Resumen de Efficacy of Preprocedural Mouth Rinsing in Reducing Aerosol Contamination Produced by Ultrasonic Scaler: A Pilot Study
Background: The aerosol generated by an ultrasonic scaler contains microorganisms that can penetrate into the body through the respiratory system of dental surgeons and patients. The aim of this pilot study is to evaluate and compare the efficacy of commercially available preprocedural mouthrinses containing 0.2% chlorhexidine gluconate, an herbal mouthwash, and water in reducing the levels of viable bacteria in aerosols.
Methods: This single-center, double-masked, placebo-controlled, randomized, three-group parallel design was conducted over a period of 45 days. Twenty-four patients with chronic periodontitis were divided randomly into three groups (A, B, and C) of eight patients each to receive 0.2% chlorhexidine gluconate, herbal mouthwash, and water, respectively, as a preprocedural rinse. The aerosol produced by the ultrasonic unit was collected at patient�s chest area, doctor�s chest area, and assistant�s chest area on blood agar plates in all three groups. The blood agar plates were incubated at 37°C for 48 hours, and the total number of colony-forming units (CFUs) was counted and statistically analyzed.
Results: The results showed that CFUs in groups A and B were significantly reduced compared with group C, P <0.001 (analysis of variance). Also, CFUs in group A were significantly reduced compared with group B, P <0.05 (independent t-test). The numbers of CFUs were highest at the patient�s chest area and lowest at the assistant�s chest area.
Conclusion: This study suggests that a routine preprocedural mouthrinse could eliminate the majority of bacterial aerosols generated by the use of an ultrasonic unit, and that 0.2% chlorhexidine gluconate is more effective than herbal mouthwash.
The spread of infection through aerosol and splatter has long been considered one of the main concerns in the dental community because of possible transmission of infectious agents and their potential harmful effects on the health of patients and dental personnel.1 Aerosol is a suspension of solid or liquid particles containing bacteria or viruses, suspended (for at least a few seconds) in a gas. Particle size may vary from 0.001 to >100 µm.2 The smaller particles of an aerosol (0.5 to 10 µm in diameter) have the potential to penetrate and lodge in the smaller passages of the lungs and are thought to carry the greatest potential for transmitting infections.1 The oral cavity harbors numerous bacteria and viruses from the respiratory tract, dental plaque, and oral fluids. Any dental procedure that has a potential to aerosolize saliva will cause airborne contamination with organisms. Dental handpieces, ultrasonic scalers, air polishing devices, and air abrasion units produce airborne particles by the combined action of water sprays, compressed air, organic particles such as tissue and tooth dust, and organic fluids such as blood and saliva from the site where the instrument is used.1 Miller3 found that aerosols generated from patients� mouths contained up to a million bacteria per cubic foot of air. Other studies have reported association of these aerosols with respiratory infections, ophthalmic and skin infections, tuberculosis, and hepatitis B.3-6 Current research suggests that having patients use an antimicrobial rinse before treatment may decrease microbial aerosols.7-10 Despite commonly known side effects such as temporary loss of taste; staining of teeth, restorations, and mucosa; dryness and soreness of mucosa; bitter taste; and a slight increase in supragingival calculus formation, chlorhexidine is considered the gold standard of antimicrobial rinses because of broad-spectrum antibacterial activity11 and substantivity of 8 to 12 hours. Many studies12-14 have been conducted on chlorhexidine mouthrinses; however, little research has been conducted to determine the efficacy of herbal mouthrinses.15-17 In the emerging era of pharmaceuticals, herbal medicines with their naturally occurring active ingredients offer a gentle and enduring way for restoration of health by the most trustworthy and least harmful method. Herbal medicine is both promotive and preventive in its approach. Because herbal products may be purchased over-the-counter, they have attracted millions of consumers who are looking for an alternative mouthrinse. The body of evidence pertaining to herbal products as a preprocedural mouthrinse is small; therefore, tests should be conducted to gain evidence regarding their effectiveness and safety.
The herbal mouthwash§ (HRB) used in this study is made from natural herb extracts bibhitaki (Terminalia bellirica) 10 mg, nagavalli (piper betle) 10 mg, and peelu (Salvadora persica) 5 mg; powders peppermint satva (Mentha spp.) 1.6 mg and yavani satva (caraway; Trachyspermum ammi) 0.4 mg; and oils gandhapura taila (wintergreen; Gaultheria fragrantissima) 1.2 mg and ela (cardamom; Elettaria cardamomum) 0.2 mg. It has active herbal ingredients that exhibit excellent antimicrobial activity against oral pathogens owing to the presence of anionic components (chloride, sulfate, thiocyanate, and nitrate) in peelu and hydroxychavicol and hydroxyl fatty acid esters in nagavalli. Gallic acid in bibhitaki and hydroxychavicol in nagavalli and peelu exhibit potent astringent actions and thus help in toning the gums. Methyl salicylate in gandhapura taila, cineole in ela, thymol in yavani satva, and menthol in peppermint satva impart a fragrant and refreshing effect. Thus HRB is helpful in minimizing plaque and tartar formation and also in the management of gingivitis and halitosis. In addition, it is a non-alcoholic preparation, with no added sugar and no artificial preservatives, flavors, or colors.
The aim of this study is to evaluate and compare the efficacy of bacterial aerosol contamination generated by ultrasonic scalers following commercially available preprocedural rinses with HRB, 0.2% chlorhexidine gluconate (CHX),? and water.1
