Original Research

Year : 2025 | Volume : 16 | Issue : 3 | Page : 64-81

Comparing the Efficacy Of Riboflavin and Chlorhexidine Varnish in Controlling Oral Microflora in Orthodontic Patients – A Randomized Controlled Trial

      Sobika Sudhakar,1 Sumanth Rangarajan,2 Ramasamy M,2 Thrivikhraman K,3 Haritha Prakriti Bose C,3 Pavithra Devi S,3

1-Postgraduate Resident, 2-Professor, 3-Assistant Professor, Department of Orthodontics and Dentofacial Orthopaedics,
Sri Venkateswara Dental College and Hospital (Affiliated to The Tamilnadu Dr.M.G.R Medical University), Chennai, Tamil Nadu, India

Address for Correspondence:

Dr. Sobika Sudhakar

Postgraduate Resident,

Department of Orthodontics and Dentofacial Orthopaedics,

Sri Venkateswara Dental College and Hospital,

(Affiliated to The Tamilnadu Dr.M.G.R Medical University)

Chennai, Tamil Nadu, India
Email: sobikaortho@gmail.com

ABSTRACT

Background: The occurrence of white spot lesions (WSL) seems to be unavoidable during orthodontic treatment. Maintaining proper oral hygiene can be difficult for individuals with fixed orthodontic appliances. Traditional antimicrobials, such as chlorhexidine, have certain drawbacks, side effects and potential for resistance. The present study investigates a novel approach known as Antimicrobial Photodynamic Therapy (APDT) to evaluate its effectiveness in decreasing bacterial load and the duration of effectiveness.

Aim: To compare the efficacy of 0.2% chlorhexidine varnish, riboflavin-mediated photodynamic therapy, and riboflavin + sodium dodecyl sulfate (SDS)-mediated photodynamic therapy in reducing the bacterial colony count across different time periods, and to validate the effectiveness of the compound by assessing the live and dead cells using confocal laser scanning microscopy. (CLSM)

Materials and Methods: Thirty participants undergoing fixed orthodontic treatment were randomized into three groups (n = 10 each): 0.2% CHX, Riboflavin-APDT (PDT), and Riboflavin + SDS-APDT (PDT+S). Treatments were performed weekly for 4 weeks. Plaque samples were collected at baseline (T0), 30 days (T1), and 2 months (T2). Microbial colony counts were assessed at various time intervals. To validate the microbial analysis, representative samples were collected, coated on sterilized brackets and analyzed using CLSM to evaluate the status of cells and viability of biofilm.

Results: Intra-group analysis revealed significant reductions in S. mutans and L. acidophilus from baseline to T1 across all groups, with Riboflavin showing a more sustained effect. Riboflavin-surfactant group exhibited minimal variation, suggesting a delayed yet stable response. Inter-group differences were significant at T1, especially between Riboflavin-surfactant and others, but diminished by T2. For L. acidophilus, the combination therapy achieved greater reduction than control at both T1 and T2.The CLSM results indicate that Riboflavin group showed reduced biofilm viability (13.28%) compared to CHX (22.51%) and PDT+S (40.90%). At T2, bacterial rebound was noted in all groups, most prominently in the CHX group. SDS addition did not improve efficacy.

Conclusion: Riboflavin- and Riboflavin–surfactant–mediated APDT effectively reduced S. mutans and L. acidophilus in orthodontic patients. Riboflavin produced a more sustained effect, while the surfactant combination achieved a delayed but significant reduction, particularly for L. acidophilus. Despite microbial rebound at T2, both therapies maintained lower bacterial counts than control, highlighting riboflavin-mediated APDT as a safe and promising adjunct for bacterial control during orthodontic treatment.

Keywords: Riboflavin; Photodynamic therapy; Chlorhexidine; Orthodontic biofilm; Confocal Laser Scanning Microscopy (CLSM); Streptococcus mutans; Lactobacillus acidophilus.

SOURCE OF FUNDING

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

ACKNOWLEDGMENTS

The authors gratefully acknowledge the cooperation of the participating patients and their parents.

PRIOR PRESENTATION

This manuscript has not been previously published or presented at any conference.

CONFLICTS OF INTEREST

The authors declare no conflicts of interest related to this manuscript.

ETHICAL APPROVAL

Institutional ethical clearance was obtained prior to the study. Informed consent was acquired from parents/guardians.
How to cite this article:Sobika Sudhakar, Sumanth Rangarajan, Ramasamy M, Thrivikhraman K, Haritha Prakriti Bose C, Pavithra Devi S.Comparing the Efficacy Of Riboflavin and Chlorhexidine Varnish inControlling Oral Microflorain Orthodontic Patients – A Randomized Controlled Trial.IntJOrthodRehabil2025;16(3):64-81.