International Journal of Clinical Pediatric Dentistry

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VOLUME 15 , ISSUE 3 ( May-June, 2022 ) > List of Articles


Comparative Evaluation of the Efficacy of Chlorhexidine, Fluoride and the Combined Use of Chlorhexidine and Fluoride Varnishes on Salivary Streptococcus mutans Count in Children with Mixed Dentition: An In Vivo Study

Vanita P More, Shivayogi M Hugar, Suma Sogi, Rohan S Bhambar, M Suganya, Shweta Hugar

Keywords : Chlorhexidine varnish, Fluoride varnish, Mixed dentition, S. mutans

Citation Information : More VP, Hugar SM, Sogi S, Bhambar RS, Suganya M, Hugar S. Comparative Evaluation of the Efficacy of Chlorhexidine, Fluoride and the Combined Use of Chlorhexidine and Fluoride Varnishes on Salivary Streptococcus mutans Count in Children with Mixed Dentition: An In Vivo Study. Int J Clin Pediatr Dent 2022; 15 (3):267-272.

DOI: 10.5005/jp-journals-10005-2360

License: CC BY-NC 4.0

Published Online: 30-06-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Aim: To study the effect of combination of chlorhexidine and Fluoride on the growth and colonization of cariogenic bacteria (Streptococcus mutans) in children with mixed dentition. Materials and methods: Sixty children of age 6–14 years with mixed dentition and S. mutans count > 1 x 105 CFU/mL of saliva were divided: group I–chlorhexidine varnish; group II–Fluoride varnish; group III–Combination of chlorhexidine and Fluoride varnish. chlorhexidine and Fluoride varnishes were applied to teeth once every week for four consecutive weeks in respective groups. Salivary S. mutans count was estimated and evaluated at baseline, 1, 3, and 6 months. Results: No significant difference was seen in group I and II at the end of 1, 3, and 6 months (p > 0.001) but the reduction in S. mutans count was statistically more significant in group III after a period of 6 months (p < 0.001). Maximum reduction in count was noted in group III at all intervals of varnish application. Conclusion: The concomitant use of chlorhexidine and fluoride varnish would prove to be more effective than individual components over a longer period of time and especially in high caries risk children.

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  1. National Oral Health Survey and fluoride mapping 2002–2003. Dental Council of India, New Delhi 2004.
  2. Hardman MC, Davies GM, Duxbury JT, et al. A cluster randomized controlled trial to evaluate the effectiveness of fluoride varnish as a public health measure to reduce caries in children. Caries Res 2007;41(5):371–376. DOI: 10.1159/000104795
  3. Loesche W J. Role of Streptococcus mutans in human dental decay. Microbiol Rev 1986;50(4):353–380. DOI: 10.1128/mr.50.4.353-380.1986
  4. Nissen LC, Douglass CW. Theoretical considerations in applying cost-benefit and cost effective analyses to preventive dental programs. J Public Health Dent 1984;44(4):156–168. DOI: 10.1111/j.1752-7325.1984.tb03077.x
  5. Emilson CG. Potential efficacy of chlorhexidine against mutans streptococci and human dental caries. J Dent Res 1994;73:682–691. DOI: 10.1177/00220345940730031401
  6. Löe H, Schiott CR. The effect of mouthrinses and topical application of chlorhexidine on the development of dental plaque and gingivitis in man. J Periodontal Res 5(2):79–83. DOI: 10.1111/j.1600-0765.1970.tb00696.x
  7. Bratthall D, Serinirach R, Rapisuwon S, et al. A study into the prevention of fissure caries using an antimicrobial varnish. Int Dent J 1995;45(4):245–254.
  8. Petersson LG, Magnusson K, Andersson H, et al. Effect of semiannual applications of a chlorhexidine/fluoride varnish mixture on approximal caries incidence in school children. A three year radiographic study. Eur J Oral Sci 1998; 106(2):623–627. DOI: 10.1046/j.0909-8836.1998.eos106203.x
  9. Luoma H, Murtomma H, Nuuja T, et al. A simultaneous reduction of caries and gingivitis in a group of schoolchildren receiving chlorhexidine-fluoride applications. Results after 2 years. Caries Res 1978;12(5):290–298. DOI: 10.1159/000260347
  10. Ullsfoss BN, Ogaard B, Arends J, et al. Effect of a combined chlorhexidine and NaF mouthrinse: an in vivo human caries model study. Scan J Dent Res 1994;102(2):109–111. DOI: 10.1111/j.1600-0722.1994.tb01164.x
  11. Kulkarni VV, Damle SG. Comparative evaluation of efficacy of sodium fluoride, chlorhexidine and triclosan mouth rinses in reducing the mutans streptococci count in saliva: an in vivo study. J Indian SocPedoPrev Dent 2003; 12(3):98–104.
  12. Subramaniam P, Naidu P. Effect of Tooth Mousse plus Cervitec gel on S. mutans. J of Minim Interv Dent 2009;2(3):164–168.
  13. Anna GA, Cristiane TR, Beatriz GN, et al. The use of chlorhexidine varnishes in children: what is out there? Int J Dent 2010;9(3):142–147.
  14. Beltrán-Aguilar ED, Goldstein JW, Lockwood SA. Fluoride varnishes: a review of their clinical use, cariostatic mechanism, efficacy and safety. J Am Dent Assoc 2000;131(5):589–596. DOI: 10.14219/jada.archive.2000.0232
  15. Balanyk TE, Sandham HJ. Development of sustained release antimicrobial dental varnishes effective against Streptococcus mutans in vitro. J Dent Res 1985;64(12):1356–1360. DOI: 10.1177/00220345850640120501
  16. George AM, Kalangi SK, Vasudevan M, et al. Chlorhexidine varnishes effectively inhibit porphyromonas gingivalis and streptococcus mutans- an in vivo study. J Indian Soc Periodontol 2010;14(3):178–180. DOI: 10.4103/0972-124x.75913
  17. Messer LB. Assessing caries risk in children. Austral Dent J 2000;45(1):10–16. DOI: 10.1111/j.1834-7819.2000.tb00235.x
  18. Van Houte J. Role of micro-organisms in caries etiology. J Dent Res 1994;73(3):672–681. DOI: 10.1177/00220345940730031301
  19. Pienihäkkinen K, Söderling E, Ostela I, et al. Comparison of the efficacy of 40% chlorhexidine varnish and 1% chlorhexidine-fluoride gel in decreasing the level of salivary mutans streptococci. Caries Res 1995;29(1):62–67. DOI: 10.1159/000262042
  20. Johnson G, Almqvist H. Non-invasive management of superficial root caries lesions in disabled and infirm patients. Gerodontology 2003;20(1):12–14. DOI: 10.1111/j.1741-2358.2003.00009.x
  21. Jabbarifar SE, Tabibian SA, Poursina. Effect of fluoride mouth rinse and tooth paste on number of streptococcal colony forming units of dental plaque. J Res Medical Sciences 2005;10(6):363–367.
  22. Nolte WA. Oral Microbiology: With basic microbiology and immunology. 4th edition. Mosby; 1982.
  23. Makarem A, Jahanian F, KhajehKaramodine M. Evaluation of effect of sodium fluoride tablet on level of streptococcal dental plaque. Mashhad Dental Journal 59. 1996;61.
  24. Zickert I, Emilson CG, Ekblom K, et al. Prolonged oral reduction of Streptococcus mutans in humans after chlorhexidine disinfection followed by fluoride treatment. Scand J Dent Res 1987;95(4):315–319. DOI: 10.1111/j.1600-0722.1987.tb01847.x
  25. Muerman JH. Ultrastructure, growth, and adherence of streptococcus mutans after treatment with chlorhexidine and fluoride. Caries Res 1988;22(5):283–287. DOI: 10.1159/000261122
  26. Ekenback SB, Lindver LE, Lonnies Effect of four dental varnishes on the colonization of cariogenic bacterias on exposed sound root surfacesH. Caries Res 2000;34(1):70–74. DOI: 10.1159/000016572
  27. Spets-Happonen S, Luoma H, Forss H, et al. Effects of a chlorhexidine-fluoride-strontium rinsing program on caries, gingivitis and some salivary bacteria among Finnish school children. Scan J Dent Res 1991;99(2):130–138. DOI: 10.1111/j.1600-0722.1991.tb01875.x
  28. Petersson LG, Magnusson K, Andersson H, et al. Effect of quarterly treatments with a chlorhexidine and a fluoride varnish on approximal caries in caries-susceptible teenagers: a 3 year clinical study. Caries Res 2000;34(2):140–143. DOI: 10.1159/000016581
  29. Katz S. The use of fluoride and chlorhexidine for the prevention of radiation caries. J Am Dent Assoc 1982; 104(2):164–170. DOI: 10.14219/jada.archive.1982.0016
  30. Ogaard B, Larsson E, Henriksson T, et al. Effects of combined application of antimicrobial and fluoride varnishes in orthodontic patients. Am J Orthod Dentofacial Orthop 2001;120(1):28–35. DOI: 10.1067/mod.2001.114644
  31. Gary RR. Effectiveness of methods used by dental professionals for the primary prevention of dental caries. J Dent Edu 2001;65(10): 1063–1072. DOI:
  32. Eronat C, Alpoz AR. Effect of Cervitec on the salivary S. mutans levels in patients with fixed orthodontic appliances. J Marmara Univ Dent Fac 1997;2(4):605–608.
  33. Attin R, Thon C, Schlagenhauf U, et al. Recolonisation of mutans streptococci on teeth with orthodontic appliances after antimicrobial therapy. Eur J Orthodont 2005;27(5):489–493. DOI: 10.1093/ejo/cji018
  34. Schaeken MJ, De Jong, Franklin M. Effect of chlorhexidine Iodine on the composition of human dental plaque. Caries Res 1984;18(5):401–407. DOI: 10.1159/000260794
  35. Bretz WA, Valente MI, Djahjah C, et al. Chlorhexidine varnishes prevent gingivitis in adolescents. J Dent Children 2000;67(6):399–402, 374.
  36. Svanberg M. Contamination of toothpaste and toothbrush by Streptococcus mutans. Scand J Dent Res 1978;86(5):412–414. DOI: 10.1111/j.1600-0722.1978.tb00646.x
  37. Anusavice KJ. Chlorhexidine, fluoride varnish, and xylitol chewing gum: underutilized preventive therapies? Gen Dent 1998;46(1):34–38.
  38. Achong RA, Briskle DM, Hildebrandt GH, et al. Effect of chlorhexidine varnish mouthguards on the levels of selected oral micro organisms in pediatric patients. Pediatr Dent 1999;21(3):169–175.
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