Thesis
Rough Draft
Sherry
L. Mayne
Efficacy
of Colloidal Silver in the Fight
Against
Gingivitis
Dr. Douglas
Masini
ALHE 5500
Spring
2008
Abstract:
This section should
include 2 or 3 brief paragraphs, a sentence or two from each background, purpose, methods and a brief description of results
with all of these being written out in greater detail through the body of the work.
Background: In a clinical study conducted at Loma Linda, University in California, S. Lee, P. Hujoel,
M. Su, W. Zhang, M. Arambula, M. Rothen, L. Su, G. Muller, and J. Kim, (2007) determined that the incidence of
gingivitis in the adult population is approximately 95%. At the present time, Chlorhexidine Gluconate 0.12% is the drug of
choice for treatment of gingivitis and has “been shown to be the most effective…….chemotherapeutic agent
available” Wilkins (1999). However, patient compliance is low due to side affects such as altered taste, cost and staining,
Wilkins (2007).
Purpose: To investigate the efficacy of Colloidal
Silver in the treatment of gingivitis as compared to Chlorhexidine Gluconate 0.12%
Methods:
This was a double blind
study conducted with twenty adult participants, age 18 to 43, with mild to moderate gingivitis. All participants did complete
a thorough medical history including drug and metal allergies and given contact names and phone numbers to call if any believed
complications occurred. All medical histories were read and approved
by the attending dentist
in the department of Dental Hygiene at ETSU. After IRB approval was gained from the East Tennessee State University IRB board
participants signed and returned consent forms including a HIPPA Privacy Statement.
Participants with four
or more areas of periodontal pocket depths > than 4mm were excluded from the study. All participants had a minimum of twenty
teeth with four molars present. The study rinses consisted of Chlorhexidne Gluconate 0.12%, Colloidal Silver 10ppm and a placebo
of distilled water with natural mint flavoring. Base line measurements of plaque index, bleeding index, gingival index and
periodontal probing were recorded at baseline. Participants were not given any oral hygiene education and were instructed
to not perform any oral hygiene procedures other than the rinses for the length of the study.
Rinses were distributed
randomly by a clinical dental assistant and participants were issued a number corresponding with the rinse they received.
The attending dentist received the medical histories of those who would be using the Chlorhexidine Gluconate and he approved
the dispensing of the medication. To avoid the Hawthorn effect participants were not told what the anticipated results of
the study would be. Baseline measurements were repeated on days seven, fourteen
and twenty one.
Once final data was
collected, study participants underwent a post study exit interview and asked their personal experiences while participating
in the study. Participants were
then given the
state of their oral health and provided with oral hygiene education. At this time data was compiled and statistical analysis
was performed using a nonparametric nominal t
Test to measure the statistical difference in the results of the two rinses compared to the control.
Review of Literature:
Gingivitis in
either a mild or moderate form affects approximately 95% of the American adult population (Lee, Hujoel, Su, Zhang, Arambula,
Rothen, Su, Muller and Kim 2007). Currently the treatment of choice for gingivitis is Chlorhexidine Gluconate 0.12%. While
Chlorhexidine has proven clinically effective, patient compliance is often low to due the side effects of its use in the oral
cavity. Wilkens, E., (1999) reports that the side effects include altered taste, staining of the teeth and a mild burning
sensation. Another compliance factor is the prescription cost of Chlorhexidine.
In a search for an agent
to reduce gingivitis and allow more patient compliance with fewer side effects, silver and silver compounds should be considered
in the arena of antimicrobials. Using silver and silver compounds as a topical antimicrobial is not unheard of in medicine. Wright, Lam and Burrell (1998) explained that silver has been
used for more than a
century as an antimicrobial agent. They also report silver to be a safe, broad-spectrum antibacterial with few adverse side
effects.
Research supporting
the efficacy of Ionic Silver in preventing the growth of yeast, gram-negative and gram-positive bacteria using Central Venous
Catheters (CVC's) coated with Iontophoretic Silver was supported in a study done by Bong, Kite, Wilcox and Mcmahon (2001).
During the study 289 catheters were placed in 253 patients. Of those catheters that became colonized (82) only 37 catheters
coated with Silver became colonized compared to 45 untreated catheters. While this particular study did not demonstrate a
statistically significant difference it certainly demonstrated cause for further study.
As the science of dentistry
progresses and as more collaboration with the medical community occurs it is becoming increasingly clear that moderate to
severe dental disease has many systemic consequences. Dental disease is particularly linked with Heart disease and artherosclerosis.
In a clinical trial conducted by University College London in March 2007, Dr's'. John Deanfield and Francesco D'Aiuto concluded
that patients with significant amounts of dental disease after "intensive periodontal treatment" showed high levels of improvement
in both periodontal disease and blood vessel function.
This is only one of
many studies completed over the previous ten years with very similar conclusions. Along with periodontal scaling and root
planing most all periodontal therapy includes the use of oral antimicrobial agents. The most common being Chlorhexidine Gluconate
0.12%. While Chlorhexidine is considered the Gold Standard in dentistry the adverse events (AEs) associated with it's use
must be taken into account.
A recent clinical trial
completed by the United States Department of Veterans Affairs and published in the Journal of the American Dental Association
addressed the occurrence of AEs associated with the use of Chlorhexidine. The
most common were loss of taste or taste changes (19.3%) of participants and staining of the teeth (18.3%) of participants.
When considering the
cost of prescription Chlorhexidine and the associated AEs which affect patient compliance it is important to investigate other
antimicrobial oral rinses with a possibility of fewer AEs. At the forefront of possibilities is Colloidal Silver. Colloidal
Silver has been used homeopathically for centuries against bacterial and viral pathogens and is currently used extensively
in burn clinics, over the counter and hospital bandages to fight infection. Foley catheters under the trade mark Silvertouch
produce a catheter with a silver ionic coating proven to work against both gram-positive and gram-negative bacteria. This
catheter as proven to decrease the acquired urinary tract infections associated with catheterization.
With such promising
anti-infection results in other medical applications it seems only reasonable that Colloidal Silver will prove effective against
the oral pathogens that result in dental disease.
Currently, a review
of the literature has not identified any studies using silver to combat oral pathogenic, gram-negative bacteria. However,
due to the proven efficacy in combating pathogenic bacteria, its low incidence of adverse side effects and relative low
cost, it would seem
pertinent to study its efficacy and safety in the oral environment as a topical rinse solution.
Body of the thesis:
Dr. Masini, I assume
this section would be the many pages explaining MY research including charts, measurements, statistics and greater detail
of methods. As I mention in my results and conclusion, I have no information since I have not actually completed or even started
the study. Am I in the ball park here?
Results: Perfect honesty here. I have no idea how to draw imaginary results since my study has not been conducted?
My hypothesis is that the Colloidal Silver will be just as therapeutic as the Chlorhexidine without the side effects? Any
help here?
Conclusion: I hope my conclusion will be that there is enough statistical evidence to warrant further studies.
Again, since I have not actually done the work I am not sure how to word this for this requirement?
Bibliography
Bong, J., Kyte, P., Wilcox, MH., Mcmahon,
MJ., (2001). Efficacy of iontophoretic central venous catheters in preventing catheter-related bloodstream infection amongst
high-risk patients: a randomized controlled trial. United States National Institute of Health Dec-16-19 abstract number K-1425.
retrieved March 22, 2008 from http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102269778.html 
D'Aiuto, F., Deanfield, J. (2007). Intensive
periodontitis treatment improves blood vessel health. The Journal of the American Dental Association (138) 728
Lee, S.,
Hujoel, P., Su, M., Zhang, W, Arambula, M., Rothen, M., Su, L., Muller, G., and
Kim, J., (2007). 2233 Prevalence and severity of gingivitis in american adults. Loma
Linda University, CA. Retrieved
April 07, 2008 from http://iadr.confex.com/iadr/2007orleans/techprogram/abstract_93413.htm
McCoy, L., Wehler, C., Rich, S., Garcia,
R., Miller, D., Jones, J. (2008). Adverse events associated with chlorhexidine use. The Journal of the American Dental Association
(139) 178-183
Wilkins,
E., (1999). Clinical practice of the dental hygienist (pg. 386-387). Lippicott,
Williams & Wilkins, Philadephia, PA.
Wright,
JB., Lam, K., Burrell, RE., (1998). Wound management in an era of increasing bacterial resistance: a role for topical silver
treatment. American Journal of Infection Control. 26:
(6) 572-577
