Chlorhexidine Solution Research Articles

Skincare practices in extremely premature infants: A survey of tertiary neonatal intensive care units from Australia and New Zealand

To investigate skincare practices in the first 2 weeks of life in extremely premature infants across tertiary neonatal intensive care units (NICUs). A web-based secure survey invite was emailed to the medical directors of tertiary NICUs. The survey included questions on various aspects of skincare practices in the first 2 weeks of life in extremely premature infants (born before 28 weeks gestation). The person most familiar with local skincare practices was asked to complete the survey and only one response per unit was requested. We performed a descriptive analysis. We received responses from 30 out of 32 NICUs (response rate 93%). Twenty-five NICUs (89%) reported offering resuscitation and intensive care to infants born at ≥23 weeks gestation. All NICUs reported occurrences of skin breakdown, including medical adhesive-related skin injury (30%), abrasion/friction-associated skin injury (46%), perineal skin breakdown (55%), pressure site injury (47%) and diaper dermatitis (60%). A high level of consensus (≥75%) was observed for certain practices, such as the use of polyethylene occlusive plastic wraps at birth and aqueous chlorhexidine solution for sterile procedures, but a low level of consensus (<25%) was observed for many other practices, including the skin risk assessment tool used. Skin injuries in extremely premature infants are common and skincare practices vary considerably amongst NICUs. Clinical practice improvement projects and further clinical research will help improve consistency amongst NICUs. Further research is needed to assist the development of evidence-based guidelines and benchmarking for skincare practices in these vulnerable infants.

Role of chlorhexidine on tracheostomy cannula decontamination in relation to the growth of Biofilm-Forming Bacteria Colony- a randomized controlled trial study

BackgroundRegular cleaning of the cannula in the trachea is very important for infection prevention. How to wash the tracheal cannula which is good to reduce the possibility of colonies of biofilm-forming bacteria and the growth of bacterial and the pattern of bacterial on the tracheal cannula is still unknown. This study aims to evaluate the efficacy of decontamination of the tracheal cannula using chlorhexidine and NaCl 0.9% in patients using the tracheal cannula to decrease biofilm-forming bacterial colony. Methods40 subjects were grouped into 20 subjects in the control group washing the cannula using 0.9% NaCl and the interventional group washing cannula using and with 2.5% chlorhexidine solution and 0.9% NaCl. This study used a parallel randomized controlled trial of 2 groups with a single blinded. Results40 subjects studied, 17 subjects (85%) each group produced biofilm-forming bacteria prior to intervention. After intervention in the study group, 15 subjects were biofilm negative and 5 biofilm positive subjects p = 0.001. The most common bacteria found in the control group is Pseudomonas aeruginosa, while in the study group some bacteria such as Acinetobacter sp. and Proteus mirabilis. Amoxicilin-Clavulanate had the highest resistance to biofilm forming bacteria in both groups. Piperacillin, ceftazidime, ciprofloxacin and meropenem have the highest sensitivity to biofilm-forming bacteria. ConclusionThere was a significant decrease in the number of colonies that produced biofilm in the tracheal cannula in the study group compared to the control group in tracheal cannula washing.

Antimicrobial Efficacy of 2.5% Sodium Hypochlorite, 2% Chlorhexidine, and 1.5% Hydrogen Peroxide on Enterococcus Faecalis in Pulpectomy of Necrotic Primary Teeth

Introduction: The success of the endodontic treatment is closely associated with eliminating endodontic microbiota especially bacteria like Enterococcus Faecalis (E. Faecalis). Irrigation solutions are suggested for this purpose but there are contraries regarding irrigations and their concentrations. This study aimed to compare antibacterial efficacy of irrigations including 2.5% Sodium hypochlorite (NaOCl), 2% Chlorhexidine (CHX), and 1.5% Hydrogen peroxide (H2O2). Methods: Fifty deciduous human extracted teeth were divided into 3 groups of 15 teeth, 2.5% NaOCl, 2% CHX, 1.5% H2O2, and 5 teeth in the negative control group. Later, root canals were inoculated by E. Faecalis. After cleaning and shaping, we irrigated the root canals of the teeth in each group with NaOCl, CHX, and H2O2. Samples were obtained again and sent for microbiological evaluation. Wilcoxon signed-rank test, Paired sample T-test, and Kruskal–Wallis were used to analyze data. Results: All 3 groups showed significant bacterial reduction (p <0.05). NaOCl and CHX showed no significant difference (P=0.415). But the reduction of these 2 groups was higher than H2O2 (p Conclusions: 2.5% NaOCl and 2% Chlorhexidine showed considerable efficacy against E. Faecalis while 1.5% Hydrogen peroxide was not able to eradicate all of E. Faecalis colonies. Hence, NaOCl and CHX solutions can be used for decontamination of infected root canals

Effect of epigallocatechin-3-gallate and thermal cycling on the bond strength of resin cements to the root dentin.

This study evaluated the effect of epigallocatechin-3-gallate (EGCG) solution and thermal cycling on the bond strength (BS) of fiber posts to the root dentin using two different resin cements (conventional or self-adhesive). One hundred and forty-four bovine roots were endodontically treated. After post space preparation, specimens were randomly divided into six groups (n = 24) according to dentin pretreatment [distilled water, 0.05% EGCG solution or 2% chlorhexidine (CHX) solution] and resin luting agent used for fiber post cementation (RelyX ARC or RelyX U200-3 M ESPE). Then, the samples were separated into two subgroups (n = 12): storage in distilled water at 37 °C for 24 h and thermal cycling (5 °C/55 °C, dwell time 30 s-12,000 cycles) during 6 months. After that, the specimens were subjected to the pull-out BS test (Universal Testing Machine-0.5 mm/min) and the failures pattern was analyzed in a stereomicroscope. According to the BS results (three-way ANOVA, Tukey's test, α = 0.05), the highest values were reported in the group EGCG + RelyX U200, showing significant statistical differences compared to all the other experimental groups. For Control and CHX groups BS values, there was no significant difference (p > .05) between the resin cements. For conventional resin cement, there was no significant difference among treatment solutions (p > .05). The thermal cycling did not influence the BS results (p > .05). As reported by the failure mode analysis, adhesive failure was predominant in all groups. EGCG solution improved the bond strength of self-adhesive resin cement to root dentin.

Comparison of the Sterilization Efficiency of 3 Disinfectants for Dropped Anterior Cruciate Ligament Grafts: A Systematic Review and Meta-analysis.

Background:The inadvertent contamination of anterior cruciate ligament (ACL) grafts can occur if they are accidentally dropped on the floor during ACL reconstruction. There has been no meta-analysis conducted to compare the sterilization efficiency of the different disinfectants used on dropped ACL grafts.Purpose:To compare the sterilization efficiency of 3 disinfectants to decontaminate ACL grafts as necessary.Study Design:Systematic review.Methods:A systematic literature review was performed using the MEDLINE, Embase, and Cochrane Library databases. All studies reporting the management of dropped or contaminated grafts were considered for this meta-analysis.Results:A total of 7 studies meeting inclusion criteria were identified from a literature search. The pooled results of this meta-analysis indicated that the rate of positive cultures of ACL grafts dropped on the operating room floor was 44.9% and that the commonly contaminated microbes were staphylococci and bacilli. The meta-analysis results indicated that the sterilization efficiency of a 4% chlorhexidine solution was superior to an antibiotic solution (odds ratio [OR], 0.17 [95% CI, 0.05-0.57]; P = .004) and a 10% povidone-iodine solution (OR, 0.04 [95% CI, 0.01-0.20]; P < .0001). Further, the antibiotic solution was superior to the 10% povidone-iodine solution (OR, 0.20 [95% CI, 0.07-0.55]; P = .002).Conclusion:The results of our meta-analysis demonstrated that staphylococci and bacilli were the most common contaminants on dropped ACL grafts and that decontamination using a 4% chlorhexidine solution more reliably disinfected ACL grafts. This information can help to guide surgeons as regards appropriate remedial measures.

Efficacy of EDDY, passive ultrasonic irrigation and manual irrigation on the removal of orange-brown precipitate

Aim: The aim of this study was to compare the different irrigation activation techniques for removing the orange-precipitate formed after irrigation with sodium hypochlorite (NaOCl) and chlorhexidine (CHX).&#x0D; Methodology: In total, 45-single rooted extracted human teeth were prepared with the ProTaper NEXT rotary system. The roots were respectively irrigated with 5% NaOCl and 2% CHX solutions, and an orange-precipitate formed on the canal walls. The teeth were divided longitudinally, and the precipitate was evaluated with a dental operating microscope (DOM) at 16x magnification before the sections were joined. The halves of roots were then combined, and EDDY, passive ultrasonic activation (PUI) and manual irrigation (MI) techniques were applied for 1 min with 5 ml of distilled water to remove the precipitate. The halves were re-evaluated under the DOM and the residual of percentage of precipitate removed was calculated. The data were evaluated statistically by Kruskal-Wallis tests.&#x0D; Results: A residual orange-precipitate was found in all groups. Although the orange precipitate was effectively removed in the EDDY group, there was no statistically significant difference among EDDY, PUI and MI (p&gt; 0.05).&#x0D; Conclusions: None of the techniques used completely removed the orange precipitate from the root canal surfaces. Among the irrigation activation techniques, there was no superior technique for removing the orange-precipitate from the root canals. &#x0D; &#x0D; How to cite this article: İnce Yusufoglu S, Keskin NB. Efficacy of EDDY, passive ultrasonic ırrigation and manual irrigation on the removal of orange-brown precipitate. Int Dent Res 2021;11(1):1-5. https://doi.org/10.5577/intdentres.2021.vol11.no1.1&#x0D; &#x0D; Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.

In vivo evaluation of the virucidal efficacy of chlorhexidine and povidone-iodine mouthwashes against salivary SARS-CoV-2. A randomized-controlled clinical trial

ObjectivesThe oral cavity is potentially high-risk transmitter of COVID-19. Antimicrobial mouthrinses are used in many clinical preprocedural situations for decreasing the risk of cross-contamination in the dental setting. It is important to investigate the efficacy of mouthwash solutions against salivary SARS-CoV-2 in order to reduce the exposure of the dental team during dental procedures. AimsThe aim of this in vivo study was to evaluate the efficacy of 2 preprocedural mouthrinses in the reduction of salivary SARS-CoV-2 viral load and to compare the results of the mouthwashes to a control group. Materials and MethodsIn this randomized-controlled clinical trial, studied group comprised laboratory-confirmed COVID-19 positive patients through nasopharyngeal swabs. Participants were divided into 3 groups. For 30 s, the control group mouthrinsed with distilled water, the Chlorhexidine group mouthrinsed with 0.2% Chlorhexidine and the Povidone-iodine group gargled with 1% Povidone-iodine. Saliva samples were collected before and 5 min after mouthwash. SARS-CoV-2 rRT-PCR was then performed for each sample. Evaluation of the efficacy was based on difference in cycle threshold (Ct) value. The analysis of data was carried out using GraphPad Prism version 5 for Windows. Kristal wullis and Paired t-test were used. A probability value of less than 0.05 was regarded as statistically significant. ResultsSixty-one compliant participants (36 female and 25 male) with a mean age 45.3 ± 16.7 years-old were enrolled. A significant difference was noted between the delta Ct of distilled water wash and each of the 2 solutions Chlorhexidine 0.2% (P = .0024) and 1% Povidone-iodine (P = .012). No significant difference was found between the delta Ct of patients using Chlorhexidine 0.2% and 1% Povidone-iodine solutions (P = .24). A significant mean Ct value difference (P < .0001) between the paired samples in Chlorhexidine group (n = 27) and also in Povidone-iodine group (n = 25) (P < .0001) was found. In contrast, no significant difference (P = .566) existed before and after the experiment in the control group (n = 9). ConclusionChlorhexidine 0.2% and 1% Povidone-iodine oral solutions are effective preprocedural mouthwashes against salivary SARS-CoV-2 in dental treatments. Their use as a preventive strategy to reduce the spread of COVID-19 during dental practice should be considered.

In Vitro Efficacy of Bacterial Cellulose Dressings Chemisorbed with Antiseptics against Biofilm Formed by Pathogens Isolated from Chronic Wounds.

Local administration of antiseptics is required to prevent and fight against biofilm-based infections of chronic wounds. One of the methods used for delivering antiseptics to infected wounds is the application of dressings chemisorbed with antimicrobials. Dressings made of bacterial cellulose (BC) display several features, making them suitable for such a purpose. This work aimed to compare the activity of commonly used antiseptic molecules: octenidine, polyhexanide, povidone-iodine, chlorhexidine, ethacridine lactate, and hypochlorous solutions and to evaluate their usefulness as active substances of BC dressings against 48 bacterial strains (8 species) and 6 yeast strains (1 species). A silver dressing was applied as a control material of proven antimicrobial activity. The methodology applied included the assessment of minimal inhibitory concentrations (MIC) and minimal biofilm eradication concentration (MBEC), the modified disc-diffusion method, and the modified antibiofilm dressing activity measurement (A.D.A.M.) method. While in 96-well plate-based methods (MIC and MBEC assessment), the highest antimicrobial activity was recorded for chlorhexidine, in the modified disc-diffusion method and in the modified A.D.A.M test, povidone-iodine performed the best. In an in vitro setting simulating chronic wound conditions, BC dressings chemisorbed with polyhexanide, octenidine, or povidone-iodine displayed a similar or even higher antibiofilm activity than the control dressing containing silver molecules. If translated into clinical conditions, the obtained results suggest high applicability of BC dressings chemisorbed with antiseptics to eradicate biofilm from chronic wounds.

Evaluation of effectiveness of a new treatment method for healing infected wounds: an animal model.

To evaluate the effectiveness of a new treatment method in healing superficial infected wounds compared with surgical debridement with chlorhexidine solution. In this animal model, two wounds were created on the back of 10 male adult rabbits. Wounds treated by Method 1 were debrided using 0.02% chlorhexidine aqueous solution and an antibiotic topical ointment. Wounds treated by Method 2 wounds were treated using a newly developed device which enabled visual monitoring of the wound as it was treated with various pharmacological solutions (including antiseptic, antiseptic oxidant and an osmotically active agent) specifically formulated for each wound healing stage. Wound area size (using digital planimetry) and time taken to clean the wound were recorded, and biopsies were taken, at the beginning of the study and at various timepoints throughout. It was observed that both wound cleaning and wound healing were accelerated by treatment with method 2 compared with method 1 (by 43.8% and 36.7%, respectively). There were also a significantly smaller number of complications in these wounds [p=0.0044] due to the positive ratios of neutrophils and fibroblasts in the wound cavities (from the third to the fourteenth day after wound modelling). Wounds treated with the new device in method 2 had a shorter wound healing time than wounds treated with a traditional method. The automated influx-outflow of solutions removed any fragments of necrotic tissue from the wound surface. Wounds were able to be monitored without the need to remove dressings. The transparent, airtight film, which allowed for wound monitoring without the need to remove dressings, meant that suturing was not required. This resulted in no complications in the wounds treated by this new method.

Evaluation of latex and non-latex intermaxillary elastics strength degradation when submitted to the use of chlorhexidine

ABSTRACT Purpose: To assess the influence of 0.12% chlorhexidine solution (CHX) in the strength degradation of different intermaxillary latex and non-latex elastics. Materials and methods: Eighty ¼ inch elastics were separated into eight groups (n = 10) according to manufacturers (Morelli™ and American Orthodontics™), elastic’s type (latex and non-latex) and storage solution (artificial saliva and CHX). Each sample was extended to 19.2 mm, corresponding to 3x the size of their inner diameter, and initial force was verified on the universal testing machine. The elastics were then kept extended, immersed in artificial saliva and their strength was once again evaluated in the following period of time: 12 and 24 hours. Following the storage period, elastics of CHX groups were immersed for 1 min into PerioGard (0.12% chlorhexidine solution) before the strength evaluation. The data (gf) was submitted to a three-way repeated measure analysis of variance and Tukey’s test (α = 0.05). Results: Significant differences between elastics and time were observed (p < 0.000). Statistically significant reduction in strength was found in non-latex and latex elastics between the initial condition and after 12 h and 24 h (p < 0.05). The non-latex elastics showed statistically higher degradation values than the latex elastics, in the three analysis times (p < 0.05). No statistical difference was found between saliva and CHX, regardless of the time and elastic type (p > 0.05). Conclusions: Generally, the latex elastics showed less strength degradation compared to non-latex elastics. CHX did not affect strength degradation and time influenced strength degradation in the first 12 hours, keeping practically constant for up to 24 hours.

Polymyxin Resistance Among XDR ST1 Carbapenem-Resistant Acinetobacter baumannii Clone Expanding in a Teaching Hospital.

Acinetobacter baumannii is an opportunistic pathogen primarily associated with multidrug-resistant nosocomial infections, for which polymyxins are the last-resort antibiotics. This study investigated carbapenem-resistant A. baumannii strains exhibiting an extensively drug-resistant (XDR) phenotype, including four isolates considered locally pan drug-resistant (LPDR), isolated from inpatients during an outbreak at a teaching hospital in Brazil. ApaI DNA macrorestriction followed by PFGE clustered the strains in three pulsotypes, named A to C, among carbapenem-resistant A. baumannii strains. Pulsotypes A and B clustered six polymyxin-resistant A. baumannii strains. MLST analysis of representative strains of pulsotypes A, B, and C showed that they belong, respectively, to sequence types ST1 (clonal complex, CC1), ST79 (CC79), and ST903. Genomic analysis of international clones ST1 and ST79 representative strains predicted a wide resistome for β-lactams, aminoglycosides, fluoroquinolones, and trimethoprim-sulfamethoxazole, with blaOXA–23 and blaOXA–72 genes encoding carbapenem resistance. Amino acid substitutions in PmrB (Thr232Ile or Pro170Leu) and PmrC (Arg125His) were responsible for polymyxin resistance. Although colistin MICs were all high (MIC ≥ 128 mg/L), polymyxin B MICs varied; strains with Pro170Leu substitution in PmrB had MICs > 128 mg/L, while those with Thr232Ile had lower MICs (16–64 mg/L), irrespective of the clone. Although the first identified polymyxin-resistant A. baumannii strain belonged to ST79, the ST1 strains were endemic and caused the outbreak most likely due to polymyxin B use. The genome comparison of two ST1 strains from the same patient, but one susceptible and the other resistant to polymyxin, revealed mutations in 28 ORFs in addition to pmrBC. The ORF codifying an acyl-CoA dehydrogenase has gained attention due to its fatty acid breakdown and membrane fluidity involvement. However, the role of these mutations in the polymyxin resistance mechanism remains unknown. To prevent the dissemination of XDR bacteria, the hospital infection control committee implemented the patient bathing practice with a 2% chlorhexidine solution, a higher concentration than all A. baumannii chlorhexidine MICs. In conclusion, we showed the emergence of polymyxin resistance due to mutations in the chromosome of the carbapenem-resistant A. baumannii ST1, a high-risk global clone spreading in this hospital.

Formulation and antimicrobial activity evaluation of a 0.2% chlorhexidine canine mouthwash with essential oils

Background: Periodontal disease is the infection and inflammation of the gums, bones, and tissues involved in teeth support, and it is one of the most common diseases affecting pet dogs. Essential oils have shown antimicrobial activity against bacteria causing periodontal disease; therefore, they are considered potential therapeutic agents. Objectives: The main objective was to formulate and evaluate the antimicrobial activity of a 0.2% chlorhexidine canine mouthwash with essential oils. Methods: Three microemulsion formulations were obtained by constructing a pseudo-ternary phase diagram using the phase titration method. Different surfactant agents were evaluated, and hydrogenated castor oil was selected as the emulsifier agent. The antimicrobial activity of oregano essential oil (Origanum vulgare), thyme essential oil (Thymus vulgaris), and the three formulations were evaluated against Staphylococcus aureus, Streptococcus mutans, Streptococcus salivarius, and Escherichia coli. Results: Pure thyme and oregano essential oils showed higher antimicrobial activity than a 0,2% chlorhexidine solution. The formulations with essential oils plus chlorhexidine and chlorhexidine alone showed antimicrobial activity. The formulation containing only essential oils did not show antimicrobial activity. Conclusions: A canine mouthwash was formulated with chlorhexidine and thyme and oregano essential oil. Based on the evaluation of antimicrobial activity, two of the proposed formulations could be a therapeutic option to reduce the risk and prevent periodontal disease in canines.

Inactivation of SARS-CoV-2 through Treatment with the Mouth Rinsing Solutions ViruProX® and BacterX® Pro

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic effects daily dental work. Therefore, infection control measures are necessary to prevent infection of dental personnel during dental treatments. The use of a preprocedural mouth rinse with chlorhexidine (CHX), cetylpyridinium chloride (CPC), or hydrogen peroxide (H2O2) solution for 30–60 s may reduce the viral load and may protect the personnel in a dental practice. In the present study the virucidal effect of the mouth rinsing solutions ViruProX® with 0.05% CPC and 1.5% H2O2 and BacterX® pro containing 0.1% CHX, 0.05% CPC, and 0.005% sodium fluoride (F-) was investigated in vitro. The mouth rinsing solutions successfully inactivated infectious SARS-CoV-2 particles, the causative agent of coronavirus disease 2019 (COVID-19), within 30 s. To determine the effective components, CHX, CPC, H2O2, and a combination of CHX and CPC, were tested against SARS-CoV-2 in addition. While a combination of CPC and CHX as well as CPC alone led to a significant reduction of infectious viral particles, H2O2 and CHX alone had no virucidal effect against SARS-CoV-2. It can be assumed that preprocedural rinsing of the mouth with ViruProX® or BacterX® pro will reduce the viral load in the oral cavity and could thus lower the transmission of SARS-CoV-2 in dental practice.

The assortment analysis of chlorhexidine-containing medicines and procurement data of state and municipal organizations

Chlorhexidine is an effective cationic antiseptic and disinfectant that has been used in medical practice for decades. It is generally recommended to use different concentrations of aqueous or alcoholic solutions of chlorhexidine for different therapeutic purposes.&#x0D; Objective. To determine the proportions of different chlorhexidine concentrations in medicines purchased by state and municipal organizations and to identify possible issue of chlorhexidine formulations utilization in the suboptimal or insufficient concentrations.&#x0D; Results. The vast majority of the chlorhexidine-containing medicines found in the State Register of Medicines of Ukraine are 0.05% solutions for external use, 0.05% gels for dental and urological use and vaginal suppositories (pessaries) with 16 mg of chlorhexidine in one dose. While the most common representatives of chlorhexidine-containing medicines abroad are solutions with a concentration of 4% and 2%, as well as mouthwashes with a concentration of 0.12%. The highest share - 96% - among the procurements of chlorhexidine-containing medicines by state and municipal organizations is 0.05% aqueous solution for external use. Instructions for medical use of 0.05% aqueous chlorhexidine solution for external use contain indications that are not supported by international documents: WHO Model List of Essential Medicines and British National Formulary.&#x0D; Conclusions. The obtained results suggest probable cases of irrational use of chlorhexidine medicines in medical practice in Ukraine. The consequences of such cases are not limited to the failure to achieve therapeutic goals or to the development of nosocomial infection, but includes also the selection of chlorhexidine-resistant strains of microorganisms.&#x0D; Key words: chlorhexidine; assortment analysis; medicinal procurements study; suboptimal concentration; rational pharmacotherapy

The efficacy of convenient cleaning methods applicable for customized abutments: an in vitro study

BackgroundThe demand for implant dentistry, which includes customized abutments, is increasing. A lot of pollutions are generated on the customized abutment surface following milling procedure. This study evaluated the surface topography and cleanliness of customized abutments after cleaning procedures, which are simply applicable in the dental clinic.MethodsThirty computer-aided design and computer-aided manufacturing internal connection type titanium abutments were produced, milled, and randomly divided into 3 groups: steam cleaning (control group), chlorhexidine (CHX) scrubbing (test group 1), and ultrasonic cleaning with CHX solution, acetone, and ethyl alcohol (test group 2). Each group was evaluated using microscopic and microbial analysis.ResultsForeign bodies were observed on the abutment surfaces in control group and test group 1, but not in test group 2. Bacteria were observed on 40% of the agar plates following steam cleaning; most of the colonies consisted of Bacillus cereus and Staphylococcus warneri. Colony growth was absent following test group 1 and 2.ConclusionFor customized abutments, cleaning with steam is ineffective. CHX scrubbing effectively eliminates only bacteria. Ultrasonic cleaning with CHX solution, acetone, and ethyl alcohol successfully removes both foreign bodies and bacteria. Thus, the ultrasonic cleaning method is conveniently applicable in the dental clinic for eliminating contamination of the customized abutment surface.

Postoperative Pain after Endodontic Treatment under Irrigation with 8.25% Sodium Hypochlorite and Other Solutions: A Randomized Clinical Trial

IntroductionThe aim of this study was to evaluate the postoperative pain in patients after endodontic treatment using 8.25% sodium hypochlorite (NaOCl) compared with other concentrations and 2% chlorhexidine (CHX). MethodsIn this double-blind randomized trial, 180 patients were evaluated who underwent a single session of endodontic treatment under irrigation with 2.5%, 5.25%, or 8.25% NaOCl or 2% CHX solutions. The presence of postoperative pain was assessed 24, 48, and 72 hours after treatment and recorded using the visual analog scale (VAS). A descriptive analysis, logistic regression, and Wald test were performed. ResultsAltogether 169 patients participated, of whom 107 were women, and the mean age was 38.1 ± 14.4 years. No significant differences occurred between the irrigants and the pain outcomes, not even for the use of postoperative pain medication and responses to VAS (P > .05). In the multivariate model including irrigants, after 24 hours or at any time, a significant difference (P < .05) remained in preparation time ≥10 minutes and the presence of overfilling. Also, in relation to the VAS, the overfilling presented significantly different results (P < .05). ConclusionsThere was no significant difference in the presence of postoperative pain between the 8.25% NaOCl and the other irrigation solutions. However, the extended preparation time and the overfilling material were responsible for the increase of postoperative pain.

Effectiveness of social and behavioral change communication intervention to promote the use of 7.1% chlorhexidine for umbilical cord care in hard-to-reach rural Bangladesh: A mixed method study.

BackgroundDeveloping countries account for 99.0% of the 2.7 million neonatal deaths occurring worldwide each year. Umbilical cord infection contributes greatly to this predicament, but evidence shows that 7.1% chlorhexidine solution (CHX) can substantially reduce the risk of infection. To address this challenge, this study aimed to determine the effect of a social and behavioral change communication (SBCC) intervention on promoting the use of WHO recommended CHX as well as on improving the knowledge, attitude, and practices of rural communities regarding umbilical cord care in hard-to-reach areas of Bangladesh.MethodsA pretest-posttest quasi-experimental study was conducted in two unions of Jamalpur district during 2017-2019 among 748 pregnant women in their third trimester. The SBCC intervention was implemented through town-hall meetings (n = 3), community meetings (n = 30), and door-to-door meetings (n = 22 223) in Dangdhora union, which served as the intervention group, while Hativanga union was kept as a real-time comparator group. Qualitative data were collected from a total of 200 respondents, where 100 participants were chosen from both intervention and control groups. Statistical analysis was carried out in R and outcomes with P values less than 0.05 at 95% confidence intervals (CIs) were presented.ResultsFollowing SBCC intervention, significant (P < 0.001) improvements were observed in the intervention group with regards to the primary objective: CHX use increased from 1.07% to 57.80%, while CHX use decreased from 1.6% to 0.0% in the control group. Meaningful improvements were also observed in relation to knowledge (29.0% to 43.0%), attitude (53.0% to 90.0%), and practices (25.0% to 70.0%) of rural communities regarding cord care. Marked improvements were also observed in the intervention group related to understanding causes of cord infections; importance of cord cleanliness; use of antiseptic and other preventive measures; care-seeking behavior; and ensuring hygienic childbirth.ConclusionsThis pioneer study revealed that SBCC interventions led to an increase in CHX use and improved the knowledge, attitude and practices of Bangladeshi communities regarding cord care and cord infection. This indicates that SBCC intervention is indeed an effective and feasible method for reducing infant mortality rates in hard-to-reach populations and achieving SDG goal 3.2.

Preoperative vaginal cleansing with chlorhexidine solution in preventing post-cesarean section infections in a low resource setting: A randomized controlled trial.

Infection is one of the most common causes of maternal morbidities and mortality and has been reported to be responsible for about 15% of maternal deaths. Any woman is at risk of infection during childbirth, but women undergoing cesarean section are at higher risk. Improvement in surgical procedures with asepsis and the use of antibiotics have helped reduce postoperative infectious morbidities. However, ascending infection from the lower to the upper genital tract is a common but often neglected source of infection. Cleaning the vagina with chlorhexidine antiseptic solution before cesarean section can be a cheap and affordable source of infection control. This study is aimed at evaluating the efficacy of preoperative vaginal cleansing using 1.0% chlorhexidine in the reduction of post-cesarean section infectious morbidities. This prospective randomized control trial was conducted among 322 pregnant women who underwent an emergency cesarean section at Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AE-FUTHA). The women were randomized into two groups. The interventional group received vaginal cleansing with three standard gauzes soaked in 30mL 1.0% chlorhexidine gluconate solution preoperatively in addition to surgical skin cleaning with chlorhexidine-alcohol. The women in the control group only had surgical skin cleaning with chlorhexidine-alcohol. All the women received pre- and postoperative antibiotics. The primary outcomes were endometritis and wound infections. Infectious morbidity was significantly reduced from 36.8% in the control group to 12.0% in the intervention group (P=.001). Endometritis occurred significantly less frequently in the intervention group than the control group (respectively 6.6% compared with 27.6%: relative risk [RR] 0.29, 95% confidence interval [CI] 0.16-0.53; P<.05). Foul-smelling vaginal discharge was significantly more common in the control group than in the intervention group (11.8% vs 1.3%, respectively) but the CI was wide (RR 8.5, 95% CI 1.30-64.55; P<.001). Fever and wound infection were more common in the control group (5.9% vs 3.3% and 9.2% vs 5.3%) but the difference was not significant. The hospital stay was significantly shorter among the intervention group (5.54±1.04days compared with 6.01±1.55days, P<0.05). The most common microbial isolate implicated in endocervical colonization was Staphylococcus aureus followed by Klebsiella species. Vaginal cleansing with 1.0% chlorhexidine gluconate solution before emergency cesarean section appears to be effective in reducing rates of post-cesarean section infectious morbidity in the study area. We recommend its use among women undergoing cesarean section to help reduce the contribution of infections to a poor obstetrics outcome.

Photodynamic optimization by combination of xanthene dyes on different forms of Streptococcus mutans: An in vitro study.

The photokilling rate in antimicrobial photodynamic therapy (a-PDT) is highly related to interaction of reactive oxygen species (ROS) produced, ability of photosensitizers (PS) in incorporating into microorgansims and light devices/microorganism type. Since xanthene dyes (Rose Bengal and Erythrosine) are present in the dental practice as PS, have high quantum yield of singlet oxygen and are efficiently incorporated into bacterial cells, the additive bactericidal ability of a combination of xanthene dyes was tested on planktonic cultures and biofilms of Streptococcus mutans when irradiated by a hand-held LED photopolymerizer unit. Planktonic cultures of S. mutans (UA 159 ATCC 700610) were grown in BHI broth with 1 % sucrose. This culture was exposed to a concentrations of Rose Bengal (RB) and Erythrosine (ER) at 1.5, 3.5 μM, in combination (RB + ER + L+) / alone (RB + L+/ ER + L+) and irradiated with a blue LED high light intensity (L). Accordingly, concentrations of dyes and time irradiation were increased in 10 times and applied on 120 h - biofilms of S. mutans and compared with a 0.12 % Chlorhexidine solution (0.12 % - CHX). For statistical analysis, parametrical procedures were applied (n = 6; ANOVA test and Tukey post hoc test; α = 0.05) and data transformed into log 10. Substantial antimicrobial reduction was verified in planktonic cultures (∼ 7 log reduction) and biofilm (∼ 1 log reduction) for combined a-PDT group (RB + ER + L+) presenting a significant statistical difference to control group (p < 0.05) with similar effect to CHX group (p > 0.05). Different forms of S. mutans can be effectively controlled by photodynamic therapy and optimized when in combination of xanthene dyes.

Resin-based dental materials containing 3-aminopropyltriethoxysilane modified halloysite-clay nanotubes for extended drug delivery

ObjectiveTo synthesize and characterize a novel resin-based dental material containing 3-aminopropyltriethoxysilane (APTES) surface-modified halloysite-clay nanotubes (HNTs) for long-term delivery of guest molecules. MethodsThe optimal concentrations of HNT (10, 15, 20 wt.%) and silane (0, 2, 4 vol.%sil) to be incorporated into the resin-based materials were determined (15 wt.%HNT, 4 vol.%sil) after assessment of the mechanical properties (DC%, degree of conversion; FS, flexural strength; FM, flexural modulus; and UTS, ultimate tensile strength). The HNTsil-powder was loaded with chlorhexidine (CHX) to evaluate the effect of the silanization on drug release. Resin-discs were prepared for the following groups: RES (resin), HNT (resin+15 wt.%HNT), HNTsil (resin+15 wt.%HNT silanized), HNT-CHX (resin+15 wt.%HNT loaded with chlorhexidine), HNTsil-CHX (resin+15 wt.%HNTsil-CHX), and 0.2 vol.%CHX (resin+0.2 vol.%CHX solution). Specimens were stored in water for 1, 3, 5, 10, and 15 days at 37 °C. Aliquots from each time point and the final 15-day specimens were evaluated for the zone of inhibition (ZOI) against Streptococcus mutans. CHX release was analyzed using spectrophotometry at absorbance of 300 nm. Data were statistically analyzed (α = 0.05). ResultsAll materials presented similar DC%. Reduced FS but increased FM was detected for 20 wt.%HNT–4%APTES. Groups with 15 wt.% and 20 wt.%HNT with/without APTES presented higher values of UTS. Agar diffusion data indicates that the HNTsil-CHX had a greater ZOI than all other groups over 15 days. HNTsil-CHX had the highest absorbance for day 1 but presented similar values to other groups every time point after. SignificanceSilanization of nanotubes followed by encapsulation of chlorhexidine is a promising technique for long-term delivery of guest molecules.