Gerarda D’Elia

Background: Chlorhexidine (CHX) is the reference chemical plaque control agent used after periodontal surgery, but higher concentrations are associated with adverse effects that can reduce patient compliance. This randomized controlled trial evaluated whether a mouthrinse combining a reduced CHX concentration (0.09%) with Citrox and hyaluronic acid (HA) could match the clinical performance of conventional 0.12% CHX after periodontal flap surgery, while improving tolerability. Methods: Thirty-two patients undergoing open flap debridement with an experimental vertical releasing incision randomly received a mouthrinse containing 0.09% CHX with Citrox and HA (TEST group) or conventional 0.12% CHX (CONTROL group) twice daily for 14 days. The primary outcome was the presence of edema; secondary outcomes were the Early Wound Healing Score (EHS) and its components, the plaque index (TQHPI), the gingival index (GI), the tooth/tongue staining index (SI), and the adverse events of oral ulcers and dysgeusia, assessed at baseline and at 3, 7, and 14 days. Results: Edema, EHS, and the GI did not differ significantly between the groups at any time point (edema at day 3: 37.5% in both groups; risk difference 0.0%; 95% CI −30.5% to 30.5%). The plaque index was significantly higher in the TEST group from day 7 (p = 0.003; median difference 0.20, 95% CI 0.10 to 0.40) to day 14 (p = 0.005; median difference 0.30, 95% CI 0.10 to 0.40). The distribution of staining scores differed significantly at day 14 (p = 0.008), with heavy staining observed only in the control group. Conclusions: No statistically significant differences between the reduced-concentration, multi-component mouthrinse, and 0.12% CHX were detected in the assessed wound-healing outcomes; the test formulation was associated with higher plaque scores from day 7 and with a different distribution of staining scores at day 14, without heavy staining. These preliminary findings require confirmation in larger trials.

Dental plaque is a biofilm structured in an extracellular matrix of polymers of host and microbial origin; the microorganisms can coexist in harmony with the host, thus guarantying oral health. Environmental modifications can lead to dysbiosis and onset of oral diseases; in fact, plaque is the etiological agent both of periodontal disease and dental decay. The use of an effective oral hygiene index should be considered as a relevant goal for the clinicians and the researchers, and consequently, numerous plaque indices have been proposed during the years. The present literature review aims primarily to obtain a complete summary of these scores to assess plaque deposits. It is useful because the clinician/researcher will select the right scoring method for the specific situation only if he knows the available options and if he is aware of both their strengths and weaknesses. This review applies a basic classification of plaque indices that distinguishes the ones that use non-quantitative methods from the ones that use quantitative methods. Non-quantitative methods are more subjective because they are based on the ability of the clinician to point out the presence or the entity of deposits, while quantitative methods introduce objectifiable means to measure plaque deposits.