Could polyhexanide and chlorine dioxide be used as an alternative to chlorhexidine? A systematic review

ABSTRACT BACKGROUND: Maintenance of oral microbiota balance is the simplest way to prevent infectious oral diseases, through controlling dental biofilm. Combined use of mouthwash and mechanical removal has been shown to be a very effective way for this. OBJECTIVES: To identify clinical studies comparing the antimicrobial effect and possible adverse effects and/or side effects of chlorhexidine-based mouthwashes with those of mouthwashes containing chlorine dioxide and/or polyhexanide, for controlling oral microbiota. DESIGN AND SETTING: Systematic review designed by the stomatology sector of postgraduation in applied dental sciences of Bauru Dentistry School, University of São Paulo, Brazil. METHODS: A systematic review was conducted using online databases (PubMed, Embase, Web of Science and Science Direct) up to April 8, 2020. The search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: The studies included comprised eight articles published between 2001 and 2017. A total of 295 young adults, adults and elderly people were evaluated (males 44.75% and females 55.25%). Three articles compared polyhexanide with chlorhexidine and five articles compared chlorine dioxide with chlorhexidine. No studies comparing all three mouthwashes were found. The concentrations of the study solutions were quite varied, and all rinses had an antimicrobial effect. In four studies, it was stated that no side effects or adverse effects had been found. Three studies did not address these results and only one study addressed side effects and/or adverse effects. CONCLUSION: Mouthwashes containing chlorine dioxide and polyhexanide are viable alternatives to chlorhexidine, since they reduce oral biofilm and have little or no reported side or adverse effects.

Evaluation of in vitro antifungal effects of synthetic and herbal mouth rinses on oral Candida albicans and Candida glabrata

@#Mouth rinses which function as breath fresheners, medicaments, and antiseptics can also deliver oral therapeutic agents. This study evaluated and compared the antifungal effects of synthetic and herbal mouth rinses on oral C. albicans and C. glabrata via disk diffusion, minimal inhibition concentration (MIC), minimum fungicidal concentration (MFC), time-kill assay, and growth profile tests. The four chemical mouth rinses, namely Brand O (A), Brand M (B), Brand H (C), and Brand B (D) used in the study showed positive antifungal activity in these two species. The average diameter of the inhibition zones obtained from the disk diffusion test was higher in mouth rinse B (C. albicans = 12.0 ± 0.9 mm, C. glabrata = 13.5 ± 0.8 mm) compared to those in C, A and D. Both Candida species exhibited similar MIC and MFC values, ranging from 1.63 ± 0.5 to 18.75 ± 0.0 µg/mL and 6.51 ± 2.01 to 50.00 ± 9.36 µg/mL, respectively. These synthetic mouth rinses had efficient killing activity eliminating 50% of the growing population of both Candida spp. following 15 seconds exposure time. Analyses of the growth profile curves showed that mouth rinses B and A resulted in rapid growth depletion of both Candida spp. Meanwhile, three herbal mouth rinses, namely Brand S (E), Brand C (F), and Brand P (G), were less effective against C. albicans and C. glabrata. Mouth rinses B and A contained cetylpyridinium chloride and chlorhexidine, respectively, and could be an effective alternative for controlling and preventing oral candidiasis.

Antimicrobial activity of mouth rinses against bacteria that initially colonizes dental's surface / Atividade antimicrobiana de enxaguatórios bucais sobre bactérias que iniciam a colonização das superfícies dentais

Abstract Introduction Much advertising in mouthwash is conveyed in all media appealing to the anti-plaque effect and rendering a disservice to the community. Mouth rinses are available over-the-count and differ on their compositions and antimicrobial effectiveness. Objective In this study, we evaluated the antimicrobial activity of 35 widely available mouth rinses against bacterial species involved in initiation of dental biofilm - Streptococcus gordonii, Streptococcus mitis, Streptococcus oralis, Streptococcus salivarius, and Streptococcus sanguinis. Material and method The Minimum Inhibitory Concentration (MIC) and the Minimum Bactericidal Concentration (MBC) of the evaluated mouth rinses were determined according to the Clinical & Laboratory Standards Institute protocols. Data were submitted to Kruskal-Wallis test and Mann-Whitney post hoc (α=0.05). Result About 70% of the mouth rinses achieved high antibacterial activity and 30%, a low antibacterial activity against all the species tested. The most ineffective mouth rinse showed antibacterial activity (MIC) at 1:1 dilution, while the most effective showed activity even at 1:2048 dilution, which may imply prolonged effect in the mouth. About 51% of mouth rinses showed bactericidal activity, and it was verified that cetylpyridinium chloride or chlorhexidine digluconate containing in the formulation were associated with the highest activity. Conclusion Most - but not all - mouth rinses commercially available are effective in inhibiting in vitro initial colonizers of dental surfaces.

Resumo Introdução Muita publicidade sobre enxaguatórios bucais é veiculada em todos os meios de comunicação apelando para o efeito anti-placa e prestando um desserviço à comunidade. Grande quantidade de enxaguatórios bucais está disponível no mercado e estes diferem em suas composições e eficácia antimicrobiana. Objetivo Neste estudo, avaliamos a atividade antimicrobiana de 35 enxaguatórios bucais amplamente disponíveis contra espécies bacterianas envolvidas na iniciação do biofilme dental - Streptococcus gordonii, Streptococcus mitis, Streptococcus oralis, Streptococcus salivarius e Streptococcus sanguinis. Material e método A Concentração Inibitória Mínima (CIM) e a Concentração Bactericida Mínima (CBM) dos enxaguatórios avaliados foram determinadas de acordo com os protocolos do Clinical & Laboratory Standards Institute. Os dados foram submetidos ao teste Kruskal-Wallis e Mann-Whitney post hoc (α=0,05). Resultado Aproximadamente 70% dos enxaguatórios bucais alcançaram alta atividade antibacteriana e 30%, baixa atividade antibacteriana contra todas as espécies testadas. O enxaguatório bucal mais ineficaz mostrou atividade antibacteriana (CIM) na diluição de 1:1, enquanto a mais eficaz mostrou atividade mesmo na diluição de 1:2048, o que pode implicar em efeito prolongado na boca. Cerca de 51% dos enxaguatórios bucais apresentaram atividade bactericida, e verificou-se que formulações contendo cloreto de cetilpiridíneo ou digluconato de clorexidina estavam associados à maior atividade. Conclusão A maior parte - mas não todos - dos enxaguatórios bucais comercialmente disponíveis são eficazes na inibição de colonizadores iniciais de superfícies dentárias in vitro.

In vitro study of the effect of an essential oil and a delmopinol mouth rinse on dental plaque bacteria.

Context: Mouthrinses are used, by many of our patients, as a complement to daily dental hygiene routine. The use of a toothbrush and an interproximal cleaning method may not be enough to control dental plaque. Essential oils and delmopinol mouth rinses are effective for the prevention of dental caries and gingivitis. To study the effect of an essential oil and a delmopinol mouth rinse on dental plaque bacteria, an in vitro study was developed. Aims: The objective of this study was to determine the antibacterial activity of an essential oil and a delmopinol mouth rinse on Streptococcus mutans, Lactobacilli, and aerobic and anaerobic dental plaque nonspecific bacteria. Design: Samples of human dental plaque were collected from consenting participants and bacteria isolated. Disk‑diffusion tests were performed to obtain the minimum concentration of the mouth rinses necessary to inhibit bacterial growth. The ability of the commercial mouth rinses to inhibit bacterial growth was studied in comparison to a positive control (0.2% chlorhexidine) and a negative laboratorial control (sterilized water). Results: The minimum inhibitory concentration was found to be inferior to the commercial essential oils and delmopinol mouth rinses concentrations. Delmopinol and essential oils have significant antibacterial properties shown in vitro only for aerobic bacteria, and for S. mutans, Lactobacillus, and anaerobic bacteria, the results were not statistically significant. Conclusions: Essential oils and chlorhexidine are statistically similar and better than delmopinol for aerobic bacteria growth inhibition. For the other bacteria, essential oils and delmopinol are not statistically promising. Results show that essential oils only may help patients to maintain good oral health as a complement to daily brushing and interproximal cleaning.

Effect of electron‑beam irradiation on antimicrobial, antibiofilm activity, and cytotoxicity of mouth rinses.

Background: Oral health diseases are common in all regions of the world. Mouth rinses are widely used generally by population as a port of daily oral care regimen. In addition to antimicrobial activity, mouth rinses possess certain cytotoxic effects. Electron‑beam (E‑beam) radiation is a form of ionizing energy known to induce structural, physical, and chemical changes in irradiated products. In this study, the modulatory effects of E‑beam in irradiated mouth rinses were evaluated for its biological activities. Materials and Methods: The antimicrobial activities of nonirradiated and irradiated mouth rinses were evaluated for its antimicrobial and antibiofilm activities against oral pathogens, Enterococcus faecalis, Streptococcus mutans, Staphylococcus aureus, and Candida albicans. The antimicrobial activity was evaluated by disc diffusion method and antibiofilm activity was evaluated by O’Toole method. The cytotoxicity was evaluated against human gingival fibroblast (HGF) cells by 3‑(4, 5 Dimethythiazol‑yl)‑2,5‑Diphenyl‑tetrazolium bromide assay. Results: Colgate Plax (CP) exhibited the antimicrobial activity against the tested pathogens, and a significant (P < 0.05) increase was observed against S. aureus at 750 Gy irradiation. Further, CP significantly (P < 0.05) suppressed S. mutans, S. aureus, and C. albicans biofilm. Listerine (LS) inhibited S. mutans and C. albicans biofilm. Whereas irradiated CP and LS significantly (P < 0.05) suppressed the biofilm formed by oral pathogens. The suppression of biofilm by irradiated mouth rinses was dose‑ and species‑dependent. There was no significant (P > 0.05) difference in the cytotoxicity of irradiated and nonirradiated mouth rinses on HGF cells. However, an increased percentage viability of HGF cells was observed by mouth rinses irradiated at 750 Gy. Conclusion: The E‑beam irradiation enhanced the antibiofilm activity of mouth rinses without modifying the cytotoxicity.

Effect of Lippia sidoides in mouthrinses on de novo plaque formation: A double-blind clinical study in humans.

Aim: The aim of this study was to evaluate the antiplaque effect of Lippia sidoides (LS) by in vivo investigation. Materials and Methods: Ten healthy volunteers participated in a cross-over, double-blind clinical study, using a 3-day partial-mouth plaque accumulation model. The participants abolished any method of mechanical oral hygiene and they were randomly assigned initially to use just the following mouth rinses: Distilled water (negative control group), 0.12% chlorhexidine digluconate (positive control group) or 10% LS (test group). The plaque index was recorded in the six anterior upper teeth at the end of the trial and the one-way ANOVA and Bonferroni tests were used to estimate the difference among groups. Results: The clinical results did show statistically significant difference among three groups (P < 0.05), favoring the positive control group and test group, however, no difference in efficacy was found between them (P > 0.05). Conclusions: The mouth rinses containing 0.12% chlorhexidine digluconate and 10% LS were equally able to inhibit plaque re-growth.

Effect of fluoride mouth rinses on various orthodontic archwire alloys tested by modified bending test: An in vitro study.

Objective: Fluorides can cause corrosion and degradation in mechanical properties of commonly used archwires by forming hydrofluoric acid HF and causing disruption of protective titanium oxide layer. Hence, the aim of this study was to assess the change in load deflection characteristics of Ni-Ti, Cu Ni-Ti, S.S, and β-Ti wires on immersing in fluoride mouth rinses of two types- Phosflur and neutral NaF mouth rinse utilizing a modified bending test and comparing it to control. Materials and Methods: Round preformed wires were immersed in 10 ml of control and test solution (Phosflur and S-Flo mouth rinse) for 1.5 hours and incubated at 37°C. Modified bending test was carried out to evaluate load-deflection characteristics of different wires using Instron. Analysis of variance (ANOVA) was applied to determine if statistically significant difference exist among the mean load values obtained at various deflections in control and test solutions. Results: There was no statistically significant reduction in load deflection characteristics of Ni-Ti, copper Ni-Ti, β-Ti, and S.S wires on immersing in Phosflur mouth rinse and neutral sodium fluoride mouth rinses as compared to control at 2.5 and 1 mm of deflection in unloading phase. Conclusion: Phosflur and a neutral sodium fluoride mouth rinse did not affect the mechanical bending properties of Ni-Ti, copper Ni-Ti, B-Ti, and SS wires in in vitro conditions.