Chlorhexidine treatment for the prevention of dental caries in children and adolescents
Background Dental caries (tooth decay) is a common disease that is preventable by reducing the dietary intake of free sugars and using topical sodium fluoride products. An antibacterial agent known as chlorhexidine may also help prevent caries. A number of over‐the‐counter and professionally adminis...
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| creator | Walsh, Tanya Oliveira‐Neto, Jeronimo M Moore, Deborah Walsh, Tanya |
| description | Background
Dental caries (tooth decay) is a common disease that is preventable by reducing the dietary intake of free sugars and using topical sodium fluoride products. An antibacterial agent known as chlorhexidine may also help prevent caries. A number of over‐the‐counter and professionally administered chlorhexidine‐based preparations are available in a variety of formulations and in a range of strengths. Although previous reviews have concluded that some formulations of chlorhexidine may be effective in inhibiting the progression of established caries in children, there is currently a lack of evidence to either claim or refute a benefit for its use in preventing dental caries.
Objectives
To assess the effects of chlorhexidine‐containing oral products (toothpastes, mouthrinses, varnishes, gels, gums and sprays) on the prevention of dental caries in children and adolescents.
Search methods
We searched the Cochrane Oral Health Group Trials Register (25 February 2015), the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 12), MEDLINE via OVID (1946 to 25 February 2015), EMBASE via OVID (1980 to 25 February 2015) and CINAHL via EBSCO (1937 to 25 February 2015). We handsearched several journals placed no language restrictions on our search. After duplicate citations were removed, the electronic searches retrieved 1075 references to studies.
Selection criteria
We included parallel‐group, randomised controlled trials (RCTs) that compared the caries preventive effects of chlorhexidine gels, toothpastes, varnishes, mouthrinses, chewing gums or sprays with each other, placebo or no intervention in children and adolescents. We excluded trials with combined interventions of chlorhexidine and fluoride or comparisons between chlorhexidine and fluoride interventions.
Data collection and analysis
Two review authors independently extracted trial data and assessed risk of bias. We resolved disagreements by consensus. We contacted trial authors for clarification or additional study details when necessary. The number of included studies that were suitable for meta‐analysis was limited due to the clinical diversity of the included studies with respect to age, composition of intervention, and variation in outcome measures and follow‐up. Where we were unable to conduct meta‐analysis, we elected to present a narrative synthesis of the results.
Main results
We included eight RCTs that evaluated the effects of chlorhexidine varnishes (1%, 10% or 40% concentrat |
| doi_str_mv | 10.1002/14651858.CD008457.pub2 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10726983</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1710657061</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5452-24179b44d6819b69ca289980e5996449ce7eed58cb5683aa0463fa930fc0557b3</originalsourceid><addsrcrecordid>eNqFUctOHDEQtFBQIJBfQD7mshvb4-cpShZIIiFxScTR8nh6GEfe8WLP8vj7eLQsglxy6m5VdVW3CqEzSpaUEPaZcimoFnq5OidEc6GWm23LDtDxDCxm5N2r_gh9KOUPIY00TL1HR0xoqTSVx-hmNcSUB3gMXRgBTxnctIZxwn3KeBoAbzLc1zmkEaced7V1EXuXAxQcRuyHELsMI3Zjh12XIhRfOeUUHfYuFvj4XE_Q78uLX6sfi6vr7z9XX68WXnDBFoxTZVrOO6mpaaXxjmljNAFhjOTceFAAndC-FVI3zhEum96ZhvSeCKHa5gR92enW99fQzd7ZRbvJYe3yk00u2LfIGAZ7m-4tJYpJo5uq8OlZIae7LZTJrkP9IUY3QtoWSxUlUigiaaXKHdXnVEqG_sWHEjvHYvex2H0sszuri2evr3xZ2-dQCd92hIcQ4cn65Idc_f-j-4_LX3nOns0</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1710657061</pqid></control><display><type>article</type><title>Chlorhexidine treatment for the prevention of dental caries in children and adolescents</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Alma/SFX Local Collection</source><source>Cochrane Library</source><creator>Walsh, Tanya ; Oliveira‐Neto, Jeronimo M ; Moore, Deborah ; Walsh, Tanya</creator><creatorcontrib>Walsh, Tanya ; Oliveira‐Neto, Jeronimo M ; Moore, Deborah ; Walsh, Tanya</creatorcontrib><description>Background
Dental caries (tooth decay) is a common disease that is preventable by reducing the dietary intake of free sugars and using topical sodium fluoride products. An antibacterial agent known as chlorhexidine may also help prevent caries. A number of over‐the‐counter and professionally administered chlorhexidine‐based preparations are available in a variety of formulations and in a range of strengths. Although previous reviews have concluded that some formulations of chlorhexidine may be effective in inhibiting the progression of established caries in children, there is currently a lack of evidence to either claim or refute a benefit for its use in preventing dental caries.
Objectives
To assess the effects of chlorhexidine‐containing oral products (toothpastes, mouthrinses, varnishes, gels, gums and sprays) on the prevention of dental caries in children and adolescents.
Search methods
We searched the Cochrane Oral Health Group Trials Register (25 February 2015), the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 12), MEDLINE via OVID (1946 to 25 February 2015), EMBASE via OVID (1980 to 25 February 2015) and CINAHL via EBSCO (1937 to 25 February 2015). We handsearched several journals placed no language restrictions on our search. After duplicate citations were removed, the electronic searches retrieved 1075 references to studies.
Selection criteria
We included parallel‐group, randomised controlled trials (RCTs) that compared the caries preventive effects of chlorhexidine gels, toothpastes, varnishes, mouthrinses, chewing gums or sprays with each other, placebo or no intervention in children and adolescents. We excluded trials with combined interventions of chlorhexidine and fluoride or comparisons between chlorhexidine and fluoride interventions.
Data collection and analysis
Two review authors independently extracted trial data and assessed risk of bias. We resolved disagreements by consensus. We contacted trial authors for clarification or additional study details when necessary. The number of included studies that were suitable for meta‐analysis was limited due to the clinical diversity of the included studies with respect to age, composition of intervention, and variation in outcome measures and follow‐up. Where we were unable to conduct meta‐analysis, we elected to present a narrative synthesis of the results.
Main results
We included eight RCTs that evaluated the effects of chlorhexidine varnishes (1%, 10% or 40% concentration) and chlorhexidine gel (0.12%) on the primary or permanent teeth, or both, of children from birth to 15 years of age at the start of the study. The studies randomised a total of 2876 participants, of whom 2276 (79%) were evaluated. We assessed six studies as being at high risk of bias overall and two studies as being at unclear risk of bias overall. Follow‐up assessment ranged from 6 to 36 months.
Six trials compared chlorhexidine varnish with placebo or no treatment. It was possible to pool the data from two trials in the permanent dentition (one study using 10% chlorhexidine and the other, 40%). This led to an increase in the DMFS increment in the varnish group of 0.53 (95% confidence interval (CI) ‐0.47 to 1.53; two trials, 690 participants; very low quality evidence). Only one trial (10% concentration chlorhexidine varnish) provided usable data for elevated mutans streptococci levels > 4 with RR 0.93 (95% CI 0.80 to 1.07, 496 participants; very low quality evidence). One trial measured adverse effects (for example, ulcers or tooth staining) and reported that there were none; another trial reported that no side effects of the treatment were noted. No trials reported on pain, quality of life, patient satisfaction or costs.
Two trials compared chlorhexidine gel (0.12% concentration) with no treatment in the primary dentition. The presence of new caries gave rise to a 95% confidence interval that was compatible with either an increase or a decrease in caries incidence (RR 1.00, 95% CI 0.36 to 2.77; 487 participants; very low quality evidence). Similarly, data for the effects of chlorhexidine gel on the prevalence of mutans streptococci were inconclusive (RR 1.26, 95% CI 0.95 to 1.66; two trials, 490 participants; very low quality evidence). Both trials measured adverse effects and did not observe any. 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.
Authors' conclusions
We found little evidence from the eight trials on varnishes and gels included in this review to either support or refute the assertion that chlorhexidine is more effective than placebo or no treatment in the prevention of caries or the reduction of mutans streptococci levels in children and adolescents. There were no trials on other products containing chlorhexidine such as sprays, toothpastes, chewing gums or mouthrinses. Further high quality research is required, in particular evaluating the effects on both the primary and permanent dentition and using other chlorhexidine‐containing oral products.</description><identifier>ISSN: 1465-1858</identifier><identifier>EISSN: 1465-1858</identifier><identifier>EISSN: 1469-493X</identifier><identifier>DOI: 10.1002/14651858.CD008457.pub2</identifier><identifier>PMID: 25867816</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject>Adolescent ; Anti-Bacterial Agents - therapeutic use ; Antimicrobial ; Anti‐Bacterial Agents ; Cariostatic Agents ; Cariostatic Agents - therapeutic use ; Child ; Child health ; Child, Preschool ; Chlorhexidine ; Chlorhexidine - therapeutic use ; Dental Caries ; Dental Caries - prevention & control ; Dentistry & oral health ; Gels ; Humans ; Infant ; Medicine General & Introductory Medical Sciences ; Mouthwashes ; Mouthwashes - therapeutic use ; ORAL HEALTH ; Prevention ; Randomized Controlled Trials as Topic</subject><ispartof>Cochrane database of systematic reviews, 2015-04, Vol.2015 (4), p.CD008457-CD008457</ispartof><rights>Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5452-24179b44d6819b69ca289980e5996449ce7eed58cb5683aa0463fa930fc0557b3</citedby><cites>FETCH-LOGICAL-c5452-24179b44d6819b69ca289980e5996449ce7eed58cb5683aa0463fa930fc0557b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25867816$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Walsh, Tanya</creatorcontrib><creatorcontrib>Oliveira‐Neto, Jeronimo M</creatorcontrib><creatorcontrib>Moore, Deborah</creatorcontrib><creatorcontrib>Walsh, Tanya</creatorcontrib><title>Chlorhexidine treatment for the prevention of dental caries in children and adolescents</title><title>Cochrane database of systematic reviews</title><addtitle>Cochrane Database Syst Rev</addtitle><description>Background
Dental caries (tooth decay) is a common disease that is preventable by reducing the dietary intake of free sugars and using topical sodium fluoride products. An antibacterial agent known as chlorhexidine may also help prevent caries. A number of over‐the‐counter and professionally administered chlorhexidine‐based preparations are available in a variety of formulations and in a range of strengths. Although previous reviews have concluded that some formulations of chlorhexidine may be effective in inhibiting the progression of established caries in children, there is currently a lack of evidence to either claim or refute a benefit for its use in preventing dental caries.
Objectives
To assess the effects of chlorhexidine‐containing oral products (toothpastes, mouthrinses, varnishes, gels, gums and sprays) on the prevention of dental caries in children and adolescents.
Search methods
We searched the Cochrane Oral Health Group Trials Register (25 February 2015), the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 12), MEDLINE via OVID (1946 to 25 February 2015), EMBASE via OVID (1980 to 25 February 2015) and CINAHL via EBSCO (1937 to 25 February 2015). We handsearched several journals placed no language restrictions on our search. After duplicate citations were removed, the electronic searches retrieved 1075 references to studies.
Selection criteria
We included parallel‐group, randomised controlled trials (RCTs) that compared the caries preventive effects of chlorhexidine gels, toothpastes, varnishes, mouthrinses, chewing gums or sprays with each other, placebo or no intervention in children and adolescents. We excluded trials with combined interventions of chlorhexidine and fluoride or comparisons between chlorhexidine and fluoride interventions.
Data collection and analysis
Two review authors independently extracted trial data and assessed risk of bias. We resolved disagreements by consensus. We contacted trial authors for clarification or additional study details when necessary. The number of included studies that were suitable for meta‐analysis was limited due to the clinical diversity of the included studies with respect to age, composition of intervention, and variation in outcome measures and follow‐up. Where we were unable to conduct meta‐analysis, we elected to present a narrative synthesis of the results.
Main results
We included eight RCTs that evaluated the effects of chlorhexidine varnishes (1%, 10% or 40% concentration) and chlorhexidine gel (0.12%) on the primary or permanent teeth, or both, of children from birth to 15 years of age at the start of the study. The studies randomised a total of 2876 participants, of whom 2276 (79%) were evaluated. We assessed six studies as being at high risk of bias overall and two studies as being at unclear risk of bias overall. Follow‐up assessment ranged from 6 to 36 months.
Six trials compared chlorhexidine varnish with placebo or no treatment. It was possible to pool the data from two trials in the permanent dentition (one study using 10% chlorhexidine and the other, 40%). This led to an increase in the DMFS increment in the varnish group of 0.53 (95% confidence interval (CI) ‐0.47 to 1.53; two trials, 690 participants; very low quality evidence). Only one trial (10% concentration chlorhexidine varnish) provided usable data for elevated mutans streptococci levels > 4 with RR 0.93 (95% CI 0.80 to 1.07, 496 participants; very low quality evidence). One trial measured adverse effects (for example, ulcers or tooth staining) and reported that there were none; another trial reported that no side effects of the treatment were noted. No trials reported on pain, quality of life, patient satisfaction or costs.
Two trials compared chlorhexidine gel (0.12% concentration) with no treatment in the primary dentition. The presence of new caries gave rise to a 95% confidence interval that was compatible with either an increase or a decrease in caries incidence (RR 1.00, 95% CI 0.36 to 2.77; 487 participants; very low quality evidence). Similarly, data for the effects of chlorhexidine gel on the prevalence of mutans streptococci were inconclusive (RR 1.26, 95% CI 0.95 to 1.66; two trials, 490 participants; very low quality evidence). Both trials measured adverse effects and did not observe any. 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.
Authors' conclusions
We found little evidence from the eight trials on varnishes and gels included in this review to either support or refute the assertion that chlorhexidine is more effective than placebo or no treatment in the prevention of caries or the reduction of mutans streptococci levels in children and adolescents. There were no trials on other products containing chlorhexidine such as sprays, toothpastes, chewing gums or mouthrinses. Further high quality research is required, in particular evaluating the effects on both the primary and permanent dentition and using other chlorhexidine‐containing oral products.</description><subject>Adolescent</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Antimicrobial</subject><subject>Anti‐Bacterial Agents</subject><subject>Cariostatic Agents</subject><subject>Cariostatic Agents - therapeutic use</subject><subject>Child</subject><subject>Child health</subject><subject>Child, Preschool</subject><subject>Chlorhexidine</subject><subject>Chlorhexidine - therapeutic use</subject><subject>Dental Caries</subject><subject>Dental Caries - prevention & control</subject><subject>Dentistry & oral health</subject><subject>Gels</subject><subject>Humans</subject><subject>Infant</subject><subject>Medicine General & Introductory Medical Sciences</subject><subject>Mouthwashes</subject><subject>Mouthwashes - therapeutic use</subject><subject>ORAL HEALTH</subject><subject>Prevention</subject><subject>Randomized Controlled Trials as Topic</subject><issn>1465-1858</issn><issn>1465-1858</issn><issn>1469-493X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>RWY</sourceid><sourceid>EIF</sourceid><recordid>eNqFUctOHDEQtFBQIJBfQD7mshvb4-cpShZIIiFxScTR8nh6GEfe8WLP8vj7eLQsglxy6m5VdVW3CqEzSpaUEPaZcimoFnq5OidEc6GWm23LDtDxDCxm5N2r_gh9KOUPIY00TL1HR0xoqTSVx-hmNcSUB3gMXRgBTxnctIZxwn3KeBoAbzLc1zmkEaced7V1EXuXAxQcRuyHELsMI3Zjh12XIhRfOeUUHfYuFvj4XE_Q78uLX6sfi6vr7z9XX68WXnDBFoxTZVrOO6mpaaXxjmljNAFhjOTceFAAndC-FVI3zhEum96ZhvSeCKHa5gR92enW99fQzd7ZRbvJYe3yk00u2LfIGAZ7m-4tJYpJo5uq8OlZIae7LZTJrkP9IUY3QtoWSxUlUigiaaXKHdXnVEqG_sWHEjvHYvex2H0sszuri2evr3xZ2-dQCd92hIcQ4cn65Idc_f-j-4_LX3nOns0</recordid><startdate>20150413</startdate><enddate>20150413</enddate><creator>Walsh, Tanya</creator><creator>Oliveira‐Neto, Jeronimo M</creator><creator>Moore, Deborah</creator><creator>Walsh, Tanya</creator><general>John Wiley & Sons, Ltd</general><scope>7PX</scope><scope>RWY</scope><scope>ZYTZH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20150413</creationdate><title>Chlorhexidine treatment for the prevention of dental caries in children and adolescents</title><author>Walsh, Tanya ; Oliveira‐Neto, Jeronimo M ; Moore, Deborah ; Walsh, Tanya</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5452-24179b44d6819b69ca289980e5996449ce7eed58cb5683aa0463fa930fc0557b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adolescent</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Antimicrobial</topic><topic>Anti‐Bacterial Agents</topic><topic>Cariostatic Agents</topic><topic>Cariostatic Agents - therapeutic use</topic><topic>Child</topic><topic>Child health</topic><topic>Child, Preschool</topic><topic>Chlorhexidine</topic><topic>Chlorhexidine - therapeutic use</topic><topic>Dental Caries</topic><topic>Dental Caries - prevention & control</topic><topic>Dentistry & oral health</topic><topic>Gels</topic><topic>Humans</topic><topic>Infant</topic><topic>Medicine General & Introductory Medical Sciences</topic><topic>Mouthwashes</topic><topic>Mouthwashes - therapeutic use</topic><topic>ORAL HEALTH</topic><topic>Prevention</topic><topic>Randomized Controlled Trials as Topic</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Walsh, Tanya</creatorcontrib><creatorcontrib>Oliveira‐Neto, Jeronimo M</creatorcontrib><creatorcontrib>Moore, Deborah</creatorcontrib><creatorcontrib>Walsh, Tanya</creatorcontrib><collection>Wiley-Blackwell Cochrane Library</collection><collection>Cochrane Library</collection><collection>Cochrane Library (Open Aceess)</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Cochrane database of systematic reviews</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Walsh, Tanya</au><au>Oliveira‐Neto, Jeronimo M</au><au>Moore, Deborah</au><au>Walsh, Tanya</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Chlorhexidine treatment for the prevention of dental caries in children and adolescents</atitle><jtitle>Cochrane database of systematic reviews</jtitle><addtitle>Cochrane Database Syst Rev</addtitle><date>2015-04-13</date><risdate>2015</risdate><volume>2015</volume><issue>4</issue><spage>CD008457</spage><epage>CD008457</epage><pages>CD008457-CD008457</pages><issn>1465-1858</issn><eissn>1465-1858</eissn><eissn>1469-493X</eissn><abstract>Background
Dental caries (tooth decay) is a common disease that is preventable by reducing the dietary intake of free sugars and using topical sodium fluoride products. An antibacterial agent known as chlorhexidine may also help prevent caries. A number of over‐the‐counter and professionally administered chlorhexidine‐based preparations are available in a variety of formulations and in a range of strengths. Although previous reviews have concluded that some formulations of chlorhexidine may be effective in inhibiting the progression of established caries in children, there is currently a lack of evidence to either claim or refute a benefit for its use in preventing dental caries.
Objectives
To assess the effects of chlorhexidine‐containing oral products (toothpastes, mouthrinses, varnishes, gels, gums and sprays) on the prevention of dental caries in children and adolescents.
Search methods
We searched the Cochrane Oral Health Group Trials Register (25 February 2015), the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 12), MEDLINE via OVID (1946 to 25 February 2015), EMBASE via OVID (1980 to 25 February 2015) and CINAHL via EBSCO (1937 to 25 February 2015). We handsearched several journals placed no language restrictions on our search. After duplicate citations were removed, the electronic searches retrieved 1075 references to studies.
Selection criteria
We included parallel‐group, randomised controlled trials (RCTs) that compared the caries preventive effects of chlorhexidine gels, toothpastes, varnishes, mouthrinses, chewing gums or sprays with each other, placebo or no intervention in children and adolescents. We excluded trials with combined interventions of chlorhexidine and fluoride or comparisons between chlorhexidine and fluoride interventions.
Data collection and analysis
Two review authors independently extracted trial data and assessed risk of bias. We resolved disagreements by consensus. We contacted trial authors for clarification or additional study details when necessary. The number of included studies that were suitable for meta‐analysis was limited due to the clinical diversity of the included studies with respect to age, composition of intervention, and variation in outcome measures and follow‐up. Where we were unable to conduct meta‐analysis, we elected to present a narrative synthesis of the results.
Main results
We included eight RCTs that evaluated the effects of chlorhexidine varnishes (1%, 10% or 40% concentration) and chlorhexidine gel (0.12%) on the primary or permanent teeth, or both, of children from birth to 15 years of age at the start of the study. The studies randomised a total of 2876 participants, of whom 2276 (79%) were evaluated. We assessed six studies as being at high risk of bias overall and two studies as being at unclear risk of bias overall. Follow‐up assessment ranged from 6 to 36 months.
Six trials compared chlorhexidine varnish with placebo or no treatment. It was possible to pool the data from two trials in the permanent dentition (one study using 10% chlorhexidine and the other, 40%). This led to an increase in the DMFS increment in the varnish group of 0.53 (95% confidence interval (CI) ‐0.47 to 1.53; two trials, 690 participants; very low quality evidence). Only one trial (10% concentration chlorhexidine varnish) provided usable data for elevated mutans streptococci levels > 4 with RR 0.93 (95% CI 0.80 to 1.07, 496 participants; very low quality evidence). One trial measured adverse effects (for example, ulcers or tooth staining) and reported that there were none; another trial reported that no side effects of the treatment were noted. No trials reported on pain, quality of life, patient satisfaction or costs.
Two trials compared chlorhexidine gel (0.12% concentration) with no treatment in the primary dentition. The presence of new caries gave rise to a 95% confidence interval that was compatible with either an increase or a decrease in caries incidence (RR 1.00, 95% CI 0.36 to 2.77; 487 participants; very low quality evidence). Similarly, data for the effects of chlorhexidine gel on the prevalence of mutans streptococci were inconclusive (RR 1.26, 95% CI 0.95 to 1.66; two trials, 490 participants; very low quality evidence). Both trials measured adverse effects and did not observe any. 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.
Authors' conclusions
We found little evidence from the eight trials on varnishes and gels included in this review to either support or refute the assertion that chlorhexidine is more effective than placebo or no treatment in the prevention of caries or the reduction of mutans streptococci levels in children and adolescents. There were no trials on other products containing chlorhexidine such as sprays, toothpastes, chewing gums or mouthrinses. Further high quality research is required, in particular evaluating the effects on both the primary and permanent dentition and using other chlorhexidine‐containing oral products.</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>25867816</pmid><doi>10.1002/14651858.CD008457.pub2</doi><oa>free_for_read</oa></addata></record> |
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| ispartof | Cochrane database of systematic reviews, 2015-04, Vol.2015 (4), p.CD008457-CD008457 |
| issn | 1465-1858 1465-1858 1469-493X |
| language | eng |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection; Cochrane Library |
| subjects | Adolescent Anti-Bacterial Agents - therapeutic use Antimicrobial Anti‐Bacterial Agents Cariostatic Agents Cariostatic Agents - therapeutic use Child Child health Child, Preschool Chlorhexidine Chlorhexidine - therapeutic use Dental Caries Dental Caries - prevention & control Dentistry & oral health Gels Humans Infant Medicine General & Introductory Medical Sciences Mouthwashes Mouthwashes - therapeutic use ORAL HEALTH Prevention Randomized Controlled Trials as Topic |
| title | Chlorhexidine treatment for the prevention of dental caries in children and adolescents |
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