Effectiveness Of Chlorhexidine Oral Rinse In Preventing Plaque Accumulation And Gingivitis In Patients Undergoing Orthodontic Treatment- A Systematic Review And Meta Analysis.
Abstract
Aim: The aim of this review was to systematically assess and report the effectiveness of chlorhexidine (CHX) mouthwash in preventing plaque accumulation and gingivitis in patients undergoing orthodontic treatment.
Material and Methods: The review was prepared according to the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines and registered under PROSPERO database (CRD42020170776). Four electronic databases were systematically searched along with a complimentary manual search of orthodontic journals until June 2022. Only Randomized Control Trials (RCTs) reporting on antiplaque and antigingivitis efficacy of Chlorhexidine mouthwash compared with placebo or control in orthodontic patients were included. Risk of bias assessment was done using Cochrane ROB-2. Quantitative analysis (Random-Effects Model and Standard Mean Difference (SMD)) with 95 % confidence interval was used.
Results: Six RCTs were included for qualitative analysis and four were included for quantitative analysis with a total of 211 participants. Out of six studies, 3 were judged to have a low risk of bias, two had some concerns and one of them had high risk of bias. Random effects meta-analysis performed for anti-plaque effect reported a significant reduction of -1.2 SMD for CHX at 4 to 6 weeks with low heterogeneity (I2-35%). The anti-gingivitis effect at 4 to 6 weeks was significant for CHX with a SMD of -1.03 and a moderate heterogeneity (I2-65%).
Conclusion: On analyzing the available evidence a moderate level of certainty supports a short-term reduction in plaque accumulation and gingivitis in orthodontic patients subjected to rinsing with chlorhexidine oral rinse.
References
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[21] Brightman LJ, Terezhalmy GT, Greenwell H, Jacobs M, Enlow DH. The effects of a 0.12% chlorhexidine gluconate mouthrinse on orthodontic patients aged 11 through 17 with established gingivitis. Am J Orthod Dentofacial Orthop. 1991 Oct;100(4):324-9. doi: 10.1016/0889-5406(91)70069-9. PMID: 1927982.
[22] Nelson-Filho P, Valdez RM, Andrucioli MC, Saraiva MC, Feres M, Sorgi CA, Faccioli LH. Gram-negative periodontal pathogens and bacterial endotoxin in metallic orthodontic brackets with or without an antimicrobial agent: an in-vivo study. Am J Orthod Dentofacial Orthop. 2011 Dec;140(6):e281-7. doi: 10.1016/j.ajodo.2011.06.026. PMID: 22133962.
[23] Goes P, Dutra CS, Lisboa MR, Gondim DV, Leitão R, Brito GA, Rego RO. Clinical efficacy of a 1% Matricaria chamomile L. mouthwash and 0.12% chlorhexidine for gingivitis control in patients undergoing orthodontic treatment with fixed appliances. J Oral Sci. 2016;58(4):569-574. doi: 10.2334/josnusd.16-0280. PMID: 28025442.
[24] Anderson GB, Bowden J, Morrison EC, Caffesse RG. Clinical effects of chlorhexidine mouthwashes on patients undergoing orthodontic treatment. Am J Orthod Dentofacial Orthop. 1997 Jun;111(6):606-12. doi: 10.1016/s0889-5406(97)70312-3. PMID: 9199591.
[25] Nelson-Filho P, Carpio-Horta KO, Andrucioli MC, Feres M, Bezerra da Silva RA, Garcia Paula-Silva FW, Romano FL. Molecular detection of Aggregatibacter actinomycetemcomitans on metallic brackets by the checkerboard DNA-DNA hybridization technique. Am J Orthod Dentofacial Orthop. 2012 Oct;142(4):481-6. doi: 10.1016/j.ajodo.2012.04.021. PMID: 22999671.
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[29] Sobouti F, Rakhshan V, Heydari M, Keikavusi S, Dadgar S, Shariati M. Effects of fixed orthodontic treatment and two new mouth rinses on gingival health: A prospective cohort followed by a single-blind placebo-controlled randomized clinical trial. Int Orthod. 2018;16(1):12-30. doi: 10.1016/j.ortho.2018.01.027. Epub 2018 Feb 23. PMID: 29478929.
[30] Solís C, Santos A, Nart J, Violant D. 0.2% chlorhexidine mouthwash with an antidiscoloration system versus 0.2% chlorhexidine mouthwash: a prospective clinical comparative study. J Periodontol. 2011;82(1):80-5. doi: 10.1902/jop.2010.100289. Epub 2010 Jul 27. PMID: 20653433.
[31] James P, Worthington HV, Parnell C, Harding M, Lamont T, Cheung A, Whelton H, Riley P. Chlorhexidine mouthrinse as an adjunctive treatment for gingival health. Cochrane Database Syst Rev. 2017;3(3):CD008676. doi: 10.1002/14651858.CD008676.pub2. PMID: 28362061; PMCID: PMC6464488.
[32] Jacob B, Nivedhitha MS. Comparative Assessment of the Antibacterial Efficacy of Natural Products and Chlorhexidine Mouthwash against Streptococcus Mutans: A Systematic Review. J Clin Diag Res. 2018; 12(12): ZE01-ZE07.
[33] Kapoor D, Kaur N, Nanda T. Efficacy of two different concentrations of chlorhexidine mouth-rinse on plaque re-growth. Indian J Dent. 2011; 2: 11–15.
[34] Afennich F, Slot DE, Hossainian N, Van der Weijden GA. The effect of hexetidine mouthwash on the prevention of plaque and gingival inflammation: a systematic review. Int J Dent Hyg. 2011 Aug;9(3):182-90. doi: 10.1111/j.1601-5037.2010.00478.x. Epub 2010 Sep 6. PMID: 21356020.
[35] Jassoma E, Baeesa L, Sabbagh H. The antiplaque/anticariogenic efficacy of Salvadora persica (Miswak) mouthrinse in comparison to that of chlorhexidine: a systematic review and meta-analysis. BMC Oral Health. 2019 Apr 27;19(1):64. doi: 10.1186/s12903-019-0741-5. PMID: 31029127; PMCID: PMC6486980.
[36] Al-Maweri SA, Nassani MZ, Alaizari N, Kalakonda B, Al-Shamiri HM, Alhajj MN, Al-Soneidar WA, Alahmary AW. Efficacy of aloe vera mouthwash versus chlorhexidine on plaque and gingivitis: A systematic review. Int J Dent Hyg. 2020 Feb;18(1):44-51. doi: 10.1111/idh.12393. Epub 2019 Mar 25. PMID: 30829440.
[2] Zachrisson BU, Zachrisson S. Gingival condition associated with partial orthodontic treatment. Acta Odontol Scand. 1972 Mar;30(1):127-36. doi: 10.3109/00016357209004597. PMID: 4504433.
[3] Zachrisson BU. Periodontal condition in orthodontically treated and untreated individuals. American Journal of Orthodontics 1974; 65(4): 435. doi.org/10.1016/0002-9416(74)90282-6.
[4] Zachrisson BU, Alnaes L. Periodontal condition in orthodontically treated and untreated individuals. II. Alveolar bone loss: radiographic findings. Angle Orthod. 1974 Jan;44(1):48-55. doi: 10.1043/0003-3219(1974)044<0048:PCIOTA>2.0.CO;2. PMID: 4520950.
[5] Ristic M, Vlahovic Svabic M, Sasic M, Zelic O. Clinical and microbiological effects of fixed orthodontic appliances on periodontal tissues in adolescents. Orthod Craniofac Res. 2007 Nov;10(4):187-95. doi: 10.1111/j.1601-6343.2007.00396.x. PMID: 17973685.
[6] Paolantonio M, Festa F, di Placido G, D'Attilio M, Catamo G, Piccolomini R. Site-specific subgingival colonization by Actinobacillus actinomycetemcomitans in orthodontic patients. Am J Orthod Dentofacial Orthop. 1999 Apr;115(4):423-8. doi: 10.1016/s0889-5406(99)70263-5. PMID: 10194288.
[7] Sinclair PM, Berry CW, Bennett CL, Israelson H. Changes in gingiva and gingival flora with bonding and banding. Angle Orthod. 1987 Oct;57(4):271-8. doi: 10.1043/0003-3219(1987)057<0271:CIGAGF>2.0.CO;2. PMID: 3479031.
[8] Gunsolley JC. A meta-analysis of six-month studies of antiplaque and antigingivitis agents. J Am Dent Assoc. 2006 Dec;137(12):1649-57. doi: 10.14219/jada.archive.2006.0110. PMID: 17138709.
[9] Paraskevas S. Randomized controlled clinical trials on agents used for chemical plaque control. Int J Dent Hyg. 2005 Nov;3(4):162-78. doi: 10.1111/j.1601-5037.2005.00145.x. PMID: 16451305.
[10] James P, Worthington HV, Parnell C, Harding M, Lamont T, Cheung A, Whelton H, Riley P. Chlorhexidine mouthrinse as an adjunctive treatment for gingival health. Cochrane Database Syst Rev. 2017 Mar 31;3(3):CD008676. doi: 10.1002/14651858.CD008676.pub2. PMID: 28362061; PMCID: PMC6464488.
[11] Jones CG. Chlorhexidine: is it still the gold standard? Periodontol 2000. 1997 Oct;15:55-62. doi: 10.1111/j.1600-0757.1997.tb00105.x. PMID: 9643233.
[12] Davies A. The mode of action of chlorhexidine. J Periodontal Res Suppl. 1973;12:68-75. doi: 10.1111/j.1600-0765.1973.tb02167.x. PMID: 4269603.
[13] Brecx M, Theilade J. Effect of chlorhexidine rinses on the morphology of early dental plaque formed on plastic film. J Clin Periodontol. 1984 Oct;11(9):553-64. doi: 10.1111/j.1600-051x.1984.tb00908.x. PMID: 6593327.
[14] García-Caballero L, Quintas V, Prada-López I, Seoane J, Donos N, Tomás I. Chlorhexidine substantivity on salivary flora and plaque-like biofilm: an in situ model. PLoS One. 2013 Dec 27;8(12):e83522. doi: 10.1371/journal.pone.0083522. PMID: 24386220; PMCID: PMC3873939.
[15] Puig Silla M, Montiel Company JM, Almerich Silla JM. Use of chlorhexidine varnishes in preventing and treating periodontal disease. A review of the literature. Med Oral Patol Oral Cir Bucal. 2008 Apr 1;13(4):E257-60. PMID: 18379452.
[16] Emilson CG. Susceptibility of various microorganisms to chlorhexidine. Scand J Dent Res. 1977 May;85(4):255-65. doi: 10.1111/j.1600-0722.1977.tb00561.x. PMID: 266752.
[17] Matthijs S, Adriaens PA. Chlorhexidine varnishes: a review. J Clin Periodontol. 2002 Jan;29(1):1-8. doi: 10.1034/j.1600-051x.2002.290101.x. PMID: 11846842.
[18] Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, Cates CJ, Cheng HY, Corbett MS, Eldridge SM, Emberson JR, Hernán MA, Hopewell S, Hróbjartsson A, Junqueira DR, Jüni P, Kirkham JJ, Lasserson T, Li T, McAleenan A, Reeves BC, Shepperd S, Shrier I, Stewart LA, Tilling K, White IR, Whiting PF, Higgins JPT. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019 Aug 28;366:l4898. doi: 10.1136/bmj.l4898. PMID: 31462531.
[19] Shah SS, Nambiar S, Kamath D, Suman E, Unnikrishnan B, Desai A, Mahajan S, Dhawan KK. Comparative Evaluation of Plaque Inhibitory and Antimicrobial Efficacy of Probiotic and Chlorhexidine Oral Rinses in Orthodontic Patients: A Randomized Clinical Trial. Int J Dent. 2019 Feb 20;2019:1964158. doi: 10.1155/2019/1964158. PMID: 30930947; PMCID: PMC6410424.
[20] Sobouti F, Rakhshan V, Heydari M, Keikavusi S, Dadgar S, Shariati M. Effects of fixed orthodontic treatment and two new mouth rinses on gingival health: A prospective cohort followed by a single-blind placebo-controlled randomized clinical trial. Int Orthod. 2018 Mar;16(1):12-30. doi: 10.1016/j.ortho.2018.01.027. Epub 2018 Feb 23. PMID: 29478929.
[21] Brightman LJ, Terezhalmy GT, Greenwell H, Jacobs M, Enlow DH. The effects of a 0.12% chlorhexidine gluconate mouthrinse on orthodontic patients aged 11 through 17 with established gingivitis. Am J Orthod Dentofacial Orthop. 1991 Oct;100(4):324-9. doi: 10.1016/0889-5406(91)70069-9. PMID: 1927982.
[22] Nelson-Filho P, Valdez RM, Andrucioli MC, Saraiva MC, Feres M, Sorgi CA, Faccioli LH. Gram-negative periodontal pathogens and bacterial endotoxin in metallic orthodontic brackets with or without an antimicrobial agent: an in-vivo study. Am J Orthod Dentofacial Orthop. 2011 Dec;140(6):e281-7. doi: 10.1016/j.ajodo.2011.06.026. PMID: 22133962.
[23] Goes P, Dutra CS, Lisboa MR, Gondim DV, Leitão R, Brito GA, Rego RO. Clinical efficacy of a 1% Matricaria chamomile L. mouthwash and 0.12% chlorhexidine for gingivitis control in patients undergoing orthodontic treatment with fixed appliances. J Oral Sci. 2016;58(4):569-574. doi: 10.2334/josnusd.16-0280. PMID: 28025442.
[24] Anderson GB, Bowden J, Morrison EC, Caffesse RG. Clinical effects of chlorhexidine mouthwashes on patients undergoing orthodontic treatment. Am J Orthod Dentofacial Orthop. 1997 Jun;111(6):606-12. doi: 10.1016/s0889-5406(97)70312-3. PMID: 9199591.
[25] Nelson-Filho P, Carpio-Horta KO, Andrucioli MC, Feres M, Bezerra da Silva RA, Garcia Paula-Silva FW, Romano FL. Molecular detection of Aggregatibacter actinomycetemcomitans on metallic brackets by the checkerboard DNA-DNA hybridization technique. Am J Orthod Dentofacial Orthop. 2012 Oct;142(4):481-6. doi: 10.1016/j.ajodo.2012.04.021. PMID: 22999671.
[26] Schünemann H, Brożek J, Guyatt G, Oxman A. The GRADE handbook. Available at: https://gdt.gradepro.org/app/handbook/handbook.html
[27] OCEBM Levels of Evidence. Available at: https://www.cebm.ox.ac.uk/resources/levels-of-evidence/ocebm-levels-of-evidence.
[28] Shah SS, Nambiar S, Kamath D, Suman E, Unnikrishnan B, Desai A, Mahajan S, Dhawan KK. Comparative Evaluation of Plaque Inhibitory and Antimicrobial Efficacy of Probiotic and Chlorhexidine Oral Rinses in Orthodontic Patients: A Randomized Clinical Trial. Int J Dent. 2019 Feb 20;2019:1964158. doi: 10.1155/2019/1964158. PMID: 30930947; PMCID: PMC6410424.
[29] Sobouti F, Rakhshan V, Heydari M, Keikavusi S, Dadgar S, Shariati M. Effects of fixed orthodontic treatment and two new mouth rinses on gingival health: A prospective cohort followed by a single-blind placebo-controlled randomized clinical trial. Int Orthod. 2018;16(1):12-30. doi: 10.1016/j.ortho.2018.01.027. Epub 2018 Feb 23. PMID: 29478929.
[30] Solís C, Santos A, Nart J, Violant D. 0.2% chlorhexidine mouthwash with an antidiscoloration system versus 0.2% chlorhexidine mouthwash: a prospective clinical comparative study. J Periodontol. 2011;82(1):80-5. doi: 10.1902/jop.2010.100289. Epub 2010 Jul 27. PMID: 20653433.
[31] James P, Worthington HV, Parnell C, Harding M, Lamont T, Cheung A, Whelton H, Riley P. Chlorhexidine mouthrinse as an adjunctive treatment for gingival health. Cochrane Database Syst Rev. 2017;3(3):CD008676. doi: 10.1002/14651858.CD008676.pub2. PMID: 28362061; PMCID: PMC6464488.
[32] Jacob B, Nivedhitha MS. Comparative Assessment of the Antibacterial Efficacy of Natural Products and Chlorhexidine Mouthwash against Streptococcus Mutans: A Systematic Review. J Clin Diag Res. 2018; 12(12): ZE01-ZE07.
[33] Kapoor D, Kaur N, Nanda T. Efficacy of two different concentrations of chlorhexidine mouth-rinse on plaque re-growth. Indian J Dent. 2011; 2: 11–15.
[34] Afennich F, Slot DE, Hossainian N, Van der Weijden GA. The effect of hexetidine mouthwash on the prevention of plaque and gingival inflammation: a systematic review. Int J Dent Hyg. 2011 Aug;9(3):182-90. doi: 10.1111/j.1601-5037.2010.00478.x. Epub 2010 Sep 6. PMID: 21356020.
[35] Jassoma E, Baeesa L, Sabbagh H. The antiplaque/anticariogenic efficacy of Salvadora persica (Miswak) mouthrinse in comparison to that of chlorhexidine: a systematic review and meta-analysis. BMC Oral Health. 2019 Apr 27;19(1):64. doi: 10.1186/s12903-019-0741-5. PMID: 31029127; PMCID: PMC6486980.
[36] Al-Maweri SA, Nassani MZ, Alaizari N, Kalakonda B, Al-Shamiri HM, Alhajj MN, Al-Soneidar WA, Alahmary AW. Efficacy of aloe vera mouthwash versus chlorhexidine on plaque and gingivitis: A systematic review. Int J Dent Hyg. 2020 Feb;18(1):44-51. doi: 10.1111/idh.12393. Epub 2019 Mar 25. PMID: 30829440.
Published
2022-08-31
How to Cite
ABIRAMI, Selvaraj; NAVANEETHAN, Ramasamy; JAIN, Ravindra Kumar.
Effectiveness Of Chlorhexidine Oral Rinse In Preventing Plaque Accumulation And Gingivitis In Patients Undergoing Orthodontic Treatment- A Systematic Review And Meta Analysis..
Journal of Oral Research, [S.l.], v. 11, n. 4, p. 1-16, aug. 2022.
ISSN 0719-2479.
Available at: <https://joralres.com/index.php/JOralRes/article/view/joralres.2022.049>. Date accessed: 18 apr. 2024.
doi: https://doi.org/10.17126/joralres.2022.049.
Section
Reviews
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