Comparative evaluation of 0.2% Chlorhexidine Mouthwash, Xylitol Chewing Gum, and Combination of 0.2% Chlorhexidine Mouthwash and Xylitol Chewing Gum on Salivary Streptococcus mutans and Biofilm Levels in 8- to 12-Year-Old Children
Citation Information :
Syed M, Shrivastava V. Comparative evaluation of 0.2% Chlorhexidine Mouthwash, Xylitol Chewing Gum, and Combination of 0.2% Chlorhexidine Mouthwash and Xylitol Chewing Gum on Salivary Streptococcus mutans and Biofilm Levels in 8- to 12-Year-Old Children. Int J Clin Pediatr Dent 2016; 9 (4):313-319.
Aim: To assess the effect of combining 0.2% chlorhexidine (CHX) mouthwash with xylitol (XYL) chewing gum on Streptococcus mutans and biofilm levels among 8- to 12-year-old children.
Materials and methods: Sixty children aged 8 to 12 years were selected with moderate and high salivary S. mutans levels. They were divided into three groups of 20 children each: (1) XYL group where the subjects chewed XYL twice daily; (2) CHX where rinsing was done twice daily; and (3) combination of XYL and CHX group (XYL+CHX) where both the agents were used once daily. The S. mutans colony-forming units (CFUs) were counted by using the mitis salivarius agar plate at the beginning of the study and at 15 days, 1, 2, and 6 months from the start of the study.
Results: The XYL+CHX group showed the maximum reduction in both the biofilm and S. mutans scores throughout the study period.
Conclusion: The XYL+CHX combination reduced both the biofilm and S. mutans score significantly better than either XYL chewing gums or CHX mouthwash used alone.
How to cite this article: Syed M, Chopra R, Shrivastava V, Sachdev V. Comparative evaluation of 0.2% Chlorhexidine Mouthwash, Xylitol Chewing Gum, and Combination of 0.2% Chlorhexidine Mouthwash and Xylitol Chewing Gum on Salivary Streptococcus mutans and Biofilm Levels in 8- to 12-Year-Old Children. Int J Clin Pediatr Dent 2016;9(4):313-319.
Shafer, WG; Maynard, KH; Barnet MLA. Text book of oral pathology. 4th ed. Philadelphia: W.B Sunders Company; 1993.
Bowden, GHW. Which bacteria are cariogenic in man in markers of high and low risk groups and individuals for Dental Caries. Johnson, NW), editor. Cambridge: Cambridge University Press; 1991. pp. 266-286.
Banas JA, Miller JD, Fuschino ME, Hazlett KR, Toyofuku W, Porter KA, Reutzel SB, Florczyk MA, McDonough KA, Michalek SM. Evidence that accumulation of mutants in a biofilm reflects natural selection rather than stress-induced adaptive mutation. Appl Environ Microbiol 2007 Jan;73(1):357-361.
American Dental Association Council on Dental Therapeutics. Guidelines for acceptance of chemotherapeutic products for the control of supragingival dental plaque and gingivitis. J Am Dent Assoc 1986;11(2):529-532.
Hennessey TD. Some antibacterial properties of chlorhexidine. J Periodont Res (Suppl) 1973 Dec;12:61-67.
Burt BA. The use of sorbitol and xylitol sweetened chewing gum in caries control. J Am Dent Assoc 2006 Feb;137(2):190-196.
Söderling E, Isokangas P, Pienihakkinen K, Tenovuo J, Alanen P. Influence of maternal xylitol consumption on mother-child transmission of mutans streptococci: 6-year follow-up. Caries Res 2001 May-Jun;35(3):173-177.
Assev S, Stig S, Scheie AA. Cariogenic traits in xylitol-resistant and xylitol-sensitive mutans streptococci. Oral Microbiol Immunol 2002 Apr;17(2):95-99.
Wennerholm K, Arends J, Birkhed D, Ruben J, Emilson CG, Dijkman AG. Effect of xylitol and sorbitol in chewing-gums on mutans streptococci, plaque pH and mineral loss of enamel. Caries Res 1994 Jan-Feb;28(1):48-54.
Ly KA, Milgrom P, Rothen M. Xylitol, sweetners and dental caries. Pediatr Dent 2006 Mar-Apr;28(2):154-163.
Ly KA, Milgrom P., Rothen M. The potential of dental-protective chewing gum in oral health interventions. J Am Dent Assoc 2008 May;139(5):553-563.
Makinen KK, Alanen P, Isokangas P, Isotupa K, Soderling E, Makinen PL, Wenhui W, Weijian W, Xiaochi C, Yi W, et al. Thirty-nine-month xylitol chewing-gum programme in initially 8-year-old school children: a feasibility study focusing on mutans streptococci and lactobacilli. Int Dent J 2008 Feb;58(1):41-50.
Tanzer JM, Thompson AS, Wen ZT, Burne R. So called xylitol resistance is associated with partial loss of cariogenicity of Streptococcus mutans. J Dent Res 2006 Apr;85(4):369-373.
Lif Holgerson P, Stecksen-Blicks C, Sjostrom I, Twetman S. Effect of xylitol-containing chewing gums on interdental plaque-pH in habitual xylitol consumers. Acta Odontol Scand 2005 Aug;63(4):233-238.
Holgerson PL, Sjostrom I, Twetman S. Decreased salivary uptake of [14C]-xylitol after a four-week xylitol chewing gum regimen. Oral Health Prev Dent 2007;5(4):313-319.
Kimmel L, Tinanoff N. A modified mitis salivarius medium for caries diagnostic test. Oral Microbiol Immunol 1991 Oct;6(5):275-279.
Ribeiro A, Souza IP. Relacao entre biofilme, atividade de carie e gengivite em criancas HIV+ Pesqui. Odontol Bras 2002 Apr-Jun;16(2):15-22.
Thaweboon S, Nakornchai S, Miyake Y, Yanagisawa T, Thaweboon B, Soo-Ampon S, Lexomboon D. Remineralization of enamel subsurface lesions by xylitol chewing gum containing funoran and calcium hydrogenphosphate. Southeast Asian J Trop Med Public Health 2009 Mar;40(2):345-353.
Thystrup A, Fejerskov O. Textbook of clinical cariology. 2nd ed. Copenhagen, Denmark: Munksgaard; 1994. p. 333-353.
Schiott CR. Effect of chlorhexidine on microflora of oral cavity. J Periodont Res 1973;8:7-10.
Järvinen H, Tenovuo J, Huovinen P. In vitro susceptibility of Streptococcus mutans to chlorhexidine and six other antimicrobial agents. Antimicrob Agents Chemother 1993 May;37(5): 1158-1159.
Clark DC, Guest JL. The effectiveness of three different strength of chlorhexidine mouth rinse. J Cand Assoc 1994 Aug;60(8): 711-714.
Wan AK, Seow WK, Purdie DM, Bird PS, Walsh LJ, Tudehope DI. The effects of chlorhexidine gel on Streptococcus mutans infection in 10-month-old infants: a longitudinal, placebo-controlled, double-blind trial. Pediatr Dent 2003 May-Jun;25(3):215-222.
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 Soc Pedo Prev Dent 2003 Sep;21 (3):98-104.
Köhler B, Andrèen I, Jonsson B. The earlier the colonization by mutans streptococci, the higher the caries prevalence at 4 years of age. Oral Microbiol Immunol 1988 Mar;3(1):14-17.
Zickert I, Emilson CG, Krasse B. Effect of caries preventive measures in children highly infected with the bacterium Streptococcus mutans. Arch Oral Biol 1982;27(10):861-868.
Deshpande A, Jadad AR. The impact of polyol-containing chewing gums on dental caries. A systematic review of original randomized controlled trials and observational studies. J Am Dent Assoc 2008 Dec;139(12):1602-1614.
Mäkinen KK, Isotupa KP, Mäkinen P-L, Söderling E, Song KB, Nam SH, et al. Six-month polyol chewing-gum programme in kindergarten-age children: a feasibility study focusing on mutans streptococci and dental plaque. Int Dent J 2005;55:81-88.
Milgrom P, Ly KA, Roberts MC, Rothen M, Mueller G, Yamaguchi DK. Mutans streptococci dose response to xylitol chewing gum. J 2005; Dent Res 85:177-181.
Haresaku S, Hanioka T, Tsutsui A, Yamamoto M, Chou T, Gunjishima Y. Long-term effect of xylitol gum use on mutans streptococci in adults. Caries Res 2007;41:198-203.
Mäkinen KK, Söderling E, Isokangas P, Tenovuo J, Tiekso J. Oral biochemical status and depression of Streptococcus mutans in children during 24- to 36-month use of xylitol chewing gum. Caries Res 1989;23:261-267.
Söderling EM. Xylitol, mutans streptococci and dental plaque. Adv Dent Res 2009;21(1):74-78.
Simões Moraes R, Modesto A, Regina NDSK, Drake D. The effect of 1% chlorhexidine varnish and 40% xylitol solution on Streptococcus mutans and plaque accumulation in children. Pediatr Dent 2011 Nov-Dec;33(7):484-490.
Hildebrandt G, Lee I, Hodges J. Oral mutans streptococci levels following use of a xylitol mouth rinse; a double-blind, randomized controlled clinical trial. Spec Care Dent 2010 Mar-Apr;30(2):53-58.
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 Dec;1(6):488-490.
Flotra, L; Gjemo, P; Rolla G. Side effects on chlorhexidine mouthwashes: Cited in Seymour RA, Heasman PA. Macgregar IDM: Drugs, diseases and periodontium. Oxford: Oxford University Press; 1992. p. 158-167.
American Academy of Pediatric Dentistry. Policy on the use of xylitol in caries prevention. Pediatr Dent 2010;32(special issue):36-38.
Miyasawa-Hori H, Aizawa S, Takahashi N. Difference in the xylitol sensitivity of acid production among Streptococcus mutans strains and the biochemicalmechanism. Oral Microbiol Immunol 2006 Aug;21(4):201-205.
Stecksen-Blicks C, Holgerson P L, Twetman S. Effect of xylitol and xylitol-fluoride lozenges on approximal caries development in high-caries-risk children. Int J Paediatr Dent 2008 May;18(3):170-177.
Twetman S. Consistent evidence to support the use of xylitol and sorbitol-containing chewing gum to prevent dental caries. Evid Based Dent 2009;10(1):10-11.
Paula VAC, Modesto A, Santos KRN, Gleiser R. Antimicrobial effects of the combination of chlorhexidine and xylitol. Br Dent J 2010 Dec;209(12):E19.
Modesto A, Drake DR. Multiple exposures to chlorhexidine and xylitol: adhesion and biofilm formation by Streptococcus mutans. Curr Microbiol 2006 Jun;52(6):418-423.