ABSTRACT Introduction: Patients who have received radiation therapy due to oral cancers often present with complications such as salivary dysfunction, mucositis, soft tissue necrosis, infections and dental caries. The aim of this study was to investigate the antimicrobial properties of an experimental mouthrinse which also contains analgesic and anticaries compounds and can be used in the management of patients with oral cancers after radiation therapy. Methods: The experimental mouthrinse contained a mixture of 30% glycerine (antimicrobial agent), 7% potassium nitrate (analgesic) and 0.025% sodium fluoride (anticaries agent). The minimal inhibitory concentration (MIC) of these ingredients was tested against Candida albicans, Staphylococcus aureus and Streptococcus mutans over 24 hours at different concentrations. MICs of commercially available mouthrinses containing chlorhexidine digluconate (Corsodyl®) and fluoride with triclosan (Plax®) were also determined using the same organisms. All mouthrinses were then tested to determine the percentage kill over 1, 2, and 3 minutes. The costs of these mouthrinses were also compared. Results: The MICs for glycerine were 10%, 25% and 10% for C. albicans, S. aureus and S. mutans respectively. Potassium nitrate, sodium fluoride and alum did not show any antimicrobial effects. The MIC of Corsodyl® was <0.02 mg/ml for all the test organisms. The MIC for Plax was 0.02 mg/ml, <0.002 mg/ml and 0.005 mg/ml for C. albicans, S. aureus and S. mutans respectively. Combining glycerine, potassium nitrate and sodium fluoride into a mixture did not affect the antimicrobial properties of these constituents. The mixture killed 99.78%, 99.88% and 99.98% of C. albicans, 61.74%, 70.64% and 85.09% of S. aureus and 91.72%, 99.47% and 99.99% of S. mutans after 1, 2 and 3 minutes respectively. Two percent chlorhexidine digluconate killed 98.98%, 99.97% and 99.99% of C. albicans, 95.83%, 99.68% and 99.97% of S. aureus and 99.98%, 99.96% and 99.99% of S. mutans after 1, 2 and 3 minutes respectively. Plax® killed 99.99% of C. albicans in one minute, 99.66%, 99.99% of S. aureus in 1 and 2 minutes respectively; and 99.89%, 99.96% and 99.99% of S. mutans in 1, 2 and 3 minutes respectively. The costs of similar amounts of the experimental mouthrinse, Corsodyl® and Plax® were R5.24, R30.00 and R10.00 respectively. Conclusion: A mouthrinse effective in relieving oral symptoms in patients receiving radiation therapy needs to show some antimicrobial activity against in particular, C. albicans and S. mutans, whilst at the same time having a palliative effect. This study has shown that the experimental mouthrinse will fulfil these requirements. The experimental mouthrinse was found to be the cheapest in comparison to Corsodyl® and Plax®.

Objectives: Mouthrinses are widely used by dental patients in daily oral hygiene practices. However, claims of antimicrobial effects are often made by mouthrinse manufacturers without substantiation by laboratory testing on complex oral microbial communities, such as the dorsal tongue microbiota, which are readily exposed in vivo to mouthrinse solutions, and contribute to the etiology of oral halitosis (bad breath). This study employed a modified Kirby-Bauer zone of inhibition test to comparatively examine the in vitro antimicrobial activity of 12 commercial mouthrinse formulations on a mixture of three bacterial species frequently isolated from the human tongue dorsum. Methods: The 12 commercial mouthrinse formulations tested were 1.) Perio-Aid Treatment Mouthwash (Dentaid S.L., Cerdanyola del Vallès, Spain; containing 0.12% chlorhexidine gluconate and 0.05% cetylpyridinium chloride without alcohol), 2.) Paroex (Sunstar Americas, Inc., Schaumburg, IL; containing 0.12% chlorhexidine gluconate without alcohol), 3.) Peridex (3M ESPE Dental Products, St. Paul, MN, USA; containing 0.12% chlorhexidine gluconate plus 11.6% alcohol), 4.) Perio-Aid Maintenance Mouthwash (Dentaid S.L.; containing 0.05% chlorhexidine gluconate and 0.05% cetylpyridinium chloride without alcohol), 5.) Halita Mouthwash for Halitosis (Dentaid S.L.; containing 0.05% chlorhexidine gluconate, 0.05% cetylpyridinium chloride, and 0.14% zinc lactate without alcohol), 6.) Crest Pro-Health Clinical (Procter & Gamble, Cincinnati, OH, USA; containing 0.1% cetylpyridinium chloride without alcohol), 7.) Therasol (formerly from OraTec Corp., Manassas, VA; containing C31G complex of alkyl dimethyl amine oxide and alkyl dimethyl glycine plus 8% alcohol), 8.) Listerine Cool Mint Zero Alcohol (Johnson & Johnson Consumer, Inc., Skillman, NJ, USA; containing essential oils 0.092% eucalyptol, 0.042% menthol, 0.06% methyl salicylate, and 0.064% thymol, without alcohol), 9.) PerioShield Oral Health Rinse (formerly from Sunstar Americas, Inc.; containing 0.2% delmopinol hydrochloride plus 1.5% alcohol), 10.) Listerine Cool Mint (Johnson & Johnson Consumer, Inc.; containing essential oils 0.092% eucalyptol, 0.042% menthol, 0.06% methyl salicylate, and 0.064% thymol, plus 21.6% alcohol), 11.) CloSys Antiseptic Oral Rinse (Rowpar Pharmaceuticals, Scottsdale, AZ, containing stabilized chlorine dioxide without alcohol), and 12.) PerioMed Antimicrobial Oral Rinse (3M ESPE Dental Products; containing 0.63% stannous fluoride without alcohol). Streptococcus salivarius subsp. salivarius ATCC 13419, Veillonella atypica ATCC 17744, and Prevotella melaninogenica ATCC 25845, which are among the most frequent bacterial isolates from the human tongue dorsum, were grown on enriched Brucella blood agar, comprised of 4.3% Brucella agar supplemented with 0.3% bacto-agar, 5% defibrinated sheep blood, 0.2% hemolyzed sheep red blood cells, 0.0005% hemin, and 0.00005% menadione. Pure cell suspensions of each species were adjusted to a 0.5 McFarland turbidity standard (approximately 1.5 x 108 CFU/ml), and combined equally into a standardized mixture. Undiluted 0.1 ml aliquots of the standardized bacterial mixture were spread with sterile cotton-tipped swabs onto non- selective enriched Brucella blood agar culture plates. After inoculation, four 7-mm diameter cylindrical wells were punched into each of the culture plates and filled with 60 μl of one of the commercial mouthrinse formulations, or sterile saline as a negative control. The inoculated culture plates were incubated upright in anaerobic jars containing 85% N2-10% H2-5% CO2 at 37 °C for four days, after which the diameter of inhibition zones against the standardized bacterial mixture at each well was measured at three locations to the nearest millimeter with a Boley gauge. Differences in mean bacterial inhibition zones (after subtraction of the agar well diameter) among the mouthrinse formulations and sterile saline were evaluated using a one-way analysis-of-variance and a post-hoc Tukey honestly significant difference test, with a Bonferroni adjustment for multiple comparisons. A P-value of &lt; 0.05 was required for statistical significance. Results: Perio-Aid Treatment exhibited significantly greater in vitro antimicrobial inhibition than the other tested mouthrinse formulations and sterile saline, followed in descending in vitro antibacterial activity by Paroex, Peridex, Perio-Aid Maintenance, Halita, Crest Pro-Health Clinical, Therasol, Listerine Cool Mint Zero Alcohol, and PerioShield. Listerine Cool Mint with alcohol, Closys, and PerioMed were not significantly different from sterile saline in antibacterial in vitro activity. Conclusions: The mouthrinse containing 0.12% chlorhexidine gluconate plus 0.05% cetylpyridinium chloride (Perio-Aid Treatment) exerted the greatest in vitro inhibitory potential against a combination of three bacterial species frequently predominant on the human tongue dorsum. Significantly less antibacterial effects were found with chlorhexidine gluconate or cetylpyridinium chloride alone, or chlorhexidine gluconate at lower concentrations in combination with cetylpyridinium chloride. The relative lack of in vitro antibacterial activity of mouthrinses comprised of essential oils with alcohol, stabilized chlorine dioxide, or stannous fluoride raises questions about their potential clinical effectiveness against dorsal tongue surface biofilms and oral halitosis. / Oral Biology

O uso de enxaguatórios bucais contendo substâncias ativas antimicrobianas tem sido proposto como um importante meio de redução da formação de biofilme dental supragengival quando usados concomitantemente com higienização mecânica da cavidade bucal. A microemulsão é um moderno sistema de liberação de fármacos, que pode solubilizar tanto compostos lipo quanto hidrossolúveis. Foi demonstrado que extratos de Baccharis dracunculifolia (Bd), popularmente conhecido como alecrim-do-campo apresentaram atividade anticariogênica, sugerindo sua utilização em produtos para higiene bucal. No entanto, o extrato de Baccharis dracunculifolia é pouco solúvel em água. No presente trabalho, nós desenvolvemos e caracterizamos microemulsões com extrato e óleo essencial das folhas de Bd para incorporar em formulação de enxaguatório bucal sem álcool, com finalidades preventiva e terapêutica, contendo extrato hidroetanólico e óleo essencial das folhas de Baccharis dracunculifolia e avaliar o seu efeito sobre fatores de virulência de Streptococcus mutans (S. mutans) in vitro. Foram obtidos 4 diagramas de fase pseudo-ternário: 1. Labrasol® (L-polietilenoglicol-8-caprilato/caprato)/Plurol® (P-isoestearato de poligliceril) (3:1)/Oleato Etila - (LP); 2. PEG 40 (óleo de rícino hidrogenado e etoxilado)/Sorbitol (2:1)/ Oleato de etila - (PSO); 3. PEG 40/Sorbitol (2:1)/Miristato de isoropila - (PSM) e 4. PEG 40/Sorbitol/Glicerol (1:1:1)/Oleato de etila e óleo essencial de B. dracunculifolia - (PSG). Os sistemas foram caracterizados (microscopia óptica, estabilidade preliminar, reologia, pH, tamanho de gotículas, viscosidade, condutividade elétrica, densidade relativa e índice de refração). Foram desenvolvidas 4 formulações enxaguatórias com a microemulsão escolhida e submetidas à análise sensorial por teste de preferência. O efeito do enxaguatório bucal contendo o extrato hidroetanólico e óleo essencial de B. dracunculifolia foi avaliado in vitro, sobre fatores cariogênicos de S. mutans: inibição do potencial acidogênico, concentração inibitória mínima (CIM) e influência no perfil de crescimento. Além disso, foram avaliados citotoxicidade por MTT e capacidade de manchamento de dentes de estoque pelo padrão CIELAB do enxaguatório bucal. O sistema microemulsionado escolhido apresentou as seguintes propriedades físico-químicas: viscosidade de 12,40 cP, tamanho de gotícula 19,53 nm, condutividade 204,63 µS/cm, pH final 4,95, densidade relativa 1,0394g/mL, índice de refração igual a 1,3595. A formulação escolhida para desenvolver o enxaguatório bucal, apresenta pH final igual a 5,89, densidade igual a 1,0425 g/mL, índice de refração de 1,3614 e viscosidade igual a 12,0 cP. O enxaguatório bucal apresentou atividade inibitória sobre a produção bacteriana de ácidos, com valor de CI50 igual a 128 µg de extrato bruto/mL da formulação, apresentando CIM (Concentração Inibitória Mínima) igual a 400 g de extrato bruto/mL da formulação, para uma concentração final de inóculo igual a 5 x 103 ufc/mL. Na avaliação de mudança de coloração dos dentes, o enxaguatório bucal de referência Periogard® (contendo digluconato de clorexidina 0,12%) e o enxaguatório de B. dracunculifolia apresentaram valores de E iguais a 2,62 e 0,55 unidades CIELAB, respectivamente, evidenciando que o primeiro mancha os dentes e o segundo não, mas que os dois são clinicamente aceitáveis. Além disso, enxaguatorio bucal contendo extrato e óleo essencial de B. dracunculifolia apresenta baixa interferência na proliferação celular, por teste de MTT (brometo de 3-(4,5-dimetiltiazol-2-il)-2,5-difenil tetrazolium). Os resultados sugerem que a formulação final escolhida possui propriedades antimicrobianas superiores ao extrato hidroetanólico bruto, com baixo efeito citotóxico, credenciando-o para avaliação clínica. / The use of antimicrobial mouthrinses to help the plaques supragengival control and gingivitis has been shown to significantly contribute to patients daily oral hygiene. Formulations based on microemulsions have several interesting characteristics such as the ability to protect labile drugs, their release control, and to increase their solubility and bioavailability. It has been demonstrated that extracts from Baccharis dracunculifolia (Bd), a Brazilian shrub species, popularly known as alecrim-do-campo, show anticariogenic properties, which suggests its appliance into oral care products. However, Baccharis dracunculifolia extracts are poorly water soluble. In this work, we have developed and characterized microemulsions in which Baccharis dracunculifolia extract and essential oil may be incorporated to produce a clear solution in an alcohol-free mouthrinse. Four Bd extract - containing microemulsion systems (1) ethyl oleate/Labrasol®/Plurol® (LP), (2) isopropyl miristate/PEG 40/Sorbytol (PSM), (3) ethyl oleate/PEG 40/Sorbytol (PSO) and (4) ethyl oleate/Baccharis dracunculifolia extract/essencial oil/PEG 40/Sorbytol/Glycerol (PSG), were prepared in aqueous mixtures at room temperature, using the conventional titration technique. The pseudo-ternary phase diagrams were prepared at room temperature. The systems were characterized by optical microscopy, preliminary stability, rheology, pH, droplet size, electrical conductivity, relative density, viscosity and refractive index. The inhibitory effect on bacterial acid production was evaluated through the potentiometric measurement of pH from bacterial suspensions treated with serial concentrations of Bd mouthrinse (16 - 400 µg/mL). For the antibacterial activity assay, the inhibitory effect on bacterial growth and the minimum inhibitory concentrations (MIC) were determined. Bd mouthrinses four formulations sensory analysis was evaluated at preference test. The citotoxicity was evaluated by MTT method and staining potential was measured by CIELAB standart. Two regions were identified in the first diagram (bifasic system and microemulsion) while three regions were identified on the others (bifasic system, emulsion and microemulsion). All systems displayed an oil-in-water microemulsion region. The system chosen for the mouthrinse presented viscosity (12.40 cP), droplet size (19.53nm), conductivity (204.63 S/cm), pH (4.95), relative density (1.0394g/mL) and refractive index (1.3595). The chosen mouthrinse presented viscosity (12.00 cP), droplet size (19.53nm), final pH (5.89), relative density (1.0425g/mL) and refractive index (1.3614). The mouthrinse displayed inhibitory effects upon S. mutans virulence factors. The IC50 value for the inhibitory effect on the bacterial acid production was 128 µg/mL. The MIC value was 400µg/mL. Bd mouthrinse tested by the agar diffusion method, was not displayed growth inhibition. The acrylic resin teeth stainability test displayed E values of 2.62 CIELAB units for the reference mouthrinse (Periogard®) and 0,55 for Bd mouthrinse. According to results, the reference mouthrinse (Periogard®) causes resin acrylic teeth color variation while Bd mouthrinse did not cause teeth staining or cytotoxicity by MTT method. The Results indicate that these systems could be an interesting Bd vehicle for a mouthrinse and suggest that the final rising formulation has antimicrobial properties superior to the rough hydroetanolic extract, with low cytotoxic effect, turning it credible to clinical evaluation.

O uso de enxaguatórios bucais contendo substâncias ativas antimicrobianas tem sido proposto como um importante meio de redução da formação de biofilme dental supragengival quando usados concomitantemente com higienização mecânica da cavidade bucal. A microemulsão é um moderno sistema de liberação de fármacos, que pode solubilizar tanto compostos lipo quanto hidrossolúveis. Foi demonstrado que extratos de Baccharis dracunculifolia (Bd), popularmente conhecido como alecrim-do-campo apresentaram atividade anticariogênica, sugerindo sua utilização em produtos para higiene bucal. No entanto, o extrato de Baccharis dracunculifolia é pouco solúvel em água. No presente trabalho, nós desenvolvemos e caracterizamos microemulsões com extrato e óleo essencial das folhas de Bd para incorporar em formulação de enxaguatório bucal sem álcool, com finalidades preventiva e terapêutica, contendo extrato hidroetanólico e óleo essencial das folhas de Baccharis dracunculifolia e avaliar o seu efeito sobre fatores de virulência de Streptococcus mutans (S. mutans) in vitro. Foram obtidos 4 diagramas de fase pseudo-ternário: 1. Labrasol® (L-polietilenoglicol-8-caprilato/caprato)/Plurol® (P-isoestearato de poligliceril) (3:1)/Oleato Etila - (LP); 2. PEG 40 (óleo de rícino hidrogenado e etoxilado)/Sorbitol (2:1)/ Oleato de etila - (PSO); 3. PEG 40/Sorbitol (2:1)/Miristato de isoropila - (PSM) e 4. PEG 40/Sorbitol/Glicerol (1:1:1)/Oleato de etila e óleo essencial de B. dracunculifolia - (PSG). Os sistemas foram caracterizados (microscopia óptica, estabilidade preliminar, reologia, pH, tamanho de gotículas, viscosidade, condutividade elétrica, densidade relativa e índice de refração). Foram desenvolvidas 4 formulações enxaguatórias com a microemulsão escolhida e submetidas à análise sensorial por teste de preferência. O efeito do enxaguatório bucal contendo o extrato hidroetanólico e óleo essencial de B. dracunculifolia foi avaliado in vitro, sobre fatores cariogênicos de S. mutans: inibição do potencial acidogênico, concentração inibitória mínima (CIM) e influência no perfil de crescimento. Além disso, foram avaliados citotoxicidade por MTT e capacidade de manchamento de dentes de estoque pelo padrão CIELAB do enxaguatório bucal. O sistema microemulsionado escolhido apresentou as seguintes propriedades físico-químicas: viscosidade de 12,40 cP, tamanho de gotícula 19,53 nm, condutividade 204,63 µS/cm, pH final 4,95, densidade relativa 1,0394g/mL, índice de refração igual a 1,3595. A formulação escolhida para desenvolver o enxaguatório bucal, apresenta pH final igual a 5,89, densidade igual a 1,0425 g/mL, índice de refração de 1,3614 e viscosidade igual a 12,0 cP. O enxaguatório bucal apresentou atividade inibitória sobre a produção bacteriana de ácidos, com valor de CI50 igual a 128 µg de extrato bruto/mL da formulação, apresentando CIM (Concentração Inibitória Mínima) igual a 400 g de extrato bruto/mL da formulação, para uma concentração final de inóculo igual a 5 x 103 ufc/mL. Na avaliação de mudança de coloração dos dentes, o enxaguatório bucal de referência Periogard® (contendo digluconato de clorexidina 0,12%) e o enxaguatório de B. dracunculifolia apresentaram valores de E iguais a 2,62 e 0,55 unidades CIELAB, respectivamente, evidenciando que o primeiro mancha os dentes e o segundo não, mas que os dois são clinicamente aceitáveis. Além disso, enxaguatorio bucal contendo extrato e óleo essencial de B. dracunculifolia apresenta baixa interferência na proliferação celular, por teste de MTT (brometo de 3-(4,5-dimetiltiazol-2-il)-2,5-difenil tetrazolium). Os resultados sugerem que a formulação final escolhida possui propriedades antimicrobianas superiores ao extrato hidroetanólico bruto, com baixo efeito citotóxico, credenciando-o para avaliação clínica. / The use of antimicrobial mouthrinses to help the plaques supragengival control and gingivitis has been shown to significantly contribute to patients daily oral hygiene. Formulations based on microemulsions have several interesting characteristics such as the ability to protect labile drugs, their release control, and to increase their solubility and bioavailability. It has been demonstrated that extracts from Baccharis dracunculifolia (Bd), a Brazilian shrub species, popularly known as alecrim-do-campo, show anticariogenic properties, which suggests its appliance into oral care products. However, Baccharis dracunculifolia extracts are poorly water soluble. In this work, we have developed and characterized microemulsions in which Baccharis dracunculifolia extract and essential oil may be incorporated to produce a clear solution in an alcohol-free mouthrinse. Four Bd extract - containing microemulsion systems (1) ethyl oleate/Labrasol®/Plurol® (LP), (2) isopropyl miristate/PEG 40/Sorbytol (PSM), (3) ethyl oleate/PEG 40/Sorbytol (PSO) and (4) ethyl oleate/Baccharis dracunculifolia extract/essencial oil/PEG 40/Sorbytol/Glycerol (PSG), were prepared in aqueous mixtures at room temperature, using the conventional titration technique. The pseudo-ternary phase diagrams were prepared at room temperature. The systems were characterized by optical microscopy, preliminary stability, rheology, pH, droplet size, electrical conductivity, relative density, viscosity and refractive index. The inhibitory effect on bacterial acid production was evaluated through the potentiometric measurement of pH from bacterial suspensions treated with serial concentrations of Bd mouthrinse (16 - 400 µg/mL). For the antibacterial activity assay, the inhibitory effect on bacterial growth and the minimum inhibitory concentrations (MIC) were determined. Bd mouthrinses four formulations sensory analysis was evaluated at preference test. The citotoxicity was evaluated by MTT method and staining potential was measured by CIELAB standart. Two regions were identified in the first diagram (bifasic system and microemulsion) while three regions were identified on the others (bifasic system, emulsion and microemulsion). All systems displayed an oil-in-water microemulsion region. The system chosen for the mouthrinse presented viscosity (12.40 cP), droplet size (19.53nm), conductivity (204.63 S/cm), pH (4.95), relative density (1.0394g/mL) and refractive index (1.3595). The chosen mouthrinse presented viscosity (12.00 cP), droplet size (19.53nm), final pH (5.89), relative density (1.0425g/mL) and refractive index (1.3614). The mouthrinse displayed inhibitory effects upon S. mutans virulence factors. The IC50 value for the inhibitory effect on the bacterial acid production was 128 µg/mL. The MIC value was 400µg/mL. Bd mouthrinse tested by the agar diffusion method, was not displayed growth inhibition. The acrylic resin teeth stainability test displayed E values of 2.62 CIELAB units for the reference mouthrinse (Periogard®) and 0,55 for Bd mouthrinse. According to results, the reference mouthrinse (Periogard®) causes resin acrylic teeth color variation while Bd mouthrinse did not cause teeth staining or cytotoxicity by MTT method. The Results indicate that these systems could be an interesting Bd vehicle for a mouthrinse and suggest that the final rising formulation has antimicrobial properties superior to the rough hydroetanolic extract, with low cytotoxic effect, turning it credible to clinical evaluation.

Made available in DSpace on 2014-12-17T15:30:48Z (GMT). No. of bitstreams: 1 LizaBV.pdf: 651863 bytes, checksum: 861130b51ad28ee890a75755594ddae3 (MD5) Previous issue date: 2006-05-19 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / The purpose of this study was evaluate the effectiveness of the chitosan at 0.4 with high molecular weight and high deacetylation degree mouthrinse over the total decrease of the streptococci, Streptococcus mutans, lactobaci/li and over the perceptible bacterial film and gingival bleeding indices. For that, a total of 68 healthy students between 11 and 13 years old, not allergic to crustacean and not users of antibiotics or antimicrobial agent for the last three months or during the treatment, was selected. From those, thirty two individuaIs used the mouthrinse test, and thirty six, the control one. The participants rinsed 10 mL of the solutions twice a day, one during the moming (which was supervised), and another one during the aftemoon (which was not supervised), for fifteen days. The saliva collect for the microbiological analysis, as well as the perceptible bacterial film and gingival bleeding indices check, were made before the use ofthe mouthrinses (base line), immediately after the last mouthrinse on the day (zero time) and fifteen days after (fifteen time). These data were collected at school and the saliva was carried inside the ice to the laboratory. The samples were diluted, and 0.1 mL ofthe 10 -1 dilution was seeded in Rogosa SL agar, for further analysis of the total of lactobaci/lus~ 0.1 mL of the 10-4 dilution in Mitis Salivarius with bacitracin, for S. mutans analysis; and 0.1 mL of the 10-6 dilution in Mitis Salivarius for the analysis ofthe total of streptococcus. The Rogosa SL agar plates were incubated in aerobic at 37?C for 72 hours and the MSB and the MS were incubated in anaerobic in Gaspak@ jars at 37?C for 48 hours for further count ofColonies Former Units (CFUs). The assay was made in duplicate for each bacterial group analyzed. The number of CFUs transformed in LOGlO was analyzed according to the following tests: ANOV A, t of Paired and Not Paired Student, Friedman, Man-Whitney and square-qui test. On the base line, alI the variables analyzed were similar on both tested groups. On both groups, for the total of streptococcus there was no significant difference along the time and for S. mutans there was a statistic significant increase of the CFUs from the base line to the zero time. For the total of lactobaccilus there was no significant difference on the test group along the time, and on the control there was a significant increase ofthe CFUs ITom the base line to the zero time. For both groups, there was significant decrease ofthe perceptible bacterial film index along the time, and that can be explained by the mechanic effect of the mouthrinse over the bacterial film and by the participation of the students on the research which could have motivated him to a better toothbrushing (Hawthome effect). The gingival bleeding index also showed a decrease along the time, even though it was not significant. Therefore, the conclusion of this study was that the chitosan at 0.4 % mouthrinse was not effective on the CFUs reduction of the three bacterial groups analyzed, as well as on the reduction of the perceptible bacterial film and gingival bleeding indices / O objetivo deste estudo foi avaliar a efic?cia do bochecho de quitosana a 0,4% com alto peso molecular e alto grau de desacetiliza??o sobre a redu??o do total de estreptococcus, Streptococcus mutans, total de lactobacilos e sobre os ?ndices de placa vis?vel e sangramento gengival. Para tanto, foram selecionados 68 estudantes saud?veis, com idade entre 11 e 13 anos, n?o al?rgicos a crust?ceos e que n?o tivessem usado antibi?tico ou antimicrobiano nos ?ltimos tr?s meses ou durante o tratamento. Trinta e dois indiv?duos utilizaram o bochecho teste e trinta e seis o controle. Os participantes bochecho 10 ML das solu??es duas vezes ao dia, um pela manh? (supervisionado) e outro ? tarde (n?o supervisionado, durante quinza dias. A coleta de saliva para an?lise microbiol?gica, bem como a aferi??o dos ?ndices de placa vis?vel e de sangramento gengival, deu-se antes do uso dos bochechos (linha base),no dia imediatamento ap?s o ?ltimo bochecho (tempo zero) e quinze dias ap?s (tempo quinze). Esses dados foram coletados na escola e a saliva transportada em gelo at? o laborat?rio. As amostras de saliva foram diluidas e 0,1ML da dilui??o 10 elevado a menos 1 foi semeada em Rogosa SL ?gar para a posterior an?lise do total de lactobacilos; 0,1mL da dilui??o 10 elevado a menos 4 em Mitis Salivarus com bacitracina, para an?lise de S mutans, e 0,1mL da dilui??o 10 elevado a menos 6 em Mitis Salivarius para an?lise do total de estreptococous. As placas de Rogosa SL ?gar foram incubadas em aerobiose a 37 grau cent?grado por 72 horas e as de MSB e MS foram incubadas em anaeribiose em jarras Gaspak a 337 grau cent?grado, por 48 horas, para posterior contagem das unidades formadoras de col?nias (UFCs). O ensaio foi feito em duplicadta para cada grupo bacteriano analisado. O n?mero de UFCs transformados em LOG10 foi analisado mediante os seguintes testes: ANOVA, t de Student emparelhado e n?o emparelhado, Friedman, Man-Whitney e teste do qui-quadrado. Na linha base, todas as vari?veis analisadas no estudo foram semelhantes nos dois grupos testados. Em ambos os grupos, para o total de estreptococcus n?o houve diferen?a significativa ao longo do tempo; para o S. mutans, houve aumento estatisticamente significativo das UFCs da linha base para o T0. Para o total de lactobacilos, n?o houve diferen?a no grupo teste ao longo do tempo e, no controle, houve aumento significativo das UFCs da linha base para o T0. Em ambos os grupos, houve diminui??o significativa do IPV ao longo do tempo. O ISG tamb?m apresentou redu??o ao longo do tempo, por?m n?o foi significativa. Portanto, este estudo concluiu que o bochecho de quitosana a 0,4% n?o foi eficaz na redu??o das UFCs dos tr?s grupos bacterianos analisados, assim como, na redu??o do IPV e ISG

Objective: Toothbrushing with fluoride toothpaste followed by rinsing with mouthwash is a routine procedure to maintain good oral hygiene. It is unknown to what extent these rinses can modulate the effect of fluoride in its ability to prevent erosion/abrasion.The aim of this in-vitro study was to investigate and compare the impact of chlorhexidine (CHX), essential oils (EO) and cetylpyridinium chloride (CPC) mouthrinses on erosive tooth wear protection afforded by conventional fluoride toothpastes. Materials and Methods: The following experimental factors were considered: five rinses: CHX, EO, CPC, a fluoride rinse, and deionized water, two fluoride toothpastes: stannous fluoride (SnF2) or sodium fluoride (NaF) and two models: (erosion/ erosion+abrasion). Slabs of bovine enamel and dentin were prepared and embedded in resin blocks and generated 10 enamel and dentin testing groups (n = 8). UPVC tapes were placed on the sides of each slab leaving 1mm area exposed in the center. The blocks were subjected to a five-day cycling model. Then, the blocks were placed in a brushing machine and exposed to fluoride toothpaste slurry (one side was brushed and the other wasn’t). The blocks were then exposed to rinse treatments. Artificial saliva was used to remineralize the specimens after erosions and treatment challenges, and as storage media. After the fifth day of cycling, surface loss (in micrometers) was determined by profilometer. Data were analyzed using ANOVA (α = 0.05). Results: There was no interaction among the three factors (type of toothpaste, mouthrinse and abrasion or not (dentin p = 0.0520, enamel p = 0.4720). There were no significant two-way interactions as SL was only affected by toothpaste and mouthrinse. NaF caused less SL than SnF2 (4.60 vs. 5.83 μm; p < 0.0001) in dentin, whereas the opposite was found in enamel (5.20 vs. 3.56 μm; p < 0.0001). Toothbrushing abrasion caused comparatively more SL in enamel (6.53 vs. 2.23 μm; p < 0.0001) than in dentin (6.06 vs. 4.38 μm; p < 0.0001). None of the tested mouthrinses affected SL. Conclusion: Commonly used mouthrinses containing antimicrobial agents or additional fluoride, do not impair the erosion/abrasion protection afforded by fluoride toothpastes. Tested SnF2 dentifrice offered greater protection against enamel surface loss and NaF dentifrices showed more protection for the dentin surface. Clinical relevance: The understanding of the interaction between commonly used rinses and fluoride dentifrices will help dentists provide better recommendations to patients with erosive lesions.

Made available in DSpace on 2014-12-17T14:13:37Z (GMT). No. of bitstreams: 1 CiceroFF.pdf: 3167978 bytes, checksum: d9de3f0c1f071f112b7a1ab53a79b32c (MD5) Previous issue date: 2008-08-14 / The objective of this clinical study was to evaluate the effectiveness of the toothbrushing with and without fluoride and the daily fluoride rinse (NaF 0.05%) on produced white spot, in vivo. This was a clinical study, controlled, randomized and triple blind. Thirty patients were selected for orthodontics reasons from Orthodontics Specialization Course at the Brazilian Dental Association - Section of Rio Grande do Norte. In this study it was used 4 bicuspid upper and lower. They had orthodontic reason for extractions, in 35 days, at least. The sample had one hundred and twenty teeth that received orthodontic bands. The bands were fixed with polycarboxylate cement, and there was a space standardized between bands and one surface of teeth. The four bicuspid of each patients were randomized and nominated as A, B, C and D. These nominations determinated the sequence of the extractions and what was done in each tooth. All the patients had been submitted to the toothbrushing with or without fluoride for 35 days. After this period, the A tooth of each patient was extracted to serve as control. The others teeth (B, C and D) were extracted one by each week. The entire sample was analyzed through the clinical examination and by laser fluorescence (DIAGNOdent?) in three different times: before orthodontic bands, 28 days after fixed and then removed the bands and, the last one, 07 days after one of the three treatments (toothbrushing with or without fluoride, tooth paste with fluoride and mouth rinse with fluoride). At the beginning all groups (A, B, C and D) had the same conditions, no significant difference was found. The same situation was found in a clinical examination. The results of the DIAGNOdent? for the groups that used tooth paste without fluoride, with fluoride and mouth rinse with fluoride, after 28 days, there was no significant difference. Clinically, the white spot was formed in all teeth after 28 days. When it was compared the three treated groups, the group without fluoride in tooth paste had worst result than the others groups. But there was no significant association between the number of active and inactive white spots and the type of treatment that the teeth had received. The demineralization of the enamel surface, under the orthodontic bands, it happened in a few weeks. The exposition of the white spots in oral environmental resulted in an improvement, but it was not enough to return to the values from the base line, either for the toothbrushing and/or the use of fluorite mouth rinse. Mouth rinse and toothpaste with fluoride have showed to reduce the incidence of demineralization in the enamel, but none seems to be superior to another one in an in vivo study / O objetivo desse estudo cl?nico foi avaliar a efetividade da escova??o com e sem dentifr?cio fluoretado e o enxaguat?rio bucal fluoretado na forma de bochecho di?rio (NaF 0,05%) associado a escova??o com dentifr?cio fluoretado sobre as les?es brancas de esmalte produzidas in vivo. Este estudo se constituiu em um ensaio cl?nico controlado e randomizado. Para tanto, foram selecionados 32 pacientes do Curso de Especializa??o em Ortodontia da Associa??o Brasileira de Odontologia Sec??o do Estado do Rio Grande do Norte, que necessitavam como parte do tratamento de exodontias. Os cento e vinte e oito dentes receberam an?is ortod?nticos, cimentados com cimento de policarboxilato, com espa?o padronizado na superf?cie vestibular, S?tio Cariog?nico . Os quatro premolares de cada paciente foram aleatorizados individualmente, em dente A, B, C e D, com a finalidade de se determinar a seq??ncia das exodontias e os tipos de procedimentos a serem realizados para cada dente. Todos os pacientes foram submetidos ? escova??o com dentifr?cio sem fl?or por um per?odo de 35 dias. Ap?s esse per?odo, o dente A de cada paciente foi extra?do para servir como controle. Os demais dentes B, C e D foram extra?dos ap?s uma, duas e tr?s semanas, respectivamente. Os esp?cimes foram analisados atrav?s do exame cl?nico e da fluoresc?ncia a laser (DIAGNOdent?) antes da cimenta??o dos an?is ortod?nticos, 28 dias ap?s o desafio cariog?nico e 07 dias ap?s ter sido submetido a um dos tr?s tratamentos (escova??o com dentifr?cio sem fl?or, dentifr?cio com fl?or e bochecho com enxaguat?rio bucal fluoretado associado a escova??o com dentifr?cio com fl?or) institu?dos nesse estudo. Clinicamente, a les?o branca foi formada em todos os elementos dent?rios analisados ap?s 28 dias do desafio cariog?nico. Observou-se que n?o houve diferen?a estat?sticamente significativa entre as medianas para os valores do DIAGNOdent? e para os valores dos escores relacionados ao exame cl?nico entre os grupos de tratamentos ap?s 07 dias. Quando comparou-se os tr?s grupos tratados, o grupo dentifr?cio sem fl?or apresentou um n?mero de les?es brancas ativas maior que os grupos dentifr?cio com fl?or e bochecho com fl?or, nos quais ocorreu um predom?nio do n?mero de les?es brancas inativas. No entanto, n?o houve associa??o significativa entre o n?mero de les?es brancas ativas e inativas e o tipo de tratamento que os dentes receberam. A desmineraliza??o do esmalte subjacente aos an?is ortod?nticos mal adaptados ? um processo r?pido e ocorre dentro de poucas semanas. A exposi??o das les?es brancas de esmalte, ativas ao meio bucal, resulta em uma r?pida inativa??o das mesmas, mas n?o o suficiente para retornar aos valores da linha base, seja por dist?rbios mec?nicos da escova??o e/ou a utiliza??o de enxaguat?rio bucal fluoretado associado ao dentifr?cio fluoretado. Os dentifr?cios a base de fl?or e os enxaguat?rios bucais fluoretados t?m mostrado reduzir a incid?ncia de desmineraliza??o do esmalte, mas nenhum parece ser superior ao outro tomando como base o modelo de c?rie in vivo