ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Electrolyzed Ion-Reduced Water Could Reduce Oral Counts of Periodontal Pathogens
Clinical Question For patients with chronic periodontitis, will a mouthwash containing electrolyzed ion-reduced water reduce oral counts of periodontopathic bacteria?
Clinical Bottom Line For patients with chronic periodontitis, a mouthwash containing electrolyzed ion-reduced water may reduce oral counts of periodontopathic bacteria, but more clinical research is indicated to confirm laboratory findings.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 22466442Masahiro/2011Cultures of Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitansLaboratory study
Key resultsAll viable P. gingivalis & Aggregatibacter actinomycetemcomitans have been eliminated with the use of solutions of electrolyzed ion-reduced water (ERI) and ERI + sodium caraboxymethylcellulose (CMC-Na) in under 30 seconds, whereas exposure to the control solutions (0.3% NaCl and 0.3% NaCl + CMC-Na) produced no bactericidal action. Furthermore, the concentration of ERI influenced the bactericidal action (P. gingivalis remained viable in solutions <15% ERI; A. actinomycetemcomitans <50% ERI). Also, the pH of the ERI solution was lowered to determine the effect on the bactericidal action (P. gingivalis remained viable at pH >11.0; A. actinomycetemcomitans >11.6). Lastly, the bactericidal action of ERI diluted with HCl was compared with a solution of 0.3% NaCl diluted with NaOH (no viable P. gingivalis were present in the ERI solution with a pH >11.0 and in the 0.3% NaCl solution >11.6 where no viable Aggregatibacter actinomycetemcomitans were present in the ERI solution with a pH >11.4 and in the 0.3% NaCl solution >11.8).
#2) 16953177Lee/2006Saliva of 16 subjects; contaminated toothbrushesLaboratory study
Key resultsBacterial counts of A. actinomycetemcomitans, F. nucleatum, P. intermedia, and P. gingivalis were reduced to 12.6-15.4% of the original growth media after exposure to Puri-water for 30 seconds (P < 0.05). Also, Puri-water inhibited growth of T. denticola during a 7-day incubation period whereas tap water did not. Toothbrushes contaminated with A. actinomycetemcomitans, F. nucleatum, P. intermedia, and P. gingivalis and washed with Puri-water resulted in bacterial counts of about 50% of that found after a wash with tap-water. Similarly, the Puri-wash itself harbored 11.0-12.4% of the bacterial numbers as that of the tap water wash (P < 0.05). Subjects who washed their mouths with Puri-water found a substantial reduction in aerobic (1.7±0.6%), anaerobic bacteria (34.4±14.1%), and mutans streptococci (21.0±8.7%) as compared with the same subjects washing with tap water.
Evidence Search electrolyzed[All Fields] AND reduced[All Fields] AND ("water"[MeSH Terms] OR "water"[All Fields] OR "drinking water"[MeSH Terms] OR ("drinking"[All Fields] AND "water"[All Fields]) OR "drinking water"[All Fields]) AND ("periodontal diseases"[MeSH Terms] OR ("periodontal"[All Fields] AND "diseases"[All Fields]) OR "periodontal diseases"[All Fields] OR ("periodontal"[All Fields] AND "disease"[All Fields]) OR "periodontal disease"[All Fields])
Comments on
The Evidence
Validity: With the majority of research conducted as in vitro laboratory studies, it is not known how well the bactericidal action translates into real clinical effectiveness. Given the fact that substantivity is required for the bactericidal action of ERI was examined in the Masahiro study by adding CMC-Na, this laboratory study showed no effect on the bactericidal action. However, it may be the case that the presence of an additive is needed in the oral environment. Likewise, the clinical trial in the Lee study lacked randomization, double blinding, and the inclusion of a large and diverse patient pool. Perspective: Although this research is promising, a randomized controlled trial is needed to determine whether the effect is present in an oral environment and the efficacy for clinical indications.
Applicability ERI may be more effective, convenient, and safer than Chlorhexidine. It also requires no prescription and may have other benefits. However, ERI loses its effectiveness rather quickly and for the purpose of this study it was utilized immediately after its production. It is quite possible the patient would need to have the means to produce ERI at their home to follow this specific regimen that would ultimately make this form of treatment cost prohibitive. Furthermore, the difference between ERI as compared with a 0.3% NaCl solution diluted with NaOH is minimal. Finally, although ERI is reported as safe, the validity can be questioned. Future studies are encouraged to assure potential effective use of this technique.
Specialty/Discipline (General Dentistry) (Periodontics)
Keywords electrolyzed ion-reduced water; antimicrobial mouthwash
ID# 2987
Date of submission: 02/22/2016spacer
E-mail mowery@livemail.uthscsa.edu
Author Brent Mowery
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Moshtagh Farokhi, DDS, MPH
Faculty mentor/Co-author e-mail farokhi@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
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