Antimicrobial Efficacy of the Use of Mouthwash with Cetylpiridinium Chloride for Aerosol Producing Procedures. A Systematic Review / Eficacia antimicrobiana del uso del enjuague bucal con cloruro de cetilpiridinio en procedimientos que generan aerosoles. Revisión sistemática

Abstract The present research aims to determine the antimicrobial efficacy of the mouthwashes based on cetylpyridinium chloride (CPC), before aerosol producing dental procedures. A data search was performed during August 2021 in five databases MEDLINE (PubMed), SCOPUS, SCIELO, Cochrane Central Register of Controlled Trials (CENTRAL) and Google Scholar. Randomized clinical trials (RCTs) were included based on the PICO question, comparing the efficacy of the mouthwashes based on cetylpyridinium chloride (CPC), versus other mouthwashes and water, before aerosol producing dental procedures, papers in English, Spanish and Portuguese were included without time limits. The risk of the included studies was evaluated with the tool RoB 2.0. Number of registration PROSPERO N° CRD42021275982. 120 papers were obtained in the preliminary search, discarding those that didn't comply with the selection criteria, leaving only 3 studies. These papers reported the use of cetylpyridinium chloride (CPC) was effective for the reduction of bacteria during the ultrasonic prophylactic procedure. The use of CPC mouthwashes previous to the dental treatment with ultrasonic prophylaxis showed only antibacterial capacity.

Resumen El presente trabajo de investigación tiene como objetivo determinar la eficacia antimicrobiana de los colutorios a base de cloruro de Cetilpiridinio (CPC), previo a tratamientos dentales que generen aerosol. Se realizó una búsqueda bibliográfica hasta agosto del 2021 en cinco bases de datos: MEDLINE (vía PubMed), SCOPUS, SCIELO, Cochrane Central Register of Controlled Trials (CENTRAL) y Google Scholar. Se incluyeron ensayos clínicos aleatorizados (ECAs), basándose en la pregunta PICOS, que compare la eficacia del colutorio a base de cloruro de Cetilpiridinio (CPC) con otro colutorio, placebo o agua, previo a un tratamiento dental que genere aerosol, en los idiomas español, inglés o portugués y sin límite de tiempo. El riesgo de los estudios incluidos se evaluó con la herramienta RoB 2.0. Número de registro PROSPERO N° CRD42021275982. Se obtuvo un total de 120 artículos en la búsqueda preliminar, descartando aquellos que no cumplían con los criterios de selección, quedando sólo 3articulos. Estos artículos informaron que el uso de CPC es efectivo para la reducción de bacterias durante el procedimiento de profilaxis con ultrasonido. El uso de los enjuagues bucales a base de CPC previo al tratamiento dental de profilaxis con ultrasonido sólo tiene eficacia antibacteriana.

Potencial antimicrobiano de los enjuagues bucales para niños / Potencial antimicrobiano dos enxaguantes bucais para crianças / Antimicrobial potential of child mouthwashes

Objetivo: Poco se sabe del potencial antimicrobiano de los enjuagues bucales sobre la bacteria Streptococcus mutans. El objetivo de este estudio in vitro fue investigar los efectos antimicrobianos de los enjuagues bucales para niños contra esas bacterias. Materiales y Métodos: Se utilizó la cepa de S. mutans para realizar zonas de inhibición mediante prueba de difusión en agar. Las placas de agar Brain Heart Infusion (BHI) se dividieron en cuadrantes: G1 - cloruro de cetilpiridinio (Cepacol Teen®); G2 - xilitol y triclosán (Dentalclean Garfield®); G3: Malva sylvestris, xilitol (Malvatrikids Jr®) y G4: solución de tampón fosfato salino (PBS). Después del ajuste de las bacterias, se sembró una alícuota de cada grupo en el agar BHI y se transfirió a una atmósfera a 37ºC durante 48 horas para realizar las mediciones de las zonas de inhibición. Los datos se analizaron mediante ANOVA de un factor para la comparación entre grupos (α = 0,05). Resultados: Se verificaron zonas de inhibición solo para G1 (10,82 ± 2,13) ​​y G3 (12,75 ± 1,04). No se verificó diferencia estadística significativa entre G1 y G3 (p = 0,287) y G2 y G4 (p ≥ 0,05). Conclusión: A pesar de los efectos beneficiosos de los enjuagues bucales, una combinación de xilitol y triclosán no fue eficaz para controlar el crecimiento de S. mutans en esta condición in vitro. Se deben implementar restricciones adicionales para regular la venta de sustancias antimicrobianas y proporcionar aclaraciones adicionales a la población.

Introdução: Pouco se sabe sobre o potencial antimicrobiano dos enxaguantes bucais em relação à bacteria Sreptococcus mutans. O objetivo deste estudo in vitro foi investigar o efeito antimicrobiano de enxaguatórios bucais infantis contra essa bactéria. Materiais e métodos: Este estudo in vitro utilizou a cepa de Streptococcus mutans para gerar zonas de inibição por meio do teste de difusão em ágar. As placas de ágar BHI foram divididas em quatro quadrantes, seguindo os grupos: G1- Cloreto de Cetilperidíneo (Cepacol Teen®); G2- xilitol e triclosan (Dentalclean Garfield®); G3- Malva silvestres e xilitol (Malvatrikids Jr®) e G4- solução salina tamponada com fosfato. Após o ajuste das bactérias, uma alíquota de cada grupo foi semeada no ágar BHI e transferida para uma atmosfera a 37ºC por 48 horas, para medir as zonas de inibição. Os dados foram analisados, utilizando ANOVA one-way, para comparação intergrupos (α = 0.05). Resultado: As zonas de inibição foram verificadas em G1(10.82±2.13) e G3(12.75 ±1.04), com ausência de zonas de inibição para outros grupos estudados. Não foi verificada diferença estatisticamente significante entre G1 e G3 (p=0,287) e G2 e G4 (p≥0.05). Conclução Apesar dos efeitos benéficos dos enxaguantes bucais, uma combinação de xilitol e triclosan não foi eficaz no controle do crescimento de S. mutans nessa condição in vitro.

Introduction: Little is known about the antimicrobial potential of mouthwashes in Streptococcus mutans bacteria. The objective of this in vitro study was to investigate the antimicrobial effects of infant mouthwashes against those bacteria. Materials and methods: This in vitro study used S. mutans strain to perform inhibition zones by agar diffusion test. Brain Heart Infusion (BHI) agar dishes were divided into quadrants: G1 ­ cetylperidinium chloride (Cepacol Teen®); G2 ­ xylitol and triclosan (Dentalclean Garfield®); G3 ­ Malva sylvestris, xylitol (Malvatrikids Jr®) and G4 - phosphate buffer saline (PBS). After adjustment of bacteria, an aliquot of each group was plated on the BHI agar and transferred to an atmosphere at 37ºC for 48 hours to perform the inhibition zones measurements. The data was analyzed by one-way ANOVA for intergroup comparison (α = 0.05). Results: Inhibition zones were verified only to G1 (10.82 ± 2.13) and G3 (12.75 ± 1.04). No significant statistical difference was verified between G1 and G3 (p = 0.287) and G2 and G4 (p ≥ 0.05). Conclusion: Despite of the beneficial effects of mouthwashes, a combination of xylitol and triclosan was not effective to control S. mutans growth in this in vitro condition.

Relación del uso de colutorios bucales con la disminución de la carga viral del SARS-CoV-2 en la práctica odontológica: tema de revision / Relationship of the use of mouthwashes with the decrease in the viral load of SARS-CoV-2 in dental practice: review topic

Resumen Actualmente, el odontólogo es uno de los profesionales de la salud con mayor riesgo de contagio de la COVID-19 debido a su contacto directo con la cavidad bucal. La alta exposición a los aerosoles, generados por los instrumentos rotatorios, en pacientes con la COVID-19, eleva el contacto con la carga viral del SARS-CoV-2 en los procedimientos de rutina. Se ha descrito que los colutorios bucales, previos a la atención odontológica, podrían ser soluciones efectivas para la reducción del contagio pese a su poca evidencia clínica. Los colutorios con cloruro de cetilpiridinio (CPC), peróxido de hidrógeno (H2O2), povidona yodada (PVP-I) y gluconato de clorhexidina (CHX) muestran un gran potencial para reducir la carga viral del SARS- CoV-2 en los aerosoles generados a partir de la saliva durante la consulta odontológica. Por lo expuesto, el presente artículo tuvo por objetivo hacer una revisión de la información científica actual sobre la relación del uso de los colutorios bucales con la disminución de la carga viral del SARS-CoV-2.

Abstract It is currently known that the dentist is one of the health professionals with the highest risk of contagion of COVID-19 due to its direct contact with the oral cavity. High exposure to aerosols generated by rotating instruments in COVID-19 patients increases contact with the SARS-CoV-2 viral load in routine procedures. It has been described that mouthwashes prior to dental care could be effective solutions to reduce contagion despite their little clinical evidence. Mouthwashes with cetylpyridinium chloride (CPC), hydrogen peroxide (H2O2), povidone-iodine (PVP-I) and chlorhexidine gluconate (CHX) show great potential to reduce the viralload of SARS-CoV-2 in the aerosols generated from saliva during the dental visit. Therefore, the objective of this article was to review the current scientific information on the relationship of the use of mouthwashes with the decrease in the viral load of SARS-CoV-2.

In vitro antimicrobial effect of cetylpyridinium chloride on complex multispecies subgingival biofilm

Abstract Periodontopathogenic subgingival biofilm is the main etiological agent of periodontitis. Thus, a search for antimicrobials as adjuvant for periodontal treatment in the literature is intense. Cetylpyridinium chloride (CPC) is a well-known antimicrobial agent commonly used in mouthrinses. However, CPC effects on a complex biofilm model were not found over the literature. Therefore, the aim of this manuscript is to evaluate 0.075% CPC antimicrobial properties in a multispecies subgingival biofilm model in vitro. The subgingival biofilm composed by 31 species related to periodontitis was formed for 7 days, using the calgary device. The treatments with CPC and chlorhexidine (CHX) 0.12% (as positive control) were performed 2x/day, for 1 min, from day 3 until the end of experimental period, totaling 8 treatments. After 7 days of biofilm formation, biofilm metabolic activity was evaluated by a colorimetric reaction and biofilms microbial composition by DNA-DNA hybridization. Statistical analysis was performed using ANOVA with data transformed via BOX-COX followed by Dunnett post-hoc. Both CPC and CHX reduced biofilm metabolic activity in 60% and presented antimicrobial activity against 13 different species. Specifically, only CHX reduced levels of F.n. vicentii and P. gingivalis while only CPC reduced A. odontolyticus and A. israelli. CPC was as effective as CHX as antimicrobial through in vitro complex multispecies subgingival biofilm. However, future studies using in vivo models of experimental periodontal disease should be performed to prove such effect.

Resumo O biofilme subgengival periodontopatogênico é o principal agente etiológico da periodontite. Assim, a pesquisa de antimicrobianos como adjuvantes para o tratamento periodontal na literatura é intensa. Cloreto de cetilpiridínio (CPC) é um agente antimicrobiano comumente usado em enxaguatórios bucais. No entanto não foram encontrados na literatura estudos avaliando os efeitos do CPC em um modelo complexo de biofilme. Portanto, o objetivo deste artigo é avaliar as propriedades antimicrobianas do cloreto de cetilpiridinio 0,075% em um modelo de biofilme subgengival multiespécie in vitro. O biofilme subgengival composto por 31 espécies relacionadas à periodontite foi formado por 7 dias, utilizando o dispositivo calgary. Os tratamentos com CPC e clorexidina (CHX) 0,12% (controle positivo) foram realizados 2x/dia, por 1 min, do dia 3 até o final do período experimental, totalizando 8 tratamentos. Após 7 dias de formação do biofilme, a atividade metabólica do biofilme foi avaliada por reação colorimétrica e a composição microbiana dos biofilmes por hibridização DNA-DNA. A análise estatística foi realizada usando ANOVA com dados transformados via BOX-COX seguido do teste de Dunnett. Tanto o CPC como a CHX reduziram a atividade metabólica do biofilme em aproximadamente 60% e apresentaram atividade antimicrobiana contra 13 espécies diferentes. Especificamente, apenas os níveis de F.n. Vicentii e P. gingivalis foram reduzidos somente pelo tratamento com a CHX enquanto apenas o CPC reduziu A. odontolyticus e A. israelli. O CPC foi tão eficaz quanto o CHX como antimicrobiano através de biofilme subgengival complexo multiespecífico in vitro. No entanto, futuros estudos usando modelos in vivo de doença periodontal experimental devem ser realizados para comprovar tal efeito.

The effect of different mouth washes and text messages reminder in the oral health of orthodontic patients

Aim: The aim of this study was to investigate the effect of different mouth washes and to study the effect of text message reminder on the oral health status of orthodontic patients treated with fixed appliances. Methods: This study was a clinical trial with pre-test and post-test control group design, conducted on 24 patients undergoing fixed orthodontic treatment aged 15-30 years. The patients randomly divided into two groups; one received a weekly telephone text massage reminder for the instructions of brushing and rinsing while the second group did not receive any messages. Ortho-plaque index and gingival index were used to evaluate the patient's oral hygiene status. The reading indices after brushing only were regarded as a control, then the patients were instructed to use two mouth washes, one containing sodium fluoride with cetylpyridinium chloride, the second containing chlorhexidine digluconate with cetylpyridinium chloride and Aloe Vera. Each one was used routinely for 4 weeks with the same amount and method. The washout period between the two types mouth washes was 4 weeks with a standardized toothbrush and paste. Results: Ortho-plaque index values decreased over the time between first, second and third visits. However, this index raised up at the fourth visit and again dropdown at the fifth visit. Similar results were detected for gingival index. Also, significant interaction between messages and the assessments was recorded for gingival index with a significant difference between the group of text messages and without text messages group (p<0.05). Conclusions: The results of this study showed that the combination of sodium fluoride with cetylpyridinium chloride was more potent for plaque control, while chlorhexidine digluconate with cetylpyridinium chloride and Aloe Vera combination showed a better gingival improvement. Moreover, the text messages reminder could enhance, but not replace direct oral hygiene instruction in orthodontic patients

Clinical evaluation of cetylpyridinium chloride-containing mouthwash in halitosis

Halitosis is a very common disease that affects the majority of the population and is characterized by unpleasant odor during expiration. Anaerobic bacteria produce a range of malodorous substances including volatile sulfur compounds. To reduce oral malodor, the amount of oral microorganisms should be managed through brushing, scraping, and use of antibacterial agents. In this study, a mouthwash containing 0.05% cetylpyridinium chloride was tested on 22 candidates with oral malodor for two weeks to confirm oral malodor reduction through the use of antibacterial mouthwashes. Volatile sulfur compound measurements were significantly lower after using the mouthwash than before using it; thus, the mouthwash effectively reduced oral malodor.

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.

Antifungal activity of synthetic antiseptics and natural compounds against Candida dubliniensis before and after in vitro fluconazole exposure

ABSTRACT INTRODUCTION: This study evaluated the susceptibilities of oral candidiasis-derived Candida albicans, fluconazole-resistant (FR) Candida dubliniensis, and fluconazole-susceptible (FS) C. dubliniensis to synthetic antiseptics [chlorhexidine gluconate (CHX), cetylpyridinium chloride (CPC), and triclosan (TRC)] and natural compounds (carvacrol, eugenol and thymol). METHODS: Susceptibility tests were performed based on the M27-A3 reference method. The fluconazole-resistant C. dubliniensis strains were obtained after prolonged in vitro exposure to increasing fluconazole concentrations. The geometric mean values for minimum inhibitory concentrations and minimum fungicidal concentrations were compared among the groups. RESULTS: Fluconazole-susceptible C. dubliniensis was more sensitive to CPC and TRC than FR C. dubliniensis and C. albicans were. However, eugenol and thymol were more active against FR C. dubliniensis. The fungicidal activities of CHX and TRC were similar for the three groups, and FR C. dubliniensis and C. albicans had similar sensitivities to CPC. CONCLUSIONS: The resistance of C. dubliniensis to fluconazole affects its sensitivity the synthetic antiseptics and natural compounds that were tested.

Efficacy of two mouthwashes with cetylpyridinium chloride: a controlled randomized clinical trial

Abstract This study aimed to evaluate the anti-plaque and anti-gingivitis effects of two mouthwashes containing cetylpyridinium chloride (CPC), in comparison to negative control mouthwash. One hundred and twenty subjects were randomly assigned to study groups: test (0.075% CPC and 0.28% zinc lactate), positive control (0.07% CPC) and negative control mouthwash without CPC. All volunteers were examined by a calibrated examiner for the Quigley-Hein Plaque Index (Turesky modification) and Löe-Silness Gingival Index (GI). Gingival severity was also measured by the percentage of sites with positive gingival bleeding. During six weeks, oral hygiene consisted of brushing twice daily with a toothbrush and toothpaste and rising with their assigned mouthwash. Plaque and gingival parameters were assessed at baseline, after four and six weeks of product use. Statistical analyses were performed separately for plaque and gingival indices, by ANOVA, paired t-test and ANCOVA (α < 0.05). After 4 and 6 weeks, all mouthwashes groups presented statistically significant reductions in plaque and gingival parameters as compared to baseline. In comparison to the positive control, the test group presented additional reductions in dental plaque of 19.8% and 16.8%, after 4 and 6 weeks, respectively. For GI, the additional reductions in the test group were 9.7% and 14.3%, at 4 and 6 weeks, respectively. The test group showed additional reduction of 35.3% and 54.5% in the gingival severity, at week 4 and 6, respectively. It is concluded that the mouthwash containing CPC and zinc lactate presents significant anti-plaque and anti-gingivitis effects as compared to positive and negative control mouthwashes.

Effectiveness of a pre-procedural mouthwash in reducing bacteria in dental aerosols: randomized clinical trial

Abstract The aim of this randomized, single blinded clinical trial was to evaluate the effect of a pre-procedural mouthwash containing cetylpyridinium chloride (CPC), zinc lactate (Zn) and sodium fluoride (F) in the reduction of viable bacteria in oral aerosol after a dental prophylaxis with ultrasonic scaler. Sixty systemically healthy volunteers receiving dental prophylaxis were randomly assigned to one of the following experimental groups (15 per group): (i) rinsing with 0.075% CPC, 0.28% Zn and 0.05% F (CPC+Zn+F), (ii) water or (iii) 0.12% chlorhexidine digluconate (CHX), and (iv) no rinsing. Viable bacteria were collected from different locations in the dental office on enriched TSA plates and anaerobically incubated for 72 hours. The colonies were counted and species were then identified by Checkerboard DNA–DNA Hybridization. The total number of colony-forming units (CFUs) detected in the aerosols from volunteers who rinsed with CPC+Zn+F or CHX was statistically significantly (p<0.05) lower than of those subjects who did not rinse or who rinsed with water. When all locations were considered together, the aerosols from the CPC+Zn+F and CHX groups showed, respectively, 70% and 77% fewer CFUs than those from the No Rinsing group and 61% and 70% than those from the Water group. The mean proportions of bacterial species from the orange complex were statistically significantly (p<0.05) lower in aerosols from the CPC+Zn+F and CHX groups compared with the others two groups. In conclusion, the mouthwash containing CPC+Zn+F, is effective in reducing viable bacteria in oral aerosol after a dental prophylaxis with ultrasonic scaler.

The antibacterial activity and release of quaternary ammonium compounds in an orthodontic primer

The aim of this study was to evaluate the impact of 10 wt% benzalkonium chloride (TBBAC) or 10 wt% cetylpyridinium chloride (TBCPC) on the antimicrobial properties of the orthodontic adhesive primer, Transbond XT™ (TB). Antimicrobial activity was assessed using a zone of inhibition diffusion test and the release of the antimicrobial compounds was monitored by high performance liquid chromatography (HPLC). Shear bond strength (SBS) was tested using bovine enamel. Control, TB, specimens failed to demonstrate intrinsic antibacterial activity at 1, 7 and 14 days; whereas, TBBAC and TBCPC showed antibacterial effects at all times. HPLC analysis indicated no significant differences in the release behaviour of TBBAC and TBCPC (ttest, p > 0.05), except for the 7day release which was higher for TBBAC (p < 0.05). By 14 days the extents of release were 27 ± 2% and 25 ± 5% of the total initial loading for TBBAC and TBCPC, respectively. The incorporation of 10 wt% BAC or CPC in Transbond XT™ adhesive primer also resulted in superior shear bond strength at 7 and 14 days (Fisher's LSD, p < 0.05) with no significant change in the mode of bracket failure under shear stress (Pearson's chisquared, p > 0.05) (AU)

El objetivo de este estudio fue evaluar el impacto del cloruro de benzalconio al 10% en peso del peso (TBBAC) o de cloruro de cetilpiridinio al 10% del peso (TBCPC) con propiedades antimicrobianas presentes en el adhesivo acondicionador ortodóncico, Transbond XT ™ (TB). La actividad antimi crobiana se evaluó usando una zona de prueba de difusión de inhibición y la liberación de los compuestos antimicrobianos se controló mediante cromatografía líquida de alta resolución (HPLC). La resistencia de adhesión al corte (SBS) se probó usando esmalte bovino. Las muestras control, TB no lograron demostrar actividad antibacteriana intrínseca a 1, 7 y 14 días; mientras que TBBAC y TBCPC mostraron efectos antibac terianos en todo momento. El análisis por HPLC no indicó diferencias significativas en el comportamiento de liberación de TBBAC y TBCPC (prueba t, p> 0,05), excepto en la liberación a los 7 días que fue más alta para TBBAC (p <0,05). A los 14 días, los grados de liberación fueron de 27 ± 2% y de 25 ± 5% de la carga inicial total para TBBAC y TBCPC, respectivamente. La incorpora ción de 10% en peso de BAC o CPC en el imprimador adhesivo Transbond XT ™ también dio como resultado una resistencia superior corte a los 7 y 14 días (Fisher's LSD, p <0.05) sin cambios significativos en el modo de falla del bracket bajo tensión de corte (Pearson's chicuadrado, p> 0.05) (AU)

The antiplaque and bleeding control effects of a cetylpyridinium chloride and tranexamic acid mouth rinse in patients with gingivitis

PURPOSE: This study aimed to evaluate the effects of a cetylpyridinium chloride (CPC) and tranexamic acid (TXA) mouth rinse on patients with gingivitis. METHODS: This randomized, placebo-controlled, double-blind, parallel-group, clinical trial included 45 healthy adults with gingivitis, who were randomized into 2 groups. The experimental group used a 0.05% CPC and 0.05% TXA mouth rinse, and the control group used a placebo mouth rinse. The following clinical indices were assessed at baseline, at 3 weeks, and at 6 weeks: the Turesky-Quigley-Hein plaque index (QHI), the Löe-Silness gingival index (GI), and bleeding on marginal probing (BOMP). The subjects used the mouth rinse during the experimental period for 20 seconds, 4–5 times daily (10 mL each time). RESULTS: There were no significant differences in the clinical indices between the groups at baseline. In the experimental group (CPC+TXA), a statistically significant improvement was evident in the QHI, GI, and BOMP at 3 and 6 weeks. These results were similar to those observed in the control group at 3 and 6 weeks, although the change in BOMP was not statistically significant in that group. At 6 weeks, the experimental group had a significantly lower mean score for the QHI than the control group. CONCLUSIONS: This study demonstrated that a CPC and TXA mouth rinse exhibited significant antiplaque and anti-gingivitis efficacy, and had a positive effect on bleeding control when used daily for 6 weeks.

In vitro antimicrobial activity of different mouthwashes available in Korea / 대한구강보건학회지

OBJECTIVES: The purpose of this study was to compare the oral antimicrobial effects of seven different mouthwashes available in Korea. METHODS: To examine the antimicrobial effects of the seven mouthwashes, their minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) were determined using broth microdilution methods. Streptococcus mutans ATCC 25175, Lactobacillus acidophilus ATCC 4355, Candida albicans KCTC 7270, and Porphyromonas gingivalis ATCC 33277 were used in this experiment. S. mutans and P. gingivalis were examined using a scanning electron microscope (SEM), after treatment with the mouthwashes containing cetylpyridinium chloride (CPC). RESULTS: Mouthwashes containing CPC had lower MIC and MBC values against the four microorganisms. Their bactericidal effects were concentration-dependent. S. mutans and C. albicans were highly sensitive to the concentration of CPC in the mouthwashes. According to the SEM observation, the treatment of bacteria with mouthwashes containing CPC, changed the cell surface texture of S. mutans and P. gingivalis. CONCLUSIONS: Mouthwashes containing CPC showed relatively lower MIC and MBC values under the same conditions against the four microorganisms used in this study.

Effects of a mouthwash containing potassium nitrate, sodium fluoride, and cetylpyridinium chloride on dentin hypersensitivity: a randomized, double-blind, placebo-controlled study

PURPOSE: We evaluated the efficacy of a mouthwash containing potassium nitrate (KNO3) as its main component, along with sodium fluoride (NaF) and cetylpyridinium chloride (CPC). The primary endpoint was the relief of dentin hypersensitivity (DH) against the cold stimuli. The effects on other DH tests and periodontal inflammation were also evaluated. METHODS: We used a single-center, double-blind, placebo-controlled, randomized design. A total of 82 patients with DH (40 in the test group, 42 placebo controls) were analyzed using visual analog scales (VASs) for a cold test, a tactile test, a compressive air test, and self-reported pain during daily activities, as well as clinical parameters including plaque index, gingival index, modified sulcular bleeding index (mSBI), gingival recession, and probing depth, which were collected at baseline and after four and six weeks of mouthwash use. RESULTS: VAS scores for cold sensations, tactile sensations, the compressive air test, and self-reported pain significantly decreased from baseline during the six weeks in both groups (P<0.01), and no significant differences between the groups were found. In male patients (10 in the test group and 7 in the control group), both groups showed significant reductions in VAS scores for the cold test over the six weeks, and greater reductions were found in the test group than in the control group between four and six weeks (P=0.01) and between baseline and six weeks (P<0.01). In addition, the mSBI in the test group significantly decreased from baseline during the six weeks (P<0.01), and the changes at four and six weeks from baseline were significantly greater in the test group compared to the control group (P=0.03 and P=0.02, respectively). CONCLUSIONS: A mouthwash containing a mixture of KNO3, NaF, and CPC reduced DH and gingival inflammation, however, the efficacy was comparable to the control group.

Destabilizing effect of glycyrrhetinic acid on pre-formed biofilms of Streptococcus mutans / 대한구강보건학회지

OBJECTIVES: In this study, the destabilizing effect of glycyrrhetinic acid on pre-formed biofilms of Streptococcus mutans (S. mutans) was observed. METHODS: Alamar blue assay was used to determine the toxicity of glycyrrhetinic acid on pre-formed biofilms of S. mutans. Four different concentrations (0, 3.75, 7.5, 15 µg/ml) of glycyrrhetinic acid were tested. Changes in the biofilm architecture after exposure to glycyrrhetinic acid were analyzed by scanning electron microscopy (SEM). Moreover, the role of glycyrrhetinic acid in enhancing the antimicrobial activity of cetylpyridinium chloride (CPC), an antimicrobial agent commonly used in oral health care products, was evaluated. RESULTS: Glycyrrhetinic acid concentration of up to 15 µg/ml had little cytotoxic effect but significantly changed the biofilm architecture. SEM analysis revealed destabilized biofilm structure after the preformed biofilms were exposed to glycyrrhetinic acid. Supplementing 2.5 µg/ml CPC with 15 µg/ml glycyrrhetinic acid significantly enhanced the bactericidal effect of CPC on the pre-formed biofilms than that in the non-supplemented CPC treated control. This indicates that glycyrrhetinic acid enhanced the antimicrobial activity of CPC by modifying the structure, thus facilitating the penetration of CPC into the biofilm. CONCLUSIONS: Glycyrrhetinic acid could be a potential agent to effectively control S. mutans biofilms responsible for dental caries.

Eficacia del uso concomitante de dentífrico con Triclosán a 0.3 por ciento y copolímero PVM/MA a 2.0 por ciento, enjuague bucal a base de cloruro de cetilpiridinio a 0.05 por ciento y terapia de raspado/alisado radicular en pacientes con gingivitis / Efficacy of concomitant use of dentifrice with 0.3 per cent Triclosan and 2.0 per cent PVM/MA copolymer, 0.05 per cent cetylpyridinium chloride mouthrinse and scaling/root planning therapy in patients with gingivitis

Introducción: La placa dentobacteriana es el principal factor etiológico en el desarrollo y progresión de la gingivitis. Comúnmente se han sugerido productos de cuidado oral como cremas dentales y/o enjuagues bucales como adyuvante en la terapia mecánica. Objetivo: Evaluar la eficacia del uso combinado de un dentífrico a base de Triclosán a 0.3 por ciento y copolímero PVM/MA a 2.0 por ciento (Colgate Total 12®) y enjuague bucal a base de cloruro de cetilpiridinio a 0.05 por ciento (Colgate Plax®) en pacientes con gingivitis marginal crónica después de una terapia de raspado y alisado radicular comparado con un grupo control. Material y métodos: Se realizó un ensayo clínico controlado, aleatorizado y doble ciego en 50 pacientes sanos con diagnóstico sistemático de gingivitis marginal crónica. Se dividieron en grupo A experimental y grupo B control. Se evaluó índice gingival de Lõe y Silness e índice de placa de Quigley Hein modifi cado por Turesky al inicio y al fi nal del estudio; el periodo de estudio fue de seis semanas. Al inicio se realizó a cada paciente tratamiento de raspado y alisado radicular y se le instruyó sobre el uso correcto de los productos. Al concluir la sexta semana se tomaron mediciones finales bajo las mismas condiciones que las iniciales...

Introduction:Dental plaque is considered to be the main etiological factor in the development and progression of gingivitis. Oral care products such as toothpaste and mouthwash have commonly been rec-ommended as an adjunct to mechanical periodontal therapy. Objective:To evaluate the effi cacy of using a dentifrice containing 0.3% triclosan and 2.0% PVM/MA copolymer (Colgate Total 12®) in combination with a 0.05% cetylpyridinium chloride mouthwash (Colgate Plax®) in patients with chronic marginal gingivitis following scaling and root-planing therapy compared to a control group. Material and methods:A randomized double-blind controlled clinical study was performed on 50 systemically healthy patients diagnosed with chronic marginal gingivitis. These were divided into two groups: A (experimental) and B (control). The Lõe and Silness gingival index and the Turesky modifi ca-tion of the Quigley-Hein plaque index were recorded at baseline and after 6 weeks (the duration of the study). Patients were treated with scaling and root-planning, and all received instructions on the proper use of the oral care products. Final measurements were taken at the end of the six-week assessment under the same conditions as those at the time of the baseline assessment...

Effects of cetylpyridinium chloride buccal tablets on halitosis induced by oral conditions / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effect of cetylpyridinium chloride buccal tablets on halitosis induced by oral conditions.</p><p><b>METHODS</b>With Porphyromonas gingivalis, Prevotella intermedia and Fusobacterium nucleatum as the testing bacteria, the minimal inhibitory concentration (MIC) of cetylpyridinium chloride buccal tablets was determined using minute amount serial dilution test. The production of volatile sulfur compounds (VSCs) was measured using sulfide detector halimeter in the anaerobic bacteria culture at 4 and 8 h after addition of the tablets. The effect of the tablets in suppressing odor production by mouth-borne halitosis bacteria was assessed using cysteine challenge test in healthy volunteers, and the effectiveness was evaluated by measuring the reduction in VSCs production and the duration of the effect.</p><p><b>RESULTS</b>Cetylpyridinium chloride buccal tablets inhibited the growth of all the 3 bacteria. The tablets obviously inhibited VSCs production by the 3 bacteria with a effect similar to chlorhexidine. Compared with distilled water gargle, the buccal tablets significantly reduced cysteine-induced VSCs production level in the healthy volunteers (P<0.05), and the effect lasted for 230 min.</p><p><b>CONCLUSION</b>Cetylpyridinium chloride tablets can obviously suppress bacteria responsible for oral halitosis and produce good effects in the treatment of halitosis induced by oral conditions.</p>

[Comparison of the substantivity of several mouthwashes and their effect on microbial plaque using epifluorescence microscope]

Several techniques have been used to assess the efficacy and substantivity of mouthwashes. Considering the variability of available mouth rinses, this study aimed to assess the substantivity of several mouthwashes and their effect on microbial plaque using an epifluorescence microscope. This crossover double blind clinical trial evaluated 0.2%, and 0.12% [from 2 different brands] chlorhexidine [CHX], Persica and cetyl pyridinium chloride [CPC] mouth washes as well as normal saline as the negative control. Non-stimulated saliva samples were obtained from 16 candidates at baseline, 30s, 1, 3, 5 and 7h after one time use of mouthwashes. Epifluorescence technique was used to assess the viability of bacteria. For clinical examination following prophylaxis, subjects were asked not to use any oral hygiene measure except for the provided mouthwashes [twice a day] for 4 days. A 10-day washout period was allowed between the use of mouthwashes. Repeated measures ANOVA and Scheffe's test were applied for the comparison of viable bacterial count between the groups and Kruskal Wallis test was used for the assessment of microbial plaque. Persica and 0.12% CHX maintained their substantivity for 3 and 5h, respectively. A significant reduction in bacterial count was observed up to 7h after the use of 0.2% CHX only [P<0.001]. On clinical examination, 0.2% and 0.12% CHX mouthwashes had significant differences with the others but had no significant difference with one another [P<0.02]. Persica and CPC had similar efficacy [P<0.02]. Efficacy of mouthwashes strongly depends on their substantivity. Daily application frequency of other mouth rinses should be increased in order to achieve an efficacy equal to that of CHX

Exposure to cetyl pyridinium chloride and loss of integrity of cell wall of mycobacteria.

Background: Cetyl pyridinium chloride (CPC) liquefied sputum was shown to reduce AFB smear positivity presumably damaging cell wall of M. tuberculosis. Settings: National Institute for Research in Tuberculosis, Chennai, (Tamil Nadu). Objective: To assess the cell wall damage of mycobacteria in CPC liquefied sputum, by Transmission Electron Microscopy (TEM) and mycobacteriophage adsorption studies. Methods: Pooled sputum sample from smear positive pulmonary TB patients was homogenized and liquefied with CPC. It was examined in TEM daily for four days, to assess cell wall damage of M. tuberculosis, and photomicrographs were taken. M. smegmatis mc2155, treated with CPC, was infected with mycobacteriophage (phAE129) to study phage adsorption on cell wall and plaque formation. CPC untreated sputum and M. smegmatis formed controls. Results: Photomicrographs showed that cell wall of M. tuberculosis was intact in controls and damaged in CPC preserved sputum for 96 hours. Plaque formation was seen and absent respectively in CPC untreated and treated M. smegmatis cells. Conclusion: Exposure to CPC damaged the cell wall of M. tuberculosis within 96 hours. Mycobacteriophage failed to form plaques after M. smegmatis mc2155 was treated with CPC implying inhibition of phage adsorption on damaged cell wall and thus providing a clue for poor staining and smear positivity in microscopy.