Effect of Different Mouthwashes on Gingival Health of Dental Students ISSN : 1812 – 1217

Aims: To evaluate and compare the effectiveness of different mouthwashes in decreasing the gingival inflammation. Materials and Methods: The participants were (88) dental students, aged between 18 to 25 years (44 males and 44 females). The students with mild to moderate gingivitis were randomly divided into four groups, 22 Participants for each one. In Group A, participants were advised kin gingival mouthwash, Group B participants used Wisdom daily gum health mouthwashes, Group C participants are given LACALUT aktiv mouthwashes, and KIN B5Gums mouthwash was given to Group D. The students were advised to use 10 ml of given mouthwash for 30 seconds, twice a day, not immediately after tooth brushing (at least 5minutes after tooth brushing), for 14 days. The parameter was recorded for gingival index (GI) at 0 and 14 days. Results: The reduction in the gingival inflammation is highly significant on day 14 (T1) compared to baseline values (T 0). There are highly significant differences among the four types of mouthwashes used for the reduction of gingival inflammation. These results prove that the four mouthwashes used have variable efficiency on gingival inflammation depending on their major active chemical components. Mouthwash C is the most effective one in reducing gingival inflammation. Mouthwash A, mouthwash B and mouthwash D have no significant differences between them. Conclusions: In this study, all the mouthwashes were used showed clinical efficacy in reducing gingival inflammation. The mouthwash LACALUT aktiv is the most effective one.


INTRODUCTION
Gingivitis is the mildest sort of periodontal disease caused by the dental plaque that accumulates on teeth nearby the gingiva (1) . A direct relationship has been verified between dental plaque levels and the severity of gingivitis (2) . Chemotherapeutic agents have been suggested to be useful adjuncts to the daily oral home care within the control of gingivitis (3) . A number of chemical agents are advocated like Chlorhexidine, quaternary ammonium compounds (Cetylpyridinium chloride), essential oils and triclosan as mouthwash.
The chlorhexidine gluconate is considered as the gold standard in dentistry for the prevention of bacterial plaque (2) . Chlorhexidine mouthwash is very effective but it has certain side effects as brown discoloration in the teeth, bitter taste and oral mucosal erosion (4) . The 0.2% concentration of chlorhexidine has been utilized for years as a therapeutic and preventive agent (5) . The Chlorhexidine has an elevated substantivity, which is a main cause for its superior antimicrobial efficiency (6) . In spite of the popularity of the antimicrobial agents usually found in markets, there is little information about their efficacy on the control of bacterial plaque. Therefore, this study is to gather information about the efficacy of the commonly available antimicrobial agents used to prevent dental plaque accumulation and gingivitis. The actual available products should carefully be tested, since added ingredients for commercial mouthwashes enhanced taste, flavor and color, could decrease the effect of the highly reactive chlorhexidine molecule.

Study design
This study was a parallel, single blinded, randomized comparative clinical study.

Inclusion and exclusion criteria
To be eligible for the study the subsequent inclusion and exclusion criteria were be applied :

Inclusion criteria:
Students who gave informed consent, agreement to delay any elective dental treatment as an oral prophylaxis, and agreement to fulfill the study visits was included within the study.

Exclusion criteria:
Uncooperative students, students with severe mal-alignment teeth, orthodontic appliances and removable partial dentures, students already using mouthwash, tobacco consumers, or having smoke or hookah.
Students with any medical or pharmacological history that may compromise the conduct of the study were excluded. The students were excluded from the study if they were diagnosed with non-plaque induced gingivitis or use systemic antibiotics within 3 months before enrolment. Exclusion criteria were designed to standardize all samples.

Sample size
The total sample size was 88 students divided into 4 groups, 22 students for each group (11males and 11 females) to possess a two-sided five percent (5%) significance level and a power of eighty percent (80%), so given an anticipated dropout rate of 10% (7) . 5. Disposable cups and towels.

Instruments and equipments
6. Dental chair with suitable light.

Gingival index
This was assessed according to the criteria of gingival index of Loe and Silness, 1963 (8) , the criteria as follow:

Periodontal clinical examination
The clinical examination was done in sequence to exam at least 5 to 6 students daily until reach the required sample size.
The gingival index (GI) by Loe and Silness (8) was recorded, all records was maintained on a record chart.
Before the baseline examination, the students were refrained from conducting oral hygiene for at least eight hours, but not more than 18 hours (9) ceased eating, drinking for the same periods.

First examination (T1)
At baseline (T1) gingivitis was be evaluated with Gingival Index (GI) ( (7) . Students must also wait until all traces of toothpaste are removed before rinsing with Chlorhexidine so best utilized mouthwash at least five minutes after the tooth brushing. A measuring cup was given for each patient to measure the quantity of the mouthwash to be used. They were asked not to eat or drink anything at least halfan-hour after using the rinse.

Final examination (T2)
Compliance was be checked with the help of a reminder sheet to be filled by the   (8) showed that there are significant differences between mouthwashes groups. Duncan's post hoc statistical result showed that mouthwash C is more effective than other types of mouthwashes. Also there are no significant differences in reduction of gingivitis between mouthwashes A, B

Preliminarily
and D as showed in Tables (2) and (3).