povidone-iodine and Gingivitis

This review article addresses the effects of povidone-iodine (PVP-I) and its utility in the treatment of periodontal diseases. There are data to support the following statements: PVP-I is a potent antiseptic and, when used as a component in a rinse with H202, the rinse can decrease the level of gingivitis. With regards to patients with adult periodontitis, there is some evidence to indicate that PVP-I delivered via an ultrasonic device achieves better results in deep pockets than ultrasonic debridement when water is the irrigant. The benefits of PVP-I in the treatment of refractory periodontitis are unclear. Subgingival irrigation with PVP-I may reduce the incidence of bacteremia if it is employed as a pre-procedural intrasulcular irrigant; however, this technique is not recommended for high-risk patients. PVP-I is a safe antiseptic and does not appear to impede wound healing or induce resistant bacteria. It is an approved drug whose intraoral use is an unlabeled indication. In conclusion, the literature suggests that utilization of PVP-I is potentially beneficial in the management of some periodontal diseases. However, additional clinical trials are needed to verify this assessment, since it is based upon a limited number of studies.

Topics: Anti-Infective Agents, Local; Bacteremia; Bacteria; Drug Labeling; Gingivitis; Humans; Mouthwashes; Periodontitis; Povidone-Iodine; Therapeutic Irrigation

A number of mouthrinse formulations containing antimicrobials have been evaluated to determine their effectiveness as antiplaque and/or antigingivitis agents. These have included the bis-biguanides, phenols, quaternary ammonium compounds, oxygenating compounds, plant extracts, fluorides, antibiotics and antimicrobial combinations. These mouthrinses have often been tested as adjuncts to normal oral hygiene procedures as well as in the experimental gingivitis model. 2 agents in particularly, chlorhexidine gluconate and listerine, have been shown to both inhibit or reduce plaque accumulation and the severity of gingivitis. Chlorhexidine has been reported to reduce the accumulation of plaque by approximately 60% and the severity of gingivitis by 50-80% as determined by improvements in clinical indices. A 0.12% chlorhexidine gluconate rinse resulted in significant reductions after both 3 and 6 months use in the numbers of total anaerobes, total aerobes, streptococci, and actinomyces recovered from supragingival plaque. Listerine has been reported to retard the development of plaque by 45 to 56% and to reduce existing plaque by 39 to 48%. Gingivitis scores were reduced as much as 59%. Microbial studies have shown that the effect of listerine is exerted against the total microbial mass and results in an overall decrease in both the biomass and the activity. Long-term use of neither mouthrinse, chlorhexidine or listerine, resulted in the emergence of opportunistic or oral pathogens. Preliminary data obtained following the use of a novel mouthrinse consisting of a combination of povidone-iodine and hydrogen peroxide appears promising. This combination was more effective than was more effective than either single component alone in reducing gingivitis scores.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Anti-Infective Agents, Local; Bacteria; Chlorhexidine; Dental Plaque; Drug Combinations; Gingivitis; Humans; Hydrogen Peroxide; Mouthwashes; Povidone-Iodine; Salicylates; Terpenes

The aim of this double blind study was to evaluate the effect of various mouthwashes: Chlorhexidine, Essential oil, Azadirachta indica (Neem) extract, and Povidone iodine on gingival tissue interleukin-2 (IL-2) and interferon-gamma (IFN-gamma) levels in patients with chronic gingivitis. A total of 8O patients (42 boys, 38 girls; mean age 16.0 +/- 1.8 years) were included in this study. Patients were randomly assigned into four groups of 20 each: Group I--Azadirachta indica (Neem) extract, Group II--Essential oil, Group III--Povidone iodine, and Group IV--Chlorhexidine. They were instructed to use these mouthwashes for two weeks. Plaque and gingival indices scores, and IL-2 and IFN-gamma levels in the gingival tissues were measured at baseline and after two weeks of mouthwash use. Results showed the reduction of plaque and gingival indices, and IL-2 and IFN-gamma level with Chlorhexidine, Essential oil, and Povidone iodine, which were found to be statistically significant. Although Neem reduced the level of plaque and gingival indices, and IL-2 and IFN-gamma to a certain level, it was not statistically significant. Therefore, Chlorhexidine, Essential oil, and Povidone iodine mouthwashes can be used as an adjunct to oral prophylaxis in reducing pro-inflammatory cytokines, IL-2 and IFN-gamma in patients with chronic gingivitis.

Topics: Adolescent; Adult; Anti-Infective Agents, Local; Child; Chlorhexidine; Chronic Disease; Dental Care for Children; Dental Plaque; Dental Plaque Index; Double-Blind Method; Female; Gingiva; Gingivitis; Glycerides; Humans; Interferon-gamma; Interleukin-2; Male; Mouthwashes; Oils, Volatile; Periodontal Index; Plant Oils; Povidone-Iodine; Statistics, Nonparametric; Terpenes; Treatment Outcome

To investigate rinsing with povidone-iodine on bacteraemia caused by ultrasonic scaling.. Sixty patients with gingivitis undertook a randomized, placebo-controlled trial in which 30 rinsed with 0.9% saline and 30 with 7.5% povidone-iodine for 2 min. before ultrasonic scaling of FDI teeth 31-35. Blood samples before and after 30 s and 2 min. of scaling were cultured by lysocentrifugation.. Oral bacteraemia occurred in 33.3% of the saline group and 10% of the povidone-iodine group. Regression analysis showed that rinsing with povidone-iodine was approximately 80% more effective than rinsing with saline in reducing the occurrence of bacteraemia, with a statistically significant odds ratio (OR) of 0.189 (95% confidence intervals, OR=0.043-0.827). There were 24 oral bacterial isolates in the saline group and 3 in the povidone-iodine group. Viridans streptococci comprised 11 of the isolates in the saline group and none in the povidone-iodine group. Bacteraemia magnitude was 0.1 colony-forming units/ml in the povidone-iodine subjects and 0.1-0.7 CFU/ml in the saline group.. Rinsing with 7.5% povidone-iodine reduced the incidence and magnitude of bacteraemia and eliminated viridans streptococci from such bacteraemia. Povidone-iodine rinsing may be helpful for ultrasonic scaling of gingivitis patients at risk of infective endocarditis.

Topics: Adult; Anti-Infective Agents, Local; Bacteremia; Dental Plaque Index; Dental Prophylaxis; Dental Scaling; Female; Gingivitis; Humans; Male; Middle Aged; Mouthwashes; Povidone-Iodine; Statistics, Nonparametric; Treatment Outcome

The present study was performed to assess the effect of topically-applied PVP-iodine, used as an adjunct both during basic non-surgical therapy and at re-treatment during the long-term maintenance of patients with advanced periodontal disease.. 223 patients with advanced destructive periodontitis were recruited. The participants met the following inclusion criteria: (i) a minimum of 8 non-molar teeth, (ii) probing pocket depth of > or = 6 mm at > or = 2 teeth in each dentate quadrant, and radiographic bone loss exceeding 40% at the same teeth. A baseline I examination included assessment of plaque, gingivitis, probing pocket depth (PPD), probing attachment level (PAL) and radiographic bone height (RxBL). Following baseline I, the patients were stratified into 2 treatment groups; 2 subjects out of 3 were included in a control group and 1 in a test group. All participants, on an individual basis, received a case presentation and were instructed in proper self-performed plaque control measures. Non-surgical therapy was performed by the use of an ultrasonic device. The instrumentation in the test group was combined with the administration of 0.1% PVP-iodine. All subjects were recalled for comprehensive examinations 3, 6 and 12 months (baseline II) after baseline I and then after 3, 5 and 13 years of maintenance therapy. PAL determinations were performed annually. Subjects (losers) who at the re-examinations after 1, 2 and 3 years of maintenance demonstrated an annual further loss of PAL > or = 2 mm at > or = 4 teeth were exited from the study and referred for re-treatment. There were 9 losers in the test and 31 in the control group. In addition, 8 subjects in the test and 25 subjects in the control group withdrew from the trial for reasons unrelated to the study. These 73 subjects were not included in the data presentation from the various examinations.. It was demonstrated that non-surgical periodontal therapy resulted in (i) improved gingival conditions, (ii) reduced PPD, (iii) gain in PAL. It was also documented that the topical application of 0.1% PVP-iodine in conjunction with the mechanical root debridement established conditions which further improved the outcome of therapy. This was evidenced by the fact that at the 3, 6, and 12 months re-examinations after baseline I, the test group had significantly lower mean PPD values and significantly more gain of PAL than the control group. During the 12 years of SPT, it was possible for most subjects in both groups to maintain shallow pockets and to avoid marked further loss of PAL. There were, however, a larger number of losers in the control than in the test group.. PVP-iodine, topically applied during subgingival instrumentation, may improve the outcome of non-surgical periodontal therapy.

Topics: Administration, Topical; Adult; Alveolar Bone Loss; Analysis of Variance; Anti-Infective Agents, Local; Chronic Disease; Dental Plaque; Dental Plaque Index; Dental Scaling; Female; Follow-Up Studies; Gingivitis; Humans; Iodophors; Longitudinal Studies; Male; Oral Hygiene; Periodontal Attachment Loss; Periodontal Index; Periodontal Pocket; Periodontitis; Povidone-Iodine; Statistics as Topic; Treatment Outcome; Ultrasonic Therapy

A trial was made comparing the effects of efficient and thorough removal of plaque and debris alone, and with a daily antiseptic mouthwash. The results showed considerable variation but no significant difference in gingival inflammation between hygienic treatment and a daily mouthwash with chlorhexidine-gluconate or povidone-iodine. Povidone-iodine caused less staining of the teeth than chlorhexidine-gluconate.

Topics: Anti-Infective Agents, Local; Chlorhexidine; Clinical Trials as Topic; Combined Modality Therapy; Dental Care; Dental Plaque; Gingivitis; Humans; Mouthwashes; Oral Hygiene; Povidone; Povidone-Iodine; Random Allocation

A trial was conducted to compare the effectiveness of povidone iodine and chlorhexidine gluconate with buffered peroxyborate in the treatment of acute ulcerative gingivitis. After 20 patients had entered the trial and 11 had required additional therapy with metronidazole to control their symptoms, the study was terminated. Those patients receiving peroxyborate all showed a satisfactory improvement in clinical signs and symptoms. One patient each receiving povidone iodine or chlorhexidine reported a symptomatic improvement, although gingival ulceration was still apparent at 1 week. The remaining patients all required metronidazole therapy to control their symptoms. Povidone iodine and chlorhexidine gluconate therefore cannot be recommended for the treatment of acute ulcerative gingivitis.

Topics: Acute Disease; Biguanides; Borates; Chlorhexidine; Clinical Trials as Topic; Drug Evaluation; Gingivitis; Gluconates; Humans; Mouthwashes; Povidone; Povidone-Iodine

Kostmann syndrome is a rare, congenital immunological disorder caused by a mutation of the hematopoietic cell-specific LYN substrate 1-associated protein X1. These patients pose a unique challenge to the dental practitioner due to the severe oral infections that are often seen in this population. The patient described in this report is a 16-year-old female with Kostmann syndrome-associated periodontitis. The treatment consisted of scaling and root planing performed in conjunction with subgingival irrigation with povidone-iodine solution. This report details how Kostmann syndrome-associated periodontitis can be successfully treated and maintained long-term, using non-surgical treatment modalities and local antimicrobial therapy.

Topics: Adolescent; Anti-Infective Agents, Local; Congenital Bone Marrow Failure Syndromes; Dental Scaling; Female; Follow-Up Studies; Furcation Defects; Gingival Recession; Gingivitis; Humans; Neutropenia; Periodontal Debridement; Periodontal Pocket; Periodontitis; Povidone-Iodine; Root Planing; Therapeutic Irrigation

Dentists generally recognize the importance of periodontal treatment in patients with leukemia, with the most attention paid to preventing the development of odontogenic infection. For physicians, the worst type of infection is one caused by multidrug-resistant bacteria. Here, we report a patient with an abnormal increase in multidrug-resistant opportunistic bacteria in the gingiva during hematopoietic cell transplantation (HCT).. A 53-year-old woman receiving HCT for leukemia had an insufficient blood cell count for invasive periodontal treatment before HCT. Even brushing caused difficulties with hemostasis. Therefore, frequent pocket irrigation and local minocycline administration were performed.. The multidrug-resistant opportunistic bacterium Stenotrophomonas maltophilia was detected first in phlegm 2 days before HCT, and it was detected in a gingival smear and a blood sample 7 and 11 days after HCT, respectively. The patient developed sepsis on day 11 and died 14 days after HCT. Frequent irrigation and local antibiotic application were ineffective against S. maltophilia on the gingiva. Inflammatory gingiva without scaling and root planing showed bleeding tendency, and this interfered with the eradication of this bacterium.. The gingiva in patients undergoing leukemia treatment acts as sites of proliferation and reservoirs for multidrug-resistant opportunistic bacteria. Severe systemic infection by multidrug-resistant bacteria in such patients with leukemia also may involve the gingiva. To prevent abnormal increases in such bacteria on the gingiva, scaling and/or root planing before chemotherapy, which reduces bleeding on brushing during the neutropenic period caused by chemotherapy, may contribute to infection control in such patients, although it was impossible in this case.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Drug Resistance, Multiple, Bacterial; Fatal Outcome; Female; Gingival Diseases; Gingivitis; Gram-Negative Bacterial Infections; Hematopoietic Stem Cell Transplantation; Humans; Immunocompromised Host; Leukemia, Myeloid, Acute; Middle Aged; Minocycline; Opportunistic Infections; Periodontitis; Povidone-Iodine; Sepsis; Stenotrophomonas maltophilia; Transplantation Conditioning; Whole-Body Irradiation

This is the first known case report that used a polymerase chain reaction (PCR)-based method to help identify the oral microflora in patients with chronic neutropenia. In this study, we report clinical periodontal findings and microflora profiles of 2 children, 1 with severe congenital neutropenia (SCN, Kostmann type) and 1 with cyclic neutropenia (CN).. The SCN patient had severe gingivitis, whereas the patient with CN had mild gingivitis in the gingival margins. Monthly oral cleaning instruction and review were performed without subsequent periodontal therapy. Oral hygiene conditions remained satisfactory and visible plaque was scarce, despite the persistence of mild gingivitis. Under supervised oral hygiene, we examined the presence of periodontal pathogens from patient plaque samples.. By a PCR-based method, Prevotella nigrescens, Bacteroides forsythus, Campylobacter rectus, and Capnocytophaga gingivalis were detected in the SCN patient and P. intermedia, C. rectus, C. gingivalis, and C. sputigena in the CN patient, suggesting the existence of periodontal pathogens. Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Treponema denticola, and C. ochracea were not found in either patient.. Use of 1% povidone iodine solution and local antibiotic application under supervised oral hygiene were helpful to improve gingival conditions in patients with chronic neutropenia.

Topics: Aggregatibacter actinomycetemcomitans; Anti-Infective Agents, Local; Bacteroides; Campylobacter; Capnocytophaga; Child, Preschool; Chronic Disease; Dental Plaque Index; Gingival Diseases; Gingival Hemorrhage; Gingival Pocket; Gingivitis; Gram-Negative Bacteria; Humans; Male; Neutropenia; Oral Hygiene; Periodicity; Polymerase Chain Reaction; Porphyromonas gingivalis; Povidone-Iodine; Prevotella; Prevotella intermedia; Treponema

12 patients (7 men and 5 women) with advanced periodontitis and probing depths of 4mm or more were selected to assess the effectiveness of an antiseptic: betadine used in situ, as a subgingival irrigation in periodontal pockets. Although widely used in other fields of medicine such as gynecology and dermatology, betadine has not been used in periodontology. However, betadine is an excellent antiseptic with a wide range of action. The slow release of iodine explains why this antiseptic is well tolerated by mucosae. The oral cavity was divided in 2 parts: the left side was irrigated with betadine while the right side was irrigated with saline which was used as a control. Irrigations were performed once a day during a period of 15 days. Patients were able to carry out the irrigations themselves after careful, instruction. Thc practitioner carried out the irrigation on day 0 and day 8. The comparison of clinical and histological data showed a decrease in gingival inflammation after 15 days of treatment. By means of the Student "t" test significant decreases in the plaque index, the gingival, index and the bleeding index were observed between day 0 and day 15 as well as a significant increase in recession. These clinical results were correlated with histological findings. Significant decreases in the volumetric density of the infiltrated connective tissue, the non collagenous structures and the number of plasma cells were observed as well as significant increases in the volumetric density of the non-infiltrated connective tissue of the collagenous structures and the number of fibroblasts.

Topics: Administration, Topical; Adult; Connective Tissue; Dental Plaque; Dental Plaque Index; Epithelium; Female; Gingivitis; Humans; Male; Middle Aged; Periodontal Index; Periodontal Pocket; Periodontitis; Povidone-Iodine; Therapeutic Irrigation; Time Factors

The purpose of this investigation was to determine the effectiveness of irrigating periodontal pockets with povidone-iodine in reducing the incidence of bacteremia found during subgingival scaling. Twenty male patients requiring subgingival scaling had the following factors recorded on two contralateral groups of three posterior teeth: age, race, mean pocket depth, mobility, and scores of gingival, plaque, calculus, bleeding indices. In control areas, 5 ml blood samples were taken before, during and after scaling through an in dwelling Minicath. In experimental areas, the patients first rinsed with a povidone-iodine mouthwash for 1 minute, and the teeth then received a 3-minute sulcus irrigation with 10% povidone-iodine. Blood samples were taken as with the controls, and also 2 minutes after the irrigation. Blood samples were anaerobically cultured, and isolates were classified by Gram staining and cellular morphology. No significant difference in factors between control and experimental areas was noted. All preoperative blood cultures, including those taken 2 minutes after irrigation, were negative. In the 11 patients (55%0 who showed positive cultures during the scaling, cultures were positive in both control and experimental areas. None of the preoperatively recorded factors in either control or experimental ares were significantly correlated with the occurrence of bacteremia. Local degerming by mouthrinsing and sulcus irrigation with povidone-iodine prior to subgingival scaling seems neither to increase nor decrease the incidence of bacteremia.

Topics: Adult; Dental Prophylaxis; Dental Scaling; Gingivitis; Humans; Male; Middle Aged; Periodontal Index; Povidone; Povidone-Iodine; Sepsis; Subgingival Curettage; Therapeutic Irrigation