Evaluation of stannous fluoride and chlorhexidine sprays on plaque and gingivitis in handicapped children Usuf M. Chikte', Ebrahim Pochee^ Michael J. Rudolph^ and Stephanus G. Reinach^ ^Department of Community Dentistry, - University of the Witwatersrand, Johannesburg; ^Department of Microbiology, Medical University of South Africa Medunsa; ^Institute of Biostatistics, Medical Research Council, Johannesburg, South Africa Chikte UM, Pochee E, Rudolph MJ and Reinach SG: Evaluation of stannous fluoride and chlorhexidine sprays on plaque and gingivitis in handicapped children. J Clin Periodontol 1991; 18: 281-286. Abstract. The objective of this study was to evaluate the effect of twice-daily oral sprays of 2 ml chlorhexidine (0.2%) and 2 ml stannous fluoride (0.2%) as the sole oral hygiene measure on plaque and gingivitis in handicapped children. 52 institutionalized mentally handicapped itidividuals (aged 10-26 years) were divided into 4 groups to participate in a 9-week, double-blind, randomized clinically controlled trial, which included a cross-over. For the first 3 weeks, groups 3 and 2 had their mouths sprayed with chlorhexidine and stannous fluoride, respectively. Following a 3-week wash-out interval, groups 1 and 4 were sprayed with chlorhexidine and stannous fluoride, respectively. The alternate groups received a placebo, water. Plaque (PI) and gingival indices (GI) were recorded. Subgingival plaque samples were collected and counts of spirochaetes, motile rods and cocci were taken using darkfield microscopy. By the 9th week of trial, the PI and GI were reduced by 48% and 52% for the stannous fluoride group. In the chlorhexidine group, reductions of 75% (PI) and 78% (GI) were achieved. Pair-wise comparisons of placebo, stannous fluoride and chlorhexidine using the f/-test of Mann-Whitney revealed significant (p<0.05) differences for both PI and GI scores in the placebo/stannous fluoride and placebo/chlorhexidine pair by the 9th week of the trial. In the stannous fluoride/chlorhexidine pair, only the PI was significantly reduced for those on chlorhexidine. Coccoid cells were more dominant at sites with low PI and GI scores (stannous fluoride and chlorhexidine groups), while spirochaetes and motile rods were more frequent at sites with high PI and GI scores (placebo group). Key words: stannous fluoride; chlorhexidine; handicapped; sprays; plaque; gingivitis. Accepted for publication 22 May 1990 ,; Poor oral hygiene and a high prevalence of periodontal disease is commonly re- ported in institutionalized mentally- handicapped children (Tesini 1981). There is considerable evidence that the major aetiological factor in gingivitis is the presence of dental plaque (Loe et al. 1965) and that regular and effective re- moval will prevent and control this con- dition (Axelsson & Lindhe 1974). Re- search into the provision of dental care for mentally handicapped children has recognised the importance of regular plaque removal as part of the preventive programme (Tesini 1981). At present, the recognised approach to effective plaque control is through mechanical removal of the material. The use of mechanical means to maintain an adequate level of oral hygiene in handicapped individuals is difficult, time-consuming and of doubtful effectiveness. While some indi- viduals are capable of being taught basic oral hygiene procedures, others, due to learning disabilities and muscular inco- ordination will always need help. Chemi- cal control of plaque offers an alternative and effective method to the conventional mechanical means (Mann 1984). The effectiveness of chlorhexidine (Flotra et al. 1972, Lang et al. 1982) and fluorides (Svatun et al. 1977, Tinanoff et al. 1980) as plaque-reducing agents has received considerable attention in the liter attire. The use of a chlorhexidine mouthrinse (Flotra et al. 1972) and chlorhexidine gel (Usher 1975) has been shown to reduce plaque. The use of chlorhexidine as an oral subgingival irri- gator (Weider et al. 1983) and in a spray (Dever 1979) for plaque removal has been investigated with encouraging re- sults. Numerous studies have demon- strated the antimicrobial properties of stannous fluoride (Birkland 1972, Bay & Rolla 1980, Ogaard et al. 1980, Tinanoff et al. 1980 and Weider et al. 1983). These works suggest that a spray containing either stannous fluoride or chlorhexidine could deliver these agents to the gingival crevice area and reduce the amount of plaque and gingivitis. The present study describes a double- blind randomized controlled clinical tri- al of 9 weeks duration to determine the effect of stannous fluoride and chlor- hexidine sprays, as the sole oral hygiene measure, on plaque, gingivitis and subgingival tnicroflora of an insti- tutionalized handicapped population.