ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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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) 19718007Minguez-Serra/200912 clinical trials with a total of 1818 patientsMeta-analysis
Key resultsIn 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) 18280375Hita-Iglesias/200873 patients requiring third molar extraction with ages ranging from 18-60 yearsRCT
Key resultsA 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)
Keywords Chlorhexidine, Dry socket, Third molar extraction
ID# 2587
Date of submission: 09/09/2013spacer
E-mail olubunmi.osunfisan@ucdenver.edu
Author Olubunmi Osunfisan
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Ronald N. Brown, DDS
Faculty mentor/Co-author e-mail Ronald.Brown@ucdenver.edu
Basic Science Rationale
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