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Mouthrinses for High-Risk Kids

How effective are antimicrobial mouthrinses in reducing caries prevalence among children assessed as high risk?

Caries is a multifactorial disease caused by oral microorganisms acting upon sugars and carbohydrates in the presence of dental hard tissues. Streptococcus mutans is the prime microbe implicated in caries production. Certain children can be at increased risk for caries as a result of genetic predisposition, poor oral hygiene, diets high in sugars and carbohydrates, and health issues that may impact the quantity and quality of saliva and their immune system. The most accepted and effective means of reducing the incidence of caries is by removing, or significantly reducing, the intake of dietary sugars and carbohydrates, and the use of multiple topical fluoride products. However, there is considerable interest in identifying a product that would prevent the creation of dental plaque on the teeth, or disrupt it, that harbors caries-causing microorganisms. Chlorhexidine has been used for years to reduce bacteria levels to prevent caries but has found more favor recently in addressing chronic periodontal diseases. 

Numerous studies have evaluated chlorhexidine in various forms (gels, varnishes, gums, sprays, mouthrinses) as a caries-preventing agent with limited or mixed results.1,2 A 2015 Cochrane review assessed the effects of chlorhexidine on the prevention of dental caries.3 They found little evidence from the eight trials on varnishes and gels to support or refute the assertion that chlorhexidine is effective in the reduction of S. mutans or prevention of caries in children and adolescents. No trials on other chlorhexidine products, such as sprays, toothpastes, chewing gums, or mouthrinses, met the review criteria. However, a recent study found a statistically significant reduction in S. mutans when using a chlorhexidine or fluoride mouthrinse.4

Recently, the ability of herb-containing mouthrinses, or green tea extracts, to prevent plaque accumulation, gingival inflammation, and caries has been investigated.5–7 Herbal mouthrinses have been reported to provide a viable alternative as they are alcohol-free and may contain time-tested herbal oils and extracts that contain phytochemicals to achieve the desired antimicrobial and anti-inflammatory effects. Although some of these products have shown promise, there is little research evaluating herbal mouthrinses in children. However, one study did compare the colony count changes of S. mutans and Lactobacillus in saliva following various mouthrinses, including green tea extract, in children. Results showed that the green tea rinse was effective at reducing the numbers of caries-causing bacteria.7 

In conclusion, there is no antimicrobial mouthrinse available that is superior in preventing caries in children than daily (0.05%) or weekly (0.2%) fluoride rinses. The reduction of sugars and carbohydrates in the diet, accompanied by effective oral hygiene practices remain the cornerstone of caries prevention in children. 

References

  1. Du MQ, Tai BJ, Jiang H, Lo ECM, Fan MW, Bian Z. A two-year randomized clinical trial of chlorhexidine varnish on dental caries in Chines preschool children. J Dent Res. 2006;85:557–559.
  2. Forgie AH, Paterson M, Pine CM, Pitts NB, Nugent ZH. A randomized controlled trial of the caries-preventive efficacy of a chlorhexidine-containing varnish in high-caries-risk adolescents. Caries Res. 2000;34:432-439.
  3. Walsh T, Oliveira-Neto JM, Moore D. Chlorhexidine treatment for the prevention of dental caries in children and adolescents. Cochrane Database Syst Rev. 2015:4:CD008457.
  4. Sharma A, Agarwal NN, Anand A, Jabin Z. To compare the effectiveness of different mouthrinses on Streptococcus mutans count in caries active children. J Oral Biol Craniofac Res. 2018;8:113–117.
  5. Megalaa N, Thirumurugan K, Kayalvizhi G, et al. A comparative evaluation of the anticaries efficacy of herbal extracts (Tulsi and Black myrobalans) and sodium fluoride as mouthrinses in children: a randomized controlled trial. Indian J Dent Res. 2018;29:760–767.
  6. Jaidka S, Somani R, BajaJ N, Jaidka R, Sharma S, Singh A. Comparative evaluation of various mouthwashes for their effect on oral health: an in-vitro study. J Oral Biol Craniofac Res. 2015;3:56–62.
  7. Hegde RJ, Kamath S. Comparison of the Streptococcus mutans and Lactobacillus colony count changes in saliva following chlorhexidine (0.12%) mouth rinse, combination mouth rinse, and green tea extract (0.5%) mouth rinse in children. J Indian Soc Pedod Prev Dent. 2017;35:150–155.
The Ask the Expert column features answers to your most pressing clinical questions provided by Dimensions of Dental Hygiene’s online panel of key opinion leaders, including: Jacqueline J. Freudenthal, RDH, MHE, on anesthesia; Nancy K. Mann, RDH, MSEd, on cultural competency; Claudia Turcotte, CDA, RDH, MSDH, MSOSH, on ergonomics; Van B. Haywood, DMD, and Erin S. Boyleston, RDH, MS, on esthetic dentistry; Michele P. Carr, RDH, MA, EdD, on ethics and risk management; Denise Muesch Helm, RDH, EdD, on fluoride; Kandis V. Garland, RDH, MS, on infection control; Mary Kaye Scaramucci, RDH, MS, on instrument sharpen ing; Kathleen O. Hodges, RDH, MS, on instrumentation; Karen Davis, RDH, BSDH, on insurance coding; Cynthia Stegeman, EdD, RDH, RD, LD, CDE, on nutrition; Olga A.C. Ibsen, RDH, MS, on oral pathology; Martha McComas, RDH, MS, on patient education; Michael W. Roberts, DDS, MScD, on pediatric dentistry; Purnima Kumar DDS, PhD, on periodontal therapy; Ann Eshenaur Spolarich, RDH, PhD, on pharmacology; and Caren M. Barnes, RDH, MS, on polishing. Log on to dimensionsofdentalhygiene.com/asktheexpert to submit your question.

From Dimensions of Dental Hygiene. February 2022; 20(2)47.

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