Does chlorhexidine mouthwash, with an anti-discoloration system, reduce tooth surface discoloration without losing its efficacy? A systematic review and meta-analysis

Assessment of colour modifications in two different composite resins induced by the influence of chlorhexidine mouthwashes and gels, with and without anti-staining properties: An in vitro study

OBJECTIVES

Chlorhexidine (CHX)-based products are the most effective chemical agents used in plaque control and oral disinfection. One of their side effects is tooth and restoration staining. For this reason, CHX products with anti-discolouration systems (ADS) have been developed. The aim of this in vitro study was to compare different CHX-based products (gel and mouthwash) with or without ADS in composite colour modification.

METHODS

Two hundred specimens were created, 100 of which were made of packable composite and 100 of flowable composite. After 24 h, colour coordinates (L*, a*, b*, C*, h°) were recorded using a spectrophotometer (T0). Then, all samples were subjected to a CHX/tea staining model and immersed in human saliva for 2 min. Composite specimens were divided in 10 groups (N = 20). Control groups (PC, FC) were soaked in distilled water and test groups (PG, PGads, FG, FGads, PM, PMads, FM and FMads) were immersed in CHX-based solutions or brushed with CHX gel. Then the cycle was repeated 6 times, and colour differences (ΔEab and ΔE00) were finally calculated.

RESULTS

Through flowable composites, FC and FG showed the highest colour differences, respectively ΔEab = 3.48 ± 1.0, ΔE00 = 2.24 ± 0.6 and ΔEab = 2.95 ± 1.3, ΔE00 = 1.53 ± 0.6. In the composite groups instead, PM and PMads showed the highest colour differences, respectively ΔEab = 2.78 ± 1.3, ΔE00 = 1.94 ± 0.8 and ΔEab = 2.71 ± 1.4, ΔE00 = 1.84 ± 0.9.

CONCLUSIONS

CHX-containing products are able to cause stains on restorative composite materials. Discolouration is more likely to occur in flowable composites than packable composites, and ADS-containing products cause fewer pigmentations than CHX products without ADS. Packable composites showed more staining after mouthwash treatment, whereas flowable composites underwent higher discolouration after treatment with gels.

Early periodontal wound healing after chlorhexidine rinsing: a randomized clinical trial

OBJECTIVES

This single-center randomized, parallel design, clinical trial with a 2-week follow-up involved patients affected by periodontitis undergoing periodontal surgery. The aim was to evaluate periodontal surgical wound healing with the use of chlorhexidine-based mouth rinses versus an untreated control group.

MATERIALS AND METHODS

Periodontal surgery was performed following a standardized protocol. Patients were randomly prescribed i) chlorhexidine (CHX) + anti-discoloration system (ADS) + hyaluronic acid (HA), ii) CHX + ADS or iii) no treatment (control group). Plaque score, gingival inflammation, and Early Healing Index (EHI), assessing the degree of wound closure and the presence of fibrin and necrosis, were evaluated at 3, 7 and 14 days after surgery.

RESULTS

In total, 33 patients were enrolled. Patients were comparable at baseline for all measured clinical parameters. At 3-days wound healing was significantly improved in all patients treated with CHX + ADS-based mouth rinses with a lower EHI score at the interdental papillae compared with control group (p < 0.01). CHX + ADS + HA group presented improved healing across all time points in terms of EHI, plaque containment, and gingival inflammation when compared to control group (p < 0.01).

CONCLUSIONS

The usage of CHX-ADS following periodontal surgery improved early wound healing, reduced plaque accumulation and gingival inflammation. During the early post-operative period the adjunct of HA further improved soft tissue closure.

CLINICAL RELEVANCE

This study aims at evaluating the response of gingival tissues to mouth rinsing with chlorhexidine and anti-discoloration system (CHX + ADS) or CHX + ADS + hyaluronic acid (CHX + ADS + HA) versus no rinse in terms of healing of the periodontal surgical wound. CHX + ADS mouth rinses enhanced early soft tissue closure after periodontal surgery and contributed to the reduction in plaque accumulation and gingival inflammation. The adjunct of HA may be beneficial especially in the early post-operative period. CHX + ADS administration following periodontal surgery may improve soft tissue healing in the first two post-operative weeks.

Supra and subgingival application of antiseptics or antibiotics during periodontal therapy

Periodontal diseases (gingivitis and periodontitis) are characterized by inflammatory processes which arise as a result of disruption of the balance in the oral ecosystem. According to the current S3 level clinical practice guidelines, therapy of patients with periodontitis involves a stepwise approach that includes the control of the patient's risk factors and the debridement of supra and subgingival biofilm. This debridement can be performed with or without the use of some adjuvant therapies, including physical or chemical agents, host modulating agents, subgingivally locally delivered antimicrobials, or systemic antimicrobials. Therefore, the main aim of this article is to review in a narrative manner the existing literature regarding the adjuvant application of local agents, either subgingivally delivered antibiotics and antiseptics or supragingivally applied rinses and dentifrices, during the different steps in periodontal therapy performed in Europe.

DMF scores in patients with diabetes mellitus: A systematic review and meta-analysis of observational studies

OBJECTIVE

The aim of this systematic review(SR) is to comprehensively and critically summarise and synthesise the available scientific evidence from observational studies that use the decayed-missed-filled(DMF) index to determine caries experiences among adult patients with diabetes mellitus  (DM) as compared to individuals without DM(non-DM).

DATA

Indices that present examinations of decayed-filled-surfaces(DFS), decayed-missed-filled-surfaces(DMFS), and decayed-missed-filled-teeth(DMFT) established from observational studies were considered.

SOURCES

MEDLINE-PubMed and Cochrane Central databases were searched through 1 February 2023 to identify studies that evaluate DMF indices for adult patients with DM compared to non-DM. The reference lists of the selected studies were reviewed to identify additional potentially relevant studies.

STUDY SELECTION

All studies were independently screened by two reviewers. Included papers were critically appraised using pre-designed forms, and the risk of bias was assessed. Data as means and standard deviations were extracted. A descriptive data presentation was used for all studies. If quantitative methods were feasible, then a meta-analysis was performed. It was decided 'a priori' to perform a sub-analysis on type of DM(I or II). The quality of the studies was assessed.

RESULTS

Initially 932 studies were found, and screening resulted in 13 eligible observational studies. The total number of subjects included in this SR is 21,220. A descriptive analysis of the comparisons demonstrated that eight studies provided data and demonstrated higher DFS (1/2), DMFS (2/3) and DMFT (5/8). This was confirmed by the meta-analysis difference of means(DiffM), which was 3.01([95%CI:1.47,4.54],p=0.0001) for DMFT and 10.30([95% CI:8.50,12.11],p<0.00001) for DMFS. Subgroup analysis showed that this difference is irrespective to the type of DM(DiffM=3.09;[95%CI:2.09,4.09],p<0.00001).

CONCLUSION

There is moderate certainty for a higher DMF index score in DM patients as compared to those without DM disease.

CLINICAL SIGNIFICANCE

This SR indicates a higher DMF index in DM patients. Oral disease prevention should be the focus of the dental care practitioner in this patient category.

Revisiting Oral Antiseptics, Microorganism Targets and Effectiveness

A good oral health status is mostly dependent on good oral hygiene habits, which knowingly impacts systemic health. Although controversial, chemical oral antiseptics can be useful in adjunct use to mechanical dental plaque control techniques in the prevention and management of local and overall health and well-being. This review aims to revisit, gather and update evidence-based clinical indications for the use of the most popular oral antiseptics, considering different types, microorganism targets and effectiveness in order to establish updated clinical recommendations.

Assessment of color changes in teeth and composite resins under the influence of chlorhexidine with and without anti-discoloration system: An in vitro study

Aim

The aim of this study was to assess color changes in teeth and two different composite resins under the influence of chlorhexidine (CHX) with and without anti-discoloration system (ADS).

Materials and Methods

A total of 20 extracted human premolar teeth for periodontal and orthodontic purposes were selected for the study. Further, a total of 40 composite specimens comprising 20 each nanoceramic and nanohybrid composite disks of size 10-mm diameter and 0.5-mm thickness were prepared on a customized model for standardization using the composite filling instrument. The specimens were cured with light-curing unit for 20 s and polished with a composite polishing kit. Two mouthrinses comprising CHX and CHX with ADS were used. Baseline color values of natural tooth and two composite resins were recorded using an ultraviolet spectrophotometer. After baseline spectrophotometric measurements, all the samples were subjected to the mouthrinses. The postimmersion color values of the samples were then recorded, respectively, using the same spectrophotometer.

Statistical Analysis Used

The statistical analysis was done using paired t-test.

Results

Reflectance values showed a statistically significant difference between CHX and CHX with ADS among nanoceramic and nanohybrid composite samples. There was no statistically significant difference in reflectance values among natural teeth samples with either CHX or CHX with ADS.

Conclusion

Within the limitations of the current study, CHX with ADS may aid in avoiding stains caused due to use of CHX mouthwash, thereby making it more acceptable for patients.

Experimentally Justified Choice of Optimal Antiseptic Solution for Hygienic Care of Oral Cavity and Dentures

INTRODUCTION: The range of antiseptic agents used in clinical practice, is rather wide. However, only single studies are devoted to comparative characteristics of their effectiveness in the conditions of the oral cavity. AIM: To choose the optimal antiseptic dental cleaner by experimental study. MATERIALS AND METHODS: An aqueous solution of Furacilin (0.02%), chlorhexidine bigluconate (0.05%), Miramistin (0.01%), cetylpyridinium chloride (0.05%), hydrogen peroxide (3%), Iodinol, Rotokan, distilled water were used as washing liquids for elimination of dental plaque. The model of the dentition was created from quartz plates with an imitation of fresh plaque. Biomaterial imitating dental plaque included two solutions: 1) a strong fresh infusion of black tea leaves, cooled to +25C; 2) oatmeal jelly with temperature from +60C to +65C. The authors method of screening dental cleaners was used, based on comparing the transparency of the laboratory model of the dentition before and after exposure to the test solution by determination with an amperemeter of strength of the electric current in the photosensor device from the oxyhemograph sensor after white light emitted by a mini-emitter passed through biological material and plates and fell on it. RESULTS: The cleaning capacity of distilled water is the lowest (p 0.050.001). Rotokan, Furacilin and Iodinol have a low cleaning capacity, and Iodinol can cause a burn of the gingival cuff in case of high reaction to it, and allergic reactions. Hydrogen peroxide has an average degree of efficiency, but it dries the oral mucosa. Chlorhexidine bigluconate has the highest cleaning effect, Miramistin and cetylpyridinium chloride are slightly inferior to it (p 0.05). By the cleaning capacity, chlorhexidine bigluconate solution is significantly superior to hydrogen peroxide (p 0.05), Iodinol (p 0.02), Furacilin (p 0.02), Rotokan (p 0.01). CONCLUSION: The described method received the patent for invention of the Russian Federation No. 2019121293. Experimental studies have shown the best cleaning effect of 0.05% solution of chlorhexidine bigluconate.

Effects of bioflavonoid-containing mouth rinses on optical properties of tooth-coloured dental restorative materials

This study investigated differences in colour (ΔE₀₀) and translucency parameter (ΔTP₀₀) of nanofilled/microhybrid composites and a glass-ionomer cement following immersion in bioflavonoid (Citrox)- or chlorhexidine-based mouth rinses. Sixty disc-shaped specimens (N = 5/group) of Filtek Supreme (3M), Gradia Anterior (GC) and Fuji IX (GC) were exposed to Citrox/0.2%CHX (Perio+0.2, Curaprox), Citrox/0.09%CHX (Perio+0.09, Curaprox), 0.2%CHX (Savacol, Colgate-Palmolive) or distilled water by 2-min agitation daily for 28 days in an orbital shaker at 200 rpm at 37 °C. Colour recordings were performed using a clinical spectrophometer to obtain CIELab coordinates. General linear model, ANOVA, Tukey test (α = 0.05) and Pearson correlation test were used to analyse data. ΔE₀₀ ranged between 0.33 (Gradia_Savacol_T28) and 6.35 (Fuji_Savacol_T28) (p < 0.001). ΔTP₀₀ ranged between 0.36 (Fuji_ Perio+0.2) and 1.73 (Fuji_Savacol) (p < 0.05). Savacol resulted in higher ΔE₀₀ of Filtek and Fuji and ΔTP₀₀ of Filtek than Perio+0.09 and Perio+0.2 (p = 0.005). Perio+0.09 and Perio+0.2 resulted in higher ΔE₀₀ at T7 than T28 (p < 0.05). There was no correlation between ΔTP₀₀ and ΔE₀₀ (r = 0.445, p = 0.147). Generally, Perio+0.2 and Perio+0.09 mouth rinses produced similar or lower ΔE₀₀ and ΔTP₀₀ than Savacol. GIC Fuji showed higher ΔE₀₀ and similar or higher ΔTP₀₀ than composites Filtek and Gradia. ΔE₀₀ in all materials decreased in Perio+0.2 and Perio+0.09 over time.

Chlorhexidine in Dentistry: Pharmacology, Uses, and Adverse Effects

Objectives

The aim of this work was to review the current uses of chlorhexidine (CHX) in dentistry based on its mechanism of action, whilst highlighting the most effective protocols that render the highest clinical efficacy whilst limiting adverse drug reactions.

Methods

A literature search was conducted using the key words chlorhexidine, mechanism of action, adverse effects, and dentistry using databases in the University of Toronto library system. The titles and abstracts were read, and relevant articles were selected.

Results

A total of 1100 publications were identified, 100 were investigated, and 67 of them were used. Out of the 67 selected articles, 12 were reviews on CHX; 5 articles focussed on CHX gels; 13 focussed on CHX mouthwashes; 8 focussed on CHX products; 13 discussed adverse effects associated with CHX; 13 focussed on periodontal pathology and treatment; 6 focussed on implant periodontal and dental surgeries; 7 evaluated effects on caries; 6 looked at the mechanisms of action; and 12 focussed on the antibacterial and antimicrobial impact on the oral biome. There were multiple areas of overlap amongst the articles, and results showed that CHX provides different uses, but mainly as an adjunct to various treatments. Mouthwash was the most superior medium when used in short time spans when mechanical prophylaxis was not possible for the prevention of gingivitis and maintenance of oral hygiene. CHX products are often used in periodontics, post–oral surgical procedures, and as a prophylaxis for multiple invasive procedures with minimal adverse effects. Tooth staining was the most negative adverse effect reported by patients.

Conclusions

CHX's antimicrobial properties make it an ideal prophylactic when mechanical debridement is not possible. CHX mouthwash appears to be more effective compared to gels. Concentrations of 0.12% to 0.2% are recommended; any mouthwash with concentrations above 0.2% will unnecessarily increase the unwanted side effects. CHX is useful amongst various areas of dentistry including oral surgery, periodontics, and even general dentistry. For long-term treatments, especially in periodontitis patients (stage I-III) undergoing nonsurgical treatments, CHX chips are recommended. CHX chips are also recommended as an adjunct to implant debridement in patients with peri-implant mucositis and peri-implantitis over CHX mouthwash and gels.

The risk of tooth loss in patients with diabetes: A systematic review and meta-analysis

AIM

The aim of this systematic review was to comprehensively and critically summarize and synthesize the risk of losing teeth among with diabetes mellitus (DM) compared to those without DM, as established in observational studies.

MATERIALS AND METHODS

MEDLINE-PubMed and Cochrane databases were searched through a period from their inception through October 2020 to identify eligible studies. Papers that primarily evaluate the number of teeth in DM patients compared to non-DM individuals were included. A descriptive analysis of the selected studies was conducted, and when feasible, a meta-analysis was performed. The quality of the studies was assessed.

RESULTS

A total of 1087 references were generated, and screening of the papers resulted in 10 eligible publications. A descriptive analysis demonstrated that six of these studies indicate a significantly higher risk of tooth loss in DM patients. This was confirmed by the meta-analysis risk ratio of 1.63 95% CI (1.33; 2.00, p < 0.00001). Subgroup analysis illustrates that this is irrespective of the risk-of-bias assessment. The higher risk of tooth loss in DM patients was also higher when only DM type II patients or studies with a cross-sectional design were considered. Patients with a poor DM control status presented a significantly increased risk of tooth loss. When the data were separated by the world continent where the study was performed, Asia and South America had numerically higher risks and a 95% CI that did not overlap with Europe and North America.

CONCLUSION

There is moderate certainty for a small but significantly higher risk of tooth loss in DM patients as compared to those without DM.

A Proteomic Analysis of Discolored Tooth Surfaces after the Use of 0.12% Chlorhexidine (CHX) Mouthwash and CHX Provided with an Anti-Discoloration System (ADS)

Chlorhexidine (CHX) is considered the gold standard for the chemical control of bacterial plaque and is often used after surgical treatment. However, CHX employment over an extended time is responsible for side effects such as the appearance of pigmentations on the teeth and tongue; the discoloration effects are less pronounced when using a CHX-based mouthwash with added an anti-discoloration system (ADS). The aim of this study was to evaluate, using one- and two-dimensional gel electrophoresis combined with mass spectrometry, the possible proteomic changes induced by CHX and CHX+ADS in the supragingival dental sites susceptible to a discoloration effect. The tooth surface collected material (TSCM) was obtained by curettage after resective bone surgery from three groups of patients following a supportive therapy protocol in which a mechanical control was combined with placebo rinses or CHX or a CHX+ADS mouthwash. The proteomic analysis was performed before surgery (basal conditions) and four weeks after surgery when CHX was used (or not) as chemical plaque control. Changes in the TSCM proteome were only revealed following CHX treatment: glycolytic enzymes, molecular chaperones and elongation factors were identified as more expressed. These changes were not detected after CHX+ADS treatment. An ADS could directly limit TSCM forming and also the CHX antiseptic effect reduces its ability to alter bacterial cell permeability. However, Maillard’s reaction produces high molecular weight molecules that change the surface properties and could facilitate bacterial adhesion.

The Effect of Chlorhexidine Disinfectant Gels with Anti-Discoloration Systems on Color and Mechanical Properties of PMMA Resin for Dental Applications

Chlorhexidine (CHX)-based dental hygiene products are widely used by dental patients. As these products may have long-term contact with denture poly(methyl methacrylate) (PMMA) resin, anti-discoloration systems (ADSs) were included in them to prevent discoloration of the natural teeth and dental materials. Purpose: The aim of this study was to evaluate the effect of two newly designed CHX-containing gels with ADSs and two commercial products with ADSs (Curasept 0.5% and Curasept 1%) in preventing staining and to analyze the mechanical properties of heat-curing PMMA denture base resin. Materials and methods: Twenty-five discs (five for each test group) of PMMA dental resin with a thickness of 1 mm and a diameter of 20 mm were polymerized according to the manufacturer’s instructions and stored in distillate water at a temperature of 37 °C. The surface of the specimens was covered with two commercially available gels—Curasept 1% and Curasept 0.5%, or two experimental gel formulations containing 1% CHX. PMMA specimens stored in distilled water were used as control. The initial values of color and Brinell hardness of the specimens were measured immediately after specimen preparation. The changes in color and Brinell hardness, as well as water sorption, and solubility of the specimens were measured after one year of conditioning. Statistical analysis of the obtained data was performed using one-way analysis of variance and Dunn–Bonferroni post hoc tests. Results: In the group of specimens covered with gel 1 with citric acid or Curasept 0.5%, the color change was clinically acceptable (ΔE* < 2.7). In the specimens stored in contact with gel 2 with polyvinylpyrrolidone (PVP) and Curasept 1%, the ΔE* values were 3.6 and 3.67, respectively. In the control group, the level of hardness decreased significantly from 150 to 140 during the experiment. In addition, a statistically significant decrease in hardness was observed in specimens stored with Curasept 1% and gel 2 with PVP. Specimens stored in contact with Curasept 0.5% and gel 1 with citric acid also showed a lower hardness, but the change was not statistically significant. The sorption of all the groups of PMMA specimens ranged from 22.83 to 24.47 µg/mm³, with no significant differences found between them. All the PMMA specimens stored in contact with the tested CHX gels exhibited a significantly higher solubility (6.84 ± 7.91 µg/mm³) compared to the control group (6.74 µg/mm³), with the highest solubility noted for specimens stored with Curasept 1%. Conclusions: The results showed that CHX used in the gel form with ADSs at a concentration of 0.5% and the experimental gel containing 1% CHX with citric acid caused limited changes to the color and mechanical properties of the PMMA denture base resin during the study period. These gels may be safely used by dental patients for oral hygiene regimen even for prolonged periods of time. ADSs contained in these gels seem to be effective in preventing CHX discoloration.

Curcumin mouthwashes versus chlorhexidine in controlling plaque and gingivitis: A systematic review and meta-analysis

OBJECTIVES

The purpose of the present systematic review and meta-analysis was to assess the available evidence regarding the efficacy of curcumin mouthwashes on plaque and gingivitis.

METHODS

A comprehensive online search of multiple databases (PubMed, Scopus, Web of Science, and Google Scholar) was performed to identify all relevant studies published up to August 2020, using the following keywords: curcumin, turmeric, gingivitis, periodontal health, and plaque control. All clinical trials that compared the efficacy of curcumin mouthwash with chlorhexidine in controlling dental plaque and gingivitis were included. Data were analysed using Review Manager (RevMan) 5.3 software. The risk of bias was evaluated by two independent reviewers using the Cochrane assessment tool.

RESULTS

Six randomized clinical trials (comprising 320 subjects) fulfilled the eligibility criteria. Five studies showed a high risk of bias and only one study showed a low risk of bias. The pooled data of the six included studies revealed comparable efficacy of curcumin and chlorhexidine in reducing dental plaque (I²  = 91%; standardized mean difference [SMD]: 0.27, 95% CI: -0.53, 1.07, p = 0. 51) and gingival inflammation (I²  = 40%; SMD: -0.13, 95% CI: -0.35, 0.09, p = 0.24), with no statistically significant differences between the two groups.

CONCLUSION

The results suggest that curcumin mouthwashes have promising anti-plaque and anti-gingivitis properties. Further clinical trials with adequate sample sizes and standardized methodologies are required to discern the efficacy of curcumin mouthwash in reducing plaque and gingivitis.

Recent Development of Active Ingredients in Mouthwashes and Toothpastes for Periodontal Diseases

Periodontal diseases like gingivitis and periodontitis are primarily caused by dental plaque. Several antiplaque and anti-microbial agents have been successfully incorporated into toothpastes and mouthwashes to control plaque biofilms and to prevent and treat gingivitis and periodontitis. The aim of this article was to review recent developments in the antiplaque, anti-gingivitis, and anti-periodontitis properties of some common compounds in toothpastes and mouthwashes by evaluating basic and clinical studies, especially the ones published in the past five years. The common active ingredients in toothpastes and mouthwashes included in this review are chlorhexidine, cetylpyridinium chloride, sodium fluoride, stannous fluoride, stannous chloride, zinc oxide, zinc chloride, and two herbs—licorice and curcumin. We believe this comprehensive review will provide useful up-to-date information for dental care professionals and the general public regarding the major oral care products on the market that are in daily use.

Current uses of chlorhexidine for management of oral disease: a narrative review

OBJECTIVES

Chlorhexidine (CHX) is a commonly used antiseptic mouthwash, used by dental practitioners and the public, due to its antimicrobial effects. The aim of this article was to provide a narrative review of current antimicrobial uses of CHX relevant to dentistry in the context of oral diseases, highlighting need for further studies to support its safe and appropriate use.

STUDY SELECTION, DATA AND SOURCES

Randomised controlled trials, systematic reviews and national (UK and US) guidelines were consulted where available, with search terms for each subject category entered into MEDLINE, PubMed, Google Scholar and the Cochrane database.

RESULTS

Some evidence existed to support adjunctive short-term use of CHX to manage dental plaque, and reduce clinical symptoms of gingivitis, dry socket, as well as reduce aerosolisation of bacteria. However, use must be weighed alongside the less desirable effects of CHX, including extrinsic staining of teeth, antimicrobial resistance to antiseptic agents and the rare, but fatal, allergic reactions to CHX. Conversely, evidence for the effectiveness of chlorhexidine to manage or prevent periodontitis, dental caries, necrotising periodontal diseases, peri-implantitis, and infections associated with extraction and aerosolised viruses remains less certain.

CONCLUSIONS

The use of CHX in dentistry and oral healthcare continues to be widespread and thus it is important that dental practitioners understand that, based on its differential mechanisms of action on different microbes, appropriate clinical and dental use of CHX should be oral disease specific. However, further scientific and clinical research is required before full recommendations can be made.

COVID-19 and Oral Surgery: A narrative review of preoperative mouth rinses

OBJECTIVE

To provide a narrative review of the preprocedural mouth rinse protocols suggested for oral surgery in order to contrast the presence of SARS-CoV-2 in aerosol.

SOURCES AND METHODS

Electronic searches were performed in medical databases PubMed, Medline, CINAHN and Scopus to identify relevant studies published up until the third week of April 2020. This research was supplemented by exploration through a web-based search engine as well as a manual search for international and national guidelines. Studies and protocols which suggested preoperative mouth rinsing as a recommended measure during the COVID-19 outbreak were included. Given the small number of studies, a narrative literature review was conducted. In total, 15 references (11 articles and 4 guidelines) were considered relevant and were critically analysed.

CONCLUSION

The findings show a high heterogeneity in the protocols suggested. Further research is required to better understand the viral features and epidemiologic characteristics of this new virus and to test the efficacy of commonly used antiseptics against SARS-CoV-2 in future clinical trials. However, the use of chlorhexidine, hydrogen peroxide, PVP-I and cetylpyridinium chloride in contrasting the spread of Covid-19 is described as advisable and substantial in different publications.

Does chlorhexidine mouthwash, with an anti-discoloration system, reduce tooth surface discoloration without losing its efficacy? A systematic review and meta-analysis

OBJECTIVES

To investigate whether chlorhexidine mouthwash (CHX-MW), with an anti-discoloration system(ADS), is effective in preventing extrinsic tooth surface discoloration. Additionally, this paper seeks to evaluate whether CHX combined with an ADS maintains its efficacy with respect to reducing plaque and gingivitis scores.

MATERIAL AND METHODS

MEDLINE-PubMed and Cochrane-Central were searched up to October 2018 to identify eligible studies. Papers evaluating the effect of CHX-MW+ADS compared to CHX without an ADS were included. A descriptive analysis and when feasible a meta-analysis was performed.

RESULTS

Screening resulted in 13 eligible publications, presenting 16 comparisons. Six of these evaluated the MW in a non-brushing model and ten as an adjunct to toothbrushing. A descriptive analysis demonstrated that the majority showed no differences in bleeding, gingivitis and plaque scores. This was confirmed by the meta-analysis. In non-brushing experiments, the difference-of-means (DiffM) for plaque scores was 0.10 (P = 0.45, 95%CI: [-0.15; 0.34]) and for the gingival index 0.04 (P = 0.15,95%CI: [-0.02; 0.11]). The DiffM in brushing studies for plaque scores was 0.01 (P = 0.29, 95%CI: [-0.01; 0.02]) and for the gingival index 0.00 (P = 0.87,95%CI: [-0.05; 0.06]). With respect to staining scores, the meta-analysis revealed that in non-brushing studies, the standardized mean difference was 3.19 (P = 0.0005,95%CI: [-3.98; -1.41]) while in brushing studies, the DiffM was 0.12 (P = 0.95,95%CI: [-3.32; 3.55]).

CONCLUSION

There is moderate quality evidence from non-brushing studies that the addition of an ADS to CHX-MW reduces tooth surface discoloration and does not appear to affect its properties with respect to gingival inflammation and plaque scores. In brushing studies, there is also moderate quality evidence that ADS does not affect the anti-plaque and anti-gingivitis efficacy of CHX. The majority of comparisons and the meta-analysis including these indicate no significant effect of ADS on tooth staining in situations where the mouthwash is used in addition to toothbrushing.