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Vliv kombinace beta-glukanu a laktaÂtu hliniteÂho na tvorbu

a slozÏenõÂ biofilmu u ortodontickyÂch pacientuÊ.

Pilotnõ placebem kontrolovana studie.

The effect of beta-glucan and aluminium lactate

combination on the formation and composition of biofilm

in orthodontic patients. Pilot placebo-controlled study.

*Doc. Ing. KaterÏina ValentovaÂ, Ph.D., **MUDr. Jan Palas, ***RNDr. Jana PetrzÏelovaÂ, **doc. MUDr. MilosÏ SÏpidlen, Ph.D., *prof. MUDr. VilõÂm SÏimaÂnek, DrSc.

*UÂstav leÂkarÏske chemie a biochemie LF UP v Olomouci

*Department of Medical Chemistry and Biochemistry, Medical Faculty of Palacky University, Olomouc **Ortodonticke oddeÏlenõÂ, Klinika zubnõÂho leÂkarÏstvõ LF UP v Olomouci

**Department of Orthodontics, Institute of Oral Medicine, Medical Faculty of Palacky University, Olomouc ***UÂstav leÂkarÏske mikrobiologie LF UP v Olomouci

***Department of Medical Microbiology, Medical Faculty of Palacky University, Olomouc

Souhrn

UÂvod:LeÂcÏba fixnõÂm ortodontickyÂm aparaÂtem klade veÏtsÏõÂ naÂroky na uÂstnõÂ hygienu a je u pacientuÊ se sÏpatnou hygienou nebo nespraÂvnou technikou cÏisÏteÏnõÂ zubuÊ spojena se zvyÂsÏenyÂm usazovaÂnõÂm zubnõÂho plaku (biofilmu) v mõÂstech huÊrÏe prÏõÂstupnyÂch. Tyto prostory mohou byÂt predilekcÏnõÂm mõÂstem vzniku zubnõÂho kazu, gingivitid cÏi pa-rodontopatiõÂ.

CõÂl:CõÂlem studie bylo sledovaÂnõÂ tvorby a slozÏenõÂ biofilmu na skupineÏ pacientuÊ s fixnõÂm ortodontickyÂm aparaÂtem a diagnostikovanou gingivitidou po opakovaneÂm vyplachovaÂnõÂ uÂst roztoky beta-glukanu a laktaÂtu hliniteÂho.

Metody:Ve dvojiteÏ slepe zkrÏõÂzÏene (ªcross-overª) studii byly u subjektuÊ (n=21) hodnoceny indexy zaÂneÏtliveÂ, pla-kem podmõÂneÏne zmeÏny gingivy (CPITN), krvaÂcivost daÂsnÏovyÂch papil (PBI), tvorba plaku (PLI) a prÏõÂtomnost neÏkte-ryÂch rezidentnõÂch bakteriõ prÏed a po cÏtyrÏdennõÂm vyplachovaÂnõ uÂst roztoky kombinace laktaÂtu hliniteÂho s beta-glu-kanem, laktaÂtu hliniteÂho a placebem bez soucÏasneÂho mechanickeÂho cÏisÏteÏnõ zubuÊ a mezizubnõÂch prostor.

VyÂsledky:PLI index vzrostl po pouzÏõÂvaÂnõÂ vsÏech trÏõÂ uÂstnõÂch vod, u kombinace laktaÂtu hliniteÂho s beta-glukanem poklesl index PBI; hodnoty CPITN vzrostly u placeba, u dvou experimentaÂlnõÂch vod se hodnoty indexu nezmeÏnily. PrÏi pouzÏõÂvaÂnõÂ uÂstnõÂ vody s laktaÂtem hlinityÂm dosÏlo k poklesu celkoveÂho pocÏtu sledovanyÂch bakteriõÂ.

ZaÂveÏry:UÂstnõ vody obsahujõÂcõ beta-glukan a/nebo laktaÂt hlinity se prokaÂzaly jako biobezpecÏneÂ. V kombinaci s mechanickyÂm cÏisÏteÏnõÂm muÊzÏe beta-glukan v kombinaci s laktaÂtem hlinityÂm rozsÏõÂrÏit skupinu prÏõÂrodnõÂch chemo-profylaktik v prÏõÂpravcõÂch uÂstnõ hygieny(Ortodoncie 2013, 22, cÏ. 1, s. 18-26).

Abstract

Introduction:For patients with fixed orthodontic appliances oral hygiene is demanding. Insufficient oral hy-giene and inappropriate toothbrushing results in plaque (biofilm) in places that are difficult to reach. These can become places of early origin of caries, gingivitis, and periodontitis.

Aim:This study focused on the formation and composition of biofilm in the group of patients with fixed ortho-dontic appliances, who were suffering from gingivitis a following repeated mouthwash with a solution of beta-glucan and aluminium lactate.

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Introduction

Oral hygiene plays an important role in dental medi-cine for prevention of damage hard dental and perio-dontal tissues. Caries, gingivitis and periodontitis cau-sed by plaque, have a common pathogenic basis, i.e. microbial biofilm (dental plaque), which if not removed properly, results in the problems mentioned [1].

A biofilm is basically a community of microorga-nisms characterized by cells that are irreversibly atta-ched to the enamel or to other bacteria embedded in a matrix of extracellular polymeric substances produ-ced by the cells. These cells have a different phenotype with regard to growth speed and gene transcription [2, 3]. Dentistry was the first branch of medicine where microbiologists found on that the biofilm (dental pla-que) is a natural living mode for bacteria [4]. Bacterial biofilms are found on the surfaces of human organs (gastrointestinal, reproductive and urinary tract), body implants, e.g. cannulas, prosthetic joints and valves. The growth in biofilm confers biological advantage to the bacterial colonies. They are then more resistant to antibiotics, mechanical damage, host immunity, and they attach in an environment rich in nutrients and take advantage of the cooperation [3].

The buccal cavity is populated by resident microflora. So far about 700 bacterial species have been identified [5,6]; however, only about 60% of the species can be cultivated. Partial knowledge of non-cultivated species can be obtained using methods of molecular biology (e.g. PCR and Raman's microscopy) [7].

Dental plaque composed of resident microflora, co-vers enamel of natural as well as surface of artificial teeth, fixed orthodontic appliances, and gingiva. Resi-dent microflora prevent exogenous microorganisms from enamel colonization [8]. Plaque is the major cause of periodontal disease and caries. Plaque, that is not regularly removed, undergoes a process of calcifica-tion [9, 10]. Pathogenic bacteria containing plaque

bio-Methods:The double-blind cross-over study on 21 patients who were evaluated using community periodon-tal index of treatment needs (CPITN), periodonperiodon-tal bleeding index (PBI), plaque formation index (PLI), and some resident bacteria before and after four days treatment with rinses of beta-glucan and aluminium lactate, alumi-nium lactate and placebo, without simultaneous mechanical tooth brushing or cleaning of interdental spaces.

Results:PLI increased after the use of all three mouthrinses. The combination of aluminium lactate and beta-glucan caused decreased PBI; CPITN increased in the case of placebo; in two mouth rinses tested CPITN values did not change. When mouth rinse with aluminium lactate was used, the overall number of bacteria monitored lowered considerably.

Conclusion:Mouth rinses with beta-glucan and/or aluminium lactate proved safe from the biological view-point. Together with mechanical tooth brushing, beta-glucan with aluminium lactate could be used as a natural chemo-prophylactic agent in oral hygiene(Ortodoncie 2013, 22, No. 1, p. 18-26).

KlõÂcÏova slova:fixnõ aparaÂt, beta-glukan, laktaÂt hlinityÂ, zubnõ plak, chemoprofylaxe

Key words:fixed appliance, beta-glucane, aluminium lactate, plaque, chemoprophylaxis UÂvod

UÂstnõ hygiena hraje v zubnõÂm leÂkarÏstvõ vyÂznamnou roliv prevencivzniku posÏkozenõ tvrdyÂch zubnõÂch tkaÂnõ a zaÂveÏsneÂho aparaÂtu. Zubnõ kaz a plakem podmõÂneÏna gingivitida a parodontitida majõ spolecÏny patogeticky zaÂklad - mikrobiaÂlnõ biofilm (zubnõ plak), jehozÏ ne-dostatecÏne odstranÏovaÂnõÂma za naÂsledek rozvoj teÏchto onemocneÏnõ [1].

Biofilm je spolecÏenstvo mikroorganismuÊ, charakte-rizovane tõÂm, zÏe bunÏky, ktere jsou ireverzibilneÏ prÏichy-cene k podkladu nebo jedna k druheÂ, jsou zapusÏteÏne v matrici bunÏkamiprodukovanyÂch extracelulaÂrnõÂch po-lymernõÂch laÂtek. Ty vykazujõ odlisÏny fenotyp s ohledem na rychlost ruÊstu a transkripci genuÊ [2, 3]. Zubnõ leÂkarÏ-stvõ bylo prvnõ oborem medicõÂny, kde bylo mikrobio-logy prÏijato, zÏe biofilm (zubnõ plak) je prÏirozenyÂm zpuÊ-sobem zÏivota bakteriõ [4]. S biofilmem se setkaÂvaÂme v mnoha dalsÏõÂch leÂkarÏskyÂch oborech, zahrnujõÂcõ po-vrchy cÏaÂstõ lidskeÂho organismu (traÂvi cõ uÂstrojõÂ, pohlavnõ a mocÏovy trakt), teÏlnõÂch implantaÂtuÊ, naprÏ. kanyl, kloub-nõÂch a chlopenkloub-nõÂch naÂhrad. RuÊst v biofilmu je z mnoha pohleduÊ pro bunÏky vyÂhodneÏjsÏõÂ. Jsou odolneÏjsÏõ vuÊcÏian-tibiotikuÊm, mechanickeÂmu posÏkozenõÂ, systeÂmu bu-neÏcÏne imunity hostitele a umozÏnÏuje jejich uchycenõ se v prostrÏedõ bohateÂm na zÏiviny a vyuzÏitõ kooperativ-nõÂch vyÂhod [3].

Dutina uÂstnõ je osõÂdlena prÏirozenou mikrofloÂrou. Do-sud bylo identifikovaÂno prÏiblizÏneÏ 700 druhuÊ bakteriõ [5, 6], prÏicÏemzÏ kultivovatelnyÂch je jen asi60 % druhuÊ. CÏaÂ-stecÏne znalostio nekultivovatelnyÂch druzõÂch se zõÂskaÂ-vajõ zejmeÂna molekulaÂrneÏ biologickyÂmimetodami (naprÏ. PCR a Ramanova mikroskopie) [7].

Zubnõ plak, tvorÏeny rezidentnõ mikrofloÂrou, pokryÂva jak sklovinu puÊvodnõÂch, tak povrchy umeÏlyÂch zubuÊ, fix-nõÂch ortodontickyÂch aparaÂtuÊ a gingivy. Rezidentnõ mi-krofloÂra braÂnõ exogennõÂm mikroorganismuÊm v koloni-zacizubnõ skloviny [8]. Plak je hlavnõ prÏõÂcÏinou parodon-topatiõ a vzniku zubnõÂho kazu. V pravidelneÏ

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film may infect other surfaces of the human body, e.g. vascular catheters, implants, artificial or damaged heart valves, joint substitutes, and result in severe health conditions. The invasive treatment and even mi-nor injuries due to tooth brushing cause the bacteria to escape into the bloodstream [4, 11].

The composition of oral microflora is specific for each individual depending on their constitution, age and gender (pregnancy, menopause), tendency to ca-ries and quality of oral hygiene. The daily diet (some micronutrients) plays an important role, as well as di-seases (e.g. diabetes mellitus), amount and composi-tion of saliva, lower self-cleaning due to e.g. teeth crowding, faulty fillings, prosthetics, and orthodontic appliances. The bacterial biofilm composition differs according to the type of oral cavity surface. There are different environments in the oral cavity - e.g. lips, buc-cal surfaces and soft palate, tongue, supragingival and subgingival tooth surface. However, overall represen-tation of individual microorganisms in already formed biofilm remains stable during the life of an individual [4]. Tooth brushes and interdental brushes with tooth-paste, dental thread, interdental stimulators, and den-tal showers (irrigators) play a key role in biofilm removal [1]. More effective elimination is ensured using chemi-cal inhibitors that slow down biofilm formation and in-hibit oral pathogens. Effective synthetic/natural che-moprophylaxis should combine antimicrobial (anti-septic) and antiadhesive effects. These requirements are met by several antiseptics. Chlorhexidine digluco-nate [12] and essential oils - thymol, eucalyptol, men-thol and methylsalicylate are the most effective. The latter are active components of ListerineÒ products

[13]. However, a number of secondary plant metaboli-tes, e.g. quarternary benzophenantridine alcaloids found in e.g. extract ofMacleya cordata[14, 15], proan-thocyanidines of A2 types found in fruits of cranberry

(Vaccinium macrocarpon) [16-19], polyphenols found in fruits ofVitis vinifera[20] display antiplaque effects. Natural substances with anti-inflammatory, antioxi-dant and adstringent effects, such as allantoin, pheno-lic acids, green tea components, natural oils, probiotic bacteria, vitamins B, C, D, E, biominerals Ca, Mg, Zn are used as active components of oral hygiene pro-ducts as well [15, 21-25].

Beta-glucans, polysaccharides of yeast cell wall (Sa-charomyces cerevisie), fungi, some bacteria and plants have significant immunomodulation effects [26], and are recommended to enhance healing process before and after surgery in the oral cavity [15]. The effect of beta-glucans on experimental gingivitis was recently studied in rats [27] and human volunteers [28]. Alumi-nium lactate is adstringent, it also stops bleeding, and helps in elimination of halitosis [29]. Therefore, it is often neodstranÏovaneÂm plaku probõÂha proces kalcifikace [9,

10]. Biofilm zubnõÂho plaku, pokud obsahuje patogennõ bakterie, muÊzÏe infikovat i jine povrchy v lidskeÂm teÏle, naprÏ. ceÂvnõÂkatetry, implantaÂty, umeÏle nebo posÏkozene srdecÏnõÂchlopneÏ, ale inaÂhrady kloubuÊ, a zpuÊsobit zaÂva-zÏne zdravotnõ komplikace. Do krevnõÂho obeÏhu se bak-terie dostaÂvajõ jak prÏi invazivnõÂch vyÂkonech, ale iprÏi drobnyÂch traumatizacõÂch zpuÊsobenyÂch pouhyÂm cÏi sÏteÏ-nõÂm zubuÊ [4, 11].

SlozÏenõ uÂstnõ mikrofloÂry kazÏdeÂho cÏloveÏka je rozdõÂlne a je podmõÂneÏno jeho konstitucõÂ, veÏkem s prÏihleÂdnutõÂm k pohlavõ (gravidita, klimakterium), dispozicõ k tvorbeÏ zubnõÂho kazu a kvalitou uÂstnõ hygieny. DuÊlezÏitou roli ma slozÏenõ dennõ diety (neÏktere mikronutrienty), one-mocneÏnõ (naprÏ. diabetes mellitus), mnozÏstvõ a slozÏenõ slin, snõÂzÏene samoocÏi sÏt'ovaÂnõ podmõÂneÏne naprÏ. steÏsnaÂ-nõÂm zubuÊ, chybnyÂmivyÂplneÏmi, protetickyÂminaÂhradami a v neposlednõ rÏadeÏ ortodontickyÂmiaparaÂty. SlozÏenõ mikrobiaÂlnõÂho biofilmu se take li sÏõ na ruÊznyÂch povrsÏõÂch dutiny uÂstnõÂ, odlisÏna prostrÏedõ pro mikrobiaÂlnõ koloni-zacitak poskytujõ naprÏ. rty, bukaÂlnõ povrchy a meÏkke patro, jazyk, supragingivaÂlnõ a subgingivaÂlnõ plochy zubu, celkove zastoupenõ jednotlivyÂch mikroorga-nismuÊ v jizÏ vytvorÏeneÂm biofilmu vsÏak byÂva pomeÏrneÏ konstantnõ po cely zÏivot [4].

Mechanicke cÏi sÏteÏnõ zubuÊ a mezizubnõÂch prostor zubnõÂmia mezizubnõÂmikartaÂcÏky za pouzÏitõ zubnõ pasty, dentaÂlnõÂch nitõÂ, mezizubnõÂmi stimulaÂtory, prÏõÂpadneÏ dentaÂlnõ sprchou ma klõÂcÏovou roliv odstranÏovaÂnõ bio-filmu [1]. UÂcÏinneÏjsÏõÂho odstranÏovaÂnõ plaku je mozÏno do-saÂhnout pouzÏitõÂm chemickyÂch inhibitoruÊ zpomalujõÂcõÂch tvorbu biofirmu a inhibujõÂcõÂch aktivitu oraÂlnõÂch pato-genuÊ. UÂcÏinek syntetickyÂch/ prÏõÂrodnõÂch chemoprofylak-tik by nemeÏl byÂt daÂn jen uÂcÏinkem antimikrobiaÂlnõÂm (an-tiseptickyÂm), ale take antiadhezivnõÂm. Tyto pozÏadavky splnÏuje neÏkolik antiseptik. Prioritnõ postavenõ ma chlor-hexidin diglukonaÂt [12] a esenciaÂlnõ oleje thymol, euka-lyptol, mentol a methylsalicylaÂt. Ty jsou aktivnõ slozÏkou ve vyÂrobcõÂch rÏady ListerineÒ[13]. Antiplakove uÂcÏinky

vsÏak vykazuje take cela rÏada sekundaÂrnõÂch metabolituÊ rostlin naprÏ. kvarternõ benzofenantridinove alkaloidy obsazÏene naprÏ. v extraktu nadzemnõ cÏaÂsti Macleaya cordata[14, 15], proanthokyanidiny typu A2 v plodech klikvy velkoplode (Vaccinium macrocarpon) [16-19], polyfenoly v plodechVitis vinifera[20]. AktivnõÂmi slozÏ-kamiprÏõÂpravkuÊ uÂstnõ hygieny jsou take prÏõÂrodnõ laÂtky s protizaÂneÏtlivyÂmi, antioxidacÏnõÂmicÏiadstringentnõÂmi uÂcÏinky, jako naprÏ. alantoin, fenolove kyseliny, obsa-hove laÂtky zeleneÂho cÏaje, prÏõÂrodnõ oleje, probaticke bakterie, vitaminy B, C, D, E, biomineraÂly Ca, Mg, Zn [15, 21-25].

Beta-glukany, polysacharidy z buneÏcÏne steÏny kva-sinek(Sacharomyces cerevisie), hub, neÏkteryÂch bakte-riõ a rostlin majõ vyÂrazne imunomodulacÏnõ uÂcÏinky [26]

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added to oral hygiene products, very often in combina-tion with chlorhexidine digluconate [30].

Insufficient elimination of dental plaque is frequently observed especially in adolescent orthodontic pa-tients with fixed appliance [12], for this reason, we fo-cused on this group in our study. The aim of our work was to evaluate the impact of mouth rinses withb -glu-canes and/or aluminium lactate on plaque formation in patients treated with fixed orthodontic appliances using a double-blind study and volunteers.

Material and method

Mouth rinses containing 1) placebo, and 2) combina-tion of aluminium lactate andb-glucan, and 3) aluminium lactate were used. The study protocol was approved by the Ethics Committee of the University Hospital and Fa-culty of Medicine and Dentistry, Palacky University in Olomouc on February 14, 2011 (ref. No. 14/11). The sample was of 21 patients between the ages of 12 and 28 (16.0 ± 3.8), with complete dentition, healthy, non-smokers, treated with fixed orthodontic appliances. All had significant manifestations of gingivitis.

To assess the impact of mouth rinses we used do-uble-blind cross-over design (Fig. 1) [31]. The volun-teers gradually used all mouth rinses tested in random order. The control group included the same patients using placebo (Sample 1). During each check-up we evaluated the following parameters: periodontium condition by means of CPITN and PBI, the level of oral hygiene by means of plaque index PLI [32]. In the given intervals (6x) from each volunteer a sample of plaque swab was taken and sent for microbiological examina-tion. Samples were cultivated in blood agar, Sabou-raud agar, and MacConkey agar. They were evaluated semiquantitatively starting with ¹rareª and ending with ¹+++ª. The evaluation was translated into the scale 0-3 for individual microorganisms, and in each individual the amount of microbes at the beginning and at the end of the testing period was calculated.

During the preliminary examination we removed tar-tar and plaque from all patients and gave them a sam-ple of mouth rinse. For 4 days, the patients abandoned common oral hygiene (tooth brush and tooth paste) and 5 times a day (after they woke up, after breakfast, lunch, dinner, and before going to bed) they intensively rinsed their mouths (around teeth and gums) with 10 ml experimental mouthwash/placebo for 1 min. On day 4 there was a check-up, subjective impressions related to the use of a mouthwash were recorded, and patients were instructed on how to care for dentition according to Stillman. Over 14 days (i.e. wash-out period) the pa-tients used tooth brush and interdental brush with a tooth paste containing no inhibitors of dental plaque with the exception of sodium fluoride, for 5 min in the morning and in the evening.

a jsou doporucÏovaÂny pro lepsÏõ hojivost prÏed a po chi-rurgickyÂch zaÂkrocõÂch v dutineÏ uÂstnõ [15]. Jejich vliv na experimentaÂlnõ gingivitis byl nedaÂvno studovaÂn na po-tkanech [27] ilidskyÂch dobrovolnõÂcõÂch [28]. LaktaÂt hli-nity ma uÂcÏinky stahujõÂcõ (adstringentnõÂ) a krvaÂcenõ za-stavujõÂcõÂ, pomaÂha take odstranÏovat halitoÂzu [29]. DõÂky svyÂm vlastnostem byÂva prÏidaÂvaÂn do prÏõÂpravkuÊ uÂstnõ hygieny, cÏasto v kombinaci s chlorhexidindiglukonaÂ-tem[30].

NedostatecÏne odstranÏovaÂnõ zubnõÂho plaku je pozo-rovaÂno zejmeÂna u adolescentnõÂch ortodontickyÂch pa-cientuÊ s fixnõÂm aparaÂtem [12], a proto jsme se na neÏ v nasÏõ studii zameÏrÏili. CõÂlem teÂto praÂce bylo zhodnocenõ vlivu uÂstnõÂch vod s obsahemb-glukanuÊ a/nebo laktaÂtu hliniteÂho na tvorbu zubnõÂho plaku u pacientuÊ leÂcÏenyÂch fixnõÂm ortodontickyÂm aparaÂtem ve dvojiteÏ slepe studii na dobrovolnõÂcõÂch.

MateriaÂl a metodika

Studie byla provedena se vzorky uÂstnõÂch vod 1) pla-cebem a s obsahem, 2) kombinace laktaÂtu hliniteÂho s beta-glukanem a 3) laktaÂtu hliniteÂho. Protokol studie byl schvaÂlen Etickou komisõ Fakultnõ nemocnice Olo-mouc a LeÂkarÏske fakulty Univerzity PalackeÂho dne 14.2.2011 pod cÏ. j. 14/11. Byl sestaven soubor 21 pa-cientuÊ ve veÏku 12 - 28 (16.0 ±3.8) let, s kompletnõÂm chrupem, celkoveÏ zdravyÂch, bez medikace, nekurÏaÂkuÊ, leÂcÏenyÂchfixnõÂm ortodontickyÂm aparaÂtema svyÂraznyÂmi projevy zaÂneÏtu gingivy.

Pro hodnocenõ vlivu uÂstnõÂch vod byl pouzÏit dvojiteÏ slepy zkrÏõÂzÏeny (cross-over) design (Obr. 1) [31]. VsÏichni uÂcÏastnõÂcistudie tak postupneÏ, v naÂhodneÂm porÏadõÂ, uzÏõÂvalivsÏechny testovane uÂstnõ vody. Kontrolnõ skupi-nou bylititõÂzÏ pacienti pouzÏõÂvajõÂcõ placebo (Vzorek 1). U pacientuÊ byly prÏikazÏde naÂvsÏteÏveÏ hodnoceny: stav parodontu pomocõ indexu pro potrÏebu

parodontolo-Tab. 1.SlozÏenõÂ uÂstnõÂch vod (v %)

Tab. 1.Mouth wash composition (v %)

Vzorek 1

Sample 1 Sample 2Vzorek 2 Sample 3Vzorek 3 Aluminium lactate - 0.05 0.05 b-1,3/1,6-glucan - 0.1 -Zinc sulphate 0.05 0.05 Potassium sorbate 0.1 0.1 0.1 Saccharin 0.01 0.01 0.01 Denat. ethanol 3.0 3.0 3.0 Pastadent Royal 20.35 20.35 20.35 Tagat CH 40 0.4 0.4 0.4 Glycerine 3.0 3.0 3.0 Purified water ad 100% ad 100% ad 100%

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Statistical data were processed with software SPSS v.15, SPSS Inc., Chicago, USA, the level of signifi-cance 0.05. In each patient individual parameters were always evaluated before and after a testing period with individual mouth rinses using paired tests (t-test, Wil-coxon paired test), and with ANOVA and Friedman test, respectively. For each mouth rinse, final n = 20 was evaluated.

Results

One volunteer dropped out due to subjective dis-comfort. The care that was limited only to the use of mouth rinse was considered insufficient substitute for tooth brushing; some volunteers reported the fee-ling of insufficient oral hygiene. However, no negative side effects were found.

Paired tests confirmed statistically significant dec-rease in PBI after the use of mouth rinse containing the combination of aluminium lactate and beta-glucan. For CPITN, the values increased after the use of pla-cebo (p=0.033), but they did not change significantly for tested mouth rinses (p = 0.017, Fig.2). The plaque index PLI increased significantly after the use of each mouth rinses tested. Nevertheless, ANOVA did not gickeÂho osÏetrÏenõÂ (CPITN) a indexu krvaÂcivosti

daÂsnÏo-vyÂch papil (PBI) a uÂrovenÏ hygieny uÂstnõ dutiny plako-vyÂm indexem (PLI) [32]. KazÏdeÂmu dobrovolnõÂku byl v danyÂch intervalech 6x odebraÂn vzorek steÏru z plaku a zaslaÂn na mikrobiologicke vysÏetrÏenõÂ. Zde byly vzorky kultivovaÂny na krevnõÂm agaru, SabouraudoveÏ agaru a MacConkeyho puÊdeÏ a hodnoceny semikvantitativneÏ od hodnoty ¹ojedineÏleª azÏ po ¹+++ª. Hodnocenõ bylo prÏevedeno na cÏõÂselne vyjaÂdrÏenõ 03 pro jednotlive mi -kroorganismy a u kazÏdeÂho jedince bylo spocÏõÂtaÂno cel-kove mnozÏstvõ mikrobuÊ na zacÏaÂtku a koncikazÏdeÂho te-stovacõÂho obdobõÂ.

PrÏivstupnõÂm vysÏetrÏenõ byl kazÏdeÂmu pacientovi od-straneÏn zubnõ kaÂmen a plak a obdrzÏel vzorek uÂstnõ vody. Po dobu 4 dnuÊ vynechal beÏzÏnou uÂstnõ hygienu zubnõÂm kartaÂcÏkem a mõÂsto toho si5x denneÏ (po probu-zenõÂ, po snõÂdani, obeÏdeÏ, vecÏerÏia prÏed spaÂnkem) inten-zivneÏ vyplachoval uÂsta (okolo zubuÊ a daÂsneÏ) experi-mentaÂlnõ uÂstnõ vodou/placebem v mnozÏstvõ 10 ml po dobu 1 min. CÏtvrty den naÂsledovala kontrola, byly za-znamenaÂny subjektivnõ pocity prÏipouzÏõÂvaÂnõ uÂstnõ vody a provedena instruktaÂzÏ domaÂcõ peÂcÏe o chrup metodou dle Stillmana. Ve 14 dennõÂm intervalu mezi testovacõÂmi obdobõÂmisipacienticÏistili chrup 5 min. raÂno a vecÏer zubnõÂm a mezizubnõÂm kartaÂcÏkem za pouzÏitõ zubnõ pa-sty, ktera neobsahovala s vyÂjimkou fluoriduÊ zÏaÂdne inhi-bitory tvorby zubnõÂho plaku.

Ke statistickeÂmu zpracovaÂnõ vyÂsledkuÊ byl pouzÏit program SPSS v. 15, SPSS Inc. Chicago, USA na hla-dineÏ vyÂznamnosti0,05. U kazÏdeÂho pacienta byly jed-notlive parametry hodnoceny vzÏdy prÏed a po testova-cõÂm obdobõ s jednotlivyÂmiuÂstnõÂmivodami, bez ohledu na porÏadõÂ, paÂrovyÂmitesty (t-test, prÏõÂpadneÏ WilcoxonuÊv paÂrovy test) a naÂsledneÏ analyÂzou rozptylu, resp. Fried-manovyÂm testem. Pro kazÏdou uÂstnõ vodu se vyhodno-coval vyÂsledny pocÏet n = 20 pacientuÊ.

VyÂsledky

TestovaÂnõ se zuÂcÏastnilo celkem 21 dobrovolnõÂkuÊ, z nichzÏ jeden studii nedokoncÏil pro neprÏõÂjemne subjek-tivnõ pocity. DobrovolnõÂci pouhe vyplachovaÂnõ uÂstnõÂmi vodamihodnotilivesmeÏs jako nedostatecÏnou naÂhradu cÏi sÏteÏnõ zubuÊ kartaÂcÏkem, neÏkterÏõ dobrovolnõÂcisisteÏzÏo-valina pocit nedostatecÏne uÂstnõ hygieny, nebyly vsÏak pozorovaÂny zÏaÂdne negativnõ vedlejsÏõ uÂcÏinky.

PaÂrovyÂmitesty byl prokaÂzaÂn statisticky vyÂznamny pokles indexu PBI po pouzÏõÂvaÂnõ uÂstnõ vody s obsahem kombinace laktaÂtu hliniteÂho s beta-glukanem; u indexu CPITN byl prokaÂzaÂn naÂruÊst hodnot po pouzÏõÂvaÂnõ pla-ceba (p = 0,033), u testovanyÂch uÂstnõÂch vod se hod-noty beÏhem testovacõÂch obdobõ vyÂznamneÏ nezmeÏnily (p = 0,017, Obr. 2.). Plakovy index PLI statisticky vyÂ-znamneÏ vzrostl po pouzÏõÂvaÂnõ vsÏech vod. AnalyÂzou ptylu vsÏak nebyly prokaÂzaÂny statisticky vyÂznamneÂ

roz-Obr. 1.ScheÂma studie

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proved statistically significant differences between the effectiveness of three mouth rinses related to PBI, CPITN, and PLI.

In the dental plaque we found a wide range of mic-roorganisms; some occurred repeatedly, some only rarely. Mostly common oral flora was cultivated. Viri-dans streptococci, coagulase-negative streptococci, oral neiseria, and coliform bacteria, depending on the patient's dental condition, and his/her food were iden-tified. In 12 swabs yeasts were found that persisted du-ring the whole study. The Wilcoxon paired test showed a statistically significant reduction of bacteria after the use of mouth rinse containing aluminium lactate (p = 0.025, Fig. 2); however, Friedman test did not show statistically any significant difference in number of microorganisms between individual mouth rinses (p = 0.252).

dõÂly meziefektem trÏõÂ uÂstnõÂch vod na indexy PBI, CPITN cÏiPLI.

Ve vzorcõÂch zubnõÂho plaku uÂcÏastnõÂkuÊ studie byla nalezena sÏiroka sÏkaÂla mikroorganismuÊ, prÏicÏemzÏ neÏ-ktere se vyskytovaly opakovaneÏ, jine jen vyÂjimecÏneÏ. PrÏevaÂzÏneÏ byla vykultivovaÂna beÏzÏna uÂstnõ floÂra, naprÏ.: viridujõÂcõ streptokoky, koagulaÂza negativnõ stafylo-koky, uÂstnõ neiserie a koliformnõ bakterie, v zaÂvislosti na stavu chrupu pacienta a jeho aktuaÂlnõ straveÏ. Ve 12 odbeÏrech byly prokaÂzaÂny kvasinky, ktere prÏetrvaÂ-valy po celou dobu studie. WilcoxonovyÂm testem byl prokaÂzaÂn statisticky vyÂznamny uÂbytek pocÏtu bakteriõ po pouzÏõÂvaÂnõ uÂstnõ vody s obsahem laktaÂtu hliniteÂho (p = 0,025, Obr. 2.); FriedmanovyÂm testem vsÏak nebyly prokaÂzaÂny statisticky vyÂznamne rozdõÂly v rozdõÂlech po-cÏtu mikroorganismuÊ mezijednotlivyÂmiuÂstnõÂmivodami, p = 0,252.

Obr. 2.Vliv testovanyÂch uÂstnõÂch vod na index krvaÂcivosti daÂsnÏovyÂch papil (PBI), index pro potrÏebu parodontologickeÂho osÏetrÏenõ (CPITN), plakovy index (PLI) a celkove pocÏty mikroorganismuÊ v plaku (N) u pacientuÊ prÏed a po pouzÏõÂvaÂnõ placeba (bõÂlou), kombinace laktaÂtu hliniteÂho s beta-glukanem (zÏlutou) a laktaÂtu hliniteÂho (zelenou, n= 20).

VyÂsledky jsou prezentovaÂny jako box grafy (vodorovna cÏaÂra v boxu znaÂzornÏuje hodnotu mediaÂnu, dolnõÂa hornõÂhrana 1. kvartil, resp. 3. kvartil, anteÂnky ukazujõ maximaÂlnõ a minimaÂlnõ nameÏrÏene hodnoty; pokud byly v souboru nalezeny odlehle a extreÂmnõ hodnoty, jsou zakresleny krouzÏky a hveÏzdicÏkami).

Fig. 2.The impact of mouth rinses on PBI, CPITN, PLI, and overall number of microorganisms in plaque (N) in patients before and after the use of placebo (white), combination of aluminium lactate and beta-glucan (yellow), and aluminium lactate (green, n=20).

The results are presented in the form of box graphs (horizontal line in the box represents median, bottom and top edge 1st quartile and 3rd quartile, respectively, antennae show maximum and minimum values measured; if there were recorded distant and extreme values, they are depicted with rings and stars).

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Discussion

The study showed that substitution of mechanical tooth brushing with intensive rinsing of mouth with experimental mouthwashes resulted in increased accu-mulation of plaque (according to the plaque index PLI). When placebo was applied, then CPITN increased. The results agree with the conclusions of a similar study of a mouthwash containing hop polyphenols [31].

The use of mouthwash containingb-glucan led to PBI decrease. A recent study with rats showed that

b-glucan administered in drinking water significantly reduced the loss of bone tissue in a model of experi-mental periodontitis [27]. Similar effects were recorded in healthy men that with experimentally induced gingi-vitis. In comparison with a control group the PLI and gingival index were not influenced - the values of these indexes increased in all volunteers during the experi-ment. A significant increase in gingival liquid was ob-served in the group of probands who rinsed their mouths withb-glucan containing mouthwash and then swallowed it [28].

The use of a mouthwash with aluminium lactate led to decrease in overall number of microorganisms in dental plaque. This is the first report for this substance to date. Aluminium lactate is known and used espe-cially for its astringent effects. It is assumed that on the gum and tooth neck surface it initiates the forma-tion of a coagulaforma-tion membrane that for a short time protects gums/dentine against irritation. This stops in-flammation and inhibits pain. Optimum effect of alumi-nium lactate was achieved in the concentration 0.05% and lasted for 3-4 hours. Coagulation action of alumi-nium lactate on albuminoid components in dentine ducts inhibits their ability to transmit irritation which re-sults in desenzibilitation of exposed necks. Aluminium lactate also helps to eliminate halitosis [29].

Conclusion

The study found thatb-glucan and aluminium lac-tate positively, though insignificantly, influence oral hygiene but they cannot fully substitute for mechanical cleaning with a tooth brush. The method of option thus seems to be combined use of tooth brush and inter-dental brush and rinses with mouthwashes containing active substances.

Acknowledgment: Authors would like to thank the company FAVEA (KoprÏivnice) for preparation of tested mouthwashes, and to Mgr. KaterÏina LangovaÂ, Ph.D. for statistical processing of the data.

Conflict of interests: Authors have no engagement or other professional relationship to company FAVEA. Diskuse

Studie ukaÂzala, zÏe naÂhrada mechanickeÂho cÏi sÏteÏnõ zubuÊ pouhyÂm intenzivnõÂm vyplachovaÂnõÂm uÂst experi-mentaÂlnõÂmiuÂstnõÂmivodamivedla ke zvyÂsÏene akumu-laciplaku, hodnocene plakovyÂm indexem. U placeba byl zjisÏteÏn naÂruÊst indexu CPITN. Tyto vyÂsledky jsou v souladu se zaÂveÏry podobne studie, provedene s uÂstnõ vodou obsahujõÂcõ polyfenoly chmele [31].

PouzÏõÂvaÂnõ uÂstnõ vody s obsahemb-glukanu se pro-jevilo ve snõÂzÏenõ indexu PBI. V nedaÂvne studii na potka-nech b-glukan podaÂvany v pitne vodeÏ signifikantneÏ snõÂzÏil ztraÂty kostnõ tkaÂneÏ v modelu experimentaÂlnõ pa-rodontitis [27]. Podobny uÂcÏinek byl pozorovaÂn prÏipou-zÏõÂvaÂnõ uÂstnõ vody sb-glukanem u zdravyÂch muzÏuÊ, kte-ryÂm byla indukovaÂna experimentaÂlnõ gingivitis. Ve srovnaÂnõ s kontrolnõ skupinou nebyl ovlivneÏn PLI ani gingivaÂlnõ index, ktere u vsÏech dobrovolnõÂkuÊ v pruÊbeÏhu experimenty vzrostly. U skupiny, ktera proplachovala uÂsta prÏõÂpravkem sb-glukanem a naÂsledneÏ jej spolkla, dosÏlo k signifikantnõÂmu zvyÂsÏenõ mnozÏstvõ gingivaÂlnõ te-kutiny [28].

PouzÏõÂvaÂnõ uÂstnõ vody s laktaÂtem hlinityÂm se v nasÏõ studii projevilo snõÂzÏenõÂm celkoveÂho pocÏtu mikroorga-nismuÊ v dentaÂlnõÂm plaku. Takovy efekt nebyl pro tuto laÂtku dosud popsaÂn. LaktaÂt hlinity je v prÏõÂpravcõÂch uÂstnõ hygieny pouzÏõÂvaÂn zejmeÂna pro sve adstringentnõ uÂcÏinky. PrÏedpoklaÂda se, zÏe na povrchu daÂsnõ a krcÏkuÊ zubuÊ iniciuje tvorbu koagulacÏnõ membraÂny, ktera kraÂt-kou dobu chraÂnõ daÂsneÏ/dentin prÏed vneÏjsÏõÂm podraÂzÏdeÏ-nõÂm. To vede k zastavenõ zaÂneÏtu a uÂtlumu bolesti. Opti-maÂlnõÂho uÂcÏinku laktaÂtu hliniteÂho bylo dosazÏeno prÏi koncentraci0,05 % a prÏetrvaÂval 3 azÏ 4 hodiny. Koagu-lacÏnõ uÂcÏinek laktaÂtu hliniteÂho na bõÂlkovinne slozÏky v dentinovyÂch kanaÂlcõÂch snizÏuje jejich funkci ve vedenõ podraÂzÏdeÏnõÂ, cozÏ prÏispõÂva k desenzibilizaci obnazÏenyÂch zubnõÂch krcÏkuÊ. LaktaÂt hlinity take pomaÂha odstranÏovat zaÂpach z uÂst (halitoÂzu) [29].

ZaÂveÏr

VyÂsledkem studie bylo zjisÏteÏnõÂ, zÏe prÏõÂrodnõ laÂtkyb -glukan a laktaÂt hlinity nesignifikantneÏ pozitivneÏ ovliv-nÏujõ uÂrovenÏ uÂstnõ hygieny, ale jejich samotne uzÏitõ nena-hrazuje mechanicke cÏi sÏteÏnõ zubnõÂm kartaÂcÏkem. Jako metoda volby se tudõÂzÏ jevõ kombinovane pouzÏõÂvaÂnõ zubnõÂho a mezizubnõÂho kartaÂcÏku spolu s vyÂplachy uÂstnõ vodou s aktivnõÂmi laÂtkami.

PodeÏkovaÂnõÂ: AutorÏi deÏkujõ firmeÏ FAVEA (KoprÏivnice) za prÏõÂpravu testovanyÂch uÂstnõÂch vod a Mgr. KaterÏineÏ LangoveÂ, Ph.D., za statisticke zpracovaÂnõ vyÂsledkuÊ.

StrÏet zaÂjmuÊ: ZÏaÂdny z autoruÊ nenõ s firmou FAVEA v zameÏstnaneckeÂm cÏi jineÂm pracovnõÂm vztahu.

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Literatura/References

1. Hellwig, E.; Klimek, J.; Attin, T.: ZaÂchovna stomatologie a parodontologie. Praha: Grada Publishing; 2002. 2. Donlan, R. M.; Costerton, J. W.: Biofilms: survival

me-chanisms of clinically relevant microorganisms. Clin. Microbiol. Rev. 2002, 15, cÏ. 2, s. 167-193.

3. RulõÂk, M.; RuÊzÏicÏka, F.; HolaÂ, V.: Struktura, fyziologie a ekologie biofilmuÊ. In: RulõÂk, M.; HolaÂ, V.; RuÊzÏicÏka, F.; Votava, M., eds.: MikrobiaÂlnõÂ biofilmy. Olomouc: Univer-sita PalackeÂho v Olomouci; 2011. s. 11-54.

4. HolaÂ, V., KapraÂlovaÂ, S.: Biofilm dutiny uÂstnõÂ. In: RulõÂk, M., HolaÂ, V., RuÊzÏicÏka, F., Votava, M., eds. MikrobiaÂlnõÂ bio-filmy. Olomouc: Universita PalackeÂho v Olomouci; 2011. s. 79-99.

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6. Paster, B. J.; Boches, S. K.; Galvin, J. L.; Ericson, R. E.; Lau, C. N.; Levanos, V. A.; Sahasrabudhe, A.; Dewhirst, F. E.: Bacterial diversity in human subgingival plaque. J. Bacteriol. 2001, 183, cÏ. 12, s. 3770-3783.

7. Suzuki, N.; Yoshida, A.; Nakano, Y.: Quantitative analy-sis of multi-species oral biofilms by TaqMan Real-Time PCR. Clin. Med. Res. 2005, 3, cÏ. 3, s. 176-185.

8. Marsh, P. D.: Dental plaque as a microbial biofilm. Caries Res. 2004, 38, cÏ. 3, s. 204-211.

9. DrÏõÂzhal, I.; SlezaÂk, R.: ZaÂklady parodontologie. Praha: Karolinum; 1993.

10. Kilian, J.; BartaÂkovaÂ, V.; Bilder, J.; FialovaÂ, S.; HalacÏkovaÂ, Z.; Handzel, J.; HoubovaÂ, H.; HubkovaÂ, V.; KoraÂbek, L.; LekesÏovaÂ, I.; MaresÏ, J.; MerglovaÂ, V.; Penka, M.; PrazÏaÂ-kovaÂ, L.; SemraÂd, B.; SÏubrtovaÂ, I.; VaneÏk, J.; Vomela, J.; Zicha, A.: Prevence ve stomatologii. 2nd, Praha: Ga-leÂn; 1999.

11. Biasotto, M.; Chiandussi, S.; Costantinides, F.; Di Le-narda, R.: Descending necrotizing mediastinitis of odon-togenic origin. Recent Pat. Antiinfect. Drug Discov. 2009, 4, cÏ. 2, s. 143-150.

12. Babay, N.; Bukhary, M.T.: Clinical effects of chlorhexi-dine, sanguinarine and saline as coolants during ultraso-nic scaling on gingivitis in orthodontic patients. Saudi Dent. J. 2001, 13, cÏ. 1, s. 25-29.

13. Claffey, N.: Essential oil mouthwashes: a key component in oral health management. J. Clin. Periodontol. 2003, 30 Suppl 5, s. 22-24.

14. Adamkova, H.; Vicar, J.; Palasova, J.; Ulrichova, J.; Si-manek, V.: Macleya cordata and Prunella vulgaris in oral hygiene products - their efficacy in the control of gingivi-tis. Biomed. Pap. Med. Fac. Univ. Palacky Olomouc Czech Repub. 2004, 148, cÏ. 1, s.103-105.

15. VicÏar, J.; AdaÂmkovaÂ, H.; Eber, M.; UlrichovaÂ, J.; SÏimaÂ-nek, V.; PalasovaÂ, J.: PrÏõÂrodnõÂ laÂtky v prÏõÂpravcõÂch uÂstnõÂ hy-gieny. Progressdent 2005, 3, s. 6-11.

16. Yamanaka, A.; Kouchi, T.; Kasai, K.; Kato, T.; Ishihara, K.; Okuda, K.: Inhibitory effect of cranberry polyphenol on biofilm formation and cysteine proteases of Porphy-romonas gingivalis. J. Periodontal. Res. 2007, 42, cÏ. 6, s. 589-592.

17. Labrecque, J.; Bodet, C.; Chandad, F.; Grenier, D.: Effects of a high-molecular-weight cranberry fraction on growth, biofilm formation and adherence of Porphy-romonas gingivalis. J. Antimicrob. Chemother. 2006, 58, cÏ. 2, s. 439-443.

18. Bodet, C.; Chandad, F.; Grenier, D.: Inhibition of host extracellular matrix destructive enzyme production and activity by a high-molecular-weight cranberry fraction. J. Periodontal Res. 2007, 42, cÏ. 2, s. 159-168.

19. Bodet, C.; Chandad, F.; Grenier, D.: Cranberry compo-nents inhibit interleukin-6, interleukin-8, and prostaglan-din E production by lipopolysaccharide-activated gingi-val fibroblasts. Eur. J. Oral Sci. 2007, 115, cÏ. 1, s. 64-70. 20. Yano, A.; Kikuchi, S.; Takahashi, T.; Kohama, K.; Yos-hida, Y.: Inhibitory effects of the phenolic fraction from the pomace of Vitis coignetiae on biofilm formation by Streptococcus mutans. Arch Oral Biol. 2012, 57, cÏ. 6, s. 711-719.

21. Petti, S.; Scully, C.: Polyphenols, oral health and disease: A review. J. Dent. 2009, 37, cÏ. 6, s. 413-423.

22. Rasooli, I.; Shayegh, S.; Taghizadeh, M.; Astaneh, S.D.A.: Phytotherapeutic prevention of dental biofilm formation. Phytotherapy Research 2008, 22, cÏ. 9, s. 1162-1167.

23. Rasooli, I.; Shayegh, S.; Taghizadeh, M.; Astaneh, S.D.A.: Rosemarinus officinalis and Thymus eriocalyx essential oils combat in vitro and in vivo dental biofilm formation. Pharmacognosy Magazine 2008, 4, cÏ. 14, s. 65-72.

24. AL-Bayaty, F. H.; Taiyeb-Ali, T. B.; Abdulla, M. A.; Mah-mud, Z. B.: Antibacterial effects of Oradex, Gengigel and Salviathymol-n mouthwash on dental biofilm bacte-ria. Afr. J. Microbiol. Res. 2011, 5, cÏ. 6, s. 636-642. 25. Van der Velden, U.; Kuzmanova, D.; Chapple, I. L.:

Mic-ronutritional approaches to periodontal therapy. J. Clin. Periodontol. 2011, 38 Suppl. 11, s. 142-158.

26. Murphy, E. A.; Davis, J. M.; Carmichael, M. D.: Immune modulating effects of beta-glucan. Curr. Opin. Clin. Nutr. Metab. Care 2010, 13, cÏ. 6, s. 656-661.

27. Breivik, T.; Opstad, P. K.; Engstad, R.; Gundersen, G.; Gjermo, P.; Preus, H.: Soluble beta-1,3/1,6-glucan from yeast inhibits experimental periodontal disease in Wistar rats. J. Clin. Periodontol. 2005, 32, cÏ. 4, s. 347-352. 28. Preus, H. R.; Aass, A. M.; Hansen, B. F.; Moe, B.; Gjermo,

P.: A randomized, single-blind, parallel-group clinical study to evaluate the effect of soluble beta-1,3/1,6-glu-can on experimental gingivitis in man. J. Clin. Periodon-tol. 2008, 35, cÏ. 3, s. 236-241.

29. Higuchi, Y.; Kurihara, H.; Nishimura, F.; Miyamoto, M.; Arai, H.; Nakagawa, M.; Murayama, Y.; Suido, H.; Tanii, S.: Clinical evaluation of a dental rinse containing alumi-num lactate for treatment of dentinal hypersensitivity. J. Clin. Dent. 1996, 7, cÏ. 1, s. 9-12.

30. Rathe, F.; Auschill, T. M.; Sculean, A.; Gaudszuhn, C.; Arweiler, N. B.: The plaque and gingivitis reducing effect of a chlorhexidine and aluminium lactate containing den-tifrice (Lacalut aktiv) over a period of 6 months. J. Clin. Periodontol. 2007, 34, cÏ. 8, s. 646-651.

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31. Shinada, K.; Tagashira, M.; Watanabe, H.; Sopaporna-morn, P.; Kanayama, A.; Kanda, T.; Ikeda, M.; Kawagu-chi, Y.: Hop bract polyphenols reduced three-day dental plaque regrowth. J. Dent. Res. 2007, 86, cÏ. 9, s. 848-851.

32. Loesche, W. J.: Ecology of the oral flora. In: Nisengard, R. J., Newman, M. G., eds. Oral microbiology and immu-nology. Philadelphia: W. B. Saunders; 1994. s. 307-319.

Doc. Ing. KaterÏina ValentovaÂ, Ph.D., UÂstav leÂkarÏske chemie a biochemie LF UP HneÏvotõÂnska 3, 775 15 Olomouc

Altis Group spol. s r. o.

± vyÂhradnõÂ zaÂstupce pro CÏeskou republiku a Slovensko

V roce 2013 pro VaÂs prÏipravujeme:

TermõÂn:

8.±10. 11. 2013

MõÂsto konaÂnõÂ:

Mikulov

TeÂma:

Ortodonticko-chirurgicka leÂcÏba pacientuÊ s cÏelistnõÂmi vadami ± zaÂklady a nove zkusÏenosti

PrÏednaÂsÏejõÂcõÂ: Doc. MUDr. Rene FoltaÂn, Ph.D.

MUDr. JirÏõÂ Petr

TeÏsÏõÂ se na VaÂs kolektiv Altis Group s.r.o.

Altis Group spol. s r. o.,

ZÏerotõÂnova 901/12, 690 02 BrÏeclav

Tel./fax: 519 325 414, e-mail: ortho@altisgroup.cz, Petra Karafova - 731 476 456, Marie PõÂsarÏõÂkova ± 606 746 716 Zelena linka: 800 100 535(VOLEJTE ZDARMA!)

Figure

Tab. 1. SlozÏenõÂ uÂstnõÂch vod (v %) Tab. 1. Mouth wash composition (v %)
Fig. 2. The impact of mouth rinses on PBI, CPITN, PLI, and overall number of microorganisms in plaque (N) in patients before and after the use of placebo (white), combination of aluminium lactate and beta-glucan (yellow), and aluminium lactate (green, n=20

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