Accelerating effects of epidermal growth factor on skin lesions of pemphigus vulgaris: a double-blind, randomized, controlled trial.

BACKGROUND: Pemphigus vulgaris (PV) is a severe blistering disease involving the skin and mucous membranes. The most common causes of death in these patients are adverse effects of drugs, and infection. Skin lesions are one of the important sources of infection. Thus, any local treatment that could reduce healing time of lesions and consequently reduce the total dosage of drugs needed to treat is favourable. OBJECTIVE: To evaluate the efficacy of epidermal growth factor (EGF) in reducing healing time of lesions in patients with pemphigus vulgaris. METHODS: In this randomized, double-blind, within-patient, left/right, controlled trial, 20 hospitalized patients with pathologial and immunohistologial (direct and indirect immunoflourecence) proven pemphigus vulgaris (PV) were chosen. In addition, all patients had at least one appropriate pemphigus lesion on each side of the body that had not healed after 2-week systemic therapy and sterile saline washing. EGF (10 microg/g) in 0.1% silver sulfadiazine cream vs. 0.1% silver sulfadiazine cream alone was applied randomly on one side of the body. RESULTS: Kaplan-Meier survival analysis suggested that median time to heal with application of EGF plus silver sulfadiazine cream was 9 days, in comparison with 15 days for silver sulfadiazine cream alone (log-rank test, P=0.0003). No intervention-related adverse effect was observed during the study. CONCLUSIONS: EGF can significantly reduce healing time of skin lesions in patients with pemphigus vulgaris, at least when this cream base is applied (Cochrane skin group identifier: CSG20).

Plaque formation and gingivitis after mouthrinsing with 0.2% delmopinol hydrochloride, 0.2% chlorhexidine digluconate and placebo for 4 weeks, following an initial professional tooth cleaning.

A double-blind, randomised, 4-week clinical trial with parallel group design in 57 patients with gingivitis was conducted for studying the antibacterial efficacy and safety of a delmopinol HCl aqueous solution 2 mg/ml (0.2% w/v), which was used for unsupervised mouth-rinsing and compared with placebo and chlorhexidine digluconate 2 mg/ml (0.2% w/v, Hibitane Dental, ICI Pharmaceuticals, UK). The plaque index and plaque wet weight were used to measure plaque formation, and gingival fluid flow and bleeding on probing to measure gingivitis. According to the reduction from baseline, chlorhexidine showed a significantly better effect on plaque formation than the placebo after 4 weeks treatment for both plaque measurements. Delmopinol exhibited significantly lower plaque index scores than placebo. The difference between chlorhexidine and delmopinol was not statistically significant for any of the plaque measurements. For gingivitis, no statistically significant differences were obtained between the effects of delmopinol, chlorhexidine and placebo. A transient anaesthetic sensation in the oral mucosa was experienced more clearly by the patients in the delmopinol group than by those using chlorhexidine or placebo rinses. Rinsing with chlorhexidine resulted in more staining of the teeth and tongue than did delmopinol and placebo. The placebo solution tasted better than the 2 active solutions. The results showed that rinsing with either delmopinol HCl aqueous solution 2 mg/ml or chlorhexidine digluconate 2 mg/ml 2x daily for 60 as a supplement to normal oral hygiene, following an initial professional tooth cleaning, leads to a lower plaque formation than rinsing with placebo.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparability and discriminating power of 4 plaque quantifications.

This study was designed for analysis of the discriminating power of 4 different quantifications of supragingival plaque: (1) plaque wet weight (PWW); (2) the plaque index (PlI); (3) the PLQ index measuring the coronal extension of plaque; (4) the area % of stained plaque. Different quantities of plaque were produced by adding chlorhexidine acetate (CHX), hydrogen peroxide (H2O2), or sucrose to experimental chewing gums. Total mean scores of 12 subjects in each of 3 test groups revealed that chewing of CHX gum resulted in the lowest plaque scores with all 4 quantifications and that the highest scores were recorded for the PWW or PlI of the sucrose gum users. Chewing of the H2O2 gum produced as much plaque as the sucrose gum when evaluated according to the PLQ index and exceeded the sucrose gum scores when evaluated according to the area % index. The PWW discriminated best between low, medium and high plaque scores after chewing of both CHX, H2O2 and sucrose gums. PlI scores 1 and 3 remained stable whereas the frequency of PlI score 0 strongly decreased and that of score 2 strongly increased when going from gums producing low (CHX) and medium (H2O2) to large (sucrose) amounts of plaque. The PLQ index discriminated well between low and medium but poorly between medium and large amounts of plaque. The area % index functioned well when subjects with low (CHX) and medium (H2O2) plaque scores were subgrouped into those with < 30%, 30-70% or > 70% of their tooth surfaces covered with stained plaque.(ABSTRACT TRUNCATED AT 250 WORDS)

Plaque-growth inhibiting effect of chewing gum containing urea hydrogen peroxide.

The plaque-reducing effect of a chewing gum containing hydrogen peroxide was assessed. 12 dental hygienist students participated in a double-blind 3 x randomly crossed-over study. During the 4-day test periods, from Monday to Friday, no oral hygiene measures were allowed other than chewing 2 pieces of gum for approximately 10 min 5 x daily. The 800 mg pieces of gum were V6+regular (V6+) containing 0.4 g sorbitol and 6.3 mg hydrogen peroxide, V6 placebo gum (PLAC) containing 0.45 g sorbitol and no hydrogen peroxide, and only the gum base (GB) as a negative control. The quantity of plaque was assessed using the plaque index and the visible plaque index, and by scraping "all" plaque off the teeth in half the mouth during 2.5 min for determination of plaque wet weight. With all 3 measurements, chewing of the hydrogen peroxide-releasing gum (V6+) resulted in significantly lower plaque increments, from Monday to Friday, than chewing of the gum base (P less than 0.05). Chewing of the V6 placebo gum (PLAC) resulted in plaque scores which differed from neither those recorded after use of the hydrogen peroxide releasing (V6+) nor the placebo (GB) gums. The observed plaque-growth inhibiting effect of the hydrogen peroxide-releasing chewing gum in the present study was found to be of limited clinical significance.

Effect on plaque growth and salivary micro-organisms of amine fluoride-stannous fluoride and chlorhexidine-containing mouthrinses.

Amine fluoride-stannous fluoride mouthrinse was tested in a double-blind cross-over clinical trial on 16 healthy subjects. Chlorhexidine mouthrinse prepared in the same colour and taste was used as the control. After a preparatory phase of 2 weeks, during which the subjects' plaque and gingival indices were reduced to zero by professional cleaning, 1-week test periods without mechanical cleaning were started in random order. The fluoride test solution did not prevent plaque accumulation and growth of salivary S. mutans and lactobacilli as did chlorhexidine. Furthermore, the plaque wet weight was statistically highly significantly greater during test periods of fluoride rinsing than during the chlorhexidine phase. The cleansing effect, as subjectively estimated by questionnaire, was in favour of chlorhexidine, but discolorations of teeth were assessed as significantly worse during chlorhexidine periods. Neither of the test solutions showed any effect on salivary flow rate, pH, buffering capacity, or lysosomal enzyme activity.

[Gingival abrasion and plaque removal with manual vs. electric toothbrushes]. / Gingivale Abrasion und Plaqueentfernung mit manuellen gegenüber elektrischen Zahnbürsten.

In a clinical study, the relative incidence of gingival injuries after standardized tooth brushing was tested by 22 volunteer dental assistants whose teeth were brushed with a soft multi-tufted toothbrush, a manual V-form toothbrush, and an electric toothbrush. At the beginning of the study, a dental hygienist cleaned the right or left side of the jaw of each subject with a manual V-form toothbrush or an electric toothbrush; the other side was manually cleaned with a multi-tufted toothbrush. At the second cleansing one week later, the same dental hygienist cleaned the side contralateral to that brushed in the first test week with the multi-tufted brush; the manual V-form brush was used instead of the electric toothbrush and vice versa. The number of new gingival lesions was recorded after each brushing. The cleansing effect was established by determining the amount of residual plaque. The subjects did not know which type of toothbrush was used to cleanse the evaluated side of the jaw. The results showed that the manual V-form toothbrush abraded the gingiva more than the electric toothbrush (p less than 0.005). A similar difference was found between the manual multi-tufted and the electric toothbrush (p less than 0.05). No significant differences could be established with respect to the plaque-removing properties of the three types of toothbrush tested.

Prevention of plaque growth with chewing gum containing chlorhexidine acetate.

The purpose of the study was to assess the anti-plaque effect of chlorhexidine (CHX) in chewing gum. The 0.80 g pieces of test gum contained 5 mg chlorhexidine acetate with or without a hydrogen peroxide releasing agent. The gum base with flavouring agents but containing neither CHX nor H2O2 was used as a control. 12 dental hygiene students volunteered to participate in the 3 x crossed-over double blind clinical trial. During the 4-day test periods, no other oral hygiene measures were allowed than chewing 2 pieces of gum at the time for approximately 10 min, 5 times daily. Between test periods, meticulous mechanical oral hygiene measures were practised for 3 days. At the beginning and at the end of each test period, the quantity of plaque was assessed using the plaque index, plaque wet weight, and the area of plaque on the tooth surface as criteria. The results indicated that both CHX gums completely inhibited the increase in plaque index and plaque weight. With regard to area of plaque, the difference between the 2 test gums and the control gum was less marked but still present. The test persons subjectively assessed the gum base to have a poor cleansing effect but also the least unpleasant taste. It was concluded that use of both the chlorhexidine gum and the gum-containing chlorhexidine in addition to the hydrogen peroxide releasing agent had an excellent plaque growth inhibiting effect during the 4-day test periods.

Lacking anti-plaque efficacy of 2 sanguinarine mouth rinses.

The aim of the study was to compare the anti-plaque effect of sanguinaria extract to that of a known effective agent, chlorhexidine gluconate, and to that of a known ineffective agent, tap water. The study was conducted as a 3 times crossed-over and blindly evaluated 3 week clinical trial. 12 dental students rinsed in an individually randomized sequence twice daily for 4 days (Monday to Friday) with Viadent containing 0.03% sanguinaria extract (0.01% sanguinarine chloride) and a 1000 ppm concentration of zinc ions (ZnCl2), 2 X 30 s X 10 ml; with Hibitane Dental containing 0.2% chlorhexidine gluconate, 1 min X 10 ml; and with tap water, 1 min X 10 ml. Mechanical oral hygiene was allowed only during the 3 days between test periods. When measured according to the plaque index or in terms of plaque wet weight, only the chlorhexidine rinse further reduced the low Monday scores. No significant difference was observed between Friday scores after rinses with Viadent and water. The variation in effect of the 3 rinses was less marked when assessed by means of area of plaque on the tooth surfaces. Subjectively, both the taste and effect of Viadent was reported to be poor. In a second controlled clinical trial using the same design, no significant difference in anti-plaque effect was found between the commercially available Viadent rinse and an experimental rinse with a tripled concentration of sanguinarine chloride but the same content of zinc.

The effect of toothbrush grip on gingival abrasion and plaque removal during toothbrushing.

The aim of the present study was to determine whether the type of toothbrush grip affects gingival injury during brushing. The cleanness of the teeth achieved by use of 2 different brush grips was also evaluated. The teeth of 13 dental nurse students were brushed by a dental hygienist. Using the split mouth technique, one side of the mouth was brushed for 2 min holding the toothbrush with a pen grip and the other side for another 2 min using the palm grip. The procedure was repeated 11 days later with reversed brush grips on the 2 sides of the jaws. More gingival injuries were found when the toothbrush was held with the palm grip than with the pen grip. This difference was statistically significant (P less than 0.01). No statistically significant difference were observed between corresponding plaque scores as measured according to the PLQ-index, irrespective of whether the plaque scores were presented as plaque remaining after experimental brushing or as the difference between the PLQ scores before and after brushing.

Gingival abrasion and plaque removal with manual versus electric toothbrushing.

A clinical trial was designed to test the relative numbers of gingival lesions caused during standardized brushing of the teeth of 22 volunteer dental nurse students with a manual soft multitufted, a manual soft V-shaped, and an electric toothbrush. First, the left or the right side of the jaws of each subject was brushed by a dental hygienist using the manual V-shaped or the electric brush, and the other side using the manual multitufted brush. At the 2nd brushing 1 week later, the same hygienist used the multitufted brush for brushing the side contralateral to the one in which it was used the 1st week and the V-shaped manual brush instead of the electric and vice versa. After each brushing, the number of new gingival lesions was recorded and the cleansing effect evaluated by assessment of the amount of remaining plaque. This examiner was unaware of the type of brush used. The V-shaped manual toothbrush was found to have caused more gingival abrasion than the electric toothbrush (P less than 0.005) and a similar difference was found between the multitufted manual and the electric toothbrush (P less than 0.05). There was no clinically significant difference between the plaque removing effects of the 3 brushes tested.

Reliability of standardized narrow strips in the Periotron.

In clinical practice the authors have found the 2-mm wide Periopaper slightly too large for insertion into the gingival crevice. This study investigated the reliability of Periotron readings for quantitation of gingival fluid when using filter paper strips which are narrower than the Periopaper. The round-ended strips were cut to a standard size 1 mm wide and 15 mm long using a conchotome. A microsyringe was used to deposit 0.1 microliter of four different fluids (distilled water, undiluted horse serum, diluted horse (1:2) and human (1:2) sera) onto Periopaper and the narrow S-690 strips. The moistened end of each strip was placed between the jaws of both the Periotron 600 and the Periotron 6000, and the maximum digital reading was recorded in two series of 20 measurements for each of the four fluids and two strips, giving a total of 640 assessments. A comparison between the two series confirmed the excellent reproducibility of Periotron readings. The comparison between strips revealed from 10% (Periotron 600) to 20% (Periotron 6000) lower readings for the S-690 than for the Periopaper strips for all fluids. The SD of the readings for both the S-690 and the Periopaper strip was low enough to make the difference between strips statistically significant. The slightly lower readings obtained with the narrow S-690 strip were found as reliable as those recorded when using Periopaper.

Plaque growth-inhibiting effects of an abrasive fluoride-chlorhexidine toothpaste and a fluoride toothpaste containing oxidative enzymes.

The aim of this 4 times cross-over double-blind clinical trial was to test the plaque-inhibiting effect of 2 fluoride-containing toothpastes. One toothpaste contained 0.8% chlorhexidine together with amine fluoride (0.1% F degrees) and a suitable abrasive agent. The other contained 1.7 U/g glucose oxidase and 8.0 U/g amyloglucosidase, added to an amine fluoride (0.1% F degrees) toothpaste. 1% Hibitane dental gel was used as a positive and a conventional fluoride toothpaste (Vademecum MFP Fluor) as a negative control. 9 dental students, in a randomized sequence, applied the 4 dentifrices twice daily from Monday afternoon to Friday morning with cap splints, designed to cover the teeth and about 2 mm of gingiva. No other oral hygiene measures were allowed during the 4 test periods. On Fridays, the teeth were cleaned professionally and good oral hygiene was maintained during the week-ends. At the beginning and at the end of each test period, per student plaque thickness was recorded using the plaque index, the visible plaque index, and plaque fresh weight as parameters, and the area of plaque as related to the area of the tooth surface was recorded planimetrically and according to the PLQ index. The best plaque growth-inhibiting effect was recorded for the positive control (CHX) with the test chlorhexidine toothpaste (TX) as next best. The enzyme-containing toothpaste (TE) did not differ significantly from the negative control (C). All the significant differences in anti-plaque effect between the 4 toothpastes were obtained by recordings of plaque thickness and none on the basis of area of plaque.