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Table of Contents
ORIGINAL ARTICLE
Year : 2021  |  Volume : 8  |  Issue : 3  |  Page : 67-70

Efficacy of darolac probiotic and chlorhexidine mouth rinse in reducing plaque and gingival inflammation in children: A clinical trial


1 PG Third Year, Department of Pediatric Dentistry, Vyas Dental College and Hospital, Jodhpur, Rajasthan, India
2 PG Third Year, Department of Endodontics, Vyas Dental College and Hospital, Jodhpur, Rajasthan, India
3 PG 2nd year, Department of Oral Medicine and Radiology, Vyas dental College and Hospital, Jodhpur, Rajasthan, India
4 BDS Intern, MGM Dental College, Navi Mumbai, India
5 General Dentist, Barpeta, Assam, India
6 Associate Professor, Department of Oral and Maxillofacial Surgery, Dr RRK Dental College and Hospital, Akola, Maharashtra, India
7 Associate Professor, Department of Oral Medicine and Radiology, Vyas Dental College and Hospital, Jodhpur, Rajasthan, India

Date of Submission28-Jun-2021
Date of Acceptance21-Jul-2021
Date of Web Publication27-Sep-2021

Correspondence Address:
Dr. Sugandha Arya
Associate Professor, Department of Oral Medicine and Radiology. Vyas Dental College and Hospital, Jodhpur, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpcdr.ijpcdr_25_21

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  Abstract 


Background: Chemical agents have been increasingly used as an adjunct to mechanical control. The use of a mouthwash augments maintenance of oral health through its antiplaque and antibacterial chemical properties.Recently, Probiotics can be used an effective alternative for other traditional mouthrinses in reducing plaque accumulation and gingival inflammation.
Aim: To evaluate the clinical efficacy of a probiotic and chlorhexidine mouth rinses on plaque and gingival accumulation in children.
Materials and Methods: Randomized controlled 14 day trial including 30 healthy children (6–8 years) was done in which 10 children were in control group and 20 children were instructed to rinse 5ml/day for 1 min of each solution (probiotics and chlorhexidine) for 14 days.
Results: A Statistically significanct difference was noted between mean PI and mean GI score of control group when compared with probiotic and chlorhexidine after 14 days in comparison to baseline (P < 0.001). However, there was no significant difference in mean plaque accumulation and gingival inflammation between the probiotics and chlorhexidine on the 14th day examination.
Conclusion: Probiotics mouth rinse was effective in reducing plaque accumulation and gingival inflammation in 6 to 8 year old children.

Keywords: Chlorhexidine, probiotics, mouthwashes


How to cite this article:
Bande Y, Ade S, Baroopal S, Joshi A, Pathak J, Deshmukh AV, Arya S. Efficacy of darolac probiotic and chlorhexidine mouth rinse in reducing plaque and gingival inflammation in children: A clinical trial. Int J Prev Clin Dent Res 2021;8:67-70

How to cite this URL:
Bande Y, Ade S, Baroopal S, Joshi A, Pathak J, Deshmukh AV, Arya S. Efficacy of darolac probiotic and chlorhexidine mouth rinse in reducing plaque and gingival inflammation in children: A clinical trial. Int J Prev Clin Dent Res [serial online] 2021 [cited 2021 Nov 29];8:67-70. Available from: https://www.ijpcdr.org/text.asp?2021/8/3/67/326828




  Introduction Top


Dental disease such as dental caries and periodontal disease remains a “silent epidemic” in the world that threatens children and adults.[1] It results from the accumulation of many different bacteria that form dental plaque, a naturally acquired bacterial biofilm that develops on the teeth.[2] Streptococcus mutans, the microbial species most strongly associated with carious lesion, is naturally present in the human oral plaque.[3] Plaque control measures employ a variety of mouthwashes to augment mechanical removal by inhibiting or reducing plaque accumulation and gingival inflammation. Chlorhexidine gluconate is considered the most effective antiplaque and antigingivitis agent.[4]

The term probiotic, as an antonym to the term antibiotic, was first used by Lilly and Stillwell in 1965 to describe substances secreted by one microorganism which stimulates the growth of another.[5],[6] The definition of “probiotics” has been adopted by the International Scientific Association and the World Health Organization: “live microorganisms, if administered in adequate amounts, confer a health benefit on the host.“[7] Probiotic technology represents a breakthrough approach to maintaining oral health by utilizing natural beneficial bacteria commonly found in healthy mouths to provide a natural defense against those bacteria thought to be harmful to teeth and gums.[5] However, data are still sparse on the probiotic action in the oral cavity. Hence, the present study was conducted with the aim to clinically investigate the efficacy of a probiotic and chlorhexidine mouth rinse in reducing plaque accumulation and gingival inflammation among schoolchildren aged 6–8 years.


  Materials and Methods Top


In this study, the trial design is a double blind randomized controlled trial and powered to evaluate the effect of probiotic mouth rinse on plaque and gingivitis. The subjects and the examiner were blinded regarding the product allocation. This study included 30 healthy children in the age group of 6–8 years who had been selected from Stepping Stones Sec. School, Jodhpur (Rajasthan). All procedures performed in the study were conducted in accordance with the ethics standards given in 1964 Declaration of Helsinki, as revised in 2013. The study proposal was submitted for approval and clearance was obtained from the ethical committee of our institution. A written informed consent was obtained from each participant. This study included children between 6 and 8 years of age as per school records, who were willing to participate with parental consent and had no history of any recent antibiotic therapy (within 4 weeks) whereas children suffering from any systemic illness, who were using any other commercially available mouth rinse or probiotic products or any other oral hygiene aids other than routine teeth brushing were excluded from the study. The children were randomly divided into 3 groups (Groups A, B, and C) with 10 children in each group. Group A: control group (mint water), Group B: probiotic group (Darolac), and Group C: chlorhexidine group. The children were assessed for gingival inflammation and plaque accumulation using a mouth mirror and blunt WHO periodontal probe. Gingival and plaque statuses were assessed using Loe and Silness gingival index (GI) (1963) and Silness and Loe plaque index (PI) (1964), respectively.

Probiotic mouth rinse preparation and administration

A commercially available probiotic named Darolac (Lallemand Health Solutions, India) available in individual sachets was utilized as shown in [Figure 1]. Each sachet contains 2 g powder of 2.5 billion freezedried bacterial combination comprising Lactobacillus rhamnosus (LGG), Bifidobacterium longum, and Saccharomyces cerevisiae. The probiotic mouth rinse had to be freshly prepared by dispensing the contents of one sachet in 20 ml of filtered water in a measuring beaker. Before administering the probiotic mouth rinse, the children were trained to rinse using 20 ml of plain-filtered water for 2 days. Thereafter, the probiotic mouth rinse was prepared and administered to the children. The children were instructed to rinse with 5 ml of the solution for 1 min and then swallow the solution. This was repeated till the total content (i.e. 20 ml) of the preparation had been consumed. In case the child expectorated the solution, he/she was made to repeat the process. Mouth rinsing was carried out 1 h after lunch for a period of 14 days. After this period of mouth rinsing, the probiotic rinse was then discontinued and the children were asked to continue performing tooth brushing as advised.
Figure 1: Probiotic (Darolac Z) and Chlorhexidine Mouthwash

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Chlorhexidine administration

Children were instructed to rinse chlorhexidine [Figure 1] for 60 sec once a daily about 30 min after toothbrushing with 15 ml of the solution with 1:1 dilution followed by expectoration of residual mouth rinse. This was followed by full mouth prophylaxis again. The parents were asked to supervise the children during the use of mouth wash.

On day 14, all subjects returned for clinical measurements and the PI and GI scores were evaluated. Results revealed that the mean baseline scores of PI and GI were similar for all the 3 groups as shown in [Table 1]. The mean PI values for all the 3 groups were 0 after scaling and polishing was done for all tooth surfaces. On applying paired t test, the effects of PI for the 3 groups showed a P < 0.001. Thus, the differences in the mean PI for all the 3 groups were statistically significant. At day 14 when comparison with the baseline data was made, there was a significant increase in the mean PI scores of the control group when compared with that of probiotic and chlorhexidine groups. (P < 0.001 and P < 0.001, respectively) as shown in Graph 1. On day 14 when comparison with the baseline data was made, there was a significant decrease in the mean GI scores of probiotic and chlorhexidine groups when compared with that of the control group (P < 0.001 and P < 0.001, respectively) as shown in Graph 2. The degree of increment of mean plaque scores was more pronounced in the control group compared with that of the probiotic and chlorhexidine groups. Probiotic and chlorhexidine groups had less plaque accumulations compared with the control group. There were no significant differences in the mean plaque accumulations between the probiotic and chlorhexidine groups on examination on the 14th day. Effects for GI for the 3 groups showed P < 0.001, and thus, the differences in mean GI for all the 3 groups were statistically significant. However, unlike the PI score, there was a significant difference in the GI between the probiotic and the chlorhexidine groups (P = 0.017). Probiotic group is better than the chlorhexidine group (mean = 0.191 and 0.284), respectively.
Table 1: Comparison between GI and PI scores at baseline and after 14 days between test groups

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  Discussion Top


In the present era, dental caries is one of the most common chronic oral diseases affecting 60%–90% of the young population.[8] Mechanical removal with brushing followed by flossing is the most efficient way in the prevention of the dental caries and periodontal problems. Mouth rinsing provides additional benefits for controlling gingivitis and formation of plaque.[9] The most effective antimicrobial agent is known as chlorhexidine mouthwash which is considered as a “gold standard” antimicrobial agent for plaque control.[10] Chlorhexidine gluconate is a cationic bisbiguanide having a broad spectrum of action and good substantivity. On being used as a mouthwash, it results in membrane disruption of the bacteria, causing a concentration-dependent growth inhibition and cell death.[8] It blocks the acidic groups of salivary glycoprotein, adsorbs to the extracellular polysaccharides of bacteria, and reduces its ability to bind to tooth surfaces, and finally, it competes with calcium ion agglutinating factors present in plaque. However, it is not recommended for long-term use due to its side effects including brown discoloration of teeth, taste alteration, oral mucous irritation, and burning sensation.[11],[12] In contrast, probiotics have been referred to as “correctives of the ecosystem” and adopt a wellness rather than an illness model, wherein they heal/stabilize oral disease conditions by establishing an oral health balance. They act by competing for the binding site with the lethal bacteria, production of antimicrobial substances, and regulation of immune response.[8] Consumption of products containing probiotic bacteria such as lactobacilli or bifidobacterium could reduce the level of S. mutans in saliva. Probiotic strains hold many advantages such as the bacterial strains present in them are not harmful to the oral cavity, concerns of antibiotic resistance are not there, and no proven toxicities have been reported related to their usage.[8] In light of the above facts, the current study was designed with an aim to compare the effectiveness of probiotic and chlorhexidine mouth rinses on plaque accumulation and gingival inflammation. Lactobacillus acidophilus was used in our study because it can reduce the adherence of oral streptococcal strains to the tooth surface. In this study, significance difference between mean PI and mean GI score of control group when compared with probiotic and chlorhexidine after 14 days in comparison to baseline (P < 0.001) had been observed. However, there was no significant difference in mean plaque accumulation and gingival inflammation between the probiotics and chlorhexidine on the 14th day examination. Study done by Thakkar et al.[2] found that probiotic mouth rinse was more effective against plaque accumulation both at 14 days of study and 3 weeks after discontinuation of probiotics. Another study by probiotics in the form of mouth rinse had been tested among adults in another study by Noordin and Kamin 2007[13] and concluded that rinsing with probiotic mouth rinse resulted in a significant reduction of plaque accumulation and gingival inflammation which is similar to our study. Purunaik et al.[14] evaluated the efficacy of probiotic mouth rinses (1 g powder of 1.25 billion freeze-dried combination, a mixture of L. acidophilus, L. rhamnosus, B. longum, and S. boulardii), and chlorhexidine mouth rinses on plaque and gingival scores demonstrated that probiotic had comparable efficacy to chlorhexidine mouth rinses and caused significant reduction in plaque and gingival score. Mishra et al.[15] reported that herbal and chlorhexidine mouthwashes were more effective than probiotic mouth rinse in children between 6 and 14 years of age when used for a period of 7 days which was not in accordance with that reported in our study. Hence, from the present study, it was observed that probiotics mouth rinse was effective in reducing plaque accumulation and gingival inflammation in 6- to 8-year-old children and so to overcome the drawbacks of antimicrobial chemical agents, probiotic therapy can be considered as a viable alternative in the prevention of oral disease. A major limitation of our study is that we did not carry out a microbial evaluation of plaque samples to assess a change in the bacterial ecology. Further studies should be conducted with a larger sample size to assess the effect of continued probiotic use on the dental caries status of the study cohort.


  Conclusion Top


Probiotic mouth rinse has a potential therapeutic value and is an effective and safe alternative to chlorhexidine mouthwash appearing to be a boon for the treatment of dental caries and periodontitis. Follow-up studies are needed to ensure its long-term effects, the specific probiotic strain for the specific disease, age according dosage, and frequency of supplementation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Purunaik S, Thippeswamy HM, Chavan SS. To evaluate the effect of probiotic mouthrinse on plaque and gingivitis among 15-16 year old school children of Mysore City, India – Randomized controlled trial. J Dent Otolaryngol 2014;14:9-14.  Back to cited text no. 1
    
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Thakkar PK, Imranulla M, Kumar N, GM Prashant, B Sakeenabi, VH Sushanth. Effect of probiotic mouthrinse on dental plaque accumulation: A randomized controlled trial. Dent Med Res 2013;1:7-12.  Back to cited text no. 2
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Caglar E, Cildir SK, Ergeneli S, Sandalli N, Twetman S. Salivary mutans streptococci and lactobacilli levels after ingestion of the probiotic bacterium Lactobacillus reuteri ATCC 55730 by straws or tablets. Acta Odontol Scand 2006;64:314-8.  Back to cited text no. 3
    
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Deogade SC. Probiotics: Contributions to oral and dental health. Oral Health and Dental Management 2015;14:145-53.  Back to cited text no. 6
    
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Jindal G, Pandey RK, Agarwal J, Singh M. A comparative evaluation of probiotics on salivary mutans streptococci counts in Indian children. Eur Arch Paediatr Dent 2011;12:211-5.  Back to cited text no. 7
    
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Jothika M, Vanajassun PP, Someshwar B. Effectiveness of probiotic, chlorhexidine and fluoride mouthwash against Streptococcus mutans-Randomized, single-blind, in vivo study. J Int Soc Prev Community Dent 2015;5:S44-8.  Back to cited text no. 8
    
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Shah RK. Comparative evaluation of efficacy of probiotic, chlorhexidine and flouride mouthrinses in children: A short-term clinical study. Int J Dent Med Res 2014;1:21-6.  Back to cited text no. 9
    
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Parineeta Sharma, Geetika Datta, Kapil Gandhi, Dipanshu Kumar. A comparative evaluation of efficacy of probiotic and chlorhexidine mouthrinses on gingival health and plaque accumulation in 6-9 year old children. Int J Appl Dent Sci 2019;5:156-62.  Back to cited text no. 10
    
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Vivek K, Amrita, Mahender P. Comparison of the effectiveness of probiotic and chlorhexidine mouth rinses on plaque accumulation and gingival inflammation. Int J Drug Res Dent Sci 2019;1:1-5.  Back to cited text no. 11
    
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McBain AJ, Bartolo RG, Catrenich CE, Duane Charbonneau, Ruth G Ledder, Peter Gilbert. Effects of a chlorhexidine gluconate containing mouthwash on the vitality and antimicrobial susceptibility of in vitro oral bacterial ecosystems. Appl Environ Microbiol 2003;69:4770-6.  Back to cited text no. 12
    
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Noordin K, Kamin S. The effect of probiotic mouth rinse on plaque and gingival inflammation. Ann Dent Univ Malaya 2007;14:19-25.  Back to cited text no. 13
    
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Purunaik S, Thippeswamy HM, Chavan SS. To evaluate the effect of probiotic mouthrinse on plaque and gingivitis among 15-16 year old school children of Mysore City, India – Randomized controlled trial. Glob J Med Res 2014;14:9-14.  Back to cited text no. 14
    
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Mishra R, Tandon S, Rathore M, Banerjee M. Antimicrobial and plaque inhibitory potential of herbal and probiotic oral rinses in children: A randomized clinical trial. Indian J Dent Res 2014;25:485-92.  Back to cited text no. 15
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