Influence of Repeated Chlorhexidine Varnish Applications on Mutans Streptococci Counts and Caries Increment in Patients Treated with Fixed Orthodontic Appliances

Abstract

The occurrence of new carious lesions is among the most detrimental side effects in subjects undergoing orthodontic therapy with fixed appliances. The present study evaluated the efficacy of repeated applications of a 40% chlorhexidine varnish in this patient group with regard to long-term suppression of elevated mutans streptococci levels and the frequency and location of new carious lesions. Thirty-three prospective orthodontic patients age 11 to 18 harboring more than 10(5) mutans streptococci per ml saliva at the initial examination participated in the study. At baseline the previous carious involvement in each subject was recorded using the DMFS index, and extensive information on caries prevention was given. Using a random assignment 18 subjects were included in the test group while the remaining 15 subjects were assigned to the placebo group. From the time of banding until removal of the fixed appliances (median: 21 months) salivary mutans streptococci counts were recorded once every 8 weeks in both groups. At the same appointments all teeth and introaral appliances in the test group were coated with a 40% chlorhexidine varnish. Subjects in the placebo group were treated in the same way, using a placebo varnish with the same varnish base. After debanding, the DMFS score of each participant was recorded again. Analysis of the data revealed that mutans streptococci counts in the test group were only temporarily suppressed and were restored almost to baseline levels by the end of the study. In both groups a clinically relevant increase in the average DMFS score was recorded. Inter-group differencies were not significant.

Effects of chlorhexidine varnish on caries during orthodontic treatment: a systematic review and meta-analysis

“…One article was excluded because of the lack of a control group. Six articles 16,17,18,19,20,21 were included in the systematic review. Figure 1 illustrates the search results.…”

“…Only one article 18 used 40% CHX varnish. The other five articles 16,17,19,20,21 used CHX varnish 1% with thymol 1%.…”

“…In the selected articles, different concentrations of CHX varnishes were used. Jenatschke et al 18 used 40% CHX varnish every 8 weeks; they relayed that the application of the viscous varnish was very difficult. Despite the high concentration of CHX used by the authors, no statistically significant difference was demonstrated.…”

“…The data from four 16,18,19,21 articles included studies that compared via meta-analysis. Three articles 16,18,19 were included in the continuous data meta-analysis, two articles 16,21 were included in the dichotomy data meta-analysis, and one article was 16 .…”

“…Three articles 16,18,19 were included in the continuous data meta-analysis, two articles 16,21 were included in the dichotomy data meta-analysis, and one article was 16 . Two articles 17,20 were excluded from meta-analysis because in addition to the CHX, they applied fluoride varnish, hence constituting a bias.…”