Comparative Effects of Chitosan, Chlorhexidine, And Chitosan-Chlorhexidine Mouthwashes On the Enamel Color of Natural Teeth

Abstract

Background: Chitosan mouthwash has higher antibacterial and anti-plaque effects with lower cytotoxicity than many other mouthwashes. Due to the side effects of chlorhexidine mouthwash on the color of teeth and the need to find alternative mouthwashes, the present study, for the first time, compared the enamel discoloration of natural teeth by using chitosan, chlorhexidine, and chitosan-chlorhexidine mouthwashes in order to investigate whether the Chitosan containing mouthwashes could be suitable alternatives to chlorhexidine with similar antibacterial properties and fewer side effects or not.

Materials and Methods: In this laboratory study, 45 premolar teeth extracted for orthodontic reasons without structural defects, cracks, restorations and observable caries were randomly divided into three groups (Chitosan, Chlorhexidine, and Chitosan-Chlorhexidine) of 15 each. First, prophylaxis pastes and plastic rubbers were used to clean the surfaces of the teeth; then, a spectrophotometer was used to measure the initial color of the buccal surfaces of the teeth. Then the first-, second-, and third-group of teeth were immersed in the 0.5% chitosan solution, 0.2% chlorhexidine solution, and the combined 0.5% chitosan and 0.2% chlorhexidine solution, respectively, for 24 h. Then the color of buccal surfaces of the teeth were again measured by the spectrophotometer, and discoloration (ΔE) was calculated. Statistical analysis was performed by SPSS.26 software, ANOVA analysis of variance and Bonferroni post hoc tests.

Results: In the chitosan group, discoloration (3.14±1.86) was significantly higher than those in the chitosan-chlorhexidine group (1.74±0.88) and the chlorhexidine group (1.78±0.58); however, the latter two groups experienced similar discoloration.

Conclusion: Chitosan-chlorhexidine mouthwash revealed dental discoloration effects similar to those of chlorhexidine. Tooth discoloration caused by chitosan mouthwash is more than chlorhexidine and chitosan-chlorhexidine mouthwashes.