Effect of Chloramine T and Chlorhexidine in reducing gingivitis in patients admitted to a reference hospital for cardiopulmonary care: a randomized, controlled clinical trial

doi:10.21203/rs.3.rs-3970782/v1

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Research Article

Effect of Chloramine T and Chlorhexidine in reducing gingivitis in patients admitted to a reference hospital for cardiopulmonary care: a randomized, controlled clinical trial

https://doi.org/10.21203/rs.3.rs-3970782/v1

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Journal Publication

published 31 Oct, 2024

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Objective

The aim of this study is to evaluate the effect of Chloramine T in reducing gingivitis in hospitalized patients, in addition to providing an alternative to the use of Chlorhexidine.

Material and methods

A randomized, triple-blind, placebo controlled clinical trial was performed with 45 volunteers presenting with gingivitis. Patients were randomly allocated into one of three groups: (G1): Chloramine T 0.2%; (G2): Chlorhexidine 0.12% and (G3): distilled water.

Results

After five days, the control group (G3) remained without relevant differences in relation to the first pre-treatment assessment, while the groups tested with chlorhexidine and chloramine T showed improvement in the Löe Gingival Index (LGI) (p< 0.05). After ten days, G3 maintained the results of the previous assessments, G1 repeated the five-day assessment and G2 obtained a statistically significant difference, with a better result in relation to the previous assessment (p<0.05). After fifteen days, G3 showed no differences in relation to the other assessments, G1 had a statistically significant difference, showing better performance in relation to the previous assessment and G2 continued the gradual improvement it had been showing in the LGI (p<0.05).

Conclusions

Chloramine T and Chlorhexidine present similar results in the treatment of gingivitis, when evaluated by probing by the LGI, and Chloramine T can be used effectively, without causing the adverse effects inherent to prolonged use of chlorhexidine.

Clinical relevance

Importance of oral hygiene for patients admitted to hospitals with the use of adjuvant substances that do not present adverse effects such as chlorhexidine, which is considered the gold standard, seeking to provide better clinical protocols.

Gingivitis

Chloramine T

Chlorhexidine

Hospital

Hospitalized patients are more likely to neglect oral cavity hygiene. The hospital environment, each patient's own limitations derived from their underlying disease and the lack of an adequate structure are factors that lead to a reduction in this care [1]. Therefore, the accumulation and complexity of dental biofilm may be proportional to the length of hospital stay, which can lead to periodontal disease and oral infections, worsening the patient's systemic condition. [2]. In this context, Hospital Dentistry is a specialty that aims to adapt and maintain the oral health of hospitalized patients, with the focus on reducing harm to the patient's general health, thus improving their quality of life. [3].

The association between periodontal disease and systemic diseases has been researched, which has already established a relationship between oral problems and heart, respiratory and metabolic diseases [4]. Health problems such as bacterial pneumonia, chronic obstructive pulmonary disease and cardiovascular diseases are some of the complications that can be caused by pathogenic microorganisms from the oral environment, which, when entering the bloodstream through minor trauma such as brushing, colonize these other organs, generating important systemic infections [3].

To achieve balance in the periodontal health-disease process, effective control of sub- and supragingival biofilm is necessary. This control may be inadequate on some occasions, with the need to complement it with chemical substances that have safe and effective properties, supporting the mechanical process of biofilm elimination. [5].

Chlorhexidine is a cationic bisguanidine found in the form of glucanate, diglucanate and acetate salts, has high substantivity, retaining in the oral cavity for 12 hours [6]. It has a broad spectrum of action, proving to be effective in combating gram-positive and gram-negative bacteria, fungi, yeasts, and lipophilic viruses. [5]. However, some adverse effects are related to the continuous oral use of chlorhexidine in mouthwashes, such as: brownish stains on teeth, restorations or on the back of the tongue, loss of oral sensitivity, peeling of mucous membranes, bitter taste and changes in taste sensation. [7]. Therefore, it is necessary to carry out research that finds strategies to control biofilm and that do not present adverse effects.

Chloramine T is a bactericidal antiseptic widely used as a disinfectant in various applications, ranging from use in veterinary hygiene to food processing. In the health sector, it has been applied for decades in the treatment of ulcers with intense contamination, as an antiseptic for materials, equipment and surfaces and in the treatment of burns. [8]. In dentistry, chloramine T has been used in the formulation of “Papacárie”, a product that causes chemical-mechanical removal of tooth decay [9] and as a mouthwash, reducing salivary microorganisms and as toothpastes [10]. It is a biocidal agent; its mechanism of action is through oxidative reaction and protein hydrolysis. It reacts with the organic material of microorganisms, penetrating and breaking the cell walls of bacteria, causing the destruction of cellular material, and interrupting essential processes leading to their destruction. This reaction affects different types of pathogens, such as Gram positive and Gram-negative bacteria, fungi, viruses, mycobacteria, yeast, both in aerobic and anaerobic environments, even at low concentrations [11]. Its use in recommended doses does not present local side effects. Even though it is used for a long time, it does not present morphological changes to oral structures or pigmentation, functioning as an effective prophylactic and sanitizing agent. [12].

In view of the above, it is extremely important to seek alternatives to reduce infections and inflammation of oral tissues and evaluate the effect of chloramine T in combating these pathogens, so that they do not generate a negative impact on the patient's general health, being used in a prolonged and safe way and without causing adverse effects. Thus, the objective of this research was to evaluate the effect of Chloramine T in reducing gingivitis in hospitalized patients, in addition to providing an alternative to the use of Chlorhexidine, with a reduction in its side effects.

Ethical considerations

This work was carried out in accordance with the Health Research Standards of the Messejana Heart Hospital Dr. Carlos Alberto Studart Gomes and the Brazilian National Health Council (Resolution n° 466, 2012). The research protocol was submitted and approved by the Human Research Ethics Committee of the Messejana Heart Hospital Dr. Carlos Alberto Studart Gomes (Approval number 6,167,888). The volunteers of the present study received an informed consent form (ICF), in which the objectives, methodology, as well as related risks and benefits were explained, and patient confidentiality was guaranteed. Furthermore, the statements and guidelines of the Declaration of Helsinki were followed and respected.

Study design

A randomized, split-mouth, prospective, triple-blind, placebo controlled, analytical clinical trial was performed carried out in the infirmary units of the Hospital de Messejana Dr. Carlos Alberto Studart Gomes, a reference in cardiopulmonary care in the State of Ceará, Brazil. This study was registered in the Brazilian Clinical Trials Registry (ReBEC) platform (https://ensaiosclinicos.gov.br) (nº RBR-8x7534h). The present clinical trial followed the recommendations described in the latest version of the Consolidated Standards of Reporting Trials (CONSORT, http://www. consort-statement.org/extensions/checklists).

Participants

Individuals admitted to one of the wards of the Hospital de Messejana Dr. Carlos Alberto Studart Gomes were invited to participate in this study. The volunteers were initially assessed according to the eligibility criteria that guided the process of selecting participants for this clinical trial. An appropriate clinical form was completed at the time of the initial consultation and during subsequent periods. Furthermore, all biosafety parameters were taken and patients were evaluated for clinical signs or complaints regarding the pandemic associated with Coronavirus (SARS-COV-2) [13].

Individuals classified according to the American Society of Anesthesiology - ASA II and III, of both sexes, aged between 30 and 85 years, oriented and cooperative, with autonomy to promote self-care regarding oral hygiene and with a mouthing and spitting reflex, presenting gingivitis and admitted to a ward were included in the study.

Volunteers who met at least one of the following criteria were excluded: (1) confirmed history of allergy to Chloramine T 0.2% and Chlorhexidine 0.12% or components of the formulas; (2) pregnant or breastfeeding women; (3) oral cavity infections present; (4) patients with impaired self-care; (5) individuals with a history of adverse reactions to chlorhexidine or components of the formula; (6) patients/guardians who did not sign the informed consent form.

The removal criteria that were considered during the development of the study were (1) patients who died before completing the study; (2) patients who were transferred to another hospital before completing the study; (3) patients who were transferred to another sector/ward of the hospital before completing the study.

Interventions

In consultation prior to the therapeutic procedure, data regarding gender, age, general health status, blood count, platelet count, international normalized ratio (INR), C-reactive protein (CRP) were collected.

At this stage, during the oral examination, they were screened according to the Löe Gingival Index (Fig. 1), to record the degree of gingival inflammation before administration of the solutions [14].

The patients were randomly divided into one of three groups, all of which underwent the same administration technique, (G1): Chloramine T 0.2% (TRYDAL, Paraná, Brazil); (G2): Chlorhexidine 0.12% (VIC PHARMA, São Paulo, Brazil); (G3): distilled water (FARMACE, Ceará, Brazil) in a standardized way and carried out in a hospital environment, following strict biosafety control in relation to the Coronavirus. A single Dental Surgeon was calibrated for this activity. The proposed treatment with the solutions lasted 15 (fifteen) days and the product was administered 2 (two) times a day.

Outcomes

The primary outcome was the evaluation of the effectiveness of the substances tested in reducing gingival inflammation in hospitalized patients.

Assessment of the reduction of gingival inflammation

To evaluate the reduction of gingival inflammation, the Löe Gingival Index was collected with an WHO periodontal probe (Golgran) in four sites per tooth, namely: mesio-buccal, mesio-lingual, disto-buccal and disto-lingual (Fig. 2). The sum of these values found divided by four (number of sites) resulted in the gingival index for the evaluated tooth. The sum of the gingival indices of each tooth, divided by the number of teeth examined, resulted in the gingival index per patient [14]. This assessment occurred immediately before the start of administration of the solutions and was repeated every five days after the start of treatment, totaling fifteen days of administration of the solutions and four assessments. The results of the Löe Gingival Index were computed in individual clinical records.

Sample size

Considering that Soares et al. (2021) [6], using Chlorhexidine to reduce oral microorganisms in patients admitted to an intensive care unit, a significant decrease in the amount of microorganisms present in the oral cavity was observed, a sample of 37 volunteers was estimated for a power of 87%. Considering possible losses of volunteers, the sample size was increased by 20%, with a final sample totaling 45 patients.

Randomization

The method used to generate the random allocation sequence was done using the “randbetween” function of the Microsoft Excel® version 2020 program. Randomization was simple, without any restrictions. The implementation of the random allocation sequence was through envelopes containing randomization numbers on the outside. When opened, these envelopes showed the professional the group to which each study volunteer belonged. A collaborator who did not participate in any stage of the study was responsible for generating the random allocation sequence, as well as for organizing and properly distributing participants into the clinical trial groups.

Blinding

To provide triple blinding in this study, the operator, patient and statistician were unaware of which group each volunteer belonged to [15]. Before the procedures, a list containing the random distribution of all sites and respective pharmaceutical formulations administered was kept in a sealed envelope by an external collaborator who was blinded to the study protocol until final data analysis. Furthermore, a collaborator filled in the data obtained in an electronic table with the groups of the present study coded by letters “A” and “B” and “C” (chlorhexidine, chloramine T, distilled water, respectively) to guarantee blinding. of the statistician. The statistical analysis was initially carried out in a coded form and, only after obtaining the results, these codes were revealed.

Statistical methods

Data were expressed as absolute and percentage frequencies or mean and standard deviation and compared using Pearson's chi-square or Fisher's exact tests (categorical data) and ANOVA or ANOVA for repeated measures, followed by Bonferroni (quantitative, parametric data). All analyzes were carried out using SPSS v20.0 software for Windows, adopting a confidence level of 95%.

Characterization of the study

An initial screening was carried out in which 90 patients were selected. After applying the inclusion and exclusion criteria, 56 volunteers were included in the study, of which 11 were removed because they were discharged from the hospital before completing the protocols. Thus, 45 patients with gingivitis, 15 women and 30 men, with an average age of 63 years, participated in the research (Fig. 3).

Among the participants, six were smokers, the main reasons for hospitalization were heart failure, acute myocardial infarction and valvular heart disease and the most prevalent comorbidities were hypertension, diabetes, kidney disease and coronary artery disease (Table 1).

Table 1

Relative and absolute frequency of patients in relation to groups.
		Group			p-
	Total	Distilled water	Chlorhexidine	Chloramine T	Value
Sex
Female	15 (33.3%)	3 (20.0%)	6 (40.0%)	6 (40.0%)	0.407
Male	30 (66.7%)	12 (80.0%)	9 (60.0%)	9 (60.0%)
Age	63.13 ± 11.50	65.00 ± 9.69	63.73 ± 10.10	60.67 ± 14.47	0.580
Reason for hospitalization
1	24 (53.3%)	10 (66.7%)	5 (33.3%)	9 (60.0%)	0.369
2	6 (13.3%)	2 (13.3%)	3 (20.0%)	1 (6.7%)
3	8 (17.8%)	2 (13.3%)	3 (20.0%)	3 (20.0%)
4	2 (4.4%)	0 (0.0%)	2 (13.3%)	0 (0.0%)
5	3 (6.7%)	0 (0.0%)	2 (13.3%)	1 (6.7%)
6	1 (2.2%)	0 (0.0%)	0 (0.0%)	1 (6.7%)
7	1 (2.2%)	1 (6.7%)	0 (0.0%)	0 (0.0%)
Comorbidities
Cardiac insufficiency	7 (15.6%)	2 (13.3%)	3 (20.0%)	2 (13.3%)	0.844
Acute myocardial infarction	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	1.000
Valvular diseases	9 (20.0%)	3 (20.0%)	1 (6.7%)	5 (33.3%)	0.189
Unstable angina	2 (4.4%)	0 (0.0%)	0 (0.0%)	2 (13.3%)	0.123
Coronary artery disease	9 (20.0%)	3 (20.0%)	5 (33.3%)	1 (6.7%)	0.189
Total atrioventricular block	1 (2.2%)	1 (6.7%)	0 (0.0%)	0 (0.0%)	0.360
Abdominal aortic aneurysm	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	1.000
Kidney diseases	10 (22.2%)	3 (20.0%)	4 (26.7%)	3 (20.0%)	0.879
Arterial hypertension	20 (44.4%)	7 (46.7%)	7 (46.7%)	6 (40.0%)	0.914
Diabetes Mellitus	14 (31.1%)	4 (26.7%)	5 (33.3%)	5 (33.3%)	0.902
Dyslipidemia	3 (6.7%)	1 (6.7%)	1 (6.7%)	1 (6.7%)	1.000
Atrial fibrillation	4 (8.9%)	1 (6.7%)	1 (6.7%)	2 (13.3%)	0.760
HIV/AIDS	1 (2.2%)	0 (0.0%)	1 (6.7%)	0 (0.0%)	0.360
Rheumatic fever	1 (2.2%)	0 (0.0%)	0 (0.0%)	1 (6.7%)	0.360
Pulmonary hypertension	3 (6.7%)	2 (13.3%)	0 (0.0%)	1 (6.7%)	0.343
Pulmonary sepsis	1 (2.2%)	0 (0.0%)	0 (0.0%)	1 (6.7%)	0.360
Cardiorenal syndrome	1 (2.2%)	0 (0.0%)	0 (0.0%)	1 (6.7%)	0.360
Dilated cardiomyopathy	1 (2.2%)	0 (0.0%)	0 (0.0%)	1 (6.7%)	0.360
Smoker	6 (13.3%)	4 (26.7%)	1 (6.7%)	1 (6.7%)	0.177
*p < 0.05, Pearson's chi-square test or Fisher's exact test (n, %) or ANOVA/Bonferroni (mean ± SD).

The medications most used by the patients evaluated were antihypertensives, anticoagulants, diuretics and antidiabetics. Hematological exams did not show major atypia, as shown in Table 2.

Table 2

Absolute and relative frequency of medication profile and patient exams.
		Group			p-
	Total	Distilled water	Chlorhexidine	Chloramine T	Value
Medications in use
Anticoagulants	34 (75.6%)	9 (60.0%)	13 (86.7%)	12 (80.0%)	0.209
Antihypertensives	36 (80.0%)	12 (80.0%)	14 (93.3%)	10 (66.7%)	0.189
Antibiotics	10 (22.2%)	2 (13.3%)	2 (13.3%)	6 (40.0%)	0.128
Diuretics	28 (62.2%)	11 (73.3%)	5 (33.3%)*	12 (80.0%)	0.017
Hypoglycemic drugs	24 (53.3%)	8 (53.3%)	7 (46.7%)	9 (60.0%)	0.765
Vasoactive drugs	5 (11.1%)	2 (13.3%)	1 (6.7%)	2 (13.3%)	0.799
Retrovirals	1 (2.2%)	0 (0.0%)	1 (6.7%)	0 (0.0%)	0.360
Hematological tests
Red Cells	4.23 ± 0.81	4.06 ± 0.83	4.37 ± 0.80	4.27 ± 0.83	0.575
Hemoglobin	12.06 ± 2.30	11.61 ± 2.52	12.43 ± 1.98	12.15 ± 2.47	0.624
Hematocrit	36.47 ± 6.51	35.03 ± 6.64	37.57 ± 5.86	36.80 ± 7.14	0.559
Leukocytes	7753 ± 2831	8180 ± 3013	7920 ± 3504	7160 ± 1798	0.602
Neutrophils	5023 ± 2491	5011 ± 1861	5437 ± 3538	4620 ± 1780	0.678
Eosinophils	273.64 ± 482.07	394.00 ± 767.45	214.53 ± 284.63	212.40 ± 192.66	0.506
Basophils	69.87 ± 49.39	84.13 ± 66.73	58.40 ± 45.91	67.07 ± 27.16	0.357
Lymphocytes	1625.62 ± 765.23	1841.87 ± 969.41	1507.07 ± 716.83	1527.93 ± 558.02	0.415
Platelets	246933 ± 106504	243133 ± 88606	274400 ± 118858	223267 ± 110669	0.425
INR	1.21 ± 0.27	1.20 ± 0.19	1.15 ± 0.14	1.29 ± 0.41	0.403
aPTT	1.28 ± 0.22	1.28 ± 0.23	1.30 ± 0.23	1.28 ± 0.23	0.962
CRP	2.02 ± 3.12	2.17 ± 3.54	1.45 ± 2.78	2.43 ± 3.13	0.685
*p < 0.05, Pearson's chi-square test or Fisher's exact test (n, %) or ANOVA/Bonferroni (mean ± SD).

Analysis of gingivitis reduction considering the Löe Gingival Index

The results of the evaluations of the protocols applied in the study are presented in Table 3. In the first evaluation, before treatment with the substances, all groups were statistically balanced in terms of the Löe Gingival Index (p > 0.05).

Table 3

Absolute and relative frequency of association of treatment with solutions in relation to the evaluation period.
		Group			p-
	Total	Distilled water	Chlorhexidine	Chloramine T	Value*
Avaliation
Initial	1.49 ± 0.26^a	1.55 ± 0.28^Aa	1.49 ± 0.28^Aa	1.44 ± 0.22^Aa	0.518
5 days	1.24 ± 0.35^b	1.58 ± 0.28^Aa	1.17 ± 0.22^Bb	0.98 ± 0.25^Bb	< 0.001
10 days	1.15 ± 0.88^b	1.57 ± 0.30^Aa	0.90 ± 0.28^Bc	0.99 ± 1.41^Bb	0.037
15 days	0.82 ± 0.59^c	1.56 ± 0.29^Aa	0.55 ± 0.24^Bd	0.34 ± 0.18^Bc	< 0.001
p-Value^†	< 0.001	0.673	< 0.001	< 0.001
*p < 0.05, ANOVA/Bonferroni test; ^†p < 0.05, ANOVA test for repeated measures/Bonferroni; Different capital letters = difference between groups; Different lowercase letters = difference between assessment periods (mean ± SD).

After five days of administration of the products, the control group remained without relevant differences in relation to the first pre-treatment assessment, while the groups tested with chlorhexidine and chloramine T showed an improvement in the Löe Gingival Index when compared to the first probe (p < 0.05) but did not show any relevant statistical difference between them.

Regarding the evaluation after ten days of treatment, the control group maintained the results of previous evaluations, chloramine T repeated the performance of the five-day evaluation and chlorhexidine obtained a statistically significant difference, with a better result compared to the previous evaluation (p < 0.05).

In the last evaluation of the study, referring to fifteen days of treatment, the control group showed no differences in relation to the other evaluations. Chloramine T had a statistically significant difference, presenting a better performance in relation to the ten-day evaluation and chlorhexidine continued the gradual improvement it had been showing in the Löe Gingival Index (p < 0.05).

No relevant statistical differences were found between the chlorhexidine and chloramine T groups during the study stages. However, there were statistically relevant differences between the evaluation periods for the groups.

Over the decades, chlorhexidine has been considered the gold standard in combating oral microorganisms, when compared to other antimicrobial agents, for preventing the formation of dental biofilm [16]. Roos-Jansaker et al. (2003) [17] points out in his work that chlorhexidine has several advantages such as broad spectrum bacterial control and prolonged substantivity even in the presence of blood and other fluids. However, its prolonged use triggers several adverse effects, leading to the need to search for new safe and effective substances for long-term use [18].

The antimicrobial action of chloramine T was evaluated and proven in several studies, where the substance was applied in different methodologies and concentrations and tested against the most varied types of microorganisms such as Escherichia coli, Enterococcus faecalis, Staphylococcus aureus, Pseudomonas aeruginosa, Lactobacillus acidophilus, Klebsiella pneumoniae, Staphylococcus epidermidis and Streptococcus mutans, which corroborates the present study, since if there is a reduction in gingival inflammation, it is because there has been a reduction in the microorganisms that cause gingivitis. Furthermore, its antifungal action against species such as Aspergillus fumigatus, Candida spp. and Aspergillus flavus [8].

In one study, different concentrations of chloramine T were tested against microorganisms colonizing the oral cavity, such as Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa. It was proven that a concentration of 0.003% of chloramine T was effective in reducing the viability of these pathogens at intervals of 10, 30 and 60 minutes, respectively [19], which proves what was said in this research, that even at low concentrations, it is an effective product in combating oral pathogens.

Rams, Keyes and Jenson (1984) [20], evaluated in their research the morphological effects of inorganic salts, chloramine T and citric acid on subgingival bacterial plaque and found that chloramine T significantly reduces bacterial colonization in cases of peri-implantitis and post-extraction bacteremia.

In an experimental study, seeking to simulate the conditions to control bacterial growth in osseointegrated implants, different mouthwashes were tested, where the oral environment and periodontal conditions were simulated in vitro on titanium discs with different surface treatments. At the conclusion of the research, the substances tested did not show statistical differences between them, corroborating the present study, however, the essential oils and chloramine T had a lower amount of bacteria when compared to the control group (saline solution), which shows that chlorhexidine, the current gold standard antiseptic, is not as effective at reducing biofilm as chloramine T and essential oils [21].

Pitten & Kramer (1999) [22], sought to evaluate the activity of thirteen different mouthwash solutions in comparison with sterile water and sage tea against aerobic bacteria from the oral cavity, collected from healthy patients at different time intervals. The results obtained made it possible to classify the substances into four groups according to the antimicrobial activity carried out: products that do not present antimicrobial activity (sterile water, sage tea, Fluomint-Lysoform), products with a weak and temporary effect that does not exceed a reduction in salivary bacterial count of 1.5 log colony-forming units immediately after application and 1.0 log colony-forming units 1 h after application (hydrogen peroxide, Meridol, Listerine, Lavasept), products with a strong immediate effect but without prolonged activity (betaisodone solution, acriflavine) and products that have a prolonged effect in reducing at least 1.0 log of colony-forming units 1h after application (chloramine T, gurfix, skinsept mucosa, corsodyl, dobendan, octenisept). In their conclusion, the authors classified chloramine T at 0.25g/100ml as an antiseptic with strong and prolonged action, maintaining its antimicrobial effect even after 1 hour of application, as well as what was identified in the present research, it has an effective action against causative agents of gingivitis.

Fuursted, Hjort and Knudsen (1997) [23] conducted research in which they evaluated the time required for new bacterial growth after the use of five mouthwashes (chlorhexidine, chloramine T, povidone iodine, phenoxyethanol and mandelic-lactic acid) on nine species of microorganisms. It was observed that the use of 0.2% chloramine T resulted in a longer time interval for the new emergence of bacteria, when compared to the other antiseptics tested and its antimicrobial activity against Escherichia coli, Enterococcus faecalis, Staphylococcus aureus, Proteus mirabilis, Enterobacter cloacae, Pseudomonas aeruginosa, Klebsiella pneumoniae, Staphylococcus epidermidis and Serratia marcescens, it was similar to that of chlorhexidine and povidone iodine and superior to the other substances evaluated. In the present study, it was also concluded that the biocidal activity exerted by the substances chloramine T and chlorhexidine are similar when used to combat oral pathogens.

As limitations of the study, we have the scarcity of research comparing the two substances in the literature, as well as the difficulty in finding more recent studies mentioning both solutions. Furthermore, we can point out the difference in the methodology of other studies, which address microbiological analysis, and the present work, which evaluates using a gingival inflammation scale. These limitations make it necessary to carry out further research to confirm the antimicrobial activity of the antiseptics tested and the feasibility of replacing chlorhexidine safely and effectively with chloramine T, without causing long-term side effects.

Therefore, based on the results collected, it is concluded that Chloramine T and Chlorhexidine have similar results in combating gingivitis, when evaluated by probing using the Löe Gingival Index, and Chloramine T can be used effectively, without causing the adverse effects inherent to prolonged use of chlorhexidine.

Author contribution

All authors conducted the study read the articles, interpreted, and analyzed the data. All authors reviewed and approved the final manuscript.

Funding

none

Ethics approval

Approval by the Ethics Committee, under protocol number 6,167,888.

Informed consent

All patients signed the consent form and agreed to participate in this study.

Conflict of interest

The authors declare no conflict of interest.

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No competing interests reported.

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Effect of Chloramine T and Chlorhexidine in reducing gingivitis in patients admitted to a reference hospital for cardiopulmonary care: a randomized, controlled clinical trial

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Abstract

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Introduction

Material and methods

Ethical considerations

Study design

Participants

Interventions

Outcomes

Assessment of the reduction of gingival inflammation

Sample size

Randomization

Blinding

Statistical methods

Results

Characterization of the study

Analysis of gingivitis reduction considering the Löe Gingival Index

Discussion

Declarations

References

Additional Declarations

Status:

Journal Publication

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