ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title No Strong Evidence in Support of Either Chlorhexidine Mouthwash or Varnish in Preventing Dental Caries
Clinical Question Is chlorhexidine mouthwash more effective in preventing caries development than chlorhexidine varnish?
Clinical Bottom Line The available clinical evidence supporting the efficacy of chlorhexidine varnish on preventing dental caries is weak. There is also no evidence to support the efficacy of chlorhexidine mouthwash in preventing dental caries.
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) 19051866Autio-Gold/2008All age groupsLiterature review
Key resultsA review of the current literature on chlorhexidine mouthwashes did not reveal a beneficial effect on root caries prevention, while the benefit of varnishes was also largely unsupported. In one of the trials included in the review, a double-blind study compared .12% chlorhexidine mouthwash with .25% fluoride mouthwash and found that the CHX mouthwash increased the incidence of caries in the sampled population, while the fluoride mouthwash decreased the incidence of caries. Clinical trials comparing chlorhexidine varnishes against control groups revealed only a slight significant effect on caries prevention, and often the CHX varnish was combined with other solutions such as fluoride. It is recommended that a more evidence-based means of prevention be used, until more studies are conducted on the efficacy of chlorhexidine in preventing caries development.
#2) 25398366Wierichs/201530 studies; 10,136 patients ages 20-101 Meta-analysis
Key resultsA review of the clinical studies investigating the efficacy of chemical agents in reducing the initiation and development of root caries was conducted. A meta-analysis of 30 trials revealed an overall reduction of root caries index when chlorhexidine varnish (MD = -0.67; 95% CI = -1.01, -0.32) versus when a placebo varnish was used. Professionally applied chlorhexidine varnish on a quarterly basis can be efficacious in preventing the initiation and development of root caries. However, these results were based on a small sample of clinical trials. The study did not examine the efficacy of chlorhexidine on preventing caries development.
Evidence Search chlorhexidine varnish and chlorhexidine mouthwash in preventing dental caries
Comments on
The Evidence
Validity: Autio-Gold (2008) included results from studies comparing chlorhexidine varnishes and washes, resulting in a review of 4 articles examining the effects of chlorhexidine on the development of root caries. The investigation did not show an overall significant effect on the benefits of chlorhexidine on preventing root caries. However, this may be due to the limited sample included in the review. Wierichs and Meyer Lueckel (2015) conducted a meta-analysis looking at the effects of 28 chemical agents on root caries initiation and development. With specific inclusion criteria, a total of 30 studies were included in the analysis. Among the chemical agents studied was chlorhexidine varnish applied quarterly in a professional setting. Perspective: Based on the lack of clear evidence for the efficacy of chlorhexidine mouthwash and varnish on caries development, further research should be conducted to determine if there is a benefit to patient use of chlorhexidine varnish or mouthwash. There were no studies that compared varnish and mouthwash head-to-head. Most studies focus on root caries, and evidence for caries development is slim. Furthermore, more studies should be conducted comparing chlorhexidine varnish and mouthwash to determine which is a more suitable method of preventing dental caries.
Applicability At this current juncture, there is not enough evidence to suggest the use of chlorhexidine to patients as a method of preventing caries development. It is better to suggest more evidence-based measures until there are more studies that support the efficacy of chlorhexidine on preventing caries development.
Specialty/Discipline (Public Health) (General Dentistry)
Keywords Chlorhexidine mouthwash, chlorhexidine varnish, caries, prevention
ID# 2885
Date of submission: 04/08/2015spacer
E-mail Malakouti@livemail.uthscsa.edu
Author Marjan Malakouti
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Bennett T. Amaechi, BDS, PhD
Faculty mentor/Co-author e-mail amaechi@uthscsa.edu
Basic Science Rationale
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