The effect of chlorhexidine dentifrice or gel versus chlorhexidine mouthwash on plaque, gingivitis, bleeding and tooth discoloration: a systematic review.

OBJECTIVE: To systematically review and evaluate the available scientific evidence on the effectiveness of chlorhexidine dentifrice or gel (CHX DF/gel) compared to chlorhexidine mouthwash (CHX MW) on plaque, bleeding, gingival inflammation and tooth discoloration scores. MATERIAL AND METHODS: PubMed-MEDLINE, Cochrane-CENTRAL and EMBASE databases were searched to identify appropriate studies. RESULTS: Independent screening of the 2256 unique titles and abstracts resulted in five publications that met the eligibility criteria. Considerable heterogeneity was found between the studies. Three of the five studies showed a positive effect on plaque scores in favour of the CHX MW. With respect to gingival index and bleeding scores, no significant differences were found. Chlorhexidine mouthwash, however, showed a significantly more tooth discoloration than the CHX DF/gel. A meta-analysis of the effect on 'de novo' plaque formation of CHX DF/gel versus CHX MW resulted in a difference in means of 0.27 [95% CI: 0.14; 0.39] (P < 0.0001). CONCLUSION: Chlorhexidine gel can be successfully formulated and will inhibit plaque growth to some degree, but not to the same extent, as a CHX MW. When CHX DF/gel is used in a non-brushing model, it is significantly less effective in plaque inhibition compared to CHX MW. Based on one study when CHX gel was applied with a finger after brushing, it is significantly more effective on plaque scores and the gingival index. The only brushing study also with a long follow-up showed that there is no significant difference between CHX DF and CHX MW. However, as a corollary, significantly more tooth discoloration was observed with the CHX MW. Altogether, the data show that when daily oral hygiene cannot be performed, CHX MW is the first product of choice.

Gingival abrasion and recession in manual and oscillating-rotating power brush users.

OBJECTIVE: To assess gingival recession (GR) in manual and power toothbrush users and evaluate the relationship between GR and gingival abrasion scores (GA). METHODS: This was an observational (cross-sectional), single-centre, examiner-blind study involving a single-brushing exercise, with 181 young adult participants: 90 manual brush users and 91 oscillating-rotating power brush users. Participants were assessed for GR and GA as primary response variables. Secondary response variables were the level of gingival inflammation, plaque score reduction and brushing duration. Pearson correlation was used to describe the relationship between number of recession sites and number of abrasions. Prebrushing (baseline) and post-brushing GA and plaque scores were assessed and differences analysed using paired tests. Two-sample t-test was used to analyse group differences; ancova was used for analyses of post-brushing changes with baseline as covariate. RESULTS: Overall, 97.8% of the study population had at least one site of ≥1 mm of gingival recession. For the manual group, this percentage was 98.9%, and for the power group, this percentage was 96.7% (P = 0.621). Post-brushing, the power group showed a significantly smaller GA increase than the manual group (P = 0.004); however, there was no significant correlation between number of recession sites and number of abrasions for either group (P ≥ 0.327). CONCLUSIONS: Little gingival recession was observed in either toothbrush user group; the observed GR levels were comparable. Lower post-brushing gingival abrasion levels were seen in the power group. There was no correlation between gingival abrasion as a result of brushing and the observed gingival recession following use of either toothbrush.