Mechanical and chemical plaque control in the simultaneous management of gingivitis and caries: a systematic review.

AIM: To report the evidence on the effect of mechanical and/or chemical plaque control in the simultaneous management of gingivitis and caries. MATERIAL AND METHODS: A protocol was designed to identify randomized (RCTs) and controlled (CCTs) clinical trials, cohort studies and prospective case series (PCS), with at least 6 months of follow-up, reporting on plaque, gingivitis and caries. Relevant information was extracted from full papers, including quality and risk of bias. Meta-analyses were performed whenever possible. RESULTS: After the screening of 1,373 titles, 15 RCTs, 10 CCTs and 2 PCS were included. Low to moderate evidence support that combined professional and self-performed mechanical plaque control significantly reduces standardized plaque index [n = 4; weighted mean difference (WMD) = 1.294; 95% CI (0.445; 2.144); p = 0.003] and gingivitis scores [n = 4; WMD = 1.728; 95% CI (0.631; 2.825); p = 0.002]. The addition of fluoride to mechanical plaque control is relevant for caries management [n = 5; WMD = 1.159; 95% CI (0.145; 2.172); p = 0.025] while chlorhexidine rinses are relevant for gingivitis. CONCLUSION: Mechanical plaque control procedures are effective in reducing plaque and gingivitis. The addition of fluoride to mechanical plaque control is significant for caries management. Chlorhexidine rinse has a positive effect on gingivitis and inconclusive role in caries.

Chapter 9.1: The Use of Fluorides in the Control of Coronal Caries.

Fluoride is the main agent used to control dental caries, with a very successful history after its widespread implementation worldwide, resulting in significant caries declines around the globe. In this chapter, the mechanism of action and peculiarities of different methods of fluoride use are revised. Fluoride controls caries progression by interfering with the processes of mineral exchanges (demineralization, remineralization) to which teeth are frequently subjected upon exposure to dental biofilm and a diet rich in fermentable sugars. Because caries is a ubiquitous disease of modern societies, different strategies have been developed to successfully keep fluoride available in oral fluids: (1) community-based approaches, such as water fluoridation, in which fluoride is delivered to communities at very low levels; (2) individual-based approaches, such as fluoride toothpastes, in which fluoride is delivered at higher concentrations, directly into the oral cavity, in a convenient combination with the act of brushing teeth to remove dental biofilm; (3) professionally-delivered approaches, such as fluoride gels and varnishes, in which very-high concentration products react with teeth resulting in local fluoride reservoirs that release the ion for weeks/months; and (4) combinations of these approaches, such as the concomitant use of fluoridated water and toothpaste, or the use of professional fluorides in caries-active patients. In conclusion, this chapter reviews the different modalities of fluoride use for coronal caries control, and summarizes the combined application of these methods according to the best evidence available.

Antimicrobial Activity of 4-Chlorocinnamic Acid Derivatives.

The microbial resistance of fungi and bacteria is currently considered a major public health problem. Esters derived from cinnamic acid have a broad spectrum of pharmacological properties that include antimicrobial activity. In this study, a collection of structurally related 4-chlorocinnamic acid esters was prepared using Fischer esterification reactions, alkyl or aryl halide esterification, and Mitsunobu and Steglich reactions. All of the esters were submitted to antimicrobial tests against strains of the species Candida albicans, Candida glabrata, Candida krusei, Candida guilliermondii, Pseudomonas aeruginosa, and Staphylococcus aureus. The compounds also were subjected to molecular docking study with the enzyme 14α-demethylase. Twelve esters derived from 4-chlorocinnamic acid were obtained, with yields varying from 26.3% to 97.6%, three of which were unpublished. The ester methyl 4-chlorocinnamate (1) presented activity against S. aureus at the highest concentration tested. In the antifungal evaluation, all of the esters were bioactive, but methoxyethyl 4-chlorocinnamate (4) and perillyl 4-chlorocinnamate (11) were the most potent (MIC = 0.13 and 0.024 µmol/mL, respectively). The data of molecular docking suggested that all the compounds present good affinity towards the active site related to antifungal activity. Therefore, the esters tested may be inhibitors of the enzyme 14α-demethylase. In addition, the results demonstrate that substituents of short alkyl chains with presence of heteroatom, such as oxygen, or those with a perillyl type terpenic substructure promote better antifungal profiles.