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ISSN 0970-4388

A Clinical Assessment Of The Effectiveness Of Mouthwashes InComparison To ToothBrushing In Children

SHARMA Ua, JAIN R L

b, PATHAK A

C.

ABSTRACT

The study compared the efficacy of unsupervised tooth-brushing

done once a day before breakfast (phase 1), with twice daily mouth-

rinsing with the three different commercially available

mouthwashes containing 0.2% sodium fluoride (phase 2), a

combination of 0.03% triclosan and 0.05% sodium fluoride (phase

3), and 0.2% chlorhexidine (phase 4) in 20 children aged 13-14

year, in reducing dental plaque formation. The results showed that

there was a statistically significant difference in plaque reduction

between phases 1 & 2 ; 1 & 3 ; 2 & 4 and 3 & 4. The mandibular

arch harboured more plaque than the maxillary arch in phase 1

(p

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A Clinical Assessment of Mouthwashes Vs ToothBrushing

3rd molars); normal occlusion; absence of caries and / or

restorations on the facial, lingual and proximal surfaces and a

healthy state of periodontium. 0.075% solution of Basic

Fuchsin was used as a disclosing solution to disclose dental

plaque. Ten ml of this solution was given to each participant

to rinse for twenty seconds followed by two plain water rinses.

All the participants were provided with an identical 'Plak-off 4'

tooth brush and an identical non-fluoridated dentifrice

(Colgate Dental Cream). The three mouthwashes used in the

study were; 0.2% sodium fluoride (S-flo); 0.03% triclosan and

0.05% sodium fluoride (Junior A.M.-P.M.) and 0.2%

chlorhexidine gluconate (Clohex). The study was carried out

in four phases with each phase lasting for eight days.

Phase 1 : Tooth brushing done once a day, in the morning

before breakfast. This phase was unsupervised and

undirected.

Phase 2 : Mouth rinsing with 10ml of S-flo mouthwash twice

daily, after breakfast and after dinner, for 1 minute.

Phase 3 : Mouth rinsing with 10 ml of Junior A.M.-P.M. twice

daily, after breakfast and after dinner, for 1 minute.

Phase 4 : Mouth rinsing with 10 ml of Clohex mouthwash

twice daily after breakfast and after dinner for 1 minute.

The subjects were told to refrain from all other oral hygiene

measures except the directed ones and to avoid eating or

drinking for at least thirty minutes after using the mouthwash.

At the start of each phase, the plaque score of all the subjects

was brought to zero with a thorough dental prophylaxis, the

result of which was checked by staining 0.075% of Basic

Fuchsin. The Dental plaque scoring was performed daily in

the morning for seven days in each phase. Teeth selected for

plaque scoring were as directed by Ramfjord.5

For recording plaque, Turesky - Gilmore - Glickman modificati

on6

of the Quigley-Hein index further modified by Riar, D.S.

and Gill, A.S.7

was employed. Each tooth was assigned two

scores; one on the facial and one on the palatal / ligual

aspect. The results were compiled, tabulated and the

recorded data was analysed statistically using the students

't' test for the paired value and ANOVA for the whole group.

RESULTS

PLAQUE SCORES IN PHASE 1

The mean cumulative plaque score in the maxillary arch was

1.97 + 0.35 and in the mandibular arch was 2.48 0.39. The

mean cumulative plaque scores on the facial and palatal

surfaces of the maxillary arch were 2.17 0.55 and 1.77 +

0.34 respectively. The mean cumulative plaque scores on the

facial and lingual surfaces of the mandibular arch were 2.03 +

0.38 and 2.92 + 0.48 respectively. On the facial and lingual/

palatal surface, the mean cumulative plaque scores were

2.10 + 0.34 and 2.34 + 0.34 respectively (p>0.05) as shown

in Table 1, Figure 1.

PLAQUE SCORES IN PHASE 2

The mean cumulative plaque score in the maxillary arch was

3.36 0.42 and in the mandibular arch was 3.78 + 0.42. The

mean cumulative plaque scores on the facial and palatal

surfaces of the maxillary arch were 4.80 + 0.49 and 2.47 +

0.37 respectively. The mean cumulative plaque scores on the

facial and lingual surfaces of the mandibular arch were 4.43

0.57 and 3.13 + 0.49 respectively. On the facial and lingual /

palatal surfaces, the mean cumulative plaque scores were4.62 0.46 and 2.80 0.37 respectively (p

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A Clinical Assessment of Mouthwashes Vs Toothbrushing

2. The comparison between the mean cumulative plaque

scores of the facial and the lingual / palatal surfaces in phase

2,3 and 4 was found to be statistically significant (p

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*significant, **not significant

Phase 1 : Toothbrushing done, once a day, before breakfast.

Phase2 : Mouthwash used: 0.2% sodium fluoride

Phase3 : Mouthwash used: 0.03% triclosan & 0.05% sodium fluoride

Phase4 : Mouthwash used: 0.2% chlorhexidine gluconate

Table 2 : Interphasic Comparison of the Mean Cumulative Plaque Scores in different Phases

chlorhexidine turned out to be the most effective antiplaque

agent. It was more effective than the combination mouthwash

containing 0.03% triclosan and 0.05% sodium fluoride

(p

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Fig. 1 : Comparison of the difference in the mean cumulative plaque scores on the facial and the lingual /

palatal surfaces in all the phases.


Phase 2 : Mouthwash used: S-flo

Phase 3 : Mouthwash used: Junior AM.-P.M.

Phase 4 : Mouthwash used: Clohex

specific areas of the mouth.210

The results in the present study indicated that the

unsupervised mechanical method of plaque control had a

lesser efficacy as compared to 0.2% chlorhexidine

mouthwash though it was statistically non-significant

(p

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MEAN CUMULATIVE PLAQUE SCORES

Fig. 2 : Comparison of the difference in the interphasic cumulative mean plaque scores.


Phase 2 : Mouthwash used: S-flo

Phase 3 : Mouthwash used: Junior A.M.-P.M.

Phase 4 : Mouthwash used: Clohex

the tongue.4

Since natural cleansing of dentogingival areas of the human

dentition is insufficient, plaque control can be achieved

through active plaque removal at regular intervals. Both

mechanical and chemical means of plaque removal require

considerable skill and individualized training. No single

method or technique is universally acceptable. The chemical

agents for plaque inhibition are more useful for sites that

receive little attention during tooth-brushing e.g.lingual and

palatal surface. The ultimate aim of plaque control must

ideally be the discovery of a totally effective chemical agent

which could be used as a replacement to mechanical

methods of plaque removal. In this study, 0.2% chlorhexidine

proved to be the best antiplaque agent but on account of

certain local side-effects encountered during the study like

extrinsic brownish-black staining of the teeth and taste

disturbance, it can be concluded that this mouthwash is a

valuable adjunct to tooth brushing and not a replacement.

The study should be further evaluated in more long- term trials

and on a larger sample.

It can therefore, be concluded from this study that 0.2%

chlorhexidine is the most effective antiplaque agent. This agent

however, dose not replace the mechanical methods of plaque

control but has proven to be an adjunct in controlling plaque.

It is apparent that mechanical mode of plaque removal,

particularly the toothbrush, despite limitations is still the

most effective method of preventing and controlling dental

diseases.

REFERENCES

1. Carranza F.A. Jr.: Glickman's Clinical Periodontology, 7th /

Asian ed, W.B.Saunders, 1990 : 342 - 372, 684 - 711.

J Indian Soc Pedo Prey Dent June (2004) 22 (2) 43

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2. Binney A., Addy M. and Robert G.: The plaque removal effects

of single rinsings and brushings. J Periodontol 1993 ; 64 :

181 - 185.

3. Rolla G. and Melsen B.: On the mechanism of plaque

inhibition by chlorhexidine. J Dent Res (Spec Issue) 1975 ;

54 : B57 - B62.

4. Grant, Daniel A., Stern, Irring B., Everett and Frank G.:

Periodonticsin the tradition of Orban and Gottleib 1979 ; 5th

edition: 130 -151 .

5. Ramfjord S.P.: Indices for prevalence and incidence of

periodontal diseases. J Periodontol 1959 ; 30 : 51.

6. Turesky S., Gilmore N.D. and Gilckman I.: Reduced plaque

formaion by the chloromethyl analogue of vitamin C.J

Periodontol 1970 ; 41 : 41.

7. Riar. D.S. and Gill A.S.: Modified plaque index developed by

modification of indices employed by Quigley & Hein and Elliot.

Quoted from Chadha A.D.; M.D.S. Thesis, Pbi. Unmv., 1994.

8. Guteress T.W.: Periodontal health and periodontal disease in

young people : global epidemiology. Int Dent J 1986 ; 36 :146

- 151.

9. Jenkins S., Addy M. and Newcombe R.G.: Dose response of

Chlorhexidine against plaque and comprison with triclosan.

J Clin Periodontol 1994 ;21 : 250 - 255.

10. Kleber C.J., Putt M.S. and Muhler J.C.: Duration and pattern of

tooth brushing in childern using a gel or paste dentifrice. J Am

Dent Assoc 1981 ; 103 : 723 - 726.

Reprint Requests to :

Dr. Urvashi Sharma

433, Sector 37 - A,

Chandigarh - 160036

INDIA

J Indian Soc Pedo Prev Dent June (2004) 22 (2) 44

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