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International Dental Journal Nov 2023This narrative review describes the oral microbiome, and its role in oral health and disease, before considering the impact of commonly used over-the-counter (OTC)... (Review)
Review
This narrative review describes the oral microbiome, and its role in oral health and disease, before considering the impact of commonly used over-the-counter (OTC) mouthwashes on oral bacteria, viruses, bacteriophages, and fungi that make up these microbial communities in different niches of the mouth. Whilst certain mouthwashes have proven antimicrobial actions and clinical effectiveness supported by robust evidence, this review reports more recent metagenomics evidence, suggesting that mouthwashes such as chlorhexidine may cause "dysbiosis," whereby certain species of bacteria are killed, leaving others, sometimes unwanted, to predominate. There is little known about the effects of mouthwashes on fungi and viruses in the context of the oral microbiome (virome) in vivo, despite evidence that they "kill" certain viral pathogens ex vivo. Evidence for mouthwashes, much like antibiotics, is also emerging with regards to antimicrobial resistance, and this should further be considered in the context of their widespread use by clinicians and patients. Therefore, considering the potential of currently available OTC mouthwashes to alter the oral microbiome, this article finally proposes that the ideal mouthwash, whilst combatting oral disease, should "balance" antimicrobial communities, especially those associated with health. Which antimicrobial mouthwash best fits this ideal remains uncertain.
Topics: Humans; Mouthwashes; Chlorhexidine; Mouth; Anti-Infective Agents; Bacteria; Microbiota
PubMed: 37867065
DOI: 10.1016/j.identj.2023.08.010 -
The New England Journal of Medicine Nov 2023Nursing home residents are at high risk for infection, hospitalization, and colonization with multidrug-resistant organisms. (Comparative Study)
Comparative Study Randomized Controlled Trial
BACKGROUND
Nursing home residents are at high risk for infection, hospitalization, and colonization with multidrug-resistant organisms.
METHODS
We performed a cluster-randomized trial of universal decolonization as compared with routine-care bathing in nursing homes. The trial included an 18-month baseline period and an 18-month intervention period. Decolonization entailed the use of chlorhexidine for all routine bathing and showering and administration of nasal povidone-iodine twice daily for the first 5 days after admission and then twice daily for 5 days every other week. The primary outcome was transfer to a hospital due to infection. The secondary outcome was transfer to a hospital for any reason. An intention-to-treat (as-assigned) difference-in-differences analysis was performed for each outcome with the use of generalized linear mixed models to compare the intervention period with the baseline period across trial groups.
RESULTS
Data were obtained from 28 nursing homes with a total of 28,956 residents. Among the transfers to a hospital in the routine-care group, 62.2% (the mean across facilities) were due to infection during the baseline period and 62.6% were due to infection during the intervention period (risk ratio, 1.00; 95% confidence interval [CI], 0.96 to 1.04). The corresponding values in the decolonization group were 62.9% and 52.2% (risk ratio, 0.83; 95% CI, 0.79 to 0.88), for a difference in risk ratio, as compared with routine care, of 16.6% (95% CI, 11.0 to 21.8; P<0.001). Among the discharges from the nursing home in the routine-care group, transfer to a hospital for any reason accounted for 36.6% during the baseline period and for 39.2% during the intervention period (risk ratio, 1.08; 95% CI, 1.04 to 1.12). The corresponding values in the decolonization group were 35.5% and 32.4% (risk ratio, 0.92; 95% CI, 0.88 to 0.96), for a difference in risk ratio, as compared with routine care, of 14.6% (95% CI, 9.7 to 19.2). The number needed to treat was 9.7 to prevent one infection-related hospitalization and 8.9 to prevent one hospitalization for any reason.
CONCLUSIONS
In nursing homes, universal decolonization with chlorhexidine and nasal iodophor led to a significantly lower risk of transfer to a hospital due to infection than routine care. (Funded by the Agency for Healthcare Research and Quality; Protect ClinicalTrials.gov number, NCT03118232.).
Topics: Humans; Administration, Cutaneous; Administration, Intranasal; Anti-Infective Agents, Local; Baths; Chlorhexidine; Cross Infection; Hospitalization; Nursing Homes; Patient Transfer; Povidone-Iodine; Skin Care; Asymptomatic Infections
PubMed: 37815935
DOI: 10.1056/NEJMoa2215254 -
International Dental Journal Nov 2023This narrative review summarises "alternative" or "natural" over-the-counter (OTC) mouthwashes not covered elsewhere in this supplement and newly emerging products, as... (Review)
Review
This narrative review summarises "alternative" or "natural" over-the-counter (OTC) mouthwashes not covered elsewhere in this supplement and newly emerging products, as potential mouthwashes of the future. The "natural" mouthwashes reviewed include saltwater, baking soda, coconut oil, charcoal, propolis, seaweeds, and probiotics. Other than essential oils, it is apparent that their clinical effectiveness is still under debate, but there is some evidence to suggest that propolis reduces plaque and gingivitis. This review also covers the host immune response, via novel anti-inmmunomodulant mouthwashes, such as erythropoietin to reduce inflammation with oral mucositis (OM) after radiotherapy. The emerging concept of nanoparticle-containing mouthwashes, such as iron oxide, is further discussed for OM, this agent having the potential for more targeted delivery of chemical antimicrobials. Unfortunately, there are impacts on the environment of widening mouthwash use with more new products, including increased use of packaging, antimicrobial resistance, and possible detrimental effects on marine life. Further, there are roadblocks, relating to regularly approvals and side effects, that still need to be overcome for any OTC deivered immunomodulant or nanoformulation mouthwashes. Despite these caveats, there are many new mouthwashes under development, which could help manage major oral diseases such as caries, gingivitis, and periodontal disease.
Topics: Humans; Mouthwashes; Propolis; Dental Plaque; Oils, Volatile; Gingivitis
PubMed: 37867066
DOI: 10.1016/j.identj.2023.08.011 -
American Journal of Infection Control Nov 2023Skin antiseptics are used for several purposes before surgical procedures, for bathing high-risk patients as a means of reducing central line-associated infections and...
BACKGROUND
Skin antiseptics are used for several purposes before surgical procedures, for bathing high-risk patients as a means of reducing central line-associated infections and other health care associated infections.
METHODS
A PubMed search was performed to update the evidence on skin antiseptic products and practices.
RESULTS
Current guidelines for prevention of surgical site infections (SSIs) recommend preoperative baths or showers with a plain or antimicrobial soap prior to surgery, but do not make recommendations on the timing of baths, the total number of baths needed, or about the use of chlorhexidine gluconate (CGH)-impregnated cloths. Randomized controlled trials have demonstrated that pre-operative surgical hand antisepsis using an antimicrobial soap or alcohol-based hand rub yields similar SSI rates. Other studies have reported that using an alcohol-based hand rub caused less skin irritation, was easier to use, and required shorter scrub times than using antimicrobial soap. Current SSI prevention guidelines recommend using an alcohol-containing antiseptic for surgical site infection. Commonly used products contain isopropanol combined with either CHG or with povidone-iodine. Surgical site preparation protocols for shoulder surgery in men may need to include coverage for anaerobes. Several studies suggest the need to monitor and improve surgical site preparation techniques. Daily bathing of intensive care unit (ICU) patients with a CHG-containing soap reduces the incidence of central line-associated bloodstream infections (CLABSIs). Evidence for a similar effect in non-ICU patients is mixed. Despite widespread CHG bathing of ICU patients, numerous barriers to its effective implementation exist. Measuring CHG levels on the skin is useful for identifying gaps in coverage and suboptimal skin concentrations. Using alcohol-based products with at least 2% CHG for skin preparation prior to central line insertion reduces CLABSIs.
CONCLUSIONS
Progress has been made on skin antisepsis products and protocols, but improvements in technique are still needed.
Topics: Male; Humans; Soaps; Anti-Infective Agents, Local; Chlorhexidine; Povidone-Iodine; Antisepsis; Anti-Infective Agents; Surgical Wound Infection; Ethanol; Skin; Preoperative Care; 2-Propanol
PubMed: 37890954
DOI: 10.1016/j.ajic.2023.02.002 -
International Dental Journal Nov 2023This is the concluding article in the supplement on the role of mouthwashes in oral care, which summarises the current guidelines across the globe regarding their... (Review)
Review
This is the concluding article in the supplement on the role of mouthwashes in oral care, which summarises the current guidelines across the globe regarding their acceptable adjunctive use for managing caries, gingivitis, and periodontal disease. Based on moderate evidence for clinical effectiveness, most current guidelines suggest fluoride mouthwashes for the management of dental caries, and chlorhexidine for the management of periodontal diseases. However there still appears to be gaps in the literature underpinning these recommendations. Importantly, all evidence supports such mouthwash use "adjunctively," alongside mechanical oral hygiene measures. Other antimicrobial mouthwashes such as essential oils and cetylpyridinium chloride may also be clinically effective against plaque and gingivitis, but there is a current lack of robust evidence of natural mouthwashes to recommend their adjunctive use. The authors of the current review are of the view that mouthwashes may not be of much value in those with good periodontal health or low caries risk. The reasons for this are, the potential i) risks of allergic reactions, ii) dysbiosis of the oral microbiota, iii) emergence of antimicrobial resistance, and iv) deleterious effects on the environment. There is, however, much empirical research needed on mouthwashes, particularly in vivo research derived through clinical trials. Thus, dental practitioners need to keep abreast of the evidence base on the current, and the emerging, over-the-counter mouthwashes, and pay heed to the consensus views emanating from systematic reviews, as well as international guidelines on mouthwashes.
Topics: Humans; Mouthwashes; Dental Caries; Dentists; Professional Role; Chlorhexidine; Gingivitis; Periodontal Diseases; Anti-Infective Agents; Anti-Infective Agents, Local
PubMed: 37867062
DOI: 10.1016/j.identj.2023.08.013 -
International Dental Journal Apr 2024Mouthwashes, a cornerstone of oral and dental hygiene, play a pivotal role in combating the formation of dental plaque, a leading cause of periodontal disease and dental... (Review)
Review
OBJECTIVES
Mouthwashes, a cornerstone of oral and dental hygiene, play a pivotal role in combating the formation of dental plaque, a leading cause of periodontal disease and dental caries. This study aimed to review the composition of mouthwashes found on retail shelves in Turkey and evaluate their prevalence and side effects, if any.
METHODS
The mouthwashes examined were sourced from the 5 largest chain stores in each district of Istanbul. A comprehensive list of the constituents was meticulously recorded. The research was supported by an extensive compilation of references from scholarly databases such as Google Scholar, PubMed, and ScienceDirect. Through rigorous analysis, the relative proportions of mouthwash ingredients and components were determined.
RESULTS
A total of 45 distinctive variations of mouthwashes, representing 17 prominent brands, were identified. Amongst the 116 ingredients discovered, 70 were evaluated for potential adverse effects and undesirable side effects. The aroma of the mouthwash (n = 45; 100%), as welll as their sodium fluoride (n = 28; 62.22%), sodium saccharin (n = 29; 64.44%), sorbitol (n = 21; 46.6%), and propylene glycol (n = 28; 62.22%) content were the main undesireable features.
CONCLUSIONS
The limited array of mouthwashes found on store shelves poses a concern for both oral and public health. Furthermore, the intricate composition of these products, consisting of numerous ingredients with the potential for adverse effects, warrants serious attention. Both clinicians and patients should acknowledge the importance and unwarranted side effects of the compnents of the mouthwashes.
Topics: Humans; Dental Caries; Dental Plaque; Gingivitis; Mouthwashes; Sodium Fluoride
PubMed: 37709645
DOI: 10.1016/j.identj.2023.08.004 -
International Dental Journal Nov 2023This narrative literature review is the first in a 6-section supplement on the role of mouthwashes in oral care. This introduction briefly summarises current knowledge... (Review)
Review
This narrative literature review is the first in a 6-section supplement on the role of mouthwashes in oral care. This introduction briefly summarises current knowledge on antimicrobial mechanisms, relating to some of the most common over-the-counter mouthwash products available worldwide: chlorhexidine, hydrogen peroxide, cetylpyridinium chloride, povidone iodine, and essential oils. The aim of this first article is to describe how mouthwashes "kill" pathogenic microbes when used adjunctively and thus provide a basis for their widespread use to manage key oral diseases, namely caries, gingivitis, and periodontal disease. This article therefore sets the scene for subsequent, more detailed exploration of mouthwashes regarding their clinical effectiveness, impact on the oral microbiome, and possible effects on systemic health as well as natural alternatives and future directions. Other than the clinical effectiveness (for certain agents) of mouthwashes, on many topics there remains insufficient evidence for systematic review or formulation of robust national guidelines. The supplement, therefore, compiled by an international task team, is aimed at general dental practitioners across the globe, as an easy-to-read guide for helping to advise patients on mouthwash use based on the current best available evidence.
Topics: Humans; Mouthwashes; Anti-Infective Agents, Local; Dentists; Professional Role; Chlorhexidine; Anti-Infective Agents; Gingivitis
PubMed: 37867063
DOI: 10.1016/j.identj.2023.08.009 -
Indian Journal of Dental Research :... Oct 2023Chlorhexidine (CHX) is a chemical mouthwash that has been considered the gold standard, but has its drawbacks. When used for a longer duration, it produces taste... (Comparative Study)
Comparative Study Randomized Controlled Trial
INTRODUCTION
Chlorhexidine (CHX) is a chemical mouthwash that has been considered the gold standard, but has its drawbacks. When used for a longer duration, it produces taste alteration and staining on the tooth surfaces. Nowadays, herbal extracts from plants have been widely used as they possess anti-inflammatory, antimicrobial and analgesic actions.
MATERIAL AND METHODS
A group of 45 healthy subjects in the age group of 19-35 years were selected and randomly divided into three groups, Group A - Himalaya complete care mouthwash, Group B - CHX mouthwash, Group C - Distilled water as a control group. Gingival index and plaque index, OHI-s index, and Ainamo and Bay index for bleeding were recorded. Subjects received complete supragingival scaling at baseline and were instructed to use 10 ml of mouthwashes twice a day in their group. Variables were again recorded on the seventh and 14th day after the use of mouthwashes, and data obtained was subjected to statistical analysis. Posthoc and ANOVA tests were used for statistical analysis.
RESULTS
It was found that both CHX and herbal mouthwash proved to be more effective than placebo in maintaining gingival health. There was no significant difference between the test group on gingival health.
CONCLUSION
Herbal mouthwash is an effective alternative to CHX mouthwash, in the light of the reported side effects of CHX mouthwash.
Topics: Humans; Mouthwashes; Chlorhexidine; Adult; Young Adult; Male; Periodontal Index; Female; Plant Extracts; Anti-Infective Agents, Local; Phytotherapy; Dental Plaque Index; Gingivitis
PubMed: 38739820
DOI: 10.4103/ijdr.ijdr_293_22 -
Pediatrics Sep 2023Pediatric ethicists hold a privileged position of influence within health care institutions. Such a position confers a corresponding responsibility to address barriers...
Pediatric ethicists hold a privileged position of influence within health care institutions. Such a position confers a corresponding responsibility to address barriers to the health and flourishing of all children. A major barrier to children's health is racism. Pediatric ethicists can, and should, leverage their position to address racism both in institutional policy and the provision of pediatric care. Health care's historical and continued contributions to fostering and sustaining racist values and systems mean that those within all medical fields- regardless of race, ethnicity, gender, age, or profession-should consider ways they can work to offset and ultimately dismantle those values and systems. Institutional policy is a critical mechanism propagating racism in hospitals and an area where ethicists have a unique perspective to bring antiracism into ethical analysis. Many institutional and organizational policies have unintended consequences, negatively impacting children and families who have been historically marginalized and oppressed. In this paper, we report and discuss existing policies, along with how they are implemented (procedures) and how they are conducted (practices), identified through a workshop during a pediatric subgroup meeting at an annual bioethics conference. We highlight the need to focus on these structural factors and reference scholarship that can be used to correct institutional policies that uphold white supremacy. We conclude with actionable, concrete recommendations for change.
Topics: Humans; Child; Antiracism; Racism; Bioethics; Child Health; Chlorhexidine
PubMed: 37560789
DOI: 10.1542/peds.2022-059804 -
JAMA May 2024
Topics: Humans; Administration, Intranasal; Anti-Infective Agents, Local; Bacterial Infections; Baths; California; Chlorhexidine; Cross Infection; Drug Resistance, Multiple, Bacterial; Health Facilities; Hospitals; Infection Control; Iodophors; Patient Transfer; Skilled Nursing Facilities; Skin Care; Universal Precautions
PubMed: 38557704
DOI: 10.1001/jama.2024.0267