Uso de clorexidina e vancomicina na inibição de streptococcus mutans salivares em crianças com cárie : um ensaio clínico duplo-cego, randomizado

Abstract

Aim: Compare the effectiveness of four different substances, e.g., 1% chlorhexidine, 3% vancomycin, 10% vancomycin and 1,23 % sodium fluoride, in the reduction of Mutans streptococci (MS) in children with dental caries. Methods: Seventy one children, with ages between 4 and 8 years, were randomly assigned to one of four groups. The antimicrobial agents were prepared as gels and applied during 6 consecutive days, in previously fabricated custom trays. Saliva samples were collected before treatment application (D1), on the last day of treatment (D6), 15 (D15) and 30 days from day 1 (D30). For microbiological analysis samples were placed on MSB Agar medium, incubated at 37o C, under microaerophilic condition for 48 hours and then reading was performed in order to identify number of colony forming units (CFU)/mL. Results: When comparing D6 and D1 the following results were observed: Vancomycin 10% (p = 0.0008) and Chlorhexidine (p = 0.0001) expressed significantly lower bacterial counts. Comparisons between D30 and D1 revealed that Fluoride and Chlorhexidine demonstrated a return to baseline values (D1), while Vancomycin 3% (p = 0.004) and 10% (p = 0.003) generated significantly higher counts in D30 than baseline. At D6 Vancomycin 10% (p = 0.0001) and Chlorhexidine (p = 0.000) expressed the lowest bacterial counts when compared to Fluoride (Mann-Whitney test), with no statistically significant difference between these two groups (p = 0.24) being observed. Conclusions: In the present study, after 6 consecutive days of topical administration, 1% Chlorhexidine gel demonstrated to be as effective as 10% Vancomycin gel in salivary MS reduction in children with dental caries. However, 1.23% Sodium Fluoride and 3% Vancomycin gel demonstrated to be equally ineffective. In conclusion, the use of a 1% Chlorhexidine gel during 10 minutes, for 6 consecutive days demonstrated a great efficacy in salivary MS reduction in children with caries, not leading to bacterial counts higher than what was initially observed.