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Title |
Low Level Evidence Suggests Chlorhexidine Gel (0.2%) is a Better Alternative to Chlorhexidine Rinse (0.12%) in Preventing Dry Socket in Third Molar Extractions When Both are Applied Post-Operatively |
Clinical Question |
Is chlorhexidine gel (0.2%) more effective than chlorhexidine rinse (0.12%) in preventing dry socket in third molar extractions? |
Clinical Bottom Line |
In the prevention of dry socket, treatment with chlorhexidine (gel and rinse) is better than placebo. There is minimal evidence to support that the gel has better effectiveness than the rinse. Both gel and rinse were post-operative applications. |
Best Evidence |
(you may view more info by clicking on the PubMed ID link) |
PubMed ID |
Author / Year |
Patient Group |
Study type
(level of evidence) |
#1) 19718007 | Minguez-Serra/2009 | 12 clinical trials with a total of 1818 patients | Meta-analysis | Key results | In the 12 clinical trials, the efficacy of chlorhexidine in the prevention of dry socket was examined in relation to 3 different dosing forms (rinses at concentrations of 0.12% and 0.2%, and the gel at a concentration of 0.2%). The analysis revealed that daily administration is effective every 12hours for up to 7 days. It expressed concerns that using chlorhexidine before extraction and for more than 7 days post-op could cause discomfort and adverse effects. The analysis proved the gel to be a better alternative for treatment commencing within 24 hours of extraction because it helps prevent clot detachment. 0.12% rinses have established efficacy in prevention of dry socket but few studies have been made concerning 2% rinse and gel. The analysis also presented the fact that the gel may be more expensive for the patient. Studies comparing the rinse and the gel are limited. | #2) 18280375 | Hita-Iglesias/2008 | 73 patients requiring third molar extraction with ages ranging from 18-60 years | RCT | Key results | A total of 73 patients underwent the trial and there were 41 patients in the gel group and 32 patients in the rinse group. They were randomly grouped and each patient started using the assigned form of chlorhexidine twice daily starting on the day of extraction. The independent variable was the form of chlorhexidine used and the dependent variable was the presence of a dry socket. Risk variables, difficulty index for extraction and patient compliance were analyzed. A single blind investigator carried out clinical assessments on the 3rd and 7th day post-op. In the gel group, 7.5% of dry socket incidence was found, while in the rinse group, there was 25% incidence. The difference was statistically significant, P=0.040. | |
Evidence Search |
Chlorhexidine, Dry socket, Prevention |
Comments on
The Evidence |
These studies represent a full spectrum of patients who had extractions. The criteria for conclusions were explicit and credible. The diagnostic work up was comprehensive and consistent. The studies did not include long term follow up. The authors had no apparent competing interests. |
Applicability |
The study participants were representative of surgical patients. The selection of these materials is feasible in the operator of General Dentists, Oral Surgeons and Periodontists. |
Specialty/Discipline |
(General Dentistry) (Oral Surgery) (Periodontics) (Dental Hygiene) |
Keywords |
Chlorhexidine, Dry socket, Third molar extraction
|
ID# |
2587 |
Date of submission: |
09/09/2013 |
E-mail |
olubunmi.osunfisan@ucdenver.edu |
Author |
Olubunmi Osunfisan |
Co-author(s) |
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Co-author(s) e-mail |
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Faculty mentor/Co-author |
Ronald N. Brown, DDS |
Faculty mentor/Co-author e-mail |
Ronald.Brown@ucdenver.edu |
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) |
post a rationale |
None available | |
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Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
None available | |
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