Comparative Evaluation of Anti-Microbial Efficacy of Alum Mouthwash and 0.2% Chlorhexidine Mouthwash in Reducing Streptococcus Mutans Biofilm from Conventional Metal Brackets - an in Vitro Study.

Abstract

Introduction: A lot of individuals seek fixed orthodontic treatment to correct their misaligned teeth, where brackets plays a crucial role for  passive components in the orthodontic process. Utilizing fixed orthodontic devices makes maintaining strict oral hygiene an important challenge. Chlorhexidine, the gold standard, used for cleaning fixed orthodontic appliances in reducing the plaque build-up on brackets, but cannot be advocated for routine use in orthodontic patients because of staining on teeth if administered for long-term, but might rather be used temporarily for patients with present inflammation or increased risk of gingival inflammation due to microbial burden. Potash Alum also known as 'Phitkary' has proved to be significant as Alum mouthwash in continued daily usage for decreasing the level of streptococcus mutants in saliva. The efficacy of a daily use of alum  rinse has lead  in reducing the pathogenicity of bacteria and also decreased bleeding and inflammation.

Objectives: To evaluate and compare anti-microbial efficacy of Alum and 0.2% Chlorhexidine mouthwashes in reducing Streptococcus mutants biofilm on conventional metal brackets.

Methods: A total of Forty-five conventional metal brackets 3M™ were randomly selected and sterilized by immersion in 1% NaOCl (sodium hypochlorite) for 30 minutes. After sterilization the brackets were removed with sterile forceps and rinsed thrice in sterile distilled water. The brackets were then placed in the plaque solution consisting of 15 ml of sterile sucrose, 30 ml of Brain Heart Infusion (BHI) broth and 5 ml of Streptococcus mutans and were incubated aerobically at 37⁰ C for 24 hours. After cultivation of Streptococcus mutans biofilm, the brackets were removed and Colony forming unit baseline was calculated followed by dividing the brackets into 3 groups (15 brackets in each group were divided randomly) from which first group is the control group in which the brackets were soaked in artificial saliva for 1 minute and the rest two groups were subjected to the effects of Alum and 0.2% chlorhexidine mouthwash respectively for 1 minute. After 1 minute, the data was calculated for Steptococcus mutans biofilm. Quantitative assessment was carried out by comparing the number of viable colonies of Streptococcus mutans. One way Anova F test was used to compare the data between the experimental and control groups. (p < 0.001).

Results: There is a significant difference in colony forming unit count soaking conventional metal brackets with alum mouthwash and chlorhexidine mouthwash. Even though a highly significant result was seen with alum mouthwash, but when compared with gold standard chlorhexidine the results were still less significant than chlorhexidine mouthwash.

Conclusions: Streptococcus mutans colonies on conventional metal brackets can be reduced effectively by Chlorhexidine digluconate and Alum mouthwashes. 0.2% Chlorhexidine digluconate is more effective than Alum mouthwash.