Per Gjermo

A comparison between chlorhexidine and some quaternary ammonium compounds with regard to retention, salivary concentration and plaque-inhibiting effect in the human mouth after mouth rinses

The oral retention of chlorhexidine, cetylpyridinium chloride and hexadecyltrimethylammonium bromide (a component of cetrimide) was measured by means of 14C-labelled compounds in 7 subjects after 10-ml 2.2 mM mouth rinses for 1 min. The oral retention of chlorhexidine was 32 ± 6 per cent, of cetylpyridinium chloride 65 ± 5 per cent and of hexadecyltrimethylammonium bromide 70 ± 7 per cent of the administered dose. The salivary concentration was measured after similar mouth rinses in 3 subjects and calculated according to the 14C-activity of saliva samples from 0.5 to 24 h after the rinsing. Although the concentrations of the quaternary ammonium compounds were usually higher than those of chlorhexidine shortly after rinsing, their concentrations were significantly lower (p < 0.001) than those of chlorhexidine from 4 h and onwards. The plaque-inhibiting effect was assessed in subjects who rinsed with 2.2 mM test solutions twice daily for 3 days, using sucrose rinses to provoke plaque formation. The plaque-inhibiting effect of the quaternary ammonium compounds was also tested when used in a mouth rinse four times daily. A moderate degree of plaque inhibition was obtained when the quaternary ammonium compounds were used twice daily. When the frequency was increased to four times daily, the plaque-inhibiting effect of the quaternary ammonium compounds seemed to approach that of chlorhexidine.

Relationship between plaque-inhibiting effect and retention of chlorhexidine in the human oral cavity

Abstract Two clinical trials were performed. In the first experiment, five subjects rinsed with 0.2 per cent aqueous solutions of chlorhexidine digluconate (pH 6.4) with radioactive markers (14C) and then performed five consecutive after-rinses with diluted acetic acid pH 3.0. The amount of chlorhexidine initially retained and the amount eluted with the acid was estimated. About 65 per cent of the drug initially retained was released by three acetic after-rinses. The same principle was employed in the second clinical study to investigate the clinical significance of loss of retained chlorhexidine. This procedure caused a markedly reduced plaque inhibition. Thus the clinical effect of chlorhexidine as a plaque inhibitor seems to be dependent on the retention of the agent in the oral cavity.

A system to classify the need for periodontal treatment

A system to determine the periodontal therapeutic needs of a population — the Periodontal Treatment Need System (PTNS) is suggested. It is based on defined diagnostic criteria and systematize the needs according to three standardized therapeutic procedures: (1) individual oral hygiene motivation and instruction (OH), (2) scaling and elimination of overhangs (Sc) and (3) periodontal surgery (Su). The classification is: Class 0 — no need, Class A — need for OH, Class B — need for Sc and OH, and Class C — need for Su, OH and Sc. Class A is given for the mouth and Classes B and C for quadrants. To evaluate the application of the system, 42 patients were treated for inflammatory periodontal disease. The therapy consisted of OH, Sc and Su. The time used for performing the treatment was recorded in each session. The patients were classified according to the system and the average time for each type of therapy was: OH — 72 minutes per patient, Sc — 32 minutes per quadrant and Su — 57 minutes per quadrant. The fol...

A comparison of the plaque-inhibiting effect of stannous fluoride and chlorhexidine

A double blind clinical trial was undertaken in order to compare the plaque inhibiting effect of SnF2 (0.2% and 0.3%) with chlorhexidine (0.1%) applied as mouthrinses in a test panel of 12 dental hygienist students. The experimental series were performed in periods of four days. The mean Plaque Index values were 0.35 and 0.2 when employing SnF2 and 0.1 when chlorhexidine was used, whereas distilled water resulted in a mean value close to 1.0. The long-term effect of a 0.3% SnF2 solution was tested in another group of five students for a period of three weeks. The two trials confirmed previous reports claiming that SnF2 is effective as a plaque inhibitor and, furthermore, that this effect could be maintained for a period of at least three weeks. The staining problem was less than in similar studies using chlorhexidine.

Clinical and Microbiologic Effects of Adjunctive Antibiotics in Treatment of Localized Juvenile Periodontitis. A Controlled Clinical Trial

The aim of this study was to assess the clinical and microbiologic effects of the combination of amoxicillin and metronidazole therapy as an adjunct to mechanical treatment in the management of localized juvenile periodontitis. Twenty-five localized juvenile periodontitis (LJP) patients from a Brazilian population were randomly allocated into an experimental group receiving mechanical treatment and antibiotics, and a control group receiving mechanical treatment and placebo. Clinical and radiographic assessments, as well as microbiologic sampling for Actinobacillus actinomycetem.comitans, were performed at baseline and one year after the end of the treatment. At the termination of the study A. actinomycetemcomitans could be isolated from the oral cavity of all patients in the control group who harbored the bacterium at baseline and in 4 out of 8 patients in the experimental group. Both treatment modalities resulted in significant benefit on an individual basis. The experimental group, however, displayed better results than did the control group regarding gingival index (GI), probing depth (PD), clinical attachment level (CAL), and radiographic analysis of crestal alveolar bone mass, but not with respect to plaque index (PI). No serious adverse effects of the antibiotic treatment were observed in the present study. J Periodontol 1998;69:1355-1363.

Influence of Variation of pH of Chlorhexidine Mouth Rinses on Oral Retention and Plaque-Inhibiting Effect

Two clinical trials have been performed. In the first series the oral retention of chlorhexidine after mouth rinses of various pH values was determined, employing 14C-ring-labelled chlorhexidine for quantitation. The amount of chlorhexidine retained in the mouth was found to be considerably less when the mouth rinses were adjusted to low pH values (1.5 and 3.0) than when the pH was neutral or alkaline (6.4 and 9.0). In another series the plaque formation during a 3-day period without oral hygiene was estimated, employing chlorhexidine mouth rinses of various pH values. The plaque-inhibiting capacity of chlorhexidine was almost eliminated by lowering the pH of the mouth rinses to 1.5 or 3.0. Bacteriologic in vitro tests, employing a cariogenic streptococcus as the target bacteria, failed to demonstrate differences between the bactericidal effect of the drug at low and high pH. The findings that both the plaque-inhibiting property of chlorhexidine and the retention of the drug in the oral cavity were pH-dependent support the hypothesis that the drug’s clinical effect is related to its retention in the mouth.

Plaque-inhibiting effect in orthodontic patients of a dentifrice containing stannous fluoride.

The present investigation was undertaken to study the plaque-inhibiting effect of a dentifrice containing stannous fluoride/stannous pyrophosphate during treatment with fixed orthodontic appliances. The test toothpaste was compared with sodium monofluorophosphate toothpaste and paste without fluoride and tin. When applied directly on the teeth, the test paste was found to reduce plaque growth significantly for 24 hours (P < 0.001). A double-blind cross-over designed study with twenty-one subjects showed statistically significant plaque inhibition after a 3-week test period on subjects showed statistically significant plaque inhibition after a 3-week test period on subjects showed statistically significant plaque inhibition after a 3-week test period on teeth with the appliances placed more than 1.5 mm. from the gingival margin (P < 0.01). Plaque reduction on teeth with the appliances placed close to the gingival margin was not statistically significant (P > 0.05). No statistically significant improvement in the gingival condition and no side effects were observed. It is concluded that because of its dual action on plaque and teeth stannous fluoride/stannous pyrophosphate toothpaste may be recommended as supplement to and not substitute for other forms of fluoride supplementation in this category of patients.

Periodontitis in psoriasis patients. A blinded, case-controlled study

Abstract Objective. Destructive periodontitis is one of the most frequent and widespread bacterial infections in humans. Psoriasis is a common condition in the general population. Since both psoriasis and periodontal diseases are characterized by an exaggerated response of the immune system to the epithelial surface microbiota, there may possibly be an association between these two conditions. The aim of the present pilot study was to investigate the prevalence of periodontal disease in psoriasis patients compared to healthy controls. Material and methods. Dental bite-wing X-rays were obtained from 155 psoriasis patients aged 45–60 years, as well as from 155 age- and gender-matched controls. All X-rays were examined by the same investigator for accumulated destructive periodontitis using bone level and loss of teeth as endpoints. Results. A significantly lower radiographic bone level (p < 0.001) and a significantly higher number of missing teeth (p < 0.001) were observed in the psoriasis cases compared to the controls. Conclusion. Our study indicates that psoriasis patients experience more bone loss than age- and gender-matched controls.

Associations between six DNA probe-detected periodontal bacteria and alveolar bone loss and other clinical signs of periodontitis.

The purpose of the present study was to assess the associations between the presence and amounts of Actinobacillus actinomycetemcomitans, Bacteroides gingivalis, B. intermedius, Eikenella corrodens, Wolinella recta, and Fusobacterium nucleatum in the periodontal pocket and the degree of alveolar bone loss and other clinical signs of periodonitis, such as probing pocket depth, attachment level, and presence of bleeding on probing at the same site. The study material comprised 16 subjects with or without approximal sites showing longitudinal alveolar bone loss who were selected from a group of 142 subjects monitored radiographically over the past 4 years. In this group 105 sites were examined, of which 58 showed recent alveolar bone loss greater than or equal to 1 mm. Subgingival plaque was collected with absorbent paper points and hybridized with 32P-labeled DNA probes specific for the above-mentioned bacteria. The amount of each bacterial species was correlated with the degree of bone loss over time and the three clinical measurements by means of Spearman rank correlation. A. actinomycetemcomitans showed poor correlations with all three clinical signs of periodontal inflammation, whereas B. gingivalis and W. recta demonstrated significant positive correlations with the three clinical measurements and with attachment level and pocket depth, respectively. In addition, the amount of A. actinomycetemcomitans, B. gingivalis and W. recta showed significant positive correlation with the extent of alveolar bone loss at the site. In contrast, the amounts of B. intermedius, E. corrodens, and F. nucleatum showed negative correlations with all four measurements.(ABSTRACT TRUNCATED AT 250 WORDS)

Bacteriophage infection—a possible mechanism for increased virulence of bacteria associated with rapidly destructive periodontitis

We have recently isolated several groups of bacteriophages infecting Actinobacillus actinomycetemcomitans from periodontal lesions in patients with rapidly destructive periodontitis. Bacteriophage infection of these bacteria in these patients was restricted to periodontal pockets showing radiographic evidence of recent bone loss and suggests an association between phage-infected A. actinomycetemcomitans and active periodontal disease. On the basis of the biological activity of bacteriophages we propose a working hypothesis to explain the mechanism by which a phage may increase bacterial virulence in periodontal disease.