ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Clinically Significant Data to Prove Chlorhexidine Ineffective in Caries Prevention
Clinical Question In an adult patient presenting with high caries risk, does chlorhexidine varnish or chlorhexidine rinse prevent new caries development when compared to placebo?
Clinical Bottom Line Chlorhexidine varnish and chlorhexidine rinse do not prevent the development of coronal caries in adults compared to placebo.
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) 22156917Papas/2012983 adults, 20 intact teeth, 2 or more lesions at screening, mean age: 42, age range: 18-80Randomized Controlled Trial
Key resultsThis clinical trial found no significant difference in new caries development between the 10% (w/v) chlorhexidine diacetate coating (varnish) group and the placebo varnish group. The mean combined coronal and root net D1-2, FS increment was 2.68 in the chlorhexidine group and 2.43 in the placebo group (p=0.56).
#2) 17284909Wyatt/20071,101 low-income, mean age: 67, age range: 60-75Randomized Controlled Trial
Key resultsThe clinical trial found no significant difference in new caries development between the regular chlorhexidine rinse group and the placebo rinse group. The hazard ratios associated with chlorhexidine rinsing compared to placebo for a sound surface to become filled, decayed, or extracted was 0.87 for coronal surfaces (95% confidence interval: 0.71-1.14, p = 0.20) and 0.91 for root surfaces (95% confidence interval: 0.73-1.14, p = 0.41). In the chlorhexidine group 91% and in the placebo group 89% of the coronal surfaces remained sound over the 5-year study.
Evidence Search "Chlorhexidine"[Mesh] AND "Dental Caries"[Mesh]
Comments on
The Evidence
Both studies are randomized controlled trials. Though the two studies have differing demographics of study patients, each have study groups that are similar at the start of the trial. Both had a placebo group as well as a trial group with one study using a chlorhexidine varnish and one using a chlorhexidine rinse and both had greater than 80% completion rate. I find that the follow-up was adequate for the two studies as the varnish study was a 13 month trial and the rinse study included 5 years of research. The compliance for the first study was more than adequate while the second study included a rate of 91% remained sound tooth structure for the test group and 89% of remained sound tooth structure for the placebo group. Though this small bit of information seems to have missing pieces, since the study was done over a 5 year period, the compliance rate seems to maintain adequacy. These two double-blind studies presented with no competing interests and with unlikely recall bias.
Applicability This study did not show a significant beneficial effect of either chlorhexidine varnish or chlorhexidine rinse for preventing caries in adults. Although other studies have shown that Chlorhexidine may be beneficial in certain subgroups of high caries risk patients (xerostomia, radiation, and elderly), the subject of this topic would be best treated with other known preventive intervention (fluoride, oral hygiene, and dietary considerations).
Specialty/Discipline (Endodontics) (General Dentistry) (Periodontics) (Restorative Dentistry)
Keywords Chlorhexidine, caries, prevention
ID# 2236
Date of submission: 04/25/2012spacer
E-mail walding@livemail.uthscsa.edu
Author Travis Walding
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Charles Hermesch, DMD
Faculty mentor/Co-author e-mail hermesch@uthscsa.edu
Basic Science Rationale
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