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
Current version onlyChlorhexidine 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 |
Chlorhexidine varnish vs Placebo or no intervention (including routine care)
Population: Children and adolescents below the age of 18 years, with both permanent and deciduous dentition, regardless of caries incidence, risk category, socioeconomic status, health status or geographical location (participants undergoing fixed/removable orthodontic treatment excluded)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | no estimate extracted | 0 studies | No studies |
Chlorhexidine gel vs Placebo or no intervention (including routine care)
Population: Children and adolescents below the age of 18 years, with both permanent and deciduous dentition, regardless of caries incidence, risk category, socioeconomic status, health status or geographical location (participants undergoing fixed/removable orthodontic treatment excluded)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | no estimate extracted | 0 studies | No studies |
Chlorhexidine toothpaste vs Placebo or no intervention (including routine care)
Population: Children and adolescents below the age of 18 years, with both permanent and deciduous dentition, regardless of caries incidence, risk category, socioeconomic status, health status or geographical location (participants undergoing fixed/removable orthodontic treatment excluded)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | no estimate extracted | 0 studies | No studies |
Chlorhexidine mouthrinse vs Placebo or no intervention (including routine care)
Population: Children and adolescents below the age of 18 years, with both permanent and deciduous dentition, regardless of caries incidence, risk category, socioeconomic status, health status or geographical location (participants undergoing fixed/removable orthodontic treatment excluded)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | no estimate extracted | 0 studies | No studies |
Chlorhexidine chewing gum vs Placebo or no intervention (including routine care)
Population: Children and adolescents below the age of 18 years, with both permanent and deciduous dentition, regardless of caries incidence, risk category, socioeconomic status, health status or geographical location (participants undergoing fixed/removable orthodontic treatment excluded)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | no estimate extracted | 0 studies | No studies |
Chlorhexidine spray vs Placebo or no intervention (including routine care)
Population: Children and adolescents below the age of 18 years, with both permanent and deciduous dentition, regardless of caries incidence, risk category, socioeconomic status, health status or geographical location (participants undergoing fixed/removable orthodontic treatment excluded)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | no estimate extracted | 0 studies | No studies |
Chlorhexidine oral product (specific formulation/concentration) vs Another chlorhexidine formulation, concentration or application frequency
Population: Children and adolescents below the age of 18 years, with both permanent and deciduous dentition, regardless of caries incidence, risk category, socioeconomic status, health status or geographical location (participants undergoing fixed/removable orthodontic treatment excluded)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | no estimate extracted | 0 studies | No studies |