title: The effect of a polyhexamethylene biguanide mouthrinse compared with a triclosan rinse and a chlorhexidine rinse on bacterial counts and 4-day plaque re-growth.
abstract: OBJECTIVE
  For various clinical applications, polyhexamethylene biguanide hydrochloride (PHMB) has been used for many years as an antiseptic in medicine. Recently, a 0.04% and a 0.12% PHMB mouthwash were shown to inhibit plaque re-growth and to reduce oral bacterial counts. In this study, a 0.2% PHMB mouthrinse (A) was compared with a positive control 0.12% aqueous chlorhexidine solution (B), a commercially available 0.3% triclosan/2.0% polyvinyl methyl ether maleic acid copolymer mouthrinse (Colgate Total Plax) (C), and a negative control placebo rinse (10% ethanol, flavour) (D).
  
  
  METHODS
  The controlled clinical study was a double blind, randomized, four replicate cross - over design. Plaque re-growth was assessed with the Turesky et al. (1970) modification of the Quigley & Hein (1962) plaque index. The antibacterial effect was assessed by taking bacterial counts on the tooth surface (smears from the buccal surface of 16/26) and mucosa (smears from the buccal mucosa in opposite of area 16/26) after the professional prophylaxis and after the first rinse with the preparations on day 1 and prior to the clinical examination on day 5. Sixteen volunteers participated and, on day 1 of each study period were rendered plaque-free, ceased toothcleaning, and rinsed twice daily with the allocated mouthrinse. On day 5, plaque was scored and smears were collected according to the protocol. A 10-day wash-out period was carried out between each rinse evaluation. Data were analysed using ancova with Bonferroni HSD adjustment for multiple comparisons (colony forming units per sample) with a significance level alpha=0.05.
  
  
  RESULTS
  The 0.2% PHMB mouthrinse (A) was significantly better at inhibiting plaque than the placebo (D), but significant less effective than the 0.12% aqueous chlorhexidine solution (B). There is no significant difference between A and the 0.3% triclosan/2.0% copolymer mouthrinse (C). Bacterial count reductions (tooth surface and mucosa) with PHMB (A) were significantly greater compared with the placebo (D) and triclosan (C), but significantly lower compared with chlorhexidine (B) (tooth surface) and equally effective compared with chlorhexidine (B) (mucosa).
  
  
  CONCLUSIONS
  Consistent with previous studies, a PHMB mouthrinse was shown to inhibit plaque re-growth and to reduce oral bacterial counts, indicating that PHMB could be an alternative to established mouthrinses in preventive applications.
authors.affiliation: Department of Operative Dentistry, Periodontology, and Paediatric Dentistry, University of Greifswald, Germany. awelk@utmem.edu
authors.forename: A
authors.initials: A
authors.lastname: Welk
authors.forename: C H
authors.initials: CH
authors.lastname: Splieth
authors.forename: G
authors.initials: G
authors.lastname: Schmidt-Martens
authors.forename: Ch
authors.initials: Ch
authors.lastname: Schwahn
authors.forename: Th
authors.initials: T
authors.lastname: Kocher
authors.forename: A
authors.initials: A
authors.lastname: Kramer
authors.forename: M
authors.initials: M
authors.lastname: Rosin
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D000891:Anti-Infective Agents, Local / Q000494:pharmacology* / Q000627:therapeutic use; D001419:Bacteria / Q000187:drug effects; D001565:Benzoates / Q000494:pharmacology; D001645:Biguanides / Q000494:pharmacology* / Q000627:therapeutic use; D002710:Chlorhexidine / Q000494:pharmacology / Q000627:therapeutic use; D015169:Colony Count, Microbial; D018592:Cross-Over Studies; D003773:Dental Plaque / Q000382:microbiology* / Q000517:prevention & control; D003774:Dental Plaque Index; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008298:Maleates / Q000494:pharmacology / Q000627:therapeutic use; D009061:Mouth Mucosa / Q000382:microbiology; D009067:Mouthwashes / Q000494:pharmacology* / Q000627:therapeutic use; D011095:Polyethylenes / Q000494:pharmacology / Q000627:therapeutic use; D015203:Reproducibility of Results; D012967:Sodium Dodecyl Sulfate / Q000494:pharmacology; D014260:Triclosan / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D000891:Anti-Infective Agents, Local; D001565:Benzoates; D001645:Biguanides; D008298:Maleates; D009067:Mouthwashes; C070868:Plax; D011095:Polyethylenes; C031233:polihexanide; D012967:Sodium Dodecyl Sulfate; D014260:Triclosan; C043105:poly(methyl vinyl ether-co-maleic anhydride); D002710:Chlorhexidine