|Year : 2011 | Volume
| Issue : 2 | Page : 113-116
Efficacy of two commonly available mouth rinses used as preprocedural rinses in children
Department of Pedodontics and Preventive Dentistry, Meenakshi Ammal Dental College, Chennai, India
|Date of Web Publication||9-Sep-2011|
Department of Pedodontics and Preventive Dentistry, Meenakshi Ammal Dental College, Alapakkam Main Road, Maduravoyal, Chennai 600 095
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Aim: There are many studies on the effect of preprocedural mouth rinses in adults, but there is a dearth of the literature on the effects of these mouth rinses in children. This study aims to evaluate the efficacy of two commercially available brands, one containing chlorhexidine 0.12% (Colgate Periogard) and the other containing cetylpyridinium chloride 0.05% (Johnson and Johnson's Reach) used as preprocedural mouth rinses in children. Materials and Methods: The study was conducted on 18 patients in the age group of 10-15 years. A crossover design was used with the random assignment of the first rinse tested and a wash out period of at least 1 week before the second rinse was used. The saliva samples were collected prerinse, 2 min, 30 min, and 60 min after rinsing with the solution. The samples were inoculated and cultured for aerobic and anaerobic microorganisms. After 48 h, the resultant bacterial colonies were counted. Results: Statistical analysis was done using Wilcoxon's signed rank test, ANOVA, and Newman-Keul's studentized range test. Periogard had the highest percentage reduction in both aerobic and anaerobic microorganisms followed by Reach and the least effective was normal saline which was used as a control. Conclusions: Periogard is comparatively better as a preprocedural mouth rinse than Reach.
Keywords: Cetylpyridinium chloride, chlorhexidine, preprocedural mouth rinses
|How to cite this article:|
Thomas E. Efficacy of two commonly available mouth rinses used as preprocedural rinses in children. J Indian Soc Pedod Prev Dent 2011;29:113-6
|How to cite this URL:|
Thomas E. Efficacy of two commonly available mouth rinses used as preprocedural rinses in children. J Indian Soc Pedod Prev Dent [serial online] 2011 [cited 2019 Jul 24];29:113-6. Available from: http://www.jisppd.com/text.asp?2011/29/2/113/84682
| Introduction|| |
The oral cavity provides a unique ecosystem in the human body. Its moist environment, temperature, and the existence of endogenous and exogenous metabolic substrates make it an ideal medium for bacterial growth.  Over 6 million microorganisms have been reported to be present in 1 ml of saliva. 
There is a difference in the amount and types of microorganisms present in the oral cavity of children and adults. Microorganisms causing periodontal diseases are not prevalent in children as compared to adults.  Tappuni and Challacombe stated that adults had significantly higher total and streptococcal counts than children. 
The amount of microorganisms in a patient's oral cavity has implications both for the patient and the dental personnel working in close proximity with the patient. The dental professional takes care in reducing the transmission of these microorganisms by using various barriers like face masks, eye shields, gloves, etc. However, these barriers are not enough to totally eliminate the risk of transmission of microorganisms.
The use of ultrasonics and high speed rotary instruments has brought along with their benefits, some problems that are not encountered with low speed rotary instruments. These devices spread the organic fluid found in the oral cavity, such as saliva, blood, pus, and their own cooling fluids.  This results in a considerable increase in airborne microbial contents. Microorganisms isolated in dental aerosols have been associated with respiratory infections, hepatitis, tuberculosis, conjunctivitis, herpetic, and other skin infections. 
The current literature suggests that having patients use an antimicrobial rinse before treatment may decrease microbial aerosols.  Chlorhexidine gluconate is considered to be one of the most potent antibacterial agents in dentistry. Logothetis and Martinez-Welles showed that when 0.12% chlorhexidine gluconate was used as a prerinse 10 min before air polishing, there was a reduction in the airborne microbial load than when an antiseptic mouth wash with essential oils or water was used as a prerinse.  Fine et al. showed that preprocedural rinsing with the antiseptic mouth wash produced a 94.1% reduction in recoverable colony forming units compared to the nonrinsed control, while the control rinse produced a 33.9% reduction. 
Although several studies have been done in the past on the effect of various mouth rinses on salivary bacterial counts in adults, there is very limited literature on the effects of mouth rinses in children and adolescents.
Hence in this study an attempt has been made to compare the effectiveness of two mouth rinses, one containing chlorhexidine 0.12% and another containing cetylpyridinium chloride 0.05%, on the salivary bacterial counts in children.
| Materials and Methods|| |
The study was conducted on 18 patients visiting the Department of Pedodontics and Preventive Dentistry in the age group of 10-15 years. A crossover design was used with the random assignment of the first rinse tested and a wash out period of at least 1 week before the second rinse was used.
Criteria for the selection of patients
- The subjects should not have used systemic antibiotics, anti-inflammatory medications, and other antimicrobial mouth rinses for 1 week prior to or during the study period.
- The subjects should not be wearing any oral appliances during the study period.
- The subjects should be caries free.
The study protocol was submitted to and approved by the ethical clearance committee of the institution and the university. A written informed consent was obtained from the subjects and their parents or guardians prior to the commencement of the study.
The formulations tested were:
- Colgate Periogard, India (chlorhexidine 0.12%).
- Johnson and Johnson's Reach, India (combination of cetylpyridinium chloride 0.05% and sodium fluoride 0.05%).
- Normal saline (control).
Each subject rinsed once with 10 ml of the designated mouth rinse for 30 s and then expectorated it.
The saliva samples were collected:
- Before rinsing with the solution.
- 2 min after rinsing with the solution.
- 30 min after rinsing with the solution.
- 60 min after rinsing with the solution.
The samples were collected by asking the patient to spit into a sterile test tube. The test tube was then put in a vortex mixer and agitated. A saliva sample of 0.01 ml was then transferred using sterile disposable syringes into a test tube containing 0.9 ml of Dulbecco's phosphate buffered saline. This test tube was then vortex mixed. This gave a dilution of 1:10. It was then serially diluted to arrive at 1:1000 dilution. From this dilution 0.005 ml was taken and inoculated on the blood agar culture media in the petridish. The inoculated petridishes were then incubated under aerobic and anaerobic conditions for 48 h. After 48 h, the resultant bacterial colonies were counted.
Since the distribution of colony forming units at each point of time was positively skewed, log transformations were done to conform with normal distribution. Decrements in log CFU from corresponding baseline levels to each time point for all the treatments were analyzed by Wilcoxon's signed rank test. Intergroup comparisons of changes from the prerinse (baseline) with time were done by analysis of variance (ANOVA) followed by Newman-Keul's studentized range test.
| Results|| |
The mean prerinse (baseline) salivary aerobic bacterial counts for Reach, Periogard, and normal saline were 254.7 × 10,  250.8 × 10,  257.1 × 10  CFUs, respectively [Table 1]. The mean prerinse salivary anaerobic bacterial counts for Reach, Periogard, and normal saline were 253.1 × 10,  270.1 × 10,  267.7 × 10  CFUs, respectively [Table 2].
|Table 1: Effect of different mouth rinses on aerobic microorganisms at different time intervals|
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|Table 2: Effect of different mouth rinses on anaerobic microorganisms at different time intervals|
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At 2-min, 30-min, and 1-h postrinse, Periogard showed the maximum reduction from the baseline followed by Reach and the least reduction was from the normal saline group. The reduction in bacterial counts from the baseline values for all the rinses at 2, 30 min, and 1 h were statistically significant (P < 0.01) [Table 1] and [Table 2].
Periogard showed a marginally greater percentage reduction of the aerobic and anaerobic counts at the 1-h postrinse (96%) than the 30-min postrinse count (95.2% and 94.6%, respectively) [Table 1] and [Table 2].
Periogard showed statistically significant higher reductions (P < 0.01) in both aerobic [Table 1] and anaerobic counts [Table 2] than Reach and normal saline at 2-min, 30-min, and 1-h postrinse. Reach showed statistically significant reduction (P < 0.01) in aerobic counts compared to normal saline at 2-min, 30-min, and 1-h postrinse [Table 1], but was not significant statistically in the 2-min postrinse anaerobic count [Table 2]. However, there was a statistically significant difference between Reach and normal saline in the 30-min and 1-h postrinse anaerobic count [Table 2].
| Discussion|| |
The oral cavity with its moist environment harbors millions of microorganisms. The measurement of the magnitude and duration of the effects of antimicrobial agents on salivary bacterial counts have proved to be a useful screening method for the efficacy of oral hygiene products.
The mean prerinse salivary bacterial counts results are similar to a study on children by Tappuni and Challacombe.  They stated that adults had significantly higher total and streptococcal counts than did predentate and dentate children. 
Various studies have been done using 0.2% chlorhexidine, 0.12% chlorhexidine, and 0.1% chlorhexidine mouth rinses. The 0.12% and 0.2% chlorhexidine mouth rinses produced similar large and prolonged reductions in salivary bacterial counts. The 0.1% chlorhexine rinse produced significant bacterial count reduction, but to a lesser degree of magnitude than to the 0.12% and the 0.2% chlorhexidine mouth rinses. 
Periogard had the highest percentage reduction of colony forming units in both aerobic and anaerobic counts. Similar results were obtained in studies done in adults by Elworthy et al.,  and Veksler et al. 
Chlorhexidine is effective against both Gram positive and Gram negative bacteria including aerobes and anaerobes and yeasts and fungi. Its antibacterial action is due to an increase in cellular membrane permeability followed by coagulation of the cytoplasmic macromolecules.  Oral structures such as plaque, oral mucosa, and hydroxyapatite absorb chlorhexidine and these structures then become reservoirs that slowly release chlorhexidine. The effectiveness of chlorhexidine depends on its antimicrobial effects and oral retention which prolongs its antimicrobial activity. 
The long-term side effects of chlorhexidine include altered taste sensation, and it produces brown staining on the teeth, oral mucosa, and tongue. It tends to stain the margins and surfaces of composite and glass ionomer restorations. Intake of tea, coffee, and red wine precipitates the staining. Other rarer side effects are mucosal erosion and parotid swelling. 
Reach had a greater effect than normal saline on salivary bacterial counts, but it was less compared to the effect of Periogard. The findings for Reach were similar consistent with previous investigations by Roberts and Addy,  Jenkins et al.,  and Elworthy et al. 
Cetylpyridinium chloride is a quaternary ammonium compound. It exerts its bactericidal effect by inactivating membrane associated enzymes or by physically disorganising the membrane itself. They have greater activity against Gram positive bacteria than against Gram negative bacteria and are inactivated by the presence of organic matter, by low pH and by anionic compounds, soaps and metallic ions. Occasional side effects of quaternary ammonium compounds include oral ulcerations and discomfort and a mild-burning sensation of the tongue. 
Most dental procedures using rotary or vibratory instruments, disperses aerosols which could lead to cross contamination in the dental operatory resulting in an increased risk of infection to both patients and dental personnel. Preprocedural rinsing with an antimicrobial mouth rinse reduces this risk. Suppression of the oral flora over a 30-60-min period would be sufficient as this is a common duration of dental office visits. The results of this study indicates that Periogard (chlorhexidine 0.12%) is comparatively better as a preprocedural mouth rinse than Reach (cetylpyridinium chloride) and can be used during the treatment of patients in the dental office.
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[Table 1], [Table 2]