Pre-procedural Mouthwash in Reducing Bacteria in Dental Aerosols
Condition: Chronic Periodontitis
MeSH terms: Periodontitis; Chronic Periodontitis
Study type: Interventional
Phase: Phase 3

Summary: 
      The aim of this randomized, single blinded clinical trial was to evaluate the effect of a
      pre-procedural mouthwash containing cetylpyridinium chloride (CPC), zinc lactate (Zn) and
      sodium fluoride (F) in the reduction of viable bacteria in oral aerosol/splatter after a
      dental prophylaxis with ultrasonic scaler.
    

Detailed description: 
      The propagation of oral microorganisms in the dental office during different oral procedures
      has been a concern. The use of certain equipment such as ultrasonic devices, highspeed dental
      handpieces or three-way syringes may spread aerosols and splatters containing microorganisms
      in the environment. These microorganisms may cause cross-infections in the dental office,
      jeopardizing the health of patients and dental professionals. Different procedures, materials
      and antimicrobial agents have been proposed to minimize microbial cross-contamination in the
      dental office. Chlorhexidine (CHX) is considered the gold standard substance in controlling
      oral biofilm growth in the oral cavity or microbial spread by oral aerosols due to its broad
      antibacterial spectrum and substantivity of 8 to 12 hours. However, other antiseptics have
      also been used as pre-procedural mouthwashes. CPC has an important antimicrobial activity and
      is considered a safe product for marketing. In this context, the present trend has been to
      combine more than one active substance in mouthwash and toothpaste formulations with the aim
      of increasing the efficacy of the products, or treating more than one clinical problem, such
      as plaque accumulation and halitosis, caries or gingival inflammation. Therefore, the aim of
      this randomized clinical trial (RCT) was to evaluate the effectiveness of a new mouthwash
      formulation containing 0.075% CPC, 0.28% zinc lactate and 0.05% sodium fluoride (CPC+Zn+F) in
      reducing viable bacteria present in oral aerosol/splatter. Sixty systemically healthy
      volunteers receiving dental prophylaxis were randomly assigned to one of the following
      experimental groups (15 per group): i) rinsing with 0.075% CPC, 0.28% Zn and 0.05% F
      (CPC+Zn+F), ii) 0.12% chlorhexidine digluconate (CHX), iii) no rinsing and iv) rinsing with
      water. Viable bacteria were collected from different locations in the dental office on
      enriched TSA plates and anaerobically incubated for 72 hours. The colonies were counted and
      species were then identified by Checkerboard DNA-DNA Hybridization. The total number of
      colony-forming units (CFUs) detected in the aerosols/splatters from volunteers who rinsed
      with CPC+Zn+F or CHX was statistically significantly (p<0.05) lower than of those subjects
      who did not rinse or who rinsed with water. When all locations were considered together, the
      aerosols/splatters from the CPC+Zn+F and CHX groups showed, respectively, 70% and 77% fewer
      CFUs than those from the no rinsing group and 61% and 70% than those from the water group.
      The mean proportions of bacterial species from the orange complex were statistically
      significantly (p<0.05) lower in aerosols/splatter from the CPC+Zn+F and CHX groups compared
      with the two negative controls. In conclusion, the results of the present investigation
      showed that a mouthwash containing 0.075% CPC, 0.28% Zn and 0.05% F, is effective in reducing
      viable bacteria in oral aerosol/splatter after a dental prophylaxis with ultrasonic scaler.
      This finding is highly relevant to the clinical practice, as it may greatly reduce the risk
      of cross-contamination in dental offices.
    

Intervention name(s): Dental prophylaxis; Mouthwash CPC+Zn+F; Mouthwash CHX; No rinsing; Water
Intervention type(s): Procedure; Drug; Drug; Other; Other
Intervention description(s): Full mouth dental prophylaxis (FMDP) was conducted in one appointment lasting 10 minute, using an ultrasonic scaler at a frequency of 25 kHz (Cavitron Select SPC, Dentsply professional, York, PA, USA) at less than 50% power. The FMDP performed without anesthesia and in order to eliminate supragingival plaque, calculus and stainings.; The volunteer rinsed with pre-procedural mouthwash containing 0.075% cetylpyridinium chloride, 0.28% zinc lactate and 0.05% sodium fluoride in an Alcohol-free base for one minute, 20 ml of solution and then expectorated all remaining liquid.; The volunteer rinsed with pre-procedural mouthwash containing 0.12% CHX with 10% alcohol for one minute, 20 ml of solution and then expectorated all remaining liquid.; The volunteer did not rinse with any pre-procedural mothwash.; The volunteer rinsed with pre-procedural mouthwash containing water from a three-way syringe for one minute, 20 ml of water and then expectorated all remaining liquid.
Other intervention name(s): Pre-procedural mouthwash CPC+Zn+F; Pre-procedural mouthwash
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Care Provider)
Primary purpose: Prevention
Keywords: cetylpyridinium chloride; chlorhexidine; oral aerosol; oral splatter; mouthwash; microbiology