Home | About us | Editorial board | Search | Ahead of print | Current issue | Archives | Submit article | Instructions| Reviewers

Login 
  Home Print this page Email this page Small font sizeDefault font sizeIncrease font size Users Online: 227    
     


 
Table of Contents   
ORIGINAL ARTICLE
Year : 2016  |  Volume : 6  |  Issue : 3  |  Page : 206-212
Evaluation of the effect of hydrogen peroxide as a mouthwash in comparison with chlorhexidine in chronic periodontitis patients: A clinical study


Department of Periodontology, College of Dentistry, Al Jouf University, Sakaka, Saudi Arabia

Date of Submission03-Mar-2016
Date of Acceptance06-Apr-2016
Date of Web Publication30-May-2016

Correspondence Address:
Dr. Hazem Tarek Rashed
Department of Periodontology, College of Dentistry, Al Jouf University, Sakaka
Saudi Arabia
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2231-0762.183114

Rights and Permissions

   Abstract 

Aims and Objective: This study was conducted to evaluate the effect of hydrogen peroxide (H2O2) as a mouthwash in comparison with chlorhexidine (CHX) in chronic periodontitis patients. Materials and Methods: A total of 45 patients suffering from localized mild to moderate chronic periodontitis were chosen. The subjects were divided equally into three groups. Group A patients were treated only with scaling and root planning (SRP). Group B were treated with SRP in combination with 0.2% CHX gluconate mouthwash twice daily for 10 days. Group C were treated with SRP in combination with 1.5% H2O2mouthwash twice daily for 10 days. Gingival index, plaque index, pocket depth, and clinical attachment level were recorded for patients of all groups on day 0 (Baseline), 15, 30, and 90, respectively. Statistical analysis was done using the Statistical Package for the Social Sciences version 22.0. Repeated measures analysis of variance was used to assess the differences in the abovementioned indices because of time and groups. Results: Both CHX gluconate and H2O2mouthwashes significantly reduced the gingival index more than that observed in the control group, but similar to each other. There were no significant differences in the clinical attachment loss, plaque index, and pocket depth among the study groups, but improvement was seen within the CHX group participants. In participants with chronic periodontitis, SRP in combination with 0.2% CHX gluconate mouthwash was an effective treatment in reducing the gingival index and the pocket depth, as well as improving the clinical attachment level. Conclusion: The use of CHX gluconate was observed to be higher than H2O2for the reduction in the gingival index and the pocket depth, as well as for the improvement of the clinical attachment level.


Keywords: Chlorhexidine gluconate, chronic periodontitis, hydrogen peroxide


How to cite this article:
Rashed HT. Evaluation of the effect of hydrogen peroxide as a mouthwash in comparison with chlorhexidine in chronic periodontitis patients: A clinical study. J Int Soc Prevent Communit Dent 2016;6:206-12

How to cite this URL:
Rashed HT. Evaluation of the effect of hydrogen peroxide as a mouthwash in comparison with chlorhexidine in chronic periodontitis patients: A clinical study. J Int Soc Prevent Communit Dent [serial online] 2016 [cited 2019 Dec 13];6:206-12. Available from: http://www.jispcd.org/text.asp?2016/6/3/206/183114



   Introduction Top


Periodontal problems have been considered to be major health issues in different populations for a long time.[1] Chronic periodontitis has a slow to moderate rate disease progression, which can be associated with local predisposing factors such as dental plaque, calculus deposits, and iatrogenic factors, and systemic diseases such as diabetes mellitus.[2] The severity and extent of damage vary between individuals and over time, mainly affected by individual's immune and inflammatory responses to microbial challenge.[3],[4]

At present, an efficacious and widely accepted modality of treatment for periodontal disease is the mechanical removal of the bacterial biofilm and their toxins from the tooth surface by scaling and root planning (SRP), making it convenient with biologic reattachment, which is the basis of any ultimate adjunctive therapy.[5] An acceptable therapeutic measure is usually gained when personal plaque control is achieved in conjunction with professional removal of plaque, calculus, and other local factors.[6]

Dental calculus removal is complemented by SRP procedures using hand, sonic, or ultrasonic equipments. The therapeutic aim of SRP is the removal of plaque and calculus to minimize subgingival bacteria below a threshold level which is capable of inducing clinical inflammation. The prosperity of instrumentation is determined by the evaluation of the periodontal tissues after treatment and during the maintenance phase of the therapy.[7] Using topical antibacterial agents to reduce bacterial plaque may be advantageous for the prevention and treatment of gingivitis in some patients. A number of these agents in oral rinses and dentifrices have been examined in clinical trials.[8],[9]

Chlorhexidine (CHX) digluconate is considered to be one of the most frequently used compounds; since 1950, it has been used as a potent broad-spectrum antiseptic agent in medicine with a pronounced antimicrobial effect on both Gram-negative and Gram-positive bacteria, as well as on fungi and some viruses. Moreover, the ability of CHX to inhibit the formation and development of bacterial plaque for several hours was demonstrated in 1970's because of its high affinity for oral surfaces.[10],[11]

In addition, CHX is a positively charged cationic bisbiguanide that can be adsorbed to a variety of negatively charged sites, including mucous membranes, salivary pellicle on teeth, as well as several components of the biofilm on the tooth surfaces, e.g., bacteria, extracellular polysaccharides, and glycoproteins.[12],[13]In vitro studies showed that, in low concentrations, CHX causes destruction to the cell membrane and low molecular weight molecules escape from the microorganisms. On the other hand, a higher concentration of CHX causes precipitation and coagulation of the proteins in the cytoplasm of the exposed microbes. These properties interfere with biofilm formation and prevent its growth.[14],[15],[16]

Hydrogen peroxide (H2O2) has been used in dentistry in combination with salts or alone for more than 70 years.[17] Therapeutic delivery of H2O2 to prevent periodontal disease requires mechanical access to subgingival pockets. Furthermore, wound healing following gingival surgery is enhanced because of the antimicrobial effects of topically administered H2O2. For most subjects, beneficial effects have been seen with H2O2 levels above 1%. H2O2 has been shown to possess a wide spectrum of antimicrobial activity because it is active against bacteria, yeasts, fungi, viruses, and spores.[18]

Moreover, H2O2 is an oxidizer that has been employed in plaque control. Applications of oxygenating agents include the control of supragingival plaque and the treatment of acuteulcerative gingivitis with no side effects to the tissues.[19]

In 1982, Wolff et al., studied the effect of 3% H2O2 on gingival inflammation and concluded its effectiveness in reducing pocket depth of more than 4 mm, however, it showed no effect on bleeding and other gingival indices.[20]

Considering the side effects of CHX that include brown discoloration of the teeth, restorative materials and dorsum of tongue,[21],[22] as well as the role of anaerobic bacteria in periodontal diseases and the ecosystem in periodontal pockets that allows microbial growth, it was decided to evaluate the effect of H2O2 as a mouthwash in comparison with CHX in chronic periodontitis patients.


   Material and Methods Top


Patients' selection

Forty-five patients participated in this study. The participants were suffering from localized mild to moderate chronic periodontitis and were selected from the outpatient clinic of the Faculty of Dentistry, Al Jouf University. An informed consent was signed before starting the treatment for all patients. Clearance was obtained from the institutional ethical clearance committee. The patients were chosen on the basis of inclusion criteria.

Inclusion criteria

  • Localized mild to moderate chronic periodontitis patients with a minimum of 20 permanent teeth and having clinical attachment loss ≤4 mm in less than 30% of the sites were included.
  • Age range of patients: 30–50 years of age.
  • Gender: Only male patients were selected (Because of the restriction of the conservative society, it was difficult to enroll the female sample).


Exclusion criteria

  • Patients suffering from systemic diseases, which may have an impact on the periodontium, such as diabetes mellitus and osteoporosis.
  • Uncooperative patients who failed to preserve proper oral hygiene during and after phase I therapy.
  • Patients on antibiotics and/or antiinflammatory drugs.
  • Patients allergic to CHX or H2O2.
  • Smokers.


The following assumptions were used for sample size estimation: Alpha error = 5%, study power = 80%, estimated mean pocket depth in CHX group at the end of the study = 3.5 mm and in the H2O2 group = 4 mm, and common standard deviation = 0.4. The required sample size per group was calculated to be 11, which was increased to 15 to allow for probable loss to follow up.

Grouping

The subjects were divided equally into three groups:

  • Group A: Fifteen patients were treated only with SRP.
  • Group B: Fifteen patients were treated with SRP in combination with 0.2% CHX gluconate mouthwash (AVOHEX ® mouth wash).
  • Group C: Fifteen patients were treated with SRP in combination with 1.5% H2O2 mouthwash (Colgate ® Peroxyl ® Mouth Sore Rinse).


Methods

  1. Comprehensive personal, medical, and dental history was taken for all patients.
  2. Intraoral clinical assessment was done including the following: Evaluation of the gingival status through Gingival Index (GI) according to Löe H,[23] evaluation of the amount of dental plaque through Plaque Index (PLI) by applying the (O'Leary Index),[24] and measurement of the periodontal probing depth (PD)[25] and the clinical attachment level (CAL).[26]
  3. Phase I therapy included:
    1. Patient's education and motivation was done for all cases.
    2. Plaque control and oral hygiene instructions were given.
    3. Proper scaling, polishing, and root planning was assured.


[Appendix 1] shows the consort flow diagram of the study.



Study design

Gingival index, plaque index, pocket depth, and clinical attachment level were recorded. SRP was performed for all patients. In group A, SRP only was performed; in group B, 0.2% CHX gluconate mouthwash was prescribed as an adjunct to SRP. In group C, 1.5% H2O2 mouthwash was used after SRP. Patients of groups B and C were instructed to use the prescribed mouthwash concentrate twice daily for 10 days. The abovementioned indices were recorded on day 0 (Baseline), 15, 30, and 90.

Statistical analysis

For evaluation of the effect of H2O2 as a mouthwash compared with CHX in chronic periodontitis patients, the data were collected and statistically analyzed. Repeated measures analysis of variance was used to assess the differences in gingival index, plaque index, pocket depth, and clinical attachment level because of time and groups. Percent reduction in gingival index, plaque index, and pocket depth was calculated as follows:

[(values after 90 days − values at baseline)/values at baseline] × 100.

Percent reduction in pocket depth was used as an outcome in a regression model with the following variables used as independent variables: Percent change in gingival index and percent change in plaque index and group. Adjusted means and 95% confidence intervals were calculated. Significance level was set at 5%. Statistical analysis was performed using the Statistical Package for the Social Sciences, version 22.0. IBM Corp., Armonk, NY, USA.


   Results Top


Gingival index

[Figure 1] shows the change in the gingival index across time in the 3 study groups. A significant improvement in gingival index was noted over time (P < 0.0001). There was a significant reduction in gingival index from baseline to after 15 days, after 30 days, and after 90 days (P < 0.0001 for all). The highest gingival index was observed in the control group whereas the gingival index in the CHX and H2O2 were significantly lowered, but similar to each other.
Figure 1: Change in gingival index across time in the study groups. Effect of time [F = 430.28, P< 0.0001; a, b, c, and d: Different letters denoting significant difference between follow up period]. Effect of groups [F = 10.12, P< 0.0001; A and B: Different letters denoting significant difference between the follow-up period]

Click here to view


Plaque index

[Figure 2] shows the change in the plaque index across time in the 3 study groups. Time had a significant effect on plaque index (P < 0.0001). There was a significant reduction in plaque index from baseline to after 15 days, after 30 days, and after 90 days (P < 0.0001 for all). There were no significant differences in plaque index among the study groups (P = 0.11).
Figure 2: Change in plaque index across time in the study groups. Effect of time [F = 291.73, P< 0.0001; a, b, c, and d: Different letters denoting significant difference between the follow-up period]. Effect of groups [F = 2.33, P= 0.11]

Click here to view


Pocket depth

[Figure 3] shows the change in pocket depth across time in the 3 study groups. Time had a significant effect on pocket depth (P < 0.0001). There was a significant reduction in pocket depth from baseline to after 15 days, after 30 days, and after 90 days (P < 0.0001 for all). There were no significant differences in pocket depth among the study groups (P = 0.06).
Figure 3: Change in pocket depth across time in the study groups. Effect of time [F = 596.36, P< 0.0001; a, b, c, and d: Different letters denoting significant difference between follow-up period]; effect of groups [F = 2.95, P = 0.06]

Click here to view


[Table 1] shows the adjusted mean reduction in pocket depth in the 3 study groups. By the end of the study, there were statistically significant differences in reduction in pocket depth from baseline values (P < 0.0001). The pocket depth reduction within the CHX group was significantly greater than in the H2O2 and the control groups, which were statistically similar. The regression model accounted for 55% of the variation in pocket depth reduction.
Table 1: Percent reduction in pocket depth in the three study groups

Click here to view


Clinical attachment level

[Figure 4] shows the change in clinical attachment level across time in the 3 study groups. Time had no significant effect on clinical attachment level (P = 0.21). There were no significant differences in clinical attachment level among the study groups (P = 0.98).
Figure 4: Change in the clinical attachment level across time in the study groups. Effect of time [F = 1.60, P = 0.21]; effect of groups [F = 0.02, P
= 0.98]


Click here to view



   Discussion Top


Till date, mechanical plaque removal with assorted devices remains the primary and most widely accepted means of controlling plaque and preserving good oral hygiene. As an adjunct to mechanical techniques, chemical plaque control comprising of a variety of chemotherapeutic agents, have been beneficial and advisable.[19],[27]

The greatest success has been with CHX, which is now considered the gold standard, against which other potential antiplaque agents are measured.[28] However, the local side effects of CHX, particularly extrinsic staining and taste aberrations, may limit its long-term use in oral hygiene products.[29]

The present study was initiated to evaluate the effect of H2O2 as a mouthwash in comparison with CHX in chronic periodontitis patients. The findings of the present study show that rinsing using CHX as an adjunct to SRP can help in achieving desirable clinical outcomes in the treatment of chronic periodontitis.

The results of the present study show asignificant reduction in gingival index when using the CHX or H2O2 as adjunct to SRP as is evident from [Figure 1]. Similarly, this finding has been confirmed in the study done by Hasturk et al., which indicated that H2O2 mouthwashes reduce the signs of gingival inflammation.[30]

The study of Sahebjam et al. indicated that subgingival irrigation with 3% H2O2 plays a potential role in inflammation control and reduction of gingival bleeding.[18]

In a double blind parallel group study, the efficacy of CHX mouth rinses with and without alcohol was evaluated, and it was found that the alcohol-free rinse was as effective as one containing alcohol in controlling plaque and reducing gingival inflammation.[31]

Furthermore, all study groups showed a significant reduction in plaque index with time from baseline to after 15 days, after 30 days, and after 90 days (P < 0.0001 for all). There were no significant differences in plaque index among the study groups as patient's education and motivation was done for all cases. Plaque control and oral hygiene instructions were also given to all groups.

Regarding the pocket depth, the study results showed a significant reduction in pocket depth with time from baseline to after 15 days, after 30 days, and after 90 days (P < 0.0001 for all). This study failed to reveal a significant difference in pocket depth among the study groups. This is in line with Sahebjam et al. who studied the effect of periodontal pocket irrigation with 3% H2O2 and reported that there was no significant effect on probing depth compared to saline or to nonirrigation groups.[18]

Time had no significant effect on clinical attachment level (P = 0.21). There were no significant differences in clinical attachment level among the study groups (P = 0.98).

According to Sahebjam et al.[18] irrigation with H2O2 resulted in a significant reduction of attachment levels between the 3 groups on day 21.

This is in agreement with Pietruska et al.[21] who demonstrated the efficacy of local treatment with H2O2 drugs on the clinical status of periodontium in chronic periodontitis patients. Plaque and gingival indices were significantly reduced after treatment. Pocket depths after treatment were markedly reduced, on other hand, no significant changes were observed after 3 months in the attachment level as compared to the baseline.

Strength of the study

CHX proved to be more effective than H2O2 regarding the reduction in the gingival index and the pocket depth, as well as in the improvement of the clinical attachment level, this aspect may be considered as the positive aspect of this study.

Limitations of the study

Limited time duration and the small and nonprobability sample of convenience were the limitations of this study. The size, convenience, and homogeneity of the sample limit the generalizability of this study, and hence further studies are recommended.


   Conclusion Top


Within the limitations of this study, it can be concluded that CHX is more effective than H2O2 in reducing gingival index, pocket depth, and improving the clinical attachment level. CHX is the most effective agent as an adjunct to routine oral hygiene procedures. Rinsing with CHX twice daily can be recommended as an adjunct to SRP to treat chronic periodontitis. Further studies to clarify the effect of CHX, as well as H2O2, mouthwashes in chronic periodontitis patients are recommended.

Financial support and sponsorship

This study was funded by the Al Jouf University, Kingdom of Saudi Arabia - Research project No. (308/35).

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Lui J, Corbet EF, Jin L. Combined photodynamic and low-level laser therapies as an adjunct to nonsurgical treatment of chronic periodontitis. J Periodontal Res 2011;46:89-96.  Back to cited text no. 1
    
2.
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 Dent Res 2015;26:53-6.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.
Pattnaik S, Anand N, Chandrasekaran SC, Chandrashekar L, Mahalakshmi K, Satpathy A. Clinical and antimicrobial efficacy of a controlled-release device containing chlorhexidine in the treatment of chronic periodontitis. Eur J Clin Microbiol Infect Dis 2015;34:2103-10.  Back to cited text no. 3
    
4.
Genovesi A, Barone A, Toti P, Covani U. The efficacy of 0.12% chlorhexidine versus 0.12% chlorhexidine plus hyaluronic acid mouthwash on healing of submerged single implant insertion areas: A short-term randomized controlled clinical trial. Int J Dent Hyg 2015.  Back to cited text no. 4
    
5.
Sigusch BW, Engelbrecht M, Volpel A, Holletschke A, Pfister W, Schutze J. Full-mouth antimicrobial photodynamic therapy in Fusobacterium nucleatum-infected periodontitis patients. J Periodontol 2010;81:975-81.  Back to cited text no. 5
    
6.
Rusu D, Stratul SI, Sarbu C, Roman A, Anghel A, Didilescu A, et al. Evaluation of a hydrophobic gel adhering to the gingiva in comparison with a standard water-soluble 1% chlorhexidine gel after scaling and root planing in patients with moderate chronic periodontitis. A randomized clinical trial. Int J Dent Hyg 2015.  Back to cited text no. 6
    
7.
Jain M, Dave D, Jain P, Manohar B, Yadav B, Shetty N. Efficacy of xanthan based chlorhexidine gel as an adjunct to scaling and root planing in treatment of the chronic periodontitis. J Indian Soc Periodontol 2013;17:439-43.  Back to cited text no. 7
[PUBMED]  Medknow Journal  
8.
Chauhan AS, Bains VK, Gupta V, Singh GP, Patil SS. Comparative analysis of hyaluronan gel and xanthan-based chlorhexidine gel, as adjunct to scaling and root planing with scaling and root planing alone in the treatment of chronic periodontitis: A preliminary study. Contemp Clin Dent 2013;4:54-61.  Back to cited text no. 8
[PUBMED]  Medknow Journal  
9.
Elkerbout TA, Slot DE, Bakker E, Van der Weijden GA. Chlorhexidine mouthwash and sodium lauryl sulphate dentifrice: Do they mix effectively or interfere? Int J Dent Hyg 2016;14:42-52.  Back to cited text no. 9
    
10.
Jain A, Bhaskar DJ, Gupta D, Agali C, Gupta V, Gupta RK, et al. Comparative evaluation of honey, chlorhexidine gluconate (0.2%) and combination of xylitol and chlorhexidine mouthwash (0.2%) on the clinical level of dental plaque: A 30 days randomized control trial. Perspect Clin Res 2015;6:53-7.  Back to cited text no. 10
    
11.
Aghili H, Jafari Nadoushan AA, Herandi V. Antimicrobial effect of zataria multiflora extract in comparison with chlorhexidine mouthwash on experimentally contaminated orthodontic elastomeric ligatures. J Dent 2015;12:1-10.  Back to cited text no. 11
    
12.
Bidar M, Naderinasab M, Talati A, Ghazvini K, Asgari S, Hadizadeh B, et al. The effects of different concentrations of chlorhexidine gluconate on the antimicrobial properties of mineral trioxide aggregate and calcium enrich mixture. Dent Res J 2012;9:466-71.  Back to cited text no. 12
[PUBMED]  Medknow Journal  
13.
Singh H, Kapoor P, Dhillon J, Kaur M. Evaluation of three different concentrations of Chlorhexidine for their substantivity to human dentin. Indian J Dent 2014;5:199-201.  Back to cited text no. 13
  Medknow Journal  
14.
Jayaprakash R, Sharma A, Moses J. Comparative evaluation of the efficacy of different concentrations of chlorhexidine mouth rinses in reducing the mutans streptococci in saliva: An in vivo study. J Indian Soc Pedod Prev Dent 2010;28:162-6.  Back to cited text no. 14
[PUBMED]  Medknow Journal  
15.
Mahendra A, Koul M, Upadhyay V, Dwivedi R. Comparative evaluation of antimicrobial substantivity of different concentrations of chlorhexidine as a root canal irrigant: An in vitro study. J Oral Biol Craniofac Res 2014;4:181-5.  Back to cited text no. 15
    
16.
Zhang TT, Tang SS, Fu LJ. The effectiveness of different concentrations of chlorhexidine for prevention of ventilator-associated pneumonia: A meta-analysis. J Clin Nurs 2014;23:1461-75.  Back to cited text no. 16
    
17.
Fernandez y mostajo m, van der reijden wa, buijs mj, beertsen w, van der weijden f, crielaard w, et al. Effect of an oxygenating agent on oral bacteria in vitro and on dental plaque composition in healthy young adults. Front cell infect microbiol 2014;4:95.  Back to cited text no. 17
    
18.
Sahebjam Atabaki M, Moradi Haghgoo J, Khoshhal M, Arabi R, Khodadoostan A, Gholami L. Clinical Effect of Periodontal Pocket Irrigation with H2O2. Avicenna J Dent Res 2011;3.  Back to cited text no. 18
    
19.
Jhingta P, Bhardwaj A, Sharma D, Kumar N, Bhardwaj VK, Vaid S. Effect of hydrogen peroxide mouthwash as an adjunct to chlorhexidine on stains and plaque. J Indian Soc Periodontol 2013;17:449-53.  Back to cited text no. 19
[PUBMED]  Medknow Journal  
20.
Wolff LF, Bandt C, Pihlstrom B, Brayer L. Phase contrast microscopic evaluation of subgingival plaque in combination with either conventional or antimicrobial home treatment of patients with periodontal inflammation. J Periodontal Res 1982;17:537-40.  Back to cited text no. 20
    
21.
Pietruska M, Paniczko A, Waszkiel D, Pietruski J, Bernaczyk A. Efficacy of local treatment with chlorhexidine gluconate drugs on the clinical status of periodontium in chronic periodontitis patients. Adv Med Sci 2006;51(Suppl 1):162-5.  Back to cited text no. 21
    
22.
Plantinga NL, Wittekamp BH, Leleu K, Depuydt P, Van den Abeele AM, Brun-Buisson C, et al. Oral mucosal adverse events with chlorhexidine 2% mouthwash in ICU. Intensive Care Med 2016;42:620-1.  Back to cited text no. 22
    
23.
Loe H. The Gingival Index, the Plaque Index and the Retention Index Systems. J Periodontol 1967;38(Suppl):610-6.  Back to cited text no. 23
    
24.
O'Leary TJ, Drake RB, Naylor JE. The plaque control record. J Periodontol 1972;43:38.  Back to cited text no. 24
    
25.
Listgarten MA. Periodontal probing: What does it mean? J Clin Periodontol 1980;7:165-76.  Back to cited text no. 25
    
26.
Davies GN. The different requirements of periodontal indices for prevalence studies and clinical trials. Int Dent J 1968;18:560-9.  Back to cited text no. 26
    
27.
Wu CD, Savitt ED. Evaluation of the safety and efficacy of over-the-counter oral hygiene products for the reduction and control of plaque and gingivitis. Periodontol 2000 2002;28:91-105.  Back to cited text no. 27
    
28.
Kumar AJ, Ramesh Reddy BV, Chava VK. Effect of chlorhexidine chip in the treatment of chronic periodontitis. J Nat Sci Biol Med 2014;5:268-72.  Back to cited text no. 28
    
29.
Ernst CP, Canbek K, Dillenburger A, Willershausen B. Clinical study on the effectiveness and side effects of hexetidine and chlorhexidine mouthrinses versus a negative control. Quintessence Int 2005;36:641-52.  Back to cited text no. 29
    
30.
Hasturk H, Nunn M, Warbington M, Van Dyke TE. Efficacy of a fluoridated hydrogen peroxide-based mouthrinse for the treatment of gingivitis: A randomized clinical trial. J Periodontol 2004;75:57-65.  Back to cited text no. 30
    
31.
Leyes Borrajo JL, Garcia VL, Lopez CG, Rodriguez-Nunez I, Garcia FM, Gallas TM. Efficacy of chlorhexidine mouthrinses with and without alcohol: A clinical study. J Periodontol 2002;73:317-21.  Back to cited text no. 31
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1]

This article has been cited by
1 Protocol for a randomized clinical trial exploring the effect of antimicrobial agents on the penile microbiota, immunology and HIV susceptibility of Ugandan men
Ronald M. Galiwango,Bernard Bagaya,Juliet Mpendo,Vineet Joag,Brenda Okech,Annet Nanvubya,Ali Ssetaala,Moses Muwanga,Rupert Kaul
Trials. 2019; 20(1)
[Pubmed] | [DOI]
2 N-acetyl cysteine versus chlorhexidine mouthwashes in prevention and treatment of experimental gingivitis: a randomized, triple-blind, placebo-controlled clinical trial
Ahlam Al-Kamel,Wadhah Abdulnaser Al-Hajj,Esam Halboub,Saleem Abdulrab,Khaled Al-Tahami,Nezar Noor Al-Hebshi
Clinical Oral Investigations. 2019;
[Pubmed] | [DOI]
3 Over-the-counter mouthwash use and risk of pre-diabetes/diabetes
Kaumudi J. Joshipura,Francisco J. Muñoz-Torres,Evangelia Morou-Bermudez,Rakesh P. Patel
Nitric Oxide. 2017;
[Pubmed] | [DOI]



 

Top
Print this article  Email this article
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Article in PDF (942 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
   Introduction
   Material and Methods
   Results
   Discussion
   Conclusion
    References
    Article Figures
    Article Tables

 Article Access Statistics
    Viewed2299    
    Printed27    
    Emailed1    
    PDF Downloaded137    
    Comments [Add]    
    Cited by others 3    

Recommend this journal