Diluted Home Bleach as a Preprocedural Mouthrinse Prior to Ultrasonic Scaling: A Non Randomised Clinical Trial

Abstract

Introduction: The benefit of mouth rinsing with an antiseptic prior to aerosol generating dental procedures has been reported and widely accepted. Chlorhexidine (CHX), the widely employed antiseptic mouthrinse is not without side effects. Diluted home bleach (sodium hypochlorite) has been in use as an antiseptic mouthrinse and its role in plaque control is well documented. It is safe, less expensive and readily available. Aim: To compare the aerosol microbial load after ultrasonic scaling between three preprocedural rinses namely 0.1% sodium hypochlorite (diluted home bleach), 0.2% CHX and distilled water. Materials and Methods: A non randomised clinical trial was conducted in the Postgraduate Clinic, Department of Periodontics, Government Dental College, Kottayam and Department of Microbiology, Government Medical College, Kottayam, Kerala, India, from April 2021 to September 2021. Study included sixty systemically healthy adults {Full-mouth Plaque Score (FMPS) and Full-mouth Bleeding Score (FMBS) >25%, with atleast one periodontal pocket >4 mm in each quadrant} who were divided into three groups of 20 receiving diluted home bleach, CHX or distilled water, respectively as preprocedural rinse. Subjects rinsed 15 mL of solution for 30 seconds, 10 minutes prior to ultrasonic scaling. Blood agar plates kept at patient’s chest and doctor’s chest locations to collect aerosols were incubated for 48 hours and microbial Colony Forming Units (CFUs) counted. Analysis of Variance (ANOVA) was used to compare the amount of CFUs at the two sites between three groups. Independent t-tests were used to compare the intragroup CFU counts between two sites. Results: The mean age of group A, group B and group C was 45.15±7.01 years, 41.9±9.96 years and 43.2±7.93 years, respectively. There were 13 males and 7 females, 7 males and 13 females and, 11 males and 9 females in group A, group B and group C, respectively. There were more CFUs in patient’s chest location sample compared to doctor’s chest location in all three mouthrinse groups. For Sodium hypochlorite (NaOCl), mean difference was 43.850 (95% CI 15.2-72.4), for CHX 45.800 (95% CI 25.9-65.6), for distilled water 56.650 (95 % CI 20.2-93.0), respectively which were statistically significant (p-value<0.05). The home bleach and CHX groups showed significantly fewer CFUs than distilled water on both locations. On comparison with CHX, diluted home bleach demonstrated fewer CFUs, but this difference was not statistically significant. Conclusion: Diluted home bleach and CHX preprocedural rinses were comparable in terms of CFU counts in dental aerosols generated during ultrasonic scaling. Diluted home bleach mouthrinse is safe, economical and readily available in every house hold.