Dental-Plaque Decontamination around Dental Brackets Using Antimicrobial Photodynamic Therapy: An In Vitro Study

Background: In orthodontic therapy, the enamel around brackets is very susceptible to bacterial-plaque retention, which represents a risk factor for dental tissues. The aim of this study was to evaluate the effect of methylene blue and a chlorophyllin–phycocyanin mixture, used with and without light activation, in contrast with a 2% chlorhexidine solution, on Streptococcus mutans colonies. Methods: Twenty caries-free human extracted teeth were randomized into five groups. A Streptococcus mutans suspension was inoculated on teeth in groups B, C, D, and E (A was the positive-control group). Bacterial colonies from groups C, D, and E (B was the negative-control group) were subjected to photosensitizers and 2% chlorhexidine solution. For groups C and D, a combined therapy consisting of photosensitizer and light activation was performed. The Streptococcus mutans colonies were counted, and smears were examined with an optical microscope. Two methods of statistical analysis, unidirectional analysis of variance and the Tukey–Kramer test, were used to evaluate the results. Results: A statistically significant reduction in bacterial colonies was detected after the combined therapy was applied for groups C and D, but the most marked bacterial reduction was observed for group D, where a laser-activated chlorophyll–phycocyanin mixture was used. Conclusions: Photodynamic therapy in combination with methylene blue or chlorophyllin–phycocyanin mixture sensitizers induces a statistically significant decrease in the number of bacterial colonies.

PECULIARITIES OF TREATMENT OF CHANGES IN PERIODONTAL TISSUES IN CHILDREN LIVING IN POLLUTED PRECARPATHIAN REGIONS

Today special attention to the influence of environmental factors on the condition of the dental-maxillary system and periodontal tissues in children is paid. Scientists have proved that environmentally unfavorable conditions also change the immunological reactivity of the body, form violations of the immune status, and changes in the local immunity in the oral cavity stimulate the development of pathogenic microflora. Our research is devoted to the study of changes in periodontal tissues in children living in ecologically favorable conditions and in ecologically polluted Precarpathian regions, a comparative characterization of changes in periodontium, a treatment plan for chronic catarrhal gingivitis, supplemented with chlorhexidine dentin and quercetin. According to the results of many researches, 0.12% chlorhexidine solution provides a pronounced antimicrobial effect on pathogenic microflora; and under the action of quercetin there is a stabilization of the antioxidant system, improvement of peripheral blood circulation, improvement of rheological properties of the patient's blood. We examined 60 patients with chronic catarrhal gingivitis living in environmentally stable conditions (Ivano-Frankivsk) (1 group), 15 people with intact periodontium and 60 children with chronic catarrhal gingivitis living in contaminated Precarpathian regions (Burshtyn) (group 2). All patients were treated with a set of therapeutic measures, which are recommended for the conventional treatment of patients with chronic catarrhal gingivitis. In groups 1a and 2a, patients were treated with chlorhexidine, calendula and chamomile infusion and 1% mefenamine paste. In groups 1b and 2b we applied a quercetin gel on the mucous membrane of the patient’s gums under an individual dental-gingival cap. For the purpose of comparative characterization of the two groups, an index assessment of the condition of periodontal tissues, study of rheographic parameters of periodontal tissues and radiographic characteristics of jaw bone tissue were performed. The results of the research showed a significant difference between clinical and laboratory parameters in patients with chronic catarrhal gingivitis living in environmentally friendly conditions compared with persons living permanently in ecologically polluted Precarpathian regions (p <0.05 ). In people living in ecologically polluted areas there is a pronounced cyanosis of the gums and mild diffuse cyanosis of the oral mucosa, high rates of bleeding gums. Scientists believe that the main mechanisms of pathogenetic effects on periodontal tissues are transmitted infectious and toxic diseases, trophic and metabolic disorders, changes in neurohumoral regulation, vitamin imbalance in the body, immune disorders, hypoxia, oxidative stress, disorders of plastic processes in any tissues of the body, the mucous membrane of the oral cavity. We proved that the use of the proposed treatment regimen for chronic catarrhal gingivitis (groups 1b and 2b) shows a significantly higher effectiveness over the treatment of basic therapy in groups 1a and 2a. This treatment stimulates metabolic processes in periodontal tissues, reduces cyanosis, edema of periodontal tissues, eliminates inflammatory phenomena in periodontal tissues. The results show that the use of quercetin and 0.12% chlorhexidine solution in the complex treatment of patients with chronic catarrhal gingivitis provides a significant improvement in clinical parameters and laboratory characteristics of periodontal tissues in children living in different environmental conditions.

Microbiological analysis of root canal space prepared for prosthetic intracanal posts

The aim of the study was to microbiologically analyze the root canal space prepared for prosthetic intracanal posts. Thus, a 2% chlorhexidine solution was used after the intraradicular preparation of ten teeth with endodontic treatment performed for prosthetic purposes and pulp vitality history. Two collections were performed for microbiological analysis: one before the use of the studied solution, showing positive microbiological culture in all cases; and another, after application for 3 minutes of 2% chlorhexidine solution. The results showed the effectiveness of the solution in nine of ten cases, presenting negative results in microbial culture.

Comparison of the Sterilization Efficiency of 3 Disinfectants for Dropped Anterior Cruciate Ligament Grafts: A Systematic Review and Meta-analysis

Background: The inadvertent contamination of anterior cruciate ligament (ACL) grafts can occur if they are accidentally dropped on the floor during ACL reconstruction. There has been no meta-analysis conducted to compare the sterilization efficiency of the different disinfectants used on dropped ACL grafts. Purpose: To compare the sterilization efficiency of 3 disinfectants to decontaminate ACL grafts as necessary. Study Design: Systematic review. Methods: A systematic literature review was performed using the MEDLINE, Embase, and Cochrane Library databases. All studies reporting the management of dropped or contaminated grafts were considered for this meta-analysis. Results: A total of 7 studies meeting inclusion criteria were identified from a literature search. The pooled results of this meta-analysis indicated that the rate of positive cultures of ACL grafts dropped on the operating room floor was 44.9% and that the commonly contaminated microbes were staphylococci and bacilli. The meta-analysis results indicated that the sterilization efficiency of a 4% chlorhexidine solution was superior to an antibiotic solution (odds ratio [OR], 0.17 [95% CI, 0.05-0.57]; P = .004) and a 10% povidone-iodine solution (OR, 0.04 [95% CI, 0.01-0.20]; P < .0001). Further, the antibiotic solution was superior to the 10% povidone-iodine solution (OR, 0.20 [95% CI, 0.07-0.55]; P = .002). Conclusion: The results of our meta-analysis demonstrated that staphylococci and bacilli were the most common contaminants on dropped ACL grafts and that decontamination using a 4% chlorhexidine solution more reliably disinfected ACL grafts. This information can help to guide surgeons as regards appropriate remedial measures.

The assortment analysis of chlorhexidine-containing medicines and procurement data of state and municipal organizations

Chlorhexidine is an effective cationic antiseptic and disinfectant that has been used in medical practice for decades. It is generally recommended to use different concentrations of aqueous or alcoholic solutions of chlorhexidine for different therapeutic purposes. Objective. To determine the proportions of different chlorhexidine concentrations in medicines purchased by state and municipal organizations and to identify possible issue of chlorhexidine formulations utilization in the suboptimal or insufficient concentrations. Results. The vast majority of the chlorhexidine-containing medicines found in the State Register of Medicines of Ukraine are 0.05% solutions for external use, 0.05% gels for dental and urological use and vaginal suppositories (pessaries) with 16 mg of chlorhexidine in one dose. While the most common representatives of chlorhexidine-containing medicines abroad are solutions with a concentration of 4% and 2%, as well as mouthwashes with a concentration of 0.12%. The highest share - 96% - among the procurements of chlorhexidine-containing medicines by state and municipal organizations is 0.05% aqueous solution for external use. Instructions for medical use of 0.05% aqueous chlorhexidine solution for external use contain indications that are not supported by international documents: WHO Model List of Essential Medicines and British National Formulary. Conclusions. The obtained results suggest probable cases of irrational use of chlorhexidine medicines in medical practice in Ukraine. The consequences of such cases are not limited to the failure to achieve therapeutic goals or to the development of nosocomial infection, but includes also the selection of chlorhexidine-resistant strains of microorganisms. Key words: chlorhexidine; assortment analysis; medicinal procurements study; suboptimal concentration; rational pharmacotherapy

Comparison of the effect of isopropyl alcohol and chlorhexidine solution rinses on body temperature of female cats undergoing sterilization surgery

Objectives Isopropyl alcohol 70% as a rinse agent for chlorhexidine scrub has been shown to decrease body temperature more quickly than chlorhexidine solution in mice prepared aseptically prior to surgery. For this reason, some high-quality, high-volume (HQHV) surgical sterilization clinics use chlorhexidine solution rather than alcohol. We sought to determine if temperature upon entry to recovery, heat loss per kg and rate of temperature decline during surgery were different between cats rinsed with chlorhexidine solution vs 70% isopropyl alcohol following surgical scrub, and if there were significant predictors of recovery temperature. Methods Female cats admitted for surgery to trap–neuter–return (TNR) clinics at a veterinary college were assigned chlorhexidine solution or alcohol rinse agents via block randomization. Veterinary students and veterinarians performed spay surgeries using HQHV techniques. In recovery, heat support and reversal agents were available for cats with a low body temperature or that were slow to recover. Baseline values, outcome variables and duration of each stage (preparation, surgery, recovery) were assessed using Wilcoxon rank-sum and t-tests. Recovery temperature was evaluated using random effects multiple linear regression. Results The recovery temperature, heat loss per kg, heat loss per min, need for reversal and need for heat support in recovery were not significantly different between rinse groups. Weight <2.3 kg, body condition score <4, duration of surgery and postinduction temperature were predictors of recovery temperature. The rate of heat loss in the first 30 mins of surgery was slightly lower for cats in the alcohol rinse group and the recovery duration was shorter for cats weighing less <2.3 kg in the alcohol rinse group. Conclusions and relevance There were no clinically meaningful differences in body temperature between chlorhexidine and alcohol rinses. Both chlorhexidine solution and isopropyl alcohol 70% are appropriate rinse agents for aseptic preparation of feline spay surgeries.

Alcohol (70%) versus alcoholic chlorhexidine solution (0.5%) in skin antisepsis for neuraxial blocks: a randomized clinical trial

ABSTRACT Objective: to compare the use of 0.5% alcoholic chlorhexidine and 70% alcohol in skin antisepsis for neuraxial blocks. Method: this is a non-inferiority randomized clinical trial, with two parallel arms. Seventy patients who were candidates for neuraxial block were randomly allocated to group A (n = 35), in whom antisepsis was performed with 0.5% alcoholic chlorhexidine, or to group B (n = 35), in whom we used 70% hydrated ethyl alcohol. Swabs were harvested for culture at three times: before antisepsis, two minutes after application of the antiseptic, and immediately after puncture. The samples were sown in three culture media and the number of colony forming units (CFU) per cm² was counted. Results: there was no difference between the groups regarding age, sex, body mass index, time to perform the block or type of block. There were no differences between groups in the CFU/cm² counts before antisepsis. There was less bacterial growth in group B two minutes after application of the antiseptic (p = 0.048), but there was no difference between the groups regarding the number of CFU/cm² at the end of the puncture. Conclusion: 70% alcohol was more effective in reducing the number of CFU/cm² after two minutes, and there was no difference between the two groups regarding skin colonization at the end of the procedure. These results suggest that 70% alcohol may be an option for skin antisepsis before neuraxial blocks. Trial registration: ClinicalTrials.gov, NCT02833376.

Comparison of the Effect of Perineal Care with Normal Saline and 2% Chlorhexidine Solution on the Rate of Catheter-Associated Urinary Tract Infection in Women Hospitalized in Intensive Care Units: A Quasi-Experimental Study

Background: Urinary tract infection is the most common site of infection associated with health care in the Intensive Care Unit (ICU) patients. Long-term catheterization is the most important risk factor for Urinary Tract Infections (UTIs). These infections are more common in women than in men. Colonized microorganisms in the perineal skin and around the urethra may move into the urinary system through the external surfaces of the urinary catheter to cause infection. Objectives: The present study aimed to compare the effect of perineal care with normal saline and 2% chlorhexidine solution on the rate of catheter-associated urinary tract infection (CAUTI) in women hospitalized in ICUs. Methods: A quasi-experimental study was performed on 70 female patients hospitalized in the ICU of Khatam-Al-Anbia Hospital of Zahedan in 2019. The research units meeting the inclusion criteria were selected using convenience sampling and then randomly divided into two groups of normal saline (n = 35) and chlorhexidine (n = 35). The perineal area of patients in the first group was washed with normal saline and the second group with 2% chlorhexidine solutions twice a day for seven days in both groups. To diagnose UTIs, urine samples were cultured on the first and seventh days. Data were analyzed using SPSS 21 via the independent t-test, chi-square test, and Fisher’s exact test at a significance level of less than 0.05. Results: Finally, 60 participants completed the study. The two groups did not differ significantly in terms of age, marital status, level of education, cause of hospitalization, antibiotic use, underlying diseases, fluid intake, and urinary output. At the end of the seventh day after the intervention, the incidence of UTIs was significantly lower in the chlorhexidine group (13.3%) than in the normal saline group (76.7%) (P = 0.001). Conclusions: The results showed that washing the perineal area every 12 hours with 2% chlorhexidine solution compared to normal saline reduces the incidence of CAUTIs in women hospitalized in ICUs. Therefore, perineal care with a 2% chlorhexidine solution is recommended for perineal care of female patients with urinary catheters hospitalized in ICUs.