Clinical effects of a new mouthrinse containing chlorhexidine, cetylpyridinium chloride and zinc-lactate on oral halitosis. A dual-center, double-blind placebo-controlled study. Use of a novel group of oral malodor measurements to evaluate an anti-oral malodor mouthrinse (TriOralTM) in humans. Antimicrobial effect of 0.2% chlorhexidine in infected root canals. Antibacterial activity of 2% chlorhexidine gluconate and 5.25% sodium hypochlorite in infected root canal: in vivo study. Effects of mouthrinses with linseed extract Salinum without/with chlorhexidine on oral conditions in patients with Sjögren's syndrome. A double-blind crossover investigation. Effects of chlorhexidine mouthrinse on oral health in patients with acute leukemia. Tongue-cleaning methods: a comparative clinical trial employing a toothbrush and a tongue scraper. Control of oral mucositis and candidiasis in marrow transplantation: a prospective, double-blind trial of chlorhexidine digluconate oral rinse. Efficacy of a 2-phase oil: water mouthrinse in controlling oral malodor, gingivitis, and plaque.
The aim of this double-blind, parallel study was to test the clinical efficacy of a newly developed mouthrinse in the treatment of oral halitosis in patients without periodontitis.
                Forty volunteers, recruited in two centers, participated in this study. Patients were selected on the basis of (1) halitosis of oral origin, (2) full-mouth organoleptic score>1, using an arbitrary 0-5 scale, (3) level of volatile sulfur compounds (VSC)>170 parts per billion (ppb) and (4) Winkel tongue coating index (WTCI)>4 (0-12). Intervention included gargling with a mouthrinse containing chlorhexidine (0.05%), cetylpyridinium chloride (0.05%) and zinc-lactate (0.14%) or with a placebo mouthrinse without active ingredients. At days 0 and 14 clinical variables were assessed in order of performance: (1) organoleptic assessments, (2) levels of VSC, and (3) WTCI.
                Treatment with the active mouthrinse resulted in a significant mean reduction in the organoleptic score from 2.8 to 1.5 (p<0.005). In the placebo group, no significant reduction in the mean organoleptic score occurred. Consequently, this resulted, after 2 weeks, in a greater change of the organoleptic scores in the test group in comparison to the placebo group (p<0.005). The mean VSC scores were reduced from 292 to 172 ppb in the test group (p<0.005), whereas no reduction was observed in the placebo group. At the 2-week examination, the mean change of the VSC scores in the test group was significantly greater than the mean change in the placebo group (p<0.005). Neither in the test nor in the placebo group a significant reduction in tongue coating was observed.
                In conclusion, the tested mouthrinse is effective in the treatment of oral halitosis. This study compared the ability of a test mouthwash containing zinc chloride and sodium chlorite (TriOral) to reduce intrinsic oral malodor, to that of two other mouthrinses, one with zinc chloride only and the other with no zinc chloride/no sodium chlorite, using a novel group of oral malodor parameter measurements.
                Forty-eight subjects completed the study; 16 in the test group, 17 in the zinc only group, and 15 in the no zinc chloride/ no sodium chlorite group. At baseline and after two and four weeks, parameters assessed were 1) malodorants in the headspace of and in solution in resting whole saliva determined organoleptically, 2) breath volatile sulfur compounds (VSC) measured with a sulfide monitor (Halimeter), 3) fresh and incubated saliva oxidation-reduction potential (E(h)) measured with a platinum electrode, and 4) level of saliva indolic compounds (IC), indole and skatole, determined colorimetrically with Kovac's reagent. The VSC, E(h), and IC data for the three mouthrinses were analyzed statistically by repeated measures ANOVA between groups, and by 2-way ANOVA within groups. Corresponding organoleptic data were analyzed by Kruskal-Wallis and Friedman non-parametric tests.
                Organoleptic, VSC, and E(h) evaluations clearly showed the zinc chloride/sodium chlorite test mouthrinse to be more effective than the other two rinses. In all cases, the level of significance was p < 0.001 between the test mouthrinse and its no zinc chloride/no sodium chlorite control; between test mouthrinse and the zinc chloride only product, significance was p < 0.05, < 0.001 and < 0.01 for the organoleptic, VSC, and E(h) tests, respectively. Noteworthy was the observation that the mean organoleptic saliva headspace score with the test mouthrinse was reduced to zero, and VSC levels fell below 50 ppb S by the end of the study, a level where the breath is usually non-odorous. The test mouthwash also appeared more effective in reducing the salivary IC levels, but the results did not reach significance at p < 0.05 unless IC levels were amplified in the saliva by incubation overnight at 37 degrees C. Correlations between the various procedures were highly significant, achieving in almost all cases a probability level of p < 0.001.
                The results supported the conclusion that the zinc chloride plus sodium chlorite mouthrinse (TriOral) is more effective in reducing oral malodor than a zinc chloride alone mouthrinse, and even more effective than its no zinc chloride/no sodium chlorite mouthrinse control. The methods used in this study were consistent with one another, and highly effective in measuring various parameters that characterize oral malodor. The aim of this study was to identify bacteria from the infected root canals of teeth with chronic apical periodontitis, and to evaluate the antibacterial effect of 0.2% chlorhexidine (CHX), as an irrigant, in reducing the microbial flora 48h after root canal preparation. A total of 44 subjects were randomly divided in the experimental group and the control group. The first bacterial samples from all root canals were obtained in the beginning, before any treatment. During mechanical instrumentation, root canals were irrigated three times, with 0.2% CHX in the experimental group, and with saline solution in the control group. All canals were dried and temporarily sealed with zinc oxide-sulfate cement. After 48 h the second samples were obtained. Bacterial samples were subjected to microbiologic processing. The study indicates that 0.2% CHX is significantly effective in reducing the microbial flora, and could be used as an irrigant solution. In this study, the antibacterial activity of the different antibacterial solutions using as root canal irrigant was compared in the teeth with pulpal necrosis and with periapical pathosis. Thirty root canals of incisors and premolars of 20 patients were used. Before and after the root canal preparation, two canal samples were obtained by a harvesting method using a sterile paper point in the first appointment. During the biomechanical preparation, both irrigant solutions were used for each tooth which were randomly divided into two groups. Last samples were also obtained before the root filling procedure. Samples obtained from the root canals were subjected to microbiologic processing, including anaerobic incubation on trypticase soy agar for 5 to 7 days. After counting of CFU on the plates, we concluded that both chlorhexidine gluconate and sodium hypochlorite were significantly effective to reduce the microorganisms in the teeth with necrotic pulp, periapical pathologies, or both, and could be used successfully as an irrigant solution. To study the effect of mouthrinses with salivary replacement substances on oral conditions in patients with primary Sjögren's syndrome.
                Cross-over, double-blind study.
                Facilities at the Centre for Oral Health Sciences, Malmö University and at Malmö University Hospital, Malmö, Sweden.
                Twenty-two patients with Sjogren's syndrome.
                Linseed extract Salinum alone (Sal) or with addition of chlorhexidine (Sal/Chx) was used for mouthrinsing during 3-week periods of rinsings separated by a 3-week "wash-out" period.
                Recordings of percentages of sites with dental plaque and bleeding on probing, mirror friction test and microbiological analyses. Questionnaire on oral symptoms due to reduced salivation.
                Dental plaque and bleeding on probing were reduced after Sal and after Sal/Chx. Friction was reduced after both treatments. No significant differences for counts of studied microbial groups were seen after Sal but the total anaerobically cultured microorganisms and of mutans streptococci fell after Sal/Chx (p<0.05 and p<0.001). Symptoms of oral dryness improved following Sal and Sal/Chx (p<0.05 and p<0.001 respectively). Speaking problems and burning mouth symptoms improved after use of Sal (p<0.05).
                Positive effects on symptoms in patients with Sjögren's syndrome were seen after use of Salinum without or with chlorhexidine. The effects of chlorhexidine mouthrinses, used as a supplement to mechanical oral hygiene measures, were studied in patients receiving treatment for acute leukemia. Twenty-eight patients were randomly divided into two groups. During two periods, when the patients were taking medication for the leukemia, one group rinsed with a 0.2% chlorhexidine solution twice daily and the other group did not. Chlorhexidine had no effects of any clinical significance on parameters such as number of days with fever, number of oral lesions, plaque score, gingival bleeding score, or occurrence of candidiasis. There was, however, an increased number of patients who had a burning sensation in the mouth, and a tendency toward increased numbers of salivary enterococci, enterobacteria, and/or Pseudomonas in patients who rinsed with chlorhexidine. The results of the present study do not support the use of chlorhexidine mouthrinses in patients who are able to maintain good oral hygiene by mechanical means during their illness. It is estimated that approximately 85% of all halitosis cases have their origin within the mouth; of these, 50% are caused by tongue residues. Previous studies have established that hydrogen sulfide and mercaptans are the primary components of halitosis. Thus, tongue cleaning gains importance as a means of halitosis management.
                This investigation compared the efficacy of two mechanical methods for tongue cleaning through a handheld sulfide monitor. This crossover trial was carried out with 10 healthy subjects, 20 to 50 years old. Before the baseline measurement of the volatile sulfur compounds (VSCs), the subjects were instructed to refrain from any tongue cleaning method for 48 hours. The 10 participants were then placed in one of two groups (five each): 1) first week: tongue scraper, second week: soft-bristle toothbrush; 2) first week: toothbrush, second week: tongue scraper, with a 48-hour wash-out period between each week.
                The baseline measurements were compared with those of the end of each week using the Dunn method (alpha = 0.01). The tongue scraper showed a 75% reduction in VSCs, while the toothbrush only achieved a 45% reduction in VSCs.
                Although the tongue coating was removed by both methods, the tongue scraper performed better in reducing the production of volatile sulfur compounds. Conditioning chemoradiotherapy damages the mucosal barrier of the mouth and throat and often produces severe oral inflammation and infection. In a prospective, double-blind, randomized study, we examined the use of a chlorhexidine digluconate mouthrinse for prophylaxis against oral mucosal complications in 51 bone marrow transplant patients. Use of chlorhexidine mouthrinse produced significant reductions in the incidence and severity of oral mucositis. Mucositis also resolved more quickly in patients receiving chlorhexidine. Concomitant reductions in total oral streptococci (p less than 0.02-p less than 0.001) and oral candida (p less than 0.004) were seen in patients using chlorhexidine. Persistent clinical oral candidiasis (thrush) was observed in 15 to 27 control group patients (56%), but only transiently in two (8%) of 24 patients who used chlorhexidine rinse (p less than 0.001). Five of 27 control group patients (19%) had candidemia, while no candidemia was observed in the chlorhexidine group (p less than 0.03). Three deaths from disseminated candidiasis occurred in the placebo group; none occurred in patients who received chlorhexidine. Prophylactic use of chlorhexidine mouthrinse produces reductions in oral soft tissue disease and oral microbial burden in patients undergoing bone marrow transplantation. The reductions in mucositis and in oral candida infections observed with prophylactic chlorhexidine mouthrinse represent a significant advantage for patients undergoing marrow transplantation. The purpose of the study was to examine the anti-malodor, anti-gingivitis, and plaque reducing properties of a 2 phase oil:water mouthrinse compared with a control mouthrinse. Fifty subjects rinsed with one of the two rinses for 30 seconds twice a day over 6 weeks, while continuing their normal oral hygiene habits. Measurements were made at time zero (prior to beginning the rinsing regimen), and > or = 9 hours following rinsing, at intervals of 1, 3, and 6 weeks. Malodor of whole mouth, as well as tongue dorsum anterior and posterior, was assessed on a 0 to 5 semi-integer scale by two odor judges. Volatile sulphide compounds (VSC) were determined using a sulphide monitor. Gingival, plaque, and bleeding indices were recorded for Ramfjord teeth. Oral microbial levels were assessed using the oratest. Salivary levels of diamines (putrescine and cadaverine) were analyzed by HPLC. Results were analyzed by 2-tailed covariant ANOVA, with the time zero value as covariant. Dramatic improvements were observed in parameters associated with malodor, periodontal health, plaque accumulation, and microbial levels in both groups. As compared to time zero scores, whole mouth odor, tongue dorsum anterior and posterior odors decreased continuously over time, attaining 80%, 79% and 70%, reductions, respectively following 6 weeks, in the 2-phase mouthrinse group, versus 70%, 77% and 59% for the control group. For whole mouth and tongue dorsum posterior, the reductions observed in the 2-phase mouthrinse group were significantly greater than those obtained with the control mouthrinse (P = 0.026 and P = 0.025, respectively), suggesting that the 2-phase mouthrinse is superior to the control mouthrinse in long-term reduction of oral malodor. For bleeding index, gingival index, oral microbial levels, and VSC, differences between the groups were not significant. Diamine levels were not significantly reduced in either group. The control mouthrinse reduced plaque index more significantly than the 2-phase mouthrinse (P < 0.005). The results of this randomized clinical trial suggest that the 2-phase oil:water mouthrinse formulation is superior to the control mouthrinse in long-term reduction of oral malodor.
Mouthrinses containing antibacterial agents such as chlorhexidine and cetylpyridinium chloride may play an important role in reducing the levels of halitosis-producing bacteria on the tongue, and chlorine dioxide and zinc containing mouthrinses can be effective in neutralisation of odouriferous sulphur compounds.Well designed randomised controlled trials with a larger sample size, a longer intervention and follow-up period are still needed.