ORIGINAL ARTICLE


https://doi.org/10.5005/jp-journals-10083-1039
Journal of Scientific Dentistry
Volume 13 | Issue 2 | Year 2023

Comparative Evaluation of the Efficacy of a Novel Composition based on Hypochlorous Acid vs Sodium Hypochlorite in Prevention of Cross-infection during Dental Treatment Procedures: A Pilot Study


Manovijay Arulmani1, Kurinchichelvan Ramalingam2https://orcid.org/0000-0002-7443-101X, Vanathy Desingu3, Alarmelu Natarajan4, Sama Dharsh5, Natarajan Rajagopal6

1,3Department of Periodontology, Vinayaka Mission’s Sankarachariyar Dental College, Vinayaka Mission’s Research Foundation (Deemed to be University), Salem, Tamil Nadu, India

2Department of Periodontology, Indira Gandhi Institute of Dental Sciences, Sri Balaji Vidyapeeth, Puducherry, India

4Department of Periodontology, Saveetha Medical College, Chennai, Tamil Nadu, India

5Department of Periodontology, Vellore Institute of Technology, Vellore, Tamil Nadu, India

6Department of Administration, Vinayaka Mission’s Shankaracharya Dental College, Vinayaka Mission’s Research Foundation (Deemed to be University) Salem, Tamil Nadu, India

Corresponding Author: Kurinchichelvan Ramalingam, Department of Periodontology, Indira Gandhi Institute of Dental Sciences, Sri Balaji Vidyapeeth, Puducherry, India, Phone: +91 8825853991, e-mail: drkurinchiperio@gmail.com

How to cite this article: Arulmani M, Ramalingam K, Desingu V, Natarajan A, Dharsh S, Rajagopal N. Comparative Evaluation of the Efficacy of a Novel Composition based on Hypochlorous Acid vs Sodium Hypochlorite in Prevention of Cross-infection during Dental Treatment Procedures: A Pilot Study. J Sci Den 2023;13(2):38–40.

Source of support: Nil

Conflict of interest: None

Received on: 06 April 2023; Accepted on: 28 April 2023; Published on: 23 November 2023

ABSTRACT

Introduction: The probability of infection during dental practice is extremely significant, particularly when utilizing water from the dental chair’s water boosters, which is often provided directly to the patient. As a result, there is a pressing need to create a unique disinfection composition for use in dental treatments, particularly in water lines.

Aim: The aim of this study is to examine and compare the efficacy of a novel composition based on hypochlorous acid (HOCl) vs sodium hypochlorite in preventing cross-infection during dental treatment operations.

Materials and methods: Patients with moderate-to-severe gingivitis were randomly assigned to one of three groups of five. They had been designated for ultrasonic scaling. Group I (control): For ultrasonic scaling, freshly prepared reverse osmosis (RO) water was utilized in the dental unit water booster. Group II (test group 1): As a disinfectant in the dental unit water booster, sodium hypochlorite (100 ppm) was utilized. Group III (test group 2): A novel (100 ppm)-based composition was used as a disinfectant in the dental unit water booster. The water units’ oxidation-reduction potential (ORP) after scaling was also assessed.

Results: Postoperatively, all three groups exhibit a decrease in oxidation-reduction potential. Group II has a significant decrease in ORP (p = 0.001).

Conclusion: This study found that using sodium hypochlorite as an ultrasonic liquid coolant considerably decreases the ORP during scaling when compared to RO water and HOCl.

Clinical significance: As an ultrasonic liquid cooler, sodium hypochlorite considerably decreases the ORP during scaling.

Keywords: Disinfection, Hypochlorous acid, Sodium hypochlorite, Ultrasonic scaling.

INTRODUCTION

The possibility of infection during dental therapy is exceedingly high, especially when utilizing water from the dental chair’s water boosters, which are often provided directly to the patient.

During dental practice, the risk of cross-infection between dentist and patient, as well as among patients, is exceedingly high. Cross-infection during dental operations must thus be avoided, and water must be cleansed on a regular basis.1

As a result, there is an urgent need to create innovative disinfection compositions for use in dental treatments, particularly in water lines. There is also a need for a disinfectant composition that can overcome the inadequacies associated with the known arts and provide safe disinfection for use in water lines as well as the patient’s oral cavity.

A dental aerosol consists of an aerosol formed during dental operations employing dental tools and other high-speed devices. These bioaerosols contain a variety of microorganisms, including germs from the mouth cavity, in addition to contaminants in the water from dental units.

In more contemporary systems, oxidation reduction potential (ORP) sensors are used in conjunction with pH sensors to give automated “demand-based administration of hypochlorite (or equivalent oxidizing disinfectant) and acid.2

AIM

The aim is to assess and contrast the efficacy of a novel composition based on hypochlorous acid (HOCl) vs sodium hypochlorite in preventing cross-contamination during dental treatment operations.

OBJECTIVE

To compare the ORP of dental water units after using a novel composition based on HOCL (100ppm) and sodium hypochlorite (100ppm) individually.

MATERIALS AND METHODS

The patients in the current research were from the Department of Periodontology at Vinayaka Mission’s Shankaracharya Dental College in Ariyanur, Salem, Tamil Nadu, India. Patients were informed about the study, and their informed consent was obtained. Patients with moderate-to-severe gingivitis aged 18–55 years were included in the study. The study comprised patients who had been advised for ultrasonic scaling.

Patients with systemic disorders, smokers, pregnant women, patients on antibiotics or other medications, patients who had oral prophylaxis in the previous 6 months, and patients wearing orthodontic equipment were all excluded.

METHODOLOGY

Participants with moderate-to-severe gingival inflammation were distributed at random to one of three distinct groups of five patients. They were allotted for ultrasonic scaling.

RESULTS

In this study, 15 patients were selected and were randomly divided into 3 groups of 5 patients each. Oxidation-reduction potential was evaluated preoperatively and postoperatively. Table 1 shows preoperative values and Table 2 shows post-operative values.

Table 1: Preoperative values of ORP
Group Mean SD
Group I 261.0 30.1
Group II 751.2 21.9
Group III 526.8 90.5
SD, standard deviation
Table 2: Postoperative values of ORP
Group Mean SD
Group I 210.4 23.0
Group II 369.8 52.4
Group III 331.6 42.1
SD, standard deviation

Table 3 shows the comparison. All three groups show a decrease in ORP postoperatively. In comparison, group II shows a significant reduction in ORP (p < 0.001) (Fig. 1).

Table 3: Comparison of the ORP between groups
  Preoperative Postoperative Mean difference p-value
Group I 261.0 (30.1) 210.4 (23) −50.6 (11.4) 0.001*
Group II 751.2 (21.9) 369.8 (52.4) −381.4 (51.1) <0.001**
Group III 526.8 (90.5) 331.6 (42.1) −195.2 (107.7) 0.02*
*Significant at 5%.
**Significant at 1%

Fig. 1: Graphical comparison of the ORP between groups

DISCUSSION

Periodontal disease is a recurrent inflammatory illness caused by bacteria that causes loss of tissue in the dentition’s attachment apparatus. Periodontal disease risk factors are environmental responses that may or may not be associated with periodontal disease, and their combination may or may not be causal. Some risk factors are modifiable, while others are not. Dental plaque is a breeding place for a wide range of oral germs.3

To disturb tooth plaque, a variety of mechanical tools can be employed. However, eliminating plaque and calculus completely is difficult. Incomplete removal of bacteria and their metabolites may result in germ development.4

Aerosols created during operative procedures such as scaling and restorative operations provide a substantial risk of nosocomial infection to dental professionals Legnani et al.5 and Bennett et al.6 revealed that employing ultrasonic scaling treatments resulted in the highest microbial aerosol levels in dental therapy. Preprocedural mouth-rinsing, along with universal barrier defense and high-power evacuation, has been proven in studies by Worrall et al. and Gupta et al. to significantly reduce the risk of aerosols.7

Various dental operations, such as ultrasonic scaling, crown preparation, caries excavation, and so on, produce aerosols that may contain potentially contagious bacteria.

Barrier protection (mask, gloves, and eye protection), preoperative rinse with antiseptic mouthwash such as chlorhexidine, high-volume evacuator, high-efficiency particulate air room filters, and ultraviolet treatment of the ventilation system are all methods for controlling airborne contamination produced by dental procedures.8

The intent of this research was to examine and compare the efficacy of a novel HOCl-based composition to sodium hypochlorite in preventing cross-infection during dental treatment procedures.

Water disinfection is a crucial step in minimizing disease transmission from a water supply to a lot and across lots over time. ORP, which is measured in millivolts (mV), has become a common method for standardizing water disinfection properties.9

The ORP sensors, which work identically to a digital thermometer or a pH probe, will allow for convenient tracking and surveillance of essential disinfection levels in water systems.10

Among the several advantages of ORP is the capacity to monitor and record disinfection of water potential, a critical water quality indicator, in real time. Innovations in probe design and continuous digital recording via computer-linked data input have occurred. Maintaining records can be largely automated. The graphical projections of diverse systems, for example, make it simple to analyze process control by water quality, product, and season. To alert the person in charge of out-of-range operations, probes have been combined with audible, visible, and distant alarm systems. Portable devices, such as more typical dose-related test kits, are inexpensive and an important backup for cross-referencing the functioning of an inline ORP sensor.11

The main benefit of adopting ORP for water system monitoring is the fact that it enables the operator to instantly examine the disinfecting capabilities of water in a postharvest system. Instead of assessing the dose, the operator can evaluate the disinfectant’s activity.

The ORP values accurately show the water’s antimicrobial capability for free-floating bacteria in postharvest applications such as transport flumes, cooling flumes, and ice injection.

Sahrmann et al. discovered that subgingival instrumentation combined with povidone iodine rinse reduced but did not fully eliminate bacteremia. Povidone iodine is thus acceptable for use as an ultrasonic liquid coolant.12

Muir et al. observed that a 2-minute prerinse with CHX greatly reduced ultrasonic scaler emissions.13

Limitations

Anaerobic culture would have improved the study by influencing the retrievable CFU counts. Despite the best efforts to unify the ultrasonic scaler settings, evacuation system, and patient, operator, and assistant positions within the realm of human error, there may be some variability in the same.

CONCLUSION

The authors conclude that when compared to RO water and HOCl, sodium hypochlorite as an ultrasonic liquid coolant significantly decreases the ORP during scaling.

ORCID

Kurinchichelvan Ramalingam https://orcid.org/0000-0002-7443-101X

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