Chlorhexidine Varnish Research Articles

A chlorhexidine varnish implemented treatment strategy for chronic periodontitis

The aim of this study was to investigate the clinical outcome of a subgingivally applied chlorhexidine varnish when used as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis. A randomized controlled, single blind, parallel trial was conducted on the basis of 16 volunteers suffering from chronic periodontitis. The control group received oral hygiene instructions and was scaled and root planed in two sessions. The test group received the same instructions and treatment, however, all pockets were additionally disinfected using a chlorhexidine varnish. The gingival index, plaque index, bleeding on probing, probing pocket depth (PPD) and clinical attachment level (CAL) were recorded at baseline and subsequently after 1 and 3 months. Both treatment strategies showed significant reductions in PPD and CAL at both follow-up visits by comparison with baseline levels (p<0.001). Yet, at study termination, combination therapy resulted in additional pocket reductions between 0.73 and 1.23 mm (p<0.02), and clinical attachment gains between 0.63 and 1.09 mm (p<0.02). These findings suggest that a varnish-implemented strategy may improve the clinical outcome for the treatment of chronic periodontitis in comparison with SRP alone.

Recolonization of mutans steptococci on teeth with orthodontic appliances after antimicrobial therapy

The aim of the present study was to compare the recolonization pattern of mutans streptococci on densely colonized teeth with and without fixed orthodontic appliances after treatment with a 40 per cent chlorhexidine (CHX) varnish (EC 40, Explore). Healthy subjects free of carious lesions requiring fixed orthodontic appliance treatment but with high bacterial mutans streptococci saliva counts were recruited (n = 10). For baseline registration, plaque from buccal sites was sampled and cultivated on Dentocult strips. Following professional tooth cleaning, CHX varnish was applied to all teeth for 8 minutes. Subsequently, orthodontic brackets and bands were inserted in either the upper or lower arch. Eight weeks after varnish application the degree of recolonization with mutans streptococci was reassessed on the buccal sites. Statistical analysis showed that recolonization with mutans streptococci was significantly higher (P < 0.05) on teeth with orthodontic appliances. The results indicate that the use of fixed orthodontic appliances creates artificial environments suitable for the proliferation of mutans streptococci after CHX varnish suppression.

Suppression of Caries-Related Microorganisms in Dentine Lesions after Short-Term Chlorhexidine or Antibiotic Treatment

This study investigated the efficiency of a chlorhexidine varnish and an antibiotic paste in suppressing the cultivable microflora of deep dentine cavities in a stepwise excavation procedure. Subsequent to enamel preparation and removal of the central biomass, infected dentine was sampled from the cavity floor. Ten cavities each were either covered with the 1% chlorhexidine- and 1% thymol-containing varnish Cervitec (CE), the demeclocycline hydrocortisone-containing ointment Ledermix (LE) or received no treatment as control (CO). A compomer composite was used as intermediate restorative. Cavities were reassessed after 6 weeks and again dentine samples were microbiologically investigated for total viable counts, mutans streptococci and lactobacilli. After 6 weeks a significant reduction of the total viable counts was observed in the LE group (p = 0.011) compared to the control, whereas no differences were found in the CE group (p > 0.05). Mutans streptococci were rarely recovered at baseline and after 6 weeks. Compared to the CO group counts of lactobacilli were significantly reduced in the CE and LE groups (p < 0.05). Lactobacillus species were frequently recovered at baseline and after 6 weeks of observation. Lactobacillus rhamnosus was the predominant species in all samples investigated. Application of CE or LE resulted in reduced counts of lactobacilli after a period of 6 weeks. Although none of the materials completely eliminated the viable microorganisms, the use of LE was more effective than CE in reducing the total anaerobic microorganisms associated with carious dentine.

Antimicrobials in Future Caries Control?

The aim of this paper was to examine recent evidence for the effect of the antibacterial approach to prevent and control caries with special reference to the use of chlorhexidine (CHX). Existing information from the mid 1990s provided limited evidence for the effectiveness of CHX gels, rinses and toothpaste in preventing caries in permanent teeth of children and adolescents. An updated literature search on CHX intervention in controlled clinical trials from 1995 to May 2003 unveiled 22 studies covering over 4,500 patients with clinical caries as end point. The vast majority (n = 21) were dealing with CHX-containing varnishes. Since the studies exhibited disparities in design, diagnosis and intervention, the findings were subgrouped with respect to caries type and localization. According to the ranking system of the Swedish Council on Technology Assessment in Health Care, the evidence for an anticaries effect of CHX varnishes was rated as inconclusive for caries-active schoolchildren and adolescents with regular fluoride exposure. Regarding fissure caries, a preventive effect of CHX varnishes was demonstrated in 4 studies out of 5 when compared to no treatment in children with low fluoride exposure. The evidence for arresting root caries in dry-mouth patients and frail elderly subjects was inconclusive. In conclusion, the evidence from the recent literature was inconclusive for the use of CHX varnishes for caries prevention in risk groups.

The Effect of a Single Application of 40% Chlorhexidine Varnish on the Numbers of Salivary Mutans Streptococci and Acidogenicity of Dental Plaque

The relationship between the numbers of salivary mutans streptococci and the acid production in dental plaque after a single application of the 40% chlorhexidine varnish EC40^® has been studied. Thirteen healthy subjects were treated with EC40 varnish. Saliva samples were taken before and up to 12 weeks after treatment to count mutans streptococci and lactobacilli. At the same time points plaque samples were taken before and after sucrose challenge and analyzed for protein and organic acid. Suppression of salivary mutans streptococci was observed together with a reduced production of lactic acid in sucrose-challenged dental plaque in 9 subjects while inhibition of acid production without significant suppression of mutans streptococci was observed in the other 4 participants. The duration of the effects differed among the individuals but never exceeded 6 weeks. We conclude that a prolonged suppression of mutans streptococci and acid production was not achieved by a single treatment with EC40 varnish in all subjects. Moreover, reduced acidogenicity of dental plaque after chlorhexidine treatment was not necessarily predicted by suppression of mutans streptococci in saliva.

Effect of a Varnish Containing Chlorhexidine and Thymol (Cervitec®) on Approximal Caries in 13- to 16-Year-Old Schoolchildren in a Low Caries Area

Background: Previous studies on the effect of the chlorhexidine and thymol-containing varnish (Cervitec^®) have consistently shown a reduction in Streptococcus mutans, while the data on the caries-inhibiting effect are conflicting. Aim: To measure the effect of a chlorhexidine- and thymol-containing varnish (Cervitec) on approximal caries in a low caries population. Material: Eighty-five schoolchildren, 13 years of age, entered the study after being selected on the basis of bitewing radiographs. Children with at least one approximal lesion were included after informed consent. Methods: The study was carried out as a double-blind, randomized controlled trial according to a split-mouth design using Cervitec on one side and a placebo varnish on the other side. All approximal surfaces between molars and premolars were treated every 3rd month. After 2 years new bitewing radiographs were taken. A total of 73 children completed the 2-year study. Results: Neither the difference in number of new lesions between the Cervitec-treated and the placebo-treated side (d: –0.21; 95% CI: –0.57; 0.16) nor the mean difference in number of already existing lesions that progressed (d: –0.01; 95% CI: –0.33; 0.30) were statistically significant (pairedt test; p > 0.05). Conclusion: The results of our study do not indicate an effect of Cervitec on initiation or progression of approximal caries in a population with a low DMFS.

Efficacy of differently concentrated chlorhexidine varnishes in decreasing Mutans streptococci and lactobacilli counts

The objective of the present prospective trial was to compare the efficacy of differently concentrated chlorhexidine varnishes (EC40 ® = 40% chlorhexidine and Cervitec ® = 1% chlorhexidine + 0.1% thymol) on levels of Mutans streptococci ( ms), lactobacilli ( lb) and plaque formation in interproximal plaque and saliva. Twenty-four volunteers with a high level of ms in saliva were randomized into two groups and treated with the experimental varnishes. Varnish applications were performed in accordance with literature. Over a period of 2 weeks Cervitec ® was applied three times and EC40 ® once or twice, depending on ms counts after first application. Four and 12 weeks after final varnish application ms in plaque and saliva were evaluated. Furthermore, lactobacilli ( lb) counts in saliva and the effect on plaque formation were recorded. Both varnishes revealed a reduction of ms in interproximal plaque and saliva after 4 and 12 weeks. The highly concentrated varnish revealed a significantly stronger reduction of ms in plaque and saliva compared with the lowly-concentrated varnish. No effect could be demonstrated on lb counts and plaque formation. The results indicate that the chlorhexidine varnishes tested may reduce ms in both interproximal plaque and saliva. However, the application of the highly concentrated varnish EC40 ® results in a higher decrease of ms in plaque sites and saliva.

Does chewing xylitol gum result in suppression of mutans streptococci?

Design Randomised controlled trail using a health-centre population in Finland.Intervention 195 pregnant women with high mutans streptococci counts were randomised into three groups, xylitol (X; n=127), chlorhexidine varnish (CHX; n=32) or fluoride varnish (F; n=36). In group X, mothers were recommended to chew xylitol gum two to three times per day, starting at 3 months from delivery and continuing until their child was 3 years of age. The CHX- and F-group mothers received chlorhexidine or fluoride varnish at 6, 12 and 18 months after the birth of the child. Children received routine dental care (oral hygiene instruction, dietary advice fluoride treatment and restorative treatment) where necessary. Standardised plaque and salivary sampling was undertaken.Outcome measure Mutans streptococcus levels in plaque and saliva.Results Loss to follow-up was 19% at 3 years and 25% at 6 years. The reported proportion of the children who were colonised by mutans streptococci are shown (see Table 1) with a calculated worst-case scenario analysis assuming the best possible outcomes for groups CHX and F and the worst for group X. Numbers-needed-to-treat are presented comparing groups X and F.Conclusions Chewing xylitol gum by mothers who have high mutans streptococcus counts results in long-term suppression of the bacterium in their offspring.

Effect of sustained-release chlorhexidine varnish on Streptococcus mutans and Actinomyces viscosus in orthodontic patients

This study evaluated the effect of sustained-release chlorhexidine varnish on orthodontic patients. Ten children, ages 10 to 16 years, participated. Bacterial levels of Streptococcus mutans and Actinomyces viscosus and total counts were evaluated in sputum samples. These counts were evaluated at 4 stages: before orthodontic treatment, at least 2 weeks after bonding of the brackets, 1 week after application of chlorhexidine varnish, and 3 weeks after application of chlorhexidine varnish. Increases in bacterial levels of S mutans and in the total bacterial count were detected after the bracktes were bonded. One week after the sustained-release chlorhexidine varnish was applied, a significant decrease of total bacterial levels and S mutans was observed. This decrease persisted for 3 weeks after the first application. No significant change in A viscosus levels occurred during that period. The results provide additional evidence that sustained-release chlorhexidine varnish decreases S mutans levels in orthodontic patients with fixed appliances and therefore might be useful in preventing caries lesions. (Am J Orthod Dentofacial Orthop 2003;123:345-8)

No difference between topical chlorhexidine and fluoride varnishes in preventing caries?

Design A 3-year randomised controlled trial in 180 13 to 14-year-old subjects.Intervention Either 0.1% fluoride or 1% chlorhexidine/thymol varnish professionally applied after prophylaxis every 3 months.Outcome measure Caries increment was identified using bitewing radiographs. The assessor was blind to treatment allocation.Results There were no significant differences between the two groups, with about three new approximal surfaces per child decayed or filled in each group, mostly restricted to the enamel surface (see Table 1).Conclusions There was no difference in caries experience with the use of fluoride varnish compared with the use of chlorhexidine varnish.

Xylitol and Dental Caries: an Overview For Clinicians

An overview of studies about xylitol and dental caries suggests potential clinical dental applications for xylitol. Xylitol is a naturally occurring, low-calorie sugar substitute with anticariogenic properties. Data from recent studies indicate that xylitol can reduce the occurrence of dental caries in young children, schoolchildren, and mothers, and in children via their mothers. Xylitol, a sugar alcohol, is derived mainly from birch and other hardwood trees. Short-term consumption of xylitol is associated with decreased Streptococcus mutans levels in saliva and plaque. Aside from decreasing dental caries, xylitol may also decrease the transmission of S. mutans from mothers to children. Commercial xylitol-containing products may be used to help control rampant decay in primary dentition. Studies of schoolchildren in Belize and Estonia, along with data from the University of Washington, indicate that xylitol gum, candy, ice pops, cookies, puddings, etc., in combination with other dental therapies, are associated with the arrest of carious lesions. A prospective trial in Finland has demonstrated that children of mothers treated with xylitol had lower levels of S. mutans than children of mothers treated with chlorhexidine or fluoride varnish. Food products containing xylitol are available commercially and through specialized manufacturers, and have the potential to be widely accessible to consumers.

The Effect of 6-Monthly Application of 40% Chlorhexidine Varnish on the Microflora and Dental Caries Incidence in a Population of Children in Surinam

This study is aimed at determining whether a commercially available varnish, containing 40% chlorhexidine, is able to reduce the numbers of mutans streptococci and lactobacilli in saliva, in a moderately caries-active population in Surinam. 238 children, ages 13–14 years, were selected from different schools in Paramaribo, Surinam. From these children, total dental status was recorded and saliva samples were taken. At baseline and every 6 months, a 40% chlorhexidine varnish (EC40^®) was applied. The control group received a neutral gel that did not contain chlorhexidine. The numbers of salivary mutans streptococci and lactobacilli were calculated by standard methods, and the caries status was recorded every 12 months. The study lasted 30 months. The results indicate that chlorhexidine varnish did not decrease the numbers of cariogenic bacteria, nor did it decrease caries progression. Moreover, in this population with a low dental health care, children with lactobacilli present in the saliva above our detection level, the chlorhexidine varnish even tended to increase caries progression, possibly due to selection of aciduric and acidogenic oral bacterial species. We therefore conclude that 40% chlorhexidine varnish is not likely to decrease caries in children in a high-treatment-need population without treatment of the sources of infection.

Effect of Chlorhexidine Varnish and Gel on Mutans Streptococci in Margins of Restorations in Adults

The aim of this study was to compare the effect of two different chlorhexidine regimens, varnish and gel, on mutans streptococci (MS) in the margins of restorations and in saliva. Eighteen subjects (mean age 44 years) with >250,000 MS/ml saliva and with many restored teeth were assigned to three groups, each comprising 6 individuals. They were treated with: (1) Cervitec^® varnish, containing 1% chlorhexidine and 1% thymol; (2) placebo varnish, or (3) Corsodyl^® gel, containing 1% chlorhexidine. The varnish was applied on two separate occasions to all tooth surfaces at an interval of 3–4 days. The gel was applied for 3×5 min in individual applicators on 2 consecutive days. Plaque samples from 8–9 margins of restorations per subject, mainly in the premolar and molar region, and stimulated saliva samples were collected at baseline and after 1, 4, 8 and 12 weeks. The general finding was that the Corsodyl gel gave the most pronounced reduction of MS followed by the Cervitec varnish. According to repeated measures ANOVA, no significant differences could be demonstrated either for MS in margins or in saliva among the three groups (p = 0.06 for margins and p = 0.07 for saliva). However, within the groups, the reduction of MS over time was statistically significant, both in margins and in saliva (p < 0.001 and p < 0.05, respectively). Student-Newman-Keuls test showed that MS in margins were significantly reduced at most sampling occasions in both chlorhexidine groups: the reduction was more pronounced in the Corsodyl gel group. The conclusion from this study is that the 1% chlorhexidine gel Corsodyl, administered 6 times during 2 days, is more effective in suppressing MS in the margins of restorations and in saliva than the 1% chlorhexidine varnish Cervitec, administered twice within 3–4 days.

Clinical and microbiological effects of local chlorhexidine applications

To study the effects of an application of chlorhexidine varnish (40%) on dental plaque. Randomised controlled clinical trial. 40 patients (50% females), aged 25-34 years after undergoing any necessary restorative treatment. Exactly one half of these individuals practiced good oral hygiene, the efforts of the others were poor. Test groups received a chlorhexidine varnish application, the control group received a placebo varnish. Initially and after 2 and 6 weeks, a modified Dentocult SM-test, bleeding on probing, and a plaque index (Quigley-Hein) were recorded. In contrast to the control group, improvements in plaque index and bleeding on probing scores were found in patients with poor oral hygiene. The results of the Dentocult SM-tests showed a considerable reduction of streptococcus colonisation. The test group with good oral hygiene showed only slight improvement of the examined indices after chlorhexidine application. The index parameters of all patients of the placebo groups remained unchanged over the examination time period. The application of a chlorhexidine varnish reduced the quantity of the Streptococcus mutans colonies significantly and improved clinical parameters in patients with elevated plaque accumulation.

Prevention of Early Mutans Streptococci Transmission in Infants by Professional Tooth Cleaning and Chlorhexidine Varnish Treatment of the Mother

Mutans streptococci (MS) are transmitted in early childhood from the mother to the infant, mostly by saliva. This study evaluated the influence of chlorhexidine (CHX) varnish-mediated suppression of MS in mothers with high salivary MS counts on the frequency of MS colonization in their children at 2 years of age. Professional tooth cleaning followed by CHX varnish application in 16 mothers with high salivary MS counts resulted in a significantly lower number of MS-colonized infants at 2 years of age when compared to a control group of 13 untreated mother-child pairs with high maternal salivary MS levels. The frequency of MS colonization in the CHX-treated group was not significantly different from the one found in a negative control group of 15 mother-child pairs with low maternal salivary MS levels.

Lack of Effect of Chlorhexidine Varnish on Streptococcus mutans Transmission and Caries in Mothers and Children

In a randomized clinical trial, we evaluated the effect of a 10% chlorhexidine varnish (Chlorzoin^®) on the mother-child transmission of Streptococcus mutans and on subsequent caries experience. Chlorhexidine (n = 38) or a placebo varnish (n = 37) was applied to the dentitions of 75 mothers at a time when their first babies were about 6 months old (approximate time of first tooth emergence). Three more applications at weekly intervals and subsequent applications at 6-month intervals followed the initial application. The mother-child pairs were followed up until the child’s fourth birthday. Maternal salivary S. mutans levels in the treatment group remained significantly lower (p < 0.05) compared to the control group up to 12 months after the initial application. However, this intervention did not significantly alter the S. mutans colonization in children or the caries increment in either the mother or the child.

Clinical outcomes of risk-based caries prevention in preschool-aged children.

The aim of this study was to evaluate outcomes in young children of risk-based management of dental caries in comparison with routine prevention. The study was carried out in two municipal health centers in Central Finland. The risk-based prevention group consisted of 299 children from Vanha Korpilahti, and the routine prevention group of 226 children from Saarijärvi. The children were 2 yr old at baseline, and they were followed up for 3 yr. All children received regular annual oral health care. In the risk-based prevention group, the presence of mutans streptococci (MS) in plaque (Dentocult-SM strip mutans -test, Orion Diagnostica, Espoo, Finland) and incipient caries lesions were the screening criteria. Additional prevention was targeted at MS-positive subjects twice a year, consisting of health education and application of fluoride varnish. For those who had incipient lesions, 'the high-risk category', additional prevention was given four times a year and this included also chlorhexidine varnish treatments. The screening and the preventive measures were successfully carried out by specially trained dental assistants. The proportion of children with cavitated caries or fillings was significantly lower in the risk-based than in the routine prevention group. The treatment effect was strongest within the high-risk category: two subjects had to be treated with intensive care for 3 yr to avoid restorative treatment of dental caries by the age of 5 yr in one subject (number needed to treat (NNT) = 2.0; 95% CI 1.4-3.8). The accuracy of screening was evaluated in the routine prevention group and found acceptable. The results indicate that in young children, risk-based management of caries seems practical, and prevention of caries can be targeted efficiently to individuals at risk.

Chlorhexidine varnish may have a role in the management of dental caries in adults with dry mouth

Question: Is chlorhexidine varnish effective in reducing caries in adults who have reduced salivary flow? Objective To determine whether chlorhexidine varnish would reduce caries incidence in adults who have reduced salivary flow due to medication.Design A multicentre randomised controlled trial conducted at three dental schools.Intervention A two-stage application of either active (10% chlorhexidine), sham (to mimic taste) or placebo varnish treatment was carried out once a week for 4 weeks by a dental hygienist, with a single re-application at 6 months. Clear inclusion and exclusion criteria were defined. If patients developed two or more carious lesions in any 2-month period or more than four carious lesions during the study period they were withdrawn.Outcome measures Caries increment.Results Of 540 screened patients, 240 were enrolled in study with 236 completing at least on the follow-up visit. Comparison of the active and placebo groups showed a significant reduction (see Table 1) in root caries increment of 41% and 25% in total caries increment. The 14% reduction in coronal caries did not reach clinical significance. A number of transient minor adverse events were noted.Conclusions The results suggest that 10% chlorhexidine varnish may have an important role to play in the management of dental caries in adults with dry mouth.

Chlorhexidine varnishes: a review.

Of all chemical plaque control agents, chlorhexidine digluconate has proven to be the most effective and safe. Since 1964, varnishes have been used for local delivery of fluor and are reported to be an effective and easy to use vehicle. During the past decade, varnishes for local delivery of antimicrobial agents have been developed and investigated in vitro and in vivo. In this paper, the existing literature on the use of 3 different chlorhexidine varnishes in different fields in dentistry is reviewed. In vitro results concerning the release of the antimicrobial agents are compared for the 3 different varnish formulations. Clinical reports on the efficacy of controlled-release systems in altering cariogenic and periodontopathic microflora are summarized.

Effectiveness of Methods Used by Dental Professionals for the Primary Prevention of Dental Caries

This paper summarizes and rates the evidence for the effectiveness of methods available to dental professionals for their use in the primary prevention of dental caries. It reviews operator-applied therapeutic agents or materials and patient counseling. Evidence of effectiveness is extracted from published systematic reviews. A search for articles since publication of these reviews was done to provide updates, and a systematic review of the caries-inhibiting effects of fluoride varnish in primary teeth is provided. Good evidence is available for the effectiveness of fluoride gel and varnish, chlorhexidine gel, and sealant when used to prevent caries in permanent teeth of children and adolescents. The evidence for effectiveness of fluoride varnish use in primary teeth, chlorhexidine varnish, and patient counseling is judged to be insufficient. Use of fluoride, chlorhexidine and sealant according to tested protocols and for the populations in which evidence of effect is available can be recommended. However, they may need to be used selectively. Estimates for the number of patients or tooth surfaces needed to treat to prevent a carious event suggest that the effects of these professional treatments are low in patients who are at reduced risk for dental caries. The literature on use of these preventive methods in individuals other than school-aged children needs expansion.