Chlorhexidine Gel Research Articles

Gingivitis Control in Children, Adolescents and Young Adults With Chronic Kidney Disease by a Need‐Related Programme: A Randomised Clinical Trial

ABSTRACTObjectivesChildren and young patients with chronic kidney disease (CKD) are at persistent risk of gingivitis despite usual preventive measures. This clinical study aimed to determine the efficacy of an intensive oral preventive programme (OPP) for young patients with CKD in treating plaque‐induced gingivitis modified by systemic factors.MethodsYoung patients with CKD (N = 30) were recruited/randomised to a need‐related OPP (n = 15) or treatment as usual (TAU) including mainly motivation and instructions (controls, n = 15) followed by a single intensive prophylactic appointment after 3 months. For the OPP group, depending on the baseline degree of inflammation (PBI) professional mechanical plaque removal, local chlorhexidine gel application and mouth rinse were applied at need‐related appointments focussing on local plaque control and reduction in inflammation.ResultsAfter 3 months OPP, lower plaque indices were found (2.62–0.66, p < 0.05) in contrast to TAU (2.32–2.05, p > 0.05) with differences between study groups (p < 0.05). Regarding gingivitis, lower PBI values than baseline were observed in OPP (1.03–0.05, p < 0.05) than TAU (1.15–1.00; p > 0.05); OPP reductions (effect size) were higher than after a single intensive appointment (1.00–0.36; p < 0.05). Degree of immunosuppressive therapy did not differ between groups throughout the study.ConclusionsYoung patients with CKD suffer from generalised gingivitis with increased bleeding sites. This moderate degree of inflammation shows a normal distribution of high and low plaque responders, with no pattern of impact for the degree of immunosuppression. Effectiveness and duration of preventive measures follow a dose–response principle. Therefore, need‐related preventive measures should be implemented and maintained in future regular care for CKD patients.Trial RegistrationGerman Clinical Trials Register, registration number: DRKS00010580

Comparative Efficacy of Intracanal Medicaments in Healing Apical Periodontitis: Insights from a Comprehensive Clinical Study

ABSTRACT Background: Apical periodontitis is a prevalent condition that necessitates effective intracanal medicaments for successful endodontic therapy. Materials and Methods: A randomized controlled clinical trial was conducted on 120 patients diagnosed with apical periodontitis. The patients were randomly assigned to three groups, Group A (calcium hydroxide), Group B (triple antibiotic paste), and Group C (chlorhexidine gel), with 40 patients in each group. Each medicament was placed in the root canal after standard endodontic procedures, and the patients were evaluated at 1, 3, and 6 months using radiographic assessment and clinical examination. The primary outcome measure was the reduction in lesion size, and secondary outcomes included pain relief and healing time. Results: After 6 months, Group B (triple antibiotic paste) showed the highest reduction in lesion size, with an average decrease of 75%, followed by Group C (chlorhexidine gel), with a 60% reduction, and Group A (calcium hydroxide), with a 50% reduction. Pain relief was observed in 85% of patients in Group B, 75% in Group C, and 65% in Group A. The average healing time was the shortest in Group B (4 months), compared to Group C (5 months) and Group A (6 months). Conclusion: Triple antibiotic paste demonstrated superior efficacy in healing apical periodontitis compared to calcium hydroxide and chlorhexidine gel.

Nanostructured silver vanadate gel: Evaluation of physicochemical, mechanical, and antibiofilm properties against a five-species oral model

The aim of this study was to develop a gel with nanostructured silver vanadate decorated with silver nanoparticles (β-AgVO3) and to evaluate its physicochemical, mechanical, and antibiofilm properties against a five-species oral model composed of Candida albicans, Staphylococcus aureus, Escherichia coli, Enterococcus faecalis, and Pseudomonas aeruginosa. The formulations were prepared with 0 % w/v (G0), 0.02 % w/v (G1), 0.05 % w/v (G2), and 0.12 % w/v (G3) β-AgVO3. The physicochemical properties of pH (n = 5), viscosity (n = 5), spreadability (n = 10) and syringability (n = 10) were evaluated, as well as the mechanical properties of hardness, cohesiveness, compressibility, elasticity, and adhesiveness using the texture profile assay (TPA) (n = 5) and ex vivo mucoadhesion (n = 5). The antibiofilm effect was assessed by counting colony-forming units (CFU/mL) (n = 8), metabolic activity (XTT) (n = 8), and scanning electron microscopy (SEM) (n = 1), using 0.12 % chlorhexidine gel (CG) as a positive control and G0 as a negative control. All groups demonstrated a neutral pH. G2 and G3 exhibited reduced viscosity and syringeability, along with increased spreadability. The incorporation of β-AgVO3 did not impact the gel's elasticity or cohesiveness but led to a decrease in hardness, compressibility, and adhesiveness. Ex vivo mucoadhesion was not altered by the addition of the nanomaterial. G3 showed a higher microbial reduction compared to GC and G0. It was concluded that the formulations with β-AgVO3 showed compatible physicochemical and mechanical properties for application and maintenance in the oral cavity. G3 showed superior antimicrobial effect against all microorganisms compared to GC and G0.

Real-world use of the CarestartTM glucose-6-phosphate dehydrogenase rapid diagnostic test to determine G6PD deficiency in Nigerian neonates.

G6PD deficiency (G6PDd) is the most common X-linked genetic disease worldwide and the most common cause of severe neonatal hyperbilirubinemia (NH) in Nigeria. Screening for G6PDd has been recommended for over thirty years but is still not routinely done in Nigeria. We sought to investigate a low-cost rapid diagnostic test to determine G6PDd in Nigerian neonates. Enrolled neonates were screened using the CareStartTM G6PD point-of-care rapid diagnostic test; and mothers/caregivers of neonates with G6PDd were asked about their cord care product(s); transcutaneous bilirubin levels were done on neonates with G6PDd using the JM 103 meter. One hundred and forty neonates were enrolled between 15 January and 1 July 2022. Eighteen (12.8%) of all neonates enrolled and 13.9% of enrolled males (0% of females) were G6PDd. Seventeen of the mothers/caregivers of the G6PDd neonates were asked about cord care. The majority of mothers/caregivers (15/17, 88%%) reported including methylated spirits in their neonate's cord care; seven of these used chlorohexidine plus methylated spirits (41.2%) while only one mother/caregiver used chlorohexidine alone. One mother/caregiver used mentholatum alone and another used mentholatum, chlorhexidine gel, and methylated spirits. Maximum bilirubin levels for those infants with G6PDd ranged from 3.2 to 18.8 mg/dl with 16/17 (94.1%) of bilirubin levels exceeding 5.5 mg/dl. This study again highlights the need for large-scale G6PDd screening. Additionally, it highlights the need to correlate the type of cord care with the risk of NH in future studies.

Antimicrobial efficacy of 2% chlorhexidine gel, triphala, and Azadirachta indica as intracanal medicaments against Enterococcus faecalis: A randomized clinical trial.

Concerns about adverse reactions and the development of antibiotic resistance have prompted an alternative treatment strategy that utilizes traditional medicinal herbs. This randomized control trial assessed the antimicrobial efficacy of 2% chlorhexidine (CHX) gel, Triphala, and Azadirachta indica as intracanal medicaments against Enterococcus faecalis. Forty patients with nonvital teeth and single root canals were selected (n = 10). Following the initial access opening, the first microbial samples (S1) were collected using paper points. Second microbial samples (S2) were collected following the chemo-mechanical preparation and 1 week after introducing the intracanal medicaments. Group I: 2% CHX, Group II: A. indica, Group III: Triphala, and Group IV: Calcium hydroxide (Ca(OH)2). S1 and S2 samples were collected, and bacterial growth was observed using the colony-forming unit (CFU) count. Comparison of the difference in CFU count among four groups was performed using one-way ANOVA test (P < 0.05) followed by post hoc Tukey test. Reduction in CFU count postmedication S2 from S1 in each group was statistically significant. Percentage reduction in CFU count was highest in Triphala group followed by A. indica and 2% CHX group. Percentage reduction in CFU count was least in Ca(OH)2 group. The post hoc pairwise comparison of % reduction in CFU count among four groups showed that the percent reduction was highest in Triphala group. Triphala has considerable antimicrobial efficacy against E. faecalis.

Mustard Gel versus Chlorhexidine Gel as Root-Canal Medicament Against Enterococcus Faecalis: An in vitro Study.

To evaluate the efficacy of mustard gel versus chlorhexidine (CHX) gel in treating the most resistant Enterococcus faecalis (E. faecalis) bacteria as intra-canal medications. Randomised controlled trial (in vitro study). Place and Duration of the Study: Department of Operative Dentistry, de'Montmorency College of Dentistry, in collaboration with Lahore General Hospital, between March and October 2021. Forty single-rooted teeth, extracted and randomly allocated, were divided into two groups. Group 1 underwent treatment with CHX gel, while Group 2 was treated with Mustard gel. Subsequently, after disinfection, each tooth was horizontally divided into three equal parts. The middle section was standardised and inoculated with a controlled strain of E. faecalis. Intra-canal medicaments were administered for seven days. Bacterial colonies were quantified as colony forming units (CFU/mL) and subjected to analysis using Statistical Package for Social Sciences (SPSS) version 25. The median bacterial count observed was 1,550 (range 775 - 2,500) for Group 1, contrasting with 400 (range 200 - 775) for Group 2, indicating a significant difference in bacterial count between the groups (p <0.001). Mustard gel demonstrated significantly superior efficacy compared to chlorhexidine gel against E. faecalis in root canal procedures. Chlorhexidine, Enterococcus faecalis, Mustard, Root canal medicament, Antimicrobial drug-resistance, Root canal irrigants.

Antibacterial Efficacy of Benzalkonium Chloride Gel with Tongue Brush on S. Mutans and L. Acidophilus and Tongue Coating – A Randomized Controlled Trial

Introduction: The tongue microbiota, like other parts of the oral cavity, plays a significant role in the development of dental caries. S. mutans and L. acidophilus species, are associated with the initiation and progression of dental caries.  Aim: To assess the efficacy of benzalkonium Chloride gel along with tongue cleaning aids in the reduction of tongue coating and bacterial count on dorsal surface of the tongue.  Materials and Methods: A double blinded randomized control trial was conducted among 17-25 years old college students. A total of 60 participants were randomly divided into 4 groups according to their use of tongue cleaning aids as follows: Group A, Tongue Brush Alone; Group B, Tongue Brush with Chlorhexidine Mouthwash (Clohex ADS); Group C, Tongue Brush with Chlorhexidine Gel (Hexigel); and Group D, Tongue Brush with Benzalkonium Chloride Gel. The Winkel tongue coating index (WTCI) was used to measure the tongue coating at baseline and at 14th day and the participant’s tongue coatings on dorsal surface were sampled using swab method, and the number of S. mutans and L. acidophilus colonies were counted before and after intervention.  Results: Both the Hexigel group and Benzalkonium chloride gel group reduced both the bacterial load and tongue coating at 14th Day compared to the baseline data.  Conclusion: This study suggests that usage of Tongue brush along with Benzalkonium Chloride gel decreased the tongue coating and the number of bacteria on the dorsal tongue surface.

Unveiling the correlation between in vivo endodontic reciprocate instrumentation and crack formation

IntroductionDentinal microcracks have been supposedly associated with unrestorable vertical root fractures and consequently long-term treatment failure. This study aimed to investigate whether in vivo root canal instrumentation in mandibular incisors with vital pulps causes dentinal microcracks using two different irrigating solutions. MethodsFive patients with four vital mandibular incisors indicated for extraction were included. In vivo root canal preparation was performed using Reciproc R40 (tip #40 and taper 0.06). From these, two teeth were randomly assigned for root canal instrumentation irrigated with 5.25 % sodium hypochlorite irrigation (n = 10) or 2 % chlorhexidine gel with saline solution irrigation (n = 10). In sequence, all teeth were carefully extracted, stored in saline solution until microtomography (µCT) scan. Images were reconstructed and assessed for the presence or absence of dentinal microcracks where microcracks originating from the root canal lumen would be considered. All reconstructed samples were analysed dynamically and rendered in videos through the entire extension of the teeth, evaluating the axial cuts considering each third separately from the apex to the enamel-dentinal junction. Teeth were analysed using the DataViewer software at 100 % magnification without filters by three examiners blinded to the condition allocation. ResultsNo complete dentinal microcracks were observed after root canal instrumentation of mandibular incisors with vital pulps using Reciproc R40 regardless the irrigating solutions, 5.25 % sodium hypochlorite or 2 % chlorhexidine gel. ConclusionsIn vivo root canal instrumentation of mandibular incisors with vital pulps and bone/periodontal insertion does not cause dentinal microcracks and the irrigating solutions tested did not influence this occurrence. Microcrack evaluation must be performed in vivo conditions of dental tissue moist and periodontal support to avoid dryness dentinal alterations after extraction provoking false positive results. Clinical relevanceReciprocating instrumentation performed in vivo is safe and do not induce dentinal microcracks in mandibular incisors.

TRATAMENTO ENDODÔNTICO DO PRIMEIRO PRÉ-MOLAR SUPERIOR COM EXTRAVASAMENTO DE CIMENTO OBTURADOR – RELATO DE CASO

This study aims to describe a clinical case of endodontic treatment with leakage of filling cement. Patient 30 years old, male, Caucasian, referred to the private office for endodontic treatment of tooth 14. Radiographic examination showed communication with the pulp chamber and absence of periapical bone radiolucency. After anesthesia and coronary opening, the toxic content was neutralized with a K-File 10 manual file and electronic odontometry with apical locator (Root ZX Mini, Morita, Osaka, Japan and root canal preparation with Logic 25.05 (Easy Equipamentos odontológicas- Belo Horizonte – Brazil), foraminal enlargement exceeding 1 millimeter of the real length of the tooth and, with the help of Easy Clean and this time 2% chlorhexidine gel irrigating solution, shaking it 3 cycles of 20 seconds, then 3 cycles with Edta 17 %, completed with saline. Filling the root canal system with a single cone and Bio-C Sealer cement (Angelus –Londrina -Brazil) and restoration with RC Flow Opallis resin. to the apical region.

Efficacy of Adjunctive Local Antimicrobials to Non-Surgical Periodontal Therapy in Pocket Reduction and Glycemic Control of Patients with Type 2 Diabetes: A Network Meta-Analysis.

This network meta-analysis [NMA] investigated the efficacy of adjunctive use of subgingivally delivered antimicrobials to non-surgical periodontal therapy [NSPT] in the glycemic control and periodontal pocket depth (PPD) reduction in patients with type 2 diabetes (T2D). Seven databases, grey literature, and registry platforms were searched up to February 2024 to identify randomized clinical trials (RCT) fulfilling the eligibility criteria. The risk of bias was assessed through Cochrane's tool (RoB 2). Two frequentist NMA were performed using a random-effects model to calculate mean differences (MD) as an effect measure and to quantitatively evaluate the glycated hemoglobin (HbA1c) and PPD. The certainty of evidence was assessed through the GRADE approach in a partially contextualized framework for interpreting results. Ten RCTs were included. In total, 261 patients were treated with eight different local antimicrobials adjuvants to NSPT (azithromycin gel, clarithromycin gel, tetracycline fiber or ointment, chlorhexidine gel, doxycycline nanospheres, minocycline gel, and satranidazole gel), while 249 patients received NSPT alone or associated to placebo. Considering PPD reduction (8 included studies), the best results were found after six months for satranidazole gel (MD -2.64mm; 95%CI -3.56, -1.72; moderate evidence certainty). For HbA1c control (7 included studies), doxycycline gel (MD - 0.80%; 95%CI -1.70, 0.10), chlorhexidine gel (MD -0.68%; 95%CI -1.34, -0.02), and tetracycline fiber (MD -0.62%; 95%CI -0.85, -0.39) showed promising results after three months (low evidence certainty). The adjunctive use of satranidazole gel probably reduces PPD after a 6-month follow-up, while doxycycline gel, chlorhexidine gel, and tetracycline fiber may decrease HbA1c values in patients with T2D and periodontitis treated with NSPT after a 3-month follow up.

Outcome of Nonsurgical Root Canal Retreatment of Teeth with Persistent Apical Periodontitis Treated with Foraminal Enlargement and 2% Chlorhexidine Gel: A Retrospective Cohort Study

IntroductionNonsurgical root canal retreatment (NS-RCRT) becomes necessary when primary endodontic procedures fail. This study evaluates the efficacy of NS-RCRT using 2% chlorhexidine gel and foraminal enlargement techniques, aiming to assess whether these approaches enhance periapical healing outcomes and success rates compared to traditional NS-RCRT techniques reported in the literature. MethodsThis retrospective cohort study analyzed 120 teeth diagnosed with persistent apical periodontitis, from 80 patients who underwent NS-RCRT between January 2014 and December 2018 at a specialist's private practice. Data were collected following the Preferred Reporting Items for Observational Studies in Endodontics 2023 guidelines. Periapical healing was evaluated using digital periapical radiographs by three calibrated examiners. The outcome of the treatment was analyzed through descriptive statistics and bivariate analyses, including the Chi-Square and Fisher's Exact tests. Treatment outcomes were deemed successful if they showed complete or incomplete repair and unsuccessful if no repair was observed. ResultsThe average follow-up period was 30 months. Under loose criteria, 92.50% (n = 111) of the teeth were categorized as successful, and 7.5% (n = 9) as unsuccessful. Bivariate analysis indicated that the radiographic restoration of apical transportation was the only factor that significantly influenced the outcome. ConclusionsNS-RCRT performed in a single visit using the foraminal enlargement technique and 2% chlorhexidine gel demonstrated high success rates and may be an effective alternative to tooth extraction. This method promoted periapical healing and could significantly improve NS-RCRT protocols. Further prospective studies are recommended to corroborate these findings.

Probiotics, tetracycline fibres and chlorhexidine gel's effectiveness in treating chronic periodontitis as a supplement to scaling and root planning.

A periodontal pocket can result into progressive loss of attachment. Many agents are tried to improve periodontal health. Hence this research was done to estimate the effectiveness of Tetracycline fibers; Probiotics and Chlorhexidine gel as a conjunction to scaling and root planning (SRP) in the treatment of chronic periodontitis. In all, 60 patients between the ages of 25 and 35 who had generalized chronic periodontitis and had a probing pocket depth (PPD) of at least 5 mm were enrolled for this study. Four groups of 15 patients each were created from the patients: Group 1: Tetracycline fibres after SRP, Group 2: Chlorhexidine gel, Group 3: Probiotic mouthwash and Group 4: Rinse with regular saline. At baseline, oral prophylaxis was administered to all groups. Gingival index (GI), Plaque index (PI), and probing depth (PD), among other clinical indicators, were evaluated at baseline, two weeks, and four weeks, respectively. All clinical findings, along withPlaque index (PI), Gingival index (GI), and Probing depth at various time intervals, decreased statistically significantly. Tetracycline fibres, Chlorhexidine gel, and probiotic mouthwash are all similarly effective for treating chronic periodontitis, but they are all more effective than SRP alone, according to an intergroup comparison. When it comes to SRP, local medication delivery methods are beneficial in treating periodontitis.

Analysis of tooth staining by endodontic medication in root canal therapy using spectrophotometry.

The assessment of the discoloration caused by calcium hydroxide, triple antibiotic paste, and chlorhexidine gel when used as intra-canal medicaments in teeth undergoing root canal treatment is of interest. The study measured the discoloration over seven and fourteen days using a spectrophotometer. After obtaining ethical clearance, ninety anterior teeth requiring root canal therapy were selected based on eligibility criteria. Using basic randomization, participants were split up into three groups, each consisting of thirty patients. The colorimeter was used to measure preoperative, one and two weeks following the medication's removal. All groups showed significant discoloration, with 2% chlorhexidine gel (p≤0.03) and triple antibiotic paste (p≤0.02) causing the highest discoloration in the central region of teeth. The discoloration was inversely correlated with the remaining dentin thickness. Thus, intracanal medicaments used for endodontic treatment cause tooth discolouration.

Effect of ozonated oil versus chlorhexidine gel among Indian patients with chronic periodontitis.

The efficacy of Ozonated oil in treating chronic periodontitis compared to Chlorhexidine gel following Scaling and Root Planing (SRP) is of interest. Fifty-six patients were randomly assigned to two groups: one receiving Ozonated oil post-SRP and the other receiving Chlorhexidine gel. Periodontal indices (Plaque Index, Gingival Index), Periodontal Probing Depth (PPD), and Clinical Attachment Level (CAL) were measured at baseline, one month, and three months. Intragroup comparisons for Plaque and Gingival indices showed statistically significant improvements over time (p < 0.05), but intergroup comparisons did not reveal significant differences. However, both groups demonstrated statistically significant improvements in PPD and CAL at all-time points (p < 0.05). Further research is warranted to explore Ozonated oil's potential as an antimicrobial treatment for chronic periodontitis and other oral microbial infections.

Mangostanin hyaluronic acid hydrogel as an effective biocompatible alternative to chlorhexidine

Periodontal disease (PD) prevention and treatment products typically demonstrate excellent antibacterial activity, but recent studies have raised concerns about their toxicity on oral tissues. Therefore, finding a biocompatible alternative that retains antimicrobial properties is imperative. In this study, a chemically modified hyaluronic acid (HA) hydrogel containing mangostanin (MGTN) was developed. Native HA was chemically modified, incorporating amino and aldehyde groups in different batches of HA, allowing spontaneous crosslinking and gelation when combined at room temperature. MGTN at different concentrations was incorporated before gelation. The structure, swelling characteristics MGTN release, rheological parameters, and in vitro degradation performance of the loaded hydrogel were first evaluated in the study. Then, antimicrobial properties were tested on Porphyromonas gingivalis and its biocompatibility in 3D-engineered human gingiva. HA hydrogel was very stable and showed a sustained release for MGTN for at least 7 days. MGTN-loaded HA hydrogel showed equivalent antimicrobial activity compared to a commercial gel of HA containing 0.2 % chlorhexidine (CHX). In contrast, while MGTN HA hydrogel was biocompatible, CHX gel showed high cytotoxicity, causing cell death and tissue damage. Modified HA hydrogel allows controlled release of MGTN, resulting in a highly biocompatible hydrogel with antibacterial properties. This hydrogel is a suitable alternative therapy to prevent and treat PD.

The effects of chlorhexidine gel and tranexamic acid application after tooth extraction on the risk of alveolar osteitis formation: a double blind clinical study.

Alveolar osteitis(AO), one of the most common complications occurring in 1-10% of cases following tooth extraction, occurs due to the disruption of clot formation in the extraction socket. This study aims to evaluate the effect of using absorbable gelatin sponge, chlorhexidine gel, and tranexamic acid agents on the development of AO following extraction. Between March and October 2023, the teeth of 98 healthy patients (average age: 38, range: 19-62) with extraction indications were extracted at Recep Tayyip Erdoğan University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery. 113 extraction sockets(85 molars and 28 premolars) were randomly treated with absorbable gelatin sponge(AGS), chlorhexidine gel with AGS, and tranexamic acid with AGS. Pain and edema levels were recorded using visual analog scale(VAS) ranging from 0 to 10 by the patients. Additionally, presence of halitosis, trismus and exposed bone was noted on forms on 3rd and 7th days (recorded as present or absent). The study prospectively aimed to prevent AO using 3 different dental agents in the extraction sockets. Statistical analyses of the study were conducted using the SPSS software package. Alveolitis was observed in 12 out of 113 tooth extractions(%10.6). Pain and edema scores significantly decreased in absorbable gelatin sponge group on the 7th day (p < 0.05). Pain score on the 7th day in chlorhexidine group and age, edema score on the 7th day in tranexamic acid group, were found to be significantly higher (p < 0.05). Incidence of AO, can be reduced by placing agents in the extraction socket, preventing post-extraction pain experienced by patients. NCT06435832.

The Impact of the Chlorhexidine Gel (WISDOM®) on Postoperative Sequelae Associated with the Surgical Removal of Impacted Mandibular Third Molars: A Randomized Controlled Clinical Trial

Background: One of the most prevalent procedures in oral surgery is the removal of impacted mandibular third molars, typically accompanied by trismus, edema, and pain. Several methods and biomaterials were implemented to mitigate or avoid these surgical problems. Objectives: To evaluate the efficiency of chlorhexidine gel (WISDOM®) in minimizing postoperative sequelae associated with the impacted mandibular third molar that will be surgically extracted and its role in promoting early soft tissue closure of the surgical site. Methods: The study design was a double-masked and randomized, controlled clinical study that included healthy patients needing the removal of a mandibular third molar through surgery. The participants were randomly assigned to two groups. The extraction site of the study group was filled with a mixture of gel foam and WISDOM®. In contrast, we filled the extraction sites of the control group patients with gel foam and sutured the surgical sites for both groups. The patients were evaluated on the first, third, and seventh postoperative days for pain, swelling, trismus, and early soft tissue healing. Results: Sixty eligible patients were enrolled in this study. The study group exhibited a statistically significant decrease in pain, edema, trismus, and early soft tissue healing on the first, third, and seventh postoperative days compared to the control group. Conclusions: WISDOM® gel can effectively reduce postoperative pain, trismus, and swelling and promote early soft tissue healing after surgical removal of an impacted mandibular wisdom tooth.

Comparative Efficacy of Amitriptyline and Chlorhexidine Gels in Managing Periodontitis: A Randomized Controlled Trial

Background: Amitriptyline is a tricyclic antidepressant which also has anti-inflammatory and analgesic activity. But it has not been applied as a local delivery drug in patients with periodontitis. Objective: To compare the effectiveness of 1 % amitriptyline gel with conventional 1% chlorhexidine gel as a local drug delivery, adjunctive to scaling and root planning in patients with periodontitis. Materials and Methods: This randomized clinical control trial was done in Department of Pharmacology, University of Karachi, Sindh, Pakistan and HEJ research institute of Chemistry, University of Karachi, from 1st December 2022 to 31st July 2023. A total of 30 patients both male and female were equally divided into 3 groups. Control group: received only scaling and root planning (SRP). Study group 1: treated with SRP followed by the application of 1% chlorhexidine (CHX) gel. Study group 2: treated with SRP followed by the application of 1% amitriptyline gel. Clinical parameters including pocket depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), tooth mobility (TM), plaque index (PI), gingival index (GI), as well as biochemical parameters, tumor necrosis factor- alpha (TNF-á) levels, were evaluated using ELISA kit. Statistical analysis was done by One way ANOVA followed by Tuckey's HSD for comparisons among groups.Results: Reduction in PD, CAL, BOP, PI, GI and TNF-á was observed by both amitriptyline and CHX gel groups as compared to control group (p&lt;0.001) But reduction in PD (p&lt;0.001), CAL (p&lt;0.001) and TM (p&lt;0.05) was greater in amitriptyline group as compared to CHX group. Conclusion: Unconventional 1% amitriptyline gel is more effective in reducing the clinical and inflammatory biomarkers as compared to conventional 1% CHX gel in treating the periodontal disease via local drug delivery method (LDD).Keywords: Amitriptyline, Chlorhexidine, Local drug delivery, Periodontitis

A Ten-Year Review of Neonatal Tetanus Seen in a Tertiary Health Facility in Sokoto North-Western Nigeria: Before and During the Covid-19 Pandemic

Background: Neonatal tetanus (NNT) remains among the leading cause of preventable morbidity and mortality among neonates in Nigeria. Nigeria remains among the countries carrying the global NNT burden. At the onset of the COVID-19 pandemic, reports have predicted that the pandemic will significantly impact on the health system globally, and low-resource countries where vaccination programs fared even worse are likely to see a surge in vaccine-preventable diseases during and after COVID-19 pandemic. Aims: To determine the prevalence, yearly trend, risk factors, and outcome of NNT cases seen in the Special Care Baby Unit (SCBU) of Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria over a ten year period: before and during COVID-19 pandemic. Methods: This was a retrospective study. Data was retrieved from all the case notes of neonates admitted with a clinical diagnosis of NNT into the SCBU of the UDUTH, Sokoto from 1st January, 2013 to 31st December, 2022. The data obtained was analyzed using SPSS version 21. Results: During the 10 years period of the study, NNT accounted for 0.4% of admissions. The majority 15(57.0%) of the mothers of the neonates with NNT were from rural areas, 15(56.0%) had no antenatal care (ANC), and only 10(37.0%) of the mothers received vaccination against tetanus. All the mothers were from lower socio-economic classes. Most 17(63.0%) of the neonates were delivered at home by traditional birth attendants. The umbilical cord was the portal of entry in 26(96.0%) of cases, while 1(4.0%) followed traditional uvulectomy. Cord care was done using hot water fermentation in more than half of the neonates 17(63.0%), while only 1(4.0%) of the mothers used chlorhexidine gel for cord care. The case- fatality rate was 6(22.0%). the yearly trend showed an increased incidence of NNT admissions in 2022. Conclusion: The study showed that NNT is still a public health problem, with an increased scourge during the COVID-19 pandemic, which can be tackled through health education of mothers via mass media, improving the quality and access to ANC services, tetanus toxoid vaccination, hospital delivery and avoidance of traditional uvulectomy particularly in rural areas by the Sokoto state government. Antenatal and vaccination services should be given priority in response to future pandemics to sustain gains of the SDG 3.

Comparison Between the Effects of Alvogyl Paste and 0.2% Chlorhexidine Gel on Postoperative Swelling Following Mandibular Third Molar Surgery

Facial swelling, pain, and trismus are typical side sequelae of mandibular third molar surgery. These symptoms are all caused by tissue inflammation followed by trauma from surgery and the quality of life of these patients has been significantly impacted by these symptoms in the immediate post-operative period. Both Alvogyl and chlorhexidine bio-adhesive gel are routinely used in dental practice to reduce post-operative sequelae due to their antimicrobial and anti-inflammatory properties. The study was set up as a randomized controlled clinical study and conducted from February 2022 to September 2022. The study involved patients 18-39 years old who sought extraction of an impacted lower third molar attending the Oral Surgery Clinic in the College of Dentistry in Baghdad. The sample was divided into three groups, the first group received Alvogyl paste following third molar surgery while the second group received periokin chlorhexidine bio-adhesive gel and the last control group didn’t receive any medication. Results of a study with 51 patients, equally assigned into two study groups and a control group, indicate that in the study groups, there was a reduction in post-operative facial swelling in comparison with the control group and the reduction was statistically significant (P =0.001), and the Alvogyl paste was superior to chlorhexidine in swelling reduction but statistically not significant.