Phenol 1.2% / Chlorhexidine gluconate 0.25% spray

AIM: To evaluate the effectiveness of cetylpyridinium chloride (CPC) and chlorhexidine (CHX) mouthwashes (MW) on plaque and gingivitis scores for patients with gingivitis, in brushing as well as non-brushing situations. METHODS: A comprehensive search of MEDLINE-PubMed and Cochrane-CENTRAL was conducted to identify clinical and randomised controlled trials comparing CPC and CHX mouthwashes on plaque and gingivitis scores. The staining index was evaluated as a secondary outcome. In addition, the risk of bias was assessed. The data was summarised using a descriptive approach, and whenever possible, a meta-analysis was conducted. The results for brushing and non-brushing studies were presented separately. Grading was applied using the GRADE approach to rate the certainty of evidence. RESULTS: The search resulted in 424 unique papers, from which 14 full-text papers providing 18 comparisons were selected. Different concentrations of CPC-MW (0.1%, 0.075%, 0.05%) and CHX-MW (0.2%, 0.12%) were used. The risk of bias was estimated to be low, moderate or high for each study. A meta-analysis for non-brushing models showed a significant favour for CHX-MW in plaque index scores (0.55 [95% CI: 0.19; 0.91], p = 0.003). For brushing, no significant differences were found between CPC-MW and CHX-MW. The descriptive analysis supports these findings. CHX-MW tends to stain more than CPC-MW. CONCLUSION: There is moderate certainty for a small statistically significant favourable effect of CHX-MW over CPC-MW for plaque control in non-brushing situations, but no difference between them for plaque and gingivitis prevention in brushing situations.

Abstract licence: CC BY

Background and Aims: Antiseptics have been widely used in periodontology and implantology as an adjunct to mechanical plaque control. The main objective of this review was to summarize the best evidence for the use of antiseptics in the prevention and treatment of periodontal and peri-implant diseases. Methods: A comprehensive literature search was conducted across multiple databases, including Scopus, PubMed/Medline, Web of Science, and ScienceDirect. Keywords such as (Antiseptics OR mouthwashes) AND (gingivitis OR periodontitis OR peri-implantitis OR mucositis) were used. Inclusion criteria included narrative or systematic reviews with or without meta-analysis and clinical studies. In vitro, animal studies, and case reports were excluded. Results: Antiseptics, including chlorhexidine, essential oils, and povidone-iodine, proved effective in reducing gingival inflammation and improving the plaque index. Other molecules, such as octenidine dihydrochloride, showed some effectiveness, although further studies are needed to expand their use. Conclusion: Antiseptics play a crucial role in improving periodontal health. Prescriptions should be tailored to therapeutic goals to ensure appropriate dosage and duration, while avoiding excessive use.

Abstract licence: CC BY-NC-ND

Abstract Introduction: Endodontic retreatment cases are complicated by persistent biofilm-forming pathogens such as Enterococcus faecalis , as well as remnants of prior obturation material. Intracanal medicaments (ICMs), especially calcium hydroxide (Ca[OH] 2 ), play a vital role in improving treatment outcomes through effective disinfection. This systematic review aims to assess the efficacy of Ca(OH) 2 in reducing postoperative pain, microbial load, and flare-ups in retreatment cases. Materials and Methods: A comprehensive search strategy was conducted using four electronic databases (PubMed/MEDLINE, Scopus, Web of Science, and Cochrane Library) to identify clinical studies from January 2005 to August 2024. Inclusion criteria focused on randomized controlled trials evaluating Ca(OH) 2 alone or in combination with other medicaments or adjuncts. Risk of bias (RoB) was assessed using the Cochrane RoB 2.0 tool. Results: Six studies involving 430 participants were included. Four assessed postoperative pain using various scales (VAS, Numeric Rating Scale, and Verbal Rating Scale), two evaluated flare-ups, one assessed bacterial reduction, and another measured inflammatory markers. Ca(OH) 2 combined with chlorhexidine (CHX) or in nanoformulations yielded improved pain control and fewer flare-ups compared to Ca(OH) 2 alone. Four studies showed low RoB, while two had moderate risk. Conclusion: Ca(OH) 2 remains a valuable ICM in endodontic retreatment. Its efficacy is enhanced when used with adjuncts such as CHX or in nanoformulations. However, the evidence is limited by heterogeneity in outcome measures and sample sizes. Further standardized, high-powered trials are warranted.

Abstract licence: CC BY-NC-SA

Chlorhexidine (CHX) is the most commonly used mouthwash with proven antiplaque and antibacterial activity. The aim is to evaluate the effect of vitamin C (VitC) in CHX mouthwash on plaque accumulation and gingivitis, and to compare it with CHX alone mouthwash and antiseptic phenol-containing mouthwashes. This study conducted as a multicenter, randomized, controlled, double-blind, parallel design clinical study. Sixty patients were included, randomly divided into three groups. 1. Antiseptic phenol agent (P, Phenol), 2. Antiseptic bisbiguanide agent CHX-only (CHX) and 3. Antiseptic bisbiguanide agent CHX + VitC mouthwash (CHX + VitC). The study assessed oral hygiene and periodontal health status, followed by scaling and root planning (SRP) and subsequent polishing. After using the mouthwash for 60 s twice daily along 14 days, patients recalled for evaluation of plaque index (PI), gingival index (GI), bleeding on probing (BOP) and staining. One-way analysis of variance (ANOVA) was used to compare the differences formed between groups and Tukey multiple comparison analysis was used to determine groups that showed the differences. Statistical significance was determined using a p-value threshold of 0.05. There were no significant differences between the groups regarding baseline PI, GI and BOP (p > 0.05). Changes at 14th day in PI, GI and BOP in all groups were similar and no significant differences were observed (p > 0.05). Regarding 'all surfaces', staining density of two mouthwashes containing CHX was significantly higher than that of P mouthwash. CHX, CHX + VitC, and P mouthwashes appeared to exhibit comparable effects as oral hygiene adjuncts to periodontal mechanical treatment, with the exception of staining, which was more noticeable in the CHX groups compared to the P group. Adding vitamin C did not enhance the effects of CHx alone.

Abstract licence: CC BY-NC-ND

Background: Ventilator-associated pneumonia (VAP) is a major cause of infection in patients, and reducing oral cavity contamination can lower mortality rates due to VAP. This study evaluates the effects of the combined administration of three medications, colistin, chlorhexidine, and tobramycin, on the prevention of VAP. Materials and Methods: This double-blind randomized clinical trial was conducted on 96 patients connected to ventilators and admitted to the intensive care unit of Al-Zahra Hospital in Isfahan. The patients were randomly divided into three groups of 32. Over five days, they received “Colistin + Chlorhexidine,” “Tobramycin + Chlorhexidine,” and “Chlorhexidine-alone” four times daily. The Clinical Pulmonary Infection Score (CPIS), patients’ oral hygiene using the Beck Oral Assessment Scale (BOAS), and positive or negative results of oral and tracheal cultures were evaluated before and after the intervention. Results: The results of the present study showed that the CPIS score in the chlorhexidine + colistin group, with the mean of 7.23 ± 1.87, was significantly lower than the chlorhexidine + tobramycin group and the chlorhexidine-alone group, with the means of 12.32 ± 2.67 and 14.05 ± 1.10, respectively ( P = .038). Additionally, the BOAS score in the chlorhexidine + colistin group, with the mean of 3.04 ± 1.02, was significantly lower than the chlorhexidine + tobramycin group and the chlorhexidine-alone group, with the means of 6.25 ± 2.00 and 7.06 ± 2.35, respectively ( P = .042). Conclusion: Preventive and hygienic oral care is an effective factor in reducing VAP. There was no significant difference among the three treatment combinations in reducing the incidence of VAP. However, it appears that adding colistin may have a slightly better performance in preventing lung infections and inhibiting bacterial agents.

Abstract licence: CC BY-NC-SA

BACKGROUND: Native bees of the tribe Meliponini produce a distinct kind of propolis called geopropolis. Although many pharmacological activities of propolis have already been demonstrated, little is known about geopropolis, particularly regarding its antimicrobial activity against oral pathogens. The present study aimed at investigating the antimicrobial activity of M. fasciculata geopropolis against oral pathogens, its effects on S. mutans biofilms, and the chemical contents of the extracts. A gel prepared with a geopropolis extract was also analyzed for its activity on S. mutans and its immunotoxicological potential. METHODS: Antimicrobial activities of three hydroalcoholic extracts (HAEs) of geopropolis, and hexane and chloroform fractions of one extract, were evaluated using the agar diffusion method and the broth dilution technique. Ethanol (70%, v/v) and chlorhexidine (0.12%, w/w) were used as negative and positive controls, respectively. Total phenol and flavonoid concentrations were assayed by spectrophotometry. Immunotoxicity was evaluated in mice by topical application in the oral cavity followed by quantification of biochemical and immunological parameters, and macro-microscopic analysis of animal organs. RESULTS: Two extracts, HAE-2 and HAE-3, showed inhibition zones ranging from 9 to 13 mm in diameter for S. mutans and C. albicans, but presented no activity against L. acidophilus. The MBCs for HAE-2 and HAE-3 against S. mutans were 6.25 mg/mL and 12.5 mg/mL, respectively. HAE-2 was fractionated, and its chloroform fraction had an MBC of 14.57 mg/mL. HAE-2 also exhibited bactericidal effects on S. mutans biofilms after 3 h of treatment. Significant differences (p < 0.05) in total phenol and flavonoid concentrations were observed among the samples. Signs toxic effects were not observed after application of the geopropolis-based gel, but an increase in the production of IL-4 and IL-10, anti-inflammatory cytokines, was detected. CONCLUSIONS: In summary, geopropolis produced by M. fasciculata can exert antimicrobial action against S. mutans and C. albicans, with significant inhibitory activity against S. mutans biofilms. The extract with the highest flavonoid concentration, HAE-2, presented the highest antimicrobial activity. In addition, a geopropolis-based gel is not toxic in an animal model and displays anti-inflammatory effect.

Abstract licence: CC BY

Background In adhesive dentistry, creating a long-lasting bond between resin composite and dentin is crucial. The durability of this bond dramatically depends on the structural integrity of collagen fibrils present in the hybrid layer. However, matrix metalloproteinases (MMPs) can degrade collagen fibrils, compromising the bond's longevity. Aim The objective is to evaluate the potential effectiveness of natural extracts from Moringa and Centella in preventing collagen degradation caused by MMPs. Material and methods The phenol and flavonoid content of the extracts were evaluated. Dentin beams were demineralized and pre-treated with 1% or 5% Moringa, 1% or 5% Centella, or 2% chlorhexidine (CHX) (five minutes), with untreated beams as control. Beams were incubated in calcium- and zinc-containing media (CM) at pH 7.2 and 37°C for one, 10, 20, and 30 days, and C-terminal cross-linked telopeptide of type I collagen (ICTP) release (collagen telopeptide) was assessed using an enzyme-linked immunosorbent assay (ELISA) kit after 30 days. Results Data were analyzed with a one-way analysis of variance (ANOVA). All test groups showed a different dry mass loss. The control group had the highest loss, followed by CHX, with the least loss in the 5% Moringa and Centella groups. ICTP release ranged from 1.781 ± 0.319 to 3.146 ± 0.684, with 5% Moringa showing the most negligible release. Conclusion The group that received 5% Moringa exhibited the most effective reduction in collagen degradation compared to all the other groups.

Abstract licence: CC BY

The rise of antibiotic-resistant bacteria has become an alarming global health challenge. Disinfectants, such as alcohols, aldehydes, chlorine compounds, phenols, quaternary ammonium compounds (QACs), peroxides, and chlorhexidine, are widely used in healthcare settings as a critical line of defense against infection. Nevertheless, their overuse or misuse, especially at subinhibitory concentrations, can promote the emergence of bacterial resistance, potentially leading to cross-resistance to antibiotics. Several mechanisms, including efflux pump activation, alterations in membrane permeability, and biofilm formation, drive this process. A possible concern, although currently supported by limited and sometimes conflicting evidence-is that biocide-induced resistance might contribute indirectly to adverse clinical outcomes, such as treatment challenges, prolonged hospital stays, and increased healthcare costs. This review examines the molecular mechanisms of disinfectant-induced resistance, the epidemiological impact of multidrug-resistant (MDR) pathogens, and contemporary infection control strategies. Furthermore, the review evaluates the benefits and risks associated with disinfectant use, underscoring the necessity for optimized, evidence-based disinfection protocols to minimize the development of resistance while ensuring effective infection prevention.

Abstract licence: CC BY-NC-ND