What do systematic reviews say?

Fluoride mouthrinse (0.05-0.32% sodium fluoride or amine fluoride) added to daily fluoride toothpaste vs Control: fluoride toothpaste alone, placebo mouthrinse + toothpaste, or non-fluoride (chlorhexidine) mouthrinse + toothpaste

When only aesthetic-zone teeth (incisors and canines) were considered, two studies reported a significant reduction in initial caries incidence favoring fluoride mouthrinse (ungraded, narrative; no pooled estimate).

• Fluoride mouthrinses for prevention of initial caries in orthodontic patients - a systematic review and meta-analysis. 2025 All outcomes

  At debonding (Gorelick index) · Clinical orthodontic (fixed multi-bracket appliance) treatment · Aesthetic zone (central and lateral incisors, canines)
  In two studies, a significant reduction of the incidence of initial caries around orthodontic brackets was reported in the FMR group when only teeth in the 'aesthetic zone' (central and lateral incisors, canines) were…
  2 studies
  GRADE not reported

Fluoride mouthrinse (0.05-0.32% sodium fluoride or amine fluoride) added to daily fluoride toothpaste vs Control: fluoride toothpaste alone, placebo mouthrinse + toothpaste, or non-fluoride (chlorhexidine) mouthrinse + toothpaste

Only one included study assessed proximal caries incidence from bitewing radiographs; it was not included in the meta-analysis and no pooled estimate is available (ungraded).

• Fluoride mouthrinses for prevention of initial caries in orthodontic patients - a systematic review and meta-analysis. 2025 All outcomes

  At debonding (~23-24 months) · Clinical orthodontic (fixed multi-bracket appliance) treatment
  In one study assessments of proximal caries incidence were made as well [18]. However, just the data on the incidence of white spot lesions was included in our meta-analysis as different endpoints for the assessments…
  1 study
  GRADE not reported

Fluoride mouthrinse (0.05-0.32% sodium fluoride or amine fluoride) added to daily fluoride toothpaste vs Control: fluoride toothpaste alone, placebo mouthrinse + toothpaste, or non-fluoride (chlorhexidine) mouthrinse + toothpaste

Adding a fluoride mouthrinse to daily fluoride toothpaste produced a small reduction in the incidence of initial caries/white spot lesions adjacent to brackets (pooled risk difference -0.07, 95% CI -0.14 to -0.01; 5 studies, 491 subjects), but the authors judged the overall evidence inconclusive (ungraded).

• Fluoride mouthrinses for prevention of initial caries in orthodontic patients - a systematic review and meta-analysis. 2025 All outcomes

  End of intervention (6-26 months) to within 6 weeks after debonding · Clinical orthodontic (fixed multi-bracket appliance) treatment
  RD -0.07 [-0.14, -0.01]
  5 studies · 491 participants
  GRADE not reported

Fluoride mouthrinse (0.05-0.32% sodium fluoride or amine fluoride) added to daily fluoride toothpaste vs Control: fluoride toothpaste alone, placebo mouthrinse + toothpaste, or non-fluoride (chlorhexidine) mouthrinse + toothpaste

No adverse effects were reported in any of the seven included studies (ungraded).

• Fluoride mouthrinses for prevention of initial caries in orthodontic patients - a systematic review and meta-analysis. 2025 All outcomes

  During treatment · Clinical orthodontic (fixed multi-bracket appliance) treatment
  No side- or adverse effects were reported in any of the included reports.
  7 studies · 704 participants
  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

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

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

Light vibrational forces (LVF) vs Conventional orthodontic appliance treatment

The review found no eligible studies for this question.

• Non‐surgical adjunctive interventions for accelerating tooth movement in patients undergoing orthodontic treatment 2023 · Cochrane All outcomes
  Cost of treatment was not investigated in any of the included studies.
  Studies not reported
  No studies found

Light vibrational forces (LVF) vs Conventional orthodontic appliance treatment

• Non‐surgical adjunctive interventions for accelerating tooth movement in patients undergoing orthodontic treatment 2023 · Cochrane All outcomes
  Siriphan 2019 (lateral cephalometric radiographs): rate of molar movement and tipping, and canine rotation and tipping were not significantly different between groups (P>0.05).
  1 study
  GRADE not reported

Light vibrational forces (LVF) vs Conventional orthodontic appliance treatment

Light vibrational forces (LVF) showed no clear difference in patient perception of pain and discomfort (VAS 0 to 100 mm),… compared with conventional orthodontic appliance treatment (placebo or no adjunct) (low certainty).

• Non‐surgical adjunctive interventions for accelerating tooth movement in patients undergoing orthodontic treatment 2023 · Cochrane All outcomes

  Immediately after ligation of initial archwire (also 4-8h, 1, 3, 7 days)
  MD 2.56 [-2.35, 7.47]
  3 studies · 153 participants
  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

Light vibrational forces (LVF) vs Conventional orthodontic appliance treatment

Light vibrational forces (LVF) showed no clear difference in harms and side effects: orthodontically-induced inflammatory root… compared with conventional orthodontic appliance treatment (placebo or no adjunct) (low certainty).

• Non‐surgical adjunctive interventions for accelerating tooth movement in patients undergoing orthodontic treatment 2023 · Cochrane All outcomes
  MD 0.09 [-0.35, 0.53]
  1 study · 50 participants
  Low

Fluoride varnish vs Placebo varnish, resin sealant, or standard care (oral hygiene instructions)

Fluoride varnish applied regularly during fixed orthodontic treatment may reduce the prevalence of white spot lesions at debonding (pooled RR 0.64, 95% CI 0.42 to 0.98), but the certainty of evidence is very low.

• Prevention of white spot lesions with fluoride varnish during orthodontic treatment with fixed appliances: a… 2023 All outcomes

  At debonding · Orthodontic care (fixed multi-bracket appliance treatment)
  RR 0.64 [0.42, 0.98]
  5 studies · 558 participants
  Very low

Light vibrational forces (LVF) vs Conventional orthodontic appliance treatment

• Non‐surgical adjunctive interventions for accelerating tooth movement in patients undergoing orthodontic treatment 2023 · Cochrane All outcomes
  No serious adverse effects were reported across five studies that assessed harms (Katchooi 2018; Lombardo 2018; Pavlin 2015; Reiss 2020; Taha 2020).
  5 studies
  GRADE not reported

Light vibrational forces (LVF) vs Conventional orthodontic appliance treatment

Light vibrational forces (LVF) showed no clear difference in rate of orthodontic tooth movement (OTM) during space closure stage… compared with conventional orthodontic appliance treatment (placebo or no adjunct) (low certainty).

• Non‐surgical adjunctive interventions for accelerating tooth movement in patients undergoing orthodontic treatment 2023 · Cochrane All outcomes

  Space closure stage
  MD 0.10 [-0.08, 0.29]
  2 studies · 81 participants
  Low

Light vibrational forces (LVF) vs Conventional orthodontic appliance treatment

• Non‐surgical adjunctive interventions for accelerating tooth movement in patients undergoing orthodontic treatment 2023 · Cochrane All outcomes
  Woodhouse 2015 (81 participants, 22 dropouts): PAR reduction intervention median 28.0 (IQR 21.0-38.0), control median 29.0 (IQR 24.0-31.0), placebo median 27.0 (IQR 20.0-35.0); percentage improvement medians 88.9 /…
  1 study · 59 participants
  GRADE not reported

Light vibrational forces (LVF) vs Conventional orthodontic appliance treatment

Light vibrational forces (LVF) showed no clear difference in patient-reported need for analgesics during first week of initial… compared with conventional orthodontic appliance treatment (placebo or no adjunct) (low certainty).

• Non‐surgical adjunctive interventions for accelerating tooth movement in patients undergoing orthodontic treatment 2023 · Cochrane All outcomes

  First week of initial aligning archwire
  OR 1.64 [0.60, 4.53]
  2 studies · 76 participants
  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

Light vibrational forces (LVF) vs Conventional orthodontic appliance treatment

• Non‐surgical adjunctive interventions for accelerating tooth movement in patients undergoing orthodontic treatment 2023 · Cochrane All outcomes
  Katchooi 2018 (unclear risk of bias): light vibrational forces had no statistically significant (P>0.05) effect on OHRQoL when used with orthodontic aligners.
  1 study · 27 participants
  GRADE not reported

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