Keywords
xylitol
Streptococcus mutans
dental caries
Abstract
Introduction: Chlorhexidine is considered the most potent chemotherapeutic agent against Streptococcus mutans. However, its side effects due to prolonged use, indicates need for alternatives. The study intended to assess and compare antimicrobial efficacies of probiotic, xylitol and chlorhexidine mouth rinses in children and elderly.
Methods: The study was a Double blind Randomized Controlled Trial conducted among residential school children aged 5- 12 years and elderly greater than 60 years residing in old age homes. (ClinicalTrials.gov ID: NCT04399161). 30 participants each among children and elderly were chosen based on eligibility criterion (high risk for caries). They were further randomly divided into 3 groups with 10 participants in each group. Participants were asked to rinse with 15 ml of freshly prepared mouth rinses once daily for 2 minutes for 14 days. Antimicrobial efficacy was determined by assessing change in Streptococcus mutans levels in dental plaque.
Results: Significant reduction in Streptococcus mutans counts were observed in both children and elderly (Chlorhexidine: mean difference=3.11 log10CFU/g, p=0.022, Xylitol: mean difference=0.93 log10CFU/g, p=0.046, Probiotic: mean difference=1.91 log10CFU/g, p=0.023 in children); (Chlorhexidine: mean difference=2.23 log10CFU/g, p=0.004, Xylitol: mean difference=1.39 log10CFU/g, p=0.009, Probiotic: mean difference=1.61 log10CFU/g, p=0.018 in elderly). Intergroup comparison showed no significant difference.
Conclusions: Antimicrobial efficacy of xylitol and probiotic mouth rinses were comparable to that of chlorhexidine in both children and elderly. Probiotics could potentially be more efficacious than xylitol among children.
References
[2] Barnett ML. The role of therapeutic antimicrobial mouthrinses in clinical practice: control of supragingival plaque and gingivitis. J Am Dent Assoc. 2003;134(6):699-704. doi: 10.14219/jada.archive.2003.0255.
[3] van Rijkom HM, Truin GJ, van’t Hof MA. A meta-analysis of clinical studies on the caries-inhibiting effect of chlorhexidine treatment. J Dent Res. 1996;75(2):790-795. doi: 10.1177/00220345960750020901.
[4] ElSalhy M, Sayed Zahid I, Honkala E. Effects of xylitol mouthrinse on Streptococcus mutans. J Dent. 2012;40(12):1151-1154. doi: 10.1016/j.jdent.2012.08.014.
[5] Harini PM, Anegundi RT. Efficacy of a probiotic and chlorhexidine mouth rinses: A short-term clinical study. J Indian Soc Pedod Prev Dent 2010;28(3):179-182. doi: 10.4103/0970-4388.73799.
[6] Emilson CG. Prevalence of Streptococcus mutans with different colonial morphologies in human plaque and saliva. Scand J Dent Res. 1983;91(1):26-32. doi: 10.1111/j.1600-0722.1983.tb00771.x.
[7] Söderling EM, Ekman TC, Taipale TJ. Growth inhibition of Streptococcus mutans with low xylitol concentrations. Curr Microbiol. 2008;56(4):382-385. doi: 10.1007/s00284-007-9076-6.
[8] Emilson CG. Potential efficacy of chlorhexidine against mutans streptococci and human dental caries. J Dent Res. 1994;73(3):682-691. doi: 10.1177/00220345940730031401.
[9] Yousuf A, Nagaraj A, Ganta S, Sidiq M, Pareek S, Vishnani P, Acharya S, Singh, K. Comparative Evaluation of Commercially Available Freeze Dried Powdered Probiotics on Mutans Streptococci Count: A Randomized, Double Blind, Clinical Study. J Dent (Tehran). 2015;12(10):729-738.
[10] Priyadharshini VI, Ingle NA, Chaly PE, Reddy VC. Effectiveness of probiotic and chlorhexidine mouthrinses on reduction of plaque, gingivitis & mutans streptococci count in saliva-a clinical trial. J Indian Assoc Public Health Dent. 2013;11(1):23-32.
[11] Arunakul M, Thaweboon B, Thaweboon S, Asvanund Y, Charoenchaikorn K. Efficacy of xylitol and fluoride mouthrinses on salivary Mutans streptococci. Asian Pac J Trop Biomed. 2011;1(6):488-490. doi: 10.1016/S2221-1691(11)60106-8.
[12] Najafi MH, Taheri M, Mokhtari MR, Forouzanfar A, Farazi F, Mirzaee M, Ebrahiminik Z, Mehrara R. Comparative study of 0.2% and 0.12% digluconate chlorhexidine mouth rinses on the level of dental staining and gingival indices. Dent Res J (Isfahan). 2012;9(3):305-308.
[13] Gibbons RJ, van Houte J. Dental caries. Annu Rev Med. 1975;26:121-136. doi: 10.1146/annurev.me.26.020175.001005.
[14] Seki M, Karakama F, Terajima T, Ichikawa Y, Ozaki T, Yoshida S, Yamashita Y. Evaluation of mutans streptococci in plaque and saliva: correlation with caries development in preschool children. J Dent. 2003;31(4):283-290. doi: 10.1016/s0300-5712(03)00033-2.
[15] Jindal G, Pandey RK, Agarwal J, Singh M. A comparative evaluation of probiotics on salivary mutans streptococci counts in Indian children. Eur Arch Paediatr Dent. 2011; 12(4):211-215. doi: 10.1007/BF03262809.
[16] Laleman I, Detailleur V, Slot DE, Slomka V, Quirynen M, Teughels W. Probiotics reduce mutans streptococci counts in humans: a systematic review and meta-analysis. Clin Oral Investig. 2014;18(6):1539-1552. doi: 10.1007/s00784-014-1228-z.
[17] Marya CM, Taneja P, Nagpal R, Marya V, Oberoi SS, Arora D. Efficacy of Chlorhexidine, Xylitol, and Chlorhexidine + Xylitol against Dental Plaque, Gingivitis, and Salivary Streptococcus mutans Load: A Randomised Controlled Trial. Oral Health Prev Dent. 2017;15(6):529-536. doi: 10.3290/j.ohpd.a39669.