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Background So far, the impact of sodium bicarbonate solution on the oral health status of patients with chronic heart failure has not been comprehensively investigated.This study aims to evaluate the effectiveness of sodium bicarbonate solution gargling in improving the tongue coating, oral hygiene, and oral health status of patients with heart failure. Methods This prospective, randomized, controlled, single-blind study included 108 heart failure patients, randomly assigned to three groups ( n  = 36 each).Group A received standard oral hygiene care and underwent monitoring for 7 days. Group B received standard oral hygiene care plus twice-daily gargling with 5% sodium bicarbonate solution (once in the morning and once before bedtime) for 7 days. Group C similarly received standard oral hygiene care but performed gargling five times daily (upon waking, before bedtime, and within 30 min after each meal) for the same duration. The evaluation focused on tongue coating status, oral bacterial colony count, oral plaque index scores, and overall oral health status. Results During the first three days of the intervention, there were no significant differences in Winkel tongue coating index among groups A, B, and C ( P  > 0.05). However, from the fourth day onwards, the Winkel tongue coating index in groups B and C was significantly lower than that in group A ( P  < 0.05). By the sixth day, group C demonstrated significantly greater reduction in Winkel Tongue Coating Index scores compared to Group B ( P  < 0.05). On the seventh day of the intervention, statistically significant differences were observed in the number of oral bacterial colonies and dental plaque index among groups A, B, and C ( P  < 0.05). Significant differences in Beck Oral Assessment scores were observed among all three groups (A, B, and C) throughout the 7-day intervention period ( P  < 0.05). Conclusions sodium bicarbonate solution improves tongue coating, oral hygiene, and overall oral health in HF patients with good tolerability and safety. Trial registration This study was retrospectively registered in the Chinese Clinical Trial Registry, Registration number ChiCTR2400094457. Reg Date20241223.

This study implemented an intra-oral test-platform to assess the sensory, psychophysical, and vasomotor responses to nicotine and menthol, alone or in combination. Two double-blinded, placebo-controlled, randomized, cross-over studies, including healthy nonsmoking participants were performed. Study I: A dose-response relationship (N = 20) between 0, 2, and 4 mg nicotine gum. Study II: An interaction response (N = 22) to 30 mg menthol and 4 mg nicotine alone or in combination. Heart rate, blood pressure, tactile and thermosensory thresholds, intra-oral blood flow and temperature, pain/irritation intensities/locations, McGill Pain Questionnaire, and taste experience were assessed before, during or after the completion of a standardized chewing regime. A dose-response elevation in heart rate was attenuated when nicotine was combined with menthol. Blood flow, temperature, and warm-detection thresholds, as assessed on the tongue, similarly increased for all gums. Pain intensity and taste experiences were similar between nicotine doses. Nicotine attenuated the sweet, cooling, and freshening sensation of menthol. Within the first 4 minutes, menthol reduced the intensity but not the area of nicotine-induced pain and irritation. The 4-mg nicotine dose led to a continued increase in the intensity and area of irritation in the throat post-chewing. Moreover, one-half of participants responded to menthol as an irritant, and these individuals demonstrated larger areas of nicotine-induced irritation in the throat post-chewing. The intra-oral test platform provides a basis to optimize the assessment of nicotine-related taste and sensory experiences and can be used in future studies for profiling nicotine gum.

This study was to evaluate the effect of Streptococcus salivarius K12 on tongue coating–associated halitosis. Twenty-eight subjects having tongue coating–associated halitosis were randomly divided into either a test or control group. For each of the 30 days, the test subjects sucked S. salivarius K12 tablet while the control subjects sucked placebo tablets. All the subjects did not take physical (tongue scraping) and chemical (antiseptic mouth-rinse) oral cavity pretreatment prior to use of the tablets. At baseline, and on the 1st, 7th, and 14th day after completing the course of tablets, the subjects were assessed for their organoleptic test (OLT) scores, volatile sulfur compound (VSC) levels, and tongue coating scores (TCS). During the course, all subjects kept their routine oral care habits without scraping their tongue coating. Plaque index, probing depth, and bleeding index were recorded at baseline and at the completion of the trial. On the 1st day following the end of tablet use, the OLT scores and VSC levels had significantly decreased in the test group when compared with the baseline values ( P  = 0.001 and P  = 0.012). The TCS in the test group were also significantly decreased ( P  = 0.05). At days 7 and 14, the OLT scores in the test group were still significantly lower than the baseline levels ( P  = 0.006 and P  = 0.039 respectively). However, there were no statistical differences with OLT, VSC, and TCS between the test group and the placebo group by analysis of multi-level regression model. The use of S. salivarius K12 did not have significant effect on halitosis with tongue coating cause when the tongue coating was not physically or chemically pre-treated, which implies removing tongue coating is required before Streptococcus salivarius K12 use.

Objectives This study aims to assess the effects of rinsing with zinc- and chlorhexidine-containing mouth rinse with or without adjunct tongue scraping on volatile sulfur compounds (VSCs) in breath air, and the microbiota at the dorsum of the tongue. Material and methods A randomized single-masked controlled clinical trial with a cross-over study design over 14 days including 21 subjects was performed. Bacterial samples from the dorsum of the tongue were assayed by checkerboard DNA–DNA hybridization. Results No halitosis (identified by VSC assessments) at day 14 was identified in 12/21 subjects with active rinse alone, in 10/21with adjunct use of tongue scraper, in 1/21 for negative control rinse alone, and in 3/21 in the control and tongue scraping sequence. At day 14, significantly lower counts were identified only in the active rinse sequence ( p  < 0.001) for 15/78 species including , Fusobacterium sp., Porphyromonas gingivalis , Pseudomonas aeruginosa , Staphylococcus aureus , and Tannerella forsythia . A decrease in bacteria from baseline to day 14 was found in successfully treated subjects for 9/74 species including: P. gingivalis , Prevotella melaninogenica , S. aureus , and Treponema denticola . Baseline VSC scores were correlated with several bacterial species. The use of a tongue scraper combined with active rinse did not change the levels of VSC compared to rinsing alone. Conclusions VSC scores were not associated with bacterial counts in samples taken from the dorsum of the tongue. The active rinse alone containing zinc and chlorhexidine had effects on intra-oral halitosis and reduced bacterial counts of species associated with malodor. Tongue scraping provided no beneficial effects on the microbiota studied. Clinical relevance Periodontally healthy subjects with intra-oral halitosis benefit from daily rinsing with zinc- and chlorhexidine-containing mouth rinse.

Background Halitosis is an unpleasant breath odour that can interfere with the professional life, social life and quality of life of people who suffer from it. A modality of treatment that has been increasing in dentistry is antimicrobial photodynamic therapy (aPDT). Bixa orellana , popularly known as “urucum” is a plant native to Brazil. The seeds are used to produce a dye that is largely used in the food, textile, paint and cosmetic industries. The aim of this study is to verify whether aPDT with Bixa orellana extract and blue light-emitting diodes (LEDs) is effective in reducing halitosis. This method will also be compared with tongue scraping, the most commonly used conventional method for tongue coating removal, and the association of both methods will be evaluated. Methods/design A randomized clinical trial will be conducted at the dental clinic of the Universidade Nove de Julho . Thirty-nine patients will be divided by block randomization into three groups ( n  = 13) according to the treatment to be performed. In Group 1, tongue scraping will be performed by the same operator in all patients for analysis of the immediate results. Patients will also be instructed on how to use the scraper at home. Group 2 will be treated with aPDT with Bixa orellana extract and the LED light curing device: Valo Cordless Ultradent®. Six points in the tongue dorsum with a distance of 1 cm between them will be irradiated. The apparatus will be pre-calibrated at wavelength 395–480 nm for 20 s and 9.6 J per point. In Group 3, patients will be submitted to the tongue scraping procedure, as well as to the previously explained aPDT. Oral air collection with the Oral Chroma™ and microbiological collections of the tongue coating shall be done before, immediately after and 7 days after treatment for comparison. Discussion Halitosis treatment is a topic that still needs attention. The results of this trial could support decision-making by clinicians regarding aPDT using blue LEDs for treating halitosis on a daily basis, as most dentists already have this light source in their offices. Trial registration ClinicalTrials.gov, NCT03346460 . Registered on 17 November 2017.

Background Previous research has shown the oxidizing properties and microbiological efficacies of chlorine dioxide (ClO 2 ). Its clinical efficacies on oral malodor have been evaluated and reported only in short duration trials, moreover, no clinical studies have investigated its microbiological efficacies on periodontal and malodorous bacteria. Thus, the aim of this study was to assess the inhibitory effects of a mouthwash containing ClO 2 used for 7 days on morning oral malodor and on salivary periodontal and malodorous bacteria. Methods/Design A randomized, double blind, crossover, placebo-controlled trial was conducted among 15 healthy male volunteers, who were divided into 2 groups. Subjects were instructed to rinse with the experimental mouthwash containing ClO 2 or the placebo mouthwash, without ClO 2 , twice per day for 7 days. After a one week washout period, each group then used the opposite mouthwash for 7 days. At baseline and after 7 days, oral malodor was evaluated with Organoleptic measurement (OM), and analyzed the concentrations of hydrogen sulfide (H 2 S), methyl mercaptan (CH 3 SH) and dimethyl sulfide ((CH 3 ) 2 S), the main VSCs of human oral malodor, were assessed by gas chromatography (GC). Clinical outcome variables included plaque and gingival indices, and tongue coating index. The samples of saliva were microbiologically investigated. Quantitative and qualitative analyses were performed using the polymerase chain reaction-Invader method. Results and Discussion The baseline oral condition in healthy subjects in the 2 groups did not differ significantly. After rinsing with the mouthwash containing ClO 2 for 7 days, morning bad breath decreased as measured by the OM and reduced the concentrations of H 2 S, CH 3 SH and (CH 3 ) 2 S measured by GC, were found. Moreover ClO 2 mouthwash used over a 7-day period appeared effective in reducing plaque, tongue coating accumulation and the counts of Fusobacterium nucleatum in saliva. Future research is needed to examine long-term effects, as well as effects on periodontal diseases and plaque accumulation in a well-defined sample of halitosis patients and broader population samples. Trial registration ClinicalTrials.gov NCT00748943

Objectives It was the aim to investigate experimental mouth rinses concerning their tooth and tongue staining potential using the standardized short-term forced staining model. Materials and methods A single centre, clinically controlled, randomized, investigator-blinded study was conducted in a crossover design. In healthy dental students, three experimental AmF/SnF 2 (A, B, C) mouth rinses and a phenolic/essential oil rinse (D) were compared to a water control (E). Four treatment days consisted of eight hourly rinses with mouth rinse and black tea. Mechanical oral hygiene was ceased. At the fifth day, tooth and tongue staining indices were recorded. Between treatment periods, a 10-day washout phase was performed. Results Twenty-eight participants entered and completed the study. All mouth rinses including the water control led to tooth and tongue staining. Most tooth staining occurred after rinsing with test rinse A, followed by B, D, C and E. Statistically significant differences existed between products A and C, D, and E. Most tongue staining happened in group B, followed by A, D, C and E (not statistically significant). Conclusion Within the limitations of the model, mouth rinse C has a promising potential of causing less tooth discoloration than other AmF/SnF 2 rinses. C is highly recommended to be investigated in further long-term clinical studies on its in vivo staining potential and antiplaque efficacy. Clinical relevance This forced staining study has proven that one of the experimental AmF/SnF 2 rinses leads to less staining than the other experimental AmF/SnF 2 rinses. These experimental results have to be confirmed by further clinical investigations.

This study compared the staining potential of two experimental amine fluoride/stannous fluoride mouth rinses (A and B), a phenolic/essential oil rinse (C) and a negative control, water, rinse (D). The study was a single centre, randomized, single-blind, four treatment crossover study design among healthy participants. Prior to each study period, participants received a dental prophylaxis. On the Monday of each period, subjects suspended oral hygiene, and under supervision, rinsed with the allocated mouth rinse immediately followed by a warm black tea solution at hourly intervals eight times a day for 4 days. On Friday, the area and intensity of staining on the teeth, the primary outcome measure and dorsum of tongue were assessed. This regimen was repeated for all the three subsequent treatment periods. Rinse B produced less stain than rinse A, but the difference was not significant ( p  = 0.20). Rinse B produced significantly more stain than rinse C ( p  < 0.05) and D ( p  < 0.001). For tongue staining, rinse B produced significantly more staining than D ( p  < 0.01) but not A or C. Overall, all test rinses produced more staining than placebo with an overall pattern for more staining with stannous formulations. Individuals using stannous or phenolic/essential oil mouth rinse formulations should be advised of the possible staining side effect and that this can be easily removed by a professional dental cleaning.

The objective was to evaluate the early-stage immunoexpression of markers (COX-2, NF-kB, VEGFR-1 and apoptotic index) related to inflammation, angiogenesis, and cell survival in the tongue dorsum epithelium of mice exposed to hookah smoke. The sample consisted of Swiss mice (N = 20), female gender, aged 2 months, and approximately 25g each, four groups (n = 5) mice: group exposed to fresh air and groups exposed to hookah smoke for 7, 15, and 30 days. Tongues were embedded in paraffin. A tissue microarray was constructed, and immunohistochemistry was performed for Cyclooxygenase 2, NF-kappa B, Vascular Endothelial Growth Factor Receptor 1, and terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) for apoptotic analysis. The positive and negative cells were quantified in the epithelium of the mid-dorsal tongue region. Kruskal-Wallis and Dunn tests was made. The apoptotic index was higher at 30 days of smoke exposure (20.38% basal/ 19.63%/ suprabasal) compared to the group exposed to air (9.55%/ 11.88%), The expression of Vascular Endothelial Growth Factor Receptor 1 was higher at 30 days of smoke exposure (30.15%/ 38.15%) compared to the group exposed to air (18.25%/ 3.60%). Hookah smoke induced greater apoptosis and increased expression of Vascular Endothelial Growth Factor Receptor 1 in the epithelium of the tongue at 30 days, potentially playing a role in the initial stages of carcinogenesis, in the early stages of hookah use.

Striking taste disturbances are reported in cancer patients treated with Hedgehog (HH)-pathway inhibitor drugs, including sonidegib (LDE225), which block the HH pathway effector Smoothened (SMO). We tested the potential for molecular, cellular, and functional recovery in mice from the severe disruption of taste-organ biology and taste sensation that follows HH/SMO signaling inhibition. Sonidegib treatment led to rapid loss of taste buds (TB) in both fungiform and circumvallate papillae, including disruption of TB progenitor-cell proliferation and differentiation. Effects were selective, sparing nontaste papillae. To confirm that taste-organ effects of sonidegib treatment result from HH/SMO signaling inhibition, we studied mice with conditional global or epithelium-specific Smo deletions and observed similar effects. During sonidegib treatment, chorda tympani nerve responses to lingual chemical stimulation were maintained at 10 d but were eliminated after 16 d, associated with nearly complete TB loss. Notably, responses to tactile or cold stimulus modalities were retained. Further, innervation, which was maintained in the papilla core throughout treatment, was not sufficient to sustain TB during HH/SMO inhibition. Importantly, treatment cessation led to rapid and complete restoration of taste responses within 14 d associated with morphologic recovery in about 55% of TB. However, although taste nerve responses were sustained, TB were not restored in all fungiform papillae even with prolonged recovery for several months. This study establishes a physiologic, selective requirement for HH/SMO signaling in taste homeostasis that includes potential for sensory restoration and can explain the temporal recovery after taste dysgeusia in patients treated with HH/SMO inhibitors.