Comparison of combined application treatment with one-visit varnish treatments in an orthodontic population

OBJECTIVE To evaluate the effect of chlorhexidine-thymol varnish alone, its combination with chlorhexidine-fluoride containing dentifrice and fluoride varnish on oral hygiene and caries prevention in orthodontic patients. STUDY DESIGN Sixty patients, aged 12-18, with orthodontic fixed appliances were randomly assigned into three groups as follows: Group 1 (n=20): 1% chlorhexidine and 1% thymol varnish (CervitecPlus); Group 2 (n=20): CervitecPlus+ 0.2% chlorhexidine and 0.2% sodium fluoride (900 ppm fluoride) (CervitecGel)); and Group 3 (n=20): 0.1% fluoride varnish (Fluor Protector). Mutans streptococci (MS), lactobacilli (LB) levels, buffering capacity (BC), visible plaque index (VPI), and gingival bleeding index (GBI) scores were evaluated at four stages: T0, before orthodontic bonding; T₁, one week after orthodontic bonding; T₂, one week; and T₃, four weeks after the first application, respectively. Inter and intra group comparisons were made by the Kruskal-Wallis, Mann-Whitney U, Friedman and Wilcoxon Signed-Rank tests with Bonferroni step-down correction (P<0.017). RESULTS Significantly lower MS and LB levels were found in Group 2 than Group 1 (T₂) and 3 (T₂, T₃) (P<0.017). Groups 1-2 (T₂) showed significantly higher BC (P<0.017) and lower VPI and GBI (P<0.017) scores compared with Group 3. Decreased MS levels at T₂ (P<0.017) and T₃ (P>0.017) were found in Group1-2 compared with T0. Significantly lower LB levels were recorded in Group 2 at T₂ compared with T₀ (P<0.017) while no significant differences were seen in Group 1 and 3 (P>0.017). CONCLUSIONS Addition of CervitecPlus+CervitecGel combination to the standard oral hygiene regimen may be beneficial for orthodontic patients for maintaining oral health by reducing bacterial colonisation and gingivitis.