Comparative study of 0.2% and 0.12% digluconate chlorhexidine mouth rinses on the level of dental staining and gingival indices

Introduction

Periodontal disease and caries are the most prevalent infectious oral diseases in human, where both are associated with dental plaque. The removal of plaque is the main key of prevention and the first step in treatment of periodontal disease and one of which is through chemical agents.

Relevance

chlorhexidine (CHX) as a gold standard appears to be the most effective antimicrobial agent for reduction of both plaque and gingivitis. Its effectiveness can be attributed to it bactericidal and bacteriostatic effects within the oral cavity (8 h after rinsing).

However, the adverse-effects of CHX limit the long-term use of this antiseptic agent and include taste alteration, excess formation of supragingival calculus, soft-tissue lesions in young patients, allergic responses, and staining of teeth and soft tissues.

Chlorhexidine is available in concentrations between 0.1% to 0.2%. Studies are somewhat contradicting because it was shown that plaque inhibition by chlorhexidine is dose dependant and other studies reported that both concentrations are equally effective.

Objective 

The aim of this study was to compare the efficacy of two concentrations of chlorhexidine solutions (0.12% and 0.20%) on gingival indices and the level of dental staining during 14 days.

Materials and Methods  

A randomized, cross-over, double blind design was chosen in order to generate the best possible evidence.  60 patients aged 17–56 years with history and existing gingivitis and bleeding on probing were randomly selected from whom referred to Periodontology Department of Dental Clinic of Mashad University. Patients with attachment loss or bone loss, history of periodontitis, use of medicines that may cause gingival overgrowth, pregnant, drug addicted, r any systemic condition that could negatively influence oral health have been excluded from the study. Plaque Index, Gingival Index, Bleeding Index, Stain Index were the parameters used to examine each patient before and after the study.

Each patient were handed out coded bottles of CHX 0.12%, 0.20% and placebo. Patients were asked to rinse their mouthwash twice daily after brushing for 2 weeks.

In the day 14 all the mentioned clinical parameters were re-assessed by one trained experienced examiner under standard dental office and light source conditions.

Results  

The mean difference of Plaque index and gingival index before and after the examination period for both groups rinsed CHX (0.2% or 0.12%) was statistically higher than the placebo group. However, no statistically significant differences were observed between both chlorhexidine concentration regimes.

For gingival bleeding index, the mean difference of the group that rinsed 0.2% CHX was 24.157 that is significantly higher than 0.12% CHX group (13.672) and placebo group (0.020)

Results showed that after 14 days taking CHX the dental staining area and intensity increased significantly in comparison with the placebo group). Significance difference was seen between 2 CHX concentration so that the 0.2% CHX caused much more staining on the teeth than 0.12% CHX

Discussion  

In this study, there were found no significant differences between 0.2% and 0.12% CHX mouth rinses in term of PI and GI that is similar to the results of previous studies.  GBI was also found to be decreased significantly more by CHX 0.2% than 0.12% CHX. In term of dental staining index, lower concentrations of CHX induce significantly less dental staining

Conclusion  

Based on the results of this study, we can conclude that the lower concentrations of CHX should be prescribed, decreasing side effects, since higher concentrations do not seem to be more effective in controlling dental plaque and gingivitis.

REFERENCES

1. Franco Neto CA, Parolo CC, Rösing CK, Maltz M. Comparative analysis of the effect of two chlorhexidine mouthrinses on plaque accumulation and gingival bleeding. Braz Oral Res. 2008;22:139–44. [PubMed: 18622483]

2. Bossmann K. Plaque and plaque control. Oralprophylaxe. 1988;10:18–27. [PubMed: 3078890]

3. Hogg SD. Chemical control of plaque. (332-4).Dent Update. 1990;17:330. [PubMed: 2097233]

4. Bral M, Brownstein CN. Antimicrobial agents in the prevention and treatment of periodontal diseases. Dent Clin North Am. 1988;32:217–41. [PubMed: 3288511]

5. Hase JC, Attström R, Edwardsson S, Kelty E, Kisch J. 6-month use of 0.2% delmopinol hydrochloride in comparison with 0.2% chlorhexidine digluconate and placebo. (I). Effect on plaque formation and gingivitis. J Clin Periodontol. 1998;25:746–53. [PubMed: 9763330]

6. Keijser JA, Verkade H, Timmerman MF, Van der Weijden FA. Comparison of 2 commercially available chlorhexidine mouthrinses. J Periodontol. 2003;74:214–8. [PubMed: 12666710]

7. Lorenz K, Bruhn G, Heumann C, Netuschil L, Brecy M, Hoffmann T. Effect of two new chlorhexidine mouthrinses on the development of dental plaque, gingivitis, and discolouration. A randomized, investigator-blind, placebo-controlled, 3-week experimental gingivitis study. J Clin Periodontol. 2006;33:561–7. [PubMed: 16899099]

8. Van Strydonck DA, Demoor P, Timmerman MF, van der Velden U, van der Weijden GA. The anti-plaque efficacy of a chlorhexidine mouthrinse used in combination with toothbrushing with dentifrice. J Clin Periodontol. 2004;31:691–5. [PubMed: 15257749]

9. Lang N, Brecx MC. Chlorhexidine digluconate–an agent for chemical plaque control and prevention of gingival inflammation. J Periodontal Res. 1986;21:74–89.

10. Addy M. Chlorhexidine compared with other locally delivered antimicrobials. A short review. J Clin Periodontol. 1986;13:957–64. [PubMed: 3540026]

11. Kornman KS. The role of supragingival plaque in the prevention and treatment of periodontal diseases. J Periodontal Res. 1986;21:5–22.

12. Denton GW. Chlorhexidine, Disinfection, sterilization and preservation. 4th ed. Philadelphia: Elsevier; 1991.

13. Jones CG. Chlorhexidine: Is it still the gold standard? Periodontol. 2000;1997(15):55–62.

14. Flötra L, Gjermo P, Rölla G, Waerhaug J. Side effects of chlorhexidine mouth washes. Scand J Dent Res. 1971;79:119–25. [PubMed: 5280246]

15. Quirynen M, Avontroodt P, Peeters W, Pauwels M, Cauck W, Steen Berghe D. Effect of different chlorhexidine formulations in mouthrinses on de novo plaque formation. J Clin Periodontol. 2001;28:1127–36. [PubMed: 11737510]

16. Addy M, Wade W, Goodfield S. Staining and antimicrobial properties in vitro of some chlorhexidine formulations. Clin Prev Dent. 1991;13:13–7.

17. Gurgan CA, Zaim E, Bakirsoy I, Soykan E. 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. J Periodontol. 2006;77:370–84. [PubMed: 16512751]

18. Stoeken JE, Versteeg PA, Rosema NA, Timmerman MF, Van der velden U. Inhibition of “de novo” plaque formation with 0.12% chlorhexidine spray compared to 0.2% spray and 0.2% chlorhexidine mouthwash. J Periodontol. 2007;78:899–904. [PubMed: 17470024]

19. Mendieta C, Vallcorba N, Binney A, Addy M. Comparison of 2 chlorhexidine mouthwashes on plaque regrowth in vivo and dietary staining in vitro. J Clin Periodontol. 1994;21:296–300. [PubMed: 8195448]

20. Lang NP, Hotz P, Graf H, Geering AH, Saxer UP, Sturzenberger OP, et al. Effects of supervised chlorhexidine mouthrinses in children.A longitudinal clinical trial. J Periodontal Res. 1982;17:101–11. [PubMed: 6211534]

21. Cumming BR, Loe H. Optimal dosage and method of delivering chlorhexidine solutions for the inhibition of dental plaque. J Periodontal Res. 1973;8:57–62. [PubMed: 4267946]

22. Jenkins S, Addy M, Newcombe R. Comparision of two commercially available chlorhexidine mouthrinses: II.Effect on plaque reformation, gingivitis and tooth staining. Clin Prev Dent. 1999;11:12–6. [PubMed: 2638954]