Effect of 0.25% sodium hypochlorite oral rinse and subgingival irrigation on periodontal clinical parameters

2013-09-16Background: Conventional periodontal therapy includes an anti-infective phase and, if necessary, may be followed by a surgical phase. Once the end-point of active therapy has been reached, a maintenance phase is instituted. Anti-infective therapy includes mechanical removal of biofilm. An array of adjunctive antimicrobial therapies have been proposed for the therapy with varying results. The application of diluted sodium hypochlorite has been examined in previous studies and there is significant data in favor of this agent. The purpose of the present study is to determine the initial and 3 months clinical effects of two rinses (0.25% sodium hypochlorite and water), performed twice a week, in the treatment of periodontitis. Our research hypothesis is that 2 weeks post-baseline and 3 months post-baseline, those participants who rinse with diluted bleach solutions will exhibit improved periodontal health vs. those participants who rinse with water alone. ❧ Methods: Thirty otherwise healthy adults, diagnosed with periodontitis, were included in the study. The following clinical variables were evaluated at baseline (visit 1), two weeks post-baseline (visit 2) and 3 months post-baseline (visit 3): medical history, dental radiographs, number of teeth, presence or absence of plaque, presence or absence of bleeding on probing, pocket depth and gingival recession. Participants randomly received professional subgingival irrigation with either sodium hypochlorite 0.25% (test) or water (control) at visit 1 and visit 2 and rinsed at home twice a week with either sodium hypochlorite 0.25% (test) or water (control) throughout the course of the study. At the end of the study participants were given a questionnaire to evaluate compliance with the regimen and perceived adverse effects of the rinse. Normality of the underlying distribution was assumed based on visual assessment and tested using Shapiro–Wilk Normality test. Wilcoxon-Mann-Whitney test was used to compare improvement between the two groups. Wilcoxon Signed Rank test was used to test the difference within the groups. Spearman Correlation (non parametric) test was used to determine the correlation coefficient between the difference in absence of plaque from visit 1 to visit 3 and difference in absence of bleeding on probing (BOP) from visit 1 to visit 3. ANOVA Repeated Measures was used to evaluate the difference in improvement over the 3 visits. The significance level was set at α = 0.05. Statistical analysis was performed using STATA statistical software version 12 (StataCorp, Texas, USA). ❧ Results: The results indicate that for those participants that completed visit 1 and visit 2, the difference of plaque-free facial surfaces within the test group was statistically significant (p= 0.009*). The control group showed no statistically significant difference. For those patients that completed visit 1 to visit 3, the test group showed a statistically significant improvement of, 0.009* plaque-free facial surfaces, 0.006* plaque-free lingual surfaces and 0.006* BOP-free teeth. However, the control group showed no statistically significant difference. The comparison at visit 3 of test group versus control group showed statistically significant difference for plaque-free facial surfaces (0.0042*), plaque-free lingual surfaces (0.042*) and BOP-free teeth (0.012*). The correlation between the difference in absence of plaque from visit 1 to visit 3 and difference in absence of BOP from visit 1 to visit 3, was evaluated using Spearman Correlation test (non parametric). The correlation coefficient was 0.62 (p=0.03*). ❧ Conclusions: Within the limitations of this study, it can be concluded that mouthrinsing with 0.25% sodium hypochlorite is highly safe, minimally invasive, extremely inexpensive and may be efficacious to reduce the presence of plaque and bleeding on probing, and therefore possibly prevent the risk of future attachment loss