Effects of hypochlorous acid mouthwash on salivary bacteria including Staphylococcus aureus in patients with periodontal disease: a randomized controlled trial

Ying‑Chu Lin¹ , Cheng‑Feng Tsai^1,2* and Hsiao‑Ling Huang^3*

Abstract

Background The effects of a low concentration of hypochlorous acid (HOCl) mouthwash on salivary bacteria remained unclear. We aimed to evaluate the antibacterial effects of 100 ppm HOCl mouthwash on salivary bacteria, including Staphylococcus aureus (S. aureus), in patients with periodontal disease (PD).

Methods Patients with PD were randomized into mouthwash-only (MW, n=26) and mouthwash with periodon‑tal flosser (MWPF, n=27) groups. Patients without PD were selected for the control group (n=30). S. aureus culture and saliva samples (before and after the intervention) were collected for bacterial DNA extraction. A real-time poly‑ merase chain reaction assay and serial dilutions of S. aureus culture and saliva samples were used to measure the salivary bacteria total count (SBTC) and confirm the antibacterial effects of the mouthwash using S. aureus.

Results No significant difference in demographic data was observed among the three groups. Before the intervention, the baseline SBTC of the MW and MWPF groups was significantly higher than that of the control group. After the mouthwash rinses, the SBTC data significantly changed in the MW and MWPF groups only (by 62.4% and 77.4%, respectively). After the base-2 log-transformation of the SBTC data, a similar trend was observed. Linear regression revealed that baseline SBTC and the MWPF intervention significantly affected SBTC reduction percentage by volume. After incubation with 10% (v/v) of mouthwash, the survival rates of 106 and 107 colony-forming units/mL of S. aureus were 0.51%±0.06% and 1.42%±0.37%, respectively.

Conclusions These study results indicated that 100 ppm HOCl mouthwash treatment could effectively reduce SBTC in patients with PD and the abundance of S. aureus. It provides that the HOCl mouthwash can be an option for individuals to help control SBTC, especially in patients with PD.

Trial registration The study protocol was approved by the Institutional Review Board of Kaohsiung Medical University Hospital (KMUHIRB-F(I)-20200042) on 20/03/2020 and retrospectively registered at ClinicalTrial.gov (NCT05372835) on 13/05/2022.

Keywords Antibacterial ability, Total bacterial count, Hypochlorous acid, Mouthwash, Intervention, Bacterial growth estimation

次氯酸消毒剂在骨科术后切口愈合中的应用：一项实效性随机对照试验

张 燕１，朱 迪１，孙 磊１，王任贤２

（１．徐州仁慈医院感染管理科，江苏 徐州 ２４１００４；２．台湾防疫学会，台湾 台中 ４０４４７）

［摘 要］ 目的 探讨次氯酸应用于外科术后切口愈合及减少术后切口感染的临床效果。方法 纳入某三级甲等医院足踝外科住院患者，按手术时序进行分组：第一阶段（２０２４年１０月１６日—１２月１６日）为对照组，采用４５００～５５００ｍｇ／Ｌ碘伏消毒术后切口；第二阶段（２０２４年１２月１７日—２０２５年２月１７日）为试验组，采用（１１０±１６．５）ｍｇ／Ｌ次氯酸消毒术后切口。术后第１、３、５、７、１０、１４天进行切口消毒、指标评价并记录。主要结局指标为手术部位感染，次要指标包括术后４８ｈ红肿、过敏及疼痛程度评分。结果 对照组感染发病率为０．９６％，术后４８ｈ红肿发生率为１６．９９％，疼痛评分（１．４１±０．４９）分；试验组未发生感染，术后４８ｈ红肿发生率为９．５８％，疼痛评分为（１．３６±０．４８）分。两组感染发病率及疼痛评分差异均无统计学意义（均 犘＞０．０５），红肿发生率差异具有统计学意义（犘＝０．００６）。按切口类型进行分层分析显示，开放性外伤亚组中，对照组感染发病率为３．１９％，红肿发生率为２９．７９％，疼痛评分为（１．６２±０．４９）分；试验组术后４８ｈ红肿发生率为８．１４％，疼痛评分为（１．４１±０．４９）分，两组感染发病率差异无统计学意义（犘＞０．０５），红肿发生率（犘＜０．００１）及疼痛程度评分（犘＝０．００５）差异均有统计学意义。闭合性外伤亚组中，各结局指标组间比较差异均无统计学意义（均犘＞０．０５）。结论 次氯酸溶液在闭合性外伤术后切口应用的效果与碘伏相当；在开放性外伤术后应用中，其控制术后红肿发生及疼痛的效果优于碘伏。

［关 键 词］ 次氯酸；碘伏；骨科；切口愈合；实效性随机对照试验

［中图分类号］ Ｒ１８１．３＋２ Ｒ１８７＋ ．１

Comparison of the preventive effects of slightly acidic HOCl mouthwash and CHX mouthwash for oral diseases.

Yu-Rin Kim¹ , Seoul-Hee Nam^2*

¹Department of Dental Hygiene, Silla University, Busan, Republic of Korea

²Department of Dental Hygiene, College of Health Science, Kangwon National University, Samcheok-si, Republic of Korea

Abstract

The purpose of this study was to compare the preventive effects of the slightly acidic hypochlorous acid (HOCl) mouthwash and chlorhexidine (CHX) mouthwash as a chemical plaque control agent for oral diseases. This study was conducted for 15 patients who had no systemic disease among the patients who visited M Dental Clinic in Busan, South Korea, excluding the patients with incomplete data. The patients were divided into three groups: five patients in the 0.005% CHX (Bukwang Pharm Co., Ltd.) gargling group, five in the slightly acidic HOCl gargling group, and five in the saline gargling group. The patients were instructed to gargle with 15 ml of each mouthwash for 1 minute, and to then spit saliva for 1 min to remove the remaining gargling solution. Then the halitosis, O’Leary index, dental caries activity, bacterial species, and motility were measured. As a result, these decreased in the CHX gargling group compared to the saline gargling group, but the difference was not statistically significant (P>0.005), while there were significant decreases in the HOCl gargling group. The O’Leary index, Snyder test, bacterial motility, and Filamentous more distinctly and effectively decreased in the HOCl gargling group than in the CHX gargling group, showing statistically significant differences (p<0.05). Based on this study, CHX, which is currently widely used in dentistry, can be said to be inconvenient to use due to its strong fragrance and taste, and there have been many reports on the side effects on the oral cavity of its long-term use. Therefore, if HOCl, which is harmless to the human body and has an extensive sterilizing power, is used instead of CHX, safe and effective oral care will be achieved.

Keywords: Dental caries, Periodontal disease, Slightly acidic hypochlorous acid (HOCl), Chlorhexidine (CHX),Bacteria.

Does chlorhexidine and povidone-iodine preoperative antisepsis reduce surgical site infection in cranial neurosurgery?

BM Davies, HC Patel

Greater Manchester Neuroscience Centre, Salford Royal Foundation Trust, UK

ABSTRACT

INTRODUCTION Surgical site infection (SSI) is a significant cause of postoperative morbidity and mortality. Effective preoperative antisepsis is a recognised prophylactic, with commonly used agents including chlorhexidine (CHG) and povidone-iodine (PVI). However, there is emerging evidence to suggest an additional benefit when they are used in combination. METHODS We analysed data from our prospective SSI database on patients undergoing clean cranial neurosurgery between October 2011 and April 2014. We compared the case-mix adjusted odds of developing a SSI in patients undergoing skin preparation with CGH or PVI alone or in combination.

RESULTS SSIs were detected in 2.6% of 1146 cases. Antisepsis with PVI alone was performed in 654 (57%) procedures, while 276 (24%) had CHG alone and 216 (19%) CHG and PVI together. SSIs were associated with longer operating time (p<0.001) and

younger age (p=0.03). Surgery type (p<0.001) and length of operation (p<0.001) were significantly different between antisepsis groups. In a binary logistic regression model, CHG and PVI was associated with a significant reduction in the likelihood of developing an SSI (adjusted odds ratio [AOR] 0.12, 95% confidence interval [CI] 0.02–0.63) than either agent alone. There was no difference in SSI rates between CHG and PVI alone (AOR 0.60, 95% CI 0.24–1.5).

CONCLUSIONS Combination skin preparation with CHG and PVI significantly reduced SSI rates compared to CHG or PVI alone. A prospective, randomized study validating these findings is now warranted.

KEYWORDS

Antisepsis – Chlorhexidine – Neurosurgery – Povidone-iodine – Surgical wound infection

Comparative evaluation of efficacy of 0.2% sodium hypochlorite (Hi Wash) mouthwash with 0.2% chlorhexidine mouthwash on plaque‑induced gingivitis: A clinical trial

Rohit Mishra, Kabbur Thippanna Chandrashekar, Vandana Dubey Tripathi, Anushree Hazari, Blessy Shin Sabu, Anurag Sahu

Abstract:

Background: Bleeding gums are one of the common complaints to visit a dentist. Mechanical removal of plaque alone is not sufficient for the reduction of gingival inflammation associated with plaque. Mouthwashes are supplemented to it as a homecare product. The objective of this study is to evaluate the efficacy of 0.2% sodium hypochlorite mouthwash on plaque and gingival inflammation and to assess the clinical parameters of gingivitis patients from baseline to 21 days with the use of 0.2% sodium hypochlorite and 0.2% chlorhexidine mouthwashes.

Materials and Methods: This clinical trial study included 60 patients with gingival inflammation evaluated using clinical parameters such as bleeding on probing index, plaque index, and gingival index at baseline and 21 days. Group A patients were given Hi Wash mouthwash and Group B 0.2% chlorhexidine mouthwash with 30 patients in each group. Results: The scores for clinical parameters were significantly reduced after 21 days in Group A and Group B patients, and there was a reduction in plaque‑associated gingival inflammation without scaling and root planning.

Conclusions: 0.2% sodium hypochlorite mouthwash is as effective as 0.2% chlorhexidine for the treatment of gingivitis as it is an adjunct to mechanical plaque removal in terms of safety, less side effects, less staining and can be used as a routine mouthwash.

Key words:

0. 2% sodium hypochlorite, 0.2% chlorhexidine, gingivitis

Hydrogen-rich electrolyzed water is a useful mouthwash due to its biofilm-control properties: an in vitro and in vivo study

Ha-Young Youn^1,*, Ji-Hye Kim^1,*, Min-Jeong Cho¹ , Su-Hyung Hong² , Eun-Kyong Kim¹

¹ Department of Preventive Dentistry, School of Dentistry, Kyungpook National University, Daegu, Korea

² Department of Oral Microbiology and Immunology, School of Dentistry, Kyungpook National University, Daegu, Korea

Background: Previous studies have demonstrated the inhibitory effect of hydrogen-rich water on biofilm formation. However, hydrogen-rich electrolyzed water (HEW) has not been evaluated as mouthwash, despite being economical, convenient, and biologically safe. We assessed the antibiofilm effects of HEW on Streptococcus mutans and its potential as a mouthwash.

Methods: The effect of HEW on S. mutans growth was assessed by measuring bacterial colony-forming units, and biofilm formation capacity was examined by crystal violet staining after culturing on a polystyrene plate. The effect of HEW on biofilm formation-related gene expression in S. mutans was assessed by real-time polymerase chain reaction. Finally, the effect of HEW on salivary S. mutans and plaque maturation was evaluated in 24 participants; after gargling with HEW twice daily, the salivary S. mutans count was quantified using a Caries Risk Test bacteria kit (Ivoclar Vivadent AG), and plaque maturation was compared using quantitative light-induced fluorescence imaging.

Results: Exposure to HEW resulted in no significant changes in S. mutans growth but a significant reduction in biofilm formation in vitro (p<0.001). Furthermore, the gene expression of glucosyltransferases (gtfB, gtfC) was significantly lower than that in the control group treated with tap water (p<0.05, p<0.01). S. mutans counts and plaque maturation were significantly lower in participants who gargled with HEW than in those who gargled with tap water (p<0.01).

Conclusion: Our data suggest that oral rinsing with HEW exerts antibiofilm effects on S. mutans, indicating that it can be used as a mouthwash to treat dental biofilm-dependent diseases.

Keywords: Biofilms; Dental caries; Electrolysis; Hydrogen; Mouthwashes