Short-term effects of Chlorhexidine mouthwash and Listerine on oral microbiome in hospitalized patients

Tsunglin Liu; Yen-Chin Chen; Shuen-Lin Jeng; Jui-Jen Chang; Jiu-Yao Wang; Cheng-Han Lin; Pei-Fang Tsai; Nai-Ying Ko; Wen-Chien Ko; Jiun-Ling Wang

doi:10.3389/fcimb.2023.1056534

Short-term effects of Chlorhexidine mouthwash and Listerine on oral microbiome in hospitalized patients

Front Cell Infect Microbiol. 2023 Feb 2:13:1056534. doi: 10.3389/fcimb.2023.1056534. eCollection 2023.

Authors

Tsunglin Liu¹, Yen-Chin Chen^{2

3}, Shuen-Lin Jeng⁴, Jui-Jen Chang⁵, Jiu-Yao Wang⁶, Cheng-Han Lin⁶, Pei-Fang Tsai⁷, Nai-Ying Ko^{2

3}, Wen-Chien Ko^{8

9}, Jiun-Ling Wang^{8

9}

Affiliations

¹ Department of Biotechnology and Bioindustry Sciences, National Cheng Kung University, Tainan, Taiwan.
² Department of Nursing, National Cheng Kung University Hospital, Tainan, Taiwan.
³ Department of Nursing, National Cheng Kung University, Tainan, Taiwan.
⁴ Department of Statistics, Institute of Data Science, Center for Innovative FinTech Business Models, National Cheng Kung University, Tainan, Taiwan.
⁵ Graduate Institute of Integrated Medicine, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
⁶ Center of Allergy, Immunology and Microbiome (AIM), Department of Allergy and Immunology, China Medical University Children's Hospital, Taichung, Taiwan.
⁷ Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁸ Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
⁹ Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

Abstract

Introduction: Chlorhexidine (CHX) and essential oil containing mouthwashes like Listerine^® can improve oral hygiene via suppressing oral microbes. In hospitalized patients, CHX mouthwash reduces the incidence of ventilator-associated pneumonia. However, CHX use was also associated with increased mortality, which might be related to nitrate-reducing bacteria. Currently, no study determines oral bacteria targeted by essential oils mouthwash in hospitalized patients using a metagenomic approach.

Methods: We recruited 87 hospitalized patients from a previous randomized control study, and assigned them to three mouthwash groups: CHX, Listerine, and normal saline (control). Before and after gargling the mouthwash twice a day for 5-7 days, oral bacteria were examined using a 16S rDNA approach.

Results: Alpha diversities at the genus level decreased significantly only for the CHX and Listerine groups. Only for the two groups, oral microbiota before and after gargling were significantly different, but not clearly distinct. Paired analysis eliminated the substantial individual differences and revealed eight bacterial genera (including Prevotella, Fusobacterium, and Selenomonas) with a decreased relative abundance, while Rothia increased after gargling the CHX mouthwash. After gargling Listerine, seven genera (including Parvimonas, Eubacterium, and Selenomonas) showed a decreased relative abundance, and the magnitudes were smaller compared to the CHX group. Fewer bacteria targeted by Listerine were reported to be nitrate-reducing compared to the CHX mouthwash.

Discussion: In conclusion, short-term gargling of the CHX mouthwash and Listerine altered oral microbiota in our hospitalized patients. The bacterial genera targeted by the CHX mouthwash and Listerine were largely different and the magnitudes of changes were smaller using Listerine. Functional alterations of gargling CHX and Listerine were also different. These findings can be considered for managing oral hygiene of hospitalized patients.

Keywords: Chlorhexidine; Listerine antiseptic mouth rinse; essential oil; mouthwash; oral microbiome.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Bacteria
Chlorhexidine*
Humans
Microbiota*
Mouthwashes
Nitrates

Substances

Chlorhexidine
Mouthwashes
Listerine
Nitrates

Grants and funding

This research was supported in part by Higher Education Sprout Project, Ministry of Education to the Headquarters of University Advancement at National Cheng Kung University (NCKU), and Ministry of Science, Taiwan MOST 110-2314-B-006 -093 -MY2 and MOST 110-2221-E-006-142-MY2.