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Title Application of Chlorhexidine Varnish Decreases Incidence of Caries During Orthodontic Treatment
Clinical Question In patients with fixed orthodontic appliances, does the professional application of chlorhexidine varnish decrease the incidence of caries during orthodontic treatment?
Clinical Bottom Line In patients with fixed orthodontic appliances, the professional application of chlorhexidine (CHX) varnish decreases the incidence of caries during orthodontic treatment. This is supported by a systematic review and meta-analysis of six studies, three split-mouth studies and three case control studies, which determined that caries was significantly lower with chlorhexidine application every 6-13 weeks during orthodontic treatment. Application of chlorhexidine by an orthodontist is a reasonable procedure that is likely to be well-tolerated by the average orthodontic patient.
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) 27901199 Okada/2016580 adolescents or young adults in 6 included studiesMeta-Analysis
Key resultsA meta-analysis of the three studies with continuous data demonstrated that CHX varnish had a greater effect on caries reduction than the placebo (standard mean difference = -1.49 [95% CI: -2.47, -0.51]; p = 0.003). A meta-analysis of the two studies with dichotomous data did not show an association between CHX varnish and caries reduction (OR = 0.52; [95% CI = 0.17, 1.59]; p = 0.25). Overall heterogeneity was low.
Evidence Search ("chlorhexidine"[MeSH Terms] OR "chlorhexidine"[All Fields]) AND ("paint"[MeSH Terms] OR "paint"[All Fields] OR "varnish"[All Fields]) AND (orthodontic[All Fields] AND ("dental caries"[MeSH Terms] OR ("dental"[All Fields] AND "caries"[All Fields]) OR "dental caries"[All Fields] OR "caries"[All Fields]))
Comments on
The Evidence
Validity: The authors used multiple databases to find 182 relevant articles, and the articles were thoroughly inspected to meet certain specific criteria. The systematic review only identified six articles that qualified for inclusion in the review. Half of the selected studies were split-mouth studies, which have a high risk of bias due to the carry-over effect of CHX varnish. Two of the selected studies included the use of fluoride varnish with the CHX varnish, which may have further increased bias. Perspective: CHX varnish has been proven in other studies to be an effective antimicrobial against S. mutans, which is commonly known to be associated with initial caries formation. It appears reasonable to expect that this varnish could reduce caries incidence since it acts on the major caries-inducing bacterium. Applying CHX varnish to orthodontic patients, whose oral hygiene is already more difficult to maintain, is a practical consideration.
Applicability The 580 patients in the 6 studies included in this review were all adolescents and young adults with fixed orthodontic appliances. Younger patients struggle with oral hygiene, and fixed orthodontic appliances increase the difficulty of maintaining good oral hygiene. The application of CHX varnish is a reasonable and inexpensive way to help orthodontic patients reduce S. mutans levels and hence the risk of developing initial caries lesions. CHX mouth rinses have been known to cause tooth staining, but this has not been an issue with the varnish form. Some patients may report a bitter taste after initial application.
Specialty/Discipline (General Dentistry) (Orthodontics) (Pediatric Dentistry)
Keywords Chlorhexidine varnish, orthodontics, fixed orthodontic appliances, caries reduction
ID# 3172
Date of submission: 03/23/2017spacer
E-mail wynnek@livemail.uthscsa.edu
Author Kathryn Wynne
Co-author(s) e-mail
Faculty mentor/Co-author Peter Gakunga, BDS, MS, PhD
Faculty mentor/Co-author e-mail gakunga@uthscsa.edu
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