Alcohol-free Chlorhexidine Research Articles

The Antibacterial Analysis of Alcohol-Free and Alcohol-Based Chlorhexidine Mouthwashes Against Oral Bacteria

Background: Chlorhexidine (CHX) is the gold standard chemical agent against oral pathogenic bacteria and is widely used for plaque/gingivitis control. The aim of the present study was to compare the effect of alcohol-based and alcohol-free CHX mouthwashes on oral microorganisms. Methods: In the present in vitro study, the standard strains of four microorganisms present in the oral cavity were prepared, including Streptococcus mutans, Streptococcus sanguinis, Streptococcus salivarius, and Lactobacillus casei. The serial dilutions of CHX antimicrobial agents were obtained, and the level of minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) was determined using the broth dilution method. Finally, data were analyzed using the Kruskal-Wallis test, the Mann-Whitney U test, and SPSS-16. Results: The MIC values of 0.12% and 0.2% alcohol-free CHX and 0.2% alcohol-based CHX for S. mutans were 1.17, 0.48, and 0.24 µg/mL, respectively. The MBC values of 0.12% and 0.2% alcohol-free CHX and 0.2% alcohol-based CHX for S. mutans were 18.78, 7.81, and 7.81 µg/mL, respectively. The MIC and MBC values of the tested CHX mouthwashes for S. mutans were significant (P≤0.05). Conclusions: Overall, the 0.2% alcohol-based CHX mouthwash had the highest antibacterial activity against gram-positive bacteria.

Evaluating the Effect of Different Mouthwashes on the Titanium and Nickel Ions Released from Ordinary and Blue NiTi Archwires (An In-vitro Study)

Objectives: This studywas carried out to evaluate the effect of alcohol present in mouthwash on the Ni and Ti ions release from ordinary andblue NiTiarchwire.Materials and Methods: Sixty specimens of 2cm length from 0.017×0.025 inch maxillary Flexy and Blue Flexy NiTi archwire (30 per each archwires) were immersed in 15 ml. distilled water, alcoholic and alcohol-free Corsodyl mouthwashes (10 per immersing media for each archwire) for one and half hour. After that, Ni and Ti ions released in mouthwashes and distilled waterwere measured using atomic absorption spectrophotometer. Unpaired sample t-test and one way ANOVA test were used for comparison between the archwire types and among different immersion media.Results: Regarding Ni ion, the release of this ion washigher significantly in distilled water followed by alcohol-free Chlorhexidine while the least amount released in alcoholic Chlorhexidine. For Ti ion, the higher amount of Ti ion was released significantly from alcoholic Chlorhexidine followed by alcoholfree Chlorhexidine and the least amount was released in distilled waterin both types of archwires.Both ions were released significantly more from conventional NiTi archwire in all mouthwashes.Conclusions: Ions released from the tested archwires appear to be low with blue NiTi archwire. Ni ion was released more with alcohol-free mouthwash and just the opposite forTiion.

Effect of two different alcohol-free chlorhexidine formulations in mouthrinses on the immediate postoperative period for oral mucosal biopsies.

Oral biopsy is a common surgical practice. To date, few authors have described the healing of mucosal wounds following oral biopsy. The aim of the present single-center, prospective, randomized, controlled study is to evaluate the differences between two chlorhexidine (CHX) mouthrinses and a treatment-free approach in the immediate postoperative period following oral mucosal biopsy. 354 patients were included in this study and were randomly allocated to three groups: A) CHX 0.12% mouthrinse (twice daily, 10 mL rinse for 30 s), B) CHX 0.20% mouthrinse (twice daily, 10 mL rinse for 30 s), and C) no topical treatment. 118 patients were treated in group A and 115 in group B; 121 received no therapy in group C, reporting the greatest improvement in related symptoms. Outcome variables included the age, gender, site and size of lesions, visual analog score (VAS), Oral Health Impact Profile questionnaire (OHIP-14), and number of painkillers taken during the first week post-surgery. Use of a CHX 0.12% mouthrinse exhibited the poorest outcome. On the other hand, best clinical healing was found for patients treated with CHX 0.20%. These findings suggest that regardless of its concentration, CHX was found to be ineffective in reducing related symptoms, whereas CHX 0.20% can be recommended to facilitate enhanced healing.

Antibacterial properties and side effects of chlorhexidine-based mouthwashes. A prospective, randomized clinical study

Aim Chlorhexidine (CHX) is commonly used in clinical applications, including plaque control and gingivitis treatment. The im of this study was to evaluate the clinical properties, in terms of plaque control, bleeding and discoloration levels, of six CHX mouthwashes that differ in the following characteristics: CHX concentration, presence/absence of alcohol and presence/absence of an anti-discoloration system (ADS). Materials and methods A single-center, prospective, double-blind randomized clinical trial was carried out on 78 consecutive patients. Six mouthwashes (CHX 0.12% alcohol free; CHX 0.20% alcohol free; CHX 0.12% alcohol free with ADS; CHX 0.20% alcohol free with ADS; CHX 0.12% with alcohol; CHX 0.20% with alcohol) were tested. Plaque Index (PI) and Bleedind Index (BI) were recorded, along with tooth staining (spectrophotometry) at T0 (beginning), at T1 (after 7 days), at T2 (after 14 days), and T3 (after 21 days). Data obtained were subjected to statistical analysis. Results All CHX mouthwashes significantly reduced PI (p<0.0001), while only alcohol free CHX 0.20% significantly reduced BI (p<0.0001). Only the CHX 0.12% with alcohol and CHX 0.20% with alcohol mouthwashes showed a significant presence of extrinsic tooth staining (p<0.05). Conclusions Within the limitations of the present study, the alcohol-free mouthwash CHX 0.20% allows a good control of the clinical indices, in particular the bleeding index.

Cytotoxicity and antimicrobial effects of citronella oil (Cymbopogon nardus) and commercial mouthwashes on S. aureus and C. albicans biofilms in prosthetic materials

Although the effectiveness of some mouthwashes has been proven, phytotherapy is still a field to be explored as an alternative to commercial products. Objective: To evaluate, in vitro, the cytotoxicity and efficacy of two solutions based on citronella oil (CN), on S. aureus and C. albicans biofilms (in formation–adhesion phase and 24 h-biofilm formation) on acrylic resin and nickel-chromium alloy samples (one trademark of each material), compared to two alcohol-free commercial mouthwashes. Material and Methods: Two solutions containing CN at concentrations of 5x and 10x the minimum bactericidal/fungicidal concentration (MBC/MFC) were prepared by microdilution. After contamination of the samples surfaces with these microorganisms, the mouthwashes (CN - 5x and 10x; CHX - 0,12% alcohol-free chlorhexidine and LT - alcohol-free essential oils) were evaluated. Mouthwash simulation was performed for 1 min at two moments, the first simulation after 4 h of microbial adhesion and 24 h-biofilm formation, and the second simulation, 6 h after the first simulation. For biofilm quantification, the number of cultured cells was evaluated by CFUs. The cytotoxicity assay was performed on HaCat epithelial cells and quantified by the MTT method. Results: Tested solutions completely inhibited the growth of both microorganisms in the adhesion phase. All solutions showed inhibitory activity against 24 h-biofilm formation. However, CN led to greater microbial reduction, regardless of the surface of the sample. All solutions demonstrated a toxic effect. However, after serial dilution, CN presented the lowest cytotoxic effect. Conclusion: Citronella had a lower cytotoxic effect and a higher action compared to commercial solutions.

Paraneoplastic Pemphigus Associated with Lymphoid Leukemia: A Case of Persistent and Refractory Oral Ulcerations

A 53-year-old man was diagnosed with chronic lymphoid leukemia in December 2016 and was subjected to FCR-Lite protocol (cyclophosphamide 249 mg/m2 and fludarabine 33.2 mg/m2) in January 2017. The patient developed exanthema on the skin (torso and lower members), bullous lesions on the feet, and ulcers in the oral mucosa. Initially, the diagnosis was pharmacodermia and mucositis, rendered by oncologists. The dental team prescribed 0.12% alcohol-free chlorhexidine associated with low-level laser therapy for analgesia. The oral lesions have persisted with an increased extension and bleeding in the lips. Therefore, an incisional biopsy of skin lesions was performed and revealed intraepidermal vesicles, which supported the initial hypothesis of pharmacodermia. Due to persistence of the oral lesions, paraneoplastic pemphigus was suggested by the dental team as a diagnostic hypothesis and confirmed after an incisional biopsy and immunofluorescence assay. A 2-week follow-up revealed improvement of oral lesions, and no pain symptoms were reported.

Determining the Antibacterial Activity of Chlorhexidine Mouthwashes with and without Alcohol against Common Oral Pathogens

Aims and Objectives Mouthwashes with antibacterial activity inhibit the growth of bacteria in the mouth and teeth. Chlorhexidine is one of the most widely used mouthwashes that inhibits dental plaque and prevents tooth surface decay. Recently, concerns have been raised that alcohol-containing mouthwashes may have carcinogenic properties and may be harmful to children and pregnant and lactating women. The aim of this study was to determine the antibacterial effects of chlorhexidine mouthwashes with and without alcohol on common oral bacteria. Material and Methods In this in vitro study, bacterial species were purchased from a research center and were cultured separately in proprietary environments in test tubes. Thereafter, mouthwashes with alcohol, without alcohol, and with salt water (saline) were added to test tubes containing the bacteria grown. The samples were then analyzed using a spectrophotometer to determine viability, growth rate, and bacteria waste. Finally, the data were analyzed using SPSS version 17 through analysis of variance (ANOVA) and Tukey statistical tests. Results The obtained results showed that the saline group had the highest antibacterial activity and that the average antibacterial activity of the alcohol and alcohol-free groups did not differ significantly (P &gt; 0.05). Post hoc test results showed that the antibacterial activity of the saline group was significantly different statistically from that of the other two groups. Conclusion On the basis of the results, it can be concluded that both alcohol-free chlorhexidine and alcohol-containing chlorhexidine are effective in removing oral microbes. Moreover, by using alcohol-free chlorhexidine, the harmful effects of alcohol can be prevented.

A randomized controlled clinical trial on the effectiveness of three different mouthrinses (chlorhexidine with or without alcohol and C31G), adjunct to periodontal surgery, in early wound healing.

The use of chlorhexidine (CHX) with or without alcohol has been recommended for a number of clinical applications. On the other hand, there is a plethora of widely subscribed antiseptics, such as agent C31G (alkyl dimethyl glycine/alkyl dimethyl amine oxide), which has not yet been evaluated postsurgically. The effectiveness of three different mouthrinses (CHX with and without alcohol, C31G) in plaque control and early wound healing was compared postoperatively. In this, randomized, double-blind, controlled clinical trial 42 patients were allocated to three groups assigned to 2weeks rinsing after non-regenerative periodontal flap surgery with or without osseous surgery with C31G (group A), alcohol-free CHX 0.12% (group B) or alcohol-based CHX 0.12% (group C). At days 7 and 14, plaque and early wound healing indices were recorded. At day 14, total bacterial counts were estimated utilizing real-time quantitative polymerase chain reaction (qPCR). Statistics included linear and generalized linear mixed models. At day 7, healing response was not significantly different among groups. At day 14, group A revealed the highest while group C demonstrated the lowest plaque index values (B vs A, odds ratio-OR = 0.18, p= 0.012; C vs A, OR = 0.01, p< 0.001; C vs B, OR = 0.06, p< 0.001). Group C demonstrated the lowest bacterial counts levels at day 14 (38.470 × 106, 48.190 × 106, and 3.020 × 106 for groups A, B, and C, respectively). At day 14, healing was significantly better in group C compared to B (p= 0.007). Group A showed no significant differences compared to other groups. (1) The presence of alcohol may increase the effectiveness of CHX in early wound healing, (2) C31G might be an alternative solution prescribed during early postoperative period after non-regenerative periodontal flap surgery. The present study found that active agent C31G displayed no significant differences to CHX formulations regarding periodontal wound healing improvement and might be used alternatively after non-regenerative periodontal flap surgery. In addition, an alcohol based 0.12% CHX mouthwash was more effective than an alcohol-free 0.12% CHX and C31G mouthrinse on plaque control in the absence of mechanical oral hygiene.

Chlorhexidine with or without alcohol against biofilm formation: efficacy, adverse events and taste preference.

In recent years, different chlorhexidine formulations have been tested, including an alcohol-free alternative, but the effect of this solution on early biofilm formation is not clear. A crossover, randomized, double-blind clinical trial was conducted to evaluate the effect of two chlorhexidine solutions against supra- and subgingival biofilm formation (NCT#02656251). Thirty-five participants were randomized and asked to rinse twice daily with 15 ml of an alcohol-containing 0.12% chlorhexidine solution, an alcohol-free 0.12% chlorhexidine solution, or placebo. The study was conducted in three experimental periods of 4 days each, with a 10-day washout between the periods. All the experimental periods followed the same protocol, except that the solutions were switched. Biofilm distribution was evaluated every 24 hours by the Plaque-Free Zone Index, during 96 hours. Adverse events were self-reported and sensory evaluation was performed using a hedonic scale. Compared to the placebo, the chlorhexidine solutions resulted in a significantly higher number of surfaces free of plaque over 96 hours (p < 0.01), and were able to prevent subgingival biofilm formation (p < 0.01). The alcohol-free chlorhexidine solution was associated with a lower incidence of adverse events, compared with alcohol-containing chlorhexidine (p < 0.05); it also received better sensory evaluation and acceptance by trial participants, compared with the alcohol-containing chlorhexidine (p = 0.007), and had a similar inhibitory effect on the formation of supra- and subgingival biofilms.

Effect of essential oils containing and alcohol-free chlorhexidine mouthrinses on cariogenic micro-organisms in human saliva

Objective. The aim of this study was to evaluate the effect on mutans streptococci and lactobacilli in saliva of mouthrinsing with essential oils and an alcohol-free chlorhexidine. Materials and method.Twenty healthy volunteers (mean age 59 years) participated in the double-blind randomized cross-over study. Three mouthrinses were used in 16 days rinsing periods in addition to their regular mechanical oral hygiene: a solution with essential oils (EO; Listerine), a solution with alcohol-free chlorhexidine (CHX; Paroex) and water (negative control). The mouthrinse periods were separated by 3-month washout periods. At days 0 (baseline) and 17 (end) of each mouthrinse period, paraffin stimulated whole saliva was collected in order to analyse CFU/ml saliva of mutans streptococci and lactobacilli. Results. Only the CHX rinse showed a significant difference for CFU mutans streptococci between baseline and end (p = 0.004). The CFU mutans streptococci at the end of the rinse periods showed statistically significant differences between CHX vs EO (p = 0.039) and CHX vs water (p = 0.022). The difference in CFU lactobacilli between baseline and end was significant for CHX (p = 0.031), but not for the other rinses. No statistically significant differences for lactobacilli were found at the end of the rinse periods between the mouthrinses. Conclusion. A significant reduction in amount of cariogenic bacteria in saliva was observed after 16 days of alcohol-free chlorhexidine mouthrinse but not after the essential oils rinse. The high number of participant's not changing to a bacterial class with a reduced number of micro-organisms showed that both rinses had little clinical significance as a caries preventing treatment method, which can decrease the number of CFU cariogenic micro-organisms.

Short‐term side effects of 0.2% alcohol‐free chlorhexidine mouthrinse in geriatric patients: a randomized, double‐blind, placebo‐controlled study

To determine the effects of a 0.2% alcohol-free chlorhexidine mouthwash applied twice a day during 30 days in patients over 65 years of age. A randomized, double-blind, placebo-controlled study was made of 70 denture wearers over 65 years of age. The study subjects were randomly assigned to one of the two groups (chlorhexidine or placebo). The patients were instructed to complete a first whitening phase with a duration of 1 week, followed by a 30-day treatment period. The following data were collected: Silness and Löe plaque index, gingival index, the number of colony-forming units of Candida albicans at the start and end of treatment and the possible adverse effects of chlorhexidine. Significant differences were observed in the evolution of the Silness and Löe plaque index and gingival index in the two groups, as well as in the number of colony-forming units of C. albicans between the start and end of treatment. These results suggest that the clinical benefits of antiplaque, antigingivitis mouthrinses in both study groups.

The Role of the Dentist in Geriatric Palliative Care

The Role of the Dentist in Geriatric Palliative Care

Effects of mouthrinses containing essential oils and alcohol-free chlorhexidine on human plaque acidogenicity

The aim of this in vivo study was to evaluate the effect of two antimicrobial mouthrinses on dental plaque acidogenicity after a sucrose challenge. Twenty subjects, with a mean age of 59 years, participated in a double-blind intraindividual randomized study. Three mouthrinses were used in 16-day rinsing periods in addition to their regular mechanical oral hygiene: a solution with essential oils (EO), solution with alcohol-free chlorhexidine (CHX) and water (negative control). The three test periods were separated by 3-month washout periods. Changes in plaque acidogenicity were evaluated after a sucrose challenge at day 0 (baseline) and at day 17 of each mouthrinse period using the microtouch method. Both CHX and EO resulted at day 17 in statistically significant less attenuated pH falls compared to the water rinse. The CHX mouthrinse resulted in the least pronounced pH values compared with EO (ns) during the whole 30-min period. When calculated as area under the curve (AUC), significantly lower values (AUC(6.2) ) were found for CHX and EO at day 17 compared to day 0. A significant difference for AUC(6.2) between CHX and water was found at day 17. No statistically significant differences were found for any of the comparisons with AUC(5.7). The results from this study indicate that both the essential oils and the alcohol-free chlorhexidine reduced plaque acidogenicity after a sucrose challenge. Large interindividual variations were observed.

Effect of an Alcohol-Free, 1% Chlorhexidine Gel as an Adjunct to a Fluoridated Dentifrice Using an Intraoral Crown Model

Background/Aims: The use of chlorhexidine as a topically applied oral antiseptic is well documented; however, clinical studies examining the effects of chlorhexidine gel on in situ dental caries are limited. This study utilized an in situ caries model and a modified crossover design to examine whether the addition of a biweekly topical, alcohol-free, 1% chlorhexidine digluconate gel to a daily fluoridated dentifrice inhibited artificial caries in dental tissues better than the fluoridated dentifrice alone when compared to a nonfluoridated placebo dentifrice. Methods: Thirty patients were recruited based on their need for a mandibular, full crown. Artificial caries lesions were created in extracted human teeth and enamel and root tissue sections 100 µm in thickness were characterized using polarized light microscopy. The sections were fixed in the crown and placed on the prepared tooth. The participants were assigned a placebo toothpaste, a toothpaste with 1,100 ppm F or a 1,100 ppm F toothpaste followed by 1 ml of 1% chlorhexidine gel at day 1 and day 14 (chlorhexidine+). Patients were instructed to brush twice daily for 4 weeks. Following each round, the sections in the crown were replaced with new sections. The sections were recharacterized and the mean changes were compared using ANOVA at α = 0.05. Results: The chlorhexidine + Fdentifrice and the F dentifrice alone significantly reduced lesion area in enamel tissue when compared to the placebo dentifrice. Both treatments also inhibited lesion progression and initiation in root tissue better than control in this model system. Although the chlorhexidine+ group enhanced remineralization and inhibited lesion progression better than the F^– dentifrice alone for all outcomes measured, the differences were not significant. Conclusions: The chlorhexidine, in conjunction with a fluoride dentifrice, was no more effective than the fluoride dentifrice alone. Further study is needed before this 1% alcohol-free chlorhexidine gel should be recommended as an adjunct to a fluoride dentifrice in the treatment of dental caries.

Differences in efficacy of two commercial 0.2% chlorhexidine mouthrinse solutions: a 4‐day plaque re‐growth study

The purpose of this clinical cross-over study was to examine the antibacterial and plaque-inhibiting properties of two chlorhexidine solutions compared with a negative control. Twenty-one volunteers refrained from all oral hygiene measures, but rinsed instead twice daily with 10 ml of a conventional chlorhexidine solution (0.2%; CHX), a chlorhexidine solution with anti-discolouration system (ADS) (0.2%, alcohol-free chlorhexidine solution (CSP)) or a placebo solution (Pla). Plaque index (PI), plaque area (PA) and bacterial vitality were assessed after 24 h (PI1, vital flora (VF)1) and 96 h (PI2; VF2, PA). After a 10-day wash-out period, a new test cycle was started. Results for Pla were 0.94, 1.59, 27.4 (PI1, PI2, PA) and 79% and 72% (VF1 and VF2). CSP significantly reduced the parameter PI1, PI2 and PA to 0.67 (p=0.012), 1.0 and 15.7 (p<0.001). VF1 and VF2 (63% and 53%) were not significantly affected. The corresponding figures of CHX were 0.42, 0.43, 6.77, 33 and 16%, which were all significantly lower (all p<0.001). On comparing the two chlorhexidine solutions, CHX showed significantly higher reductions of all parameters. The results suggest that the 0.2% alcohol-containing solution showed superiority in inhibiting plaque re-growth and reducing bacterial vitality compared with the solution with ADS.

Efficacy of an alcohol-free chlorhexidine mouthrinse as an antimicrobial agent

Statement of problem. Antimicrobial mouthrinses have become an important part of comprehensive dental care. However, mouthrinses that contain alcohol have been shown to be detrimental to patients undergoing radiation therapy for head and neck cancer, to some immunocompromised patients, to families with small children, and to persons sensitive to alcohol. Purpose. This study evaluated the effectiveness of alcohol-free, 0.12% chlorhexidine mouthrinse in reducing microbial levels when compared with commercially available 0.12% chlorhexidine (CHX) and essential oils mouthrinses. Material and methods. This study consisted of both in vitro and in vivo investigations. The double-blind study included 32 subjects randomly assigned to 3 groups, equalized according to the indices tested. One group (n = 11) received essential oils rinse; the second group (n = 11) received CHX; and the last group (n = 10) received the alcohol-free CHX. Subjects were asked not to use any mechanical means of oral hygiene for 21 days. The in vitro part of the study consisted of Streptococcus mutans strip tests. Results. Mean plaque scores for both CHX products decreased after 21 days, whereas the mean for the essential oils increased. Bleeding and gingival index scores for all 3 groups increased, which may be due to the initially healthy tissues of the participants. Relative microbial growth for S mutans for both the CHX products decreased to 0 after 21 days, whereas the counts for the essential oils group remained varied.(J Prosthet Dent 1998;80:685-90.)

An outbreak of Serratia marcescens infections related to contaminated chlorhexidine.

An outbreak of Serratia marcescens infections occurred in a university tertiary-care hospital. Alcohol-free chlorhexidine solutions were contaminated with S marcescens. The majority of patient and chlorhexidine strains had similar pulsed field-gel electrophoresis banding patterns. Chlorhexidine was recalled, and the rate of S marcescens isolation returned to baseline. Chlorhexidine without alcohol should not be used as an antiseptic.

An Outbreak of Serratia marcescens Infections Related to Contaminated Chlorhexidine

An outbreak of Serratia marcescens infections occurred in a university tertiary-care hospital. Alcohol-free chlorhexidine solutions were contaminated with S marcescens. The majority of patient and chlorhexidine strains had similar pulsed field-gel electrophoresis banding patterns. Chlorhexidine was recalled, and the rate of S marcescens isolation returned to baseline. Chlorhexidine without alcohol should not be used as an antiseptic.