What do systematic reviews say?

Intervention not reported

• Strategies to integrate oral health into primary care: a systematic review. 2023 All outcomes
  1 study reported an unfavourable outcome
  1 study
  GRADE not reported

Chlorhexidine mouthwash vs placebo

Chlorhexidine mouthwash reduced Mutans streptococci 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
  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

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

Surgery vs Radiotherapy alone

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes
  Adverse events: grade 2+ treatment-related events similar (31/34 radiotherapy vs 33/34 surgery; RR 0.94, 0.83 to 1.06); more hearing loss/neutropenia/constipation/tinnitus with radiotherapy, more oral bleeding/trismus…
  1 study · 68 participants
  Very low

Herbal mouthwash vs placebo

Herbal mouthwash reduced some plaque-related indices versus placebo, with low-certainty evidence.

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

  ≤ 3 months
  PI was significantly reduced compared to placebo [56]; VPI was significantly reduced compared to placebo [41]; PI was insignificantly reduced compared to placebo [19].
  3 studies
  Low

Fluoride mouthwash vs Blank control

Short-term fluoride mouthwash reduced Mutans streptococci, 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 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

Chlorhexidine mouthwash vs Placebo mouthwash

Chlorhexidine mouthwash may reduce pocket probing depth versus placebo in the short term (low certainty).

• 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)
  PD was significantly reduced except mid-lingual site compared to placebo [32]. The changes of PD were significantly higher compared to placebo [56].
  2 studies
  Low

Chlorhexidine mouthwash vs Blank control

Chlorhexidine mouthwash may reduce the Plaque Index versus blank control in the short term (WMD -0.70, 95% CI -1.12 to -0.27), but the evidence is very uncertain (very low certainty).

• 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)
  WMD -0.70 [-1.12, -0.27]
  4 studies · 188 participants
  Very low

Cetylpyridinium chloride mouthwash vs Blank control

CPC mouthwash may reduce plaque-related indexes versus blank control in the short term, but the evidence is very uncertain (very low certainty).

• 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)
  BBPI was significantly reduced compared to blank control [47]. PI was significantly reduced compared to blank control [50]. The amount of dental plaque was significantly reduced compared to baseline [38].
  3 studies
  Very low

Herbal mouthwash vs placebo

Herbal mouthwash reduced Mutans streptococci 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
  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

Fluoride mouthwash vs Blank control

Short-term fluoride mouthwash has uncertain effects on gingival inflammation-related indexes versus blank control (very low certainty).

• 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)
  MGI' and BI' was significantly reduced compared to baseline [34]. BOP and GI was slightly lower compared to blank control [46].
  2 studies
  Very low

Fluoride mouthwash vs Blank control

Long-term fluoride mouthwash showed mixed plaque-index effects, with very low-certainty evidence.

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

  ≥ 12 months
  PI was similar to blank control [37]; API was slightly reduced compared to blank control and significant at 6 and 9 months [59].
  2 studies
  Very low
• The efficacy of mouthwashes on oral microorganisms and gingivitis in patients undergoing orthodontic treatment:… 2023 All outcomes

  ≤ 3 months
  TI was significantly reduced compared to baseline [34]; PI was significantly reduced compared to baseline but similar to blank control [46].
  2 studies
  Very low

Surgery vs Radiotherapy alone

Surgery showed no clear difference in total mortality compared with radiotherapy alone (low certainty).

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes

  3 years
  HR 0.83 [0.09, 7.46]
  1 study · 68 participants
  Low

Fluoride mouthwash vs Blank control

Long-term (>=12 months) fluoride mouthwash may make little or no difference to Lactobacilli colony counts versus blank control (very low certainty).

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

  >=12 months (long-term) · Orthodontic patients undergoing orthodontic treatment (randomized controlled trials; multiple countries)
  Colony count of LB was similar to blank control according to two studies [37, 59].
  2 studies
  Very low

Surgery vs Radiotherapy alone

The review found no eligible studies for this question.

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes
  Locoregional recurrence: not reported.
  0 studies
  No studies found

Chlorhexidine mouthwash vs Blank control

Chlorhexidine mouthwash may reduce the Gingival Index versus blank control in the short term (WMD -0.54, 95% CI -0.96 to -0.13), but with very high heterogeneity the evidence is very uncertain (very low certainty).

• 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)
  WMD -0.54 [-0.96, -0.13]
  6 studies · 274 participants
  Very low

Herbal mouthwash vs placebo

Herbal mouthwash reduced gingival inflammation-related indices 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
  GBI was significantly reduced compared to placebo [41]; GBI was significantly reduced compared to placebo [56]; BI was significantly reduced compared to placebo [40].
  3 studies
  Very low

Herbal mouthwash vs Blank control

Herbal mouthwash probably reduces the Gingival Index versus blank control in the short term (WMD -0.20, 95% CI -0.32 to -0.09; moderate certainty).

• 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)
  WMD -0.20 [-0.32, -0.09]
  3 studies · 132 participants
  Moderate

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

Surgery vs Radiotherapy alone

Surgery showed no clear difference in disease-free survival (new disease, progression, and mortality) compared with radiotherapy alone (low certainty).

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes

  3 years
  HR 1.07 [0.27, 4.22]
  1 study · 68 participants
  Low