COMPARATIVE EVALUATION OF THE EFFICACY OF 4% MANGOSTEEN GEL AND 1% CHLORHEXIDINE DIGLUCONATE GEL IN MANAGEMENT OF PATIENTS WITH CHRONIC GINGIVITIS: A RANDOMIZED CLINICAL TRIAL

To clinically evaluate & compare the efficacy of 4% Mangosteen Gel and 1% chlorhexidine digluconate gel in managing patients with chronic gingivitis. Materials and Methods: A total of 50 patients with an age group of 20-45 years diagnosed with generalized plaque-induced gingivitis were selected for this clinical trial once attaining their informed consent. A thorough case history was chronicled comprising plaque index (P.I.), gingival index (G.I.) and Sulcus bleeding index (SBI) at baseline; then full-mouth scaling and polishing (SAP) was performed by a solitary attuned examiner. Patients were then randomly assigned into two groups using a computer-generated random numbering sequence system. Patients in group A received 4% Mangosteen Gel, and group B received 1% chlorhexidine digluconate gel for home application. The post-treatment follow-up examination for P.I., G.I. and SBI changes were assessed after 14 days and 21 days and compared with baseline data. Results: In both the groups, the mean plaque index, gingival index and sulcus bleeding index scores were significantly decreased after the 14th and 21st day compared to baseline scores. There was no significant difference between the groups, but only in group B, there was a substantial difference in SBI scores observed on day 21. Conclusion: 4% Mangosteen Gel and 1% chlorhexidine digluconate gel were clinically effective when used as an adjunct to SAP in managing patients with gingivitis. Hence, 4% Mangosteen Gel can be considered an alternative to 1% chlorhexidine digluconate gel without any side effects in managing generalized plaque-induced gingivitis.

Efektivitas antibakteri gel chitosan dengan berat molekul berbeda terhadap jumlah koloni bakteri Streptococcus mutans pada permukaan email sekitar braket ortodonti Antibacterial effectiveness of chitosan gel with different molecular weights on the number of Streptococcus mutans colonies in the enamel surface around orthodontic bracket

Pendahuluan: Chitosan merupakan bahan alami, bersifat antibakteri, dan dapat dibentuk menjadi gel sehingga berpotensi sebagai agen profilaksis terhadap Streptococcus mutans, penyebab demineralisasi email. Lesi white spot merupakan salah satu risiko penggunaan alat ortodonti cekat. Berat molekul merupakan salah satu faktor yang memengaruhi efektivitas antibakteri chitosan, namun hubungannya masih memberikan hasil yang inkonsisten. Penelitian ini bertujuan menganalisis perbedaan efektivitas gel chitosan dengan berat molekul berbeda terhadap jumlah koloni bakteri Streptococcus mutans pada permukaan email sekitar braket ortodonti. Metode: Penelitian ini menggunakan metode eksperimen laboratoy dengan menggunakan 24 sampel gigi dengan braket dioles gel chitosan A (50-80 kDa), gel chitosan B (50-150 kDa), gel chitosan C (190-310 kDa), dan gel kontrol klorheksidin diglukonat 0,2% (CHX) masing-masing 6 sampel. Seluruh sampel diinkubasi dalam biakan Streptococcus mutans secara bertahap, 10 μl suspensi dari plak yang terbentuk pada sampel dibiakkan untuk memperoleh koloni pada biakan agar. Data dianalisis dengan uji one-way ANOVA dan Least Significant Difference (LSD). Hasil: Jumlah koloni bakteri Streptococcus mutans setelah aplikasi gel chitosan A, B, C, dan gel klorheksidin diglukonat 0,2% (CHX) didapatkan sebesar 10,05x106 CFU/ml; 9,72x106 CFU/ml; 10,96x106 CFU/ml; dan 4,35x106 CFU/ml sehingga tidak terdapat perbedaan bermakna jumlah koloni bakteri Streptococcus mutans antara ketiga kelompok gel chitosan (p>0,05) dan terdapat perbedaan jumlah koloni bakteri Streptococcus mutans yang bermakna antara ketiga gel chitosan dengan gel kontrol (p<0,05). Simpulan: Efektivitas antibakteri gel chitosan dengan berat molekul berbeda terhadap jumlah koloni bakteri Streptococcus mutans pada permukaan email sekitar braket ortodonti adalah sama besar, namun lebih rendah daripada efektivitas antibakteri gel klorheksidin diglukonat 0,2% pada studi ini.Kata kunci: berat molekul; braket ortodontik; kitosan; email; Streptococcus mutans ABSTRACTIntroduction: Chitosan is a natural ingredient, antibacterial, and can be formed into a gel so that it has the potential as a prophylactic agent against Streptococcus mutans, the cause of enamel demineralization. White spot lesions are one of the risks of using fixed orthodontic appliances. Molecular weight is one factor that affects the antibacterial effectiveness of chitosan, but the relationship still gives inconsistent results. This study aimed to analyze the differences in the effectiveness of chitosan gels with different molecular weights on the number of Streptococcus mutans bacteria colonies on the enamel surface around orthodontic brackets. Methods: This study used an experimental laboratory method using 24 dental samples with brackets smeared with chitosan A gel (50-80 kDa), chitosan B gel (50-150 kDa), chitosan C gel (190-310 kDa), and chlorhexidine control gel. digluconate 0.2% (CHX) each of 6 samples. All samples were incubated in Streptococcus mutans culture in stages, 10 l suspension of the plaque formed on the samples was cultured to obtain colonies on agar cultures. Data were analyzed by one-way ANOVA and Least Significant Difference (LSD). Results: The number of Streptococcus mutans colonies after application of chitosan gel A, B, C, and 0.2% chlorhexidine digluconate (CHX) gel was 10.05x106 CFU/ml; 9.72x106 CFU/ml; 10.96x106 CFU/ml; and 4.35x106 CFU/ml, so that there was no significant difference in the number of Streptococcus mutans colonies between the three chitosan gel groups (p>0.05) and there was a significant difference in the number of Streptococcus mutans bacteria colonies between the three chitosan gels and the control gel (p<0.05). Conclusions: The antibacterial effectiveness of chitosan gel with different molecular weights on the number of Streptococcus mutans bacterial colonies on the enamel surface around orthodontic brackets was simi-lar but lower than the antibacterial effectiveness of 0.2% chlorhexidine digluconate gel.Keywords: molecular weight; orthodontic bracket; chitosan; enamel; Streptococcus mutans

Effect of Cobalt and Chromium Ions on the Chlorhexidine Digluconate as Seen by Intermolecular Diffusion

Metal ions such as cobalt (II) and chromium (III) might be present in the oral cavity, as a consequence of the corrosion of Co-Cr dental alloys. The diffusion of such metal ions into the organism, carried by saliva, can cause health problems as a consequence of their toxicity, enhanced by a cumulative effect in the body. The effect of the chlorhexidine digluconate, which is commonly used in mouthwash formulations, on the transport of these salts is evaluated in this paper by using the Taylor dispersion technique, which will allow an assessment of how the presence of chlorhexidine digluconate (either in aqueous solution or in a commercial formulation) may affect the diffusion of metal ions. The ternary mutual diffusion coefficients of metal ions (Co and Cr) in the presence of chlorhexidine digluconate, in an artificial saliva media, were measured. Significant coupled diffusion of CoCl2 (and CrCl3) and chlorhexidine digluconate is observed by analysis of the non-zero values of the cross-diffusion coefficients, D12 and D21. The observed interactions between metal ions and chlorhexidine digluconate suggest that the latter might be considered as an advantageous therapeutic agent, once they contribute to the reduction of the concentration of those ions inside the mouth.

INHIBITORY ACTIVITY OF ULIN BARK (Eusideroxylon zwageri) EXTRACT TO Lactobacillus acidophilus

Background: Lactobacillus acidophilus is a bacterium which plays a role in dental caries. It is believed as a pioneering bacterium in advanced caries and much likely to be isolated in dentin caries zone, resulting in the needed for tooth restoration. The use of 2% Chlorhexidine digluconate as cavity cleanser is recommended as an effort to prevent seconday caries but can cause side effects. One of the natural materials that can be used as a cavity cleanser is ulin bark extract (Eusideroxylon zwageri), a traditional medicine originally from Kalimantan, because it contains phenolic, flavonoid, tannin, alkaloid, saponin and terpenoid. Purpose: To discover the inhibitory activity of ulin bark extract on Lactobacillus acidophilus growth. Methods: This was a true experimental laboratory and post test only with control group design, that used 20%, 40%, 60%, 80%, 100% concentrations of ulin bark extracts and K(+) 2% Chlorhexidine digluconate. Difussion method was used to test inhibitory activity with 6 treatment groups and 4 replications, comprising a total of 24 samples. All groups were incubated for 24 hours at 37ºC temperature. The inhibition zone was measured using calipers. Results: The 20%, 40%, 60%, 80% and 100% concentration of ulin bark extracts and 2% Chlorhexidine digluconate had an average inhibition zone of 7.17 mm, 9.02 mm, 11.14 mm, 13.06 mm, 15.17 mm and 19.22 mm. One Way ANOVA and Post Hoc Bonferroni tests showed significant difference between all groups. Conclusion: Ulin bark extract can inhibit Lactobacillus acidophilus growth starting from 20%, 40%, 60%, 80% and 100% concentration.

Influence of Chlorhexidine and Cetylpyridine on Periodontal Status and Indicators of Oxidative Stress in Patients with Type 1 Diabetes

Objective: One of the treatment goals in type 1 diabetes and periodontitis is to address chronic inflammation to prevent the development of neurovascular complications. The aim of this study was to assess the local anti-inflammatory effects of chlorhexidine digluconate and cetylpyridine chloride on periodontal status and indicators of oxidative stress in saliva in patients with type 1 diabetes. Materials and Methods: A total of 42 subjects aged 27 (interquartile range, IQR 22–35) years, with type 1 diabetes for a duration of 12 (IQR 9–18) years, and glycated hemoglobin 8.05 (IQR 7.1–9.4)% were included. Patients were examined twice—initially, and after 14 days of using toothpaste with chlorhexidine and cetylpyridine. Clinical examination of gingival tissues was performed. Certain oxidative stress markers (TP, TEAC, TBARS, AOPP) were measured in the saliva samples. Results: There were significant changes in clinical indicators of periodontal status before and after the application of the toothpaste (API before 0.35 (0.24–0.65) vs. API after 0.265 (0.18–0.39), p = 0.03; SBI before 0.07 (0.04–0.15) vs. SBI after 0.035 (0-0.06), p = 0.002; GI before 0.88 (0.46–1) vs. GI after 0.67 (0.25–1), p = 0.0008). The concentration of saliva TBARS decreased (p = 0.00005) and TEAC increased (p = 0.09). Conclusion: Proper oral hygiene supported by antibacterial chemicals may improve the periodontal status and reduce inflammation.

Effect of Chlorhexidine Digluconate in Early Wound Healing of Human Gingival Tissues. A Histological, Immunohistochemical and Biomolecular Analysis

Chlorhexidine digluconate (CHX) is considered the gold standard for oral cavity antiseptic treatment. Nevertheless, several in vitro studies have reported detrimental effects in oral tissue repair. The aim of the present study was to evaluate the in vivo effect of post-surgical CHX mouth rinse on gingival tissue (G) 24 h after injury. G biopsies were obtained in three patients 24 h after surgery with the indication of post-surgical 0.12% CHX use and were compared with those obtained from the same patients without any antiseptic use. Changes in collagen production, cell proliferation, and apoptosis were examined by histological and Ki-67/P53 immunohistochemical analysis. Fibrotic markers (COL1A1, αSMA), proapoptotic protein (BAX) expression, and wound healing-related gene modulation (RAC1, SERPINE1, TIMP1) were analyzed by quantitative real-time PCR analysis. CHX was able to reduce cellular proliferation and increase collagen deposition, proapoptotic molecule and fibrotic marker expression, and myofibroblast differentiation, reduce expression of RAC1 and trigger expression of SERPINE1 and TIMP1, showing “scar wound healing response” pattern. This study assessed for the first time the in vivo effects of CHX on gingival tissue. The demonstration of a CHX-induced fibrotic transformation, leading to scar repair, supports the need for new post-surgical clinical protocols based on a strategic and personalized use of CHX.

Prevalence of Resistance Genes to Biocides in Antibiotic-Resistant Pseudomonas Aeruginosa Clinical Isolates

Background: Biocides are frequently used as preservative, disinfectant and sterilizer against many microorganisms in hospitals, industry and home. However, the resistance rate of Pseudomonas aeruginosa (P. aeruginosa) strains to biocides is increasing. The aim of this study was to evaluate the antimicrobial activity of four frequently used biocides against P. aeruginosa and to determine the prevalence of genes involved in biocide resistance. Methods: A total of 76 clinical isolates of P. aeruginosa strains were used in the present study. The minimum inhibitory concentrations (MICs) of four biocides, i.e. chlorhexidine digluconate, benzalkonium chloride, triclosan and formaldehyde, against P. aeruginosa strains were determined using agar dilution method. In addition, the prevalence of biocide resistance genes was determined using the polymerase chain reaction (PCR) method.Results: In the present study, the highest MIC90 value was observed for benzalkonium chloride (MIC90=1024 μg/mL), followed by formaldehyde (MIC90=512 μg/mL), triclosan (MIC90=512 μg/mL) and chlorhexidine digluconate (MIC90=64 μg/mL). Furthermore, the prevalence of qacEΔ1, qacE, qacG, fabV, cepA and fabI genes were 73.7% (n=56), 26.3% (n=20), 11.8% (n=9), 84.2% (n=64), 81.5% (n=62) and 0% (n=0), respectively. A significant association was observed between the presence of biocide resistance genes and MICs (p<0.05). Furthermore, there was no significant association between the presence of biocide resistance genes and antibiotic resistance (p>0.05), except for levofloxacin and norfloxacin antibiotics and qacE and qacG genes (p<0.05). Conclusion: Our results revealed that chlorhexidine digluconate is the most effective biocide against P. aeruginosa isolates in Ardabil hospitals. However, we recommend continuous monitoring of the antimicrobial activity of biocides and the prevalence of biocide-associated resistance genes for a better prevention of microorganism dissemination and infection control in hospitals.