Cochrane · intervention · CD008457
Chlorhexidine treatment for the prevention of dental caries in children and adolescents
Walsh, T, Oliveira‐Neto, JM, Moore, D · Cochrane Database of Systematic Reviews · 2015 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
14
current version
GRADE rated
4
No studies
7
Included studies
8
as reported
No studies 7 · 50%Ungraded 3 · 21.4%Very low 4 · 28.6%Low 0 · 0%Moderate 0 · 0%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.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Children and adolescents below 18 years at study start (included studies: children from birth to 15 years), with mixed, permanent or primary dentition, moderate to high caries risk | Children from birth to 15 years with moderate to high caries risk (2876 randomised, 2276 evaluated); 4 studies permanent dentition only, 1 study both primary and permanent, 3 studies primary dentition only |
| Intervention | Chlorhexidine-containing oral products (gels, toothpastes, varnishes, mouthrinses, chewing gums, sprays); different concentrations and application frequencies; combined chlorhexidine+fluoride excluded | Chlorhexidine varnish 1% (n=723); Chlorhexidine varnish 10% (n=579); Chlorhexidine varnish 40% (n=484); Chlorhexidine gel 0.12% (n=490) |
| Comparison | Placebo or no intervention (including routine dental care); head-to-head comparisons of different chlorhexidine interventions | No treatment (n=1063); Placebo (n=1213) |
| Outcomes | Primary: caries increment at the dentine level (change from baseline in D(M)FS/T for permanent teeth and d(m)fs/t for primary teeth; caries incidence as number of children developing caries); mutans streptococci (dichotomous: presence/absence or high/low). Secondary: pain; quality of life; patient satisfaction; direct and indirect costs; adverse effects (tooth staining/discolouration, soft tissue damage, hypersensitivity reactions, nausea, vomiting) | Caries increment (n=8); Mutans streptococci levels (n=5); Adverse events (n=4) |
| Study designs | Randomised controlled trial (parallel-group; split-mouth design excluded); treatment period of less than one year now eligible | Randomised controlled trial (n=8; 6 individually randomised parallel, 2 cluster-randomised) |
| Timing | Outcomes measured at the end of the study period; follow-up at final examination | 6 to 36 months follow-up |
Search date: 2015-02. Databases: Cochrane Oral Health Group Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE via OVID; EMBASE via OVID; CINAHL via EBSCO
Questions and results
Show all 2 versionsChlorhexidine varnish vs Placebo or no treatment
Population: Children and adolescents below 18 years at study start (included studies: children from birth to 15 years), with mixed, permanent or primary dentition, moderate to high caries risk
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse events (e.g. ulcers, tooth staining) | One study reported no adverse events for ulcers or tooth staining. One study stated "side-effects due to the CHX treatment were not noted". | 2 studies | Ungraded |
Caries increment in permanent dentition (DMFS; higher values indicate greater caries) 30 to 36 months · permanent dentition | MD 0.53 [-0.47, 1.53] 0.53 [-0.47, 1.53] DMFS increment (higher = more caries) | 2 studies · 690 participants | Very low Downgraded: risk of bias, inconsistency |
Pain, quality of life, patient satisfaction or costs | No trials reported on pain, quality of life, patient satisfaction or costs. | 0 studies | No studies |
Caries increment in the primary teeth (d(m)fs/t) 24 months · primary dentition | Two trials with unit of analysis problem. Data imputations indicated no evidence to claim or refute a benefit | 2 studies · 471 participants | Ungraded |
Elevated mutans streptococci levels (>=4 with caries screen; high vs low) 6 to 36 months · permanent dentition | RR 0.93 [0.80, 1.07] -43 [-124, 44] per 1000 (fewer with chlorhexidine) | 1 study · 496 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Chlorhexidine gel (0.12%) vs No treatment
Population: Children and adolescents below 18 years at study start (included studies: children from birth to 15 years), with mixed, permanent or primary dentition, moderate to high caries risk
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse events 24 months · primary dentition | Both studies reported there were no adverse events. | 2 studies | Ungraded |
Mutans streptococci prevalence (presence/absence) 24 months · primary dentition | RR 1.26 [0.95, 1.66] 180 per 1000; 466 per 1000 vs 227 per 1000 (171 to 299); 587 per 1000 (443 to 774) | 2 studies · 490 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Pain, quality of life, patient satisfaction or costs | Neither of these trials reported on the other secondary outcomes such as measures of pain, quality of life, patient satisfaction or direct and indirect costs of interventions. | 0 studies | No studies |
Presence of new caries in the primary teeth 24 months · primary dentition | RR 1.00 [0.36, 2.77] 0 per 1000 (no difference; RR 1.00) | 2 studies · 487 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Chlorhexidine toothpaste vs Placebo or no intervention (including routine care)
Population: Children and adolescents below 18 years at study start (included studies: children from birth to 15 years), with mixed, permanent or primary dentition, moderate to high caries risk
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | There were no trials on other products containing chlorhexidine such as sprays, toothpastes, chewing gums or mouthrinses. | 0 studies | No studies |
Chlorhexidine mouthrinse vs Placebo or no intervention (including routine care)
Population: Children and adolescents below 18 years at study start (included studies: children from birth to 15 years), with mixed, permanent or primary dentition, moderate to high caries risk
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | There were no trials on other products containing chlorhexidine such as sprays, toothpastes, chewing gums or mouthrinses. | 0 studies | No studies |
Chlorhexidine chewing gum vs Placebo or no intervention (including routine care)
Population: Children and adolescents below 18 years at study start (included studies: children from birth to 15 years), with mixed, permanent or primary dentition, moderate to high caries risk
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | There were no trials on other products containing chlorhexidine such as sprays, toothpastes, chewing gums or mouthrinses. | 0 studies | No studies |
Chlorhexidine spray vs Placebo or no intervention (including routine care)
Population: Children and adolescents below 18 years at study start (included studies: children from birth to 15 years), with mixed, permanent or primary dentition, moderate to high caries risk
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | There were no trials on other products containing chlorhexidine such as sprays, toothpastes, chewing gums or mouthrinses. | 0 studies | No studies |
Chlorhexidine oral product (one formulation/concentration) vs Another chlorhexidine formulation, concentration or application frequency
Population: Children and adolescents below 18 years at study start (included studies: children from birth to 15 years), with mixed, permanent or primary dentition, moderate to high caries risk
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | no estimate extracted | 0 studies | No studies |