A randomized, controlled clinical trial on the clinical, microbiological, and staining effects of a novel 0.05% chlorhexidine/herbal extract and a 0.1% chlorhexidine mouthrinse adjunct to periodontal surgery

Journal of Clinical Periodontology

Volumn 37, Issue 11, 2010, Pages 988-997

  Duss, Christof ^a   Lang, Niklaus P ^a,b   Cosyn, Jan ^c   Persson, G Rutger ^a,d,e  

^a UNIVERSITY OF BERN   (Switzerland)

^b UNIVERSITY OF HONG KONG   (Hong Kong)

^c GHENT UNIVERSITY   (Belgium)

^d UNIVERSITY OF WASHINGTON   (United States)

^e KRISTIANSTAD UNIVERSITY   (Sweden)

Author keywords

chlorhexidine; gingivitis; herbal extract; microbiota; periodontal surgery; plaque; prevention; staining

Indexed keywords

BACTERIAL DNA; CHLORHEXIDINE; CHLORHEXIDINE GLUCONATE; DRUG DERIVATIVE; FLUORIDE SODIUM; MOUTHWASH; MYRRH OIL; PEPPERMINT OIL; PLANT MEDICINAL PRODUCT; TERPENE; TOPICAL ANTIINFECTIVE AGENT; VEGETABLE OIL;

ADULT; AGED; ARTICLE; BACTERIAL COUNT; BACTERIAL LOAD; CHEMICALLY INDUCED DISORDER; CHEMISTRY; CHRONIC PERIODONTITIS; CLINICAL TRIAL; CONTROLLED CLINICAL TRIAL; CONTROLLED STUDY; DOUBLE BLIND PROCEDURE; DRUG COMBINATION; DRUG EFFECT; FEMALE; HUMAN; MALE; MICROBIOLOGY; MIDDLE AGED; NONPARAMETRIC TEST; PERIODONTAL DEBRIDEMENT; PHYTOTHERAPY; RANDOMIZED CONTROLLED TRIAL; RISK; SALVIA; STATISTICAL MODEL; TOOTH DISCOLORATION; TOOTH PLAQUE;

ADULT; AGED; ANTI-INFECTIVE AGENTS, LOCAL; BACTERIAL LOAD; CHLORHEXIDINE; CHRONIC PERIODONTITIS; COLONY COUNT, MICROBIAL; DENTAL PLAQUE; DNA, BACTERIAL; DOUBLE-BLIND METHOD; DRUG COMBINATIONS; FEMALE; HUMANS; LOGISTIC MODELS; MALE; MIDDLE AGED; MOUTHWASHES; ODDS RATIO; PERIODONTAL DEBRIDEMENT; PHYTOTHERAPY; PLANT OILS; PLANT PREPARATIONS; SALVIA; SODIUM FLUORIDE; STATISTICS, NONPARAMETRIC; TERPENES; TOOTH DISCOLORATION;

EID: 78449264166     PISSN: 03036979     EISSN: 1600051X     Source Type: Journal    
DOI: 10.1111/j.1600-051X.2010.01609.x     Document Type: Article

References (84)

1. Addy, J. S., &, Wade, W., (1988) The mechanism of action of chlorhexidine. Journal of Clinical Periodontology 15, 415 - 424.
2. Albandar, J. M., Gjermo, P., &, Preus, H. R., (1994) Chlorhexidine use after two decades of over-the-counter availability. Journal of Periodontology 65, 109 - 112.
3. Al-Tannir, M. A., &, Goodman, H. S., (1994) A review of chlorhexidine and its use in special populations. Special Care in Dentistry 14, 116 - 122.
4. Arweiler, N. B., Boehnke, N., Sculean, A., Hellwig, E., &, Auschill, T. M., (2006) Differences in efficacy of two commercial 0.2% chlorhexidine mouthrinse solutions: a 4-day plaque re-growth study. Journal of Clinical Periodontology 33, 334 - 339.
5. Attia, M. L., Aguiar, F. H., Mathias, P., Ambrosano, G. M., Fontes, C. M., &, Liporoni, P. C., (2009) The effect of coffee solution on tooth color during home bleaching applications. American Journal of Dentistry 22, 175 - 179.
6. Axelsson, P., &, Lindhe, J., (1987) Efficacy of mouthrinses in inhibiting dental plaque and gingivitis in man. Journal of Clinical Periodontology 14, 205 - 212.
7. Axelsson, P., Nyström, B., &, Lindhe, J., (2004) The long-term effect of a plaque control program on tooth mortality, caries and periodontal disease in adults. Results after 30 years of maintenance. Journal of Clinical Periodontology 31, 749 - 757.
8. Berger, S. B., Coelho, A. S., Oliveira, V. A., Cavalli, V., &, Giannini, M., (2008) Enamel susceptibility to red wine staining after 35% hydrogen peroxide bleaching. Journal of Applied Oral Science 16, 201 - 204.
9. Braatz, L., Garrett, S., Claffey, N., &, Egelberg, J., (1985) Antimicrobial irrigation of deep pockets to supplement non-surgical periodontal therapy. II. Daily irrigation. Journal of Clinical Periodontology 12, 630 - 638.
10. Carlen, A., Olsson, J., &, Ramberg, P., (1996) Saliva mediated adherence, aggregation and prevalence in dental plaque of Streptococcus mutans, Streptococcus sanguis and Actinomyces spp, in young and elderly humans. Archives of Oral Biology 41, 1133 - 1140.
11. Carlson, R. V., Boyd, K. M., &, Webb, D. J., (2004) The revision of the Declaration of Helsinki: past, present and future. British Journal of Clinical Pharmacology 57, 695 - 713.
12. Charles, C. H., Mostler, K. M., Bartels, L. L., &, Mankodi, S. M., (2004) Comparative antiplaque and antigingivitis effectiveness of a chlorhexidine and an essential oil mouthrinse: 6-month clinical trial. Journal of Clinical Periodontology 31, 878 - 884.
13. Christie, P., Claffey, N., &, Renvert, S., (1998) The use of 0.2% chlorhexidine in the absence of a structured mechanical regimen of oral hygiene following the non-surgical treatment of periodontitis. Journal of Clinical Periodontology 25, 15 - 23.
14. Climo, M. W., Sepkowitz, K. A., Zuccotti, G., Fraser, V. J., Warren, D. K., Perl, T. M., Speck, K., Jernigan, J. A., Robles, J. R., &, Wong, E. S., (2009) The effect of daily bathing with chlorhexidine on the acquisition of methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and healthcare-associated bloodstream infections: results of a quasi-experimental multicenter trial. Critical Care Medicine 37, 1858 - 1865.
15. Cortellini, P., Labriola, A., Zambelli, R., Prato, G. P., Nieri, M., &, Tonetti, M. S., (2008) Chlorhexidine with an anti discoloration system after periodontal flap surgery: a cross-over, randomized, triple-blind clinical trial. Journal of Clinical Periodontology 35, 614 - 620.
16. Costerton, J. W., Stewart, P. S., &, Greenberg, E. P., (1999) Bacterial biofilms: a common cause of persistent infections. Science 284, 1318 - 1322.
17. Cosyn, J., &, Wyn, I. A., (2006) A systematic review on the effects of the chlorhexidine chip when used as an adjunct to scaling and root planing in the treatment of chronic periodontitis. Journal of Periodontology 77, 257 - 264.
18. Davies, R. M., Schiott, C. R., &, Löe, H., (1973) Streptococci isolated from plaque in subjects rinsing with chlorhexidine. Archives of Oral Biology 18, 297 - 299.
19. De Soete, M., Mongardini, C., Peuwels, M., Haffajee, A., Socransky, S., Van Steenberghe, D., &, Quirynen, M., (2001) One-stage full-mouth disinfection. Long-term microbiological results analyzed by checkerboard DNA-DNA hybridization. Journal of Periodontology 72, 374 - 382.
20. Egelberg, J., (1965) Local effect of diet on plaque formation and development of gingivitis in dogs. Effect of hard and soft diets. Odontologisk Revy 6, 31 - 41.
21. Falagas, M. E., Kapaskelis, A. M., Kouranos, V. D., Kakisi, O. K., Athanassa, Z., &, Karageorgopoulos, D. E., (2009) Outcome of antimicrobial therapy in documented biofilm-associated infections: a review of the available clinical evidence. Drugs 69, 1351 - 1361.
22. Feres, M., Figueiredo, L. C., Barreto, I. M., Coelho, M. H., Araujo, M. W., &, Cortelli, S. C., (2005) In vitro antimicrobial activity of plant extracts and propolis in saliva samples of healthy and periodontally-involved subjects. Journal of International Academy of Periodontology 7, 90 - 96.
23. Ferretti, G. A., Ash, R. C., Brown, A. T., Parr, M. D., Romond, E. H., &, Lillich, T. T., (1988) Control of oral mucositis and candidiasis in marrow transplantation: a prospective, double-blind trial of chlorhexidine digluconate oral rinse. Bone Marrow Transplant 3, 483 - 493.
24. Fickl, S., Thalmair, T., Kebschull, M., Böhm, S., &, Wachtel, H., (2009) Microsurgical access flap in conjunction with enamel matrix derivative for the treatment of intra-bony defects: a controlled clinical trial. Journal of Clinical Periodontology 36, 784 - 790.
25. Flötra, L., Gjermo, P., Rölla, G., &, Waerhaug, J., (1972) A 4-month study on the effect of chlorhexidine mouth washes on 50 soldiers. Scandinavian Journal of Dental Research 80, 10 - 17.
26. Fürst, M. M., Salvi, G. E., Lang, N. P., &, Persson, G. R., (2007) Bacterial colonization immediately after installation on oral titanium implants. Clinical Oral Implants Research 18, 501 - 508.
27. García-Godoy, F., &, Ellacuria, J., (2002) Effectiveness of Sonicare power toothbrush to remove chlorhexidine stains. American Journal of Dentistry 15, 290 - 302.
28. Gunay, H., Dmoch-Bockhorn, K., Gunay, Y., &, Geurtsen, W., (1998) Effect on caries experience of a long-term preventive program for mothers and children starting during pregnancy. Clinical Oral Investigations 2, 137 - 142.
29. Gürgan, C. A., Zaim, E., Bakirsoy, I., &, Soykan, E., (2006) Short-term side effects of 0.2% alcohol-free chlorhexidine mouthrinse used as an adjunct to non-surgical periodontal treatment: a double-blind clinical study. Journal of Periodontology 77, 370 - 84.
30. Gursoy, U. K., Gursoy, M., Gursoy, O. V., Cakmakci, L., Könönen, E., &, Uitto, V. J., (2009) Anti-biofilm properties of Satureja hortensis L. essential oil against periodontal pathogens. Anaerobe 15, 164 - 167.
31. Haffajee, A. D., Socransky, S. S., Patel, M. R., &, Song, X., (2008) Microbial complexes in supragingival plaque. Oral Microbiology and Immunology 23, 196 - 205.
32. Hall, D. L., (2003) Methicillin-resistant Staphylococcus aureus and infection control for restorative dental treatment in nursing homes. Special Care in Dentistry 23, 100 - 107.
33. Hall-Stoodley, L., Costerton, J. W., &, Stoodley, P., (2004) Bacterial biofilms: from the natural environment to infectious diseases. Nature Reviews of Microbiology 2, 95 - 108.
34. Heitz-Mayfield, L. J., Trombelli, L., Heitz, F., Needleman, I., &, Moles, D., (2002) A systematic review of the effect of surgical debridement vs non-surgical debridement for the treatment of chronic periodontitis. Journal of Clinical Periodontology 29 (Suppl. 3), 92 - 102.
35. Ioannou, I., Dimitriadis, N., Papadimitriou, K., Sakellari, D., Vouros, I., &, Konstantinidis, A., (2009) Hand instrumentation versus ultrasonic debridement in the treatment of chronic periodontitis: a randomized clinical and microbiological trial. Journal of Clinical Periodontology 36, 132 - 141.
36. Jarvinen, H., Pienihakkinen, K., Huovinen, P., &, Tenovuo, J., (1995) Susceptibility of Streptococcus mutans and Streptococcus sobrinus to antimicrobial agents after short-term oral chlorhexidine treatments. European Journal of Oral Sciences 103, 32 - 35.
37. Jenkins, S., Addy, M., Wade, W., &, Newcombe, R. G., (1994) The magnitude and duration of the effects of some mouthrinse products on salivary bacterial counts. Journal of Clinical Periodontology 21, 397 - 401.
38. Johansen, J. R., Gjermo, P., &, Eriksen, H. M., (1975) Effect of 2-years' use of chlorhexidine-containing dentifrices on plaque, gingivitis, and caries. Scandinavian Journal of Dental Research 83, 288 - 292.
39. Kim, T. S., Schenk, A., Lungeanu, D., Reitmeir, P., &, Eickholz, P., (2007) Nonsurgical and surgical periodontal therapy in single-rooted teeth. Clinical Oral Investigations 11, 391 - 399.
40. Kroes, I., Lepp, P. W., &, Relman, D. A., (1999) Bacterial diversity within the human subgingival crevice. Proceedings of the National Academy of Sciences of the United States of America 96, 14547 - 14552.
41. Lang, N. P., Catalanotto, F. A., Knöpfli R, U., &, Antczak, A. A., (1988) Quality-specific taste impairment following the application of chlorhexidine digluconate mouthrinses. Journal of Clinical Periodontology 15, 43 - 48.
42. Lang, N. P., Hotz, P., Graf, H., Geering, A. H., Saxer, U. P., Sturzenberger, O. P., &, Meckel, A. H., (1982) Effects of supervised chlorhexidine mouthrinses in children. A longitudinal clinical trial. Journal of Periodontal Research 17, 101 - 111.
43. Lang, N. P., &, Räber, K., (1981) Use of oral irrigators as vehicle for the application of antimicrobial agents in chemical plaque control. Journal of Clinical Periodontology 8, 177 - 188.
44. Lang, N. P., &, Ramseier-Grossmann, K., (1981) Optimal dosage of chlorhexidine digluconate in chemical plaque control when applied by the oral irrigator. Journal of Clinical Periodontology 8, 189 - 202.
45. Leard, A., &, Addy, M., (1997) The propensity of different brands of tea and coffee to cause staining associated with chlorhexidine. Journal of Clinical Periodontology 24, 115 - 118.
46. Lee, J. W., Ji, Y. J., Lee, S. O., &, Lee, I. S., (2007) Effect of Saliva miltiorrhiza bunge on antimicrobial activity and resistant gene regulation against methicillin-resistant Staphylococcus aureus (MRSA). Journal of Microbiology 45, 350 - 357.
47. Levy, R. M., Giannobile, W. V., Feres, M., Haffajee, A. D., Smith, C., &, Socransky, S. S., (2002) The effect of apically repositioned flap surgery on clinical parameters and the composition of the subgingival microbiota: 12-month data. International Journal of Periodontics and Restorative Dentistry 22, 209 - 219.
48. Lobene, R. R., (1968) Effects of dentifrices on tooth stains with controlled brushing. Journal of the American Dental Association 77, 849 - 855.
49. Löe, H., (1973) Does chlorhexidine have a place in the prophylaxis of dental diseases? Journal of Periodontal Research 12 (Suppl.), 93 - 99.
50. Löe, H., Schiött, C. R., Karring, G., &, Karring, T., (1976) Two years oral use of chlorhexidine in man. I. General design and clinical effects. Journal of Periodontal Research 11, 135 - 44.
51. McCoy, L. C., Wehler, C. J., Rich, S. E., Garcia, R. I., Miller, D. R., &, Jones, J. A., (2008) Adverse events associated with chlorhexidine use: results from the Department of Veterans Affairs Dental Diabetes Study. Journal of American Dental Association 139, 178 - 283.
52. Moran, J., Addy, M., Wade, W. G., Maynard, J. H., Roberts, S. E., Aström, M., &, Movert, R., (1992) A comparison of delmopinol and chlorhexidine on plaque regrowth over a 4-day period and salivary bacterial counts. Journal of Clinical Periodontology 19, 749 - 753.
53. Noiri, Y., Okami, Y., Narimatsu, M., Takahashi, Y., Kawahara, T., &, Ebisu, S., (2003) Effects of chlorhexidine, minocycline, and metronidazole on Porphyromonas gingivalis strain 381 in biofilms. Journal of Periodontology 74, 1647 - 1651.
54. Nomura, Y., Takeuchi, H., Kaneko, N., Matin, K., Iguchi, R., Toyoshima, Y., Kono, Y., Ikemi, T., Imai, S., Nishizawa, T., Fukushima, K., &, Hanada, N., (2004) Feasibility of eradication of mutans streptococci from oral cavities. Journal of Oral Sciences 46, 179 - 183.
55. Newman, M. G., Sanz, M., Nachnani, S., Saltini, C., &, Anderson, L., (1989) Effect of 0.12% chlorhexidine on bacterial recolonization following periodontal surgery. Journal of Periodontology 60, 577 - 581.
56. Osborn, J. B., Stoltenberg, J. L., Huso, B. A., Aeppli, D. M., &, Pihlstrom, B.L, (1992) Comparison of measurement variability in subjects with moderate periodontitis using a conventional and constant force periodontal probe. Journal of Periodontology 63, 283 - 289.
57. Papapanou, P. N., Behle, J. H., Kebschull, M., Celenti, R., Wolf, D. L., Handfield, M., Pavlidis, P., &, Demmer, R. T., (2009) Subgingival bacterial colonization profiles correlate with gingival tissue gene expression. Biomedical Central Microbiology 18, 221.
58. Paster, B. J., Olsen, I., Aas, J. A., &, Dewhirst, F. E., (2006) The breadth of bacterial diversity in the human periodontal pocket and other oral sites. Periodontology 2000 42, 80 - 87.
59. Persson, G. R., Weibel, M., Hirschi, R., &, Katsoulis, J., (2008) Similarities in the subgingival microbiota assessed by a curet sampling method at sites with chronic periodontitis. Journal of Periodontology 79, 2290 - 2296.
60. Persson, G. R., Yeates, J., Persson, R. E., Hirschi-Imfeld, R., Weibel, M., &, Kiyak, H. A., (2007) The impact of a low-frequency chlorhexidine rinsing schedule on the subgingival microbiota (the TEETH clinical trial). Journal of Periodontology 78, 1751 - 1758.
61. Persson, R. E., Truelove, E. L., LeResche, L., &, Robinovitch, M. R., (1991) Therapeutic effects of daily or weekly chlorhexidine rinsing on oral health of a geriatric population. Oral Surgery, Oral Medicine, Oral Pathology Oral radiology and Endodontics 72, 184 - 191.
62. Pizzo, G., Guiglia, R., La Cara, M., Giuliana, G., &, D'Angelo, M., (2004) The effects of an amine fluoride/stannous fluoride and an antimicrobial host protein mouthrinse on supragingival plaque regrowth. Journal of Periodontology 75, 852 - 857.
63. Quirynen, M., Vogels, R., Pauwels, M., Haffajee, A. D., Socransky, S. S., Uzel, N. G., &, Van Steenberghe, D., (2005) Initial subgingival colonization of 'pristine' pockets. Journal of Dental Research 84, 340 - 344.
64. Renton-Harper, P., Addy, M., Moran, J., Doherty, F. M., &, Newcombe, R.G, (1998) A comparison of chlorhexidine, cetylpyridinium chloride, triclosan, and C31G mouthrinse products for plaque inhibition. Journal of Periodontology 67, 486 - 489.
65. Rindom-Schiott, C., Briner, W. W., &, Löe, H., (1976a) Two-year oral use of chlorhexidine in man. II. The effect on the salivary bacterial flora. Journal of Periodontal Research 11, 145 - 152.
66. Rindom-Schiott, C., Löe, H., &, Briner, W. W., (1976b) Two year use of chlorhexidine in man. IV. Effect on various medical parameters. Journal of Periodontal Research 11, 158 - 164.
67. Rosan, B., &, Lamont, R. J., (2000) Dental plaque formation. Microbes and Infection 2, 1599 - 1607.
68. Rushton, A., (1977) Safety of hibitane. II. Human experience. Journal of Clinical Periodontology 4, 73 - 79.
69. Sanz, M., Newman, M. G., Anderson, L., Matoska, W., Otomo-Corgel, J., &, Saltini, C., (1989) Clinical enhancement of post-periodontal surgical therapy by a 0.12% chlorhexidine gluconate mouthrinse. Journal of Periodontology 60, 570 - 576.
70. Seki, M., Yamashita, Y., Shibata, Y., Torigoe, H., Tsuda, H., &, Maeno, M., (2006) Effect of mixed mutans streptococci colonization on caries development. Oral Microbiology and Immunology 21, 47 - 52.
71. Shiloah, J., Patters, M. R., Dean, J. W. III, Bland, P., &, Toledo, G., (1997) The survival rate of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Bacteroides forsythus following 4 randomized treatment modalities. Journal of Periodontology 68, 720 - 728.
72. Socransky, S. S., &, Haffajee, A. D., (2005) Periodontal microbial ecology. Periodontology 2000 38, 135 - 187.
73. Socransky, S. S., Haffajee, A. D., Cugini, M. A., Smith, C., &, Kent, R. L. Jr., (1998) Microbial complexes in subgingival plaque. Journal of Clinical Periodontology 25, 134 - 144.
74. Socransky, S. S., Haffajee, A. D., Smith, C., Martin, L., Haffajee, J. A., Uzel, N. G., &, Goodson, J. M., (2004) Use of checkerboard DNA-DNA hybridization to study complex microbial ecosystems. Oral Microbiology and Immunology 19, 352 - 362.
75. Socransky, S. S., Smith, C., Martin, L., Paster, B. J., Dewhirst, F. E., &, Levin, A. E., (1994) Checkerboard DNA-DNA hybridization. Biotechniques 17, 788 - 792.
76. Souza, R. F., Regis, R. R., Nascimento, C., Paranhos, H. F., &, Silva, C. H., (2009) Domestic use of a disclosing solution for denture hygiene: a randomised trial. Gerodontology, doi:DOI: 10.1111/j.1741-2358.2009.00309.x.
77. Terézhalmy, G. T., He, T., Walters, P. A., Grender, J. M., &, Biesbrock, A. R., (2009) Clinical assessment of extrinsic stain removal efficacy with a new Pulsonic toothbrush. Journal of Clinical Dentistry 20, 1 - 4.
78. Tilliss, T. S., (1999) Use of a whitening dentifrice for control of chlorhexidine stain. Journal of Contemporary Dental Practice 15, 9 - 15.
79. Tuan, M. C., Nowzari, H., &, Slots, J., (2000) Clinical and microbiologic study of periodontal surgery by means of apically positioned flaps with and without osseous recontouring. Internatational Journal of Periodontics Restorative Dentistry 20, 468 - 475.
80. Van Strydonck, D. A., Demoor, P., Timmerman, M. F., Van Der Velden, U., &, Van Der Weijden, G.A, (2004) The anti-plaque efficacy of a chlorhexidine mouthrinse used in combination with toothbrushing with dentifrice. Journal of Clinical Periodontology 31, 691 - 695.
81. Verkaik, M. J., Busscher, H. J., Rustema-Abbing, M., Slomp, A. M., Abbas, F., &, Van Der Mei, H. C., (2009) Oral biofilm models for mechanical plaque removal. Clinical Oral Investigations, doi:DOI: 10.1007/s00784-009-0309-x.
82. Wennström, J. L., Dahlén, G., Gröndahl, K., &, Heijl, L., (1987) Periodic subgingival antimicrobial irrigation of periodontal pockets. II. Microbiological and radiographical observations. Journal of Clinical Periodontology 14, 573 - 580.
83. Westfelt, E., Nyman, S., Lindhe, J., &, Socransky, S. S., (1983) Use of chlorhexidine as a plaque control measure following surgical treatment of periodontal disease. Journal of Clinical Periodontology 10, 22 - 36.
84. Zybutz, M. D., Laurell, L., Rapoport, D. A., &, Persson, G. R., (2000) Treatment of intrabony defects with resorbable materials, non-resorbable materials and flap debridement. Journal of Clinical Periodontology 27, 169 - 178.