What do systematic reviews say?

7 questions · 8 findings · 2 reviews · Oral Health

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No studies found 0 · 0%GRADE not reported 1 · 12.5%Very low 7 · 87.5%Low 0 · 0%Moderate 0 · 0%High 0 · 0%

Chlorhexidine mouthwash vs placebo

Cariogenic bacteria (Mutans streptococci) · People undergoing orthodontic treatment (any age; 9 to 34 years in included studies)

Chlorhexidine mouthwash reduced Mutans streptococci versus placebo, but certainty is very low.

1 finding from 1 review

The efficacy of mouthwashes on oral microorganisms and gingivitis in patients undergoing orthodontic treatment:… 2023 All outcomes
≤ 3 months
Colony count of MS was significantly reduced compared to placebos according to three studies [34; 48; 52]; colony count of MS was slightly reduced compared to placebo in a short time in one study [40].
4 studies
Very low

Chlorhexidine mouthwash vs Blank control

Cariogenic bacteria (Mutans streptococci) · People undergoing orthodontic treatment (any age; 9 to 34 years in included studies)

Chlorhexidine mouthwash reduced Mutans streptococci versus blank control, but certainty is very low.

1 finding from 1 review

The efficacy of mouthwashes on oral microorganisms and gingivitis in patients undergoing orthodontic treatment:… 2023 All outcomes
≤ 3 months
Colony count of MS was significantly reduced compared to blank control according to one study [53]; one study reported a significant reduction compared to baseline [51].
2 studies
Very low

Fluoride mouthwash vs Blank control

Cariogenic bacteria (Mutans streptococci) · People undergoing orthodontic treatment (any age; 9 to 34 years in included studies)

Short-term fluoride mouthwash reduced Mutans streptococci, but certainty is very low.

2 findings from 1 review

The efficacy of mouthwashes on oral microorganisms and gingivitis in patients undergoing orthodontic treatment:… 2023 All outcomes
≤ 3 months
Colony count of MS was significantly reduced compared to baseline according to two studies [33; 34].
2 studies
Very low
The efficacy of mouthwashes on oral microorganisms and gingivitis in patients undergoing orthodontic treatment:… 2023 All outcomes
≥ 12 months
Colony count of MS was similar to blank control according to two studies [37; 59].
2 studies
Very low

Herbal mouthwash vs placebo

Cariogenic bacteria (Mutans streptococci) · People undergoing orthodontic treatment (any age; 9 to 34 years in included studies)

Herbal mouthwash reduced Mutans streptococci versus placebo, but certainty is very low.

1 finding from 1 review

The efficacy of mouthwashes on oral microorganisms and gingivitis in patients undergoing orthodontic treatment:… 2023 All outcomes
≤ 3 months
Colony count of MS was significantly reduced compared to placebo [52]; colony count was slightly reduced compared to placebo in a short time in one study [40].
2 studies
Very low

Herbal mouthwash vs Blank control

Cariogenic bacteria (Mutans streptococci) · People undergoing orthodontic treatment (any age; 9 to 34 years in included studies)

Herbal mouthwash showed mixed effects on Mutans streptococci, with very low-certainty evidence.

1 finding from 1 review

The efficacy of mouthwashes on oral microorganisms and gingivitis in patients undergoing orthodontic treatment:… 2023 All outcomes
≤ 3 months
Colony count of MS was significantly reduced compared to baseline [48]; another study found an insignificant reduction compared to baseline [51].
2 studies
Very low

Probiotic mouthwash (e.g., Lactobacillus-based) vs Blank control

Cariogenic bacteria (Mutans streptococci) · Orthodontic patients (any age) undergoing orthodontic treatment (mostly fixed appliances)

Probiotic mouthwash has inconsistent effects on Mutans streptococci colony counts versus blank control; the evidence is very uncertain (very low certainty).

1 finding from 1 review

The efficacy of mouthwashes on oral microorganisms and gingivitis in patients undergoing orthodontic treatment:… 2023 All outcomes
<=3 months (short-term) · Orthodontic patients undergoing orthodontic treatment (randomized controlled trials; multiple countries)
Colony count of MS was significantly reduced compared to blank control [53]. Colony count of MS was insignificantly increased compared to baseline [33].
2 studies
Very low

E-cigarette aerosol / e-liquid exposure (flavored and unflavored; nicotine and non-nicotine) vs Unexposed controls / unflavored e-liquid / conventional cigarette smoke

Cariogenic and commensal oral bacteria (S. mutans and commensal streptococci growth, adhesion, biofilm) · Oral bacteria (streptococci), dental hard tissue (enamel/dentin) and e-liquids studied in vitro/ex vivo (with a few clinical microbiome…

Most in vitro studies indicate e-cigarette aerosol/e-liquid (especially flavored/high-concentration) disrupts normal oral flora and favors cariogenic S. mutans growth and biofilm, plausibly increasing caries risk; not pooled (ungraded, narrative).

1 finding from 1 review

The effects of electronic smoking on dental caries and proinflammatory markers: a systematic review and meta-analysis. 2025 All outcomes
Laboratory (in vitro/ex vivo) studies of oral bacteria and dental hard tissue, plus a few clinical oral-microbiome studies
Narrative synthesis of 9 studies (Table 2). E-cigarette aerosol/e-liquid at higher concentrations (>=5%) and flavored liquids inhibited commensal oral streptococci and allowed S. mutans to proliferate, with increased…
9 studies
GRADE not reported