Effects of Chlorine Dioxide on Oral Hygiene - A Systematic Review and Meta-analysis

Author(s): Beáta Kerémi, Katalin Márta, Kornélia Farkas, László M. Czumbel, Barbara Tóth, Zsolt Szakács, Dezső Csupor, József Czimmer, Zoltán Rumbus, Péter Révész, Adrienn Németh, Gábor Gerber, Péter Hegyi, Gábor Varga*

Journal Name: Current Pharmaceutical Design

Volume 26 , Issue 25 , 2020


Become EABM
Become Reviewer
Call for Editor

Abstract:

Background: Effective and selective oral rinses are required in the daily medical and dental practice. Currently mouthwashes used have substantial side effects.

Objectives: Our aim was to evaluate the efficacy of chlorine dioxide-containing mouthwashes in comparison with other previously established mouth rinses in healthy adults using oral hygiene indices.

Methods: This work was registered in PROSPERO (CRD42018099059) and carried out using multiple databases and reported according to the PRISMA statement. The search terms used were “chlorine dioxide” AND “oral”, and only randomised controlled trials (RCTs) were included. The primary outcome was the alteration of the plaque index (PI), while the secondary outcomes were the gingival index (GI) and bacterial counts. For the risk of bias assessment, the Cochrane Risk of Bias Tool was used. Statistical analysis for data heterogeneity was performed by Q-value and I2-tests.

Results: 364 articles were found in the databases. After the selection process, only five RCTs were eligible for meta-analysis. Data heterogeneity was low. There were no statistical differences in effectiveness between chlorine dioxide and other effective mouth rinses in PI (0.720±0.119 vs 0.745±0.131; 95%; confidence intervals (CIs): 0.487-0.952 vs 0.489-1.001, respectively) and GI (0.712±0.130 vs 0.745±0.131; 95% CIs: 0.457–0.967 vs 0.489– 1.001, respectively) and also in bacterial counts.

Conclusion: Chlorine dioxide reduces both plaque and gingival indices and bacterial counts in the oral cavity similar to other routinely used oral rinses, however, the evidence supporting this outcome is very limited. Therefore, further large scale RCTs are needed to decrease the risk of bias.

Keywords: Chlorine dioxide, plaque index, gingival index, oral hygiene, mouthwash, systematic review, meta-analysis.

[1]
Keremi B, Beck A, Fabian TK, et al. Stress and Salivary Glands. Curr Pharm Des 2017; 23(27): 4057-65.
[http://dx.doi.org/10.2174/1381612823666170215110648] [PMID: 28215154]
[2]
Lohinai Z, Burghardt B, Zelles T, Varga G. Nitric oxide modulates salivary amylase and fluid, but not epidermal growth factor secretion in conscious rats. Life Sci 1999; 64(11): 953-63.
[http://dx.doi.org/10.1016/S0024-3205(99)00021-1] [PMID: 10201644]
[3]
Márton K, Boros I, Varga G, et al. Evaluation of palatal saliva flow rate and oral manifestations in patients with Sjögren’s syndrome. Oral Dis 2006; 12(5): 480-6.
[http://dx.doi.org/10.1111/j.1601-0825.2005.01224.x] [PMID: 16910919]
[4]
Márton K, Madléna M, Bánóczy J, et al. Unstimulated whole saliva flow rate in relation to sicca symptoms in Hungary. Oral Dis 2008; 14(5): 472-7.
[http://dx.doi.org/10.1111/j.1601-0825.2007.01404.x] [PMID: 18938274]
[5]
Racz R, Nagy A, Rakonczay Z, Dunavari EK, Gerber G, Varga G. Defense Mechanisms Against Acid Exposure by Dental Enamel Formation, Saliva and Pancreatic Juice Production. Curr Pharm Des 2018; 24(18): 2012-22.
[http://dx.doi.org/10.2174/1381612824666180515125654] [PMID: 29769002]
[6]
Földes A, Kádár K, Kerémi B, et al. Mesenchymal Stem Cells of Dental Origin-Their Potential for Antiinflammatory and Regenerative Actions in Brain and Gut Damage. Curr Neuropharmacol 2016; 14(8): 914-34.
[http://dx.doi.org/10.2174/1570159X14666160121115210] [PMID: 26791480]
[7]
Grimm WD, Dannan A, Becher S, et al. The ability of human periodontium-derived stem cells to regenerate periodontal tissues: a preliminary in vivo investigation. Int J Periodontics Restorative Dent 2011; 31(6): e94-e101.
[PMID: 22140674]
[8]
Grimm WD, Dannan A, Giesenhagen B, et al. Translational Research: Palatal-derived Ecto-mesenchymal Stem Cells from Human Palate: A New Hope for Alveolar Bone and Cranio-Facial Bone Reconstruction. Int J Stem Cells 2014; 7(1): 23-9.
[http://dx.doi.org/10.15283/ijsc.2014.7.1.23] [PMID: 24921024]
[9]
Kadar K, Kiraly M, Porcsalmy B, Molnar B, Racz GZ, Blazsek J, et al. Differentiation potential of stem cells from human dental origin - promise for tissue engineering. J Physiol Pharmacol 2009; 60(Suppl. 7): 167-75.
[PMID: 20388961]
[10]
Keremi B, Lohinai Z, Komora P, Duhaj S, Borsi K, Jobbagy-Ovari G, et al. Antiinflammatory effect of BPC 157 on experimental periodontitis in rats. J Physiol Pharmacol 2009; 60(Suppl. 7): 115-22.
[PMID: 20388954]
[11]
Racz GZ, Kadar K, Foldes A, Kallo K, Perczel-Kovach K, Keremi B, et al. Immunomodulatory and potential therapeutic role of mesenchymal stem cells in periodontitis. J Physiol Pharmacol 2014; 65(3): 327-9.
[PMID: 24930504]
[12]
Wilder RS, Bray KS. Improving periodontal outcomes: merging clinical and behavioral science. Periodontol 2000 2016; 71(1): 65-81.
[http://dx.doi.org/10.1111/prd.12125] [PMID: 27045431]
[13]
Kornman KS. Contemporary approaches for identifying individual risk for periodontitis. Periodontol 2000 2018; 78(1): 12-29.
[http://dx.doi.org/10.1111/prd.12234] [PMID: 30198138]
[14]
Yadav SR, Kini VV, Padhye A. Inhibition of tongue coat and dental plaque formation by stabilized chlorine dioxide vs chlorhexidine mouthrinse: A randomized, triple blinded. J Clin Diagn Res 2015; 9(9): ZC69-74.
[http://dx.doi.org/10.7860/JCDR/2015/14587.6510] [PMID: 26501017]
[15]
Jones CG. Chlorhexidine: is it still the gold standard? Periodontol 2000 1997; 15: 55-62.
[http://dx.doi.org/10.1111/j.1600-0757.1997.tb00105.x] [PMID: 9643233]
[16]
McCoy LC, Wehler CJ, Rich SE, Garcia RI, Miller DR, Jones JA. Adverse events associated with chlorhexidine use: results from the Department of Veterans Affairs Dental Diabetes Study. J Am Dent Assoc 2008; 139(2): 178-83.
[http://dx.doi.org/10.14219/jada.archive.2008.0134] [PMID: 18245686]
[17]
Gürgan CA, Zaim E, Bakirsoy I, Soykan E. Short-term side effects of 0.2% alcohol-free chlorhexidine mouthrinse used as an adjunct to non-surgical periodontal treatment: a double-blind clinical study. J Periodontol 2006; 77(3): 370-84.
[http://dx.doi.org/10.1902/jop.2006.050141] [PMID: 16512751]
[18]
Supranoto SC, Slot DE, Addy M, Van der Weijden GA. The effect of chlorhexidine dentifrice or gel versus chlorhexidine mouthwash on plaque, gingivitis, bleeding and tooth discoloration: a systematic review. Int J Dent Hyg 2015; 13(2): 83-92.
[http://dx.doi.org/10.1111/idh.12078] [PMID: 25059640]
[19]
Varoni E, Tarce M, Lodi G, Carrassi A. Chlorhexidine (CHX) in dentistry: state of the art. Minerva Stomatol 2012; 61(9): 399-419.
[PMID: 22976567]
[20]
Frank ME, Gent JF, Hettinger TP. Effects of chlorhexidine on human taste perception. Physiol Behav 2001; 74(1-2): 85-99.
[http://dx.doi.org/10.1016/S0031-9384(01)00558-3] [PMID: 11564456]
[21]
Grover R, Frank ME. Regional specificity of chlorhexidine effects on taste perception. Chem Senses 2008; 33(4): 311-8.
[http://dx.doi.org/10.1093/chemse/bjm095] [PMID: 18263592]
[22]
Wang MF, Marks LE, Frank ME. Taste coding after selective inhibition by chlorhexidine. Chem Senses 2009; 34(8): 653-66.
[http://dx.doi.org/10.1093/chemse/bjp047] [PMID: 19703921]
[23]
James P, Worthington HV, Parnell C, et al. Chlorhexidine mouthrinse as an adjunctive treatment for gingival health. Cochrane Database Syst Rev 2017; 3CD008676
[http://dx.doi.org/10.1002/14651858.CD008676.pub2] [PMID: 28362061]
[24]
Kamath NP, Tandon S, Nayak R, Naidu S, Anand PS, Kamath YS. The effect of aloe vera and tea tree oil mouthwashes on the oral health of school children. Eur Arch Paediatr Dent 2019.
[PMID: 31111439]
[25]
Mathur A, Gopalakrishnan D, Mehta V, Rizwan SA, Shetiya SH, Bagwe S. Efficacy of green tea-based mouthwashes on dental plaque and gingival inflammation: A systematic review and meta-analysis. Indian Journal of Dental Research: official publication of Indian Society for Dental Research 2018; 29(2): 225-32.
[26]
Diefenbach AL, Muniz FWMG, Oballe HJR, Rösing CK. Antimicrobial activity of copaiba oil (Copaifera ssp.) on oral pathogens: Systematic review. Phytother Res 2018; 32(4): 586-96.
[http://dx.doi.org/10.1002/ptr.5992] [PMID: 29193389]
[27]
Van Leeuwen MP, Slot DE, Van der Weijden GA. The effect of an essential-oils mouthrinse as compared to a vehicle solution on plaque and gingival inflammation: a systematic review and meta-analysis. Int J Dent Hyg 2014; 12(3): 160-7.
[http://dx.doi.org/10.1111/idh.12069] [PMID: 24720368]
[28]
Wirthlin MR, Roth M. Dental unit waterline contamination: a review of research and findings from a clinic setting. Compendium Of Continuing Education In Dentistry (Jamesburg, NJ: 1995) 2015; 36(3): 216-9.
[29]
Praeger U, Herppich WB, Hassenberg K. Aqueous chlorine dioxide treatment of horticultural produce: Effects on microbial safety and produce quality-A review. Crit Rev Food Sci Nutr 2018; 58(2): 318-33.
[http://dx.doi.org/10.1080/10408398.2016.1169157] [PMID: 27196114]
[30]
Sowerby LJ, Rudmik L. The cost of being clean: A cost analysis of nasopharyngoscope reprocessing techniques. Laryngoscope 2018; 128(1): 64-71.
[http://dx.doi.org/10.1002/lary.26770] [PMID: 28815686]
[31]
Watamoto T, Egusa H, Sawase T, Yatani H. Clinical evaluation of chlorine dioxide for disinfection of dental instruments. Int J Prosthodont 2013; 26(6): 541-4.
[http://dx.doi.org/10.11607/ijp.3465] [PMID: 24179967]
[32]
Kuroyama I, Osato S, Nakajima S, Kubota R, Ogawa T. Environmental monitoring and bactericidal efficacy of chlorine dioxide gas in a dental office. Biocontrol Sci 2010; 15(3): 103-9.
[http://dx.doi.org/10.4265/bio.15.103] [PMID: 20938095]
[33]
Anna H, Barnabás P, Zsolt L, Romána Z. Tracking of the degradation process of chlorhexidine digluconate and ethylenediaminetetraacetic acid in the presence of hyper-pure chlorine dioxide in endodontic disinfection. J Pharm Biomed Anal 2019; 164: 360-4.
[http://dx.doi.org/10.1016/j.jpba.2018.11.005] [PMID: 30439663]
[34]
Ballal NV, Khandewal D, Karthikeyan S, Somayaji K, Foschi F. Evaluation of Chlorine Dioxide Irrigation Solution on the Microhardness and Surface Roughness of Root Canal Dentin. Eur J Prosthodont Restor Dent 2015; 23(4): 173-8.
[PMID: 26767238]
[35]
Cobankara FK, Ozkan HB, Terlemez A. Comparison of organic tissue dissolution capacities of sodium hypochlorite and chlorine dioxide. J Endod 2010; 36(2): 272-4.
[http://dx.doi.org/10.1016/j.joen.2009.10.027] [PMID: 20113788]
[36]
Fráter M, Braunitzer G, Urbán E, Bereczki L, Antal M, Nagy K. In vitro efficacy of different irrigating solutions against polymicrobial human root canal bacterial biofilms. Acta Microbiol Immunol Hung 2013; 60(2): 187-99.
[http://dx.doi.org/10.1556/AMicr.60.2013.2.9] [PMID: 23827750]
[37]
Herczegh A, Ghidan A, Friedreich D, Gyurkovics M, Bendő Z, Lohinai Z. Effectiveness of a high purity chlorine dioxide solution in eliminating intracanal Enterococcus faecalis biofilm. Acta Microbiol Immunol Hung 2013; 60(1): 63-75.
[http://dx.doi.org/10.1556/AMicr.60.2013.1.7] [PMID: 23529300]
[38]
Herczegh A, Gyurkovics M, Ghidan Á, Megyesi M, Lohinai Z. Effect of dentin powder on the antimicrobial properties of hyperpure chlorine-dioxide and its comparison to conventional endodontic disinfecting agents. Acta Microbiol Immunol Hung 2014; 61(2): 209-20.
[http://dx.doi.org/10.1556/AMicr.61.2014.2.10] [PMID: 25046882]
[39]
Lundstrom JR, Williamson AE, Villhauer AL, Dawson DV, Drake DR. Bactericidal activity of stabilized chlorine dioxide as an endodontic irrigant in a polymicrobial biofilm tooth model system. J Endod 2010; 36(11): 1874-8.
[http://dx.doi.org/10.1016/j.joen.2010.08.032] [PMID: 20951304]
[40]
Ablal MA, Adeyemi AA, Jarad FD. The whitening effect of chlorine dioxide-an in vitro study. J Dent 2013; 41(Suppl. 5): e76-81.
[http://dx.doi.org/10.1016/j.jdent.2013.05.006] [PMID: 23707537]
[41]
Li Y, Greenwall L. Safety issues of tooth whitening using peroxide-based materials. Br Dent J 2013; 215(1): 29-34.
[http://dx.doi.org/10.1038/sj.bdj.2013.629] [PMID: 23846062]
[42]
Torres CRG, Bonício GC, Crastechini É, Mailart MC, Borges AB. Effect of whitening mouthrinses on enamel toothbrush abrasion. Am J Dent 2018; 31(6): 285-9.
[PMID: 30658373]
[43]
Soolari N, Soolari A. Closure of an open wound associated with bisphosphonate-related osteonecrosis of the jaw in a breast cancer patient. Open Dent J 2011; 5: 163-7.
[http://dx.doi.org/10.2174/1874210601105010163] [PMID: 22135700]
[44]
Valente JH, Jay GD, Zabbo CP, Reinert SE, Bertsch K. Activated chlorine dioxide solution can be used as a biocompatible antiseptic wound irrigant. Adv Skin Wound Care 2014; 27(1): 13-9.
[http://dx.doi.org/10.1097/01.ASW.0000439060.79822.b3] [PMID: 24343388]
[45]
Alleyn CD, O’Neal RB, Strong SL, Scheidt MJ, Van Dyke TE, McPherson JC. The effect of chlorhexidine treatment of root surfaces on the attachment of human gingival fibroblasts in vitro. J Periodontol 1991; 62(7): 434-8.
[http://dx.doi.org/10.1902/jop.1991.62.7.434] [PMID: 1920010]
[46]
Barnhart BD, Chuang A, Lucca JJ, Roberts S, Liewehr F, Joyce AP. An in vitro evaluation of the cytotoxicity of various endodontic irrigants on human gingival fibroblasts. J Endod 2005; 31(8): 613-5.
[http://dx.doi.org/10.1097/01.don.0000153840.94227.87] [PMID: 16044047]
[47]
Nishikiori R, Nomura Y, Sawajiri M, Masuki K, Hirata I, Okazaki M. Influence of chlorine dioxide on cell death and cell cycle of human gingival fibroblasts. J Dent 2008; 36(12): 993-8.
[http://dx.doi.org/10.1016/j.jdent.2008.08.006] [PMID: 18819741]
[48]
Tonzetich J. Production and origin of oral malodor: a review of mechanisms and methods of analysis. J Periodontol 1977; 48(1): 13-20.
[http://dx.doi.org/10.1902/jop.1977.48.1.13] [PMID: 264535]
[49]
Ratcliff PA, Johnson PW. The relationship between oral malodor, gingivitis, and periodontitis. A review. J Periodontol 1999; 70(5): 485-9.
[http://dx.doi.org/10.1902/jop.1999.70.5.485] [PMID: 10368052]
[50]
Fedorowicz Z, Aljufairi H, Nasser M, Outhouse TL, Pedrazzi V. Mouthrinses for the treatment of halitosis. Cochrane Database Syst Rev 2008; (4):
[http://dx.doi.org/10.1002/14651858.CD006701.pub2]
[51]
Frascella J, Gilbert RD, Fernandez P, Hendler J. Efficacy of a chlorine dioxide-containing mouthrinse in oral malodor.Compendium Of Continuing Education In Dentistry (Jamesburg, NJ: 1995). 2000; 21: p. (3)241.
[52]
Krespi YP, Shrime MG, Kacker A. The relationship between oral malodor and volatile sulfur compound-producing bacteria. Otolaryngol Head Neck Surg 2006; 135(5): 671-6.
[http://dx.doi.org/10.1016/j.otohns.2005.09.036] [PMID: 17071291]
[53]
Silness J, Löe H. Periodontal disease in pregnancy, II Correlation between oral hygiene and periodontal condition. Acta Odontol Scand 1964; 22: 121-35.
[http://dx.doi.org/10.3109/00016356408993968] [PMID: 14158464]
[54]
Löe H, Silness J. Periodontal diesase in pregnancy. I Prevalence and severity. Acta Odontol Scand 1963; 21: 533-51.
[http://dx.doi.org/10.3109/00016356309011240] [PMID: 14121956]
[55]
Lundgren T, Mobilia A, Hallström H, Egelberg J. Evaluation of tongue coating indices. Oral Dis 2007; 13(2): 177-80.
[http://dx.doi.org/10.1111/j.1601-0825.2006.01261.x] [PMID: 17305619]
[56]
Winkel EG, Roldán S, Van Winkelhoff AJ, Herrera D, Sanz M. Clinical effects of a new mouthrinse containing chlorhexidine, cetylpyridinium chloride and zinc-lactate on oral halitosis. A dual-center, double-blind placebo-controlled study. J Clin Periodontol 2003; 30(4): 300-6.
[http://dx.doi.org/10.1034/j.1600-051X.2003.00342.x] [PMID: 12694427]
[57]
Moher D, Shamseer L, Clarke M, et al. PRISMA-P Group. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 2015; 4: 1.
[http://dx.doi.org/10.1186/2046-4053-4-1] [PMID: 25554246]
[58]
Higgins JPT. GSe. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. The Cochrane Collaboration. 2011.Available at: http://handbookcochraneorg 2011
[59]
Cochran WG. The combination of estimates from different experiments. Biometrics 1954; 10: 101-29.
[http://dx.doi.org/10.2307/3001666]
[60]
DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986; 7(3): 177-88.
[http://dx.doi.org/10.1016/0197-2456(86)90046-2] [PMID: 3802833]
[61]
Czumbel LM, Kerémi B, Gede N, et al. Sandblasting reduces dental implant failure rate but not marginal bone level loss: A systematic review and meta-analysis. PLoS One 2019; 14(5)e0216428
[http://dx.doi.org/10.1371/journal.pone.0216428] [PMID: 31050690]
[62]
Tóth B, Hegyi P, Lantos T, et al. The Efficacy of Saffron in the Treatment of Mild to Moderate Depression: A Meta-analysis. Planta Med 2019; 85(1): 24-31.
[http://dx.doi.org/10.1055/a-0660-9565] [PMID: 30036891]
[63]
Eunike MC, Fauziah E, Suharsini M. Antibacterial effects of 0.1% chlorine dioxide on actinomyces sp. as an agent of black stain. Inter J Applied Pharm 2017; 9(2): 79-82.
[64]
Ambalavanan S, Ganapathy D. The role of antibiotic mouth rinses in oral health care. J Pharm Sci Res 2016; 8(4): 244-6.
[65]
Kuroyama I, Osato S, Ogawa T. The bactericidal effects of an acidified sodium chlorite-containing oral moisturizing gel: a pilot study. J Oral Implantol 2013; 39(6): 689-95.
[http://dx.doi.org/10.1563/AAID-JOI-D-11-00087] [PMID: 21905903]
[66]
Yates R, Moran J, Addy M, Mullan PJ, Wade WG, Newcombe R. The comparative effect of acidified sodium chlorite and chlorhexidine mouthrinses on plaque regrowth and salivary bacterial counts. J Clin Periodontol 1997; 24(9 Pt. 1): 603-9.
[http://dx.doi.org/10.1111/j.1600-051X.1997.tb00236.x] [PMID: 9378830]
[67]
Uludamar A, Özyeşil AG, Ozkan YK. Clinical and microbiological efficacy of three different treatment methods in the management of denture stomatitis. Gerodontology 2011; 28(2): 104-10.
[http://dx.doi.org/10.1111/j.1741-2358.2009.00354.x] [PMID: 20545775]
[68]
Mohammad AR, Giannini PJ, Preshaw PM, Alliger H. Clinical and microbiological efficacy of chlorine dioxide in the management of chronic atrophic candidiasis: an open study. Int Dent J 2004; 54(3): 154-8.
[http://dx.doi.org/10.1111/j.1875-595X.2004.tb00272.x] [PMID: 15218896]
[69]
Rossato MB, Unfer B, May LG, Braun KO. Analysis of the effectiveness of different hygiene procedures used in dental prostheses. Oral Health Prev Dent 2011; 9(3): 221-7.
[PMID: 22068177]
[70]
Chapek CW, Reed OK, Ratcliff PA. Management of periodontitis with oral-care products. Compendium (Newtown, Pa) 1994; 15(6): 740.
[71]
Goultschin J, Green J, Machtei E, et al. Use of a metastabilized chlorous acid/chlorine dioxide formulation as a mouthrinse for plaque reduction. Isr J Dent Sci 1989; 2(3): 142-7.
[PMID: 2490928]
[72]
Myneni Venkatasatya SR, Wang HH, Alluri S, Ciancio SG. Phosphate buffer-stabilized 0.1% chlorine dioxide oral rinse for managing medication-related osteonecrosis of the jaw. Am J Dent 2017; 30(6): 350-2.
[PMID: 29251459]
[73]
Paraskevas S, Rosema NA, Versteeg P, Van der Velden U, Van der Weijden GA. Chlorine dioxide and chlorhexidine mouthrinses compared in a 3-day plaque accumulation model. J Periodontol 2008; 79(8): 1395-400.
[http://dx.doi.org/10.1902/jop.2008.070630] [PMID: 18672988]
[74]
Grootveld M, Silwood C, Gill D, Lynch E. Evidence for the microbicidal activity of a chlorine dioxide-containing oral rinse formulation in vivo. J Clin Dent 2001; 12(3): 67-70.
[PMID: 11505963]
[75]
Siddeshappa ST, Bhatnagar S, Yeltiwar RK, Parvez H, Singh A, Banchhor S. Comparative evaluation of antiplaque and antigingivitis effects of an herbal and chlorine dioxide mouthwashes: A clinicomicrobiological study. Indian J Dent Res 2018; 29(1): 34-40.
[http://dx.doi.org/10.4103/ijdr.IJDR_391_16] [PMID: 29442084]
[76]
Yeturu SK, Acharya S, Urala AS, Pentapati KC. Effect of Aloe vera, chlorine dioxide, and chlorhexidine mouth rinses on plaque and gingivitis: A randomized controlled trial. J Oral Biol Craniofac Res 2016; 6(1): 54-8.
[http://dx.doi.org/10.1016/j.jobcr.2015.08.008] [PMID: 26937371]
[77]
Aung EE, Ueno M, Zaitsu T, Furukawa S, Kawaguchi Y. Effectiveness of three oral hygiene regimens on oral malodor reduction: a randomized clinical trial. Trials 2015; 16(1): 31.
[http://dx.doi.org/10.1186/s13063-015-0549-9] [PMID: 25622725]
[78]
Shinada K, Ueno M, Konishi C, et al. Effects of a mouthwash with chlorine dioxide on oral malodor and salivary bacteria: a randomized placebo-controlled 7-day trial. Trials 2010; 11: 14.
[http://dx.doi.org/10.1186/1745-6215-11-14] [PMID: 20152022]
[79]
Pham TAV, Nguyen NTX. Efficacy of chlorine dioxide mouthwash in reducing oral malodor: A 2-week randomized, double-blind, crossover study. Clin Exp Dent Res 2018; 4(5): 206-15.
[http://dx.doi.org/10.1002/cre2.131] [PMID: 30386642]
[80]
Herczegh A, Gyurkovics M, Agababyan H, Ghidán A, Lohinai Z. Comparing the efficacy of hyper-pure chlorine-dioxide with other oral antiseptics on oral pathogen microorganisms and biofilm in vitro. Acta Microbiol Immunol Hung 2013; 60(3): 359-73.
[http://dx.doi.org/10.1556/AMicr.60.2013.3.10] [PMID: 24060558]
[81]
Noszticzius Z, Wittmann M, Kály-Kullai K, et al. Chlorine dioxide is a size-selective antimicrobial agent. PLoS One 2013; 8(11)e79157
[http://dx.doi.org/10.1371/journal.pone.0079157] [PMID: 24223899]
[82]
Anitha V, Rajesh P, Shanmugam M, Priya BM, Prabhu S, Shivakumar V. Comparative evaluation of natural curcumin and synthetic chlorhexidine in the management of chronic periodontitis as a local drug delivery: a clinical and microbiological study. Indian J Dental Res 2015; 26(1): 53-6.
[http://dx.doi.org/10.4103/0970-9290.156806]
[83]
Gupta D, Gupta RK, Bhaskar DJ, Gupta V. Comparative evaluation of terminalia chebula extract mouthwash and chlorhexidine mouthwash on plaque and gingival inflammation - 4-week randomised control trial. Oral Health Prev Dent 2015; 13(1): 5-12.
[PMID: 25386630]
[84]
Haydari M, Bardakci AG, Koldsland OC, Aass AM, Sandvik L, Preus HR. Comparing the effect of 0.06% -, 0.12% and 0.2% Chlorhexidine on plaque, bleeding and side effects in an experimental gingivitis model: a parallel group, double masked randomized clinical trial. BMC Oral Health 2017; 17(1): 118.
[http://dx.doi.org/10.1186/s12903-017-0400-7] [PMID: 28821290]
[85]
Shah SS, Nambiar S, Kamath D, et al. Comparative Evaluation of Plaque Inhibitory and Antimicrobial Efficacy of Probiotic and Chlorhexidine Oral Rinses in Orthodontic Patients: A Randomized Clinical Trial. Int J Dent 2019; 20191964158
[http://dx.doi.org/10.1155/2019/1964158] [PMID: 30930947]
[86]
Gupta RK, Gupta D, Bhaskar DJ, Yadav A, Obaid K, Mishra S. Preliminary antiplaque efficacy of aloe vera mouthwash on 4 day plaque re-growth model: randomized control trial. Ethiop J Health Sci 2014; 24(2): 139-44.
[http://dx.doi.org/10.4314/ejhs.v24i2.6] [PMID: 24795515]
[87]
Chhina S, Singh A, Menon I, Singh R, Sharma A, Aggarwal V. A randomized clinical study for comparative evaluation of Aloe Vera and 0.2% chlorhexidine gluconate mouthwash efficacy on de-novo plaque formation. J Int Soc Prev Community Dent 2016; 6(3): 251-5.
[http://dx.doi.org/10.4103/2231-0762.183109] [PMID: 27382543]
[88]
Manipal S, Hussain S, Wadgave U, Duraiswamy P, Ravi K. The Mouthwash War - Chlorhexidine vs. Herbal Mouth Rinses: A Meta-Analysis. J Clin Diagn Res 2016; 10(5): ZC81-3.
[http://dx.doi.org/10.7860/JCDR/2016/16578.7815] [PMID: 27437366]


open access plus

Rights & PermissionsPrintExport Cite as

Article Details

VOLUME: 26
ISSUE: 25
Year: 2020
Published on: 04 August, 2020
Page: [3015 - 3025]
Pages: 11
DOI: 10.2174/1381612826666200515134450

Article Metrics

PDF: 32
HTML: 5