Top

Published in:

01-10-2019 | Gingiva Index | Original Article

N-acetyl cysteine versus chlorhexidine mouthwashes in prevention and treatment of experimental gingivitis: a randomized, triple-blind, placebo-controlled clinical trial

Authors: Ahlam Al-Kamel, Wadhah Abdulnaser Al-Hajj, Esam Halboub, Saleem Abdulrab, Khaled Al-Tahami, Nezar Noor Al-Hebshi

Published in: Clinical Oral Investigations | Issue 10/2019

Abstract

Objectives

To compare the efficacy of N-acetyl cysteine (NAC) mouthwash with chlorhexidine (CHX) in prevention and treatment of experimental gingivitis

Materials and methods

Sixty subjects were assigned randomly and blindly into one of three equal groups: NAC, CHX, or placebo group. The study was conducted in two stages: preventive and treatment substudies. Professional prophylaxis was performed ahead of starting the preventive substudy. Then, the subjects were instructed to stop oral hygiene practices and begin rinsing twice/day with 15 ml of the assigned mouthwash (1.25% NAC, 0.2% CHX, or inert base). Plaque index (PI), gingival index (GI), and papillary bleeding index (PBI) were measured at baseline, 7, 14, and 21 days. The treatment substudy started on day 21 in which the subjects in the placebo group (now with established experimental gingivitis) were assigned to NAC (n = 10) or CHX (n = 10); the abovementioned indices were measured at 28 and 35 days. Efficacy of these interventions was compared.

Results

All groups accumulated plaque and developed some degree of gingivitis: full-blown in the placebo group and remarkably mild in the CHX group. NAC had slight preventive properties at days 14 and 21. In the treatment substudy, CHX was associated with remarkable reduction in plaque and gingivitis while NAC resulted in insignificant reductions.

Conclusions

1.25% NAC is marginally effective in prevention and treatment of experimental gingivitis.

Clinical relevance

When compared with the placebo, NAC showed promising preventive and treatment effects of gingivitis that deserve further development and studies.

Trial registration

ISRCTN31352091.

Ciancio S (1992) Agents for the management of plaque and gingivitis. J Dent Res 71:1450–1454CrossRef

Malhotra R, Grover V, Kapoor A, Saxena D (2011) Comparison of the effectiveness of a commercially available herbal mouthrinse with chlorhexidine gluconate at the clinical and patient level. J Indian Soc Periodontol 15:349–352. https://doi.org/10.4103/0972-124X.92567 CrossRefPubMedPubMedCentral

Slots J (2002) Selection of antimicrobial agents in periodontal therapy. J Periodontal Res 37:389–398CrossRef

Arunachalam LT, Sudhakar U, Vasanth J, Khumukchum S, Selvam VV (2017) Comparison of anti-plaque and anti-gingivitis effect of curcumin and chlorhexidine mouth rinse in the treatment of gingivitis: a clinical and biochemical study. J Indian Soc Periodontol 21:478–483. https://doi.org/10.4103/jisp.jisp_116_17 CrossRefPubMedPubMedCentral

Goes P, Dutra CS, Lisboa MR, Gondim DV, Leitao R, Brito GA, Rego RO (2016) Clinical efficacy of a 1% Matricaria chamomile L. mouthwash and 0.12% chlorhexidine for gingivitis control in patients undergoing orthodontic treatment with fixed appliances. J Oral Sci 58:569–574. https://doi.org/10.2334/josnusd.16-0280 CrossRefPubMed

Mamgain P, Kandwal A, Mamgain RK (2016) Comparative evaluation of triphala and ela decoction with 0.2% chlorhexidine as mouthwash in the treatment of plaque-induced gingivitis and halitosis: a randomized controlled clinical trial. J Evid Based Complementary Altern Med 22:468–472. https://doi.org/10.1177/2156587216679532 CrossRefPubMedPubMedCentral

Jones CG (1997) Chlorhexidine: is it still the gold standard? Periodontol 15:55–62CrossRef

da Costa L, Amaral C, Barbirato DDS, Leao ATT, Fogacci MF (2017) Chlorhexidine mouthwash as an adjunct to mechanical therapy in chronic periodontitis: A meta-analysis. J Am Dent Assoc 148:308–318. https://doi.org/10.1016/j.adaj.2017.01.021 CrossRefPubMed

Rashed HT (2016) Evaluation of the effect of hydrogen peroxide as a mouthwash in comparison with chlorhexidine in chronic periodontitis patients: a clinical study. J Int Soc Prev Community Dent 6:206–212. https://doi.org/10.4103/2231-0762.183114 CrossRefPubMedPubMedCentral

10.

Berchier C, Slot D, Van der Weijden G (2010) The efficacy of 0.12% chlorhexidine mouthrinse compared with 0.2% on plaque accumulation and periodontal parameters: a systematic review. J Clin Periodontol 37:829–839. https://doi.org/10.1111/j.1600-051X.2010.01575.x CrossRefPubMed

11.

Duss C, Lang NP, Cosyn J, Persson GR (2010) A randomized, controlled clinical trial on the clinical, microbiological, and staining effects of a novel 0.05% chlorhexidine/herbal extract and a 0.1% chlorhexidine mouthrinse adjunct to periodontal surgery. J Clin Periodontol 37:988–997. https://doi.org/10.1111/j.1600-051X.2010.01609.x CrossRefPubMed

12.

Strydonck DA, Slot DE, Velden U, Weijden F (2012) Effect of a chlorhexidine mouthrinse on plaque, gingival inflammation and staining in gingivitis patients: a systematic review. J Clin Periodontol 39:1042–1055. https://doi.org/10.1111/j.1600-051X.2012.01883.x CrossRefPubMed

13.

Abdulrab S, Halboub E, Barngkgei I, Al-Hebshi N (2017) N-acetylcysteine as a candidate therapeutic for recurrent aphthous and aphthous-like ulcers. Dent Hypotheses 8:17–22. https://doi.org/10.4103/2155-8213.202028 CrossRef

14.

Olofsson AC, Hermansson M, Elwing H (2003) N-acetyl-L-cysteine affects growth, extracellular polysaccharide production, and bacterial biofilm formation on solid surfaces. Appl Environ Microbiol 69:4814–4822. https://doi.org/10.1128/AEM.69.8.4814-4822.2003 CrossRefPubMedPubMedCentral

15.

Dinicola S, De Grazia S, Carlomagno G, Pintucci JP (2014) N-acetylcysteine as powerful molecule to destroy bacterial biofilms. A systematic review. Eur Rev Med Pharmacol Sci 18:2942–2948PubMed

16.

Gocer H, Emir D, Onger ME, Dabak N (2017) Effects of bone cement loaded with teicoplanin, N-acetylcysteine or their combination on Staphylococcus aureus biofilm formation: an in vitro study. Eklem Hastalik Cerrahisi 28:13–18. https://doi.org/10.5606/ehc.2017.52507 CrossRefPubMed

17.

Molina-Manso D, Del-Prado G, Gomez-Barrena E, Cordero-Ampuero J, Fernandez-Roblas R, Esteban J (2016) Effect of different agents with potential antibiofilm activity on antimicrobial susceptibility of biofilms formed by Staphylococcus spp. isolated from implant-related infections. J Antibiot (Tokyo) 69:686–688. https://doi.org/10.1038/ja.2016.9 CrossRef

18.

Zhao T, Liu Y (2010) N-acetylcysteine inhibit biofilms produced by Pseudomonas aeruginosa. BMC Microbiol 10:140. https://doi.org/10.1186/1471-2180-10-140 CrossRefPubMedPubMedCentral

19.

Pollini S, Di Pilato V, Landini G, Di Maggio T, Cannatelli A, Sottotetti S, Cariani L, Aliberti S, Blasi F, Sergio F, Rossolini GM, Pallecchi L (2018) In vitro activity of N-acetylcysteine against Stenotrophomonas maltophilia and Burkholderia cepacia complex grown in planktonic phase and biofilm. PLoS One 13:e0203941. https://doi.org/10.1371/journal.pone.0203941 CrossRefPubMedPubMedCentral

20.

Cindy H-R, Rene H-D, Sergio G-R, Diana R-P, del Socorro FGM, Claudio C-R (2013) Rifampicin and N-acteylcisteyne inhibit oral bacterial growth and biofilm formation. Pharmaceut Innovat J 2:16–23. https://doi.org/10.1016/j.bjid.2016.08.010 CrossRef

21.

Quah SY, Wu S, Lui JN, Sum CP, Tan KS (2012) N-acetylcysteine inhibits growth and eradicates biofilm of enterococcus faecalis. J Endod 38:81–85. https://doi.org/10.1016/j.joen.2011.10.004 CrossRefPubMed

22.

Darrag AM (2013) Antimicrobial efficacy of endodontic irrigation solutions against planktonic microorganisms and dual-species biofilm. Tanta Dent J 10:129–137. https://doi.org/10.1016/j.tdj.2013.11.005 CrossRef

23.

Moon JH, Jang EY, Shim KS, Lee JY (2015) In vitro effects of N-acetyl cysteine alone and in combination with antibiotics on Prevotella intermedia. J Microbiol 53:321–329. https://doi.org/10.1007/s12275-015-4500-2 CrossRefPubMed

24.

Lee D, Kook S-H, Ji H, Lee S-A, Choi K-C, Lee K-Y, Lee J-C (2015) N-acetyl cysteine inhibits H2O2-mediated reduction in the mineralization of MC3T3-E1 cells by down-regulating Nrf2/HO-1 pathway. BMB Rep 48:636–641. https://doi.org/10.5483/BMBRep.2015.48.11.112 CrossRefPubMedPubMedCentral

25.

Orihuela-Campos RC, Tamaki N, Mukai R, Fukui M, Miki K, Terao J, Ito H-O (2015) Biological impacts of resveratrol, quercetin, and N-acetylcysteine on oxidative stress in human gingival fibroblasts. J Clin Biochem Nutr 56:220–227. https://doi.org/10.3164/jcbn.14-129 CrossRefPubMedPubMedCentral

26.

Toker H, Ozdemir H, Balcı H, Ozer H (2012) N-acetylcysteine decreases alveolar bone loss on experimental periodontitis in streptozotocin-induced diabetic rats. J Periodontal Res 47:793–799. https://doi.org/10.1111/j.1600-0765.2012.01497.x CrossRefPubMed

27.

Alkadasi B, Abdulrab S, Gaafer S, Kalakonda B, Hosny M, Shaker O, Hosny M (2017) Effect of adjunctive use of systemic antioxidant therapy (N-acetylcysteine) on soluble receptor activator nuclear factor kappaB ligand levels in gingival crevicular fluid following surgical periodontal treatment for chronic periodontitis. J Oral Sci 59:519–526. https://doi.org/10.2334/josnusd.16-0701 CrossRefPubMed

28.

Li W, Wang RE, Finger M, Lang NP (2014) Evaluation of the antigingivitis effect of a chlorhexidine mouthwash with or without an antidiscoloration system compared to placebo during experimental gingivitis. J Investig Clin Dent 5:15–22. https://doi.org/10.1111/jicd.12050 CrossRefPubMed

29.

Trombelli L, Farina R, Silva CO, Tatakis DN (2018) Plaque-induced gingivitis: case definition and diagnostic considerations. J Periodontol 89(Suppl 1):S46–S73. https://doi.org/10.1002/JPER.17-0576 CrossRefPubMed

30.

Papapanou PN, Sanz M, Buduneli N, Dietrich T, Feres M, Fine DH, Flemmig TF, Garcia R, Giannobile WV, Graziani F, Greenwell H, Herrera D, Kao RT, Kebschull M, Kinane DF, Kirkwood KL, Kocher T, Kornman KS, Kumar PS, Loos BG, Machtei E, Meng H, Mombelli A, Needleman I, Offenbacher S, Seymour GJ, Teles R, Tonetti MS (2018) Periodontitis: consensus report of workgroup 2 of the 2017 world workshop on the classification of periodontal and peri-implant diseases and conditions. J Periodontol 89(Suppl 1):S173–S182. https://doi.org/10.1002/JPER.17-0721 CrossRefPubMed

31.

Silness J, Löe H (1964) Periodontal disease in pregnancy II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand 22:121–135CrossRef

32.

Löe H, Silness J (1963) Periodontal disease in pregnancy I. Prevalence and severity. Acta Odontol Scand 21:533–551CrossRef

33.

Saxer U and Mühlemann H (1975) Motivation and education. Schweizerische Monatsschrift fur Zahnheilkunde= Revue mensuelle suisse d’odonto-stomatologie 85:905–919

34.

Löe H, Theilade E, Jensen SB (1965) Experimental gingivitis in man. J Periodontol 36:177–187CrossRef

35.

García V, Rioboo M, Serrano J, Herrera D, Sanz M (2011) Plaque inhibitory effect of a 0.05% cetyl-pyridinium chloride mouth-rinse in a 4-day non-brushing model. Int J Dent Hyg 9:266–273. https://doi.org/10.1111/j.1601-5037.2010.00490.x CrossRefPubMed

36.

Ulkur F, Arun T, Ozdemir F (2013) The effects of three different mouth rinses in a 4-day supragingival plaque regrowth study. Eur J Dent Educ 7:352–358. https://doi.org/10.4103/1305-7456.115420 CrossRef

37.

Hu D, Li X, Sreenivasan PK, DeVizio W (2009) A randomized, double-blind clinical study to assess the antimicrobial effects of a cetylpyridinium chloride mouth rinse on dental plaque bacteria. Clin Ther 31:2540–2548. https://doi.org/10.1016/j.clinthera.2009.11.004 CrossRefPubMed

38.

Solís C, Santos A, Nart J, Violant D (2011) 0.2% chlorhexidine mouthwash with an antidiscoloration system versus 0.2% chlorhexidine mouthwash: a prospective clinical comparative study. J Periodontol 82:80–85. https://doi.org/10.1902/jop.2010.100289 CrossRefPubMed

39.

Lorenz K, Bruhn G, Heumann C, Netuschil L, Brecx M, Hoffmann T (2006) Effect of two new chlorhexidine mouthrinses on the development of dental plaque, gingivitis, and discolouration. A randomized, investigator-blind, placebo-controlled, 3-week experimental gingivitis study. J Clin Periodontol 33:561–567. https://doi.org/10.1111/j.1600-051X.2006.00946.x CrossRefPubMed

40.

Saxton C, Ouderaa F (1989) The effect of a dentifrice containing zinc citrate and triclosan on developing gingivitis. J Periodontal Res 24:75–80CrossRef

41.

Addy M, Mohan J (1983) Comparison of plaque accumulation after topical application and mouth rinsing with chlorhexidine gluconate. J Clin Periodontol 10:69–71CrossRef

42.

Davies R, Børglum Jensen S, Rindom Schiøtt C, Löe H (1970) The effect of topical application of chlorhexidine on the bacterial colonization of the teeth and gingiva. J Periodontal Res 5:96–101CrossRef

43.

Löe H, Rindom Schiøtt C (1970) The effect of mouthrinses and topical application of chlorhexidine on the development of dental plaque and gingivitis in man. J Periodontal Res 5:79–83CrossRef

44.

Wu M, Chen SW, Su WL, Zhu HY, Ouyang SY, Cao YT, Jiang SY (2016) Sex hormones enhance gingival inflammation without affecting IL-1beta and TNF-alpha in periodontally healthy women during pregnancy. Mediat Inflamm 2016:4897890. https://doi.org/10.1155/2016/4897890 CrossRef

Title: N-acetyl cysteine versus chlorhexidine mouthwashes in prevention and treatment of experimental gingivitis: a randomized, triple-blind, placebo-controlled clinical trial
Authors: Ahlam Al-Kamel
Wadhah Abdulnaser Al-Hajj
Esam Halboub
Saleem Abdulrab
Khaled Al-Tahami
Nezar Noor Al-Hebshi
Publication date: 01-10-2019
Publisher: Springer Berlin Heidelberg
Keywords: Gingiva Index
Dental Plaque Index
Published in: Clinical Oral Investigations / Issue 10/2019
Print ISSN: 1432-6981
Electronic ISSN: 1436-3771
DOI: https://doi.org/10.1007/s00784-019-02813-3

At a glance: The STEP trials

Springer Medicine

N-acetyl cysteine versus chlorhexidine mouthwashes in prevention and treatment of experimental gingivitis: a randomized, triple-blind, placebo-controlled clinical trial

Abstract

Objectives

Materials and methods

Results

Conclusions

Clinical relevance

Trial registration

At a glance: The STEP trials

Springer Medicine

Abstract

Objectives

Materials and methods

Results

Conclusions

Clinical relevance

Trial registration

Please log in to get access to this content

Other articles of this Issue 10/2019

Expression of concern

Are combined bleaching techniques better than their sole application? A systematic review and meta-analysis

Radiographic pattern of underlying dentin lesions (ICDAS 4) in permanent teeth

Changes in the oral health-related quality of life in adult patients with intellectual disabilities after dental treatment under general anesthesia

Effectiveness of the ozone application in two-visit indirect pulp therapy of permanent molars with deep carious lesion: a randomized clinical trial

Predictive value of FHIT, p27, and pERK1/ERK2 in salivary gland carcinomas: a retrospective study