Comparative Effects of Kemphor and Chlorhexidine Mouthwashes on Tooth Staining and Gingivitis: A Randomized Controlled Crossover Clinical Trial
,
Abstract
Objectives: Considering the side effects of chlorhexidine (CHX), which is currently the gold-standard antimicrobial mouthwash, this study aimed to compare the effects of Green Kemphor and CHX mouthwashes on tooth staining and gingivitis.
Materials and Methods: This randomized controlled crossover clinical trial evaluated 38 patients requiring CHX mouthwash following oral surgery and periodontal therapy. The patients were randomly assigned to CHX and Kemphor groups (n=19). In CHX group, patients used CHX mouthwash in the first 2 weeks, and after a 4-day washout period, they used Kemphor mouthwash for 2 weeks. This order was reverse in the Kemphor group. Gingivitis was evaluated using the Silness and Loe gingival index (GI), and tooth staining was evaluated by the Lobene index at 0 (baseline), 2 and 4 weeks. Data were analyzed by paired t-test.
Results: CHX mouthwash significantly decreased the GI and increased tooth staining (gingival stains, body stains, and stain extent) at 2 weeks (P<0.05). Kemphor mouthwash significantly decreased the GI and increased tooth staining after 2 weeks (P<0.05). The GI in Kemphor group was significantly lower than that in CHX group at 4 weeks (P<0.05). Also, the tooth staining parameters in the Kemphor group were significantly lower than the corresponding values in the CHX group at 2 and 4 weeks (P<0.05).
Conclusion: Kemphor had higher efficacy for reduction of GI and caused less tooth staining than CHX; thus, it may be recommended for use as an alternative to CHX.
1. Samorodnitzky-Naveh GR, Geiger SB, Levin L. Patients' satisfaction with dental esthetics. J Am Dent Assoc. 2007 Jun;138(6):805-8.
2. Addy M, Moran J, Newcombe R, Warren P. The comparative tea staining potential of phenolic, chlorhexidine and anti‐adhesive mouthrinses. J Clin Periodontol. 1995 Dec;22(12):923-8.
3. Ten Bosch JJ, Coops JC. Tooth color and reflectance as related to light scattering and enamel hardness. J Dent Res. 1995 Jan;74(1):374-80.
4. Joiner A, Jones NM, Raven SJ. Investigation of factors influencing stain formation utilizing an in situ model. Adv Dent Res. 1995 Dec;9(4):471-6.
5. Watts A, Addy M. Tooth discolouration and staining: a review of the literature. Br Dent J. 2001;190(6):309.
6. Peters LB, Wesselink PR, Buijs JF, Van Winkelhoff AJ. Viable bacteria in root dentinal tubules of teeth with apical periodontitis. J Endod. 2001 Feb;27(2):76-81.
7. Duss C, Lang NP, Cosyn J, Persson GR. A randomized, controlled clinical trial on the clinical, microbiological, and staining effects of a novel 0.05% chlorhexidine/herbal extract and a 0.1% chlorhexidine mouthrinse adjunct to periodontal surgery. J Clin Periodontol. 2010 Nov;37(11):988- 97.
8. Neely AL. Essential oil mouthwash (EOMW) may be equivalent to chlorhexidine (CHX) for long-term control of gingival inflammation but CHX appears to perform better than EOMW in plaque control. J Evid Based Dent Pract. 2011 Dec;11(4):171-4.
9. Lobene RR. Effect of dentifrices on tooth stains with controlled brushing. J Am Dent Assoc. 1968 Oct;77(4):849-55.
10. Loe H., Silness J. Periodontal disease in pregnancy. I. Prevalence and severity. Acta Odontol Scand. 1963;21:533-51.
11. Zarandi A, Salahaddin S, Faramarzi M. Efficacy of different concentrations of chlorhexidine mouthwash on plaque accumulation and periodontal parameters. J Periodontol Implant Dent. 2016;8(1):8-11.
12. Torkzaban P, Kadkhodazadeh M. Compare of sequntional effect of chlorhexidine NAF mouth washes on plaque control. J Dent Sch. 2012 Nov; 29(4): 399-405.
13. Solís C, Santos A, Nart J, Violant D. 0.2% chlorhexidine mouthwash with an antidiscoloration system versus 0.2% chlorhexidine mouthwash: a prospective clinical comparative study. J Periodontol. 2011 Jan;82(1):80-5.
14. Herrera D. Chlorhexidine mouthwash reduces plaque and gingivitis. Evid Based Dent. 2013 Mar;14(1):17-8.
15. Mali AM, Behal R, Gilda SS. Comparative evaluation of 0.1% turmeric mouthwash with 0.2% chlorhexidine gluconate in prevention of plaque and gingivitis: A clinical and microbiological study. J Indian Soc Periodontol. 2012 Jul;16(3):386.
16. Najafi MH, Taheri M, Mokhtari MR, Forouzanfar A, Farazi F, Mirzaee M, Ebrahiminik Z, Mehrara R. Comparative study of 0.2% and 0.12%digluconate chlorhexidine mouth rinses on the level of dental staining and gingival indices. Dent Res J. 2012 May;9(3):305.
17. Ripari F, Cera A, Freda M, Zumbo G, Zara F, Vozza I. Tea tree oil versus chlorhexidine mouthwash in treatment of gingivitis: a pilot randomized, double blinded clinical trial. Eur J Dent. 2020 Feb;14(1):55.
18. Sreenivasan PK, Prasad KV. Effects of a chlorhexidine mouthwash on clinical parameters of gingivitis, dental plaque and oral polymorphonuclear leukocytes [PMN]. Contemp Clin Trials Commun. 2020 Sep;19:100473.
19. Corbet EF, Zee KY, Lo EC. Periodontal diseases in Asia and Oceania. Periodontol 2000. 2002 Apr;29(1):122-52.
20. Sajjan P, Laxminarayan N, Kar PP, Sajjanar M. Chlorhexidine as an antimicrobial agent in dentistry–a review. Oral Health Dent Manag. 2016;15(2):93-100.
21. Kumar SB. Chlorhexidine mouthwash-a review. Int J Pharm Sci Res. 2017 Sep;9(9):1450.
22. de Andrade IM, Silva-Lovato CH, de Souza RF, Pisani MX, de Andrade KM, Paranhos HD. Trial of Experimental Toothpastes Regarding Quality for Cleaning Dentures. Int J Prosthodont. 2012 Mar;25(2).
23. Filatova LY, Donovan DM, Becker SC, Lebedev DN, Priyma AD, Koudriachova HV, Kabanov AV, Klyachko NL. Physicochemical characterization of the staphylolytic LysK enzyme in complexes with polycationic polymers as a potent antimicrobial. Biochimie. 2013 Sep;95(9):1689-96.
24. Appendini P, Hotchkiss JH. Review of antimicrobial food packaging. Innov Food Sci Emerg Technol. 2002 Jun;3(2):113-26.
25. Dang MH, Jung JE, Lee DW, Song KY, Jeon JG. Recovery of acid production in Streptococcus mutans biofilms after short-term fluoride treatment. Caries Res. 2016;50(4):363-71.
26. Bijle MN, Ekambaram M, Lo EC, Yiu CK. The combined antimicrobial effect of arginine and fluoride toothpaste. Sci Rep. 2019 Jun;9(1): 8405.
27. Marchese A, Barbieri R, Coppo E, Orhan IE, Daglia M, Nabavi SF, Izadi M, Abdollahi M, Nabavi SM, Ajami M. Antimicrobial activity of eugenol and essential oils containing eugenol: A mechanistic viewpoint. Crit Rev Microbiol. 2017 Nov;43(6):668-89.
28. Pavithra B. Eugenol-a review. Int J Pharm Sci Res. 2014 Mar;6(3):153. 29. Zahi MR, El Hattab M, Liang H, Yuan Q.
Enhancing the antimicrobial activity of d-limonene nanoemulsion with the inclusion of ε-polylysine. Food Chem. 2017 Apr;221:18-23.
30. Bevilacqua A, Corbo MR, Sinigaglia M. In vitro evaluation of the antimicrobial activity of eugenol, limonene, and citrus extract against bacteria and yeasts, representative of the spoiling microflora of fruit juices. J Food Prot. 2010 May;73(5):888-94.
31. Espina L, Gelaw TK, de Lamo-Castellví S, Pagán R, García-Gonzalo D. Mechanism of bacterial inactivation by (+)-limonene and its potential use in food preservation combined processes. PLoS One. 2013 Feb;8(2):e56769.
32. Subramenium GA, Vijayakumar K, Pandian SK. Limonene inhibits streptococcal biofilm formation by targeting surface-associated virulence factors. J Med Microbiol. 2015 Aug;64(8):879-90.
33. Otoni CG, de Moura MR, Aouada FA, Camilloto GP, Cruz RS, Lorevice MV, de FF Soares N, Mattoso LH. Antimicrobial and physical-mechanical properties of pectin/papaya puree/cinnamaldehyde nanoemulsion edible composite films. Food Hydrocoll. 2014 Dec;41:188-94.
34. Doyle AA, Stephens JC. A review of cinnamaldehyde and its derivatives as antibacterial agents. Fitoterapia. 2019 Nov;139:104405.
35. Sreenivasan PK, Haraszthy VI, Zambon JJ. Antimicrobial efficacy of 0· 05% cetylpyridinium chloride mouthrinses. Lett Appl Microbiol. 2013 Jan;56(1):14-20.
36. Van Strydonck DA, Slot DE, Van der Velden U, Van der Weijden F. Effect of a chlorhexidine mouthrinse on plaque, gingival inflammation and staining in gingivitis patients: a systematic review. J Clin Periodontol. 2012 Nov;39(11):1042-55.
37. Kumar S, Patel S, Tadakamadla J, Tibdewal H, Duraiswamy P, Kulkarni S. Effectiveness of a mouthrinse containing active ingredients in addition to chlorhexidine and triclosan compared with chlorhexidine and triclosan rinses on plaque, gingivitis, supragingival calculus and extrinsic staining. Int J Dent Hyg. 2013 Feb;11(1):35-40.
38. Baig A, He T, Buisson J, Sagel L, Suszcynsky- Meister E, White DJ. Extrinsic whitening effects of sodium hexametaphosphate--a review including a dentifrice with stabilized stannous fluoride. Compend Contin Educ Dent. 2005 Sep;26(9 Suppl 1):47.
39. Charles CH, Cronin MJ, Conforti NJ, Dembling WZ, Petrone DM, Mcguire JA. Anticalculus efficacy of an antiseptic mouthrinse containing zinc chloride. J Am Dent Assoc. 2001 Jan;132(1):94-8.
40. Mauland EK, Preus HR, Aass AM. Comparison of commercially available 0.2% chlorhexidine mouthwash with and without antidiscoloration system: A blinded, crossover clinical trial. J Clin Periodontol. 2020 Dec;47(12):1522-7.
2. Addy M, Moran J, Newcombe R, Warren P. The comparative tea staining potential of phenolic, chlorhexidine and anti‐adhesive mouthrinses. J Clin Periodontol. 1995 Dec;22(12):923-8.
3. Ten Bosch JJ, Coops JC. Tooth color and reflectance as related to light scattering and enamel hardness. J Dent Res. 1995 Jan;74(1):374-80.
4. Joiner A, Jones NM, Raven SJ. Investigation of factors influencing stain formation utilizing an in situ model. Adv Dent Res. 1995 Dec;9(4):471-6.
5. Watts A, Addy M. Tooth discolouration and staining: a review of the literature. Br Dent J. 2001;190(6):309.
6. Peters LB, Wesselink PR, Buijs JF, Van Winkelhoff AJ. Viable bacteria in root dentinal tubules of teeth with apical periodontitis. J Endod. 2001 Feb;27(2):76-81.
7. Duss C, Lang NP, Cosyn J, Persson GR. A randomized, controlled clinical trial on the clinical, microbiological, and staining effects of a novel 0.05% chlorhexidine/herbal extract and a 0.1% chlorhexidine mouthrinse adjunct to periodontal surgery. J Clin Periodontol. 2010 Nov;37(11):988- 97.
8. Neely AL. Essential oil mouthwash (EOMW) may be equivalent to chlorhexidine (CHX) for long-term control of gingival inflammation but CHX appears to perform better than EOMW in plaque control. J Evid Based Dent Pract. 2011 Dec;11(4):171-4.
9. Lobene RR. Effect of dentifrices on tooth stains with controlled brushing. J Am Dent Assoc. 1968 Oct;77(4):849-55.
10. Loe H., Silness J. Periodontal disease in pregnancy. I. Prevalence and severity. Acta Odontol Scand. 1963;21:533-51.
11. Zarandi A, Salahaddin S, Faramarzi M. Efficacy of different concentrations of chlorhexidine mouthwash on plaque accumulation and periodontal parameters. J Periodontol Implant Dent. 2016;8(1):8-11.
12. Torkzaban P, Kadkhodazadeh M. Compare of sequntional effect of chlorhexidine NAF mouth washes on plaque control. J Dent Sch. 2012 Nov; 29(4): 399-405.
13. Solís C, Santos A, Nart J, Violant D. 0.2% chlorhexidine mouthwash with an antidiscoloration system versus 0.2% chlorhexidine mouthwash: a prospective clinical comparative study. J Periodontol. 2011 Jan;82(1):80-5.
14. Herrera D. Chlorhexidine mouthwash reduces plaque and gingivitis. Evid Based Dent. 2013 Mar;14(1):17-8.
15. Mali AM, Behal R, Gilda SS. Comparative evaluation of 0.1% turmeric mouthwash with 0.2% chlorhexidine gluconate in prevention of plaque and gingivitis: A clinical and microbiological study. J Indian Soc Periodontol. 2012 Jul;16(3):386.
16. Najafi MH, Taheri M, Mokhtari MR, Forouzanfar A, Farazi F, Mirzaee M, Ebrahiminik Z, Mehrara R. Comparative study of 0.2% and 0.12%digluconate chlorhexidine mouth rinses on the level of dental staining and gingival indices. Dent Res J. 2012 May;9(3):305.
17. Ripari F, Cera A, Freda M, Zumbo G, Zara F, Vozza I. Tea tree oil versus chlorhexidine mouthwash in treatment of gingivitis: a pilot randomized, double blinded clinical trial. Eur J Dent. 2020 Feb;14(1):55.
18. Sreenivasan PK, Prasad KV. Effects of a chlorhexidine mouthwash on clinical parameters of gingivitis, dental plaque and oral polymorphonuclear leukocytes [PMN]. Contemp Clin Trials Commun. 2020 Sep;19:100473.
19. Corbet EF, Zee KY, Lo EC. Periodontal diseases in Asia and Oceania. Periodontol 2000. 2002 Apr;29(1):122-52.
20. Sajjan P, Laxminarayan N, Kar PP, Sajjanar M. Chlorhexidine as an antimicrobial agent in dentistry–a review. Oral Health Dent Manag. 2016;15(2):93-100.
21. Kumar SB. Chlorhexidine mouthwash-a review. Int J Pharm Sci Res. 2017 Sep;9(9):1450.
22. de Andrade IM, Silva-Lovato CH, de Souza RF, Pisani MX, de Andrade KM, Paranhos HD. Trial of Experimental Toothpastes Regarding Quality for Cleaning Dentures. Int J Prosthodont. 2012 Mar;25(2).
23. Filatova LY, Donovan DM, Becker SC, Lebedev DN, Priyma AD, Koudriachova HV, Kabanov AV, Klyachko NL. Physicochemical characterization of the staphylolytic LysK enzyme in complexes with polycationic polymers as a potent antimicrobial. Biochimie. 2013 Sep;95(9):1689-96.
24. Appendini P, Hotchkiss JH. Review of antimicrobial food packaging. Innov Food Sci Emerg Technol. 2002 Jun;3(2):113-26.
25. Dang MH, Jung JE, Lee DW, Song KY, Jeon JG. Recovery of acid production in Streptococcus mutans biofilms after short-term fluoride treatment. Caries Res. 2016;50(4):363-71.
26. Bijle MN, Ekambaram M, Lo EC, Yiu CK. The combined antimicrobial effect of arginine and fluoride toothpaste. Sci Rep. 2019 Jun;9(1): 8405.
27. Marchese A, Barbieri R, Coppo E, Orhan IE, Daglia M, Nabavi SF, Izadi M, Abdollahi M, Nabavi SM, Ajami M. Antimicrobial activity of eugenol and essential oils containing eugenol: A mechanistic viewpoint. Crit Rev Microbiol. 2017 Nov;43(6):668-89.
28. Pavithra B. Eugenol-a review. Int J Pharm Sci Res. 2014 Mar;6(3):153. 29. Zahi MR, El Hattab M, Liang H, Yuan Q.
Enhancing the antimicrobial activity of d-limonene nanoemulsion with the inclusion of ε-polylysine. Food Chem. 2017 Apr;221:18-23.
30. Bevilacqua A, Corbo MR, Sinigaglia M. In vitro evaluation of the antimicrobial activity of eugenol, limonene, and citrus extract against bacteria and yeasts, representative of the spoiling microflora of fruit juices. J Food Prot. 2010 May;73(5):888-94.
31. Espina L, Gelaw TK, de Lamo-Castellví S, Pagán R, García-Gonzalo D. Mechanism of bacterial inactivation by (+)-limonene and its potential use in food preservation combined processes. PLoS One. 2013 Feb;8(2):e56769.
32. Subramenium GA, Vijayakumar K, Pandian SK. Limonene inhibits streptococcal biofilm formation by targeting surface-associated virulence factors. J Med Microbiol. 2015 Aug;64(8):879-90.
33. Otoni CG, de Moura MR, Aouada FA, Camilloto GP, Cruz RS, Lorevice MV, de FF Soares N, Mattoso LH. Antimicrobial and physical-mechanical properties of pectin/papaya puree/cinnamaldehyde nanoemulsion edible composite films. Food Hydrocoll. 2014 Dec;41:188-94.
34. Doyle AA, Stephens JC. A review of cinnamaldehyde and its derivatives as antibacterial agents. Fitoterapia. 2019 Nov;139:104405.
35. Sreenivasan PK, Haraszthy VI, Zambon JJ. Antimicrobial efficacy of 0· 05% cetylpyridinium chloride mouthrinses. Lett Appl Microbiol. 2013 Jan;56(1):14-20.
36. Van Strydonck DA, Slot DE, Van der Velden U, Van der Weijden F. Effect of a chlorhexidine mouthrinse on plaque, gingival inflammation and staining in gingivitis patients: a systematic review. J Clin Periodontol. 2012 Nov;39(11):1042-55.
37. Kumar S, Patel S, Tadakamadla J, Tibdewal H, Duraiswamy P, Kulkarni S. Effectiveness of a mouthrinse containing active ingredients in addition to chlorhexidine and triclosan compared with chlorhexidine and triclosan rinses on plaque, gingivitis, supragingival calculus and extrinsic staining. Int J Dent Hyg. 2013 Feb;11(1):35-40.
38. Baig A, He T, Buisson J, Sagel L, Suszcynsky- Meister E, White DJ. Extrinsic whitening effects of sodium hexametaphosphate--a review including a dentifrice with stabilized stannous fluoride. Compend Contin Educ Dent. 2005 Sep;26(9 Suppl 1):47.
39. Charles CH, Cronin MJ, Conforti NJ, Dembling WZ, Petrone DM, Mcguire JA. Anticalculus efficacy of an antiseptic mouthrinse containing zinc chloride. J Am Dent Assoc. 2001 Jan;132(1):94-8.
40. Mauland EK, Preus HR, Aass AM. Comparison of commercially available 0.2% chlorhexidine mouthwash with and without antidiscoloration system: A blinded, crossover clinical trial. J Clin Periodontol. 2020 Dec;47(12):1522-7.
| Issue | Vol 19 (Continuously Published Article-Based) | |
| Section | Original Article | |
| DOI | https://doi.org/10.18502/fid.v19i30.10802 | |
| Keywords | ||
| Chlorhexidine Mouthwash Tooth Discoloration Gingivitis | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Hooshyarfard A, Poormoradi B, Olad F, Shahbazi A, Cheraghi Z. Comparative Effects of Kemphor and Chlorhexidine Mouthwashes on Tooth Staining and Gingivitis: A Randomized Controlled Crossover Clinical Trial. Front Dent. 2022;19.
