The Journal of Contemporary Dental Practice

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 19 , ISSUE 11 ( November, 2018 ) > List of Articles


Clinical Impact and Cosmetic Acceptability of Chlorhexidineenriched Toothpaste and Mouthwash Application on Periodontal Disease: A Randomized Clinical Study

Vanessa R Magaz, Bárbara F Llovera, Miriam Martí, Aurora Garre

Keywords : Allantoin, Chlorhexidine, Dexpanthenol, Mouthwash, Periodontal-disease-index, Toothpaste

Citation Information : Magaz VR, Llovera BF, Martí M, Garre A. Clinical Impact and Cosmetic Acceptability of Chlorhexidineenriched Toothpaste and Mouthwash Application on Periodontal Disease: A Randomized Clinical Study. J Contemp Dent Pract 2018; 19 (11):1295-1300.

DOI: 10.5005/jp-journals-10024-2421

License: CC BY-NC 4.0

Published Online: 01-10-2018

Copyright Statement:  Copyright © 2018; The Author(s).


Aims: Oral hygiene is key to prevent periodontal disease (PD). The efficacy of chlorhexidine-containing products has been largely proven, often being tooth discoloration an unwanted associated side-effect. Importantly, some differences related to the pharmaceutical presentation of these products have also been reported. This study aimed to evaluate the efficacy of two different pharmaceutical forms [toothpaste (TP) and mouthwash (MW)] of a new product containing chlorhexidine, dexpanthenol, allantoin and bioadhesive excipient (CDAB) (Bexident® Gums Coadjuvant Treatment) on volunteers with PD. Their preferences, acceptability and cosmetic properties, as well as tooth discoloration, were also assessed. Materials and methods: Total 60 subjects showing mildmoderate symptoms of gingivitis were randomly assigned to two different groups: one receiving TP (n = 30) and the other one receiving MW (n = 30). Periodontal disease index (PDI) was used to evaluate clinical signs at baseline (T0) and after 21 days (T21) of daily use of the products. Satisfaction was assessed through the affirmative/negative answers obtained with the visual analog scale (VAS). Results: All participants completed the study. A significant improvement of PDI score after treatment was reported in both groups (T21/T0) (p < 0.001). Thus, gingivitis improved from moderate to negative [increase = 20.0% (TP)/36.7% (MW)] and from mild to negative [increase = 56.7% (TP)/50.0% (MW)]. After treatment, all subjects reported to have healthier and/or less bleeding teeth (TP 9.0/9.4; MW 8.0/8.2) and would recommend the product (TP:100%/MW:96.6%) with no specific preference regarding its presentation. No change of teeth color was observed. Conclusion: Subjects with PD who received oral care with a new formulation of either chlorhexidine-containing TP or MW for 21 days, reported a significant improvement of their symptoms and resolution of the gingivitis with no associated tooth discoloration. Patients did not show a specific preference for any of the pharmaceutical presentations. Clinical significance: This new formulation of a chlorhexidinecontaining product in both TP and MW forms resulted effective for PD treatment and well accepted by the patients.

PDF Share
  1. Albandar JM. Aggressive and acute periodontal diseases. Periodontology 2000. 2014;65(1):7-12.
  2. Su F, Liu SS, Ma JL, Wang DS, E LL, Liu HC. Enhancement of periodontal tissue regeneration by transplantation of osteoprotegerin-engineered periodontal ligament stem cells. Stem cell research & therapy. 2015;6:22.
  3. Nazir MA. Prevalence of periodontal disease, its association with systemic diseases and prevention. International Journal of Health Sciences. 2017;11(2):72-80.
  4. Comission F. Mouthrinses and periodontal disease. International dental journal. 2002;52(5):346-352.
  5. Andrade Acevedo R, Machon L, Chavez N. Effectiveness of a mouthwash containing Triclosan and Gantrez in the reduction of biofilm and gingivitis: a clinical pilot study. The journal of contemporary dental practice. 2009;10(6):E033-E040.
  6. Haffajee AD, Yaskell T, Socransky SS. Antimicrobial effectiveness of an herbal mouthrinse compared with an essential oil and a chlorhexidine mouthrinse. Journal of the American Dental Association (1939). 2008;139(5):606-611.
  7. Cosyn J, Wyn I, De Rouck T, Sabzevar MM. Long-term clinical effects of a chlorhexidine varnish implemented treatment strategy for chronic periodontitis. Journal of periodontology. 2006;77(3):406-415.
  8. Duarte Fde F, Lotufo RF, Pannuti CM. Local delivery of chlorhexidine gluconate in patients with aggressive periodontitis. Journal of the International Academy of Periodontology. 2008;10(1):31-35.
  9. Ruiz-Linares M, Ferrer-Luque CM, Arias-Moliz T, de Castro P, Aguado B, Baca P. Antimicrobial activity of alexidine, chlorhexidine and cetrimide against Streptococcus mutans biofilm. Ann Clin Microbiol Antimicrob. 2014 Aug 20;13:41.
  10. Rodrigues CR, Marquezan M, Barroso LP, Grande RH, Myaki SI, Kabakura V, et al. Effect of chlorhexidine-thymol varnish on caries lesion development in first permanent molars. The Journal of clinical dentistry. 2008;19(1):18-21.
  11. Strobel S, Hellwig E. The effects of matrix-metallo-proteinases and chlorhexidine on the adhesive bond. Swiss dental journal. 2015;125(2):134-145.
  12. Slot DE, Berchier CE, Addy M, Van der Velden U, Van der Weijden GA. The efficacy of chlorhexidine dentifrice or gel on plaque, clinical parameters of gingival inflammation and tooth discoloration: a systematic review. International journal of dental hygiene. 2014;12(1):25-35.
  13. Van Strydonck DA, Slot DE, Van der Velden U, Van der Weijden F. Effect of a chlorhexidine mouthrinse on plaque, gingival inflammation and staining in gingivitis patients: a systematic review. Journal of clinical periodontology. 2012;39(11):1042-1055.
  14. Walsh T, Oliveira-Neto JM, Moore D. Chlorhexidine treatment for the prevention of dental caries in children and adolescents. The Cochrane database of systematic reviews. 2015(4):CD008457.
  15. Anand V, Govila V, Gulati M, Anand B, Jhingaran R, Rastogi P. Chlorhexidine-thymol varnish as an adjunct to scaling and root planing: A clinical observation. Journal of oral biology and craniofacial research. 2012;2(2):83-89.
  16. T S. Delivery Vehicles for Antiplaque Agents. Journal of Formulation Science & Bioavailability. 2016;1(112).
  17. Ebner F, Heller A, Rippke F, Tausch I. Topical use of dexpanthenol in skin disorders. American journal of clinical dermatology. 2002;3(6):427-433.
  18. Madrazo-Jimenez M, Rodriguez-Caballero A, Serrera-Figallo MA, Garrido-Serrano R, Gutierrez-Corrales A, Gutierrez-Perez JL, et al. The effects of a topical gel containing chitosan, 0,2% chlorhexidine, allantoin and despanthenol on the wound healing process subsequent to impacted lower third molar extraction. Medicina oral, patologia oral y cirugia bucal. 2016;21(6):e696-e702.
  19. Supranoto SC, Slot DE, Addy M, Van der Weijden GA. The effect of chlorhexidine dentifrice or gel versus chlorhexidine mouthwash on plaque, gingivitis, bleeding and tooth discoloration: a systematic review. International journal of dental hygiene. 2015;13(2):83-92.
  20. Collins FM. Factoring Patient Compliance into Oral Care. Available from: https://wwwdentalacademyofcecom/ courses/2059/PDF/1103_CEDfpc-compliance_rev1pdf Accessed February, 2018.
  21. Walker AP, Basketter DA, Baverel M, Diembeck W, Matthies W, Mougin D, et al. Test guidelines for the assessment of skin tolerance of potentially irritant cosmetic ingredients in man. European Cosmetic, Toiletry and Perfumery Association. Food and chemical toxicology : an international journal published for the British Industrial Biological Research Association. 1997;35(10-11):1099-1106.
  22. Guidelines C. Colipa guidelines. [Homepage on the Internet]. Guidelines for the Evaluation of the Efficacy of cosmetic Products. Available from: http://wwwncv-cosmeticanl/upload/ File/Richtlijnen/20080704Colipa_Guidelines_EfficacyPDF Accessed February, 2018.
  23. Ramfjord SP. The Periodontal Disease Index (PDI). Journal of periodontology. 1967;38(6):Suppl:602-610.
  24. Sjoblom M, Ainamo A, Ainamo J. Antimicrobial effect of four different toothpastes. Scandinavian journal of dental research. 1976;84(6):377-380.
  25. Santos A. Evidence-based control of plaque and gingivitis. Journal of clinical periodontology. 2003;30 Suppl 5:13-16.
  26. Gjermo P, Eriksen HM. Unchanged plaque inhibiting effect of chlorhexidine in human subjects after two years of continuous use. Archives of Oral Biology. 1974;19(4):317-319.
  27. Gjermo P, Rolla G. The plaque-inhibiting effect of chlorhexidine- containing dentifrices. Scandinavian journal of dental research. 1971;79(2):126-132.
  28. Addy M, Jenkins S, Newcombe R. Studies on the effect of toothpaste rinses on plaque regrowth. (I). Influence of surfactants on chlorhexidine efficacy. Journal of clinical periodontology. 1989;16(6):380-384.
  29. Amoian B, Omidbakhsh M, Khafri S. The clinical evaluation of Vi-one chlorhexidine mouthwash on plaque-induced gingivitis: A double-blind randomized clinical trial. Electronic physician. 2017;9(9):5223-5228.
  30. Haydari M, Bardakci AG, Koldsland OC, Aass AM, Sandvik L, Preus HR. Comparing the effect of 0.06% -, 0.12% and 0.2% Chlorhexidine on plaque, bleeding and side effects in an experimental gingivitis model: a parallel group, double masked randomized clinical trial. BMC oral health. 2017;17(1):118.
  31. Beltran-Aguilar ED, Eke PI, Thornton-Evans G, Petersen PE. Recording and surveillance systems for periodontal diseases. Periodontology 2000. 2012;60(1):40-53.
  32. Bhatsange A, Patil SR. Assessment of periodontal health status in patients undergoing renal dialysis: A descriptive, cross-sectional study. Journal of Indian Society of Periodontology. 2012;16(1):37-42.
  33. Levin L, Margvelashvili V, Bilder L, Kalandadze M, Tsintsadze N, Machtei EE. Periodontal status among adolescents in Georgia. A pathfinder study. Peer J. 2013;1:e137.
  34. Mumghamba EG, Pitiphat W, Matee MI, Simon E, Merchant AT. The usefulness of using Ramfjord teeth in predicting periodontal status of a Tanzanian adult population. Journal of clinical periodontology. 2004;31(1):16-18.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.