Oral Antiseptics Research Articles

Effect of a Chlorhexidine Mouthwash on the Risk of Postextraction Bacteremia

To investigate the prevalence, duration, and etiology of bacteremia following dental extractions performed after a single administration of chlorhexidine mouthwash. A randomized, controlled trial performed in a university hospital. A series of 106 patients with mental and behavioral disabilities who underwent dental extractions under general anesthesia were randomly assigned to a control group or chlorhexidine group. The exclusion criteria applied were use of antibiotics in the previous 3 months, use of oral antiseptics, any type of congenital or acquired immunodeficiency, and disease that predisposes the patient to infections or bleeding. The chlorhexidine group had 0.2% chlorhexidine mouthwash administered for 30 seconds before any dental manipulation. Blood samples were collected at baseline, 30 seconds, 15 minutes, and 1 hour after the dental extractions. Subculture and further identification of the isolated bacteria were performed by conventional microbiological techniques. The prevalence of bacteremia after dental extraction in the control and chlorhexidine groups were 96% and 79%, respectively, at 30 seconds (P=.008), 64% and 30% at 15 minutes (P<.001), and 20% and 2% at 1 hour (P=.005). The most frequently identified bacteria were Streptococcus species in both the control and chlorhexidine groups (64% and 68%, respectively), particularly viridans group streptococci. We recommend the routine use of a 0.2% chlorhexidine mouthwash before dental extractions to reduce the risk of postextraction bacteremia.

A fluorescence assay to determine the viable biomass of microcosm dental plaque biofilms

Dental plaque bacteria form complex and robust cell aggregates which cannot be counted accurately using epifluorescence microscopy. This causes a significant problem for quantifying their viability. The aim of the investigation was to develop a fluorescence assay to quantify the viable biomass of dental plaque biofilms. Using an artificial mouth system, microcosm plaques were grown under a range of fluoride and mineralizing conditions, and were treated with the oral antiseptics chlorhexidine (CHX) and Listerine®. Plaques were harvested, made into suspension and stained in microtitre plates with a di-chromatic fluorescent stain (Live/Dead® BacLight™). The percentage of viable biomass was calculated from the regression data generated from a viability standard. The standard was constructed using different proportions of viable (green fluorescence) and non-viable (red fluorescence) plaque bacteria, and growth conditions for optimizing green fluorescence were investigated. The results from the assay showed that fluoride at 1000 and 3000 ppm promoted plaque viability by at least 15%, from ∼ 45 to 60%, and at 5000 ppm to ∼ 87% ( P < 0.05). Plaques treated with Listerine® and CHX from d 0 yielded insufficient biomass to be tested for viability, however 14 d post-treatment, viability was comparable to untreated plaques (∼ 55%, P > 0.05). Treatment with Listerine® and CHX from d 3 reduced biomass but not viability. Development of this assay enabled viability of plaque bacteria which cannot be resolved with epifluorescence microscopy to be evaluated. It offers a rapid alternative to epifluorescence microscopy and could be applied to nonoral bacteria.

In vitro Short-Time Killing Activity of Povidone-Iodine (Isodine® Gargle) in the Presence of Oral Organic Matter

In order to estimate the clinical efficacy of a povidone-iodine oral antiseptic (PVP-I) on oral bacterial infectious diseases, we studied the effect of oral organic matter on the in vitro killing activity of PVP-I. In addition, we compared the in vitro short-time killing activity of PVP-I with those of other oral antiseptics using mouth-washing and gargling samples collected from healthy volunteers. When any of the mouth-washing and gargling samples was used, the standard (0.23–0.47%) or lower concentrations of PVP-I killed methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa, including multidrug-resistant strains, within 15–60 s in the presence of oral organic matter. 0.02% benzethonium chloride (BEC) and 0.002% chlorhexidine gluconate (CHG) did not show effects against MRSA and P. aeruginosa (including multidrug-resistant strains) in mouth-washing and gargling samples even after 60 s. The above-mentioned results show that the in vitro killing activity of the standard concentration of PVP-I was hardly affected by the oral organic matter and that a mouth-washing or gargling solution containing PVP-I has a stronger bactericidal activity than BEC and CHG. Although mouth-washing and gargling samples were obtained from healthy individuals in this study, PVP-I may be used for protection against infections in patients with various diseases, if proper concentrations and usage are encouraged.

Macroscopic and microscopic study of tissue response to oral antiseptics and its influence on carcinigenesis

Studies have related the action of alcohol on the oral mucosa as a promoter of carcinogenesis, once most oral antiseptics contain alcohol. Its utilization for mouthrinses from 30 to 60 seconds, as indicated on the labels, yields a longer-lasting topical action when compared to the intake of alcoholic beverages. This study aimed at conducting a macroscopic and microscopic analysis of the tissue response of tongue mucosa of hamsters to daily topical applications of antiseptics (Anapyon, Listerine, Oral B) during 13 and 20 weeks, following the methodology for carcinogenesis investigation developed by the Discipline of Pathology of Bauru Dental School, University of São Paulo. After sacrificing the animals, their tongues were removed and fixed on 10% formalin. Macroscopic examination did not reveal significant alterations, and the specimens were processed by routine histotechnical procedures for HE staining. Three serial sections of each tongue were evaluated, and characteristics related to epithelial hyperkeratinization, atrophy, hyperplasia and dysplasia were organized in tables. Despite the observation for moderate dysplasia in one case in the Anapyon 20 week group, the further results were very similar to the control group (saline solution), eliminating the need of comparative statistical tests. By means of such methodology for testing the carcinogenesis-initiating action, it was concluded that oral antiseptics are unable to trigger the development of neoplasms.

Impetigo: incidence and treatment in Dutch general practice in 1987 and 2001-results from two national surveys

Impetigo is a common skin infection in children. The epidemiology is relatively unknown, and the choice of treatment is subject to debate. The objective of our study was to determine the incidence and treatment of impetigo in Dutch general practice, and to assess trends between 1987 and 2001. We used data from the first (1987) and second (2001) Dutch national surveys of general practice. All diagnoses, prescriptions and referrals were registered by the participating general practitioners (GPs), 161 and 195, respectively. The incidence rate of impetigo increased from 16.5 (1987) to 20.6 (2001) per 1000 person years under 18 years old (P < 0.01). In both years, the incidence was significantly higher in summer, in rural areas and in the southern region of the Netherlands, compared with winter, urban areas and northern region, respectively. Socioeconomic status was not associated with the incidence rate. From 1987 to 2001, there was a trend towards treatment with a topical antibiotic (from 43% to 64%), especially fusidic acid cream and mupirocin cream. Treatment with oral antibiotics (from 31% to 14%) and antiseptics (from 11% to 3%) was prescribed less often. We have shown an increased incidence of impetigo in the past decade, which may be the result of an increased tendency to seek help, or increased antibiotic resistance and virulence of Staphylococcus aureus. Further microbiological research on the marked regional difference in incidence may contribute to understanding the factors that determine the spread of impetigo. Trends in prescribing for impetigo generally follow evidence-based knowledge on the effectiveness of different therapies, rather than the national practice guideline.

Efficacy of Listerine® Antiseptic in reducing viral contamination of saliva

Aim: The anti‐viral efficacy of oral antimicrobial rinses has not been adequately studied in terms of potential clinical significance. As a follow‐up to an in vitro study on the effect of oral antiseptics on Herpes simplex virus, Type 1, this study was undertaken to evaluate the in vivo effect of an essential oil containing oral antiseptic on the reduction of viral titer in saliva during active viral infection. Method: Patients were recruited and evaluated in a single visit protocol at the onset of a perioral outbreak, consistent historically and clinically with recurrent Herpes labialis. Direct immunofluorescence of cytological smears of the lesions/oral fluids was used to confirm Herpes simplex virus types I or II. Patients were randomly assigned to one of two treatment groups: (1) active ingredient and (2) sterile water control. The viral lesion was evaluated as to clinical stage according to standard protocol. Salivary fluid samples were taken: (1) at baseline; (2) immediately following a 30 s rinse; (3) 30 min. after the 30 s rinse; and (4) on the repeat trial, also at 60 min. after the 30 s rinse. All samples were evaluated for viral titer and results compared. Results: In Trial 1, the sample population consisted of 19 males and 21 females with an average age of 29.2 and in Trial 2, 21 males, 19 females with an average age of 28. In both Trials 1 and 2, recoverable infectious virions were reduced to zero after a 30 s experimental rinse; whereas, the control rinse resulted in a non‐significant (p>0.05) reduction. The experimental group also demonstrated a continued significant (p<0.05) reduction 30 min. post rinse when compared with baseline while the control group returned to baseline levels. In Trial 2, the 60 min. post rinse follow‐up demonstrated a 1–2 log residual reduction from baseline in the experimental group; however, this was not significant. Conclusions: There is clinical efficacy in utilizing an oral rinse with the antimicrobial agent Listerine® Antiseptic in reducing the presence of viral contamination in oral fluids for at least 30 min. after oral rinse. The risk of viral cross contamination generated from these oral fluids in person to person contact or during dental treatment may be reduced.

P32 Saliva incubation as replacement for intra‐oral malodour evaluation

Background Breath odor is scored by different techniques, each with its own shortcomings. Organoleptic ratings are uncomfortable for the patient, subjective, influenced by external parameters including food and cosmetics, and lack of international calibration. An intra‐oral VSC rating (Halimeter) or gas chromatography can overcome the embarrassing situation for the patient, but not every clinician has this equipment. This project evaluated the reliability of saliva incubation as an indirect, in vitro, test for bad breath.Methods In a double‐blind, randomized, long‐term, parallel study 45 moderate periodontitis patients that received a ‘one‐stage, full‐mouth’ disinfection, oral hygiene instruction (including tongue scraping) and antiseptics. The intra‐oral VSC ratings (at baseline, and at 3 and 6 months) were compared to in vitro VSC recordings of the headspace air from saliva (0.5 ml, 37°C, 1 and 2 h, anaerobic chamber). The latter recordings were further correlated to the number of CFU in the saliva. At the same time the headspace also received an organoleptic rating.Results Even though the VSC values remained within a narrow range (90% observation 10–200), a strong correlation was found between the intra‐oral VSC ratings and the 1 h (r = 0.48, P &lt; 0.0001) and 2 h (r = 0.43, P &lt; 0.0001) VSC production of saliva. The VSC values of incubated saliva correlated strongly (r = 0.71) with the CFU for anaerobic species in the saliva. The VSC values and organoleptic ratings of the incubated saliva also correlated strongly (r = 0.64 after 1 h and 0.73 after 2 h incubation).Conclusions Saliva incubation can be used as an indirect way to score bad breath. Due to its simplicity it can be useful in longitudinal studies as alternative for direct organoleptic recordings.

In vitro effect of oral antiseptics on human immunodeficiency virus‐1 and herpes simplex virus type 1

The antiviral effectiveness of widely used commercial mouthrinses has not been well studied. A project was undertaken to evaluate and compare the in vitro antiviral effectiveness of essential oil-containing mouthrinses (LA & TLA) and chlorhexidine mouthrinses (PX & CHX) on 2 different enveloped viruses, human immunodeficiency virus (HIV-1) and Herpes simplex virus (HSV-1) McIntyre strain. HIV-1(89.6) (1x10(5)/ml) and HSV-1 (1x10(6)/ml) in RPMI-1640 medium were treated with two commercially available forms of LA & TLA (tartar control LA), and 2 formulations of chlorhexidine [(PX), 0.12% chlorhexidine & (CHX), 0.2% chlorhexidine] for 30 sec. The antiviral effect was estimated by inhibition of the syncytia formation or the cytopathic effect (CPE) for HIV-1 on MT-2 cells and by inhibition of the plaque formation for HSV-1 on Vero cell monolayers. Undiluted LA, TLA, PX and CHX completely inhibited both HIV-189.6 and HSV-1 McIntyre strain. PX and CHX inhibited HIV-1 up to 1:4 dilution, whereas, LA and TLA inhibited HSV-1 up to 1:2 dilution. The antiviral effects of LA and TLA were found to be similar and also the antiviral effect of PX and CHX were also found to be comparable. The methods used in this investigation allow easy and reproducible evaluations of antiviral efficacy. The anti-HIV-1 and anti-HSV-1 effects of LA, TLA, PX and CHX as evidenced in our in vitro study suggest that we should investigate potential in vivo effects during the use of essential oil-containing or chlorhexidine containing products when used by patients as mouthrinses. If the clinical studies confirm the in vitro data, pre-procedural use by clinicians may be beneficial in reducing viral contamination of bio-aerosols during the delivery of dental care.

Salivary biomass assessed by bioluminescence ATP assay related to (bacterial and somatic) cell counts

The present work aimed (1) to evaluate ATP content in saliva by the bioluminescent luciferin–luciferase method, (2) to evaluate the relationships between ATP content, bacterial count and epithelial cell numbers in saliva, (3) to study the effect of two different antiseptics (peroxidase system producing hypothiocyanite and chlorhexidine) on the salivary biomass. In 45 young adults, the salivary ATP content ranged from 8 to 1515 nm. Salivary ATP content was significantly and directly correlated to bacterial count and epithelial cell numbers (Spearman–Rank correlation, P≤0·001). Regression analysis allowed the inference of a mean epithelial cell and bacterial ATP content of 152·7 fg and 8·3 fg per cell, respectively. The salivary ATP content decreased significantly to 38·8±12·3 per cent (mean±SEM, N=6) of its initial value after a 30-min incubation in the presence of a peroxidase system producing hypothiocyanite (OSCN−). Chlorhexidine (CHX) reduced salivary ATP content to 52·0±16·7 per cent. OSCN− did not affect the transformed logarithm of bacterial count but CHX reduced it from 7·02±0·26 to 0·52±0·33. No effect of OSCN− was seen on the ratio of epithelial cell viability while CHX reduced it from 46·7±5·1 to 3·9±1·1 per cent. It is concluded that the combination of the evaluations of the ATP content and cell numbers in saliva can provide reliable data about the effects of oral antiseptics on salivary biomass. Copyright © 2000 John Wiley & Sons, Ltd.

Effects of sublethal exposure to an antiseptic mouthrinse on representative plaque bacteria.

Although the mechanism responsible for the clinical antiplaque efficacy of oral antiseptics is generally considered to be primarily one of bactericidal activity, it has been suggested that oral antiseptics may have additional effects on bacteria exposed to sublethal levels. Studies reported herein, investigated the effects of sublethal levels of an essential oil-containing antiseptic mouthrinse (Listerine Antiseptic, Warner-Lambert Co., Morris Plains, NJ) on selected activities of representative plaque microorganisms using in vitro models. These studies demonstrated that sublethal exposure to the tested oral antiseptic can have significant effects in reducing intergeneric coaggregation, increasing bacterial generation time, and extracting endotoxin from Gram-negative bacteria. These in vitro activities can be correlated with features of plaque formation and pathogenicity seen in vivo; however, additional studies will be necessary to confirm that these mechanisms are, in fact, operative clinically.

O-T-C Topical Oral Antiseptics and Mouthwashes

O-T-C Topical Oral Antiseptics and Mouthwashes

Selective Media for Study of the Bacterial Flora ofthe Mouth Following Use of Oral Antiseptics*

The rinse method is the most satisfactory and accurate sampling procedure for use in studies of the mouth flora.Six special culture media are employed for the following purposes: general or “total” counts, aciduric organisms, lactobacilli, streptococci, staphylococci, and yeast counts.The results obtained by means of the rinse sampling method and the special media employed represent the numbers and kinds of bacteria present on mouth surfaces at the time the rinse samplings are obtained. The relative effects of oral antiseptics when used as a mouth rinse can thus be com-pared and evaluated.

The Influence of "Oral Antiseptics" on the Number of Bacteria Washed Out of the Mouth as Measured by a Rinse Technique

Hourly rinses of 20 ml. each of physiological salt solution for thirty seconds established a pattern of fluctuation in the number of bacteria in the mouth during the course of an eight-hour working day. There was a gradual increase in the number of bacteria during the first three hourly washes. The influence of eating, between the third and fourth hours, was reflected in a sharp reduction in the number of bacteria recovered at the fourth hourly wash. The number of bacteria increased at the fifth hourly wash (first hour after lunch) and continued to increase at each succeeding wash. The original prelunch levels in bacterial count were reached by approximately the seventh hour (third hour after lunch). Subsequent tests with "oral antiseptics” were made, employing four rinses at hourly intervals in order to avoid the complicating influence of eating. The results of these tests are compared with the levels indicated to be normal by physiological salt solution rinses over the same test periods.

Studies on the Numbers of Bacteria in the Mouth and their Reduction by the Use of Oral Antiseptics

Studies on the Numbers of Bacteria in the Mouth and their Reduction by the Use of Oral Antiseptics

Oral Hygiene and Oral Antiseptics

Oral Hygiene and Oral Antiseptics