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The influence of a 0.2% chlorhexidine mouthrinse on plaque regrowth in orthodontic patients

A randomized prospective study Part I: Clinical parameters
  • Ingelore Gehlen
  • Lutz Netuschil
  • Rolf Berg
  • Elmar Reich
  • Christos Katsaros
Original Contributions

Abstract

In a prospective plaque regrowth study focusing on oral hygiene during fixed appliance therapy 12 adolescent patients (mean age 14.1±1.5 years) were evaluated twice over 2-day test periods. In the randomized, double-blind study the influence of a 0.2% chlorhexidine (CHX) mouthrinse (Corsodyl®) and a commercially available dentifrice supplementing fluoride (Odol-med-3®) were compared intra- and interindividually in a crossover design with regard to plaque and gingivitis. Before starting the first test phase there was a 14-day preliminary phase for upgrading the oral hygiene. Between the 2 test phases was a 5-day “washout”. On the last day of the second test phase the patients were asked to fill in a questionnaire concerning their experiences during the study.

The 0.2% Corsodyl® reduced the plaque index scores significantly (p<0.001). The gingival index revealed a similar reduction (2nd day of test: p=0.03). Until the 5th day of washout a clear-cut carryover effect of the chlorhexidine rinse on the gingival index was observed. Both the lower mean values of the 2 clinical parameters at the beginning of the test phases as compared with those at the beginning of the preliminary phase and the evaluation of the questionnaires indicated a possible Hawthorne effect.

0.2% Corsodyl® may be employed as an adjunct to other preventive measures such as professional care and patient-oriented instruction on an intermittent basis in order to reduce the plaque-induced iatrogenic side effects and to enhance the efficacy of oral hygiene measures in connection with orthodontic therapy with fixed appliances.

Key Words

Orthodontic appliance Plaque regrowth Chlorhexidine Oral hygiene 

Die Auswirkungen einer 0,2%igen Chlorhexidinspülung auf die Plaquebildung bei jugendlichen kieferorthopädischen Patienten mit festsitzender Behandlungsapparatur

Eine randomisierte prospektive Studie Teil I: Klinische Parameter

Zusammenfassung

Zwölf jugendliche Patienten (Durchschnittsalter 14,1±1,5 Jahre) wurden zweimal im Rahmen einer jeweils zweitägigen prospektiven Plaque-Regrowth-Studie in Hinsicht auf die Mundhygieneproblematik bei festsitzender Behandlungsapparatur untersucht. Dazu wurden im Cross-over-Design randomisiert und doppelblind die intra- und interindividuellen Auswirkungen einer 0,2%igen Chlorhexidinspülung (Corsodyl®) gegenüber einem handelsüblichen fluoridhaltigen Mundwasser (Odol-med-3®) in Hinblick auf die klinischen Indizes für Plaque und Gingivitis ausgewertet. Vor Beginn der ersten Testphase lag eine 14tägige Hygienephase. Zwischen den beiden Testphasen lag eine Auswaschphase von fünt Tagen. Am letzten Testtag wurden alle Patienten mittels Fragebogen nach ihren Erfahrungen während der Studie befragt. Unter Anwendung der Chlorhexidinspülung wurde die Plaquebildung signifikant (p<0,001) reduziert. Das gleiche galt für den Gingivaindex (zweiter Testtag: p=0,03). Bis einschließlich zum fünften Tag nach Absetzen der Chlorhexidinspülung ließ sich ein deutlicher Nachhangeffekt auf den Gingivaindex nachweisen. Die niedrigeren Mittelwerte beider klinischen Parameter zu Beginn der Testphasen gegenüber den Werten vor der Hygienephase sowie die Auswertung des Fragebogens deuteten auf einen möglichen Hawthorne-Effekt.

Die intermittierende Anwendung einer 0,2%igen Corsodyl®-Spülung zusammen mit professionellen Zahnreinigungen und individuellen Instruktionen der Patienten können die plaquebedingten iatrogenen Nebeneffekte einer kieferorthopädischen Behandlung reduzieren und die Effizienz der Mundhygienemaßnahmen optimieren.

Schlüsselwörter

Kieferorthopädische Behandlungsapparatur Plaque-Regrowth-Studie Chlorhexidin Mundhygiene 

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References

  1. 1.
    Addy M, Jenkins S, Newcombe R. The effect of triclosan, stannous fluoride and chlorhexidine product on: (I) Plaque regrowth over a 4-day period. J Clin Periodontol 1990;17:693–7.CrossRefPubMedGoogle Scholar
  2. 2.
    Alexander S. Effects of orthodontic attachment on the gingival health of permanent second molars. Am J Orthod Dentofac Orthop 1991;100:337–40.Google Scholar
  3. 3.
    Alstad S, Zachrisson B. Longitudinal study of periodontal condition associated with orthodontic treatment in adolescents. Am J Orthod 1979;76:277–86.CrossRefPubMedGoogle Scholar
  4. 4.
    Berg R, Katsaros C. Therapeutische Grenzen in der Kieferorthopädie In: Diedrich P, ed. Praxis der Zahnheilkunde, Bd 11. Vol II. München: Urban & Fischer, (in press).Google Scholar
  5. 5.
    Anderson G, Bowden J, Morrison E, et al. Clinical effects of chlorhexidine mouthwashes on patients undergoing orthodontic treatment. Am J Orthod Dentofac Orthop 1997;111:606–12.CrossRefGoogle Scholar
  6. 6.
    Bourdillat C. Quality of life during orthodontic treatment: taking into account discomfort or pain? Rev Orthop Dento Faciale 1999;33:73–92.Google Scholar
  7. 7.
    Boyd R, Legoff P, Eakle W, et al. Periodontal implications of orthodontic treatment in adults with reduced or normal periodontal tissues versus those of adolescents. Am J Orthod Dentofac Orthop 1989;96:191–8.Google Scholar
  8. 8.
    Boyd R, Baumrind S. Periodontal considerations in the use of bonds or bands on molars in adolescents and adults. Angle Orthod 1992;62:117–26.PubMedGoogle Scholar
  9. 9.
    Cambell J, Maxey V, Watson W. Hawthorne effect. Implications for prehospital research. Ann Emergency Med 1995;26:590–4.Google Scholar
  10. 10.
    Gehlen I, Netuschil L, Georg T, et al. The influence of a 0.2% chlorhexidine mouthrinse on plaque regrowth in orthodontic patients. A randomized prospective study. Part II: Bacteriological parameters. J Orofac Orthop/Fortschr Kieferorthop 2000;61: in press.Google Scholar
  11. 11.
    Geiger A, Gorelick L, Gwinnet A, et al. The effect of a fluoride program on white spot formation during orthodontic treatment. Am J Orthod Dentofac Orthop 1988;93:29–37.CrossRefGoogle Scholar
  12. 12.
    Jeffcoat M. Principles and pitfalls of clinical trials design. J Periodontol 1992;63:1045–51.PubMedGoogle Scholar
  13. 13.
    Lang N, Brecx M. Chlorhexidine digluconate — an agent for chemical plaque control and prevention of gingival inflammation. J Periodont Res 1989;21:Suppl 16:74–89.Google Scholar
  14. 14.
    Löe H, Silness J. Periodontal disease in pregnancy. Acta Odontol Scand 1963;21:533–51.Google Scholar
  15. 15.
    Marcusson A, Norevall L, Persson M. White spot reduction when using glass ionomer cement for bonding in orthodontics: A longitudinal and comparative study. Eur J Orthod 1997;19:233–42.PubMedGoogle Scholar
  16. 16.
    Millett D, Nunn J, Welbury R, et al. Decalcification in relation to brackets bonded with glass ionomer cement or a resin adhesive. Angle Orthod 1999;69:65–70.PubMedGoogle Scholar
  17. 17.
    Moran J, Addy M, Newcombe R. A 4-day plaque regrowth study comparing an essential oil mouthrinse with a triclosan mouthrinse. J Clin Periodont 1997;24:636–9.Google Scholar
  18. 18.
    Morrow D, Wood D, Speechley M. Clinical effect of subgingival chlorhexidine irrigation on gingivitis in adolescent orthodontic patients. Am J Orthod Dentofac Orthop 1992;101:408–13.Google Scholar
  19. 19.
    Netuschil L, Weiger R, Preisler R, et al. Plaque bacteria counts and vitality during chlorhexidine, Meridol and Listerine mouthrinses. Eur J Oral Sci 1995;103:355–61.PubMedGoogle Scholar
  20. 20.
    Newcombe RG, Addy M, McKeown S. Residual effect of chlorhexidine digluconate in 4-day plaque regrowth crossover trials, and its implications for study design. J Periodont Res 1995;30:319–24.PubMedGoogle Scholar
  21. 21.
    Øgaard B. Prevalence of white spot lesions in 19-year-olds: A study on untreated and orthodontically treated persons 5 years after treatment. Am J Orthod Dentofac Orthop 1989;96:423–7.CrossRefGoogle Scholar
  22. 22.
    Sorensen J, Newman M. Gingival enhancement in fixed prosthodontics. Part III: anamnestic findings. J Prosthet Dent 1991;65:500–4.PubMedGoogle Scholar
  23. 23.
    Stirrups D, Laws E, Honigman J. The effect of a chlorhexidine gluconate mouthrinse on oral health during fixed appliance orthodontic treatment. Br Dent J 1981;151:84–6.CrossRefPubMedGoogle Scholar
  24. 24.
    Trimpeneers L, Wijgaerts I, Gronard N, et al. Effect of electric toothbrushes versus manual toothbrushes on removal of plaque and periodontal status during orthodontic treatment. Am J Orthod Dentofac Orthop 1997;111:492–7.CrossRefGoogle Scholar
  25. 25.
    Zachrisson B. Cause and prevention of injuries to teeth and supporting structures during orthodontic treatment. Am J Orthod 1976;69:285–300.CrossRefPubMedGoogle Scholar

Copyright information

© Urban & Vogel München 2000

Authors and Affiliations

  • Ingelore Gehlen
    • 1
  • Lutz Netuschil
    • 2
  • Rolf Berg
    • 1
  • Elmar Reich
    • 2
  • Christos Katsaros
    • 1
  1. 1.Department of OrthodonticsUniversity of SaarlandHomburg/SaarGermany
  2. 2.Department of Periodontology and Conservative DentistryUniversity of SaarlandHomburg/SaarGermany

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