Journal of Indian Society of Pedodontics and Preventive Dentistry
Journal of Indian Society of Pedodontics and Preventive Dentistry
                                                   Official journal of the Indian Society of Pedodontics and Preventive Dentistry                           
Year : 2020  |  Volume : 38  |  Issue : 4  |  Page : 419--424

Effectiveness of magnetized water and 0.2% chlorhexidine as a mouth rinse in children aged 12–15 years for plaque and gingivitis inhibition during 3 weeks of supervised use: A randomized control study


Devendra Ishwarlal Nagpal, Shrawani Suryakant Mankar, Gagandeep Lamba, Purva Chaudhary, Kavita Hotwani, Sargam D Sortey 
 Department of Paediatric and Preventive Dentistry, VSPM Dental College and Research Centre, Nagpur, Maharashtra, India

Correspondence Address:
Dr. Devendra Ishwarlal Nagpal
Department of Paediatric and Preventive Dentistry, VSPM Dental College and Research Centre, Nagpur - 440 019, Maharashtra
India

Abstract

Background: Chlorhexidine mouth rinse, a 'Gold Standard'effective in reducing plaque and gingivitis, has some drawbacks like bitter taste, light brown staining of teeth etc. limiting its long-term use. Magnetized water is alkaline and inhibits the bonding process between plaque and teeth by “magnetohydrodynamic”. Aim: To compare and evaluate effectiveness of magnetized water and 0.2% chlorhexidine as a mouth rinse in children aged 12-15 years for plaque and gingivitis inhibition during 3 weeks of supervised use. Settings and Design: This was a double blinded randomized control clinical study, carried out at a non-government high school. Methods:A total of 20 children aged 12-15 years were randomized into two groups, magnetized water and 0.2% chlorhexidine, each comprising of 10 children who were asked to rinse with the respective mouthwash. Plaque index (PI) scoresand gingival (GI) scoreswere evaluated at baseline, 2 weeks and at 3 weeksfor each child. Statistical analysis: Independent sample t test and paired sample t test were used to check the mean differences. Result: A statistically significant difference was found in reduction of mean PI and GI scores of magnetized water (p=0.0001) and Chlorhexidine groups(p=0.0001) both at 14 days (2 weeks) and at 21 days (3 weeks) with no adverse effects. Conclusion: Daily use of magnetized water as a mouth rinse was safe andeffective alternative to chlorhexidinein plaque and gingivitis reduction, which supplemented the benefits of daily toothbrushing in children.



How to cite this article:
Nagpal DI, Mankar SS, Lamba G, Chaudhary P, Hotwani K, Sortey SD. Effectiveness of magnetized water and 0.2% chlorhexidine as a mouth rinse in children aged 12–15 years for plaque and gingivitis inhibition during 3 weeks of supervised use: A randomized control study.J Indian Soc Pedod Prev Dent 2020;38:419-424


How to cite this URL:
Nagpal DI, Mankar SS, Lamba G, Chaudhary P, Hotwani K, Sortey SD. Effectiveness of magnetized water and 0.2% chlorhexidine as a mouth rinse in children aged 12–15 years for plaque and gingivitis inhibition during 3 weeks of supervised use: A randomized control study. J Indian Soc Pedod Prev Dent [serial online] 2020 [cited 2021 Mar 4 ];38:419-424
Available from: https://www.jisppd.com/text.asp?2020/38/4/419/306225


Full Text



 Introduction



Oral health has a major influence on one's general and oral health-related quality of life and well-being. One of the most prevalent periodontal diseases is plaque-induced gingivitis affecting 90% of the population, regardless of age, sex, or race. The prevalence of gingivitis in children reported is 61.5% in the USA, 85% in Australia, and 95% in India.[1] Plaque (bacterial biofilm) is the main etiological agent in the initiation and progression of both gingival and oral diseases such as dental caries. The association between plaque and periodontal diseases forms the basis for the current concept of disrupting the biofilm. The primary way for controlling oral diseases is preventing plaque accumulation and disturbing plaque formation.[2]

Mechanical cleaning methods (toothbrushing and flossing) have been found the most effective way to control plaque and gingivitis. It has also been proved that chemical adjuncts should be used in addition to toothbrushing and flossing as an efficient approach in prevention of plaque formation and bacterial infection.

Studies have proved the efficacy of chlorhexidine (CHX) digluconate mouth rinse in reducing dental plaque accumulation and gingivitis. It has been approved by the Food and Drug Administration and the American Dental Association (ADA) as the most potent antibacterial mouthwash.[1] However, CHX has some potential drawbacks such as bitter taste, light-brown staining of teeth, altered taste sensation, development of resistant microorganisms, oral mucosal erosions, and enhanced supragingival calculus formation, which limits its long-term use as mouth rinse and acceptability by patients. This has developed the need to search for safer alternatives that are more appropriate and acceptable for young children, which can be provided by natural alternatives.[3] Among various natural alternatives which have been studied, magnetized water has gained great interest in dentistry.

Magnetized water can be a safer and cheaper alternative to the chemical adjuncts. The force of magnetism has a great influence on living organisms. When a permanent magnet is kept in continuous contact with water, it becomes magnetized and acquires magnetic properties. The magnetized water is more alkaline and can have a pH as high as 9.2. Magnetizing water reduces the surface tension of the water, thus making it feel softer and taste sweet. It is thinner, wetter, and more absorbable, so it is better able to penetrate cell walls and also deliver the nutrients that it carries. There are insufficient data regarding the use of magnetized water as a mouth rinse in dentistry.[3],[4],[5] The present study aimed to compare and evaluate the effectiveness of magnetized water and 0.2% CHX as a mouth rinse in children aged 12–15 years for plaque and gingivitis inhibition during 3 weeks of supervised use.

 Methods



The present double-blinded randomized control clinical study was carried out at nongovernment high school. The study was approved by the Institutional Ethics Committee and followed the tenets of the Declaration of Helsinki. The permissions from the school authorities were also obtained before the initiation of the study. To achieve an 80% power and 5% significance level, a sample size of 20 was required. A total of twenty schoolchildren were selected by convenience sampling method.

Inclusion criteria involved children between 12 and 15 years of age without any systemic disorder, presence of gingivitis-calculus, and stains (gingival index [GI] score ≥1/plaque index [PI] score ≥1) and children whose parents/caretakers gave an informed consent. Exclusion criteria involved children who were already using mouthwashes, history of oral prophylaxis within 6 months, and having fixed or removable orthodontic appliances or removable prosthesis.

All the parameters (including sociodemographics, oral hygiene habits, baseline plaque, and gingival indices) of the selected children were recorded in the case pro forma and were assessed statistically. A written informed consent was obtained from parents of all selected children. The children were randomly divided into two groups by computer-generated random sequence: Group A – magnetized water group (unipolar) and Group B – 0.2% CHX mouthwash group (Septodont Calypso).

Magnetized water was freshly prepared 1 day before the distribution at weekly intervals. Reverse osmosis water was taken in glass bottles and kept over the magnets of power 1000 gauss for 24 h for magnetization, whose pH and electrical conductivity were found out to be 7.8 and 24.6, respectively.[3],[4]

The bottles containing magnetized water and CHX were identical and adequately sealed. The bottles were coded along with the written instructions to use before dispensing to the children. The coding was done by a person who was not involved in the study; so that the double blinding design of the study was maintained. The children were provided with 140 ml of their respective mouthwashes for home use on a weekly basis. The children and examiner were blind to allocation, i.e., the type of mouthwash.[1],[3]

All the selected children were demonstrated a correct method of using mouthwash according to the group that they were assigned to. Children were instructed to use 10 ml of mouthwash as prescribed (i.e., take 10 ml of the mouth rinse in the measuring cap, rinse for 30 s, and spit out twice daily for 21 days), under parent's supervision.[2],[6] A printed timetable for 3 weeks was given to the parents, and they were asked to put a checkmark on the form after rinsing to check the compliance of the instructions given.

Examination for the PI of Turesky-Gilmore Modification of Quigley Hein PI (1970) and GI of Loe and Silness (1963) was carried on day 0 (Baseline), 14 days (2 weeks), and 21 days (3 weeks) after application of plaque disclosing agent – Two tone dye (Alpha Plac) using cotton tips by the same examiner who was blind to the allocation and was recorded in a specific recording pro forma designed for the study. The examiner performed clinical measurements at the same time of day for all assessment visits. Furthermore, the examination dates were unannounced to the children to minimize Hawthorne effect.[7] After the end of the study, the children were demonstrated correct toothbrushing and oral hygiene methods. To monitor potential adverse effects on oral tissues as a result of daily use of the prescribed mouth rinse, intraoral examinations were performed during every visit. Furthermore, the children were asked to report the adverse effects if seen, in between the assessment visits. During the entire study period, the children were advised to exercise their usual oral hygiene practices and abstain from using other mouthwashes.[6]

Statistical analysis

The groups were de-coded before the data were handed over to the statistician. The collected data were subjected to statistical analysis. Statistical analysis was done using descriptive and inferential statistics using Student's paired and unpaired t-test and software used in the analysis was Statistical Package For Social Sciences Version 24.0 (IBM Corporation, Chicago, USA) and P < 0.05 was considered level of significance.

 Results



All twenty children who began the study were present for the 2-week and 3-week examinations. The distributions of gender and age for each group in this study are presented in [Table 1]. The mean age of the children in Group A was 12.76 ± 0.47 years, and that in Group B, it was 12.69 ± 0.77 years and was not significantly different. Sixty percent of the children in Group A were males and 40% were females and each 50% of the children in Group B were male and females.{Table 1}

Mean baseline scores of PI and GI for Group A and B are given in [Table 2]. Mean PI and GI scores at baseline in Group A were 1.54 ± 0.48 and 1.05 ± 0.05, and in Group B, they were 1.31 ± 0.31 and 1.07 ± 0.10, respectively. Using Student's unpaired t-test, statistically no significant difference was found in mean PI (t = 1.24, P = 0.22) and GI (t = 0.29, P = 0.77) in both the groups.{Table 2}

Mean PI scores for both Group A and Group B at baseline and after 2 and 3 weeks of use are given in [Table 3]. In Group A and B, mean PI scores showed a statistically significant reduction when analyzed using paired t-test with P = 0.0001. In Group A and B, at 2nd week of follow-up, PI score was 1.18 ± 0.38 and 1.03 ± 0.20, respectively, at 3rd week of follow–up, it was 0.88 ± 0.18 and 0.78 ± 0.10, respectively.{Table 3}

Mean GI scores for both Group A and Group B at baseline and after 2 and 3 weeks of use are provided in [Table 4]. In Group A and B, mean GI scores showed a statistically significant reduction when analyzed using paired t-test with P = 0.0001. In Group A and B, at 2nd week of follow–up, GI score was 0.80 ± 0.08 and 0.85 ± 0.08, respectively, at 3rd week of follow–up, it was 0.65 ± 0.14 and 0.49 ± 0.08, respectively.{Table 4}

Intergroup comparison for a mean reduction in plaque and GI scores at 2nd and 3rd-week follow-up is given in [Table 5]. Using the Student's unpaired t-test, statistically, no significant difference was found in a mean reduction of PI scores when compared between two groups at 2 weeks (t= 1.15, P = 0.26) and 3-week follow-up (t = 1.04, P = 0.31). Similarly, statistically, no significant difference was found in a mean reduction of GI scores when compared between two groups at 2nd-week follow-up (t = 1.32, P = 0.20), but a statistically significant difference was found in mean reduction at 3rd-week follow-up (t = 2.99, P = 008).{Table 5}

Adverse reactions

No adverse reactions were observed affecting either the hard or soft tissues during the 3-week study period. The taste of magnetized water was also well accepted by the children.

 Discussion



The present randomized double-blinded controlled study was conducted to assess the effectiveness of magnetized water on plaque and gingivitis inhibition during 3 weeks of supervised use. In the present study, 12–15-year old schoolchildren were included, since 12 years is the global monitoring age for dental caries and 15 years age for the assessment of periodontal disease indicator in adolescents.[2] CHX gluconate was used as a control group, since it is considered as a gold standard in the reduction of plaque and gingivitis. In the present study, the use of CHX showed a statistically significant reduction in both plaque and gingival scores at 2nd and 3rd-week follow-up from the baseline scores. Similar results were reported in the study done by Lone et al. (2016). Furthermore, the results of the present study on the use of 0.2% CHX are in agreement with the study done by Shyam and Fareed where CHX demonstrated highly potent antiplaque and antigingivitic properties when compared to placebo.[2] Lang et al. tested the effects of supervised rinsing with CHX in 158 schoolchildren aged 10–12 years. After 6 months, it was concluded that gingivitis can be controlled successfully by regularly using 0.1% or 0.2% CHX mouth rinses, and also rinsing with 0.2% CHX mouth rinse significantly reduced the development of plaque.[8] Furthermore, Santos concluded that CHX mouthwash showed better effects on plaque reduction.[9]

In the present study, CHX was used in the concentration 0.2% because Menendez et al. in their study evaluated that lower concentration of CHX (0.12%) may not be sufficiently strong to reduce the microbial load as compared to other concentration, i.e., 0.2%.[10] Addy and Moran stated that the optimum dose of CHX delivered by mouth rinse was 10 ml of 0.2% CHX.[11] In the present study, children were instructed to rinse their mouth with 10 ml of respective mouthwashes for 30 s twice daily (once in morning and after dinner), as increase in frequency and volume of mouth rinse is known to improve the concentration of the agent in the oral cavity.[12] A 3-week interval for the mouth rinsing activity was chosen on the basis of an earlier study which describes an effective reduction of plaque and gingivitis in the same period and also as mentioned by Bhattacharjee et al. (2015) in their study that the extended use of such mouth rinses by children over a 1-year period is not feasible, practical, or cost-effective, because plaque and gingivitis would subside in 2–3 weeks with appropriate care.[3],[12]

CHX is a cationic bisbiguanide having low toxicity and broad-spectrum antibacterial activity. CHX blocks the acidic groups of salivary glycoproteins, adsorbs to the extracellular polysaccharides of bacteria, and reduces its ability to bind to tooth surfaces, and finally by competing with calcium ion agglutinating factors in plaque.[13],[14] In oral use as a mouth rinse, CHX has been reported to have a number of local side effects. These side effects are brown discoloration of the teeth and tongue, oral mucosal erosion, and taste perturbation,[13] which encouraged the search for an alternative antiplaque agent. In the present study, magnetized water was used to compare its efficacy in reducing plaque accumulation and gingival inflammation against CHX.

Wevangti Vangra reported that, when water is magnetically charged, it electrically takes on a greater ionic charge than the minerals, which create a natural magnetic attraction between the two. Softening and better taste occur from an actual reduction in size of water molecule. Furthermore, the small magnetized water molecule has a greater solvency and a magnetic attraction.[4],[15] Magnetized water inhibits the bonding process by which bacteria colonize and by which plaque attaches to teeth. This inhibition can be attributed to the principle of “magnetohydrodynamics.” Magnetohydrodynamics prevents naturally occurring minerals deposits in fluids, changing from liquid to a solid state. This occurs by interruption of the normal process of colonization (electrovalent bonding of cations) and therefore, preventing the formation of deposits which would otherwise adhere to a host surface.

In the present study, magnetized water mouth rinse has shown a statistically significant reduction in plaque and gingival scores at 2nd-week and 3rd-week follow-up from the baseline scores. These findings are in accordance with the study carried out by Lone et al. (2016) where a significant reduction in both plaque as well as gingival scores was seen on using magnetized water both at 14th day and at 21st day.[3]

Lone et al. did a study on magnetized water and CHX for plaque and gingivitis and found that CHX was marginally better reduction in plaque than the magnetized water, and in the reduction of gingivitis, magnetized water has shown similar effects as compared to 0.2% CHX. In the present study, on intergroup comparison, statistically, no significant difference was found in mean reduction of PI at 2nd- and 3rd-week follow-up. Similarly, for reduction in mean GI, statistically, no significant difference was observed at 2nd-week follow-up. However, a statistically significant difference was observed in the mean reduction of GI scores at 3rd-week follow-up between two groups.

The present study was completed with no negative effects resulting from mouth rinse use, and also the magnetized water mouth rinse was well accepted by the children who took part in the study.

Limitations

Although the present study attempts to describe the effectiveness of magnetized water in plaque and gingivitis reduction at 2nd week and 3rd-week follow-up by comparing it to CHX as a gold standard, it does not address long-term clinical efficacy (6 months as prescribed by ADA) and adverse effects associated with its long-term usage. Hence, further studies exploring the potential adverse effects of their usage are needed before presuming their safety in pediatric use. Furthermore, further studies have to be done to check the substantiality of long-term effect with the larger sample size.

 Conclusion



Both magnetized water and 0.2% CHX mouthwash showed a beneficial effect in children aged 12–15 years for plaque and gingivitis inhibition during 3 weeks of supervised useMagnetized water and 0.2% CHX mouthwash showed comparable effectiveness on plaque reduction. However, 0.2% CHX mouthwash was found to be more effective in reducing GI than magnetized waterNo adverse effects to the oral hard or soft tissues were observed after using magnetized water mouth rinse for 3 weeks, and also the taste of magnetized water was well accepted by children. Therefore, magnetized water could be an appropriate and a safe alternative measure to CHX and can be used as an adjunct to mechanical plaque control.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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