Herbal and Alcohol-Free Mouthwashes as Chlorhexidine Alternatives for Preventing Enamel Demineralization in Orthodontic Patients: An In Vitro Study

TL;DR

This study compares non-alcoholic mouthwashes to chlorhexidine for preventing tooth decay in orthodontic patients.

Contribution

The study evaluates herbal and alcohol-free mouthwashes as alternatives to chlorhexidine for enamel protection in orthodontic care.

Findings

Chlorhexidine and fluoride mouthwashes were most effective in reducing S. mutans biofilms on orthodontic attachments.

Enamel microhardness was significantly affected by the type of mouthwash and orthodontic attachment used.

Herbal mouthwashes showed moderate efficacy in inhibiting bacterial growth on resin composite attachments.

Abstract

Background/Objectives: Chlorhexidine (CHX) and alcoholic (A+) mouthwashes are associated with adverse oral effects. Therefore, this study compared the efficacies of non-alcoholic mouthwashes, including fluoride (A−) and herbal (Hr) rinses, for preventing bacterial accumulation and enamel demineralization around metal brackets (MBs), ceramic brackets (CBs), and resin composite attachments (RCAs). Methods: Following the exposure to CHX, A+, A−, and Hr rinses for 1 min, the growth of Streptococcus mutans on MB, CB, and RCA was assessed using colony-forming units and scanning electron microscopy (SEM). Controls included attachments without intervention. In another setting, enamel with bonded attachments was exposed to mouthwashes for 1 min and subjected to cariogenic demineralization for 24 h. Enamel’s Vickers microhardness was measured before and after the demineralization challenge. Data were analyzed using paired t-tests and one-/two-way ANOVA with Tukey’s tests. Results: CHX mouthwash demonstrated superior antimicrobial efficacy against S. mutans biofilms across all orthodontic attachments (p < 0.05). On metallic brackets, CHX (0 ± 0 log10) and A− (1.7 ± 0.4 log10) significantly (p < 0.001) outperformed controls (6.9 ± 0.1 log10), Hr (6.08 ± 0.2 log10), and A+ (6.2 ± 0.6 log10). Similar patterns emerged for ceramic brackets, with CHX (0 ± 0 log10) and A− (1.4 ± 0 log10) superior to controls (6.6 ± 0.4 log10). On resin composite attachments, CHX (2.9 ± 0.05 log10) and Hr (3.4 ± 0.08 log10) exceeded controls (5.4 ± 0.09 log10) in inhibiting the biofilm growth (p < 0.05). Enamel microhardness reduction was significantly influenced by attachment type (p < 0.0001) and mouthwash type (p = 0.0063), with significant interaction between variables (p = 0.0052). Conclusions: CHX and A− mouthwashes effectively inhibited S. mutans biofilms on orthodontic attachments, while attachment type and mouthwash significantly influenced enamel microhardness reduction.

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