Lacalut, application in periodontal practice.

Janitorov,E., Staov,A., Veselinyov,Z.,Markovsk,N.

I. Dental Clinic, Faculty of Medicine, Pavol J. Safarik University in Koice, Slovac Republic

Summary
The autors in their study observed the effects of local application of Lacalut solution in
order to reduce the inflammation of periodontal tissues. After 10 days detected a marked
reduction of inflammation, which was objectively evaluated by Bleeding on probing index.
Following the results, Lacalut seems to be an effective agent for reduction of inflammation of
periodontal tissues.
Introduction
Periodontitis is a destructive , inflammatory disease of periodontal tissues.
It involves more than 70% of adult population , periodontitis is the second most frequent
cause of premature tooth loss [ 24].
Significant improvement in the aetiology and pathogenesis of gingival and periodontal
inflammation was reached in the last twenty years. This latest information helps to find more
possibilities in therapy , including surgical treatment. At present the early correct diagnosis
and treatment of gingivitis enables restitutio ad integrum and prevents further disease
progression of periodontitis.
Both gingivitis and periodontitis can be successfully treated by current effective methods.
Local antiseptics and antibiotics are preferred in the periodontal therapy, because of their
minimal side effects, why the use of conventional antibiotic treatment.
Local treatment of inflammation in the oral cavity by antiseptic solutions started in the last
decade of the 19th century. The increase of it started in the late decade of the 70th of 20th
century, when where tested several types of antiseptics in large amounts.
Chlorhexidine gluconate solution showed the best results[2,6,9,13,14,17,18,19,21,33,34,35].
Since 1954 chlorhexidine is considered to be commonly used by professionals as
one of the most effective local antiseptics against plaque and as a supplemental agent of the
conventional oral hygiene especially in handicapped patients[4].
Chlorhexidine action mode is based on the plaque inhibition formation. Primarily the
interaction between anorganic and organic part of the tooth surface, and its active agent[8].
The mouthrinse concentration of 0,2% per 60 seconds in the oral cavity is considered to be
the most effective [1,11,28].
Also in inhibition in plaque formation sufficient is the concentration 0,1% chlorhexidine[5].
The local application of chlorhexidine selectively inhibits the salivary microflora and it
changes the concentration of microorganisms. The reduction reaches 30 50 % value.
This change declines after treatment cessation [30,31].
Currently offered mouthrinses are based on many solutions with chlorhexidine gluconate. In
this study was used the mouthrinse Lacalut distributed by NATUR PRODUCT.

Lacalut is a special concentrated antibacterial mouthrinse, it may be used as a concentrated

solution 2 to 5 drops into 0,5 1 dcl, or as a concentrate, or 2 to 5 drops spread directly on
the tongue surface [7].
The main goal of this study was to evaluate the effect of the local intrasulcular Lacalut
application, due to the dilution scheme devised by the producer, and the estimation of the
decline of inflammatory changes on gingival and periodontium, with orientation to gingival
bleeding [using BoP].
Materials a methods
The study was provided on the periodontology department, I. Dental clinic UPJ Koice.
Thirty patients were involved , 7 males and 23 females, age range 15 to 55 years. The average
age was 38,4.
These patients suffering from gingivitis and / or periodontitis. The treatment included
nonsurgical and surgical methods.
Fig.1 Examined patients and their diagnosis

Diagnosis
Gingivitis chronic
Parodontitis

Simplex
Complex
Adult
Juvenile

patients
4
1
20
5

The examination of patients at the Department of Periodontology was the first step in the
study. Improvement of the oral hygiene was reached during the treatment, all local irritating
factors [ plaque and calculus] were eliminated. Gingival bleeding was examined by Bleeding
on probing index [BoP] before the first rinsing [26].
Periodontal probe N 621 WHO was inserted into the sulcus and the probe circulated round
the tooth neck. Bleeding was examined on mesial, vestibular, distal and oral side of the tooth.
The presence of bleeding during probing was used sign + and if no bleeding occured, the
minus sign ( - ) was used. The final result was calculated by this formula :
sum of positive surfaces ( + )
BoP% = x 100
the total sum of all examined surfaces

After the 10th rinse the BoP was examined and the result was compared with that one, found
after the initial treatment. The treatment by Lacalut mouthrinse solution [ the ratio : 5 drops in
5 ml of destilled water] was performed by means of the blunt cannula around the complete
dentition during 10 days.

Results
The short termed 10 days Lacalut application into the gingival sulcus , or periodontal pocket
once daily were seen considerable reduction of inflammatory symptoms in gingivae.
This result was estimated objectively by BoP index. Before the first application BoP was
35,9%, after 10 days therapy it declined to 6,4 %.
Graph 1 Middle value equality of BoP before and after the treatment.
35,90%

before
after
6,40%

BoP

For testing the statistical hypothesis of the middle value equality, before and after the
treatment the dual T - test was used. Statistically significant difference on level 0,01 was
confirmed between the BoP results before and after the treatment. Treatment was successful
with probability 99 % [ on level 0,01].
Discussion
Dental microbial plaque is an aetiological factor in gingivitis and periodontitis. For a long
time the best result for plaque removal was only its mechanical elimination. But due to
current knowledge the best treatment is the combination of mechanical and chemical plaque
elimination.
The mode of action for mouthrinse solutions can be divided into [22] :
1. Inhibition of plaque formation by antimicrobial action
2. Inhibition of oral matrix absorption on the tooth surface
3. Inhibition of plaque formation by concentration of the intermicrobial substance.
Chlorhexidine application reducing microorganisms and the matrix if the established plaque
improves the clinical parameters in patients with greater plaque accumulation [12].
The local effect of antiseptics depends on the type of the used solution. These solutions can be
divided into [29] :

1. Products without any active antimicrobial effect [ sterile water, sage tea]
2. Products with a weak and temporary effect that doesnt exceed a salivary bacterial
count reduction [ hydrogen peroxide]
3. Products with a strong immediate effect, but no prolonged activity [ acriflavine]
4. Products that exert a sustained effect of at least 1 hour after application
[ Chlorhexidine]
The unwanted side effects of chlorhexidine were discussed in many studies yellowish
staining of the tooth surface and composite fillings, erythema and ardour of the tongue and
oral mucosa, sometimes connected with epithelial desquamation [3,15,16,28].
Changes in normal structure of keratinised oral epithelium as a consequence of prolonged
usage of 0,2% chlorhexidine [ 2 times daily longer than 1 year] werent recorded, as the same
as systemic changes [20,32].
During this study any unwanted side effects werent recored as well as any other problems.

Conclusion
The use of mouthrinses together with the systematic and correct oral hygiene has its
importance [10].
Other solutions are compared with chlorhexidine used for plaque reduction and elimination of
inflammation [25]. Due to our experiences and objective results, the solution Lacalut is a
very effective product for reducing inflammation in gingivae and other periodontal tissues.
It can be used both by a dentist in the everyday practice and also by patients for their
individual care.
Lacalut is indicated for patients with diagnosis chronic gingivitis, periodontitis and also
after surgical periodontal treatment and its recall.

Literature
1. Balai, V.: Corsodyl - nvrat chlorhexidnu do ambulantnej praxe, Zubn lekr, ro. 9, 2002,
. 11, s. 11
2. Barnes, G.P., Carter, H.G., Gross, A., Bhaskar, S.N., Schildt, N.N., Bush, A.G.: Dental plaque
reduction with antibacterial mouth rinse. Part I., Oral Surg. Oral Med. Oral. Pathol., 34, 1972,
s. 553-558
3. Barnes, G.P., Roberts, D.W., Katz, R.V., Woolridge, E.D.: Effects of two cetylpyridinium
chloride - containing mouthwashes on bacterial plaque, J. Periodontol., 47, 1976, . 7, s. 419422
4. Bergstrm, J., Holmberg, B.: The effect of chlorhexidine emulsion on plaque. An
intraindividual study of local application, Swed. Dent. J., 66, 1973, s. 461-465
5. Cancro, L.P., Paulovich, D.B., Klein, K., Picozzi, A.: Effects of a chlorhexidine gluconate
mouthrinse on dental plaque and calculus, J. Periodontol., 43, 1972, . 11, 687-691
6. Ciancio, S.G., Mather, M.L., Bunnell, H.L: Clinical evaluation of a quaternary ammonium containing mouthrinse, J. Periodontol., 46, 1975, . 7, s. 397-401
7. Cumming, B.R., Le, H.: Optimal dosage and method of delivering chlorhexidine solutions
for the inhibition of dental plaque, J. Periodontol. Res., 8, 1973, s. 57-62
8. Davies, R.M., Borglum Jensen S, Rindom Schiott C, Le, H.: The effect of topical aplication
of chlorhexidine on the bacterial colonization of the teeth and gingiva, J. Periodontol., 5, 1970,
s. 96-101
9. De La Rosa, R.M., Sturzenberger, O.P.: Clinical reduction of gingivitis through the use of a
mouthwash containing two quaternary ammonium compounds, J. Periodontol., 47, 1976, . 9,
s. 535-537
10. FDI Commission.Mouthrinses and periodontal disease, Int. Dent. J., 52, 2002, . 5, s. 346-52
11. Forouhar, M., Sitko, M., Markovsk, N.: Loklne pouitie chlorhexidnu v liebe
parodontitdy, Stomatolg, ro. 12, 2002, . 1, s. 30-31
12. Frentzen, M., Ploenes, K., Braun, A.: Clinical and microbiological effects of local
chlorhexidine applications, Int. Dent. J., 52, . 5, s. 325-9
13. Gross, A., Grower, M.F., Barnes, G.P., Bhaskar, S.N.: Dental plaque reduction with an
antibacterial mouth rinse. II. A comparison of clinical and physical scoring methods, Oral
Surg. Oral Med. Oral Pathol., 34, 1972, . 5, s. 850-854
14. Holbeche, J.D., Ruljancich, M.K., Reade, P.C.. A clinical trial of the efficacy of a
cetylpyridinium chloride - based mouthwash, I. Effect on plaque accumulation and gingival
condition, Australian Dental Journal, 20, 1975, . 6, s. 397-404
15. Johansen, J.R., Gjermo, P., Ericsen, H.M.: Effect of 2-years use of chlorhexidine - containing
dentifrices on plaque, gingivitis, and caries, Scand. J. Dent. Res., 83, 1975, s. 288-292
16. Kalteis T, Luring C, Schaumburger J, Perlick L, Bathis H, Grifka J.Tissue toxicity of
antiseptics. Z Orthop Ihre Grenzgeb 2003 Mar-Apr;141(2):233-8
17. Kaslick, R.S., Shapiro, W.B., Chasens, A.I.: Studies on the effects of a urea peroxide gel on
plaque formation and gingivitis, J. Periodontol., 46, 1975, . 4, s. 230-232
18. Kligerman, B.A., Bissada, N.F.: Clinical Study of Iodine as a Chemoterapeutic Agent for the
Control of Dental Plaque and Gingivitis in Man, J. Periodontol., 46, 1975, . 8, s. 478-487
19. Lobene, R.R., Soparkar, P.M., Hein, J.W., Quigley, G.A: A study of the effects of antiseptic
agents and pulsating irrigating device on plaque and gingivitis, J. Periodontol., 43, 1972, . 9,
s. 564-568
20. Le, H., Schitt, R., Glavind, L, Karring, T.: Two years oral use of chlorhexidine in man, I.
General design and clinical effects, J. Periodontal. Res., 11, 1976, s. 135-144
21. Mackenzie, I.C., Nuki, K., Le, H., Schitt, R.C.: Two years oral use of chlorhexidine in man,
V. Effects on stratum corneum of oral mucosa, J. Periodontal. Res., 11, 1976, s. 165-171

22. Markovsk, N., urovi, E., Martiukov, B.: Sasn monosti redukcie zubnho
mikrobilneho povlaku. Sborn refert, Prakt. Zub. Lk., 25, 1977, . 6, s. 165-169
23. Markovsk, N.: Zubn mikrobilny povlak, Literrny prehad k odbornej skke z
kandidtskej prce, II. Stomatologick katedra LF UPJ v Koiciach, 1980, 120 s.
24. Markovsk, N., Janitorov, E., omajov, Z.: Indikcie chirurgickej lieby parodontitis,
Stomatolg, ro. 13, 2003, . 2, s. 2-4
25. Moshrefi, A.: Chlorhexidine, J. West. Soc. Periodontol., Periodontal. Abstr., 50, 2002, . 1, s.
5-9
26. Mutschelknauss, R. E.: Praktick parodontologie, Klinick postupy, Quintessenz, s.r.o., Praha
2002, 532 s.
27. ONeil, T.C.A.: The use of chlorhexidine mouthwash in the control of gingival inflammation,
Brit. dent. J., 141, 1976, . 9, s. 276-280
28. Pipkov, I., Nedvdov, M.: Corsodyl - ppravek pro prevenci a len parodontu a sliznice
dutiny stn, Quintessenz Parodontologie, ro. 2, 2001, . 1, s. 6
29. Pitten, F.A., Kramer, A.: Antimicrobial efficacy of antiseptic mouthrinse solutions, Eur. J.
Clin. Pharmacol., 55, 1999, . 2, s. 95-100
30. Schitt, R., Briner, W.W., Le, H.: Two year oral use of chlorhexidine in man, II. The effect on
the salivary bacterial flora, J. Periodontal. Res., 11, 1976, s. 145-152
31. Schitt, R., Briner, W.W., Kirkland, J.J., Le, H.: Two years oral use of chlorhexidine in man,
III. Changes in sensitivity of the salivary flora, J. Periodontal. Res., 11, 1976, s. 153-157
32. Schitt, R., Le, H., Briner, W.W.: Two year oral use of chlorhexidine in man, IV. Effect on
various medical parameters, J. Periodontal. Res., 11, 1976, s. 158-164
33. Shapiro, W.B., Kaslick, R.S., Chasens, A.I., Eisenberg, R.: The influence of urea peroxide gel
on plaque, calculus and chronic gingival inflammation, J. Periodontol., 44, 1973, . 10, s. 636639
34. Shipman, B., Cohen, E., Kaslick, R.S.: The Effect of a Urea Peroxide Gel on Plaque Deposits
and Gingival Status, J. Periodontol., 42, 1971, s. 283-285
35. Turesky, S., Gilmore, D. N., Glickman, I.: Reduced Plaque Formation by the Chloromethyl
Analogue of Victamine C, J. Periodontol., 41, 1970, s. 41-43