The role of chlorhexidine (CHX) in inhibiting plaque growth has been extensively studied. The aim of the review was to evaluate the effectiveness of CHX-containing dentifrice (DF) or gel (CHX DF/gel) compared with CHX mouthwash (MW).

Searches were conducted in Medline-PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL) and Embase databases. Randomized controlled trials (RCTs) or controlled clinical trials (CCTs) in adults ≥ 18 years of age comparing CHX DF/gel with CHX MW written in English or Dutch were considered. Two reviewers independently screened, quality assessed and abstracted data from the studies.

• 5 RCTs (4 parallel design; 1 cross-over) were included.
• 4 were considered to be at low risk of bias and one at moderate risk.
• 3 of the 5 studies showed a positive effect on plaque scores in favour of the CHX MW.
• No significant differences were found in relation to gingival index and bleeding scores
• Chlorhexidine mouthwash, showed significantly more tooth discoloration than the CHX DF/gel.
• A meta-analysis (3 studies) of the effect on ‘de novo’ plaque formation of CHX DF/gel versus CHX MW resulted in a difference in means of 0.27 [95% CI: 0.14; 0.39] (P < 0.0001).

The authors concluded

Chlorhexidine gel can be successfully formulated and will inhibit plaque growth to some degree, but not to the same extent, as a CHX MW. When CHX DF/gel is used in a non-brushing model, it is significantly less effective in plaque inhibition compared to CHX MW. Based on one study when CHX gel was applied with a finger after brushing, it is significantly more effective on plaque scores and the gingival index. The only brushing study also with a long follow-up showed that there is no significant difference between CHX DF and CHX MW. However, as a corollary, significantly more tooth discoloration was observed with the CHX MW. Altogether, the data show that when daily oral hygiene cannot be performed, CHX MW is the first product of choice.

Comment

The authors note considerable heterogeneity in the included studies in relation to study design, participants, evaluation period, oral prophylaxis, and the intervention regimen. The difficulty in blinding patients owing to the different products was also highlighted. The limited number os studies available should be taken into account when assessing this evidence.

Links

Supranoto S, Slot D, Addy M, Van der Weijden G. The effect of chlorhexidine dentifrice or gel versus chlorhexidine mouthwash on plaque, gingivitis, bleeding and tooth discoloration: a systematic review. Int J Dent Hyg. 2014 Jul 24. doi: 10.1111/idh.12078. [Epub ahead of print] PubMed PMID: 25059640.

 Dental Elf 2^nd Sept 2013 – Review suggests that brushing with a chlorhexidine-containing dentifrice may help control plaque and gingivitis