What do systematic reviews say?

Postoperative systemic antibiotics (phenoxymethylpenicillin/penicillin VK, 7-day course), partial or total chemo-mechanical debridement and analgesics vs Matched placebo, partial or total chemo-mechanical debridement and analgesics

• Systemic antibiotics for symptomatic apical periodontitis and acute apical abscess in adults 2024 · Cochrane All outcomes

  3 days
  1 participant reported diarrhoea (placebo group); 1 participant reported fatigue and reduced energy postoperatively (antibiotic group). 61 participants (2 studies).
  2 studies · 61 participants
  Very low

Single preoperative dose of systemic antibiotics (clindamycin 600 mg), total chemo-mechanical debridement and root filling vs Matched placebo, total chemo-mechanical debridement and root filling

• Systemic antibiotics for symptomatic apical periodontitis and acute apical abscess in adults 2024 · Cochrane All outcomes

  7 days
  No adverse effects reported in the placebo group; 1 participant reported dizziness in the intervention group. 72 participants (1 study).
  1 study · 72 participants
  Low

Systemic oral acyclovir vs placebo or no treatment

• Acyclovir for treating primary herpetic gingivostomatitis 2008 · Cochrane All outcomes
  Amir 1997b: two children in each group (2 vs 2) had mild gastrointestinal symptoms that resolved spontaneously after 24 to 48 hours without a change in study treatment. Ducoulombier 1988: no significant adverse effects…
  2 studies
  GRADE not reported

Interdental brushing plus toothbrushing vs Toothbrushing alone

• Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal… 2019 · Cochrane All outcomes
  Harms and adverse outcomes (SoF): Neither study reported any information about adverse events. Jared 2005 assessed adverse events (participants issued a symptom diary) but did not report the findings; Graziani 2017 did…
  1 study
  GRADE not reported
• Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults 2013 · Cochrane All outcomes
  Not estimable. Only 1 study reported adverse outcomes in terms of problems with the use of the assigned interdental cleaning aids. (See comment) In this comparison the single study (Jared 2005) asked participants to…
  1 study
  GRADE not reported

Interdental brushing plus toothbrushing vs Flossing plus toothbrushing

• Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal… 2019 · Cochrane All outcomes
  Five studies reported there were no adverse events. Two studies reported on problems with the use of interdental brushes or floss, which sometimes caused soreness. (Six studies reported on adverse events; none…
  6 studies
  GRADE not reported
• Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults 2013 · Cochrane All outcomes
  Not estimable. 2 studies reported adverse outcomes in terms of problems with the use of the assigned interdental cleaning aids. We were unable to pool data. (See comment) Three further studies reported that no adverse…
  5 studies
  GRADE not reported

Rubber/elastomeric cleaning stick plus toothbrushing vs Flossing plus toothbrushing

• Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal… 2019 · Cochrane All outcomes
  Five studies assessed adverse events. One did not report findings, but the others reported either no adverse events or minor adverse events that did not significantly differ between interventions.
  5 studies
  GRADE not reported

Flossing plus toothbrushing vs Toothbrushing alone

• Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal… 2019 · Cochrane All outcomes
  Adverse effects were assessed and reported in seven studies. Three reported no adverse events on the oral hard or soft tissues. Four reported sporadic adverse events with mild severity, with no evidence of a difference…
  7 studies
  GRADE not reported

Oral irrigation plus toothbrushing vs Toothbrushing alone

• Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal… 2019 · Cochrane All outcomes
  Three studies reported that there were no adverse events, one reported one incidence of aphthous ulcer in irrigator group, one reported oral lacerations but found no difference between the interventions, and one did…
  5 studies
  GRADE not reported

Rubber/elastomeric cleaning stick plus toothbrushing vs Toothbrushing alone

The review found no eligible studies for this question.

• Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal… 2019 · Cochrane All outcomes
  Harms and adverse outcomes: Not reported (neither study reported on adverse effects).
  0 studies
  No studies found

Wooden cleaning stick plus toothbrushing vs Flossing plus toothbrushing

The review found no eligible studies for this question.

• Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal… 2019 · Cochrane All outcomes
  Harms and adverse outcomes: Not reported (neither study reported on adverse effects).
  0 studies
  No studies found

Wooden cleaning stick plus toothbrushing vs Toothbrushing alone

The review found no eligible studies for this question.

• Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal… 2019 · Cochrane All outcomes
  Harms and adverse outcomes: Not reported (neither study reported on adverse effects).
  0 studies
  No studies found

Rubber/elastomeric cleaning stick plus toothbrushing vs Interdental brushing plus toothbrushing

• Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal… 2019 · Cochrane All outcomes
  Harms and adverse outcomes (SoF): Not reported. Yost 2006 performed examinations of the oral soft tissue at the final visit but did not report the findings; Graziani 2017 and Smith 1988 did not measure adverse effects.
  1 study
  GRADE not reported

Oral irrigation plus toothbrushing vs Flossing plus toothbrushing

• Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal… 2019 · Cochrane All outcomes
  Both studies reported that there were no adverse events in either study group.
  2 studies
  GRADE not reported

Flossing plus toothbrushing (self-performed; manual or automated floss) vs Toothbrushing alone

• Flossing for the management of periodontal diseases and dental caries in adults 2011 · Cochrane All outcomes
  Not estimable (5 studies). Adverse effects were assessed in five studies, but they used different outcome measures, so meta-analysis was not appropriate. The main harm identified was soft-tissue trauma to the gingival…
  5 studies
  GRADE not reported

Periodontal treatment (scaling and root planing, polishing, or surgery), alone or with oral hygiene counselling, antiseptics, or antimicrobials vs no treatment

• Treating periodontal disease for preventing adverse birth outcomes in pregnant women 2017 · Cochrane All outcomes
  0% in both groups; Not estimated; 2389 participants (4 RCTs)
  4 studies · 2389 participants
  GRADE not reported

Periodontal treatment (scaling and root planing, alone or with antimicrobials) vs Alternative (less intensive) periodontal treatment, alone or with placebo

The review found no eligible studies for this question.

• Treating periodontal disease for preventing adverse birth outcomes in pregnant women 2017 · Cochrane All outcomes
  Adverse effects of therapy: Not reported for this comparison.
  0 studies
  No studies found

Periodontal treatment (subgingival instrumentation, with or without antimicrobials/surgery) vs usual care or no treatment

• Treatment of periodontitis for glycaemic control in people with diabetes mellitus 2022 · Cochrane All outcomes

  3-4 months
  SoF comment: insufficient evidence to determine whether SRP for glycaemic control is associated with any harms; most studies did not evaluate adverse effects. Where reported (e.g. D'Aiuto 2018) serious adverse events…
  Studies not reported
  GRADE not reported

Guided tissue regeneration (GTR) with barrier membrane (resorbable or non-resorbable) vs Open flap debridement (access flap surgery)

• Guided tissue regeneration for periodontal infra-bony defects 2006 · Cochrane All outcomes
  Adverse effects were generally minor. Healing was generally uneventful for both test and control groups. Exposure of the GTR barrier membrane was widely reported, ranging from 20% of sites (non-resorbable…
  16 studies
  GRADE not reported

Chlorhexidine mouthrinse (any concentration; 0.05% to 0.2%) used in conjunction with mechanical oral hygiene procedures vs Placebo/control mouthrinse, or no mouthrinse (mechanical oral hygiene alone); controls pooled (protocol's separate comparisons versus mechanical oral hygiene alone and versus placebo/control merged)

• Chlorhexidine mouthrinse as an adjunctive treatment for gingival health 2017 · Cochrane All outcomes
  SoF narrative row (Other adverse effects): 22 trials reported at least 1 adverse effect apart from extrinsic tooth staining and calculus formation in the chlorhexidine rinse arms. The adverse effects most commonly…
  22 studies
  GRADE not reported

Occlusal adjustment as an adjunct to surgical periodontal therapy vs Surgical periodontal therapy alone (no occlusal adjustment)

The review found no eligible studies for this question.

• Occlusal interventions for periodontitis in adults 2008 · Cochrane All outcomes

  Minimum 3 months (planned)
  no estimate extracted
  0 studies
  No studies found