Preprocedural Rinse Research Articles

Comparative Evaluation of Antimicrobial Activity of 0.2% Lemongrass Oil and 0.2% Chlorhexidine as a Preprocedural Mouth Rinse: A Randomised Controlled, Parallel Design, Split-mouth Clinical Trial

Introduction: The aerosols produced by an ultrasonic scaler contain bacteria that may enter the respiratory systems of both dental surgeons and patients. Lemongrass oil is one of the essential oils with enormous antibacterial, antifungal, antioxidant, anti-inflammatory, and antipyretic effects. Aim: To evaluate and compare the efficacy of commercially available preprocedural mouth rinses, containing 0.2% lemongrass oil mouthwash and a 0.2% chlorhexidine gluconate solution, in reducing the levels of viable bacteria in aerosols. Materials and Methods: This single-centre double-blinded randomised controlled parallel design split-mouth clinical trial was planned among patients in the Department of Periodontics attending Vishnu Dental College and Hospital in Bhimavaram, Andhra Pradesh, India. The study was conducted for 40 days, from August 2022 to October 2022. Two distinct types of preprocedural mouth rinses (lemongrass oil and chlorhexidine) were used on 56 participants with Stage II or III and Grade B periodontitis. A total of 56 subjects were randomly assigned to two groups: Group A (0.2% lemongrass oil) and Group B (0.2% chlorhexidine), using a simple coin toss method. Colonyforming units (CFUs) with and without rinsing in each group were assessed and studied. CFUs collected on blood agar plates were counted during ultrasonic scaling both with and without rinsing. International Business Machine (IBM) Statistical Package for Social Sciences (SPSS) version 20.0 was used for data analysis. Paired t-tests and independent t-tests were used for intragroup and intergroup comparisons for both groups. Results: The mean CFU count in the chlorhexidine group without rinsing was 259.6±26.6, and with rinsing, it was 140.7±22.6, which was statistically significant (p-value < 0.001). In the lemongrass oil group, the CFU count without rinsing was 263.5±26.9, and with rinsing, it was 147.18±33.82, which was also statistically significant (p-value<0.001). In the intergroup comparison, the p-values for both groups-using preprocedural rinse (Group A vs. Group B for quadrants 2 and 3) and without preprocedural rinse (Group A vs. Group B for quadrants 1 and 4)-were 0.40 and 0.58, respectively, which were not significant. Conclusion: Both preprocedural mouth rinses were equally effective in reducing microbial counts in aerosols during ultrasonic scaling.

Clorhexidina y Morinda citrifolia como enjuague bucal profiláctico previo al raspado ultrasónico: un ensayo clínico aleatorizado

Background: Aerosols released during ultrasonic scaling can cause cross-contaminations. Infections like hepatitis and SARS-CoV-2 can spread through these aerosols. Preprocedural rinse is a cost-effective method to reduce aerosol contami-nation produced during ultrasonic scaling. Materials and Methods: This was a double-blinded randomised trial on 105 subjects diagnosed with chronic generalised periodontitis which was randomly allocated into three groups: Group I received 0.12% chlorhexidine (CHX), Group II received 5% Morinda citrifolia (noni) mouthrinse, Group III received distilled water. Participants were advised to mouthrinse for 60 seconds just before the start of ultrasonic scaling. The aerosols released during ultrasonic scaling were gathered on blood agar plates placed at three locations. Colony forming units (CFUs) were counted after 48 hours of incubation. Results: The highest CFU values were observed in the distilled water group and the lowest in chlorhexidine group (p<0.05). Patient chest area has the highest number of CFU than doctors’ and assistant chest area (p<0.05). Conclusions: Preprocedural rinsing with noni mouthwash can be used as an effective method of reducing aerosol contamination during ultrasonic scaling. Keywords: Aerosols; Chlorhexidine; Morinda citrifolia; mouthwashes; Dental prophylaxis; Dental scaling.

Efficacy of Oxygen-Enriched Mouthwash as a Pre-procedural Mouth Rinse Against Oral Microbes Produced During Ultrasonic Scaling.

Aim Oxygen-enriched mouthwash products are based on oral topical oxygen therapy (OOT), whichsupports the formation of new blood vessels and the removal of toxins and waste products from the affected areaand stimulates the synthesis of collagen. These antioxidant mouthwashes containhoney, lactoferrin, and sodium carbonate peroxide. Lactoferrinis an anti-inflammatory protein that binds the ferrous ironions surrounding micro-organismsregulating bacterial growth. Hence, these products can be included as an adjunct to toothbrushing after oral surgeries and in the treatment ofconditions like gingival inflammation and peri-implantitis.The aim of the study was to evaluate the efficacy of oxygen-enriched mouthwash as a pre-procedural mouth rinse against oral microbes in the aerosol produced during ultrasonic scaling. Materials and methods A total of 40 patients with an age range of 20-40 years who have been advised to undergo ultrasonic scalingwere selected as study subjects and were randomly allocated to group 1 (test group; n = 20; blue®m mouthwash) and group 2 (control group; n = 20; chlorhexidine). After evaluating the initial bacterial loadafter the use of water (placebo) as pre-rinse on the patient's chest and shoulder areas in both experimental and control groups, both the group subjects were instructed to gargle with 10 ml of the provided mouth rinse for one minute before ultrasonic scaling procedure. Blood agar plates were placed at the patient's chest and shoulder area to collect the aerosol and were later incubated to assess the colony-forming units (CFUs). An independent t-test was done to compare the CFUs between the groups. Results The mean initial bacterial loadafter the use of water (placebo) as pre-rinse on the patients' chest area (122.4 ± 0.6) and shoulder area (109.3 ± 2.6) in the experimental group was similar to the bacterial load seen on the chest area (126.2 ± 4.8) and shoulder area (115.4 ± 3.8) in the control group. The CFUs found in blood agar plates placed on the chest (59.8 ± 2.5) and shoulder (35.3 ± 3.6) areas of patients in group 1 were less as compared to CFUs found in blood agar plates placed on the chest (104.8 ± 3.2) and shoulder (75.3 ± 2.8) areas of patients in group 2. The difference between both groups was statistically significant with a p-value of ≤0.05. Conclusion There is a reduction in the bacterial load in the aerosols that are emitted during the ultrasonic scaling procedure with the use of oxygen-enriched mouthwash as a pre-procedural rinse when compared with chlorhexidine.

Preprocedural Viral Load Effects of Oral Antiseptics on SARS-CoV-2 in Patients with COVID-19: A Systematic Review.

(1) There are limited clinical trials to support the effectiveness of mouth rinses when used as a preprocedural rinse against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This systematic review aims to evaluate the efficacy of antiseptic mouth rinses as a preprocedural rinse in reducing SARS-CoV-2 oral viral load in-vivo. (2) Methods: A literature search was conducted through November 2022 for the following databases: PubMed, Web of Science, Cochrane Library, and Google Scholar. The evaluated outcomes were quantitative changes in viral load and the statistical significance of that change after using antiseptic mouth rinses. (3) Results: 14 randomized controlled trials (RCT) were selected for risk of bias assessment and data extraction. (4) Conclusion: Within the limits of this systematic review, preprocedural mouth rinses may significantly reduce SARS-CoV-2 in the mouth, thus, reducing the viral particles available for airborne dispersion. Preprocedural mouth rinses may be an effective strategy for reducing airborne SARS-CoV-2 dispersion in the environment. Their use may be a preventive strategy to reduce the spread of COVID-19 in selected medical and healthcare facilities, including dental clinics. Potential preprocedural mouth rinses are identified for use as an integral part of safe practice for healthcare protocols. This systematic review was registered with the National Institute for Health Research, international prospective register of systematic reviews (PROSPERO): CRD42022315177.

Diluted Home Bleach as a Preprocedural Mouthrinse Prior to Ultrasonic Scaling: A Non Randomised Clinical Trial

Introduction: The benefit of mouth rinsing with an antiseptic prior to aerosol generating dental procedures has been reported and widely accepted. Chlorhexidine (CHX), the widely employed antiseptic mouthrinse is not without side effects. Diluted home bleach (sodium hypochlorite) has been in use as an antiseptic mouthrinse and its role in plaque control is well documented. It is safe, less expensive and readily available. Aim: To compare the aerosol microbial load after ultrasonic scaling between three preprocedural rinses namely 0.1% sodium hypochlorite (diluted home bleach), 0.2% CHX and distilled water. Materials and Methods: A non randomised clinical trial was conducted in the Postgraduate Clinic, Department of Periodontics, Government Dental College, Kottayam and Department of Microbiology, Government Medical College, Kottayam, Kerala, India, from April 2021 to September 2021. Study included sixty systemically healthy adults {Full-mouth Plaque Score (FMPS) and Full-mouth Bleeding Score (FMBS) >25%, with atleast one periodontal pocket >4 mm in each quadrant} who were divided into three groups of 20 receiving diluted home bleach, CHX or distilled water, respectively as preprocedural rinse. Subjects rinsed 15 mL of solution for 30 seconds, 10 minutes prior to ultrasonic scaling. Blood agar plates kept at patient’s chest and doctor’s chest locations to collect aerosols were incubated for 48 hours and microbial Colony Forming Units (CFUs) counted. Analysis of Variance (ANOVA) was used to compare the amount of CFUs at the two sites between three groups. Independent t-tests were used to compare the intragroup CFU counts between two sites. Results: The mean age of group A, group B and group C was 45.15±7.01 years, 41.9±9.96 years and 43.2±7.93 years, respectively. There were 13 males and 7 females, 7 males and 13 females and, 11 males and 9 females in group A, group B and group C, respectively. There were more CFUs in patient’s chest location sample compared to doctor’s chest location in all three mouthrinse groups. For Sodium hypochlorite (NaOCl), mean difference was 43.850 (95% CI 15.2-72.4), for CHX 45.800 (95% CI 25.9-65.6), for distilled water 56.650 (95 % CI 20.2-93.0), respectively which were statistically significant (p-value<0.05). The home bleach and CHX groups showed significantly fewer CFUs than distilled water on both locations. On comparison with CHX, diluted home bleach demonstrated fewer CFUs, but this difference was not statistically significant. Conclusion: Diluted home bleach and CHX preprocedural rinses were comparable in terms of CFU counts in dental aerosols generated during ultrasonic scaling. Diluted home bleach mouthrinse is safe, economical and readily available in every house hold.

Comparison of the Effectiveness of Preprocedural Rinse and Ultrasonic Coolant using Chlorhexidine Gluconate and Povidoneiodine in Reducing Aerosol Contamination: A Randomised Clinical Trial

Introduction: The production of airborne particles with embedded microorganisms poses a high risk to dental professionals. Antimicrobials, when used in various forms such as pre-procedural rinse or ultrasonic coolant agents, could reduce the aerosol load. Aim: To compare the effectiveness of ultrasonic coolant, preprocedural rinse using 0.2% Chlorhexidine (CHX) gluconate, and 2% Povidone-iodine (PVI) in reducing aerosol contamination. Materials and Methods: A prospective single-centre, triple-blind, randomised clinical trial was conducted in the Department of Periodontology at Sree Sai Dental College and Research Institute, Srikakulam, India. The study duration was four months, from November 2021 to February 2022. A total of 75 patients diagnosed with gingivitis, aged 20 to 30 years, systemically healthy, with probing depths of <3 mm were included and randomly assigned to one of two groups: pre-procedural rinse or ultrasonic cooling agent. They were then divided into five subgroups: Subgroup I - CHX pre-procedural rinse, Subgroup II - PVI pre-procedural rinse, Subgroup III - ultrasonic cooling agent CHX, Subgroup IV - ultrasonic cooling agent PVI, and Subgroup V - control (distilled water). Agar plates were placed at three different locations, followed by a 20-minute ultrasonic scaling procedure. The agar plates were then incubated at 37°C for 48 hours, and the Colony Forming Units (CFU) were counted using a digital colony counter. Multiple measures Analysis of Variance (ANOVA) was performed for group-wise comparisons, and Tukey’s post-hoc test was performed for intergroup comparison of CFU. Results: All the groups reported statistically significant differences. The control group had higher CFU (616.85, 871.77, 342.23 for the operator, patient, and back of the patient’s head, respectively) compared to the rinse and coolant groups. However, the CHX coolant group showed lower CFU (186.31±41.508 at the operator’s chest area, 415.38±59.219 at the patient’s chest area, 71.69±10.323 at the back of the patient’s head) compared to the other subgroups. The patient’s chest area had higher CFUs (415.38±59.219 for CHX coolant, 545.85±38.105 for PVI coolant group, 580.38±48.290 for CHX rinse group, 752.46±41.667 for PVI rinse group, 871.77±98.826 for the control group) compared to the blood agar plates placed at other locations. Conclusion: The results of the study clearly indicate that CHX coolant can be considered a promising alternative in reducing aerosol contamination produced during ultrasonic scaling procedures.

Dental Aerosol Hazard Prevention with Pre-procedural Antiseptic Mouthwashes (Comparative Study)

Background: One of the recommended methods for reducing aerosol contamination during the daily regular usage of high-speed turbine and ultrasonic scaling is the use of preprocedural mouth rinse. Several agents have been investigated as a preprocedural mouth rinse. Chlorhexidine significantly reduce the viable microbial content of aerosol when used as a preprocedural rinse. Studies have shown that cetylpridinum chloride (CPC) mouthwash is equally effective as chlorhexidine in reducing plaque and gingivitis. This study compared the effect of 0.07% CPC to 0.2% chlorhexidine gluconate (CHX) as preprocedural mouth rinses in reducing the aerosol contamination by high-speed turbine. Materials and Methods: 36 patients were divided into three groups based on the preprocedural rinse used (0.2% CHX, 0.07% CPC and distilled water). Conservative treatment was done for 20 min. (10 min before rinsing and 10 min after rinsing) in the same closed operatory for all the patients after keeping blood agar plates opened at three standardized locations (patient chest, dentist chest and at 12-inch from patient mouth). Colony forming units (CFUs) on blood agar plates were counted, after incubation at 37°C for 48 hr. Statistical analysis was done with (SPSS version 21(. Results: This study showed that the two antiseptic mouthwashes significantly reduced the bacterial colony forming units (CFUs) in aerosol samples at three plates locations. Chlorhexidine rinses were found to be superior to cetylpridinum chloride when used pre-procedurally in reducing aerolized bacteria. The number of CFUs were higher at the patient’s chest location as compared to other locations. Conclusion: 0.07% CPC and 0.2% CHX were effective as a pre-procedural rinse in reducing CFU count during dental treatment using high-speed turbine.

Preprocedural mouth rinses for preventing transmission of infectious diseases through aerosols in dental healthcare providers.

Aerosols and spatter are generated in a dental clinic during aerosol-generating procedures (AGPs) that use high-speed hand pieces. Dental healthcare providers can be at increased risk of transmission of diseases such as tuberculosis, measles and severe acute respiratory syndrome (SARS) through droplets on mucosae, inhalation of aerosols or through fomites on mucosae, which harbour micro-organisms. There are ways to mitigate and contain spatter and aerosols that may, in turn, reduce any risk of disease transmission. In addition to personal protective equipment (PPE) and aerosol-reducing devices such as high-volume suction, it has been hypothesised that the use of mouth rinse by patients before dental procedures could reduce the microbial load of aerosols that are generated during dental AGPs. To assess the effects of preprocedural mouth rinses used in dental clinics to minimise incidence of infection in dental healthcare providers and reduce or neutralise contamination in aerosols. We used standard, extensive Cochrane search methods. The latest search date was 4 February 2022. We included randomised controlled trials and excluded laboratory-based studies. Study participants were dental patients undergoing AGPs. Studies compared any preprocedural mouth rinse used to reduce contaminated aerosols versus placebo, no mouth rinse or another mouth rinse. Our primary outcome was incidence of infection of dental healthcare providers and secondary outcomes were reduction in the level of contamination of the dental operatory environment, cost, change in mouth microbiota, adverse events, and acceptability and feasibility of the intervention. Two review authors screened search results, extracted data from included studies, assessed the risk of bias in the studies and judged the certainty of the available evidence. We used mean differences (MDs) and 95% confidence intervals (CIs) as the effect estimate for continuous outcomes, and random-effects meta-analysis to combine data MAIN RESULTS: We included 17 studies with 830 participants aged 18 to 70 years. We judged three trials at high risk of bias, two at low risk and 12 at unclear risk of bias. None of the studies measured our primary outcome of the incidence of infection in dental healthcare providers. The primary outcome in the studies was reduction in the level of bacterial contamination measured in colony-forming units (CFUs) at distances of less than 2 m (intended to capture larger droplets) and 2 m or more (to capture droplet nuclei from aerosols arising from the participant's oral cavity). It is unclear what size of CFU reduction represents a clinically significant amount. There is low- to very low-certainty evidence that chlorhexidine (CHX) may reduce bacterial contamination, as measured by CFUs, compared with no rinsing or rinsing with water. There were similar results when comparing cetylpyridinium chloride (CPC) with no rinsing and when comparing CPC, essential oils/herbal mouthwashes or boric acid with water. There is very low-certainty evidence that tempered mouth rinses may provide a greater reduction in CFUs than cold mouth rinses. There is low-certainty evidence that CHX may reduce CFUs more than essential oils/herbal mouthwashes. The evidence for other head-to-head comparisons was limited and inconsistent. The studies did not provide any information on costs, change in micro-organisms in the patient's mouth or adverse events such as temporary discolouration, altered taste, allergic reaction or hypersensitivity. The studies did not assess acceptability of the intervention to patients or feasibility of implementation for dentists. AUTHORS' CONCLUSIONS: None of the included studies measured the incidence of infection among dental healthcare providers. The studies measured only reduction in level of bacterial contamination in aerosols. None of the studies evaluated viral or fungalcontamination. We have only low to very low certainty for all findings. We are unable to draw conclusions regarding whether there is a role for preprocedural mouth rinses in reducing infection risk or the possible superiority of one preprocedural rinse over another. Studies are needed that measure the effect of rinses on infectious disease risk among dental healthcare providers and on contaminated aerosols at larger distances with standardised outcome measurement.

Efficacy of Combining an Extraoral High-Volume Evacuator with Preprocedural Mouth Rinsing in Reducing Aerosol Contamination Produced by Ultrasonic Scaling.

The coronavirus disease pandemic has afforded dental professionals an opportunity to reconsider infection control during treatment. We investigated the efficacy of combining extraoral high-volume evacuators (eHVEs) with preprocedural mouth rinsing in reducing aerosol contamination by ultrasonic scalers. A double-masked, two-group, crossover randomized clinical trial was conducted over eight weeks. A total of 10 healthy subjects were divided into two groups; they received 0.5% povidone-iodine (PI), essential oil (EO), or water as preprocedural rinse. Aerosols produced during ultrasonic scaling were collected from the chest area (PC), dentist’s mask, dentist’s chest area (DC), bracket table, and assistant’s area. Bacterial contamination was assessed using colony counting and adenosine triphosphate assays. With the eHVE 10 cm away from the mouth, bacterial contamination by aerosols was negligible. With the eHVE 20 cm away, more dental aerosols containing bacteria were detected at the DC and PC. Mouth rinsing decreased viable bacterial count by 31–38% (PI) and 22–33% (EO), compared with no rinsing. The eHVE prevents bacterial contamination when close to the patient’s mouth. Preprocedural mouth rinsing can reduce bacterial contamination where the eHVE is positioned away from the mouth, depending on the procedure. Combining an eHVE with preprocedural mouth rinsing can reduce bacterial contamination in dental offices.

Povidone-Iodine as a Pre-Procedural Mouthwash to Reduce the Salivary Viral Load of SARS-CoV-2: A Systematic Review of Randomized Controlled Trials.

The use of pre-procedural rinses has been investigated to reduce the number of viral particles and bacteria in aerosols, potentially decreasing the risk of cross-infection from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during medical and dental procedures. This review aims to confirm whether there is evidence in the literature describing a reduction in salivary load of SARS-CoV-2 when povidone-iodine (PVP-I) is used as a pre-intervention mouthwash. An search of the MEDLINE, Embase, SCOPUS, and the Cochrane library databases was conducted. The criteria used followed the PRISMA® Statement guidelines. Randomized controlled trials investigating the reduction of salivary load of SARS-CoV-2 using PVP-I were included. Ultimately, four articles were included that met the established criteria. According to the current evidence, PVP-I is effective against SARS-CoV-2 in saliva and could be implemented as a rinse before interventions to decrease the risk of cross-infection in healthcare settings.

KNOWLEDGE AND ATTITUDE OF DENTAL AND ENT PROFESSIONALS TOWARDS PRE-PROCEDURAL USE OF POVIDONE-IODINE MOUTH RINSE DURING COVID -19 -- A QUESTIONNAIRE-BASED CROSS-SECTIONAL STUDY

Aims And Objectives: The aim of this study is to assess the knowledge and attitude of dental and ENT Professionals towards Pre-procedural use of Povidone-Iodine Mouth rinse during Covid -19. The latent objective was to revitalize the usage of pre-procedural Povidone iodine rinse in clinical settings for Covid-19 cross infection containment. Material And Methods: A cross-sectional study was carried out in the Post Graduate Department of Periodontics and Oral Implantology, Govt Dental College & Hospital Srinagar, J & K. An online questionnaire was distributed among dental and ENT professionals including Interns, Junior residents, Post Graduate Students, Dental and ENT Surgeons. Online social media platforms were utilized to disseminate the questionnaire. The study had a sample size of 223 participants. Results:39.5% participants were doing pre-procedural mouth rinse of patients before Covid-19 pandemic. Post Covid -19 pandemic, 53.5 % practitioners started doing the pre-procedural mouth rinsing of patients. 51.9 % participants were using PVP-I as pre-procedural mouth rinse,41.3 % of participants were using CHX while as 6.8 % were using any other rinsing agent.52.2 % of participants viewed it as moderately effective in containment of Covid-19 cross infection. 43.5 % of participants considered PVP-I as having higher virucidal activity,26.1 % of participants considered CHX as having higher virucidal activity.30.4 % participants considered Hydrogen peroxide as more effective anti-viral agent than both PVP-I and CHX. Conclusion: There is a dire need to raise awareness amongpractitioners in general and dentists in particular, regardingthe virucidal activity of available mouthwashes as is backed by various in-vitro studies. With the Covid-19 pandemic carving out a new normal, the specialists dealing with aerosol producing procedures need to perform the clinical duties more safely. This would be a shot in the arm in our fight against SARS COV-2 driven pandemic.

Comparison of Chlorhexidine and Hydrogen Peroxide as Preprocedural Mouthrinse during Ultrasonic Scaling: A Triple-Blinded Randomized Controlled Clinical Trial.

Background:Every year, around 2 million people suffer from hospital-acquired infections worldwide. Aerosols are produced while performing ultrasonic scaling. They are potential source of infection and cross contamination. It can result in spread of several infections including hepatitis, HIV, SARS CoV 2, etc. Preprocedural rinse before scaling is considered an effective measure to reduce the microbial load in aerosols.Materials and Methods:This study was a triple-blinded randomized controlled trial performed on 90 participants diagnosed with chronic periodontitis. Random allocation of participants into three groups, i.e., Group-1, Group-2, and Group-3, was done, wherein 0.12% chlorhexidine (CHX), 1.5% hydrogen peroxide (HP), and distilled water (DW) were used, respectively, as preprocedural mouthrinse. The participants of each group were instructed to perform mouthrinse for 60 s before the start of ultrasonic scaling sessions. Blood agar plates were kept at three locations, i.e., operator's chest area, patient's chest area, and assistant's chest area for aerosol collection after scaling. Colony-forming units (CFUs) were counted for microbiological analysis.Results:Least number of CFUs was found in the CHX group, followed by HP and DW groups. Location wise, the patient's chest area had the highest CFU count and the least was at the assistant's chest area. CFU count between the groups was statistically significant.Conclusion:Preprocedural rinse using HP can effectively be used as a method to reduce dental aerosols generated during ultrasonic scaling.

Preprocedural mouth rinses can reduce bacterial contamination in aerosols during periodontal prophylaxis.

Aim This study evaluates the effectiveness of preprocedural mouth rinsing when performing non-surgical periodontal prophylaxis to reduce bacterial aerosol contamination.Data sources The authors used the population, intervention, control and outcomes (PICO) question format to perform a systematic online search in Scopus, PubMed, Cochrane Library and Web of Science. All the databases were explored with no time limit until April 2020.Study selection Randomised clinical trials were included in this systematic review. No inclusion or exclusion criteria are mentioned in this study and it is limited to bacterial contamination studies.Data extraction and synthesis The authors extracted the following information from the included studies: authors; article publication year; study design; sampling size and allocation of test and control groups; intervention details; type and description of periodontal prophylaxis procedures; and primary outcomes. They focused on statistically significant findings and the reduction of bacterial aerosol contamination between groups was measured by colony forming units (CFU) using means and percentages. The primary outcome was that bacterial count expressed as CFU on blood agar plates. If permissible, they calculated the mean CFU reduction in the included studies and reported them. The authors also assessed the studies' risk of bias using the revised Cochrane risk of bias tool for randomised trials.Results In total, 30 randomised controlled trials were included, 21 of which assessed the preprocedural rinsing and the remaining nine focused on other interventions. The bacterial incubation protocol differed among studies. The data collection sites differed among the studies in terms of the number of samples obtained, position, direction and distance from the subjects' mouths. There were no marked differences in the CFU reduction regarding the periodontal prophylaxis devices used and the location of aerosol sampling collection from these studies. Nearly half of the studies (52.4%, 11/21) collected the sample at or near the operator and dental assistant. Chlorhexidine (CHX) rinse was mostly tested (80.9%, 17/21) with various concentrations and volumes. Among studies comparing CHX with other agents (71.4%, 15/21), CHX was more effective for the better part of studies, with more than half of the studies (7/15) reporting over a 70% reduction in CFU when using CHX preprocedural mouth rinse.Conclusions Evidence corroborates the effectiveness of preprocedural mouth rinses, especially CHX, in reducing the bacterial contamination of aerosols in periodontal, non-surgical prophylaxis compared with mouth rinsing with water, or with no rinsing. Nevertheless, the low-quality of evidence and the high heterogeneity among the included studies warn that one should be cautious in generalising the findings of this study to other settings and contaminating agents, like viruses. The findings of this study emphasise the need for more studies on the efficacy and effectiveness of preprocedural rinses in reducing the viral load in aerosols (and droplets) during periodontal prophylaxis procedures.

Self Prepared Herbal Mouthwash Used As Pre-procedural Rinse in Reducing Dental Aerosol: A Substitute to Chemical Mouthrinse: A Clinico-Microbiological Study

Aim:To evaluate and compare the efficacy of pre-procedural mouth rinses in reducing microbial content of aerosol product during ultrasonic-scaling procedures by viable bacterial count.Materials And Methods:5 patients were assigned in each group: A- Neem, B -CHX, C-Triphala, D - Control Group.In Group A, B, C -Patient were asked to rinse their mouth with 10 ml mouthwash for 30 seconds before SRP, of which A and C are self- prepared herbal mouthwashes i.e Triphala and Neem. Aerosol will be collected, cultured and incubated on blood agar plates at specified sites from operator. CFU will be counted and result will be assessed statistically. Conclusion: The study suggests that 10 ml of Neem Mouth rinse when used 10 minutes prior to ultrasonic scaling is more potent in reducing the aerosol contamination as compared to the Triphala mouth rinse and commercially available 0.2 % Chlorhexidine mouthrinse. Also the reduction in aerosol content was seen in Tray location when rinsed with CHX and aerosol reduction in Spitoon and Chest location while rinsing with Neem mouthrinse.

Effect of chlorhexidine on covid 19 virus

High generation of aerosols, and the presence of SARS-CoV-2 in saliva have suggested oral cavity as a reservoir for COVID-19 transmission. COVID-19 can penetrate the human body. The transmission can occur during coughing, sneezing, talking and even during dental care. SARS-CoV-2 is an enveloped virus, characterized by an outer lipid membrane. It has been seen that preprocedural rinses with mouthwash reduces the viral load. Chlorhexidine gluconate has been used in the clinical practice since ages. It is a broad spectrum antimicrobial agent, causing distruction of cellular membranes. It acts against gram positive and gram negative bacteria, aerobes, facultative anaerobes and fungus. It is also seen to be effective against viruses. Therefore, this review focuses on the role of chlorhexidine in COVID-19.

Efficacy of Preprocedural Boric Acid Mouthrinse in Reducing Viable Bacteria in Dental Aerosols Produced during Ultrasonic Scaling.

Introduction:Aerosols and droplets contaminated with bacteria and blood are produced during ultrasonic scaling. Measures to control aerosol contamination in dental clinics are recommended by the Centers for Disease Control and Prevention. This study aimed to evaluate the efficacy of preprocedural boric acid (BA) mouthrinse in reducing bacterial contamination in dental aerosols generated during ultrasonic scaling.Materials and Methods:This was a randomised clinical trial in 90 systemically healthy subjects (25-55 yrs) diagnosed with chronic periodontitis who were allocated into three groups of 30 subjects each to receive, Group A - 0.12% chlorhexidine (CHX), Group B - 0.75% BA and Group C-water, as a preprocedural rinse for 1 min. The aerosol generated while performing ultrasonic scaling for 30 min was collected at three locations on blood agar plates. Incubation of the blood agar plates at 37°C for next 48 h for aerobic culture was performed and subsequently colony-forming units (CFUs) were counted.Results:CFUs in Group A were significantly reduced compared with Group B (P < 0.001). When we compare CFUs in all the three groups, CFUs in Groups A and B were statistically significantly reduced compared with Group C (P < 0.001). Furthermore, it was also observed that the assistant's chest area had lowest CFUs whereas patient's chest area had highest.Conclusion:This study recommends routine use of preprocedural mouthrinse as a measure to reduce bacterial aerosols generated during ultrasonic scaling and that 0.12% CHX gluconate is more effective than 0.75% BA mouthwash in reducing CFUs count.

Effect of preprocedural oral rinses with active ingredients like chlorhexidine, povidone-iodine and cetylpyridinium chloride in neutralizing SARS-COV-2 concentration in aerosol

The havoc of COVID 19 pandemic, has created a situation of panic among the health care professionals and general population worldwide. The Virus being a droplet infection has increased the vulnerability of infection among the dental professionals, affecting the clinical practice. The patient being reluctant to visit the dentist due to fear of cross contamination in the dental office has reduced the patient in flow to a certain extent. Various measures have been suggested by the health authorities to avoid the transmission of the virus in the dental office. One such measure is the use of a preprocedural rinse. This acts as the need of the hour to reduce the virus transmission from the patients and prevent cross contamination in dental clinics. Various formulation of mouthwashes are used for preprocedural rinsing. The most common being chlorhexidine, povidone-iodine, cetypyridinium chloride and hydrogen peroxide. The antimicrobial property of these have also been found to be effective against severe acute respiratory syndrome corona virus 2. These ingredients in mouth washes are found to temporarily neutralize the virus load for certain amount of time in saliva and other oral fluids. Thus preprocedural rinse can reduce the risk of transmission of virus and can be used as an adjunct with air filters and PPE kits for prevention and protection from infection.

Povidone-iodine preprocedural rinse-An evidence-based, second-line defense against severe acute respiratory coronavirus virus 2 (SARS-CoV-2) in dental healthcare.

The ongoing COVID-19 pandemic has posed unique challenges to dentistry as a profession and has prompted dental healthcare professionals worldwide to risk manage the delivery of dental care by taking cognizance of the necessity for enhanced safety standards, including enhanced 'personal protective equipment' and 'infection prevention and control' measures. Even so, in light of the perceived vulnerability to the coronavirus infection in dental settings or becoming potential carriers in dental settings, implications for resumption of routine dental care are enormous and cannot be ignored. While reconciling the fact that post-pandemic resurgences can occur in future, safeguarding the oral health care workforce and patients becomes even more pertinent considering the perceived vulnerability to the SARS-CoV-2 infection in dental healthcare. With growing body of direct evidence consistently supporting the effectiveness of Povidone-Iodine against SARS-CoV-2, it would be reasonable to prioritize the use of PVP-I as an effective and adjunctive procedural risk mitigation measure in dental healthcare occupation in the contemporary pandemic crisis and through unforeseen similar pandemic threats.

Effect of different mouth washes as a pre-procedural rinse to combat aerosol contamination– A cross-sectional study

Background: Ultrasonic scaling is a potent source of aerosol generation in dental offices, thus causing increase risk of bacterial infections. Pre-procedural mouth rinsing has been found effective in reducing the bacterial load of the aerosol produced during the procedure. Aim and objectives: the aim of the present study was to evaluate and compare the efficacy of two different mouthwashes containing Chlorhexidine and Octenidine with distilled water, by using them as preprocedural rinsing agents in reducing the bacterial load of the aerosol produced by ultrasonic scaler. Materials and Methods: 80 subjects aged 18-35years were randomly divided into three groups on the basis of mouth rinses used for preprocedural mouthrinsing - Group 1: Distilled Water (Control), Group 2: 0.2% Chlorhexidine (CHX), Group 3: 0.1% Octenidine. The aerosols were collected on agar plates placed and stabilized on patient’s as well as on operator’s chest. all the agar plates were sent for microbiological analysis to the microbiological laboratory for Colony Forming Unit (CFU) count on the same day of ultrasonic scaling procedure. The data obtained was subjected to the statistical analysis using SPSS software version 20.0. Result: At all locations, the mean CFU was significantly highest in Group I, followed by Group II and Group III. It was observed that aerosol generation on patients was significantly more than operator. Conclusion: In our study 0.1% octenidine was found to be most effective preprocedural mouthwash in reducing the bacterial load in the aerosol produced during ultrasonic scaling followed by 0.2% chlorhexidine and distilled water.

Efficacy of commercial mouth-rinses on SARS-CoV-2 viral load in saliva: randomized control trial in Singapore.

PurposeOne of the key approaches to minimize the risk of COVID-19 transmission would be to reduce the titres of SARS-CoV-2 in the saliva of infected COVID-19 patients. This is particularly important in high-risk procedures like dental treatment. The present randomized control trial evaluated the efficacy of three commercial mouth-rinse viz. povidone–iodine (PI), chlorhexidine gluconate (CHX) and cetylpyridinium chloride (CPC), in reducing the salivary SARS-CoV-2 viral load in COVID-19 patients compared with water.MethodsA total of 36 SARS-CoV-2-positive patients were recruited, of which 16 patients were randomly assigned to four groups—PI group (n = 4), CHX group (n = 6), CPC group (n = 4) and water as control group (n = 2). Saliva samples were collected from all patients at baseline and at 5 min, 3 h and 6 h post-application of mouth-rinses/water. The samples were subjected to SARS-CoV-2 RT-PCR analysis.ResultsComparison of salivary Ct values of patients within each group of PI, CHX, CPC and water at 5 min, 3 h and 6 h time points did not show any significant differences. However, when the Ct value fold change of each of the mouth-rinse group patients were compared with the fold change of water group patients at the respective time points, a significant increase was observed in the CPC group patients at 5 min and 6 h and in the PI group patients at 6 h.ConclusionThe effect of decreasing salivary load with CPC and PI mouth-rinsing was observed to be sustained at 6 h time point. Within the limitation of the current study, as number of the samples analyzed, the use of CPC and PI formulated that commercial mouth-rinses may be useful as a pre-procedural rinse to help reduce the transmission of COVID-19.ISRCTN (ISRCTN95933274), 09/09/20, retrospectively registered