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Periodontal diseases (gingivitis and periodontitis) are characterized by inflammatory processes which arise as a result of disruption of the balance in the oral ecosystem. According to the current S3 level clinical practice guidelines, therapy of patients with periodontitis involves a stepwise approach that includes the control of the patient's risk factors and the debridement of supra and subgingival biofilm. This debridement can be performed with or without the use of some adjuvant therapies, including physical or chemical agents, host modulating agents, subgingivally locally delivered antimicrobials, or systemic antimicrobials. Therefore, the main aim of this article is to review in a narrative manner the existing literature regarding the adjuvant application of local agents, either subgingivally delivered antibiotics and antiseptics or supragingivally applied rinses and dentifrices, during the different steps in periodontal therapy performed in Europe., (© 2023 The Authors. Periodontology 2000 published by John Wiley & Sons Ltd.)

Root coverage procedures have become very common in clinical dental practice. Even though these techniques are considered safe, the clinician may face several issues during the therapy due to their surgical nature. Some of these issues can be defined strictly as complications inherent to the procedure, whereas others are medical errors or treatment errors. This review will focus on describing treatment errors and complications that may arise during different phases of the root coverage therapeutic process and on how to prevent and manage them., (© 2023 The Authors. Periodontology 2000 published by John Wiley & Sons Ltd.)

Dental caries is a global health problem that requires better prevention measures. One of the goals is to reduce the prevalence of the cariogenic Gram-positive bacterium Streptococcus mutans. We have recently shown that naturally occurring arachidonic acid (AA) has both anti-bacterial and anti-biofilm activities against this bacterium. An important question is how these activities are affected by other anti-bacterial compounds commonly used in mouthwashes. Here, we studied the combined treatment of AA with chlorhexidine (CHX), cetylpyridinium chloride (CPC), triclosan, and fluoride. Checkerboard microtiter assays were performed to determine the effects on bacterial growth and viability. Biofilms were quantified using the MTT metabolic assay, crystal violet (CV) staining, and live/dead staining with SYTO 9/propidium iodide (PI) visualized by spinning disk confocal microscopy (SDCM). The bacterial morphology and the topography of the biofilms were visualized by high-resolution scanning electron microscopy (HR-SEM). The effect of selected drug combinations on cell viability and membrane potential was investigated by flow cytometry using SYTO 9/PI staining and the potentiometric dye DiOC2(3), respectively. We found that CHX and CPC had an antagonistic effect on AA at certain concentrations, while an additive effect was observed with triclosan and fluoride. This prompted us to investigate the triple treatment of AA, triclosan, and fluoride, which was more effective than either compound alone or the double treatment. We observed an increase in the percentage of PI-positive bacteria, indicating increased bacterial cell death. Only AA caused significant membrane hyperpolarization, which was not significantly enhanced by either triclosan or fluoride. In conclusion, our data suggest that AA can be used together with triclosan and fluoride to improve the efficacy of oral health care. [ABSTRACT FROM AUTHOR]

Early childhood caries (ECC), a severe form of dental caries, is exacerbated by the synergistic interaction between Streptococcus mutans and Candida albicans, leading to greater disease severity than their individual effects. This underscores the need for more targeted and potent therapeutic alternatives. Given the promising anti-infective properties of quaternary ammonium surfactants (QAS), this study explores the microbicidal properties of one such QAS, cetyltrimethylammonium chloride (CTAC), against both individual- and dual-species cultures of S. mutans and C. albicans for effective ECC treatment. Initially, the minimal inhibitory concentrations (MICs) of CTAC were determined to range from 4 to 8 µg/mL against S. mutans, C. albicans, and dual-species cultures. Time-kill kinetics, assessed via spot assays and spectrometry, demonstrated that CTAC completely eradicated both individual- and dual-species cultures within 30 min of exposure. Furthermore, at sub-MIC concentrations, CTAC effectively reduced biofilm formation and virulence traits in S. mutans (including acidogenicity and aciduricity) and C. albicans (including yeast-to-hyphal transition and filamentation). To explore therapeutic application, a mouthwash containing CTAC was formulated. The results showed that the formulated CTAC mouthwash was as effective at eradicating pathogens as a commercially available mouthwash containing 0.075% cetylpyridinium chloride (CPC). Moreover, the CTAC mouthwash maintained stable physicochemical characteristics and antimicrobial activity over 4 weeks. It exhibited rapid killing activity against pathogens, achieving efficacy within just 2 min of exposure. Fluorescence microscopy and SEM micrographs confirmed the strong biofilm eradication potential of the CTAC mouthwash. The non-toxic nature of the formulated mouthwash was validated using human buccal epithelial cells, and in vivo studies further demonstrated that CTAC mouthwash significantly reduced bacterial and fungal loads in Galleria mellonella. Overall, the findings of this study highlight the potential application of QAS-CTAC in the treatment of ECC., Competing Interests: Declarations. Ethical Approval: In the present study, human buccal epithelial cells and saliva samples were used. The collection process adhered to established ethical guidelines and was approved by the Institutional Ethical Committee of Alagappa University, Karaikudi (approval reference: IEC/AU/2018/5). Consent to Participate: Informed consent was obtained from all participants involved in the study. Consent for Publication: Not applicable. Competing Interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

This study aimed to analyse the effect of chlorhexidine digluconate (CHX DG) mouthwash on the adhesion of oral bacteria to orthodontic appliances. The interactions of four bacteria (S. mutans, A. actinomycetemcomitans, S. oralis, and V. parvula) with two alloys (stainless steel [SS] and nickel-titanium [NiTi]) and three CHX DG solutions (commercial products Curasept and Perio Plus, and pure CHX DG, all with 0.12% active substance) were tested. The adhesive effect on the orthodontic wires was evaluated after 24 h for S. oralis and after 72 h for the other bacteria. The minimum bactericidal concentration of the solution for each bacterial strain was determined using the dilution method to test the antibacterial action. Salivary-pretreated orthodontic archwires were exposed to minimal bactericidal concentrations of solution and bacteria. Commercial antiseptic products, especially Perio Plus, showed a better inhibition of bacterial adhesion to both alloys than pure CHX DG solution (p < 0.05). A. actinomycetemcomitans was most inhibited in the adhesion of all bacteria by the CHX DG products. A greater inhibition of streptococci adherence was observed on SS, while that of A. actinomycetemcomitans was observed on NiTi. V. parvula inhibition was product-dependent. Although there were differences between the strains and the tested agents, it can be concluded that Perio Plus most effectively inhibited the adhesion of all tested bacteria to the SS and NiTi alloys. A. actinomycetemcomitans was most sensitive to all tested agents, while S. mutans showed the highest resistance. The effectiveness of the tested agents was better on NiTi alloys. [ABSTRACT FROM AUTHOR]

(1) Background: The discrepant antimicrobial susceptibility between planktonic and biofilm bacterial modes poses a problem for clinical microbiology laboratories and necessitates a relevant 3D experimental model allowing bacteria to grow in biofilm mode, in vitro, for use in anti-biofilm susceptibility testing. (2) Methods: This work develops a 3D biofilm model consisting of alginate beads containing S. aureus biofilm and encased within two thick layers of alginate matrix. The constructed model was placed on a thin Boyden chamber insert suspended on a 24-well culture plate containing the culture medium. The antibacterial activity of bacitracin and chlorhexidine digluconate (CD), either combined or separately, against 2D S. aureus culture was compared to that in the 3D biofilm model. Quantitative analysis and imaging analysis were performed by assessing the bacterial load within the matrix as well as measuring the optical density of the culture medium nourishing the matrix. (3) Results: The 3D biofilm model represented the typical complex characteristics of biofilm with greater insusceptibility to the tested antimicrobials than the 2D culture. Only bacitracin and CD in combination at 100× the concentration found to be successful against 2D culture were able to completely eliminate the 3D biofilm matrix. (4) Conclusions: The 3D biofilm model, designed to be more clinically relevant, exhibits higher antimicrobial insusceptibility than the 2D culture, demonstrating that the model might be useful for testing and discovering new antimicrobial therapies. The data also support the view that combination therapy might be the optimal approach to combat biofilm infections. [ABSTRACT FROM AUTHOR]

Periodontal pockets are characteristic of periodontitis. Scaling and root planing is the gold standard for periodontitis treatment. Additional local antimicrobials are recommended in patients with a probing depth of ≥ 5 mm. This study aims to determine the effectiveness of chlorhexidine compared to other local antimicrobials in periodontitis. Searches were conducted using the Preferred Reporting Items for Systematic Reviews and Meta Analysis (PRISMA) guidelines. Meta-analysis was performed on studies that met inclusion criteria after risk of bias assessment. Meta-analysis between chlorhexidine chips and other antimicrobials showed a mean difference in probing depth after one month of 0.58 mm (p < 0.00001) whereas after three months the mean difference in probing depth was 0.50 mm (p = 0.001), index plaque 0.01 (p = 0.94) and gingival index − 0.11 mm (p = 0.02). Between chlorhexidine gel and other antimicrobials showed a mean difference in probing depth of 0.40 mm (p = 0.30), plaque index of 0.20 mm (p = 0.0008) and gingival index of -0.04 mm (p = 0.83) after one month. Chlorhexidine chips were more effective on the gingival index than other antimicrobials after three months. The other antimicrobials were more effective than chlorhexidine chips on probing depth after one and three months, and than chlorhexidine gels on plaque index after one month. [ABSTRACT FROM AUTHOR]

The aim of this brief overview is to give clinicians a background for assessing publications presenting in vivo human clinical trials regarding the effect of common dental mouthwashes on SARS‐CoV‐2 virus. It explains how the effects of oral mouthwashes on oro‐nasally transmitted infectious virus was assessed in the early phase of the Covid‐19 pandemic. The method of virus quantification including effect measures and factors, trial design that may cause flaws in the effect estimates presented in publications are explained. The status of in vivo human clinical trials regarding the anti‐virucidal effect of sodium lauryl sulfate, povidone‐iodine, chlorhexidine, hydrogen peroxide and cetylpyridinium chloride is presented from the few systematic reviews available at this time. [ABSTRACT FROM AUTHOR]

Antibiotic-resistant Acinetobacter baumannii infections among patients in hospital settings are rising at an alarming rate. The World Health Organization has designated carbapenem-resistant A. baumannii as a priority pathogen for drug discovery. Based on the open drug discovery approach, we screened 400 compounds provided as a Pandemic Response Box by MMV and DNDi to identify compounds with antibacterial and antibiofilm activity against two A. baumannii reference strains using a highly robust resazurin assay. In vitro screening identified thirty compounds with MIC ≤ 50μM having growth inhibitory properties against the planktonic state. Five compounds, with MMV IDs MMV396785, MMV1578568, MMV1578574, MMV1578564, and MMV1579850, were able to reduce metabolically active cells in the biofilm state. Of these five compounds, MMV396785 showed potential antibacterial and antibiofilm activity with MIC, MBIC, and MBEC of 3.125 μM, 12.5, and 25–100 µM against tested A. baumannii strains, respectively, showing biofilm formation inhibition by 93% and eradication of pre-formed biofilms by 60–77.4%. In addition, MMV396785 showed a drastic reduction in the surface area and thickness of biofilms. Further investigations at the molecular level by qRT-PCR revealed the downregulation of biofilm-associated genes when exposed to 50 µM MMV396785 in all tested strains. This study identified the novel compound MMV396785 as showing potential in vitro antibacterial and antibiofilm efficacy against A. baumannii. [ABSTRACT FROM AUTHOR]

(1) There are limited clinical trials to support the effectiveness of mouth rinses when used as a preprocedural rinse against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This systematic review aims to evaluate the efficacy of antiseptic mouth rinses as a preprocedural rinse in reducing SARS-CoV-2 oral viral load in-vivo. (2) Methods: A literature search was conducted through November 2022 for the following databases: PubMed, Web of Science, Cochrane Library, and Google Scholar. The evaluated outcomes were quantitative changes in viral load and the statistical significance of that change after using antiseptic mouth rinses. (3) Results: 14 randomized controlled trials (RCT) were selected for risk of bias assessment and data extraction. (4) Conclusion: Within the limits of this systematic review, preprocedural mouth rinses may significantly reduce SARS-CoV-2 in the mouth, thus, reducing the viral particles available for airborne dispersion. Preprocedural mouth rinses may be an effective strategy for reducing airborne SARS-CoV-2 dispersion in the environment. Their use may be a preventive strategy to reduce the spread of COVID-19 in selected medical and healthcare facilities, including dental clinics. Potential preprocedural mouth rinses are identified for use as an integral part of safe practice for healthcare protocols. This systematic review was registered with the National Institute for Health Research, international prospective register of systematic reviews (PROSPERO): CRD42022315177. [ABSTRACT FROM AUTHOR]

Aim: Critically assessed reviews on the effectiveness of Triphala for the promotion of oral health are hard to come by. As a result, the goal of this study was to conduct a systematic evaluation of the existing literature to determine the impact of Triphala on oral health. Materials and Methods: PubMed, PubMed Central, Campbell systematic review, Cochrane, Embase, Google Scholar, and Scopus were used to perform a systematic review of the literature. This review includes only randomized control trials (RCTs) comparing Triphala to chlorhexidine (CHX) or placebo. To perform risk of bias and meta-analysis, relevant information was collected from chosen publications. Results: The overall risk of bias was high for the majority of the included studies except two studies showed an unclear risk of bias and one study showed a low risk of bias. Statistically significant differences were observed in favor of Triphala when compared with placebos for gingival, plaque and modified plaque indices (gingival index: mean difference [MD] = -0.53, 95% confidence interval [CI] (-0.83, -0.23), P = 0.006; plaque index: MD = -0.57, 95% CI (-0.99, -0.16), P = 0.007; Quigley-Hein Plaque Index: MD = -1.12, 95% CI (-1.52, -0.72), P = 0.0001). No statistically significant difference was found between herbal and CHX mouthwashes. Conclusion: Triphala mouthwash is more effective than placebo mouthwashes in reducing gingivitis, although there was no statistically significant difference between Triphala and CHX mouthwashes in the included studies. Because of their herbal nature, Triphala mouthwashes might be regarded as an alternative to CHX mouthwashes in maintaining oral hygiene. [ABSTRACT FROM AUTHOR]

Chlorhexidine is a broad spectrum antimicrobial agent, which has been into used in the dental practice as a major anti plaque agent. Chlorhexidine not only shows the property of substantivity, but due to its broad spectrum of antimicrobial property, it is used in various oral diseases. Different uses of chlorhexidine are, prime most is as a major antiplaque agent, it can be used as a root canal irrigant during the process of root canal treatment, it can be used in the prevention of the dental caries as it results in the suppression of the streptococcus mutans in the oral cavity. It helps in the prevention of the secondary infection from the apthous ulcers as well as from the alveolar osteitis, it can also be prescribed to the patient suffering from denture stomatitis, show promising results also as an anti fungal agent. The use of chlorhexidine mouth wash is not recommended for long term use, as it results in discoloration, so to over come this disadvantage of the chlorhexidine a new formulation with properties of anti discoloration is preferred in case for long term use of the chlorhexidine, and this new system with property of anti discoloration shows promising results in every manner. [ABSTRACT FROM AUTHOR]

Quaternary ammonium silane [(QAS), codename – k21] is a novel biomaterial developed by sol-gel process having broad spectrum antimicrobial activities with low cytotoxicity. It has been used in various concentrations with maximum antimicrobial efficacy and biocompatibility. The antimicrobial mechanism is displayed via contact killing, causing conformational changes within the bacterial cell membrane, inhibiting Sortase-A enzyme, and causing cell disturbances due to osmotic changes. The compound can attach to S1’ pockets on matrix metalloproteinases (MMPs), leading to massive MMP enzyme inhibition, making it one of the most potent protease inhibitors. Quaternary ammonium silane has been synthesized and used in dentistry to eliminate the biofilm from dental tissues. QAS has been tested for its antibacterial activity as a cavity disinfectant, endodontic irrigant, restorative and root canal medication, and a nanocarrier for drug delivery approaches. The review is first of its kind that aims to discuss applications of QAS as a novel antibacterial biomaterial for dental applications along with discussions on its cytotoxic effects and future prospects in dentistry [ABSTRACT FROM AUTHOR]

Background: During ultrasonic scaling, the harbored microorganisms in the oral cavity get aerosolized, which have important impacts on air quality and can cause a serious health threat to the clinician, patients, and the surroundings. Therefore, this study was conducted to evaluate whether preprocedural mouth rinse has any effect on bacterial load in aerosols generated during ultrasonic scaling. Materials and Methods: A total of 80 subjects with chronic periodontitis were selected and randomly grouped into four comprising twenty in each. The groups were based on the use of preprocedural mouth rinse: no rinse group (control) (A), and test groups with preprocedural mouth rinse with water (B), 0.2% Chlorhexidine gluconate (C), and herbal mouthwash (D). The aerosol produced during ultrasonic scaling was collected on blood agar plates positioned at the chest area of patients, operators, and assistants. Aerosol collected in the operatory before the procedure was considered as baseline. Colonies on the blood agar plates were counted after incubating at 37°C for 24 h. Pairwise comparisons involving positions and mouth rinses on microbial colonies were conducted using independent sample t-test and Tukey's test for post hoc analysis considering 0.05 as the significance level. Results: Microbial colonies were significantly reduced with chlorhexidine gluconate compared to that of others (P < 0.001), followed by herbal mouthwash and water. Again, microbial colonies were highest at the chest area of the operator and lowest at the chest area of the assistant. Conclusions: 0.2% Chlorhexidine gluconate is superior in reducing the microbial load in aerosols produced during ultrasonic scaling. [ABSTRACT FROM AUTHOR]

Aim: Evaluate the efficacy of 0.3% chlorhexidine mouthwash (CHX) and 2‐g amoxicillin (AMX) on the prevalence and nature of transient bacteraemia after surgical removal of an impacted lower third molar. Materials and Methods: Thirty patients were assigned to either the CHX, AMX, or placebo groups (CTR) in a triple‐blind, randomized, placebo‐controlled trial. Blood was cultured and identified at three time points; baseline, 30 s and 15 min following flap incision. Samples were processed for using BACTECTM FX and then Matirx‐assisted laser desorption/ionization‐time of flight mass spectrometry for positive identification. Results: The prevalence of transient bacteraemia was 50% in the CTR group, and 10% each in the CHX and AMX groups. At 30 s, there was no difference in the prevalence of transient bacteraemia in the CHX (10%), AMX (10%) and CTR (30%) groups (p = 0.477). However, at 15 min, there was a statistically significant difference in the prevalence of bacteraemia between the CHX (0), AMX (10%) and CTR (40%) groups (p = 0.029). The majority of cultures yielded gram‐positive cocci. The most frequently isolated organisms were viridans streptococci and Actinomyces oris. Conclusion: 0.3% CHX is effective in preventing postoperative bacteraemia for at least 15min and may be considered as a prophylaxis antiseptic prior to thrid molar surgery. The trial was registered and approved by Thai Clinical Trails Registry Committee (TCTR20210531006). [ABSTRACT FROM AUTHOR]

Objectives: The gingiva epithelium accounts for a significant proportion of the surface around the tooth. An inflammatory reaction occurs in the presence of bacterial biofilm, adhesion is reduced, and the depth of the sulcus gingivalis increases. The most common antiseptic agents in oral rinses are chlorhexidine digluconate (CHX) and cetylpyridinium chloride. We examined long-lasting effects of residual concentrations of eight commercially available rinses. Our main goals were (i) to analyze the effect of different chemical compositions on cell proliferation, (ii) to examine apoptosis, and (iii) cell morphology on human epithelial progenitor cell line (HGEPp). Materials and methods: Cell proliferation was measured in a real-time system (0–48 h) by impedimetry (xCELLigence). Apoptosis was measured with labeled Annexin-V (BD-FACScalibur). Results: Changes in proliferation were measured at certain concentrations: (i) H2O2 proved to be cytotoxic at almost all concentrations; (ii) low concentrations of CHX (0.0001%; 0.0003%) were proliferation inducers, while higher concentrations were cytotoxic; (iii) for ClO2, advantageous proliferative effect was observed over a broad concentration range (0.06–6 ppm). In mouthwashes, additives in the formulation (e.g., allantoin) appeared to influence cellular responses positively. Apoptosis marker assay results suggested a low-level activation by the tested agents. Conclusions: Mouthwashes and their reference compounds proved to have concentration-dependent cytotoxic effects on human gingival epithelial cells. Clinical relevance: A better understanding of the effects of mouthwashes and their reference compounds is particularly important. These concentration-dependent effects (cytotoxic or proliferation inducing) interfere with human cells physiology while being used in the fight against the pathogenic flora. [ABSTRACT FROM AUTHOR]

Abstract: This study aimed to evaluate the effects of chlorhexidine, metronidazole, and ozone application on the healing of palatal wounds in diabetic rats. A defect in the form of a 4 mm-diameter wound was created on the palatal mucosa of 84 adult female Wistar albino rats, which were randomly divided into 4 groups: control, chlorhexidine, metronidazole, and ozone groups. The animals were euthanized after 3, 6, and 10 days, and wound closure was histologically assessed. On day 3, polymorphonuclear leukocytes were significantly higher in the control group than in the chlorhexidine and ozone groups ( P < 0.05). Fibrosis was higher in the ozone group than in the control and chlorhexidine groups ( P < 0.05). Vascular endothelial growth factor was higher in the metronidazole and ozone groups than in the control group ( P < 0.05). On day 6, the quantity of polymorphonuclear leukocytes was higher in the control, metronidazole, and chlorhexidine groups than in the ozone group ( P < 0.05). Vascular endothelial growth factor was higher in the ozone group than in the control, chlorhexidine, and metronidazole groups ( P < 0.05). On day 10, Vascular endothelial growth factor was higher in the control, chlorhexidine, and metronidazole groups than in the ozone group ( P < 0.05). The authors concluded that the use of chlorhexidine, ozone, and metronidazole pastes resulted in enhanced wound healing, as determined histologically.The authors suggest that ozone supplementation can be an alternative therapy to chlorhexidine in impaired wound healing in diabetes mellitus., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 by Mutaz B. Habal, MD.)