Periodontal disease and caries are the most prevalent infectious oral diseases in human, where both are associated with dental plaque. The removal of plaque is the main key of prevention and the first step in treatment of periodontal disease and one of which is through chemical agents.
Chlorhexidine (CHX) as a gold standard appears to be the most effective antimicrobial agent for reduction of both plaque and gingivitis. Its effectiveness can be attributed to it bactericidal and bacteriostatic effects within the oral cavity (8 h after rinsing).
However, the adverse-effects of CHX limit the long-term use of this antiseptic agent and include taste alteration, excess formation of supragingival calculus, soft-tissue lesions in young patients, allergic responses, and staining of teeth and soft tissues.
Chlorhexidine is available in concentrations between 0.1% to 0.2%. Studies are somewhat contradicting because it was shown that plaque inhibition by chlorhexidine is dose dependant and other studies reported that both concentrations are equally effective.
The aim of this study was to compare the efficacy of two concentrations of chlorhexidine solutions (0.12% and 0.20%) on gingival indices and the level of dental staining during 14 days.
Materials and Methods
A randomized, cross-over, double blind design was chosen in order to generate the best possible evidence. 60 patients aged 17–56 years with history and existing gingivitis and bleeding on probing were randomly selected from whom referred to Periodontology Department of Dental Clinic of Mashad University. Patients with attachment loss or bone loss, history of periodontitis, use of medicines that may cause gingival overgrowth, pregnant, drug addicted, r any systemic condition that could negatively influence oral health have been excluded from the study. Plaque Index, Gingival Index, Bleeding Index, Stain Index were the parameters used to examine each patient before and after the study.
Each patient was handed out coded bottles of CHX 0.12%, 0.20% and placebo. Patients were asked to rinse their mouthwash twice daily after brushing for 2 weeks.
In the day 14 all the mentioned clinical parameters were re-assessed by one trained experienced examiner under standard dental office and light source conditions.
The mean difference of Plaque index and gingival index before and after the examination period for both groups rinsed CHX (0.2% or 0.12%) was statistically higher than the placebo group. However, no statistically significant differences were observed between both chlorhexidine concentration regimes.
For gingival bleeding index, the mean difference of the group that rinsed 0.2% CHX was 24.157 that is significantly higher than 0.12% CHX group (13.672) and placebo group (0.020)
Results showed that after 14 days taking CHX the dental staining area and intensity increased significantly in comparison with the placebo group). Significance difference was seen between 2 CHX concentration so that the 0.2% CHX caused much more staining on the teeth than 0.12% CHX
In this study, there were found no significant differences between 0.2% and 0.12% CHX mouth rinses in term of PI and GI that is similar to the results of previous studies. GBI was also found to be decreased significantly more by CHX 0.2% than 0.12% CHX. In term of dental staining index, lower concentrations of CHX induce significantly less dental staining
Based on the results of this study, we can conclude that the lower concentrations of CHX should be prescribed, decreasing side effects, since higher concentrations do not seem to be more effective in controlling dental plaque and gingivitis.
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