ArticlePDF Available

Efficacy of chlorine dioxide mouthwash against halitosis

Authors:

Abstract and Figures

To ascertain the effectiveness of using chlorine dioxide mouthwash in addressing halitosis. Forty people were divided equally into the test group (required to gargle with mouthwash containing chlorine dioxide) and the control group (required to gargle with aquadest). The volatile sulfur compound (VSC) and organoleptic scores were measured before gargling and 30 min, 2 h, 4 h, and 6 h after. The Wilcoxon test analysis showed a significant difference (p<0.05) in the mean value of VSC scores between the test group and the control group in four testing periods after gargling. Chlorine dioxide mouthwash is effective in addressing halitosis.
Content may be subject to copyright.
This content has been downloaded from IOPscience. Please scroll down to see the full text.
Download details:
IP Address: 198.252.60.87
This content was downloaded on 31/08/2017 at 02:53
Please note that terms and conditions apply.
Efficacy of chlorine dioxide mouthwash against halitosis
View the table of contents for this issue, or go to the journal homepage for more
2017 J. Phys.: Conf. Ser. 884 012136
(http://iopscience.iop.org/1742-6596/884/1/012136)
Home Search Collections Journals About Contact us My IOPscience
1
Content from this work may be used under the terms of the Creative Commons Attribution 3.0 licence. Any further distribution
of this work must maintain attribution to the author(s) and the title of the work, journal citation and DOI.
Published under licence by IOP Publishing Ltd
1234567890
The 1st Physics and Technologies in Medicine and Dentistry Symposium IOP Publishing
IOP Conf. Series: Journal of Physics: Conf. Series 884 (2017) 012136 doi :10.1088/1742-6596/884/1/012136
Efficacy of chlorine dioxide mouthwash against halitosis
M D Bestari, H Sunarto and Y Kemal*
Department of Periodontics, Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia
*E-mail: yulianti.kemal@ui.ac.id
Abstract. To ascertain the effectiveness of using chlorine dioxide mouthwash in addressing
halitosis. Forty people were divided equally into the test group (required to gargle with
mouthwash containing chlorine dioxide) and the control group (required to gargle with
aquadest). The volatile sulfur compound (VSC) and organoleptic scores were measured before
gargling and 30 min, 2 h, 4 h, and 6 h after. The Wilcoxon test analysis showed a significant
difference (p<0.05) in the mean value of VSC scores between the test group and the control
group in four testing periods after gargling. Chlorine dioxide mouthwash is effective in
addressing halitosis.
1. Introduction
Oral health is essential and has an important role in everyday life. In Indonesia, oral health remains
one of the main problems suffered by the community. The Indonesian Household Health Survey in
2001 showed that oral health problems are the complaints of 60% of the Indonesian population. Dental
and oral diseases, which are usually found among the people of Indonesia, include dental caries,
periodontitis, gingivitis, stomatitis apthosa, and halitosis [1]. Halitosis or bad breath is defined as an
unpleasant breath arising from physiological and pathological factors derived from oral or systemic
sources and is one of the most frequent oral health problems. Several studies conducted in
industrialized countries showed a prevalence of halitosis of as high as 50% with various severities [2].
Besides health problems, halitosis can also greatly affect the social life of patients.
About 80%90% of halitosis comes from the oral cavity, and the accumulation of bacteria on the
posterior part of the tongue is one of its main causes [3]. Halitosis can be caused by various factors,
such as foods and drinks, poor oral hygiene, periodontal diseases, tongue coating, xerostomia (dry
mouth), and systemic diseases [2]. Moreover, halitosis can be caused by upper and lower respiratory
tract disorders, digestive disorders, and use of certain drugs [4]. Volatile sulfur compound (VSC) is the
major cause of halitosis. The VSC components, are hydrogen sulfide gas (H2S), methyl mercaptan
(CH3SH), and dimethyl sulfide ((CH3)2S). VSC is formed through the reactions of non-volatile
materials in the mouth, especially protein, with anaerobic bacteria in the oral cavity [2].
Prevention efforts and treatment of halitosis are brushing the teeth and the tongue, using
mouthwash, and improving one’s diet. Treatments such as brushing the teeth and tongue or using an
antiseptic mouthwash have been proved to reduce hydrogen sulfide and methyl mercaptan, which are
the components of VSC [5].
The use of mouthwash is a simple effort to overcome halitosis. Particularly in Indonesia, the
market offers a wide variety of brands with different active ingredients of mouthwashes.
Chlorhexidine is the most commonly used antibacterial agent. However, although chlorhexidine is one
2
1234567890
The 1st Physics and Technologies in Medicine and Dentistry Symposium IOP Publishing
IOP Conf. Series: Journal of Physics: Conf. Series 884 (2017) 012136 doi :10.1088/1742-6596/884/1/012136
of the most effective oral antiseptic agents, research shows that the long-term use of chlorhexidine has
some side effects, such as staining on the teeth and tongue and reduced sensitivity of taste buds [6,7].
Developments in dentistry have produced several discoveries of new products that can be used as
supporting periodontal treatment, one of which is chlorine dioxide (ClO2). ClO2 is a strong oxidizing
agent that can kill bacteria through a protein synthesis mechanism [8]. It contains oxygen, which can
be used as an antiseptic on wounds and accelerates healing, and is effective for halitosis, gingivitis,
periodontitis, and bleeding gums [10-12]. ClO2 and chlorite anion (ClO2-) together can oxidize VSC to
become a non-malodor product and destroy amino acids, such as cysteine and methionine, which are
VSC precursors, in the process of oxidation [12]. Mouthwashes containing ClO2 have been widely
used in developed countries, such as Japan and the United States, and ClO2 mouthwash has been
reported to be effective in reducing bad breath in the morning (morning breath malodor) up to 4 h after
application in healthy subjects [13]. In Indonesia, mouthwashes containing ClO2 are not too popular
among the public. Moreover, studies on the efficacy of the use of mouthwash containing ClO2 against
halitosis in Indonesia have not yet been conducted. Therefore, this research is conducted to analyze the
efficacy of using mouthwash containing ClO2 as the active ingredient to address halitosis. The results
are expected to improve the knowledge of dentists in dealing with halitosis and to help people to
choose the right mouthwash to overcome halitosis.
2. Materials and Methods
This study used a blind randomized clinical trial by taking samples randomly before and after the
study. Data retrieval was conducted before and after a subject gargled with mouthwash provided by
the researcher. The entire protocol of this study was reviewed and approved by the Research Ethics
Committee of the Faculty of Dentistry, University of Indonesia. The sample comprised 40 people who
were chosen randomly, met all the criteria for inclusion, and were exempted from the exclusion
criteria. The 40 subjects were divided evenly into two groups: the test group, which was required to
rinse with mouthwash containing ClO2 (i.e., Oxyfresh® “Oxygene® Mouthrinse”), and the control
group, which was required to rinse with aquadest.
One day prior to the measurement, the subjects were instructed not to consume pungent foods to
prevent overload levels of VSC. All subjects were also instructed not to eat, drink, gargle, brush their
teeth, and consume chewing gum for at least 2 h prior to the initial measurements to obtain an initial
score that was not too diverse among subjects. To eliminate the psychological factors that could
become confounding factors in the study, the subjects were not told to which group they would be
included prior to the measurement. The Oxyfresh® “Oxygene® Mouthrinse” used in this study was
non-colored and clear, similar to aquadest, so that the subjects would be unaware of the type of
mouthwash they would use.
The VSC scores were measured by OralChroma™, and organoleptic measurement was performed
at 0 min before the subjects gargled (baseline), 30 min after the subjects gargled, 2 h after the subject
gargled, 4 h after the subject gargled, and 6 h after the subject gargled.The VSC scores were analyzed
by the Wilcoxon statistical test. A significance level of 0.05 (p = 0.05) and confidence level of 95% (α
= 0.05) were obtained.
3. Results and Discussion
3.1 Results
The comparison of the measurement results of the VSC scores between the test group and the control
group in each measurement period is presented in Figure 1. The comparison of the measurement
results of each score of the VSC components, the H2S scores, the CH3SH scores, and the (CH3)2S
scores is illustrated in Figures 2, 3, and 4, respectively. The results of the organoleptic measurements
in each group are shown in Figures 5 and 6.
3
1234567890
The 1st Physics and Technologies in Medicine and Dentistry Symposium IOP Publishing
IOP Conf. Series: Journal of Physics: Conf. Series 884 (2017) 012136 doi :10.1088/1742-6596/884/1/012136
Figure 1. Comparison chart of the mean value of the VSC scores between the test group and the
control group
Figure 2. Comparison chart of the mean value of the H2S scores between the test group and the
control group
0.383
0.002
0.08
0.174
0.342
0.075
0.478
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
Baseline
30 minutes
2 hours
4 hours
6 hours
Measurement time
H2S Scores (ng/10ml)
The test group
The control group
VSC Scores (ng/10ml)
1.041
0.007
0.857
0.216
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
Baseline
30 minutes
2 hours
4 hours
6 hours
Measurement time
The test group
The control group
4
1234567890
The 1st Physics and Technologies in Medicine and Dentistry Symposium IOP Publishing
IOP Conf. Series: Journal of Physics: Conf. Series 884 (2017) 012136 doi :10.1088/1742-6596/884/1/012136
Figure 3. Comparison chart of the mean value of the CH3SH scores between the test group and the
control group
Figure 4. Comparison chart of the mean value of the (CH3)2S scores between the test group and the
control group
0.232
0
0.038
0.131
0.198
0.194
0.049
0.182
0.315
0.431
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
0.4
0.45
0.5
Baseline
30 minutes
2 hours
4 hours
6 hours
Measurement time
The test group
The control group
0.426
0.005
0.322
0.093
0
0.1
0.2
0.3
0.4
0.5
0.6
Baseline
30 minutes
2 hours
4 hours
6 hours
Measurement time
The test group
The control group
CH3SH Scores(ng/10ml)
(CH3)2S Scores
(ng/10ml)
5
1234567890
The 1st Physics and Technologies in Medicine and Dentistry Symposium IOP Publishing
IOP Conf. Series: Journal of Physics: Conf. Series 884 (2017) 012136 doi :10.1088/1742-6596/884/1/012136
Figure 5. Diagram of the organoleptic scores in the test group
Figure 6. Diagram of the organoleptic scores in the control group
The p-value in the Wilcoxon test analysis showed no significant difference in the baseline
measurement before gargling in the VSC, H2S, CH3SH, and (CH3)2S scores between the test group and
the control group (p> 0.05). In the measurement 30 min, 2 h, 4 h, and 6 h after gargling, the p value of
the Wilcoxon test showed a significant difference in the VSC scores between the test group and the
control group (p <0.05).
3.2 Discussion
Measuring VSC with Oral Chroma has been widely used. The advantage of Oral Chroma are its
compactness, and is able to measure individual VSC (H2S, CH3SH, and (CH3)2S) [9]. The results of
9
2
4
11
8
2
16
10
17
14
1
6
0
2
4
6
8
10
12
14
16
18
Baseline
30minutes
2hours
4hours
6hours
Measurement time
Number (N)
Score 0
Score 1
Score 2
Score 3
20
13
1
3
7
19
11
17
9
0
5
10
15
20
25
Baseline
30 minutes
2 hours
4 hours
6 hours
Measurement time
Number (N)
Score 0
Score 1
Score 2
6
1234567890
The 1st Physics and Technologies in Medicine and Dentistry Symposium IOP Publishing
IOP Conf. Series: Journal of Physics: Conf. Series 884 (2017) 012136 doi :10.1088/1742-6596/884/1/012136
the VSC measurement by Oral Chroma after analyzing the Wilcoxon statistical test showed a
significant difference in the VSC scores between the control group and the test group 30 min, 2 h, 4 h,
and 6 h after treatment. In the initial measurement prior to the treatment or the baseline measurement,
no significant difference was observed between the control group and the test group. The mean value
of the VSC scores in the test group 30 min after gargling was only 0.007 ng/10 ml and that in the
control group was 0.09 ng/10 ml. At 2 h after gargling, the mean value of the VSC scores was 0.168
ng/10 ml in the test group and 0.718 ng/10 ml in the control group. At 4 h after gargling, the difference
in the mean value of the VSC scores was significant at 0.465 ng/10 ml in the test group and 1.178
ng/10 ml in the control group. At 6 h after gargling, the mean value of the VSC scores was 0.737
ng/10 ml in the test group and 1.636 ng/10 ml in the control group; the mean value of the control
group was two times greater than that of the test group. The scores of each component of VSC,
namely, the H2S, CH3SH, and (CH3)2S scores, also showed a statistically significant difference
between the test group and the control group at 30 min, 2 h, 4 h, and 6 h after treatment. The baseline
measurement of the H2S, CH3SH, and (CH3)2S scores showed no significant difference between the
test group and the control group.
VSC compounds are produced by gram-negative anaerobic bacteria that exist in the oral cavity
[14]. Silwood et al. [17] and Al-Bayaty et al. [11] found that ClO2 interacts with bacteria-specific
biomolecules and disrupts the physiological functions of microorganisms through the reactions
between the organic substances of bacterial cell wall with ClO2, which damages the cell membranes of
bacteria that produce VSC. The function of the bacterial cell membrane is to maintain the integrity of
the overall contents of the cytoplasm and selectively controls the transport of nutrients to cells;
therefore, damage to a cell membrane of bacteria can cause bacterial death [11,16]. Silwood also
observed that ClO2 could penetrate into the bacterial cell wall and react with vital amino acids in the
bacterial cytoplasm, thus killing the bacteria [17].
The results of the study by Taiyeb-ali et al. [20] strengthened those of the study by Chapek [18],
who found that the oxygen produced by ClO2 could maintain the amount of oxygen in the saliva and
gingival sulcus [18]. Anaerobic bacteria cannot survive with the presence of oxygen in the saliva and
gingival sulcus [19-20]. This condition delays the formation of VSC in the oral cavity. In addition, the
oxygen contained in ClO2 is one of the sources of antioxidants that can be used in the treatment of
periodontal diseases, as oxygen can increase the metabolic process and thus enhance immunity by
reducing the free radicals that cause inflammation [21-22].
Similar to the measurement of VSC compound with oral chromatography, the results of the
organoleptic measurement at 30 min, 2 h, 4 h, and 6 h after the treatment also showed a significant
difference between the control group and the test group. Based on the results of the VSC scores
measured by Oral Chroma and the organoleptic scores measured by the sense of smell, the increase in
VSC scores was directly proportional to the increase in organoleptic scores. Therefore, the higher the
level of VSC in the oral cavity is, the more pungent the smell of the oral cavity is perceived.
Previous study found that ClO2 mouthwash was effective in inhibiting the formation of plaque.
Moreover, research on the antibacterial effect of ClO2 indicated that ClO2 gel had a stronger
antibacterial effect against dental biofilm than hyaluronic gel and chlorhexidine, thus making it an
alternative therapy in dentistry [11,19]. The results of this study proved that ClO2 is an oxidizing agent
with a strong antibacterial effect, thus making it effective in reducing the number of VSC and as a
masking agent against halitosis. Mouthwashes containing ClO2 can be used in dentistry as an
antibacterial to effectively reduce halitosis
4. Conclusion
Gargling with mouthwash containing ClO2 is effective against halitosis in the capacity of lowering the
levels of the VSC components, namely, H2S, CH3SH, and (CH3)2S, in the oral cavity. Unlike in the
control group, the test group indicates that gargling with mouthwash containing ClO2 is effective in
reducing halitosis.
7
1234567890
The 1st Physics and Technologies in Medicine and Dentistry Symposium IOP Publishing
IOP Conf. Series: Journal of Physics: Conf. Series 884 (2017) 012136 doi :10.1088/1742-6596/884/1/012136
Acknowledgement
This study was greatly supported by the Oral Epidemiology and Clinical Studies Research Cluster.
References
[1] Badan Penelitian dan Pengembangan Kesehatan Departemen Kesehatan Republik Indonesia.
2001 Survei kesehatan rumah tangga 2001. (Jakarta: Departemen Kesehatan Republik
Indonesia).
[2] Tonzeitich J 1977 Production and origin of oral malodor: a review of mechanisms and methods of
analysis. J. Clin. Periodontol. 48 13.
[3] Quirynen M and Steenberghe D 2006 Oral Malador. Carranza's Clinical Periodontology. 10th ed,
ed M G Newman, H H Takei, P R Klokkevold, F A Carranza (Missouri: WB Saunders
Company)
[4] Rosenberg M 2002 The science of bad breath. Scientific American Magazine, USA, 286.
[5] Mirdza N and Brigette R 1999 Operation of bad breath clinics. Quintessence Int. 30 295-301.
[6] Lorenz K, Bruhn G, Heumann C, Netuschil L, Brecx M and Hoffmann T 2006 Effect of two new
chlorhexidine mouthrinses on the development of dental plaque, gingivitis, and discolouration:
A randomized, investigator-blind, placebo-controlled, 3-week experimental gingivitis study. J.
Clin. Periodontol. 33 561-67.
[7] Fedorowicz Z, Aljufairi H, Nasser M, Outhouse T L and Pedrazzi V 2008 Mouthrinses for the
treatment of halitosis. J. Dent. Res. 60 379.
[8] Bernarde M A, Snow W B, Olivieri V P and Davidson B 1967 Kinetics and mechanism of
bacterial disinfection by chlorine dioxide. J. Appl. Microbiol. 15 257-65.
[9] Amin A, Radji M, Rahardjo A and Mun’im A 2017 Halitosis activity against volatile sulfur
compound of methyl mercaptan component from burahol (Stelechocarpus burahol) fruit
extract. Asian J. Pharm. Clin. Res. 10 116.
[10] Quirynen M, Van den Velde S, Vandekerchove B, and Dadamio J 2012 Oral Malodor, ed M G
Newman, H Takei, P R Klokkevold and F A Carranza (Philadelphia: WB Saunder Company).
[11] Al-Bayaty F, Taiyeb-ali T, Abdulla M A and Hashim F 2010 Antibacterial Effect of Chlorine
Dioxide and Hyaluronate on Dental Biofilm. Afr. J. Microbiol. Res. 4 25-25-31.
[12] Iwan S W 2010 Pengaruh Pemberian Oxygene Dental Gel® Pada Soket Gigi Pasca Operasi
Molar Ketiga Bawah Terhadap Pencegahan Alveolar Osteitis. Thesis (Yogyakarta:
Universitas Gadjah Mada).
[13] Lynch E, Sheerin A, Claxson A W D, Atherton M D, Rhodes C J, Silwood C J L, Naughton D P,
and Grootveld M 1997 Multicomponent spectroscopic investigations of salivary antioxidant
consumption by an oral rinse preparation containing the stable free radical species chlorine
dioxide (ClO2). Free Radic. Res. J. 26 209-34.
[14] Shinada K, Ueno M, Konishi C, Takehara S, Yokoyama S and Kawaguchi Y 2008 A randomized,
double blind, crossover, placebo-controlled clinical trial to assess the effects of a mouthwash
containing chlorine dioxide on oral malodor. J. Clin. Trials. 9 71.
[15] Kharbanda O P, Sidhu S S, Sundaram K and Shukla D K 2003 Oral habits in school going
children of Delhi: a prevalence study. J Indian Soc Pedodontics Prev. Dent. 21 120-4.
[16] Grootveld M, Silwood C J, Gill D and Lynch E 2001 Evidence for the microbicidal activity of a
chlorine dioxide-containing oral rinse formulation in vivo. J. Clin. Dent. 12 67-70.
[17] Silwood C J, Grootveld M and Lynch E 2001 A multifactorial investigation of the ability of Oral
Health Care Products (OHCPs) to alleviate oral malodour. J. Clin. Periodontol. 28 634-41.
[18] Chapek C W, Reed O K and Ratcliff P A 1994 Management of periodontitis with oral care
products. Compend. Contin Educ Dent. 15 704.
[19] Yates R, Moran J, Addy M, Mullan P J, Wade W G and Newcombe R 1997 The comparative
effect of acidified sodium chlorite and chlorhexidine mouthrinses on plaque regrowth and
salivary bacterial counts. J. Clin. Periodontol. 24 603-9.
8
1234567890
The 1st Physics and Technologies in Medicine and Dentistry Symposium IOP Publishing
IOP Conf. Series: Journal of Physics: Conf. Series 884 (2017) 012136 doi :10.1088/1742-6596/884/1/012136
[20] Taiyeb-Ali T B, Kaveh B S and Mohddom T N 2004 Oxygene Gel ® as an adjunct to treatment
of periodontal pockets. Periodontal Research Therapy Program for CADR 82nd General
Session (Malaysia: University of Malaya).
[21] Dumitrescu A L 2011 The Use of Chemical Supragingival Plaque Control in Periodontal
Therapy.ed A L Dumitrescu (Berlin: Springer Verlag).
[22] Battino M, Bullon P, Wilson M and Newman H 1999 Oxidative injury and inflammatory
periodontal diseases: the challenge of anti-oxidants to free radicals and reactive oxygen
species. Crit. Rev. Oral Biol. Med. 10 458-76.
... 7 Chlorhexidine is an ingredient in mouthwash with good anti-microbial power to reduce plaque. 8 Chlorhexidine used continuously has several deficiencies that is, it can reduce the sensitivity of the sense of taste and discoloration of the mucosa, dorsum of the tongue, teeth and composite resin. The alcohol content of chlorhexidine mouthwash has a major effect on discoloration of the composite resin. ...
... 12 Chlorine dioxide is an oxygen oxidizing agent that can be used as an antiseptic in wounds and accelerates healing and is effective for gingivitis, periodontitis, bleeding gums and especially for halitosis. 8 The difference in the use of mouthwash between those containing chlorhexidine and mouthwash containing chlorine dioxide is mouthwash containing chlorine dioxide in long-term use does not cause changes in taste taste on the tongue. 13 Based on this, a study was made to find out better mouthwash content between 0.12% chlorhexidine digluconate and 0.1% chlorine dioxide on the color stability of nanofil composite resins. ...
Article
Full-text available
ABSTRAK Background: Composite resins are able to generate the color of dental restorative materials based on the original teeth's color. Nanofilled composite resins have compressive strength, good polishing, and color stability compared to other types of composite resins. Color changes may occur due to intrinsic and extrinsic factor example mouthwash. Mouthwash that is commonly used is chlorhexidine. The use of chlorhexidine mouthwash continuously may stain the composite resins. Mouthwash that has a good anti-plaque other than chlorhexidine is chlorine dioxide which has a clear color and does not cause changes in taste on the tongue.Aim: To determine the effect of 0.12% chlorhexidine digluconate mouthwash and 0.1% chlorine dioxide mouthwash to the discoloration of nanofilled composite resins. Methods: This study is an experimental study with a pre-test and post-test control group design. Samples are nanofilledcomposite resins made into discs in total of 27 and divided into three groups with different treatments, soaked with 0.12% chlorhexidine digluconate mouthwash, 0.1% chlorine dioxide mouthwash, and sterile distilled water. Each group was soaked for 24 hours and tested for staining using chromameter.Result: ANOVA test showed the significant difference between group, that the greatest color change is the one soaked with 0.12% chlorhexidine digluconate mouthwash compared to 0.1% chlorine dioxide mouthwashConclusions: The use of 0.1% chlorine dioxide mouthwash does not cause discoloration as much as 0.12% chlorhexidine digluconate mouthwash.Keywords: Chlorhexidine digluconate, Chlorine dioxide, nanofilled composite resin, discoloration
... Their main advantage is the lack of known side effects and efficacy in low concentrations [17]. Most ClO 2 mouthwashes contain a stabilized form of ClO 2 [18][19][20][21]. However, they are assumed to be less effective than hyperpure ClO 2 due to lower concentrations of active ClO 2 molecules and contamination with other ingredients [14,22]. ...
Article
Full-text available
Introduction Intra-oral halitosis (IOH) is the most common type of bad breath; its consequences impair quality of life. However, evidence-based treatment protocols and guidelines are lacking. Our aim is to investigate the effectiveness of chlorine dioxide as an applicable complementary treatment modality in IOH after tongue cleaning. Methods and analysis The ODOR trial will be a single-center, double-blinded, parallel-group, double-armed pilot randomized controlled trial with a non-inferiority design. The efficacy of hyperpure chlorine dioxide will be compared to chlorhexidine mouthwash. We plan to investigate the short-term effects of the intervention over a 3-h period. The primary endpoint will be changes in organoleptic test scores. At the end of the pilot investigation of the first 30 patients each, sample size calculation will be performed. If feasible, the investigators will continue the study by enrolling more patients. Trial registration The trial has been registered at ClinicalTrials.gov (NCT06219226).
... Klorin dioksida yang bereaksi dengan asam amino dalam saliva juga mampu menembus biofilm sehingga dapat mengganggu pertumbuhan bakteri dan meningkatkan laju aliran saliva atau menggantikan sekresi saliva yang hilang. 29,30,31 Penggunaan obat kumur yang mengandung klorin dioksida diharapkan dapat membantu melembabkan mukosa rongga mulut pasien sedangkan pemberian vaselin album ditujukan untuk melembabkan bibir yang eksfoliatif dengan mekanisme menunda penguapan air sehingga dapat mencegah bibir kering. 28 Kesehatan rongga mulut penderita SLE memiliki keterkaitan erat dengan manifestasi oralnya, 8,32 sehingga bagian penting dalam tatalaksana oral penderitanya adalah penekanan akan pentingnya edukasi, dukungan dan konseling berikut implementasinya. ...
Article
Full-text available
ABSTRAK Pendahuluan : Systemic Lupus Erythematosus (SLE) merupakan penyakit autoimun kompleks yang menyerang berbagai sistem organ tubuh dengan angka morbiditas dan mortalitas yang tinggi. Manifestasi klinis paling umum adalah keterlibatan mukokutan dan manifestasi oral yang meliputi ulkus oral, lesi discoid, lichen planus-like lesion dan xerostomia. Manifestasi oral SLE pada orang dewasa jarang ditemukan. Tujuan dari Laporan Kasus ini adalah untuk mendeskripsikan manifestasi tatalaksana lesi oral pada pasien penderita systemic lupus erythematosus (SLE). Laporan kasus : Seorang wanita berusia 21 tahun dengan SLE dirujuk dari Divisi Rheumatologi RSUP. Dr. Hasan Sadikin, Bandung dengan keluhan rasa sakit pada rongga mulut, serta kesulitan makan dan minum . Pemeriksaan ekstra oral menemukan ruam malar pada wajah dan bibir terlihat eksfoliatif. Intra oral ditemukan lesi erosif, eritem, tunggal, berbentuk bulat dengan diameter 0,7 cm pada mukosa bukal. Terdapat ulser erosif, eritem dengan dasar putih, multiple, berbatas jelas, ukuran bervariasi pada palatum durum dan pada gingiva anterior terdapat hematom keunguan yang mudah berdarah. Diagnosis SLE dalam kasus ini ditetapkan melalui pemeriksaan penunjang ANA test yang menunjukan hasil reactive dengan pola speckled dan titer 1:100 ( Strong Positive ). Terapi farmakologi untuk mengatasi kelainan rongga mulut dan bibir adalah triamsinolon asetonid 0,1% in orabase , obat kumur klorin dioksida dan vaselin album. Terapi non-farmakologi berupa edukasi untuk menghindari makanan yang pedas dan keras serta menjaga kesehatan gigi dan mulut. Simpulan: Pasien dengan SLE dapat menunjukan berbagai macam manifestasi oral. Diagnosis dan tatalaksana yang tepat memainkan peranan penting dalam mencegah progresivitas dan kronisitas dari penyakit ini sehingga dapat menurunkan angka morbiditas dan mortalitas pasien. Kata K unci : systemic lupus erythematosus , tatalaksana SLE, manifestasi oral Manifestation and management of oral lesion in patient with systemic lupus erythematosus (SLE): case report ABSTRACT Introduction : Systemic Lupus Erythematosus (SLE) is a complex autoimmune disease that affectsvarious systems and organs with high morbidity and mortality rates. The most common clinical manifestation is mucocutaneous involvement and oral manifestations comprised of oral ulcers, discoid lesions, lichen planus-like lesions and xerostomia. Oral manifestations of SLE in adults were rare. This study is aimed to describe oral manifestations of SLE and its management. Case report : A 21-year-old woman with SLE was referred from Rheumatology Division of RSUP. Dr. Hasan Sadikin, Bandung, complaining of painful in oral cavity as well as difficulty in eating and drinking. Extraoral examination revealed malar rash on face and lips that looked exfoliative. Intraorally, revealed erosive lesion, erythematous, single, round-shaped with diameter of 0.7 cm on buccal mucosa. There were erosive ulcers, erythematous with white base, multiple, well-demarcated and varying in sizes on hard palate and on anterior gingiva there was purplish hematoma that bleeds easily. Diagnosis of SLE in this case was established based on supporting examination of ANA test which showed reactive results with speckled pattern and titer of 1:100 (Strong Positive). Pharmacological therapy to treat disorder of oral cavity and lips were 0.1% triamcinolone acetonide in orabase, chlorine dioxide mouthwash and vaseline album. Non-pharmacological therapy was giving education to avoid spicy and hard foods and maintain oral hygiene. Conclusion : SLE patients may exhibit variety of oral manifestations. Correct diagnosis and management play an important role to prevent the progression and chronicity of this disease to reduce patient morbidity and mortality. . Keywords : systemic lupus erythematosus, Management SLE, Oral Manifestation.
Article
Full-text available
Objectives We aimed to conduct a systematic review on published data in order to investigate the efficacy of mouthwash products containing chlorine dioxide in halitosis. Study design Systematic review and meta-analysis Methods Our search was conducted on 14th October 2021. We searched the following electronic databases: MEDLINE, Embase, Scopus, Web of Science, and CENTRAL. We analysed data on adults with halitosis, included only randomised controlled trials and excluded in vitro and animal studies. The interventional groups used chlorine dioxide, and the comparator groups used a placebo or other mouthwash. Our primary outcomes were changes in organoleptic test scores (OLS) and Volatile Sulfur Compound (VSC) levels from baseline to the last available follow-up. Results We found 325 articles in databases. After the selection process, ten articles were eligible for qualitative synthesis, and 7 RCTs with 234 patients were involved in the meta-analysis. Our findings showed a significant improvement in the parameters of the chlorine dioxide group compared to the placebo group in OLS one-day data (mean difference (MD): -0.82; 95% confidence intervals (95% CIs): [-1.04 –-0.6]; heterogeneity: I² = 0%, p = 0.67); and one-week OLS data (MD: -0.24; 95% CIs: [-0.41 –-0.07]; I² = 0%, p = 0.52); and also changes in H2S one-day data (standardised mean difference (SMD): -1.81; 95% CIs: [-2.52 –-1.10]); I² = 73.4%, p = 0.02). Conclusion Our data indicate that chlorine dioxide mouthwash may be a good supportive therapy in oral halitosis without known side effects.
Article
Full-text available
Objective: This research was conducted to prove the activity of Stelechocarpus burahol fruit (SBF) extracts against volatile sulfur compound (VSC) of methyl mercaptan in anaerobic Gram-negative oral bacteria causing halitosis. Materials and Methods: Burahol fruits were extracted by ethanol and partitioned by several solvents and then identified the chemical constituents of the extracts using phytochemical screening test and polyphenol content by spectroscopic ultraviolet instrument. The halitosis activity against VSC of methyl mercaptan component derived from anaerobic Gram-negative oral bacteria after administration of SBF extracts with a dose of 20 mg/ml was conducted in vitro using gas chromatography-oral chroma. Results: All extracts (ethanol, ethyl acetate, butanol, water, and methanol) contain flavonoids and polyphenols, whereas saponin was found in all extracts except methanol. Halitosis activity shows the ethanol extract of SBF, has absorption capability against methyl mercaptan, and was higher than the other extracts, with catechins as control. Conclusion: All extracts of SBF (ethanol, ethyl acetate, butanol, water, and methanol) can inhibit and reduce VSC of methyl mercaptan causing halitosis.
Article
Full-text available
Objective: This research was conducted to prove the activity of Stelechocarpus burahol fruit (SBF) extracts against volatile sulfur compound (VSC) of methyl mercaptan in anaerobic Gram-negative oral bacteria causing halitosis. Materials and Methods: Burahol fruits were extracted by ethanol and partitioned by several solvents and then identified the chemical constituents of the extracts using phytochemical screening test and polyphenol content by spectroscopic ultraviolet instrument. The halitosis activity against VSC of methyl mercaptan component derived from anaerobic Gram-negative oral bacteria after administration of SBF extracts with a dose of 20 mg/ml was conducted in vitro using gas chromatography-oral chroma. Results: All extracts (ethanol, ethyl acetate, butanol, water, and methanol) contain flavonoids and polyphenols, whereas saponin was found in all extracts except methanol. Halitosis activity shows the ethanol extract of SBF, has absorption capability against methyl mercaptan, and was higher than the other extracts, with catechins as control. Conclusion: All extracts of SBF (ethanol, ethyl acetate, butanol, water, and methanol) can inhibit and reduce VSC of methyl mercaptan causing halitosis.
Article
Full-text available
The objective of this study is to investigate antimicrobial action of chlorine dioxide (ClO 2) gel and hyaluronate gel (Gengigel ®) on dental biofilm. Pooled supra and subgingival dental biofilm were obtained from healthy individuals and incubated aerobically and anaerobically. Plaque bacteria investigated including Streptococcus constellatus, Streptococcus mitis, Eikenella corrodens, Fusobacterium nucleatum, dental plaque pool samples (aerobic and anaerobic) and Staphylococcus aureus and Escherichia coli as internal control microorganisms. All bacteria were grown in Brain Heart Infusion (BHI) broth and the clinical isolate strains were sub-cultured on BHI agar. Single pure colonies of bacteria were transferred into fresh BHI broth and incubated overnight. Bacterial counting was done using hemocytometer. Antibacterial activities were determined using bacteria grown on Mueller Hinton II agar and antimicrobial disc diffusion susceptibility testing with paper discs impregnated with ClO 2 and Hyaluronate gels as well as by minimum inhibition concentration (MIC) test. Bacterial morphological alterations following treatment with ClO 2 and Hyaluronate gels were viewed under Scanning Electron Microscope (SEM) at 3500x, 10000 x and 20000x magnification. Positive results were obtained with disc diffusion technique whereby both agents exhibited antibacterial action against the microorganisms tested. ClO 2 gel produced large diameter inhibition zones while Hyaluronate gel resulted in smaller diameter inhibition zones. In MIC test the lowest MIC value of ClO 2 gel (0.02% w/v) was obtained for S. aureus, S. mitis and S. constellatus. The other bacteria and pool samples of dental biofilm indicated slightly higher MIC values (0.2% w/v) for ClO 2 gel. However, MIC values for Hyaluronate gel could not be determined. Under SEM, ClO 2 gel produced obvious alterations to the bacterial morphology while no changes were observed after treatment with hyaluronate gel. Chlorine dioxide gel demonstrated stronger and obvious antibacterial activity.
Article
Full-text available
Previous research has shown the oxidizing properties and microbiological efficacies of chlorine dioxide (ClO(2)), however, its clinical efficacies on oral malodor have been evaluated only with organoleptic measurements (OM) or sulphide monitors. No clinical studies have investigated the inhibitory effects of ClO(2) on volatile sulfur compounds (VSCs) using gas chromatography (GC). The aim of this study was to assess the inhibitory effects of a mouthwash containing ClO(2) on morning oral malodor using OM and GC. A randomized, double blind, crossover, placebo-controlled clinical trial was conducted among 15 healthy male volunteers, who were divided into 2 groups. In the first test phase, the group 1 subjects (N = 8) were instructed to rinse with the experimental mouthwash containing ClO(2), and those in group 2 (N = 7) to rinse with the placebo mouthwash without ClO(2). In the second test, phase after a one week washout period, each group used the opposite mouthwash.Oral malodor was evaluated before rinsing, right after rinsing and every 30 minutes up to 4 hours with OM, and concentrations of hydrogen sulfide (H2S), methyl mercaptan (CH(3)SH) and dimethyl sulfide ((CH3)2S), the main VSCs of human oral malodor, were evaluated with GC. The baseline oral condition in the subjects in the 2 groups did not differ significantly. The mouthwash containing ClO(2) improved morning bad breath according to OM and reduced concentrations of H(2)S, CH(3)SH and (CH(3)(2)S according to GC up to 4 hours after rinsing. OM scores with ClO(2) were significantly lower than those without ClO(2) at all examination times. Significant reductions in the concentrations of the three kinds of VSCs measured by GC were also evident at all examination times. The concentrations of the three gases with ClO(2) were significantly lower than those without ClO(2) at most examination times. In this explorative study, ClO(2) mouthwash was effective at reducing morning malodor for 4 hours when used by healthy subjects. ClinicalTrials.gov NCT00655772.
Book
From basic science and fundamental procedures to the latest advanced techniques in reconstructive, esthetic, and implant therapy, Newman and Carranza's Clinical Periodontology, 13th Edition is the resource you can count on to help master the most current information and techniques in periodontology. Full color photos, illustrations, radiographs and videos show you how to perform periodontal procedures, while renowned experts from across the globe explain the evidence supporting each treatment and lend their knowledge on how to best manage the outcomes. Access to the Expert Consult website provides fully-searchable online chapters and unique case-based clinical scenarios that mimic the new format of credentialing exams. The Expert Consult platform also includes a wealth of resources to enhance understanding, such as: a periodontal pathology atlas, virtual microscope, animations, case reports, videos, audio slides, review questions, reference lists, and much more. It's the perfect resource for dental students, periodontal residents, and clinicians alike!
Article
A multicomponent evaluation of the oxidative consumption of salivary biomolecules by a commercially-available oral rinse preparation containing an admixture of the stable free radical species chlorine dioxide (ClO2.) with chlorite anion (ClO2-) has been investigated using high resolution H-1 NMR spectroscopy. The results obtained demonstrated that ClO2. and/or ClO2- present in this preparation effected the oxidative decarboxylation of salivary pyruvate (to acetate and CO2). Experiments conducted on chemical model systems confirmed the oxidative decarboxylation of pyruvate by this oral rinse, and also demonstrated that urate, thiocyanate anion, and the amino acids cysteine and methionine (precursors to volatile sulphur compounds responsible for oral malodour), were oxidatively consumed. The biochemical, periodontal and therapeutic significance of the results are discussed.
Article
Organoleptic studies indicate that the oral cavity is usually the principal source of physiologic malodor associated with the early morning halitosis. In all individuals, regardless of the age or health status of the oral tissues, the most intense oral malodor is exhibited after prolonged periods of reduced saliva flow and abstinence from food and liquid. This results from normal metabolic activity in the oral cavity and is accentuated in cases with poriodontal involvement. Physiologic oral malodor is transient in duration as it can be controlled to varying degrees in most individuals by oral hygiene measures, such as tooth brushing, dental prophylaxis, tongue scraping and rinsing with antiseptic mouth washes. Experimental evidence strongly suggests that putrefaction of sulphur containing proteinaceous substrates by predominantly gram negative oral microorganisms is the primary cause of oral malodor. Brushing studies indicate that both plaque and tongue are important sources of malodor with most of the odor emanating from the dorso posterior surface of the tongue. None of the gas chromatographic or mass spectrometric analyses have detected the presence of amines, indole, or skatole in the head space, mouth air, or breath vapor samples.
Article
Survival data are presented for a fecal strain of Escherichia coli exposed to three concentrations of chlorine dioxide at four temperatures. Chick's first-order reaction equation is generalized to a pseudo nth-order model. Nonlinear least squares curve-fitting of the survival data to the nth order model was performed on an analogue computer. The data were observed to follow fractional order kinetics with respect to survival concentration, with an apparent activation energy of 12,000 cal/mole. Initial experiments support the thesis that the mechanism of chlorine dioxide kill occurs via disruption of protein synthesis.