group 3), and use of 7.5% povidone-iodine-containing mouthwash (Group 4). Plaque indices and gingival indices of the patients were measured at the beginning (T0) and at their appointments 3 weeks later (T1). In addition, biological samples were collected from the sulcus around the mini-screw with the help of sterile paper point. Results: The total number of microorganisms around the mini-screw in Group 2, Group 3, and Group 4 decreased significantly compared to Group 1. A significant decrease in Streptococcus oralis, Streptococcus mitis, Candida parapsilosis, total bacteria, plaque index, and gingival index count was observed in T1compared to T0. Conclusion: Antiseptic mouthwash in Group 2, Group 3, and Group 4 can be used to reduce the number of microbial microbiota around the mini-screw and to improve oral hygiene.


Assuntos
Anti-Infecciosos Locais/farmacologia , Bactérias/efeitos dos fármacos , Parafusos Ósseos/microbiologia , Clorexidina/análogos & derivados , Antissépticos Bucais/farmacologia , Adolescente , Anti-Infecciosos Locais/uso terapêutico , Bactérias/isolamento & purificação , Clorexidina/farmacologia , Clorexidina/uso terapêutico , Placa Dentária/prevenção & controle , Feminino , Humanos , Masculino , Microbiota , Boca , Antissépticos Bucais/uso terapêutico , Índice Periodontal
6.
Oral Health Prev Dent ; 18(1): 981-990, 2020 10 27.
Artigo em Inglês | MEDLINE | ID: mdl-33215489

RESUMO

PURPOSE: To analyze in vitro new formulations with Citrox and chlorhexidine digluconate (CHX) regarding their antibacterial activity against planktonic bacteria and their potential to inhibit biofilm formation or to act on existing biofilms. MATERIALS AND METHODS: Five oral health care products with 0.05%-0.5% CHX formulations (four rinses and one gel) were compared with Citrox preparations and additive-free CHX solutions. The minimal inhibitory concentrations (MIC) were determined against 13 oral bacteria associated with caries or periodontitis. Further, the activity on retarding biofilm formation and on existing biofilms was analyzed; both a 'cariogenic' (5 species) and a 'periodontal' (12 species) biofilm were included. RESULTS: The MIC values did not differ between the CHX mouthrinse/gel formulations and the respective additive-free CHX solutions. Citrox was active against selected periodontopathogens (e.g. Porphyromonas gingivalis). The CHX formulations more effectively retarded biofilm formation than did solutions with the same concentration of CHX but without additives. The anti-biofilm activities depended on the CHX concentration in the formulations. Both CHX solutions and formulations (rinse and gel) were only slightly active on an already formed biofilm. Citrox did not exert any anti-biofilm effect. CONCLUSION: The present in vitro data support the anti-biofilm activity of the novel CHX, Citrox, poly-L-lysine and xylitol oral health-care formulations. Further studies are warranted to confirm the present findings in various clinical settings.


Assuntos
Clorexidina , Saúde Bucal , Biofilmes , Clorexidina/análogos & derivados , Clorexidina/farmacologia , Antissépticos Bucais/farmacologia
7.
Am J Orthod Dentofacial Orthop ; 158(5): e73-e82, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33008710

RESUMO

INTRODUCTION: White spot lesions are a common side effect of orthodontic treatment. This laboratory study aimed to explore the suitability of chlorhexidine hexametaphosphate (CHX-HMP) as a coating for orthodontic elastomeric ligatures to provide sustained chlorhexidine (CHX) release. METHODS: Dissolution kinetics of CHX-HMP were firstly explored using spectroscopy and a colorimetric phosphate assay. Elastomeric ligatures were categorized into 3 groups-acetone-conditioned, ethanol-conditioned, and as received-and were then immersed in 5 mM CHX-HMP suspension or 5 mM chlorhexidine digluconate solution and rinsed. CHX release was measured over 8 weeks, and the effects of conditioning and immersion on elastomeric force and extension at rupture and surface topography were investigated. RESULTS: CHX-HMP exhibited a gradual equilibration that had not reached equilibrium within 8 weeks, releasing soluble CHX and a mixture of polyphosphate and orthophosphate. CHX digluconate-treated ligatures showed no CHX release, whereas CHX-HMP-treated ligatures showed varying degrees of release. As received, CHX-HMP-treated ligatures showed a modest release of CHX up to 7 days. Acetone conditioning did not enhance CHX-HMP uptake or subsequent CHX release and caused a deterioration in mechanical properties. Ethanol conditioning enhanced CHX-HMP uptake (6×) and led to a sustained CHX release over 8 weeks without affecting mechanical properties. CONCLUSIONS: Within the inherent limitations of this in-vitro study, CHX-HMP led to a sustained release of CHX from orthodontic elastomeric ligatures after ethanol conditioning. Conditioned and coated elastomeric ligatures may ultimately find application in the prevention of white spot lesions in orthodontic patients.


Assuntos
Anti-Infecciosos , Clorexidina , Antibacterianos , Humanos , Fosfatos
8.
Int J Nanomedicine ; 15: 6935-6944, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33061360

RESUMO

Introduction: Nanoparticle solutions have been studied to improve antimicrobial effect. The aim of this study was to develop, characterize, and evaluate the in vitro and in vivo antiseptic efficacy of 0.25% aqueous-based chlorhexidine nanoemulsion (NM-Cl 0.25% w/v). Methods: The NM-Cl 0.25% w/v (2.5mg/mL) and free chlorhexidine nanoemulsion (FCN; same composition of NM-Cl without the molecule of chlorhexidine) were synthetized by the spontaneous emulsification method. Characterization analyses of physical and chemical properties were performed. The NM-Cl 0.25% w/v was compared with chlorhexidine 0.5% alcohol base (CS-Cl 0.5%) in vitro studies (microdilution study and kill curve study), and in vivo study (antisepsis of rats dorsum). Kruskal-Wallis test was used between groups and inside the same group, at different sample times and the Mann-Whitney test was performed when difference was detected. Results: The NM-Cl 0.25% w/v presented adequate physicochemical characteristics for a nanoemulsion, revealing a more basic pH than FCN and difference between zeta potential of NM-Cl 0.25% w/v and FCN. The NM-Cl 0.25% w/v and CS-Cl 0.5% solutions were more effective on Gram-positive than on Gram-negative bacteria (p≤0.05). NM-Cl 0.25% w/v presented upper antiseptic effect in the microdilution study and residual antiseptic effect was maintained for a longer time when compared to CS-Cl 0.5% (kill curve study). The four-fold (minimal inhibitory concentration) of NM-Cl 0.25% were the formulations with most durable effect within those tested, presenting residual effect until T6 for both bacteria. In the in vivo study, both formulations (NM-Cl 0.25% w/v and CS-Cl 0.5%) had a reduction of the microorganisms in the skin of the rats (p<0.0001) not revealing any difference between the formulations at different times, showing the antiseptic effect of NM-Cl (p≤0.05). Conclusion: Both in vitro and in vivo experiments demonstrated that NM-Cl showed promising future as an antiseptic for cutaneous microbiota.


Assuntos
Anti-Infecciosos Locais/farmacologia , Clorexidina/farmacologia , Emulsões/química , Nanoestruturas/química , Animais , Anti-Infecciosos Locais/química , Clorexidina/química , Emulsões/farmacologia , Etanol/química , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Positivas/efeitos dos fármacos , Masculino , Testes de Sensibilidade Microbiana , Nanoestruturas/uso terapêutico , Ratos Wistar , Pele/efeitos dos fármacos , Pele/microbiologia
9.
J Indian Soc Pedod Prev Dent ; 38(3): 289-292, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33004728

RESUMO

Objective: In this coronavirus disease 2019 pandemic, pediatric children who are admitted in the intensive care unit (ICU) are more susceptible to ventilator-associated pneumonia. Ventilator-associated pneumonia is the second-most common hospital-acquired infection in pediatric ICU. Oral hygiene maintenance is a challenge here. To maintain oral hygiene and to prevent colonization of microorganisms such as Pseudomonas aeruginosa and Staphylococcus aureus which cause ventilator-associated pneumonia, a study was conducted, which aimed at finding the efficacy of chlorhexidine (CHX) wipes (as an oral hygiene aid) on colonization of these organisms in pediatric ICU. Methods and Methodology: The study was conducted among twenty children (8 in ventilation and 12 without ventilation) in the age range of 6-14 years admitted in the pediatric ICU. Swab sample was taken on the 1st day from both groups. Culturing of swab sample was done for colonization of microorganisms. CHX gluconate with a concentration of 0.2% was used as wipes. Swab sample was collected at the end of the 2nd day. Culturing of swab sample was done for colonization of microorganisms. Statistical analysis was done. Results: A statistically significant difference (P ≤ 0.04) was seen in the ventilator group with a mean of 0.75 ± 13.241 in the reduction of S. aureus count. P. aeruginosa growth was not seen in either of the groups before or after the use of CHX wipe. Conclusions: Standard oral hygiene practice has the potential to contribute to improved oral and general health of children in pediatric ICU. CHX wipes significantly reduced S. aureus count in ventilator patients. Hence, it could be used as an effective antimicrobial agent in pediatric ICU.


Assuntos
Clorexidina , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Staphylococcus aureus , Adolescente , Betacoronavirus , Criança , Humanos , Unidades de Terapia Intensiva Pediátrica , Pseudomonas aeruginosa
10.
Shanghai Kou Qiang Yi Xue ; 29(4): 400-404, 2020 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-33089290

RESUMO

PURPOSE: To study the effect of chlorhexidine combined with mechanical debridement on peri-implant inflammation and the influence on SF-36 score of patients. METHODS: One hundred patients with peri-implantitis admitted to Zhejiang Provincial People's Hospital from January 2015 to January 2019 were selected and randomly divided into control group and combined group with 50 cases in each group according to random number table method.Patients in both groups were treated with mechanical debridement, and patients in the combined group were gargled with chlorhexidine gargle apart from mechanical debridement. Plaque biofilm average activity and modified plaque index (mPLI), bleeding on probing (BOP), modified sulcus bleeding index (mSBI), probing the depth (PPD), clinical attachment level(AL) were measured before and after treatment. Sf-36 scale and VAS visual pain score were used to evaluate the quality of life and pain degree of patients, and the therapeutic effect and incidence of complications were assessed. The data were analyzed with SPSS 20.0 software package. RESULTS: There was no significant difference in average activity, mPLI, mSBI, AL, PPD, BOP, VAS and SF-36 scores between the two groups before treatment(P>0.05); after treatment, the average activity, mPLI, mSBI, AL, PPD, BOP and VAS scores of plaque biofilm in the combined group were significantly lower than those of the control group, and the total effective rate of SF-36 score was significantly higher than that of the control group. The total effective rate of the combined group was significantly higher than that of the control group(P<0.05). The incidence of complications in the combined group was significantly lower than that in the control group(P<0.05). CONCLUSIONS: Chlorhexidine combined with mechanical debridement is an effective treatment of peri-implantitis, which can effectively inhibit plaque biofilm activity and plaque formation, alleviate pain and improve the quality of life of patients.


Assuntos
Clorexidina , Peri-Implantite , Clorexidina/uso terapêutico , Desbridamento , Índice de Placa Dentária , Humanos , Peri-Implantite/tratamento farmacológico , Qualidade de Vida
11.
Ann. intensive care ; 118: 1-26, Sept. 07, 2020.
Artigo em Inglês | BIGG - guias GRADE | ID: biblio-1128263

RESUMO

The French Society of Intensive Care Medicine (SRLF), jointly with the French-Speaking Group of Paediatric Emer­ gency Rooms and Intensive Care Units (GFRUP) and the French-Speaking Association of Paediatric Surgical Inten­ sivists (ADARPEF), worked out guidelines for the management of central venous catheters (CVC), arterial catheters and dialysis catheters in intensive care unit. For adult patients: Using GRADE methodology, 36 recommendations for an improved catheter management were produced by the 22 experts. Recommendations regarding catheterrelated infections' prevention included the preferential use of subclavian central vein (GRADE 1), a one-step skin disinfection(GRADE 1) using 2% chlorhexidine (CHG)-alcohol (GRADE 1), and the implementation of a quality of care improvement program. Antiseptic- or antibiotic-impregnated CVC should likely not be used (GRADE 2, for children and adults). Catheter dressings should likely not be changed before the 7th day, except when the dressing gets detached, soiled or impregnated with blood (GRADE 2− adults). CHG dressings should likely be used (GRADE 2+). For adults and children, ultrasound guidance should be used to reduce mechanical complications in case of internal jugular access (GRADE 1), subclavian access (Grade 2) and femoral venous, arterial radial and femoral access (Expert opinion). For children, an ultrasound-guided supraclavicular approach of the brachiocephalic vein was recommended to reduce the number of attempts for cannulation and mechanical complications. Based on scarce publications on diagnostic and therapeutic strategies and on their experience (expert opinion), the panel proposed defnitions, and therapeutic strategies.


Assuntos
Humanos , Adulto , Controle de Infecções/métodos , Infecções Relacionadas a Cateter/diagnóstico , Infecções Relacionadas a Cateter/prevenção & controle , Infecções Relacionadas a Cateter/transmissão , Clorexidina/uso terapêutico , Medicina Baseada em Evidências , Unidades de Terapia Intensiva/normas
12.
Med. oral patol. oral cir. bucal (Internet) ; 25(5): e608-e615, sept. 2020. tab, graf, ilus
Artigo em Inglês | IBECS | ID: ibc-196516

RESUMO

BACKGROUND: With greater number of implants being placed in clinical practice, incidence of peri-implant diseases are on the rise. It is not known whether chlorhexidine (CHX) improves outcomes in the management of peri-implant diseases. The aim of this systematic review and meta-analysis was to evaluate the role of CHX in improving outcomes with non-surgical management of peri-implant mucositis and periimplantitis. MATERIAL AND METHODS: An electronic search of PubMed, Scopus, Embase, and CENTRAL (Cochrane Central Register of Controlled Trials) databases up to 1st August 2019 was carried out to search for studies evaluating the efficacy of CHX for non-surgical management of peri-implant diseases. RESULTS: Seven studies were included. Four studies evaluated the role of CHX in peri-implant mucositis and three in peri-implantitis. Oral prophylaxis with mechanical cleansing of implant surface prior to CHX use was carried out in all seven studies. Meta-analysis indicated that use of CHX did not improve probing depths in peri-implant mucositis (SMD = 0.11; 95% CI: -0.16 to 0.38; p = 0.42, I2= 0%). Similarly, CHX did not significantly reduce probing depths in patients with peri-implantitis (MD= 1.57; 95% CI: -0.88 to 4.0; p = 0.21, I2 = 98%). Results on the efficacy of CHX in reducing BOP in peri-implantitis are conflicting. CONCLUSIONS: Results of our study indicate that adjunctive therapy with CHX may not improve outcomes with non-surgical management of periimplant mucositis. Conclusions with regards to its role in non-surgical management of periimplantitis cannot be drawn. There is a need for more homogenous RCTs with large sample size to define the role of CHX in non-surgical management of peri-implant mucositis and peri-implantitis


No disponible


Assuntos
Humanos , Clorexidina/uso terapêutico , Estomatite/tratamento farmacológico , Peri-Implantite/tratamento farmacológico , Anti-Infecciosos Locais/uso terapêutico , Implantes Dentários/efeitos adversos , Resultado do Tratamento , Higiene Bucal/métodos
13.
Med. oral patol. oral cir. bucal (Internet) ; 25(5): e644-e651, sept. 2020.
Artigo em Inglês | IBECS | ID: ibc-196520

RESUMO

BACKGROUND: The aim of this study was to evaluate and compare the postoperative effect of a topic gel containing chlorhexidine, chitosan, allantoine and dexpanthenol versus a placebo for pain and inflammation control after third molar surgery. MATERIAL AND METHODS: A gel combining 0.2% chlorhexdine, 0.5% chitosan, 5% dexpanthenol, 0.15% allantoin and 0.01% sodium saccharin was selected for this split mouth randomized controlled and double-blind trial including 36 patients with bilaterally and symmetrically impacted lower third molars. The teeth (n = 72) were randomly divided into two groups before surgical removal: control group (CG; in which a placebo was given) and experimental group (EG). Swelling, trismus, postoperative pain, wound healing and complications were measured and recorded in order to evaluate differences between the placebo and experimental product. RESULTS: Five patients suffered from an alveolitis in the CG (13.9%), and none in the study group (0%), but no statistically significant difference was found (p = 0.063). From day 0 to day 7, trismus and swelling were significantly less pronounced in the EG, and wound healing was considered 'good' in 22.2% for the CG and 97.2% for the EG (p < 0.001). Mean VAS scores during the seven postoperative days were statistically lower in the study (2.56 ± 1,19) compared to the placebo group (3.25 ± 1.6) (p = 0.002). The mean consumption of analgesic pills during the first 92 hours was also statistically lower in the EG (0.26 ± 0.51) in comparison to the CG (0.56 ± 0.67) (p = 0.003). CONCLUSIONS: The use of an experimental gel containing chlorhexidine, chitosan, allantoine and dexpanthenol seems to significantly reduce postoperative pain, trismus and signs of inflammation. Future studies should further evaluate, if the gel is effective in dry socket preventing after third molar removal


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Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Dente Serotino/cirurgia , Extração Dentária/métodos , Dor Pós-Operatória/prevenção & controle , Quitosana/uso terapêutico , Clorexidina/uso terapêutico , Alantoína/uso terapêutico , Ácido Pantotênico/análogos & derivados , Complicações Pós-Operatórias/prevenção & controle , Anti-Inflamatórios/uso terapêutico , Administração Tópica , Géis/uso terapêutico , Estatísticas não Paramétricas , Resultado do Tratamento , Medição da Dor , Fatores de Tempo , Trismo/prevenção & controle , Método Duplo-Cego
14.
Medicine (Baltimore) ; 99(39): e22218, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991414

RESUMO

BACKGROUND: Chlorhexidine and silver sulfadiazine coated central venous catheters (CSS-CVC) may cause loss of antimicrobial efficacy due to friction between the CVC surface and sheer stress caused by the blood flow. Therefore, the aim of this study was to investigate the antibacterial efficacy of CSS-CVC at various flow rates using a bloodstream model. METHODS: Each CVC was subjected to various flow rates (0.5, 1, 2, and 4 L/min) and wear-out times (0, 24, 48, 72, 96, and 120 hours), and the optical density (OD) 600 after a Staphylococcus aureus incubation test was used to determine the antibacterial effect of CSS-CVC. RESULTS: In the 0.5 L/min group, there was no significant change in the OD600 value up to 120 hours compared with the baseline OD600 value for CSS-CVC (P > .467). However, the OD600 values of CSS-CVC in the 1 L/min (P < .001) and 2 L/min (P < .001) groups were significantly reduced up to 72 hours, while that in the 4 L/min (p < 0.001) group decreased rapidly up to 48 hours. CONCLUSION: This study suggests that there is a doubt whether sufficient antibacterial function can be maintained with prolonged duration of catheter placement.


Assuntos
Anti-Infecciosos Locais/farmacologia , Velocidade do Fluxo Sanguíneo , Cateterismo Venoso Central/instrumentação , Clorexidina/farmacologia , Sulfadiazina de Prata/farmacologia , Antibacterianos/farmacologia , Anti-Infecciosos Locais/administração & dosagem , Infecções Relacionadas a Cateter/prevenção & controle , Cateteres Venosos Centrais/normas , Clorexidina/administração & dosagem , Humanos , Modelos Biológicos , Projetos Piloto , Sulfadiazina de Prata/administração & dosagem
15.
Am J Trop Med Hyg ; 103(5): 2116-2126, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32959761

RESUMO

Observational data suggest maternal handwashing with soap prevents neonatal mortality. We tested the impact of a chlorhexidine-based waterless hand cleansing promotion on the behavior of mothers and other household members. In rural Bangladesh in 2014, we randomized consenting pregnant women to chlorhexidine provision and hand cleansing promotion or standard practices. We compared hand cleansing with chlorhexidine or handwashing with soap before baby care, among mothers and household members in the two groups, and measured chlorhexidine use in the intervention arm. Chlorhexidine was observed in the baby's sleep space in 97% of 130 intervention homes, versus soap in 59% of 128 control homes. Hand cleansing before baby care was observed 5.6 times more frequently among mothers in the intervention arm than in the controls (95% CI = 4.0-7.7). Hand cleansing was significantly more frequently observed in the intervention arm among women other than the mother (RR = 10.9) and girls (RR = 37.0). Men and boys in the intervention arm cleansed hands before 29% and 44% of baby care events, respectively, compared with 0% in the control arm. The median number of grams consumed during the neonatal period was 176 (IQR = 95-305 g), about 7.8 g/day (IQR = 4.2-13.8 g). Promotion of waterless chlorhexidine increased hand cleansing behavior among mothers and other household members. Discrepancy between observed use and measured chlorhexidine consumption suggested courtesy bias in structured observations. A waterless hand cleanser may represent one component of the multimodal strategies to prevent neonatal infections in low-resource settings.


Assuntos
Anti-Infecciosos Locais/farmacologia , Clorexidina/farmacologia , Desinfecção das Mãos , Bangladesh , Demografia , Feminino , Mãos , Humanos , Recém-Nascido , Masculino , Mães , Gravidez , Sabões
16.
Exp Parasitol ; 218: 108008, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32979343

RESUMO

Acanthamoeba sp. is a free living amoeba that causes severe, painful and fatal infections, viz. Acanthamoeba keratitis and granulomatous amoebic encephalitis among humans. Antimicrobial chemotherapy used against Acanthamoeba is toxic to human cells and show side effects as well. Infections due to Acanthamoeba also pose challenges towards currently used antimicrobial treatment including resistance and transformation of trophozoites to resistant cyst forms that can lead to recurrence of infection. Therapeutic agents targeting central nervous system infections caused by Acanthamoeba should be able to cross blood-brain barrier. Nanoparticles based drug delivery put forth an effective therapeutic method to overcome the limitations of currently used antimicrobial chemotherapy. In recent years, various researchers investigated the effectiveness of nanoparticles conjugated drug and/or naturally occurring plant compounds against both trophozoites and cyst form of Acanthamoeba. In the current review, a reasonable effort has been made to provide a comprehensive overview of various nanoparticles tested for their efficacy against Acanthamoeba. This review summarizes the noteworthy details of research performed to elucidate the effect of nanoparticles conjugated drugs against Acanthamoeba.


Assuntos
Acanthamoeba/efeitos dos fármacos , Amebicidas/administração & dosagem , Nanopartículas/administração & dosagem , Acanthamoeba/crescimento & desenvolvimento , Ceratite por Acanthamoeba/tratamento farmacológico , Ceratite por Acanthamoeba/parasitologia , Amebíase/tratamento farmacológico , Amebíase/mortalidade , Amebíase/parasitologia , Amebicidas/farmacologia , Amebicidas/uso terapêutico , Biguanidas/administração & dosagem , Biguanidas/farmacologia , Biguanidas/uso terapêutico , Infecções Protozoárias do Sistema Nervoso Central/tratamento farmacológico , Infecções Protozoárias do Sistema Nervoso Central/mortalidade , Infecções Protozoárias do Sistema Nervoso Central/parasitologia , Clorexidina/administração & dosagem , Clorexidina/farmacologia , Clorexidina/uso terapêutico , Sistemas de Liberação de Medicamentos , Imunocompetência , Hospedeiro Imunocomprometido , Encefalite Infecciosa/tratamento farmacológico , Encefalite Infecciosa/mortalidade , Encefalite Infecciosa/parasitologia , Nanopartículas/classificação , Nanopartículas/uso terapêutico , Trofozoítos/efeitos dos fármacos
17.
J Appl Oral Sci ; 28: e20200217, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32997087

RESUMO

OBJECTIVE: Pulp revascularization is an effective treatment for immature necrotic teeth. Calcium hydroxide has been used in pulp revascularization as an intracanal medication due to its antimicrobial action and the non-exhibition of crown discoloration and cytotoxicity for stem cells from the apical papilla. Our study aimed to investigate the clinical success and quantitative radiographic changes of root development in immature traumatized teeth using calcium hydroxide plus 2% chlorhexidine gel as intracanal medication. METHODOLOGY: In this retrospective study, 16 patients were treated with a standardized pulp revascularization protocol. Calcium hydroxide and 2% chlorhexidine gel were manipulated in a 1:1 (v/v) ratio and inserted into root canals with Lentulo spirals (Dentsply Maillefer, Baillaigues, Switzerland). Patients were followed up for a period from 9 to 36 months for the evaluation of clinical and radiological data. Radiographic measurements of root length, root width, apical diameter, and MTA placement from the apex were quantified using software ImageJ. Wilcoxon test and t-test were used, according to nonparametric or parametric data, respectively, for changes over time in root length, root width, and apical diameter. RESULTS: Fifteen teeth survived during the follow-up period (93.75%) and met the criteria for clinical success. Although the changes seem to be very small in many cases, significant increases in the average root length (14.28%, p<0.0001), root width (8.12%, p=0.0196), and decrease in apical diameter (48.37%, p=0.0007) were observed. MTA placement from the apex and age at the time of treatment was not significantly associated with the quantitative radiographic outcomes. CONCLUSIONS: Pulp revascularization in traumatized immature teeth treated with calcium hydroxide plus 2% chlorhexidine gel as intracanal medication had high success and survival rates, showing periodontal healing and resolution of signs and symptoms. However, concerning the continued root development, the outcomes can still be considered unpredictable.


Assuntos
Hidróxido de Cálcio , Clorexidina , Polpa Dentária/irrigação sanguínea , Irrigantes do Canal Radicular/uso terapêutico , Adolescente , Hidróxido de Cálcio/uso terapêutico , Criança , Clorexidina/uso terapêutico , Necrose da Polpa Dentária/tratamento farmacológico , Feminino , Humanos , Masculino , Estudos Retrospectivos , Ápice Dentário , Resultado do Tratamento
18.
PLoS One ; 15(9): e0238428, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32941438

RESUMO

OBJECTIVES: Recurrent vulvovaginal candidiasis (RVVC) causes significant morbidity. Candida albicans is the main pathogen associated with both sporadic and recurrent candidiasis. Due to unsatisfactory treatment effect, the impact of chlorhexidine digluconate and fluconazole alone or in combination on C. albicans and biofilm was investigated. METHODS: Vaginal C. albicans isolates from 18 patients with recurrent candidiasis and commensals from 19 asymptomatic women were isolated by culture. Crystal violet, XTT and colony forming unit assay were used to analyze the effect of chlorhexidine digluconate and fluconazole on growth of C. albicans, formation of new and already established, mature, biofilm. RESULTS: Fluconazole reduced the growth of planktonic C. albicans. However, in established biofilm, fluconazole had no effect on the candida cells and was not able to disperse and reduce the biofilm. By contrast, chlorhexidine digluconate had a direct killing effect on C. albicans grown both planktonically and in biofilm. Chlorhexidine digluconate also dispersed mature biofilm and inhibited formation of new biofilm. No major differences were observed between commensal isolates and candida causing recurrent vulvovaginitis with respect to biofilm or growth after chlorhexidine digluconate treatment. CONCLUSION: Biofilm is a problem in patients with recurrent vulvovaginal candidiasis reducing the effect of antifungal treatment. Development of new treatment strategies are urgently needed to decrease the recurrences. In already established biofilm, chlorhexidine digluconate dispersed the biofilm and was more effective in eradicating candida compared to fluconazole. Future treatment strategy may thus be a combination of chlorhexidine digluconate and fluconazole and prophylactic use of chlorhexidine digluconate to prevent biofilm formation and restrict infections.


Assuntos
Biofilmes/efeitos dos fármacos , Candida albicans/efeitos dos fármacos , Clorexidina/análogos & derivados , Adulto , Antifúngicos/farmacologia , Biofilmes/crescimento & desenvolvimento , Candida/efeitos dos fármacos , Candida albicans/isolamento & purificação , Candidíase/tratamento farmacológico , Candidíase Vulvovaginal/tratamento farmacológico , Candidíase Vulvovaginal/microbiologia , Clorexidina/metabolismo , Clorexidina/farmacologia , Feminino , Fluconazol/farmacologia , Humanos , Testes de Sensibilidade Microbiana/métodos , Vagina/microbiologia
20.
J Endod ; 46(9S): S115-S127, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32950183

RESUMO

INTRODUCTION: This review aimed to provide a critical appraisal of alternative antimicrobial strategies in lieu of traditional triple antibiotic paste (TAP). METHODS: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The literature search was performed in 8 databases (PubMed/Medline, Embase, LILACS, Web of Science, Scopus, BVS, SciELO, and the Cochrane Library), selecting clinical, in vitro, in vivo, and in situ studies that evaluated antimicrobial alternatives to TAP in regenerative endodontics. Studies lacking an experimental TAP group were excluded. RESULTS: A total of 1705 potentially relevant records were initially identified. From the 38 studies retrieved for full-text reading, 16 fulfilled all selection criteria and were included in the qualitative analysis. According to the study design, 11 studies were solely in vitro, 1 study was both in vitro and in vivo (animal model), 2 studies were solely animal experiments, and 2 studies were clinical trials. The alternative antimicrobial agents to TAP consisted of modified TAP formulations (eg, a combination of TAP with chitosan); TAP-eluting nanofibers; propolis; chlorhexidine (CHX) gels/solutions; double antibiotic pastes composed of distinct combinations of antibiotics; Ca(OH)2-based formulations; and sodium hypochlorite. Overall, most of the alternative agents performed similarly to TAP, although some strategies (eg, Ca(OH)2- and CHX-based formulations) seemed to present dubious importance in the control of infection. CONCLUSIONS: TAP still remains an excellent option in terms of the complete elimination of microorganisms. This review points to the use of electrospun fibers as a drug delivery system to offer a controlled release of the antimicrobial agent, as well as the use of natural compounds, deserving future investigation.


Assuntos
Anti-Infecciosos , Endodontia Regenerativa , Animais , Antibacterianos , Clorexidina , Hipoclorito de Sódio
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