The efficacy of chlorhexidine dentifrice or gel on plaque, clinical parameters of gingival inflammation and tooth discoloration: a systematic review.

AIM: Based on the existing scientific literature, the effect of chlorhexidine (CHX) dentifrice/gel as compared to a regular or placebo dentifrice/gel is established in healthy adults on the primary outcome parameters of plaque and gingivitis scores. As secondary parameter, tooth surface discoloration was evaluated as a side effect. MATERIALS AND METHODS: MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials were searched up to July 2013 to identify eligible studies. Included were (randomized) controlled clinical trials, regarding self-performed brushing by adults without periodontitis with a minimum duration of 4 weeks. RESULTS: Independent screening of 389 unique titles and abstracts resulted in 16 comparisons. Of these, nine evaluated CHX dentifrice (0.4-1.0%) and 7 CHX gel (0.2-2.0%). It was not possible to perform a meta-analysis; therefore, a descriptive analysis was carried out. Regarding plaque score reduction, the majority of the experiments using a CHX dentifrice provided a significant positive effect. All studies assessing gingival bleeding as parameter for gingivitis observed a significant reduction in favour of CHX dentifrice over placebo dentifrice. Tooth surface discoloration was more pronounced with CHX dentifrice. The combined data concerning parameters of interest for CHX gel compared with a placebo did not show a trend towards a beneficial effect on plaque and bleeding scores. CONCLUSIONS: Within the limitations of this analysis, it may be concluded that toothbrushing with a CHX gel does not provide conclusive evidence. Brushing with a CHX dentifrice can be effective with regard to the control of plaque and gingivitis. Tooth surface discoloration was observed as side effect, which potentially can have a negative impact on patients' compliance.

The efficacy of 0.12% chlorhexidine mouthrinse compared with 0.2% on plaque accumulation and periodontal parameters: a systematic review.

OBJECTIVES: The aim of this systematic review was to evaluate the effects of 0.12% chlorhexidine (CHX) mouthrinse compared with 0.2% on plaque and periodontal parameters. MATERIALS AND METHODS: MEDLINE-PubMed and the Cochrane Central Register of Controlled Trials were searched for (randomized) clinical trials and cohort studies. Plaque scores, parameters of periodontal inflammation and periodontal attachment loss were selected as primary outcome parameters. RESULTS: Screening of 409 titles and abstracts identified eight eligible publications. A meta-analysis of seven studies using the same plaque index showed a significant difference between 0.2% and 0.12% CHX (p=0.008). The Weighted Mean Difference for plaque based on the Quigley & Hein Plaque Index (1968) was 0.10 (95%CI [0.03-0.17]) (heterogeneity I(2)=0%, p=0.87). Three studies that compared 0.12% and 0.2% CHX mouthrinse products provided data on gingival inflammation. No difference in the effect of gingivitis between the two concentrations was found in these studies. No studies could be found that compared the two CHX concentrations and evaluated the probing pocket depth and/or the periodontal attachment level. CONCLUSIONS: In comparing 0.12% and 0.2% CHX, information concerning the effect on gingival inflammation was sparse and no studies could be found that compared the two CHX concentrations and evaluated the probing pocket depth and/or the periodontal attachment level. With respect to plaque inhibition, the results showed a small but significant difference in favour of the 0.2% CHX concentration. However, the clinical relevance of this difference is probably negligible.

The efficacy of dental floss in addition to a toothbrush on plaque and parameters of gingival inflammation: a systematic review.

OBJECTIVES: The aim of this study was to assess systematically the adjunctive effect of both flossing and toothbrushing versus toothbrushing alone on plaque and gingivitis. MATERIALS: The MEDLINE and Cochrane Central register of Controlled Trials (CENTRAL) databases were searched through December 2007 to identify appropriate studies. The variables of plaque and gingivitis were selected as outcomes. RESULTS: Independent screening of titles and abstracts of 1166 MEDLINE-Pubmed and 187 Cochrane papers resulted in 11 publications that met the eligibility criteria. Mean values and SD were collected by data extraction. Descriptive comparisons are presented for brushing alone or brushing and flossing. A greater part of the studies did not show a benefit for floss on plaque and clinical parameters of gingivitis. A meta-analysis was performed for the plaque index and gingival index. CONCLUSIONS: The dental professional should determine, on an individual patient basis, whether high-quality flossing is an achievable goal. In light of the results of this comprehensive literature search and critical analysis, it is concluded that a routine instruction to use floss is not supported by scientific evidence.

The effect of cetylpyridinium chloride-containing mouth rinses as adjuncts to toothbrushing on plaque and parameters of gingival inflammation: a systematic review.

OBJECTIVE: To review the literature concerning cetylpyridinium chloride (CPC) containing mouth rinses as effective adjuncts to toothbrushing in the prevention of plaque accumulation and gingival inflammation. MATERIALS AND METHODS: Medline and the Cochrane Central Register of Controlled Trials were searched up to January 2008 to identify appropriate studies. The primary outcome measurements were plaque accumulation and gingivitis. RESULTS: Independent screening of titles and abstracts of 3250 papers resulted in eight publications that met the criteria of eligibility. Mean values and standard deviations were obtained by data extraction. Descriptive comparisons are presented for brushing only or brushing and rinsing. Meta-analyses were performed when possible. CONCLUSIONS: The existing evidence supports that CPC containing mouth rinses, when used as adjuncts to either supervised or unsupervised oral hygiene, provide a small but significant additional benefit in reducing plaque accumulation and gingival inflammation.