Chlorhexidine- clinical trial

Scientific Paper Presentation
A Clinical Trial on The Effect of a
Pre Procedural 0.2 % Chlorhexidine
Mouth Rinse on Aerosol Contamination
While Using Ultrasonic Scalers in Different
Clinical Set up

Dr.Civy V Pulayath
PROFESSOR
Department of Public Health Dentistry

Aim
To assess the effect of preprocedural
0.2% chlorhexidine rinse on aerosol
contamination while using ultrasonic
scalers in different clinical set up.

Objective
• To asses the aerosol contamination in a
ventilated and non ventilated clinical set
ups.
• To asses the effect of preprocedural
chlorhexidine rinse in different clinical
set ups.

•Private dental clinic
•Non-Ventilated
•One ton split AC
•Filter cleaned
•Pre fumigated
•Department OPD
•Ventilated
•Minimal speed fan

•Baseline contamination collected
•30 Sec prerinsing with 5 ml 0.2% Chlorhexidine
Gluconate (Hexidine,Glaxo)TM
•32 mhz Ultrasonic Scaler
•No suction used
•20 minutes scaling of lower anteriors

• 3 patients in each session-
6 patients in each clinical setup-
12 sample size.
• 7 culture plate collected during each session making a
total of 84.
• Adult generalized gingivitis case.
• Single case a day.
• Post session contamination measured.

Before and After
Incubation ( 370 C 48 H)

Microbial colony
forming units

77.33
56
50.33
64
25
0
10
20
30
40
50
60
70
80
Without Pre-Procedural Rinse
Mouth Mask
Doctors Apron
Patient apron
50 Cm aw ay
150 Cm Aw ay
Graph 1 : Without Preprocedural Rinse in Non Ventilated Clinical Set Up
Average CFU/Plate

Graph 1 (a) : Without Preprocedural Rinse in Ventilated Clinical Set Up
78
57.33
50.33
63
25.33
0
10
20
30
40
50
60
70
80
Mouth Mask
Doctors Apron
Patient apron
50 Cm aw ay
150 Cm Aw ay
Average CFU/Plate

Graph 2 : With Preprocedural Rinse in Non Ventilated Clinical Set Up
26.33
24
18
12
10.33
0
5
10
15
20
25
30
With Pre-Procedural Rinse
Mouth Mask
Doctors Apron
Patient apron
50 Cm aw ay
150 Cm Aw ay
Average CFU/Plate

Graph 2 (a) : With Preprocedural Rinse in Ventilated Clinical Set Up
29
36
19.33
11
8.33
0
5
10
15
20
25
30
35
40
Mouth Mask
Doctors Apron
Patient apron
50 Cm aw ay
150 Cm Aw ay
Average CFU/Plate

Graph 3 : Without Preprocedural Rinse in Non Ventilated Clinical Set Up
5.33
77.33
18.67
0
10
20
30
40
50
60
70
80
Baseline
Maximum cont
Level of Cont after 30 min
Average CFU/Plate

Graph 3 (a) : Without Preprocedural Rinse in Ventilated Clinical Set Up
7.67
78
20.33
0
10
20
30
40
50
60
70
80
BASELINE
Maximum Count
Level of Cont after 30
min
Average CFU/Plate

Graph 4 : With Preprocedural Rinse in Non Ventilated Clinical Set Up
5.6
26.33
7
0
5
10
15
20
25
30
Baseline
Maximum cont
Average CFU/Plate
count

Graph 4 (a) : With Preprocedural Rinse in Ventilated Clinical Set Up
7
36
7.33
0
5
10
15
20
25
30
35
40
BASELINE
Maximum Count
Average CFU/Plate

Graph 5 : Without and With Preprocedural Rinse in
Non Ventilated Clinical Set Up
0
10
20
30
40
50
60
70
80
Without Pre-Procedural Rinse With Pre-Procedural Rinse
Mouth Mask
Doctors Apron
Patient apron
50 Cm aw ay
150 Cm Aw ay
t= 32.54 p<0.05
AverageCFU/Plate

0
10
20
30
40
50
60
70
80
Without Pre-Procedural
Rinse
With Pre-Procedural
Rinse
Mouth Mask
Doctors Apron
Patient apron
50 Cm away
150 Cm Away
Graph 5 (a) : Without and With Preprocedural Rinse in
Ventilated Clinical Set Up
t= 45.6 p<0.05

0
10
20
30
40
50
60
70
80
Mouth
Mask
Doctors
Apron
Patient
apron
Rinse
With Pre-Procedural
Rinse
t= 35.24 p<0.05

78
7.67
57.33
36
50.33
19.33
0
10
20
30
40
50
60
70
80
Mouth
Mask
Doctors
Apron
Patient
apron
Rinse
t= 35.64 p<0.05

0
10
20
30
40
50
60
70
50 Cm aw ay 150 Cm Aw ay
Rinse
t= 42.44 p<0.05

63
11
25.33
8.33
0
10
20
30
40
50
60
70
50 Cm aw ay 150 Cm Aw ay
t= 44.54 p<0.05

• The Occupational Safety and Health
Administration (OSHA) has mandated that
all known blood splatter and aerosols must
be controlled.
• WHO advocates use of high vacuum
evacuator to control aerosol cross
infection.

• Previous studies have demonstrated that
to ensure a healthy office environment,
universal precautions must be used with
all patients as well as the need for
adequate control of the transmission of
infectious diseases associated with an
indoor environment whether airborne or
otherwise.

• Larato et al. have observed similar patterns of microbial
air contamination as this study before, during, and after
dental treatment in a closed operatory.
• A subsequent decrease of atmospheric microbial
contamination was noticed 30 minutes after the end of
the working period in this study. This is in agreement
with the results reported by Grenier, Larato et al., and
Travaglini et al.
• The CFU/plate values after pre rinse in this study
showed less significant results, in contrast with the
findings of the study conducted by Timmerman et al.
This may be because they did two consecutive prerinses
before ultrasonic scaling procedures.

• A similar study in the closed operatory of mobile dental
unit by Shivakumar K M et al concluded that high risk of
aerosol contamination in mobile units can be a health
risk to the dentists attending public health programs.
• A study conducted by Fine has proved that
preprocedural oral rinsing with an antiseptic mouthwash
significantly reduces the viable microbial content of
bioaerosols generated during dental operative
procedures.
• They concluded that this preprocedural rinsing may have
a potential role in reducing the risk of cross-
contamination with infectious agents in the dental
operatory.

0.2% chlorhexidine preprocedural rinse is
effective in reducing the aerosols contamination
generated by the use of ultrasonic scaler.
A preprocedural rinsing by the patient with 0.2%
chlorhexidine 5ml for 30 seconds before any
dental procedure will be highly beneficial.

Recommendation
The higher level of contamination seen in
operator’s apron and mask warrants the need of
effective utilization of personal protective
equipments like mouth masks, gloves,
eyeglasses, lateral protective shields, and head
caps during dental procedures.

Limitation
The numbers presented as CFU/plate are relative values
representing only aerobic bacteria capable of growth on
nutrient agar media plates. It is likely actual microbial
content in the specified areas was much higher than that
reported here, as all types of organisms including
viruses, anaerobic bacteria, and organisms requiring
specialized medium were not identified.

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