Placebo Mouthwash Research Articles

Post-exercise hypotension and skeletal muscle oxygenation is regulated by nitrate-reducing activity of oral bacteria

Post-exercise hypotension (PEH) is a common physiological phenomenon leading to lower blood pressure after acute exercise, but it is not fully understood how this intriguing response occurs. This study investigated whether the nitrate-reducing activity of oral bacteria is a key mechanism to trigger PEH. Following a randomized, double blind and crossover design, twenty-three healthy individuals (15 males/8 females) completed two treadmill trials at moderate intensity. After exercise, participants rinsed their mouth with antibacterial mouthwash to inhibit the activity of oral bacteria or a placebo mouthwash. Blood pressure was measured before, 1h and 2 h after exercise. The microvascular response to a reactive hyperaemia test, as well as blood and salivary samples were taken before and 2 h after exercise to analyse nitrate and nitrite concentrations and the oral microbiome. As expected, systolic blood pressure (SBP) was lower (1 h: -5.2 ± 1.0 mmHg; P < 0.001); 2 h: -3.8 ± 1.1 mmHg, P = 0.005) after exercise compared to baseline in the placebo condition. This was accompanied by an increase of circulatory nitrite 2 h after exercise (2h: 100 ± 13 nM) compared to baseline (59 ± 9 nM; P = 0.013). Additionally, an increase in the peak of the tissue oxygenation index (TOI) during the reactive hyperaemia response was observed after exercise (86.1 ± 0.6%) compared to baseline levels (84.8 ± 0.5%; P = 0.010) in the placebo condition. On the other hand, the SBP-lowering effect of exercise was attenuated by 61% at 1 h in the recovery period, and it was fully attenuated 2 h after exercise with antibacterial mouthwash. This was associated with a lack of changes in circulatory nitrite (P > 0.05), and impaired microvascular response (peak TOI baseline: 85.1 ± 3.1%; peak TOI post-exercise: 84.6 ± 3.2%; P > 0.05). Diversity of oral bacteria did not change after exercise in any treatment. These findings show that nitrite synthesis by oral commensal bacteria is a key mechanism to induce the vascular response to exercise over the first period of recovery thereby promoting lower blood pressure and greater muscle oxygenation.

Efficacy of an All-Natural Polyherbal Mouthwash in Patients With Periodontitis: A Single-Blind Randomized Controlled Trial.

Aim: This study aimed to evaluate the anti-inflammatory effect and the incidence of adverse effects of an all-natural polyherbal mouthwash in patients with periodontitis, after 3 months of use. These aims were accomplished by using full mouth bleeding score (FMBS), full mouth plaque score (FMPS), probing depth (PD) clinical attachment level (CAL) and a questionnaire recording any adverse events.Methods: The present randomized controlled clinical study considered 40 patients with moderate or severe periodontitis, randomized in two groups: a test group (TG) and a control group (CG). TG was instructed to use a polyherbal mouthwash composed of Propolis resin extract, Plantago lanceolata, Salvia officinalis leaves extract, and 1.75% of essential oils and the CG was given a placebo mouthwash. Both groups were instructed to rinse for 2 min, twice daily after their routine oral home care with the different mouthwashes. Clinical measurements of FMBS, FMPS, PD and CAL were recorded at baseline (T0) and after 3 months (T1). The incidence of adverse outcomes was recorded at every follow-up. Mann–Whitney U test and Wilcoxon signed-rank test were used for the statistical analysis (p < 0.05).Results: The final study sample consisted of 34 healthy individuals, 17 individuals in each of the two groups. TG and CG showed a statistically significant reduction in FMBS (p = 0.001 TG; p = 0.002 CG), FMPS (p = 0.001 TG; p = 0.003 CG), PD (p = 0.001 TG; p = 0.011 CG) and CAL (p < 0.001 TG; p = 0.020 CG) values from baseline to 3 months. The TG showed a statistically significant decrease in FMBS and FMPS compared with the CG. No adverse events or side effects were reported or observed in both groups.Conclusion: The use of polyherbal mouthwash in patients with moderate or severe periodontitis has proved safe and effective in reducing bleeding score and plaque accumulation, after 3 months, compared with placebo, although no difference between the two groups were reported on PD and CAL (both improving at T1).

Dietary intake of inorganic nitrate in vegetarians and omnivores and its impact on blood pressure, resting metabolic rate and the oral microbiome

Vegetarian diets are commonly associated with lower blood pressure levels. This has been related to greater consumption of inorganic nitrate, since vegetables are the main source of this anion. Dietary nitrate is reduced to nitrite by commensal bacteria in the mouth, which in turn leads to increased circulatory nitrite availability. Nitrite can form nitric oxide by several pathways promoting a reduction in the vascular tone and lower blood pressure. This study tested whether vegetarians have higher concentrations of nitrite in saliva and plasma, and lower blood pressure and resting metabolic rate (RMR), due to higher intakes of nitrate, compared to omnivores. Following a non-randomized, cross-over and single-blinded design we measured dietary nitrate intake, blood pressure and RMR in young and healthy vegetarians (n = 22) and omnivores (n = 19) with similar characteristics after using placebo or antibacterial mouthwash for a week to inhibit oral bacteria. Additionally, we analyzed salivary and plasma nitrate and nitrite concentrations, as well as the oral nitrate-reduction rate and oral microbiome in both groups. Dietary nitrate intake in vegetarians (97 ± 79 mg/day) was not statistically different (P > 0.05) to omnivores (78 ± 47 mg/day). Salivary and plasma nitrate and nitrite concentrations were similar after placebo mouthwash in both groups (P > 0.05). The oral nitrate-reducing capacity, abundance of oral bacterial species, blood pressure and RMR were also similar between vegetarians and omnivores (P > 0.05). Antibacterial mouthwash significantly decreased abundance of oral nitrate-reducing bacterial species in vegetarians (_16.9%; P < 0.001) and omnivores (_17.4%; P < 0.001), which in turn led to a significant reduction of the oral nitrate-reducing capacity in vegetarians (−78%; P < 0.001) and omnivores (−85%; P < 0.001). However, this did not lead to a significant increase in blood pressure and RMR in either groups (P > 0.05). These findings suggest that vegetarian diets may not alter nitrate and nitrite homeostasis, or the oral microbiome, compared to an omnivore diet. Additionally, inhibition of oral nitrite synthesis for a week with antibacterial mouthwash did not cause a significant raise in blood pressure and RMR in healthy, young individuals independent of diet.

A Trial to Compare Antibacterial vs. Placebo Mouthwash to Reduce the Incidence of STIs in MSM Taking HIV PrEP

A Trial to Compare Antibacterial vs. Placebo Mouthwash to Reduce the Incidence of STIs in MSM Taking HIV PrEP

Evaluation of the clinical effect of a probiotic mouthwash in the treatment of generalized marginal chronic gingivitis. Randomized pilot study

Objective. To evaluate the clinical effect of a probiotic mouthwash in reducing generalized marginal chronic gingivitis using positive and negative control groups. Methodology. Four-week study conducted in San Luis Potosí, Mexico, from January to March 2017. Participants were healthy, non-smokers with generalized marginal chronic gingivitis; age range 18-45 years. Subjects were randomized and divided into three groups: Group A: mouthwash based on 0.05% cetylpyridinium chloride (CPC) (positive control); Group B: mouthwash based on probiotics (experimental); Group C: placebo mouthwash (negative control). No oral hygiene practices or routines were modified; subjects were followed for 4 weeks. The primary outcome variable of interest was the Löe and Silness gingival index, and the secondary one, the Quigley Heinn plaque index modified by Turesky. Results. Of the 45 patients included, 19 (42.2%) were men and 26 (57.7%) women, mean age was 22.8±2.07. Each group consisted of 15 subjects; all subjects completed the study. There was no statistically significant reduction in gingival inflammation when comparing the 3 treatment groups (p=0.540) with respect to the gingival index. A comparison was made before and after the treatment and in the 3 groups there was no reduction of the gingival inflammation. Plaque reduction was not statistically significant when comparing the 3 groups (p=0.278). However, when doing intra-group comparison, it was found that the patients in group A had a reduction in plaque index (p&lt;0.005), which was not observed in groups B (p=0.1103) and C (p=0.1508). Conclusions. The use of a probiotic mouth mouthwash did not reduce gingival inflammation or the accumulation of dentobacterial plaque in a period of 4 weeks. There were no statistically significant differences between the study groups.

Effectiveness of Herbal Mouthwash among Visually Impaired Residential School Students

Visually impaired patients are unable to visualize the plaque on tooth surfaces resulting in inadequate plaque removal and therefore the progression of dental caries and inflammatory disease of the periodontium. The objective of the study was to assess the effectiveness of herbal mouth wash in reduction of plaque and gingivitis among visually impaired children. Randomized controlled clinical trial was conducted with parallel groups study, comprising 6 to 20 year old visually impaired children, 20 in each group (herbal mouth wash or chlorhexidine mouthwash or placebo mouthwash). Plaque and gingival index were recorded at baseline and at the end of the study. Children were asked to use the mouth wash twice daily for two weeks. Analysis was done using Chi-square test for categorical data and Mann-Whitney U test/independent t-test and one way analysis of variance/Kruskal-wallis H test for quantitative data. The level of significance was set at P<0.05. Participants showed fair oral hygiene (mean plaque scores of 1.14±0.53) and moderate gingivitis (mean gingival scores of 1.12±0.45) with no significant difference between three groups (P=0.47 and 0.84, respectively). Significant reduction of plaque and gingivitis was seen at follow-up with no significant difference between herbal and chlorhexidine mouthwash. However, significant difference was found between placebo and herbal/chlorhexidine mouthwash. Herbal mouthwash showed significant effect on reducing plaque formation and gingivitis in visually impaired students. The effectiveness of herbal mouthwash was analogous to the gold standard chlorhexidine.

Clinical and microbiological effects of egg yolk antibody againstPorphyromonas gingivalisas an adjunct in the treatment of moderate to severe chronic periodontitis: a randomized placebo-controlled clinical trial

PurposeTo evaluate the clinical and microbiological effects of the local use of egg yolk immunoglobulin against Porphyromonas gingivalis (anti-P.g. IgY) as an adjunct to scaling and root planing (SRP) in the treatment of moderate to severe chronic periodontitis.MethodsThis was a randomized, placebo-controlled, double-blind trial involving 60 systematically healthy patients with moderate to severe chronic periodontitis. Subjects (n=20/group) were randomly assigned to receive SRP combined with subgingival irrigation of anti-P.g. IgY and anti-P.g. IgY mouthwash, subgingival irrigation of 0.2% chlorhexidine and 0.2% chlorhexidine mouthwash, or subgingival irrigation of placebo and placebo mouthwash for 4 weeks. Probing pocket depth, clinical attachment level, bleeding on probing, and the plaque index were evaluated at baseline and at 4 weeks. Subgingival plaque, gingival crevicular fluid, and saliva were simultaneously collected for microbiological analysis.ResultsOur results showed that anti-P.g. IgY mouthwash was as effective as chlorhexidine at improving clinical parameters over a 4-week period. All the groups showed a significant reduction in levels of P.g. at 4 weeks. No significant difference was observed in the test group when compared to placebo regarding the reduction in the levels of P.g. Anti-P.g. IgY significantly suppressed the numbers of red complex bacteria (RCB) in subgingival plaque and saliva in comparison with placebo. No adverse effects were reported in any of the subjects.ConclusionsWithin the limitations of the study, the present investigation showed that passive immunization with anti-P.g. IgY may prove to be effective in the treatment of chronic periodontitis due to its ability to improve clinical parameters and to reduce RCB. No significant differences were found between the anti-P.g. IgY and placebo groups in the reduction of P.g.

Impact of gingivitis treatment for diabetic patients on quality of life related to periodontal objective parameters: A randomized controlled clinical trial

ObjectivesPatients with diabetes have a poor oral health-related quality of life (OHRQoL). It is not clear if this situation could be changed with effective periodontal treatment. This study examined both patients with diabetes and systemically healthy individuals to discover the impact of a gingivitis treatment protocol on OHRQoL and its relation to objective periodontal parameters. DesignAfter ultrasonic debridement, patients were randomly assigned to an essential-oils (EO) or placebo mouthwash group. At baseline and 3 months, OHRQoL was assessed with the Oral Health and Quality of Life-United Kingdom questionnaire (OHQoL–UK) along with clinical, halitometric, microbiological and inflammatory objective parameters. The primary outcome was a change in OHQoL–UK scores. A factor analysis was performed and the impact of the extracted quality of life factor (QLF) and its interactions with diabetes, treatment, and time on the objective parameters, were tested by multiple linear regression models (p < 0.05). Chi-Square test compared questionnaire-answering profiles (p<0.05). ResultsCombined treatment with EO provided OHQoL improvements in both systemic conditions. Positive effect of oral health status on quality of life increased in EO groups but not in placebo groups. Question I (self-confidence) showed the greatest factorial weight, while Question A (food intake) showed the lowest factorial weight. All patients who showed OHRQoL improvements and used the EO rinse showed the lowest plaque and gingival indices and lower levels of bacteria and volatile sulfur compounds. ConclusionsOHRQoL positively changed overtime. Most effective treatment protocols would provide better improvements in OHRQoL which is related to periodontal objective measures.

Oral L-menthol reduces thermal sensation, increases work-rate and extends time to exhaustion, in the heat at a fixed rating of perceived exertion.

The study investigated the effect of a non-thermal cooling agent, L-menthol, on exercise at a fixed subjective rating of perceived exertion (RPE) in a hot environment. Eight male participants completed two trials at an exercise intensity between 'hard' and 'very hard', equating to 16 on the RPE scale at ~35°C. Participants were instructed to continually adjust their power output to maintain an RPE of 16 throughout the exercise trial, stopping once power output had fallen by 30%. In a randomized crossover design, either L-menthol or placebo mouthwash was administered prior to exercise and at 10min intervals. Power output, [Formula: see text]O2, heart rate, core and skin temperature was monitored, alongside thermal sensation and thermal comfort. Isokinetic peak power sprints were conducted prior to and immediately after the fixed RPE trial. Exercise time was greater (23:23±3:36 vs. 21:44±2:32min; P=0.049) and average power output increased (173±24 vs. 167±24W; P=0.044) in the L-menthol condition. Peak isokinetic sprint power declined from pre-post trial in the L-menthol l (9.0%; P=0.015) but not in the placebo condition (3.4%; P=0.275). Thermal sensation was lower in the L-menthol condition (P=0.036), despite no changes in skin or core temperature (P>0.05). These results indicate that a non-thermal cooling mouth rinse lowered thermal sensation, resulting in an elevated work rate, which extended exercise time in the heat at a fixed RPE.

Anti-Bacterial Mouthwash Reduces Plasma Nitrite Following Dietary Nitrate Supplementation but Does Not Alter Stress Response

Rinsing the mouth with anti-bacterial mouthwash (MW) suppresses the reduction of nitrate (NO3-) to nitrite (NO2-) and nullifies the reduction in blood pressure (BP) often reported after dietary NO3- supplementation. Given the known interactions between the microbiome and the central nervous system, we speculated that disruption of the oral flora with MW would induce a stress response exemplified by increased BP and cortisol secretion. PURPOSE: To determine the effects of ingesting NO3--rich beetroot juice (BR) and using MW on BP, plasma [NO2-] and [NO3-], and salivary [cortisol]. METHODS: After a ‘no treatment’ control (CON), ten healthy male participants rinsed with an inert placebo mouthwash (PM) prior to ingestion of 5 x 70 ml BR (~31 mmol NO3-) over the 24 h prior to the experiment (PM+BR) followed by two further experimental arms conducted in a randomised order. In one arm, participants used MW prior to ingestion of BR (MW+BR) and in the other they used MW prior to the ingestion of a NO3--depleted beetroot juice placebo (MW+PLA). Blood was collected and measurements performed after 30 min of laying supine. Plasma [NO2-] and [NO3-] were measured by chemiluminescence. RESULTS: Plasma [NO2-] in PM+BR (209 ± 98 nM) was elevated in comparison to all other experimental arms (all P<0.04). Plasma [NO2-] was similar between CON (95 ± 27 nM) and MW+BR (115 ± 57 nM, P=1.0) but lower in MW+PLA (41 ± 24 nM) compared to all other arms (all P<0.03). Plasma [NO3-] was higher in PM+BR (382 ± 104 μM) and MW+BR (412 ± 87 μM) both compared separately to CON and MW+PLA (all P<0.001). Plasma [NO3-] was not different between CON (64 ± 24 μM) and MW+PLA (43 ± 14 μM, P=0.385) or between PM+BR and MW+BR (P=1.0). Diastolic BP was lower in PM+BR (63 ± 5 mmHg) compared to MW+BR (67 ± 5 mmHg, P=0.018) but not different between other experimental arms (all P>0.43). There were no differences in systolic BP, mean arterial BP, or salivary cortisol between any arms of the experiment (all P>0.16). CONCLUSIONS: As expected, MW reduced plasma [NO2-] but not [NO3-], with and without ingestion of BR. Contrary to our hypothesis, however, MW did not alter BP or cortisol levels suggesting that it does not induce a stress response with short-term use. Further research employing a longer intervention and more extensive assessment of stress markers is required to confirm these observations.

Effectiveness of a single-tuft toothbrush for control of newly formed dental biofilm

Aim: To compare the effectiveness of a single-tuft toothbrush (STB) with conventional toothbrushes (CT) to control dental biofilm neoformation in the dentogingival area. Methods: For this cross-sectional prospective blind study, 20 periodontally healthy subjects were selected and randomly divided into 4 groups: STB; CT; CHX - chlorhexidine mouthwash (positive control) and PS - placebo mouthwash (negative control). The subjects were instructed to use only the assigned care method for 72 h with a 7-day washout period between experiments. The evaluated parameters were visible and disclosed plaque indices (PI and DPI), gingival bleeding index (GBI) at baseline (T-0) and at the end of each experimental period (T-72). Results: Data analysis demonstrated that at T-0 no difference was observed for any of the parameters (p&gt;0.05); after 72 h, CT, STB and CHX showed equivalente effectiveness at controlling biofilm. When the PI data were analyzed, between T-0 and T-72, STB was similar to CT and CHX (p&lt;0.05), whereas for DPI, STB was significantly superior to the other methods. Except for PS, all methods yielded similar results for GBI (p&lt;0.05). Conclusions: The tested STB was effective at controlling short-term dental biofilm neoformation on the dentogingival area.

Evaluation of Salvadora persica L. and green tea anti-plaque effect: a randomized controlled crossover clinical trial.

BackgroundIn the author’s earlier in vitro investigation, a combination of 0.25 mg/ml green tea and 7.82 mg/ml Salvadora persica L. aqueous extracts was found to exhibit significant synergistic anti-bacterial and anti-adherence effects against primary plaque colonizers biofilm. A clinical trial was needed to support these preliminary in vitro results and to investigate its efficacy as a mouthwash in the control of dental plaque.MethodsA 24 h plaque re-growth, double-blinded, randomized crossover trial was carried out. Participants (n = 14) randomly rinsed with test formulation, 0.12% chlorhexidine (control) and placebo mouthwashes for 24 h. A week before the trial, all participants received scaling, polishing and oral hygiene education. On the trial day, the participants received polishing at baseline and rinsed with 15 ml of randomly allocated mouthwash twice daily without oral hygiene measures. After 24 h, plaque index was scored and then the participants entered a 6-days washout period with regular oral hygiene measures. The same protocol was repeated for the next 2 mouthwashes.ResultsThe results were expressed as mean (±SD) plaque index. The test mouthwash (0.931 ± 0.372) significantly reduced plaque accumulation when compared with placebo (1.440 ± 0.498, p < 0.0167) and chlorhexidine (1.317 ± 0.344, p < 0.0167) mouthwashes. No significant difference was found between chlorhexidine and placebo (p > 0.0167).ConclusionsThe test mouthwash has an anti-plaque effect for a 24 h period. Longer-term clinical studies are highly encouraged to investigate its anti-plaque effect for longer periods.Trial registrationThis study was registered in ClinicalTrials.gov as NCT02624336 in December 3, 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s12906-016-1487-0) contains supplementary material, which is available to authorized users.

Triphala, a New Herbal Mouthwash for the Treatment of Gingivitis: A Randomized Controlled Clinical Trial.

An antiplaque agent with minimal side effects that can be used as an effective adjunct to mechanical plaque control is needed. The current study is designed to evaluate efficacy of triphala (TRP) mouthwash in reduction of plaque and gingivitis. Ninety individuals with chronic generalized gingivitis were randomly assigned to three groups: 1) group I, placebo mouthwash; 2) group II, TRP mouthwash; and 3) group III, chlorhexidine (CHX) mouthwash. All individuals were instructed to rinse with their respective mouthwash twice daily. 1) Plaque index (PI); 2) gingival index (GI); 3) oral hygiene index-simplified (OHI-S); and 4) microbiologic colony counts were recorded at baseline and at 7, 30, and 60 days. All three groups showed gradual reduction in PI, GI, and OHI-S levels from baseline to 7, 30, and 60 days. There was also significant reduction in microbial counts in all groups at all time intervals except in group I. A significant difference was noticed with respect to reduction in PI, GI, OHI-S, and microbiologic counts in group I compared with groups II and III. However, no significant differences were found between groups II and III for any parameters at any time intervals. TRP mouthwash was found to decrease inflammatory parameters from baseline to follow-up intervals. Because improvement in gingivitis was comparable with that of CHX mouthwash, TRP mouthwash can be considered a potential therapeutic agent in the treatment of gingivitis.

Effects of antiseptic mouthwash on resting metabolic rate: A randomized, double-blind, crossover study

The nitrate-nitrite-nitric oxide pathway has emerged as a significant source of nitric oxide (NO) bioactivity. Dietary intake of inorganic nitrate has a number of cardiovascular effects as well as a decrease in oxygen cost during exercise and a reduction in resting metabolic rate (RMR). Oral bacteria have a key role in bioactivation of inorganic nitrate since they catalyse the conversion of salivary nitrate to the more reactive nitrite anion. Recent studies demonstrate that blood pressure increases with the use of an antiseptic mouthwash, indicating that endogenous, NO-synthase derived nitrate is recycled into nitrite and NO, sufficiently to modulate cardiovascular function. Here we tested if also RMR would be affected by an antiseptic mouthwash.Seventeen healthy normotensive female subjects (23 ± 4 y) participated in this randomized, double-blinded, crossover study. During two 3-day periods separated by 28 days the subjects consumed a diet low in nitrate combined with rinsing their mouth three times daily with a chlorhexidine-containing mouthwash (mouthwash) or placebo mouthwash (placebo) with similar taste but no antiseptic properties. Resting metabolic rate (RMR) was measured by indirect calorimetry and 24 h ambulatory blood pressure recordings were obtained after each intervention together with blood, saliva and urine samples.Treatment with chlorhexidine-containing mouthwash effectively reduced oral conversion of nitrate to nitrite but had no effect on plasma levels of these anions or plasma cGMP. RMR and 24 h ambulatory blood pressure were unaffected by the intervention.We conclude that in young healthy females an antiseptic mouthwash was effective in disrupting oral bacterial nitrate conversion to nitrite, but this was not associated with changes in plasma nitrite, RMR or blood pressure.

Evaluation of anti-aphthous activity of decoction of Nicotiana tabacum leaves as a mouthwash: a placebo-controlled clinical study

ObjectiveTo determine the effects of decoction derived from the leaves of Nicotiana tabacum (L.) as a mouthwash on minor recurrent aphthous. MethodsA randomized double-blinded placebo-controlled clinical trial was conducted on 60 patients with minor recurrent aphthous. Treatment comprised of application of tobacco or placebo mouthwash (10 mL 3 times a day) for 5 days. Clinical evaluation included pain level using a visual analog scale and ulcer size on days 1, 3, and 5 were measured. Adverse effects after mouthwash application were recorded, and the oral mucosa was examined by the investigator at each visit. ResultsA total of 54 subjects with the mean age (38 ± 10) years fulfilled the study. No minor and major adverse effects were observed. In the treatment group, ulcer pain score was decreased by 79.2% and 93.8% and ulcer size was reduced by 69.1% and 92.2% (days 3 and 5, respectively), which was significantly greater than the control group (P < 0.01). ConclusionThe decoction prepared with of Nicotiana tabacum leaves, used as mouthwash are well-tolerated and safe, and can be used for the management of recurrent aphthous.

Clinical efficacy of an herbal mouth wash composed of Salix alba, Malva sylvestrais and Althaea officinalis in chronic periodontitis patients

BackgroundThe aim of this pilot study was to evaluate the adjunctive use of a herbal mouthwash consisting of Salix alba, Malva sylvestris and Althaea officinalis with scaling and root planing, compared with chlorhexidine (CHX) as a standard chemical mouthwash in the treatment of chronic periodontitis and gingivitis. Materials and methodsIn the first part of this trial (study No 1) the clinical efficacy of a prepared herbal mouthwash was assessed in chronic periodontitis patients; in study No 2, the same mouthwash was assessed in gingivitis patients. In study No 1, 30 periodontitis patients were randomly selected and divided into three groups. Along with their scaling and root planing, group A received CHX as their mouthwash, group B received a herbal mouthwash and group C received a placebo mouthwash. Each of the groups were assessed for bleeding on probing, probing depth and clinical attachment level at baseline and 6 weeks after scaling and root planing plus 4 weeks usage of their bottle of mouthwash. In study No 2, 34 gingivitis patients were divided into the same three groups. For 2 weeks patients rinsed with their mouthwash twice daily. Each of the groups were assessed for bleeding on probing, gingival index and plaque index at baseline and 2 weeks after using mouthwashes. ResultsIn study No 1 the results showed greater reduction in indices in the CHX group than the herbal mouthwash group and the herbal mouthwash compared to the placebo group. However, the differences in indices between the three groups were not statistically significant. No adverse reaction was seen in the herbal mouthwash group. In study No 2, the CHX and herbal mouthwash groups produced greater reduction in bleeding on probing and gingival indices than the placebo group, but the difference between groups A and B was not statistically significant. Furthermore, the reduction in plaque index in all three groups was statistically significant, but differences between the groups were not significant. ConclusionWithin the limitation of this small pilot investigation, an herbal mouthwash consisting of Salix alba, Malva sylvestris and Althaea officinalis, provided a clinical benefit comparable to that of CHX if used as an adjunct to scaling and root planing, especially in gingivitis patients, however, further large-scale studies are warranted.

Efficacy of local use of probiotics as an adjunct to scaling and root planing in chronic periodontitis and halitosis: A randomized controlled trial.

Objective:Periodontitis is known to have multifactorial etiology, involving interplay between environmental, host and microbial factors. The current treatment approaches are aimed at reducing the pathogenic microorganisms. Administration of beneficial bacteria (probiotics) has emerged as a promising concept in the prevention and treatment of periodontitis. Thus, the aim of the present study is to evaluate the efficacy of the local use of probiotics as an adjunct to scaling and root planing (SRP) in the treatment of patients with chronic periodontitis and halitosis.Methods:This is a randomized, placebo-controlled, double-blinded trial involving 32 systemically healthy chronic periodontitis patients. After SRP, the subjects were randomly assigned into the test and control groups. Test group (SRP + probiotics) received subgingival delivery of probiotics and probiotic mouthwash, and control group (SRP + placebo) received subgingival delivery of placebo and placebo mouthwash for 15 days. Plaque index (PI), modified gingival index (MGI), and bleeding index (BI) were assessed at baseline, 1 and 3 months thereafter, whereas probing depth (PD) and clinical attachment level were assessed at baseline and after 3 months. Microbial assessment using N-benzoyl-DL-arginine-naphthylamide (BANA) and halitosis assessment using organoleptic scores (ORG) was done at baseline, 1 and 3 months.Findings:All the clinical and microbiological parameters were significantly reduced in both groups at the end of the study. Inter-group comparison of PD reduction (PDR) and clinical attachment gain (CAG) revealed no statistical significance except for PDR in moderate pockets for the test group. Test group has shown statistically significant improvement in PI, MGI, and BI at 3 months compared to control group. Inter-group comparison revealed a significant reduction in BANA in test group at 1 month. ORG were significantly reduced in test group when compared to control group.Conclusion:Within the limitations of the study, the present investigation showed that the adjunctive use of probiotics offers clinical benefit in terms of pocket depth reduction in moderate pockets and reduced oral malodor parameters.

Evaluation of the efficacy of a polyherbal mouthwash containing Zingiber officinale, Rosmarinus officinalis and Calendula officinalis extracts in patients with gingivitis: A randomized double-blind placebo-controlled trial

BackgroundGingivitis is a highly prevalent periodontal disease resulting from microbial infection and subsequent inflammation. The efficacy of herbal preparations in subjects with gingivitis has been reported in some previous studies. ObjectiveTo investigate the efficacy of a polyherbal mouthwash containing hydroalcoholic extracts of Zingiber officinale, Rosmarinus officinalis and Calendula officinalis (5% v/w) compared with chlorhexidine and placebo mouthwashes in subjects with gingivitis. MethodsSixty patients participated in this randomized double-blind placebo-controlled trial and were randomly assigned to the polyherbal mouthwash (n = 20), chlorhexidine mouthwash (n = 20) or placebo mouthwash (n = 20). Participants were instructed to use the mouthwash twice a day (after breakfast and dinner) for 30 s for a period of two weeks. Gingival and plaque indices were assessed using MGI, GBI and MQH scales at baseline, day 7 and day 14 of the trial. ResultsThere were significant improvements in all assessed efficacy measures i.e. MGI, GBI and MQH scores from baseline to the end of trial in both polyherbal and chlorhexidine mouthwash groups; however, the scores remained statistically unchanged in the placebo group. MGI, BGI and MQH scores in the treatment groups were significantly lower compared with those of the control group at both day 7 and day 14 of the trial. However, there was no significant difference between the polyherbal and chlorhexidine groups, neither at day 7 nor day 14 of the trial. Polyherbal mouthwash was safe and there was neither report of adverse reactions, nor any drop-out during the course of study. ConclusionPolyherbal mouthwash containing hydroalcoholic extracts of Z. officinale, R. officinalis and C. officinalis (5%) was effective in the treatment of gingivitis and its efficacy was comparable to that of chlorhexidine mouthwash.

Preventing and Therapeutic Effect of Propolis in Radiotherapy Induced Mucositis of Head and Neck Cancers: A Triple-Blind, Randomized, Placebo-Controlled Trial.

Background:Mucositis is one of the acute complications of radiotherapy which can ulcerate oral mucosa and cause severe pain and discomfort which can affect oral normal function. Propolis is a natural source of flavenoid which has antiulcer, antibacterial, antifungal, healing and anti-inflammatory effects. Using such an affordable compound without any bad smell or taste that has reasonable price can help the radiotherapy undergoing patients.Objectives:Our goal is assessing the preventing and therapeutic effect of propolis in radiotherapy induced mucositis in patients with head and neck cancer.Patients and Methods:In a randomized triple blind clinical trial, 20 patient were selected randomly to swish and swallow 15 ml of water based extract of propolis mouth wash 3 times a day in the case group (n = 10) and 15 ml placebo mouth wash in control group (n = 10). we use NIC-CTC scale for determining mucositis grading.Results:We use T-test, Man-Whitney, Chi-square, and Friedman as analyzing tests. Case group had significantly (P < 0.05) lower grade of mucositis in all of the follow-ups, but xerostomia is not significantly different in two groups (P > 0.05).Conclusions:This is a pilot study which shows water based extract of propolis efficiently prevents and heals radiotherapy induced mucositis.

Cytogenetic analysis of oral mucosa cells, induced by chlorhexidine, essential oils in ethanolic solution and triclosan mouthwashes

ObjectivesThe aim of this study was to evaluate DNA damage and cytokinetic defects, proliferative potential and cell death caused by the frequent use of mouthrinses containing chlorhexidine, triclosan and essential oils in ethanolic solution, compared to a placebo mouthwash. Study designThis double-blind, prospective, randomized clinical trial included 80 Caucasian patients. Subjects were divided into four groups: Group I used a mouthrinse, Triclosan; Group II used physiological saline; Group III used chlorhexidine; Group IV a mouthrinse with essential oils in ethanolic solution. All subjects used the mouthrinses for two weeks (15ml, twice a day, rinsing for 30s). Two cell samples per subject were collected, before and after mouthrinse use (on day 0 and day 15). Samples were processed as follows: cell collection from cheeks with a cytobrush; cell centrifuge; slide preparation, fixation and staining; and fluorescent microscope analysis. 2000 exfoliated cells were screened for nuclear abnormalities, particularly the presence of micronuclei by means of cytome assay. ResultsNo significant differences between study times (before and after use of mouthwash) were identified for any of the variables studied (p>0.05). Differences between mouthrinse groups were also compared but no significant differences were found (p>0.05). ConclusionsThis study did not observe any genotoxic effect resulting from mouthrinse use.