Efficacy of Oxygen-Enriched Mouthwash as a Pre-procedural Mouth Rinse Against Oral Microbes Produced During Ultrasonic Scaling

Abstract

Aim Oxygen-enriched mouthwash products are based on oral topical oxygen therapy (OOT), which supports the formation of new blood vessels and the removal of toxins and waste products from the affected area and stimulates the synthesis of collagen. These antioxidant mouthwashes contain honey, lactoferrin, and sodium carbonate peroxide. Lactoferrin is an anti-inflammatory protein that binds the ferrous iron ions surrounding micro-organisms regulating bacterial growth. Hence, these products can be included as an adjunct to toothbrushing after oral surgeries and in the treatment of conditions like gingival inflammation and peri-implantitis. The aim of the study was to evaluate the efficacy of oxygen-enriched mouthwash as a pre-procedural mouth rinse against oral microbes in the aerosol produced during ultrasonic scaling. Materials and methods A total of 40 patients with an age range of 20-40 years who have been advised to undergo ultrasonic scaling were selected as study subjects and were randomly allocated to group 1 (test group; n = 20; blue®m mouthwash) and group 2 (control group; n = 20; chlorhexidine). After evaluating the initial bacterial load after the use of water (placebo) as pre-rinse on the patient's chest and shoulder areas in both experimental and control groups, both the group subjects were instructed to gargle with 10 ml of the provided mouth rinse for one minute before ultrasonic scaling procedure. Blood agar plates were placed at the patient's chest and shoulder area to collect the aerosol and were later incubated to assess the colony-forming units (CFUs). An independent t-test was done to compare the CFUs between the groups. Results The mean initial bacterial load after the use of water (placebo) as pre-rinse on the patients' chest area (122.4 ± 0.6) and shoulder area (109.3 ± 2.6) in the experimental group was similar to the bacterial load seen on the chest area (126.2 ± 4.8) and shoulder area (115.4 ± 3.8) in the control group. The CFUs found in blood agar plates placed on the chest (59.8 ± 2.5) and shoulder (35.3 ± 3.6) areas of patients in group 1 were less as compared to CFUs found in blood agar plates placed on the chest (104.8 ± 3.2) and shoulder (75.3 ± 2.8) areas of patients in group 2. The difference between both groups was statistically significant with a p-value of ≤0.05. Conclusion There is a reduction in the bacterial load in the aerosols that are emitted during the ultrasonic scaling procedure with the use of oxygen-enriched mouthwash as a pre-procedural rinse when compared with chlorhexidine.

Keywords: aerosol contamination; blue m; chlorhexidine gluconate mouthwash; infection prevention and control; pre-procedural rinse.

Figure 1. Sample size calculation using G*Power software

Figure 2. Initial bacterial load on the patient's chest area in the experimental group

The image shows the colony-forming units (CFUs) on the blood agar plates placed on the patient's chest area after the use of water (placebo) as a pre-rinse indicating the initial bacterial load of the experimental group.

Figure 3. Initial bacterial load on the patient's shoulder area in the experimental group

The image shows the colony-forming units (CFUs) on the blood agar plates placed on the patient's shoulder area after the use of water (placebo) as a pre-rinse indicating the initial bacterial load of the experimental group.

Figure 4. Initial bacterial load on the patient's chest area in the control group

The image shows the colony-forming units (CFUs) on the blood agar plates placed on the patient's chest area after the use of water (placebo) as a pre-rinse indicating the initial bacterial load of the control group.

Figure 5. Initial bacterial load on the patient's shoulder area in the control group

The image shows the colony-forming units (CFUs) on the blood agar plates placed on the patient's shoulder area after the use of water (placebo) as a pre-rinse indicating the initial bacterial load of the control group.

Figure 6. CFUs on the blood agar plate placed on the patient’s chest area after the pre-procedural rinse in the experimental group

Colony-forming units (CFUs) on the blood agar plate placed on the chest area of the experimental group where blue®m mouthwash was used as a pre-procedural rinse.

Figure 7. CFUs on the blood agar plate placed on the patient’s shoulder area after the pre-procedural rinse in the experimental group

Colony-forming units (CFUs) on the blood agar plate placed on the shoulder area of the test group where blue®m mouthwash was used as a pre-procedural rinse.

Figure 8. CFUs on the blood agar plate placed on the patient’s chest area after the pre-procedural rinse in the control group

Colony-forming units (CFUs) found on the blood agar plate placed on the patient's chest area where chlorhexidine mouthwash was used as a pre-procedural rinse.

Figure 9. CFUs on the blood agar plate placed on the patient’s shoulder area after the pre-procedural rinse in the control group

Colony-forming units (CFUs) found on the blood agar plate placed on the patient's shoulder area where chlorhexidine mouthwash was used as a pre-procedural rinse.