Prevalence of halitosis in elderly living in nursing homes.

OBJECTIVES: Halitosis is a concern for many people, but has sparsely been studied in elderly living in nursing homes. The aim of this investigation was to study the prevalence of halitosis in this particular group and factors that could be associated with this condition. METHOD AND MATERIALS: One hundred and twenty-four residents at three different nursing homes were included in the study. The level of halitosis was assessed using an organoleptic method based on a 6-graded scale. Oral status, including registrations of plaque, gingivitis and assessment of hyposalivation, was performed by two investigators who both examined all patients. Medical history, that is medication, neurological conditions, diabetes, cardiovascular disease, chronic obstructive pulmonary disease (COPD)/asthma, dementia and mental illness, was obtained from the patient files. Registrations of the use of oral hygiene aids, ADL (Activity of Daily Life) and the frequency of contact with dental services were included in the clinical examination. RESULTS: Halitosis occurred in over 50% of residents living in nursing homes and was found to be associated with the presence of hyposalivation, periodontal disease, calculus, fixed prosthodontics and dementia. CONCLUSION: Halitosis was a common finding in the elderly living in Swedish nursing homes.

Antimicrobial activity of polyhexamethylene guanidine phosphate in comparison to chlorhexidine using the quantitative suspension method.

BACKGROUND: Polyhexamethylene guanidine phosphate (PHMG-P) belongs to the polymeric guanidine family of biocides and contains a phosphate group, which may confer better solubility, a detoxifying effect and may change the kinetics and dynamics of PHMG-P interactions with microorganisms. Limited data regarding PHMG-P activity against periodontopathogenic and cariogenic microorganisms necessitates studies in this area. Aim is to evaluate polyhexamethylene guanidine phosphate antimicrobial activity in comparison to chlorhexidine. METHODS: Quantitative suspension method was used enrolling Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli and Candida albicans, Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Streptococcus mutans and Lactobacillus acidophilus. RESULTS: Both tested antiseptics at their clinically-used concentrations, of 0.2% (w/v) and 1% (w/v), correspondingly provided swift bactericidal effects against S. aureus, P. aeruginosa, E. coli and C. albicans, A. actinomycetemcomitans and P. gingivalis with reduction factors higher than 6.0. Diluted polyhexamethylene guanidine phosphate and chlorhexidine to 0.05% continued to display anti-bacterial activity and decreased titers of standard quality control, periopathogens to below 1.0 × 10(3) colony forming units/ml, albeit requiring prolonged exposure time. To achieve a bactericidal effect against S. mutans, both antiseptics at all concentrations required a longer exposure time. We found that a clinically-used 1% of polyhexamethylene guanidine phosphate concentration did not have activity against L. acidophilus. CONCLUSION: High RF of polyhexamethylene guanidine phosphate and retention of bactericidal effects, even at 0.05%, support the use of polyhexamethylene guanidine phosphate as a biocide with sufficient anti-microbial activity against periopathogens. Polyhexamethylene guanidine phosphate displayed bactericidal activity against periopathogens and S. mutans and could potentially be applied in the management of oral diseases.

The effect of a dentifrice containing Magnolia extract on established plaque and gingivitis in man: a six-month clinical study.

AIM: The aim was to evaluate the clinical effect of a dentifrice containing 0.3% Magnolia extract on dental plaque and gingivitis. MATERIAL AND METHODS: The trial was a 6-month double-blind, stratified, randomized and 2-armed parallel group study. Forty-six subjects in the test group brushed their teeth with a dentifrice containing 0.3% Magnolia extract and 48 subjects in the control group brushed with a placebo dentifrice. Plaque and gingivitis were assessed at baseline, 3 and 6 months. RESULTS: There was a significantly larger gingivitis reduction in the Magnolia group than in the control group (0.26 ± 0.11 versus 0.11 ± 0.12) (P < 0.001). There was a greater increase in the total number of healthy gingival units Gingival Index (GI score 0) in the Magnolia group than in the control group (149% versus 31%) and a larger reduction in inflamed gingival units (GI score 2/3) (60% versus 30%). Furthermore, at sites with similar amounts of plaque, less clinical signs of gingival inflammation were observed in the Magnolia group than in the control group. CONCLUSION: Six months' unsupervised use of a dentifrice containing 0.3% Magnolia extract resulted in significantly greater gingivitis reduction than a corresponding control dentifrice.

Effect on de novo plaque formation of rinsing with toothpaste slurries and water solutions with a high fluoride concentration (5,000 ppm).

The aim of this study was to evaluate the effect, on de novo plaque formation, of rinsing with toothpaste slurries and water solutions containing a high concentration of fluoride (F). Sixteen subjects rinsed three times per day for 4 d with dentifrice slurries containing 5,000, 1,500, and 500 ppm F, while 12 subjects rinsed with water solutions containing 5,000, 1,500, 500, and 0 ppm F, and 1.5% sodium lauryl sulphate (SLS). Plaque was scored [using the Quigley & Hein index (QHI)] after each 4-d period. Plaque samples for F analysis were collected. Significantly less plaque was scored for the dentifrice slurry containing 5,000 ppm F (buccal and all surfaces) and for 1.5% SLS (buccal surfaces). The differences in plaque scores between dentifrice containing 5,000 and 1,500 ppm F were 19% for all surfaces and 33% for buccal surfaces. The difference between the water solutions containing 1.5% SLS and 1,500 ppm F for buccal surfaces was 23%; the corresponding difference for 5,000 ppm F was 17%. The dentifrice slurry containing 5,000 ppm F accumulated 56% more F in plaque. The combination of high levels of F and SLS in dentifrice reduces de novo plaque formation and increases the accumulation of F in plaque after 4 d.

The effect of a triclosan dentifrice on mucositis in subjects with dental implants: a six-month clinical study.

OBJECTIVE: The objective of the present clinical study was to assess the effect of the use of a dentifrice containing triclosan on peri-implant mucositis in subjects that had been restored with dental implants. METHODS: The trial was designed as a double-blind, randomized, two-treatment, parallel-group clinical study. Sixty male and female subjects, aged 30-70 years, were recruited. All subjects had lost teeth due to periodontal disease, and had been restored with a minimum of two implants at least one year prior to the start of the trial. Subjects were randomly assigned to two treatment groups. The subjects in the test group (Test) brushed their teeth and implant-supported restorations with a dentifrice containing triclosan, while the control subjects brushed with a sodium fluoride dentifrice. Only subjects with a minimum of one implant site showing clinical signs of peri-implant mucositis, i.e., bleeding after probing, were enrolled in the study. Clinical examinations were performed at baseline, and after three and six months. The following parameters were scored: Probing pocket depth (PPD), bleeding on probing (BoP), and plaque. The change from baseline within each treatment group at three months and six months was evaluated for all parameters using ANOVA and ANCOVA. RESULTS: Subjects with peri-implant mucositis who used a dentifrice containing 0.3% triclosan, as an adjunct to mechanical tooth brushing, exhibited significantly fewer clinical signs of inflammation than subjects who used a regular fluoride dentifrice at six months. The BoP scores were reduced from 53.8% to 29.1% in the Test group, whereas in the same interval there was an increase from 52.3% to 58.8% in the Control group. Furthermore, the individual mean PPD, as well as the frequency of sites with 5 mm and > or = 6 mm deep pockets, were reduced significantly more in the Test than in the Control group. CONCLUSION: The regular use of a dentifrice containing triclosan may reduce the clinical signs of inflammation in the mucosa adjacent to dental implants.

Effects of stabilized stannous fluoride dentifrice on dental calculus, dental plaque, gingivitis, halitosis and stain: A systematic review.

OBJECTIVES: The aim of the present systematic review was to examine the scientific evidence for the efficacy of stabilized stannous fluoride (SnF2) dentifrice in relation to dental calculus, dental plaque, gingivitis, halitosis and staining. DATA AND SOURCES: Medline OVID, Embase.com, and the Cochrane Library were searched from database inception until June 2017. Six researchers independently selected studies, extracted data, and assessed methodological quality. A meta-analysis of the 6-month gingivitis studies was done. Risk of bias was estimated using a checklist from the Swedish Agency for Health Technology Assessment (SBU, 2018). STUDY SELECTION: Two studies on dental calculus, 21 on dental plaque and gingivitis, 4 on halitosis, and 5 on stain met the inclusion criteria. Risk of bias was high for the studies on dental calculus, halitosis, and stain, and varied for the dental plaque and gingivitis studies. Significant reductions in dental calculus and in halitosis were reported for the SnF2 dentifrice; no differences in stain reduction were noted. A meta-analysis on gingivitis found better results for the SnF2 dentifrice compared to other dentifrices, though the results of the individual trials in the meta-analyses showed a substantial heterogeneity. CONCLUSIONS: The present review found that stabilized SnF2 toothpaste had a positive effect on the reduction of dental calculus build-up, dental plaque, gingivitis, stain and halitosis. A tendency towards a more pronounced effect than using toothpastes not containing SnF2 was found. However, a new generation of well conducted randomized trials are needed to further support these findings. CLINICAL RELEVANCE: Adding a SnF2 toothpaste to the daily oral care routine is an easy strategy that may have multiple oral health benefits.

Saliva mediated adherence, aggregation and prevalence in dental plaque of Streptococcus mutans, Streptococcus sanguis and Actinomyces spp, in young and elderly humans.

Salivary components in the pellicle mediate bacterial adherence to the tooth. Such components may also aggregate bacteria in saliva and prevent them becoming established in dental plaque. In the present study, the adherence and aggregation of Streptococcus mutans strain Ingbritt, S. sanguis strain 10556 and Actinomyces viscosus-strain 19246 mediated by parotid and whole saliva from groups of young and elderly people were examined. Significant differences were found between test strains, salivary secretions and age groups. S. sanguis 10556 and A. viscosus 19246 generally adhered more strongly than S. mutans Ingbritt, which adhered better to pellicles from parotid saliva than from whole saliva Strain 19246 bound in higher numbers to parotid saliva pellicles from elderly compared to young individuals. Strain 10556 adhered better to whole saliva than parotid saliva pellicles, and the difference was significant among the young individuals, indicating reduced adherence ability in elderly whole saliva. The streptococci were aggregated by parotid and whole saliva, and S. sanguis aggregation was less with whole saliva from the elderly than from the young participants. Besides a correlation between whole saliva aggregation of S. mutans and proportions of bacteria in plaque, no correlations were found for the individual binding properties of saliva and prevalence of bacteria in vivo. However, the level of saliva-mediated adherence in vitro was in the following order: S. mutans. Actinomyces S sanguis, which corresponded to their isolation frequency in plaque. These findings emphasize the importance of initial adherence to salivary receptors in bacterial colonization on teeth. Further studies are needed to reveal if individual patterns in the in vitro binding characteristics of saliva lead to variation of colonization in vivo.

Plaque formation at healthy and inflamed gingival sites in young individuals.

The present investigation was performed to evaluate the influence of gingivitis on the amount of de novo plaque that forms during a 24-h period of no oral hygiene. 292 fully dentate subjects participated in the study. The condition of the gingiva and the presence of supragingival plaque were examined at 4 surfaces of each tooth at a baseline examination. Following this examination, the participants were subjected to a comprehensive mechanical tooth cleaning and instructed to refrain from tooth cleaning measures during the subsequent 24 h. The plaque examinations were repeated at the end of the 24-h period. The results from the clinical trial revealed that during a 24-h period of no tooth cleaning, subjects with naturally occurring overt gingivitis, in general, formed more plaque than young individuals with healthy gingivae. Furthermore, plaque in all parts of the dentition, formed more frequently on tooth surfaces adjacent to sites with gingivitis than at healthy sites. It was concluded that the condition of the gingiva plays an important role for de novo plaque formation.

A model for studying the effects of mouthrinses on de novo plaque formation.

The aim of the present study was to describe a 4-day no oral hygiene model to assess the pattern of de novo plaque formation and to use this model to appraise the potential of some mouthwash preparations to retard or inhibit plaque formation in the human dentition. 10 subjects were recruited for the trial. During a preparatory period, the participants were exposed to repeated professional plaque control and given oral hygiene instruction to eliminate signs of gingivitis. At the end of the preparatory period, each participant received a final professional tooth cleaning and was subsequently told to abstain from mechanical plaque control efforts for the next 4 days. They were asked to rinse twice daily for 60 s with 10 ml varying test solutions. On Day 4, the volunteers were exposed to a new clinical examination and the presence and amount of plaque were examined by the use of the plaque index system (P1I). The participants were subsequently given a professional tooth cleaning and asked to exercise proper self performed plaque control during the next 10 days. A new test period was then initiated. 6 different mouthwash preparations were tested in each subject namely, (1) placebo (a negative control rinse), (2) Veadent mouthrinse, (3) Listerine mouthrinse, (4) 0.06% triclosan + polyvinyl phosphonic acid (PVPA), (5) 0.06% triclosan + phenolic flavor and (6) 0.12% chlorhexidine digluconate (a positive control rinse). The results from the study revealed that the mean P1I values for individuals, groups of teeth and tooth surfaces provide an adequate but gross overall estimation of the potential of a given mouthrinse to retard/inhibit plaque build up. More detailed information on the effects of the test rinses could be obtained by data describing the % distribution of different P1I score categories; a high frequency of score 0 describes the potential of a mouthrinse to maintain tooth surfaces free from plaque while a low frequency of score 2/3 describes the ability of a treatment to retard/prevent gross plaque formation. The plaque pattern displays finally allowed assessment of the magnitude of plaque prevention, in comparison to the positive and negative controls, that could be achieved by a given compound in various parts and surfaces of the dentition. In this model, all test rinses (i) were significantly more effective than the placebo rinse in retarding de novo plaque build up and (ii) had a minor effects on plaque build up in the maxillary molars and at the approximal surfaces.(ABSTRACT TRUNCATED AT 400 WORDS)

Patterns of de novo plaque formation in the human dentition.

The objective of the present clinical trial was to carefully assess the pattern of de novo plaque formation in the human dentition. 10 subjects aged 24-29 years were recruited for the study. None of the participants showed signs of destructive periodontitis. At the start of the preparatory period, they were given a thorough dental prophylaxis and oral hygiene instruction. For the next 2 weeks, the participants were carefully monitored and 1 x every 2 days examined with respect to plaque and gingivitis. At the re-examinations, they were also given professional tooth cleaning and instruction in proper plaque control measures. Towards the end of this 2-week period, the Day 0 examination was performed which revealed that the gingival tissues of all participants were in excellent clinical health. Following the Day 0 examination, all 10 subjects were exposed to professional tooth cleaning. During the next 14 days, they abolished all mechanical tooth cleaning efforts but were examined with respect to plaque on Days 1, 4, 7 and 14. The amount of plaque formed was examined using the criteria of the Plaque Index system (PlI). Each of 6 surfaces of each tooth in the dentition was given a score from 0 to 3. The results from the re-examinations demonstrated that in humans with clean teeth and normal gingiva, the abolishment of mechanical tooth cleaning rapidly resulted in de novo plaque formation. Most plaque, as assessed by the plaque index system, formed during the first 4 days of no tooth cleaning after which moderate additional amounts of plaque formed. It was observed that the mean PlI values for individuals, for groups of teeth and tooth surfaces, provide a proper overall estimation of plaque build up. The dynamics of plaque formation between examinations and in different parts of the dentition were more easily disclosed by the data describing % distributions of different score categories and the transition between scores from one examination to the next. The total amount of plaque formed on various tooth surfaces was best presented by so called "plaque pattern displays". The results also revealed that (i) the mandibular dentition harbored more plaque than the maxillary dentition, (ii) there was a difference in the mean PlI scores between the molar and the anterior tooth regions in the maxilla, but in the mandible such a difference could not be observed (except on Day 1), (iii) plaque accumulated most at the approximal surfaces and least at the palatal surfaces, and that (iv) differences in PlI scores between groups of teeth and tooth surfaces observed on Day 4 persisted through the Day 14 examination.

The treatment of localized metastases in the proximal humerus from renal cell carcinoma.

Four cases of a localized metastatic renal cell carcinoma within the proximal humerus are reviewed. In three of these cases radiation therapy resulted in relief of bone pain but did not control progression of the secondary tumor. In one case palliative radiation treatment combined with intramedullary nailing resulted in the total destruction of the whole humerus by secondary tumor during the 10-month period before the patient died. In the other three cases aggressive surgical treatment was performed. This treatment consisted of an en bloc resection of the proximal humerus, with reconstruction of the proximal humerus with a long-stem Neer humeral head replacement prosthesis. To obtain a good functional result, the soft tissues were reconstructed onto on intercalary allograft in one case; artificial rotator cuffs were used in two cases. After a mean follow-up period of 20 months, all three patients who underwent aggressive treatment hod painless shoulders, with fair function and no recurrence of carcinoma. En bloc resection with reconstruction of the proximal humerus is on effective method of avoiding limb oblation and contrailing painful solitary lesions from metastatic renal cell carcinoma.

Prevalence of periodontal disease in young diabetics.

In the present study, the frequency of sites exhibiting gingival inflammation and periodontal tissue breakdown was assessed in one group of 46 individuals (19-25 years old; test group T) who had suffered from diabetes mellitus (Type 1) for 10 years or more, and in another group of 41 non-diabetic controls (18-26 years old; control group C). Each individual was examined regarding oral hygiene status, gingival conditions, probing depths, probing attachment levels and gingival recessions. The interproximal marginal bone level was assessed in bitewing radiographs. No significant differences were found between the 2 groups regarding their oral hygiene status, frequency of sites with probing depths of greater than 3 mm and the position of the interproximal alveolar bone margin. The mean distance between the cemento-enamel junction (CEJ) and the interproximal bone crest was in group T, 0.91 +/- 0.14 (SD) mm and in group C, 0.95 +/- 0.18 (SD) mm. About 80% of the individuals in both groups were free from signs of marginal bone loss and only 1 subject in each group had greater than 6 sites with definitive bone loss. The group of diabetic patients had higher frequencies of inflamed buccal/lingual gingival units, gingival recessions and sites with attachment loss of greater than or equal to 2 mm. Most of the sites (85%) with attachment loss were located at the buccal and lingual surfaces. There were no significant correlations between the periodontal variables and the duration of diabetes, insulin dosage and HbA1 level. Individuals with both retinopathy and nephropathy had significantly more gingival inflammation than diabetic individuals without complications.

Short-term effects of triclosan on healing following subgingival scaling.

The present clinical trial was performed to evaluate short-term effects of a triclosan-containing dentifrice/gel combination on soft tissue healing, when applied supra-/sub-gingivally at periodontal sites treated with scaling and root planing. 16 subjects with moderate periodontitis participated in a 2x 2-week, split-mouth designed clinical trial. 2 combinations of gel/dentifrice (the test combination containing triclosan) were used. 2 pairs of contralateral sites with probing pocket depth (PPD) > or 5 mm, and which bled on probing (BoP +) were selected in each patient as experimental units. A baseline examination included assessments of PPD, BoP, gingival index scores, plaque index scores, and the composition of the subgingival microbiota (dark-field microscopy). The assigned quadrant was anaesthetized and the teeth exposed to meticulous scaling and root planing. Immediately after the completion of mechanical therapy, either the test or control gel was applied subgingivally at the experimental sites. The volunteer was instructed to brush his/her teeth with an assigned dentifrice and to apply the gel (via a custom-made stent) supra-gingivally 2x daily for the following 2 weeks. He/she was recalled on day 7 for a second professional subgingival gel application. Re-examinations were carried out on days 2, 7 and 14 after treatment. 1-week wash-out periods separated the 2 experimental periods. The mean PPD reductions (between days 0 and 14) were 1.8 mm and 1.9 mm for the test and control gel/dentifrice sites. The reduction in BoP and gingival index scores was significantly greater during the test than during the control regimen. No significant differences were observed between the 2 regimens regarding plaque scores and composition of the subgingival microbiota. The findings from the present investigation demonstrated that triclosan, applied both sub- and supra-gingivally reduced soft tissue inflammation following scaling and root planing.

The effect of supragingival plaque control on the subgingival microflora in human periodontitis.

The aim of the present trial was to study if carefully practiced supragingival plaque control influenced the subgingival microbiota at periodontal sites with suprabony, infrabony, or furcation pockets. 12 subjects, 5 males and 7 females aged 44 to 69 years (mean age 55 years) participated in the study. None of the participants had during the last 12 months received periodontal therapy, and none of the subjects had used antibiotics during a 3-month period preceding the study. Following a screening examination, 6 to 8 sites per subject were selected which had a probing depth of > or = 5 mm. Among these sites, 1-3 sites had a suprabony location, 1-3 sites had an infrabony location, and 1-3 sites were associated with a furcation defect. The selected sites were exposed to a baseline examination at which the following parameters were recorded: plaque, gingivitis, probing pocket depth and probing attachment level. A bacterial sample was obtained from each of the selected sites: 2 sterile paper points were inserted into the pocket and kept in place for 30 seconds. The paper point samples were removed, placed in a vial containing an anaerobically prepared transport medium, and processed using routine procedures. Following the baseline examination, each subject was given a case presentation, received thorough supragingival scaling and was instructed to practice proper plaque control with the use of toothbrush and dentifrice. During the subsequent 30 weeks they were recalled 2-3xper week for professional tooth cleaning. Each session was handled by a dental hygienist and required about 15 min. Re-examinations were performed after 30 weeks. The findings indicated that professionally delivered and frequently repeated supragingival tooth cleaning, combined with careful self-performed plaque control had a marked effect on the subgingival microbiota of moderate to deep periodontal pockets. Thus, at sites with suprabony and infrabony pockets, as well as at furcation sites, the meticulous and prolonged supragingival plaque removal reduced the total number of microorganisms that could be harvested, as well as the % of sites with P. gingivalis.

Plaque and gingivitis in the deciduous and permanent dentition.

The aim of the present investigation was to monitor de novo plaque formation and associated alterations of the gingival conditions in the deciduous, mixed and permanent dentition in man. 31 volunteers, divided into 3 study groups participated in the trial. Group 1 was made up of 11 subjects, 4-6 years of age (deciduous dentition), group 2 comprised of 10 subjects, 8-9 years of age (mixed dentition) and group 3 included 10 subjects, 14-16 years of age (permanent dentition). After a screening examination, each participant received detailed instruction in a proper oral hygiene technique and was subjected to professional tooth cleaning. The professional debridement and the oral hygiene instruction were repeated after 1 week. After another week, a given day was termed Day 0 and a baseline examination was performed. This examination included assessments of plaque and gingivitis. Each subject received an additional, comprehensive professional tooth cleaning and was asked to abstain from all mechanical oral hygiene measures. Re-examinations were performed after 3 and 7 days. The findings demonstrated that: (i) during a 7-day period of no active oral hygiene, subjects with a mixed or a permanent dentition formed visible amounts of plaque and developed modest signs of gingivitis; (ii) during the 7 days of the trial, young subjects with a fully erupted deciduous dentition formed less plaque than the older subjects, and failed to respond to de novo plaque formation with enhanced signs of gingivitis; (iii) in subjects with a mixed dentition, the amount of plaque formed during the 7 days of experiment and the matching gingivitis development were similar in the deciduous and permanent tooth segments of the dentition.

The influence of gingival inflammation on de novo plaque formation.

The aim of the present clinical trial was to examine the influence of gingival inflammation on de novo plaque formation. In addition, the effect of a varying number of salivary bacteria on early plaque formation was evaluated. 10 subjects were recruited for the trial which was designed to establish 2 different starting points for de novo plaque formation, 1 in a healthy dentition and 1 in a gingivitis dentition. On Day 0 and at regular intervals during a 5-week period, the panelists were examined with respect to gingivitis, plaque and number of salivary bacteria. The findings from the study demonstrated that the condition of the marginal gingiva plays an important role in the early stages of plaque formation. Thus, in both phases of the study, it was observed that at sites with initially healthy gingival units, less plaque formed (PlI = 0.93 and 0.82) than at sites with GI > 0 (PlI = 1.24 and 1.28) at the 2 different starting points. The number of salivary bacteria seemed to be less important than the state of the gingiva for the amount of plaque that formed during a 4-day period of no active mechanical tooth cleaning.

Some effects of mouthrinses containing salifluor on de novo plaque formation and developing gingivitis.

Three clinical trials were carried out to evaluate the effects of mouthrinses containing 5n-octanoyl-3'-trifluormethylsalicylanilide (salifluor) on plaque and gingivitis. Each trial was performed as a double-blind, randomised and cross-over designed study (studies 1, 2 and 3). In each study, 10 young individuals with healthy gingiva abolished all means of mechanical plaque control during the course of the experimental period including 6 x 4 days (study 1), 3 x 18 days (study 2) and 3 x 14 days (study 3). They rinsed, 2 x daily, with various mouthwash preparations for 4 days (study 1), for the last 4 days of a 18 day period (study 2) or for 14 days (study 3). 6 (control, vehicle control, 0.08%, 0.12% and 0.2% salifluor and 0.12% chlorhexidine), 3 (control, 0.12% salifluor and 0.12% chlorhexidine) and 3 (control, 0.12% salifluor and 0.12% chlorhexidine) mouthwash preparations were tested in studies 1, 2 and 3, respectively. The findings of study 1 indicated that (i) mouthrinses containing salifluor were significantly more effective than control rinses and that (ii) the salifluor mouthrinses were equally effective as the 0.12% chlorhexidine mouthrinse, in retarding 4-day de novo plaque formation. The findings of study 2 indicated that (i) the mouthrinse containing 0.12% salifluor retarded de novo plaque formation to the same extent as the 0.12% chlorhexidine mouthrinse at healthy as well as at inflamed sites but that (ii) the anti-plaque effects of the salifluor and chlorhexidine mouthrinses were significantly smaller at sites with inflamed than with healthy gingiva. In study 3, it was observed that there was no significant difference between the 0.12% salifluor and 0.12% chlorhexidine mouthrinses in retarding de novo plaque formation and the development of gingivitis during a 14-day period of no mechanical plaque control. Thus, the results of the 3 clinical trials demonstrated the potential of salifluor as an effective anti-plaque and anti-inflammatory agent.

The effects of antimicrobial mouthrinses on de novo plaque formation at sites with healthy and inflamed gingivae.

The objective of the present investigation was to evaluate to what extent mouthrinses containing triclosan and chlorhexidine may modify the amount of de novo plaque that forms on tooth surfaces adjacent to healthy and inflamed gingival units. 10 volunteers were recruited. On day 0, gingival crevicular fluid (GCF) was obtained at predetermined sites and gingivitis (GI) was assessed. A careful oral prophylaxis was given to each of the volunteers who subsequently abstained from all mechanical plaque control measures for the following 18 days. During the first 4 days (rinse phase I), they rinsed with either 0.12% chlorhexidine, 0.06% triclosan or placebo solution. Clinical examinations (GCF, GI) were repeated and the amount of plaque formed determined on days 4, 7 and 14. On day 14, the participants received a new professional tooth cleaning after which rinse phase II was initiated. During this 2nd phase, the participants rinsed for 4 days with the same mouthwash preparation and in the same manner as during rinse phase I. The examinations were repeated on day 18. Each participant received a comprehensive oral prophylaxisis and was instructed to perform meticulous mechanical plaque control during the following 4 weeks. A 2nd experimental period was then initiated. A total of 3 experimental periods were repeated until all subjects had rinsed with the 3 different mouthwash preparations. The results demonstrated (i) that significantly more plaque formed at sites with gingivitis than at surfaces adjacent to healthy gingival units and (ii) pre-existing gingivitis significantly increased the amount of de novo plaque that formed in subjects who rinsed with mouthwash preparations containing chlorhexidine and triclosan.

The effect of systemic antibiotics in the treatment of patients with recurrent periodontitis.

BACKGROUND: Subjects with periodontal disease exist who either (i) respond poorly to initial mechanical therapy ("refractory" periodontitis) or (ii) fail to adopt adequate self-performed plaque control techniques and hence develop recurrent disease ("recurrent" periodontitis) at multiple sites during the supportive treatment phase (SPT). Various systemic antibiotic regimens have been tried as adjuncts to the mechanical (re-) treatment of such "difficult to treat"-patients. While most studies indicated a positive outcome of the adjunctive therapy, some clinical investigators reported that this additional measure provided little or no benefit. AIM: The aim of the present investigation was to study the more long term effect of adjunctive antibiotic therapy in the re-treatment of patients with a well defined history of recurrent periodontitis. MATERIAL AND METHODS: 17 subjects with recurrent advanced periodontal disease were, following a baseline examination, subjected to non-surgical therapy including the use of systemic antibiotics (amoxicillin and metronidazole). They were placed in a careful SPT program and re-examined after 1, 3 and 5 years. The examinations included both clinical and microbiological assessments. RESULTS: It was demonstrated that in subjects with advanced and recurrent periodontitis, re-treatment including (i) comprehensive scaling and root planing (SRP), (ii) systemic administration of antibiotics and (iii) meticulous supragingival plaque control by both mechanical and chemical means established periodontal conditions that in the short term (3 years) and in the majority of subjects could be properly maintained by traditional SPT measures. Between 3 and 5 years, however, only 5 of the 17 subjects exhibited stable periodontal attachment levels. CONCLUSIONS: Some deep pockets and furcations were most likely inadequately instrumented during the active treatment phase. Microorganisms residing in biofilms left in such locations were probably not sufficiently affected by the 2 weeks of adjunctive antibiotic therapy. It is suggested that removal of certain subgingival deposits, therefore, may require surgical intervention.