Abstract
ABSTRACTThis study aimed to demonstrate subgingival microbial changes associated with development, prevention, and treatment of experimental gingivitis using chlorhexidine (CHX) and N-acetylcysteine (NAC) mouthwashes. This randomized clinical trial comprised two parts: a 3-week prevention sub-study in which 30 study subjects were equally assigned to either mouthwash or placebo while developing experimental gingivitis; followed by a 2-week treatment sub-study in which 20 subjects with experimental gingivitis were assigned to either mouthwash. Subgingival samples were collected at the beginning and end of each sub-study for microbial profiling with 16S rRNA gene sequencing. As expected, CHX was effective in both preventing and reversing experimental gingivitis; NAC had a modest effect. Gingivitis was associated with enrichment of TM7 HOT-346/349, Tannerella HOT-286, Cardiobacterium valvarum, Campylobacter gracilis, Porphyromonas catoniae, Leptotrichia HOT-219, and Selenomonas spp. At the phylum/genus level, TM7 showed the strongest association. Gingival health was associated with increased abundance of Haemophilus parainfluenzae, Lautropia mirabilis, Rothia spp., Streptococcus spp., and Kingella oralis. CHX demonstrated largely indiscriminate antimicrobial action, resulting in significant drop in biomass and diversity. Our results substantiate the role of specific oral bacterial species in the development of gingivitis. They also indicate that NAC is not a promising mouthwash at the concentration tested.
Highlights
Gingivitis is a reversible inflammation of the gingiva; the most common form of it is ‘plaque-induced gingivitis’ which is caused by dental biofilm accumulation below and around the gingival margin [1]
This study is a sub-study of that clinical trial, in which we aimed to (1) demonstrate subgingival microbiome changes associated with the development of experimental gingivitis and (2) characterize the microbiome shifts induced by the use of 1.25% N-acetyl cysteine (NAC) mouthwash for prevention and treatment of gingivitis as compared to 0.2% CHX
In the former, 30 subjects brought to optimal gingival health were randomly and allocated into either NAC, CHX, or placebo for 3 weeks, during which they were instructed to refrain from other oral hygiene measures to induce experimental gingivitis
Summary
Gingivitis is a reversible inflammation of the gingiva; the most common form of it is ‘plaque-induced gingivitis’ which is caused by dental biofilm accumulation below and around the gingival margin [1]. Huang et al [15] used the same approach to characterize the microbial shifts associated with antigingivitis treatments, including a comparison between tooth brushing alone and combining it with a cetylpyridinium chloride-based mouthwash. In a very recent clinical trial [23], we have compared the clinical efficacy of a NAC-based mouthwash in the prevention and treatment of experimental gingivitis as compared to CHX. This study is a sub-study of that clinical trial, in which we aimed to (1) demonstrate subgingival microbiome changes associated with the development of experimental gingivitis and (2) characterize the microbiome shifts induced by the use of 1.25% NAC mouthwash for prevention and treatment of gingivitis as compared to 0.2% CHX
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