Effectiveness of an alcohol-free essential oil-containing mouthwash in institutionalised elders receiving long-term care: a feasibility study.

OBJECTIVES: To conduct a feasibility study on investigating the effectiveness of an alcohol-free essential oil mouthwash (AF-EOMW) to reduce plaque accumulation and oral pathogen levels in institutionalised elders receiving long-term care and to obtain preliminary results. BACKGROUND: Although simple, cost-effective strategies to improve oral hygiene in seniors such as the use of mouthwashes have been shown to reduce the risks of respiratory diseases, little information is available on the feasibility of implementing these measures. METHODS: Twenty-five elderly participants with significant loss of autonomy were initially recruited and divided into two groups. A test group rinsed with an AF-EOMW twice a day, and a control group rinsed with tap water. Data on demographic characteristics, dental history and tobacco use were collected from a questionnaire. Problems encountered during recruitment and data collection were documented. Plaque index, denture cleanliness and salivary levels of several pathogens were measured at three time points: baseline (T0 ), day 22 (T1 ) and day 45 (T2 ). RESULTS: Eighteen participants completed the study. Several problems were encountered during recruitment and execution of the study protocol. No significant differences in clinical or microbiological measures were found between the test group and controls at three time points (p > 0.05). CONCLUSION: This pilot study shows that, if sufficient logistical and financial resources are available, it is feasible to conduct randomised clinical trials in a seniors' facility. The use of an AF-EOMW to improve oral hygiene in seniors was not found to be superior to tap water. However, larger controlled clinical studies are needed to confirm these results.

Concentration and fate of histatins and acidic proline-rich proteins in the oral environment.

Saliva plays a critical role in the protection of oral hard and soft tissues and contains a multitude of constituents with well-characterized biological activities in vitro. Among these are histatins and acidic proline-rich proteins (PRPs). Nevertheless, few functional studies have recognized the structural instability of these proteins in the proteolytic environment of whole saliva. The aim of this investigation was to determine histatin and acidic PRP levels in parotid secretion (PS) and in whole saliva (WS) as well as to establish their susceptibility to proteolysis in these salivary fluids. Using cationic polyacrylamide gel electrophoresis and densitometric analysis the average total histatin concentration (histatin 1+3+5) in WS was determined to be 33.3+/-16.7 microg/ml (n=22) and the average total acidic PRP concentration (PRP1/PIF-s+PRP3/PIF-f) was 427.9+/-123.3 microg/ml (n=22). Histatin and acidic PRP concentrations in PS were 6 and 1.5 times higher than in WS (n=7), respectively. WS histatin and acidic PRP levels each correlated significantly with WS total protein concentrations (P<0.01 and P<0.05, respectively), as well as with each other (P<0.01). Stability studies of histatin 3 and PRP1/Pif-s in PS revealed t(1/2) times of 7.2+/-5.5 and 50.3+/-24.8h, respectively (n=7). Histatin 3 (40 microg/ml) and PRP1 (400 microg/ml), added to WS in concentrations equivalent to their concentrations in PS, disappeared at a much faster rate, with t(1/2) values of 1.7+/-1.6 min and 29.3+/-15.3 min, respectively (n=7). The data indicate that proteolysis in WS is an important factor in explaining the substantially lower concentrations of histatins and acidic PRPs in WS as compared to in glandular secretions.