The effect of chlorhexidine on plaque index and mutans streptococci in orthodontic patients: A pilot study

Gisele Faria, Milton Santamaria Jr., Bianca Mota dos Santos, Izabel Yoko Ito, Janete Cinira Bregagnoloq, Maria Bernadete Sasso Stuani

Department of Clinical Analysis, Toxicology and Bromatology, School of Pharmaceutical Sciences of Ribeirao Preto, University of S?o Paulo (USP), Ribeir?o Preto, Brazil.
Department of Pediatric Clinics, Preventive and Social Dentistry, School of Dentistry of Ribeirao Preto, University of S?o Paulo (USP), Ribeir?o Preto, Brazil.
Department of Restorative Dentistry, School of Dentistry of Araraquara, University of the State of S?o Paulo (UNESP), Araraquara, Brazil.
Private Practice, Aracaju, Brazil.

DOI: 10.4236/ojst.2013.36054                

Abstract

Aim: The purpose of this study was to assess chlorhexidine effects on plaque index and salivary levels of mutans streptococci (MS) when used as the immersion solution for removable orthodontic appliances and added to their acrylic resin composition. Methods: Forty-five patients (6 to 12 years old) were randomly assigned into three groups with 15 patients each. Group I (control)—without orthodontic appliances disinfection; Group II—removable orthodontic appliances which had been immersed in 0.12% chlorhexidine digluconate overnight (8 hours), and Group III—orthodontic appliances in which 0.12% chlorhexidine digluconate solution had been incorporated into their resin composition. Saliva was collected for quantification of MS and evaluation of plaque index was performed before and after installation of orthodontic appliance at 0, 2, 4, 6, 8, and 10 weeks. Data were analyzed by using analysis of variance. Results: Number of MS colonies in saliva and plaque index showed no statistically differences among groups at the different periods (p > 0.05). Conclusions: It could be concluded that chlorhexidine incorporation into the acrylic resin of removable orthodontic appliances at 0.12% concentration and immersion of the appliance into 0.12% chlorhexidine solution were not effective in reducing plaque index and the number of MS in saliva.

Keywords

Chlorhexidine; Self-Polymerising Acrylic; Removable Orthodontic Appliances; Mutans Streptococci; Plaque Index

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Batoni, G., Pardini, M., Giannotti, A., Ota, F., Giuca, M.R., Gabriele, M., et al. (2001) Effect of removable orthodontic appliances on oral colonisation by mutans streptococci in children. European Journal of Oral Sciences, 109, 388-392. doi:10.1034/j.1600-0722.2001.00089.x
[2]	Catalbas, B., Ercan, E., erdemir, A., Gelgor, I.E. and Zorba, Y.O. (2009) Effects of different chlorhexidine formulations on shear bond strengths of orthodontic brackets. Angle Orthodontist, 79, 312-316. doi:10.2319/032008-158.1
[3]	Lundstrom, F. and Krasse, B. (1987) Streptococcus mutans and lactobacilli frequency in orthodontic patients; the effect of chlorhexidine treatments. European Journal of Orthodontics, 9, 109-116. doi:10.1093/ejo/9.1.109
[4]	Leung, N.M., Chen, R., Rudney, J.D. (2006) Oral bacteria in plaque and invading buccal cells of young orthodontic patients. American Journal of Orthodontics and Dentofacial Orthopedics, 130, 698. doi:10.1016/j.ajodo.2006.05.028
[5]	Nelson, F.P., Macari, S., Faria, G., Assed, S. and Ito, I.Y. (2000) Microbial contamination of toothbrushes and their decontamination. Pediatric Dentistry, 22, 381-384.
[6]	Diedrich, P. (1989) Microbial colonization and various cleaning procedures for orthodontic appliances. Fortschr Kieferorthop, 50, 231-239. doi:10.1007/BF02168746
[7]	Magno, A.F., Enoki, C., Ito, I.Y., Matsumoto, M.A., Faria, G. and Nelson-Filho, P. (2008) In-vivo evaluation of the contamination of Super Slick elastomeric rings by Streptococcus mutans in orthodontic patients. American Journal of Orthodontics and Dentofacial Orthopedics, 133, S104-S109. doi:10.1016/j.ajodo.2006.04.054
[8]	Auschill, T.M., Hein, N., Hellwig, E., Follo, M., Sculean, A. and Arweiler, N.B. (2005) Effect of two antimicrobial agents on early in situ biofilm formation. Journal of Clinical Periodontology, 32, 147-152. doi:10.1111/j.1600-051X.2005.00650.x
[9]	Lessa, F.C., Enoki, C., Ito, I.Y., Faria, G., Matsumoto, M.A. and Nelson-Filho, P. (2007) In-vivo evaluation of the bacterial contamination and disinfection of acrylic baseplates of removable orthodontic appliances. American Journal of Orthodontics and Dentofacial Orthopedics, 131, 705-707. doi:10.1016/j.ajodo.2006.09.042
[10]	Sreenivasan, P.K., Mattai, J., Nabi, N., Xu, T. and Gaffar, A. (2004) A simple approach to examine early oral microbial biofilm formation and the effects of treatments. Oral Microbiology and Immunology, 19, 297-302. doi:10.1111/j.1399-302x.2004.00158.x
[11]	da Silva, F.C., Kimpara, E.T., Mancini, M.N., Balducci, I., Jorge, A.O. and Koga-Ito, C.Y. (2008) Effectiveness of six different disinfectants on removing five microbial species and effects on the topographic characteristics of acrylic resin. Journal of Prosthodontics, 17, 627-633. doi:10.1111/j.1532-849X.2008.00358.x
[12]	Kocak, M.M., Ozcan, S., Kocak, S., Topuz, O. and Erten, H. (2009) Comparisation of the efficacy of three different mouthrinse solutions in decreasing the level of streptococcus mutans in saliva. European Journal of Dentistry, 3, 57-61.
[13]	Jurela, A., Repic, D., Pejda, S., Juric, H., Vidakovic, R., Matic, I. and Bosnjak, A. (2013) The effect of two different bracket types on the salivary levels of S mutans and S sobrinus in the early phase of orthodontic treatment. The Angle Orthodontist, 83, 140-145. doi:10.2319/030612-187.1
[14]	Jordan, C. and LeBlanc, D.J. (2002) Influences of orthodontic appliances on oral populations of mutans streptococci. Oral Microbiology and Immunology, 17, 65-71. doi:10.1046/j.0902-0055.2001.00083.x
[15]	Denton, G.W. (1991) Chlorhexidine. In: Block, S.S., Ed., Disinfction, Sterization, Preservations, 4 Edition, Lea & Fegiber, Philadelphia, 274-289.
[16]	André, R.F., Andrade, I.M., Silva-Lovato, C.H., Paranhos Hde, F., Pimenta, F.C. and Ito, I.Y. (2011) Prevalence of mutans streptococci isolated from complete dentures and their susceptibility to mouthrinses. Brazilian Dental Journal, 22, 62-67.
[17]	Azevedo, A., Machado, A.L., Vergani, C.E., Giampaolo, E.T., Pavarina, A.C. and Magnani, R. (2006) Effect of disinfectants on the hardness and roughness of reline acrylic resins. Journal of Prosthodontics, 15, 235-242. doi:10.1111/j.1532-849X.2006.00112.x
[18]	Pavarina, A.C., Machado, A.L., Giampaolo, E.T. and Vergani, C.E. (2003) Effects of chemical disinfectants on the transverse strength of denture base acrylic resins. Journal of Oral Rehabilitation, 30, 1085-1089. doi:10.1046/j.1365-2842.2003.01150.x
[19]	Bishara, S.E., Vonwald, L., Zamtua, J. and Damon, P.L. (1998) Effects of various methods of chlorhexidine application on shear bond strength. American Journal of Orthodontics and Dentofacial Orthopedics, 114, 150-153. doi:10.1053/od.1998.v114.a84780
[20]	Cacciafesta, V., Sfondrini, M.F., Stifanelli, P., Scribante, A. and Klersy, C. (2006) Effect of chlorhexidine application on shear bond strength of brackets bonded with a resin-modified glass ionomer. American Journal of Orthodontics and Dentofacial Orthopedics, 129, 273-276. doi:10.1016/j.ajodo.2004.07.050
[21]	George, A.M., Kalangi, S.K., Vasudevan, M. and Krishnaswamy, N.R. (2010) Chlorhexidine varnishes effectively inhibit Porphyromonas gingivalis and Streptococcus mutans—An in vivo study. Journal of Indian Society of Periodontology, 14, 178-180.
[22]	Chamele, J., Bhat, C., Saraf, T., Jadhav, A., Beg, A., Jagtap, C., Ubeja, R. and Patil, P. (2012) Efficacy of microwaves and chlorhexidine for disinfection of pacifiers and toothbrushes: An in vitro study. Journal of Contemporary Dental Practice, 13, 690-694.
[23]	Kulak, Y., Arikan, A., Albak, S., Okar, I. and Kazazoglu, E. (1997) Scanning electron microscopic examination of different cleaners: Surface contaminant removal from dentures. Journal of Oral Rehabilitation, 24, 209-215. doi:10.1111/j.1365-2842.1997.tb00315.x
[24]	Ciancio, S.G. (1992)Agents for management of plaque and gingivitis. Journal of Dental Research, 71, 1450-1454. doi:10.1177/00220345920710071701
[25]	Shklair, I.L. and Keene, H.J. (1974) A biochemical scheme for the separation of the five varieties of Streptococcus mutans. Archives of Oral Biology, 19, 1079-1081. doi:10.1016/0003-9969(74)90099-5
[26]	Whittenbury, R. (1964) Hydrogen peroxide formation and catalase activity in the lactic acid bacteria. Journal of General Microbiology, 35, 13-26. doi:10.1099/00221287-35-1-13
[27]	Peixoto, I.T., Enoki, C., Ito, I.Y., Matsumoto, M.A. and Nelson-Filho, P. (2011) Evaluation of home disinfection protocols for acrylic baseplates of removable orthodontic appliances: A randomized clinical investigation. American Journal of Orthodontics and Dentofacial Orthopedics, 140, 51-57.
[28]	Morgan, T.D. and Wilson, M. (2000) Anti-adhesive and antibacterial properties of a proprietary denture cleanser. Journal of Applied Microbiology, 89, 617-623. doi:10.1046/j.1365-2672.2000.01158.x
[29]	Lamb, D.J. and Martin, M.V. (1983) An in vitro and in vivo study of the effect of incorporation of chlorhexidine into autopolymerizing acrylic resin plates upon the growth of Candida albicans. Biomaterials, 4, 205-209. doi:10.1016/0142-9612(83)90012-1
[30]	Wilson, S.J. and Wilson, H.J. (1993) The release of chlorhexidine from modified dental acrylic resin. Journal of Oral Rehabilitation, 20, 311-319. doi:10.1111/j.1365-2842.1993.tb01613.x
[31]	Addy, M. (1981) In vitro studies into the use of denture base and soft liner materials as carries for drugs in the mouth. Journal of Oral Rehabilitation, 8, 131-142. doi:10.1111/j.1365-2842.1981.tb00486.x
[32]	Sandham, H.J., Brown, J., Chan, K.H., Phillips, H.I., Burgess, R.C. and Stokl, A.J. (1991) Clinical trial in adults of an antimicrobial varnish for reducing mutans streptococci. Journal of Dental Research, 70, 1401-1408. doi:10.1177/00220345910700110201
[33]	Beyth, N., Redlich, M., Harari, D., Friedman, M. and Steinberg, D. (2003) Effect of sustained-release chlorhexidine varnish on Streptococcus mutans and Actinomyces viscosus in orthodontic patients. American Journal of Orthodontics and Dentofacial Orthopedics, 123, 345-348. doi:10.1067/mod.2003.19
[34]	Addy, M. and Handley, R. (1981) The effects of the incorporation of chlorhexidine acetate on some physical properties of polymerized and plasticized acrylics. Journal of Oral Rehabilitation, 8, 155-163. doi:10.1111/j.1365-2842.1981.tb00488.x
[35]	Douglas, W.H. (1977) Dental materials as carriers for therapy. Dental Update, 4, 395-399.
[36]	Parfitt K. (1999) The complete drug reference. 32 Edition, Pharmaceutical Press, London.