{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T05:48:53Z","timestamp":1784958533551,"version":"3.55.0"},"reference-count":39,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2022,4,29]],"date-time":"2022-04-29T00:00:00Z","timestamp":1651190400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Oral conditions such as gingivitis and oral malodor are commonly reported globally. Objective: This investigation clinically stratified subjects to healthy, malodor and gingivitis groups and enumerated oral polymorphonuclear leukocytes (PMN) as a measure of inflammation prior to and after rinsing with a chlorhexidine (CHX) mouthwash. The study also assessed clinical outcomes (dental plaque and gingival bleeding indices), malodor (halimeter scores, organoleptic and tongue coat index and microbiological parameters (anaerobic and malodor organisms of dental plaque, tongue surface and saliva) for a comprehensive assessment of the oral inflammatory burden. Methods: Consenting adults were stratified into control (n = 17), gingivitis (n = 19) and halitosis (n = 17) groups based on clinical criteria. At baseline, oral samples were examined for PMN in addition to microbiological analysis of dental plaque, saliva and tongue scrapings for anaerobic and malodor bacteria. Subjects were issued a commercially available fluoride toothpaste and a chlorhexidine mouthwash for two-week use prior to post-treatment assessments identical to baseline. Results: At baseline, PMN were lowest in the control that increased amongst the halitosis subjects, with the gingivitis group registering the highest levels (p &lt; 0.05) with these outcomes corresponding with clinical parameters (p &lt; 0.05). CHX use improved outcomes with a 56\u201361% reduction in PMN with significant differences between groups (p &lt; 0.05). Dental plaque and bleeding indices were lower by 57\u201378% with oral malodor, demonstrating reductions of 33\u201359% (p &lt; 0.05). Significant reductions in anaerobic and malodor organisms ranging from 78\u201396% and 76\u201394%, respectively, were noted after CHX use (p &lt; 0.05). Conclusions: At study enrollment, PMN scores were lowest in healthy subjects, with increasing numbers amongst halitosis followed by gingivitis. Amongst all subject groups, CHX use significantly reduced oral PMN and corroborated with corresponding decreases in clinical, malodor and bacterial outcomes. Together, these results demonstrate the significant reductions in the oral inflammatory burden following CHX use.<\/jats:p>","DOI":"10.3390\/antibiotics11050603","type":"journal-article","created":{"date-parts":[[2022,4,29]],"date-time":"2022-04-29T16:49:57Z","timestamp":1651250997000},"page":"603","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Chlorhexidine Improves Hygiene Reducing Oral Polymorphonuclear Leukocytes with Antimicrobial Effects at Distinct Microenvironments amongst Subjects Stratified by Health Status"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3902-1135","authenticated-orcid":false,"given":"Prem K.","family":"Sreenivasan","sequence":"first","affiliation":[{"name":"HITLAB, 3960 Broadway, New York, NY 10032, USA"},{"name":"Department of Oral Biology, Rutgers School of Dental Medicine, Newark, NJ 07103, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0297-3474","authenticated-orcid":false,"given":"Violet. I.","family":"Haraszthy","sequence":"additional","affiliation":[{"name":"Department of Restorative Dentistry, University at Buffalo, Buffalo, NY 14214, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,4,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.cden.2018.08.005","article-title":"Evidence-Based Update on Diagnosis and Management of Gingivitis and Periodontitis","volume":"63","author":"Kumar","year":"2019","journal-title":"Dent. Clin. N. Am."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1902\/jop.1999.70.5.485","article-title":"The relationship between oral malodor, gingivitis, and periodontitis. A review","volume":"70","author":"Ratcliff","year":"1999","journal-title":"J. Periodontol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1016\/j.otohns.2005.09.036","article-title":"The relationship between oral malodor and volatile sulfur compound-producing bacteria","volume":"135","author":"Krespi","year":"2006","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1034\/j.1600-051x.2001.028009813.x","article-title":"Association between oral malodor and adult periodontitis: A review","volume":"28","author":"Morita","year":"2001","journal-title":"J. Clin. Periodontol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1007\/s00784-017-2164-5","article-title":"Estimated prevalence of halitosis: A systematic review and meta- regression analysis","volume":"22","author":"Silva","year":"2018","journal-title":"Clin. Oral Investig."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1111\/omi.12259","article-title":"Induction and inhibition of oral malodor","volume":"34","author":"Suzuki","year":"2019","journal-title":"Mol. Oral Microbiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1159\/000350472","article-title":"The role of toothpastes in oral malodor management","volume":"23","author":"Dadamio","year":"2013","journal-title":"Monogr. Oral Sci."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2005","DOI":"10.1007\/s10096-019-03641-9","article-title":"Oral microbial biofilms: An update","volume":"38","author":"Mosaddad","year":"2019","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_9","first-page":"160","article-title":"Emigration of blood neutrophil polymorphonuclear leukocytes and monocytes into the gingival crevice","volume":"4","author":"Attstrom","year":"1969","journal-title":"J. Periodontal. Res."},{"key":"ref_10","first-page":"63","article-title":"The differential count of oral leukocytes","volume":"80","author":"Raeste","year":"1972","journal-title":"Scand. J. Dent. Res."},{"key":"ref_11","first-page":"33","article-title":"Extracellular polymorphonuclear leukocyte constituents: Importance to oral health","volume":"61","author":"Smith","year":"1982","journal-title":"Northwest Dent."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1046\/j.1365-2249.1996.d01-846.x","article-title":"Neutrophils in mucosal secretion are functionally active","volume":"106","author":"Ebenfelt","year":"1996","journal-title":"Clin. Exp. Immunol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.archoralbio.2018.04.019","article-title":"Polymorphonuclear neutrophil integrity and functionality are preserved when exposed to saliva","volume":"92","author":"Rijkschroeff","year":"2018","journal-title":"Arch. Oral Biol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1007\/s00441-018-2802-5","article-title":"Neutrophils: Multitasking first responders of immunity and tissue homeostasis","volume":"371","author":"Jenne","year":"2018","journal-title":"Cell Tissue Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1111\/cea.13207","article-title":"Nasal cytology: Methodology with application to clinical practice and research","volume":"48","author":"Heffler","year":"2018","journal-title":"Clin. Exp. Allergy"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"3195","DOI":"10.1007\/s00405-016-3989-2","article-title":"Woodworkers and the inflammatory effects of softwood\/hardwood dust: Evidence from nasal cytology","volume":"273","author":"Lovato","year":"2016","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1177\/1753425917737825","article-title":"Streptococcus pneumoniae burden and nasopharyngeal inflammation during acute otitis media","volume":"23","author":"Morris","year":"2017","journal-title":"Innate Immun."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"S271","DOI":"10.1093\/cid\/cix083","article-title":"Microscopic Analysis and Quality Assessment of Induced Sputum from Children with Pneumonia in the PERCH Study","volume":"64","author":"Murdoch","year":"2017","journal-title":"Clin. Infect. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"6212","DOI":"10.1167\/iovs.17-22449","article-title":"Neutrophil and T-Cell Homeostasis in the Closed Eye","volume":"58","author":"Postnikoff","year":"2017","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e201960170","DOI":"10.1002\/jbio.201960170","article-title":"Point-of-care detection of neutrophils in live skin microsamples using chemiluminescence","volume":"13","author":"Raff","year":"2020","journal-title":"J. Biophotonics"},{"key":"ref_21","first-page":"662","article-title":"Neutrophil Count and Level of Interleukin-1\u03b2 and Interleukin-8 in the Saliva of Three to Five Year Olds with and without Dental Caries","volume":"12","author":"Seyedmajidi","year":"2015","journal-title":"J. Dent."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Petker, W., Weik, U., Margraf-Stiksrud, J., and Deinzer, R. (2019). Oral cleanliness in daily users of powered vs. manual toothbrushes\u2014A cross-sectional study. BMC Oral Health, 19.","DOI":"10.1186\/s12903-019-0790-9"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1016\/j.cden.2015.06.002","article-title":"Can Chemical Mouthwash Agents Achieve Plaque\/Gingivitis Control?","volume":"59","author":"Ciancio","year":"2015","journal-title":"Dent. Clin. N. Am."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1128\/CMR.00049-15","article-title":"Decolonization in Prevention of Health Care-Associated Infections","volume":"29","author":"Septimus","year":"2016","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1111\/j.1600-0757.2011.00436.x","article-title":"Examiner alignment and assessment in clinical periodontal research","volume":"59","author":"Hefti","year":"2012","journal-title":"Periodontol 2000"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.14219\/jada.archive.2007.0325","article-title":"Identification of oral bacterial species associated with halitosis","volume":"138","author":"Haraszthy","year":"2007","journal-title":"J. Am. Dent. Assoc."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1034\/j.1600-0722.2003.00037.x","article-title":"The effects of a triclosan\/copolymer dentifrice on oral bacteria including those producing hydrogen sulfide","volume":"111","author":"Sreenivasan","year":"2003","journal-title":"Eur. J. Oral Sci."},{"key":"ref_28","first-page":"320","article-title":"Oral malodor in children and volatile sulfur compound-producing bacteria in saliva: Preliminary microbiological investigation","volume":"21","author":"Minah","year":"1999","journal-title":"Pediatr. Dent."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"103497","DOI":"10.1016\/j.jdent.2020.103497","article-title":"Current uses of chlorhexidine for management of oral disease: A narrative review","volume":"103","author":"Brookes","year":"2020","journal-title":"J. Dent."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"100473","DOI":"10.1016\/j.conctc.2019.100473","article-title":"Effects of a chlorhexidine mouthwash on clinical parameters of gingivitis, dental plaque and oral polymorphonuclear leukocytes [PMN]","volume":"19","author":"Sreenivasan","year":"2019","journal-title":"Contemp. Clin. Trials Commun."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1016\/j.micres.2004.08.002","article-title":"The effects of a chlorhexidine mouthrinse on culturable microorganisms of the tongue and saliva","volume":"159","author":"Sreenivasan","year":"2004","journal-title":"Microbiol. Res."},{"key":"ref_32","first-page":"41","article-title":"Reduced plaque formation by the chloromethyl analogue of victamine C","volume":"41","author":"Turesky","year":"1970","journal-title":"J. Periodontol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1111\/j.1600-0765.1989.tb00860.x","article-title":"The effect of a dentifrice containing zinc citrate and Triclosan on developing gingivitis","volume":"24","author":"Saxton","year":"1989","journal-title":"J. Periodontal. Res."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1007\/s00784-002-0155-6","article-title":"Effect of a toothpaste containing triclosan on dental plaque, gingivitis, and bleeding on probing\u2014An investigation in periodontitis patients over 28 weeks","volume":"6","author":"Bruhn","year":"2002","journal-title":"Clin. Oral Investig."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1436","DOI":"10.1177\/00220345910700110801","article-title":"Reproducibility and sensitivity of oral malodor measurements with a portable sulphide monitor","volume":"70","author":"Rosenberg","year":"1991","journal-title":"J. Dent. Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1034\/j.1600-051X.2003.00342.x","article-title":"Clinical effects of a new mouthrinse containing chlorhexidine, cetylpyridinium chloride and zinc-lactate on oral halitosis. A dual-center, double-blind placebo-controlled study","volume":"30","author":"Winkel","year":"2003","journal-title":"J. Clin. Periodontol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"100836","DOI":"10.1016\/j.conctc.2021.100836","article-title":"Increasing oral PMN during experimental gingivitis and its reversal by prophylaxis","volume":"24","author":"Sreenivasan","year":"2021","journal-title":"Contemp. Clin. Trials Commun."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"5785","DOI":"10.1007\/s00784-021-03881-0","article-title":"Reductions in clinical inflammation and oral neutrophils with improving oral hygiene","volume":"25","author":"Sreenivasan","year":"2021","journal-title":"Clin. Oral Investig."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1093\/ecco-jcc\/jjw044","article-title":"Faecal Lactoferrin, Calprotectin, PMN-elastase, CRP, and White Blood Cell Count as Indicators for Mucosal Healing and Clinical Course of Disease in Patients with Mild to Moderate Ulcerative Colitis: Post Hoc Analysis of a Prospective Clinical Trial","volume":"10","author":"Langhorst","year":"2016","journal-title":"J. Crohn\u2019s Colitis"}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/11\/5\/603\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:04:15Z","timestamp":1760137455000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/11\/5\/603"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,29]]},"references-count":39,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2022,5]]}},"alternative-id":["antibiotics11050603"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics11050603","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,29]]}}}