Thus, initially plaque-covered surfaces were stained earlier than plaque-free surfaces. There is scarce evidence investigating the presence of plaque over CHX side effects. Corbet, et al. In our study, we used a randomized split-mouth design. Thus, each subject was its own control. Both test and control surfaces were exposed the same dietary compounds influence. This methodological aspect aimed at reducing inter-individual variability, reducing bias and consequently increasing statistical confidence in the results obtained.
Furthermore, a single calibrated clinical examiner unaware of group allocation assessed all clinical parameters. The observed results indicate the mechanisms by which staining is higher in plaque-covered surfaces is subject to further investigations.
However, a possible explication could be that plaque presence could increase the CHX salivary protein precipitation. The increase of calculus formation due to CHX mouthrinse is a usual finding in early long-term investigations 19, However, short-term studies suggested reduced calculus formation with CHX rinsing 6, Our data showed that initial prophylaxis was important to reduce calculus formation.
Thus, plaque-covered surfaces presented calculus earlier than plaque-free surfaces. These results may be explained by the fact that supragingival calculus is essentially mineralized plaque 8. The process of mineralization and the CHX influence on the process are not fully understood, but involves localized supersaturation, nucleation, crystal growth and the transformation of precursor phases such as dicalcium phosphate dehydrate, octacalcium phosphate and amorphous calcium phosphate into more stable, crystalline deposits of hydroxyapatite The higher tendency to calculus formation in lingual aspects of lower anterior and buccal aspects of upper posterior tooth surfaces may be due to the location of the submandibular and parotid ducts location.
In these areas, the abundant supply of urea from the saliva and the high salivary film velocity tend to promote base formation to plaque and calcium phosphate precipitation 8. Hence, it has been advocated that these locations may be more susceptible to calculus formation because of the low sucrose concentration in saliva with a high saliva film velocity promoting clearance of salivary sugar and acid from plaque, and the higher plaque pH associated to better access to salivary urea However, these results have to be interpreted with care because our criteria for calculus included both stained and non-stained calculus.
Thus, the increased scores could represent the incremental build-up and hardening of stain in the gingival third of the crowns. In the present study a modified tooth stain index was used. Macpherson, et al. The reason to assess calculus in a dichotomous index was to facilitate the assessment in all present teeth due to the most calculus index use only specific teeth and regions. On the other hand, while these calculus indexes allow for quantification of calculus presence, a dichotomous calculus index shows only calculus presence or absence.
However, it did not compromise our results because we aimed at verifying if calculus formation would be present first over plaque-covered surfaces. CHX was selected for the antimicrobial treatment because it is the best characterized and most effective chemical antiplaque agent known today , The concentration selected corresponds to that used clinically for plaque control 0. Moreover, extensive evidence showed similar plaque reduction and gingival inflammation effectiveness when comparing 0.
Franco Neto, et al. It should be emphasized that for some individuals 15 mL is a high amount and might be uncomfortable. However, evidences show that 0. The results of the present study are intriguing and should be interpreted from a clinical perspective. Clinicians prescribe rinsing sometimes without professionally cleaning teeth. This could be a practice that would increase the undesirable side effects.
The initially plaque-covered and plaque-free surfaces presented tooth stain and calculus formation with different magnitude and timing. The clinical relevance of these results is subject to individual interpretation. However, significant differences in calculus formation and staining were found and the clinical impact consists in an indication that it is always desirable to diminish such side effects. Whenever possible, when starting with CHX regimes, plaque should be previously removed in the best achievable way in order to reduce side effects.
The present investigation is independent and was supported by the University and the authors. Abrir menu Brasil. Journal of Applied Oral Science. Abrir menu.
Oral Sci. Chlorhexidine; Adverse effects; Staining; Tooth discoloration; Dental calculus. Inclusion criteria - Age between years; - Male, in order to avoid hormonal influences during the experimental period, especially concerning gingival inflammation; - No relevant medical conditions that could interfere on the periodontal health; - Willingness to comply. Dietary staining in vitro by mouthrinses as a comparative measure of antiseptic activity and predictor of staining in vivo J Dent.
The effect of single morning and evening rinses of chlorhexidine on the development of tooth staining and plaque accumulation. A microbiological study of dental calculus.
The in vitro calcification of microorganisms from dental calculus. J Periodontal Res. Wong L, Sissons CH. Human dental plaque microcosm biofilms: effect of nutrient variation on calcium phosphate deposition and growth. Arch Oral Biol. Relationship between plaque mineralization in vitro and calculus formation in vivo. J Dent Res. Karduck P. Quantitative near-surface microanalysis and depth profiling by EPMA.
Vienna: Mikrochimica Acta. Splinger; ;— Efficacy of adjunctive anti-plaque chemical agents: a systematic review and network meta-analyses of the Turesky modification of the Quigley and Hein plaque index. Chlorhexidine mouthrinse as an adjunctive treatment for gingival health.
Cochrane Database Syst Rev. Schroeder HE, Shanley D. Formation and inhibition of dental calculus. J Periodontol. Magnesium-containing crystals in human dental calculus. J Electron Microsc. A quantitative study of calcium binding by isolated streptococcal cell walls and lipoteichoic acid: comparison with whole cells.
Calcium phosphate deposition in human dental plaque microcosm biofilms induced by a ureolytic pH-rise procedure. Tissue response in the Guinea pig to sterile and non-sterile calculus. Nichols FC, Rojanasomsith K. Porphyromonas gingivalis lipids and diseased dental tissues. Oral Microbiol Immunol. Download references. This work was supported by Grants-in-Aid for Scientific Research grant nos.
You can also search for this author in PubMed Google Scholar. YS and TO established an artificial biofilm model and performed the reaction procedures. YS performed mineral analysis.
ST contributed to the interpretation of data and the statistical analysis. YS and ST wrote the manuscript. YT and YN performed the final review of the manuscript. All authors read and approved the final version of this manuscript. Correspondence to Yuichiro Noiri. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Reprints and Permissions. Sakaue, Y. The effect of chlorhexidine on dental calculus formation: an in vitro study. BMC Oral Health 18, 52 Download citation. Received : 22 June Accepted : 19 March Published : 27 March Anyone you share the following link with will be able to read this content:.
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Skip to main content. Search all BMC articles Search. Download PDF. Abstract Background Chlorhexidine gluconate CHG has been proven to be effective in preventing and controlling biofilm formation.
Results The concentrations of Ca and Pi following a single exposure to CHG increased significantly compared with the control. Conclusions Findings suggested that CHG may promote mineral uptake into the biofilm soon after its use. Background Periodontal diseases are initiated by bacterial biofilms that induce a host inflammatory immune response, which could lead to tooth loss and contribute to systemic inflammation [ 1 ].
Methods Saliva collection and preparation Human saliva that had been stimulated by chewing wax was collected from one healthy male one of the authors who had not consumed food for 2 h prior to donation.
Full size image. Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing. Chlorhexidine may have a bitter aftertaste. Do not rinse your mouth with water immediately after using chlorhexidine, since doing so will increase the bitterness.
Rinsing may also decrease the effect of the medicine. Chlorhexidine may change the way foods taste to you. Sometimes this effect may last up to 4 hours after you use the oral rinse.
In most cases, this effect will become less noticeable as you continue to use the medicine. When you stop using chlorhexidine, your taste should return to normal.
Chlorhexidine may cause staining and an increase in tartar calculus on your teeth. Brushing with a tartar-control toothpaste and flossing your teeth daily may help reduce this tartar build-up and staining.
In addition, you should visit your dentist at least every 6 months to have your teeth cleaned and your gums examined. If you think that a child weighing 22 pounds 10 kilograms or less has swallowed more than 4 ounces of the dental rinse, get emergency help at once. In addition, if a child of any age drinks the dental rinse and has symptoms of alcohol intoxication, such as slurred speech, sleepiness, or a staggering or stumbling walk, get emergency help at once.
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention. Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.
The higher tendency to calculus formation in lingual aspects of lower anterior and buccal aspects of upper posterior tooth surfaces may be due to the location of the submandibular and parotid ducts location. In these areas, the abundant supply of urea from the saliva and the high salivary film velocity tend to promote base formation to plaque and calcium phosphate precipitation 8.
Hence, it has been advocated that these locations may be more susceptible to calculus formation because of the low sucrose concentration in saliva with a high saliva film velocity promoting clearance of salivary sugar and acid from plaque, and the higher plaque pH associated to better access to salivary urea However, these results have to be interpreted with care because our criteria for calculus included both stained and non-stained calculus.
Thus, the increased scores could represent the incremental build-up and hardening of stain in the gingival third of the crowns.
In the present study a modified tooth stain index was used. Macpherson, et al. The reason to assess calculus in a dichotomous index was to facilitate the assessment in all present teeth due to the most calculus index use only specific teeth and regions. On the other hand, while these calculus indexes allow for quantification of calculus presence, a dichotomous calculus index shows only calculus presence or absence.
However, it did not compromise our results because we aimed at verifying if calculus formation would be present first over plaque-covered surfaces. CHX was selected for the antimicrobial treatment because it is the best characterized and most effective chemical antiplaque agent known today 13 - 16 , The concentration selected corresponds to that used clinically for plaque control 0.
Moreover, extensive evidence showed similar plaque reduction and gingival inflammation effectiveness when comparing 0. Franco Neto, et al. It should be emphasized that for some individuals 15 mL is a high amount and might be uncomfortable. However, evidences show that 0.
The results of the present study are intriguing and should be interpreted from a clinical perspective. Clinicians prescribe rinsing sometimes without professionally cleaning teeth. This could be a practice that would increase the undesirable side effects. The initially plaque-covered and plaque-free surfaces presented tooth stain and calculus formation with different magnitude and timing. The clinical relevance of these results is subject to individual interpretation.
However, significant differences in calculus formation and staining were found and the clinical impact consists in an indication that it is always desirable to diminish such side effects. Whenever possible, when starting with CHX regimes, plaque should be previously removed in the best achievable way in order to reduce side effects. The present investigation is independent and was supported by the University and the authors.
National Center for Biotechnology Information , U. J Appl Oral Sci. Author information Article notes Copyright and License information Disclaimer. Copyright notice. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
This article has been cited by other articles in PMC. Abstract Objectives Studies concerning side effects of chlorhexidine as related to the presence of plaque are scarce. Methods This study had a single-blind, randomized, split-mouth, 21 days-experimental gingivitis design, including 20 individuals who abandoned all mechanical plaque control methods during 25 days. Conclusion The presence of plaque increased 0.
Inclusion criteria - Age between years; - Male, in order to avoid hormonal influences during the experimental period, especially concerning gingival inflammation; - No relevant medical conditions that could interfere on the periodontal health; - Willingness to comply. Open in a separate window. Figure 1. Assessment of intraexaminer reproducibility Before starting the trial, multiple sessions of training exercises for clinical parameters were performed.
Figure 2. Blindness On days 11, 18 and 25, the examiner was kept unaware of randomization sequence and blinded to which quadrant was test or control. Statistical analysis Data analysis was performed using commands that take into account clustering of observations within subjects Stata 9.
Figure 3. Figure 4. Table 1 Mean calculus scores on days 0, 11, 18 and Figure 5. Dietary staining in vitro by mouthrinses as a comparative measure of antiseptic activity and predictor of staining in vivo. J Dent. The effect of single morning and evening rinses of chlorhexidine on the development of tooth staining and plaque accumulation. A blind cross-over trial. J Clin Periodontol. Addy M, Moran J. The formation of stain on acrylic surfaces by the interaction of cationic antiseptic mouthwashes and tea.
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