The efficacy and safety of electrolyzed water against Covid-19 as an alternative hand sanitizer.

Aim To investigate the efficacy of electrolyzed water against viruses and its safety to the skin. Methods Virus culture was carried out at level-3 Bio-Safety (BSL3) facilities. The test material was prepared at room temperature mixed with one part virus suspension and one organic load. As an antiseptic and disinfectant control, 0.7% formaldehyde was used. Cytotoxic effects of electrolyzed water were performed on Vero cells. In order to assess the safety of electrolyzed water, a skin sensitivity test was conducted for electrolyzed water exposure. Results Electrolyzed water has a higher value of reduction factor than antiseptic and disinfectant control, formaldehyde, and it was statistically different from control. Cytotoxicity test results on Vero cells showed that electrolyzed water demonstrated safety in Vero cell viability. As many as 58 participants who met the inclusion criteria took electrolyzed water sensitivity test to the skin. The sensitivity test showed that participants with reactions to electrolyzed water were all female, with a mean age of 32.6 years. The patch-test was positive in 3 of 4 participants who reacted to the product. Conclusion Electrolyzed water is effective as a new antiseptic and disinfectant against viruses and safe for human skin.

The Effect of Chlorhexidine Disinfectant Gels with Anti-Discoloration Systems on Color and Mechanical Properties of PMMA Resin for Dental Applications.

Chlorhexidine (CHX)-based dental hygiene products are widely used by dental patients. As these products may have long-term contact with denture poly(methyl methacrylate) (PMMA) resin, anti-discoloration systems (ADSs) were included in them to prevent discoloration of the natural teeth and dental materials. Purpose: The aim of this study was to evaluate the effect of two newly designed CHX-containing gels with ADSs and two commercial products with ADSs (Curasept 0.5% and Curasept 1%) in preventing staining and to analyze the mechanical properties of heat-curing PMMA denture base resin. Materials and methods: Twenty-five discs (five for each test group) of PMMA dental resin with a thickness of 1 mm and a diameter of 20 mm were polymerized according to the manufacturer's instructions and stored in distillate water at a temperature of 37 °C. The surface of the specimens was covered with two commercially available gels-Curasept 1% and Curasept 0.5%, or two experimental gel formulations containing 1% CHX. PMMA specimens stored in distilled water were used as control. The initial values of color and Brinell hardness of the specimens were measured immediately after specimen preparation. The changes in color and Brinell hardness, as well as water sorption, and solubility of the specimens were measured after one year of conditioning. Statistical analysis of the obtained data was performed using one-way analysis of variance and Dunn-Bonferroni post hoc tests. Results: In the group of specimens covered with gel 1 with citric acid or Curasept 0.5%, the color change was clinically acceptable (ΔE* < 2.7). In the specimens stored in contact with gel 2 with polyvinylpyrrolidone (PVP) and Curasept 1%, the ΔE* values were 3.6 and 3.67, respectively. In the control group, the level of hardness decreased significantly from 150 to 140 during the experiment. In addition, a statistically significant decrease in hardness was observed in specimens stored with Curasept 1% and gel 2 with PVP. Specimens stored in contact with Curasept 0.5% and gel 1 with citric acid also showed a lower hardness, but the change was not statistically significant. The sorption of all the groups of PMMA specimens ranged from 22.83 to 24.47 µg/mm3, with no significant differences found between them. All the PMMA specimens stored in contact with the tested CHX gels exhibited a significantly higher solubility (6.84 ± 7.91 µg/mm3) compared to the control group (6.74 µg/mm3), with the highest solubility noted for specimens stored with Curasept 1%. Conclusions: The results showed that CHX used in the gel form with ADSs at a concentration of 0.5% and the experimental gel containing 1% CHX with citric acid caused limited changes to the color and mechanical properties of the PMMA denture base resin during the study period. These gels may be safely used by dental patients for oral hygiene regimen even for prolonged periods of time. ADSs contained in these gels seem to be effective in preventing CHX discoloration.

Clinical Efficacy of Repeated Applications of Local Drug Delivery and Adjunctive Agents in Nonsurgical Periodontal Therapy: A Systematic Review.

The aim of this systematic review is to compare the clinical efficacy of repeated applications of local drug delivery and adjunctive agents (LDAs) in nonsurgical periodontal therapy (NSPT) compared to subgingival mechanical debridement (SMD) alone. The Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, EMBASE, Web of Science, hand-searched literature and grey literature databases were searched for randomized controlled clinical trials (RCTs) with a minimum of 6-month follow-up. The outcomes of interest were changes in probing pocket depth and clinical attachment level as well as patient-centred outcomes. Of 1094 studies identified, 16 RCTs were included in the qualitative analysis. Across 11 different adjuncts analysed, only two studies utilizing minocycline gel/ointment and antimicrobial photodynamic therapy (aPDT) with indocyanine green photosensitizer had statistically significant differences in primary outcomes when compared to their control groups. Only one study on aPDT methylene blue 0.005% had compared single versus multiple applications against its control group. A mean range of 0.27-3.82 mm PD reduction and -0.09-2.82 mm CAL gain were observed with repeated LDA application. Considerable clinical heterogeneity and methodological flaws in the included studies preclude any definitive conclusions regarding the clinical efficacy of repeated LDA applications. Future RCTs with a direct comparison between single and repeated applications should be conducted to confirm or refute the clinical advantages of repeated LDA application in the nonsurgical management of periodontitis.

Evaluation of the Antibacterial Effects of Single and Combined use of Different Irrigation Solutions Against Intracanal Enterococcus Faecalis.

OBJECTIVES: This study assessed the antibacterial activity of both separate and combined uses of 5.25% sodium hypochlorite (NaOCl), 2% chlorhexidine (CHX), 17% ethylenediaminetetraacetic acid (EDTA), 3% hydrogen peroxide (H2O2), MTAD, SmearClear (SC) and 13.8% chlorine dioxide (ClO2) irrigation solutions against Enterococcus faecalis. MATERIALS AND METHODS: Two hundred eighty single rooted human premolars were randomly grouped into 26 test and 2 control (negative and positive) groups and were incubated for 24 h with E. faecalis, except for the negative control group. The tested solutions were as follow: NaOCl; CHX; ClO2; MTAD; SC; EDTA; H2O2; NaOCl + CHX; NaOCl + MTAD; SC + NaOCl; EDTA + NaOCl; H2O2 + NaOCl; ClO2 + CHX; CHX + MTAD; SC + CHX; EDTA + CHX; CHX + H2O2; ClO2 + MTAD; SC + ClO2; EDTA + ClO2; ClO2 + H2O2; SC+MTAD; EDTA+MTAD; MTAD + H2O2; SC + H2O2; and EDTA + H2O2. Optic density values were recorded at 0, 6, 12, 18, 24, 30, 36, 42 and 48 h and bacterial growth curve created for each solution. RESULTS: The CHX, MTAD and ClO2 showed a high potential for the elimination of E. faecalis, both alone and in all combinations. The EDTA, H2O2, H2O2+ EDTA, H2O2 + NaOCl and SC + NaOCl groups showed less antibacterial activity than the other groups. The SC + CHX group showed the best antibacterial effect against E. faecalis. CONCLUSION: The SC + CHX combination can be recommended as the most effective irrigation regimen against E. faecalis in persistent endodontic infections.

Treatment of Peri-Implant Mucositis with Repeated Application of Chlorhexidine Chips or Gel during Supportive Therapy - A Randomized Clinical Trial.

Background: To assess the effect of chlorhexidine (CHX) chip application in patients with peri-implant mucositis as compared to CHX gel application. Methods: In peri-implant sites with mucositis, CHX gel was applied in the control group (GC) and CHX chips in the test group (CC) at baseline and after three months. At baseline and after six months, peri-implant pocket depths (PPD), bleeding-on-probing (BOP) and activated matrix metalloproteinase-8 (aMMP8) were assessed. Longitudinal changes were tested for inter-group differences. Results: Thirty-two patients were treated. BOP was more reduced (p = 0.006) in CC than in GC, with means and standard deviations of 46 ± 28% and 17 ± 27%, respectively. PPD was more reduced (p = 0.002) in CC than in GC with 0.65 ± 0.40 mm and 0.18 ± 0.32 mm, respectively. Regarding BOP, the percentages of improved, unchanged and worsened sites accounted for 32%, 61% and 7% in GC and 46%, 53% and 1% in CC, respectively. For probing pocket depth, the according values were 26%, 66% and 8% (GC) versus 57%, 38% and 5% (CC). Conclusions: During supportive therapy, repeated CHX chip application might resolve marginal peri-implant inflammation in terms of bleeding better than CHX gel.

Comparison of clinical effectiveness of single and multiple applications of 1% chlorhexidine varnish (Cervitec Plus) along with scaling and root planing in patients with chronic periodontitis.

BACKGROUND: Local drug delivery is most commonly used as an adjunct to scaling and root planing (SRP) for the treatment of periodontal disease. Varied success rates have been documented for various vehicles used for intrasite delivery of active therapeutic agents. Recently, varnishes acting as a reservoir of chlorhexidine have shown potential for the management of chronic periodontitis patients. The aim of the present investigation was a comparative evaluation of the clinical effectiveness of single and multiple applications of 1% chlorhexidine and thymol varnish (Cervitec Plus) along with SRP in patients with chronic periodontitis. MATERIALS AND METHODS: The present study included 30 patients with chronic periodontitis divided into three groups based on the number of subgingival applications of chlorhexidine varnish single application (Group A), two applications at a week's interval (Group B), and three applications with 7-day interval in between two applications (Group C). Clinical parameters, namely plaque index (PI), sulcus bleeding index, probing pocket depth (PPD), and relative attachment level (RAL) were recorded at baseline, 1 month and 3 months in all three groups to compare the clinical efficacy. RESULTS: A statistically significant reduction was observed in PI, sulcus bleeding index, PPD, and RAL at 1 and 3 months in all the three groups. Greater (though statistically nonsignificant) improvements were observed in Groups B and C. CONCLUSION: Within limitations of the study, it can be concluded that multiple applications of 1% chlorhexidine and thymol varnish (Cervitec Plus) have an added benefit over the single application in the treatment of chronic periodontitis.

Non-Surgical Therapy for Peri-Implant Diseases: a Systematic Review.

OBJECTIVES: The purpose of this paper was to systematically evaluate the effectiveness of non-surgical therapy for the treatment of peri-implant diseases including both, mucositis and peri-implantitis lesions. MATERIAL AND METHODS: An electronic search in two different databases was performed including MEDLINE (PubMed) and EMBASE from 2011 to 2016. Human studies reporting non-surgical treatment of peri-implant mucositis and peri-implantitis with more than 10 implants and at least 6 months follow up published in English language were evaluated. A systematic review was performed to evaluate the effectiveness of the different methods of decontamination employed in the included investigations. Risk of bias assessment was elaborated for included investigations. RESULTS: Twenty-five articles were identified of which 14 were further evaluated and included in the analysis. Due to significant heterogeneity in between included studies, a meta-analysis could not be performed. Instead, a systematic descriptive review was performed. Included investigations reported the used of different methods for implant decontamination, including self-performed cleaning techniques, and professionally delivered treatment such as laser, photodynamic therapy, supra-/sub-mucosal mechanical debridement, and air-abrasive devices. Follow-up periods ranged from 6 to 60 months. CONCLUSIONS: Non-surgical treatment for peri-implant mucositis seems to be effective while modest and not-predictable outcomes are expected for peri-implantitis lesions. Limitations include different peri-implant diseases definitions, treatment approaches, as well as different implant designs/surfaces and defect characteristics.

Experience with intrawound vancomycin powder for posterior cervical fusion surgery.

OBJECT: Recent studies have reported that the local delivery of vancomycin powder is associated with a decrease in spinal surgical site infection. This retrospective cohort study compares posterior cervical fusion cases before and after the routine application of spinal vancomycin powder to evaluate the ability of local vancomycin powder to prevent deep wound infection after posterior cervical spinal fusion. METHODS: Posterior cervical fusion spinal surgeries performed at a single institution were reviewed from January 2011 to July 2013. Each cohort's baseline characteristics, operative data, and rates of wound infection were compared. Associations between infection and vancomycin powder, with and without propensity score adjustment for risk factors, were determined using logistic regression. RESULTS: A total of 289 patients (174 untreated and 115 treated with vancomycin powder) were included in the study. The cohorts were similar in terms of baseline and operative variables. No significant change in deep wound infection rate was seen between the control group (6.9%) and intervention group (5.2%, p = 0.563). Logistic regression, with and without propensity score adjustment, demonstrated that the use of vancomycin powder did not impact the development of surgical site infection (OR 0.743 [95% CI 0.270-2.04], p = 0.564) and (OR 0.583 [95% CI 0.198-1.718], p = 0.328), respectively. CONCLUSIONS: Within the context of an ongoing debate on the effectiveness of locally administered vancomycin powder, the authors found no significant difference in the incidence of deep wound infection rates after posterior cervical fusion surgery with routine use of locally applied vancomycin powder. Future prospective randomized series are needed to corroborate these results.

O que usar no preparo cirúrgico da pele: povidona-iodo ou clorexidina? / What to use in preoperative skin preparation: povidone-iodine or chlorhexidine? / ¿Qué usar en la preparación quirúrgica de la piel: povidona-iodo o clorhexidina?

Objetivo: Discorrer sobre a eficácia do gluconato de clorexidina e do povidona-iodo em soluções aquosas ou alcoólicas na redução de infecções do sítio cirúrgico e na contagem bacteriana da pele, no preparo pré-operatório do paciente. Método: Estudo de reflexão acerca do melhor antisséptico a ser usado no preparo cirúrgico da pele. Resultados: Verificou-se que tanto a clorexidina quanto o povidona-iodo são igualmente seguros e efetivos e que os manuais de boas práticas internacionais têm recomendado a sua utilização em soluções alcoólicas. Observou-se uma tendência na indicação da clorexidina alcoólica e a emergência de estudos que têm avaliado o uso sequencial ou concomitante da clorexidina e do povidona-iodo com resultados favoráveis a essa prática. Conclusão: Há uma tendência mundial mais favorável ao uso da clorexidina alcoólica em detrimento ao povidona-iodo. Contudo, a decisão pelo melhor agente antisséptico deve considerar cada caso clínico, (contra) indicações e situação

Objective: To discuss the efficacy of chlorhexidine gluconate and povidone-iodine in aqueous or alcoholic solutions in reducing surgical site infections and skin bacterial counts in the preoperative preparation of the patient. Method: Reflective study about the best antiseptic to use in preoperative skin preparation. Results: We found that chlorhexidine and povidone-iodine are equally safe and effective and that international guidelines for good practices have recommended their use in alcoholic solutions. We observed a trend in recommending alcoholic chlorhexidine and an emergence of studies that have evaluated the sequential or concurrent use of chlorhexidine and povidone-iodine with favorable results for this practice. Conclusion: There is a global trend that favors the use of alcoholic chlorhexidine over povidone-iodine. However, the decision about the best antiseptic agent to useshould be based on each clinical case, (contra)indications, and situation

Objetivo: Discutir sobre la eficacia del gluconato de clorhexidina y del povidona-yodo en soluciones acuosas o alcohólicas en la reducción de infecciones del sitio quirúrgico y en el recuento bacteriano de la piel en la preparación preoperatoria del paciente. Método: Estudio de reflexión acerca del mejor antiséptico a utilizarse en la preparación quirúrgica de la piel. Resultados: Se ha comprobado que tanto la clorhexidina como el povidona yodo son igualmente seguros y efectivos y que los manuales de buenas prácticas internacionales han recomendado su utilización en soluciones alcohólicas. Se observó una tendencia en la indicación de la clorhexidina alcohólica y la emergencia de estudios que han evaluado el uso secuencial o concomitante de la clorhexidina y del povidona-yodo con resultados favorables a esa práctica. Conclusión: Hay una tendencia mundial más favorable al uso de la clorhexidina alcohólica en detrimento del povidona-yodo. Sin embargo, la decisión por el mejor agente antiséptico debe considerar cada caso clínico, (contra) indicaciones y situación.

Effect of incorporation of 2-tert-butylaminoethyl methacrylate on flexural strength of a denture base acrylic resin

Polymethyl methacrylate (PMMA) resins have commonly been used as a denture base material. However, denture bases may act as a reservoir for microorganisms and contribute to oral diseases in denture wearers. It is hypothesized that the 2-tert-butylaminoethyl methacrylate (TBAEMA) incorporated to acrylic resins should have antimicrobial activity related to the presence of amino groups on acrylic resin surface. OBJECTIVES: The objectives of this study were to evaluate the presence of amino groups on acrylic resin surface and the influence on flexural strength after incorporation of TBAEMA. MATERIAL AND METHODS: Six groups were divided according to the concentration of TBAEMA incorporated to acrylic resin (Lucitone 550): 0, 0.5, 1.0, 1.5, 1.75 and 2 percent. Specimens surface were evaluated by Electron Spectroscopy for Chemical Analysis (ESCA) to detect the presence of amino groups, represented by nitrogen ratios. Flexural strength of the specimens was tested and results were analyzed by ANOVA and Tukey's test (α=0.05). RESULTS: Different nitrogen ratios were observed on specimen surfaces: 0, 0.13, 0.74, 0.66, 0.92 and 0.33 percent for groups 0, 0.5, 1.0, 1.5, 1.75, and 2 percent, respectively. Significant differences were found for flexural strength (p<0.001). The mean flexural strength values were 98.3±3.9, 93.3±3.2, 83.9±2.1, 82.8±5.2, 71.2±5.1 and 17.3±3.2 MPa for groups 0, 0.5, 1.0, 1.5, 1.75, and 2 percent, respectively. CONCLUSION: Within the limitations of this study, the incorporation of TBAEMA results in the presence of the potentially antimicrobial amino groups on specimen surfaces, but affect the flexural strength, depending on the concentration of TBAEMA.