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N-acetyl cysteine versus chlorhexidine mouthwashes in prevention and treatment of experimental gingivitis: a randomized, triple-blind, placebo-controlled clinical trial

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Abstract

Objectives

To compare the efficacy of N-acetyl cysteine (NAC) mouthwash with chlorhexidine (CHX) in prevention and treatment of experimental gingivitis

Materials and methods

Sixty subjects were assigned randomly and blindly into one of three equal groups: NAC, CHX, or placebo group. The study was conducted in two stages: preventive and treatment substudies. Professional prophylaxis was performed ahead of starting the preventive substudy. Then, the subjects were instructed to stop oral hygiene practices and begin rinsing twice/day with 15 ml of the assigned mouthwash (1.25% NAC, 0.2% CHX, or inert base). Plaque index (PI), gingival index (GI), and papillary bleeding index (PBI) were measured at baseline, 7, 14, and 21 days. The treatment substudy started on day 21 in which the subjects in the placebo group (now with established experimental gingivitis) were assigned to NAC (n = 10) or CHX (n = 10); the abovementioned indices were measured at 28 and 35 days. Efficacy of these interventions was compared.

Results

All groups accumulated plaque and developed some degree of gingivitis: full-blown in the placebo group and remarkably mild in the CHX group. NAC had slight preventive properties at days 14 and 21. In the treatment substudy, CHX was associated with remarkable reduction in plaque and gingivitis while NAC resulted in insignificant reductions.

Conclusions

1.25% NAC is marginally effective in prevention and treatment of experimental gingivitis.

Clinical relevance

When compared with the placebo, NAC showed promising preventive and treatment effects of gingivitis that deserve further development and studies.

Trial registration

ISRCTN31352091.

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Acknowledgements

The authors wish to thank Shiba-Pharma (Shiba-Pharmaceuticals & Chemicals Mfg. Co. Ltd., Yemen) for it is cooperation and manufacturing of research rinsing. They also thank the students of the University of Science and Technology, Sana’a, Yemen, who volunteered to participate in this study and for their dedication.

Author information

Authors and Affiliations

  1. Department of preventive and biomedical science, Faculty of dentistry, University of Science and Technology, Sana’a, Yemen

    Ahlam Al-Kamel & Wadhah Abdulnaser Al-Hajj

  2. Department of periodontology, Faculty of dentistry, Thamar University, Thamar, Yemen

    Wadhah Abdulnaser Al-Hajj

  3. Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia

    Esam Halboub

  4. Madinat Khalifa Health Center, Primary Health Care Corporation, Doha, Qatar

    Saleem Abdulrab

  5. Alkhaled pharmaceuticals, Sana’a, Yemen

    Khaled Al-Tahami

  6. Maurice H. Kornberg School of Dentistry, Temple University, Philadelphia, PA, USA

    Nezar Noor Al-Hebshi

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  1. Ahlam Al-Kamel
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  2. Wadhah Abdulnaser Al-Hajj
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  3. Esam Halboub
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  4. Saleem Abdulrab
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  5. Khaled Al-Tahami
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  6. Nezar Noor Al-Hebshi
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Correspondence to Esam Halboub.

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The authors declare that they have no conflict of interest.

Ethical approval

“The study protocol was formally approved by the Research Ethics Committee at the Faculty of Medicine and Health Sciences, University of Sciences and Technology, Sana’a, Yemen (No 2016/20). The study has been conducted in full accordance with the World Medical Association Declaration of Helsinki.”

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“A written informed consent was obtained from each of the participants.”

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Al-Kamel, A., Al-Hajj, W.A., Halboub, E. et al. N-acetyl cysteine versus chlorhexidine mouthwashes in prevention and treatment of experimental gingivitis: a randomized, triple-blind, placebo-controlled clinical trial. Clin Oral Invest 23, 3833–3842 (2019). https://doi.org/10.1007/s00784-019-02813-3

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