Journal of Clinical Pehodontology 1983: 10: S9-99
K^y word?: Chl/trliexidinc - phque - laolhpialc.
Aecepled fpr piihlication April 27, I9S2
Effect of toothpaste rinses compared with
chlorhexidine on plaque formation during a
M. ADDY, L, WILLIS AND J. MORAN
Department of Periodontology, Dental School, Welsh National School of Medicine, Heath Park, Cardiff, UK
Abstract. Evidence suggests that brushing with a toothpaste may slow plaque reformation over 24 h.
This study measured the effect of toothpaste alone on plaqueregrowth over a 96 h period and compared
the effect with water and the known antiplaque agent chlorhexidine. At 9 a.m. at the beginnmg of 7,4day no oral hygiene periods, iO volunteers were scaled and polished. At 5 p.m. subjects brushed their
own teeth with water until plaque free. Each subject rinsed for I min with 10 ml ofa randomly allocated
rinse. Rinsing was repeated at 10 a.m. and 10 p.m. on subsequent days. The rinses were water,
chlorhexidine D.2% or 3 g/lO ml slurrie.s oftoothpastes containing(1) monofluorophosphate{MFP), (2)
monofluorophosphatc +sodium fluoride (MFP+NaE) (3) monofluoropho.sphate + zinc citrate
(M F P + ZCT) (4) staiinous fluoride (SnE;) (5| sodium fluoride (NaE). At 16, 24, 4S and 72 h plaque on
the buccal surface of the upper and lower premolars, canines and incisors was scored by the Gingivai
Margin Plaque Index (GMPI) and gram films of plaque samples made. Ai 96 h plaque was recorded
diagrammatically and areas of coverage measured visually (Debris Index) and by planimetry.
Progressive plaque formation to a Gingivai Margin Plaque Index of 100% at 72 h was observed for
toothpaste and water rinses. Eor chlorhexidine the Gingivai Margin Plaque index at 72 h was 6%. At 96
h plaque areas were significantly less with toothpaste rinses compared with water. Chlorhexidine very
significantly reduced plaqtie areas compared with toothpaste and water. The bacteriological assessment
of smears revealed essentially similar plaque development during toothpasie and water rinses and was
consistent with previous reports. However, with chlorhexidine the densities of organisms in the smears
were greatly reduced. It was concluded that thesmalleffect of toothpaste rinses on plaque accumulation
compared with chlorhexidine would not alone represent a true antiplaque effect resulting in therapeutic
benefit.
The mechanical removal of plaque by the
regular use ofatoothpastestillappears to bethe
containing such achemicalantiplaqueagentare
not, in general, available commercially. Many
most effective and widely employed oral hy-
other compounds have been incorporated into
gieiie method. Chemical control by plaque
inhibitors, in particular chlorhexidiiie, has been
toothpaste preparations, however it is only with
the fluoride formulations that a significant
limited by the occurrence of local side effects
(Loe & Schiott 1970, Flotra et ai. 1971). Thus.
despite the evidence demonstrating the efficacy
of chlorhexidine in the reduction of gingivitis
reduction in a dental disease, namely caries, has
been repeatedly reported (Reviews - Murray
1976, Accepted Dental Therapeutics I97I/2).
The action of fluoride in reducing caries is
(Loe & Schiott 1970, Davies & Hull 1973. Bay
1978)andtosomeextentcaries(Loeetal. 1972.
complex and would not appear to be mediated
primarily through a plaque reducing effect.
Regolati et al. 1974, Emilson J977), toothpastes
Thus, with the possible exception of stannous
0303-6979/83/010089-11 $02.50/0 © 1983 Munksgaard, Copenhagen
ADDY, WILLIS AND MORAN
fluoride (Tinanoff et al. 1976, 1980, Svatum
et al. 1977, Hock & Tinanoff 1979), fluorides exhibit only minima] inhibitory effects on
plaque formation in vivo (Loesche et al. 1975,
Tinanoff etaJ. 1976, Tinanoff &Camosci 1980).
Moreover, plaque reducing effects of fluorides in toothpastes have not been established.
This is perhaps not surprising since studies
attempting to assess the effects of toothpastes
on plaque formation are hampered not only by
the number of variables created by the formulation, but also by the mechanical action of the
toothbrush delivery method. Consequently
proven chemical plaque inhibitors may fail to
exert significant effects above placebo when
delivered by a toothbrush (Hoyos et ai. 1977).
Nevertheless reductions in plaque regrowth
following the use of some toothpaste formulations have been demonstrated (Harrap 1974,
Stean & Forward 1980) or claimed by manufacturers. Such short-term study methods, measured in hours, largely overcome the toothbrushing variable but pose certain problems.
The scoring of the minute accumulations of
plaque which develop in 16-24 h may be
difficult, particularly in view of the non-specificity of disclosing solutions. Measurement techniques for this purpose have been reported
(Harrap 1974), but no attempt to identify the
nature of the stained material on the tooth at
these time periods was made. More important,
perhaps, must be the relevance to dental disease
of the observed reductions in plaque formation
after such short periods.
To date therefore it has not been possible to
determine whether the reduction in plaque
reformation resulting from single brushings
with toothpaste represents a true chemical
antiplaque effect of the paste, that is one which
would significantly reduce caries or chronic
gingivitis. The aim of this study was to measure
the effects of toothpaste alone on plaque formation over a 96 h period by delivering the
preparations in mouthwash form without the
concurrent use of a toothbrush. Moreover, it
was hoped to assess, by comparison with rinses
of water and the known antiplaque agent
chlorhexidine, the relevance to disease of any
plaque reduction observed.
Material and Methods
A group of 10 volunteers (4 female and 6 male),
of age range 22-39 years (mean 27.6 years) and
all employed within the Dental School, took
part in a 7X4 day rinsing study. The subjects
were dentate, not wearing oral apphances, with
no relevant medical history and not taking any
pharmacotherapy. Between 9-10 a.m. on each
Monday of the rinsing periods, all subjects were
scaled to remove all stain and calculus and
polished with a slow running bristle brush
without paste until plaque free. At 4 p.m. the
subjects were requested to brush their teeth with
a brush and water only until again plaque free.
The absence of plaque was established by
careful examination of the teeth using a mirror
and probe. Normal oral hygiene procedures
were then suspended for the remainder of each
period. At 5 p.m. all subjects rinsed for I min
with 10 ml of the preparation randomly allocated for the respective period.
The rinses employed during the 7 periods
were (I) water, (2) chlorhexidine gluconate
0.2% or toothpaste slurries in water, of commercial toothpastes identified as containing (3)
monofiuorphosphate 0.76%, (4) monofluorphosphate 0.76% + sodium fluoride 0.1%, (5)
monofiuorphosphate 0.8% and zinc citrate
0.5%, (6) sodium fluoride 0.24%, (7) stannous
fluoride 0.4%. Rinsing was repeated twice a day
on subsequent days at 10 a.m. and 10 p.m. In an
attempt to produce toothpaste slurries of comparable concentration, albeit higher dose, to
that delivered by toothbrush, 3 g/lO ml of each
paste was employed (the normal quantity of
toothpaste used on a brush was reported to be
1.45 g (Duke & Forward 1982) which is diluted
approximately 1 in 4 by saliva.) The toothpaste
slurries were prepared immediately before use
to avoid possible inactivation of ingredients
with time. Thus, the first and subsequent 10
TOOTHPASTE AND PLAQUE
a.m. toothpaste rinses were made up by the
pharmacist. For the 10 p.m. rinses the subjects
were provided with a 10 ml stoppered tube and
a 10 ml disposable plastic syringe filled with the
respective toothpaste. The subjects were instructed to inject 2 ml of paste into 10 tnl of
water and shake the sealed tube vigorously until
the paste was completely dispersed. The slurries
were then used immediately as a ritise. Preliminary studies demonstrated that 2 ml of paste
delivered by this method gave a weight reproducibility of the various pastes employed of
2.8-3.1 g.
present on the teeth was then diagrammatically
recorded using the Fxtrinsic Stain Index method (Shaw & Murray 1977). Thus accurate scale
drawings of tooth form were obtained from the
Tooth Atlas (Wheeler 1969). These outline
drawings of the labial surface of the relevant
teeth are magnified 4 times and on this a grid of
4 mm squares is drawn. Plaque was determined
using a planimeter (Apple Graphics Tablet linked to Apple II microcomputer. Apple Computers Incorporated, 10260 Bandley Drive,
Cupeltino, CA 95014, U.S.A.) to measure the
area of piaque recorded on the scale drawings.
Total plaque areas were then obtained by
summation of individual areas. A period of 72 h
was allowed between the rinsing regimens when
subjects returned to their normal oral hygiene
measures. All scoring of plaque was carried out
by a scorer blind to the rinsing regimen, and
analysis of smears was similarly carried out
blind using coded shdes.
At 16, 24, 48 and 72 h, plaque accumulation
along the gingival margin of the buccal surface
of the upper and lower premolars, canines and
incisors was measured employing the Gingival
Margin Plaque Index (GMPI) (Harrap 1974).
Thus the teeth were disclosed with an erythrocin
solution and after a single rinse with water the
stained material remaining at the gingival margin was considered as plaque. This was subjectively scored as a percentage of the length of the
gingival margin from the tip of the mesial to the
tip of the distal papillae. Teeth with restorations, which encroached upon the gingival
margin were excluded and no substitutions were
made. The index for each subject was determined by summing the individual tooth scores
and dividing by the number of teeth. From 6
subjects plaque samples at 16, 24, 4S and 72 h
were taken from alternate first molars at each of
the 4 measurement times. Thus a Williams
round probe was gently drawn along the gingival margin to remove material stained by the
disclosing solution. The accumulation at the tip
of the probe was spread on a microscope slide
and Gram stained. The bacterial deposit was
then categorised for predominant types and
densities of organisms under oi! immersion at
XIOOO magnification.
Staiislical analysis
The significance of daily plaque growth at the
gingiva! margin was determined using the one
way analysis of variance. Differences in plaque
on individual days for each preparation and
between preparations were assessed using the
Wilcoxon paired signed ranks test for nonparametric data. The significance of the differences between the 96 h plaque scores was
determined using the Wilcoxon paired signed
rank test for scores recorded using the criteria of
the Debris Index, Plaque areas determined by
planimetry were treated as parametric data and
the differences determined using the student t
test for paired data. Adjustments in 96 h plaque
measurements to take into account differences
in the number of teeth scored for each individual, were not made since alJ analyses were
paired.
At 96 h after again disclosing, buccal plaque
was scored according to the criteria of the
Debris Index (Greene &. VermilUon i960). A
total Plaque Index was obtained by summing
the individual scores for each tooth. The plaque
1. Gingival Margin Plague Index
The mean and standard deviation of the GMPI
at each time period during the use of the 7 rinses
Results
ADDY, WILLIS AND MORAN
Table I. Gingival Margin Plaque Index (%) during the use of water, chlorhexidine and toothpaste rinses
Der Plaqueindex (in %) beim Mundspiilen mil (Vasser, Chlorhexidin undmil eincr Aufschlammung von Zahtipctsle
Jndice de Plaque du Rebuid Gingival (%) lors de I'utilisaiion dcs bains de bouche (mouthwash) a I'eaii. a la
chlorhexidine et a la pate deniifrice
Mouthwash
1 Water
2 Chi
3MFP
4 MFP-fNaF
5 MFP + ZCT
6 NaF
7SnF2
14.3
(8.5)
1.8
(1.0)
3.4
(4.3)
7.4
(8.4)
4.3
(5.3)
4.5
(6.6)
10.1
(6.76)
Time
48
24
16
NS
S**
NS
s**
s**
S"
s*
22.9
(13.3)
5.3
0•^)
10.9
(9.5)
25.9
(16-0)
25.3
(13-1)
23.0
(M.i)
24.8
(16.2)
S***
NS
S***
S***
57.8
(29.0)
5.4
(2.7)
49.9
(23.2)
81.0
(26.0)
76.6
(24.6)
76.8
S***
NS
S***
S***
S*=^*
(n.2)
s***
(
) = s.d. ((
)^Siandarddeviation, (
)~ecart-iype),
Chi'^ chlorhexidine), time (Zeitdaucr. temps ecoule).
84.0
(21.5)
s***
72
F value
P
94.6
(7.3)
6.0
(3.9)
83.3
(15.8)
95.8
(9.3)
99.6
(1.5)
99.4
(1.5)
100.0
(0)
45.6
< 0.0001
4.6
<0.005
67.5
<0.0001
73.8
< 0.0001
81.0
< 0.0001
137.0
< 0.0001
108.0
<0.000!
i. = chlorhexidme {Chl. = Chlovhexidin.
/•values: *<0,05; ** <0.0i; ***<0.00I
is shown in Table 1. The overall significance of
the change in plaque indices with time is shown
by the F values and the significance of the
differences between the respective scoring times
is indicated. During the use of water or toothpaste slurry rinses there was a progressive and
highly significant increase in plaque with time.
This arose from significant increases in plaque
with all these rinses between the 24-48 h and
48-72 h periods. Moreover a significant increase in plaque occurred with toothpaste rinses
4, 5, 6 and 7 between the 16-24 h period. For
chiorhexidine, plaque growth at the gingival
margin also significantly increased with time;
however, this resulted from a significant increase in plaque only between the 16-24 h
periods. After 24 h plaque growth did not
significantly increase.
By 72 h the maximum (!00%) for the Gingival Margin Plaque Index had, in mean terms,
almost been reached during the use of water or
toothpaste rinses. This contrasted with the
plaque growth with chlorhexidine which was in
excess of 14 times less than the plaque scores
achieved with the toothpaste rinses. Analysis
between rinses demonstrated that mean plaque
growth was aiways less with chlorhexidine
compared with the other rinses and these differences were in most cases significant as summarised in Table 2. At 16 h there was a mean
reduction in piaque growth with toothpaste
rinses compared with water; however, the differerence was small in clinical terms and only
significant for toothpastes 3 and 5. In fact, for
all time periods to 72 h no consistent trend for
significant reductions in plaque growth along
the gingival margin was observed for toothpaste
compared with water rinses. Comparisons
between the toothpastes revealed some significantly greater effects for preparations on
plaque growth at certain time periods, most noticeably toothpaste 3. However, compared with
chlorhexidine the differences were very small
and in the case of toothpaste 3, progessively
decreased in percentage term.s with time.
2. Plaque areas and indices at 96 h
The mean and standard deviation of the plaque
areas at 96 h for the group during the use of the
various rinses are shown in Fig. 1 together with
lilis cition
TOOTHPASTE AND PLAQUE
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a summary of statistical differences. Compared
with water, the plaque area was significantly
reduced following the use of chiorhexidine or
toothpaste rinses. For chiorhexidine the plaque
area was also markedly and highly significantly
reduced compared with the toothpaste rinses.
In numerical terms plaque accumulating with
toothpaste rinses or water was 6-11 times
greater than that observed with chiorhexidine.
Comparison between toothpastes demonstrated relatively small mean differences in
tooth plaque areas seen at 96 h which were only
significant on 2 occasions.
The mean total plaque scores recorded according to the criteria of the Debris Index are
shown in Fig. 2 together with a summary of
statistical differences. For chiorhexidine and
the toothpastes the mean plaque was less than
with water and with the exception of toothpaste
6 the differences were again significant. Plaque
scored by this method demonstrated scores
approximately twice those of chiorhexidine
when water or toothpaste were used.
-s
a-
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93
it
i>
3. Bacteriological assessment
At a macroscopic level during the use of
toothpastes and water, an increase in the
amount and density of stained materiai on the
slides with time, was apparent. For chiorhexidine, such a change with time was not observed
and for some specimens a lack of visible stained
deposit on the slides was reported even at 72 h.
At a microscopic level the subjective assessments of individual samples for respective time
periods for all toothpastes and water were
essentially simitar and no obvious differences
between treatments were discernable. Thus in
alt cases at 16 h, a scant smear of organisms was
apparent with occasional small groups or
"clumps" of bacteria seen. The predominant
organisms were Gram-positive cocci together
with Gram-negative cocci. The picture was not
markedly changed at 24 h except for a slight
trend to increased densities of organisms. At 16
and 24 h only a very few Gram-positive rods
were observed. At 48 h the density of the
m
ADDY, WILLIS AND MORAN
bacterial smear was increased and many large
clumps of organism were apparent. Again the
predominant organisms were Gram-positive
cocci with Gram-negative cocci readily apparent. Small numbers of Gram-positive and
Gram-negative rods were frequently reported
on individual smears together with very occasional fusiform and filamentous organisms.
At 72 h the densities and dumping of organisms
were increased; however, the predominant organisms were similar to the 48 h observations.
Nevertheless, fusiforms and filaments were rel-
1
2
3
4.467
(1.454)
0,417
(0.212)
2,776
(1,503)
1
S**
atively easily found amongst the cocci although
the numbers were comparatively small. Many
of the smears taken during the use of chiorhexidine were at each time period reported as
almost bacteria free. The densities of organisms
never exceeded those reported for the 16 h
samples from the toothpaste and water periods.
Gram-positive and Gram-negative cocci predominated; however at 72 h the presence of a
small number of fusiform and Gram-negative
rods was observed in some smears.
4
3,529
(1 ,219)
S*
5
6
7
2,581
(0,772)
2.S91
(1.417)
2,969
(1.147)
S"
3
E"
4
S"*
MS
NS
S'
6
£...
NS
NE
NE
7
£«»»
NS
NS
S*
5
p values
NS
<D,05
<D,01
<0,001
Fig. J. Total plaque areas at 96 h after water, chlorhexidine and toothpaste rinses (sq. ins).
Die gesamien Fhqueregionen nach 96Stunden. nuch Wusser-, Chlorhexiclin-. undSpUhingen mil Aufschlammungen
von Zaimpasie (in ''square inches": 1 in'~645.l6 mm').
Elendue lotah de la plaque (moyenne ei ecarl lype) 96 h apres les vintages a I'eaii, a la chlorhexidine
et u la pate dentifrice (en "square inches'"''; 1 in^ = 645.16 mrri^).
TOOTHPASTE AND PLAQUE
1
CHLORHEXIDINE
2
24.6
(5.2)
10.0
(3.0)
WATER
1
2
3
4
£«*
5
s**
19.9
(5.1)
S«
MFP +
NaF
4
MFP +
ZCT
5
NaF
EnFj
6
7
20.6
(3.4)
19.2
(2.7)
20-4
(3.3)
19.9
(2.6)
S*
S*
NS
S*
S**
NS
6
s**
7
p values
HFP
95
NS
S*
NS
NS
NS
NS
NS
NS
KS
* <0.05
** <0.01
**• <0.001
Fig. 2. Total plaque scores at 96 h after water, chlorhexidine and toothpaste rinses.
Die gc'samien Plaquescores nacli 96 Sriinden nadi Wasser-. Chlorhexidin-. und Spiilungcn mil Aufschldmmungen
von Zahnpasie.
Score total de la plaque, 96 h apres ies rin(:ages a I'eau. a la chlorhexidine ei a la pate dentifrice.
Discussion
This study employed 2 different plaque scoring systems to measure plaque regrowth over a
96 h period and the effects of toothpaste applied
in slurry form on this regrowth. The first plaque
scoring method was the Gingival Margin
Plaque Index (Harrap 1974) which records
plaque in a single dimension along the gum
margin. This site was reported as that of the
earliest formation of plaque on a clean tooth
surface (Saxton 1973). The results demonstrated that all toothpastes and chlorhexidine
produced a mean reduction in plaque at 16 h
compared with water but this was only
significant in the case of two toothpastes and
chlorhexidine. One paste also showed a
significant effect up to 24 h and interestingiy
was that previously reported to reduce plaque
regrowth by area over the same time period
(Stean & Forward 1980). None of the
toothpastes maintained this effect upon plaque
regrowth throughout the 72 h measurement
period. In fact it was noteworthy that there was
a progressive increase in plaque scores between
each scoring time for the toothpastes and water
which on almost every occasion was significant.
Such progressive plaque regrowth towards the
100% maximumfor the index was not seen with
chlorhexidine and at 72 h the mean group
Plaque Index was extremely small by
comparison.
ADDY, WILLIS AND MORAN
Individual significant differences for the effects of toothpaste on plaque regrowth were
worthy of note. Nevertheless, it must be emphasized that in terms of the amount of plaque
measured at the gum margin the differences
were minute. Moreover, the differences have to
be considered in the light of the index used.
Thus, the Gingival Margin Plaque Index, although having a theoretical scoring range of
100, is a subjective index where it was noted that
the examiner tended to record at intervals of 5
and 10%. Visual accuracy above this level is
unlikely to be achieved without recourse to
direct measurement either from photographs or
the use of schematic drawings. Thus, differences
observed for the effects of the toothpastes on
plaque formation could not be considered to
represent a potentially greater therapeutic value
of one preparation over another. Thus, although not assessed, continued plaque growth
from the interproximal regions along the gingival margins indicated that these toothpastes
would not inhibit or reduce chronic gingivitis or
caries by a reduction in plaque regrowth. This
was further supported by the lack of effect of the
pastes on the bacterial composition of the
developing plaque. The same progressive changes in plaque bacteria with time as previously
reported (Loe et al. 1965, Egelberg 1970, Theilade & Theiiade 1970) were observed and
contrasted with those seen with chiorhexidine.
The use of the Gingival Margin Plaque Index
or plaque scoring by area to measure effects on
regrowth after 16 or 24 h cannot be extrapolated
into effects on the diseases of gingivitis or caries,
but may, however, as suggested (Stean & Forward 1980), provide a rapid screening method
for potential antiplaque agents. The results of
this study demonstrated that measurements
after such short periods may give misleading
results. Thus the known antiplaque effect of
chiorhexidine (Loe & Schiott 1980) was not
demonstrated to be significantly greater than 2
toothpastes until after 16 h and for i paste until
after 24 h. The very dramatic differences being
seen only at, or beyond 48 h. The previous use of
these scoring methods has been limited to 16 or
24 h by the toothbrush delivery of the paste
(Harrap 1974, Stean & Forward 1980).
At 96 h the second plaque scoring system
recorded plaque in 2 dimensions. This plaque
area was subjectively assessed by the 3-point
scale of the Debris Index (Greene & Vermillion
i960) and after a schematic representation by
accurate area measurement using a planimeter.
By these methods a significant reduction in
plaque area around the interproximal and
gingival areas was apparent for all toothpastes
and chiorhexidine compared with water. The
differences between the positive control,
namely the antiplaque agent, chiorhexidine,
and the test toothpastes, were highly significant
and striking at the clinical level. Such visually
apparent differences between the pastes and
water were not observed. Thus, although the
differences in plaque area appear numerically
large, the plaque scores are totals for the mouth
and when considered as plaque per tooth, are in
fact relatively small. Nevertheless, the measured
differences do indicate that toothpaste per se
reduced plaque formation over the tooth surface, although the 16-72 h scores failed to
demonstrate a consistent trend for a plaque
reducing effect along the gingival margin. It is
again, however, concluded that such area reductions in plaque would not be expected to
reduce the diseases of gingivitis and caries,
particularly in the light of the unaltered bacterial
development in the plaque.
The possible interpretation of these fmdings
for a preparation widely used by the public
suggests caution in terming the observed action
of the toothpastes as an antiplaque effect. There
is perhaps now a need to defme more clearly
this term as one which results in a reduction
in either caries and/or gingivitis. From this
study it is not possible to identify which ingredient or ingredients, were responsible for the
reduction in ptaque growth over the tooth surface, particularly since this effect was observed
with all toothpastes. The importance of the
contained detergents must be considered since
97
TOOTHPASTE AND PLAQUE
many surfactants, including those in commercial formulations, have been shown from in
vitro studies to reduce plaque formation {Baker
et al. 1978). Of the other ingredients incorporated into the toothpastes with the exception
of stannous fluoride (Review - Tinanoff &
Weeks 1979) there is little evidence to demonstrate clinically a plaque reducing effect for the
fluorides when applied topically or in mouthrinses. A small but significant reduction in
plaque formation of questionable clinical value
was reported for zinc citrate in mouthwash
form (Addy et al. 1980); however, no published
data is available for the toothpaste containing
zinc citrate.
In conclusion, the results of this study demonstrated that toothpaste alone did not significantly alter the progressive nature of plaque
formation at the gingival margin, although
growth over the tooth surface was significantly
reduced, albeit to a small amount compared
with water. By comparison with chlorhexidine
an agent known to prevent gingivitis and reduce
caries, the toothpaste effects were too small to
have a therapeutic benefit to these diseases
mediated through plaque reduction.
Zusammenfassung
Del- Effeki 4-liigJgcr Mundspiihmgeii mi! aufges'chlammter Zahnpasle aiif die Aiilagcrung von Plaque
im Vergleich zur Spiilung mil Chlarhexidin
Begrundetc Vermiitungen besagen, dass das Biirsten
der Ziihne mit Zahnpaste in der Lage ist die NcubiJdung von Plaque 24 Swnden lang zu verringern.
Die vorliegeiide Studie untersuchte wahrend eines
Zeitabschnittes von 96 Stunden den alleinigen Effekt
von Zahnpaste auf die Neubildung der Plaque und
verglich diesen Effekt mil Was.serspuiung und mit der
Wirkung des bekannten Antiplaquemittels Chlorhexidin. Um 9 Uhr friih, zu Beginn von 7 4-tagigen
Perioden in denen die orale Hygiene eingestcllt worden war, wurden bei iO freiwilligen Probanden der
Zahnstein entfernt und die Zahne polien. Um 5 Uhr
nachmittags bursteten die Probanden ihre Zahne mit
Wasser bis zur Plaquefreiheit. .leder Proband spulte
dann 1 Minute lang den Mund mit 10 ml einer zufailig
ausgewahlten Flussigkeil. Dieses Mundspuien wurdc
an den folgenden Tagen um 10 Uhr vormittags und
um ]0 Uhr abends wiederholt. Die Mundspiilfliissig-
keiten waren Wasser, 0.2%-iges Chlorhexidin oder 3
Granim /lO ml Aufschlammungen von Zahnpaste,
die (]) Monofluorphosphat (MFP), (2) Monofluorphosphat+ Natriumfluorid (MFP+ NaF), (3) Mononuorphosphat-hZinkzitrat (MFP-FZCT), (4) Zinntluorid (SnFj) und (5) Natriumfluorid (NaF) enthielien. Nach 16, 24, A% und 72 Stunden wurde der
Beurieilungsiiidex der Plaque am Gingivaisaum
(GMPI) der bukkaien Flachen der oberen und unteren
Pramolaren, der Eckzahne und der Frontzahne festgestellt. Ausserdem wurden Plaqueabstrtche entnommen und mil Gramfarbung behandelt. Nach 96
Stunden wurde die Plaque in Diagrammen registriert
und die plaquebedecklen Regionen wurde okular
(Debrisindex) und planimetrisch vermessen. Bei den
Mundspiilungen mit Zahnpaste und mit Wasserwurde
nach 72 Stunden eine fortschreitende Piaqueanlagerung bis zur Eri'eichung des Plaqueindexes von 100%
gemesser. Bei den Chlorhexidinspulungen wurde nach
72 Siunden ein Plaqueindex von 6 % am Gingivaisaum
registriert. Bei den mit Zahnpaste spiilenden Probanden waren die plaquebedeckten Regionen nach 96
Stunden .signifikant kleiner als bei den Probanden, die
mit Wasser spiilten. Chlorhexidin reduzierte - im
Vcrgleich za Wa.sser imd Zahnpaste ~ die Plaqueregionen signifikant. Die biologische Analyse der Abstriche zeigte im wesentiichen die gleiche Plaqueentwicklung bei Mundspiilungen rait Zahnpaste und
mit Wasser, was auch fruheren Berichten entspricht.
Die Chlorhexidinspulungen reduzierten jedoch die
Dichte der Mikroorganismen in den Abstrichen bedeutend. Es wurde gefolgert. dass im Vergieich mit
der Wirkung des Chlorhcxidin, bei Mundspulungcn
mit Zahnpaste ein nur geringfugiger Effekt auf Plaqueansammlungen vorliegt und dass alleinige Anwendungvon Zahnpaste keinen therapeutischen Gewinn zu bieten vermag.
Resume
Action de rini^ages a la pale demifrice sur la formation
de la plague pendant une periode de 4 jours, par
comparaison avec la chlorhexidine
li semble ctabli que ies brassages a l'aide d'une pate
dentifrice raientissent la reconstitution de la plaque
pendant une periode de 24 h. La presente etude visait
a mesurer l'action de la pate dentifrice seule sur
l'accumulation de ia plaque qiii se reforme aa cours
d'une periode de 96 h, et a comparer cette action avec
celie de I'eau et avec ceile de la chlorhexidine dont
Faction antipiaque est connue. A 9 h du matin, au
debut de 7 periodes de 4 jours sans soins d'hygiene
bucco-dentaire, 10 sujets volontaires ont subi un
detartrage et un polissage. A 17 h, )es sujet.s se sont
brosse Ies dents avec de I'eau, jusqu'a elimination de
toute plaque. Chacun des sujets s'est rince la bouche
ADDY, WILLIS AND MORAN
avec 10 ml d'un bain de bouche choisi par tirage au
sort. LesrinfagesonteterepetesJesjourssiiivantsa 10
li du madn et a 22 h. Les rinpages etaient faits avec les
produits suivants: eau (water), chlorhexidine a 0,2%,
ou des dilutions de 3 g/lO ml de pate dentifrice
contenant (1) monofluorophosphaie (MFP), (2) monofluorophosphate+fluorure de sodium (MFP +
NaF), (3) monofluorophosphate+ citrate de zinc
(MFP+ZCT), (4) fluorure stanneux (SnFj), (5)
fluonire de sodium {NaF}. Au bom de 16, 24,48 et 72
h, on a enregistre ia plaque sur la face vestibulaire des
premolaires, canines et incisives superieurcs et inferieures, en utilisant I'lndice de Plaque du Rebord
Gingival (GMPI), et on a prepare des lames colorees
au Gram avec des echantiJlons de plaque. Au bout de
96 h, un diagramme de la plaque a ete etabli et les
zones couvertes par la plaque ont ete mesurees
visueliement (Indice de Debris) et par planimetrie.
Pour la pate dentifrice et pour I'eau, on a observe une
formation progressive de plaque allant jusqu'a un
Indice de Plaque du Rebord Gingival de 100% au
bout de 72 h. Pour la chlorhexidine, I'lndice de Plaque
du Rebord Gingival au bout de 72 h etait de 6%. Au
bout de 96 h, I'etendue de ia plaque etait significativement moins imporcante avec les rin?ages a !a
pate dentifrice qu'avec les rinpages a I'eau. La chlorhexidine reduisait de fafon tres significative I'etendue
des zones de plaque par comparaison avec la pate
dentifrice et avec I'eau. L'anaiyse bacteriologique des
frottis mettait en evidence une formation de plaque
essentiellement semblable au cours des rinpages a la
pate dentifrice et des rin^ages a I'eau. et conforme aux
resultats des etudes anterieures. Cependant, avec la
chlorhexidine, la densite des microorganismes dans
les frottis etait considerablemenl reduite. En conclusion, I'action limitee des rinpages a la pate dentifrice sur TaccumuEation de la plaque, par comparaison avec la chlorhexidine, ne pourrai: a elle seule
representer une veritable action antiplaque resultant
en un avantage therapeutique.
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Address:
Dr. M. Addy
Senior Lecturer in Periodontology
Dental School
Heaih Park
Cardiff
S. Wales
U.K.