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Each row is one question a systematic review asked: who, what, compared with what, and which outcome, with the effect it found and how certain that is. Words match anywhere in the field.
288 questions in 13 reviews · Dental public health and special care
current versionsNo studies 73 · 25.3%Ungraded 90 · 31.3%Very low 90 · 31.3%Low 29 · 10.1%Moderate 6 · 2.1%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
| Question | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Tempered chlorhexidine vs Non-tempered chlorhexidine Reduction in level of contamination by particles >5 um (droplets) at <2 m from patient's oral cavity · Dental patients undergoing aerosol-generating procedures (AGPs) and the dental healthcare providers treating them · combined operator, assistant and patient level Preprocedural mouth rinses for preventing transmission of infectious diseases through aerosols in dental… (2022) · Cochrane | MD -10.8 [-15.15, -6.45] | 1 study · 20 participants | Very low |
Professional oral care vs Usual oral care Oral health indices · Residents of nursing homes and other long-term care facilities · 24 months Oral care measures for preventing nursing home‐acquired pneumonia (2022) · Cochrane | RR 2.81 [1.39, 5.69] | 1 study · 199 participants | Ungraded |
Professional oral care vs Usual oral care Change in systemic antibiotic use · Residents of nursing homes and other long-term care facilities Oral care measures for preventing nursing home‐acquired pneumonia (2022) · Cochrane | No studies measured change in systemic antibiotic use. | 0 studies | No studies |
Antibiotic prophylaxis before dental procedure vs No antibiotic prophylaxis or placebo Adverse effects of antibiotics · Adults or children at increased risk of bacterial endocarditis (pre-existing cardiac condition) undergoing an invasive… Antibiotic prophylaxis for preventing bacterial endocarditis following dental procedures (2022) · Cochrane | Adverse effects of antibiotics | No data reported | 248 (1 study) | - | - | 0 studies | No studies |
Chlorhexidine (CHX) vs Water (distilled) Reduction in level of contamination by particles >5 um (droplets) at <2 m from patient's oral cavity · Dental patients undergoing aerosol-generating procedures (AGPs) and the dental healthcare providers treating them · patient level (pharynx; not analysed) Preprocedural mouth rinses for preventing transmission of infectious diseases through aerosols in dental… (2022) · Cochrane | Bay 1993 compared 0.12% CHX with distilled water (30-second rinse) and evaluated the outcome at patient level (Andersen's level 2, oropharynx); the data were not included in the meta-analysis. No pooled estimate or… | 1 study | Ungraded |
Chlorhexidine (CHX) vs No rinsing Reduction in level of contamination by particles >5 um (droplets) at <2 m from patient's oral cavity · Dental patients undergoing aerosol-generating procedures (AGPs) and the dental healthcare providers treating them · operator level Preprocedural mouth rinses for preventing transmission of infectious diseases through aerosols in dental… (2022) · Cochrane | At operator level, because of high heterogeneity (I2 = 89%), which could not be explained, the results were not meta-analysed (2 studies, 60 participants; Feres 2010, Retamal-Valdes 2017). No pooled estimate or GRADE… | 2 studies · 60 participants | Ungraded |
Chlorhexidine (CHX) vs Ozonated water Reduction in level of contamination by particles <=5 um (droplet nuclei) at >=2 m from patient's oral cavity · Dental patients undergoing aerosol-generating procedures (AGPs) and the dental healthcare providers treating them · droplet nuclei; aerobic cultures Preprocedural mouth rinses for preventing transmission of infectious diseases through aerosols in dental… (2022) · Cochrane | MD -12.3 [-27.12, 2.52] | 1 study · 40 participants | Very low |
Chlorhexidine (CHX) vs Cetylpyridinium chloride (CPC) Reduction in level of contamination by particles >5 um (droplets) at <2 m from patient's oral cavity · Dental patients undergoing aerosol-generating procedures (AGPs) and the dental healthcare providers treating them · tempered CHX vs tempered CPC; assistant level Preprocedural mouth rinses for preventing transmission of infectious diseases through aerosols in dental… (2022) · Cochrane | MD -0.2 [-6.3, 5.9] | 1 study · 20 participants | Very low |
Chlorhexidine (CHX) vs Cetylpyridinium chloride (CPC) Reduction in level of contamination by particles >5 um (droplets) at <2 m from patient's oral cavity · Dental patients undergoing aerosol-generating procedures (AGPs) and the dental healthcare providers treating them · cold CHX vs tempered CPC; operator level Preprocedural mouth rinses for preventing transmission of infectious diseases through aerosols in dental… (2022) · Cochrane | MD 13.6 [6.73, 20.47] | 1 study · 20 participants | Very low |
Chlorhexidine (CHX) vs Water (distilled) Reduction in level of contamination by particles >5 um (droplets) at <2 m from patient's oral cavity · Dental patients undergoing aerosol-generating procedures (AGPs) and the dental healthcare providers treating them · assistant level Preprocedural mouth rinses for preventing transmission of infectious diseases through aerosols in dental… (2022) · Cochrane | At assistant level, because of high heterogeneity (I2 = 96%), the results were not meta-analysed (4 studies, 136 participants). No pooled estimate or GRADE rating. | 4 studies · 136 participants | Ungraded |
Chlorhexidine (CHX) vs Povidone iodine Reduction in level of contamination by particles >5 um (droplets) at <2 m from patient's oral cavity · Dental patients undergoing aerosol-generating procedures (AGPs) and the dental healthcare providers treating them · operator level; aerobic cultures Preprocedural mouth rinses for preventing transmission of infectious diseases through aerosols in dental… (2022) · Cochrane | MD -10.75 [-26.24, 4.74] | 2 studies · 52 participants | Very low |
Cetylpyridinium chloride (CPC) vs Water Reduction in level of contamination by particles >5 um (droplets) at <2 m from patient's oral cavity · Dental patients undergoing aerosol-generating procedures (AGPs) and the dental healthcare providers treating them · CPC vs water; operator level Preprocedural mouth rinses for preventing transmission of infectious diseases through aerosols in dental… (2022) · Cochrane | MD -48.7 [-67.82, -29.58] | 1 study · 30 participants | Very low |
Chlorhexidine (CHX) vs Essential oils/herbal mouthwash Reduction in level of contamination by particles >5 um (droplets) at <2 m from patient's oral cavity · Dental patients undergoing aerosol-generating procedures (AGPs) and the dental healthcare providers treating them · assistant level Preprocedural mouth rinses for preventing transmission of infectious diseases through aerosols in dental… (2022) · Cochrane | MD -12.21 [-15.58, -8.83] | 3 studies · 76 participants | Low |
Antibiotic prophylaxis before dental procedure vs No antibiotic prophylaxis or placebo Cost implications of antibiotic provision · Adults or children at increased risk of bacterial endocarditis (pre-existing cardiac condition) undergoing an invasive… Antibiotic prophylaxis for preventing bacterial endocarditis following dental procedures (2022) · Cochrane | The study did not provide any data on mortality, adverse events requiring hospitalisation, adverse effects of antibiotics or cost implications of treatment. | 0 studies | No studies |
Chlorhexidine (CHX) vs Essential oils/herbal mouthwash Reduction in level of contamination by particles >5 um (droplets) at <2 m from patient's oral cavity · Dental patients undergoing aerosol-generating procedures (AGPs) and the dental healthcare providers treating them · operator level Preprocedural mouth rinses for preventing transmission of infectious diseases through aerosols in dental… (2022) · Cochrane | MD -23.09 [-34.4, -11.78] | 3 studies · 76 participants | Low |
Any preprocedural mouth rinse vs Placebo, no rinsing or control Cost · Dental patients undergoing aerosol-generating procedures (AGPs) Preprocedural mouth rinses for preventing transmission of infectious diseases through aerosols in dental… (2022) · Cochrane | No included study reported cost. | 0 studies | No studies |
Tempered chlorhexidine vs Non-tempered chlorhexidine Reduction in level of contamination by particles >5 um (droplets) at <2 m from patient's oral cavity · Dental patients undergoing aerosol-generating procedures (AGPs) and the dental healthcare providers treating them · assistant level Preprocedural mouth rinses for preventing transmission of infectious diseases through aerosols in dental… (2022) · Cochrane | MD -17.6 [-23.7, -11.5] | 1 study · 20 participants | Very low |
Chlorhexidine (CHX) vs Cetylpyridinium chloride (CPC) Reduction in level of contamination by particles >5 um (droplets) at <2 m from patient's oral cavity · Dental patients undergoing aerosol-generating procedures (AGPs) and the dental healthcare providers treating them · cold CHX vs cold CPC; operator level Preprocedural mouth rinses for preventing transmission of infectious diseases through aerosols in dental… (2022) · Cochrane | MD 4.43 [-2.27, 11.13] | 2 studies · 50 participants | Very low |
Tempered chlorhexidine vs Non-tempered chlorhexidine Reduction in level of contamination by particles >5 um (droplets) at <2 m from patient's oral cavity · Dental patients undergoing aerosol-generating procedures (AGPs) and the dental healthcare providers treating them · operator level Preprocedural mouth rinses for preventing transmission of infectious diseases through aerosols in dental… (2022) · Cochrane | MD -15.8 [-22.67, -8.93] | 1 study · 20 participants | Very low |
Antibiotic prophylaxis before dental procedure vs No antibiotic prophylaxis or placebo Development of endocarditis (in those with definite indication for prophylaxis) · Adults or children at increased risk of bacterial endocarditis (pre-existing cardiac condition) undergoing an invasive… · within 180 days, Definite indication for prophylaxis Antibiotic prophylaxis for preventing bacterial endocarditis following dental procedures (2022) · Cochrane | OR 1.62 [0.57, 4.57] | 1 study · 248 participants | Very low |
Povidone iodine rinse vs Usual care (suction alone, no rinse) Incidence of VAP · Critically ill patients receiving mechanical ventilation in ICU Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia (2020) · Cochrane | Povidone iodine versus usual care (Seguin 2006, 67 participants): a reduction in VAP was found; single study, not replicated, interpret with caution. | 1 study · 67 participants | Ungraded |
Any antimicrobial mouthwash and/or nasal spray (alone or in combination), at any concentration, delivered to the patient or HCW before and/or after an AGP vs No treatment or saline or water Other adverse events: changes in microbiome in oral cavity, nasal cavity, oro- or nasopharynx · Patients without suspected or confirmed COVID-19 infection undergoing aerosol-generating procedures (AGPs), and the… Antimicrobial mouthwashes (gargling) and nasal sprays to protect healthcare workers when undertaking… (2020) · Cochrane | No data available (no included studies) | NR | No studies |
Saline rinse vs Saline-soaked swab Duration of mechanical ventilation · Critically ill patients receiving mechanical ventilation in ICU Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia (2020) · Cochrane | MD -6.83 [-8.94, -4.72] | 2 studies · 176 participants | Ungraded |
Saline rinse plus swab vs Saline-soaked swab alone (usual care) Incidence of VAP · Critically ill patients receiving mechanical ventilation in ICU Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia (2020) · Cochrane | RR 0.41 [0.23, 0.72] | 2 studies · 153 participants | Ungraded |
Any antimicrobial mouthwash and/or nasal spray (alone or in combination), at any concentration, delivered to the patient or HCW before and/or after an AGP vs No treatment or saline or water Other adverse events: allergy, irritation/burning of nasal, oral or oropharyngeal mucosa (e.g. erosions, ulcers, bleeding), long-term staining of mucous membranes or teeth, accidental ingestion · Patients without suspected or confirmed COVID-19 infection undergoing aerosol-generating procedures (AGPs), and the… Antimicrobial mouthwashes (gargling) and nasal sprays to protect healthcare workers when undertaking… (2020) · Cochrane | No data available (no included studies) | NR | No studies |
General ventilation (e.g. natural ventilation, exhaust fans, opening windows) vs No general ventilation / standard operatory Outcome NR · Dental healthcare providers (dentist, dental surgery assistant, dental hygienist, dental technologist, dental… Interventions to reduce contaminated aerosols produced during dental procedures for preventing infectious… (2020) · Cochrane | no estimate extracted | 0 studies | No studies |
High-volume evacuation (HVE) vs No HVE Reduction in contamination of aerosols on operator's face shield/mask (RCTs) · People undergoing aerosol-generating procedures (AGPs) in a dental setting Interventions to reduce contaminated aerosols produced during dental procedures for preventing infectious… (2020) · Cochrane | MD -15.71 [-46.37, 14.95] | 2 studies · 42 participants | Ungraded |
Rubber dam vs No rubber dam Reduction in level of contamination in aerosols (CFU) during restorative procedures at operator's submental region (RCT) · People undergoing aerosol-generating procedures (AGPs) in a dental setting Interventions to reduce contaminated aerosols produced during dental procedures for preventing infectious… (2020) · Cochrane | MD 0.52 [-0.11, 1.16] | 1 study · 47 participants | Ungraded |
Any method, procedure or policy to reduce contaminated aerosols in dental clinics vs Any other method, no treatment or combination of methods Costs for the interventions used · Dental healthcare providers (dentist, dental surgery assistant, dental hygienist, dental technologist, dental… Interventions to reduce contaminated aerosols produced during dental procedures for preventing infectious… (2020) · Cochrane | no estimate extracted | 0 studies | No studies |
Rubber dam vs No rubber dam Reduction in level of contamination in aerosols (CFU) during restorative procedures at operator's occiput (RCT) · People undergoing aerosol-generating procedures (AGPs) in a dental setting Interventions to reduce contaminated aerosols produced during dental procedures for preventing infectious… (2020) · Cochrane | MD 0.77 [-0.46, 2.00] | 1 study · 47 participants | Very low |
Rubber dam vs No rubber dam Reduction in level of contamination in aerosols (CFU) during restorative procedures at 2 metres from mouth (RCT) · People undergoing aerosol-generating procedures (AGPs) in a dental setting Interventions to reduce contaminated aerosols produced during dental procedures for preventing infectious… (2020) · Cochrane | MD -11.70 [-15.82, -7.58] | 1 study · 10 participants | Very low |
Any antimicrobial mouthwash and/or nasal spray (alone or in combination), at any concentration, delivered to healthcare workers, with or without the same intervention given to the patients with COVID-19 vs No treatment or saline or water Anosmia (or disturbance in sense of smell) · Healthcare workers (HCWs) treating patients with suspected or confirmed COVID-19 infection · Minimum 2 weeks Use of antimicrobial mouthwashes (gargling) and nasal sprays by healthcare workers to protect them when… (2020) · Cochrane | No data available (no included studies) | 0 studies | No studies |
Chlorhexidine vs Nanosil (nanosilver) Incidence of VAP · Critically ill patients receiving mechanical ventilation in ICU Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia (2020) · Cochrane | Chlorhexidine versus Nanosil (Khaky 2018): some evidence of a benefit for Nanosil; single study, not replicated, interpret with caution. | 1 study | Ungraded |
Chlorhexidine (mouthrinse or gel), as part of oral hygiene care vs Placebo or usual care Incidence of VAP · Critically ill patients (adults and children) receiving mechanical ventilation in ICU · Follow-up: mean 1 month Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia (2020) · Cochrane | RR 0.67 [0.47, 0.97] | 13 studies · 1206 participants | Moderate |
Any antimicrobial mouthwash and/or nasal spray (alone or in combination), at any concentration, delivered to healthcare workers, with or without the same intervention given to the patients with COVID-19 vs No treatment or saline or water Viral content of aerosol · Healthcare workers (HCWs) treating patients with suspected or confirmed COVID-19 infection Use of antimicrobial mouthwashes (gargling) and nasal sprays by healthcare workers to protect them when… (2020) · Cochrane | No data available (no included studies) | 0 studies | No studies |
Triclosan rinse vs Saline rinse Duration of ICU stay · Critically ill patients receiving mechanical ventilation in ICU Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia (2020) · Cochrane | MD -4.97 [-5.55, -4.39] | 1 study · 324 participants | Ungraded |
Hydrogen peroxide vs Normal saline Incidence of VAP · Critically ill patients receiving mechanical ventilation in ICU Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia (2020) · Cochrane | Hydrogen peroxide versus normal saline (Nobahar 2016): a reduction in VAP was found; single study, not replicated, interpret with caution. | 1 study | Ungraded |
Potassium permanganate vs Placebo Mortality · Critically ill patients receiving mechanical ventilation in ICU Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia (2020) · Cochrane | Potassium permanganate versus placebo (Meidani 2018, 100 participants): no evidence of a difference in mortality; single study. | 1 study · 100 participants | Ungraded |
Chlorhexidine (mouthrinse or gel), as part of oral hygiene care vs Placebo or usual care Caregivers' preferences for oral hygiene care · Critically ill patients (adults and children) receiving mechanical ventilation in ICU Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia (2020) · Cochrane | The outcome of caregivers' preferences was not reported by any study in this comparison. | 0 studies | No studies |
Chlorhexidine vs Potassium permanganate Incidence of VAP · Critically ill patients receiving mechanical ventilation in ICU Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia (2020) · Cochrane | RR 0.87 [0.50, 1.52] | 2 studies | Ungraded |
Listerine (essential oils) rinse vs Sodium bicarbonate rinse Incidence of VAP · Critically ill patients receiving mechanical ventilation in ICU Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia (2020) · Cochrane | Listerine versus sodium bicarbonate (Berry 2013): no evidence of a difference in VAP incidence; single study, high risk of bias. | 1 study | Ungraded |
Toothbrushing (with or without antiseptics), as part of oral hygiene care vs No toothbrushing (with or without antiseptics) Mortality · Critically ill adults receiving mechanical ventilation in ICU · Follow-up: mean 1 month Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia (2020) · Cochrane | RR 0.84 [0.67, 1.05] | 5 studies · 910 participants | Low |
Chlorhexidine (mouthrinse or gel), as part of oral hygiene care vs Placebo or usual care Adverse effects · Critically ill patients (adults and children) receiving mechanical ventilation in ICU Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia (2020) · Cochrane | Adverse effects: information from 2 studies; one stated there were none, the other reported mild reversible irritation of the oral mucosa; very low certainty. There was a lack of evidence about adverse effects. | 2 studies | Very low |
Saline rinse vs Saline-soaked swab Incidence of VAP · Critically ill patients receiving mechanical ventilation in ICU Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia (2020) · Cochrane | RR 0.47 [0.37, 0.62] | 4 studies · 488 participants | Ungraded |
Toothbrushing (with or without antiseptics), as part of oral hygiene care vs No toothbrushing (with or without antiseptics) Systemic antibiotic use · Critically ill adults receiving mechanical ventilation in ICU Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia (2020) · Cochrane | This outcome was not reported by any of the studies in this comparison. | 0 studies | No studies |
Povidone iodine coolant vs Distilled water coolant Reduction in level of contamination in aerosols (CFU): povidone iodine coolant vs distilled water during ultrasonic scaling · People undergoing aerosol-generating procedures (AGPs) in a dental setting Interventions to reduce contaminated aerosols produced during dental procedures for preventing infectious… (2020) · Cochrane | MD -656.45 [-672.74, -640.16] | 1 study · 40 participants | Very low |
Povidone iodine rinse vs Saline rinse or placebo Mortality · Critically ill patients receiving mechanical ventilation in ICU Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia (2020) · Cochrane | RR 1.00 [0.66, 1.50] | 2 studies · 217 participants | Ungraded |
Triclosan rinse vs Saline rinse Duration of mechanical ventilation · Critically ill patients receiving mechanical ventilation in ICU Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia (2020) · Cochrane | MD -5.24 [-5.64, -4.84] | 1 study · 324 participants | Ungraded |
Toothbrushing (with or without antiseptics), as part of oral hygiene care vs No toothbrushing (with or without antiseptics) Caregivers' preferences for oral hygiene care · Critically ill adults receiving mechanical ventilation in ICU Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia (2020) · Cochrane | The outcome of caregivers' preferences was not reported by any study in this comparison. | 0 studies | No studies |
Chlorhexidine (mouthrinse or gel), as part of oral hygiene care vs Placebo or usual care Mortality · Critically ill patients (adults and children) receiving mechanical ventilation in ICU · Follow-up: mean 1 month Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia (2020) · Cochrane | RR 1.03 [0.80, 1.33] | 9 studies · 944 participants | Moderate |