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Evaluation of Plaque Removal Efficacy of Dental Floss With/Without Chlorhexidine Gel Coating in Patients with Gingivitis - a Clinical and Microbological Study

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Evaluation of Plaque Removal Efficacy of Dental Floss With/Without Chlorhexidine Gel Coating in Patients with Gingivitis - a Clinical and Microbological Study Scientific Foundation SPIROSKI, Skopje, Republic of Macedonia Open Access Macedonian Journal of Medical Sciences. 2020 Jun 20; 8(D):118-123. https://doi.org/10.3889/oamjms.2020.4141 eISSN: 1857-9655 Category: D - Dental Sciences Section: Periodontology and Oral Medicine Evaluation of Plaque Removal Efficacy of Dental Floss with/without Chlorhexidine Gel Coating in Patients with Gingivitis - A Clinical and Microbological Study Monika Pal1, Santhosh Kumar1*, Padmaja A. Shenoy2, T. A. K. Chaitanya3, G. Pratibha1, G. Subraya Bhat4 1Department of Periodontology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, India; 2Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India; 3Former Post Doctoral Research Fellow, Directorate of Research (Health Sciences), Manipal Academy of Higher Education, Udupi, Karnataka, India; 4Faculty of Periodontics, Preventive Dental Sciences Division, IAU, Dammam, Saudi Arabia Abstract Edited by: Mirko Spiroski BACKGROUND: Chlorhexidine has shown anti-plaque and antimicrobial effects when used as a mouthwash and Citation: Pal M, Kumar S, Shenoy PA, Chaitanya TAK, Pratibha G, Bhat GS. Evaluation of Plaque Removal appears to be effective when used as a topical antiseptic agent. Efficacy of Dental Floss with/without Chlorhexidine Gel in Patients with Gingivitis a Clinical and Microbiological AIM: The present study aimed to compare the efficacy of chlorhexidine gel coated dental floss with that of uncoated Study. Open Access Maced J Med Sci. 2020 Jun 20; dental floss. 8(D):118-123. https://doi.org/10.3889/oamjms.2020.4141 Keywords: Chlorhexidine; Dental floss; Dental plaque; METHODS: This parallel, single-blinded, randomized controlled clinical trial Included 30 patients with moderate to Gingivitis; Patient education *Correspondence: Santhosh Kumar, Department severe gingivitis. The total population was randomly divided into three groups, with ten patients in each group. Group of Periodontology, Manipal College of Dental A received dental floss with 1% chlorhexidine gel, and Group B received only dental floss, while in Group C no dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, India. floss was provided. All thirty volunteers were provided with standard toothpaste and toothbrush. Clinical parameters E-mail: [email protected] such as gingival index, plaque index, and bleeding index were recorded along with supragingival plaque sample Received: 03-Dec-2019 Revised: 16-Apr-2020 collection for microbiological culture. Subjects were recalled after 15 days and clinical and microbiological analysis Accepted: 04-May-2020 was performed. All parameters were re-assessed at the follow up visit after two weeks. Copyright: © 2020 Monika Pal, Santhosh Kumar, Padmaja A. Shenoy, T. A. K. Chaitanya, G. Pratibha, RESULTS: All the groups showed a significant reduction in values of plaque index, gingival index, and bleeding G. Subraya Bhat Funding: This research did not receive any financial support index, as well as the microbial counts post-enrollment in the study. A significant reduction in the bleeding indices was Competing Interests: The authors have declared that no noticed in Group A in comparison to C (p < 0.05). competing interests exist Open Access: This is an open-access article distributed CONCLUSIONS: The use of dental floss coated with 1% chlorhexidine gluconate gel was effective as an interproximal under the terms of the Creative Commons Attribution- NonCommercial 4.0 International License (CC BY-NC 4.0) aid for patients with moderate to severe gingivitis. *Authors 1 and 2 have contributed equally to the work. Introduction the interproximal areas, several interproximal cleaning devices such as interdental brushes and dental floss are advised. The morphology of gingival embrasures should It is an eminent fact that plaque induces be considered for selecting the most pertinent interdental inflammatory changes in the periodontium. Plaque is the device for each individual [7]. Less bleeding from the gums main cause of gingivitis and periodontitis and needs to is seen in patients without periodontal attachment loss who be restrained or eliminated on a quotidian [1], [2]. Plaque brush and floss their teeth regularly in comparison to those removal is crucial for a robust gingiva and dental flossing who use a toothbrush only [8], thus suggesting that the use acts as an adjunct along with a toothbrush. Most of the of dental floss might be advantageous for these patients. individuals perform tooth brushing once or diurnally. To maintain good hygiene in the interproximal Dental floss adds on to tooth brushing in the removal of areas of the teeth, depending on the embrasure plaque than in comparison to tooth brushing alone [3], area dental floss/unitufted or multitufted brushes particularly in interproximal areas [4]. There are in vivo are advised. It has already been the standard of studies comparing the plaque removal efficacy of dental care [9]. Along with mechanical control of dental floss [5]. Perhaps, it is of utmost importance to provide plaque, there is a possibility of the chemical mode the individuals with modalities for plaque removal from of prevention for which chlorhexidine has long been the interproximal surfaces of the teeth as well [6]. gold standard [10]. Chlorhexidine acts by lysis of the Periodontal diseases generally start and are bacteria and it also has a good substantivity. Although more noticeable in interproximal niches because they are chlorhexidine mouthwash has certain drawbacks such ideal places for biofilm to grow and difficult to eliminate as staining of the dentition and tongue and oral mucosal completely. To provide adequate plaque removal from desquamation [11], the study showed no side effects of 118 https://www.id-press.eu/mjms/index Paletal.PlaqueRemovalEfficiencyoftheChlorhexidineGelCoatedDentalFloss chlorhexidine when used in the local application in gel Colgate Plus, Colgate-Palmolive, India) and a standard form [12]. Mechanical plaque control like tooth brushing dentifrice (Colgate Colgate plus, Colgate-Palmolive, should be accompanied with interproximal flossing in India). Furthermore, the volunteers were requested to every patient. Additionally the effect of chlorhexidine refrain from the use of any antimicrobial mouthwash would improve the overall effect of flossing the throughout the study period. All the participants were interproximal surface [13]. Thus, there is a need for a instructed to brush twice daily and floss their teeth as clinical study that addresses the efficacy of dental floss instructed every night before bed. A reminder message as a mechanical aid with an added benefit of chemical was sent to the participants of Group A and B to floss plaque control agent chlorhexidine included during the after brushing every evening and to reply back once interproximal flossing. they have completed it. On the 15th day, subjects Considering these facts, the present study sets were recalled for the follow-up. After recording the the goal to evaluate the plaque removal efficiency of the clinical indices, the plaque sample was collected for dental floss coated with chlorhexidine. The study would microbiological analysis (Figure 1). fulfill the following objectives: (A) Compare the plaque removal efficiency between the patients using dental floss with or without the chlorhexidine gel, (B) Compare Clinical evaluation the microbial colony forming units (CFU) between the An investigator performed supragingival patients using dental floss with or without chlorhexidine, scaling and polishing, to make the dentition free of and (C) Evaluate the gingival and bleeding indices plaque and calculus. At first microbiological sample between the control and the test groups. was collected from interdental spaces using unwaxed dental floss piece. Second, Loe and Silness gingival index [15] was utilized to mark the gingival condition followed by the recording of interproximal bleeding Materials and Methods on probing [16] using Williams probe. Finally, plaque indices were recorded as per Rustogi modified navy plaque index (RMNPI) using a disclosing agent [17]. The study was designed as parallel arm, Subjects were recalled again after 15 days for follow-up single blind, and single-centered, open-labeled, and the gingival, papillary bleeding, and plaque indices non-experimental clinical study. Subjects visiting were recorded and supragingival plaque sample for the Department of Periodontology with moderate to microbial analysis was collected at this second visit. severe gingivitis, aged between 29 to 33 years, were Other parameters recorded during the follow-up were enrolled in the study. The study commenced only difficulty experienced by the subjects while flossing after obtaining the approval of the Institutional Ethics their teeth. These parameters were applicable only Committee. A total of thirty subjects were included in for Group A and B. Difficulty score was purely a the study. After obtaining written informed consent, the subjective rating on the scale of 1–5 as marked by the subjects were randomly distributed, by lottery method, participants. into three groups with ten volunteers in each group. All the subjects had a minimum of twenty teeth, with class 1 gingival embrasure. Individuals with carious teeth, Microbiological evaluation severe periodontal disease, were either undergoing Dental floss was used to collect the supragingival
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