ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Chlorhexidine-Thymol Varnish May Provide a Benefit in the Prevention of Root Caries in High Caries Risk Individuals with Poor Oral Hygiene
Clinical Question In adults at high caries risk, is application of Chlorhexidine varnish better than Fluoride varnish in reducing root caries incidence?
Clinical Bottom Line Chlorhexidine-Thymol Varnish (CHX-V), when applied to high risk patients with poor oral hygiene, limits the incidence of root carries as well as reduces the rate of growth of existing lesions.
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) 21525751Slot/2011574 adult patients in 6 included studiesMeta-Analysis
Key resultsSystematic reviews of over six different randomized control trials were included in reviewing the outcome of CHX-V application on exposed root surfaces. Although the findings are inconsistent and as such the evidence considered ‘weak’, in the absence of regular professional tooth cleaning and oral hygiene instructions, 3 monthly applications of either 1, 10, or 40% CHX-V does provide significant benefits in preventing root caries better than fluoride Varnish for high caries risk patients (elderly or xerostomic). However, when professional tooth cleaning and hygiene instructions are regularly followed, little to no additional effect of CHX-V is evident. The overall weighted mean difference between the CHX-V and control/placebo was 0.65 in favor of the CHX-V (p = 0.0003, 95% CI –1.01 to –0.30).
#2) 19497653Baca/200968 institutionalized elderlyRandomized Controlled Trial
Key resultsThis study by Baca et al (2009) aimed to examine the effectiveness of CHX-V in preventing root caries in elderly institutionalized individuals. The the randomized control trial states that the application of CHX-V over a 12 month period. The results demonstrated that 3 monthly application of CHX-V significantly lowered increase in the root caries (p=0.039). The study concluded that CHX-V may help to control established root lesions and reduce the incidence of root caries lesion among institutionalized elderly.
Evidence Search ("chlorhexidine, thymol drug combination"[Supplementary Concept] OR "chlorhexidine, thymol drug combination"[All Fields] OR "chlorhexidine thymol"[All Fields]) AND ("root caries"[MeSH Terms] OR ("root"[All Fields] AND "caries"[All Fields]) OR "root caries"[All Fields]) AND ("paint"[MeSH Terms] OR "Fluoride"[All Fields] OR "paint"[All Fields] OR "varnish"[All Fields]) AND (systematic[sb] OR Randomized Controlled Trial[ptyp])
Comments on
The Evidence
Validity: Slot et al., 2011 conducted a systematic review of clinical trials. The initial meta analysis covered over 32 articles and only 6 met the qualified criteria of an experimental study with clinical environment having participants, intervention, and outcome. The study involved Chlorhexidine in ranges from 1% to 40%. Data from the included randomized controlled trials showed that when professional tooth cleaning and hygiene instructions are regularly followed, there is no significant reduction in caries incidence when CHX-V is used compared to Fluoride varnish or placebo. But Chlorhexidine may provide beneficial effects in the absence of professional prophylaxis. Baca et al., 2009 conducted a double blind research of geriatric population with participants split into 2 groups with various treatment methods, intervention, and outcome compared to a placebo. A statistical analysis showed an overall treatment effectiveness of CHX-V with 3-monthly application at residential homes with portable equipment.
Applicability The search results did not reveal strong evidence to answer whether Chlorhexidine is better than fluoride varnish but limited evidence supports Chlorhexidine when compared to placebo. As many geriatric patients in developed countries are expected to retain their teeth into old age but with associated gum recession and root exposure. Hence, root caries prevalence increases with increasing age, and is thus a frequent problem among the dentate elderly, especially the institutionalized who depends on caregivers to maintain their oral hygiene. Clinician may find this information useful to determine whether CHX-V is an appropriate intervention for the growing pool of geriatric population.
Specialty/Discipline (Public Health) (General Dentistry) (Periodontics) (Restorative Dentistry)
Keywords Root caries, Caries prevention, Chlorhexidine, Topical Varnish, Fluoride Varnish, Chlorhexidine varnish, CHX, Chlorhexidine-Thymol
ID# 2890
Date of submission: 04/08/2015spacer
E-mail marediaa@livemail.uthscsa.edu
Author Anisa Maredia
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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