Chlorhexidine and Morinda citrifolia mouthwash as a preprocedural mouthrinse during ultrasonic scaling – A randomised clinical trial

Abstract

Background: Aerosols released during ultrasonic scaling can cause cross-contaminations. Infections like hepatitis and SARS-CoV-2 can spread through these aerosols. Preprocedural rinse is a cost-effective method to reduce aerosol contami-nation produced during ultrasonic scaling.
Materials and Methods: This was a double-blinded randomised trial on 105 subjects diagnosed with chronic generalised periodontitis which was randomly allocated into three groups: Group I received 0.12% chlorhexidine (CHX), Group II received 5% Morinda citrifolia (noni) mouthrinse, Group III received distilled water. Participants were advised to mouthrinse for 60 seconds just before the start of ultrasonic scaling. The aerosols released during ultrasonic scaling were gathered on blood agar plates placed at three locations. Colony forming units (CFUs) were counted after 48 hours of incubation.
Results: The highest CFU values were observed in the distilled water group and the lowest in chlorhexidine group (p<0.05). Patient chest area has the highest number of CFU than doctors’ and assistant chest area (p<0.05).
Conclusions: Preprocedural rinsing with noni mouthwash can be used as an effective method of reducing aerosol contamination during ultrasonic scaling.
Keywords: Aerosols; Chlorhexidine; Morinda citrifolia; mouthwashes; Dental prophylaxis; Dental scaling.

References

1. Gandolfi MG, Zamparini F, Spinelli A, Sambri V, Prati C. Risks of Aerosol Contamination in Dental Procedures during the Second Wave of COVID-19—Experience and Proposals of Innovative IPC in Dental Practice. International Journal of Environmental Research and Public Health. 2020;17(23):8954. doi: 10.3390/ijerph17238954. PMID: 33271981; PMCID: PMC7729834.
2. Ali K, Raja M. COVID-19: dental aerosol contaminati-on in open plan dental clinics and future implicati-ons. Evidence-Based Dentistry. 2021;22(2):54–55. doi: 10.1038/s41432-021-0168-0. PMID: 34172904; PMCID: PMC8226348.
3. Yang M, Chaghtai A, Melendez M, Hasson H, Whitaker E, Badi M, Sperrazza L, Godel J, Yesilsoy C, Tellez M, Orrego S, Montoya C, Ismail A. Mitigating saliva aerosol contamination in a dental school clinic. BMC Oral Health. 2021;21(1):52. doi: 10.1186/s12903-021-01417-2. PMID: 33546674; PMCID: PMC7863034.
4. Sette-de-Souza PH, Soares Martins JC, Martins-de-Barros AV, Rodrigues Vieira B, Fernandes Costa MJ, da Costa Araújo FA. A critical appraisal of evidence in the use of preprocedural mouthwash to avoid SARS-CoV-2 transmission during oral interventions. Eur Rev Med Pharmacol Sci. 2020;24(19):10222-10224. doi: 10.26355/eurrev_202010_23245. PMID: 33090432.
5. Innes N, Johnson IG, Al-Yaseen W, Harris R, Jones R, Kc S, McGregor S, Robertson M, Wade WG, Gallagher JE. A systematic review of droplet and aerosol generation in dentistry. J Dent. 2021;105:103556. doi: 10.1016/j.jdent.2020.103556. Epub 2020 Dec 23. PMID: 33359043; PMCID: PMC7834118.
6. Villani FA, Aiuto R, Paglia L, Re D. COVID-19 and Dentistry: Prevention in Dental Practice, a Literature Review. International Journal of Environmental Research and Public Health. 2020;17(12):4609. doi: 10.3390/ijerph17124609. PMID: 32604906; PMCID: PMC7344885.
7. Nisha S, Shivamallu A, Gujjari S, Shashikumar P, Ali N, Kulkarni M. Efficacy of preprocedural boric acid mouthrinse in reducing viable bacteria in dental aerosols produced during ultrasonic scaling. Contemporary Clinical Dentistry. 2021;12(3):282-288. doi: 10.4103/ccd.ccd_374_20. Epub 2021 Sep 21. PMID: 34759686; PMCID: PMC8525822.
8. Manipal S, Hussain S, Wadgave U, Duraiswamy P, Ravi K. The Mouthwash War - Chlorhexidine vs. Herbal Mouth Rinses: A Meta-Analysis. J Clin Diagn Res. 2016;10(5):ZC81-3. doi: 10.7860/JCDR/2016/16578.7815. Epub 2016 May 1. PMID: 27437366; PMCID: PMC4948542.
9. Assi RA, Darwis Y, Abdulbaqi IM, Khan AA, Vuanghao L, Laghari M. Morindacitrifolia (Noni): A comprehensive review on its industrial uses, pharmacological activities, and clinical trials. Arabian Journal of Chemistry. 2017;10:691–707.
10. Choudhary E, Indushekar KR, Saraf BG, Sheoran N, Sardana D, Shekhar A. Exploring the role of Morinda citrifolia and Triphala juice in root canal irrigation: An ex vivo study. J Conserv Dent. 2018; 21(4):443-449. doi: 10.4103/JCD.JCD_58_18. PMID: 30122829; PMCID: PMC6080181.
11. Glang J, Falk W, Westendorf J. Effect of MorindacitrifoliaL. fruit juice on gingivitis/periodontitis. Modern Research in Inflammation. 2013;02(02):21–7.
12. Aldi Y, Khairiyah H, Kasuma N, Afriwardi A A, Banowo AS. The Effect of Noni Fruit Extract (Morindacitrifolia L.) in Gingivitis Patient. Pharmacognosy Journal. 2019;11(4):678–82.
13. Löe H, Silness J. Periodontal Disease in Pregnancy I. Prevalence and Severity. Acta Odon-tologica Scandinavica. 1963;21(6):533–51. doi: 10.3109/0001635 6309011240. PMID: 14121956.
14. Sette-DE-Souza PH, Costa MJF, Amaral-Machado L, Araújo FADC, Almeida Filho AT, Lima LRA. Dental workers in front-line of COVID-19: an in silico evaluation targeting their prevention. J Appl Oral Sci. 2021;29:e20200678. doi: 10.1590/1678-7757-2020-0678. PMID: 33787730; PMCID: PMC8007088.
15. Haffner EA, Bagheri M, Higham JE, Cooper L, Rowan S, Stanford C, Mashayek F, Mirbod P. An experimen-tal approach to analyze aerosol and splatter formations due to a dental procedure. Experiments in Fluids. 2021;62(10):202. doi: 10.1007/s00348-021-03289-2. Epub 2021 Sep 18. PMID: 34566249; PMCID: PMC8449526.
16. Almeida ÉS, Oliveira D, Hotza D. Properties and Applications of Morindacitrifolia (Noni): A Review. Comprehensive Reviews in Food Science and Food Safety. 2019;18(4):883–909. doi: 10.1111/1541-4337.12456. Epub 2019 Jun 10. PMID: 33336991.
17. Shashikumar P, Nisha S, Das D, Debanth K, Kanthal LK, Pattanayak S. Effect of Morinda citrifolia L. Mouthwash on Periodontal Health in Type 2 Diabe-tes Mellitus Patients − A Randomized Controlled Trial. Int J NutrPharmacolNeurol Dis 2022;12:7-13.
18. Laheij AMGA, Kistler JO, Belibasakis GN, Välimaa H, de Soet JJ, European Oral Microbiology Workshop (EOMW) 2011. Healthcare-associated viral and bacterial infections in dentistry. Journal of oral microbiology. 2012;4.
19. Nisha.KarmakarS,DasS,JanaD,AliNM,Shashiku-mar P.Comparison of chlorhexidine and hydrogen peroxide as preprocedural mouthrinse during ultrasonic scaling.A triple-blinded randomized controlled clinical trial.J Pharma Bioall Sci 2021. doi:10.4103/jpbs.jpbs_595_21. epub ahead of print.
20. Brookes ZLS, Belfield LA, Ashworth A, Casas-Agustench P, Raja M, Pollard AJ, et al. Effects of chlorhexidine mouthwash on the oral microbiome. Journal of dentistry. 2021;113:103768.
21. Mirhoseini SH, Koolivand A, Bayani M, Sarlak H, Moradzadeh R, Ghamari F, et al. Quantitative and qualitative assessment of microbial aerosols in different indoor environments of a dental school clinic. Aerobiologia. 2021 Jun 13;37(2):217–24.
22. Zemouri C, Volgenant CMC, Buijs MJ, Crielaard W, Rosema NAM, Brandt BW, et al. Dental aerosols: microbial composition and spatial distribution. Journal of oral microbiology. 2020;12(1):1762040.
23. Gupta G, Mitra D, Ashok KP, Gupta A, Soni S, Ahmed S, Arya A. Efficacy of preprocedural mouth rinsing in reducing aerosol contamination produced by ultrasonic scaler: a pilot study. J Periodontol. 2014; 85(4):562-8. doi: 10.1902/jop.2013.120616. Epub 2013 Jul 15. PMID: 23855840.
24. Paul B, Baiju RMP, Raseena NB, Godfrey PS, Shanimole PI. Effect of aloe vera as a preprocedural rinse in reducing aerosol contamination during ultrasonic scaling. Journal of Indian Society of Periodontology. 24(1):37–41.
25. Retamal-Valdes B, Soares GM, Stewart B, Figueiredo LC, Faveri M, Miller S, et al. Effectiveness of a pre-procedural mouthwash in reducing bacteria in dental aerosols: randomized clinical trial. Brazilian oral research. 2017;31:e21.
26. Kumbargere Nagraj S, Eachempati P, Paisi M, Nasser M, Sivaramakrishnan G, Verbeek JH. Interventions to reduce contaminated aerosols produced during dental procedures for preventing infectious diseases. The Cochrane database of systematic reviews. 2020;10:CD013686.
27. Janakiram C, Venkitachalam R, Fontelo P, Iafolla TJ, Dye BA. Effectiveness of herbal oral care products in reducing dental plaque & gingivitis - a systematic review and meta-analysis. BMC complementary medicine and therapies. 2020;20(1):43.
28. Kumar PS, Geisinger ML, Avila-Ortiz G. Methods to mitigate infection spread from aerosol-generating dental procedures. Journal of periodontology. 2021;92(6):784–92.
29. Verbeek JH, Rajamaki B, Ijaz S, Sauni R, Toomey E, Blackwood B, Tikka C, Ruotsalainen JH, Kilinc Balci FS. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database Syst Rev. 2020;4(4):CD011621. doi: 10.1002/14651858.CD011621.pub4. Update in: Cochrane Database Syst Rev. 2020 May 15;5:CD011621. PMID: 32293717; PMCID: PMC7158881.
30. Pierre-Bez AC, Agostini-Walesch GM, Bradford Smith P, Hong Q, Hancock DS, Davis M, Marcelli-Munk G, Mitchell JC. Ultrasonic scaling in COVID-era dentistry: A quantitative assessment of aerosol spread during simulated and clinical ultrasonic scaling procedures. Int J Dent Hyg. 2021;19(4):474-480. doi: 10.1111/idh.12548. Epub 2021 Aug 28. PMID: 34418305; PMCID: PMC8652710.
31. Allison JR, Currie CC, Edwards DC, Bowes C, Coulter J, Pickering K, Kozhevnikova E, Durham J, Nile CJ, Jakubovics N, Rostami N, Holliday R. Evaluating aerosol and splatter following dental procedures: Addressing new challenges for oral health care and rehabilitation. J Oral Rehabil. 2021;48(1):61-72. doi: 10.1111/joor.13098. Epub 2020 Oct 8. PMID: 32966633; PMCID: PMC7537197.
32. Sabu BS, Chandrashekar KT, Mishra R, Tripathi VD, Khatri H, Deo A. Evaluation of Morinda citrifolia (noni) fruit extract as a bone regenerative material in the treatment of periodontal intrabony osseous defects: Clinical and cone-beam computed tomography assessment. J Indian Soc Periodontol. 2021;25(2):144-149.
Published
2023-11-30
How to Cite
NISHA, Swet; DAS, Debanjan; SHASHIKUMAR, Pratibha. Chlorhexidine and Morinda citrifolia mouthwash as a preprocedural mouthrinse during ultrasonic scaling – A randomised clinical trial. Journal of Oral Research, [S.l.], v. 12, n. 1, p. 277-287, nov. 2023. ISSN 0719-2479. Available at: <https://joralres.com/index.php/JOralRes/article/view/joralres.2023.024>. Date accessed: 28 feb. 2024. doi: https://doi.org/10.17126/joralres.2023.024.
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Articles