Lack of adjunctive effect of 0.1% sodium hypochlorite mouthwash combined to full‐mouth ultrasonic debridement on supragingival plaque, gingival inflammation, and subgingival microbiota: A randomized placebo‐controlled 6‐month trial

Abstract

To test the adjunctive effect of 0.1% sodium hypochlorite (NaOCl) mouthwash combined to full‐mouth ultrasonic debridement (FMUD) on reducing supragingival plaque, gingival inflammation, and microbial pathogens. In this 6‐month double‐blinded randomized clinical trial, individuals with gingivitis were assigned to test (n = 16) or placebo group (n = 16) and received FMUD followed by rinsing with 0.1% NaOCl (test) or distilled water (placebo), respectively, twice a day for 1 month. Full‐mouth periodontal examination was performed at baseline, 1, 3, and 6 months posttherapy, and subgingival plaque samples were obtained at the same time points and analysed for their composition by checkerboard. Differences between groups over time were examined by Student t test, Mann–Whitney, generalized linear model, and Friedman and chi‐square tests. Both therapeutic protocols resulted in significant clinical improvement in periodontal parameters over time, except for probing depth and attachment level, which had a slight mean increase of 0.2 mm (p < .01). No significant differences between groups were observed for any clinical parameter (p > .05). Most species (>65%) decreased similarly in levels in both groups over time. Significant reductions in the microbial complexes were seen mainly at 1 and 3 months, but they returned to baseline levels in both groups, except for the red and yellow complexes, and other oral species, which were kept in low levels at 6 months (p < .05). A 0.1% NaOCl mouthwash did not provide additional benefits to FMUD in reducing supragingival plaque, gingivitis, and/or microbial pathogens.

Effect of a sodium hypochlorite mouthwash on plaque and clinical parameters of periodontal disease‐a systematic review

“…The fact that one of the three comparisons with a negative control (II 28 ) included in this systematic review showed no additional benefits of NaOCl‐MW on plaque and periodontal parameters can presumably be explained by differences in NaOCl concentrations, study design, periodontal condition of the participants selected for the study, as well as usage, frequency and duration of rinsing with the anti‐microbial mouthwash. Among the brushing studies that included patients with gingivitis, Espindola et al (II 28 ) used the lowest concentration 0.1%, as recommended by the American Dental Association (ADA). The other two studies, III 27 and IV 25 used a 2.5 and 5 times higher concentration, respectively, and in study IV, 25 the patients used the mouthrinse for a duration twice as long.…”

“…Furthermore, the patients in these studies (III 27 and IV 25 ) were instructed not to drink or eat for 30 min after rinsing, which means that the anti‐microbial agent could be present in the mouth for a longer period. Considering the outcome, it is likely that the ADA‐recommended concentration of 0.1% NaOCl does not provide the best anti‐microbial effect against the microflora related to periodontal disease, which may explain the findings reported by Espindola et al (II 28 ). However, comparison V 39,40 used a 2.5 times higher NaOCl concentration, but participants used the mouthrinse only twice a week.…”

“…The rinsing procedure was set at twice daily for 60 s in studies I 26 and IV, 25 twice daily for 30 s in studies II 28 and III, 27 and twice per week for 30 s in comparison V 39,40 . In study VI, 41 participants used the mouthrinse twice per week, but the rinsing duration was not specified.…”

“…The descriptive analysis based on the data from the included studies suggests that NaOCl‐MW reduces plaque scores and has a positive effect on the parameters of periodontal inflammation. Three comparisons (I, 26 II 28 and V 39,40 ) concerning NaOCl‐MW and a negative control group (Water) showed an inconsistent pattern, with two short‐term comparisons (I 26 and V 39,40 ) showing significantly lower PI, GI, and BI scores and one long‐term comparison (II 28 ) showing no significant difference. None of the comparisons showed an effect on PPD.…”

“…Several studies have shown that it has anti‐microbial activity against the dental plaque microflora and can reduce gingivitis 25‐27 . However, there are other scientific studies that do not support this proposition 28 . Therefore, at present, the results published regarding the effectiveness of NaOCl remain inconclusive.…”