ORIGINAL RESEARCH |
https://doi.org/10.5005/jp-journals-10015-2278 |
Comparative Evaluation of Wettability of Chlorhexidine, Betadine, and Herbal Mouthwash: An In Vitro Study
1Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS) (Deemed to be University), Chennai, Tamil Nadu, India
2Department of Periodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS) (Deemed to be University), Chennai, Tamil Nadu, India
Corresponding Author: M Jeevitha, Department of Periodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS) (Deemed to be University), Chennai, Tamil Nadu, India, Phone: +91 7904613787, e-mail: jeevitham.sdc@saveetha.com
Received on: 02 June 2023; Accepted on: 05 July 2023; Published on: 31 August 2023
ABSTRACT
Aim: The study aims to assess the wettability of three different commercially available types of mouthwash—Betadine, chlorhexidine (CHX), and herbal mouthwash (HiOra) using contact angle goniometer.
Materials and methods: A total of 30 anterior teeth was sectioned longitudinally to produce 10 mm long, thin enamel plates with intact labial surfaces and divided into three groups corresponding to the three different types of mouthwash (Betadine, CHX, and HiOra mouthwash) with 10 enamel plates in each group. Using the Ossila goniometer, the contact angle for each droplet was measured from the base of the enamel plate section and the line angle at which the droplet makes contact with the tooth surface. The wettability of the samples was evaluated as it is inversely proportional to the contact angle with the facial surface of the microtomed teeth. One-way analysis of variance (ANOVA) test was used to compare the contact angle measurements among the three different types of mouthwash and multiple intergroup comparisons were done using Tukey’s post hoc test.
Results: HiOra mouthwash had the lowest average contact angle of 15.7980 than Betadine (17.9600) and CHX (23.5340) and the results were statistically significant (p-value of 0.0070).
Conclusion: The results showed that the wettability of HiOra was more when compared to Betadine and CHX and thus further studies are to be evaluated to determine its beneficial activities.
Clinical significance: Low contact-angle values demonstrate the tendency of the mouthwash to spread and adhere to the surface. Numerous biological processes depend heavily on surface wettability of mouthwashes. Evaluating the wettability of commonly prescribed mouthwashes is crucial in determining the efficacy of these mouthwashes for their biological actions.
How to cite this article: Harshitha VRS, Jeevitha M. Comparative Evaluation of Wettability of Chlorhexidine, Betadine, and Herbal Mouthwash: An In Vitro Study. World J Dent 2023;14(7):634–638.
Source of support: The present project is supported by Saveetha Institute of Medical and Technical Sciences, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS) (Deemed to be University), and Kamala Dental Specialty Hospital.
Conflict of interest: None
Keywords: Betadine, Chlorhexidine, Contact angle, Herbal, Mouthwash, Wettability
INTRODUCTION
One of the main causative factors for periodontal disease is dental plaque.1,2 Different plaque control strategies are employed to halt or slow the spread of periodontal diseases. To maintain good dental hygiene, one of them includes mechanical plaque reduction procedures. Mouthwash, dentifrices, chewing gum, and gel are just a few of the many chemical plaque management products that are offered on the market.3 But they also cause tooth stains, vomiting, and other unpleasant side effects. Mouthwashes can help patients who are mentally or physically unable to brush their teeth alone, as well as those people who lack the dexterity, competence, or motivation necessary for mechanical plaque removal.4
A bisbiguanide known as chlorhexidine (CHX) was created in the United Kingdom in the 1940s and has been marketed as a general disinfectant. The most effective chemotherapeutic drug at the present time for decreasing oral biofilm is CHX mouthwash widely used after periodontal surgeries.5,6 Dental CHX products, including mouthwashes, gels, chips, and varnishes are accessible with a prescription. It is marketed as a salt preparation in the forms of gluconate, acetate, and dihydrochloride. Due to its cationic charge, CHX effectively binds to anionic proteins found in the skin and mucous membranes, producing long-lasting antiseptic effects.7 The most frequent adverse effect of using the drug, extrinsic tooth discoloration, is caused by the cationic structure of the CHX molecule. Such tooth discoloration appears to be caused by a local precipitation interaction between chromogens present in foods and beverages and CHX that is bound to teeth.8
Betadine, commonly known as povidone-iodine (PVP-I), is an antiseptic used to treat infected wounds and to prepare the skin and mucous membranes before surgery. It has broad-spectrum, fast-acting bactericidal properties and also has sporicidal, fungicidal, and virucidal activity. The PVP-I solution is less potent than products that contain free I, but it is also less hazardous because it releases I gradually. Among all other antiseptics, Betadine has the longest-lasting effect, leaves no stains, and doesn’t trigger allergies but is reported to cause nonallergic effects like a chemical burn, cytotoxic effects, and general patient discomfort.9,10
Herbal mouthwashes are derived from plants with medicinal values. These products contain a variety of active ingredients with therapeutic effects. Herbal mouthwashes can also possess other properties such as anti-inflammatory and antioxidant benefits in addition to their antimicrobial effects, which may improve oral health.11 One such mouthwash is HiOra (Himalaya drug company) which asserts that it functions as an oral antiseptic, protects against tooth decay, decreases plaque and gingivitis, and also prevents bad breath.
The bonding relationship between two surfaces is revealed by measuring the contact angle in order to ascertain the solid-liquid and vapor-solid interfacial tensions existing in the materials. The hydrophilicity of a material is assessed using the contact angle. Greater contact angles denote limited wettability or greater hydrophobicity, whereas lower contact angles denote increased wettability or greater hydrophilicity.11,12 Determining the effectiveness of these mouthwashes for their biological effects requires evaluating the wettability of the commonly prescribed mouthwashes. Evaluation of natural alternatives is necessary to get beyond the drawbacks of synthetic agents. Hence the present study aims to evaluate the wettability of three different commercially available mouthwashes—Betadine, CHX, and an herbal mouthwash (HiOra) using a contact angle goniometer.
MATERIALS AND METHODS
The in vitro study was conducted in the white lab which is the material testing lab at Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS) (Deemed to be University), Chennai, Tamil Nadu, India from January to March 2023. The study design was approved by the institute’s scientific research board in December 2022. No human ethical clearance was required because there were no participants in the study who were humans. The study was designed and performed by two researchers (V RS Harshitha and M Jeevitha) with the assistance of Saveetha white lab (material testing lab) personnel. A total of 30 anterior teeth were procured from the in-house Saveetha tooth bank. Inclusion criteria include human anterior teeth with intact and even labial surfaces that were extracted due to periodontal disease. Exclusion criteria include teeth from different species, posterior teeth with uneven surfaces that could result in an incorrect reading, carious teeth, teeth with enamel and dentin abnormalities, and teeth that are discolored or decayed.
The acquired teeth were carefully cleansed and sized. These teeth were later divided longitudinally to produce 10 mm long, thin enamel plates with intact labial surface. Thirty enamel plates were divided into three groups (n = 10) to study the wettability of three different types of mouthwash, with ten enamel plates in each group. In the present study, the wettability of three different types of mouthwash: Betadine (Betadine 2%), CHX (hexidine 0.2%), and HiOra (HiOra mouthwash regular, manufactured by Himalaya drug company, India) mouthwash were compared. Firstly, the enamel plate was mounted on the contact angle goniometer (Ossila, Netherlands). Sessile drop goniometry is the technique used in the protocol to measure contact angle. It is carried out by filming a water drop on a solid surface and using a fitting technique to extract the contact angle from the video’s images.
A drop of mouthwash was dispensed using a precalibrated microsyringe to the labial surface of the enamel plate and the same was repeated for the subsequent enamel plates.
The contact angle for each droplet is measured from the base of the enamel plate section and the line angle at which the droplet makes contact with the surface using a camera with a resolution of 1920 × 1080. The values were entered in an Excel sheet and exported to Statistical Package for the Social Sciences software version 23.0 and were statistically analyzed. A one-way analysis of variance (ANOVA) test was used to compare the wettability among three different drops of mouthwash and multiple intergroup comparisons were done using the Tukey post hoc test. p-value ≤ 0.05 was considered to be statistically significant.
RESULTS
The wettability of three different types of mouthwash was compared using the Ossila goniometer. It is well known that the relationship between contact angle and wettability is inverse. Comparing the three different types of mouthwash in the present study, HiOra mouthwash had the lowest average contact angle of 15.7980 than Betadine (17.9600) and CHX (23.5340) and the results were statistically significant (p-value of 0.0070) (Table 1 and Fig. 1). Intergroup comparisons revealed that CHX had lower wettability when compared to Betadine (p-value of 0.056) and also when compared to HiOra (p-value of 0.006) with statistically significant results (Table 2). Therefore, the present study revealed the higher hydrophilic nature of HiOra when compared to Betadine and CHX mouthwashes.
Mean | p-value | |
---|---|---|
Betadine | 17.9600 | 0.0070 |
CHX | 23.5340 | |
HiOra | 15.7980 |
Groups | Mean difference | p-value | |
---|---|---|---|
Betadine | CHX | −5.57400 | 0.056 |
HiOra | 2.16200 | 0.619 | |
CHX | Betadine | 5.57400 | 0.056 |
HiOra | 7.73600 | 0.006 | |
HiOra | Betadine | −2.16200 | 0.619 |
CHX | −7.73600 | 0.006 |
Fig. 1: Comparison of average contact angle of the three groups of mouthwashes—Betadine, CHX, and HiOra. X-axis represents the type of mouthwash and Y-axis represents the mean contact angle of the mouthwash with the microtomed tooth
DISCUSSION
Research is ongoing to provide efficient oral hygiene aids for oral self-care regimes as the prevalence of periodontal diseases and dental caries rises. Complete removal of dental plaque is not possible with mechanical plaque control alone. By removing dental plaque from hard-to-reach regions, antimicrobial mouthwashes may aid in enhancing plaque control and thereby oral hygiene.
Chlorhexidine (CHX) has been demonstrated to have the best results when compared to other antiplaque agents and as a result, it is regarded as the gold standard for plaque removal. However, its long-term use has been constrained because of its local adverse effects like alteration of taste and tooth staining. Most of the commercially available synthetic mouthwashes report certain side effects like burning sensation and gingival irritation which led to the emergence of herbal formulations of mouthwashes that are considered eco-friendly and safe with phytotherapeutic properties. However, despite numerous studies employing different kinds of herbal mouthwash to lessen dental plaque or gingivitis, the results are still ambiguous.13,14
The present study revealed that HiOra mouthwash had the lowest average contact angle than CHX and Betadine. The contact angle, which is the angle between the tangent to the liquid-vapor interface and the solid surface at the three-phase contact line, is a typical way to describe wetting. The contact angle is generally calculated from the liquid side.15 Sessile-drop goniometry is the most popular approach for the surface-wetting character because of its ease of use. It is done by filming a video of a water drop on a solid surface and using a fitting process to calculate the contact angle from the movie’s visuals. Numerous biological processes depend heavily on surface wettability.12 Garg et al. compared the antibacterial efficiency of herbal mouthwash (HiOra™) with CHX and the results showed that chlorhexidine’s antibacterial action was more effective than HiOra with statistically significant results. Though the mean colony forming units of Staphylococcus aureus were lower in HiOra mouthwash compared to CHX the result was determined to be statistically nonsignificant between herbal and CHX mouthwash.16 Herbal mouthwash is a good alternative for patients with xerostomia and diabetes and for those who want to avoid alcohol, any artificial preservatives, and colors in their mouth rinses because of its all-natural constituents.14,17-22 Garapati et al. compared the antimicrobial activity of a novel polyherbal mouthwash with HiOra mouthwash and the results showed that the HiOra mouthwash demonstrated relatively more potent antimicrobial activities against pathogens than the polyherbal mouthwash.23 In general, mouthwash is of two varieties based on its purpose—cosmetic and therapeutic. Cosmetic mouthwash lacks active components that provide biological application; they may manage halitosis briefly by leaving a pleasing flavor, but they do not destroy the associated bacteria. Therapeutic mouthwash, on the other hand, contains active chemicals such as cetylpyridinium chloride, Betadine, CHX, fluoride, and peroxide. In other words, cosmetic mouthwashes are not antimicrobial and do not give the bacteriostatic and bacteriocidal benefits that therapeutic mouthwashes do. When a clinician prescribes therapeutic mouthwash, it is usually for a limited period of time and is always evidence-based for treating specific illnesses. Therapeutic mouthwashes have been shown to be clinically beneficial in reducing dental plaque biofilm buildup and for the treatment of periodontal diseases when used as an adjunct.24 CHX products are exclusively available by prescription in dentistry. Chemomechanical action is utilized by CHX mouthwashes in dentistry for both preventive and therapeutic objectives. CHX is utilized at a concentration of 0.1–0.2% in these applications to provide an optimal dosage of 18–20 mg per application to maximize efficacy while minimizing adverse drug effects. It is widely regarded as the most effective chemotherapeutic mouthwash and the gold standard for eliminating dental plaque.25 However, it appears that a CHX mouthwash concentration of 0.2% is much more effective than 0.12 and 0.06% in eliminating supragingival plaque.26 Brownish discoloration of teeth, dental prostheses, restorations, and oral surfaces, increased calculus formation, and altered taste perception were among the most commonly reported side effects associated with continuous use of CHX mouthwash at therapeutic concentrations. Desquamation and irritation of the oral mucosa, ulceration and erosion of the oral mucosa, tooth pain, headache, sialadenitis, and parotid gland enlargement were among the less frequently reported adverse effects. However, CHX 0.12 and 0.2% are suggested for short-term usage, and the risk of side effects exists regardless of concentration; so, the possibility for adverse drug reactions should be recognized in the dental environment whenever CHX is administered.27 Compared to other antiseptics such as CHX, PVP-I has a stronger antibacterial and better virucidal activity. Following the release of free I from polyvinylpyrrolidone, PVP-I works by rapidly penetrating into microorganisms, disrupting protein structure by oxidation of nucleic acid structures, and ultimately killing the microbes.28 But in order to transport molecular I (I2) to target cells, PVP-I primarily relies on the free I component, which is bonded to a polyvinylpyrrolidone molecule. The fact that Betadine (10% PVP-I) can only produce a maximum of 3 ppm of I2 out of 31600 ppm of total I makes this concern even more crucial. Due to the high concentration of “nonactive” I, PVP-I’s negative features, such as staining and toxicity, are amplified. As a result, only the molecular I is a biocidal species of I.29 Herbal types of mouthwash can offer anti-inflammatory and antioxidant qualities in addition to the antibacterial effects, which may help to maintain the health of the gingiva. Herbal mouthwashes are an excellent alternative to synthetic mouthwashes for the treatment of periodontal diseases to avoid any side effects in the usage of these synthetic mouth rinses. Herbal mouthwashes are made with essential oils and plant extracts from healing herbs, and they contain a variety of active ingredients such as catechins, tannins, flavonoids, and sterols. Each gram of HiOra mouthwash contains 5.0 mg of Pilu, 10 mg of Bibhitaka, 10 mg of Nagavalli (Piper betle), 1.2 mg of Gandhapura taila, 0.2 mg of Ela, 1.6 mg of Peppermint satva, and 0.4 mg of Yavani satva. Previous studies have revealed the potent antioxidant potential of Pilu (Salvadora persica), astringent effect of Bibhitaka, antioxidant, anti-inflammatory, antiplatelet, antimicrobial properties of Nagavalli, analgesic and anti-inflammatory effect of Gandhapura taila, beneficial uses of Ela in the treatment of chronic ulcers, pruritus, dental ailments and oral malodor and peppermint as flavoring and cooling agent.30 Therefore, it is necessary to study the wettability of this widely available herbal formulation for better efficacy when compared to synthetic mouthwashes. No other studies compared the wettability of commonly prescribed mouthwashes, CHX, and Betadine with the commercially available herbal mouthwash HiOra. The present study revealed higher wettability of HiOra to teeth surface than CHX and Betadine and thus the higher hydrophilic nature of HiOra may pave the way for better biological actions. The limitations of the present study are that the other physiological properties and biological processes of different herbal mouthwashes are to be evaluated in long-term clinical trials. In order to demonstrate the efficacy of herbal products and hence demonstrate their benefits, further research must be conducted.
CONCLUSION
The results of the study proved that the HiOra mouthwash had more surface wettability with the lowest average contact angle which may contribute to its better efficacy compared to CHX and Betadine mouthwash. Further studies comparing the biological actions in vivo are vital in order to continue the development and use of this natural product. HiOra mouthwash can serve as a natural alternative to synthetic mouthwash in patients who want to avoid alcohol, artificial preservatives, and adverse drug reactions.
Acknowledgments
We would like to thank Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS) (Deemed to be University), Chennai, Tamil Nadu, India for providing us with support to conduct the study.
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