Comparison of effects of different types mouthrinses on gingivitis and bacterial plaque on orthodontic patients

The purpose of this study was to compare the effects of four different mouthrinses with respect to reducing plaque population growth, changes in the taste sense and in vitro staining ratios . Following professional plaque cleaning, tests were conducted after the use of mouthrinses for four consecutive days without any additional mechanical cleaning. This was a double blind, randomised, prospective, single center and parallel group clinical study.The study was conducted on 55 healthy adult (32 female and 23 male, mean age: 14.1±1.37) patients who were receiving orthodontic treatment at the Department of Orthodontics at Yeditepe University Faculty of Dentistry. Patients were randomly selected to form five test groups. The groups were comprised of twelve patients who had braces for the last 2-6 months on both lower and upper dental arches. After the professional mechanical cleaning, the pellicle samples were collected from the teeth with braces, namely upper right central, upper right first premolar, lower left central and lower first premolar teeth. The samples were then spreaded on the granular segments of the square head/tip plaque strips. The salivary flow rate was increased by having the patients chew paraffin gum and the samples were collected from the surface of the tongue using round head/tip Dentocult® strip. The saliva sampling was then clipped with plaque strips and placed into the bacitracin containing tubes. Prior to the trials, patients were informed concerning the set of rules and constraints of the study such as type and amount of mouthrinses, the treatment frequency. They were also told not to perform any means of mechanical cleaning and not to consume any chewing gum and similar products. The first test group was selected as the positive control group and directed to use 10 ml of 0.12% chlorhexidin containing G-U-M Paroex® (Sunstar Butler, Europe) mouthrinse twice a day for thirty seconds each time. The second group was directed to use 10 ml of 0.06% chlorhexidin and cetylpyridinium chloride containing G-U-M GingidexTM (Sunstar Butler, Europe) mouthrinse four times a day for thirty seconds each time. The third group was directed to use 15 ml of cetylpyridinium chloride and sodium fluoride containing Oral-B® Antiplaque (Procter&Gamble, UK) twice a day for thirty seconds each time. The fourth group was directed to use 15 ml of triclosan and centella asiatica containing Capitano® Mouthrinse (Farmaceutici Dott. Ciccarelli, Italy) twice a day for thirty seconds each time. The final group was selected as the control group and directed to use 10 ml of 1% alcohol solution two times a day for thirty seconds each time. At the end of the test period, the saliva and plaque samples were collected and analyzed along with the initial samples for comparison. A total of 110 samples were tagged with patients information and kept in an incubator at 37°C for ninety six hours. Following incubation, S. mutans colony numbers were evaluated on a population density scale from zero to three using plaque and saliva template placed in Dentocult® set. Patient?s appreciation of the taste of the mouthrinse they used was assessed by the use of visual analogue scale. İn the in vitro part of the study, the propencity of the rinses to induce dietary stainining was assesed using with Vita Easyshade® (VITA Zahnfabrik H.Rauter GmbH&Co.KG, Germany). For statistical evaluations, Mann Whitney U ve Wilcoxon tests were used.In our study, G-U-M Paroex® oral mouthrinse significantly reduced the number of S. mutans in the plaque on the surface of the teeth. G-U-M GingidexTM mouthrinse succeeded in keeping the number of S. mutans under beginning level, though it was not statistically significant. Oral-B® Anti-Plaque mouthrinse showed the characteristic of keeping the number of S. mutans close to the beginning level although it did not reduce the number of S. mutans. Capitano® mouthrinse and control group were not able to prevent the increase in the number of S. mutans. All mouthrinses reduced the number of colonies of S. mutans on tongue. The order of staining was Oral-B® Anti-plaque, G-U-M GingidexTM and G-U-M Paroex® mouthrinses from most to least. Patients liked the taste of G-U-M Paroex® at most followed by Capitano® and Oral-B® Antiplaque. Patients did not like the taste of control group mouthrinse composed of 1 % hydroalcohol solution.In our study, in order to find a mouthrinse which has minor side effects for using long time in orthodontic clinic we tested alchol free mouthrinses which are commercially available. 0.12% chlorhexidin containing G-U-M Paroex® mouthrinse was found optimal mouthrinse when assesed taste, staining and efficiancy. Taking these weakneses of this mouthrinse into consideration, more research is needed to study alternative mouthrinses with different contents.Key words: S. mutans, chlorhexidine, triclosan, cetypyridinium chloride, white spot lesion,dental staining.