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TITLE: EFFECT OF A NEW MOUTHWASH FORMULA ON XEROSTOMIA AND ORAL LESIONS: A PRELIMINARY REPORT

SECTION: Case series

TOPIC: Oral Diseases

AUTHORS:

1. Beatrice Mainardi*; e-mail: beatrice2mainardi@gmail.com
2. Alessandra Lissoni; e-mail: alessandralissoni@yahoo.com
3. Letizia Carenzi; e-mail: letiziacarenzi@live.it
4. Maria Teresa Sberna; e-mail: mariateresasberna@gmail.com
5. Filippo Pirani; e-mail: pirani91@icloud.com
6. Silvio Abati; e-mail: abati.silvio@hsr.it

AFFILIATION:

1 Oral Pathology Unit, Dept. of Dentistry, IRCCS San Raffaele Scientific Institute, Milan, Italy, Vita-Salute San Raffaele University, Milan, Italy

KEYWORDS: Mouthwash, Xerostomia, Tea Tree Oil, Oral lichen Planus, Pemphigoid

AIM Mouthwashes are usually liquid solutions held passively or swilled around the mouth. They are generally intended to prevent or treat oral infections and excess of oral biofilms reducing the microbial load in the oral cavity. Mouthwashes can be administrated also for their analgesic, anti-inflammatory or anti-fungal action or cosmetic action to control bad breath or as saliva substitutes in patients with xerostomia. Besides to the stabilizers and preservatives, many active ingredients have been used to obtain the curative and preventative effects in mouthwashes: essential oils, fluorides, antiseptic compounds, anti-inflammatory drugs, fluorides. Historically and recently many plants extracts have proposed and investigated as active ingredients of mouthwashes with variable results. The aim of this report is to present the results of a preliminary investigation of the effects of a new mouthwash proprietary formula containing selected natural ingredients in active concentrations: tea tree oil i.e. Melaleuca Alternifolia extract, Centella Asiatica extract, enzymes such as papain, dextranase, and lysozyme, the Idebenone antioxidant in a special viscous and bioadhesive vehicle with natural carrageenans and xanthan gum. The mouthwash is claimed to have a strong antibacterial and antifungal activity and anti-inflammatory properties together with a mucosal lubricating effect for its physical characteristics; due to its content this commercial product is claimed to reintegrate the natural defenses of the mouth, providing daily protection to gingiva and oral mucosa and promoting the balance of the oral ecosystem.

PATIENTS AND METHOD a small cohort of 23 patients has been selected to assess the soothing and lubricating properties of the commercial mouthwash (LionelloBio QUIET® - OralItaly - Milano, Italy) to prevent and relieve any further oral dryness and discomfort. The cohort was represented by 17 females and 6 males with an age range from 30 to 79 years old, and a mean age of 60.7 with a standard deviation of 13.5. The oral diseases and conditions affecting the cohort were xerostomia, burning mouth disease (BMS), oral candidiasis, oral lichen planus and autoimmune disorders represented by membrane mucous pemphigoid (MMP). These inflammatory conditions were selected after the claim of the mouthwash, that has anti-inflammatory and antibacterial properties, due to its own active ingredients and natural extracts.

RESULTS After a 1-month period, the patients were recalled and the oral lesions and conditions reevaluated. Out of the 23 patients, 3 of them did not show up to the appointment. The effects on xerostomia improvement, taste of the mouthwash and soothing effects were consistent for 18 patients out of 23 (78.3%), while just 2 patients did not find any relief or palatability (8.7%). The 13 patients of the cohort (56.5%) affected by oral lichen planus (5 patients) and with vesicular bullous lesions caused by the pemphigoid (3 patients) had a visible oral condition improvement and a quality of life noticeable upgrading. The other oral lesions were 2 patients with aphthous conditions, one patient with lichenoid lesions and a generalized gingivitis.

DISCUSSION The mouthwash showed clearly a soothing and calming effect with the patients complaining about xerostomia and BMS and had a visible improvement on the reticular lesions and bullae of the patients affected by inflammatory and autoimmune diseases. This success is due to the components and ingredients that have been studied and reported in the scientific literature for their anti-inflammatory effects. Although their properties as anti-microbial agents are still debated and require further investigation, their action, especially on xerostomic patients, is favorable. Lysozyme and Melaleuca alternifolia extracts enhance the natural defenses of the oral cavity against microbes and preventing caries and gingival inflammation. Dextranase fights the bacterial adhesion and preventing the build-up of biofilm and debris. Centella Asiatica speeds up the healing processes and keeps a good balance of the local micro-circulation, reducing the pain and discomfort of gingival edema. The mouthwash has a viscous consistency that promotes its action inside the oral cavity since it is not washed out completely after spitting. The numbers obviously represent a small cohort but it should be considered as a good starting point for a more in-depth study.

REFERENCES:

1. C. F. Carson, K. A. Hammer, T. V. Riley Melaleuca alternifolia (Tea Tree) Oil: a Review of Antimicrobial and Other Medicinal Properties CLINICAL MICROBIOLOGY REVIEWS, Jan. 2006, p. 50–62
2. S.F. Van Vuuren a,⁎, Y. Docrat a, G.P.P. Kamatou b, A.M. Viljoen Essential oil composition and antimicrobial interactions of understudied tea tree species South African Journal of Botany 92 (2014) 7–14
3. Arweiler, N. B., N. Donos, L. Netuschil, E. Reich, and A. Sculean. 2000. Clinical and antibacterial effect of tea tree oil—a pilot study. Clin. Oral 
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