Cochrane · intervention · CD008676
Chlorhexidine mouthrinse as an adjunctive treatment for gingival health
James, P, Worthington, HV, Parnell, C, et al. · Cochrane Database of Systematic Reviews · 2017 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
12
current version
GRADE rated
5
No studies
0
Included studies
51
as reported
No studies 0 · 0%Ungraded 7 · 58.3%Very low 0 · 0%Low 0 · 0%Moderate 1 · 8.3%High 4 · 33.3%
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 or adults with gingivitis or periodontitis capable of performing normal mechanical oral hygiene procedures (participants aged 16 or less classified as children); studies with some or all participants having medical conditions or special care needs included | Children and adults with gingivitis or periodontitis, including some with medical conditions or special care needs; 5345 participants analysed in relevant study arms (per-study analysed numbers 20 to 852) (n=51 studies) |
| Intervention | Chlorhexidine mouthrinse (any concentration, volume, frequency or duration of rinsing) used in conjunction with mechanical oral hygiene procedures (could include chlorhexidine containing fluoride, and baseline prophylaxis if applied to all arms) | Chlorhexidine mouthrinse, concentrations 0.05% to 0.2% (n=51 studies) |
| Comparison | Mechanical oral hygiene alone; or mechanical oral hygiene plus placebo/control mouthrinse | Placebo mouthrinse (n=35 studies); Control mouthrinse (n=7 studies); No mouthrinse / mechanical oral hygiene alone (n=9 studies) |
| Outcomes | Primary: Gingivitis (gingival inflammation and gingival bleeding) measured using any appropriate index/scale (e.g. Gingival Index of Loe and Silness, Modified Gingival Index, Gingival Bleeding Index). Secondary: Dental plaque (any index, e.g. Plaque Index, Turesky modification of Quigley and Hein Index); Calculus (any index); Tooth staining (any index); Adverse effects (e.g. mucosal desquamation, taste disturbances, allergic reactions) | Gingival inflammation - Gingival Index (n=31 studies); Gingival bleeding (n=34 studies); Plaque (n=48 studies); Calculus (n=12 studies); Extrinsic tooth staining (n=21 studies); Other adverse effects (n=22 studies) |
| Study designs | Parallel-group randomised controlled trials (RCTs); cross-over studies excluded | Parallel-group RCT (n=51 studies) |
| Timing | Duration of mouthrinsing at least 4 weeks; outcomes grouped at 4 to 6 weeks, 7 to 12 weeks, 13 weeks to 6 months and greater than 6 months (primary analyses at 4 to 6 weeks and 6 months) | Studies ranged from 4 weeks to 2 years duration; outcomes extracted at 4 to 6 weeks, 7 to 12 weeks, 13 weeks to 6 months and greater than 6 months |
Search date: 2016-09. Databases: Cochrane Oral Health's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE Ovid; Embase Ovid; CINAHL EBSCO
Questions and results
Current version onlyChlorhexidine 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)
Population: Children or adults with gingivitis or periodontitis capable of performing normal mechanical oral hygiene procedures (some with medical conditions or special care needs)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Supragingival calculus formation (various calculus indices) 7 to 12 weeks | SMD 0.32 [-0.04, 0.69] | 6 studies · 425 participants | Ungraded |
Gingivitis (gingival inflammation) measured by Gingival Index of Loe and Silness 6 months | MD -0.20 [-0.30, -0.11] | 13 studies · 2616 participants | High |
Gingival bleeding (various bleeding indices) 6 months | SMD -0.72 [-1.02, -0.42] | 8 studies · 1132 participants | Ungraded |
Supragingival calculus formation (various calculus indices) 4 to 6 weeks | SMD 0.02 [-0.09, 0.14] | 2 studies · 102 participants | Ungraded |
Gingival bleeding (various bleeding indices) 4 to 6 weeks | SMD -0.56 [-0.79, -0.33] | 8 studies · 649 participants | Ungraded |
Supragingival calculus formation (various calculus indices) 6 months | SMD 0.80 [0.33, 1.26] | 4 studies · 323 participants | Ungraded |
Gingivitis (gingival inflammation) measured by Gingival Index of Loe and Silness 4 to 6 weeks | MD -0.21 [-0.31, -0.11] 0.17 to 1.40 across control groups (mean 0.93, median 1.0) vs 0.21 lower (0.11 to 0.31 lower) | 10 studies · 805 participants | High |
Dental plaque (various plaque indices) 6 months | SMD -1.43 [-1.76, -1.10] | 11 studies · 2075 participants | High |
Other adverse effects (taste disturbance, oral mucosal effects, burning sensation) | 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 | Ungraded |
Extrinsic tooth staining (various staining indices) 6 months | SMD 1.54 [1.22, 1.86] | 4 studies · 323 participants | Ungraded |
Dental plaque (various plaque indices) 4 to 6 weeks | SMD -1.45 [-1.90, -1.00] Plaque Index 0.75 to 1.06; Turesky Quigley-Hein Index 1.2 to 3.3 vs SMD 1.45 lower (1.00 to 1.90 lower) | 12 studies · 950 participants | High |
Extrinsic tooth staining (various staining indices) 4 to 6 weeks | SMD 1.07 [0.80, 1.34] Measured on different scales (mean tooth staining score) vs SMD 1.07 higher (0.80 to 1.34 higher) | 8 studies · 415 participants | Moderate Downgraded: risk of bias |
Chlorhexidine mouthrinse (any concentration, volume, frequency or duration of rinsing) used in conjunction with mechanical oral hygiene procedures (toothbrushing with/without dental floss or interdental cleaning aids) vs Mechanical oral hygiene alone (no mouthrinse)
Population: Individuals of any age, gender or race with gingivitis, or with treated periodontitis in the maintenance phase (including after periodontal surgery), capable of performing normal mechanical oral hygiene procedures
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR Intervention duration 4 weeks or longer | Protocol (2010): planned comparison; no results reported at protocol stage. | 0 studies | No studies |
Chlorhexidine mouthrinse (any concentration, volume, frequency or duration of rinsing) used in conjunction with mechanical oral hygiene procedures (toothbrushing with/without dental floss or interdental cleaning aids) vs Placebo mouthrinse
Population: Individuals of any age, gender or race with gingivitis, or with treated periodontitis in the maintenance phase (including after periodontal surgery), capable of performing normal mechanical oral hygiene procedures
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR Intervention duration 4 weeks or longer | Protocol (2010): planned comparison; no results reported at protocol stage. | 0 studies | No studies |
Chlorhexidine mouthrinse (any concentration, volume, frequency or duration of rinsing) used in conjunction with mechanical oral hygiene procedures (toothbrushing with/without dental floss or interdental cleaning aids) vs Mouthrinse containing other plaque inhibitory, anti-plaque or anti-gingivitis agents
Population: Individuals of any age, gender or race with gingivitis, or with treated periodontitis in the maintenance phase (including after periodontal surgery), capable of performing normal mechanical oral hygiene procedures
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR Intervention duration 4 weeks or longer | Protocol (2010): planned comparison; no results reported at protocol stage. | 0 studies | No studies |
Chlorhexidine mouthrinse (any concentration, volume, frequency or duration of rinsing) used in conjunction with mechanical oral hygiene procedures (toothbrushing with/without dental floss or interdental cleaning aids) vs Mouthrinse containing a different formulation of chlorhexidine (e.g. with/without alcohol or anti-staining ingredients)
Population: Individuals of any age, gender or race with gingivitis, or with treated periodontitis in the maintenance phase (including after periodontal surgery), capable of performing normal mechanical oral hygiene procedures
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR Intervention duration 4 weeks or longer | Protocol (2010): planned comparison; no results reported at protocol stage. | 0 studies | No studies |
Chlorhexidine mouthrinse at one concentration (with mechanical oral hygiene) vs Chlorhexidine mouthrinse at another concentration, same rinsing frequency
Population: Individuals of any age, gender or race with gingivitis, or with treated periodontitis in the maintenance phase (including after periodontal surgery), capable of performing normal mechanical oral hygiene procedures
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR Intervention duration 4 weeks or longer | Protocol (2010): planned comparison; no results reported at protocol stage. | 0 studies | No studies |
Chlorhexidine mouthrinse at one rinsing frequency, e.g. once daily (with mechanical oral hygiene) vs Chlorhexidine mouthrinse at another rinsing frequency, e.g. twice daily, same concentration
Population: Individuals of any age, gender or race with gingivitis, or with treated periodontitis in the maintenance phase (including after periodontal surgery), capable of performing normal mechanical oral hygiene procedures
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR Intervention duration 4 weeks or longer | Protocol (2010): planned comparison; no results reported at protocol stage. | 0 studies | No studies |