BACKGROUND: Ensuring the safety of dental unit waterlines (DUWLs) has become a pivotal issue in dental care practices, focusing on the health implications for both patients and healthcare providers. The inherent structure and usage conditions of DUWLs contribute to the risk of biofilm formation and bacterial growth, highlighting the need for effective disinfection solutions.The quest for a disinfection method that is both safe for clinical use and effective against pathogens such as Staphylococcus aureus and Escherichia coli in DUWLs underscores the urgency of this research.
METHODS: Chlorine dioxide disinfectants at concentrations of 5, 20, and 80 mg/L were used to treat biofilms of S. aureus and E. coli cultured in DUWLs. The disinfection effectiveness was assessed through bacterial counts and culturing. Simultaneously, human skin fibroblast cells were treated with the disinfectant to observe changes in cell morphology and cytotoxicity. Additionally, the study included corrosion tests on various metals (carbon steel, brass, stainless steel, aluminum, etc.).
RESULTS: Experimental results showed that chlorine dioxide disinfectants at concentrations of 20 mg/L and 80 mg/L significantly reduced the bacterial count of S. aureus and E. coli, indicating effective disinfection. In terms of cytotoxicity, higher concentrations were more harmful to cellular safety, but even at 80 mg/L, the cytotoxicity of chlorine dioxide remained within controllable limits. Corrosion tests revealed that chlorine dioxide disinfectants had a certain corrosive effect on carbon steel and brass, and the degree of corrosion increased with the concentration of the disinfectant.
CONCLUSIONS: After thorough research, we recommend using chlorine dioxide disinfectant at a concentration of 20 mg/L for significantly reducing bacterial biofilms in dental unit waterlines (DUWLs). This concentration also ensures satisfactory cell safety and metal corrosion resistance.

Lignin is a polymer with a complex structure. It is widely present in lignocellulosic biomass, and it has a variety of functional group substituents and linkage forms. Especially during the oxidation reaction, the positioning effect of the different substituents of the benzene ring leads to differences in lignin reactivity. The position of the benzene ring branched chain with respect to methoxy is important. The study of the effect of benzene substituents on the oxidation reaction\'s activity is still an unfinished task. In this study, density functional theory (DFT) and the m062x/6-311+g (d) basis set were used. Differences in the processes of phenolic oxygen intermediates formed by phenolic lignin structures (with different substituents) with chlorine dioxide during the chlorine dioxide reaction were investigated. Six phenolic lignin model species with different structures were selected. Bond energies, electrostatic potentials, atomic charges, Fukui functions and double descriptors of lignin model substances and reaction energy barriers are compared. The effects of benzene ring branched chains and methoxy on the mechanism of chlorine dioxide oxidation of lignin were revealed systematically. The results showed that the substituents with shorter branched chains and strong electron-absorbing ability were more stable. Lignin is not easily susceptible to the effects of chlorine dioxide. The substituents with longer branched chains have a significant effect on the flow of electron clouds. The results demonstrate that chlorine dioxide can affect the electron arrangement around the molecule, which directly affects the electrophilic activity of the molecule. The electron-absorbing effect of methoxy leads to a low dissociation energy of the phenolic hydroxyl group. Electrophilic reagents are more likely to attack this reaction site. In addition, the stabilizing effect of methoxy on the molecular structure of lignin was also found.

The aim of this study was to perform a positive-controlled field study under natural exposure conditions to test the efficacy of a newly developed chlorine dioxide-based postmilking teat disinfectant (experimental product, EX) for noninferiority compared with an already established chlorine dioxide-based teat disinfectant (positive control product, PC). After blocking by parity, approximately 200 Holstein cows in early to mid-lactation stages from a dairy farm near Padua, Italy, were randomly assigned to one of 2 groups. Over a 13-wk period between September and December 2021, the teats of cows were dipped with the EX or the PC after each milking. Milk samples were collected from individual quarters of enrolled cows for 13 wk to determine infection status. Teat condition was assessed at wk 1, 5, and 9. Mixed logistic regression was used to analyze the effect of treatment on the incidence of new intramammary infections. For the noninferiority analysis, the upper limit of the 95% confidence interval for the difference in new intramammary infection (NIMI) rate between the 2 treatments (EX - PC) had to be to the left of the critical value d (0.035) to conclude that EX was noninferior to PC in terms of the risk of NIMI. The results showed that the incidence of new infections in the quarters treated with EX (3.1%) was not different from that in the udder quarters treated with PC (2.6%). No overall difference was found between the treatments in terms of teat condition. As the upper limit of the 95% confidence interval of the NIMI rate difference was smaller than the predefined noninferiority limit, we concluded that the EX was noninferior compared with the PC.

BACKGROUND: The COVID-19 pandemic has prompted the increasing popularity of several emerging therapies or preventives that lack scientific evidence or go against medical directives. One such therapy involves the consumption of chlorine dioxide, which is commonly used in the cleaning industry and is available commercially as a mineral solution. This substance has been promoted as a preventive or treatment agent for several diseases, including SARS-CoV-2 infection. As interest in chlorine dioxide has grown since the start of the pandemic, health agencies, institutions, and organizations worldwide have tried to discourage and restrict the consumption of this substance.
OBJECTIVE: The aim of this study is to analyze search engine trends in Mexico to evaluate changes in public interest in chlorine dioxide since the beginning of the COVID-19 pandemic.
METHODS: We retrieved public query data for the Spanish equivalent of the term \"chlorine dioxide\" from the Google Trends platform. The location was set to Mexico, and the time frame was from March 3, 2019, to February 21, 2021. A descriptive analysis was performed. The Kruskal-Wallis and Dunn tests were used to identify significant changes in search volumes for this term between four consecutive time periods, each of 13 weeks, from March 1, 2020, to February 27, 2021.
RESULTS: From the start of the pandemic in Mexico (February 2020), an upward trend was observed in the number of searches compared with that in 2019. Maximum volume trends were recorded during the week of July 19-25, 2020. The search volumes declined between September and November 2020, but another peak was registered in December 2020 through February 2021, which reached a maximum value on January 10. Percentage change from the first to the fourth time periods was +312.85, -71.35, and +228.18, respectively. Pairwise comparisons using the Kruskal-Wallis and Dunn tests showed significant differences between the four periods (P<.001).
CONCLUSIONS: Misinformation is a public health risk because it can lower compliance with the recommended measures and encourage the use of therapies that have not been proven safe. The ingestion of chlorine dioxide presents a danger to the population, and several adverse reactions have been reported. Programs should be implemented to direct those interested in this substance to accurate medical information.

To compare the efficiency, ease of use and user satisfaction of two methods of transvaginal ultrasound probe high-level disinfection: ultraviolet-C radiation (UV-C) and a chlorine dioxide multistep wipe system.
This was a prospective survey study. UV-C units were introduced into a busy early pregnancy assessment service and compared with a multiwipe system for disinfection. Before seeing each patient, healthcare professionals (HCPs) measured with a stopwatch the time taken to complete a cycle of disinfection using either UV-C or chlorine dioxide multistep wipes and responded to a quick-response (QR) code-linked survey. Additional essential tasks that could be completed before seeing the next patient during probe disinfection were also documented. Using another QR code-linked survey, data on ease of use, satisfaction with the system used and preferred system were collected. The ease of use and satisfaction with the system were rated on a 0 to 10 Likert scale (0 poor, 10 excellent). A free-text section for comments was then completed.
Disinfection using UV-C (n = 331) was 60% faster than the chlorine dioxide multiwipe system (n = 332) (101 vs 250 s; P < 0.0001). A greater number of tasks were completed during probe disinfection when using UV-C, saving a further 74 s per patient (P < 0.0001). The HCPs using UV-C (n = 71) reported greater ease of use (median Likert score, 10 vs 3; P < 0.0001) and satisfaction (median Likert score, 10 vs 2; P < 0.0001) compared with those using the multiwipe system (n = 43). HCPs reported that the chlorine dioxide system was time-consuming and environmentally unfriendly, while the UV-C system was efficient and easy to use. Overall, 98% of the HCPs preferred using the UV-C system.
UV-C technology is more time-efficient and allows more essential tasks to be completed during disinfection. For a 4-h ultrasound list of 15 patients, the use of UV-C would save 55 min 45 s. HCPs found UV-C preferable and easier to use. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

OBJECTIVE: To compare the effectiveness of chlorine dioxide, chlorhexidine and placebo sprays in improving oral hygiene among institutionalised elders.
BACKGROUND: Available evidence suggests that oral sprays may be an effective alternative delivery method for plaque control; however, few studies have evaluated antimicrobial agents other than chlorhexidine.
METHODS: A total of 228 elders across 11 nursing homes in Hong Kong were recruited into the clinical trial. Participants were randomly allocated into one of the following groups: 0.1% pH-balanced chlorine dioxide spray, 0.2% chlorhexidine spray or sterile water spray (placebo control), once daily. Dental plaque, gingival bleeding and other clinical oral health outcomes were assessed at baseline, 3 and 6 months. Participant acceptability of the interventions was assessed at the end of the clinical trial.
RESULTS: Review assessments were conducted for 135 elders at 6 months. Significantly greater reductions in plaque index scores were observed with the chlorhexidine spray (0.4) and chlorine dioxide spray (0.3) than the placebo spray (0.1). While significant reductions in gingival bleeding scores were observed within the chlorhexidine (7.4), chlorine dioxide (7.5) and placebo (5.3) sprays after 6 months, change scores were not significantly different between groups. Significantly greater increases in the levels of staining were observed in the chlorhexidine spray group (-0.1) than the chlorine dioxide (0.0) and placebo spray (0.0) groups.
CONCLUSIONS: Antimicrobial sprays were shown to be effective among institutionalised elders. Chlorine dioxide spray showed equivalent effects on dental plaque and gingival bleeding relative to the chlorhexidine spray over a 6-month period.

BACKGROUND: Chlorine dioxide (ClO2 ) is an inorganic, potent biocide and is available in highly purified aqueous solution. It can be administered as an oral antiseptic in this form.
OBJECTIVE: Our aim is to determine the level of inflammatory markers and cytochrome genes expressed by enterocytes exposed to different concentrations of hyperpure chlorine dioxide solution.
METHODS: Porcine jejunal enterocyte cell (IPEC-J2) cultures were treated with the aqueous solution of hyper-pure chlorine dioxide of various concentrations. We determined the alterations in mRNA levels of inflammatory mediators, such as IL6, CXCL8/IL8, TNF, HSPA6 (Hsp70), CAT and PTGS2 (COX2); furthermore, the expression of three cytochrome genes (CYP1A1, CYP1A2, CYP3A29) were analysed by quantitative PCR method.
RESULTS: The highest applied ClO2 concentration reduced the expression of all three investigated CYP genes. The gene expression of PTGS2 and CAT were not altered by most concentrations of ClO2 . The expression of IL8 gene was reduced by all applied concentrations of ClO2 . TNF mRNA level was also decreased by most ClO2 concentrations used.
CONCLUSIONS: Different concentrations of chlorine dioxide exhibited immunomodulatory activity and caused altered transcription of CYP450 genes in porcine enterocytes. Further studies are needed to determine the appropriate ClO2 concentration for oral use in animals.

The use of antimicrobials in the pork industry is critical in order to ensure food safety and, at the same time, extend shelf life. The objective of the study was to determine the impact of antimicrobials on indicator bacteria on pork loins under long, dark, refrigerated storage conditions. Fresh boneless pork loins (n = 36) were split in five sections and treated with antimicrobials: Water (WAT), Bovibrom 225 ppm (BB225), Bovibrom 500 ppm (BB500), Fit Fresh 3 ppm (FF3), or Washing Solution 750 ppm (WS750). Sections were stored for 1, 14, 28, and 42 days at 2-4 °C. Mesophilic and psychrotrophic aerobic bacteria (APC-M, APC-P), lactic acid bacteria (LAB-M), coliforms, and Escherichia coli were enumerated before intervention, after intervention, and at each storage time. All bacterial enumeration data were converted into log10 for statistical analysis, and the Kruskal-Wallis test was used to find statistical differences (p < 0.05). Initial counts did not differ between treatments, while, after treatment interventions, treatment WS750 did not effectively reduce counts for APC-M, APC-P, and coliforms (p < 0.01). BB500, FF3, and WS750 performed better at inhibiting the growth of indicator bacteria when compared with water until 14 days of dark storage.

OBJECTIVE: Periodontal ligament stem cells (PDLSCs) have an underlined significance as their high proliferative capacity and multipotent differentiation provide an important therapeutic potential. The integrity of these cells is frequently disturbed by the routinely used irrigative compounds applied as periodontal or endodontic disinfectants (e.g., hydrogen peroxide (H2O2) and chlorhexidine (CHX)). Our objectives were (i) to monitor the cytotoxic effect of a novel dental irrigative compound, chlorine dioxide (ClO2), compared to two traditional agents (H2O2, CHX) on PDLSCs and (ii) to test whether the aging factor of PDLSC cultures determines cellular responsiveness to the chemicals tested.
METHODS: Impedimetry (concentration-response study), WST-1 assays (WST = water soluble tetrazolium salt), and morphology analysis were performed to measure changes in cell viability induced by the 3 disinfectants; immunocytochemistry of stem cell markers (STRO-1, CD90, and CD105) measured the induced mesenchymal characteristics.
RESULTS: Cell viability experiments demonstrated that the application of ClO2 does not lead to a significant decrease in viability of PLDSCs in concentrations used to kill microbes. On the contrary, traditional irrigants, H2O2, and CHX are highly toxic on PDLSCs. Aging of PLDSC cultures (passages 3 vs. 7) has characteristic effects on their responsiveness to these agents as the increased expression of mesenchymal stem cell markers turns to decreased.
CONCLUSIONS: While the active ingredients of mouthwash (H2O2, CHX) applied in endodontic or periodontitis management have a serious toxic effect on PDLSCs, the novel hyperpure ClO2 is less toxic providing an environment favoring dental structure regenerations during disinfectant interventions.

Chlorine dioxide (ClO2) has been widely used as an effective disinfectant to control fungal contamination during postharvest crop storage. In this study, Fusarium oxysporum f. sp. batatas SP-f6 from the black rot symptom of sweetpotato was isolated and identified using phylogenetic analysis of elongation factor 1-α gene; we further examined the in vitro and in vivo inhibitory activities of ClO2 gas against the fungus. In the in vitro medium tests, fungal population was significantly inhibited upon increasing the concentration and exposure time. In in vivo tests, spore suspensions were drop-inoculated onto sweetpotato slices, followed by treatment using various ClO2 concentrations and treatment times to assess fungus-induced disease development in the slices. Lesion diameters decreased at the tested ClO2 concentrations over time. When sweetpotato roots were dip-inoculated in spore suspensions prior to treatment with 20 and 40 ppm of ClO2 for 0-60 min, fungal populations significantly decreased at the tested concentrations for 30-60 min. Taken together, these results showed that ClO2 gas can effectively inhibit fungal growth and disease development caused by F. oxysporum f. sp. batatas on sweetpotato. Therefore, ClO2 gas may be used as a sanitizer to control this fungus during postharvest storage of sweetpotato.