4-day Plaque Research Articles

Aloe vera mouthwashes can be a natural alternative to chemically formulated ones – A randomized-controlled trial

ObjectivesTo evaluate the antiplaque and antibacterial efficacy of commercially available mouthwashes containing aloe vera (AV), hydrogen peroxide (HP), and cetylpyridinium chloride (CPC) in a 4-day plaque regrowth study. MethodsPlaque score and salivary samples were assessed (Day-0 and Day-4) in 96 participants in a randomised, double-blind prospective parallel-arm 4-day plaque regrowth study. Participants were divided into five groups who refrained from engaging in regular oral hygiene measures during the study period and used commercially available mouthwashes containing AV, HP, and CPC as test products with distilled water (DW) and chlorhexidine (CHX) mouthwash as negative and positive controls, respectively. Salivary bacterial count was expressed as colony-forming units (CFU) (culture method). ResultsThere was a significant difference both in plaque score (p < 0.001) and in CFU (p < 0.001) among the study mouthwashes at Day-4. The plaque score and CFU of AV were significantly higher and lower than those of CHX and DW, respectively. The plaque score of HP was significantly higher than that of AV (p = 0.016) and CPC (p < 0.001). No significant difference was observed between AV and CPC (p = 0.70). Moreover, the CFU of HP was significantly higher than that of CPC (p = 0.04). There was no statistically significant difference between the CFU of mouthwashes containing AV and HP (p = 0.912) or AV and CPC (p = 0.280). No significant difference was seen in the inhibition of plaque and salivary bacterial count between AV, HP, and CPC. ConclusionThe antiplaque and antibacterial efficacy of commercially available AV mouthwash was similar to that of CPC and significantly better than that of HP mouthwash and can be a natural alternative to chemically formulated mouthwashes.

A study of anti-plaque efficacy and taste perception of Calendula officinalis mouth rinse

Introduction: An ideal mouth rinse must have an acceptable taste and very efficient antiplaque activity. Herbal mouth rinse (Plandula®), containing extracts of Calendula officinalis and other specified herbs, is widely cultivated as a herb. It is a remarkable healing agent and even useful to act as homeopathic remedies. Previous studies have compared this product with placebo; however, comparison against chlorhexidine have not been conducted thus far. Aim of this research was to analyse the efficacy of Calendula in Plandula® for controlling dental plaque and the acceptability of its taste in comparison with chlorhexidine. Methods: A double-blind, 3-day plaque regrowth, crossover, clinical study was conducted towards 16 volunteers participated in two periods, three days each, with modified oral hygiene practices through an intervening washout period of 4 days. At the commencement of each period, the participants received oral prophylaxis. They used the allocated mouth rinse and brushed teeth without toothpaste in all of the tooth surfaces, except palatal and lingual over three days. On the fourth day, the subjects were returned for plaque index measurement only on the palatal and lingual surfaces by the Quigley Hein index (modified by Turesky). The participants rinsed with 10 ml of allocated mouth rinse three times daily for 30 seconds after tooth brushing. The participants followed the same steps during the second period using the alternate mouth rinse. They were also asked to taste both mouth rinses and evaluate with a Visual Analogue Scale (VAS).Results: Median plaque score for Plandula® mouth rinse was slightly higher compared to chlorhexidine but not statistically significant, with the p-value=0.636 (p&gt;0.05). The mean VAS scale score for Plandula® taste perception was lower than the chlorhexidine, and statistically significant (p-value=0.01; p&lt;0.05). Conclusion: Plandula® mouth rinse that contain calendula officinalis comparable with chlorhexidine in controlling dental plaque accumulation, with an acceptable taste.

“Lemon grass oil mouth wash- A natural alternative”

Aim and Objective: The objective of the study was to evaluate the anti-plaque efficacy of lemongrass oil mouthwash. It also assessed the antibacterial properties of lemon grass oil against Prevotella intermedia (Pi), Porphyromonas gingivalis (Pg), and Aggregatibacter actinomycetemcomitans (Aa) in vitro. Materials and Methods: Forty-five periodontally healthy subjects between the age group of 18 and22 years were enrolled in a 4-day plaque re-growth study. Subjects were divided into three groups, i.e., 15 in each group. Mouthwashes were labelled as A (0.25% lemongrass oil mouthwash), B (0.2% Chlorhexidine mouthwash) and C (placebo). Subjects were advised to refrain from any kind of mechanical oral hygiene procedure for four days. Plaque index (PI) was evaluated at baseline and on the fifth day. In vitro testing of lemon grass oil mouthwash was done against strains of Prevotella intermedia, Porphyromonas gingivalis, and Aggregatibactor actinomycetemcomitans, to evaluate the antimicrobial concentration of lemon grass oil mouthwash. Results: PI significantly increased from day 1 to day 5 (P &lt; 0.05) in Groups A, B, and C. In inter-group comparison, there was a statistically significant difference between the three groups. However, chlorhexidine showed superior antiplaque activity. Lemon grass also demonstrated antiplaque activity, however, not as superior as chlorhexidine. In vitro test, lemon grass showed effective inhibition against all three bacterial strains Pi, Pg, and Aa at 0.01% concentration. Conclusion: Lemongrass oil mouthwash potently inhibits plaque formation and hence can be used as a natural herbal alternative. Key Words: lemongrass oil, antiplaque, antibacterial, chlorhexidine.

The antiplaque efficacy of lantibiotic Nisin extract mouthrinse.

Aim:This study aimed to determine the antiplaque efficacy of Nisin Z extract mouth rinse (Test) as compared to 0.2% chlorhexidine gluconate mouthrinse (Positive control) and distilled water (Placebo) and to assess minimum inhibitory concentrations (MICs) and minimum bactericidal concentrations (MBCs) of Nisin Z against Prevotella intermedia (Pi), Porphyromonas gingivalis (Pg), and Aggregatibacter actinomycetemcomitans (Aa) in vitro.Materials and Methods:Forty-five individuals were randomly divided into three groups (15 in each group). The baseline plaque scores were brought to 0 with scaling and polishing. They were asked not to use any kind of mechanical oral hygiene aid for 4 days and advised to use mouthwashes A, B, or C (Group A: Nisin Z; Group B: distilled water; Group C: chlorhexidine) for 4 days. Following the 4-day plaque re-growth model, Plaque Index was checked on days 1 and 5.Results:In intergroup comparison, a statistically significant difference was seen between Nisin and placebo groups and chlorhexidine and placebo groups, with Nisin and chlorhexidine showing superior antiplaque activity. There was also statistically significant difference between Nisin and chlorhexidine groups, with chlorhexidine showing superior antiplaque activity. In vitro Nisin showed effective inhibition against all three bacterial strains Pi, Pg, and Aa exhibited the highest sensitivity to Nisin with a MIC of 2.5 μg/ml and MBC of 15 μg/ml.Conclusion:Nisin Z mouthrinse was found to be a potent plaque inhibitor, though less effective than chlorhexidine mouthrinse. However, it can serve as a good natural alternative to the gold standard.

Efficacy of two mouthwashes on 3-day supragingival plaque regrowth: a randomized crossover clinical trial.

The aim of this study was to evaluate the antiplaque effects of an alcohol-free essential oil (alcohol-free EO) mouthwash and an amine fluoride/stannous fluoride with zinc lactate (SnFl-Zn) mouthwash compared to a positive control of chlorhexidine (CHX) mouthwash, using an in vivo plaque regrowth model of 3 days. The study was designed as a double-masked, randomized, crossover clinical trial, involving 20 volunteers to compare two different mouthwashes, using a 3-day plaque accumulation model. After receiving thorough professional prophylaxis at baseline, over the next 3 days, each volunteer refrained from all oral hygiene measures and performed two daily rinses with 20 ml of the test mouthwashes. A 0.20% CHX rinse served as a positive control. At the end of each experimental period, plaque was assessed, and the panellists completed a questionnaire. Each subject underwent a 14-day washout period, and then, there was another allocation. The SnFl-Zn mouthwash has shown a better inhibitory activity on plaque regrowth compared to the alcohol-free EO mouthwash in the whole mouth (plaque index = 1.93 against 2.45, respectively), but there was less of an effect compared to the CHX group, with an overall plaque index of 1.41. The differences of 0.52 between alcohol-free EO and SnFl-Zn and between SnFl-Zn and CHX and of 0.96 between alcohol-free EO and CHX were all statistically significant (P < 0.001). The alcohol-free EO mouthwash seemed to have less of an inhibiting effect on plaque regrowth than the amine fluoride/SnFl-Zn mouthwash and the CHX control.

The effects of three different mouth rinses in a 4-day supragingival plaque regrowth study.

Objective:This study compares the effects of three different mouth rinses with respect to reducing Streptococcus mutans (S. mutans) colony counts on the teeth and tongue surfaces.Materials and Methods:In this study, comparison tests using the alcohol-free 0.1% chlorhexidine mouth rinse, alcohol-containing essential oil mouth rinse, and alcohol-free essential oil-containing mouth rinse were conducted. Patients were instructed to avoid mechanical cleaning with either a toothbrush or toothpick for 4 days. The first samples were collected from teeth surfaces and the dorsum of the tongue after a professional cleaning, and the second samples were collected after a 4-day plaque re-growth period. The supragingival plaque from the buccal surfaces of teeth #11, 14, 31, 34 as well as samples from the dorsum of the tongue, were assessed using the Dentocult® strips.Results:The Listerine® and Ondrohexidine® groups did not show any statistically significant differences between the values of the two samples (P = 0.734, P = 0.307). The MC® group and the control group showed significantly higher results than the first sample values. The effectiveness of the mouth rinses on S. mutans colony counts from the teeth surfaces were higher in the Listerine®, Ondrohexidine®, and Mouthwash Concentrate® groups. The difference between the first and second samples of the S. mutans colony counts from the tongue surface was found to be statistically significant, and S. mutans colony counts were higher than the first sample (P = 0.015).Conclusion:Alcohol and essential oil-containing Listerine® mouth rinse, alcohol-free Ondrohexidine®, alcohol-free essential oil-containing MC® mouth rinse had the same effect on S. mutans counts, higher than the 1% alcohol solution on teeth surface. They had the ability to maintain the S. mutans counts at the same level for 4 days in patients who did not perform any mechanical oral hygiene regimen.

A preliminary comparison of the effect of 0.3% versus 0.2% chlorhexidine mouth rinse onde novoplaque formation: a monocentre randomized double-blind crossover trial

Chlorhexidine (CHX) is considered the gold standard against gram-negative microorganisms. Little has been written about the simultaneous influence that both time and concentration could have on antiplaque formation effectiveness of CHX. The aim of this study is to compare the clinical and microbiological effectiveness of two different CHX concentrations and time applications in a 4-day plaque regrowth study model. Twenty volunteers were enrolled in a randomized double-blind crossover study comparing the effectiveness of CHX 0.3% and CHX 0.2% mouth rinses applied for 15 and 30 s, respectively. Plaque index (PII), total bacterial counts and the detection of specific periopathogens were measured at the 5th day of each mouth rinse application. Taste acceptance was evaluated using a questionnaire. Chlorhexidine 0.3% resulted in a statistically greater reductions (10%) in PIl and periopathogens compared to CHX 0.2%. Furthermore, patients reported comparable taste acceptance in both groups. Chlorhexidine is an effective oral antiseptic. The CHX 0.3% mouth rinse formulation used for 15 s resulted in superior clinical and microbiological outcomes compared to the CHX 0.2% formulation, used for 30 s.

Comparative evaluation of anti-plaque efficacy of herbal and 0.2% chlorhexidine gluconate mouthwash in a 4-day plaque re-growth study

Background:Chlorhexidine gluconate mouthwash has earned eponym of gold standard to treat and/or prevent periodontal disease. However, it has been reported to have local side-effects on long-term use. To explore a herbal alternative, the present study was carried out with an aim to compare the anti-plaque efficacy of a herbal mouthwash with 0.2% chlorhexidine gluconate mouthwash and normal saline.Materials and Methods:It was an examiner-blinded, parallel designed clinical trial, in which 90 pre-clinical dental students with gingival index (GI) ≤1 were enrolled. To begin with, GI and plaque index (PI) were recorded. Then, baseline plaque scores were brought to zero by professionally cleaning the teeth with scaling and polishing. After that, randomized 3 groups were made (of 30 subjects each - after excluding the drop-outs) who were refrained from regular mechanical oral hygiene measures. Subjects were asked to swish with respective mouthwash (0.2% chlorhexidine gluconate mouthwash, herbal mouthwash, or normal saline) as per therapeutic dose for 4 days. Then, GI and PI scores were re-evaluated on 5th day by the same investigator, and the differences were compared statistically by ANOVA and Student's ‘t’-test.Results and Observations:Least post-rinsing GI and PI scores were demonstrated with 0.2% chlorhexidine gluconate mouthwash, followed by herbal mouthwash and highest scores with normal saline. The difference of post-rinsing PI scores between the chlorhexidine and herbal mouthwash groups was statistically non-significant, whereas this difference was significant between chlorhexidine and saline groups, and the difference between herbal and saline groups was non-significant. It was concluded that 0.2% chlorhexidine gluconate mouthwash remains the best anti-plaque agent. However, when socio-economic factor and/or side-effects of chlorhexidine need consideration, presently tested herbal mouthwash may be considered as a good alternative.

Evaluation of chlorhexidine 0.05% with the adjunct of fluoride 0.05% in the inhibition of plaque formation: a double blind, crossover, plaque regrowth study

The aim of this study was to evaluate the effect of mouthrinses containing 0.05% chlorhexidine + 0.05% fluoride solution on early dental plaque regrowth. Thirty periodontally healthy subjects were included in the study. A crossover 4-day plaque regrowth protocol was adopted. The test product was initially used in 15 patients, while a placebo was administered to the other 15 patients. Then, after a washout period, each patient used the other product. No other oral hygiene manoeuvre was allowed. Full-mouth plaque and bleeding scores (FMPS and FMBS) were evaluated at baseline and after 4 days. All subjects completed the study. The mean age was 27 ± 8.4 years. Five patients were smokers with a mean daily consumption of 1 ± 2.5 cigarettes. FMPS at baseline was 8.0 ± 4.4 for control group and 7.9 ± 3.8 for test group, without significant difference. After the 4-day plaque regrowth the mean FMPS significantly increased to 31.9 ± 16.5 and 36.3 ± 16.1 for control and test group, respectively (no significant difference between the two groups). The test product was safe and well tolerated by subjects. The similar outcomes of the two experimental groups suggest that the two products have an equivalent effect on early dental plaque regrowth. Studies with longer follow-up are needed to clarify whether there is a beneficial long-term effect of daily rinses with the tested solution.

A Comparative Evaluation of the Antibacterial Efficacy of Honey In Vitro and Antiplaque Efficacy in a 4‐Day Plaque Regrowth Model In Vivo: Preliminary Results

Honey has a potent broad-spectrum antibacterial action that may make it suitable for "anti-infective" treatment of periodontal disease. The aims of this study are as follows: 1) to evaluate the antibacterial efficacy of honey against oral bacteria and compare the same with 0.2% chlorhexidine; and 2) to compare antiplaque efficacy in vivo with chlorhexidine. The study was conducted in two parts. In the in vitro part, the inhibitory effects of three test agents, 0.2% chlorhexidine gluconate, honey mouthwash, and saline, against six oral bacteria at concentrations of 1, 2, 4, 8, 16, 32, 64, 128, 256, and 512 μg/mL were tested in duplicate. The minimum inhibitory concentration (MIC) was set as the lowest concentration of the agent that completely inhibited the growth of the test species. The in vivo part consisted of a double-masked parallel clinical trial based on a 4-day plaque regrowth model. Sixty-six volunteers, 20 to 24 years of age, participated in the study, and the plaque scores were compared at baseline and at the end of 4 days. The Kruskal-Wallis test was used for significance, and the Mann-Whitney U test was used for pairwise comparison of the groups. The mean plaque scores were 1.77 ± 0.86, 1.64 ± 0.90, and 3.27 ± 0.83 for groups 1, 2, and 3, respectively. The honey mouthrinse effectively inhibited the six tested microorganisms. The chlorhexidine gluconate rinse had the lowest MICs compared with honey and saline rinses for all test species examined. The in vivo results revealed that plaque formation was inhibited/reduced by chlorhexidine and honey rinses. Honey has antibacterial action against tested oral microorganisms and also has antiplaque action.

Efficacy of essential oil mouthwash with and without alcohol: a 3-Day plaque accumulation model

BackgroundThe aim of this study was to evaluate the antiplaque effect of a new alcohol free essential oil mouthwash with respect to a control of an essential oil with alcohol mouthwash, using an in vivo plaque regrowth model of 3-days.MethodsThe study was designed as a double-masked, randomized, crossover clinical trial, involving 30 volunteers to compare two different essential oil containing mouthwashes, during a 3-day plaque accumulation model. After receiving a thorough professional prophylaxis at the baseline, over the next 3-days each volunteer refrained from all oral hygiene measures and had two daily rinses with 20 ml of the test mouthwash (alcohol free essential oil) or the control mouthwash (essential oil with alcohol). At the end of the each experimental period, plaque was assessed and the panelists filled out a questionnaire. Each subject underwent a 14 days washout period and there was a second allocation.ResultsThe essential oil mouthwash with ethanol shows a better inhibitory effect of plaque regrowth in 3-days than the mouthwash test with only essential oil in the whole mouth (plaque index = 2.18 against 2.46, respectively, p < 0.05); for the lower jaw (plaque index = 2.28 against 2.57, respectively, p < 0.05); for the upper jaw (plaque index = 2.08 against 2.35, respectively, p < 0.05); for the incisors (plaque index = 1.93 against 2.27, respectively, p < 0.05); and the canines (plaque index = 1.99 against 2.47, respectively, p < 0.05).ConclusionThe essential oil containing mouthwash without alcohol seems to have a less inhibiting effect on the plaque regrowth than the traditional alcoholic solution.Trial RegistrationClinicalTrials.gov NCT01411618

The plaque inhibitory effect of a CPC mouthrinse in a 3-day plaque accumulation model - a cross-over study

To test the plaque inhibitory effect of an experimental 0.07% cetylpyridinium chloride (CPC) mouthrinse in a 3-day plaque accumulation model in a cross-over design. A total of 30 subjects (non-dental students), ≥18 years of age, were randomly assigned to use one of three different mouthrinses three times a day. After 3 days, the subjects returned for the clinical assessments and received a questionnaire to evaluate their attitude towards the product used by them. The cross-over procedure was repeated twice to have all subjects use all products. A total of 29 subjects completed the protocol and this resulted in a statistically significant difference between the three groups (P < 0.001) with regard to plaque scores. Over three sessions, the mean plaque scores were 2.17 for the control product, 1.14 for the CPC group and 1.12 for the 0.1% Hexetidine product (positive control). Results of the questionnaire show that, compared with hexetidine, the taste of the CPC was appreciated better, and less oral sensations were observed following rinsing. The CPC mouthrinse proved to be effective in inhibiting 'de novo' plaque formation to an extent similar to that of a 0.1% hexetidine product. Compared with hexetidine, the taste of the CPC was appreciated better and less oral sensations were observed following rinsing.

Antibacterial Activity and Anti-Biofilm Effect of Chitosan against Strains of Streptococcus Mutans Isolated in Dental Plaque

Streptococcus mutans is the major cause of dental plaque and is often associated with biofilm formation. The aim of this study is to evaluate the activity of a hydrosoluble derivative of chitosan against S. mutans biofilms in vitro and in vivo. Strains of S. mutans were isolated from the dental plaque of 84 patients enrolled in the study. The antibacterial activity of chitosan was determined by broth microdilutions. The effect of chitosan at different concentrations and exposure times on S. mutans biofilms at different phases of development was assessed by a clinical study using the classical "4-day plaque regrowth" experiment in adult volunteers. The MIC values of chitosan were between 0.5 and 2 g/L. Compared to distilled water, the chitosan solution significantly decreased the vitality of plaque microflora (p<or=0.05). Chlorhexidine, used as a positive control, reduced vitality even further. The results showed that S. mutans in the adhesion phase (4 h) was completely inhibited by chitosan at any concentration (0.1, 0.2, 0.5XMIC) or exposure time investigated (1, 15, 30, 60 min), while S. mutans at successive stages of accumulation (12-24 h) was inhibited only by higher concentrations and longer exposure times. These data confirm the effective action of chitosan against S. mutans biofilms.

The Effects of an Essential Oil and an Amine Fluoride/Stannous Fluoride Mouthrinse on Supragingival Plaque Regrowth

The side effects of chlorhexidine (CHX) have stimulated the search for alternative antiplaque agents such as amine fluoride/stannous fluoride (ASF) and essential oils (EO). The aim of the study was to investigate the plaque-inhibiting effects of two commercially available mouthrinses containing ASF and EO, respectively. The study was an observer-masked, randomized, 5 x 5 Latin square cross-over design, balanced for carryover effects, involving 15 volunteers in a 4-day plaque regrowth model. A 0.12% CHX rinse and a saline solution served as positive and negative controls, respectively. On day 1, subjects received professional prophylaxis, suspended oral hygiene measures, and commenced rinsing with their allocated rinses. On day 5, subjects were scored for disclosed plaque. The ASF rinse was tested at two dosages: 10 and 20 ml (ASF-10 and ASF-20, respectively). The ASF and EO rinses showed a significant inhibition of plaque regrowth compared to saline (P <0.0001), but the lowest plaque indices were obtained with the CHX product (P <0.01). There were no significant differences among products containing ASF-10, ASF-20, and EO (P >0.05). There was no correlation between the occurrence of side effects and the use of a particular rinse product (P >0.2). ASF and EO mouthrinses exerted effective and similar plaque inhibition. The two dosages tested for ASF did not differ in plaque reduction. These findings, together with those from long-term trials, suggest that ASF and EO rinses may represent effective alternatives to CHX rinse as adjuncts to oral hygiene.

Effect of N-chlorotaurine mouth rinses on plaque regrowth and plaque vitality

The purpose of this 4-day plaque regrowth study was to assess the effect of N-chlorotaurine (NCT) mouth rinses on plaque inhibition and plaque vitality. Eighty volunteers participated in this investigator-blind, randomized, clinical controlled study in parallel groups. No oral hygiene was permitted except rinsing with a 2% or 3% NCT mouth rinse, a positive or a negative control. Primary parameters were the plaque index (Silness and Löe, Acta Odontol Scand, 22:121-135, 1964) and plaque vitality (Netuschil et al., J Clin Periodontol, 16:484-488, 1989) after the final rinse. In addition, another plaque index (Turesky et al., J Periodontol, 41:41-43, 1970), plaque area, and bleeding on probing were recorded. All parameters were taken at baseline and day 5. U test was applied on a 5% error level. No differences in plaque inhibition were found between the two NCT formulations and the negative control. However, a statistically significant reduction of plaque vitality compared to the negative and positive control was observed. Discoloration of the tongue and unpleasant taste were recorded in participants in the NCT groups. NCT mouth rinses did not inhibit plaque regrowth, but they did reduce the vitality of plaque bacteria. Methods of prolonging the substantivity of the NCT mouth rinses should be investigated to enhance the antibacterial properties of these formulations.

The effects of sugar-free chewing gums on dental plaque regrowth: A comparative study

Sugar-free chewing gum has been claimed to be a useful means of reducing dental plaque accumulation. The incorporation of additives, such as enzymes, abrasives and divalent metal ions, into gum formulations might improve their antiplaque activity, particularly at the buccal and lingual surfaces of the teeth. The aim of this study was to investigate the plaque inhibitory effects of three sugar-free chewing gums each containing lactoperoxidase (LP), micro granules of silicon dioxide (SD), and zinc gluconate (ZG). The study was an observer-masked, randomized cross-over design balanced for carryover effects, involving 12 healthy volunteers in a 4-day plaque regrowth model. An additive-free (AF) gum served as positive/negative control for occlusal and smooth surfaces, respectively. On day 1, subjects received professional prophylaxis, suspended oral hygiene measures, and commenced chewing their allocated product. Gum chewing was one piece chewed for 30min 4 times a day. On day 5, subjects were scored for disclosed plaque. There were no significant differences in antiplaque activity of the gums tested, neither for the smooth nor for the occlusal surfaces (P=0.447 and P=0.418, respectively). Similar results were obtained for the anterior and posterior sites of smooth surfaces (P>0.05), and for the lower and upper sites of occlusal surfaces (P=0.451 and P=0.53, respectively). These findings suggest that the chewing gums containing LP, SD and ZG would provide no plaque inhibitory effects on smooth surfaces. The gums containing these additives, therefore, should not be recommended as adjuncts to mechanical oral hygiene.

Chlorhexidine mouthrinse in combination with an SLS‐containing dentifrice and a dentifrice slurry

The aim of the present study was to compare the plaque-inhibitory effect of a 0.2% chlorhexidine digluconate (CHX) rinse when preceded by ordinary toothbrushing with a 1.5% sodium lauryl sulphate (SLS)-containing dentifrice to the effect of the same rinse when used alone, or when preceded by rinsing with an SLS-containing slurry. The study was an examiner blinded, randomized three-arm, parallel design. It used a 4-day plaque accumulation model to compare three different oral hygiene regimens, which were performed under supervision. One hundred and twenty healthy volunteers were enrolled in the study and were randomly assigned to one of each group. At the beginning of each test period, they received a thorough dental prophylaxis. The experiment was performed in one randomly assigned (upper or lower) jaw, called the study jaw. The opposite jaw, referred to as the dentifrice jaw, served only to introduce the influence of toothbrushing with a dentifrice on the anti-plaque efficacy of the CHX in the study jaw of the same mouth. At the end of the 4-day test period, plaque and gingival bleeding were scored in the study jaw. In all the regimens, the oral hygiene procedure was finalized by rinsing with a CHX 0.2% solution for 1 min. The study jaw was not brushed during the experiment. Regimen A (positive control) consisted of rinsing with CHX alone. In regimen B, rinsing with CHX was preceded by rinsing with an SLS-containing slurry, while in regimen C rinsing with CHX was preceded by toothbrushing with an SLS-containing dentifrice in the dentifrice jaw. No other oral hygiene measures were allowed. After 4 days of undisturbed plaque accumulation, the amount of plaque and level of gingival health were evaluated. The overall plaque index for regimens A, B and C was 1.17, 1.62, and 1.14, respectively. There was no significant difference in plaque accumulation between the CHX alone regimen (A) and the SLS-dentifrice-CHX regimen (C). Regimen B differed significantly from regimens A and C. The overall bleeding index for regimens A, B and C was 0.24, 0.18, and 0.20, respectively. There was no significant difference between the three regimens. The present study shows that the anti-plaque efficacy of a 0.2% CHX rinse was not reduced when preceded by everyday toothbrushing with a SLS-containing dentifrice. However, when preceded by rinsing with an SLS-containing slurry, the anti-plaque efficacy of a 0.2% CHX rinse was reduced.

Effect of water-soluble reduced chitosan on Streptococcus mutans, plaque regrowth and biofilm vitality

The purpose of the present study was to examine the effects of a newly developed water-soluble reduced chitosan on Streptococcus mutans, plaque regrowth, and biofilm vitality. A 1.0%, water-soluble reduced chitosan, with pH ranging from 6.0 to 6.5, molecular weights between 3,000 and 5,000 Da, and 70% degree of deacetylation, was used. To determine antibacterial and antiplaque potency of chitosan, minimal inhibitory concentrations (MICs) for S. mutans and S. sanguinis (formerly S. sanguis), short-term exposure to S. mutans, and clinical trial of plaque regrowth and biofilm vitality were conducted. Twelve dental students volunteered to participate in the 6-week, double blind, randomized clinical trial using the classical 4-day plaque regrowth design. The MIC of water-soluble reduced chitosan for S. mutans was 1.25 g/l. While the cells exposed to distilled water (DW) grew rapidly, with a maximum turbidity reached by 16 h postinoculation, S. mutans exposed to chitosan (5.0 g/l) exhibited a substantial delay in growth and reached a maximum turbidity by 32 h postinoculation. The chitosan solution reduced the plaque index and the vitality of the plaque flora significantly when compared to DW, but this was less than the reductions found with the positive control of 0.1% chlorhexidine solution. The water-soluble reduced chitosan exhibited potent antibacterial effect on S. mutans, and displayed a significant antibacterial and plaque-reducing action during the 4-day plaque regrowth.

The Effects of Antimicrobial Sprays and Mouthrinses on Supragingival Plaque Regrowth: A Comparative Study

Due to the side effects of chlorhexidine digluconate (CHX) mouthrinsing, a spray has been proposed as an alternative method of CHX delivery to the oral cavity. The aim of this study was to investigate the plaque inhibitory effects of CHX, cetylpyridinium chloride (CPC), and triclosan (TRN) delivered by sprays and mouthrinses. The study was an observer-masked, randomized cross-over design balanced for carryover effects, involving 15 healthy volunteers in a 4-day plaque regrowth model. Products being tested (0.2% CHX, 0.12% CHX, 0.05% CPC, and 0.03% TRN) were used both as sprays and mouthrinses. A saline solution served as a negative control. On day 1, subjects received professional prophylaxis, suspended oral hygiene measures, and commenced using their allocated products. On day 5, subjects were scored for disclosed plaque. CHX sprays (P<0.01) were the most effective sprays in preventing plaque regrowth, without significant differences between the two concentrations tested (P>0.05). TRN spray showed a significant inhibition of plaque regrowth in comparison to the negative control (P<0.05). CPC spray did not differ from saline spray (P>0.05). A similar trend of efficacy was detected for rinses. Although the effect on plaque regrowth observed with CHX rinses was superior to that of CHX sprays (P<0.0003), the latter did not cause side effects (P>0.2). These findings, together with those from clinical trials, suggest that the CHX-containing sprays may represent an effective alternative to CHX rinses when mechanical oral hygiene has to be avoided in restricted areas. On the contrary, the TRN and CPC sprays showed little or no plaque inhibitory effects.

Short‐term anti‐plaque effect of two chlorhexidine varnishes

Chlorhexidine (CHX) varnishes have been mainly used for the prevention of caries in high-risk populations. Reports regarding their anti-plaque effect on a clinical level are limited to non-existing as opposed to their microbiological impact on plaque formation. The aim of this preliminary investigation was to evaluate the anti-plaque effect of two CHX varnishes applied on sound enamel in relation to a positive control, a negative control and to one another. Sixteen healthy subjects volunteered for this randomized-controlled, single-blind, four-treatment-four-period crossover-designed clinical trial. A 3-day plaque re-growth model was used to determine de novo plaque accumulation following CHX rinsing, Cervitec application, EC40 application and no therapy. The amount of plaque was measured using the Quigley and Hein plaque index and "automatic image analysis" (AIA). Varnish treatment resulted in significantly higher plaque levels than CHX rinsing irrespective of the varnish that was used (p< or =0.002), implying that the latter is likely to remain the gold standard as an anti-plaque agent. However, highly significant differences were also found in favour of both varnish systems when compared with no therapy (p<0.001), which indicates that varnish treatment is an effective means of inhibiting plaque formation in a short time span. Cervitec exhibited slightly, yet significantly, higher plaque levels in comparison with EC40 as determined by AIA (p=0.006). Large-scale trials with a longer observation period are necessary to substantiate these results.