Cetylpyridinium chloride (CPC) and sodium fluoride augment oral hygiene by inactivating bacteria and inhibiting enamel demineralisation, respectively. However, there are few reports in the literature documenting the antibacterial efficacy of their combined use in mouthrinses. We have used six experimental systems to compare the antibacterial effects of mouthrinses containing 0.075 % CPC (test rinse, TR) or 0.075 % CPC with sodium fluoride (test fluoride rinse, TFR). Effects against planktonic bacteria were determined using viable counting (for Streptococcus mutans and salivary bacteria), a redox dye (for Actinomyces viscosus and salivary bacteria) and viable counting (for ex vivo oral rinses). Effects against saliva-derived biofilms were quantified using confocal microscopy and differential viable counting. Inhibition of biofilm formation was evaluated by pre-treating hydroxyapatite coupons with mouthrinses prior to inoculation. Otherwise-identical controls without CPC (control rinse and control fluoride rinse, CR and CFR, respectively), were included throughout. Compared to the controls, TFR and TR demonstrated significant antimicrobial effects in the redox assays, by viable counts (>3 log reductions) and in oral rinse samples (>1.25 log reductions, p < 0.05). TFR and TR also significantly reduced the viability of oral biofilms. Pre-treatment of hydroxyapatite with TFR and TR significantly inhibited biofilm formation (>3 log difference, p < 0.05). Overall, there were no consistent differences in the activities of TR and TFR. Sodium fluoride did not influence the antibacterial and anti-biofilm potency of CPC-containing formulations, supporting the combined use of CPC and sodium fluoride in mouthrinses to control oral bacteria and protect tooth enamel.

Objective: The natural accumulation of supragingival plaque on surfaces of human teeth is associated with gingival inflammation and the initiation of common oral diseases. This study evaluated the distribution of dental plaque and gingivitis scores within the dental arches after prophylaxis. Methods: Adult subjects from the Dharwad, India area representing the general population who provided written informed consent were scheduled for screening. Healthy subjects over the age of 18 years, not currently requiring any medical or dental care, and presenting with a complement of at least 20 natural teeth were recruited for this parallel design study. Enrolled subjects (n = 41) underwent oral examinations for dental plaque (PI) and gingivitis (GI) using the Turesky modification of the Quigley-Hein and the Löe-Silness Index, respectively, at the baseline visit, followed by a whole mouth dental prophylaxis. Subjects were given fluoride toothpaste for twice daily oral hygiene for the next 30 days. Subjects were recalled on days 15 and 30 for PI and GI examinations identical to baseline. Results: Analyses indicated that mean scores for PI and GI on either arch and the whole mouth were higher than 2 and 1, respectively, during all examinations. Anterior surfaces consistently exhibited lower PI scores than posterior regions of either arch, or the entire dentition. Regional GI differences within the dentition were similar to PI scores, with lower scores on anterior than posterior teeth. Prophylaxis reduced both the frequency and mean scores of both PI and GI, irrespective of arch, with lower scores observed on anterior than posterior regions during all recall visits. Molar and lingual regions consistently exhibited higher PI and GI scores compared with anterior surfaces. At all examinations, mean scores for both plaque and gingivitis were higher on approximal vestibular than mid-vestibular surfaces. Conclusions: Differences observed in PI and GI within the dentition have several practical implications: (a) there are advantages of whole mouth assessments for oral health (b) a need for oral hygiene formulations to reduce the larger deposits of dental plaque in the posterior region and resultant gingival inflammation, and (c) a requirement for ongoing oral hygiene education.

This cross‐sectional survey study evaluated oral hygiene habits in conjunction with whole mouth examinations for dental plaque and gingivitis among adults in India. Subjects across several age groups who provided informed consent [220 male and 158 female (mean age 30.9 years)] were enrolled. All enrolled subjects were interviewed for oral hygiene practices and evaluated by the Turesky modification of the Quigley‐Hein and the Löe‐Silness methods for dental plaque and gingivitis, respectively. Evaluations included oral hygiene parameters, prevalence of dental plaque and gingivitis, and regional differences within the dentition for dental plaque and gingivitis. Results from this study indicate that most subjects (97%) utilized a toothbrush and toothpaste for oral hygiene with a majority (92%) using their right hand to brush their teeth. While 29% reported two or more episodes of daily oral hygiene, a majority (53%) brushed their teeth once daily. Utilization of dental floss and mouthwashes were reported by approximately 1% of this population, and most (73%) reported no dental visits in the preceding 5 years. Whole mouth plaque and gingival scores (average ± standard deviation) for this population were 2.47 ± 0.55 and 1.19 ± 0.31, respectively, with no significant differences between either gender (P > 0.05). Significant correlations (r > 0.44) were observed between plaque and gingival scores for the entire sample, either gender or between age groups (P < 0.001). Analyses indicate that anterior teeth demonstrated lower average scores for dental plaque and gingivitis than posterior and molar regions (P < 0.05). Education was associated with higher plaque and gingival scores: plaque scores [odds ratios; 95% confidence interval; 1.23; 1.01–1.50 and gingival scores odds ratios 1.25; 1.02–1.54]. In summary, results from this study demonstrate the prevalence of dental plaque and gingivitis in the general population and their relationships with demographic characteristics. They reinforce examinations of posterior regions that consistently harbor more plaque and corresponding gingivitis in evaluations of oral health.

Clinical studies indicate relationships between dental plaque, a naturally formed biofilm, and oral diseases. The crucial role of nonmicrobial biofilm constituents in maintaining biofilm structure and biofilm-specific attributes, such as resistance to shear and viscoelasticity, is increasingly recognized. Concurrent analyses of the diverse nonmicrobial biofilm components for multiparameter assessments formed the focus of this investigation. Comparable numbers of Actinomyces viscosus , Streptococcus sanguinis , Streptococcus mutans , Neisseria subflava , and Actinobacillus actinomycetemcomitans cells were seeded into multiple wells of 96-well polystyrene plates for biofilm formation. Quantitative fluorescence and confocal laser scanning microscopy (CLSM) examined the influences of dietary sugars, incubation conditions, ingredients in oral hygiene formulations, and antibiotics on biofilm components. Biofilm extracellular polymeric substances (EPS) were examined with an optimized mixture of fluorescent lectins, with biofilm proteins, lipids, and nucleic acids detected with specific fluorescent stains. Anaerobic incubation of biofilms resulted in significantly more biofilm EPS and extractable carbohydrates than those formed under aerobic conditions ( P < 0.05). Sucrose significantly enhanced biofilm EPS in comparison to fructose, galactose, glucose, and lactose ( P < 0.05). CLSM demonstrated thicker biofilms under sucrose-replete conditions, along with significant increases in biofilm EPS, proteins, lipids, and nucleic acids, than under conditions of sucrose deficiency ( P < 0.05). Agents in oral hygiene formulations (chlorhexidine, ethanol, and sodium lauryl sulfate), a mucolytic agent ( N -acetyl- l -cysteine), and antibiotics with different modes of action (amoxicillin, doxycycline, erythromycin, metronidazole, and vancomycin) inhibited biofilm components ( P < 0.05). Multiparameter analysis indicated a dose-dependent inhibition of biofilm EPS and protein by chlorhexidine and sodium lauryl sulfate, along with distinctive inhibitory patterns for subinhibitory concentrations of antibiotics. Collectively, these results highlight multiparameter assessments as a broad platform for simultaneous assessment of diverse biofilm components.

Histological features of oral inflammation include infiltration of polymorphonuclear leukocytes [PMN], however studies have not examined the effects of interventions mitigating inflammation on oral PMN. Methods: This double-blind clinical study examined the effects of rinsing with mouthwashes formulated with chlorhexidine [CHX], an ingredient widely utilized in the dental clinic in comparison to a control on oral PMN representing a novel measure of inflammation. A concurrent evaluation of dental plaque and gingival inflammation using widely accepted clinical indices was included in the study. The study enrolled adult subjects providing informed consent, met study criteria and registered gingival index scores of 1.0 or more at the screening visit. Subjects [n = 90; age range 19–58 years] completed a washout phase prior to baseline evaluations for PMN and clinical assessments for dental plaque and gingivitis. Treatments [CHX or a control mouthwash] were randomly assigned to subjects for twice-daily use for the next two weeks. Post-treatment evaluations similar to baseline were conducted after one and two week use of assigned treatment. Results: At baseline, no statistically significant differences between treatment groups for PMN or clinical indices for dental plaque or gingivitis were noted. Rinsing with CHX demonstrated significant reductions for PMN and dental plaque, gingivitis in comparison to the control group. After one and two week use of CHX, PMN demonstrated a 35.9% and 54.9% reduction respectively in comparison to the control group representing significant differences [p < 0.05]. At the one and two week post-treatment evaluations, rinsing with CHX demonstrated 15% and 25% reductions in gingivitis respectively and were significantly different from the control [p < 0.05]. Rinsing with CHX also demonstrated significant reductions in dental plaque of 15% and 19% at the one and two-week post-treatment evaluations respectively in comparison to the control [p < 0.05]. The CHX group also demonstrated reductions in interproximal scores and registered the lowest frequency of gingival index or dental plaque scores on all oral surfaces. Conclusions: Results outline an objective approach to evaluate oral inflammation demonstrating a large and sustained reduction in oral PMN by CHX with these outcomes numerically higher than a clinical index evaluating gingivitis.