What do systematic reviews say?

Chlorhexidine mouthwash vs Blank control

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

• 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

Chlorhexidine mouthwash vs placebo

Chlorhexidine mouthwash reduced Plaque Index versus placebo, but certainty is very low.

• The efficacy of mouthwashes on oral microorganisms and gingivitis in patients undergoing orthodontic treatment:… 2023 All outcomes

  ≤ 3 months
  Plaque Index was significantly reduced compared to placebos according to two studies [20; 32].
  2 studies
  Very low

Chlorhexidine mouthwash vs Salt and soda mouthwash

Chlorhexidine mouthwash showed no clear difference in mucositis eradicated compared with salt and soda mouthwash; GRADE not reported.

• Interventions for treating oral mucositis for patients with cancer receiving treatment 2010 · Cochrane All outcomes
  RR 1.10 [0.90, 1.35]
  1 study · 138 participants
  GRADE not reported

Chlorhexidine mouthwash vs Salt and soda mouthwash

Chlorhexidine mouthwash showed no clear difference in time to heal mucositis (days) compared with salt and soda mouthwash; GRADE not reported.

• Interventions for treating oral mucositis for patients with cancer receiving treatment 2010 · Cochrane All outcomes
  MD -0.40 [-1.49, 0.69]
  1 study · 100 participants
  GRADE not reported

Chlorhexidine mouthwash vs Salt and soda mouthwash

Chlorhexidine mouthwash showed no clear difference in average pain scores (0-100 VAS) compared with salt and soda mouthwash; GRADE not reported.

• Interventions for treating oral mucositis for patients with cancer receiving treatment 2010 · Cochrane All outcomes
  MD -3.50 [-13.35, 6.35]
  1 study · 63 participants
  GRADE not reported

Mouthwash (amine/stannous fluoride; or chlorhexidine + cetylpyridinium + zinc) vs Chlorhexidine mouthwash or tap water

• Interventions for managing halitosis 2019 · Cochrane All outcomes

  7 days
  Wigger-Alberti 2010 mouthwash data (ASF; CHX + CPC + Zn; CHX; tap water) were calculated from a graph (Additional Table 1) but not included, as the report did not give details of sample size per group.
  1 study
  GRADE not reported

1% chlorhexidine + 1% thymol varnish vs 38% SDF + potassium iodide solution (applied annually)

1% chlorhexidine + 1% thymol varnish may not differ from 38% SDF + potassium iodide solution (applied annually) for arrest or reversal of root carious lesions (RR 0.71, 95% CI 0.11 to 4.45; very low certainty).

• Nonrestorative Treatments for Caries: Systematic Review and Network Meta-analysis. 2019 All outcomes

  3-12 mo · Dental practice (professionally applied or prescribed nonrestorative caries treatments; parallel and split-mouth RCTs)
  RR 0.71 [0.11, 4.45]
  7 studies · 1304 participants
  Very low

1% chlorhexidine + 1% thymol varnish vs Fluoride varnish

1% chlorhexidine + 1% thymol varnish may not differ from 5% NaF varnish for arrest or reversal of root carious lesions (RR 0.57, 95% CI 0.04 to 8.69; very low certainty).

• Nonrestorative Treatments for Caries: Systematic Review and Network Meta-analysis. 2019 All outcomes

  3-12 mo · Dental practice (professionally applied or prescribed nonrestorative caries treatments; parallel and split-mouth RCTs)
  RR 0.57 [0.04, 8.69]
  7 studies · 1304 participants
  Very low

1% chlorhexidine + 1% thymol varnish vs no treatment

1% chlorhexidine + 1% thymol varnish may not differ from no treatment for arrest or reversal of root carious lesions (RR 1.67, 95% CI 0.44 to 6.31; very low certainty).

• Nonrestorative Treatments for Caries: Systematic Review and Network Meta-analysis. 2019 All outcomes

  3-12 mo · Dental practice (professionally applied or prescribed nonrestorative caries treatments; parallel and split-mouth RCTs)
  RR 1.67 [0.44, 6.31]
  7 studies · 1304 participants
  Very low

1% chlorhexidine + 1% thymol varnish vs 38% SDF solution (applied annually)

1% chlorhexidine + 1% thymol varnish may not differ from 38% SDF solution (applied annually) for arrest or reversal of root carious lesions (RR 0.88, 95% CI 0.14 to 5.6; very low certainty).

• Nonrestorative Treatments for Caries: Systematic Review and Network Meta-analysis. 2019 All outcomes

  3-12 mo · Dental practice (professionally applied or prescribed nonrestorative caries treatments; parallel and split-mouth RCTs)
  RR 0.88 [0.14, 5.6]
  7 studies · 1304 participants
  Very low

1% chlorhexidine + 1% thymol varnish vs 5,000-ppm F (1.1% NaF) toothpaste or gel

1% chlorhexidine + 1% thymol varnish may not differ from 5,000-ppm F (1.1% NaF) toothpaste or gel for arrest or reversal of root carious lesions (RR 0.64, 95% CI 0.15 to 2.7; very low certainty).

• Nonrestorative Treatments for Caries: Systematic Review and Network Meta-analysis. 2019 All outcomes

  3-12 mo · Dental practice (professionally applied or prescribed nonrestorative caries treatments; parallel and split-mouth RCTs)
  RR 0.64 [0.15, 2.7]
  7 studies · 1304 participants
  Very low

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 (any concentration; 0.05% to 0.2%) used in… showed no clear difference in supragingival calculus formation (various calculus indices) compared with placebo/control mouthrinse, or no mouthrinse (mechanical oral…; GRADE not reported.

• Chlorhexidine mouthrinse as an adjunctive treatment for gingival health 2017 · Cochrane All outcomes

  4 to 6 weeks
  SMD 0.02 [-0.09, 0.14]
  2 studies · 102 participants
  GRADE not reported
• Chlorhexidine mouthrinse as an adjunctive treatment for gingival health 2017 · Cochrane All outcomes

  7 to 12 weeks
  SMD 0.32 [-0.04, 0.69]
  6 studies · 425 participants
  GRADE not reported
• Chlorhexidine mouthrinse as an adjunctive treatment for gingival health 2017 · Cochrane All outcomes

  6 months
  SMD 0.80 [0.33, 1.26]
  4 studies · 323 participants
  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 (any concentration; 0.05% to 0.2%) used in… leads to lower gingivitis (gingival inflammation) measured by Gingival Index of Loe… compared with placebo/control mouthrinse, or no mouthrinse (mechanical oral… (high certainty).

• Chlorhexidine mouthrinse as an adjunctive treatment for gingival health 2017 · Cochrane All outcomes

  4 to 6 weeks
  MD -0.21 [-0.31, -0.11]
  10 studies · 805 participants
  High
• Chlorhexidine mouthrinse as an adjunctive treatment for gingival health 2017 · Cochrane All outcomes

  6 months
  MD -0.20 [-0.30, -0.11]
  13 studies · 2616 participants
  High

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 (any concentration; 0.05% to 0.2%) used in… led to lower gingival bleeding (various bleeding indices) compared with placebo/control mouthrinse, or no mouthrinse (mechanical oral…; GRADE not reported.

• Chlorhexidine mouthrinse as an adjunctive treatment for gingival health 2017 · Cochrane All outcomes

  4 to 6 weeks
  SMD -0.56 [-0.79, -0.33]
  8 studies · 649 participants
  GRADE not reported
• Chlorhexidine mouthrinse as an adjunctive treatment for gingival health 2017 · Cochrane All outcomes

  6 months
  SMD -0.72 [-1.02, -0.42]
  8 studies · 1132 participants
  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 (any concentration; 0.05% to 0.2%) used in… leads to lower dental plaque (various plaque indices) compared with placebo/control mouthrinse, or no mouthrinse (mechanical oral… (high certainty).

• Chlorhexidine mouthrinse as an adjunctive treatment for gingival health 2017 · Cochrane All outcomes

  6 months
  SMD -1.43 [-1.76, -1.10]
  11 studies · 2075 participants
  High
• Chlorhexidine mouthrinse as an adjunctive treatment for gingival health 2017 · Cochrane All outcomes

  4 to 6 weeks
  SMD -1.45 [-1.90, -1.00]
  12 studies · 950 participants
  High

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

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 (any concentration; 0.05% to 0.2%) used in… led to higher extrinsic tooth staining (various staining indices) compared with placebo/control mouthrinse, or no mouthrinse (mechanical oral…; GRADE not reported.

• Chlorhexidine mouthrinse as an adjunctive treatment for gingival health 2017 · Cochrane All outcomes

  6 months
  SMD 1.54 [1.22, 1.86]
  4 studies · 323 participants
  GRADE not reported
• Chlorhexidine mouthrinse as an adjunctive treatment for gingival health 2017 · Cochrane All outcomes

  4 to 6 weeks
  SMD 1.07 [0.80, 1.34]
  8 studies · 415 participants
  Moderate

Chlorhexidine gel (0.2%, intrasocket) vs placebo or no treatment

• Local interventions for the management of alveolar osteitis (dry socket) 2022 · Cochrane All outcomes

  Follow-up: median 7 days
  No adverse events were reported. Six trials (673 participants) reported no adverse events from the use of chlorhexidine gel; one study (Rubio-Palau 2015) reported gastrointestinal discomfort (30, 18%), dizziness (10,…
  7 studies
  GRADE not reported

Chlorhexidine gel (0.2%, intrasocket) vs placebo or no treatment

Chlorhexidine gel (0.2%, intrasocket) probably leads to lower presence of dry socket compared with placebo or no treatment (moderate certainty).

• Local interventions for the management of alveolar osteitis (dry socket) 2022 · Cochrane All outcomes

  Follow-up: median 7 days
  OR 0.44 [0.27, 0.71]
  7 studies · 753 participants
  Moderate

Chlorhexidine and xylitol chewing gum vs placebo (2‐week intervention)

No infant caries outcomes were assessed because the proposed randomized trial was discontinued.

• Reducing Alaska Native paediatric oral health disparities: a systematic review of oral health interventions and a case… 2013 All outcomes

  Yukon-Kuskokwim Delta · Trial discontinued
  no estimate extracted
  1 study
  GRADE not reported