Effects of chlorhexidine use on periodontal health during fixed appliance orthodontic treatment: a systematic review and meta-analysis

Abstract

Summary Background Proper oral hygiene and absence of periodontal inflammation is pre-requisite for orthodontic treatment. Chlorhexidine (CHX) is an established oral antiseptic used in the treatment of periodontal disease, but its role in orthodontic therapy is unclear. Objectives To assess the efficacy of adjunct use of CHX-containing products in maintaining gingival health among orthodontic patients with fixed appliances. Search methods Five databases were searched without limitations up to August 2021. Selection criteria Randomized clinical trials (RCTs) assessing Gingival Index (GI) (primary outcome), Plaque Index (PI), Bleeding Index (BI), or Pocket Probing Depth (PPD). Data collection and analysis Study selection, data extraction, and risk of bias assessment were done independently in duplicate. Random-effects meta-analyses of mean differences (MDs) or standardized mean differences (SMDs) with their 95% confidence intervals (CIs) were conducted, followed by sensitivity and Grades of Recommendations, Assessment, Development and Evaluation analysis. Results Twenty RCTs (1001 patients) were included assessing CHX-containing mouthwashes (n = 11), toothpastes (n = 2), gels (n = 3), or varnishes (n = 4) compared to placebo/control (n = 19) or sodium fluoride-products (n = 4). In the short-term, CHX-containing mouthwash was associated with lower GI (n = 9; MD = −0.68; 95% CI = −0.97 to −0.38; P < 0.001; high quality), lower PI (n = 9; MD = −0.65; 95% CI = −0.86 to −0.43; P < 0.001; high quality), lower BI (n = 2; SMD = −1.61; 95% CI = −2.99 to −0.22; P = 0.02; low quality), and lower PPD (n = 2; MD = −0.60 mm; 95% CI = −1.06 to −0.14 mm; P = 0.01; low quality). No considerable benefits were found from the use of CHX-gel or CHX-varnish in terms of GI, PI, or PPD (P > 0.05/low quality in all instances). Use of a CHX-containing toothpaste was more effective in lowering PI (Heintze-index) than adjunct use of fluoride-containing mouthwash (n = 2; MD = −5.24; 95% CI = −10.46 to −0.02; P = 0.04), but not GI (P = 0.68) or BI (P = 0.27), while sensitivity analyses indicated robustness. Conclusions Adjunct use of CHX mouthwash during fixed-appliance treatment is associated with improved gingival inflammation, plaque control, and pocket depths, but caution is warranted and recommendations about CHX use during orthodontic treatment of children/adults should consider the heterogeneous patient response, cost-effectiveness, and potential adverse effects. Registration PROSPERO registration (CRD42021228759).

COVID-19 Related Information on Pediatric Dental Care including the Use of Teledentistry: A Narrative Review

“…All known measures to control airborne infections, including SARS-CoV-2, have been incorporated into dental and pedodontic practice to ensure patient safety and allow pedodontic treatments to be performed while minimizing the risk of infection in dental settings [ 35 , 36 , 37 , 38 ].…”

“…Specifically, the indication for the use of manual toothbrushes or electronic toothbrushes should be based on a case-specific assessment, as they are equally effective in controlling plaque accumulation [ 35 , 36 ]. Conversely, antimicrobial gels are a valuable addition to daily oral hygiene, as these products act on cariogenic and periodontopathogenic biofilm [ 37 , 38 , 39 , 40 , 41 ], reducing the risk of caries and gingivitis occurrence. In particular, gels containing chlorhexidine are more effective in controlling biofilm than gels containing fluoride [ 39 , 42 ].…”

“…In particular, gels containing chlorhexidine are more effective in controlling biofilm than gels containing fluoride [ 39 , 42 ]. However, the administration of chlorhexidine, regardless of the formulation (toothpaste, mouth rinse, gel), must be carefully evaluated after assessing the risk-benefit ratio for the individual pedodontic patient, as it is not free of side effects [ 37 ]. Alternatively, organic plant-based products can be recommended, which are also available in different formulas and have beneficial effects on plaque accumulation and gingival inflammation without causing adverse effects [ 38 ], although the available evidence is still controversial [ 39 ].…”

“…Therefore, preventive measures to control airborne and aerosol-transmitted infections in dental settings should be continuously incorporated into pedodontic practice, at least for the time being, in addition to standard measures, to ensure the safety of unvaccinated pediatric patients [ 37 , 38 ] and to avoid the so-called “pandemic of the unvaccinated” [ 59 ].…”

Screening for Selenomonas noxia in a Pediatric and Adolescent Patient Population Reveals Differential Oral Prevalence across Age Groups

“…These bacteria are mainly associated with the development and progression of periodontitis, which has been linked with the host inflammatory response to these microbial pathogens, as well as underlying medical conditions, including diabetes [4]. The association of periodontitis among younger and pediatric patients in the United States has mainly been observed in adolescent and teenage patients with orthodontic appliances and brackets [5,6].…”