KNOWLEDGE AND ATTITUDE TOWARDS MOUTHWASHES AND THEIR USES AMONG DENTAL PRACTITIONERS IN NAIROBI AND MOMBASA A COMMUNITY DENTISTRY RESEARCH PROPOSAL SUBMITTED IN PARTIAL FULFILMENT OF THE DEGREE OF BACHELOR OF DENTAL SURGERY, UNIVERSITY OF NAIROBI. By HANNAH NG'ENDO KAGIRI SUPERVISORS Dr. F.G MACI GO: BDS, MPH, PGD- STI (NBI) Department of Periodontology, Community & Preventive Dentistry, Faculty of Dental Sciences; University of Nairobi. Dr. E. WAGAIYU: BDS (NBI), Msc (Lond) FADI, PFA Department of Periodontology, Community & Preventive Dentistry, Faculty of Dental Sciences; University of Nairobi PERIOD OF STUDY: FEBRUARY- SEPTEMBER COST OF STUDY: 5480.00 SOURCE OF FUNDING: SELF 1
Transcript
KNOWLEDGE AND ATTITUDETOWARDS MOUTHWASHES AND THEIR USES
AMONG DENTAL PRACTITIONERS IN NAIROBI ANDMOMBASA
A COMMUNITY DENTISTRY RESEARCH PROPOSAL SUBMITTED IN PARTIALFULFILMENT OF THE DEGREE OF BACHELOR OF DENTAL SURGERY,UNIVERSITY OF NAIROBI.
By
HANNAH NG'ENDO KAGIRI
SUPERVISORS
Dr. F.G MACI GO: BDS, MPH, PGD- STI (NBI)Department of Periodontology, Community &Preventive Dentistry,Faculty of Dental Sciences;University of Nairobi.
Dr. E. WAGAIYU: BDS (NBI), Msc (Lond) FADI, PFADepartment of Periodontology, Community &Preventive Dentistry,Faculty of Dental Sciences;University of Nairobi
PERIOD OF STUDY: FEBRUARY- SEPTEMBER
COST OF STUDY: 5480.00
SOURCE OF FUNDING: SELF
1
TABLE OF CONTENTS
ABBREVIA TIONS 3SUMMARY 4INTRODUCTION 5LITERATURE REVIEW 7PROBLEM STATEMENT 11JUSTIFICATION OF STUDY 11STUDY OBJECTIVES 12STUDY HYPOTHESIS , '" 12STUDY VARIABLES 12MATERIALS AND METHODS '" 13
-STUDY AREA- STUDY POPULATION- STUDY DESIG- SAMPLE SIZE DETERMINATION- SAMPLING PROCEDURE-INCLUSION AND EXCLUSION CRITERIA- DATA COLLECTION INSTRUMENTS 14- DATA COLLECTIO TECHNIQUES 14
Mouthwashes arc chemical formulations that are mainly used as adjuncts to mechanical methodsof plaque control and also in the treatment of various dental and medical conditions. Dentistshave a major role to play in the maintenance of good oral hygiene in the country. Althoughseveral studies carried out in several countries have shown the role of mouthwashes in plaquecontrol, there is an overall scarcity of information regarding the dentists' knowledge and attitudetowards mouthwashes as agents of plaque control.
The main objectives of the study will be to establish the dentists' knowledge of mouthwashes interms 0 f their constituent ingredients, their short and long term side effects; thei r attitude towardsthe use of mouthwashes as plaque control agents and their use during treatment of various dentalconditions.
A descriptive cross-sectional study will be conducted among dentists' in Nairobi and Mombasa.A total of 120 dentists will be included in the study. A self-administered questionnaire will beused to collect data. The variables sought by the questionnaire will include knowledge of thevarious brands of mouthwashes and active ingredients in those mouthwashes; attitude of dentiststowards mouthwashes as agents of plaque control; specialty of dentists and gender of thedentists.
The findings from the study may be used to formulate continuing dental health educationprogrammes for dentists and this will eventually help improve patient education on the use ofmouthwashes.
INTRODUCTION
Periodontal disease refers to a group of diseases that affect the tissues that support and anchor theteeth. Periodontal diseases have afflicted humans since the dawn of history and studies haveindicated that destructive periodontal disease as evidenced by bone loss, affected early humans insuch diverse cultures as ancient Egypt and pre-Columbian America. Almost all the preservedearly writings have chapters dealing with oral disease and periodontal problems take up asignificant amount or space in these writings. (I)
The prevalence of periodontal disease among adults in the world has been the subject of severalstudies. The WHO's compilation of more than 100 studies measuring the CommunityPeriodontal Index of Treatment (CPITlN) indicated that most adults present with calculus orgingival bleeding or both and that 5-20% of person's 40 years of age suffer from severeperiodontal disease. (2)
A Canadian National Survey, done in 1972 showed that 26% of Canadians aged 19 years and0\ er su Ifercd from serious gingivitis and that 15% had periodontal pockets. Among the subjectsaged 30-39 years, 41(% of men and 23.6% of women suffered from severe gingivitis while 13.:2(Yuof men and 7.2% of women had periodontal pockets. (3)
Periodontal disease is a major health concern affecting most of the populations in the world andstudies have also shown that prevalence of severe periodontitis is greater in developing countrieslike Kenya, than in industrialized countries. ( I)
Epidemiological studies confirm a strong correlation between dental plaque and the initiation ofperiodontal disease. Bacterial plaque is an adherent deposit on the teeth and its adherence is suchas to resist the friction of food during mastication. It forms when tooth brushing is stopped for12-24 hours. Plaque forms thick creamy deposits in the stagnation areas e.g. occlusal fissures ofposterior teeth; gingival margin of teeth and inter-proximal areas of teeth. It has been firmlyestablished that dental plaque is the main etiological agent of periodontal disease. (4).
Plaque control is the removal of microbial plaque and the prevention of its accumulation on theteeth and the adjacent gingival surface. It plays an important role in prevention of periodontaldisease, dental caries and other oral lesions caused by micro-organisms in dental plaque. Therearc 1\\ 0 main methods or plaque removal;
I. Mechanical methods which involve tooth-brushing, inter-dental cleaning e.g. flossing,use of toothpicks, inter dental brushes etc
2. Chemical methods which involve use of Mouthwashes; Antibiotics e.g. penicillin,vancomycin, erythromycin; Phenols like thymol and triclosan; Quaternary ammoniumcompounds; Herbal extracts etc
5
Mouthwashes are chemical formulations that are used in the inhibition of plaque formation. Mostpeople brush and floss inadequately and constant reinforcement is often required. Plaque isusually left behind with mechanical methods and therefore chemotherapeutic agents have a keyrole as adjuncts to mechanical methods for preventing and treating periodontal disease. Theyshould be recommended after the patient has brushed and cleaned interdentally. (5)
Dentists have a major role to play in the maintenance of good oral hygiene among the Kenyanpopulation. A study to among dentists will provide us with information that can be used toestablish the adequacy of their knowledge on mouthwashes and their attitude towardsmouthwashes in maintenance of good oral hygiene. The findings can also used in the formulationor dental health education programmes for dentists.
6
LITERATURE REVIEW
Periodontal health can be considered to be a state of balance in which the bacterial populationcocx ists with thc host and no irreparable damage occurs to either the bacteria or the host tissue.Disruption of this balance causes alterations in both the host and the bacteria in the biofilm.Studies have shown that periodontal diseases are an important cause of tooth mortality amongadults more than 40 years old (1). The main forms of periodontal disease are gingivitis andperiodontitis. Gingivitis is an inflammation of the marginal gingiva while periodontitis ischaracterized by destruction of the periodontal ligament and alveolar bone and ultimately leadsto loss of teeth. The tissues that are mainly involved in periodontal disease are gingiva,periodontal ligament and alveolar bone. The most common symptoms of periodontal disease arcred swollen gums; bleeding gums; halitosis; gum recession; mobile teeth and abscesses. (5)
The actiopatbogenctic role of bacterial plaque in periodontal disease is now widelydemonstrated. Dental plaque is a mixed microbial biofilrn growing on thc tooth surface. Itconsists of an organic matrix containing a dense concentration of bacteria, together with theirextra cellular polysaccharide matrices. Plaque formation begins by deposition of a structurclesscell- free pellicle, which is derived by deposition of salivary mucinous substances such asglycoproteins. Within 24 hours, this cell free layer becomes colonized by micro- organismsmainly Streptococci mutans and S. sanguis. As the plaque matures, Filamentous organismsproliferate and form. Other bacterial species e.g. Lactobacilli, Actinomycetes, Diptheroids, Gramnegative anaerobes also join the plaque population. (6)
Plaque control is an effective way of preventing periodontal disease. The importance of oralhygiene in primary and secondary prevention of periodontal disease is no longer disputed. Todate, the most dependable mode of plaque control is mechanical cleaning. Chemical inhibitors ofp laq lie incorporated in mouthwashes or dentri fices act as adj IIncti ve agents to mcchan ica Itechniques. (13)
Mouthwashes are formulated solutions that have been used widely in various dental and medicalconditions that include post-oral surgery patients, patients with dental implants and orthodonticappliances, periodontal patients, denture patients, patients with ANUG, dry sockets, pregnancyand puberty gingivitis, diabetics, cardiac patients and patients undergoing chemotherapy andradiation treatment'{" Due to their many uses, mouthwashes are starting to assume an importantrole in daily oral care routine. A study done in the United Kingdom (UK) shows that 24% of thepopulation used mouthwashes and 68% of the dentists in the U.K actively encourage patients touse a mouthwash at least once a day (8).
In the market today, a wide range of mouthwashes is available. A number of antimicrobial agentshave been studied in the control of plaque and are divided into;
1. Bisbiguanides like chlorhcx idine; Alex idine; Octedine
7
2. Quarternary Ammonium compounds like Cetypyridinium chloride
3. Phenolic Antiseptics like Listerine
4. l lexctidinc like Oraldinc
S. Povidone lodinc like Betadinc
6. Antiseptics like Triclosan; Salifluor
7. Metal ions like Zinc; Copper
8. atural Products like Sanguinarine; Propolis
9. Oxygenating agents like Hydrogen peroxide
The American Dental Association (ADA) council on Dental Therapeutics has adopted aprogram for acceptance of plaque control agents. The agents must be evaluated in placebocontrolled clinical trials for six months or longer and demonstrate significantly improvedgingival health compared with the controls. To date, two agents have been accepted by the ADA-Chlorhcxidinc and Listerine mouthwashes (9)
The major components of mouth-rinses are water, flavoring, humectant, surfactant, alcohol andthe active ingredients. The active ingredients vary considerably among the various mouthwashes:Listcrinc employs thc well-established therapeutic effects of phenol related essential oils, thymoland eucalyptol, in an alcohol base. A study was done in the UK, Germany and Belgium toevaluate the benefits of Listerine mouth rinse in improving the oral health status. During thestudy, each dentist received materials and instructions on how to assess gingival health andplaque scores. The subjects were invited to use Listerine twice a day for 3 months as an adjunct.After 3 months, significant improvements were measured with both gingival health and plaquecontrol improving by SO%. Most practitioners confirmed that the use of Listerine as an adjunct tonormal oral hygiene was very beneficial in control of plaque among their patients. (10)
The use of mouth- washes as adjuncts in the management of gingivitis has received increasedattention A three double blind, placebo controlled clinical study conforming to the ADAprogrammed guidelines was done among 337 adults aged between \8-60 years. All subjects hadplaque and mild to moderate gingivitis at the beginning of the study. The placebo solution was ahydro alcohol solution that mimicked Listerine. The subjects rinsed twice dai ly as an adjunct totheir usual oral hygiene for six months. At the end of the study, Lisierine was found to reduceplaque by I()-34 (Yo as compared to the placebo. (II).
Chlorhexidine is a bisbiguanide with broad- spectrum antibacterial activity. Studies done in thedepartment of Periodontology, University of Wales, showed that Chlorhexidine achieves plaqueinhibition as a result of immediate bactericidal action during the time of application and aprolonged bacteriostatic action as a result of adsorption to the pellicle coated enamelsurface(12)]n a study done in the University of Berne Switzerland, patients who had undergoneflap surgery were to rinse daily for] minute with 0.1% Chlorhexidine for 4 weeks. In addition toChlorhexidine rinsing, the patients were also supposed to apply Chlorhexidine locally using a
8
soft surgical toothbrush twice daily. All areas healed without complications. It was concludedthat daily rinsing with Chlorhexidine leads to lower degrees of inflammation resulting inimproved healing. (13)
Povidine iodinc is an iodine complex that has been shown to be active sub-gingivally. A studydone by the ADA showed that subgingival irrigation with povidone iodine was recommended toreduce pathogenic bacteria and to decrease bacteremia after dental procedures. (14)
Quarternary ammonium compounds are a group of surface -active agents that have a tendency tobind to oral tissues, due largely to their strong positive charge. The most commonly usedmember of this group is ceptylpyridiniurn chloride. A series of studies have shown significantplaque reductions of 25 to 35% and 24% reduction in gingivitis. The quarternary ammoniumcompounds exhibit some of the same side effects as chlorhexidine, and these include stainingand enhanced calculus formation. (15)
Sanguinarine is currently used in both a mouth-rinse and toothpaste as an antiplaque/gingivitisagent. It is a benzophenanthridine alkaloid extract from the root of Sanguinaria Canadensis thathas broad spectrum antibacterial activity.It is available in the United States as Viadent mouth-rinse and toothpaste. Studies have shown plaque reductions of 17-42% and reduction ingingivitis of 18-57 (%. ( IS)
A number of short- term studies have shown that stannous fluoride is an effective anti-plaqueagent. Several studies have reported significant reductions in plaque and/or gingivalinflammation. (IS)
The ADA proposed using dilute sodium hypochlorous solution as a topical antiseptic forirrigation of wounds and as a mouth rinse. (7)
The value of mouthwashes is however controversial because most of the mouthwashes havetemporary antibacterial value and many disadvantages; Chlorhexidine is an essential componentin many available preparations because of its marked antiseptic qualities. One of the mostfrequent side effects is the appearance of stains on the teeth and mucous membranes. However, anew mouthwash containing Chlorhexidine with an anti discoloration system is available. Acomparative study was carried out on a sample or 15 patients treated with two mouthwashes bothcontaining (1.20~) chlorhex idinc but one lacked the anti discoloration agent. The results obtainedshowed that in the 15 patients treated, there was no statistically signi ficant di ffcreucc in theability or the mouthwash to prevent bacterial plaque, however evidence of the stain was muchless with the new mouthwash. (16) It has also been shown to cause build up of supra- gingivalcalculus and altering taste perception after use.
9
Listerine on the other hand, has been shown to cause drying out of the mucous membranes, bittertaste and a burning sensation. (7)
Most of the mouthwashes contain alcohol. Chronic use of alcohol has been associated withdevelopment of oral cancer. In view of the association between excessive ingestion of alcoholicbeverages and oral cancer, concerns have been raised about health risks associated with use ofalcohol containing mouthwash. It is recognized, however, that the risk or oral cancer associatedwith alcoholic beverages is related to certain carcinogens round in the beverage e.g. urethanerather than the alcohol. The findings from various studies are inconsistent but the most recentstudy among 342 people using mouthwashes in Puerto Rico found no overall risk or oral cancer.(17)
Although several studies have shown the role of mouthwashes in plaque control, there is overallscarcity of information regarding the dentists' knowledge or mouthwashes as agents of plaquecontrol. Although dentists have a major role in the maintenance or good oral health, it is evidentthat they rarely educate their patients on the role of mouthwashes in oral health. This has beendemonstrated by the knowledge gap that exists in the community. This study will be aimed atestablishing the dentists' knowledge and attitude towards mouthwashes and their uses.
10
PROBLEM STATEM EN'!'
Pcriodonral disease refers to any pathological process affecting the periodontal tissues. They aresome of the most prevalent oral diseases in Kenya and the world over.Microorganisms in dental plaque are the main aetiological factors of periodontal disease.
Mouthwashes are used as adjuncts to mechanical methods in the removal of dental plaque.Out 0 f the researchers own observation and Iiterature review, it has been noted that most dentistshave little knowledge on the important role of mouthwashes. This is because most dentists do notattend continuing dental education programmes and in this way they are not able to keep in touch\\ ith the latest developments in the field of dentistry regarding the use of mouthwashes. This hasled to a knowledge gap among dentists which has been eventually passed on to the community.This is because for dentists to educate the community on use of mouthwashes, they have to haveadequate knowledge and a positive attitude towards mouthwashes and their uses.
Ihere is, therefore a need to establish the dentists' current knowledge and attitude towardsmouth» ashes and their uses.
JUSTIFICATION OF STUDY
Many studies have been done worldwide to establish the role of mouthwashes in plaque control,however very little has been done in Kenya. Dentists have a major role to play in themaintenance of good oral hygiene in this country and by doing a study among them will enablethe researcher to investigate, analyze and establish the overall knowledge and attitude towardsmouthwashes and their uses.
The findings from the study may be used to formulate continuing dental health educationprogrammes for the dentists. Improved awareness among dentists will eventually enhance patienteducation on the role of mouthwashes as agents of plaque control. This will lead to an overallimprovement of the oral hygiene. The research will also fulfill part of the requirements for Illydegree ill Dental Surgery.
11
STUDY OBJECTIVES
\1 \ll\' ORrrCTrVr:
10 determine the kno« ledge or and attitude towards mouthwashes and their uses amongdental practitioners ill Nairobi and Mornbasa.
SPECIFTC OBJECTIVES:
I. To determine the knowledge on mouthwashes among dental practitioners
2. To determine the attitude of dental practitioners towards the use of mouthwashes
3. To describe the practices regarding mouthwash prescription.
HYPOTHESIS
I. All the dental practitioners in Nairobi know the active ingredients in the l.istcrinc andCh lorhex id ine mouthwashes ..·,\11the dental practitioners prescribe mouthwashes to more than 50lYc) or their patients.
3. More than C)O% of the dentists prescribe Listerine to their patients for routine use.4. Less than 3(Jlio or the dentists will recommend long- term Lise of mouthwashes.) 7()Oj, of the dental practitioners prescribe mouthwashes for gingivitis.6. All the dentists advice their patients to use mouthwashes twiee a day.
STUDY VARIABLES
Independent variables: -Gender of the dentists-Type of practice-The number of years in practice- Specialty of the dentist
Dependent variables: -Knowlcdge of the active ingredients of mouthwashes-Knowledge 0 f the various brands 0 f mouthwashes-A tti tude 0 f dentists' towards mouthwashes as agents 0 f plaq ue control
12
MATERIALS AND METHODS
Study areaThe study \\ ill be conducted in Nairobi and Mornbasa.
I airobi is the capital city or Kenya and also the largest commercial center in the country. It is ahome to many industries and institutions. The city holds the largest number or dentists both inthe pri , ate <'1I1dpublic sector including Kcnyaua National Hospital and University or Nairobidental hospital, \\ hich are the major teaching, and referral hospitals in Kenya.
Mombasa is a coastal town located approximately SOOkms from Nairobi. lt is a portal town alongthe Indian Ocean. It is a major tourist, commercial and industrial center. The Coast Provincialhospital is located in this town.
Study populationIt wil] include dentists practicing in Nairobi and Mombasa, both in the private and public
sectors.
Study designThis will be a descriptive cross-sectional study among dentists practicing in Nairobi andMornbasa.
Sample size determinationThe sample si-c will be computed from the formula;
1. n=~where n=sample si:«: before use of second formula
Sampling methodsA list of the location of dentists will be obtained from the Medical Practitioners and Dentistsboard and owing to the small number of dentists; all the dentists practicing in Nairobi andMornbasa will be interviewed.
Inclusion criteriaI. All dental practitioners, both in private and public practice.
Exclusion criteriaI. Dental practitioners who are not willing to participate in the study2. Dentists who arc not based in either Nairobi or Mornbasa3. Recent migrants to the study areas4. Dentists employed in other industries and therefore not engaged in clinical practice.
DATA COLLECTION INSTRUMENTS AND TECHNIQUES
Data collection instrumentsA self-administered questionnaire will be used to collect information on the knowledge andattitude towards mouthwashes and their uses among the dental practitioners.
Data collection TechniquesThe researcher will distribute the questionnaires among the dentists in Nairobi and collect themafter one week while questionnaires to Mornbasa will be distributed by an assistant then they willbe collected and mailed back.
Ethical considerationsI. The names of the dentists' will not be sought or recorded and the information in the
questionnaires will be treated with utmost confidentiality.2. The researcher wi II get approval from the Kenyatta National Hospital ethical committee
to collect data.
Expected problems:I. Misplacement of questionnaires by dentists2. Lack of time to distribute the questionnaires3. ldenti fying the location of various private clinics
14
Perceived benefits1. Partial fulfillment of the degree of dental surgery2. Assist the relevant authorities to establish the level of awareness of dentists on the use of
mouthwashes as agents of plaque control and the data can be used in the formulation ofdental health education programmes
3. This recent research information can be used to form the basis for future research onmouthwashes
Data analysis and PresentationData will be grouped according to the various variables and analyzed using the SPSSprogramme. The results will be presented in form of graphs, tables and charts.
15
BUDCET
PROPOSAL DEVELOPMENTITEM UNIT UNIT COST (Ksh)Stationery: J writing pad 50
3 pens 151 rubber 10
Diskettes 1
Internet services 1700 minutes
Typing charzesJ b b
Printing charges 30 pages
Photocopy 200 pages
Binding 1report
Miscellaneous
TOTAL
PROJECT BUDGETITEM UNITS
Stationerv 1writing pad3 pensJ rubber
Diskettes 2
Typing charges
Photocopy 150 pages
Binding 1 report
Miscellaneous
TOTAL
TOTAL (Ksh)50-1510
40 40
1per minute 1700
500
15 -150
2 400
300 300
200
3.695
UNIT COST (Ksh) TOTAL (Ksh)
50 5015 4510 10
40 80
500 500
2 300
300 300
500
1785
16
REFERENCES
1. Carranza F.A&Michael G. N: Textbook of Clinical Periodontology 8th edition, 1-4;
1996
2. Miyasaki N. P: Development of the Periodontal Index of Treatment Needs (CPITN);
International Dentistry Journal 41; 74-80;1991
3. Ciancio S.G; Yaffe S.J;Current Status of Indices of Gingivitis; Journal of Periodontal
Hygiene vo1.43,411-414:1972
4. Ira B. L;Michael C.A;Mia C. S:Microbiology of Plaque Associated Periodontal
Disease; Journal of Clinical Preventive Dentistry: 56-57:1983
5. Cawsons R.A;Essentials of Dental Surgery, 5th edition; 67-71:1991
6. Cawsons R.A;Essentials of Oral Pathology and Oral Medicine, 7th edition; 2002
7. Aregeth M.; Antimicrobial Effect of Chemical Agents on Periodontitis; American
Dental Association Guide to Dental Therapeutics; 19-23:2002
8. Ciancio S.G; Bartz N.W; Lauciello F.R;Aspects of Systemic Health; Journal of
1. How many years have passed since you qualified as a dentist?a) 1 -3 yearsb) 4-6 yearsc) 7-10 yearsd) More than 10 years
2. Have you heard about mouthwashes?a) Yesb) No
1
3. If yes what brands of mouthwashes are you aware of?a) Listerineb) Remidinc) Betadined) Plaxe) Oraldenef) Sonatecg) Others (specify) .
4. Which of the following is the active ingredient inA) Remidin mouthwash
a) Chlorhexidine digluconateb) Calcium hydroxidec) Essential oilsd) Hydrogen peroxide
B) Listerine mouthwasha) Stannous fluorideb) Povidine iodinec) Essential oils e.g. thymold) Normal saline
5. Do you prescribe mouthwashes to your patients?a) Yesb) No
6. Approximately what percent of your patients on a given day would you prescribemouthwashes to?a) Less thanf.O''b) 10%-3mt()c) 30(10-50(10d) More than 50%
7. For what conditions do you prescribe mouthwashes?a) Gingivitisb) Periodontitisc) Dental cariesd) Bad breathe) Abscessesf) Mouth ulcersg) Stomatitis (viral, fungal)h) Any other (specify) .
2
8. Do you have a particular brand that you prescribe to your patients?a) Yesb) No
If yes, which one do you commonly prescribe?a) Listerineb) Remidinc) Betadined) Oraldenee) Sonatecf) Plaxg) Others (specify) '" .
9.Why do you prefer that particular brand?a) It has pleasant tasteb) It has been shown by clinical trials to be effectivec) It is cheapd) It is easily availablee) Others (specify) .
10. Do you prescribe mouthwashes to all the patients witha) Gingivitis Yes Nob) Bad breath Yes Noc) Peridontitis Yes Nod) Dental caries Yes Noe) Mouth ulcers Yes Nof) Stomatitis (viral, fungal) Yes Nog) Others (specify) .
11. In your opinion, do you think mouthwashes have a role to playa) In the inhibition of plaque formationb) In the inhibition of gingival inflammationc) In the inhibition of chronic periodontitisd) To aid healing of mouth ulcerse) In the relief of discomfort from stomatitis conditionsg) All the above .
12. How many times per day do you advise your patients to use the mouthwash?a) Onceb) Twicec) Thriced) Others (specify) .
13. When do you advise your patients to use a mouthwash?a) Before brushingb) During brushingc) After brushingd) Others (specify) .
14. Do you think mouthwashes should be used routinely?a) Yesb) No
If no, why not?a) They have side effectsb) They change taste perceptionc) They cause cancerd) They cause allergic reactionse) All the abovef) Others (specify) .
15. Is long - term use of mouthwashes safe?a) Yesb) No
A) If yes, which mouthwash would you recommend for long -term use?a) Listerineb) Remidinc) Betadined) Oraldenee) Plaxf) Sonatecg) Others (specify) .
B) If no, why not?a) They cause oral cancerb) They leave extrinsic stains on the tooth surfacec) They cause supragingival calculusd) All the abovee) Others (specify) .
