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Objective: The aim of this experimental gingivitis study was to assess the efficacy and safety of two new chlorhexidine (CHX) mouthrinses., Material and Methods: Ninety volunteers participated in this investigator-blind, randomized, clinical-controlled trial in parallel groups. During the treatment period, no oral hygiene measures except rinsing with non-alcoholic 0.2% CHX or 0.2% CHX/0.055% sodium fluoride mouthrinses, a positive control, or a negative control were permitted. The primary parameter was the gingival index; the secondary parameters were plaque index, discolouration index, and bleeding on probing. Clinical examinations were conducted 14 days before the start of the study, at baseline, and after 7, 14, and 21 days. The two sample t-test, anova, and ancova were used for the statistical analysis., Results: No difference in efficacy was found between the two new CHX formulations and the positive control. On day 21, statistically significantly less gingival inflammation and plaque accumulation compared with placebo were observed. Besides discolouration and taste irritations, no adverse events were recorded., Conclusion: The two new CHX mouthrinses were able to inhibit plaque re-growth and gingivitis. Neither the omission of alcohol nor the supplementation with sodium fluoride had weakened the clinical efficacy of CHX with respect to the analysed clinical parameters.

The aim of this double-blind, 28-week study was to evaluate the plaque-inhibitory and antigingivitis efficacy of a fluoride toothpaste containing 0.3% triclosan and essential oil (Dental Kosmetik, Dresden, Germany) in comparison with a control toothpaste. One hundred twenty subjects previously treated for chronic periodontitis were included in the study. At baseline, 8, 18, and 28 weeks, plaque accumulation (PlI) and gingival status (GI) were assessed. Probing pocket depth (PD) and bleeding on probing (BOP) were measured at baseline and week 28 using a Florida probe. No professional hygiene was delivered during the study period. Mean plaque scores decreased between baseline and week 8 in both groups. At the end of the study, a significant increase of mean PlI compared to baseline could be observed in the test and in the control groups. Comparing the two groups, the PlI in the triclosan group was significantly lower than in the control group. Mean gingival scores decreased significantly during the first 8-week period in both groups. This reduction was followed by an increase of GI in the control, while the GI in the test group reached a significantly lower value than in controls after 28 weeks. Furthermore, at week 28, in both groups the PD were decreased as compared to the pre-study data. It is concluded that the triclosan/essential oil additive in a fluoride-containing dentifrice exhibited distinctive antigingivitis as well as plaque-inhibitory effects during a 28-week maintenance period in periodontitis patients.

The aim of this randomized, parallel-group, placebo-controlled, blind clinical study was to examine the dental plaque and the gingivitis inhibitory effects of two low-dose 0.06% chlorhexidine (CHX) preparations in comparison to a commercially available 0.1% CHX solution, an amine fluoride/stannous fluoride (ASF) solution and a water control as an adjunct to the daily mechanical oral-hygiene measures. After prophylaxis, 81 medical students performed their tooth cleaning and were asked to rinse for 30 s, according to the instructions given by the manufacturers with the assigned amount of the following solutions: once daily 10 ml ASF 250 ppm or twice daily each 10 ml CHX 0.06% with fluoride, 10 ml CHX 0.06% without fluoride, 15 ml CHX 0.1% or 100 ml tap water. The plaque index (PlI), the gingival index (GI) and the discoloration index (DI) were taken at day -14 and months (M) 0, 1, 2, 3 and 6. In this study group with good oral hygiene, all test products led to a reduction of the PlI scores when used as supplements to the usual mechanical hygiene measures. At M3 subjects using both the 0.1% as well as the 0.06% CHX showed significantly less plaque accumulation than those using ASF. In the GI a significant difference between the control and 0.1 % CHX was found at M3 and at M6. If a further decrease in the GI is wanted, a minimum concentration of 0.1% CHX for long-term use in association with habitual cleaning is needed, which, however, should be limited to special patients. If maintaining clinical health is the goal, the other solutions are a good alternative to 0.1% CHX because they exhibit less staining.

Although vital plaque micro-organisms are part of the natural ecosystem in the oral cavity they are also the key factor in the development of diseases induced by the human dental plaque. In a previous study (9) the portion of vital bacteria related to the total number of plaque micro-organisms (i.e. the microbial vitality) appeared low in small plaque samples. The objective of this investigation was to determine the exact relationship of microbial vitality and age of supragingival plaque during the early phases of human dental plaque formation. Between intervals of optimal oral hygiene, thirteen participants refrained from all oral hygiene measures for periods of 1, 2, 4, 8, 24 and 72 h. Plaque was completely sampled from a defined area situated on the vestibular surface of the teeth 13, 14, 15, 23, 24 and 25. The pooled plaque from these areas was immediately processed. Total bacterial counts (BC) as enumerated by darkfield microscopy, and colony-forming units (CFU) were recorded. The microbial vitality was calculated indirectly as plating efficiency (PE = CFU per BC) and directly assessed using a vital fluorescence (VF) technique. In the 1 h old plaque samples the median values of PE and VF were 29% and 18%, respectively. Thereafter, the microbial vitality increased significantly with plaque age. The 24 h old plaque samples yielded values of 77% (PE) and 62% (VF). It was concluded that the microbial vitality of the early dental plaque investigated was considerably lower compared to that of a more mature plaque.

The aim of the present study was to compare the effect on plaque growth and gingival response of Meridol, an amine/stannous fluoride solution, during a three-month investigation, with those of a placebo preparation as a negative control and a chlorhexidine solution as a positive control, in a double-blind study. After having their teeth professionally cleaned, 36 volunteers continued their usual oral hygiene for a period of two weeks. Their teeth were then polished again (month 0) after which they rinsed twice daily (morning and evening) with one of the three mouthrinses in addition to their habitual toothcleaning. After three months of rinsing, plaque indices remained lowest in the chlorhexidine group, although the subjects using Meridol had indices significantly lower than those of individuals rinsing with the placebo solution. The gingival index scores in the Meridol group were higher than in the chlorhexidine group and lower than in the placebo group. The plaque vitality scores showed a bactericidal effect in vivo with chlorhexidine and Meridol during the entire experiment. The use of Meridol resulted in more toothstaining than with the placebo, but significantly less than with chlorhexidine. This study demonstrated that Meridol reduced plaque accumulation, retarded gingivitis development, possessed a definite bactericidal action, and produced only slight toothstaining.

The anti-plaque, anti-gingivitis and anti-microbial efficacies of a phenolic compound (Listerine) and 2 different amine/stannous fluoride mouthwashes (Meridol I, II) were compared when these solutions were used in addition to usual tooth cleaning. A placebo preparation was utilized as a negative control and a chlorhexidine solution as a positive control in this double-blind study. After professional tooth cleaning, 49 volunteers continued their habitual, self-performed and non-supervised oral hygiene for a period of 2 weeks, in order to have a more standard baseline. At day 0, they began to rinse twice daily with 1 of the 5 mouthwashes. After 3 weeks of rinsing, plaque indices remained the lowest in the chlorhexidine and the Meridol I groups, while subjects using Listerine or Meridol II demonstrated similar indices significantly lower than that of individuals rinsing with the placebo solution. Through this period, the gingival index scores were similar in the Meridol, Listerine and chlorhexidine groups. At day 21, the mean GI scores in the chlorhexidine group were significantly lower than the scores in the placebo group. The plaque vitality scores showed a bacterial effect in vivo of chlorhexidine and, to a lesser extent, of the Meridol solutions. No substantial evidence of an antibacterial effect in vivo was found for Listerine. This study has demonstrated that when mouthrinses are used to supplement habitual mechanical oral hygiene, chlorhexidine remains the most powerful solution. Furthermore, it was also shown that a combination of habitual self-performed and non-supervised oral hygiene with Meridol or Listerine is more beneficial for plaque control than the use of mechanical oral hygiene alone.

It has been suggested that the vascular alterations found in inflamed gingiva may be of significance in the enhanced extension of the pathological process into the periodontium. The purpose of this investigation was to measured the changes in blood vascular volume occurring in gingiva with the onset of gingivitis and its resolution. Twenty-six individuals participated in this study. Gingival biopsies were taken following a 21-day experimental gingivitis, following resolution of a 21-d experimental gingivitis and during a 6-month experimental gingivitis and a 6-month period of optimal oral hygiene. A total of 126 biopsies was obtained, from which 378 sections were cut at 2 microns for stereological analysis. At low magnification, reference volumes were estimated using point counting procedures and expressed as mm3 of gingiva per mm length of vestibular gingiva, in a vestibulo-lingual plane. At higher magnification the ratio between the volume of vessels and connective tissue was calculated. The final results were expressed as mm3 of vessels per mm length of vestibular gingiva, in a vestibulo-lingual plane. The mean vessel volume expressed per unit length of vestibular gingiva ranged from 0.010 to 0.024 mm3/mm. No statistically significant differences in vascular volumes were found between inflamed and non-inflamed gingiva. It was concluded that the changes in vascular architecture during early gingivitis described in the literature had either taken place in the subjects prior to the time of experimentation or that any vascular changes (cytologic or functional) which had taken place may be compensatory for the changes in architecture described in the literature.

The experimental gingivitis model was used to compare the anti-plaque, anti-gingivitis and anti-microbial efficacies of a phenolic compound (Listerine) and an amine/stannous fluoride mouthwash (Meridol), using a placebo preparation as negative control and a chlorhexidine solution as positive control in a double-blind study. After professional toothcleaning, 36 volunteers performed optimal oral hygiene for a period of 2 weeks. They then ceased all oral hygiene procedures for 21 days during which they rinsed twice daily with 1 of the 4 mouthrinses. After 3 weeks of rinsing, plaque indices remained the lowest in the chlorhexidine group, while subjects using Listerine or Meridol harbored similar indices significantly lower than that of individuals rinsing with the placebo solution. Up to that time, the gingival index scores were equal in all groups except for the chlorhexidine group in which the values only amounted to half of these encountered in the other groups. The plaque vitality scores showed a bactericidal effect in vivo of chlorhexidine during the entire time of experimental gingivitis. In contrast, the data gave no evidence of an antibacterial effect in vivo of Listerine. The efficacy of Meridol to kill micro-organisms was similar to chlorhexidine during the early stages of plaque accumulation and, with time, became insignificant. This study has demonstrated that chlorhexidine was superior to Listerine and Meridol in its ability to maintain low plaque scores and gingival health during this 3-week period of no mechanical oral hygiene. Moreover, it was also shown that Meridol was as effective as Listerine in reducing plaque accumulation and, in contrast to Listerine, possessed a remarkable but transient antibacterial effect in vivo.

Within the framework of a gingivitis study the sulcus fluid flow rate (SFFR) at the lower and upper premolars of 9 subjects was determined with the assistance of Periotron 6000. The measurements were conducted at days 0, 7, 14 and 21 with the aim to compare the SFFR after 3 minutes (Löe and Holm-Pedersen 1965, Rüdin et al. 1970) with the measurements of Lamster et al. (1985a, b) at 30 seconds. The increase of the SFFR at 30 seconds, as well as at 3 min was significant on all measurement days, but no proportional dependance of SFFR on the measurement time was seen. On the basis of these results it is justified to restrict the SFFR to 30 seconds, to reliably determine the grade of infection of gingiva.

Samples of human crevicular fluid were collected and analysed by high-performance liquid chromatography (HPLC) for purine nucleotides, nucleosides and bases. The complex chromatograms, had concentrations of compounds in two regions. Region (I) corresponded to purine bases and nucleosides, adenine and hypoxanthine were specifically identified. In region (II), where purine nucleotide mono- and diphosphates are generally observed, IMP and AMP were identified. In one subject with advanced periodontitis, additional compounds in region II were observed; crevicular fluid in gingivitis had the majority of their purine-containing compounds in region I.

The aim of the present study was to investigate stereologically the histologic alterations occurring during gingival healing after experimental gingivitis and to compare clinical parameters with histological findings. 8 dental students volunteered for the investigation. After a prophylaxis, they performed optimal oral hygiene to reach mean plaque and gingival indices approaching zero. They then abolished all oral hygiene procedures for a period of 21 days. After this experimental gingivitis phase, they again performed optimal oral hygiene for 8 days to restore gingival health. At days 0, 1, 2, 4 and 8 after experimental gingivitis, the plaque index (PlI), the gingival index (GI) and the gingival exudate flow rate (GEFR) were assessed and their buccal gingiva was biopsied. Point counting procedures were performed at 2 different levels of magnification on light microscopic sections to estimate the volume fractions of epithelium, infiltrated and non-infiltrated connective tissue, and collagen. The relative numbers of fibroblasts, polymorphonuclear neutrophils, lymphocytes, plasma cells and macrophages were estimated by counting the number of profiles of these cells in a specific connective tissue area adjacent to the apical end of the junctional epithelium. A rapid drop in the PlI was noted with increasing time after oral hygiene, followed by a slower decrease in the GI and GEFR scores. The histological picture during the entire experiment was that of an initial gingival lesion. At day 0, no chronic inflammation of the gingiva characterized by a predominance of plasma cells was observed.(ABSTRACT TRUNCATED AT 250 WORDS)

The polymorphonuclear neutrophil (PMN) appears to be an important cell in the protection of the host from pathogenic periodontal micro-organisms. The purpose of the present histological studies was to observe the emigration of the PMN from the gingival vessels to the periodontal pocket during gingivitis and ligature-induced periodontitis in the cynomolgus monkey. 2 adult female monkeys were treated by application of a silk ligature around selected posterior teeth. After 9 weeks, the monkeys were perfused and block sections of both ligated (early periodontitis) and non-ligated (gingivitis) sites were obtained, cut into smaller blocks containing a single interdental area (N = 15 for periodontitis, N = 5 for gingivitis) and processed for light and electron microscopic observations. Morphologically, no differences in PMNs between gingivitis and periodontitis were observed and therefore the following description applies to both disease states. In the vessels, the endothelial cells appeared to be actively involved in PMN emigration, maintaining long processes which surrounded the PMNs. Within the connective tissue, the PMNs maintained their typical morphology which included polylobated nuclei and numerous lysosomal granules. Many intact PMNs were observed intercellularly within the connective tissue and the epithelium. Within the periodontal pocket, a multilayer of PMNs surrounded the plaque mass. Cells with numerous bacteria-containing phagolysosomes were observed with increasing frequency as they approached the plaque. Deeper within the bacterial deposit, PMNs were seen in varying stages of degeneration. These histologic studies, when interpreted in the light of reports of severe, rapidly-progressive periodontitis in patients with PMN disorders, suggest that the interaction of PMNs with bacterial plaque may serve to maintain a defensive boundary which protects the host tissues from irreversible destruction.

The purpose of the present investigation was to study stereologically the histopathologic changes in the gingiva during 6 months of abolished oral hygiene and to study the development of chronic gingivitis in man. After a thorough prophylaxis procedure, 5 dental students performed optimal oral hygiene under supervision for a period of 3 weeks. At the end of this pre-experimental phase, they were asked to abolish all oral hygiene procedures for 4 (2 individuals) to 6 months (3 individuals). At day 21, and after 2, 3, 4, 5 and 6 months, the gingival exudate flow rate and the gingival index were assessed, and buccal gingival biopsies taken. Semi-thin histologic sections were stained with basic fuchsine and methylene blue. By point counting at 2 different levels of magnification, the volume densities of epithelium, infiltrated (ICT) and non-infiltrated connective tissue, and collagen were estimated. The %s of fibroblasts, PMN's lymphocytes, plasma cells and macrophages were estimated in a predetermined standardized area close to the apical termination of the junctional epithelium. With increasing time, the volume densities of the ICT rose concomitantly with a decrease in the volume densities of the collagen. In spite of great interindividual variations, a slow shift in the proportions of some cell populations was consistently observed. While the fraction of PMN's, lymphocytes and macrophages remained stable, a decrease of fibro-blasts (57 to 39%) and an increase of plasma cells (0.2 to 10%) was observed. This study has, therefore, demonstrated that, in 6 months of plaque accumulation, a chronic gingivitis with a predominance of PMN's and lymphocytes develops.(ABSTRACT TRUNCATED AT 250 WORDS)

During six month of abolished oral hygiene and concomitant development of gingivitis, the buccal subgingival microbiota was studied by darkfield microscopy as well as by cultural methods. Five dental students gave written informed consent and participated in this trial. In darkfield microscopy there was a slow reduction in the proportion of coccoid forms concomitant with an increase in the proportion of rods, while spirochetes were rarely detected during the entire experimental period. However, the cultural data revealed a decrease of the Gram-positive facultative and an increase of the Gram-negative anaerobic microorganisms after 6 months of abolished oral hygiene. The bacteriological data show, that in buccal sites--even after 6 months of abolished oral hygiene--the subgingival microflora reflects a population typical only for an initial lesion.

During 21 days of abolished oral hygiene and developing gingivitis the microbial changes were studied in buccal and interdental sites. The subgingival plaque of 6 dental students was analyzed by darkfield microscopy. The microbiota found in interdental sulci showed a higher complexity than that of buccal sites. Buccally and interdentally there was a significant increase in the total number of microorganisms between days 0 and 21. Yet, the development of gingivitis was slower in the buccal than in the interproximal sites. For all bacteria, but specially for more disease-associated morphotypes the accumulation rate was higher interdentally than buccally.

Based on scientific proof, only few mouthrinse solutions can be recommended. However, it is impossible to construct an extended table that would provide precise recommendations or advices for mouthrinse utilisation related to any possible discomfort or diseases. Only reliable information on the drugs available against periodontal disease can be offered to the therapist. By evaluation of her or his individual experiences, she or he has to judge all the armamentarium she or he possesses to react in the best possible way in each specific situation. [ABSTRACT FROM AUTHOR]

After prophylaxis, 5 dent hygienists optimal oral hygiene under supervision for 6 months. At months 0,1,4 and 6, Plaque Index Gingival Extudate Flow Rate and Gingival Index were assessed and a buccal biopsy of their gingiva taken. Point counting procedures were performed at 2 different levels of maginification to estimate the volume densities of epithelium, infiltrated and non infiltrated connective tissue and collagen. The percentage of fibroblasts, polymorphonuclear nutropholic granulocytes, lymphocytes, plasma cells and macrophages were estimated by counting the number of profiles of these cells in the connective tissue area close to the apical end of the junctional epithelium. All the changes insides the tissue occurred slowly. During the 6-month period there was a continuos increase of the volume density of the epithelium in the gingiva. An increase in the percentage of fibroblasts were observed between months 1 and 4 with a decrease in the percentage of lymphoocytes and in the volume density of the infiltrated connective tissue. Between months 4 and 6 an increase of the volume density of the collagen was found together with a further increase in the percentage of fibroblast and a further decrease in the percentage of lymphocytes. After 6 months of perfect oral hygine no more plasma cells visible. This study has shown that even in presence of clinically healthy gingiva subclinical changes may take place. It appear realistic to accept the presence of a very mild gingivitis localized in an area adjacent to the attachment as compatible with gingival health. [ABSTRACT FROM AUTHOR]

The experimental gingivitis model was used to compare the antigingivitis, antiplaque, and antimicrobial efficacies of two commercially available (a phenolic and a plant alkaloid) compounds used as mouthrinses with those of a mouthrinse containing chlorhexidine digluconate. Thirty-one male and female volunteers with healthy gingivae and clean teeth ceased all oral hygiene procedures for 21 days during which they rinsed twice daily with: a) a phenolic compound (Listerine®), b) sanguinarine (Viadent®), c) 0.12% chlorhexidine digluconate, or d) a placebo mouthrinse. After 21 days of rinsing, virtually no signs of clinical gingivitis were observed in the chlorhexidine group. Subjects rinsing with Listerine, Viadent, or placebo developed clinical signs of gingivitis as measured by gingivitis occurrence, severity, and the proportion of gingival bleeding sites. At the same time, plaque accumulation was only slightly higher than at baseline in the chlorhexidine group, while the Listerine, Viadent, and placebo groups had significantly greater plaque accumulations, particularly during the initial period of treatment between day 0 and day 7. Microbiological enumeration of supragingival plaque collected at the end of the treatment period showed that chlorhexidine digluconate reduced plaque bacteria by 62-99% compared to the placebo group. No significant reductions in plaque bacteria were found among subjects using Listerine or Viadent. This study demonstrated that 0.12% chlorhexidine digluconate was superior to Listerine and Viadent in its ability to maintain optimal gingival health during the entire three weeks of mouthrinse use. It was of particular interest to note these effects during the final 14 to 21-day period of extreme challenge in this experimental model when gingivitis severity and bleeding site occurrence are most pronounced in the placebo group. [ABSTRACT FROM AUTHOR]

Abstract The use of mouthrinses is increasing, especially as adjuncts to the daily mechanical oral hygiene. Different test systems may and can be used to test their antibacterial and clinical effects: bacteriology in vitro, substantivity in vivo , 4-day plaque re-growth, experimental gingivitis and long-term use. The plaque re-growth investigations of a few days are not only of limited use but may also be dangerous because often too extensive conclusions have been drawn from their design. The ‘gold standard’ test is the experimental gingivitis model to reveal the antiplaque as well as the antigingivitis effects of any mouthrinse preparation during 3 weeks. The last kind of investigations are of several months' duration, where the substances are used as supplements to mechanical oral hygiene measures. [ABSTRACT FROM AUTHOR]