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The Effect of a Quaternary Ammonium-Containing Mouthwash on Formed Plaque
Abstract
The effect on formed dental plaque of a commercial mouthwash containing cetylpyridinium chloride (CPC) was evaluated in forty-one adults. During this fourteen day study no oral hygiene other than the use of a mouthwash was provided. Plaque and gingival indices were scored on sixteen teeth at days 0, 7 and 14. The results of this study suggested that subjects using the CPC containing mouthwash formed less plaque than those using the placebo mouthwash. No change in the Gingival Index was observed. Of those patients using the CPC containing mouthwash, four showed a slight staining of the anterior teeth and five reported a mild burning sensation of the tongue.
... 20 (Sheen S, 2003). It was also confirmed by earlier studies that the CPC-containing mouthrinses result objectionable in extrinsic tooth stains 21 (Ciancio SG, 1978).Hence nowadays use of Essesntial Oil Mouth Wash (EOMW) is more preferred as an alternate chemical agent to chlorhexidine mouth wash. ...
Objective: To evaluate the clinical efficacy of an antioxidant mouth wash on fixed appliance orthodontic patients with generalized gingivitis. The mouth rinse contains the antioxidants ferulic acid and phloretin. Materials and Methods: A total of eighty one patients undergoing fixed orthodontic appliance therapy participated in the study were divided into three active interventional groups of n=27 each. Group I were given antioxidant mouthwash, group II with essential oil mouthwash and group III with chlorhexinde mouth wash were given as a interventional measure immediately after bonding of the brackets. Each patient was evaluated at four orthodontic treatment visits (T0, T1, T2, T3)for 3 months. Between T2 and T3, intervention was with withdrawn. A periodontal examination, including Gingival index (GI), Bleeding on probing (BOP), and Orthodontic plaque index (OPI) was performed at each visit. The severity of index scores was assessed by Repeated measure ANOVA followed by Post-hoc Bonferroni test and Tukey test. Results: Gingival index:Mean differences across the three time points T1, T2 and T3 for GI in all the three groups (T2-T1: 1.03±0.35, 0.47±0.2, 1.17±0.37 and T3-T2: 1.2±0.35, 0.45±0.18, 1.65±0.24 respectively) showed a statistically significant difference (p<0.001). No statistical difference is observed for Bleeding on probing between the groups across different time periods. Conclusion: Antioxidant-mouthwash equally effective as essential and Chlorhexidine mouthwashes in reducing severity of gingivitis in early stages of fixed orthodontic appliance therapy.
... Il più comune effetto collaterale causato da un utilizzo eccessivo e prolungato del CPC è la pigmentazione dentale [Ciancio et al, 1978; Lobene et al 1979], nonostante il grado di macchie formato risulti considerevolmente inferiore a quello della CHX [Llewelyn, 1980], 1995]. Sia le ricerche in laboratorio, sia le evidenze cliniche sostengono fermamente che la causa delle macchie sia la precipitazione dei cromogeni della dieta favorita dagli antisettici cationici tra cui CPC e CHX [Addy e Moran, 1985; Addy e Moran, 1995]. ...
Mounting evidence underlines the role of inducible nitric oxide synthase
(iNOS) in hepatocellular carcinoma (HCC) development,but its functional
interactions with pathways involved in HCC progression remain
uninvestigated. We analyzed in preneoplastic and neoplastic livers from
Fisher 344 and Brown Norway rats, possessing different genetic
predisposition to HCC and in human HCC iNOS function and interactions
with nuclear factor-kB (NF-kB) and Ha-RAS/extracellular signal-regulated
kinase (ERK) during hepatocarcinogenesis; influence of genetic
predisposition to liver cancer on these pathways. We found progressive iNos
induction in rat at higher levels in the most aggressive rats. iNOS, inhibitor of
kB kinase/NF-kB and RAS/ERK upregulation was significantly higher in
HCC with poorer prognosis, positively correlated with tumor proliferation,
genomic instability and microvascularization and negatively with apoptosis.
Suppression of iNOS signaling led to decreased HCC growth and NF-kB and
RAS/ERK expression and increased apoptosis both in vivo and in vitro.
Conversely, block of NF-kB signaling or ERK signaling caused iNOS
downregulation in HCC cell lines. These findings indicate that iNOS cross
talk with NFkB and Ha-RAS/ERK cascades influences HCC growth and
prognosis, suggesting that key component of iNOS signaling could represent
important therapeutic targets for human HCC.
... Cetylpyridinium chloride (CPC, l-hexadecylpyridinium chloride) is a quaternary ammonium compound contained in certain commercial mouthwashes to prevent dental plaque (1,2,3,5). As a cationic surfactant, the mechanism by which CPC kills bacteria involves the interaction of basic cetylpyridinium ions with the acid groups of bacteria to form weakly ionized compounds that subsequently inhibit bacterial me-* Author for correspondence. ...
Cetylpyridinium chloride (1-hexadecylpyridinium chloride, CPC) was evaluated for its effectiveness in removing or killing salmonellae attached to poultry skin. Two different treatment methods were used: (i) spraying 0.1% CPC solution at 15 degrees C or 50 degrees C against inoculated skin surface for I min at 138 kPa, and (ii) immersing inoculated skin surface in 0.1% CPC solution at room temperature for either 1 min, 1 min plus 2 min holding without CPC, or 3 min. After rinsing, cells on the skins were enumerated by conventional plating as well as direct counting from scanning electron microscopy (SEM). Compared with controls, CPC spraying reduced the numbers of salmonellae by 0.9 to 1.7 log units (87 to 98%) assayed by the plating method (P < 0.05). SEM gave results similar to plating. Generally 50 degrees C CPC spraying showed greater reduction than 15 degrees C CPC spraying; however, the differences were not always significant. Water spraying at either temperature did not show any reduction compared to nonsprayed skins. In the immersion test, significant differences also were noticed among the control and the three other CPC-immersed groups (P < 0.05) as assayed by plating, ranging from 1.0 to 1.6 log units, which were similar to the CPC spraying results. However, no difference was noticed among the three CPC-immersed groups. Direct counting from SEM was not a suitable method for recovering cells in CPC immersion tests because dead cells were still attached to the skin while retaining their intact morphology. On the basis of the amount of CPC used, immersion appears to be more cost-effective than spraying CPC on poultry skin.
... 10,11 Other readily available mouthrinses are perhaps less well known for their undesirable staining capabilities. For example, cetylpyridinium chloride (CPC), which is perhaps the most common ingredient in over-the-counter products, can produce dental staining 12,13 although the degree of staining formed has been noted to be considerably less than that of chlorhexidine. 14 In addition staining by essential oil mouthrinses has been noted. ...
To assess the comparative activity of mouthrinses containing cetylpyridinium chloride (CPC) and chlorhexidine using the propensity to cause extrinsic staining in vitro as the outcome variable.
Saliva-coated clear acrylic specimens were exposed to cyclical staining regimens of either CPC or chlorhexidine followed by tea. Water and 0.2% chlorhexidine were used as negative and positive controls respectively. Staining cycles were repeated until an optical density of > 2 was reached by one of the products.
For CPC there was a highly significant difference in staining between the products. Two CPC products performed numerically little better than water. For the chlorhexidine products the 0.2% formulation produced the most staining although little more than the UK version of the 0.1% rinse. The French 0.1% rinse produced by the same manufacturer as the UK formulation showed markedly reduced staining potential although significantly greater than water.
This study, supported by previous in vitro and in vivo studies, indicates discrepancies in the availability of CPC and chlorhexidine in some mouthrinse products. Importantly, this may have an effect on the potential of some rinses to provide the expected plaque inhibitory activity.
... ternary ammonium compound widely found in mouthwash, toothpaste, and throat lozenge products because of its ability to prevent dental plaques, gingivitis, and bacterial biofilm formation (1,2,8,13,17). Electron microscopy studies show that CPC kills bacterial cells by damaging their membranes, producing leakage of cellular materials (15). ...
Cetylpyridinium chloride (CPC) activity was quenched with Bacto neutralizing buffer on inoculated cut iceberg lettuce. This protocol permitted comparison of the numbers of Salmonella Gaminara- or Shigella sonnei-inoculated cells on lettuce that survived 1 min of CPC treatment. Cut lettuce was inoculated with about 6 log of Salmonella or 9 log of Shigella and stored in Whirl-Pak bags at 4 degrees C for up to 4 days. Loosely adhered pathogen cells were washed off before CPC treatment. Firmly adhered cells of Salmonella Gaminara or S. sonnei on cut iceberg lettuce survived treatment with CPC even at the 0.4% CPC level if the CPC activity was quenched after 1 min by adding Bacto neutralizing buffer. The results confirm that there is extended killing activity of residual CPC against Salmonella Gaminara or S. sonnei if the residual CPC remaining in contact with the lettuce after the initial 1-min wash is not quenched. The CPC treatment was useful in reducing the numbers of these target pathogens on lettuce.
In this article emphasis has been placed on the major chemotherapeutic aspects of periodontal therapy in the 1970s. During this decade investigations of chlorhexidine stimulated many studies relevant to the role of topical antimicrobial agents to prevent or treat gingivitis. Major attention focused on the effect of these agents on supragingival plaque.
In the 1980s attention will be focused on the effect of antimicrobial agents on subgingival plaque and gingivitis. Already, innovative methods of delivering medications into the gingival crevice are being evaluated.
The use of antibiotics systemically to treat periodontal disease will reach its peak in the next decade. It is most likely that antibiotics that concentrate in gingival crevicular fluid and have minimal side effects will become useful adjuncts in periodontal therapy.
The Disk Retention Assay (DRA) is an in vitro method developed to measure the available level of cetylpyridinium chloride (CPC) in mouthwash formulations. This method is based on the binding of the cationic CPC molecule to the anionic surface of a cellulose filter disk. Aqueous CPC solutions demonstrate a linear response (A 545) for concentrations up to 0.3%. Higher levels of CPC showed no increased response in the assay. Among common oral product ingredients, at relevant concentrations, surfactants are the primary compounds which inhibit CPC detection and hence, chemical availability. Poloxamer-407 decreased CPC availability to 60% at 0.1%, to 10% at 0.5%, and to 24-33% for 0.2-0.4%. Polysorbate-80 decreased CPC availability to 30% at 0.1% and 6% at 0.25%. A range (4-54%) of available levels of CPC were determined for several commercial products containing 0.045-0.0.5% nominal levels of CPC indicating significant formulation excipient influence. A plaque glycolysis (PG) assay was used to determine the biological activity of all mouthwash products analyzed by DRA. An experimental series of mouthwash formulations having nominal CPC levels of 0-0.10% demonstrated a good correlation (r 2=0.955) between the calculated available level of CPC (DRA) and inhibition of plaque glycolysis. The calculated available level of CPC from select commercial mouthwash products, also fit the established correlation with biological activity. The combination of DRA and plaque glycolysis methods are valuable tools which can be used during development to maximize the biological activity of CPC mouthwash formulations prior to clinical evaluation.
Chronic periodontitis may be a sequela of chronic gingivitis, usually because of accumulation of plaque and calculus. Consistent good dental hygiene can help prevent gingivitis and periodontitis. Mechanical removal of plaque through frequent and efficacious brushing and flossing is the principal means of preventing periodontal diseases and diminishing the risk of caries. According to the American Dental Association (ADA), antimicrobial mouth-washes may provide additional oral health benefits, in addition to brushing and flossing, for preventing and reducing gingivitis and plaque. There is a multitude of mouthwashes available for these purposes. The consensus panel of the Middle East Oral Hygiene Advisory Board has recommended that an antiseptic mouthwash should be used as a daily adjunct to mechanical cleaning for prevention of oral disease. Recommending particular mouthwashes should take into consideration the patient's ability to perform good oral hygiene practices (tooth brushing and dental flossing), the condition of the patient's teeth, gingivae and oral mucosa, and the proven efficacy of the mouthwash along with its potential adverse effects. Of the many mouth rinses available, only a few contain chemical agents that have some ability to penetrate biofilm and to kill plaque biofilm bacteria. Currently, only chlorhexidine mouthrinse and Listerine (an essential oil-containing mouth rinse) products, with the claim of plaque and gingivitis reduction, have been accepted for that purpose by the ADA and have a proven record of safety and efficacy. Essential oil-containing mouthrinses have been clinically proven as effective in reducing plaque and gingivitis. Dental care professionals should spend time discussing biofilm control with their patients, and be an information source for the best oral care products. Therefore, it is essential that dental care professionals should continue to monitor published research and work with their colleagues to make evidence-based decisions. In this way, patients will be directed to dental hygiene aids, including antiseptic mouthwashes that can be most effective for improving their oral health.
This study was carried out to examine the release kinetics of chlorhexidine from a sustained release device (S. R. D.) prepared from ethyl cellulose (fast S. R. D.) or ethyl cellulose with polyethylene glycol (slow S. R. D.) and to examine the effects on the bacterial flora of pockets in patients with periodontal disease.
It was shown that fast S. R. D.'s release up to 80% of the chlorhexidine within the first 3 days in insertion in periodontal pockets, whereas the slow S. R. D.'s release 50% of the chlorhexidine content after 6 days. The release kinetics of chlorhexidine from S. R. D.'s placed in pockets as expressed by the Higuchi system (Higuchi 1963) indicate that it is diffusion controlled. The rate of chlorhexidine release is dependent on the structure of S. R. D., the drag concentration within the device, and the effective surface area.
The microbial flora of sixteen pockets from 6 patients were examined using darkfield microscopy at day 0, 3, 10, and 14 after treatment with S. R. D.'s containing, chlorhexidine or placebo S. R. D.'s. The pocket depths ranged from 5–8 mm. The chlorhexidine-treated group showed a marked decrease in the relative proportions of motile rods and spirochetes and a corresponding increase in non-motile organisms compared to the flora prior to chlorhexidine treatment or compared to the flora of the placebo treated pockets. These differences were significant up to 10 days post treatment (P < 0.0025).
The study indicated the effectiveness of ethyl cellulose polymers as S. R. D.'s in vivo and their ability to reduce the relative proportions of the motile organisms of periodontal pockets to negligible amounts.
The objectives of this clinical trial were to determine the tooth staining potential as measured by the Macpherson Modification of the Lobene Stain Index, and degree of taste alteration of four currently marketed mouthrinses when used over a 12-week period.
This investigation consisted of a 12-week, observer-blind, single-center, randomized comparison of five parallel groups of subjects. One-hundred and seventy-one subjects granting their informed consent completed the trial. Subjects were randomized to one of four currently marketed mouthrinses Crest PRO-HEALTH Rinse (CPH), Cēpacol (C), Scope (S), Viadent ADVANCED CARE (V), or brushing alone (BA) with a currently marketed fluoride toothpaste. Upon randomization, subjects received a baseline stain score and then a prophylaxis to remove all extrinsic stain. Clinical assessments were repeated after six weeks and three months of product use, and subjects were asked to complete a questionnaire after the first use, at day 4, day 14, at six weeks, and 12 weeks to assess potential taste alteration.
CPH and C demonstrated significantly (p < 0.001) more extrinsic stain after six weeks of use, and CPH, C (p < 0.001), and S (p = 0.01) after 12 weeks of use versus brushing alone with fluoride toothpaste. V was not significantly different from brushing alone at either time point. After six weeks of using the product as directed, up to 53% of subjects using CPH experienced taste interference for up to three hours post-rinse.
The results of this study demonstrated that regular use of CPH and C mouthrinses resulted in extrinsic stain accumulation after six weeks, with increased accumulation after 12 weeks versus brushing alone.
Abstract Previous studies have shown that a 3-day exposure of the pocket flora to the sustained release of chlorhexidine significantly reduced the relative numbers of spirochetes and motile rods in periodontal pockets to negligible amounts. By 14 days post-treatment, their numbers had returned to pre-treatment levels. The present study extended the exposure time of the pocket flora to the sustatined release of chlorhexidine in an attempt to prolong the suppression of the microbial flora for a clinically significant period of time. Clinical parameters were also studied. Sustained release devices (SRD) were inserted into 13 pockets from 8 patients. Pocket depth ranged between 5 and 8 mm. The SRD's were replaced every 3 days to give a total exposure of 9 days. Plaque index (P1I). bleeding on probing and pocket depth were measured, and bacterial samples taken for dark field microscopy and anaerobic culture.
There was a marked decrease in the relative proportions of spirochetes and motile rods and the total anaerobic count post-treatment. Pocket depth was reduced in all 13 pockets. These results indicate that a prolonged exposure to chlorhexidine suppresses the pocket flora to negligible amounts and reduces pocket depth for up to 11 weeks post-treatment.
The aim of this study was to evaluate the effect of a 0.1% cetylpyridinium chloride mouthwash on
salivary concentration of Streptococcus mutans and halitosis microrganism; this mouthwash was
contained in jelly microcapsule.
Cetylpyridinium chloride is a quaternary ammonium compound, with an aliphatic chain with
positive cationic surface; it shows an antiseptic and bactericidal activity on gram-positive
microrganisms.
The sample was 20-40-year-old and was hight risk of caries (S. mutans > 10^5 CFU/ml). Were
excluded to sample subject with systemic pathology, under farmacology treatments or under topical
and systemic treatment with chlorexidine and fluoride compounds in the period of the study or for
30 days. A written consensus was request to all participants to study.
The protocol was based on giving 2/4/6 pearls with 0,1% CPC or placebo for 3 days to all
partecipants; samples of saliva were collected after 1, 5, 10, 60 minutes.
In the first day was collected a sample of biofilm from tongue’s back basal portion with a sterile
plug. This sample was analized with “Bana Test”.
Conclusions: 0,1% cetylpyridinium chloride’s use implies SM salivary concentration decrease. This
decrease is temporary, so pearls may be considered a method only for regulate SM salivary
concentration, but not either for avert dental caries or oral halitosis.
Dental plaque is massed packed bacterial cells which accumulate on the supra- and subgingival surfaces of the teeth as well as on the oral mucosa. The microorganisms of plaque have been shown to be associated with both dental caries and periodontal disease. This overview of clinical studies of plaque control agents reviews the properties and effects of chemical compounds which have demonstrated a potential for the control of plaque microorganisms.
The search for clinically effective antiplaque agents has been stimulated by findings in laboratory and animal studies of plaque dynamics. Based upon these in vitro and in vivo experiments, chemotherapeutic agents such as antibiotics, antiseptics, enzymes, detergents, bacteriosides, antimetabolites, and oxidizing agents have been evaluated against human plaque microorganisms using the ultimate biological model — man.
Continued study of chemotherapeutic agents should be encouraged because many of these drugs have been shown to be safe for human use and may require only the development of a delivery system to potentiate their concentration in a specific local site. Use of these chemotherapeutic agents, which can be self-administered, becomes an attractive way of providing the public with a cost-effective method of preventing caries and periodontal disease.
A NUMBER OF MOUTHWASH PRODUCTS containing cetylpyridinium chloride (CPC) are available. Data for individual products are limited, although overall the antiseptic has been shown to reduce plaque. Results for gingivitis reductions by CPC have been equivocal. This study was an active/placebo parallel group design to evaluate the use of a CPC mouthrinse as an adjunct to oral hygiene when used before toothbrushing. Plaque and gingivitis scores were recorded at baseline and after 6 weeks, following twice daily use of the active or placebo prebrushing rinses. Plaque and gingivitis were significantly reduced at 6 weeks in both groups with no significant treatment differences between the active and placebo formulations. Whether the order of rinsing to toothbrushing influenced these findings cannot be determined. However, the results further question the adjunctive benefits of CPC rinses to gingival health.
A CPC-detergent formulation in a foam vehicle, was compared with a fluoride toothpaste for its ability to prevent plaque and gingivitis over a period of 12 days. Whilst refraining from all other oral hygiene procedures, the foam or toothpaste was applied to the teeth in fluoride application trays, in a group of 14 volunteers. At days 8 and 12 of this crossover study, the following assessments were made: gingival crevicular fluid; gingival index; bleeding on probing; plaque index; plaque area. Except for plaque area at day 8 of the study, there were no significant differences between the 2 products at either day 8 or day 12. It is therefore concluded that the CPC-detergent formulation, in its present form, does not inhibit plaque and gingivitis more effectively than a conventional fluoride toothpaste.
The permeability of rabbit oral mucosa to eight nonelectrolytes was measured in vitro in the absence and in the presence of 0.025, 0.1, and 1.0% concentrations of anionic, cationic, and nonionic surfactants. The anionic surfactant sodium lauryl sulfate and the cationic surfactants cetyltrimethylammonium bromide and cetylpyridinium chloride caused greater increases in permeability than polysorbate 80, a nonionic surfactant. The increases in permeability brought about by the surfactants were concentration dependent.
Clinical and in vitro studies have implicated dietary components as major aetiological factors in staining of teeth and acrylic materials associated with chlorhexidine use, a local side effect not unique to this antiseptic. These experiments studied the precipitation and surface staining reactions of the cationic antiseptics alexidine, cetyl pyridinium chloride (CPC), chlorhexidine, and hexetidine, with the beverage tea. All of the antiseptics precipitated a standard tea solution and for alexidine and chlorhexidine acetate and gluconate, this was at concentrations greater than 100 mumol/L, for hexetidine greater than 200 mumol/L, and for CPC greater than 400 mumol/L. With the exception of CPC precipitation was reduced with decreasing pH and for chlorhexidine was inhibited below pH 3. The addition of polymethylmethacrylate (PMMA) to the antiseptic solutions increased the precipitation concentrations by an amount calculated to be adsorbed by polymer. Acrylic blocks treated with equimolar solutions of the antiseptics became progressively and significantly more stained by tea than control specimens over a 5-day period. Alexidine induced significantly greater staining and hexetidine significantly less than the other antiseptics. Staining was pH dependent and significantly reduced as the pH decreased. Both stain and precipitates were insoluble in strong acids and alkalis. It is concluded that staining observed clinically may represent a precipitation reaction with the complexing of antiseptics with dietary chromogenic material.
Eighteen female dental hygiene student took part in a double‐Wind, crossover clinical trial of equimolar (2.2 mmol) rinsing solutions of D‐301, a quaternary ammonium compound and chlorhexidine digluconate. Rinsings were partly supervised, test periods were 7 days (5 days without oral hygiene) with a 1‐week interval.
Plaque formation was significantly reduced by both test solutions versus the control: on not precleaned tooth surfaces plaque formation was equally inhibited by the chlorhexidine and D‐301 mouthrinses. On precleaned surfaces D‐301 significantly inhibited plaque formation compared with the control rinse, but was less effective than chlorhexidine. There was no significant change in the FBI, a measure of gingival inflammation, during any of the test periods. Staining of teeth and tongue was judged as equal after chlorhexidine and D‐301 use. Reports of taste and gastric disturbances were minimal but more frequent during the D‐301 test period.
Extrinsic staining of teeth is a side-effect of some antiseptic mouthrinses. However, few of the many rinse products available to the general public have been investigated for their propensity to cause staining. Dietary factors play an aetiological role in staining and have been used in vitro to study and compare the activity of rinses. The aim of this study was to assess rinse products for staining in vitro and, through the staining reaction, to compare the activity of products containing the same ingredients. Perspex blocks, with or without saliva pretreatment, were soaked in rinses for 2 min, washed and placed in a standard tea solution for 60 min and then the optical density (OD) read on a spectrophotometer. The cycle was repeated 10 times for saliva and 17 times for no saliva specimens or until the maximum OD was exceeded. A series of three separate experiments was performed by this method. The maximum OD was not exceeded by any product before seven passages and therefore data were compared at six passages. For most products OD increased with saliva pretreatment. Some cetylpyridinium chloride (CPC) rinses stained comparably to a chlorhexidine rinse. CPC rinses, most of which contained the same concentration of the antiseptic, varied considerably in their propensity to induce staining and one was little different to water controls. A 0.1% chlorhexidine rinse stained slightly more than a 0.2%. A phenolic/essential oil product produced some staining but zinc, triclosan and other essential oil rinses did not stain.(ABSTRACT TRUNCATED AT 250 WORDS)
The effect of a degradable controlled release system containing cetylpyridinium chloride (CPC) on plaque accumulation and gingivitis was evaluated when applied on the anterior teeth of volunteers (16-17 years) over 4 weeks. At baseline, plaque index (PI) and gingival index (GI) of the Ramfjord teeth were measured in the experimental and placebo groups, including 23 and 21 participants respectively. Following scaling and root planning, the participants were instructed to brush, using one brush stroke, the film-forming solution on the buccal surface of the maxillary and mandibular incisors, 1 x a day before bedtime. The applied active solution contained 9 mg of CPC (approximately 80 mg of 11% CPC solution), while the placebo solution was identical in formation, but without the active agent. After 4 weeks, in the CPC-applied group, the recorded PI scores were 0.52 (+/- 0.56) in the anterior area and 1.31 (+/- 0.80) in the posterior area, whereas the corresponding areas in the placebo group reached 1.25 (+/- 0.74) and 1.51 (+/- 1.00), respectively. The PI = 0 frequency in the buccal anterior surfaces after 4 weeks was 54.6% (+/- 38.7%) in the experimental group as compared with 21.9% (+/- 29.0%) in the placebo group (p = 0.005). In contrast to the anterior teeth, there was no significant difference between groups with respect to the PI scores in the non-applied posterior teeth. It may be postulated that the impressive 58% inhibition of plaque accumulation at the site of application is the result of an increase of the substantivity of the CPC due to its incorporation in the film-forming degradable controlled release system.
Quaternary ammonium compounds constitute a large group of antibacterial chemicals with a potential for inhibiting plaque and gingivitis. One compound, benzalkonium chloride (BC), may be of value, although there is a dearth of evidence to support efficacy. The aim of this study was to measure the ability of 2 BC mouthrinses (0.05% and 0.1%) to inhibit de novo plaque reformation.
A 4-day plaque regrowth model. For comparative purposes, a commercial mouthrinse containing cetyl pyridinium chloride (CPC) and a positive control chlorhexidine (CX) mouthrinse were also evaluated.
Compared to water control, a reduction in plaque scores of 52% was noted for the CX mouthrinse, 22.5% for CPC and 5% and 6% for the 2 BC rinses. For plaque area, reductions of 84%, 47%, 16% and 15% were found for CX, CPC, and the 2 BC rinses, respectively. Significant reductions in plaque area compared to the water rinse were also seen with the 2 BC rinses (p<0.05). However, for both plaque score and plaque area, the CX and CPC rinses significantly reduced plaque compared to the BC rinses (p<0.0001).
These findings would suggest that the 2 benzalkonium rinses would only have a limited value at inhibiting plaque formation.
To detect any differences in the propensity of individual saliva to cause in vitro staining by chlorhexidine and tea.
Unstimulated human saliva was collected on a daily basis and used to coat optically clear Perspex specimens. Specimens were subjected to the original chlorhexidine/tea staining model described by Prayitno and Addy (Journal of Periodontal Research 1979;14:397-402), and cycles repeated until a maximum optical density of two was reached.
Stain development increased incrementally with increasing cycles. Differences in chlorhexidine/tea staining between subjects were obvious by cycle 3 where the lowest 'stainer' had 56% less stain than the highest 'stainer'. Highly significant differences between subjects were seen during staining cycles 3-6, but not at cycles 7 and 8.
In vitro stain formation using saliva from different individuals occurred at differing rates when all other variables were standardised. The properties of saliva accounting for this are still unknown, and warrant further study.
The experimental gingivitis model is a well-established method in comparing the chemical antiplaque activity of agents and products. The aim of the present study was to use time in order to achieve an exit level of bleeding on probing (BOP) as the primary outcome variable.
The study was a single blind, randomised four treatment parallel group design employing 76 healthy volunteers. The cohort was accepted into the study proper if they achieved a level of </= 25% BOP after a 5-week pre-study oral hygiene phase. At baseline, 1, 2, 3, 4, 5 weeks BOP, modified gingival index (MGI) and plaque index scores were obtained from each subject. After baseline, oral hygiene was suspended and subjects rinsed twice daily with one of the test rinses, namely: 1 0.05% cetylpyridinium chloride 2 Control fluoride 3 0.2% chlorhexidine 4 0.3% triclosan Subjects were removed from the study when they achieved >/= 50% BOP. Using the baseline and exit BOP, MGI and plaque, a deterioration rate for each parameter was derived and used as the unit of analysis.
There were highly significant treatment differences for all three parameters. Paired analyses revealed chlorhexidine was highly significantly more effective than the other rinses for all three parameters. CPC and triclosan were not different from the control for BOP, but CPC was significantly different from the control for MGI and plaque, and triclosan was different from the control for plaque. There were no differences between the CPC and triclosan rinses.
The method achieved the expected result of differentiating between the chlorhexidine and the other rinses. Some modification of the method, primarily to group sizes, should improve specificity. The method has the considerable volunteer appeal of early exit, particularly when allocated to control or low activity treatments for plaque.
To detect any differences in the propensity of unstimulated and stimulated, individual whole saliva to cause in vitro staining by chlorhexidine and tea.
Unstimulated and stimulated human saliva was collected on a daily basis and used to coat optically clear acrylic specimens. Specimens were subjected to an established chlorhexidine/tea staining model in vitro shown to correlate well with in vivo staining, and cycles repeated until an optical density of <2 was reached.
Stain development increased incrementally with increasing cycles. Overall differences in chlorhexidine/tea staining were noted both between subjects and between unstimulated and stimulated saliva used. Mean staining for the subject group, at each cycle was always higher with unstimulated saliva compared to stimulated saliva and differences reached statistical significance at cycles 2-5.
In vitro stain formation using unstimulated saliva from different individuals occurred at a faster rate and to a greater extent than when stimulated saliva from the same subjects was used, presumably reflecting differences in composition. Understanding the nature of these differences could provide fundamental information on the very poorly understood process of tooth staining.
To evaluate the effect of a mouth-rinse formulation combining benzydamine hydrochloride and cetylpyridinium chloride (BNZ+CPC) in preventing de novo plaque formation, in comparison with CPC and placebo mouth rinses.
This was a controlled, observer-blind, cross-over study. In this model of plaque re-growth, subjects received a session of oral prophylaxis and were directed to withdraw oral hygiene measures for the next 4 days, using only the mouth rinse assigned. The outcome parameters were the plaque index (PlI) and gingival index (GI). In addition, microbiological evaluation of the subgingival microflora, by means of culture, was performed, as well as patient-based variables. Data analysis was carried out using anova for Latin-square design.
The analysis of variance showed a significant statistical difference between the BNZ+CPC association and placebo (p<0.0001). No differences between CPC and placebo were detected considering multiple comparisons between treatments. The 90% confidence interval of the differences between BNZ+CPC and CPC showed no equivalence between treatments, being the PlI lower in the BNZ+CPC group. No significant difference between groups in GI was observed. Mean anaerobic colony-forming units (CFU) demonstrated a significant increase between visits in all groups (p<0.001) and differences among groups were not significant. Subjects treated with BNZ+CPC frequently reported "tingling mouth" and "numbness mouth".
Within the limitations of the study model, the BNZ+CPC combination showed a statistically significant plaque-inhibitory capacity, as compared with the placebo mouth rinse, and an additive effect as compared with CPC. No relevant clinical or microbiological adverse effects were detected.
The aim of this clinical, controlled double-blind trial was to evaluate the effectiveness and side effects of two different mouthrinses.
Ninety subjects with gingivitis (or slight periodontitis) were randomly allocated to three groups: group 1, Chlorhexamed (0.1% chlorhexidine); group 2, Hexoral (0.1% hexetidine); and group 3, a placebo-control compound. The subjects were instructed on how to use the mouthrinse. At baseline, as well as after 2 and 4 weeks, the Approximal Plaque Index (API), the Bleeding Index (BI), the Community Periodontal Index of Treatment Needs, the Gingival Index (GI), and the Discoloration Index (DI), were measured. Statistical analysis was carried out with the Kruskal-Wallis test, Fisher's exact test, and Wilcoxon test.
In group 1, the mean API improved significantly (P < or = .001) after 4 weeks. The mean BI was reduced significantly, as was the GI. In group 2, the mean API and the mean BI both decreased significantly, and a statistically significant reduction of the GI was also seen. In group 3, significant improvements of the mean values of all parameters were documented after 4 weeks. When comparing group 3 with groups 1 and 2, the difference in the reduction of the API was statistically significant (P < .002). No statistical difference could be shown when comparing groups 1 and 2. Regarding the improved results of the BI and the GI, no statistically significant difference was found in the effectiveness of all 3 compounds. All 3 groups showed some increase in the mean DI after 4 weeks. Comparing groups 1 and 2 directly, the difference in the increase in the discoloration of the teeth was statistically significant (P = .0035). There was no statistical difference in the mean discoloration scores comparing groups 2 and 3.
This double-blind clinical trial demonstrated Hexoral to be a useful alternative to Chlorhexamed mouthrinse, as well as one causing less discoloration.
Patients undergoing fixed appliance treatment are at greater risk for increases in salivary and plaque levels of Streptococcus mutans and an elevated risk of dental caries. Cetylpyridinium chloride (CPC) is known to be an effective antiplaque agent. The purpose of this study was to investigate whether incorporating CPC into a commercially available orthodontic adhesive would impart antimicrobial properties without altering the diametral tensile strength of the material.
CPC was added to a commercially available, filled, photo-activated bracket adhesive (Transbond XT, Unitek 3M, Monrovia, Calif) in varying amounts, to obtain specimens with CPC concentrations of 0% (control), 2.5%, 5.0%, and 10.0% by weight. Adhesive discs 2 mm thick and 4 mm in diameter were incubated with Streptococcus mutans for 48 hours. The diameters of the zones of bacterial inhibition were measured in an agar disc diffusion assay; specimens of each concentration were tested every other week for 196 days. Other discs were soaked in distilled water for 180 days. The amount of CPC released into the water from the modified discs was measured and recorded on days 7, 15, 30, 60, and 180 by using a spectrophotometer at 254 nm. Diametral tensile strength of the modified adhesive discs was measured with a universal testing machine, and the effect of water aging was also evaluated.
The measured zone of bacterial inhibition increased as CPC content increased. All CPC-adhesive specimens maintained antimicrobial activity up to 196 days. No zone of bacterial inhibition was measured around the control specimens. CPC release was observed through the end of 180-day period, but the greatest release was recorded in the first week. There was no significant difference (P < .05) in diametral tensile strength between the 2.5% CPC-adhesive group and the control; there were significant differences among the 5.0% and 10.0% CPC-adhesive groups and the control. Water aging had no significant effect on diametral tensile strength other than decreasing it for the test group containing 10.0% CPC.
The incorporation of 2.5% CPC in adhesive material imparted antimicrobial activity without altering diametral tensile strength.
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