Chlorhexidine Gluconate Mouthrinse Research Articles

Comparing the antiplaque efficacy of 0.5% Camellia sinensis extract, 0.05% sodium fluoride, and 0.2% chlorhexidine gluconate mouthwash in children.

Background:Dental caries is a multifactorial disease which requires a susceptible host, a cariogenic microflora, and a suitable substrate that must be present for a sufficient length of time. Tea is prepared by the infusion of dried leaves of the tea plant, Camellia sinensis, which contains bioactive compounds like polyphenols, flavonoids, and catechins that are thought to be responsible for the health benefits that have traditionally been attributed to tea. These compounds have multidimensional effects such as antibacterial action, inhibitory action on the bacterial and salivary amylase, and inhibition of acid production.Aims:The aim of this study is to compare the antiplaque efficacy of 0.5% C. sinensis extract, 0.05% sodium fluoride, and 0.2% chlorhexidine gluconate mouthwash in children.Materials and Methods:A randomized blinded controlled trial with 60 healthy children of age group 9–14 years was carried out. The subjects were randomly assigned to three groups, i.e. group A – 0.2% chlorhexidine gluconate, group B – 0.05% sodium fluoride, and group C – 0.5% C. sinensis extract, with 20 subjects per group. Plaque accumulation and gingival condition were recorded using plaque index and gingival index. Oral hygiene was assessed by simplified oral hygiene index (OHIS). Salivary pH was assessed using indikrom pH strips. Plaque, gingival, and simplified OHI scores as well as salivary pH were recorded at baseline, immediately after first rinse, after 1 week, and in the 2nd week.Statistical Analysis Used:The data were analyzed using a computer software program (SPSS version 17). Analysis of variance (ANOVA) tests were used to identify significant differences between the means of the study groups. Finally, paired t-tests were used to assess the significance of changes within each group between time periods. Critical P values of significance were set at 0.05 and the confidence level set at 95%.Results:Mean plaque and gingival scores were reduced over the 2-week trial period in the experimental groups. Antiplaque effectiveness was observed in all groups, the highest being in group C (P < 0.05). Chlorhexidine gluconate and tea showed comparative effectiveness on gingiva better than sodium fluoride (P < 0.05). The salivary pH increase was sustained and significant in groups B and C compared to group A. Oral hygiene improvement was better appreciated in groups A and C.Conclusions:The effectiveness of 0.5% C. sinensis extract was more compared to 0.05% sodium fluoride and 0.2% chlorhexidine gluconate mouth rinses. It should be explored as a cost-effective and safe long-term adjunct to oral self-care of patients as it has prophylactic benefits with minimum side effects.

Efficacy of dental floss and chlorhexidine mouth rinse as an adjunct to toothbrushing in removing plaque and gingival inflammation - a three way cross over trial.

Maintaining good oral hygiene is important to combat periodontal diseases. The use of tooth brush alone does not serve the purpose of removing plaque which demands the use of some adjuncts such as proximal cleaning aids. The study was conducted to compare the efficacy of Dental Floss and 0.12% Chlorhexidine Gluconate Mouthrinse as an adjunct to toothbrushing on plaque accumulation and gingival inflammation. Department of Public Health Dentistry, Kothiwal Dental College and Research Centre, Moradabad, India. This was a randomized, double blind, three-way cross over clinical trial. Forty five dental students in the age group of 19-25yr. were enrolled into the study. Subjects were randomly assigned into three groups (n=15) i.e. Group A- Toothbrushing with Dental floss (TB+DF), Group B- Toothbrushing with 0.12% Chlorhexidine Gluconate Mouthrinse (TB+CHX-MR) and Group C- Toothbrushing alone (TB Alone) in a three-way crossover manner. After 21 d of trial period, plaque index (PI) and gingival index (GI) were assessed for each group, oral prophylaxis followed by a washout period for 14d. Mean, standard deviations and p-values were obtained. ANOVA test was used to compare the intergroup difference and Post hoc test to compare between the two groups. The inter-group comparison for GI and PI at all interventions showed statistically significant difference (p<0.001). While comparing between group A and group C at second and third follow up, no significant difference were observed though group A showed reduction in mean values for both the clinical parameters whereas while comparing between group A and group B, statistically significant difference was observed, which is in line when compared with group B and group C. The Group B showed more reduction in plaque and gingival scores which was found to be statistically significant (p<0.001). CHX-MR when used as an adjunct to toothbrushing is more effective in the reduction of plaque and gingival scores than a toothbrush alone or in combination with DF.

Chemical vs. herbal formulations as pre-procedural mouth rinses to combat aerosol production: A randomized controlled study

Background: Disease transmission and barrier techniques are the key concerns during ultrasonic instrumentation as this procedure has the hazard of aerosol production which has a multitude of deleterious effects on the body. The aerosol produced can affect both the patient and the clinician. The aim of this study was to assess the importance of pre-procedural rinsing before scaling by ultrasonic instrumentation and to compare the efficacy of commercially available herbal mouth rinse and a Chlorhexidine gluconate mouth rinse with a control group. The study was conducted from 1 st February to 15 th April 2012 in a tertiary referral care hospital. The study was approved by the institutional ethical committee. This was a randomized single blinded interventional study, where in 36 patients equally divided into three groups participated. Material and Methods: Thirty six patients were recruited in this study aged between 18-35 years. All patients had plaque index scores between1.5-3.0, and were categorized into three groups. Patients with systemic diseases and on antibiotic therapy were excluded. Group A or control group underwent scaling with water as pre-procedural rinse, Group B used 20 ml of 0.2% Chlorhexidine and group C were administered 18 ml of a herbal pre-procedural rinse. Aerosol splatter produced during the procedure were collected on blood agar plates and sent for microbiologic analysis for the assessment of bacterial Colony Forming Units (CFUs). The mean CFUs and standard deviation (SD) for each group were measured. Post hoc test was used to compare the differences between three groups, Control (A) Chlorhexidine (B) and Herbal (C). Results: The mean Colony Forming Units (CFUs) for control group was 114.50, Chlorhexidine group was 56.75 and herbal rinse group was 47.38. Conclusion: Pre-procedural rinsing was found to be effective in reducing aerosol contamination during ultrasonic scaling though no statistically significant difference was found between the two test groups Chlorhexidine and Herbal mouth rinse.

A Novel Technique for Osteotome Internal Sinus Lifts With Simultaneous Placement of Tapered Implants to Improve Primary Stability

A Novel Technique for Osteotome Internal Sinus Lifts With Simultaneous Placement of Tapered Implants to Improve Primary Stability

Corrosion in Haas expanders with and without use of an antimicrobial agent: an in situ study

ObjectivesThe purpose of this study was to evaluate in situ the occurrence of corrosion in the soldering point areas between the wire, silver brazing and band in Haas expanders. Material and MethodsThirty-four 7-12-year-old patients who needed maxillary expansion with a Haas expander were randomly assigned to two groups of 17 individuals each, according to the oral hygiene protocol adopted during the orthodontic treatment: Group I (control), toothbrushing with a fluoride dentifrice and Group II (experimental), toothbrushing with the same dentifrice plus 0.12% chlorhexidine gluconate (Periogard®) mouthrinses twice a week. The appliances were removed after approximately 4 months. Fragments of the appliances containing a metallic band with a soldered wire were sectioned at random for examination by stereomicroscopy, scanning electron microscopy (SEM) and energy dispersive x-ray spectroscopy (EDS). Data were analyzed statistically by Fisher's test at 5% significance level. ResultsThe analysis by optical microscopy revealed areas with color change suggestive of corrosion in the soldering point areas joining the band and the wire in all specimens of both groups, with no statistically significant difference between the groups (p=1). The peaks of chemical elements (Ni, Fe, Cr, O, C and P) revealed by EDS were also similar in both groups. Conclusion: Color changes and peaks of chemical elements suggestive of corrosion were observed in the soldering point areas between the wire, silver brazing and band in both control and experimental groups, which indicate that the 0.12% chlorhexidine gluconate mouthrinses did not influence the occurrence of corrosion in situ.

Evaluation of chlorhexidine gluconate mouthrinse-induced staining using a digital colorimeter: an in vivo study.

To investigate the persistence of staining after the use of chlorhexidine gluconate mouthrinse. Twenty-four subjects (nine women and 15 men) who underwent periodontal therapy and were prescribed the use of 0.2% chlorhexidine gluconate mouthrinse participated in this study. Color values of maxillary central incisors, canines, and first molars were recorded at baseline; 3 days; and 1, 2, and 3 weeks of twice-daily chlorhexidine gluconate use with a digital intraoral colorimeter according to the CIE L*a*b* coordinates. While color-change (Delta E) values showed significant differences (P=.020) at different time points (10.1, 8.9, 8.9, 9.4, after 3 days and 1, 2, and 3 weeks, respectively), the duration of chlorhexidine gluconate use did not significantly affect the results (P=.873) (two-way ANOVA, Tukey test). No significant difference was found among Delta L* (P=.070), Delta a* (P=.169), and Delta b* (P=.691) values at any time point (one-way ANOVA). Measurements of baseline to day 3 differences showed significantly higher Delta E values than those at other time points (P<.05), but this change remained nonsignificant after 1, 2, and 3 weeks of chlorhexidine gluconate use (P>.05) (Tukey test). The highest visible staining occurred on the first molars at all time points (83%, 79%, 79%, and 96% after 3 days and 1, 2, and 3 weeks, respectively) compared to the other teeth evaluated. The staining effect of chlorhexidine gluconate mouthrinse on natural dentition should be expected to be the highest in the first few days of use.

A clinical evaluation of the effect of 0.2% chlorhexidine gluconate as a mouthrinse on gingival inflammation in pregnant and non-pregnant women with and without undergoing scaling and root planing procedures

There is a high incidence of gingivitis in pregnant women due to combined effect of local and systemic factors. Chlorhexidine is an effective chemical plaque control agent by virtue of its property substantivity. Aim and Objective: In the present work we propose to study the effect of 0.2% chlorhexidine gluconate solution as a mouth rinse on gingival inflammation in pregnant women in comparison with non-pregnant women, before and after scaling and polishing procedures. Materials and Methods: A total number of seventy six healthy pregnant and non pregnant females in the age group of 20 to 30 years were included for the study. All the subjects used 0.2% chlorhexidine gluconate mouthrinse twice a day for 3 weeks. Weekly observations were made in both subgroups. Results: There was no significant reduction in plaque index, papilla,marginal gingiva and attached gingiva index and gingival bleeding index when 0.2% chlorhexidine gluconate mouth rinse was used alone without scaling and polishing procedures. When 0.2% chlorhexidine gluconate mouthrinse was used after scaling and polishing procedures at the end of 3 weeks, there was highly significant reduction in PMA index and gingival bleeding index in nonpregnant women group, whereas in pregnant women group there was only a significant reduction in the gingival bleeding index. Conclusion: 0.2% chlorhexidine gluconate used as mouth rinse twice a day for three weeks reduces gingival inflammation and gingival bleeding in both pregnant and non pregnant women, but significantly more in non pregnant women.

Investigation of bacteremia after toothbrushing in orthodontic patients

Objective: The aim of this study was to investigate the occurrence rate of bacteremia following toothbrushing with toothpastes composed of several antibacterial agents and compare the results with the conventional oral hygiene maintaining methods in orthodontic patients. Methods: This clinical study included 100 adult orthodontic patients who were divided into 4 groups. Each group comprised of 25 patients, wearing fixed orthodontic appliances. In the first group, bacteremia was assessed after toothbrushing without using any toothpaste. In the second group, a 0.2% chlorhexidine gluconate mouthrinse was used before brushing with no toothpaste. In the third group, subjects brushed with a commonly used toothpaste which did not include an additional antimicrobial agent. The fourth experimental group used toothpaste which included tea tree oil, clove oil, peppermint oil and bisabolol as antimicrobial elements. Pre- and post-brushing blood samples were obtained using a strict aseptic technique. All samples were microbiologically evaluated using blood culture bottles. Results: Toothbrushing in orthodontic patients yielded to an increase in the occurrence rate of bacteremia when using normal toothpaste or no toothpaste at all. Conclusions: The use of chlorhexidine mouthwash before toothbrushing, and brushing with antimicrobial toothpaste did not show a statistically significant difference in preventing the occurrence of bacteremia (p ＞ 0.05).

Adverse events associated with chlorhexidine use: Results from the Department of Veterans Affairs Dental Diabetes Study

The authors report adverse events (AEs) related to the use of chlorhexidine gluconate mouthrinse in a clinical trial of the efficacy of periodontal treatment in older adults with diabetes. Participants were U.S. veterans with uncontrolled diabetes (hemoglobin A(1c) value > or =8.5 percent) and periodontal disease. Treatment included periodontal scaling, 0.12 percent chlorhexidine lavage during ultrasonic scaling and use of chlorhexidine mouthrinse at home. Forty-four (31 percent) of 140 subjects reported having AEs. Most common were taste changes and tooth staining, sore mouth and/or throat, tongue irritation and wheezing/shortness of breath; the latter was reported more commonly before chlorhexidine use than after. Only body mass index greater than 30 was significantly related to AEs. AEs are common among subjects using chlorhexidine mouthrinse. Most AEs (taste change and staining) were resolved easily by subjects' discontinuing mouthrinse use and receiving dental prophylaxis. No serious AEs were reported. Clinicians should advise patients using chlorhexidine mouthrinse of possible side effects. If necessary, patients should discontinue mouthrinse use and obtain medical care. Careful monitoring of AEs in patients using chlorhexidine is warranted.

The Effect of 0.12% Chlorhexidine Gluconate Rinsing on Previously Plaque‐Free and Plaque‐Covered Surfaces: A Randomized, Controlled Clinical Trial

Previous in vitro studies showed little bactericidal effect on structured oral biofilm after exposure to chlorhexidine (CHX). In vivo evidence of a CHX effect against structured biofilm is scarce. The purpose of this study was to compare the efficacy of 0.12% CHX gluconate on previously plaque-free and plaque-covered surfaces. This study had a single-masked, randomized split-mouth, 21-day experimental gingivitis design including 20 individuals who refrained from all mechanical plaque control methods for 25 days. On day 4 of plaque accumulation, the individuals had two randomized quadrants cleaned; the other two quadrants served as the plaque-covered surfaces. Also, on day 4, the individuals started rinsing with 0.12% CHX gluconate for 21 days. The Quigley and Hein plaque index (PI), gingival index (GI), and gingival crevicular fluid (GCF) volume were assessed at baseline and days 21 and 25. The PI also was assessed at days 4, 11, and 18. Intergroup comparisons showed statistically higher PI throughout the study on the plaque-covered surfaces compared to the plaque-free surfaces. When the inflammatory response over time was analyzed, a statistically greater increase in GI (from 0.21+/-0.02 to 0.93+/-0.03 versus from 0.18+/-0.01 to 0.52+/-0.03 on plaque-covered and plaque-free surfaces, respectively) and GCF volumes (from 48.09 to 94.28 microl versus from 46.94 to 64.99 microl on plaque-covered and plaque-free surfaces, respectively) occurred on plaque-covered surfaces after 21 days of plaque accumulation. A 0.12% CHX gluconate mouthrinse had little antiplaque and antigingivitis effect on previously plaque-covered surfaces. These results confirm the diminished effect of CHX on structured biofilm and reinforce the necessity of biofilm disruption before the initiation of CHX mouthrinse.

Microbiological Evaluation of 0.2% Chlorhexidine Gluconate Mouth Rinse in Orthodontic Patients

To assess the effectiveness of 0.2% chlorhexidine gluconate mouth rinse on Streptococcus mutans and lactobacilli in orthodontic patients with fixed appliances. Twenty patients, aged 13-18, with fixed orthodontic appliances participated in the study. The levels of S mutans and lactobacilli in saliva samples were evaluated at four stages: at the beginning of the orthodontic treatment, at least 2 weeks after the bonding of brackets, 1 week after the introduction of 0.2% chlorhexidine gluconate mouth rinse, and at the fourth week. The changes in S mutans and lactobacilli levels were analyzed via Wilcoxon test. Increases in bacterial levels of S mutans and lactobacilli were detected after the orthodontic appliances were bonded. A significant decrease in S mutans levels was observed 1 week after the introduction of chlorhexidine mouth rinse. An 0.2% chlorhexidine gluconate mouth rinse decreased S mutans levels, but had no effect on lactobacilli levels.

Early biofilm formation and the effects of antimicrobial agents on orthodontic bonding materials in a parallel plate flow chamber

Decalcification is a commonly recognized complication of orthodontic treatment with fixed appliances. A technology, based on a parallel plate flow chamber, was developed to investigate early biofilm formation of a strain of Streptococcus sanguis on the surface of four orthodontic bonding materials: glass ionomer cement (Ketac Cem), resin-modified glass ionomer cement (Fuji Ortho LC), chemically-cured composite resin (Concise) and light-cured composite resin (Transbond XT). S. sanguis was used as it is one of the primary colonizers of dental hard surfaces. Artificial saliva was supplied as a source of nutrients for the biofilms. The effects of two commercially available mouthrinses (i.e. a fluoride containing rinse and chlorhexidine) were evaluated. Initial colonization of the bacterium was assessed after 6 hours of growth by the percentage surface coverage (PSC) of the biofilm on the disc surfaces. There were statistically significant differences in bacterial accumulation between different bonding materials (P < 0.05), Concise being the least colonized and Transbond XT being the most colonized by S. sanguis biofilms. All materials pre-treated with 0.05 per cent sodium fluoride mouthrinse showed more than 50 per cent reduction in biofilm formation. The 0.2 per cent chlorhexidine gluconate mouthrinse caused significant reduction of biofilm formation on all materials except Ketac Cem. This in vitro study showed that the use of a chemically-cured composite resin (Concise) reduced early S. sanguis biofilm formation. Also, fluoride had a greater effect in reducing the PSC by S. sanguis biofilms than chlorhexidine. Rinsing with 0.05 per cent sodium fluoride prior to placement of orthodontic appliances is effective in reducing early biofilm formation.

The Effects Of Alcohol-free 0.12% W/N Chlorhexidine Gluconate Mouthrinse On Oral Health

CWorhexidine gluconate, a dicationic bisbiguanide agent, contains anti-plaque properties. Most chlorhexidine gluconate mouth rinses presently available contain alcohol in varying concentrations. The role of alcohol in these mouth rinses is to act as a preservative and solvent although it may have deleterious effects on the oral epithelium on long term usage. Recently, an alcohol-free 0.12 % w/v chlorhexidine gluconate mouth rinse (Oradex?) has become available in Malaysia. This clinical study is aimed at determining the effects of this alcohol-free product compared to a placebo. A group of 60 meticulously screened subjects were assigned into two groups of 30 each. The first group started using the test product for 2 weeks followed by a washout period of 4 weeks. After this duration, this group used the placebo for a further 2 weeks. The 2nd group underwent similar protocol as the 1st except that this group started with the placebo. Measurements consisting of the following scores were recorded at baseline and after 2 weeks for each group: Plaque, Gingivitis: Papillary Bleeding, Stain and Calculus. Full mouth prophylaxis was carried out for all subjects after measurements at baseline as well as after the 2-week period. They were told to rinse with 15 ml of the designated mouth rinse twice daily for thirty seconds each after tooth brushing. The results of this study indicated that there was significant improvement in the plaque, gingival and papilla bleeding scores compared to the placebo. Stain and calculus scores were significantly increased for the test product when compared to the placebo. In conclusion, this study showed that alcohol-free 0.12 % w/v chlorhexidine gluconate mouth rinse is effective in reducing plaque and gingivitis but causes staining and calculus formation.

Evaluation of aerosol contamination during debonding procedures.

The aim of this study was to show how the aerosol generated by the use of an air turbine handpiece during debonding procedures increases the potential risk factor for the distribution of infectious agents. A second aim of the study was to evaluate the effectiveness of a preprocedural chlorhexidine mouth rinse in reducing the number of colony forming units (CFU) found in aerosol samples. Blood agar plates were attached to the face shields and the dental chair table and were used for collecting the aerosol samples. In the first part of the study, 260 samples were collected for the baseline group in an empty room, 36 samples were collected for the control group (C), in which the orthodontist, dental assistant, and the patient were in the operatory room, and 42 samples were collected for the debonding group (DB). The microbiologic analysis showed significant differences between the baseline group and the control group (P < .05). Furthermore, aerosol contamination increased significantly during the debonding procedure when compared with the control group (P < .01). In the second part of the study, an air turbine handpiece was used to remove excess adhesive from the tooth surface on one side of the mouth and air samples were collected. The patients then were instructed to rinse their mouths with 0.2% chlorhexidine gluconate for 1 minute, and the orthodontist worked on the other side of the mouth and the air sampling was repeated. An insignificant reduction was found in the number of colony forming units following the chlorhexidine mouth rinse. Results of this study indicated that orthodontists are exposed to high levels of aerosol generation and contamination during the debonding procedure, and preprocedural chlorhexidine gluconate mouth rinse appears to be ineffective in decreasing the exposure to infectious agents. Therefore, barrier equipment should be used to prevent aerosol contamination.

Perioperative use of 0.12% chlorhexidine gluconate for the prevention of alveolar osteitis: Efficacy and risk factor analysis

Objectives. The purposes of this study were to evaluate the use of 0.12% chlorhexidine gluconate as a prophylactic therapy for the prevention of alveolar osteitis and to further examine subject-based risk factors associated with alveolar osteitis. Study Design. The trial was a randomized, double-blind, placebo-controlled, parallel-group study conducted among 279 subjects, each of whom required oral surgery for the removal of a minimum of one impacted mandibular third molar. Subjects were instructed to rinse twice daily with 15 ml of chlorhexidine or placebo mouthrinse for 30 seconds for 1 week before and 1 week after the surgical extractions. This regimen included a supervised presurgical rinse. Alveolar osteitis diagnosis was based on the subjective finding of increasing postoperative pain at the surgical site that was not relieved with mild analgesics, supported by clinical evidence of one or more of the following: loss of blood clot, necrosis of blood clot, and exposed alveolar bone. Results. In comparison with use of the placebo mouthrinse, prophylactic use of the chlorhexidine mouthrinse resulted in statistically significant ( p < 0.05) reductions in the incidence of alveolar osteitis. With chlorhexidine therapy, the subject- and extraction-based incidences of alveolar osteitis in the evaluable subset (271 subjects) were reduced, relative to placebo, by 38% and 44%, respectively. The corresponding odds ratios that describe the increased odds of experiencing alveolar osteitis in the placebo group were 1.87 and 2.05 for subject- and extraction-based analyses, respectively. In comparison with nonuse of oral contraceptives, the use of oral contraceptives in female subjects was related to a statistically significant increase in the incidence of alveolar osteitis (odds ratio = 1.92, p = 0.035). Relative to male subjects, the observed incidence of alveolar osteitis for female subjects not using oral contraceptives was not statistically significant (odds ratio = 1.18, p = 0.64). Smoking did not increase the incidence of alveolar osteitis relative to not smoking (odds ratio = 1.20, p = 0.33). Conclusions. These data confirm that the prophylactic use of 0.12% chlorhexidine gluconate mouthrinse results in a significant reduction in the incidence of alveolar osteitis after the extraction of impacted mandibular third molars. In addition, oral contraceptive use in females was confirmed to be a risk factor for the development of alveolar osteitis.

Changes in the oral microflora during cytotoxic chemotherapy in children being treated for acute leukemia

Thirty-four children with diagnosed cases of acute leukemias and being treated with cytotoxic chemotherapy at St James' Hospital, Leeds, were followed for between 6 months and 1 year to determine the changes in their oral microflora. They were examined before treatment commenced and then at monthly intervals. Swabs were taken from the oral cavity to test for the presence or absence of bacteria and Candida. Saliva samples were also used to assess the levels of Streptococcus mutans in the mouth. Sensitivity tests were carried out to assess the effect of the cytotoxic agents on the oral flora. All children received prophylactic nystatin and chlorhexidine gluconate mouthrinses four times daily for the whole period of the study. There was significant difference ( p < 0.0001) for counts of S. mutans at different treatment stages. Sensitivity tests showed that S. mutans was sensitive to the cytotoxic drug daunorubicin, and this drug was probably responsible for the fall in S. mutans counts. A significant difference was also found in the types of bacteria isolated between the study and reference groups, but there was no change in the composition of the flora in the study group during treatment. These bacteria were also found to mirror those cultured from routine blood samples in children with acute leukemia.

Use of toothpicks for chlorhexidine staining.

The purpose of this study was to determine if the extrinsic dental staining associated with the use of chlorhexidine gluconate (CHX) mouthrinse could be prevented or controlled by the patient with the use of toothpicks. 25 subjects received a prophylaxis to establish a stain-free baseline and were then randomly assigned a control and experimental side of the mouth. The rinsing regimen was 1/2 oz of 0.12% CHX mouthrinse 2x a day for 3 months. Subjects self-examined daily for the appearance of stain. Where stain was visible, a toothpick was used to 'rub it away' on the distolabial, labial and mesiolabial surfaces of the experimental side only. The rubbing action was similar to the use of an eraser to remove a pencil mark from paper. The amount and intensity of stain was photographed and graded by a blinded examiner after 2 weeks, 1, 2 and 3 months. Subjects kept calendars to encourage and document compliance. When analyzed across time, teeth and surfaces, there was a statistically significant difference in stain between the control and experimental sides for stain amount, intensity, and for a composite of amount/intensity. Clinical differences were slight. The study indicates that the use of a simple toothpicking technique can affect chlorhexidine stain.

The effects of a 0.12% chlorhexidine gluconate mouthrinse on orthodontic patients aged 11 through 17 with established gingivitis

The purpose of this study was to assess the effectiveness of a 0.12% chlorhexidine gluconate (CH) mouthrinse, Peridex, on orthodontic patients 11 through 17 years of age with established gingivitis. Thirty-four subjects were divided into two groups (CH and placebo) of 17 subjects each on the basis of gender, and they were evaluated at baseline, at 6 weeks, and at 12 weeks in a double-blinded manner. The gingival index (GI) of Löe and Silness, the plaque index (PI) of Silness and Löe, the Eastman Interproximal Bleeding Index, and the CWRU staining index were recorded for each subject. The subjects in the CH group, as compared with the placebo group, had statistically significant reductions, expressed as percent reductions against baseline, at the conclusion of this 3-month period: PI = 64.9%, GI = 60.0%, and gingival bleeding = 77.2%. Staining was in the moderate range, and it was concentrated on the mandibular lingual surfaces. Peridex, in combination with mechanical plaque removal, proved to be an important therapeutic agent in controlling gingival inflammation, bleeding, and plaque accumulation in orthodontic patients 11 through 17 years of age with established gingivitis.

Bacteremia Following Subgingival Irrigation and Scaling and Root Planing

The purpose of this study was to determine the incidence of bacteremia after a single professional subgingival irrigation with a 0.12% chlorhexidine gluconate mouthrinse (CHX) as well as after a subsequent scaling and root planing (S/RP) during the same visit. Thirty subjects each with at least 1 site that probed 4 mm or more and bled on probing were randomly assigned to the following groups: 1) irrigation with 0.12% CHX; 2) irrigation with sterile water; and 3) non-irrigated controls. To begin the study blood was drawn just before and 2 minutes after irrigation. Thirty minutes later, blood was drawn again just before and 2 minutes after S/RP at the same site. Specimens were cultured for anaerobic and aerobic microorganisms using standard cultural techniques. Eighteen blood cultures from 15 subjects yielded positive cultures resulting in 23 isolates. Gram-positive rods comprised 34.8% of the total isolates; Gram-positive cocci 34.8%, Gram-negative rods 21.7%, and Gram-negative cocci 8.7%. In the CHX group, bacteremia was detected in 5 subjects after irrigation and in 2 other subjects after S/RP. In the water group, bacteremia was detected in one subject after irrigation and in 4 subjects after S/RP. The control group had 3 bacteremias after S/RP. There was no significant difference between the incidence of bacteremia associated with irrigation by CHX or sterile water (P = 0.141). There was also no significant difference in the incidence of bacteremia after S/RP between the CHX and sterile water irrigation groups and in patients who did not receive irrigation (control group) (P = 0.88).(ABSTRACT TRUNCATED AT 250 WORDS)

The effects of a 0.2% chlorhexidine gluconate mouthrinse on plaque, toothstaining and candida in aphthous ulcer patients

Despite the known effectiveness of 0.2% chlorhexidine gluconate mouthwash in preventing plaque formation, relatively few studies have assessed adjunctive benefit to normal unsupervised oral hygiene measures. Furthermore, there have been few accurate measurements of toothstaining in the presence of normal oral hygiene and little data of effects on oral candidal carriage. This study was a double-blind placebo-controlled cross-over study of a 0.2% chlorhexidine gluconate mouthwash used 3 times daily on plaque, staining and candidal carriage in a group of recurrent aphthous ulcer suffers who maintained normal oral hygiene measures. At the end of 2 6-week treatment periods, baseline plaque scores were reduced by active and placebo mouthwashes. Chlorhexidine significantly reduced plaque compared to the placebo. Staining has markedly and significantly increased during chlorhexidine rinsing. Candidal carriage was present in 22.2% of this group and there was no significant effect of chlorhexidine on the mean number of candidal colonies. The distribution of plaque and staining by tooth was plotted and observationally studied. Baseline and placebo treatment plaque distributions indicated the considerable relevance of toothbrushing behaviour for plaque distribution. The effects of toothbrushing on plaque distribution were minimised during the use of chlorhexidine. Staining associated with chlorhexidine showed a distribution again suggesting the influence of toothbrushing. In conclusion, chlorhexidine has significant adjunctive effects on plaque inhibition in the presence of normal unsupervised oral hygiene, but toothbrushing did not prevent toothstaining.