Supervisors info:
Βασιλόπουλος Σπυρίδων, Επίκουρος Καθηγητής, Τμήμα Οδοντιατρικής, Εθνικό και Καποδιστριακό Πανεπιστήμιο Αθηνών
Μαδιανός Φοίβος, Καθηγητής, Τμήμα Οδοντιατρικής, Εθνικό και Καποδιστριακό Πανεπιστήμιο Αθηνών
Μπομπέτσης Γεώργιος, Αναπληρωτής Καθηγητής, Τμήμα Οδοντιατρικής, Εθνικό και Καποδιστριακό Πανεπιστήμιο Αθηνών
Summary:
Objective: To assess the efficacy of two daily mouthrinses containing CHX (0.05% w/v) in improving periodontal and stain indices when used as an adjunctive method of mechanical oral hygiene.
Materials and Methods: In this randomized, double-blinded clinical trial, 81 participants rinsed twice daily for 3 months with either the test solutions — CHX 0.05% + CPC 0.05% + H2O2 0.8% (Group 1) and CHX 0.05% + CPC 0.05% (Group 2) — or a placebo (Group 3), in addition to conventional hygiene. Initially, supragingival prophylaxis and reinforcement of oral hygiene were conducted, followed by enrollment in a 2-week preparation program. Clinical measurements and standardized photographs were performed at baseline, 1, 2, and 3 months to evaluate plaque indices, gingival, and stain index. At the end of the experimental period, the time of professional mechanical removal was assessed, and the participants completed a questionnaire. Primary outcomes included changes in bacterial biofilm accumulation and gingival inflammation, while tooth staining was also evaluated. Secondary outcomes involved patient satisfaction and perspective.
Results: The study evaluated the efficacy of mouth rinses in reducing plaque accumulation and gingival inflammation over three months. Plaque Index (PI) scores increased significantly in all groups by the study's end, with Group 1 exhibiting a lower increase compared to Group 3 (Group 3 vs. 1: LS mean = 0.314, 95% CI [0.027 – 0.600]; p = 0.0322). The percentage of dental surface covered by plaque (PA%) also significantly increased in all groups, with Group 2 and 3 showing greater increases compared to Group 1 (Group 2 vs. 1: LS mean = 5.847, 95% CI [1.562 – 10.132]; p = 0.0075, Group 3 vs. 1: LS mean = 5.757, 95% CI [1.422 – 10.092]; p = 0.0092). Gingival Index (GI) scores varied among groups, with Group 3 having the highest mean score at the study's end. Staining was observed in Groups 1 and 2 but not in Group 3, with Group 2 having the highest Stain Index (SI) at V2 and V3 [average value 0.368, SD: ±0.8843 at V2 (p = 0.009) and 0.551, SD: ±1.1350 at V3 (p = 0.015)]. No significant differences were found in the time required for professional mechanical removal of biofilm and stains among the groups. Self-reported side effects included staining and minor irritation, with Group 2 reporting the highest incidence. Overall, participants reported good satisfaction with the mouthwash, with Group 1 having the highest percentage of participants reporting satisfaction.
Conclusion: In conclusion, regarding plaque scores, a low concentration of CHX mouthrinse combined with CPC provides an adjunctive effect in PI and PA% compared to mechanical plaque control alone. Specifically, higher effectiveness in inhibiting plaque formation was observed by adding H2O2 to 0.05% CHX and 0.05% CPC mouthrinses. Although both experimental groups showed a trend in reducing GI, gingivitis development was not significantly affected. Furthermore, the proportion of stained surfaces was significantly lower when an oxidizing mouthrinse was added to chlorhexidine.
Keywords:
Chlorhexidine, Hydrogen peroxide, Mouthwash, Periodontal indexes, Tooth staining
