Amine Fluoride/stannous Fluoride Research Articles

Nondrug Intervention for Opportunistic Infections in Individuals With Hematological Malignancy: Systematic Review

Hematological malignancies disturb the blood, lymph nodes, and bone marrow. Taking medications for treating opportunistic infections (OIs) in these individuals may enhance the risk of medication interaction as well as adverse drug reactions. This review aims to evaluate the effectiveness of nondrug interventions in reducing OIs among patients with hematological cancers. The PubMed, CENTRAL (Cochrane Central Register of Controlled Trials), and Embase databases were searched on December 26, 2022, for all randomized controlled trials (RCTs). The primary endpoint was OIs. The quality of included studies was assessed by the Cochrane Risk-of-Bias tool. A total of 6 studies were included in this review with 4 interventions: (1) types of mouthwash received, (2) presence of coating on central venous catheters (CVCs), (3) use of well-fitted masks, and (4) types of diet consumed. The results were presented in 8 different comparisons: (1) chlorhexidine-nystatin versus saline mouth rinse, (2) chlorhexidine versus saline mouth rinse, (3) nystatin versus saline mouth rinse, (4) chlorhexidine silver sulfadiazine-coated CVCs versus uncoated catheters, (5) well-fitted masks versus no mask, (6) amine fluoride-stannous fluoride versus sodium fluoride mouthwash, (7) low-bacterial diet versus standard hospital diet, and (8) herbal versus placebo mouthwash. No clear differences were reported in any of the outcomes examined in the first 3 comparisons. There were also no clear differences in the rate of catheter-related bloodstream infection or insertion site infection between the use of chlorhexidine silver sulfadiazine-coated CVCs versus uncoated catheters in the patients. Further, no significant differences were seen between patients who used a well-fitted mask and those without a mask in the incidence of OI. The all-cause mortality and mortality due to OI were similar between the 2 groups. There was no clear difference in all-cause mortality, although common adverse effects were reported in patients who used sodium fluoride mouthwash compared with those using amine fluoride-stannous fluoride mouthwash. There was no evidence of any difference in the incidence of possible invasive aspergillosis or candidemia between patients who consumed a low-bacterial diet and a standard diet. For the last comparison, no significant difference was seen between patients who received herbal and placebo mouthwash. Very limited evidence was available to measure the effectiveness of nondrug interventions in hematological cancers. The effectiveness of the interventions included in this review needs to be evaluated further in high-quality RCTs in a dedicated setting among patients with hematological malignancies. PROSPERO International Prospective Register of Systematic Reviews CRD42020169186; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=169186.

Cytotoxicity of three commercial mouthrinses on extracellular matrix metabolism and human gingival cell behaviour

This study evaluated the effects of commercially available antiseptic mouthrinses on human gingival fibroblast and keratinocyte behaviour and metabolism. Three mouthrinses containing essential oil (EO), chlorhexidine (CHX) and amine fluoride/stannous fluoride (AFSF), were tested in an in vitro study. Human gingival fibroblasts and keratinocytes were washed with 10% or 30% concentration of the commercial mouthrinses and their effects on cell adhesion and proliferation were investigated as well as the specific gene expression of markers involved in oral mucosa metabolism. As markers of cell metabolism, type I and IV collagens, laminin, fibronectin, fibromodulin and integrins were studied with real-time PCR. Moreover, interleukin-1 secretion, one of the major pro-inflammatory cytokines, was evaluated. The results showed that CHX significantly reduced fibroblast and keratinocyte substrate adhesion capacities and CHX and EO inhibited cell proliferation better than AFSF rinse. The gene expression of several matrix components and cell adhesion receptors was downregulated in cells washed with CHX and EO compared with those washed with AFSF rinse. In conclusion, the AFSF mouthrinse does not induce or induces to a lesser extent the onset of irritation and/or cytotoxicity than CHX or EO. These findings and those of future studies will enable us to gain further insight into the clinical significance and effects of commercial mouthrinses. Pending further investigations, clinicians should be aware of the potentially adverse effects of mouthrinses and warn their patients against making improper use of these products.

Validation of ATP bioluminescence as a tool to assess antimicrobial effects of mouthrinses in an in vitro subgingival-biofilm model

Objectives. The aim of this investigation was to evaluate whether the adenosine triphosphate (ATP) bioluminescence method is an appropriate tool to assess the efficacy of antiseptic mouthrinses in terms of quantitative reductions of total viable microbial counts in mixed biofilm populations in vitro. Study Design. Three mouthrinses, containing respectively, chlorhexidine and cetylpyridinium chloride (CHX/CPC), essential oils (EO) and amine fluoride/stannous fluoride (AFSF), as well as Phosphate Buffered Saline (PBS) used as control, were tested in an in vitro static biofilm model by ATP bioluminescence and compared to culture method. Biofilms were grown on saliva-coated hydroxyapatite disks for 72 hours and then exposed for 1 minute to the mouthrinse or control by immersion. The antibacterial effect of the rinses was tested by analysis of variance. The reliability of the ATP bioluminescence method was assessed by calculating the Pearson correlation coefficients when compared to the viable cell counts obtained by culture. Results. Using ATP bioluminescence, the antimicrobial activity of the tested mouthrinses was demonstrated when compared to the PBS control. The ATP bioluminescence values were significantly correlated (0.769, p<0.001) to the viable cell counts. CHX/CPC and AFSF showed similar antimicrobial activity, although AFSF had a less homogeneous effect, being both more effective than the EO rinse. Conclusion. ATP bioluminescence viability testing may be considered a useful tool to assess the in vitro efficacy of antibacterial compounds. In the proposed model, CHX/CPC and AFSF containing mouthrinses demonstrated superior antimicrobial activity, as compared to EO rinses, in a multispecies biofilm model. Key words:Biofilm, ATP bioluminescence,mouthrinse, essential oils, chlorhexidine, amine fluoride/stannous fluoride.

Short-term effect of a new mouthrinse formulation on oral malodour after single use in vivo: a comparative, randomized, single-blind, parallel-group clinical study

This study aimed to compare a new chlorhexidine (CHX)-free mouthrinse containing amine fluoride/stannous fluoride (ASF) against a benchmark containing CHX with respect to their effect on oral malodour after single use. A total of 42 male and female subjects with an intraoral cause of bad breath, each with an organoleptic rating (OR) of at least 2 and a total volatile sulfur compound (VSC) concentration higher than 130 ppb, participated in the study. Subjects were allocated to one of three treatment groups (i.e. CHX-free ASF mouthrinse, CHX benchmark mouthrinse or water) according to a randomization list. Participants received written instructions on precautions to be taken for optimal breath analysis. Eight trained and qualified odour judges assessed the subjects' malodour by OR at baseline and 30 min and 4 h after single use of the mouthrinses. Additionally, VSC levels were measured at baseline and 4 h after using the mouthrinse. Treatment with water alone led already to some reduction in OR with mean differences to baseline of −1.13 at 30 min and −0.64, 4 h after treatment. Both CHX-free ASF product (−1.51) and CHX (−1.48) provided a significantly stronger OR reduction than water at 30 min (p < 0.05). Only CHX-free ASF treatment showed a sustained benefit in terms of significantly better OR reduction after 4 h (−1.17, p < 0.05), whereas CHX (−0.81) was not significantly different from water (−0.64, p = 0.517). Both ASF (−90.9%) and CHX (−81.6%) reduced VSC levels significantly stronger than water (−53.5%; p < 0.001). OR and VSC readings in the group using the CHX mouthrinse did not differ significantly from those in the group using the CHX-free ASF formulation. The newly developed CHX-free ASF mouthrinse significantly reduced oral malodour after single use, both in terms of OR and VSC levels. Efficacy was comparable to that of the CHX benchmark product.

Efficacy of a new mouthrinse formulation on the reduction of oral malodour in vivo. A randomized, double-blind, placebo-controlled, 3 week clinical study

The present study was conducted to assess the efficacy of a new mouthrinse formulation in reducing oral malodour compared to that of commercially available products containing chlorhexidine (CHX) and a negative control. 174 healthy volunteers, each with an organoleptic score of at least 2 and an H2S level as part of the volatile sulfur compounds (VSC) higher than 50 ppb, were divided into four groups. Participants were stratified according to their organoleptic ratings (OR). Group I: mouthrinse I (250 ppm F− from amine fluoride/stannous fluoride (ASF), 0.2% zinc lactate, oral malodour counteractives); group II: mouthrinse II (0.05% CHX, 0.05% cetylpyridinium chloride, 0.14% zinc lactate); group III: mouthrinse III (0.12% CHX); group IV: tap water. All groups were instructed to perform standardized oral hygiene measures and to apply the respective test rinse twice daily after tooth brushing. Malodour was assessed by organoleptic measurement and by VSC levels at baseline, day 1, day 7, day 14 and day 21 into the study. To evaluate discolouration of the teeth, the colour was assessed at baseline and final visit. The ASF mouthrinse showed superior efficacy as compared to the negative control. A significant reduction in OR and VSC readings was achieved after single application as well as after 7 and 21 days of continuous use. Between test groups I–III no statistically significant differences were found at any time point. There was also a trend towards fewer side effects caused by the ASF product compared to the products containing CHX. The newly developed mouthrinse product significantly reduces oral malodour in patients with increased values both in OR and in VSC.

Effect of amine fluoride–stannous fluoride preparations on oral yeasts in the elderly: a randomised placebo‐controlled trial

Oral yeast infections are an emerging problem among medically compromised and frail elderly. Antifungal drug resistance is also increasing because of an increase in non-albicans Candida strains in these populations. We therefore set out to study, in the randomised-controlled trial setting if the use of a topical amine fluoride-stannous fluoride combination (AmF-SnF2) could control oral Candida growth in the elderly. The hypothesis was based on earlier findings showing that in vitro this combination had antifungal efficacy. A total of 194 nursing home residents were randomised to receive either the test mouth rinse and toothpaste or a placebo twice daily for 8 months. Of these, 136 completed the trial. Saliva samples were taken using the oral rinse method, cultivated and the strain level identified with routine microbial methods. Compliance and use of preparations was assessed by a nurse. Significantly at the end of the trial, less mucosal lesions were observed in the test group in comparison to controls. Total bacterial count decreased in both the groups during the trial. Candida albicans was the most prevalent strain detected both at baseline and 8 months later. Only a few subjects carried non-albicans strains. The AmF-SnF2 did not significantly affect mean oral Candida counts, but median Candida counts were reduced in the AmF-SnF2 group while an increase was seen in the placebo group. However, the differences observed were not statistically significant. Compliance among the regular elderly users slightly increased during the trial for both the groups. The number of subjects with high Candida counts decreased in the AmF-SnF2 group. Hence, the fluoride combination might be useful as a support therapy for oral candidiasis. Prevalence of non-albicans Candida strains was low in this population.

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.

Substantivity of amine fluoride/stannous fluoride following different modes of application: A randomized, investigator-blind, placebo-controlled trial

Objective. Amine fluoride/stannous fluoride (ASF) is proven to be effective against plaque and gingivitis. The purpose of this clinical controlled study was to investigate the influence of different application modes on the substantivity of this formulation. Material and Methods. Seventeen healthy volunteers received a professional dental prophylaxis. Undisturbed plaque growth was permitted for the next 48h. In a crossover design, participants received ASF as a single mouthrinse, toothpaste, slurries with high (HA) or low (LA) air content, or a placebo. Vitality of plaque bacteria was investigated before and at 1, 2, 3, 4, 6, and 8h after application of ASF. ANOVA was applied on a 0.05 significance level. Results. Highest reduction of plaque vitality resulted after toothpaste application, followed by mouthrinse, LA, and HA slurry. No changes occurred in the placebo group. Compared to baseline and placebo, statistically significant changes were detected up to 4h in all ASF groups. Toothpaste exerted antibacterial efficacy up to 8h. Vitality reduction was higher in the LA group than in the HA group. Conclusions. The concentration of ASF in formulations influences the time course of the antibacterial effect. Contact of ASF formulations with air might reduce their efficacy.

The Effects of an Amine Fluoride/Stannous Fluoride and an Antimicrobial Host Protein Mouthrinse on Supragingival Plaque Regrowth

Background: Chlorhexidine (CHX)‐containing mouthrinses are recommended as adjuncts to mechanical oral hygiene. The problem associated with side effects, however, has stimulated the search for alternative antiplaque agents. The aim of this study was to investigate the plaque inhibitory effects of two mouthrinses containing amine fluoride/stannous fluoride (ASF) and antimicrobial host proteins (lactoperoxidase, lysozyme and lactoferrin; LLL), respectively.Methods: The study was an observer‐masked, randomized 4×4 Latin square cross‐over design balanced for carryover effects, involving 12 healthy volunteers in a 4‐day plaque regrowth model. A 0.12% CHX mouthrinse 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.Results: The ASF rinse showed a significant inhibition of plaque regrowth in comparison to both saline and LLL solutions, but the lowest plaque indices were obtained with the CHX formulation (P &lt; 0.01). There were no significant differences between LLL rinse and saline (P &gt; 0.05). Such pattern of efficacy was the same in anterior and posterior teeth and in vestibular and lingual surfaces as well, with the exception of the lingual anterior surfaces. In these sites, differences between the CHX and ASF rinses were not significant (P &gt; 0.05). A significantly higher prevalence of side effects was found in subjects using the CHX product (P &lt; 0.0042).Conclusions: Although the effect on plaque regrowth observed with 0.12% CHX rinsing was superior to that with ASF, the ASF rinse was not associated with side effects. These findings, together with those from long‐term trials, suggest that the ASF rinse may represent an effective alternative to CHX rinse as an adjunct to oral hygiene. On the contrary, the LLL rinse did not significantly inhibit plaque regrowth.

One‐year trial of the effect of rinsing with an amine fluoride‐stannous‐fluoride‐containing mouthwash on gingival index scores and salivary microbial counts in lymphoma patients receiving cytostatic drugs

This double-blind study was undertaken to evaluate the effect of twice-daily use of a mouthwash containing 0.025% of fluoride as amine fluoride-stannous fluoride (AmF + SnF) or 0.05% of fluoride as sodium fluoride (NaF) on visible plaque index (VPI) and gingival bleeding index (GBI) and on some salivary micro-organisms in patients suffering from non-Hodgkin or Hodgkin lymphomas. 79 patients were allocated at random to the two mouthwash groups. Mouthwashing began at the start of cancer chemotherapy. Results relating to 45 patients who completed a 1-year rinsing protocol showed a significant decrease in VPI and GBI in the AmF + SnF group. An increase was found in the NaF group. Mean values for stimulated salivary secretion rates and buffering capacities mostly did not differ significantly from baseline values during the study. In both groups, mutans streptococci counts decreased significantly after the study began and remained low in the AmF + SnF group. No corresponding effect was seen in relation to lactobacilli and yeast counts. In the NaF group, lactobacilli counts increased significantly over a year. Significantly more patients reported adverse or unpleasant effects in the AmF + SnF group (52%) than in the NaF group (6%), although both solutions had the same colour and taste. However, all patients continued with rinsing.

Activity of amine-stannous fluoride combination and chlorhexidine against some aerobic and anaerobic oral bacteria.

The in vitro susceptibility of 128 bacterial strains was tested to amine fluoride-stannous fluoride (AmF + SnF) and chlorhexidine (CHX) solutions. Actinobacillus actinomycetemcomitans, Streptococcus mutans, and Bacteroides intermedius were among the species investigated. The 50% and 90% minimal inhibitory concentrations (MICs) were assessed by an agar dilution method. The MIC ranges for A. actinomycetemcomitans were 2-32 micrograms/ml for CHX and 0.25-64 micrograms/ml for AmF + SnF. The respective values for S. mutans were 0.5-8 micrograms/ml (CHX) and 2-8 micrograms/ml (AmF + SnF); and 4-8 micrograms/ml (CHX) and 2-4 micrograms/ml (AmF + SnF) for B. intermedius. Streptococcus faecalis and Staphylococcus aureus were most resistant of the control strains (MIC 64 micrograms/ml to CHX and 32 micrograms/ml to AmF + SnF, respectively). Thus, both solutions tested exerted a definite inhibitory action on the dental plaque pathogens studied.