Antiplaque Agents Research Articles

Clinicomicrobiological Evaluation of 2% Chitosan Mouthwashes on Dental Plaque.

This study was conducted to evaluate microbiological and clinical effects of a chitosan chlorhexidine (CH) mouthrinse on plaque control. Subjects were divided into three groups. Group I included 15 subjects who used 0.2% chlorhexidine digluconate (CHX), group II included 15 subjects who used 2% chitosan (CH) solution, and group III involves 15 subjects who used 0.2% chlorhexidine/2% CH combination. Plaque index (PI), gingival index (GI), and probing depth (PD) were recorded at the baseline, on day 0, and after 4 days. Supragingival plaque samples were subjected for microbiological evaluation. Statistical analysis was done using statistical software IBM Statistical Package for the Social Sciences (SPSS), version 21. Plaque index was lowest in group I at day 0, while it was highest in group III. At day 4, PI was highest in group II, while lowest in group III. Gingival index was lowest in group I and highest in group II at day 0, and lowest in group I and highest in group III at day 4. There was no statistical difference in Streptococcus mutans (S. mutans) count between groups at any time interval. Both chitosan and CH were found to be effective in controlling plaque. However, a combination of both provides even better results. The present study showed that chitosan can be used as an antiplaque agent.

Comparative evaluation of the antifungal efficacy of six different plant extracts and their synergistic effect against Candida albicans: An in vitro study

Background: Chewing of sticks was a method of cleaning teeth in ancient India and is still followed by many people in the rural parts. People of different religions also hold high value for these plants that are of high medicinal value and have antimicrobial effects. Objectives: We previously in a study tried to evaluate the antibacterial efficacy of plant extracts from neem, miswak, liquorice, babul, pine, and black cumin against Lactobacillus acidophilus and Streptococcus mutans and have seen few positive results. In this study, we aim to use these extracts to determine if they show antifungal efficacy. Materials and Methods: Chewing sticks of neem, babul, miswak, liquorice, and the leaves of pine and seeds of black cumin were collected from plants sources and sun-dried after which they were ground into coarse powder. Sterile aqueous solutions of 5%, 10%, and 20% were prepared. Aqueous extraction and cold infusion were two methodologies we used. The filtrate was inoculated onto Sabouraud dextrose agar plate with chloramphenicol containing Candida and incubated at 37°C for 48 h. Results: Pine and black cumin showed good antifungal efficacy, on increasing the concentration the extracts of miswak and liquorice also showed a better antifungal efficacy. The combination of these plant extracts had better efficacy than individual extracts of babul and pine. The extracts obtained from cold infusion method almost showed equal antifungal efficacy in comparison to the standard chlorhexidine used. Conclusion: These plants extracts previously having showed antibacterial efficacy and good antifungal effects can be considered for preparations of commercial antiplaque agents.

Evaluation of antimicrobial efficacy of Trachyspermum ammi (Ajwain) oil and chlorhexidine against oral bacteria: An in vitro study.

Plaque removal is of utmost importance for control of dental caries and other associated diseases of oral cavity. However, various natural agents have proven their efficacy over chemotherapeutic agents in terms of antibacterial activity against various microorganisms. The effect is mainly due to polyphenol as its major constituent. In this in vitro study, we aimed to determine the antibacterial efficacy of Trachyspermum ammi oil at different concentrations against five oral bacteria. Herbal compound, T. ammi oil is effective in reducing five oral plaque-forming bacteria. We determined the antimicrobial activity of T. ammi oil (test material) against chlorhexidine (gold standard). Pure cultures of Streptococcus mutans MTCC No 497, Streptococcus oralis MTCC No. 2696, Lactobacillus acidophilus MTCC No. 10307, Lactobacillus fermentum MTCC No. 903, and Candida albicans MTCC No. 183 were obtained and grown in selective culture media. Minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of both materials were evaluated by serial dilution and disc diffusion method, respectively. Our results revealed that T. ammi oil moderately inhibits bacterial growth with mean MIC of 250, 125, 250, 125, and 250 μg/ml, respectively. Mean MBC for T. ammi oil obtained was 18.60 ± 0.65, 11.60 ± 1.14, 14.10 ± 0.55, 11.50 ± 0.61, and 15.10 ± 0.74 mm. The MIC and MBC values were higher as compared to chlorhexidine gluconate and it was statistically significant. T. ammi (ajwain) can serve as a potential, natural, nontoxic, and economical therapeutic antiplaque agent.

Delivery Vehicles for Antiplaque Agents

Oral health is an integral part of general health. Poor oral health can have adverse effects on general health. Hence a good oral and general health is very essential, which in turn is achieved by good oral hygiene. Even though, the concept of good oral hygiene evolved some 5000 yrs back. It is only in the beginning of the 19th century it gained more importance. The earlier concept of maintaining oral hygiene by just cleaving the food debris has been taken over by removal of plaque, an infectious agent responsible for many common dental diseases, in the 20th century. Plaque control is one of the keystones of the practice of dentistry, without it, oral health can neither be attained, nor preserved. For patient with healthy periodontium, Plaque control means preservation of health. For the patient with periodontal disease, it means optimal healing, following treatment. For the patient with treated periodontal disease, plaque control means the prevention of recurrence of disease.

Triphala - An Indigenous Ayurvedic Mouthwash As An Anti-Inflammatory Agent - A Clinical Study

Background: An antiplaque agent with minimal side effects that can be used as an effective adjunct to mechanical plaque control is needed. Mouthwash has been used for centuries for medicinal and cosmetic purposes, but in recent years, the rationale behind the use of chemical ingredients has been subjected to scientific research and clinical trials. Herbal medicines are in great demand in the developed as well as in developing countries for primary health care because of their wide biological and medicinal activities, higher safety margin, and lower costs. Triphala mouthwash used in Ayurveda since ancient times, is well-known for its anti-plaque, anti-gingivitis and anti-microbial properties.
 Aim: To evaluate and compare the effects of an indigenously prepared 0.6% triphala mouthwash on dental plaque and gingival inflammation with a commercially available chlorhexidine mouthwash.
 Materials and Methods: 20 subjects in the age group of 20-40 years with mild to moderate gingivitis were selected and divided into two equal groups in the study. Following oral prophylaxis, Group I (n=10) subjects were instructed to rinse with 10 ml of 0.2% chlorhexidine mouthwash, Group II (n=10) subjects with 10 ml of 0.6% triphala mouthwash twice daily for 14 days. Oral Hygiene Index-Simplified, Turesky- Gilmore-Glickman modification of Quigley-Hein-Plaque index and Gingival Index were recorded at baseline, 7 and 14 days respectively.
 Results: Group I and Group II subjects showed statistically significant results in the reduction of the clinical parameters (p < 0.001). Group I subjects showed statistically significant results in reduction of the plaque status (p < 0.05) whereas; Group II subjects showed significant reduction in the gingival inflammation (p < 0.05).
 Conclusion: Although, 0.2% chlorhexidine mouthwash yielded better results, 0.6%Triphala mouthwash may be used for short duration of time without any potential side-effects as an alternative to chlorhexidine mouthwash in reducing gingival inflammation.

Anti-Inflammatory Effects of Prepared Punica Granatum Mouthwash on Patients with Moderate Gingivitis

Objective: Punica granatum is a herbal product used in the field of dentistry which has many potential effects including bactericidal, antifungal, antiviral, and immune modulation. This study aimed to evaluate the effect of prepared Punica granatum as an antiplaque and anti-inflammatory agent in the treatment of gingival inflammation. 
 Methods: Sixty patients were enrolled in this study. Fourty five patients with moderate gingivitis were divided randomly into 3 groups; chlorhexidine group included 15 patients received once-daily dose of chlorhexidine mouthwash for 1 day, Punica I group included 15 patients received once-daily dose of Punica mouthwash for 1 day, and Punica II group included 15 patients received once-daily dose of Punica mouthwash for 2 consecutive days. Plaque index, gingival index, and bleeding on probing were assessed before rinsing and after 3 and 7 days of rinsing, also saliva were collected before rinsing and after 1 hour, 2 hrs, 1 and three days of rinsing to estimate the level of interleukine-1β. The rest 15 subjects were with clinically healthy gingiva. 
 Results: Punica II group resulted in significant reduction of plaque index, gingival index, and bleeding on probing after 3 and 7 days of rinsing (p≤0.05) but with non-significant differences with chlorhexidine group (p>0.05). It had significant effect in reduction of interleukine-1β which begin after one day of rinsing and continued into three days (p≤0.05).
 Conclusions: Punica like chlorhexidine has a positive effect on reduction of plaque accumulation and improvement of gingival inflammation so can be used as an anti-plaque and anti-inflammatory agent in the treatment of gingival inflammation.

Commercial antimicrobials mouthrinses on caries and periodontitis-related biofilm control: a review of literature

This review aims to discuss the antimicrobial potential of different mouthrinses in respect to the control of dental caries and periodontal disease. The survey was conducted using PubMed and the following keywords: "antimicrobial agent " or "antiplaque agent," "dental biofilm" and "dental caries" or "periodontal disease" or "gingivitis". Only studies published in English, from 2011 to 2015, in journals with impact factor greater than 0.8, were selected. We found a total of 22 papers, 13 related to dental caries and 9 related to periodontal disease. Among the 13 studies involving cariogenic bacteria and/or biofilm, 6 were conducted in vitro, 3 in situ and 4 in vivo. Among 9 studies involving periodontal disease, 2 were in vitro and 7 in vivo. The main active agents tested were: CHX-Chlorhexidine, CPC-cetylpyridinium chloride and EO-Essential oils (alcohol/or alcohol-free). CHX was compared to EO in 6 studies, showing superiority in 3 studies, similarity in 1 study and inferiority in 2 studies. CPC has shown lower effect in plaque reduction compared to CHX and EO. There is still controversy about the effect of alcohol, but some studies have shown superiority for EO and CHX with alcohol on cariogenic and periodontopathogenic biofilms, respectively, when compared to alcohol-free version; for CPC, no difference was found. More clinical studies are needed for better understanding the mechanism of action and the differences in performance among the antiplaque agents.KeywordsAntimicrobial agents; Dental biofilm; Dental caries; Oral diseases; Periodontitis.

Kemampuan hambat ekstrak temulawak (Curcuma xanthorrhiza Roxb.) terhadap adhesi bakteri Streptococcus mutans

Background : Streptococcus mutans is the most cariogenic microorganism in the oral cavity. Streptococcus mutans has the ability to use dietary carbohydrates, such as sucrose, to synthesize extracellular polysaccharides (glucan and fructan) through glucosyltransferase and fructosyltransferase. Extracellular polysaccharide has a role in promoting the adhesion of bacteria. Chlorhexidine is the gold standard as antiplaque agent but chlorhexidine is not fully able to inhibit the adhesion of bacteria because it has an effect that can increase gtfC and gtfD expression on S. mutans in planktonic form. Temulawak extract (Curcuma xanthorrhiza Roxb.) contains of curcumin, xanthorrhizol, saponin, flavonoid and tannin that have an effect to inhibit activity and secretion of glucosyltransferase and fructosyltransferase. Purpose: The aim of this study is to find out the ability of temulawak extract (Curcuma xanthorrhiza Roxb.) to inhibit adhesion of Streptococcus mutans. Method: This study was designed as an experimental laboratory study with post test only control group design using Streptococcus mutans. Temulawak was extracted using maceration method. The number of bacteria that can perform adhesion to the tooth surface can be determined by performing calculations using formulas plate count method. Result: Temulawak extract (Curcuma xanthorrhiza Roxb.) at concentrations of 25%, 37.5%, 50% and chlorhexidine can inhibit bacterial adhesion of Streptococcus mutans. Conclusion: Temulawak extract at concentration of 50% and 37.5% has the best ability to inhibit the adhesion of bacteria among other treatment groups.

Alternative sweeteners influence the biomass of oral biofilm

ObjectiveCompact-structured oral biofilm accumulates acids that upon prolonged exposure to tooth surface, causes demineralisation of enamel. This study aimed to assess the effect of alternative sweeteners Equal Stevia®, Tropicana Slim®, Pal Sweet® and xylitol on the matrix-forming activity of plaque biofilm at both the early and established stages of formation. MethodsSaliva-coated glass beads (sGB) were used as substratum for the adhesion of a mixed-bacterial suspension of Streptococcus mutans, Streptococcus sanguinis and Streptococcus mitis. Biofilms formed on sGB at 3h and 24h represented the early and established-plaque models. The biofilms were exposed to three doses of the sweeteners (10%), introduced at three intervals to simulate the exposure of dental plaque to sugar during three consecutive food intakes. The treated sGB were (i) examined under the SEM and (ii) collected for turbidity reading. The absorbance indicated the amount of plaque mass produced. Analysis was performed comparative to sucrose as control. ResultsHigher rate of bacterial adherence was determined during the early compared to established phases of formation. Comparative to the sweeteners, sucrose showed a 40% increase in bacterial adherence and produced 70% more plaque-mass. Bacterial counts and SEM micrographs exhibited absence of matrix in all the sweetener-treated biofilms at the early phase of formation. At the established phase, presence of matrix was detected but at significantly lower degree compared to sucrose (p<0.05). ConclusionAlternatives sweeteners promoted the formation of oral biofilm with lighter mass and lower bacterial adherence. Hence, suggesting alternative sweeteners as potential antiplaque agents.

The effects of rinsing red beet root (beta vulgaris L.) juice on streptococcus sp. dental plaque

Objective : The early attachment process of plaque formation is dominated by Streptococcus sp. Chemical antiplaque agent can optimize plaque control.Material and Methods : Materials of antiplaque have side effects, so it is necessary to do research of alternative antiplaque materials. One of them use red beet root because contain some antibacterial substance. The aim of this study was examine the effectiveness of rinsing red beetroot juice to Streptococcus sp. on dental plaque.Results : This study was a quasi-experimental research with the post test only control group design. Subjects were 27 students from Faculty of Dentistry, University of Jember who fulfilled the criteria, have been scalled, and given the knowledge of how to rinse. The subjects were divided into three groups, and instructed to rinse for 30 seconds using chlorhexidine gluconate 0.2%, distilled water, and red beet root juice. Plaque were taken at the buccal maxillary first molar. Plaque were diluted and planted on streptococcus media for 24 hours, the number of colonies counted using colony counter. Analysis of One-Way ANOVA have significance 0.000, means decreased the number of Streptococcus sp.Conclusion : Rinsing red beet root juice was effective to decrease the number of Streptococcus sp. on dental plaque.

Clinical effects of different antiplaque agents on patients undergoing fixed orthodontic treatment- A comparative study

Objectives: The purpose of this study was to compare the short-term clinical effects of a Chlorhexidine mouth wash (CHX-MW), Chlorhexidine gel (CHX), Metronidazole gel (MTZ) and combination of Chlorhexidine and Metronidazole (CHX-MTZ) in orthodontic patients with fixed appliances aged from 14 to 25 years. Materials and Methods: One hundred fifty subjects undergoing fixed orthodontic treatment selected and divided into five groups: Group 1 – Controls, Group 2 – Chlorhexidine mouth wash (CHX-MW) gel, Group 3- Chlorhexidine (CHX) gel, Group 4 – Metronidazole (MTZ) gel and Group 5 – chlorhexidine-metronidazole (CHX-MTZ) gel. Clinical evaluation was undertaken using the probing depth (PD), Gingival Index (GI) and the Papillary Bleeding Index (PBI) at baseline, 2 weeks, 4 weeks, 8 weeks and 12 weeks. A subjective evaluation was also undertaken by questionnaire. Results: Groups treated with all three gels (CHX, MTZ and CHX-MTZ) showed significant clinical improvement as compared to the controls and CHX-MW group. The reduction in PD, GI and PBI in the group treated with the CHX-MTZ combination gel was significant when compared to those treated with CHX and MTZ gels. Conclusion: Topical application of CHX or MTZ alone or in combination may have a role in the management of gingivitis in orthodontic patients. Keywords: Chlorhexidine; Metronidazole; Fixed orthodontic treatment; Probing depth; Gingival Index; Papillary Bleeding Index

Effectiveness of a herbal mouthrinse on de novo plaque formation

Background: Herbal mouthrinses have been recently introduced with the objective of achieving effective plaque control. Till date, chlorhexidine has been a gold standard with regard to anti-plaque agents.Objectives: To compare the effeciveness of the herbal mouthrinse (Hiora) against chlorhexidine mouthrinse.Methods:The study is a randomized, double blind, crossover clinical study. At the baseline, the volunteers brush their teeth using toothpaste without any active ingredient for 2 minutes. Oral prophylaxis was performed to ensure that the teeth are free of plaque, stains and calculus. Each subject was randomly assigned to both the experimental groups. During the trials, the volunteers were rinsed their mouths, according to the assigned random sequence of treatments: Chlorhexidine as chemical and HiOra as herbal mouthrinse. Both the mouthrinses were packed in similar coloured bottles but labeled differently and randomly administered to the subjects by a blinded operator. Each subject received oral and written instructions on the use of mouth rinses. After one week, the study subjects were asked to suspend their oral hygiene for 24 hours, and accumulated plaque was re-evaluated with erythrosine. The plaque index was recorded in the six selected teeth at the end of the trial. After the trial period, the usual oral hygiene habits resumed.Results: There were no statistically significant differences between herbal and chemical mouthrinses.Conclusion: Herbal mouth rinses may be as effective as chlorhexidine as chemical anti-plaque agents with fewer side effects.

Bacteriostatic Effect of Simvastatin on Selected Oral Streptococci in Vitro.

Context and Objective:Simvastatin is a widely used cholesterol-lowering drug, which has been found to have a number of pleiotropic effects. The aim of this study was to evaluate the antimicrobial effectiveness of simvastatin against selected oral streptococci as determined by the minimum inhibitory concentration (MIC).Methods:Streptococcus mutans, Streptococcus sanguis, Streptococcus anginosus, and Streptococcus salivarius were the test microorganisms. The serial dilution method was used to determine the MIC of simvastatin against these organisms. The MIC was defined as the lowest concentration of simvastatin that completely inhibited growth of the test organisms.Results:The data indicate that simvastatin inhibits the growth of the test organisms, with MIC's ranging from 7.8 to 15.6 μg/ml.Conclusions:Simvastatin has MIC's against the selected bacteria that compare favorably with reported values for topical agents such as essential oil, chlorhexidine gluconate, and triclosan. The levels of simvastatin required to inhibit bacterial growth of oral bacteria exceed the reported levels of the drug found in plasma or crevicular fluid of patients who are treated with this cholesterol-lowering drug. However, clinical studies are warranted to investigate the potential use of simvastatin as a novel antiplaque agent that could be used in local drug delivery to the oral cavity of those patients who are prescribed this cholesterol-lowering drug.

ANTI-PLAQUE AND ANTI-GINGIVITIS AGENTS IN THE CONTROL OFSUPRAGINGIVAL PLAQUE.

This review considers the main agents which have been used as anti-plaque and anti-gingivitis agents in mouthwashes and other vehicles to inhibit the growth of supragingival plaque. The agents are classified into first generation, second generation and third generation agents. Bisguanide antiseptics, hexetidine, povidone iodine, triclosan, delmopinol, salifluor, metal ions, sanguinarine, propolis and oxygenating agents are included. The anti-plaque and antigingivitis properties of these agents are considered along with their substantivity, safety and possible clinical usefulness. A number of product forms are available to deliver anti-plaque agents (i.e., mouthrinses, dentrifices, aqueous gels, chewing gum and lozenges) and should facilitate optimal bioavailability at the site of action and patient compliance.

A comparative evaluation of the efficacy of curcumin and chlorhexidine mouthrinses on clinical inflammatory parameters of gingivitis: A double-blinded randomized controlled clinical study.

Aim:The aim of this study was to assess the efficacy of 0.1% curcumin mouthwash and to compare it with 0.2% chlorhexidine gluconate as an antiplaque agent and its effect on gingival inflammation.Materials and Methods:One hundred and fifty subjects, age between 20 and 30 years were recruited. Study population were randomly divided into three groups. In Group A, 50 subjects were advised the experimental mouthwash. Group B subjects used placebo mouthrinse, and chlorhexidine mouth wash was given to Group C. The subjects were advised to use 10 ml of mouthwash for 1 min twice a day 30 min after brushing. Parameters were recorded for plaque, gingival, and sulcus bleeding indices at day 0, 7, 14, and 28 days along with subjective assessment of taste.Results:On intragroup comparison between curcumin, chlorhexidine, and placebo mouthwash, the mean percentage reduction of the plaque index (PI) between 0 and 28 days were 0.58,0.57 and 1.17, respectively (P < 0.01), percentage reduction of gingival index (GI) between 0 and 28 days were 0.65, 0.66, and 1.09, respectively (P < 0.01) and sulcus bleeding index (SBI) showed a percentage reduction of 0.69, 0.66, and 1.13, respectively The intergroup comparison revealed chlorhexidine and curcumin mouthwash were statistically significant with P < 0.001 as compared to placebo.Conclusion:Curcumin mouthwash has shown an antiplaque and antigingivitis properties comparable to chlorhexidine mouthwash. Thus, curcumin mouthwash and chlorhexidine gluconate can be effectively used as an adjunct to scaling and root planning.

Evaluation of clinical effificacy of Terminalia chebula inplaque-induced gingivitis: A randomized control trial

Introduction: Plaque control is fundamental to the prevention and management of periodontal diseases. However, most of the individuals do not practice plaque removal in an adequate manner. Hence, there is a need for an antiplaque agent that can be used on a daily basis without the side effects of antibacterial chemicals. The aim of the study is to evaluate the clinical efficacy of Terminalia chebula in patients with chronic gingivitis. Materials and Methods: Eighty patients, 18–40 years of age, diagnosed with chronic generalized gingivitis were selected and randomly divided into two groups. Group I underwent oral prophylaxis alone whereas Group II underwent oral prophylaxis and advised to do gingival massage by T. chebula powder. Clinical evaluation was done using plaque index (PI), gingival index (GI), and gingival bleeding index (GBI) at baseline and after 1 month. Results: Gingival massage with T. chebula powder showed a significant reduction in PI, GI, and GBI scores from baseline to 1 month. Conclusion: T. chebula powder is a useful herbal formulation for plaque control in patients with chronic gingivitis.

Comparative Evaluation of the Efficacy of Probiotic, Herbal and Chlorhexidine Mouthwash on Gingival Health: A Randomized Clinical Trial.

Due to inherent limitations of Chlorhexidine (CHX), search for an effective and potentially safe anti-plaque agent has led to emergence of alternative products. The present study evaluated the comparative efficacy of probiotic, herbal and CHX mouthwashes on gingival health of healthy individuals. The present study was randomized parallel group controlled trial. A group of 45 healthy subjects in the age group of 18-21 years received complete supragingival scaling at baseline and study variables viz., Oral Hygiene Index - Simplified (OHI-S), Plaque Index (PI) and Gingival Index (GI) were recorded. Subjects were then randomly divided into three groups (15 in each group) and were randomly intervened with three different mouthwashes i.e., HiOra mouthwash, CHX mouthwash and Probiotic mouthwash. Variables were again recorded on the seventh and 14th day after use of mouthwashes and data obtained was subjected to statistical analysis. There was no significant difference in the efficacy of CHX, HiOra regular and probiotic mouthwashes on plaque accumulation, gingival health and oral hygiene status. Herbal and probiotic mouthwashes can prove to be effective alternatives to CHX with minimal side effects.

Antimicrobial Effects of Garcinia Mangostana on Cariogenic Microorganisms.

Garcinia mangostana commonly called as Mangosteen fruit has been used as an antibacterial agent since age old times. The mangosteen pericarp has proven to have antibacterial effect, but the effect of the same on cariogenic organisms has not been explored. The present study was an attempt to gain a better understanding of the antibacterial effect of mangosteen pericarp on the cariogenic bacteria, to unravel the therapeutic potential for the same. The aim of the study was to assess the antibacterial efficacy of the crude chloroform extract of mangosteen pericarp against cariogenic bacteria. The study was done under laboratory settings using an in vitro design. The microorganisms namely Streptococcus mutans, Streptococcus sanguis, Streptococcus salivarius, Streptococcus oralis and Lactobacillus acidophilus were procured from American Type Cell Culture (ATCC) and Microbial Type Culture Collection (MTCC) were revived and lawn cultured. The antibacterial effect of mangosteen pericarp was tested using agar well diffusion method on Trypticase Soy Agar-Blood Agar (TSA-BA) and de Man, Rogosa and Sharpe (MRS) agar media. The standard antiplaque agent chlorhexidine was used as the positive control. This cross-sectional, experimental study was done in Central Research laboratory, Meenakshi Ammal Dental College for period of eight weeks. Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) values were determined by microbroth dilution method. Statistical analysis was done by calculating the mean of the zones of inhibition on tested microorganisms. Mann-Whitney test was done to compare the zones of inhibition of mangosteen and chlorhexidine. The antibacterial bioassay showed the highest activity for Lactobacillus acidophilus (13.6 mm) and Streptococcus sanguis (13.6 mm), whereas, it showed a medium and low activity for Streptococcus oralis (11.3 mm), Streptococcus mutans (10.6 mm) and Streptococcus salivarius (3 mm) respectively. The MBC and MIC values were lowest for Lactobacillus acidophilus (MIC 25 mg/ml, MBC 50 mg/ml) and Streptococcus oralis (MIC 50 mg/ml, MBC 100 mg/ml). Mangosteen pericarp extract had a higher zone of inhibition against the tested microorganisms which suggests its potent antibacterial action against cariogenic organisms. However, further analytical studies are needed to isolate the key molecules of mangosteen pericarp, to explore its anticariogenic therapeutic potential on gram negative oral microorganisms.

Triphala, a New Herbal Mouthwash for the Treatment of Gingivitis: A Randomized Controlled Clinical Trial.

An antiplaque agent with minimal side effects that can be used as an effective adjunct to mechanical plaque control is needed. The current study is designed to evaluate efficacy of triphala (TRP) mouthwash in reduction of plaque and gingivitis. Ninety individuals with chronic generalized gingivitis were randomly assigned to three groups: 1) group I, placebo mouthwash; 2) group II, TRP mouthwash; and 3) group III, chlorhexidine (CHX) mouthwash. All individuals were instructed to rinse with their respective mouthwash twice daily. 1) Plaque index (PI); 2) gingival index (GI); 3) oral hygiene index-simplified (OHI-S); and 4) microbiologic colony counts were recorded at baseline and at 7, 30, and 60 days. All three groups showed gradual reduction in PI, GI, and OHI-S levels from baseline to 7, 30, and 60 days. There was also significant reduction in microbial counts in all groups at all time intervals except in group I. A significant difference was noticed with respect to reduction in PI, GI, OHI-S, and microbiologic counts in group I compared with groups II and III. However, no significant differences were found between groups II and III for any parameters at any time intervals. TRP mouthwash was found to decrease inflammatory parameters from baseline to follow-up intervals. Because improvement in gingivitis was comparable with that of CHX mouthwash, TRP mouthwash can be considered a potential therapeutic agent in the treatment of gingivitis.

Efficacy of adjunctive anti-plaque chemical agents: a systematic review and network meta-analyses of the Turesky modification of the Quigley and Hein plaque index.

The aim of this systematic review and network meta-analysis (NMA) was to compare the efficacy of different anti-plaque chemical agents, in 6-month, home-use, randomized clinical trials (RCTs), in terms of plaque index (PlI) changes. RCTs assessing PlI were identified, screened, and evaluated for inclusion. Relevant information was extracted, and quality and risk of bias were assessed. Mean differences between baseline-end were calculated to obtain weighted mean differences and 95% confidence intervals. NMA protocols were applied to assess direct and indirect comparisons among products using Turesky PlI. Eighty-three papers were included: 49 examined dentifrices, 32 mouthrinses and 2 both. The NMA analysed 51 studies including data from 4242 and 4180 subjects for dentifrices and mouthrinses respectively. For dentifrices, triclosan-copolymer and chlorhexidine showed the greatest effect, with significant differences when compared with stannous fluoride. For mouthrinses, essential oils and chlorhexidine showed the greatest effect, with significant differences when compared with delmopinol, alexidine and cetylpyridinium chloride. Within the limitations of this study (including the severe imbalance in the amount of evidence), dentifrices containing triclosan-copolymer or chlorhexidine and mouthrinses containing essential oils or chlorhexidine showed the greatest effect on PlI scores as assessed with NMA.