Antifungal Effect of Mouth Rinses on OralCandidaCounts and Salivary Flow in Treatment-Naïve HIV-Infected Patients

Abstract

Oral candidiasis is a major problem in developing countries where antiretroviral therapy is available to a small percentage of the infected population. HIV patients are prone to xerostomia and predisposed to Candida infection. Preventing oral candidiasis is better than the frequent use of antifungals that may lead to the development of drug resistance. This study investigated the ability of commercial mouth rinses and sodium bicarbonate to reduce salivary Candida and to improve the saliva flow of HIV-positive patients. One hundred fifty HIV patients without oral candidiasis were examined for oral lesions initially and after 2, 4, and 12 weeks. Unstimulated saliva was collected; the volume was measured and cultured for yeasts. Subjects were provided with mouth rinses containing either benzydamine hydrochloride, benzydamine hydrochloride with chlorhexidine gluconate, triclosan with sodium fluoride, 5% sodium bicarbonate, or placebo and asked to rinse twice daily for 12 weeks. The effect of the mouth rinses and placebo on Candida counts and saliva flow was analyzed using analysis of variance (ANOVA). A total of 108 patients completed the trial, 35 missed appointments, 4 died, 2 developed oral candidiasis, and 1 herpetic lesion. Triclosan/fluoride decreased the Candida count more than the placebo (p = 0.005) while chlorhexidine/benzydamine hydrochloride (p = 0.001) and triclosan/fluoride mouthrinses (p = 0.002) increased the salivary flow during the initial 4 weeks. The most effective mouth rinse triclosan/fluoride decreased oral Candida counts and increased saliva flow. Studies are needed to determine the efficacy of these mouth rinses for the long-term prevention of clinical oral candidiasis in adult HIV-positive patients.

Recommendations for the care of oral involvement in patients with systemic sclerosis

“…Antiseptic mouthwash without alcohol (chlorhexidine 0.12%) can be used, but for a short time, i.e., not more than 5 or 6 days, so as not to perturb the mouth ecosystem. Mouthwash with bicarbonate may be used for a longer time (66). After patient education on brushing and flossing techniques and eventual hand exercises, 2 sequences of scaling and root planning should be performed to care for gum inflammation.…”

Xerostomia related to HIV infection /AIDS: a critical review

“…Embora a terapia antirretroviral possa estar associada à xerostomia, responsável por vários problemas bucais, como cárie dentária e doença periodontal, de acordo com o trabalho de Engeland et al 31 , a perda dentária não foi significativamente diferente nos grupos de indivíduos HIV+ que utilizam a terapia e HIV-, mostrando, assim, que o esquema terapêutico contribui para a melhoria das condições de saúde bucal. Com relação à candidíase oral, a mesma, segundo Patel et al 29 , é um grande problema nos países em desenvolvimento, onde a terapia antirretroviral está disponível para uma pequena parcela da população infectada pelo HIV. Prevenir a candidíase oral -utilizando-se enxaguatórios bucais que, além de diminuir as contagens de candida albicans, possibilitam o restabelecimento do fluxo salivar comumente diminuído nesse grupo de pacientes -é melhor do que fazer uso frequente de antifúngicos, que podem levar ao desenvolvimento de resistência a essas drogas.…”

“…No estudo de Freed et al 3 , 12% da amostra estudada classificou sua saúde bucal como 'precária'; a xerostomia foi relatada como o sintoma mais comum (37%). Patel et al 29 , ao realizarem um ensaio clínico para avaliar a efetividade de algumas substâncias sob forma de enxaguatórios bucais na diminuição da contagem de cândida salivar em indivíduos HIV+, verificaram que a associação de triclosan e flúor reduziu significativamente a contagem de cândida salivar após três meses e duas semanas de uso. Outro enxaguatório bucal testado continha Cloridrato de Benzidamina e Gluconato de Clorexidina, o qual não apresentou um efeito significativo na redução da contagem de Cândida.…”

In Vitro Interaction between Fluconazole and Triclosan against Clinical Isolates of Fluconazole-Resistant Candida albicans Determined by Different Methods

“…The halo diameters produced by the combination were predominantly larger than ones produced by single-drug treatments. The sizes of the inhibition zones increased to 19.2, 18, 15.6, and 10.8 mm when 16 g/ml fluconazole was combined with 16,8,4, and 2 g/ml of triclosan, respectively.…”

“…It is predominantly found at low levels among the normal oral flora but can thrive in immunocompromised individuals (16,25). Fluconazole has been used successfully as a prophylactic and a first-line therapeutic antifungal agent (5,6,19).…”