Data about application of chlorhexidine as a periodontal irrigant – Systematic Review.

Introduction. The most commonly used lavage solution for periodontal irrigation are diluted antiseptic solutions, the most important of them, is chlorhexidine solution. The ability of chlorhexidine to be fixed for periods of time of 8 hours on the surface of the tooth is among the main characteristics of the mechanism of action of this solution. Aim of the study. The aim of this study is to reveal the latest news about the indications for the application of chlorhexidine in cases of periodontal pathologies. Material and Methods. The electronic search to complete the purpose of the study was carried out on PubMed website for the last 3-year period, using the selected key words. Results. Based on the analysis of 32 articles extracted from the literature, from the combination of the key words chlorhexidine and endodontics and periodontics, not antibiotics, not probiotics, it was noticed that only 1 article was not included in the scope of our study. Conclusions. For chlorhexidine as a periodontal solution, the effects are known mainly in the control of bacterial plaque, but it is believed that new ways or different systems of its release should be found to express the periodontal effect. The side effects of chlorhexidine as a periodontal irrigating solution are better known, but in the processed data no concrete conclusions emerge as to which concentration of chlorhexidine would be the most indicated for specific periodontal diagnoses. Keywords: antibiotics, probiotics, chlorhexidine, non-surgical treatment, indications, endodontic lavage solution, persistent apical periodontitis

To evaluate cases of persistent apical periodontitis (PAP) and what are the imaging and clinical aspects that could be considered in the PAP diagnosis and in their treatment decision-making process. 423 patients with apical periodontitis at the time of non-surgical root canal treatment (NSRCT) were followed-up for at least 1 year. Periapical radiographic images were used to compare and determine periapical status at each time using the PAI scoring system. Cases scored as PAI 5 at the follow-up appointment were evaluated by CBCT, using the CBCTPAI scoring system. Associated, the data from imaging exams and from clinical evaluation were considered to make a decision for PAP treatment. Regarding sample composition, it was observed an association with ethnicity and PAP (p = 0.045). After follow-up, cases classified as PAI Score 1 and 2 and absence of symptoms/complaint were classified as successful. Cases classified as PAI Score 3 and absence of symptoms/complaint were referred for new follow-up visits until complete resolution of PAP. Cases scored as PAI 4 with clinical symptoms were indicated for non-surgical root canal retreatment. Cases scored as PAI 5 were assessed by CBCT, and in the presence of symptoms/complaint and a CBCTPAI score 3 were related to non-surgical root canal retreatment, while CBCTPAI scores 4 and 5 were refereed for endodontic surgery. Clinical data, PAI and CBCTPAI scoring systems from image exams can be useful for PAP diagnosis and their treatment. In the decision-making process, clinical and imaging data are fundamental for the choose of an ideal protocol for treating PAP.

Background:The main stay of primary and secondary prevention of periodontal diseases has been the control of supra gingival plaque. Acceptable plaque control by mechanical means is difficult to achieve by most individuals, so mouth rinses represent one form of attack on oral microbes and the malodor. Chlorhexidine (CHX) is a broad-spectrum antimicrobial agent known to cause damage to the cell membrane of microorganisms and at higher concentrations causes precipitation and coagulation of the proteins in the cytoplasm of the exposed microbes. The aim of this study is to evaluate and compare the efficacy of 0.12% and 0.2% concentration of CHX gluconate clinically as well as microbiologically.Materials and Methods:The single blind placebo controlled randomized study design comprising of 75 males with an age between 25 years and 50 years were selected from out-patient Department of Periodontics. The subjects were randomly divided into five groups. After baseline clinical and microbiological examination, the groups were subjected to mechanical plaque control with or without mouthwashes containing various concentrations of CHX and placebo. After 90 days the data pertaining to clinical and microbiological parameters were compared to the baseline data so as to compare the efficacy of different concentrations of mouthwashes.Results:The results achieved with the use of 0.2% and 0.12% concentrations of CHX were comparable; taking into consideration of various clinical and microbiological parameters.Conclusion:The study recommends the use of low concentration of (0.12%) CHX for better patient compliance with the optimum clinical results

Objective To explore the efficacy and safety of chlorhexidine oral care in the prevention of ventilator-associated pneumonia (VAP) by means of meta-analysis. Methods Randomized controlled trials on the effect of chlorhexidine oral care on the incidence of VAP in patients on mechanical ventilation were searched in PubMed, Scopus, Cochrane Library, and Embase from May 1, 2022. Two researchers independently screened and included the study, extracted the data, and evaluated the literature quality. RevMan5.3 software was used for meta-analysis. Results Meta-analysis of 13 included literature studies involving 1533 patients showed that oral care with chlorhexidine solution could reduce the incidence of VAP in patients with mechanical ventilation and the difference was statistically significant (RR = 0.61, 95% CI (0.46, 0.82), P=0.04). However, the results showed that the incidence of VAP of low concentration (0.02%, 0.12%, and 0.2%) and high concentration (2%) of chlorhexidine in the intervention group was lower than that in the control group and the difference was statistically significant (RR = 0.70, 95% CI (0.51, 0.96), P=0.03; RR = 0.41, 95% CI (0.27, 0.62)). There was no significant difference in mortality between the two groups (RR = 1.01, 95% CI (0.85, 1.21), P=0.87). There was no statistical significance in days ventilated or days in ICU between the two groups (RR = −0.02, 95% CI (−0.19, 0.16), P=0.84; RR = 0.01, 95% CI (−0.11, 0.14), P=0.85). Conclusion Existing evidence shows that chlorhexidine used for oral care of patients with mechanical ventilation can reduce the incidence of VAP, and high concentration of chlorhexidine (2%) or low concentration of chlorhexidine (0.02%, 0.12%, 0.2%) has a significant effect on the prevention of VAP. Considering the safety of clinical application, it is recommended to use 0.02%, 0.12%, and 0.2% chlorhexidine solution for oral care.

Genetic Polymorphisms in RANK and RANKL are Associated with Persistent Apical Periodontitis

Immune-Inflammatory Cell Profile and Receptor Activator of Nuclear Factor Kappa B Ligand/Osteoprotegerin Expression in Persistent Apical Periodontitis after Root Canal Retreatment Failure

Interaction between polymorphisms in TNF-⍺ and RANKL genes is associated with the development of persistent apical periodontitis, in Brazilian subjects

The aim of this study was to investigate whether there is an association between inducible in single nucleotide polymorphisms in nitric oxide synthase (rs2297518 and rs2779249) and persistent apical periodontitis. A total of 291 Brazilian subjects were included: 125 with signs/symptoms of persistent apical periodontitis and 166 with root canal-treated teeth exhibiting healthy perirradicular tissues. Endodontically treated patients were followed up after 1 year. The two single nucleotide polymorphisms in nitric oxide synthase were analysed using real-time polymerase chain reaction. Chi-square test and odds ratio with 95% confidence intervals were performed to compare genotype distributions between 'healed' and 'persistent apical periodontitis' groups (p < 0.05). Logistic regression analysis was used to evaluate SNP-SNP interactions. The allele and genotype distributions for the polymorphisms between the persistent apical periodontitis and healed groups were not statistically significant (p > 0.05). In the logistic regression analysis, the polymorphisms were not associated with persistent apical periodontitis and SNP-SNP interactions.

We report the case of a 39-year-old male with Persistent Apical Periodontitis (PAP) caused by infection in an uninstrumented area, wherein conventional chemical root canal treatment is not possible, which was sterilized via highfrequency conduction. He underwent root canal filling after multiple endodontic treatments for tooth #4. As symptoms recurred, he was referred to our department with the chief complaint of dull pain during mastication. Present symptoms were percussion pain of the tooth, buccal mucosa swelling at the apical portion, and grade 1 mobility. Radiography revealed inadequate root canal filling. A radiolucent image 5×6 mm in diameter and with an unclear boundary was observed around the apex. External root resorption was mainly observed in the apical foramen, with a crown root ratio of approximately 1:1. Using 6% sodium hypochlorite under dental microscopy, chemomechanical root canal preparation was performed. Passive ultrasonic irrigation and calcium hydroxide application were conducted three times; however, periapical tissue inflammation did not subside. Therefore, the patient was diagnosed with PAP, and the uninstrumented area was sterilized via high-frequency conduction. High-frequency currents were applied to the apex, root surface, and periapical lesion at 500 kHz and 90 V; periapical tissue inflammation resolved after 2 weeks. Subsequently, the root canal was filled. Follow-up radiography revealed a bone regeneration-like image at 2 months. Bone defects healed at 11 months. Although surgical endodontic therapy is conventionally performed in PAP patients, high-frequency conduction could be a minimally invasive nonsurgical endodontic treatment option for uninstrumented areas in PAP patients.

Aim: The purpose of the present study was to evaluate the antimicrobial activity of 0.2%, 1%, and 2% chlorhexidine in root canals instrumented with the ProTaper Universal™ system. Methods: Fifty human mandibular premolar teeth were infected with a mixture of Candida albicans, Pseudomonas aeruginosa, Enterococcus faecalis and Staphylococcus aureus. The specimens were randomly divided into 5 groups with 10 root canals according to the irrigant used. All root canals were instrumented with the ProTaper Universal™ system. Assessment of the antimicrobial action of the irrigant was performed before, during, and after instrumentation. Data were analyzed statistically by Chi-squared test and the Fisher exact test at 5% significance level. Results: The 0.2% chlorhexidine solution was ineffective against all test microorganisms. The 1% chlorhexidine solution was effective in eliminating P. aeruginosa and C. albicans after the use of the F1 and F3 instruments, respectively. The 2% chlorhexidine solution was effective at killing S. aureus, P. aeruginosa and C. albicans after the use of the S1 instrument. There were statistically significant differences (p<0.05) between the concentrations of chlorhexidine and the instruments used. Conclusions: The 0.2% chlorhexidine solution in combination with rotary instrumentation was ineffective against all test microorganisms. The 1% chlorhexidine solution was ineffective against S. aureus and E. faecalis. The 2% chlorhexidine solution was not sufficient to inactivate E. faecalis.

To investigate whether the application of chlorhexidine in a two-step self-etching adhesive has an adverse effect on the immediate resin-dentin bond strength. Different amounts of 20 wt% chlorhexidine digluconate were added directly to the Clearfil SE Bond primer to prepare mixtures of 4 different concentrations of chlorhexidine: 0.05 wt%, 0.1 wt%, 0.5 wt%, and 1.0 wt%. Sixteen extracted third molars were randomly divided into 4 groups. Each group corresponded to one of the 4 chlorhexidine concentrations. Each of the 16 teeth was sectioned into halves. One half was customarily bonded with Clearfil SE Bond without chlorhexidine, and the other half was bonded with Clearfil SE Bond containing different concentrations of chlorhexidine. Microtensile bond strengths were tested immediately after specimen preparation. The modes of fractures were examined under a stereomicroscope. No significant difference of immediate resin-dentin bond strength was observed between the control groups and any of the experimental groups containing chlorhexidine (p > 0.05). The addition of chlorhexidine to a two-step self-etching adhesive primer (Clearfil SE Bond primer) has no adverse effect on the immediate resin-dentin bond strength when the chlorhexidine concentration in the primer is lower than or equal to 1.0 wt%.

Effectiveness of self-adhesive luting cements in bonding to chlorhexidine-treated dentin

The influence of chlorhexidine rinsing on wound healing was studied using standardized, open mucosal-osseous wounds in the left side of the palate in Wistar rats. In five test groups, each containing 10 rats, rinsing was performed twice daily for 30 sec with 0.1, 0.2 and 0.5% chlorhexidine solution, chlorhexidine solution vehicle, and Ringer solution. A sixth test group (control) was not rinsed at all. Seven days postoperatively, wound healing was evaluated clinically (size of the defect) and histomorphometrically (percent composition of mature connective tissue, immature connective tissue, granulation tissue, fibrin with granulocytic infiltrate). Clinically it was clear that wound healing was best in those animals that rinsed with Ringer solution, and worst in those that rinsed with 0.5% chlorhexidine solution. Increasing concentration of chlorhexidine caused a delay in wound healing, which in the following cases resulted in significant differences: rinsing with Ringer solution and vehicle versus all concentrations of chlorhexidine, no rinsing versus 0.5% chlorhexidine. Intensive rinsing with high concentrations of chlorhexidine may, after oral surgical operations, especially surgery in which bone is exposed, result in delay and disturbance of wound healing in humans.

Surgical site infection is routinely cited as the most common complication following orthopedic foot and ankle surgery. Our institution uses 4% chlorhexidine gluconate followed by 70% isopropyl alcohol to reduce skin bacterial loads prior to surgery. These solutions have potential synergistic qualities to prevent a postoperative infection. The purpose of this study was to determine if the order of these solutions has a significant effect on the residual bacterial pathogens load following operative site preparation for foot and ankle surgery, as evidenced by positive culture swabs. A total of 95 consecutive patients, undergoing surgery of the foot and ankle with a single surgeon, were prospectively randomized to 1 of 2 operative preparation groups: isopropyl alcohol (IPA) group, whose operative site preparation consisted of a 4% chlorhexidine application followed by alcohol rinse (49 patients), and chlorhexidine gluconate (CHG) group, which had 46 patients undergo operative site preparation using alcohol followed by chlorhexidine. A total of 4 aerobic culture specimens were obtained from the third web space of the operative foot on each patient: (1) prior to operative site preparation, (2) after the prep was completed, (3) after completion of the procedure, and (4) after the incision was closed. Each patient was then followed for 6 months postoperatively to monitor the operative site. Medical comorbidities were also analyzed. The average time for IPA procedures was 52 minutes vs 54 for CHG (ns). There was no difference between groups with respect to diabetes, tobacco use, obesity, race, or immunosuppression. Both groups had 100% bacterial growth from specimens obtained prior to operative site preparation (P > .05). For all postpreparation swabs, 19.0% (28/147) of the IPA cultures were positive compared to 10.9% (15/138) from the CHG group cultures (P = .07). The amount of patients with positive culture results favored the CHG group at each collection point: 6.5% (3/46) versus 25% (12/49) after draping (P = .02); 15% (7/46) versus 33% (16/49) after completion of the surgery (P = .05); and 20% (9/46) versus 35% (17/49) after skin closure (P = .07). One operative site infection was seen in the first 30 days following surgery for each treatment group, each treated with oral antibiotics. No additional skin or wound complications were encountered during the 6-month study follow-up. Postoperative infection rates following foot and ankle orthopedic surgery was low. Both chlorhexidine and isopropyl alcohol solutions were effective methods in reducing operative site bacterial colonization when combined. In this study, applying isopropyl alcohol solution followed by the chlorhexidine solution was more effective in reducing positive bacterial cultures taken after operative site preparation. No difference in clinical wound infection rate was seen. Level I, prospective randomized study.

Three concentrations of povidone‐iodine (0.1% w/v, 0.2% w/v, 0.5% w/v) and one concentration of chlorhexidine (0.5% w/v) were selected as antimicrobial joint lavage solutions. Through‐and‐through joint lavage was performed with one of these antimicrobial solutions on a tarsocrural joint of 12 horses. The contralateral tarsocrural joints (control limbs) were lavaged with a balanced electrolyte solution (BES). The effect of the lavage solution on the joints was evaluated with respect to lameness, foot flight pattern, soreness to joint palpation, articular and periarticular enlargement, and synovial fluid composition on Day 1,4, and 8 postlavage. On Day 8 postlavage, all horses were euthanized and the tarsocrural joints were examined.All solutions induced a synovitis. Based on clinical assessment, synovial fluid protein levels, color, clarity, mucin clot forming ability, gross appearance of the joint at necropsy, and synovial membrane histologic evaluation, a similar, mild, transient, synovitis was induced by the BES and 0.1% povidone‐iodine (PI) solution. The 0.2% PI solution induced a more prolonged neutrophilic response and poorer mucin clot forming ability in the synovial fluid as compared to the BES.The 0.5% PI and 0.5% chlorhexidine solutions produced severe lameness, soreness to joint palpation, and limb enlargement. The elevated synovial fluid total protein content persisted significantly longer (p &lt; 0.05) than the corresponding control (BES) solution. Histologic evaluation of the synovial membrane confirmed the presence of a moderate to severe neutrophilic synovitis in these treatment groups.