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Effect of combined boric acid and chlorhexidine mouthwashes on postoperative complications and periodontal healing after impacted third molar surgery: a-double blind randomized study

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Abstract

Objectives

This study aimed to evaluate the effects of different concentrations of boric acid (BA) combined with chlorhexidine (CHX) mouthwash on postoperative complications and periodontal healing following impacted third molar surgery.

Materials and methods

A total of 80 patients were randomly divided into eight groups. The patients in the study groups received different concentrations of BA ranging from 0.1% to 2.5% combined with CHX or 2% BA mouthwash alone. The control group received CHX mouthwash alone. The scores of self-reported pain and jaw dysfunction, trismus, edema, number of analgesics used, and periodontal parameters were compared between the groups.

Results

2.5% BA + CHX group had significantly lower pain and facial swelling values during the follow-up period. 2% BA + CHX group reported significantly lower jaw dysfunction scores on the fourth and fifth postoperative days. The control group showed significantly higher values for pain, jaw dysfunction, and facial swelling than other groups. No significant differences were found between the groups regarding trismus, analgesic use, and periodontal variables.

Conclusions

The combination of higher concentrations of BA with CHX was more effective in reducing pain, jaw dysfunction, and swelling following impacted third molar surgery than CHX mouthwash alone.

Clinical relevance

The combination of BA and CHX showed better results than the gold standard CHX mouthwash in reducing postoperative complications related to surgical removal of impacted third molars without any adverse effects. This new combination can be an effective alternative to traditional mouthwashes after impacted third molar surgery to ensure oral hygiene.

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References

  1. Osunde O, Saheeb B, Bassey G (2014) Indications and risk factors for complications of lower third molar surgery in a nigerian teaching hospital. Ann Med Health Sci Res 4:938–942. https://doi.org/10.4103/2141-9248.144919

    Article  PubMed  PubMed Central  Google Scholar 

  2. Halabi D, Escobar J, Alvarado C, Martinez N, Munoz C (2018) Chlorhexidine for prevention of alveolar osteitis: a randomised clinical trial. J Appl Oral Sci 26:e20170245. https://doi.org/10.1590/1678-7757-2017-0245

    Article  PubMed  PubMed Central  Google Scholar 

  3. Brookes ZLS, Bescos R, Belfield LA, Ali K, Roberts A (2020) Current uses of chlorhexidine for management of oral disease: a narrative review. J Dent 103:103497. https://doi.org/10.1016/j.jdent.2020.103497

    Article  PubMed  PubMed Central  Google Scholar 

  4. Wilson M, Stanley A, Bansal G, Newman HN (1990) Effect of Phenoxyethanol, Chlorhexidine and Their Combination on Subgingival Plaque Bacteria. J Antimicrob Chemother 25:921–929. https://doi.org/10.1093/jac/25.6.921

    Article  PubMed  Google Scholar 

  5. Hakki SS, Bozkurt BS, Hakki EE (2010) Boron regulates mineralized tissue-associated proteins in osteoblasts (MC3T3-E1). J Trace Elem Med Biol 24:243–250. https://doi.org/10.1016/j.jtemb.2010.03.003

    Article  PubMed  Google Scholar 

  6. Demirer S, Kara MI, Erciyas K, Ozdemir H, Ozer H, Ay S (2012) Effects of boric acid on experimental periodontitis and alveolar bone loss in rats. Arch Oral Biol 57:60–65. https://doi.org/10.1016/j.archoralbio.2011.07.012

    Article  PubMed  Google Scholar 

  7. Schubert D (2011) Boron oxides, boric acid, and borates. Kirk Othmer Ency Chem Technol:1–68. https://doi.org/10.1002/0471238961.0215181519130920.a01.pub3

  8. Ying X, Cheng S, Wang W, Lin Z, Chen Q, Zhang W, Kou D, Shen Y, Cheng X, Rompis FA, Peng L, Zhu LC (2011) Effect of boron on osteogenic differentiation of human bone marrow stromal cells. Biol Trace Elem Res 144:306–315. https://doi.org/10.1007/s12011-011-9094-x

    Article  PubMed  Google Scholar 

  9. Pizzorno L (2015) Nothing boring about boron. Integr Med: Clin J 14:35–48

    Google Scholar 

  10. Cao J, Jiang L, Zhang X, Yao X, Geng C, Xue X, Zhong L (2008) Boric acid inhibits LPS-induced TNF-α formation through a thiol-dependent mechanism in THP-1 cells. J Trace Elem Med Biol 22:189–195

    Article  PubMed  Google Scholar 

  11. Tepedelen BE, Soya E, Korkmaz M (2016) Boric Acid Reduces the Formation of DNA Double Strand Breaks and Accelerates Wound Healing Process. Biol Trace Elem Res 174:309–318. https://doi.org/10.1007/s12011-016-0729-9

    Article  PubMed  Google Scholar 

  12. Yang F, Zhu M, Zhang J, Zhou H (2018) Synthesis of biologically active boron-containing compounds. Medchemcomm 9:201–211. https://doi.org/10.1039/c7md00552k

    Article  PubMed  Google Scholar 

  13. Liu Q, Liu Z, Zhang C, Xu Y, Li X, Gao H (2021) Effects of 3% Boric Acid Solution on Cutaneous Candida albicans Infection and Microecological Flora Mice. Front Microbiol 12:709880. https://doi.org/10.3389/fmicb.2021.709880

    Article  PubMed  PubMed Central  Google Scholar 

  14. Beer LC, Vuong CN, Barros TL, Latorre JD, Tellez G, Fuller AL, Hargis BM (2020) Research Note: Evaluation of boric acid as a chemoprophylaxis candidate to prevent histomoniasis. Poult Sci 99:1978–1982. https://doi.org/10.1016/j.psj.2019.12.003

    Article  PubMed  PubMed Central  Google Scholar 

  15. Pell GJ (1933) Impacted mandibular third molars: classification and modified techniques for removal. Dent Digest 39:330–338

    Google Scholar 

  16. Winter GB (1926) Principles of exodontia as applied to the impacted mandibular third molar: a complete treatise on the operative technic with clinical diagnoses and radiographic interpretations. American medical book company

    Google Scholar 

  17. Kaplan V, Hasanoglu Erbasar GN, Cigerim L, Altay Turgut H, Cerit A (2021) Effect of St. John's wort oil and olive oil on the postoperative complications after third molar surgery: randomized, double-blind clinical trial. Clin Oral Investig 25:2429–2438. https://doi.org/10.1007/s00784-020-03639-0

    Article  PubMed  Google Scholar 

  18. Silness J, Löe H (1964) Periodontal disease in pregnancy II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand 22:121–135

    Article  PubMed  Google Scholar 

  19. Ainamo J, Bay I (1975) Problems and proposals for recording gingivitis and plaque. Int Dent J 25:229–235

    PubMed  Google Scholar 

  20. Moharamzadeh K (2017) Biocompatibility of oral care products. Elsevier

    Book  Google Scholar 

  21. Lim KS, Kam PCA (2008) Chlorhexidine - pharmacology and clinical applications. Anaesth Intensive Care 36:502–512

    Article  PubMed  Google Scholar 

  22. Osunde OD, Anyanechi CE, Bassey GO (2017) Prevention of alveolar osteitis after third molar surgery: Comparative study of the effect of warm saline and chlorhexidine mouth rinses. Niger J Clin Pract 20:470–473. https://doi.org/10.4103/1119-3077.180064

    Article  PubMed  Google Scholar 

  23. Pałka Ł, Nowakowska-Toporowska A, Dalewski B (2022) Is Chlorhexidine in Dentistry an Ally or a Foe? A Narrative Review. MDPI

    Book  Google Scholar 

  24. Gomes BP, Vianna ME, Zaia AA, Almeida JF, Souza-Filho FJ, Ferraz CC (2013) Chlorhexidine in endodontics. Braz Dent J 24:89–102. https://doi.org/10.1590/0103-6440201302188

    Article  PubMed  Google Scholar 

  25. Balagopal S, Arjunkumar R (2013) Chlorhexidine: the gold standard antiplaque agent. J Pharm Sci Res 5:270

    Google Scholar 

  26. Escribano M, Herrera D, Morante S, Teughels W, Quirynen M, Sanz M (2010) Efficacy of a low-concentration chlorhexidine mouth rinse in non-compliant periodontitis patients attending a supportive periodontal care programme: a randomized clinical trial. J Clin Periodontol 37:266–275. https://doi.org/10.1111/j.1600-051X.2009.01521.x

    Article  PubMed  Google Scholar 

  27. Nielsen FH (2008) Is boron nutritionally relevant? Nutr Rev 66:183–191

    Article  PubMed  Google Scholar 

  28. Gorustovich AA, Steimetz T, Nielsen FH, Guglielmotti MB (2008) Histomorphometric study of alveolar bone healing in rats fed a boron-deficient diet. Anat Rec (Hoboken) 291:441–447. https://doi.org/10.1002/ar.20672

    Article  PubMed  Google Scholar 

  29. Gorustovich AA, Steimetz T, Nielsen FH, Guglielmotti MB (2008) A histomorphometric study of alveolar bone modelling and remodelling in mice fed a boron-deficient diet. Arch Oral Biol 53:677–682. https://doi.org/10.1016/j.archoralbio.2008.01.011

    Article  PubMed  Google Scholar 

  30. Samman S, Naghii MR, Lyons Wall PM, Verus AP (1998) The nutritional and metabolic effects of boron in humans and animals. Biol Trace Elem Res 66:227–235. https://doi.org/10.1007/BF02783140

    Article  PubMed  Google Scholar 

  31. Hunt CD (2002) Dietary boron is a physiological regulator of the normal inflammatory response. Springer

    Book  Google Scholar 

  32. Travers RL, Rennie GC, Newnham RE (1990) Boron and arthritis: the results of a double-blind pilot study. J Nutr Med 1:127–132

    Google Scholar 

  33. Shah S, Vohora S (1990) Boron enhances anti-arthritic effects of garlic oil. Fitoterapia 61:121–126

    Google Scholar 

  34. Armstrong TA, Spears JW, Lloyd KE (2001) Inflammatory response, growth, and thyroid hormone concentrations are affected by long-term boron supplementation in gilts. J Anim Sci 79:1549–1556. https://doi.org/10.2527/2001.7961549x

    Article  PubMed  Google Scholar 

  35. Hunt CD, Idso JP (1999) Dietary boron as a physiological regulator of the normal inflammatory response: A review and current research progress. J Trace Elem Exp Med 12:221–233 https://doi.org/10.1002/(SICI)1520-670X(1999)12:3<221::AID-JTRA6>3.0.CO;2-X

    Article  Google Scholar 

  36. Luan Q, Desta T, Chehab L, Sanders VJ, Plattner J, Graves DT (2008) Inhibition of experimental periodontitis by a topical boron-based antimicrobial. J Dent Res 87:148–152. https://doi.org/10.1177/154405910808700208

    Article  PubMed  Google Scholar 

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Funding

For this study, no funding was received.

Author information

Authors and Affiliations

  1. Ankara Yıldırım Beyazıt University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Ankara, Turkey

    Guzin Neda Hasanoglu Erbasar & Fatma Nur Konarili

  2. Tekirdag Namik Kemal University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Tekirdag, Turkey

    Volkan Kaplan

  3. Van Yuzuncu Yil University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Van, Turkey

    Levent Cigerim

  4. Ankara Yıldırım Beyazıt University, Faculty of Engineering and Natural Sciences, Department of Energy Systems Engineering, Ankara, Turkey

    Mukerrem Sahin

Authors
  1. Guzin Neda Hasanoglu Erbasar
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  2. Volkan Kaplan
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  3. Levent Cigerim
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  4. Fatma Nur Konarili
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  5. Mukerrem Sahin
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Contributions

All authors contributed to the study’s conception and design. Material preparation was performed by MS; data collection was performed by GNHE, VK, LC, and FNK; and analysis was performed by GNHE, VK. The first draft of the manuscript was written by all authors, and they commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Volkan Kaplan.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study involving human participants were under the ethical standards of the ethical committee of the University of Granada and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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The study was registered at ClinicalTrials.gov (Reg. No-Date: NCT04376268-05/02/2020).

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Erbasar, G.N.H., Kaplan, V., Cigerim, L. et al. Effect of combined boric acid and chlorhexidine mouthwashes on postoperative complications and periodontal healing after impacted third molar surgery: a-double blind randomized study. Clin Oral Invest 27, 3817–3826 (2023). https://doi.org/10.1007/s00784-023-04999-z

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