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This study aimed to assess the short-term effect of alcohol-containing mouthrinse versus mouthrinse without alcohol on xerostomia scores reported by Xerostomia Inventory (XI) scores and short version of the Xerostomia Inventory (SXI). This study was a two-group parallel-arm randomised controlled trial where participants were randomly allocated to twice a day for 7 days use of either alcohol-containing or alcohol-free mouthrinse. Allocation was concealed. The participants, the outcome assessors and the statistician were blinded to the allocation status. A total of 163 participants completed the pre-and post-intervention data collection. There were no statistically significant differences between the study groups with respect to demographics or other measured independent variables. After adjusting for age and gender, regression coefficient (95% CI) for XI was 0.02 (-1.72-2.29) and that for SXI was 0.03 (-0.54-0.83). Both adjusted and unadjusted models showed no significant differences in change in XI or SXI. The mean difference in scores between the groups for XI was -0.45 (-2.45-1.55) and for SXI was 0.05 (-0.65-0.75). There was no significant difference in the change in xerostomia levels as a result of short-term exposure to alcohol-containing mouthrinse, when compared to those exposed to alcohol-free mouthrinse. Short-term use of alcohol-containing mouthrinse does not result in worsening xerostomia., (© 2017 John Wiley & Sons Ltd.)

Aim: The aim of the study was to evaluate the effect of mouth-rinses containing olive oil, fluoride, and their combination on enamel erosion., Materials and Methods: An in vitro study of 45 enamel specimens, which were prepared from 45 extracted teeth, was employed. Each specimen was subjected to 10 alternative demineralization and remineralization cycles. Remineralizing cycle includes 5 minutes exposure with one of the mouthrinse, and demineralizing cycle includes 3 minute exposure to 1% citric acid. Mean surface roughness (Ra) was measured from surfometry before and after cycles. Statistical tests used were Student's unpaired t-test and one-way analysis of variance (ANOVA), followed by Tukey's post hoc test., Results: Among the three mouthrinses, Listerine and Xerostom showed maximum protection against erosion on enamel. The 2% olive oil mouthrinse showed the least protection against erosion on enamel., Conclusion: The study indicated that the Listerine and Xerostom mouthrinses are valuable preventive measures., Clinical Significance: Mouthrinses are effective for lessening erosive demineralization and in aggregating remineralization of tooth surfaces which are the important factors to prevent enamel erosion.

Objectives: To compare the antimicrobial efficacy and kill penetration of essential oils (EO) mouthrinse versus stannous fluoride, and triclosan dentifrice slurries on saliva-derived biofilms using confocal laser scanning microscopy (CLSM)., Methods: Saliva-derived biofilms were grown for 48h on hydroxyapatite discs using pooled, homogenized saliva from 8 healthy volunteers as the inoculum. The mean thickness of these biofilms was 84μm (range, 23-241μm). CLSM with viability mapping was used to visualize the antimicrobial kill penetration of each treatment regime within a biofilm., Results: At 30s treatment durations, CLSM imaging revealed greater antimicrobial activity and kill penetration of EO mouthrinse compared to sodium fluoride-, stannous fluoride-, and triclosan-containing dentifrice slurries. Quantification of biovolume revealed that EO mouthrinse treatment at 30s resulted in a greater non-viable biovolume proportion (84.6%±15.0%) than other treatment groups. Increasing the treatment duration of the triclosan dentifrice (to 60 and 120s) resulted in better penetration and an increased reduction of viable cells, comparable to EO mouthrinse treatment at 30s duration. Further, CLSM imaging showed that the combined treatment of a non-antimicrobial dentifrice (45s) with EO mouthrinse (30s) showed superior antimicrobial activity (96.2%±3.7%) compared to the antimicrobial triclosan-containing dentifrice used without a mouthrinse step (26.0%±32.0%)., Conclusions: Within typical exposure times, the EO-containing mouthrinse can penetrate deep into the accumulating plaque biofilm compared to the chemotherapeutic dentifrice slurries, and may provide an efficacious alternative to triclosan, when used as an adjunct with a mechanical oral care regimen., Clinical Significance: Using viability mapping and CLSM, this study demonstrated that EO-containing mouthrinse penetrates and kills microorganisms deeper and more effectively in plaque biofilm in typical exposure times when compared to dentifrice chemotherapeutic agents, providing an efficacious alternative to triclosan or stannous fluoride when used as an adjunct to mechanical oral care., (Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Rinsing the mouth with water, or brushing with a dry toothbrush, does not contribute to an improvement in plaque removal during toothbrushing, nor does brushing according to a specific brushing regimen. Rinsing with water or drinking water has an immediate effect on bad morning breath. The combination of toothbrushing, tongue cleaning and a mouthwash has an effect on bad morning breath after 24 hours, in contrast with brushing with toothpaste only. The use of mouthwash with the specific ingredients chlorhexidine and essential oils has a positive effect on the reduction of gingivitis. The use of similar mouthwashes as a cooling solution in an ultrasonic device has no added effect on treatment results among periodontal patients. Water is an effective cooling solution.

Several oral rinses are commercially available to alleviate the symptoms of oral mucositis. Prolonged retention of active pharmaceutical ingredients in the oral cavity is a major problem. In this study, we modified the Stanford oral rinse by including a proprietary mucoadhesive polymer called MucoLox, which we hypothesized would improve active pharmaceutical ingredient mucoadhesion. Characterization of this newly compounded oral rinse showed absence of cytotoxicity in human oral keratinocyte and fibroblast cell lines. The compounded formulation significantly stimulated the migration of these two cell lines in Oris Cell Migration Assay plates, better than the reference commercial product Magic mouthwash. Based on this in vitro study, the new Stanford modified oral rinse with MucoLox is safe and may promote healing of oral mucositis., (Copyright© by International Journal of Pharmaceutical Compounding, Inc.)

Background: Pomegranate, Grape seed and Guava extracts have much been reviewed in Ayurveda and has been proven to have antibacterial action Aim: The objective of the study is to investigate and compare the mouthwash prepared from pomegranate, grape seed and guava extracts on salivary streptococci levels at the end of 48 hr and 7 days, of twice a day usage., Study Design: 40 school going children aged 8-10 yrs, randomly allocated into 4 groups (n=10 for experimental group) were asked to rinse with a) Mouthwash prepared from Pomegranate extract, 15 ml twice a day b) Mouthwash prepared from Grape seed extract, 15 ml twice a day, c) Mouthwash prepared from guava extract, 15 ml twice a day, d) Control- Distil water, twice a day. The oral streptococci colony forming units/ml (CFU/ml) was assessed by inoculating the salivary samples on blood agar media at the end of 48 hrs, and 7 days., Results and Conclusion: the aqueous extracts of the chosen herbal plants showed an acceptable antibacterial efficacy against oral streptococci.

Purpose: This double-blind, clinical, cross-over study evaluated the antibacterial effect of three toothpastes (ASF, HTP and STP) and a chlorhexidine mouthrinse (0.2%; CHX; positive control) after a single application on established biofilm over a period of 24 h (substantivity)., Materials and Methods: Twenty-four subjects refrained from all oral hygiene measures for a period of 72 h. After 48 h, a baseline biofilm sample was taken and vitality of the biofilm flora was examined (baseline, VF0). Then they rinsed for 1 min with one of the randomly allocated, freshly prepared toothpaste slurries (ASF, HTP, STP) or CHX. Further biofilm samples were taken every second hour up to 14 h as well as 24 h after rinsing, and biofilm vitality was assessed (VF2-24). After a wash-out period of 4 days, a new test cycle was started., Results: All subjects (18 female, 6 male) finished the four test cycles. At VF2, all products showed a statistically significant reduction in vitality compared to VF0 (p<0.05). CHX and ASF revealed the most pronounced effect (49% and 40% reduction), while the other toothpastes (HTP: 24%, STP: 11%) reached lower but still statistically significant effects. At each further time point CHX and ASF showed the lowest biofilm vitality. ASF demonstrated a significant antibacterial effect on dental biofilm over a 24-h period compared to baseline and superiority over both other toothpastes at time points VF2-VF14., Conclusion: ASF toothpaste showed a significant antibacterial action on biofilm and a high substantivity which was maintained up to 24 hours.

Aim: This study was conducted to evaluate microbiological and clinical effects of a chitosan chlorhexidine (CH) mouthrinse on plaque control., Materials and Methods: Subjects were divided into three groups. Group I included 15 subjects who used 0.2% chlorhexidine digluconate (CHX), group II included 15 subjects who used 2% chitosan (CH) solution, and group III involves 15 subjects who used 0.2% chlorhexidine/2% CH combination. Plaque index (PI), gingival index (GI), and probing depth (PD) were recorded at the baseline, on day 0, and after 4 days. Supragingival plaque samples were subjected for microbiological evaluation. Statistical analysis was done using statistical software IBM Statistical Package for the Social Sciences (SPSS), version 21., Results: Plaque index was lowest in group I at day 0, while it was highest in group III. At day 4, PI was highest in group II, while lowest in group III. Gingival index was lowest in group I and highest in group II at day 0, and lowest in group I and highest in group III at day 4. There was no statistical difference in Streptococcus mutans (S. mutans) count between groups at any time interval., Conclusion: Both chitosan and CH were found to be effective in controlling plaque. However, a combination of both provides even better results., Clinical Significance: The present study showed that chitosan can be used as an antiplaque agent.

The aim of this study was to evaluate the antimicrobial effects of non-thermal plasma-activated water (PAW) as a novel mouthwash in vitro. Three representative oral pathogens - Streptococcus mutans, Actinomyces viscosus and Porphyromonas gingivalis - were treated with PAW. The inactivation effect was evaluated using the colony-forming unit (CFU) method, and the morphological and structural changes of a cell were observed by scanning electron microscopy and transmission electron microscopy (TEM). The physicochemical properties of PAW were analysed, and its influence on the leakage of intracellular proteins and DNA was evaluated. The results showed significant reduction of Streptococcus mutans within 60 s, of Actinomyces viscosus within 40 s, and of Porphyromonas gingivalis in less than 40 s. Scanning electron microscopy and TEM images showed that the normal cell morphology changed by varying degrees after treatment with PAW. Intracellular proteins (280 nm) and DNA (260 nm) leaked from all three species of bacteria after treatment with PAW. Reactive oxygen species (ROS), especially atomic oxygen (O), hydroxyl radical (˙OH), and hydrogen peroxide (H 2 O 2 ), were generated and led to strong oxidative stress and cell damage. These results suggest that PAW has potential use as a novel antimicrobial mouthwash., (© 2017 Eur J Oral Sci.)

Background: A decline in executive function could have a negative influence on the control of actions in dynamic situations, such as sports activities. Mouth rinsing with a carbohydrate solution could serve as an effective treatment for preserving the executive function in exercise. The purpose of this study was to examine the effects of mouth rinsing with a carbohydrate solution on executive function after sustained moderately high-intensity exercise., Methods: Eight young healthy participants completed 65 min of running at 75% V̇O 2 max with two mouth-rinsing conditions: with a carbohydrate solution (CHO) or with water (CON). Executive function was assessed before and after exercise by using the incongruent task of the Stroop Color and Word Test. The levels of blood glucose; and plasma adrenocorticotropic hormone (ACTH), epinephrine, and norepinephrine (NE) were evaluated. A two-way repeated-measures ANOVA, with condition (CHO and CON) and time (pre-exercise and post-exercise) as factors, was used to examine the main and interaction effects on the outcome measures., Results: The reaction time in the incongruent condition of the Stroop test significantly increased after exercise in CON (pre-exercise 529 ± 45 ms vs. post-exercise 547 ± 60 ms, P  = 0.029) but not in CHO (pre-exercise 531 ± 54 ms vs. post-exercise 522 ± 80 ms), which resulted in a significant interaction (condition × time) on the reaction time ( P  = 0.028). The increased reaction time in CON indicates a decline in the executive function, which was attenuated in CHO. Increases in plasma epinephrine and NE levels demonstrated a trend toward attenuation accompanying CHO ( P  < 0.085), which appeared to be associated with the preservation of executive function. The blood glucose concentration showed neither significant interactions nor main effects of condition., Conclusions: These findings indicate that mouth rinsing with a carbohydrate solution attenuated the decline in executive function induced by sustained moderately high-intensity exercise, and that such attenuation seems to be unrelated to carbohydrate metabolic pathway but rather attributed, in part, to the inhibition of the excessive release of stress hormones.

Background: Patients susceptible to periodontal disease and dental caries, including those who undergo fixed prosthodontic treatments use chemical plaque control agents. However, these mouthrinses may result in adverse effects such as discoloration of the restorative materials. The aim of this study was to compare the color stability of monolithic zirconia and feldspathic porcelain after immersion in two different mouthrinses: 0.2% Chlorhexidine digluconate (CHX), or Listerine®. Color change was evaluated by color spectrophotometer and according to the Commission Internationale de l'Eclairage (CIELab) system., Methods: We prepared 72 disc-shaped porcelains (n = 36) as follows: Group A consisted of dental direkt cube X2 discs (49% translucency) as the monolithic zirconia and group B consisted of VITA VMK 95 as a feldspathic porcelain. Groups A and B were divided into three subgroups (n = 12 per group). Each subgroup was immersed in one of the following three solutions: distilled water (control), CHX, or Listerine® for 2 min, once per day. We recorded the samples' baseline color values according to the CIELab system by using a color spectrophotometer operated by an experienced operator. Color measurements were subsequently obtained following 7 days of immersion, and after the samples were rinsed with distilled water and allowed to dry. We measured CIE L*, a*, and b*and calculated the color difference (ΔE*ab). All data were analyzed by the Mann-Whitney and Kruskal-Wallis tests., Results: Color changes occurred in the experimental groups. The ΔE*ab values were significantly greater in VMK 95 porcelain compared to cube X2 (both p < 0.001) following immersion in CHX and Listerine® mouthrinses. However no significant difference was founded when distilled water was used (p = 0.630). For the two materials, the ΔE values were highest in CHX, followed by the Listerine® and distilled water., Conclusion: Both monolithic zirconia and feldspathic porcelain were susceptible to color changes following immersion in CHX and Listerine® mouthrinses.

Objective: The aim of this double-blind randomized clinical trial was to assess whether the presence of alcohol in chlorhexidine gluconate mouthwashes influences their antimicrobial potential against salivary bacteria in young adults. Additionally, the taste perception was assessed., Materials and Methods: In a randomized crossover design, 20 participants (17 women and three men; aged 18-38 years old) rinsed with the 0.12% chlorhexidine gluconate with (CHX+) or without alcohol (CHX-) for 1 min. Sterile flavoured-mint physiological saline was used as control solution. All participants rinsed with the assigned products only once with a period of at least 7 days of washout in between. For antimicrobial potential assay, stimulated saliva samples were collected from participants and had their total viable bacteria determined before and after each rinse. For taste perception assay, a visual analogue scale (VAS) was used to evaluate the taste perception after each rinse. Friedman followed by Wilcoxon tests and Bonferroni correction were performed. A P-value <0.017 was considered as statistically significant., Results: The median per cent reduction in groups CHX+ and CHX- was 16.07 and 12.87, respectively. No statistically significant difference was found between these groups (P = 0.09). Regarding the gustatory perception, the VAS median values in groups CHX+ and CHX- were 3.50 and 5.50. No statistically significant difference was found in this outcome (P = 0.052)., Conclusions: The presence of the alcohol on the formulation of gluconate chlorhexidine mouthwashes does not seem to interfere with their antimicrobial potential and with their taste perception., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: Maintaining oral hygiene is very important during orthodontic therapy mouthwashes are prescribed as an adjunct to improve patient's oral hygiene. Commercially available mouthwashes e.g. Chlorhexidine, Listerine, fluoride containing mouthwashes have shown to alter the surface characteristics of orthodontic wires. Hence the purpose of the study was to evaluate the effect of Noni mouthwash on surface quality and compositional changes of Nickel Titanium orthodontic wires., Materials and Methods: In this in vitro study pre-formed 0.014 inch NiTi arch wire was used. The study comprised of two samples, one control and one test sample which were 25mm in length. Control sample was stored at room temperature without any manipulation while test sample was immersed in Noni mouthwash solution for 1.5 hours, after which the test specimen was removed from the mouthwash solution and rinsed with distilled water. Both control and test samples were sent for scanning electron microscopy analysis, to qualitatively characterize the topography of the wire surface. Electron dispersion spectrum analysis was done to evaluate the various components of both the wires., Results: No significant difference in the average surface roughness for both wire samples was observed. There was no significant difference seen in the composition of wire after immersion in Noni mouthwash., Conclusion: Noni mouthwash did not have significant influence on the surface roughness or altered the composition of the Ni-Ti wire. Hence Noni mouthwash may be prescribed as a natural, non-destructive prophylactic agent for orthodontic patients.

Fluoride has been widely used for the prevention of dental caries since the mid-20th century. The aim of this study was to investigate the chronologic trends in studies on fluoride mechanisms of action against dental caries during the years 1950 to 2015. To this aim, queries such as "fluoride," "fluoride and demineralization," "fluoride and remineralization," "fluoride and (plaque or biofilms)," and "fluoride and (bacteria or microbials)" were submitted to PubMed to collect research article information, including titles, abstracts, publication dates, author affiliations, and publication journals. The article information that PubMed produced was then collected by an automatic web crawler and examined through informetrics and linguistic analyses. We found that the number of articles concerned with fluoride mechanisms of action against dental caries was 6,903 and gradually increased over time during the years 1950 to 2015. They were published by 1,136 journals-most notably, Caries Research and Journal of Dental Research. Of the articles published, those related to bacteria/microbials had a higher percentage (44%) than those dealing with plaque/biofilms, demineralization, and remineralization. With regard to the geographic distribution of authors, Europe and North America accounted for 65% of the articles during the years 1987 to 2015, although the number of authors in Asia sharply increased in recent years. Among the fluoride compounds, NaF was mentioned more frequently than SnF 2 , Na 2 PO 3 F, amine fluoride, and acidulated phosphate fluoride during the years 1986 to 2015. Water fluoridation received the most attention among the various fluoride application methods (toothpastes, mouthwashes, fluoride varnishes, and fluoride gels) during the same period. These results, obtained from employing informetrics and linguistic analyses, suggest that in studies on fluoride mechanisms of action, 1) the unbalanced geographic distribution of articles and 2) the heavy concentration of articles on particular fluoride compounds and application methods should be overcome in future research.

Black salves are escharotic skin cancer therapies in clinical use since the mid 19th century. Sanguinaria canadensis, a major ingredient of black salve formulations, contains a number of bioactive phytochemicals including the alkaloid sanguinarine. Despite its prolonged history of clinical use, conflicting experimental results have prevented the carcinogenic potential of sanguinarine from being definitively determined. Sanguinarine has a molecular structure similar to known polyaromatic hydrocarbon carcinogens and is a DNA intercalator. Sanguinarine also generates oxidative and endoplasmic reticulum stress resulting in the unfolded protein response and the formation of 8-hydroxyguanine genetic lesions. Sanguinarine has been the subject of contradictory in vitro and in vivo genotoxicity and murine carcinogenesis test results that have delayed its carcinogenic classification. Despite this, epidemiological studies have linked mouthwash that contains sanguinarine with the development of oral leukoplakia. Sanguinarine is also proposed as an aetiological agent in gallbladder carcinoma. This literature review investigates the carcinogenic potential of sanguinarine. Reasons for contradictory genotoxicity and carcinogenesis results are explored, knowledge gaps identified and a strategy for determining the carcinogenic potential of sanguinarine especialy relating to black salve are discussed. As patients continue to apply black salve, especially to skin regions suffering from field cancerization and skin malignancies, an understanding of the genotoxic and carcinogenic potential of sanguinarine is of urgent clinical relevance., (Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Mouth rinse that is natural, safe, cost-effective, readily available and culturally acceptable is required as an adjunct to routine tooth brushing to combat dental diseases. The aim of present study was to compare the effectiveness of salt water rinse with chlorhexidine mouth rinse in reducing dental plaque and oral microbial count., Materials and Methods: The Minimum Inhibitory Concentration (MIC) of salt water against S. mutans, L.acidophilus, A. actinomycetemcomitans and P. gingivalis was determined by Macrobroth Dilution method. Thirty participants were randomly allocated into study group (salt water rinse) and control group (chlorhexidine rinse). Baseline DMFS, defs and plaque scores were recorded. Baseline unstimulated saliva samples were collected by spitting method. Oral prophylaxis was done after baseline sample collection. The participants were advised to rinse the allocated mouthrinse for 5 days under the supervision of co- investigator. Pre- rinse (after oral prophylaxis) and Post -rinse (5th day of mouthrinsing) plaque examination and salivary microbial analysis was done. The collected salivary samples were immediately transported and streaked on the respective media for microbial count., Result: MIC of salt water was 0.7 M for S. mutans, A. actinomycetemcomitans and P. gingivalis and 0.8M for L. acidophilus. There was statistically significant reduction in the plaque scores, salivary S. mutans, L. acidophilus, A. actinomycetemcomitans and P. gingivalis count from baseline, pre-rinse to post-rinse in the study group (p=0.001) and control group (p=0.001). Salt water was as effective as chlorhexidine in reducing dental plaque (p = 0.19) and A. actinomycetemcomitans (p = 0.35) count and while chlorhexidine was superior against S. mutans (p = 0.001), L. acidophilus (p = 0.001) and P. gingivalis (p =0.001)., Conclusion: Salt water rinse can be used as adjunct to routine mechanical plaque control for prevention of oral diseases.

Aim: The aim of this study was to test the effect of varying alcohol concentrations of various commercially available mouth-washes on force decay of elastomeric chains in prestretched and unstretched condition., Materials and Methods: A total of five specimen groups were tested with a total sample size of 180 specimens. A specimen is described as a three-link, short module, clear elastomeric chain (3M Unitek, Ortho Plus, Ortho Organizer). The control and test groups were independently submerged in separate 37°C artificial saliva to simulate the oral conditions. Effects of different solution groups and time (initial, 1, 7, 14, 21, and 28 days) on three different elastomeric chains and force (cN) are analyzed with two-way analysis of variance; pair-wise comparisons are done by t-test., Results: Higher mean force was recorded initially followed by 24 hours >7 days >14 days >21 days and 28 days respectively. The difference in mean force decay among the different time intervals was found to be statistically significant (p < 0.001). Among the different solutions, higher mean force was recorded in 21.6% alcohol mixture > Listerine 8.38% > Wokadine > alcohol mixture 8.38% > artificial saliva., Conclusion: In conclusion, alcohol-containing mouth rinses cause an increase in force decay of elastomeric chain over time., Clinical Significance: These mouth rinses are commonly recommended during orthodontic treatment. The orthodontist can know better that the alcohol content of the mouth rinses and the structural and molecular modification results in the decay of elastomeric chain.

Objective: The present in situ - investigation aimed to specify the impact of pure hydroxyapatite microclusters on initial bioadhesion and bacterial colonization at the tooth surface., Design: Pellicle formation was carried out in situ on bovine enamel slabs (9 subjects). After 1min of pellicle formation rinses with 8ml of hydroxyapatite (HA) microclusters (5%) in bidestilled water or chlorhexidine 0.2% were performed. As negative control no rinse was adopted. In situ biofilm formation was promoted by the intraoral slab exposure for 8h overnight. Afterwards initial bacterial adhesion was quantified by DAPI staining and bacterial viability was determined in vivo/in vitro by live/dead-staining (BacLight). SEM analysis evaluated the efficacy of the mouthrinse to accumulate hydroxyapatite microclusters at the specimens' surface and spit-out samples of the testsolution were investigated by TEM., Results: Compared to the control (2.36×10 6 ±2.01×10 6 bacteria/cm 2 ), significantly reduced amounts of adherent bacteria were detected on specimens rinsed with chlorhexidine 0.2% (8.73×10 4 ±1.37×10 5 bacteria/cm 2 ) and likewise after rinses with the hydroxyapatite testsolution (2.08×10 5 ±2.85×10 5 bacteria/cm 2 , p<0.001). No demonstrable effect of HA-particles on Streptococcus mutans viability could be shown. SEM analysis confirmed the temporary adsorption of hydroxyapatite microclusters at the tooth surface. Adhesive interactions of HA-particles with oral bacteria were shown by TEM., Conclusion: Hydroxyapatite microclusters reduced initial bacterial adhesion to enamel in situ considerably and could therefore sensibly supplement current approaches in dental prophylaxis., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Purpose: The aim of this study was to identify the effect of Dongchimi juice containing kimchi Lactobacillus as an oral hygiene agent and to compare it with that of chlorhexidine solution (0.12% dilution)., Methods: This study employed a pretest-posttest experimental design in which a single group of patients was exposed to two different treatments over a period of time. The study included 32 patients hospitalized at a long-term care hospital in Korea. Data were collected between August 12, 2016 and September 28, 2016. The patients first used chlorhexidine solution as an oral care agent for 1 week. After an interval of 2 weeks, they used Dongchimi juice for 1 week. Each agent was applied 2 times a day depending on the protocol. The oral status of the patients was measured using Beck's Oral Exam Guide (OEG) scores. The number of pathogens in the oral cavity was counted by culture, and the patients' subjective satisfaction score for each oral agent was measured using a visual analogue scale. T-test and Mann-Whitney test were performed to identify significant differences between Dongchimi juice and chlorhexidine solution by using PASW Statistics for Windows, Version 18.0 (SPSS Inc., Chicago, IL, USA)., Results: The OEG score was not statistically different with the use of chlorhexidine solution and Dongchimi juice. However, decreasing number of pathogens and the subjective satisfaction score were higher with Dongchimi juice than with the chlorhexidine solution., Conclusion: These findings support the use of Dongchimi juice containing kimchi Lactobacillus as an oral hygiene agent for Korean patients., Competing Interests: The authors declared no conflict of interest., (© 2017 Korean Society of Nursing Science)

Background: Application of astringent hemostatic agents is the most widely used technique for gingival retraction, and a variety of products are offered commercially. However, these products may have additional unintended yet clinically beneficial properties. The authors assessed the antimicrobial activities of marketed retraction products against plaque-associated bacteria in both planktonic and biofilm assays, in vitro., Methods: The authors assessed hemostatic solutions, gels, pellets, retraction cords, pastes, and their listed active agents against a collection of microorganisms by means of conventional agar diffusion and minimum bacteriostatic and bactericidal concentration determinations. The authors then tested the most active products against monospecies biofilms grown on hydroxyapatite disks., Results: All of the tested retraction products exhibited some antimicrobial activity. The results of the most active products were comparable with those of a marketed mouthwash. The listed retraction-active agents displayed relatively little activity when tested in pure form. At 10% dilution, some products evidenced inhibitory activity against most tested bacteria within 3 minutes of exposure, whereas others displayed variable effects after 10 minutes. The most active agents reduced, but did not completely prevent, the metabolic activity of a monospecies biofilm., Conclusions: Commercial gingival retraction products exhibit antimicrobial effects to various degrees in vitro. Some products display rapid bactericidal activity. The antimicrobial activity is not owing to the retraction-active agents. Biofilm bacteria are less sensitive to the antimicrobial effects of the agents., Practical Implications: The rapidity of killing by some hemostatic agents suggests an antimicrobial effect that may be efficacious during clinical placement. The results of this in vitro study suggest that clinicians should be aware of the potential antimicrobial effects of some hemostatic agents, but more research is needed to confirm these observations in clinical use., (Copyright © 2017 American Dental Association. Published by Elsevier Inc. All rights reserved.)

This study compared and examined the effects of aroma gargling, cold water gargling, and wet gauze application on thirst, halitosis, and sore throat in patients after spine surgery. A quasiexperimental pretest/posttest control group design was employed. Samples were total 70 patients (aroma gargling: 24 samples, cold gargling: 24 samples, and wet gauze: 22 samples) after spine surgery in K Hospital in Seoul, Korea. The aroma gargle solution as an experimental intervention was prepared by blending peppermint, tea tree, and lemon oils at a ratio of 1:2:2. A 60 cc of aroma gargle solution was used 3 times for 15 to 20 seconds. The visual analog scale was used to measure the degrees of thirst and sore throat, and a portable device was used to examine the degree of halitosis. There were significant differences in the degrees of thirst, halitosis, and sore throat according to interaction between group and duration. In the comparison among 3 groups, aroma gargling provided better oral health by decreasing thirst, halitosis, and sore throat for patients with spine surgery. Aroma gargling can be utilized as an effective nursing intervention for decreasing thirst, halitosis, and sore throat for patients with spine surgery in clinical practice. Results suggest, therefore, that health professionals should consider an array of methods including aroma gargling for patients after spine surgery.

Background: Gonorrhoea is one of the most common sexually transmissible infections in men who have sex with men (MSM). Gonorrhoea rates have increased substantially in recent years. There is concern that increasing gonorrhoea prevalence will increase the likelihood of worsening antibiotic resistance in Neisseria gonorrhoeae. A recent randomised controlled trial (RCT) demonstrated that a single-dose of mouthwash has an inhibitory effect against oropharyngeal gonorrhoea. We are conducting the first RCT to evaluate whether daily use of mouthwash could reduce the risk of acquiring oropharyngeal gonorrhoea., Methods/design: The OMEGA (Oral Mouthwash use to Eradicate GonorrhoeA) study is a double-blind RCT and will be conducted at several sexual health clinics and high caseload General Practice (GP) clinics in Melbourne and Sydney, Australia. A total of 504 MSM attending the participating sites will be recruited. Participants will be randomised to either using 'Study mouthwash A' or 'Study mouthwash B' for 12 weeks. Study mouthwash A was inhibitory against N. gonorrhoeae in vitro, whereas study mouthwash B was not. Participants will be instructed to rinse and gargle the study mouthwash for 60 seconds every day. The primary outcome is the proportion of participants with oropharyngeal gonorrhoea detected by nucleic acid amplification test by 12 weeks., Discussion: The results from this trial may provide a novel way to reduce gonorrhoea prevalence and transmission without the use of antibiotics that may be associated with development of resistance. If shown to be effective, the widespread use of mouthwash will reduce the prevalence of oropharyngeal gonorrhoea, which plays key role in driving the emergence of gonococcal antimicrobial resistance through DNA exchange with oral commensal bacteria. The anticipated net effect will be interruption of onward transmission of N. gonorrhoeae within high density sexual networks within MSM populations., Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616000247471 , registered on 23rd February 2016.

The purpose of this study was to review the existing literature investigating carbohydrate mouth rinsing as an ergogenic aid using the effect sizes (ES) and percentage change in performance of the respective studies as outcome measures. A trivial-small average overall ES was present for the 25 studies included in the review (0.18, 95% confidence interval [CI] = 0.10-0.27). Effect sizes for the subgroups were ≥25 minutes (0.25, 95% CI = 0.14-0.36), ≤180 seconds (0.06, 95% CI = -0.03 to 0.15), resistance exercise (-0.09, 95% CI = -0.20 to 0.03) but the ES is still small. A subanalysis of ∼1-h cycling time trial performance resulted in an overall ES of 0.20 (95% CI = 0.02-0.38), and ES for performance time and power output of 0.31 (95% CI = -0.02 to 0.64) and 0.19 (95% CI = -0.09 to 0.46), respectively. Although ES were small, the average percentage change in performance in ∼1-hour trials was 2.48%, which may have implications for elite performers as this is greater than the 1.30% smallest worthwhile change recommended in the past research.

The purpose of this investigation was to examine to the influence of carbohydrate ingestion (CHOI) and carbohydrate mouth rinse (CHOR) on acute repeat maximal sprint performance. Fourteen healthy males (age: 21.7 ± 1.8 years, mass: 82.3 ± 12.3 kg) completed a total of five 15-s maximal repeat sprints on a cycle ergometer against 0.075 kg ・ kg -1 body mass each separated by 4 min of active recovery. Subjects completed four experimental trials and were randomly assigned one of four treatments: (1) CHOI, (2) CHOR, (3) placebo mouth rinse (PLAR), (4) placebo ingestion (PLAI). Subjects rinsed or ingested six 50 mL 10% CHO solutions throughout each trial. Performance variables measured included rating of perceived exertion, peak heart rate, peak and mean power output, fatigue index, and total work. Significant treatment main effects were observed for mean power output (p = 0.026), total work (p = 0.020), fatigue index (p = 0.004), and heart rate (p = 0.013). Overall mean power output and total work were significantly greater with CHOI (659.3 ± 103.0 watts, 9849.8 ± 1598.8 joules) compared with CHOR (645.8 ± 99.7 watts, 9447.5 ± 1684.9 joules, p < .05). CHOI (15.3 ± 8.6 watts/s) significantly attenuated fatigue index compared with CHOR (17.7 ± 10.4 watts/s, p < .05). Based on our findings, CHOI was more likely to provide a beneficial performance effect compared with CHOR, PLAI, and PLAR. Athletes required to complete repeat bouts of high intensity exercise may benefit from CHOI.

In recent years, different chlorhexidine formulations have been tested, including an alcohol-free alternative, but the effect of this solution on early biofilm formation is not clear. A crossover, randomized, double-blind clinical trial was conducted to evaluate the effect of two chlorhexidine solutions against supra- and subgingival biofilm formation (NCT#02656251). Thirty-five participants were randomized and asked to rinse twice daily with 15 ml of an alcohol-containing 0.12% chlorhexidine solution, an alcohol-free 0.12% chlorhexidine solution, or placebo. The study was conducted in three experimental periods of 4 days each, with a 10-day washout between the periods. All the experimental periods followed the same protocol, except that the solutions were switched. Biofilm distribution was evaluated every 24 hours by the Plaque-Free Zone Index, during 96 hours. Adverse events were self-reported and sensory evaluation was performed using a hedonic scale. Compared to the placebo, the chlorhexidine solutions resulted in a significantly higher number of surfaces free of plaque over 96 hours (p < 0.01), and were able to prevent subgingival biofilm formation (p < 0.01). The alcohol-free chlorhexidine solution was associated with a lower incidence of adverse events, compared with alcohol-containing chlorhexidine (p < 0.05); it also received better sensory evaluation and acceptance by trial participants, compared with the alcohol-containing chlorhexidine (p = 0.007), and had a similar inhibitory effect on the formation of supra- and subgingival biofilms.

Objective: The aim of this study was to determine the effect of an oxygenating mouthwash compared to two other established mouthwash products on bacterial composition and metabolic activity of oral biofilms in vitro., Material and Methods: Twelve healthy subjects participated as donors. Plaque-saliva mixture inoculated biofilms were grown and treated with 3 different chemotherapeutic mouthwashes [amine fluoride/stannous fluoride (MD), oxygenating agent (AX), chlorhexidine 0.12 % (PA), and water (W)]. Effects of treatments were assessed on biofilm composition (16S rRNA gene amplicon sequencing), production of organic acids (formate, acetate, lactate, propionate, butyrate using capillary electrophoresis), and viability of the remaining biofilm (CFUs)., Results: Microbial profiles of biofilms clustered per inoculum donor and were dominated by the genera Veillonella, Streptococcus, and Prevotella. Microbial diversity was only reduced after PA treatment. Significant changes in composition occurred after treatment with AX, resulting in lower proportions of Veillonella and higher proportions of non-mutans streptococci. Production of all organic acids after PA and lactate after MD was significantly lower as compared to W. AX resulted in reduction of acetate, butyrate, and propionate and increase in lactate production (p < 0.05). Viable counts were significantly lower after PA and AX treatments compared to W, while no significant reduction was observed after MD., Conclusions: All studied mouthwashes affected the in vitro biofilms differently. The effects of the AX treatment were the most prominent which resulted in changes of the bacterial composition and metabolism., Clinical Implications: Awareness by the dental team that mouthwashes can change the bacterial composition and metabolism is important when advising its use.

This study investigated the impact that mouth rinsing carbohydrate solution has on skill-specific performance and reaction time following a fatigue-inducing bout of fencing in epee fencers. Nine healthy, national-level epee fencers visited a laboratory on two occasions, separated by a minimum of five days, to complete a 1-minute lunge test and Stroop test pre- and post-fatigue. Heart rate and ratings of perceived exertion (RPE) were recorded during completion of the fatiguing protocol. Between fights the participant's mouth rinsed for 10 seconds, either 25 ml of 6.7% maltodextrin solution (MALT) or water (PLAC). Blood lactate and glucose were recorded at baseline, pre- and post-testing. Results showed an increase in heart rate and overall RPE over time in both conditions. There were no differences in blood glucose (F(1,8) = .63, P = .4, η p  = .07) or blood lactate levels (F(1,8) = .12, P = .70, η p  = .01) between conditions as a function of time. There was a significant improvement in lunge test accuracy during the MALT trial (F(1,8) = 5.21, P = .05, η p  = .40) with an increase from pre (81.2 ± 8.3%) to post (87.6 ± 9.4%), whereas there was no significant change during the placebo (pre 82.1 ± 8.8%, post 78.8 ± 6.4%). There were no recorded differences between conditions in response time to congruent (F(1,8) = .33, P = .58, η p  = .04) or incongruent stimuli (F(1,8) = .19, P = .68, η p  = .02). The study indicates that when fatigued mouth rinsing MALT significantly improves accuracy of skill-specific fencing performance but no corresponding influence on reaction time was observed.

Orthodontic appliances causes specific alterations in oral environment, including reduction of pH, increase of dental biofilm and elevation of salivary microbial levels, causing an increased risk for dental caries. This study evaluated, using microbial culture and scanning electron microscopy (SEM), the in situ contamination by mutans streptococci (MS) of different surfaces of Haas palatal expanders with and without use of chlorhexidine gluconate mouthrinses (CHX). Thirty-four patients were randomly assigned to two groups (n = 17/group), using placebo (Group I) and 0.12% CHX (Group II-Periogard ® ) mouthrinses twice a week. After 4 months, appliances were submitted to microbiological processing and after fragments were analyzed by SEM. Mann-Whitney U test (α = 5%) was used to assess differences between groups on the appliances' different surfaces and to compare the contamination on the free and nonfree surfaces of these components. There was no difference (p = 0.999) between groups regarding the number of MS colonies/biofilms on the nonfree surfaces, which showed intense contamination. However, free surfaces of Group II presented less contamination (p < 0.001) than those of Group I in all appliances' components. Results of the microbial culture were confirmed by SEM. Use of 0.12% CHX was effective in reducing the formation of MS colonies/biofilms on free surfaces of Haas expanders, in situ., (© 2016 Wiley Periodicals, Inc.)

Background: Compounds present in green tea have been shown to inhibit the growth and activity of bacteria associated with oral infections. The purpose of this study was to compare the efficacy of chlorhexidine (0.12%) mouth rinse and combination (chlorhexidine and sodium fluoride) mouth rinse to that of green tea extract (0.5%) mouth rinse in reducing the salivary count of Streptococcus mutans and Lactobacillus in children., Materials and Methods: The sample for the study consisted of 75 school children aged 8-12 years with four or more (decay component) of decayed, missing, and filled teeth index. Children were divided randomly into three equal groups and were asked to rinse with the prescribed mouth rinse once daily for 2 weeks after breakfast under supervision. Nonstimulated whole salivary sample (2 ml) was collected at baseline and postrinsing and tested for the colony forming units of S. mutans and Lactobacillus., Results: The results of the study indicate that there was a statistically significant reduction in S. mutans and lactobacilli count in all the three study groups. The statistically significant reduction in the mean S. mutans and lactobacilli counts were more in 0.12% chlorhexidine group than in the combination mouth rinse and 0.5% green tea mouth rinse group. There was no statistically significant difference in the reduction of S. mutans and lactobacilli count between combination mouth rinse group and 0.5% green tea mouth rinse group., Conclusion: Green tea mouth rinse can be a promising preventive therapy worldwide for the prevention of dental caries.

Background: Chlorhexidine mouth rinses have a proven efficacy for the prevention of alveolar osteitis after third molar surgery. This study compares the efficacy of warm saline rinse, a component of postextraction instructions, with that of chlorhexidine in our institution over a period of 2 years., Patients and Methods: Apparently healthy patients who were referred to the Oral Surgery Clinic of our institution, with an indication for surgical extraction of lower third molar were prospectively, consecutively, and uniformly randomized into warm saline and chlorhexidine groups. The experimental group (n = 50/100) were instructed to gargle twice daily with warm saline, whereas the chlorhexidine group (n = 50/100) were instructed to gargle with 0.12% chlorhexidine. Information on demographic, types and level of impaction, indications for extraction, and development of alveolar osteitis were obtained and analyzed. Comparative statistics were done using Pearson's Chi-square, Fisher's exact, or Mann-Whitney U-tests as appropriate. P <0.05 was considered statistically significant., Results: The demographic, types and level of impaction as well as indications for extractions were comparable between the study groups (P > 0.05). The overall prevalence of alveolar osteitis was 5%. There was no statistically significant difference between application of warm saline and 0.12% chlorhexidine rinse with respect to the development of alveolar osteitis (P = 0.648)., Conclusion: Warm saline mouth rinse is equally as effective as chlorhexidine mouth rinse, as prophylaxis against prevention of alveolar osteitis after third molar surgery.

Background and Objective: In the therapy of destructive periodontal disease, chemical antimicrobial agents and increasingly photodynamic therapy (PDT) play an important adjunctive role to standard mechanical anti-infective treatment procedures. However, both antiseptic methods have their shortcomings in terms of eliminating periodontal pathogens. The aim of the study was to compare the antibacterial efficacy of different antiseptic mouthrinses, of a conventional and a new, modified PDT plus as well as of the different antiseptic mouthrinses combined with either the conventional or the modified PDT plus against periopathogens., Material and Methods: Six representative periodontitis-associated bacterial strains were grown for 24 h under anaerobic conditions. After mixing the individual cell pellets they were exposed to 10 different antiseptic mouthrinse formulations: chlorhexidine (0.2%, 0.06%, CHX); CHX + cetylpyridinium chloride (each 0.05%); sodium hypochlorite (0.05%); polyhexanide (0.04%, PHMB1; 0.1%, PHMB2); octenidine dihydrochloride (0.1%); fluoride (250 ppm); essential oils; povidone iodine (10%); and saline (0.9%, NaCl) as control. Furthermore, the bacteria were treated with conventional PDT based on light-emitting diodes and a new modified photodisinfection combining photosensitizer with hydrogen peroxide to PDT plus also based on light-emitting diodes. In addition to the single treatments, a combined application of antiseptic exposure followed by use of PDT or PDT plus was performed. The microbial viability was characterized by analyzing colony growth and fluorescence-based vitality proportions., Results: Nearly all mouthrinses caused a statistically significant growth inhibition. The most effective antiseptics, CHX (0.2%), CHX/cetylpyridinium chloride and octenidine dihydrochloride, inhibited bacterial growth completely. Conventional PDT resulted in moderate reduction of colony growth. The modified PDT plus achieved maximum antimicrobial effect. The combination of antiseptic exposure and PDT against periopathogens predominantly increased antibacterial efficacy compared to the single applications. The mouthrinse containing essential oil seemed to interfere with PDT., Conclusion: A combination therapy of preceding chemotherapeutical exposure and subsequent photodisinfection may be a more effective and promising antibacterial treatment than single applications of the antiseptic methods. The modified PDT plus using oxygen-enriched toluidine showed a superior antibacterial effect on periodontal pathogens to conventional PDT and to the majority of the investigated mouthrinses., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: The aim of this study was to investigate the effects of rinsing with arginine or urea solution on initial enamel lesions in situ., Methods: Fourteen subjects who wore mandibular removable partial dentures embedded with bovine enamel blocks with artificial enamel lesions were included. The experiment included four 4-week rinsing periods with a 10-day washout period between each rinsing period. In each rinsing period, the subjects rinsed after meal or snack using water, or 2% arginine bicarbonate, or 1% urea, or 0.05% NaF solution, five times daily. The mineralization changes of the enamel lesions were assessed using quantitative light-induced fluorescence., Results: All groups except the water group showed a statistically significant decrease in the fluorescence loss after treatment, compared with their respective baseline. Although both the arginine group and urea group showed more decrease in fluorescence loss than that of the water group, the decrease was not statistically significantly different from that of the water group. The decrease in fluorescence loss of the NaF group was statistically significant than that of the water group, arginine group, and urea group., Conclusion: Rinsing with arginine or urea solution offers limited remineralizing benefit to enamel lesions over a period of 4-week time., (© 2016 The Authors. Oral Diseases Published by John Wiley & Sons Ltd.)

Background: The collection of subgingival plaque samples with paper points is time-consuming and accident-sensitive. However, the collection of saliva is simple and contains pathogens of all intraoral surfaces. The aim of this study is to investigate whether a sampling strategy with mouthrinse (mouthrinse sample [MSP]; test) leads to results comparable with standard sampling method (multiple site test from the deepest pocket of each quadrant [MT4]; control)., Methods: In 50 patients with periodontitis, subgingival plaque was sampled from the deepest pocket of each quadrant by using paper points and by gaining saliva with saline mouthrinse. Analysis was performed using a commercially available polymerase chain reaction test for 11 periodontal pathogens., Results: Detection frequency of Aggregatibacter actinomycetemcomitans (MT4/MSP: 42%/36%), Porphyromonas gingivalis (78%/66%), Tannerella forsythia (98%/84%), Treponema denticola (94%/74%), Parvimonas micra (86%/62%), Campylobacter rectus (90%/76%), Eubacterium nodatum (64%/30%), Prevotella intermedia (58%/54%), and Eikenella corrodens (90%/82%) was higher with MT4 than MSP. For Fusobacterium nucleatum (100%/100%), there was no difference between test and control. Only detection frequency of Capnocytophaga species (68%/74%) was higher with MSP than MT4. Differences were significant for P. gingivalis, T. forsythia, T. denticola, P. micra, C. rectus, and E. nodatum., Conclusions: There is no significant difference between MT4 and MSP for detection frequency of key pathogen A. actinomycetemcomitans. Key pathogens P. gingivalis, T. forsythia, T. denticola, P. micra, C. rectus, and E. nodatum show statistically higher detection frequencies with MT4.

Objectives: The accumulation of oral bacterial biofilm is the main etiological factor of oral diseases. Recently, electrolyzed hydrogen-rich water (H-water) has been shown to act as an effective antioxidant by reducing oxidative stress. In addition to this general health benefit, H-water has antibacterial activity for disease-associated oral bacteria. However, little is known about the effect of H-water on oral bacterial biofilm. The objective of this study was to confirm the effect of H-water on streptococcal biofilm formation., Methods: In vitro streptococcal biofilm was quantified using crystal violet staining after culture on a polystyrene plate. The effect of H-water on the expression of genes involved in insoluble glucan synthesis and glucan binding, which are critical steps for oral biofilm formation, was evaluated in MS. In addition, we compared the number of salivary streptococci after oral rinse with H-water and that with control tap water. Salivary streptococci were quantified by counting viable colonies on Mitis Salivarius agar-bacitracin., Results: Our data showed that H-water caused a significant decrease in in vitro streptococcal biofilm formation. The expression level of the mRNA of glucosyltransferases (gtfB, gtfc, and gtfI) and glucan-binding proteins (gbpC, dblB) were decreased remarkably in MS after H-water exposure for 60s. Furthermore, oral rinse with H-water for 1 week led to significantly fewer salivary streptococci than did that with control tap water., Conclusions: Our data suggest that oral rinse with H-water would be helpful in treating dental biofilm-dependent diseases with ease and efficiency., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Aims: This study aims to compare the efficacy of a mango (Mangifera indica) leaf mouthwash with chlorhexidine on plaque status, gingival status, and salivary Streptococcus mutans count., Materials and Methods: A sample of twenty children, aged 8-14 years, Mangalore Residential School, Karnataka, India, was allocated into two groups. Group A (10) and Group B (10) were given test mouthwash "mango leaf mouthwash" and chlorhexidine, respectively. The clinical trial was carried out for ½ h after rinsing and after 5 days, during which children were asked to rinse once daily, with 10 ml of the given mouthwash ½ h after tooth brushing., Results: There was a significant reduction in microbial count, improved plaque control and gingival health in mango leaf and chlorhexidine mouthwash groups with higher reduction in microbial count, and better plaque control and gingival health seen in chlorhexidine group., Conclusion: Herbal alternatives proved to be an effective and safe alternative to conventional modes of treatment.

Background: Gonorrhoea is increasing among men who have sex with men (MSM). We aimed to determine whether Listerine, a commercial mouthwash product, has an inhibitory effect against Neisseria gonorrhoeae in a randomised controlled trial (RCT) and an in vitro study, and therefore may be a potentially useful agent for gonorrhoea control., Methods: In vitro: a suspension of ∼10 8 colony forming units per mL (CFU/mL) of N. gonorrhoeae was added to a serial of dilutions (up to 1:32) of alcohol-containing Listerine mouthwashes (Cool Mint and Total Care) for 1 min. A 10 µL aliquot was spread over the surface of a gonococcal agar plate and the number of N. gonorrhoeae colonies present at each dilution was calculated. The phosphate buffered saline (PBS) was used as a control. RCT: we recruited MSM with pharyngeal gonorrhoea who returned for treatment at the Melbourne Sexual Health Centre between May 2015 and February 2016. Untreated men were randomised to rinse and gargle either Listerine Cool Mint or saline for 1 min. Pharyngeal swabs were taken before and after rinsing and gargling for culture of N. gonorrhoeae . The analysis included only men who were culture positive for N. gonorrhoeae before using the allocated solution on the day of recruitment., Results: In vitro: Listerine mouthwashes at dilutions of up to 1:4 for 1 min resulted in significant reduction of total N. gonorrhoeae counts but PBS has no inhibitory effect against N. gonorrhoeae . RCT: a total of 196 MSM were recruited, 58 (30%) were culture positive before using the solution. After gargling the allocated solution, men in the Listerine group were significantly less likely to be culture positive on the pharyngeal surface (52%) compared with men in the saline group (84%) (p=0.013)., Conclusions: This data suggest Listerine, significantly reduces the amount of N. gonorrhoeae on the pharyngeal surface. With daily use it may increase gonococcal clearance and have important implications for prevention strategies., Trial Registration Number: ACTRN12615000716561., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Most people have heard of the placebo effect, while relatively few have heard of nocebo, even within the circles of medical staff. Placebo effect means positive results by treatment via pharmacological inert substances. In contrast to placebo, by nocebo effect, due to negative beliefs and expectations, opposite results are achieved. Said in a more formal manner, what a sick person expects, unfortunately, he/she most often gets. It is a fact that a high number of medical staff is still uninterested in placebo and nocebo effects, although they would benefit from them. Maybe this is because the treatment would not seem "scientific enough". However, the newest scientific evidence undoubtedly shows that placebo and nocebo effects arise out of very active neurobiological processes intervened by psychological mechanisms such as expectations and conditions. Regardless of whether or not the doctor or the patient are aware of this, placebo and nocebo effects are extremely powerful and represent a significant part of the treatment process, in treatment by methods of ancient cultures, as well as in modern medicine. Of course medicines hold their role, but understanding how the human mind processes information is also very important., (Copyright© by the Medical Assotiation of Zenica-Doboj Canton.)

Purpose: To compare the antiplaque, antigingivitis and antibacterial efficacy of chlorhexidine (CHX), XYL and a mouthwash combining CHX and XYL against Streptococcus mutans (S. mutans)., Materials and Methods: A parallel design, randomised controlled trial was conducted among 75 dental students. Participants were randomised into CHX, CHX+XYL and XYL-only groups using the lottery method. Subjects were instructed to use 10 ml of the provided mouthwash for 15 s twice daily for 3 weeks. All the outcome measures, gingival index (GI), plaque index (PI) and number of salivary S. mutans CFU were recorded at baseline and 3 weeks post intervention. Nonparametric tests were used for inferential statistics., Results: All outcome variables (GI, PI scores and log10 salivary S. mutans counts) decreased significantly from baseline compared to post intervention among all three groups. Intergroup comparison demonstrated that reduction in GI was not significantly different among the three groups. The decrease in PI scores was found to be significantly higher in the XYL group, while the decrease in the log10 salivary S. mutans count was significantly higher in the CHX+XYL group., Conclusion: The present study provided sufficient data to suggest that all the three mouthwashes are effective against plaque, gingivitis and S. mutans load in saliva. Further investigations should be carried out to confirm the results and develop strategies for using such products to prevent tooth decay.

An oral cavity hygiene plays a key role in prophylactic and therapeutic measures to prevent pathological changes caused by different viruses, bacteria, fungi and protozoa. It is important to maintain proper oral hygiene and assist the removal of potent pathogens; use of the mouthrinses can be one of method providing to these goal. The purpose of this study was to investigate the effects of selected mouthrinses on the standard strains of Candida presented in the oral cavity. Eight reference strains of fungi were investigated: C. albicans (CBS 2312), C. albicans (L 45), C. albicans (ATCC 24433), C. dubliniensis (CBS 7987), C. glabrata (CBS 862), C. krusei (CBS 573), C. parapsilosis (CBS 10947) and C. tropicalis (CBS 2424). Thirteen mouthrinses were used in the study, including pure chlorhexidine (CHX), and 12 commercially available varieties: Azulan, Colgate Plax Complete Care Sensitive, Corsodyl 0,2%, Curasept ADS 205, Dentosept, Dentosept A, Eludril Classic, Listerine Total care, Octenidol, Oral-B Pro-Expert Clinic Line, Sylveco and Tinctura salviae. The present study used a qualitative diffusion in agar gel-well plate method to evaluated the antifungal properties of mouthrinses. Among the 12 commercially available mouthrinses examined in the study, the following were not found to show antifungal activity: Azulan, Dentosept, Eludril Classic, Listerine Total care, Tinctura salviae. The largest inhibition zones were produced by Dentosept, Chlorhexidine and Colgate. The smallest inhibition zones were produced by Octenidol and Curasept. With regard to mouthwash type, statistically significant differences in growth inhibition zone diameter were found between the following pairs of fungi: C. albicans and C. krusei for Colgate without dilution and with 1:2 dilution; C. albicans and C. glabrata for Corsodryl without dilution and with 1:2 dilution; C. albicans and C. dubliniensis for Dentosept A without dilution; C. glabrata and C. parapsilosis with 1:2 dilution; C. dubliniensis and C. tropicalis for Sylveco without dilution, 1:2 dilution and 1:4 dilution; C. dubliniensis and C. parapsilosis for Sylveco without dilution, 1:2 dilution and 1:4 dilution. The lowest MIC values calculated from the Iinear regression equation, indicating the strongest potential activity, were obtained for Dentosept A, followed by chlorhexidine; the lowest activity, was calculated for Curasept and for Octenidol. Some of the tested mouthrinses have antimycotic properties at commercially available concentrations. In spite of the fact that chlorhexidine is thought to be the gold standard for mouthrinse use, Dentosept has stronger antimycotic activity and acts on a wider spectrum of fungi species. Chlorhexidine and Colgate do not appear to act against C. tropicalis, neither does Curaspet against C.dubliniensis; therefore, the determination of the fungus species is necessary.

Objectives: In the present in situ/ex vivo study the impact of tannic acid on the erosion-protective properties of the enamel pellicle was tested. Additionally, the antiadherent and antibacterial effects of tannic acid were evaluated., Methods: The pellicle was formed in situ on bovine enamel samples fixed on individual splints worn by 6 subjects. Following 1 min of pellicle formation the volunteers rinsed for 10 min with tannic acid. After further oral exposure for 19 min, 109 min, and 8 h overnight, respectively, slabs were incubated in HCl ex vivo (pH 2.0, 2.3, 3.0) over 120 s. Subsequently, kinetics of calcium and phosphate release were measured photometrically. Samples after a 1-min fluoride mouth rinse as well as enamel samples with and without a 30-min in situ pellicle served as controls. Antiadherent effects were evaluated after a 1-min rinse with tannic acid and oral exposure of the slabs overnight. DAPI (4',6-diamidino-2-phenylindole) combined with concanavalin A staining and live/dead staining was used for fluorescence microscopic visualization and quantification of adherent bacteria and glucans. Modification of the pellicle's ultrastructure by tannic acid was evaluated by transmission electron microscopy (TEM)., Results: Tannic acid significantly improved the erosion-protective properties of the pellicle in a pH-dependent manner. Bacterial adherence and glucan formation on enamel were significantly reduced after rinses with tannic acid as investigated by fluorescence microscopy. TEM imaging indicated that rinsing with tannic acid yielded a sustainable modification of the pellicle; it was distinctly more electron dense., Conclusion: Tannic acid offers an effective and sustainable approach for the prevention of caries and erosion., (© 2016 S. Karger AG, Basel.)

Aims: This study was conducted to evaluate and compare the antimicrobial efficacy of green tea catechin as a mouth wash on colony count of Streptococcus mutans in children., Materials and Methods: A sample size of thirty children was selected out of screened 290 children by simple random sampling between the age group of 7 and 12 years. The study was conducted over a period of 2 weeks. After 24 h of oral prophylaxis, the baseline samples were collected and each group was subjected to mouth rinsing with green tea mouth wash for 2 weeks and further plaque and saliva samples were collected at 1- and 2-week intervals from baseline. Microbiological analysis of plaque and saliva samples was done by Dentocult SM strip kit (Orion Diagnostica, Finland), and the results were statistically analyzed and tabulated., Results: Statistically, there was highly significant reduction in S. mutans count in plaque as well as in saliva for after 1- and 2-week intervals from baseline., Conclusion: Hence, finally, our study showed that green tea catechin is effective as a mouth wash against S. mutans and having better action in plaque as compared to saliva. It can be used as an adjunct to commercially available mouthwashes.

The nitrate-nitrite-nitric oxide pathway has emerged as a significant source of nitric oxide (NO) bioactivity. Dietary intake of inorganic nitrate has a number of cardiovascular effects as well as a decrease in oxygen cost during exercise and a reduction in resting metabolic rate (RMR). Oral bacteria have a key role in bioactivation of inorganic nitrate since they catalyse the conversion of salivary nitrate to the more reactive nitrite anion. Recent studies demonstrate that blood pressure increases with the use of an antiseptic mouthwash, indicating that endogenous, NO-synthase derived nitrate is recycled into nitrite and NO, sufficiently to modulate cardiovascular function. Here we tested if also RMR would be affected by an antiseptic mouthwash. Seventeen healthy normotensive female subjects (23 ± 4 y) participated in this randomized, double-blinded, crossover study. During two 3-day periods separated by 28 days the subjects consumed a diet low in nitrate combined with rinsing their mouth three times daily with a chlorhexidine-containing mouthwash (mouthwash) or placebo mouthwash (placebo) with similar taste but no antiseptic properties. Resting metabolic rate (RMR) was measured by indirect calorimetry and 24 h ambulatory blood pressure recordings were obtained after each intervention together with blood, saliva and urine samples. Treatment with chlorhexidine-containing mouthwash effectively reduced oral conversion of nitrate to nitrite but had no effect on plasma levels of these anions or plasma cGMP. RMR and 24 h ambulatory blood pressure were unaffected by the intervention. We conclude that in young healthy females an antiseptic mouthwash was effective in disrupting oral bacterial nitrate conversion to nitrite, but this was not associated with changes in plasma nitrite, RMR or blood pressure., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Oral mucositis manifests as erythematous and ulcerative lesions of the oral mucosa. Among its various causes, cancer treatment (e.g., chemotherapy with or without radiation therapy) is one of the more well known. It has been widely mentioned that oxidative stress parameters such as lipid peroxidation levels increase during the cancer process. Glutathione is one of the major intracellular enzymes used to detoxify oxidant molecules; it exists in both a reduced and oxidized state. Reduced glutathione is used as a substrate to synthesize glutathione peroxidase. We conducted a study to investigate and compare the effects of triamcinolone (a synthetic steroid) and chlorhexidine (a chemical antiseptic) on 5-fluorouracil (5-FU; a chemotherapeutic agent)-induced oral mucositis in the buccal mucosa of 36 rats. Oral mucositis was induced through a combination of 5-FU treatment and mild abrasion of the cheek pouch with a wire brush. The rats were treated with one of four regimens: saline placebo (group I), 5-FU only (group II), 5-FU plus triamcinolone (group III), and 5-FU plus chlorhexidine (group IV). Three rats in the triamcinolone group died of unknown causes on days 7 and 8, and 3 rats in the chlorhexidine group died on days 7 and 9. On day 9, the remaining 30 rats were sacrificed and examined. Buccal mucosa lipid peroxidation levels were significantly higher in the 5-FU-only group than in the control group and significantly higher in the control group than in the triamcinolone group (p < 0.05 for both). Levels of reduced glutathione were significantly lower in the 5-FU-only group than in both the triamcinolone group and the chlorhexidine group (p < 0.05). Glutathione peroxidase activity was significantly higher in the triamcinolone group than in the 5-FU-only group (p < 0.01). Histopathologic analysis revealed that treatment with triamcinolone significantly reduced 5-FU-induced inflammatory cell infiltration and ulceration (p < 0.001); no such reduction was seen with chlorhexidine. In conclusion, we observed that triamcinolone and chlorhexidine treatment modulated chemotherapy-induced oxidative injury in rat oral mucositis. However, only triamcinolone histopathologically ameliorated 5-FU-induced oral mucositis. These findings suggest that triamcinolone is a useful agent for the management of experimental oxidative injury and oral mucositis caused by 5-FU chemotherapy.

Streptococcus mutans in dental plaque biofilms play a role in caries development. The biofilm's complex structure enhances the resistance to antimicrobial agents by limiting the transport of active agents inside the biofilm. The authors assessed the ability of high-velocity water microsprays to enhance delivery of antimicrobials into 3-d-old S. mutans biofilms. Biofilms were exposed to a 90° or 30° impact, first using a 1-µm tracer bead solution (10 9 beads/mL) and, second, a 0.2% chlorhexidine (CHX) or 0.085% cetylpyridinium chloride (CPC) solution. For comparison, a 30-s diffusive transport and simulated mouthwash were also performed. Confocal microscopy was used to determine number and relative bead penetration depth into the biofilm. Assessment of antimicrobial penetration was determined by calculating the killing depth detected by live/dead viability staining. The authors first demonstrated that the microspray was able to deliver significantly more microbeads deeper in the biofilm compared with diffusion and mouthwashing exposures. Next, these experiments revealed that the microspray yielded better antimicrobial penetration evidenced by deeper killing inside the biofilm and a wider killing zone around the zone of clearance than diffusion alone. Interestingly the 30° impact in the distal position delivered approximately 16 times more microbeads and yielded approximately 20% more bacteria killing (for both CHX and CPC) than the 90° impact. These data suggest that high-velocity water microsprays can be used as an effective mechanism to deliver microparticles and antimicrobials inside S. mutans biofilms. High shear stresses generated at the biofilm-burst interface might have enhanced bead and antimicrobial delivery inside the remaining biofilm by combining forced advection into the biofilm matrix and physical restructuring of the biofilm itself. Further, the impact angle has potential to be optimized both for biofilm removal and active agents' delivery inside biofilm in those protected areas where some biofilm might remain., (© International & American Associations for Dental Research 2016.)

Purpose: To study the reactivity of lipopolysaccharide (LPS) and lipoteichoic acid (LTA) with the cationically charged agents cetylpyridinium chloride, stannous fluoride, and the non-cationic agent triclosan. We also assessed the effect of these agents to inhibit LPS and LTA binding to cellular Toll-like Receptors (TLRs) in vitro., Methods: The ability of these antimicrobials to bind with LPS and/or LTA was assessed in both the Limulus amebocyte lysate and BODIPY-TR-cadaverine dye assays. Mass spectroscopy was then used to confirm that stannous fluoride directly binds with LPS and to determine stoichiometry. Lastly, we looked for possible inhibitory effects of these antimicrobial agents on the ability of fluorescently conjugated LPS to bind to TLR4 expressed on HEK 293 cells., Results: Cetylpyridinium chloride (CPC) and stannous salts including stannous fluoride interfered with LPS and LTA reactivity in both dye assays, while triclosan had no effect. Mass spectroscopy revealed direct binding of stannous fluoride with E. Coli LPS at 1:1 stoichiometric ratios. In the cellular assay, cetylpyridinium chloride and stannous fluoride, but not triclosan, inhibited LPS binding to TLR4., Clinical Significance: These results support a potential mechanism of action for stannous fluoride and CPC formulated in oral products in which these ingredients bind bacterial toxins and potentially render them less toxic to the host. These results may influence home care recommendations for patients at risk for plaque-related diseases., Competing Interests: All authors are employees of Procter $ Gamble Co.

The nitric oxide (NO • ) metabolites nitrite and nitrate exert antihypertensive effects by mechanisms that involve gastric formation of S-nitrosothiols. However, while the use of antiseptic mouthwash (AM) is known to attenuate the responses to nitrate by disrupting its enterosalivary cycle, there is little information about whether AM attenuates the effects of orally administered nitrite. We hypothesized that the antihypertensive effects of orally administered nitrite would not be prevented by AM because, in contrast to oral nitrate, oral nitrite could promote S-nitrosothiols formation in the stomach without intereference by AM. Chronic effects of oral nitrite or nitrate were studied in two-kidney, one-clip (2K1C) hypertensive rats (and normotensive controls) treated with AM (or vehicle) once/day. We found that orally administered nitrite exerts antihypertensive effects that were not affected by AM. This finding contrasts with lack of antihypertensive responses to oral nitrate in 2K1C hypertensive rats treated with AM. Nitrite and nitrate treatments increased plasma nitrites, nitrates, and S-nitrosothiols concentrations. However, while treatment with AM attenuated the increases in plasma nitrite concentrations after both nitrite and nitrate treatments, AM attenuated the increases in S-nitrosothiols in nitrate-treated rats, but not in nitrite-treated rats. Moreover, AM attenuated vascular S-nitrosylation (detected by the SNO-RAC method) after nitrate, but not after nitrite treatment. Significant correlations were found between the hypotensive responses and S-nitrosothiols, and vascular S-nitrosylation levels. These results show for the first time that oral nitrite exerts antihypertensive effects notwithstanding the fact that antiseptic mouthwash disrupts the enterosalivary circulation of nitrate. Our results support a major role for S-nitrosothiols formation resulting in vascular S-nitrosylation as a key mechanism for the antihypertensive effects of both oral nitrite and nitrate., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Aims: This study demonstrates the development of a mouthwash formulation containing the imidazolium salt (IMS) 1-n-hexadecyl-3-methylimidazolium chloride (C 16 MImCl), considering its stability and efficacy against Candida sp. Biofilm formation., Methods and Results: A variety of in vitro test methods were applied, assessing contaminated acrylic resin strip specimens before and after applying the mouthwash formulations. The formulation using C 16 MImCl presented a similar antibiofilm activity to cetylpyridinium chloride one and a commercial mouthwash, but at a 10 times lower concentration. Scanning electron microscopy imaging demonstrated that the selected mouthwash preparation fully destroys the biofilm cells, while with the hypoallergenicity test no irritant effect was observed in ex vivo model., Conclusions: The results presented herein indicate a high potential for imidazolium salts application as mouthwash agents that can eliminate Candida biofilm growth at very low concentrations., Significance and Impact of the Study: This study demonstrates a new and effective antibiofilm formulation containing the IMS C 16 MImCl. These findings suggest the IMS' use as mouthwash formulations active ingredient against Candida biofilms on oral surfaces, as it outperforms the often used cetylpyridinium chloride at a 10 times lower concentration., (© 2016 The Society for Applied Microbiology.)