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PurposeOne of the key approaches to minimize the risk of COVID-19 transmission would be to reduce the titres of SARS-CoV-2 in the saliva of infected COVID-19 patients. This is particularly important in high-risk procedures like dental treatment. The present randomized control trial evaluated the efficacy of three commercial mouth-rinse viz. povidone–iodine (PI), chlorhexidine gluconate (CHX) and cetylpyridinium chloride (CPC), in reducing the salivary SARS-CoV-2 viral load in COVID-19 patients compared with water.MethodsA total of 36 SARS-CoV-2-positive patients were recruited, of which 16 patients were randomly assigned to four groups—PI group (n = 4), CHX group (n = 6), CPC group (n = 4) and water as control group (n = 2). Saliva samples were collected from all patients at baseline and at 5 min, 3 h and 6 h post-application of mouth-rinses/water. The samples were subjected to SARS-CoV-2 RT-PCR analysis.ResultsComparison of salivary Ct values of patients within each group of PI, CHX, CPC and water at 5 min, 3 h and 6 h time points did not show any significant differences. However, when the Ct value fold change of each of the mouth-rinse group patients were compared with the fold change of water group patients at the respective time points, a significant increase was observed in the CPC group patients at 5 min and 6 h and in the PI group patients at 6 h.ConclusionThe effect of decreasing salivary load with CPC and PI mouth-rinsing was observed to be sustained at 6 h time point. Within the limitation of the current study, as number of the samples analyzed, the use of CPC and PI formulated that commercial mouth-rinses may be useful as a pre-procedural rinse to help reduce the transmission of COVID-19.ISRCTN (ISRCTN95933274), 09/09/20, retrospectively registered

Most public health measures to contain the COVID-19 pandemic are based on preventing the pathogen spread, and the use of oral antiseptics has been proposed as a strategy to reduce transmission risk. The aim of this manuscript is to test the efficacy of mouthwashes to reduce salivary viral load in vivo. This is a multi-centre, blinded, parallel-group, placebo-controlled randomised clinical trial that tests the effect of four mouthwashes (cetylpyridinium chloride, chlorhexidine, povidone-iodine and hydrogen peroxide) in SARS-CoV-2 salivary load measured by qPCR at baseline and 30, 60 and 120 min after the mouthrinse. A fifth group of patients used distilled water mouthrinse as a control. Eighty-four participants were recruited and divided into 12–15 per group. There were no statistically significant changes in salivary viral load after the use of the different mouthwashes. Although oral antiseptics have shown virucidal effects in vitro, our data show that salivary viral load in COVID-19 patients was not affected by the tested treatments. This could reflect that those mouthwashes are not effective in vivo, or that viral particles are not infective but viral RNA is still detected by PCR. Viral infectivity studies after the use of mouthwashes are therefore required. ( https://clinicaltrials.gov/ct2/show/NCT04707742 ; Identifier: NCT04707742)

To investigate whether preoperative chlorhexidine mouthwash can reduce the risk of postoperative pulmonary complications(PPCs) in elderly patients with tracheal intubation under general anesthesia. 78 elderly patients undergoing elective surgery under general anesthesia and endotracheal intubation were randomly divided into the chlorhexidine group (CH group, n  = 39) and the normal saline group (NS group, n  = 39). Nurses instructed patients to gargle with 15 ml saline or compound chlorhexidine mouthwash the night before surgery, on the morning of surgery, and upon entering the operating room. The primary outcome was lung ultrasound score (LUS) on postoperative day 1 (D 1 ). The secondary outcome was LUS on the preoperative day (D 0 ) and postoperative day 3 (D 3 ), bacterial colony count at the tip of the endotracheal tube, inflammatory markers (IL-1β, IL-6, TNF-α), and the incidence of postoperative fever, pneumonia, cough severity and sputum production. The CH group had significantly lower D 1 LUS compared to the NS group, whereas there was no significant difference in D 3 LUS between the groups. Within three postoperative days, there were no significant differences between the groups in cough severity, sputum production, fever, inflammatory markers, or pneumonia incidence. Bacterial colony counts on the endotracheal tube at extubation were lower in the CH group than in the NS group. Post hoc sensitivity analysis revealed that in patients with oral frailty, the number of colonies cultured at D 1 LUS, D 3 LUS, and the catheter tip in the CH group was lower than that in the NS group. However, there was no significant difference between the two groups in terms of the incidence of pneumonia and other aspects. Exploratory subgroup analysis showed that chlorhexidine mouthwash significantly reduced postoperative LUS in patients with oral frailty, while there were no significant differences in gender, smoking and age subgroups. Preoperative chlorhexidine mouthwash improved early postoperative LUS in elderly patients by reducing oropharyngeal bacterial colonization, particularly in those with oral weakness, though clinical outcomes like pneumonia showed no significant differences. Chinese clinical trial registration number: ChiCTR2400089898.

Objectives This study aimed to synthesize and characterize colloidal chitosan-silver nanoparticles-fluoride nanocomposite (CCAgNPF) and evaluate its efficacy compared to chlorhexidine on salivary Streptococcus mutans in orthodontic patients. Materials and methods AgNPs stabilized with chitosan were synthesized by chemical reduction of AgNO 3 . The nanoparticles were characterized with SEM, FTIR, DLS and ICP-OES. The MIC and MBC against S. mutans and IC50 concentration of CCAgNPF were obtained for antibacterial and cytotoxicity evaluations, respectively. For the clinical study, a total of 45 orthodontic patients were divided into three groups of 15 and used the following mouthwashes twice a day for 1 month: CCAgNPF, chlorhexidine 0.2% and the combination of these mouthwashes. The colony count of salivary S. mutans was evaluated before and after using the mouthwashes. The data were analyzed using One-way ANOVA and Tukey's test. Results Stabilized AgNPs were spherical with a diameter of 25.3 ± 3.3 nm. The MIC, MBC and IC50 of CCAgNPF were 4.42, 8.85 and 18.89 µg/ml. All mouthwashes reduced the salivary S. mutans of the orthodontic patients, however, no significant difference was found between the efficacy of CCAgNPF and chlorhexidine (P-value > 0.05). The best results were achieved by the combination of CCAgNPF and chlorhexidine mouthwashes (P-value < 0.05). Conclusion The CCAgNPF and its combination with chlorhexidine present potent bactericidal, biocompatible and effective anti-carious mouthwashes for orthodontic patients. Clinical relevance This study proved CCAgNPF as an antibacterial mouthwash with lower cytotoxicity and side effects for patients undergoing orthodontic treatments to maintain oral hygiene and reduce salivary S. mutans .

Oropharyngeal mucositis occurs in virtually all patients with head and neck cancer receiving radiochemotherapy. The manipulation of the oral cavity microbiota represents an intriguing and challenging target. A total of 75 patients were enrolled to receive Lactobacillus brevis CD2 lozenges or oral care regimen with sodium bicarbonate mouthwashes. The primary endpoint was the incidence of grade 3 or 4 oropharyngeal mucositis during radiotherapy treatment. There was no statistical difference in the incidence of grade 3-4 oropharyngeal mucositis between the intervention and control groups (40.6% vs. 41.6% respectively, p=0.974). The incidence of pain, dysphagia, body weight loss and quality of life were not different between the experimental and standard arm. Our study was not able to demonstrate the efficacy of L. brevis CD2 lozenges in preventing radiation-induced mucositis in patients with head and neck cancer. Although modulating homeostasis of the salivary microbiota in the oral cavity seems attractive, it clearly needs further study.

The posterior oral cavity serves as an entry point to both the digestive and respiratory systems. Optimal oral hygiene, particularly by means of gargling, has been shown to effectively reduce transmission and duration of respiratory illnesses (Clinical Trials registration: NCT06479226). Previous studies have demonstrated the effectiveness of gargling with an antimicrobial mouthwash in preventing the development of respiratory symptoms. To assess the impact of using an antimicrobial mouthwash for gargling in lowering the incidence of upper respiratory symptoms. A total of 150 individuals were recruited and randomly assigned to two groups: Control group: participants were requested to brush their teeth twice daily for two minutes using a commercially available fluoride toothpaste; and the Test Group, which also brushed their teeth twice daily for two minutes with a commercially available fluoride toothpaste and additional gargling twice a day with a mouthwash containing 0.075% Cetylpyridinium chloride and 0.28% Zinc Lactate (CPC+Zn). Individuals were asked to complete the WURSS-21 Daily Symptom Report over the course of the three-month study period using a diary. Regular gargling with the mouthwash containing CPC+Zn was efficacious in decreasing both the frequency (21.5% lower) and severity (11% lower) of respiratory symptoms throughout the study. Additionally, individuals that performed consistent cleansing of the posterior oral cavity with mouthwash had greater interference in daily activities, which should be further investigated. Adding gargling with a mouthwash containing 0.075% CPC + 0.28% Zn to a normal oral hygiene routine proves beneficial in lowering the incidence of upper respiratory symptoms commonly associated with cold and the flu. Trial registration: ClinicalTrials.gov NCT06479226

Chlorhexidine (CHX) is the most commonly used mouthwash with proven antiplaque and antibacterial activity. The aim is to evaluate the effect of vitamin C (VitC) in CHX mouthwash on plaque accumulation and gingivitis, and to compare it with CHX alone mouthwash and antiseptic phenol-containing mouthwashes. This study conducted as a multicenter, randomized, controlled, double-blind, parallel design clinical study. Sixty patients were included, randomly divided into three groups. 1. Antiseptic phenol agent (P, Phenol), 2. Antiseptic bisbiguanide agent CHX-only (CHX) and 3. Antiseptic bisbiguanide agent CHX + VitC mouthwash (CHX + VitC). The study assessed oral hygiene and periodontal health status, followed by scaling and root planning (SRP) and subsequent polishing. After using the mouthwash for 60 s twice daily along 14 days, patients recalled for evaluation of plaque index (PI), gingival index (GI), bleeding on probing (BOP) and staining. One-way analysis of variance (ANOVA) was used to compare the differences formed between groups and Tukey multiple comparison analysis was used to determine groups that showed the differences. Statistical significance was determined using a p -value threshold of 0.05. There were no significant differences between the groups regarding baseline PI, GI and BOP ( p  > 0.05). Changes at 14th day in PI, GI and BOP in all groups were similar and no significant differences were observed ( p  > 0.05). Regarding ‘all surfaces’, staining density of two mouthwashes containing CHX was significantly higher than that of P mouthwash. CHX, CHX + VitC, and P mouthwashes appeared to exhibit comparable effects as oral hygiene adjuncts to periodontal mechanical treatment, with the exception of staining, which was more noticeable in the CHX groups compared to the P group . Adding vitamin C did not enhance the effects of CHx alone.

Clinical research on herbal-based dentifrice +/− mouth rinse products is very limited compared with the plethora of research on conventional oral care products under normal oral hygiene conditions. The aim of this study was to determine the anti-inflammatory effects of a novel plant Carica papaya leaf extract (CPLE) on interdental bleeding in healthy subjects. In this randomized, single-blind parallel-design study, the eligible subjects were generally healthy non-smokers, aged 18–26, who exhibited healthy periodontal conditions upon study entry. The participants were equally randomized into the following four groups: CPLE dentifrice, CPLE dentifrice and mouthwash, sodium lauryl sulfate (SLS)-free enzyme-containing dentifrice and SLS-free enzyme-containing dentifrice with essential oil (EO) mouthwash. Subjects were instructed to brush their teeth twice a day without changing their other brushing habits. Interdental bleeding (BOIP) was measured from inclusion (T0) until the fourth week (T4) of the study. Clinical efficacy was assessed after one, two, three and four weeks of home use. The analyses compared BOIP between groups and were then restricted to participants with ≥70% and then ≥80% bleeding sites at T0. Pairwise comparisons between groups were performed at T0 and T4, and a logistic regression identified correlates of gingival bleeding (T4). Among 100 subjects (2273 interdental sites), the median percentage of bleeding sites per participant at T0 was 65%. The bleeding sites dramatically decreased in all groups between T0 and T4 (relative variations from −54% to −75%, p < 0.01 for all). Gingival bleeding did not significantly differ between the CPLE dentifrice and the SLS-free dentifrice +/− EO mouthwash groups (from p = 0.05 to p = 0.86), regardless of the baseline risk level. Among the CPLE dentifrice users, fewer bleeding sites were observed when toothpaste and mouthwash were combined compared to bleeding sites in those who used toothpaste alone (21% vs. 32%, p = 0.04). CPLE dentifrice/mouthwash provides an efficacious and natural alternative to SLS-free dentifrice +/−EO-containing mouthwash when used as an adjunct to mechanical oral care to reduce interdental gingival inflammation.

Objective This study aimed to examine and compare the efficacy of mouthwashes containing different proteins and peptide on the prevention of enamel erosion in vivo, as well as to evaluate the participants’ satisfaction with the formulations. Methods Twelve participants were selected and underwent five cross-over mouthwash phases: Water (control); 0.1 mg/mL CaneCPI-5; 0.5 mg/mL MaquiCPI-3; 0.1 mg/mL CsinCPI-2; and 0.037 mg/mL Stn15pSpS. After prophylaxis, the participants rinsed (1 min), followed by the acquired enamel pellicle (AEP) formation (2 h). An erosive challenge was made (biopsy, citric acid 1%, 15s) on the buccal surface of the central maxillary incisors. The Relative Surface Reflection Intensity (%SRI) was assessed and analyzed by ANOVA/Tukey’s tests. The calcium release in acid was measured by the Arsenazo method and verified by Kruskal-Wallis/Dunn’s tests. The Spearman’s correlation was used between analyses. A questionnaire evaluated the satisfaction of participants. Results For both analyses, the results showed that mouthwashes containing the proteins or peptide were significantly more effective in preventing enamel erosion compared to deionized water, with no significant differences among the active ingredients ( p  < 0.05). Also, there was a significant negative correlation between %SRI and calcium released ( r =-0.5754). The questionnaire revealed that the volunteers were satisfied with the taste of the products. In addition, the experimental procedures were well tolerable, and no side effects were reported. Conclusion All mouthwashes containing proteins or peptide were acceptable and effective in protecting enamel against initial dental erosion in vivo. Clinical significance: This study highlights the potential of these pioneer organic components for the development of mouthwashes designed for people with risk of erosive tooth wear.

Background Alterations in the mechanical properties of the materials utilized in orthodontic appliances could affect the working properties of the appliances, thereby affecting clinical progress and outcome. Numerous studies have confirmed the correlation between alloy corrosion and raised surface roughness, which has a direct impact on the working characteristics of orthodontic archwires. Methods Thirty nickel-titanium (NiTi) orthodontic archwires were utilized in this study. Patients were randomly selected and allocated into three groups according to the randomization plan; (The control group): subjects practiced regular oral hygiene; (The fluoride group): subjects used fluoride for intensive prophylaxis; (The chlorhexidine group): subjects used chlorhexidine. Representative samples were evaluated by SEM, and then SEM images with high resolution were examined using Image J software to determine the surface roughness and obtain the results for further statistical analysis. Results Our findings indicated a significant difference was found between the three groups regarding the anterior and posterior parts between the control and the two other groups and a non-significant difference between NaF and CHX groups. Overall, the p -value for group comparisons was 0.000 for both parts, indicating a highly significant difference especially between the control and NaF groups. Conclusion Mouthwashes containing sodium fluoride demonstrated more significant surface alterations than the control and CHX groups and should be prescribed in accordance with orthodontic materials to reduce side effects.