Comparative Evaluation of Tongue Coat Inhibitory Effect of 1% Stabilized Chlorine Dioxide Mouthrinse with that of 0.2% Chlorhexidine Gluconate Mouthrinse in the Treatment of Halitosis using N-benzoyl-DL-arginine-2-naphthylamide Assay: A Randomized Crossover Study
Vineet Kini, Arjumand Farooqui, Himanshu K Parekh, Sneha V Waghmare
Citation Information :
Kini V, Farooqui A, Parekh HK, Waghmare SV. Comparative Evaluation of Tongue Coat Inhibitory Effect of 1% Stabilized Chlorine Dioxide Mouthrinse with that of 0.2% Chlorhexidine Gluconate Mouthrinse in the Treatment of Halitosis using N-benzoyl-DL-arginine-2-naphthylamide Assay: A Randomized Crossover Study. J Contemp Dent 2018; 8 (1):27-32.
To evaluate the efficacy of 1% Stabilized Chlorine dioxide (ClO2) mouthrinse as compared with 0.2% Chlorhexidine gluconate (CHX) mouthrinse on tongue coat assessed by N-benzoyl-DL-arginine-2-naphthylamide (BANA) assay in the treatment of halitosis.
Materials and methods
Twenty systemically healthy subjects with self-reported halitosis were enrolled in the study as per the inclusion criteria. The participants were assigned to use either aqueous 1% stabilized ClO2 mouthrinse (Group I) or aqueous 0.2% CHX mouthrinse (Group II). The study was conducted in two phases of 15 days duration each with an intervening washout period of 7 days. Subjects were assessed at baseline and 15 days in each phase for oral hygiene using Plaque index (PI) and Winkel tongue coating index (WTCI). Volatile sulfur compound (VSC) in exhaled breath was measured using portable sulfide monitor. On the 15th day, tongue coating samples were assessed for both Groups using chairside BANA assay.
Both Groups I and II demonstrated significant reduction in PI scores at 15 days as compared with baseline. However, reduction in PI score was found to be statistically significant in favor of Group I as compared with Group II after 15 days (p-value: 0.001). Reduction in WTCI scores was statistically nonsignificant for both Groups I and II at 15 days (p-value: 0.094). Qualitative VSC scores by portable sulfide monitor on assessment of exhaled breath was statistically nonsignificant for both Groups I and II at 15 days (p-value: 0.131). The BANA scores for tongue coat samples from both Groups were comparable at 15 days with no statistical significance (p-value: 0.503).
The observation from present study settings would lead to infer that dental plaque inhibition, tongue coat inhibition, and VSC production are comparable for both the Groups in the treatment of physiological halitosis.
How to cite this article
Farooqui A, Parekh HK, Waghmare SV, Kini V. Comparative Evaluation of Tongue Coat Inhibitory Effect of 1% Stabilized Chlorine Dioxide Mouthrinse with that of 0.2% Chlorhexidine Gluconate Mouthrinse in the Treatment of Halitosis using N-benzoyl-DL-arginine-2-naphthylamide Assay: A Randomized Crossover Study. J Contemp Dent 2018;8(1):27-32.
Krespi YP, Shrime MG, Kacker A. The relationship between oral malodor and volatile sulfur compound-producing bacteria. Otolaryngol Head Neck Surg 2006 Nov;135(5):671-676.
Tonzetich J. Production and origin of oral malodor: a review of mechanisms and methods of analysis. J Periodontol 1977 Jan;48(1):13-20.
Miyazaki H, Sakao S, Katoh Y, Takehara T. Correlation between volatile sulfur compounds and certain oral health measurements in the general population. J Periodontol 1995 Aug;66(8):679-684.
Murata T, Yamaga T, Iida T, Miyazaki H, Yaegaki K. Classification and examination of halitosis. Int Dent J 2002 Jun;52 (Suppl 3):181-186.
Ohmori M, Imai R, Satoh S, Hori R, Hasegawa A. A study of daily in physiological oral malodor. J Jpn Soc Periodontol 1999;42:43-48.
Yaegaki K, Sanada K. Volatile sulfur compounds in mouth air from clinically healthy subjects and patients with periodontal disease. J Periodontal Res 1992 Jul;27(4 Pt 1):233-238.
Loesche WJ, Kazor C. Microbiology and treatment of halitosis. Periodontol 2000 2002;28:256-279.
Loesche WJ, Bretz WA, Kerschensteiner D, Stoll J, Socransky SS, Hujoel P, Lopatin DE. Development of a diagnostic test for anaerobic periodontal infections based on plaque hydrolysis of benzoyl-DL-arginine-naphthylamide. J Clin Microbiol 1990 Jul;28(7):1551-1559.
Kozlovsky A, Gordon D, Gelernter I, Loesche WJ, Rosenberg M. Correlation between the BANA test and oral malodor parameters J Dent Res 1994 May;73(5):1036-1042.
De Boever EH, Loesche WJ. Assessing the contribution of anaerobic microflora of the tongue to oral malodor. J Am Dent Assoc 1995 Oct;126(10):1384-1393.
Jose AA, Feres M, Figueiredo LC, Salvador SL, Cortelli SC. The ability of the BANA test to detect different levels of P. gingivalis, T. denticola and T. forsythia. Braz Oral Res 2010 Apr-Jun;24(2):224-230.
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 Apr;30(4):300-306.
Gürgan CA, Zaim E, Bakirsoy I, Soykan E. Short-term side effects of 0.2% alcohol-free chlorhexidine mouthrinse used as adjunct to non-surgical periodontal treatment: a double blind clinical study. J Periodontol 2006 Mar;77(3):370-384.
Noszticzius Z, Wittmann M, Kály-Kullai K, Beregvári Z, Kiss I, Rosivall L, Szegedi J. Chlorine dioxide is a size-selective antimicrobial agent. PLoS One 2013 Nov5;8(11):e79157.
Löe H. The gingival index, the plaque index and the retention index systems. J Periodontol Silness and Loe Nov-Dec;38(6):Suppl:610-616.
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 study. J Clin Diagn Res 2015 Sep;9(9):ZC69-ZC74.
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 Clin Periodontol 2008 Aug;79(8):1395-1400.
Rosenberg M, Kulkarni GV, Bosy A, McCulloch CA. Reproducibility and sensitivity of oral malodor measurements with a portable sulfide monitor. J Dent Res 1991 Nov;70(11):1436-1440.
Shinada K, Ueno M, Konishi C, Takehara S, Yokoyama S, Kawaguchi Y. A randomized, double blind, crossover, placebo-controlled clinical trial to assess the effects of a mouthwash containing chlorine dioxide on oral malodor. Trials 2008 Dec 9;9:71.
Peruzzo DC, Jandiroba PF, Nogueira Filho Gda R. Use of 0.1% chlorine dioxide to inhibit the formation of morning volatile sulphur compounds (VSC). Braz Oral Res 2007 Jan-Mar;21(1):70-74.
Hakuta C, Mori C, Ueno M, Shinada K, Kawaguchi Y. Evaluation of an oral function promotion program for the independent elderly in Japan. Gerodontology 2009 Dec;26(4):250-258.