Research Article

Effectiveness of on patients with periodontitis Boopana Kannan1, Jaiganesh Ramamurthy2, Geo Mani3, Dhanraj Ganapathy1*

ABSTRACT

Introduction: Chlorhexidine is a gold standard against which other antiplaque and antigingivitis agents are measured. Chlorhexidine is available in various forms such as digluconate, acetate, and hydrochloride salts which are sparingly soluble in water. It is dicationic at pH levels above 3.5. It prevents plaque accumulation, hence, it is a antiplaque and antigingivitis agent and reduces the adherence of to epithelial cells. It can be bacteriostatic or bactericidal depending on the dose. Most important unique property of chlorhexidine is its substantivity. Aim: This study aims to evaluate the role of chlorhexidine European Pharmacopoeia (EP) in patients with periodontitis. and periodontitis are the two major inflammatory affecting the . Their primary etiology is bacterial plaque, which can initiate destruction of the gingival tissues and periodontal attachment apparatus. Gingivitis is of the gingiva that does not result in . Materials and Methods: A total of 20 samples were taken. Test group had 10 samples with individuals with periodontitis. Control group had 10 samples. Loss of attachment, pocket depth, and gingival index were taken before the non-surgical periodontal therapy. was prescribed to the patients. The indices were repeated after 15 days and 30 days and were compared. Results: The pre-operative value of probing depth was in the range of 1.16–1.83 mm and post-operative value in the range of 0.32–1.03 mm, pre-operative value of loss of attachment was in the range of 1.0–1.5 mm and post-operative value in the range of 0–0.91 mm, and pre-operative value of gingival index was in the range of 0.92–1.03 and post-operative value in the range of 0.32–0.96. Through statistical analysis, it was conferred that there was reduction in pocket depth and gingival index (P < 0.05). Conclusion: Chlorhexidine gluconate oral rinse provides antimicrobial activity during oral rinsing. This is used along with regular brushing/flossing to treat gingivitis that causes red, swollen, and easily bleeding gingiva. Chlorhexidine belongs to a class of drugs known as antimicrobials. It works by decreasing the amount of bacteria in the mouth, helping to reduce swelling and redness. This study focuses on the effect of chlorhexidine EP on patients with periodontitis.

KEY WORDS: Chlorhexidine European Pharmacopoeia, Gingival index, Loss of attachment, Periodontitis, Pocket depth

INTRODUCTION different tooth types. Many features are genetically determined; others seem to be influenced by tooth size, The gingiva is that portion of the oral mucous membrane shape, and position and biological phenomena such as which, in a complete post-eruptive dentition of a healthy gender, growth, and age.[1] Sufficient knowledge of oral individual surrounds and is attached to the teeth and health-care behavior and understanding of scientific the alveolar processes. Normally, there is considerable reason for its improvement is an important precondition variation in both width and thickness of the gingiva, a to improve oral health.[2] fact gives rise to the assumption that numerous gingival biotypes might exist in any adult population.[1] It has Gingivitis and periodontitis are the two major been long known that the clinical appearance of healthy inflammatory diseases affecting the periodontium. gingiva differs from subject to subject and even among Their primary etiology is bacterial plaque, which can initiate destruction of the gingival tissues and Access this article online periodontal attachment apparatus. Gingivitis is inflammation of the gingiva that does not result in Website: jprsolutions.info ISSN: 0975-7619 clinical attachment loss.[3-5]

1Department of , Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India, 2Department of Periodontics, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India, 3Department of Pedodontics, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India

*Corresponding author: Dhanraj Ganapathy, Department of Prosthodontics, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India. E-mail: [email protected]

Received on: 02-09-2019; Revised on: 05-10-2019; Accepted on: 10-12-2019

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Dental caries, gingival , and periodontal to consistently maintain adequate levels of plaque disease are the most frequently occurring oral diseases control using mechanical methods alone.[9] in the world. The use of toothbrushing and fluoride toothpaste appeared to be almost universal.[6] There Their primary etiology is bacterial plaque, which is difficulty in effectively removing plaque by only can initiate destruction of the gingival tissues and using toothbrushing and flossing, as these measures periodontal attachment apparatus. Periodontitis do not remove plaque completely.[7] is inflammation of the gingiva and the adjacent attachment apparatus and is characterized by loss Many studies have shown that is superior of attachment and alveolar . in removing interproximal plaque compared to others, Appropriate therapy for patients with periodontitis and it also reduces the incidence of proximal caries.[8] varies considerably with the extent and pattern of Therefore, an easy applicable alternative is needed. attachment loss, local anatomical variations, type The incorporation of broad-spectrum antimicrobial of , and therapeutic objectives. mouth rinses as adjuncts to patient’s daily oral Periodontitis destroys the attachment apparatus of hygiene regimens has assumed greater importance teeth resulting in periodontal pocket formation and with the recognition that most individuals are unable alteration of normal osseous anatomy. The primary

Figure 1: Pro forma of the study

Drug Invention Today | Vol 13 • Issue 4 • 2020 607 Boopana Kannan, et al. objectives of therapy for patients with chronic gingival health. The subjects did not receive any periodontitis are to halt disease progression and to medication or periodontal treatment in the past 1 year. resolve inflammation. Therapy at a diseased site is aimed at reducing etiologic factors below the threshold METHODOLOGY capable of producing breakdown, thereby allowing repair of the affected region.[10-24] Name, age, gender, outpatient number, probing depth, loss of attachment, and gingival index of the test group Chlorhexidine is a gold standard against which other and control group should be recorded before the non- antiplaque and antigingivitis agents are measured. surgical periodontal treatment. The test group should Chlorhexidine is available in various forms such as be prescribed chlorhexidine EP mouthwash after the digluconate, acetate, and hydrochloride salts which are non-surgical periodontal treatment. Patient should be sparingly soluble in water. It is dicationic at pH levels recalled after 15 days and 30 days. Probing depth, loss above 3.5. It prevents plaque accumulation, hence, it of attachment, and gingival index should be recorded is a antiplaque and antigingivitis agent and reduces the during every review [Figure 1]. adherence of Porphyromonas gingivalis to epithelial cells. It can be bacteriostatic or bactericidal depending Data Analysis on the dose. Most important unique property of The gathered data were consolidated, extracted and chlorhexidine is its substantivity. Chlorhexidine mouth analysed. rinses are available in the form of 0.2% and 0.12%. There is equal efficacy for 0.2% and 0.12% rinses RESULTS when used at appropriate similar doses. The time of rinsing is 30 or 60 s depending on the adsorption rate The pre-operative value of probing depth was in the of antiseptics to the oral surfaces. The ideal regimen range of 1.16–1.83 mm and post-operative value in is twice daily (morning and night) which will have a the range of 0.32–1.03 mm, pre-operative value of substantivity for 12 h.[23,25-28] The aim of this study is to loss of attachment was in the range of 1.0–1.5 mm compare the effectiveness of chlorhexidine European and post-operative value in the range of 0–0.91 mm, Pharmacopoeia (EP) on periodontitis patients. and pre-operative value of gingival index was in the range of 0.92–1.03 and post-operative value in the MATERIALS AND METHODS range of 0.32–0.96. Through statistical analysis, it was conferred that there was reduction in pocket depth and Sample Size gingival index (P < 0.05) [Table 1]. The study comprises two groups. Test group comprises 10 individuals with periodontitis and control group DISCUSSION comprises 10 individuals without periodontitis. This study shows that there is reduction in the plaque Personal Variables index, index, and gingival index. Through The personal variables that are recorded in the study the statistical analysis, it was revealed that P value for include name, age, gender, and outpatient number of probing depth, loss of attachment, and gingival index both, the test and the control groups. Age is recorded is <0.05, which shows that P value is not significant. in terms of years and gender as male/female. Since many studies have pointed toward the Practice Variables correlation of efficacy to strength of the chlorhexidine Practice variables that are recorded are gingival used, unfortunately, higher concentrations have shown index, probing depth, and attachment loss. These are correspondingly increase in the side effects, namely, recorded before the non-surgical periodontal treatment staining of teeth and tooth-colored restorations, (scaling), 15 days after the treatment, and 30 days and impairment of taste. There are many researches [29,30] after the treatment. going on regarding this topic. Chlorhexidine’s effect on periodontitis is a result of the dicationic Inclusion Criteria nature of chlorhexidine molecule, which affords the Inclusion criteria were adult patients, older than agent property of persistence of antimicrobial effect 18 years, and systemically healthy. at the tooth surface, through both bactericidal and

Exclusion Criteria Table 1: Comparison of pre-operative and post- The exclusion criteria were, patients with activated operative readings of loss of attachment, probing depth, and gingival index caries, pregnancy, orthodontic appliances or removable prostheses, , allergies to erythrosine or Loss of attachment <0.05 1.0–1.5 mm 0–0.91 mm chlorexidine (CHX), use of in the past Probing depth <0.05 1.16–1.83 mm 0.32–1.03mm 3 months, and use other drugs that might alter normal Gingival index <0.05 0.92–1.03 0.32–0.96

608 Drug Invention Today | Vol 13 • Issue 4 • 2020 Boopana Kannan, et al. bacteriostatic effect.[31] By understanding how the applications starting from maintaining , chemical properties of the chlorhexidine molecule can pre-surgically to post-operative, and also in physically explain plethora of clinical efficacy and safety data, the and mentally handicapped patients. Chlorhexidine use of chlorhexidine can be optimally aimed toward is now routinely used by clinicians when they treat the patient groups who would most benefit from the patients with fixed appliances in orthodontia and superior therapeutic effect of agent. Specifically, maxillofacial surgeries.[35] Chlorhexidine has been used chlorhexidine would seem to be most of value to as a mouthwash for over 40 years now and has been patients, in whom the ability to perform adequate an antibacterial agent of choice in control of both the oral hygiene procedures has been compromised. quantity of bacterial colonies and formation of plaque. In these individuals, the delivery of correct dose of It has been an agent of choice for its effectiveness as chlorhexidine to the surface can be optimized through well as low scope of resistance. Periodontal disease the judicial use of the several different chlorhexidine is cause of concern because of its potential to cause formulations available. Besides, the disadvantages destruction of the dentition and its overall cost to of chlorhexidine mouthwash play an effective role patient. The association of systemic conditions with during dental treatments on short-term usage. This periodontal disease and their ability to modify and study proved that it showed positive effect on patients potentiate their effect has received tremendous interest. with periodontitis. Further studies can be carried out to Long-term use has been considered but prove its benefits among large population and across has resulted in resistance and other undesirable side a wide time range. is always effects. The advent of antibacterial like bisbiguanide preceded by chronic gingivitis; chemicals that inhibit has, therefore, been considered a boon in maintaining plaque may be expected to be of value in both the optimum levels of oral hygiene.[36,37] prevention and management of periodontal disease in some individuals. Thus, the use of a chemical plaque CONCLUSION inhibitory mouthwash as an adjunct to toothbrushing may have a major effect on improving the oral health The oral cavity represents a dynamic ecosystem; of the individual. Chlorhexidine is one chemical therefore, it would not be totally advantageous to plaque control agent which has various clinical eliminate all elements of the oral microflora in an applications in , especially in periodontics. effort to control -associated infections. When chlorhexidine is used as a mouth rinse, the Rather, it may be more ideal to remove only most mode of action is purely topical. The drug does not cariogenic and periodontopathic elements of the penetrate oral epithelium and if some solution is dental plaque microflora while permitting the most inadvertently swallowed, initial binding of the drug innocuous elements to remain. Chlorhexidine has a will be to the mucosal surfaces of gastrointestinal significant effect on periodontitis. Chlorhexidine EP tract. Chlorhexidine is poorly absorbed through is considered even more effective and beneficial as it gastrointestinal tract. 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