Chlorhexidine rinsing inhibits biofilm formation and causes biofilm disruption on dental enamel in situ
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ORIGINAL ARTICLE
Chlorhexidine rinsing inhibits biofilm formation and causes biofilm disruption on dental enamel in situ Miryam Martínez-Hernández 1,2 & Bashar Reda 1 & Matthias Hannig 1 Received: 24 May 2019 / Accepted: 20 February 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Objectives This in situ study aims to evaluate the effects of chlorhexidine (CHX) mouth rinsing on biofilm formation and moreover on the disruption of existing mature dental biofilms. Methods Biofilms were formed in situ by five volunteers on bovine enamel specimens fixed to individual acrylic splints. For biofilm formation analysis, the volunteers intraorally exposed the splint for 48 h. Mouth rinsing using 10 ml of 0.2% CHX or water as control was performed for 30 s every 12 h. For analysis of biofilm disruption, the biofilm was formed on enamel specimens for 48 h. Then, the first CHX rinse was carried out. A second rinse followed after an additional 12 h, again for 30 s using 10 ml of 0.2% CHX. Biofilm vitality was imaged by fluorescence microscopy after vital fluorescence staining. Additionally, the ultrastructure of the biofilm was examined by transmission electron microscopy. Results Rinses with 0.2% CHX significantly reduced biofilm formation on enamel. Both biofilm colonization and vitality were dramatically impaired. Moreover, a considerable biofilm disruption induced by the CHX rinses was observed. Remarkably, a single application of CHX to a 48-h mature biofilm causes biofilm ultrastructure alterations and induces a substantial reduction in biofilm thickness and bacterial vitality. Conclusions CHX mouth rinses induced a significant inhibition of biofilm formation on native enamel. Furthermore, an important biofilm disrupting effect under in situ conditions was detected. Clinical Relevance: CHX rinses could be used as a short-term treatment protocol for biofilm management focused on patients unable to reach adequate oral hygiene. Keywords Chlorhexidine . Biofilm formation . Biofilm disruption . Enamel . In situ study
Introduction Dental surfaces provide an ideal substrate for colonization and growth of a diverse variety of microorganisms, mainly bacteria [1, 2]. Immediately after a tooth surface has been cleaned by tooth brushing or professional prophylaxis, the surface will Miryam Martínez-Hernández and Bashar Reda contributed equally to this work. * Matthias Hannig [email protected] 1
Clinic of Operative Dentistry, Periodontology and Preventive Dentistry, University Hospital, Saarland University, Building 73, 66421 Homburg/Saar, Germany
2
Facultad de Odontología, División de Estudios de Posgrado e Investigación, Universidad Nacional Autónoma de México, Circuito exterior s/n, Ciudad Universitaria 04510, CDMX, México
be conditioned by a salivary pellicle [3]. Within the next few hours, this pellicle facilitates bacterial adhesion by providing receptors for binding of oral bacteria leading to a bacterial dental biofilm formation [4]. Over a period of 2 to 3 days, complex multi-layered biofilm
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